Background Mortality is extremely high immediately after the transition to dialysis therapy, but the association of blood pressure (BP) before dialysis therapy initiation with mortality after ...dialysis therapy initiation remains unknown. Study Design Observational study. Setting & Participants 17,729 US veterans transitioning to dialysis therapy in October 2007 to September 2011, with a median follow-up of 2.0 years. Predictor Systolic (SBP) and diastolic BP (DBP) averaged over the last 1-year predialysis transition period as 6 (<120 to ≥160 mm Hg in 10−mm Hg increments) and 5 (<60 to ≥90 mm Hg in 10−mm Hg increments) categories, respectively, and as continuous measures. Outcomes & Measurements Postdialysis all-cause mortality, assessed over different follow-up periods (ie, <3, 3-<6, 6-<12, and ≥12 months after dialysis therapy initiation) using Cox regressions adjusted for demographics, comorbid conditions, medications, cardiovascular medication adherence, body mass index, estimated glomerular filtration rate, and type of vascular access. Results Mean predialysis SBP and DBP were 141.2 ± 16.1 (SD) and 73.7 ± 10.6 mm Hg, respectively. There was a reverse J-shaped association of SBP with all-cause mortality, with significantly higher mortality seen with SBP < 140 mm Hg. Mortality risks associated with lower SBP were greatest in the first 3 months after dialysis therapy initiation, with multivariable-adjusted HRs of 2.40 (95% CI, 1.96-2.93), 1.99 (95% CI, 1.66-2.40), 1.35 (95% CI, 1.13-1.62), 0.98 (95% CI, 0.78-1.22), and 0.76 (95% CI, 0.57-1.00) for SBP <120, 120 to <130, 130 to <140, 150 to <160, and ≥160 (vs 140-<150) mm Hg, respectively. No consistent association was observed between predialysis DBP and postdialysis mortality. Limitations Results cannot be inferred to show causality and may not be generalizable to women or the general US population. Conclusions Lower predialysis SBP is associated with higher all-cause mortality in the immediate postdialysis period. Predialysis DBP showed no consistent association with postdialysis mortality. Further studies are needed to clarify ideal predialysis SBP levels among incident dialysis patients as a potential means to improve the excessively high early dialysis mortality.
A few 4-allyl/amino-5-aryl-1,2,4-triazoles were synthesized and tested for antibacterial and antifungal effects against Escherichia coli, Bacillus subtilis, Salmonella enteritidis, Staphylococcus ...aureus, Aspergillus niger and Candida albicans. 4-Allyl-5-aryl-1,2,4-triazoles were obtained by the oxidative cyclization of the appropriate 1-substituted-4-allylthiosemicarbazides and 4-amino-5-aryl-1,2,4-triazoles were obtained by cyclization of the potassium salts of appropriately substituted dithiocarbazinic acids with hydrazine hydrate. The new synthesized compounds were characterized using IR, 1H- NMR, 13C-NMR and UV spectral data together with elemental analysis.
Long-term liver outcome in hepatitis C virus (HCV)-negative kidney recipients who acquired HCV infection from viremic donors is of intense interest in the transplant community. We evaluated the ...incidence of fibrosis in liver biopsy specimens of recipients who were transplanted with HCV-infected grafts.
Patients were evaluated in the hepatology clinic, and 29 patients agreed to undergo liver biopsy. The liver histology was scored by the meta-analysis of histological data in viral hepatitis scoring system and was assessed by hepatopathologists. The fibrosis score was compared between patients who initiated direct-acting antiviral (DAA) within 6 wk (n = 6) and after 6 wk (n = 29).
Eighty-nine aviremic patients were transplanted with HCV-infected grafts between March 2018 and October 2019. All patients developed HCV infection and were treated with DAA treatment after kidney transplantation (median, 70 d; interquartile range, 55-85 d). All patients (n = 89) achieved sustained virologic response with DAA. The median follow-up time from kidney transplant to liver biopsy was 28 mo (interquartile range, 26-30 mo). Twenty-five patients (86%) had F0, and 4 patients (14%) had F1 fibrosis. No patient had advanced fibrosis (F3-F4). Grade 1 inflammation was present in 6 (21%) patients, whereas 26 (90%) patients had iron accumulation in the hepatocytes and reticuloendothelial cells. There was no difference in the fibrosis score between patients who received treatment within 6 wk versus after 6 wk (
= 0.55).
