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Find video protocols related to scientific articles indexed in Pubmed.
Urinary neutrophil gelatinase-associated lipocalin and clinical outcomes in chronic kidney disease patients.
Clin. Chem. Lab. Med.
PUBLISHED: 08-07-2014
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Abstract Background: Tubulointerstitial damage is a final common pathway of most renal diseases. Whether urinary neutrophil gelatinase-associated lipocalin (uNGAL), a biomarker for renal tubular damage, is of prognostic value for clinical outcomes in chronic kidney disease (CKD) patients has not been well investigated. Methods: The uNGAL and proteinuria levels were measured among a cohort of 473 advanced CKD patients of various etiologies recruited during 2002-2009. Results: The estimated glomerular filtration rate (eGFR) was 32.3±22.0 mL/min/1.73 m2 with a urine protein-to-creatinine ratio (UPCR) 680 (255-1248) mg/g and 132 (27.9%) participants had diabetes. The baseline uNGAL level was significantly associated with male gender, eGFR, UPCR, and hemoglobin. The hazard ratio (HR) of the highest uNGAL tertile for end-stage renal disease (ESRD) was 3.44 (95% CI 1.47-8.06, p=0.004). With the adjustment of urine creatinine and urine protein, HR of the highest urine NGAL-to-creatinine ratio (UNCR) tertile and the highest urine NGAL-to-protein ratio (UNPR) tertile was 3.06 (95% CI 1.19-7.90, p=0.02) and 2.10 (95% CI 1.13-3.89, p=0.02), respectively. UNPR increased the prediction of survival model for ESRD. HR of the highest UNCR tertile and UNPR tertile for cardiovascular (CV) events was 2.21 (95% CI 0.81-5.98, p=0.08) and 2.79 (95% CI 1.25-6.26, p=0.01), respectively. None of these were associated with all-cause mortality. Conclusions: Elevated uNGAL in CKD patients is associated with risks for ESRD and probably CV events. UNPR could improve the prediction for ESRD.
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Variability in Estimated Glomerular Filtration Rate by Area under the Curve Predicts Renal Outcomes in Chronic Kidney Disease.
ScientificWorldJournal
PUBLISHED: 07-16-2014
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Greater variability in renal function is associated with mortality in patients with chronic kidney disease (CKD). However, few studies have demonstrated the predictive value of renal function variability in relation to renal outcomes. This study investigates the predictive ability of different methods of determining estimated glomerular filtration rate (eGFR) variability for progression to renal replacement therapy (RRT) in CKD patients. This was a prospective observational study, which enrolled 1,862 CKD patients. The renal end point was defined as commencement of RRT. The variability in eGFR was measured by the area under the eGFR curve (AUC)%. A significant improvement in model prediction was based on the -2 log likelihood ratio statistic. During a median 28.7-month follow-up, there were 564 (30.3%) patients receiving RRT. In an adjusted Cox model, a smaller initial eGFR AUC%_12M (P < 0.001), a smaller peak eGFR AUC%_12M (P < 0.001), and a larger negative eGFR slope_12M (P < 0.001) were associated with a higher risk of renal end point. Two calculated formulas: initial eGFR AUC%_12M and eGFR slope_12M were the best predictors. Our results demonstrate that the greater eGFR variability by AUC% is associated with the higher risk of progression to RRT.
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Local nanotip arrays sculptured by atomic force microscopy to enhance the light-output efficiency of GaN-based light-emitting diode structures.
Nanotechnology
PUBLISHED: 04-24-2014
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In this work, local nanotip arrays on GaN-based light-emitting (LED) structures were fabricated through nano-oxidation using an atomic force microscope (AFM). The photoluminescence (PL) intensity of the InGaN/GaN multiple quantum wells (MQWs) active layer and the light extraction efficiency of the LED structure were enhanced by forming this nanotips structure to serve as a graded-refractive index layer, which is further validated by the finite-difference time-domain analysis. The PL emission peak of the MQWs active layer has a blue-shift phenomenon that is caused by a partial reduction of the strain on the InGaN well. It is expected that our approach opens a promising route for simultaneously enhancing both the internal quantum efficiency and the light extraction efficiency of GaN-based LEDs. The proposed AFM-based method will be of importance for local patterning the light emitting components for optoelectronic applications.
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Effects of the mTOR inhibitor Rapamycin on Monocyte-Secreted Chemokines.
BMC Immunol.
PUBLISHED: 04-18-2014
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BackgroundMammalian target of rapamycin (mTOR) inhibitors, such as sirolimus and its derivative, everolimus, are potent immunosuppressive and antiproliferative drugs. Inflammatory diseases are characterized by immunological dysfunction, and monocyte recruitment underlies the mechanism of cell damage. Chemokines attract inflammatory cells to sites of inflammation. Interleukin-8 (IL-8/CXCL8); the monocyte chemoattractant protein-1 (MCP-1/CCL2); the regulated on activation, normal T cell expressed, presumably secreted protein (RANTES/CCL5); the macrophage inflammatory protein (MIP)-1¿ (CCL3); and MIP-1ß (CCL4) are involved in the pathogenesis of inflammation. However, whether mTOR inhibitors moderate the production of chemokines in monocytes remains unclear.MethodsA human monocyte cell line, THP-1, and primary monocytes obtained from human volunteers, were stimulated using lipopolysaccharide (LPS), and then treated with sirolimus. The expression of the MCP-1, RANTES, IL-8, MIP-1¿, MIP-1ß, and TNF-¿ proteins was measured using enzyme-linked immunosorbent assays, and intracellular signalling was examined using western blotting.ResultsSirolimus significantly suppressed the LPS-induced expression of MCP-1, IL-8, RANTES, MIP-1¿, and MIP-1ß in the THP-1 cells and human primary monocytes. The mitogen-activated protein kinase (MAPK) inhibitors that were examined suppressed the LPS-induced expression of MCP-1, IL-8, RANTES, MIP-1¿, and MIP-1ß. In addition, sirolimus suppressed the LPS-induced phosphorylation of p38 and p65 in the THP-1 and human primary monocytes.ConclusionSirolimus downregulates the expression of chemokines in monocytes, including MCP-1, RANTES, IL-8, MIP-1¿, and MIP-1ß, by inhibiting the NF-¿B-p65 and MAPK-p38 signalling pathways.
