Background and purpose
Restless legs syndrome (RLS) is an underestimated movement disorder in patients with end‐stage renal disease (ESRD). Several clinical and laboratory factors were inconsistently ...reported to associate with RLS. We aim to perform a large‐scale multicenter study to investigate the possible associated risk factors of RLS in patients with ESRD in Taiwan, a country with the highest incidence of uremia in the world.
Methods
From October 2009 to October 2011, we constitutively recruited 1130 patients with ESRD from 17 hemodialysis centers. Demographic, laboratory data, presence and severity of RLS were collected. Odds ratios (ORs) were estimated by logistic regression models.
Results
We found the prevalence of RLS to be 25.3% in patients with ESRD. Having type 2 diabetes OR = 3.61 (2.27–5.77), P < 0.01, low serum transferrin saturation OR = 1.42 (1.01–2.03), P < 0.05 and duration of dialysis OR = 1.09 (1.03–1.14), P < 0.01 were associated with RLS. In contrast, high serum hemoglobin level was inversely associated with RLS OR = 0.61 (0.40–0.89), P < 0.05. RLS has a significant impact on sleep quality in dialysis patients. Among patients with RLS, history of type 2 diabetes OR = 4.04 (1.65–10.79), P < 0.05, low serum hemoglobin level OR = 5.41 (2.43–13.12), P < 0.01 and duration of dialysis OR = 1.01 (1.01–1.02), P < 0.01 were associated with increased severity of RLS.
Conclusions
Our findings demonstrated that RLS is common in Taiwanese dialysis patients. Clinicians should have a high suspicion for the presence of RLS symptoms in patients with ESRD, especially those with type 2 diabetes, anemia, low serum iron status and long duration of dialysis.
We present Chandra and Very Large Array observations of GW170817 at ∼521-743 days post-merger, and a homogeneous analysis of the entire Chandra data set. We find that the late-time nonthermal ...emission follows the expected evolution of an off-axis relativistic jet, with a steep temporal decay F ∝ t − 1.95 0.15 and power-law spectrum F ∝ − 0.575 0.007 . We present a new method to constrain the merger environment density based on diffuse X-ray emission from hot plasma in the host galaxy and find n ≤ 9.6 × 10 − 3 cm − 3 . This measurement is independent from inferences based on jet afterglow modeling and allows us to partially solve for model degeneracies. The updated best-fitting model parameters with this density constraint are a fireball kinetic energy E 0 = 1.5 − 1.1 + 3.6 × 10 49 erg ( E iso = 2.1 − 1.5 + 6.4 × 10 52 erg ) and jet opening angle θ 0 = 5.9 − 0.7 + 1.0 deg with characteristic Lorentz factor Γ j = 163 − 43 + 23 , expanding in a low-density medium with n 0 = 2.5 − 1.9 + 4.1 × 10 − 3 cm − 3 and viewed θ obs = 30.4 − 3.4 + 4.0 deg off-axis. The synchrotron emission originates from a power-law distribution of electrons with index p = 2.15 − 0.02 + 0.01 . The shock microphysics parameters are constrained to ϵ e = 0.18 − 0.13 + 0.30 and ϵ B = 2.3 − 2.2 + 16.0 × 10 − 3 . Furthermore, we investigate the presence of X-ray flares and find no statistically significant evidence of ≥2.5 of temporal variability at any time. Finally, we use our observations to constrain the properties of synchrotron emission from the deceleration of the fastest kilonova ejecta with energy E k KN ∝ ( Γ β ) − into the environment, finding that shallow stratification indexes ≤ 6 are disfavored. Future radio and X-ray observations will refine our inferences on the fastest kilonova ejecta properties.
