Empyema is a rare but important complication among patients with end-stage renal disease (ESRD). However, a nationwide, propensity-matched cohort study has never been performed.
We conducted a ...retrospective cohort study using data from the National Health Insurance Research Database of Taiwan. The ESRD group consisted of 82 765 patients diagnosed between 2000 and 2008. The comparison group consisted of individuals without kidney disease selected at a 1:1 ratio matched by propensity score estimated with age, gender, year of diagnosis and comorbidities. The occurrence of empyema was monitored until the end of 2011. The hazard ratios (HRs) of empyema were estimated using the Cox proportional hazards model.
The incidence of empyema was 2.76-fold higher in the ESRD group than in the comparison group (23.7 vs. 8.19/10 000 person-years, P <0.001), with an adjusted HR of 3.01 95% confidence interval (CI) = 2.67-3.39. There was no difference of the incidence of empyema between hemodialysis (HD) and peritoneal dialysis (PD) (adjusted HR = 0.96, 95% CI = 0.75-1.23). In addition, 30-day mortality rate since empyema diagnosis was significantly higher in ESRD group than the comparison group (15.9% vs. 10.9%), with an adjusted OR of 1.69 (95% CI = 1.17-2.44).
The risk of empyema was significantly higher in patients with ESRD than in those without kidney disease. The occurrence of empyema was without difference in patients undergoing HD compared to those undergoing PD. The 30-day mortality rate since empyema diagnosis was also significantly higher in patients with ESRD.
Diffusionless martensitic transformation (MT) exerts one of the most significant influences on the mechanical properties of alloys. However, the application of martensitic transformation to improve ...mechanical performance was seldom involved in the manufacture of high-entropy alloys (HEAs) and medium-entropy (MEAs) alloys. In this work, an innovative non-equiatomic MEA, Fe42Co42Cr16, was proposed with incorporation of martensitic transformation during water quenching and plastic deformation. Water quenching for the alloy in the high-temperature single-phase region produced a partial MT; i.e., transformation of γ–FCC austenite phase into an ε-HCP martensite phase, responsible for the coexistence of γ and ε phases in the dual-phase (DP) alloy. Another triple-phase (TP) alloy, including γ–FCC austenite, ε-HCP martensite and B2-BCC precipitates, was obtained by quenching the alloy in γ+B2 phase region. Owing to the low intrinsic stacking fault energy (γI), both DP (γI=10.9 mJ/m2) and TP (γI=12.2 mJ/m2) alloys involved the complete polymorphic MT process during plastic deformation; i.e., the transformation of the γ–FCC austenite phase into the α-BCT martensite phase with an intermediate ε-HCP martensite phase. Due to the transformation-induced plasticity effect and precipitation strengthening, the produced TP alloy exhibited a yield strength above 1 GPa with a total elongation of as high as 25%.
•Partial martensitic transformation, i.e., γ-FCC→ε-HCP, occurred in the Fe42Co42Cr16 medium-entropy alloy.•Triple-phase alloy with γ-FCC austenite, ε-HCP martensite and B2-BCC precipitates, was obtained.•Complete martensitic transformation, i.e., γ-FCC→ε-HCP→ α-BCT, were conformed in the Fe42Co42Cr16.•The triple-phase medium-entropy alloy exhibited a yield strength above 1 GPa with a total elongation of as high as 25%.