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Systolic blood pressure and outcomes in stage 3-4 chronic kidney disease patients: evidence from a taiwanese cohort.
Am. J. Hypertens.
PUBLISHED: 04-11-2014
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Systolic blood pressure (SBP) goal for chronic kidney disease (CKD) patients is ?140mm Hg. However, the SBP target provides no suggested lower limit, and some studies indicate that a lower SBP target may be harmful. We aimed to investigate the J-shaped relationship between SBP and clinical outcomes in CKD patients and the factors that modify this relationship.
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Adiponectin gene (ADIPOQ) polymorphisms correlate with the progression of nephropathy in Taiwanese male patients with type 2 diabetes.
Diabetes Res. Clin. Pract.
PUBLISHED: 03-26-2014
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Polymorphisms of the ADIPOQ gene were associated with diabetic nephropathy (DN) in case-control studies predominantly among European populations. Gender may modify the ADIPOQ associated risk for DN. We investigated the association of 18 ADIPOQ polymorphisms with DN in a prospective Taiwanese cohort of type 2 diabetes (T2D) and explored whether gender plays a role in this genetic association.
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Association of n-3 polyunsaturated fatty acids and inflammatory indicators with renal function decline in type 2 diabetes.
Clin Nutr
PUBLISHED: 02-15-2014
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The n-3 polyunsaturated fatty acids (PUFAs) and the inflammatory indicator, interleukin-6 (IL-6), have been implied in the development of renal dysfunction. This longitudinal study examined the effect of n-3 PUFAs and IL-6 on the risk of renal function decline and explored whether n-3 PUFAs modify the effect of inflammatory indicators on renal dysfunction risk in type 2 diabetes.
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Cobalt-phosphate-assisted photoelectrochemical water oxidation by arrays of molybdenum-doped zinc oxide nanorods.
ChemSusChem
PUBLISHED: 02-06-2014
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We report the first demonstration of cobalt phosphate (Co-Pi)-assisted molybdenum-doped zinc oxide nanorods (Zn(1-x)Mo(x)O NRs) as visible-light-sensitive photofunctional electrodes to fundamentally improve the performance of ZnO NRs for photoelectrochemical (PEC) water splitting. A maximum photoconversion efficiency as high as 1.05% was achieved, at a photocurrent density of 1.4?mA?cm(-2). More importantly, in addition to achieve the maximum incident photon to current conversion efficiency (IPCE) value of 86%, it could be noted that the IPCE of Zn(1-x)Mo(x)O photoanodes under monochromatic illumination (450?nm) is up to 12%. Our PEC performances are comparable to those of many oxide-based photoanodes in recent reports. The improvement in photoactivity of PEC water splitting may be attributed to the enhanced visible-light absorption, increased charge-carrier densities, and improved interfacial charge-transfer kinetics due to the combined effect of molybdenum incorporation and Co-Pi modification, contributing to photocatalysis. The new design of constructing highly photoactive Co-Pi-assisted Zn(1-x)Mo(x)O photoanodes enriches knowledge on doping and advances the development of high-efficiency photoelectrodes in the solar-hydrogen field.
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Fluid overload, pulse wave velocity, and ratio of brachial pre-ejection period to ejection time in diabetic and non-diabetic chronic kidney disease.
PLoS ONE
PUBLISHED: 01-01-2014
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Fluid overload is one of the characteristics in chronic kidney disease (CKD). Changes in extracellular fluid volume are associated with progression of diabetic nephropathy. Not only diabetes but also fluid overload is associated with cardiovascular risk factors The aim of the study was to assess the interaction between fluid overload, diabetes, and cardiovascular risk factors, including arterial stiffness and left ventricular function in 480 patients with stages 4-5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. Brachial-ankle pulse wave velocity (baPWV), as a good parameter of arterial stiffness, and brachial pre-ejection period (bPEP)/brachial ejection time (bET), correlated with impaired left ventricular function were measured by ankle-brachial index (ABI)-form device. Of all patients, 207 (43.9%) were diabetic and 240 (50%) had fluid overload. For non-diabetic CKD, fluid overload was associated with being female (??=?-2.87, P?=?0.003), heart disease (??=?2.69, P?=?0.04), high baPWV (??=?0.27, P?=?0.04), low hemoglobin (??=?-1.10, P<0.001), and low serum albumin (??=?-5.21, P<0.001) in multivariate analysis. For diabetic CKD, fluid overload was associated with diuretics use (??=?3.69, P?=?0.003), high mean arterial pressure (??=?0.14, P?=?0.01), low bPEP/ET (??=?-0.19, P?=?0.03), low hemoglobin (??=?-1.55, P?=?0.001), and low serum albumin (??=?-9.46, P<0.001). In conclusion, baPWV is associated with fluid overload in non-diabetic CKD and bPEP/bET is associated with fluid overload in diabetic CKD. Early and accurate assessment of these associated cardiovascular risk factors may improve the effects of entire care in late CKD.
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Association of angiopoietin-2 with renal outcome in chronic kidney disease.
PLoS ONE
PUBLISHED: 01-01-2014
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The pathophysiological mechanisms of renal function progression in chronic kidney disease (CKD) have still not been completely explored. In addition to well-known traditional risk factors, non-traditional risk factors, such as endothelial dysfunction, have gradually attracted physicians' attention. Angiopoietin-2 (Ang-2) impairs endothelial function through preventing angiopoietin-1 from binding to Tie2 receptor. Whether Ang-2 is associated with renal function progression in CKD is unknown.
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P wave dispersion and maximum P wave duration are associated with renal outcomes in chronic kidney disease.
