704 research outputs found
Age-dependent parathormone levels and different CKD-MBD treatment practices of dialysis patients in Hungary - results from a nationwide clinical audit
BACKGROUND: Achieving target levels of laboratory parameters of
bone and mineral metabolism in chronic kidney disease (CKD)
patients is important but also difficult in those living with
end-stage kidney disease. This study aimed to determine if there
are age-related differences in chronic kidney disease-mineral
and bone disorder (CKD-MBD) characteristics, including treatment
practice in Hungarian dialysis patients. METHODS: Data were
collected retrospectively from a large cohort of dialysis
patients in Hungary. Patients on hemodialysis and peritoneal
dialysis were also included. The enrolled patients were
allocated into two groups based on their age (=65
years). Characteristics of the age groups and differences in
disease-related (epidemiology, laboratory, and treatment
practice) parameters between the groups were analyzed. RESULTS:
A total of 5008 patients were included in the analysis and the
mean age was 63.4+/-14.2 years. A total of 47.2% of patients
were women, 32.8% had diabetes, and 11.4% were on peritoneal
dialysis. Diabetes (37.9% vs 27.3%), bone disease (42.9% vs
34.1%), and soft tissue calcification (56.3% vs 44.7%) were more
prevalent in the older group than the younger group (p<0.001 for
all). We found an inverse relationship between age and
parathyroid hormone (PTH) levels (p<0.001). Serum PTH levels
were lower in patients with diabetes compared with those without
diabetes below 80 years (p<0.001). Diabetes and age were
independently associated with serum PTH levels (interaction:
diabetes x age groups, p=0.138). Older patients were more likely
than younger patients to achieve laboratory target ranges for
each parameter (Ca: 66.9% vs 62.1%, p<0.001; PO4: 52.6% vs
49.2%, p<0.05; and PTH: 50.6% vs 46.6%, p<0.01), and for
combined parameters (19.8% vs 15.8%, p<0.001). Older patients
were less likely to receive related medication than younger
patients (66.9% vs 79.7%, p<0.001). CONCLUSIONS: The achievement
of laboratory target ranges for bone and mineral metabolism and
clinical practice in CKD depends on the age of the patients. A
greater proportion of older patients met target criteria and
received less medication compared with younger patients
Diffuse idiopathic skeletal hyperostosis (DISH): relation to vertebral fractures and bone density
UnlabelledRadiographs and spinal bone mineral density (BMD) were evaluated from 342 elderly men regarding possible effects of diffuse idiopathic skeletal hyperostosis (DISH) on vertebral fractures and densitometry measurements. Prevalent vertebral fractures were more frequent among men with DISH compared to men with no DISH even after fracture prevalence was adjusted for BMD. Paravertebral calcifications should be considered in patients with DISH when interpreting BMD measurements because both dual X-ray absorptiometry (DXA) and quantitative CT (QCT) densitometry may not be reliable.IntroductionThe purpose of this study is to evaluate the prevalence of DISH in older men and its association with vertebral fractures and with BMD determined by DXA and QCT.MethodsLateral radiographs of the spine were analyzed in a sample of 342 men aged ≥ 65 years participating in the MrOS Study concerning the presence and grade of DISH and vertebral fractures. Lumbar BMD was measured by both DXA (areal, grams per square centimeter) and QCT (volumetric, grams per cubic centimeter). The association between DISH, BMD, and presence of fractures was studied using χ ( 2 ) and t tests.ResultsDISH was present in 52% (178/342) of the men. Men with DISH were older (mean, 75.1 vs 73.3, p < 0.05) and more likely to have prevalent fractures (28% vs 20%, p < p = 0.09). BMD assessed with DXA (1.08 vs 1.00 g/cm(2), p ≤ 0.0001), but not with QCT (0.11 vs 0.11 g/cm3, p = 0.65), was significantly higher in men with DISH compared to men without DISH. Significantly lower BMD of men with both DISH and fractures compared to men with DISH but without fractures was only detected by QCT (-25%, 0.09 vs 0.12, p < 0.05). Both DXA BMD and QCT BMD were significantly higher in severe lumbar DISH (+22% and +31%, p < 0.0001), respectively.ConclusionDISH was associated with a higher prevalence of vertebral fractures in elderly men. Lumbar ossifications related to DISH should be considered when interpreting BMD measurements to predict their fracture risk
ARPES: A probe of electronic correlations
Angle-resolved photoemission spectroscopy (ARPES) is one of the most direct
methods of studying the electronic structure of solids. By measuring the
kinetic energy and angular distribution of the electrons photoemitted from a
sample illuminated with sufficiently high-energy radiation, one can gain
information on both the energy and momentum of the electrons propagating inside
a material. This is of vital importance in elucidating the connection between
electronic, magnetic, and chemical structure of solids, in particular for those
complex systems which cannot be appropriately described within the
independent-particle picture. Among the various classes of complex systems, of
great interest are the transition metal oxides, which have been at the center
stage in condensed matter physics for the last four decades. Following a
general introduction to the topic, we will lay the theoretical basis needed to
understand the pivotal role of ARPES in the study of such systems. After a
brief overview on the state-of-the-art capabilities of the technique, we will
review some of the most interesting and relevant case studies of the novel
physics revealed by ARPES in 3d-, 4d- and 5d-based oxides.Comment: Chapter to appear in "Strongly Correlated Systems: Experimental
Techniques", edited by A. Avella and F. Mancini, Springer Series in
Solid-State Sciences (2013). A high-resolution version can be found at:
http://www.phas.ubc.ca/~quantmat/ARPES/PUBLICATIONS/Reviews/ARPES_Springer.pdf.