We present a revised and complete optical afterglow light curve of the binary neutron star merger GW170817, enabled by deep Hubble Space Telescope (HST) F606W observations at 584 days post-merger, ...which provide a robust optical template. The light curve spans 110-362 days, and is fully consistent with emission from a relativistic structured jet viewed off-axis, as previously indicated by radio and X-ray data. Combined with contemporaneous radio and X-ray observations, we find no spectral evolution, with a weighted average spectral index of 〈 β 〉 = − 0.583 0.013 , demonstrating that no synchrotron break frequencies evolve between the radio and X-ray bands over these timescales. We find that an extrapolation of the post-peak temporal slope of GW170817 to the luminosities of cosmological short gamma-ray bursts matches their observed jet break times, suggesting that their explosion properties are similar, and that the primary difference in GW170817 is viewing angle. Additionally, we place a deep limit on the luminosity and mass of an underlying globular cluster (GC) of L 6.7 × 103 L , or M 1.3 × 104 M , at least 4 standard deviations below the peak of the GC mass function of the host galaxy, NGC 4993. This limit provides a direct and strong constraint that GW170817 did not form and merge in a GC. As highlighted here, HST (and soon the James Webb Space Telescope) enables critical observations of the optical emission from neutron star merger jets and outflows.
Background and purpose
Earlier studies suggested an association between idiopathic restless legs syndrome (RLS) and cardiovascular diseases. However, the risk of cardiovascular events in patients ...with secondary RLS due to end‐stage renal disease (ESRD) is unclear. Our aim was to examine whether ESRD patients with RLS had an increased risk of cardio/cerebrovascular events and mortality.
Methods
In all, 1093 ESRD patients were recruited between 2009 and 2010. The diagnosis and severity of RLS were assessed in a face‐to‐face interview. The occurrence of cardio/cerebrovascular events and death were confirmed by medical record review. The association between RLS and the outcomes of interest was examined using an adjusted multivariate Cox regression model.
Results
After a mean follow‐up period of 3.7 ± 0.8 years, ESRD patients with RLS had a significantly higher risk of developing cardiovascular events and strokes adjusted hazard ratio (aHR) 2.82, 95% confidence interval (CI) 2.02–4.11, and aHR 2.41, 95% CI 1.55–3.75, respectively compared with patients without RLS. Increasing RLS severity was associated with an increasing likelihood of cardiovascular events mild RLS severity, aHR 1.71 (95% CI 1.02–2.87); moderate, 2.79 (1.64–4.66); severe, 2.85 (1.99–4.46) and strokes mild, 1.89 (0.87–4.16); moderate, 2.42 (1.50–3.90); severe, 2.64 (1.49–4.91) in a dose‐dependent manner. RLS also increased the risk of total mortality in patients with ESRD aHR 1.53 (95% CI 1.07–2.18), P = 0.02; this association attenuated slightly after stratification by individual RLS severity category mild RLS severity, aHR 1.44 (95% CI 0.78–2.67); moderate, 1.49 (0.98–2.55); severe, 2.03 (0.93–4.45).
Conclusions
ESRD patients with RLS demonstrated an increased likelihood of cardio/cerebrovascular events and mortality.
The recent focus on topological insulators is due to the scientific interest in the new state of quantum matter as well as the technology potential for a new generation of THz optoelectronics, ...spintronics and quantum computations. It is important to elucidate the dynamics of the Dirac fermions in the topologically protected surface state. Hence we utilized a novel ultrafast optical pump mid-infrared probe to explore the dynamics of Dirac fermions near the Dirac point. The femtosecond snapshots of the relaxation process were revealed by the ultrafast optics. Specifically, the Dirac fermion-phonon coupling strength in the Dirac cone was found to increase from 0.08 to 0.19 while Dirac fermions were away from the Dirac point into higher energy states. Further, the energy-resolved transient reflectivity spectra disclosed the energy loss rate of Dirac fermions at room temperature was about 1 meV/ps. These results are crucial to the design of Dirac fermion devices.