PLoS ONE
PUBLISHED: 01-01-2014
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P wave parameters measured by 12-lead electrocardiogram (ECG) are commonly used as a noninvasive tool to evaluate left atrial enlargement. This study was designed to assess whether P wave parameters were associated with renal outcomes in chronic kidney disease (CKD) patients. This longitudinal study enrolled 439 patients with CKD stages 3-5. Renal end points were defined as the commencement of dialysis or death. Change in renal function was measured using the estimated glomerular filtration rate (eGFR) slope. We measured two ECG P wave parameters corrected for heart rate, i.e., corrected P wave dispersion and corrected maximum P wave duration. The values of P wave dispersion and maximum P wave duration were 88.8±21.7 ms and 153.3±21.7 ms, respectively. During the follow-up period (mean, 25.2 months), 95 patients (21.6%) started hemodialysis and 30 deaths (6.8%) were recorded. Multivariate Cox regression analysis identified that increased P wave dispersion [hazard ratio (HR), 1.020; 95% confidence interval (CI), 1.009-1.032; P<0.001] and maximum P wave duration (HR, 1.013; 95% CI, 1.003-1.024; P?=?0.012) were associated with progression to renal end points. Furthermore, increased P wave dispersion (unstandardized coefficient ??=?-0.016; P?=?0.037) and maximum P wave duration (unstandardized coefficient ??=?-0.014; P?=?0.040) were negatively associated with the eGFR slope. We demonstrated that increased P wave dispersion and maximum P wave duration were associated with progression to the renal end points of dialysis or death and faster renal function decline in CKD patients. Screening CKD patients on the basis of P wave dispersion and maximum P wave duration may help identify patients at high risk for worse renal outcomes.
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Hepatitis C virus infection increases risk of developing end-stage renal disease using competing risk analysis.
PLoS ONE
PUBLISHED: 01-01-2014
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Chronic kidney disease (CKD) and hepatitis C virus (HCV) infection are closely linked and both increase patient mortality. The association of HCV and risk of developing end-stage renal disease (ESRD) has not been analyzed with competing risk model.
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Modification of diet in renal disease (MDRD) study and CKD epidemiology collaboration (CKD-EPI) equations for Taiwanese adults.
PLoS ONE
PUBLISHED: 01-01-2014
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Estimated glomerular filtration rate (eGFR) using the Modification of Diet in Renal Disease (MDRD) study or the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equations may not be accurate for Asians; thus, we developed modified eGFR equations for Taiwanese adults.
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Association of relatives of hemodialysis patients with metabolic syndrome, albuminuria and Framingham Risk Score.
PLoS ONE
PUBLISHED: 01-01-2014
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Metabolic syndrome (MetS), albuminuria, and the Framingham Risk Score (FRS) are significant predictors for cardiovascular disease (CVD). However, the relationship and clinical significance of these CVD predictors in individuals with a family history of end-stage renal disease (ESRD) are unclear. We investigated the association of relatives of hemodialysis (HD) patients with MetS, albuminuria, and the FRS.
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Discrepancy between serological and virological analysis of viral hepatitis in hemodialysis patients.
Int J Med Sci
PUBLISHED: 01-01-2014
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Viral hepatitis is a health threat for hemodialysis (HD) patients and it may be transmitted during treatment. Some patients categorized to have viral hepatitis were found to be non-viremic. To clarify the discrepancy between the serological tests in HD patients, we conducted the study.
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Management of multiple myeloma in Asia: resource-stratified guidelines.
Lancet Oncol.
PUBLISHED: 11-02-2013
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Treatment of multiple myeloma has undergone substantial developments in the past 10 years. The introduction of novel drugs has changed the treatment of the disease and substantially improved survival outcomes. Clinical practice guidelines based on evidence have been developed to provide recommendations on standard treatment approaches. However, the guidelines do not take into account resource limitations encountered by developing countries. The huge disparities in economy, health-care infrastructure, and access to novel drugs in Asian countries hinder the delivery of optimum care to every patient with multiple myeloma in Asia. In this Review we outline the guidelines that correspond with different levels of health-care resources and expertise, with the aim to unify diagnostic and therapeutic guidelines and help with the design of future studies in Asia.
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Dialysis initiation: whats the rush?
Semin Dial
PUBLISHED: 09-19-2013
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The recent trend to early initiation of dialysis (at eGFR >10 ml/min/1.73 m(2) ) appears to have been based on conventional wisdoms that are not supported by evidence. Observational studies using administrative databases report worse comorbidity-adjusted dialysis survival with early dialysis initiation. Although some have concluded that the IDEAL randomized controlled trial of dialysis start provided evidence that patients become symptomatic with late dialysis start, there is no definitive support for this view. The potential harms of early start of dialysis, including the loss of residual renal function (RRF), have been well documented. The rate of RRF loss (renal function trajectory) is an important consideration for the timing of the dialysis initiation decision. Patients with low glomerular filtration rate (GFR) may have sufficient RRF to be maintained off dialysis for years. Delay of dialysis start until a working arterio-venous access is in place seems prudent in light of the lack of harm and possible benefit of late dialysis initiation. Prescribing frequent hemodialysis is not recommended when dialysis is initiated early. The benefits of early initiation of chronic dialysis after episodes of congestive heart failure or acute kidney injury require further study. There are no data to show that early start benefits diabetics or other patient groups. Preemptive start of dialysis in noncompliant patients may be necessary to avoid complications. The decision to initiate dialysis requires informed patient consent and a joint decision by the patient and dialysis provider. Possible talking points for obtaining informed consent are provided.
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Dyslipoproteinemia and impairment of renal function in diabetic kidney disease: an analysis of animal studies, observational studies, and clinical trials.
Rev Diabet Stud
PUBLISHED: 08-10-2013
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Dyslipoproteinemia is highly prevalent in diabetes, chronic kidney disease, and diabetic kidney disease (DKD). Both diabetes and chronic kidney disease (CKD) are associated with hypertriglyceridemia, lower high-density lipoprotein, and higher small, dense low-density lipoprotein. A number of observational studies have reported that dyslipidemia may be associated with albuminuria, renal function impairment, and end-stage renal disease (ESRD) in the general population, and especially in CKD and DKD patients. Diabetic glomerulopathy and the related albuminuria are the main manifestations of DKD. Numerous animal studies support the finding that glomerular atherosclerosis is the main mechanism of glomerulosclerosis in CKD and DKD. Some randomized, controlled trials suggest the use of statins for the prevention of albuminuria and renal function impairment in CKD and DKD patients. However, a large clinical study, the Study of Heart and Renal Protection (SHARP), does not support that statins could reduce ESRD in CKD. In this article, we analyze the complex association of dyslipoproteinemia with DKD and deduce its relevance from animal studies, observational studies, and clinical trials. We show that special subgroups could benefit from the statin treatment.