We describe the publicly available data from the Global OZone Chemistry And Related trace gas Data records for the Stratosphere (GOZCARDS) project and provide some results, with a focus on hydrogen ...chloride (HCl), water vapor (H2O), and ozone (O3). This data set is a global long-term stratospheric Earth system data record, consisting of monthly zonal mean time series starting as early as 1979. The data records are based on high-quality measurements from several NASA satellite instruments and the Atmospheric Chemistry Experiment Fourier Transform Spectrometer (ACE-FTS) on SCISAT. We examine consistency aspects between the various data sets. To merge ozone records, the time series are debiased relative to SAGE II (Stratospheric Aerosol and Gas Experiments) values by calculating average offsets versus SAGE II during measurement overlap periods, whereas for other species the merging derives from an averaging procedure during overlap periods. The GOZCARDS files contain mixing ratios on a common pressure-latitude grid, as well as standard errors and other diagnostics; we also present estimates of systematic uncertainties in the merged products. Monthly mean temperatures for GOZCARDS were also produced, based directly on data from the Modern-Era Retrospective analysis for Research and Applications. The GOZCARDS HCl merged product comes from the Halogen Occultation Experiment (HALOE), ACE-FTS and lower-stratospheric Aura Microwave Limb Sounder (MLS) data. After a rapid rise in upper-stratospheric HCl in the early 1990s, the rate of decrease in this region for 1997-2010 was between 0.4 and 0.7 % yr-1. On 6-8-year timescales, the rate of decrease peaked in 2004-2005 at about 1 % yr-1, and it has since levelled off, at ~ 0.5 % yr-1. With a delay of 6-7 years, these changes roughly follow total surface chlorine, whose behavior versus time arises from inhomogeneous changes in the source gases. Since the late 1990s, HCl decreases in the lower stratosphere have occurred with pronounced latitudinal variability at rates sometimes exceeding 1-2 % yr-1. Recent short-term tendencies of lower-stratospheric and column HCl vary substantially, with increases from 2005 to 2010 for northern midlatitudes and deep tropics, but decreases (increases) after 2011 at northern (southern) midlatitudes. For H2O, the GOZCARDS product covers both stratosphere and mesosphere, and the same instruments as for HCl are used, along with Upper Atmosphere Research Satellite (UARS) MLS stratospheric H2O data (1991-1993). We display seasonal to decadal-type variability in H2O from 22 years of data. In the upper mesosphere, the anticorrelation between H2O and solar flux is now clearly visible over two full solar cycles. Lower-stratospheric tropical H2O has exhibited two periods of increasing values, followed by fairly sharp drops (the well-documented 2000-2001 decrease and a recent drop in 2011-2013). Tropical decadal variability peaks just above the tropopause. Between 1991 and 2013, both in the tropics and on a near-global basis, H2O has decreased by ~ 5-10 % in the lower stratosphere, but about a 10 % increase is observed in the upper stratosphere and lower mesosphere. However, such tendencies may not represent longer-term trends. For ozone, we used SAGE I, SAGE II, HALOE, UARS and Aura MLS, and ACE-FTS data to produce a merged record from late 1979 onward, using SAGE II as the primary reference. Unlike the 2 to 3 % increase in near-global column ozone after the late 1990s reported by some, GOZCARDS stratospheric column O3 values do not show a recent upturn of more than 0.5 to 1 %; long-term interannual column ozone variations from GOZCARDS are generally in very good agreement with interannual changes in merged total column ozone (Version 8.6) data from SBUV instruments. A brief mention is also made of other currently available, commonly formatted GOZCARDS satellite data records for stratospheric composition, namely those for N2O and HNO3.
Uranium and plutonium’s 5f electrons are tenuously poised between strongly bonding with ligand spd-states and residing close to the nucleus. The unusual properties of these elements and their ...compounds (e.g., the six different allotropes of elemental plutonium) are widely believed to depend on the related attributes of f-orbital occupancy and delocalization for which a quantitative measure is lacking. By employing resonant X-ray emission spectroscopy (RXES) and X-ray absorption near-edge structure (XANES) spectroscopy and making comparisons to specific heat measurements, we demonstrate the presence of multiconfigurational f-orbital states in the actinide elements U and Pu and in a wide range of uranium and plutonium intermetallic compounds. These results provide a robust experimental basis for a new framework toward understanding the strongly-correlated behavior of actinide materials.
Aim
The study aimed to determine whether nonalcoholic fatty liver disease (NAFLD) is an independent risk factor of adenoma after negative baseline colonoscopy.
Method
A retrospective cohort study was ...conducted on 1522 health‐check individuals who underwent two consecutive colonoscopies at Taipei Veterans General Hospital between 2003 and 2010. Those developing an adenoma after an initial negative baseline colonoscopy (adenoma group) were compared with those in whom the second colonoscopy was negative (nonadenoma group). Anthropometric measurements, biochemical tests and the presence of NAFLD were compared between the two groups.
Results
The adenoma group had a higher prevalence of NAFLD than the nonadenoma group (55.6% vs 38.8%; P < 0.05). On multivariate logistic regression analysis, NAFLD was an independent risk factor (OR = 1.45, 95% CI: 1.07–1.98) for adenoma formation after a negative baseline colonoscopy. The risk of colorectal adenoma increased when NAFLD patients had other morbidities including metabolic syndrome, hypertension or smoking (OR = 2.85, 4.03 and 4.17).