The survey description and the near-, mid-, and far-infrared flux properties are presented for the 258 galaxies in the Local Volume Legacy (LVL). LVL is a Spitzer Space Telescope legacy program that ...surveys the local universe out to 11 Mpc, built upon a foundation of ultraviolet, H Delta *a, and Hubble Space Telescope imaging from 11HUGS (11 Mpc H Delta *a and Ultraviolet Galaxy Survey) and ANGST (ACS Nearby Galaxy Survey Treasury). LVL covers an unbiased, representative, and statistically robust sample of nearby star-forming galaxies, exploiting the highest extragalactic spatial resolution achievable with Spitzer. As a result of its approximately volume-limited nature, LVL augments previous Spitzer observations of present-day galaxies with improved sampling of the low-luminosity galaxy population. The collection of LVL galaxies shows a large spread in mid-infrared colors, likely due to the conspicuous deficiency of 8 Delta *mm polycyclic aromatic hydrocarbon emission from low-metallicity, low-luminosity galaxies. Conversely, the far-infrared emission tightly tracks the total infrared emission, with a dispersion in their flux ratio of only 0.1 dex. In terms of the relation between the infrared-to-ultraviolet ratio and the ultraviolet spectral slope, the LVL sample shows redder colors and/or lower infrared-to-ultraviolet ratios than starburst galaxies, suggesting that reprocessing by dust is less important in the lower mass systems that dominate the LVL sample. Comparisons with theoretical models suggest that the amplitude of deviations from the relation found for starburst galaxies correlates with the age of the stellar populations that dominate the ultraviolet/optical luminosities.
Background and purpose
Recent genome‐wide association studies have shown associations between multiple genetic variants and primary restless legs syndrome (RLS). Their roles in end stage renal ...disease (ESRD) related secondary RLS are not clear and studies in Asian populations are scarce. The association between candidate genetic variants and uremic RLS was investigated in a large cohort of Taiwanese dialysis patients.
Methods
Sixteen RLS‐related genetic variants at six loci, including MEIS1, BTBD9, MAP2K5/SKOR1, PTPRD, TOX3/BC034767 and the intergenic region of chromosome 2p14, in a total of 993 ESRD patients (259 subjects with and 734 subjects without RLS) were genotyped using TaqMan® genotyping assays. Multivariate logistic regression analysis was used to test for associations between the genotypes and RLS in ESRD. Power calculations were completed using the CATs Genetic Power Calculator with settings of a multiplicative genetic model.
Results
A modest association between the PTPRD variant rs4626664 and uremic RLS (odds ratio 1.52, 95% CI 1.03–2.23, P = 0.03) and a trend that TOX3/BC034767 variant rs3104767 may associate with the occurrence of RLS were observed in our dialysis population (odds ratio 1.74, 95% CI 0.97–3.11, P = 0.06). No associations between other genetic variants and risk and severity of RLS were observed in our ESRD cohort.
Conclusions
The genetic variants of primary RLS candidate genes did not play a major role in our uremic RLS populations. The ethnic difference and heterogeneous etiologies underlying renal failure may partly explain the minor genetic contribution to uremic RLS in our populations. Further studies for other ethnicities will be of worth.
We present results from an analysis of all data taken by the BICEP2 and Keck Array cosmic microwave background (CMB) polarization experiments up to and including the 2014 observing season. This ...includes the first Keck Array observations at 95 GHz. The maps reach a depth of 50 nK deg in Stokes Q and U in the 150 GHz band and 127 nK deg in the 95 GHz band. We take auto- and cross-spectra between these maps and publicly available maps from WMAP and Planck at frequencies from 23 to 353 GHz. An excess over lensed ΛCDM is detected at modest significance in the 95×150 BB spectrum, and is consistent with the dust contribution expected from our previous work. No significant evidence for synchrotron emission is found in spectra such as 23×95, or for correlation between the dust and synchrotron sky patterns in spectra such as 23×353. We take the likelihood of all the spectra for a multicomponent model including lensed ΛCDM, dust, synchrotron, and a possible contribution from inflationary gravitational waves (as parametrized by the tensor-to-scalar ratio r) using priors on the frequency spectral behaviors of dust and synchrotron emission from previous analyses of WMAP and Planck data in other regions of the sky. This analysis yields an upper limit r_{0.05}<0.09 at 95% confidence, which is robust to variations explored in analysis and priors. Combining these B-mode results with the (more model-dependent) constraints from Planck analysis of CMB temperature plus baryon acoustic oscillations and other data yields a combined limit r_{0.05}<0.07 at 95% confidence. These are the strongest constraints to date on inflationary gravitational waves.