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Association of cholesterol levels with mortality and cardiovascular events among patients with CKD and different amounts of proteinuria.
Clin J Am Soc Nephrol
PUBLISHED: 08-08-2013
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Malnutrition and/or inflammation may modify the risk relationship of total cholesterol with cardiovascular disease in CKD patients. However, it is unclear whether the relationship of total cholesterol with cardiovascular events and mortality varies by proteinuria.
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Association of metabolic syndrome and albuminuria with cardiovascular risk in occupational drivers.
Int J Mol Sci
PUBLISHED: 07-29-2013
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Metabolic syndrome (MetS) and albuminuria increase cardiovascular risk. However, in occupational drivers, the clinical significance of albuminuria and its association with MetS remain unclear. We investigated the prevalence of MetS, albuminuria and cardiovascular risk, and its associated risk factors in occupational drivers;
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High hepatitis B virus surface antigen levels and favorable interleukin 28B genotype predict spontaneous hepatitis C virus clearance in uremic patients.
J. Hepatol.
PUBLISHED: 07-04-2013
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Host and viral factors interplay in the spontaneous clearance of hepatitis C virus (HCV) infection. We aimed to explore the roles of IL28B genotypes and hepatitis B virus (HBV) infections in spontaneous HCV seroclearance.
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Progression of stages 3b-5 chronic kidney disease-Preliminary results of Taiwan National Pre-ESRD Disease Management Program in Southern Taiwan.
J. Formos. Med. Assoc.
PUBLISHED: 05-14-2013
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The outcomes and their predictors, and rates of estimated glomerular filtration rate (eGFR) changes among Taiwanese, an ethnic Chinese population, with chronic kidney disease (CKD) stages 3b-5, enrolled in a nationwide pre-end-stage renal disease (pre-ESRD) management program that have not been previously reported.
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Performance of the Framingham risk score in patients receiving hemodialysis.
Nephrology (Carlton)
PUBLISHED: 04-28-2013
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The Framingham Risk Score (FRS), calculated by considering conventional risk factors of cardiovascular diseases, was developed to predict coronary heart disease in various populations. However, reverse epidemiology has been raised concerning these risk factors in predicting high cardiovascular mortality in hemodialysis patients. Our objectives are to determine whether FRS is associated with overall and cardiovascular mortality and the role of new risk markers when they were added to a FRS model in hemodialysis patients.
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Ratio of transmitral E-wave velocity to early diastole mitral annulus velocity with cardiovascular and renal outcomes in chronic kidney disease.
Nephron Clin Pract
PUBLISHED: 04-16-2013
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Impaired left ventricular diastolic function and increased left ventricular filling pressure are frequently noted in patients with chronic kidney disease (CKD), even in early stages. The association of increased left ventricular filling pressure with cardiovascular and renal outcomes remains uncertain in CKD. This study is designed to assess whether the ratio of transmitral E-wave velocity (E) to early diastole mitral velocity (Ea) is associated with cardiovascular events and progression to dialysis in patients with CKD stages 3-5.
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Associations between dietary patterns and kidney function indicators in type 2 diabetes.
Clin Nutr
PUBLISHED: 04-05-2013
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BACKGROUND & AIMS: Dietary patterns link to risks for chronic diseases. Few studies explore relationships between dietary patterns and kidney function in adult type 2 diabetes in Asian. METHODS: Diabetic patients (n = 635) were selected from a cohort participating in a diabetic control study in Taiwan. Three dietary patterns, high fat (meats, processed meats, seafood, fatty foods, eggs), vegetable and fish (light- or dark- colored vegetables, pond and marine fish) and traditional Chinese-snack (soy/gluten products, rice, noodles, root vegetables, nuts), were generated using factor analysis. Urinary albumin to creatinine (ACR), creatinine and estimated glomerular filtration rate (eGFR) served as clinical indicators of kidney function. RESULTS: After adjusting for confounders, tertile scores of vegetable and fish dietary patterns correlated significantly (p-trend = 0.032) and dose-responsively with multivariable-adjusted means of decreased creatinine and marginally with increased eGFR (p- trend = 0.065). Traditional Chinese-snack dietary pattern was marginally associated with creatinine (p-trend = 0.065) and eGFR (p-trend = 0.064). High fat dietary patterns did not correlate with any kidney function indicator. CONCLUSIONS: Healthy diets such as frequent intake of fish and vegetable may be related to indicators of better kidney function in type 2 diabetes. Further prospective studies with larger sample sizes and use of sensitive indicators for studying early renal function decline are needed to confirm this association.
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Prevalence of and associated factors with chronic kidney disease in human immunodeficiency virus-infected patients in Taiwan.
J Microbiol Immunol Infect
PUBLISHED: 04-03-2013
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Chronic kidney disease (CKD) is an important issue for individuals who live with human immunodeficiency virus (HIV) following the use of highly active antiretroviral therapy; however, the prevalence rate of CKD varies between countries.
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Association of Fluid Overload With Kidney Disease Progression in Advanced CKD: A Prospective Cohort Study.
Am. J. Kidney Dis.
PUBLISHED: 03-13-2013
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Fluid overload is a common phenomenon in patients in a late stage of chronic kidney disease (CKD). However, little is known about whether fluid overload is related to kidney disease progression in patients with CKD. Accordingly, the aim of the study was to assess the association of the severity of fluid status and kidney disease progression in an advanced CKD cohort.
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Hepatitis C virus itself is a causal risk factor for chronic kidney disease beyond traditional risk factors: a 6-year nationwide cohort study across Taiwan.
BMC Nephrol
PUBLISHED: 03-12-2013
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Hepatitis C virus (HCV) infection and chronic kidney disease (CKD) have high prevalences in Taiwan and worldwide, but the role of HCV infection in causing CKD remains uncertain. This cohort study aimed to explore this association.