Conclusion
NAFLD is an independent risk factor for colorectal adenoma formation after a negative baseline colonoscopy. The risk is higher in individuals with NAFLD and other comorbidities, such as hypertension, smoking or metabolic syndrome.
TDP-43 is an important pathological protein that aggregates in the diseased neuronal cells and is linked to various neurodegenerative disorders. In normal cells, TDP-43 is primarily an RNA-binding ...protein; however, how the dimeric TDP-43 binds RNA via its two RNA recognition motifs, RRM1 and RRM2, is not clear. Here we report the crystal structure of human TDP-43 RRM1 in complex with a single-stranded DNA showing that RRM1 binds the nucleic acid extensively not only by the conserved β-sheet residues but also by the loop residues. Mutational and biochemical assays further reveal that both RRMs in TDP-43 dimers participate in binding of UG-rich RNA or TG-rich DNA with RRM1 playing a dominant role and RRM2 playing a supporting role. Moreover, RRM1 of the amyotrophic lateral sclerosis-linked mutant D169G binds DNA as efficiently as the wild type; nevertheless, it is more resistant to thermal denaturation, suggesting that the resistance to degradation is likely linked to TDP-43 proteinopathies. Taken together all the data, we suggest a model showing that the two RRMs in each protomer of TDP-43 homodimer work together in RNA binding and thus the dimeric TDP-43 recognizes long clusters of UG-rich RNA to achieve high affinity and specificity.
Carbon cycling in the coastal zone affects global carbon budgets and is critical for understanding the urgent issues of hypoxia, acidification, and tidal wetland loss. However, there are no regional ...carbon budgets spanning the three main ecosystems in coastal waters: tidal wetlands, estuaries, and shelf waters. Here we construct such a budget for eastern North America using historical data, empirical models, remote sensing algorithms, and process‐based models. Considering the net fluxes of total carbon at the domain boundaries, 59 ± 12% (± 2 standard errors) of the carbon entering is from rivers and 41 ± 12% is from the atmosphere, while 80 ± 9% of the carbon leaving is exported to the open ocean and 20 ± 9% is buried. Net lateral carbon transfers between the three main ecosystem types are comparable to fluxes at the domain boundaries. Each ecosystem type contributes substantially to exchange with the atmosphere, with CO2 uptake split evenly between tidal wetlands and shelf waters, and estuarine CO2 outgassing offsetting half of the uptake. Similarly, burial is about equal in tidal wetlands and shelf waters, while estuaries play a smaller but still substantial role. The importance of tidal wetlands and estuaries in the overall budget is remarkable given that they, respectively, make up only 2.4 and 8.9% of the study domain area. This study shows that coastal carbon budgets should explicitly include tidal wetlands, estuaries, shelf waters, and the linkages between them; ignoring any of them may produce a biased picture of coastal carbon cycling.
Plain Language Summary
A carbon budget for a particular site or region describes the inputs and outputs of carbon to that site or region as well as the processes that change carbon from one form to another. A carbon budget is needed to fully understand many important issues facing coastal waters. We constructed the carbon budget for coastal waters of eastern North America. We found that about 60% of the carbon entering the domain is from rivers and about 40% is from the atmosphere, while about 80% of the carbon leaving the domain goes to the open ocean and about 20% is buried. Transfers of carbon from wetlands to estuaries and from estuaries to the ocean were as important as transfers of carbon at the domain boundaries. Tidal wetlands and estuaries were found to be important to the carbon budget despite making up only 2.4 and 8.9% of the study domain area, respectively. This study shows that coastal carbon budgets should explicitly consider tidal wetlands, estuaries, shelf waters, and the linkages between them; ignoring any of them may produce a biased picture of coastal carbon cycling.
