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.
Sustained, drug-free control of HIV-1 replication is naturally achieved in less than 0.5% of infected individuals (here termed 'elite controllers'), despite the presence of a replication-competent ...viral reservoir
. Inducing such an ability to spontaneously maintain undetectable plasma viraemia is a major objective of HIV-1 cure research, but the characteristics of proviral reservoirs in elite controllers remain to be determined. Here, using next-generation sequencing of near-full-length single HIV-1 genomes and corresponding chromosomal integration sites, we show that the proviral reservoirs of elite controllers frequently consist of oligoclonal to near-monoclonal clusters of intact proviral sequences. In contrast to individuals treated with long-term antiretroviral therapy, intact proviral sequences from elite controllers were integrated at highly distinct sites in the human genome and were preferentially located in centromeric satellite DNA or in Krüppel-associated box domain-containing zinc finger genes on chromosome 19, both of which are associated with heterochromatin features. Moreover, the integration sites of intact proviral sequences from elite controllers showed an increased distance to transcriptional start sites and accessible chromatin of the host genome and were enriched in repressive chromatin marks. These data suggest that a distinct configuration of the proviral reservoir represents a structural correlate of natural viral control, and that the quality, rather than the quantity, of viral reservoirs can be an important distinguishing feature for a functional cure of HIV-1 infection. Moreover, in one elite controller, we were unable to detect intact proviral sequences despite analysing more than 1.5 billion peripheral blood mononuclear cells, which raises the possibility that a sterilizing cure of HIV-1 infection, which has previously been observed only following allogeneic haematopoietic stem cell transplantation
, may be feasible in rare instances.
It has been generally acknowledged that the diagnosis, treatment and prognosis evaluation of leukemia largely rely on an adequate identification of genetic abnormalities. A systemic analysis of ...genetic aberrations was performed in a cohort of 1346 patients with newly diagnosed acute lymphoblastic leukemia (ALL) in China. The pediatric patients had higher incidence of hyperdiploidy and t(12;21) (p13;q22)/ETV6-RUNX1 than adults (P<0.0001); in contrast, the occurrence of Ph and Ik6 variant of IKZF1 gene was much more frequent in adult patients (all P<0.0001). In B-ALL, the existence of Ik6 and that of BCR-ABL were statistically correlated (P<0.0001). In comparison with Western cohorts, the incidence of t(9;22) (q34;q11)/BCR-ABL (14.60%) in B-ALL and HOX11 expression in T-ALL (25.24%) seemed to be much higher in our group, while the incidence of t(12;21) (p13;q22)/ETV6-RUNX1 (15.34%) seemed to be lower in Chinese pediatric patients. The occurrence of hyperdiploidy was much lower either in pediatric (10.61% vs 20-38%) or adult patients (2.36% vs 6.77-12%) in our study than in Western reports. In addition, the frequencies of HOX11L2 in adult patients were much higher in our cohort than in Western countries (20.69% vs 4-11%). In general, it seems that Chinese ALL patients bear more adverse prognostic factors than their Western counterparts do.
Objectives
To evaluate the negative effect of physical restraint use on the hospital outcomes of older patients.
Design
A retrospective cohort study.
Setting
Internal medicine wards of a tertiary ...medical center in Taiwan.
Participants
Subjects aged 65 years and over who were admitted during April to Dec 2017 were recruited for study.
Measurements
Demographic data, geriatric assessments (polypharmacy, visual impairment, hearing impairment, activities of daily living before and after admission, risk of pressure sores, change in consciousness level, mood condition, history of falls in the previous year, risk of malnutrition and pain) and hospital conditions (admission route, department of admission, length of hospital stay and mortality) were collected for analysis.
Results
Overall, 4,352 participants (mean age 78.7±8.7 years, 60.2% = male) were enrolled and 8.3% had physical restraint. Results of multivariate logistic regression showed that subjects with physical restraints were at greater risk of functional decline (adjusted odds ratio 2.136, 95% confidence interval 1.322–3.451, p=0.002), longer hospital stays (adjusted odds ratio 5.360, 95% confidence interval 3.627–7.923, p<0.001) and mortality (adjusted odds ratio 4.472, 95% confidence interval 2.794–7.160, p<0.001) after adjustment for covariates.
Conclusion
The use of physical restraints during hospitalization increased the risk of adverse hospital outcomes, such as functional decline, longer length of hospital stay and mortality.
The rate at which interstellar gas is converted into stars, and its dependence on environment, is one of the pillars on which our understanding of the visible Universe is build. We present a ...comparison of the surface density of young stars (Σ⋆) and dust surface density (Σdust) across NGC 346 (N66) in 115 independent pixels of 6 × 6 pc2. We find a correlation between Σ⋆ and Σdust with a considerable scatter. A power-law fit to the data yields a steep relation with an exponent of 2.6 ± 0.2. We convert Σdust to gas surface density (Σgas) and Σ⋆ to star formation rate (SFR) surface densities (ΣSFR), using simple assumptions for the gas-to-dust mass ratio and the duration of star formation. The derived total SFR (4 ± 1×10−3 M⊙ yr−1) is consistent with SFR estimated from the Hα emission integrated over the Hα nebula. On small scales the ΣSFR derived using Hα systematically underestimates the count-based ΣSFR, by up to a factor of 10. This is due to ionizing photons escaping the area, where the stars are counted. We find that individual 36 pc2 pixels fall systematically above integrated disc galaxies in the Schmidt–Kennicutt diagram by on average a factor of ∼7. The NGC 346 average SFR over a larger area (90 pc radius) lies closer to the relation but remains high by a factor of ∼3. The fraction of the total mass (gas plus young stars) locked in young stars is systematically high (∼10 per cent) within the central 15 pc and systematically lower outside (2 per cent), which we interpret as variations in star formation efficiency. The inner 15 pc is dominated by young stars belonging to a centrally condensed cluster, while the outer parts are dominated by a dispersed population. Therefore, the observed trend could reflect a change of star formation efficiency between clustered and non-clustered star formation.
Abstract
Cyclotron line scattering features are detected in a few tens of X-ray pulsars (XRPs) and used as direct indicators of a strong magnetic field at the surface of accreting neutron stars ...(NSs). In a few cases, cyclotron lines are known to be variable with the accretion luminosity of XRPs. It is accepted that the observed variations of cyclotron line scattering features are related to variations of geometry and dynamics of accretion flow above the magnetic poles of an NS. A positive correlation between the line centroid energy and luminosity is typical for subcritical XRPs, where the accretion results in hot spots at the magnetic poles. The negative correlation was proposed to be a specific feature of bright supercritical XRPs, where radiation pressure supports accretion columns above the stellar surface. The cyclotron line in the spectra of the Be-transient XRP GRO J1008-57 is detected at energies from ∼75 to 90 keV, the highest observed energy of a cyclotron line feature in XRPs. We report the peculiar relation of cyclotron line centroid energies with luminosity in GRO J1008-57 during the Type II outburst in 2017 August observed by Insight-HXMT. The cyclotron line energy was detected to be negatively correlated with the luminosity at 3.2 × 10
37
erg s
−1
<
L
< 4.2 × 10
37
erg s
−1
and positively correlated at
L
≳ 5 × 10
37
erg s
−1
. We speculate that the observed peculiar behavior of a cyclotron line would be due to variations of accretion channel geometry.
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