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Terlipressin-induced hyponatremic encephalopathy in a noncirrhotic patient.
Kaohsiung J. Med. Sci.
PUBLISHED: 03-04-2013
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Terlipressin, an analogue of vasopressin, is frequently used for the management of esophageal varices bleeding and hepatorenal syndrome. Terlipressin therapy in portal hypertensive patients is frequently associated with hyponatremia, but is rarely accompanied with serious neurological manifestations. A 39-year-old female with pancreatic neuroendocrine tumor, liver metastasis, main portal vein thrombosis, and a history of esophageal varices presented to the emergency room because of hematemesis. Terlipressin was given with a loading dose of 2 mg followed by 1 mg every 6 hours. After a total of 6 mg terlipressin injection, she suffered from acute delirium. Pertinent examinations showed there was no gross brain lesion by computed tomography, whereas her serum sodium level dropped from baseline (136 mmol/L) to 116 mmol/L with a serum osmolality of 256 mOsm/kg. At that time, urine sodium and urine osmolality were 142 mmol/L and 488 mOsm/kg, respectively. Under the tentative diagnosis of terlipressin-induced hyponatremic encephalopathy, terlipressin was withheld and hypertonic saline infusion was given. Within 12 hours, her serum sodium level recovered to 130 mmol/L and she gradually regained her cognitive functions. Although symptomatic hyponatremic encephalopathy is a rare complication of terlipressin treatment, close monitoring of serum electrolyte level is warranted in patients receiving terlipressin.
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Framingham risk score with cardiovascular events in chronic kidney disease.
PLoS ONE
PUBLISHED: 02-19-2013
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The Framingham Risk Score (FRS) was developed to predict coronary heart disease in various populations, and it tended to under-estimate the risk in chronic kidney disease (CKD) patients. Our objectives were to determine whether FRS was associated with cardiovascular events, and to evaluate the role of new risk markers and echocardiographic parameters when they were added to a FRS model. This study enrolled 439 CKD patients. The FRS is used to identify individuals categorically as "low" (<10% of 10-year risk), "intermediate" (10-20% risk) or "high" risk (? 20% risk). A significant improvement in model prediction was based on the -2 log likelihood ratio statistic and c-statistic. "High" risk (v.s. "low" risk) predicts cardiovascular events either without (hazard ratios [HR] 2.090, 95% confidence interval [CI] 1.144 to 3.818) or with adjustment for clinical, biochemical and echocardiographic parameters (HR 1.924, 95% CI 1.008 to 3.673). Besides, the addition of albumin, hemoglobin, estimated glomerular filtration rate, proteinuria, left atrial diameter >4.7 cm, left ventricular hypertrophy or left ventricular ejection fraction<50% to the FRS model significantly improves the predictive values for cardiovascular events. In CKD patients, "high" risk categorized by FRS predicts cardiovascular events. Novel biomarkers and echocardiographic parameters provide additional predictive values for cardiovascular events. Future study is needed to assess whether risk assessment enhanced by using these biomarkers and echocardiographic parameters might contribute to more effective prediction and better care for patients.
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Association of dyslipidemia with renal outcomes in chronic kidney disease.
PLoS ONE
PUBLISHED: 02-04-2013
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Dyslipidemia is highly prevalent in patients with chronic kidney disease (CKD) and the relationship between dyslipidemia with renal outcomes in patients with moderate to advanced CKD remains controversial. Hence, our objective is to determine whether dyslipidemia is independently associated with rapid renal progression and progression to renal replacement therapy (RRT) in CKD patients. The study analyzed the association between lipid profile, RRT, and rapid renal progression (estimated glomerular filtration rate [eGFR] slope <-6 ml/min/1.73 m(2)/yr) in 3303 patients with stages 3 to 5 CKD. During a median 2.8-year follow-up, 1080 (32.3%) participants commenced RRT and 841 (25.5%) had rapid renal progression. In the adjusted models, the lowest quintile (hazard ratios [HR], 1.23; 95% confidence interval [CI], 1.01 to 1.49) and the highest two quintiles of total cholesterol (HR, 1.25; 95% CI, 1.02 to 1.52 and HR, 1.35; 95% CI, 1.11 to 1.65 respectively) increased risks for RRT (vs. quintile 2). Besides, the highest quintile of total cholesterol was independently associated with rapid renal progression (odds ratio, 1.36; 95% CI, 1.01 to 1.83). Our study demonstrated that certain levels of dyslipidemia were independently associated with RRT and rapid renal progression in CKD stage 3-5. Assessment of lipid profile may help identify high risk groups with adverse renal outcomes.
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Effects of a self-management program on patients with early-stage chronic kidney disease: a pilot study.
Appl Nurs Res
PUBLISHED: 01-16-2013
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Without intervention, renal function deteriorates in patients with chronic kidney disease (CKD).
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Growth of ?-Ga2O3 and GaN nanowires on GaN for photoelectrochemical hydrogen generation.
Nanotechnology
PUBLISHED: 01-16-2013
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Enhanced photoelectrochemical (PEC) performances of Ga(2)O(3) and GaN nanowires (NWs) grown in situ from GaN were demonstrated. The PEC conversion efficiencies of Ga(2)O(3) and GaN NWs have been shown to be 0.906% and 1.09% respectively, in contrast to their 0.581% GaN thin film counterpart under similar experimental conditions. A low crystallinity buffer layer between the grown NWs and the substrate was found to be detrimental to the PEC performance, but the layer can be avoided at suitable growth conditions. A band bending at the surface of the GaN NWs generates an electric field that drives the photogenerated electrons and holes away from each other, preventing recombination, and was found to be responsible for the enhanced PEC performance. The enhanced PEC efficiency of the Ga(2)O(3) NWs is aided by the optical absorption through a defect band centered 3.3 eV above the valence band of Ga(2)O(3). These findings are believed to have opened up possibilities for enabling visible absorption, either by tailoring ion doping into wide bandgap Ga(2)O(3) NWs, or by incorporation of indium to form InGaN NWs.
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Left atrial diameter and albumin with renal outcomes in chronic kidney disease.
