Serum Ferritin Variations and Mortality in Incident Hemodialysis Patients.

BackgroundHigher serum ferritin levels may be influenced by iron use and inflammation, and are associated with higher mortality in hemodialysis (HD) patients. We hypothesized that a major rise in serum ferritin is associated with a higher risk of mortality, irrespective of baseline serum ferritin in incident HD patients.MethodsIn a cohort of 93,979 incident HD patients between 2007 and 2011, we examined the association of change in serum ferritin from the baseline patient quarter (first 91 days from dialysis start) to the subsequent quarter with mortality. Multivariable adjustments were done for case-mix and markers of the malnutrition, and inflammation complex and intravenous iron dose. Change in serum ferritin was stratified into 5 groups: <-400, -400 to <-100, -100 to <100, 100 to <400, and ≥400 ng/mL/quarter.ResultsThe median change in serum ferritin was 89 ng/mL/quarter (interquartile range -55 to 266 ng/mL/quarter). Compared to stable serum ferritin (-100 to <100 ng/mL/quarter), a major rise (≥400 ng/mL/quarter) was associated with higher all-cause mortality (hazard ratio [95% CI] 1.07 [0.99-1.15], 1.17 [1.09-1.24], 1.26 [1.12-1.41], and 1.49 [1.27-1.76] according to baseline serum ferritin: <200, 200 to <500, 500 to <800, and ≥800 ng/mL in adjusted models, respectively. The mortality risk associated with a rise in serum ferritin was robust, irrespective of intravenous iron use.ConclusionsDuring the first 6-months after HD initiation, a major rise in serum ferritin in those with a baseline ferritin ≥200 ng/mL and even a slight rise in serum ferritin in those with a baseline ferritin ≥800 ng/mL are associated with higher mortality

Wearable, Ultrawide-Range, and Bending-Insensitive Pressure Sensor Based on Carbon Nanotube Network-Coated Porous Elastomer Sponges for Human Interface and Healthcare Devices

Flexible and wearable pressure sensors have attracted a tremendous amount of attention due to their wider applications in human interfaces and healthcare monitoring. However, achieving accurate pressure detection and stability against external stimuli (in particular, bending deformation) over a wide range of pressures from tactile to body weight levels is a great challenge. Here, we introduce an ultrawide-range, bending-insensitive, and flexible pressure sensor based on a carbon nanotube (CNT) network-coated thin porous elastomer sponge for use in human interface devices. The integration of the CNT networks into three-dimensional microporous elastomers provides high deformability and a large change in contact between the conductive CNT networks due to the presence of micropores, thereby improving the sensitivity compared with that obtained using CNT-embedded solid elastomers. As electrical pathways are continuously generated up to high compressive strain (∼80%), the pressure sensor shows an ultrawide pressure sensing range (10 Pa to 1.2 MPa) while maintaining favorable sensitivity (0.01–0.02 kPa–1) and linearity (R2 ∼ 0.98). Also, the pressure sensor exhibits excellent electromechanical stability and insensitivity to bending-induced deformations. Finally, we demonstrate that the pressure sensor can be applied in a flexible piano pad as an entertainment human interface device and a flexible foot insole as a wearable healthcare and gait monitoring device

Vascular access placement and mortality in elderly incident hemodialysis patients.

BackgroundArteriovenous fistulas (AVFs) are the preferred vascular access type in most hemodialysis patients. However, the optimal vascular access type in octogenarians and older (≥80 years) hemodialysis patients remains widely debated given their limited life expectancy and lower AVF maturation rates.MethodsAmong incident hemodialysis patients receiving care in a large national dialysis organization during 2007-2011, we examined patterns of vascular access type conversion in 1 year following dialysis initiation in patients <80 versus ≥80 years of age. Among a subcohort of patients ≥80 years of age, we examined the association between vascular access type conversion and mortality using multivariable survival models.ResultsIn the overall cohort of 100 804 patients, the prevalence of AVF/arteriovenous graft (AVG) as the primary vascular access type increased during the first year of hemodialysis, but plateaued thereafter. Among 8356 patients ≥80 years of age and treated for >1 year, those with initial AVF/AVG use and placement of AVF from a central venous catheter (CVC) had lower mortality compared with patients with persistent CVC use. When the reference group was changed to patients who had AVF placement from a CVC in the first year of dialysis, those with initial AVF use had similar mortality. A longer duration of CVC use was associated with incrementally worse survival.ConclusionsAmong incident hemodialysis patients ≥80 years of age, placement of an AVF from a CVC within the first year of dialysis had similar mortality compared with initial AVF use. Our data suggest that initial CVC use with later placement of an AVF may be an acceptable option among elderly hemodialysis patients

Combined effects of aerobic exercise and 40-Hz light flicker exposure on early cognitive impairments in Alzheimer’s disease of 3×Tg mice

Alzheimer’s disease (AD) is a progressive degenerative brain disease and the primary cause of dementia. At an early stage, AD is generally characterized by short-term memory impairment, owing to dysfunctions of the cortex and hippocampus. We previously reported that a combination of exercise and 40-Hz light flickering can protect against AD-related neuroinflammation, gamma oscillations, reduction in Aβ, and cognitive decline. Therefore, we sought to extend our previous findings to the 5-mo-old 3×Tg-AD mouse model to examine whether the same favorable effects occur in earlier stages of cognitive dysfunction. We investigated the effects of 12 wk of exercise combined with 40-Hz light flickering on cognitive function by analyzing neuroinflammation, mitochondrial function, and neuroplasticity in the hippocampus in a 3×Tg-AD mouse model. Five-month-old 3×Tg-AD mice performed 12 wk of exercise with 40-Hz light flickering administered independently and in combination. Spatial learning and memory, long-term memory, hippocampal Aβ, tau, neuroinflammation, proinflammatory cytokine expression, mitochondrial function, and neuroplasticity were analyzed. Aβ and tau proteins levels were significantly reduced in the early stage of AD, resulting in protection against cognitive decline by reducing neuroinflammation and proinflammatory cytokines. Furthermore, mitochondrial function improved, apoptosis was reduced, and synapse-related protein expression increased. Overall, exercise with 40-Hz light flickering was significantly more effective than exercise or 40-Hz light flickering alone, and the improvement was comparable to the levels in the nontransgenic aged-match control group. Our results indicate a synergistic effect of exercise and 40-Hz light flickering on pathological improvements in the hippocampus during early AD-associated cognitive impairment

EFFECTIVE DOSE MEASUREMENT FOR CONE BEAM COMPUTED TOMOGRAPHY USING GLASS DOSIMETER

During image-guided radiation therapy, the patient is exposed to unwanted radiation from imaging devices built into the medical LINAC. In the present study, the effective dose delivered to a patient from a cone beam computed tomography (CBCT) machine was measured. Absorbed doses in specific organs listed in ICRP Publication 103 were measured with glass dosimeters calibrated with kilovolt (kV) X-rays using a whole body physical phantom for typical radiotherapy sites, including the head and neck, chest, and pelvis. The effective dose per scan for the head and neck, chest, and pelvis were 3.37±0.29, 7.36±0.33, and 4.09±0.29 mSv, respectively. The results highlight the importance of the compensation of treatment dose by managing imaging dose