Silent cerebral infarction predicts vascular events in hemodialysis patients

Silent cerebral infarction predicts vascular events in hemodialysis patients.BackgroundCardiovascular disease is the leading cause of death in hemodialysis (HD) patients. We have previously reported a higher incidence of silent cerebral infarction (SCI) in HD patients compared with the control group using MRI studies. In the present study, we examined whether or not SCI could predict vascular events in HD patients.MethodsCranial magnetic resonance imaging (MRI) was performed on 119 HD patients without symptomatic cerebrovascular disease. SCI was detected by MRI, and the patients were prospectively followed up. The end points of the study were the incidence of major events related to vascular events (cerebral events, cardiac events, and sudden deaths). We investigated the prognostic role of SCI in cerebral, cardiac, and vascular events by using the Kaplan-Meier method and Cox proportional hazards analysis.ResultsThe prevalence of SCI was 49.6% in HD patients. During a follow-up period of maximum 60 months, vascular events, which included 13 cerebral events, 5 cardiac events, and 3 sudden deaths, occurred in 21 patients. The presence of SCI was predictive for a higher cerebral and vascular morbidity compared to the absence of SCI [18.6% (N = 11) vs. 3.3% (N = 2), P = 0.0169, and 30.5% (N = 18) vs. 5.0% (N = 3), P = 0.0006, respectively]. By multivariate Cox proportional hazards analysis, SCI remained a powerful independent predictor of cerebral and vascular events (hazard ratio for cerebral events 7.33, 95% CI 1.27–42.25: for vascular events 4.48, 95% CI 1.09–18.41).ConclusionThe findings of the present study indicate that the presence of SCI is a new risk factor for vascular events in HD patients

Severe Superior Epistaxis Controlled by Clipping the Anterior Ethmoidal Artery : Report of a Case

The case of a 40-year-old woman in whom severe superior epistaxis was controlled by clipping the left anterior ethmoidal artery is reported. The patient suddenly developed an uncontrolled epistaxis, and was brought to our hospital by ambulance. Though a Bellocq\u27s tampon was left in place for seven days, severe superior epistaxis recurred. Therefore the left anterior ethmoidal artery was clipped with self-locking hemostatic clips using an external ethmoid incision under local anesthesia, after which the symptom became inactive. Based on this experience, hemostasis of epistaxis in our division with special reference to clipping of the anterior ethmoidal artery is discussed

Duration of Electrically Induced Atrial Fibrillation Is Augmented by High Voltage of Stimulus with Higher Blood Pressure in Hypertensive Rats

Objective. Many previous clinical studies have suggested that atrial fibrillation (AF) is closely associated with hypertension. However, the benefits of antihypertensive therapy on AF are still inconsistent, and it is necessary to explore the factors augmenting AF in hypertensive rats. The aim of the present study was to investigate the correlation between arterial pressure or voltage stimulus and to the duration of electrically induced AF in normotensive or hypertensive rats. Methods. AF was reproducibly induced by transesophageal atrial burst pacing in spontaneously hypertensive rats (SHR) and Wistar-Kyoto rats (WKY). We did the burst pacing at high (20 V) or low (5 V) voltage. Results. Duration of AF did not correlate with systolic blood pressure (SBP) and stimulus voltage in WKY. However, only in SHR, duration of AF with high stimulus voltage significantly correlated with SBP and was significantly longer in high than in low voltage stimulus. Discussion and Conclusion. Duration of AF is augmented by high voltage stimulus with higher blood pressure in SHR

Imparting CO₂ reduction selectivity to ZnGa₂O₄ photocatalysts by crystallization from hetero nano assembly of amorphous-like metal hydroxides

Imparting an enhanced CO₂ reduction selectivity to ZnGa₂O₄ photocatalysts has been demonstrated by controlled crystallization from interdispersed nanoparticles of zinc and gallium hydroxides. The hydroxide precursor in which Zn(II) and Ga(III) are homogeneously interdispersed was prepared through an epoxide-driven sol–gel reaction. ZnGa₂O₄ obtained by a heat-treatment exhibits a higher surface basicity and an enhanced affinity for CO₂ molecules than previously-reported standard ZnGa₂O₄. The enhanced affinity for CO₂ molecules of the resultant ZnGa₂O₄ leads to highly-selective CO evolution in CO₂ photo-reduction with H₂O reductants. The present scheme is promising to achieve desirable surface chemistry on metal oxide photocatalysts