Int J Med Sci
PUBLISHED: 01-09-2013
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Echocardiographic left atrial diameter (LAD) has been documented to be an independent predictor of adverse cardiovascular outcomes in various populations. An enlarged left atrium is frequently noted in chronic kidney disease (CKD). We examined the association between albumin and indexed LAD (indexed to height) and assessed whether the combination of indexed LAD and albumin was independently associated with renal outcomes in patients with CKD stages 3-5.
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Is fluid overload more important than diabetes in renal progression in late chronic kidney disease?
PLoS ONE
PUBLISHED: 01-01-2013
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Fluid overload is one of the major presentations in patients with late stage chronic kidney disease (CKD). Diabetes is the leading cause of renal failure, and progression of diabetic nephropathy has been associated with changes in extracellular fluid volume. The aim of the study was to assess the association of fluid overload and diabetes in commencing dialysis and rapid renal function decline (the slope of estimated glomerular filtration rate (eGFR) less than -3 ml/min per 1.73 m(2)/y) in 472 patients with stages 4-5 CKD. Fluid status was determined by bioimpedance spectroscopy method, Body Composition Monitor. The study population was further classified into four groups according to the median of relative hydration status (?HS =fluid overload/extracellular water) and the presence or absence of diabetes. The median level of relative hydration status was 7%. Among all patients, 207(43.9 %) were diabetic. 71 (15.0%) subjects had commencing dialysis, and 187 (39.6%) subjects presented rapid renal function decline during a median 17.3-month follow-up. Patients with fluid overload had a significantly increased risk for commencing dialysis and renal function decline independent of the presence or absence of diabetes. No significantly increased risk for renal progression was found between diabetes and non-diabetes in late CKD without fluid overload. In conclusion, fluid overload has a higher predictive value of an elevated risk for renal progression than diabetes in late CKD.
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High cost and low survival rate in high comorbidity incident elderly hemodialysis patients.
PLoS ONE
PUBLISHED: 01-01-2013
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The comorbidity index is a predictor of mortality in dialysis patients but there are few reports for predicting elderly dialysis mortality and national population-based cost studies on elderly dialysis. The aim of this study was to evaluate the long-term mortality of incident elderly dialysis patients using the Deyo-Charlson comorbidity index (CCI) and to assess the inpatient and outpatient visits along with non-dialysis costs.
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Hypokalemia, its contributing factors and renal outcomes in patients with chronic kidney disease.
PLoS ONE
PUBLISHED: 01-01-2013
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In the chronic kidney disease (CKD) population, the impact of serum potassium (sK) on renal outcomes has been controversial. Moreover, the reasons for the potential prognostic value of hypokalemia have not been elucidated.
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Predicting mortality of incident dialysis patients in Taiwan--a longitudinal population-based study.
PLoS ONE
PUBLISHED: 01-01-2013
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Comorbid conditions are highly prevalent among patients with end-stage renal disease (ESRD) and index score is a predictor of mortality in dialysis patients. The aim of this study is to perform a population-based cohort study to investigate the survival rate by age and Charlson comorbidity index (CCI) in incident dialysis patients.
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Membrane sampling with microdialysis coupled to HPLC/UV for on-line simultaneous determination of melamine and cyanuric acid in non-dairy coffee creamer.
Anal Sci
PUBLISHED: 10-12-2011
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An on-line microdialysis/high-performance liquid chromatography method was developed for the simultaneous determination of melamine and cyanuric acid in non-dairy coffee creamer. To collect these analytes from aqueous samples, the microdialysis system featured a microdialysis probe incorporating a polyarylethersulfone membrane and employed 0.05 M HCl in 0.1% (v/v) MeOH as the perfusate, with optimal efficiency obtained at a flow rate of 1 µL min(-1). The chromatographic conditions were optimized when using a reverse-phase phenyl column and a mobile phase of phosphate buffer solution in 10% (v/v) MeOH, buffered at pH 3.0. Good linearity relationship (r(2) > 0.9987), intra- and inter-day precisions (RSDs < 6.6%), recoveries (96.9 - 105.0%), and limits of detection (melamine, 3 ppb; cyanuric acid, 150 ppb) were observed for the two analytes. This method has been successfully applied to simultaneous determination of melamine and cyanuric acid in commercial creamers with the recoveries in the range of 97.5 to 102.6%.
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Echocardiographic parameters are independently associated with rate of renal function decline and progression to dialysis in patients with chronic kidney disease.
Clin J Am Soc Nephrol
PUBLISHED: 10-06-2011
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Cardiac abnormalities were frequently noted in patients with chronic kidney disease (CKD). This study is designed to assess whether echocardiographic parameters are associated with rate of renal function decline and progression to dialysis in CKD stage 3 to 5 patients.
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Echocardiographic parameters are independently associated with increased cardiovascular events in patients with chronic kidney disease.
Nephrol. Dial. Transplant.
PUBLISHED: 08-03-2011
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Patients with chronic kidney disease (CKD) are associated with increased cardiovascular (CV) morbidity and mortality. Echocardiographic measures of heart structure and function have been reported to predict adverse CV outcomes in various pathologic conditions. The aim of this study is to assess whether echocardiographic parameters are independently associated with increased CV events in patients with CKD Stages 3-5.
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Deep and alignment free patterned etching of GaN surface using an atomic force microscope.
J Nanosci Nanotechnol
PUBLISHED: 07-26-2011
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Successful deep and alignment-free patterned etching on GaN using atomic force microscope (AFM) local oxidation followed by in-situ chemical etching is demonstrated. Oxide ridges are grown on GaN on an AFM by applying positive sample bias at 80% humidity, with the oxidation reaction expedited by UV light. The oxide ridges are then etched by HCl solution, leaving troughs in the GaN surface. A dripping strategy for the in-situ chemical etching is recommended that allows deep, alignment-free multiple AFM oxidation/etching works on the GaN surface without any need of substrate removal from the AFM platform. Repeated etching followed by AFM oxidation on a spot on a GaN surface resulting in a hole as deep as 800 nm was also demonstrated. Further, a preliminary evaluation of the porosity of the AFM-grown oxide indicates that the oxide ridges grown on GaN at an AFM cantilever moving speed of 300 nm/s are porous in structure, with an estimated porosity of 86%, which porosity could be reduced if longer resident time of the AFM cantilever on the target oxidation region was used.