arXiv admin note: text overlap with arXiv:cond-mat/0307085,
arXiv:cond-mat/020850
Understanding voltage decay in lithium-excess layered cathode materials through oxygen-centred structural arrangement
Lithium-excess 3d-transition-metal layered oxides (Li1+xNiyCozMn1-x-y-zO2, > 250 mAh g(-1)) suffer from severe voltage decay upon cycling, which decreases energy density and hinders further research and development. Nevertheless, the lack of understanding on chemical and structural uniqueness of the material prevents the interpretation of internal degradation chemistry. Here, we discover a fundamental reason of the voltage decay phenomenon by comparing ordered and cation-disordered materials with a combination of X-ray absorption spectroscopy and transmission electron microscopy studies. The cation arrangement determines the transition metal-oxygen covalency and structural reversibility related to voltage decay. The identification of structural arrangement with de-lithiated oxygen-centred octahedron and interactions between octahedrons affecting the oxygen stability and transition metal mobility of layered oxide provides the insight into the degradation chemistry of cathode materials and a way to develop high-energy density electrodes
Rapid T1 quantification based on 3D phase sensitive inversion recovery
<p>Abstract</p> <p>Background</p> <p>In Contrast Enhanced Magnetic Resonance Imaging fibrotic myocardium can be distinguished from healthy tissue using the difference in the longitudinal <it>T</it><sub>1 </sub>relaxation after administration of Gadolinium, the so-called Late Gd Enhancement. The purpose of this work was to measure the myocardial absolute <it>T</it><sub>1 </sub>post-Gd from a single breath-hold 3D Phase Sensitivity Inversion Recovery sequence (PSIR). Equations were derived to take the acquisition and saturation effects on the magnetization into account.</p> <p>Methods</p> <p>The accuracy of the method was investigated on phantoms and using simulations. The method was applied to a group of patients with suspected myocardial infarction where the absolute difference in relaxation of healthy and fibrotic myocardium was measured at about 15 minutes post-contrast. The evolution of the absolute <it>R</it><sub>1 </sub>relaxation rate (1/<it>T</it><sub>1</sub>) over time after contrast injection was followed for one patient and compared to <it>T</it><sub>1 </sub>mapping using Look-Locker. Based on the <it>T</it><sub>1 </sub>maps synthetic LGE images were reconstructed and compared to the conventional LGE images.</p> <p>Results</p> <p>The fitting algorithm is robust against variation in acquisition flip angle, the inversion delay time and cardiac arrhythmia. The observed relaxation rate of the myocardium is 1.2 s<sup>-1</sup>, increasing to 6 - 7 s<sup>-1 </sup>after contrast injection and decreasing to 2 - 2.5 s<sup>-1 </sup>for healthy myocardium and to 3.5 - 4 s<sup>-1 </sup>for fibrotic myocardium. Synthesized images based on the <it>T</it><sub>1 </sub>maps correspond very well to actual LGE images.</p> <p>Conclusions</p> <p>The method provides a robust quantification of post-Gd <it>T</it><sub>1 </sub>relaxation for a complete cardiac volume within a single breath-hold.</p
Drug problems among homeless individuals in Toronto, Canada: prevalence, drugs of choice, and relation to health status
<p>Abstract</p> <p>Background</p> <p>Drug use is believed to be an important factor contributing to the poor health and increased mortality risk that has been widely observed among homeless individuals. The objective of this study was to determine the prevalence and characteristics of drug use among a representative sample of homeless individuals and to examine the association between drug problems and physical and mental health status.</p> <p>Methods</p> <p>Recruitment of 603 single men, 304 single women, and 284 adults with dependent children occurred at homeless shelters and meal programs in Toronto, Canada. Information was collected on demographic characteristics and patterns of drug use. The Addiction Severity Index was used to assess whether participants suffered from drug problems. Associations of drug problems with physical and mental health status (measured by the SF-12 scale) were examined using regression analyses.