Memet Fuat, Piraye ve Nazım

Taha Toros Arşivi, Dosya Adı: Nazım Hikmetİstanbul Kalkınma Ajansı (TR10/14/YEN/0033) İstanbul Development Agency (TR10/14/YEN/0033

High-resolution CT Findings of Diffuse Lung Disease : Review Article

Introduction Computed tomography (CT), particularly high-resolution CT (HRCT), defines detailed lung morphology, and is useful in evaluating diffuse lung disease1,2 It allows assessment of the anatomic changes as well as physiologic responses in patients with diffuse lung disease. We herein review the HRCT findings of diffuse lung disease according to classification based on their predominant appearances

Photon correlation in GaAs self-assembled quantum dots

We report on photon coincidence measurement in a single GaAs self-assembled quantum dot (QD) using a pulsed excitation light source. At low excitation, when a neutral exciton line was present in the photoluminescence (PL) spectrum, we observed nearly perfect single photon emission from an isolated QD at 670 nm wavelength. For higher excitation, multiple PL lines appeared on the spectra, reflecting the formation of exciton complexes. Cross-correlation functions between these lines showed either bunching or antibunching behavior, depending on whether the relevant emission was from a biexciton cascade or a charged exciton recombination.Comment: 5 pages, 3 figure

Interobserver variability of ultrasound parameters in portal hypertension

The aim of this study was to assess interobserver agreement of ultrasound parameters for portal hypertension in hepatosplenic mansonic schistosomiasis. Spleen size, diameter of the portal, splenic and superior mesenteric veins and presence of thrombosis and cavernous transformation were determined by three radiologists in blinded and independent fashion in 30 patients. Interobserver agreement was measured by the kappa index and intraclass correlation coefficient. Interobserver agreement was considered substantial (κ = 0.714-0.795) for portal vein thrombosis and perfect (κ = 1) for cavernous transformation. Interobserver agreement measured by the intraclass correlation coefficient was excellent for longitudinal diameter of the spleen (r = 0.828-0.869) and splenic index (r = 0.816-0.905) and varied from fair to almost perfect for diameter of the portal (r = 0.622-0.675), splenic (r = 0.573-0.913) and superior mesenteric (r = 0.525-0.607) veins. According to the results, ultrasound is a highly reproducible method for the main morphological parameters of portal hypertension in schistosomiasis patients.Universidade Federal de São Paulo (UNIFESP) Departamento de Diagnóstico por ImagensUniversidade de Brasília Faculdade de MedicinaUNIFESP, Depto. de Diagnóstico por ImagensSciEL

Effects of hydrophilic polymer-coated polysulfone membrane dialyzers on intradialytic hypotension in diabetic hemodialysis patients (ATHRITE BP Study) : a pilot study

Background: Intradialytic hypotension (IDH) is a common clinical manifestation associated with poor prognosis in hemodialysis (HD) patients. HD patients who suffer from diabetic nephropathy (DN) are increasing and diabetes is a major cause of IDH. Effective interventional treatments for IDH have yet to be fully evaluated. The aim of this multicenter prospective study is to clarify the effect of biocompatible hydrophilic polymer-coated polysulfone (PS) membrane, TORAYLIGHT® NV (NV) dialyzers on IDH. Methods: This is a prospective stratified-randomized multicenter trial. Forty DN patients undergoing HD and receiving two or more times of treatments for IDH per month were enrolled in this study. They were stratified by the number of treatments for IDH and divided to two groups using NV or conventional PS/polyethersulfone (PES) dialyzers. The number of treatments for IDH and changes in systolic blood pressure (SBP) were monitored for 6 months. Patients’ demographic and clinical characteristics were also collected at enrollment and the last month of the observation period. In order to clarify the patient characteristics that induced preferable effects by using NV dialyzers, responders were defined as the patients whose average SBP falls in 1 month improved from over 30 mmHg to no more than 30 mmHg. Results: The total number of treatments for IDH decreased significantly in NV group, even though pre-dialysis body weight and ultrafiltration volume were similar. In addition, patients using NV had significantly higher post-dialysis SBP and the lowest SBP during HD at sixth month compared as those in PS/PES group. NV responders had valuables suggesting malnutrition and microinflammation, and better lipid profiles than non-responders. However, the representative markers related to nutritional status, arteriosclerosis, and inflammation were not improved by NV treatment. Conclusions: NV had preferable effects on IDH in DN HD patients. Our results suggest the usefulness of NV as a possible method to deal with IDH. Further studies are needed to clarify the mechanism of NV effects on hemodynamic status