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Pneumothorax in a female with renal angiomyolipoma.
Kaohsiung J. Med. Sci.
PUBLISHED: 07-23-2011
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Spontaneous pneumothorax occurs less in females than in males, in contrast to the relatively more commonly and incidentally found renal angiomyolipoma (AML). We report a renal AML in a 23-year-old female patient, which presented as right palpable abdominal mass. This renal tumor was removed owing to enlargement and internal hemorrhage and AML was proved by pathological examination. Three years later, she experienced a life-threatening spontaneous tension pneumothorax and pulmonary lymphangioleiomyomatosis (LAM), which was diagnosed by chest computed tomography. Clinically, she did not have tuberous sclerosis. Pulmonary LAM and renal AML are related lesions and both of these proliferative lesions occur in sporadic patients without family history and at much higher frequency in patients with tuberous sclerosis. Because of the nonspecific symptoms and high rate of complications, we should consider the possibility of LAM in patients diagnosed with AML. The association between renal AML and pulmonary LAM is reviewed.
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Outcomes of overseas kidney transplantation in chronic haemodialysis patients in Taiwan.
Nephrology (Carlton)
PUBLISHED: 06-15-2011
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Overseas kidney transplantation has often been reported to have unsatisfactory outcomes. This study aims to compare post-transplantation outcomes between overseas and domestic kidney transplant (KT) recipients in Taiwan.
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Stepwise increases in left ventricular mass index and decreases in left ventricular ejection fraction correspond with the stages of chronic kidney disease in diabetes patients.
Exp Diabetes Res
PUBLISHED: 05-09-2011
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Patients with diabetic nephropathy are reported to have a high prevalence of left ventricular structural and functional abnormalities. This study was designed to assess the determinants of left ventricular mass index (LVMI) and left ventricular ejection fraction (LVEF) in diabetic patients at various stages of chronic kidney disease (CKD).
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Brachial-ankle pulse wave velocity and rate of renal function decline and mortality in chronic kidney disease.
Clin J Am Soc Nephrol
PUBLISHED: 03-31-2011
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Increased arterial stiffness was reported to be associated with decreased estimated GFR (eGFR). Previous studies suggested that arterial stiffness might play a role in renal function progression in patients with chronic kidney disease (CKD). The aim of this study was to investigate whether there was an independent association between brachial-ankle pulse wave velocity (baPWV), a marker of arterial stiffness, and renal function progression in CKD patients.
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CYP17A1 intron mutation causing cryptic splicing in 17?-hydroxylase deficiency.
PLoS ONE
PUBLISHED: 03-22-2011
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17?-Hydroxylase/17, 20-lyase deficiency (17OHD) is an autosomal recessive disease causing congenital adrenal hyperplasia and a rare cause of hypertension with hypokalemia. The CYP17A1 gene mutation leads to 17OHD and its clinical features. We described an 18 y/o female with clinical features of 17?-hydroxylase/17, 20-lyase deficiency and characterized the functional consequences of an intronic CYP17A1 mutation. The coding regions and flanking intronic bases of the CYP17A1 gene were amplified by PCR and sequenced. The patient is a compound heterozygote for the previously described p.R358X and IVS1 +2T>C mutations. A first intron splice donor site mutation was re-created in minigene and full-length expression vectors. Pre-mRNA splicing of the variant CYP17A1 intron was studied in transfected cells and in a transformed lymphoblastoid cell line. When the full-length CYP17A1 gene and minigene containing the intronic mutation was expressed in transfected cells, the majority (>90%) of mRNA transcripts were incorrectly spliced. Only the p.R358X transcript was detected in the EBV-transformed lymphoblastoid cell line. The IVS1 +2T>C mutation abolished most 17?-hydroxylase/17, 20-lyase enzyme activity by aberrant mRNA splicing to an intronic pseudo-exon, causing a frame shift and early termination.
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Using an on-line microdialysis/HPLC system for the simultaneous determination of melamine and cyanuric acid in non-dairy creamer.
Anal. Chim. Acta
PUBLISHED: 03-22-2011
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The recent revelation of melamine (MEL) contamination in foodstuffs in China has rocked the international public health community. Many food categories have been involved in this scandal, including non-dairy creamer (NDC). In this study, we investigated the use of hollow-fiber microdialysis (MD) sampling coupled on-line with high-performance liquid chromatography (HPLC) as an alternative to sample pretreatment for the direct determination of MEL and its analogue cyanuric acid (CYA) in NDC. After MD sampling, the dialysate was injected on-line into the chromatographic system for analysis of MEL and CYA with UV detection at 203 nm. We monitored the effects of various parameters affecting the MD efficiency, namely the characteristics of the MD probe membrane, the flow-rate and the nature of the polarity modifier in the perfusion stream, and the addition of salt in the sample solution. The optimal enrichment efficiency for collecting MEL and CYA from aqueous NDC samples occurred with MD sampling using a hollow polysulfone MD fiber and MeOH as the perfusate at a flow rate of 10 ?L min(-1). The optimized chromatographic conditions involved using a reversed-phase phenyl column and a mobile phase of 5 mM phosphate buffer in 10% (v/v) MeOH, buffered at pH 6.5. Detection was linear in the concentration range from 0.02 to 5 ppm for MEL and from 2 to 100 ppm for CYA, with detection limits of 1 ppb for MEL and 30 ppb for CYA. The volume of perfusate required to extract MEL and CYA from the NDC solution was only 21 ?L. The total MD sampling time was 2.1 min. This method allows the sensitive, eco-friendly, and rapid determination of MEL and CYA in NDC-a risk food for economically motivated adulteration.
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The rs1014290 polymorphism of the SLC2A9 gene is associated with type 2 diabetes mellitus in Han Chinese.