Kidney transplantation of HCV-infected graft to HCV-negative recipients is safe and has no long-term liver-related complications with successful eradication of HCV. In our cohort, delayed treatment did not affect sustained virologic response or liver histology.
There has been considerable interest in the possibility that prenatal events could influence the adult life. Adults who were small at birth have been reported to have higher blood pressure and ...increased risk of death from ischaemic heart disease, although there are some contradictory results. The aim of the present study was to determine the association between size at birth and later risk factors (hypertension, hyperinsulinism, hyperglycaemia and dyslipidaemia) in prepubertal children. The authors examined 205 children (121 boys, 84 girls) at the age of 6-10. They compared children born full term with normal weight, height and head circumference (1st group), the children born full term with birthweight, height and head circumference less than 10th centile (2nd group), children born full term with birthweight less than 10th centile and with normal length and head circumference (3rd group) and children who were preterm at birth (4th group). The age of children at the time of investigation was comparable in the four groups. Weight and height of the children in the 2nd group were significantly lower than in the 1st and 4th groups (2nd group vs 4th group: p < 0.01; 2nd group vs 1st group: p < 0.001). Dyslipidaemia was found 21% in the 1st group, 17% in the 2nd group, 16% in the 3rd group and 28% in prematures. The mean of the systolic and diastolic blood pressures were similar in the four groups. Hypertension was 12.5% in the 1st and 3rd groups, 5.6% in the 2nd group and 8.9% among prematures. According to the results cardiovascular risk factors can not be proved among children at the age of 6-10 who were born with low birthweight. Further studies are required to determine whether which stage of pregnancy might influence birthweight and later risk factors.
Abstract Background Patients with atrial fibrillation receiving dialysis are at a high risk of ischemic stroke. The role of warfarin in mitigating this risk in patients with atrial fibrillation ...receiving dialysis is uncertain. Our objective was to examine the safety and efficacy of warfarin in patients who have atrial fibrillation and are receiving dialysis. Methods We used Medline, Embase, and the Cochrane Library to conduct a systematic review and meta-analysis of published and unpublished observational and interventional studies relating to the use of warfarin in patients with atrial fibrillation receiving dialysis, which provided data on the risk of stroke and/or bleeding outcomes relative to placebo or no anticoagulation therapy. A random effects model was used to calculate pooled adjusted hazard ratios (aHR) and 95% confidence intervals (CI) for these outcomes. Results No randomized controlled trials met the criteria for inclusion. Fourteen observational studies (20,398 participants) were included in the analysis. The use of warfarin was not associated with ischemic stroke (14 studies; 20,398 participants, aHR 0.77, 95% CI 0.55 to 1.07), intracranial hemorrhage (hemorrhagic stroke) (4 studies; 15,726 participants, aHR 1.93, 95% CI 0.93-4.00), gastrointestinal bleeding (3 studies, 14,693 participants, aHR 1.19, 95% CI 0.8-1.76) or all-cause mortality (7 studies; 16,172 participants, aHR 0.89, 95% CI 0.72-1.11). Conclusion Observational studies suggest that warfarin was not associated with a clear benefit or harm among patients who have atrial fibrillation and are receiving dialysis. These estimates were limited by study heterogeneity including the inability to account for a number of important confounders such as the time in the therapeutic range. Given the high prevalence of atrial fibrillation, stroke, and bleeding complications in this population, well-designed clinical trials of warfarin and other anti-coagulants are urgently needed.