</p> <p>Results</p> <p>Forty percent of the study sample had drug problems in the last 30 days. These individuals were more likely to be single men and less educated than those without drug problems. They were also more likely to have become homeless at a younger age (mean 24.8 vs. 30.9 years) and for a longer duration (mean 4.8 vs. 2.9 years). Marijuana and cocaine were the most frequently used drugs in the past two years (40% and 27%, respectively). Drug problems within the last 30 days were associated with significantly poorer mental health status (-4.9 points, 95% CI -6.5 to -3.2) but not with poorer physical health status (-0.03 points, 95% CI -1.3 to 1.3)).</p> <p>Conclusions</p> <p>Drug use is common among homeless individuals in Toronto. Current drug problems are associated with poorer mental health status but not with poorer physical health status.</p
Genome wide analysis of gene expression changes in skin from patients with type 2 diabetes
Non-healing chronic ulcers are a serious complication of diabetes and are a major healthcare problem. While a host of treatments have been explored to heal or prevent these ulcers from forming, these treatments have not been found to be consistently effective in clinical trials. An understanding of the changes in gene expression in the skin of diabetic patients may provide insight into the processes and mechanisms that precede the formation of non-healing ulcers. In this study, we investigated genome wide changes in gene expression in skin between patients with type 2 diabetes and non-diabetic patients using next generation sequencing. We compared the gene expression in skin samples taken from 27 patients (13 with type 2 diabetes and 14 non-diabetic). This information may be useful in identifying the causal factors and potential therapeutic targets for the prevention and treatment of diabetic related diseases
Varespladib and cardiovascular events in patients with an acute coronary syndrome: the VISTA-16 randomized clinical trial
IMPORTANCE: Secretory phospholipase A2(sPLA2) generates bioactive phospholipid products implicated in atherosclerosis. The sPLA2inhibitor varespladib has favorable effects on lipid and inflammatory markers; however, its effect on cardiovascular outcomes is unknown. OBJECTIVE: To determine the effects of sPLA2inhibition with varespladib on cardiovascular outcomes. DESIGN, SETTING, AND PARTICIPANTS: A double-blind, randomized, multicenter trial at 362 academic and community hospitals in Europe, Australia, New Zealand, India, and North America of 5145 patients randomized within 96 hours of presentation of an acute coronary syndrome (ACS) to either varespladib (n = 2572) or placebo (n = 2573) with enrollment between June 1, 2010, and March 7, 2012 (study termination on March 9, 2012). INTERVENTIONS: Participants were randomized to receive varespladib (500 mg) or placebo daily for 16 weeks, in addition to atorvastatin and other established therapies. MAIN OUTCOMES AND MEASURES: The primary efficacy measurewas a composite of cardiovascular mortality, nonfatal myocardial infarction (MI), nonfatal stroke, or unstable angina with evidence of ischemia requiring hospitalization at 16 weeks. Six-month survival status was also evaluated. RESULTS: At a prespecified interim analysis, including 212 primary end point events, the independent data and safety monitoring board recommended termination of the trial for futility and possible harm. The primary end point occurred in 136 patients (6.1%) treated with varespladib compared with 109 patients (5.1%) treated with placebo (hazard ratio [HR], 1.25; 95%CI, 0.97-1.61; log-rank P = .08). Varespladib was associated with a greater risk of MI (78 [3.4%] vs 47 [2.2%]; HR, 1.66; 95%CI, 1.16-2.39; log-rank P = .005). The composite secondary end point of cardiovascular mortality, MI, and stroke was observed in 107 patients (4.6%) in the varespladib group and 79 patients (3.8%) in the placebo group (HR, 1.36; 95% CI, 1.02-1.82; P = .04). CONCLUSIONS AND RELEVANCE: In patients with recent ACS, varespladib did not reduce the risk of recurrent cardiovascular events and significantly increased the risk of MI. The sPLA2inhibition with varespladib may be harmful and is not a useful strategy to reduce adverse cardiovascular outcomes after ACS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01130246. Copyright 2014 American Medical Association. All rights reserved
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