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A pilot randomized controlled trial that evaluated the effect of remote ischemic preconditioning (RIPC) on clinical outcomes following major vascular surgery was performed. Eligible patients were those scheduled to undergo open abdominal aortic aneurysm repair, endovascular aortic aneurysm repair, carotid endarterectomy, and lower limb revascularization procedures. Patients were randomized to RIPC or to control groups. The primary outcome was a composite clinical end point comprising any of cardiovascular death, myocardial infarction, new-onset arrhythmia, cardiac arrest, congestive cardiac failure, cerebrovascular accident, renal failure requiring renal replacement therapy, mesenteric ischemia, and urgent cardiac revascularization. Secondary outcomes were components of the primary outcome and myocardial injury as assessed by serum troponin values. The primary outcome occurred in 19 (19.2%) of 99 controls and 14 (14.1%) of 99 RIPC group patients ( P = .446). There were no significant differences in secondary outcomes. Our trial generated data that will guide future trials. Further trials are urgently needed.

Background: Although anaemia is a common complication of advanced chronic kidney disease (CKD), knowledge of quality of care and management practices in specialist clinics varies. We examined anaemia practices at specialist nephrology clinics within the Irish health system and evaluated the opinions of practicing nephrologists. Methods: A multicentre cross-sectional study was conducted at specialist nephrology clinics across six geographic regions in Ireland. Clinical characteristics and treatment practices were evaluated in a sample of 530 patients with CKD. An accompanying national survey questionnaire captured opinions and treatment strategies of nephrologists on anaemia management. Results: The prevalence of anaemia [defined as haemoglobin (Hb)

Background The extent to which smoking contributes to adverse outcomes among men and women of all ages undergoing dialysis is uncertain. The objective of this study was to determine the differential impact of smoking on risks of mortality and kidney transplantation by age and by sex at dialysis initiation. Methods We conducted a population-based cohort of incident U.S dialysis patients (n = 1, 220, 000) from 1995–2010. Age- and sex-specific mortality and kidney transplantation rates were determined for patients with and without a history of cardiovascular disease. Multivariable Cox regression evaluated relative hazard ratios (HR) for death and kidney transplantation at 2 years stratified by atherosclerotic condition, smoking status and age. Analyses were adjusted for demographic characteristics, non-cardiovascular conditions, laboratory variables, socioeconomic and lifestyle factors. Results The average age was 62.8 (±15) years old, 54 % were male, and the majority was white. During 2-year follow-up, 40.5 % died and 5.7 % were transplanted. Age- and sex-specific mortality rates were significantly higher while transplantation rates were significantly lower for smokers with atherosclerotic conditions than non-smokers (P

Background Chronic Kidney Disease (CKD) is a major non-communicable chronic disease that is associated with adverse clinical and economic outcomes. Passive surveillance systems are likely to improve efforts for prevention of chronic kidney disease (CKD) and inform national service planning. This study was conducted to determine the overall prevalence of CKD in the Irish health system, assess period trends and explore patterns of variation as part of a novel surveillance initiative. Methods We identified 207, 336 adult patients, age 18 and over, with serum creatinine measurements recorded from a provincial database between 2005-2011 in the Northwest of Ireland. Estimated glomerular filtration rates (eGFR) were determined using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation from standardized creatinine measurements and the presence of CKD was defined as eGFR

peer-reviewed The association of adult height withmortality has been extensively investigated in the general population, but little is known about this relationship among dialysis patients. We explored the relationship between height and mortality in a retrospective cohort study of 1,171,842 adults who began dialysis in the United States from 1995 to 2008 and were followed until December 31, 2010. We evaluated height-mortality associations in sex-specific quintiles of increasing height (Q1–Q5) using multivariable Cox regression models adjusted for demographics, comorbid conditions, lifestyle and disability indicators, socioeconomic status, and body weight. For men, compared with the referent quintile (Q1 ,167 cm), successive height quintiles had significantly increased hazard ratios (HRs [95%confidence interval]) for mortality: 1.04 (1.02–1.06), 1.08 (1.06–1.10), 1.12 (1.11–1.14), and 1.18 (1.16–1.20) for Q2–Q5, respectively. For women (referentQ1,155 cm),HRs formortality were 1.00 (0.99–1.02), 1.05 (1.03–1.06), 1.05 (1.03–1.07), and 1.08 (1.06–1.10) for Q2–Q5, respectively. However, stratification by race showed the pattern of association differed significantly by race (P,0.001 for interaction). For blackmen, unlike other race groups, height only associated with mortality in Q5, with an HR of 1.06 (1.02–1.09). For black women, HRs for mortality were 0.94 (0.91–0.97), 0.98 (0.95–1.02), 0.96 (0.93–0.99), and 0.99 (0.96–1.02) for Q2–Q5, respectively. These results indicate tallness is associated with higher mortality risks for adults starting dialysis, but this association did not extend to black patients.

