A Case of Traumatic Tricuspid Regurgitation Caused by Multiple Papillary Muscle Rupture

Traumatic tricuspid regurgitation is a rare complication of blunt chest trauma. With the increase in the number of automobile accidents, traumatic tricuspid regurgitation has become an important problem after blunt chest trauma. It has been reported more frequently because of better diagnostic procedures and a better understanding of the pathology. The early diagnosis of traumatic tricuspid regurgitation is important because traumatic tricuspid injury could be effectively corrected with reparative techniques, early operation is considered to relieve symptoms and to prevent right ventricular dysfunction. Echocardiography can reveal the cause and severity of regurgitation. We experienced a case of tricuspid regurgitation after blunt chest trauma early diagnosis and valve repair were performed. This case reminds the physicians in the emergency department should be aware of this potential complication following non-penetrating chest trauma and echocardiography is useful and should play an early role

On the frequentist coverage of Bayesian credible intervals for lower bounded means

For estimating a lower bounded location or mean parameter for a symmetric and logconcave density, we investigate the frequentist performance of the $100(1-\alpha)$ Bayesian HPD credible set associated with priors which are truncations of flat priors onto the restricted parameter space. Various new properties are obtained. Namely, we identify precisely where the minimum coverage is obtained and we show that this minimum coverage is bounded between $1-\frac{3\alpha}{2}$ and $1-\frac{3\alpha}{2}+\frac{\alpha^2}{1+\alpha}$; with the lower bound $1-\frac{3\alpha}{2}$ improving (for $\alpha \leq 1/3$) on the previously established ([9]; [8]) lower bound $\frac{1-\alpha}{1+\alpha}$. Several illustrative examples are given.Comment: Published in at http://dx.doi.org/10.1214/08-EJS292 the Electronic Journal of Statistics (http://www.i-journals.org/ejs/) by the Institute of Mathematical Statistics (http://www.imstat.org

Atrasentan and renal events in patients with type 2 diabetes and chronic kidney disease (SONAR): a double-blind, randomised, placebo-controlled trial

Background: Short-term treatment for people with type 2 diabetes using a low dose of the selective endothelin A receptor antagonist atrasentan reduces albuminuria without causing significant sodium retention. We report the long-term effects of treatment with atrasentan on major renal outcomes. Methods: We did this double-blind, randomised, placebo-controlled trial at 689 sites in 41 countries. We enrolled adults aged 18–85 years with type 2 diabetes, estimated glomerular filtration rate (eGFR)25–75 mL/min per 1·73 m 2 of body surface area, and a urine albumin-to-creatinine ratio (UACR)of 300–5000 mg/g who had received maximum labelled or tolerated renin–angiotensin system inhibition for at least 4 weeks. Participants were given atrasentan 0·75 mg orally daily during an enrichment period before random group assignment. Those with a UACR decrease of at least 30% with no substantial fluid retention during the enrichment period (responders)were included in the double-blind treatment period. Responders were randomly assigned to receive either atrasentan 0·75 mg orally daily or placebo. All patients and investigators were masked to treatment assignment. The primary endpoint was a composite of doubling of serum creatinine (sustained for ≥30 days)or end-stage kidney disease (eGFR <15 mL/min per 1·73 m 2 sustained for ≥90 days, chronic dialysis for ≥90 days, kidney transplantation, or death from kidney failure)in the intention-to-treat population of all responders. Safety was assessed in all patients who received at least one dose of their assigned study treatment. The study is registered with ClinicalTrials.gov, number NCT01858532. Findings: Between May 17, 2013, and July 13, 2017, 11 087 patients were screened; 5117 entered the enrichment period, and 4711 completed the enrichment period. Of these, 2648 patients were responders and were randomly assigned to the atrasentan group (n=1325)or placebo group (n=1323). Median follow-up was 2·2 years (IQR 1·4–2·9). 79 (6·0%)of 1325 patients in the atrasentan group and 105 (7·9%)of 1323 in the placebo group had a primary composite renal endpoint event (hazard ratio [HR]0·65 [95% CI 0·49–0·88]; p=0·0047). Fluid retention and anaemia adverse events, which have been previously attributed to endothelin receptor antagonists, were more frequent in the atrasentan group than in the placebo group. Hospital admission for heart failure occurred in 47 (3·5%)of 1325 patients in the atrasentan group and 34 (2·6%)of 1323 patients in the placebo group (HR 1·33 [95% CI 0·85–2·07]; p=0·208). 58 (4·4%)patients in the atrasentan group and 52 (3·9%)in the placebo group died (HR 1·09 [95% CI 0·75–1·59]; p=0·65). Interpretation: Atrasentan reduced the risk of renal events in patients with diabetes and chronic kidney disease who were selected to optimise efficacy and safety. These data support a potential role for selective endothelin receptor antagonists in protecting renal function in patients with type 2 diabetes at high risk of developing end-stage kidney disease. Funding: AbbVie

Industrialised building system in Malaysia: Issues for research in a changing financial and property market

Industrialised Building System in its different guises appears to have gained popularity in recent years. Through a thorough review of literature, this paper presents a historical appraisal of the definitions offered for the different guises of IBS, the characteristics of IBS, and the benefits it purports to offer. In the same vein, the factors that have fuelled the popularity of IBS is discussed together with the impact of the changing financial and property market crisis on the future of IBS. The implications of the current financial and property market prices on IBS in Malaysia shall also be discussed. The paper concludes by drawing inferences on the implications of the current financial and property market crisis on research in IBS from a Malaysian construction industry perspective

Analisis terhadap tahap-tahap ketagihan menurut teori al-‘Ishq Ibnu Qayyim Al-Jawziyyah

Ketagihan merupakan satu penyakit minda yang mempunyai tahap-tahap ketegarannya yang tersendiri. Ini merujuk kepada realiti kerinduan seseorang terhadap sesuatu itu berbeza-beza dan mempunyai simptom yang berlainan. Para sarjana Islam turut membuat penelitian terhadap aspek kerinduan kepada sesuatu dalam karya-karya mereka. Antaranya tokoh ilmuan Islam yang terkenal, Ibnu Qayyim al-Jawziyyah yang memperincikan hal ini dalam konsep atau teori al-‘Ishq di dalam beberapa kitabnya. Kajian ini akan menganalisis tahap-tahap ketagihan berdasarkan teori al-‘Ishq oleh Ibnu Qayyim. Kajian ini menggunakan metod induktif, deduktif, serta komparatif. Hasil kajian mendapati terdapat hubungan yang sangat rapat di antara teori al-‘Ishq dan ketagihan dari sudut definisi dan peringkat-peringkatnya. Justeru, pendekatan terapi al-‘Ishq yang dicadangkan oleh Ibn Qayyim berdasarkan tahap-tahap keasyikan boleh diterokai sebagai suatu input dalam mengemukakan langkah-langkah pemulihan terhadap sebarang isu yang melibatkan ketagihan