Key Points
Tidal wetlands, estuaries, and shelf waters each contribute substantially to the carbon budget of eastern North American coastal waters
Study region net ecosystem production, atmospheric uptake, and burial are 20.2 ± 4.4, 5.1 ± 2.4, and 2.5 ± 0.7 Tg C yr−1, respectively
Net lateral carbon fluxes between tidal wetlands, estuaries, and shelf waters are large terms in the carbon budget of eastern North American coastal waters
Abstract Background Combinations of Child-Pugh classification and Liver Cancer Study Group of Japan/Tumor-Node-Metastasis (LCSGJ/TNM) have been reported as Japan Integrated Staging (JIS). We ...previously modified the 6th AJCC/TNM to serve as a better staging system than the 5th and 6th AJCC/TNM. Aims To develop a modified TNM-based JIS to predict the survival of hepatocellular carcinoma (HCC) patients more accurately. Methods 3764 HCC patients were enrolled from 1986 to 2002 (2882 patients from 1986 to 2000 and 882 patients from 2001 to 2002). We compared the performance of original JIS, modified TNM-based JIS, modified TNM-based JIS combined α-fetoprotein (AFP), BCLC, and CLIP. Lower Akaike information criteria (AIC) values indicated better discriminatory abilities. Results AIC value was lowest in CLIP during all periods. However, during 2001–2002, when early-stage HCC patients were predominant, AIC value was lowest when modified TNM-based JIS combined AFP was used. Conclusion The CLIP system provided the best prognostic stratification in the present cohort of HCC patients who were mainly at late stages. However, early detection of HCCs has become more common in Taiwan in recent years, which has led to the predominance of early-stage HCC patients. Therefore, modified TNM-based JIS combined AFP may now be the most applicable system in recent years.
The fracturing properties and acoustic characteristics of heterogeneous and matrix-inclusion rocks are crucial to the safety of underground infrastructures and mining projects under extreme loading ...conditions. In this study, elliptically shaped matrix-inclusion specimens were fabricated with cement as the matrix and three rock materials (basalt, marble and sandstone) as inclusions which cover igneous, metamorphic and sedimentary rocks with different strength ratios to the cement. Dynamic Brazilian tests were conducted on the specimens with various inclusion orientations β (i.e. angles between impact direction and inclusion major axis) in the range of 0° and 90° using a split Hopkinson pressure bar (SHPB). By combining digital image correlation (DIC) and acoustic emission (AE) techniques, the integrated system demonstrates well-synchronised dynamic forces, DIC strain fields, and AE signals. The detailed procedures were presented to interpret dynamic mechanical properties, fracturing process and AE characteristics of specimens. Generally, for stronger inclusion materials with higher stiffness and strength, dynamic peak forces, threshold orientation angles of transgranular cracks, and AE counts and duration indicate higher characteristics. For instance, the fracture pattern of basalt inclusions transforms from interfacial crack to transgranular crack with increasing orientation angle β, and the specimens with transgranular cracks exhibit higher dynamic peak forces. It is observed that transgranular cracks are mainly induced by tensile stress with a higher AE peak frequency (200–250 kHz), whereas interfacial cracks contain additional shear cracking having a relatively lower peak frequency (100–150 kHz). Meanwhile, finite element modelling demonstrates that stress fields are affected by the elastic mismatch between inclusion and matrix, while failure modes (i.e. interfacial and transgranular cracks) are mainly governed by the tensile strength of inclusions.
Display omitted
•Synchronisation and calibration of SHPB, DIC and AE signals.•Effects of inclusion's orientation and material on failure patterns.•Failure patterns were characterised by AE counts, duration and peak frequency.•FEM modelling stress fields and further validating experimental results.
Body image seems to mediate the association between obesity and health behaviors as well as weight control attempts. We examined the distribution of children's body image by demographic ...characteristics and their subsequent associations with eating, exercise, and weight change. Child body image and health behaviors from the China Health National Survey 2000–2011 were assessed at baseline and in follow-up for 6- to 17-year-old children during 2000–2011 using mixed models. There was a large discrepancy between children's actual weight status (overweight: 16.9%) vs. self-rated body image (fat: 2.4% in 2011). Less than 1% of children desired a fat body; girls were more likely to want to be thin (52.5% vs. 40.9%) than boys. About 11% of children needed to lose weight in order to be at their desired baseline. During follow-up, those needing weight loss to be as desired were more likely to attempt dieting to change their weight (OR, 95% CI=1.9, 1.1–3.5 in boys; 1.7, 1.1–2.5 in girls) and less likely to feel they had enough physical activity (OR, 95% CI=0.5, 0.4–0.7 in boys; 0.6, 0.5–0.9 in girls), although their weight gain had been significantly higher than those having consistent self and desired body images (β SE=0.4 0.1 in boys; 0.2 0.1 in girls, all p<0.05). However, no significant difference was shown in subsequent health behaviors among overweight children by body image discrepancy. The discrepancy in self vs. desired body image motivated children to change their obesity-related health behaviors among non-overweight children in China.
•China had a large discrepancy between children's weight status vs. self-body image.•Girls were more likely to want to be thin than boys.•Self-desired body image discrepancy motivated children's behavioral changes.•Yet this motivation does not improve children's weight status.
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