Background: The transferrin saturation (TSAT) ratio is a commonly used indicator of iron deficiency and iron overload in clinical practice but precise relationships with total and cardiovascular mortality are unclear. Purpose: To better understand this relationship, we explored the association of TSAT ratio (serum iron/total iron binding capacity) with mortality in the general population. Methods: The relationships of TSAT ratio with total and cardiovascular mortality were explored in 15 823 subjects age 20 and older from the Third National Health and Nutrition Examination Survey (1988–94). All subjects had vital status assessed through to 2006. Results: During follow-up, 9.7% died of which 4.4% were from cardiovascular disease. In unadjusted analysis, increasing TSAT ratio was inversely associated with mortality. With adjustment for baseline demographic and clinical characteristics, the TSAT–mortality relationship followed a j-shaped pattern. Compared with the referent group [ratio 23.7–31.3%: hazard ratio (HR) =1.00], subjects in the lowest two quartiles, 31.3 %, experienced significantly higher mortality risks of 1.23 (1.01–1.49). The pattern of association was more pronounced for cardiovascular mortality with significantly higher mortality risks for the lowest two quartiles [HR = 2.09 (1.43–3.05) and 1.90 (1.33–2.72), respectively] and highest quartile HR = 1.59 (1.05–2.40). Conclusions: Both low and high TSAT ratios are significantly and independently associated with increased total and cardiovascular mortality. The optimal TSAT ratio associated with the greatest survival is between 24% and 40%.

Background RNA-Seq technology measures the transcript abundance by generating sequence reads and counting their frequencies across different biological conditions. To identify differentially expressed genes between two conditions, it is important to consider the experimental design as well as the distributional property of the data. In many RNA-Seq studies, the expression data are obtained as multiple pairs, e.g., pre- vs. post-treatment samples from the same individual. We seek to incorporate paired structure into analysis. Results We present a Bayesian hierarchical mixture model for RNA-Seq data to separately account for the variability within and between individuals from a paired data structure. The method assumes a Poisson distribution for the data mixed with a gamma distribution to account variability between pairs. The effect of differential expression is modeled by two-component mixture model. The performance of this approach is examined by simulated and real data. Conclusions In this setting, our proposed model provides higher sensitivity than existing methods to detect differential expression. Application to real RNA-Seq data demonstrates the usefulness of this method for detecting expression alteration for genes with low average expression levels or shorter transcript length.

We draw attention to the importance of visual symbols in the anthropological investigation of religion and cultural values and analyze a recent efflorescence in monastic mural paintings in the city of Chiengmai in northern Thailand in order to discover the iconographic code which might reveal underlying meanings and values. The popularity of certain Buddhist symbols found in the murals is established by means of a quantitative methodology. The results are analyzed in terms of traditional Buddhist explanations of the symbols and then compared with informants' accounts of why the murals were popular. The opinions of the artists and monks and laity involved are considered in reference to cultural changes in values taking place in a modernizing society. The murals are an assertion of certain core values expressed in ancient Buddhist symbols as a defense of the totality of the religious system against perceived threats from competing modern values. An unexpected result of the research was the discovery that the Thai religious symbolic system incorporates into a broad continuum a host of legends and symbols that are not just “folk” beliefs but are central to an adequate anthropological understanding of Theravada Buddhism itself.

An evaluation of an S. S. White Panorex dental x-ray machine was performed. The physical and operational characteristics of the unit were investigated, with particular emphasis on KVP and Ma. meter calibrations, focal spot characteristics, x-ray beam dimensions, beam quality, and exposure reproducibility. Isoexposure curves for radiation in the vicinity of a phantom were also determined. Survey techniques for beam quality measurement and x-ray beam alignment were investigated, and recommended procedures are described.