Coral bleaching is the single largest global threat to coral reefs worldwide. Integrating the diverse body of work on coral bleaching is critical to understanding and combating this global problem. ...Yet investigating the drivers, patterns, and processes of coral bleaching poses a major challenge. A recent review of published experiments revealed a wide range of experimental variables used across studies. Such a wide range of approaches enhances discovery, but without full transparency in the experimental and analytical methods used, can also make comparisons among studies challenging. To increase comparability but not stifle innovation, we propose a common framework for coral bleaching experiments that includes consideration of coral provenance, experimental conditions, and husbandry. For example, reporting the number of genets used, collection site conditions, the experimental temperature offset(s) from the maximum monthly mean (MMM) of the collection site, experimental light conditions, flow, and the feeding regime will greatly facilitate comparability across studies. Similarly, quantifying common response variables of endosymbiont (Symbiodiniaceae) and holobiont phenotypes (i.e., color, chlorophyll, endosymbiont cell density, mortality, and skeletal growth) could further facilitate cross-study comparisons. While no single bleaching experiment can provide the data necessary to determine global coral responses of all corals to current and future ocean warming, linking studies through a common framework as outlined here, would help increase comparability among experiments, facilitate synthetic insights into the causes and underlying mechanisms of coral bleaching, and reveal unique bleaching responses among genets, species, and regions. Such a collaborative framework that fosters transparency in methods used would strengthen comparisons among studies that can help inform coral reef management and facilitate conservation strategies to mitigate coral bleaching worldwide.
Sinus stenosis occasionally occurs in dural arteriovenous fistulas. Sinus stenosis impedes venous outflow and aggravates intracranial hypertension by reversing cortical venous drainage. This study ...aimed to analyze the likelihood of sinus stenosis and its impact on cerebral hemodynamics of various types of dural arteriovenous fistulas.
Forty-three cases of dural arteriovenous fistula in the transverse-sigmoid sinus were reviewed and divided into 3 groups: Cognard type I, type IIa, and types with cortical venous drainage. Sinus stenosis and the double peak sign (occurrence of 2 peaks in the time-density curve of the ipsilateral drainage of the internal jugular vein) in dural arteriovenous fistula were evaluated. "TTP" was defined as the time at which a selected angiographic point reached maximum concentration. TTP of the vein of Labbé, TTP of the ipsilateral normal transverse sinus, trans-fistula time, and trans-stenotic time were compared across the 3 groups.
Thirty-six percent of type I, 100% of type IIa, and 84% of types with cortical venous drainage had sinus stenosis. All sinus stenosis cases demonstrated loss of the double peak sign that occurs in dural arteriovenous fistula. Trans-fistula time (2.09 seconds) and trans-stenotic time (0.67 seconds) in types with cortical venous drainage were the most prolonged, followed by those in type IIa and type I. TTP of the vein of Labbé was significantly shorter in types with cortical venous drainage. Six patients with types with cortical venous drainage underwent venoplasty and stent placement, and 4 were downgraded to type IIa.
Sinus stenosis indicated dysfunction of venous drainage and is more often encountered in dural arteriovenous fistula with more aggressive types. Venoplasty ameliorates cortical venous drainage in dural arteriovenous fistulas and serves as a bridge treatment to stereotactic radiosurgery in most cases.
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