This book presents current spatial and temporal multiscaling approaches of materials modeling. Recent results demonstrate the deduction of macroscopic properties at the device and component level by ...simulating structures and materials sequentially on atomic, micro- and mesostructural scales. The book covers precipitation strengthening and fracture processes in metallic alloys, materials that exhibit ferroelectric and magnetoelectric properties as well as biological, metal-ceramic and polymer composites. The progress which has been achieved documents the current state of art in multiscale materials modelling (MMM) on the route to full multi-scaling. Contents:Part I: Multi-time-scale and multi-length-scale simulations of precipitation and strengthening effectsLinking nanoscale and macroscaleMultiscale simulations on the coarsening of Cu-rich precipitates in α-Fe using kinetic Monte Carlo, Molecular Dynamics, and Phase-Field simulationsMultiscale modeling predictions of age hardening curves in Al-Cu alloysKinetic Monte Carlo modeling of shear-coupled motion of grain boundariesProduct Properties of a two-phase magneto-electric compositePart II: Multiscale simulations of plastic deformation and fractureNiobium/alumina bicrystal interface fractureAtomistically informed crystal plasticity model for body-centred cubic ironFE2AT ・ finite element informed atomistic simulationsMultiscale fatigue crack growth modeling for welded stiffened panelsMolecular dynamics study on low temperature brittleness in tungsten single crystalsMulti scale cellular automata and finite element based model for cold deformation and annealing of a ferritic-pearlitic microstructureMultiscale simulation of the mechanical behavior of nanoparticle-modified polyamide compositesPart III: Multiscale simulations of biological and bio-inspired materials, bio-sensors and compositesMultiscale Modeling of Nano-BiosensorsFinite strain compressive behaviour of CNT/epoxy nanocompositesPeptide・zinc oxide interaction
Aqueous suspensions of 2 mg titanium dioxide at pH 5.8 containing metalaxyl were illuminated at above 345 nm in oxygen. The decomposition of metalaxyl was followed by TOC measurements. The ...intermediates formed during the photo-mineralization were analysed by proton nuclear magnetic resonance. On the basis of the TOC measurements, the rate of metalaxyl decomposition conformed to the Langmuir-Hinshelwood kinetic model in which the rate of degradation increased as the initial metalaxyl concentration was reduced. Rate and absorption constants determined by this model were comparable with those reported in the literature. Possible photodegradation pathways are considered.
Background Recent studies show a survival advantage with kidney transplant in elderly patients compared with those on dialysis therapy. Study Design In our present study, we examined and compared the ...association of expanded criteria donor (ECD) kidney and living kidney donation with the outcome of kidney transplant across different ages, including elderly recipients. Setting & Participants Using the Scientific Registry of Transplant Recipients, we identified 145,470 adult kidney transplant patients. Mortality and death-censored transplant failure risks were estimated by Cox proportional regression analyses during follow-up with a median of 3.9 years. Predictors ECD kidney and living kidney donation and age compared with others. Outcomes Mortality and death-censored transplant failure risk. Results Patients were aged 45 ± 16 years and included 40% women and 19% patients with diabetes. Compared with transplant recipients 55 to younger than 65 years, the fully adjusted death-censored transplant failure risk was higher in patients 75 years and older (HR, 1.30; 95% CI, 1.09-1.56), 35 to younger than 55 years (HR, 1.13; 95% CI, 1.08-1.17), and 18 to younger than 35 years (HR, 1.64; 95% CI, 1.57-1.71). Compared with non-ECD kidneys, ECD kidneys were significant predictors of mortality in nonelderly patients (18-<35 years: HR, 1.46 95% CI, 1.19-1.77; 35-<55 years: HR, 1.23 95% CI, 1.14-1.32; and 55-<65 years: HR, 1.26 95% CI, 1.15-1.38) and patients 65 to younger than 70 years (HR, 1.20; 95% CI, 1.05-1.36), but not in other groups of elderly patients (HRs of 1.12 95% CI, 0.93-1.36 for 70-<75 years and 1.04 95% CI, 0.74-1.47 for ≥75 years). Similar results were found for risk of transplant loss. Compared with deceased donor kidneys, a living donor kidney was associated with better survival in all age groups and lower transplant loss risk in patients younger than 70 years. Limitations Unmeasured confounders cannot be adjusted for. Conclusions For deceased donors, ECD kidneys are not associated with increased mortality or transplant failure in recipients older than 70 years. For all types of donors, the persistent association between living donor kidneys and lower all-cause mortality across all ages suggests that, if possible, elderly patients gain longevity from living donor kidney transplant.
The metabolic and hormonal effects of Escherichia coli endotoxin injected intraperitoneally (IP) or into the cerebral ventricles (ICV) and that of passive hyperthermia were studied in rabbits aged ...6-10 days. Irrespective of the route of administration, endotoxin caused a transient rise in blood glucose with a simultaneous rise in plasma insulin. In contrast, only in the IP, but not in the ICV group, the endotoxin resulted in a rise of the free fatty acid and a fall in the ketone body concentrations by the second hour. The blood level of pyruvate, lactate, alanine and glycerol was not altered by endotoxin. No parameter was affected by the injection of saline or passive hyperthermia.
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