Exp Diabetes Res
PUBLISHED: 02-22-2011
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The SLC2A9 gene encodes the glucose transporter 9, with the abilities of transporting both glucose and uric acid and is involved in the pancreatic glucose-stimulated insulin secretion. The single nucleotide polymorphisms (SNPs) of SLC2A9 accounted for 5% variance of serum uric acid (UA). UA was identified as a risk factor for type 2 diabetes mellitus (DM). We investigated whether the SLC2A9 gene variations are associated with type 2 DM in Han Chinese.
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Association between insulin resistance and development of microalbuminuria in type 2 diabetes: a prospective cohort study.
Diabetes Care
PUBLISHED: 02-18-2011
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An association between insulin resistance and microalbuminuria in type 2 diabetes has often been found in cross-sectional studies. We aimed to reassess this relationship in a prospective Taiwanese cohort of type 2 diabetic subjects.
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Significant correlation between ratio of brachial pre-ejection period to ejection time and left ventricular ejection fraction and mass index in patients with chronic kidney disease.
Nephrol. Dial. Transplant.
PUBLISHED: 10-08-2010
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Patients with chronic kidney disease (CKD) are associated with increased cardiovascular morbidity and mortality. An increase in the ratio of pre-ejection period (PEP) to ejection time (ET) is correlated with an increase in left ventricular mass index (LVMI) and a decrease in left ventricular ejection fraction (LVEF). Brachial PEP (bPEP) and brachial ET (bET) can be automatically determined by an ankle-brachial index (ABI)-form device. The aims of this study were to assess whether bPEP/bET is a useful parameter in evaluation of LVMI and LVEF in patients with CKD and to evaluate the diagnostic value of bPEP/bET in the prediction of LVEF
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A systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts cardiovascular events in patients with chronic kidney disease.
Circ. J.
PUBLISHED: 08-21-2010
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Patients with chronic kidney disease (CKD) are associated with an increased risk of cardiovascular (CV) events. An increase in the ratio of the pre-ejection period (PEP) to ejection time (ET) is correlated with a decrease of left ventricular systolic function. Brachial PEP (bPEP) and brachial ET (bET) can be automatically determined from an ankle-brachial index (ABI)-form device. The aim of this study is to investigate whether bPEP/bET is a useful predictor for CV events in patients with CKD.
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Epidemiology, impact and preventive care of chronic kidney disease in Taiwan.
Nephrology (Carlton)
PUBLISHED: 07-01-2010
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Chronic kidney disease (CKD) has emerged as a global public health burden. Taiwan has the highest incidence and prevalence rates of end-stage renal disease (ESRD) in the world. In this review, the following key issues of CKD in Taiwan are addressed: epidemiological data, underlying diseases patterns, risk factors, public health concerns and a preventive project. Prevalence of CKD are reported to be 6.9% for CKD stage 3-5, 9.83% for clinically recognized CKD and 11.9% for CKD stage 1-5. However, overall awareness of CKD is low, 9.7% for CKD stage 1-3 and 3.5% for stage 1-5. Diabetes mellitus (43.2%), chronic glomerulonephritis (25.1%), hypertension (8.3%) and chronic interstitial nephritis (2.8%) are four major underlying renal diseases of ESRD. Older age, diabetes, hypertension, smoking, obesity, regular use of herbal medicine, family members (both relatives and spouses), chronic lead exposure and hepatitis C are associated with higher risk for CKD. Impact of CKD increases risk of all-cause mortality and cardiovascular diseases, especially in those with overt proteinuria and advanced CKD stages. These impacts lead to increased medical costs. The nationwide CKD Preventive Project with multidisciplinary care program has proved its effectiveness in decreasing dialysis incidence, mortality and medical costs. It is crucially significant from Taiwan experience on CKD survey and preliminary outcome of the preventive project. Provision of a more comprehensive public health strategy and better care plan for CKD should be achieved by future international collaborative efforts and research.
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Impact of the clinical conditions at dialysis initiation on mortality in incident haemodialysis patients: a national cohort study in Taiwan.
Nephrol. Dial. Transplant.
PUBLISHED: 06-02-2010
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Glomerular filtration rate (GFR) and co-morbidity at dialysis initiation in relation to mortality in end-stage renal disease is still controversial. We studied factors potentially related to the mortality in incident haemodialysis (HD) patients.
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Ankle brachial index as a predictor for mortality in patients with chronic kidney disease and undergoing haemodialysis.
Nephrology (Carlton)
PUBLISHED: 05-18-2010
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The ankle brachial index (ABI) is a marker for peripheral artery disease and can predict mortality in advanced chronic kidney disease (CKD) and haemodialysis patients, respectively. However, it is seldom studied in Taiwan, an area with high prevalence of CKD and end-stage renal disease. The aim of this study was to investigate the predictors for mortality by using ABI value in patients with CKD and undergoing haemodialysis in Taiwan.
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Chronic kidney disease care program improves quality of pre-end-stage renal disease care and reduces medical costs.
Nephrology (Carlton)
PUBLISHED: 04-10-2010
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Multidisciplinary care of patients with chronic kidney disease (CKD) provides better care outcomes. This study is to evaluate the effectiveness of a CKD care program on pre-end-stage renal disease (ESRD) care.
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Impact of late-stage CKD and aging on medical utilization in the elderly population: a closed-cohort study in Taiwan.
Nephrol. Dial. Transplant.
PUBLISHED: 03-24-2010
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Taiwan has the highest incidence and prevalence of end-stage renal disease globally, especially in the elderly population. The elderly with chronic kidney disease (CKD) also had high mortality. However, population-based research on how the elderly with CKD utilize medical services is still unexplored. We aimed to examine the effects of CKD severity and aging on medical utilizations in the elderly population.
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A new systolic parameter defined as the ratio of brachial pre-ejection period to brachial ejection time predicts overall and cardiovascular mortality in hemodialysis patients.
Hypertens. Res.
PUBLISHED: 03-05-2010
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Impaired left ventricular systolic function is an important cause of mortality in hemodialysis patients. An increase in the ratio of pre-ejection period (PEP) to ejection time (ET) is associated with a decrease in left ventricular systolic function. Brachial PEP (bPEP) and brachial ET (bET) can be automatically determined from an ankle-brachial index (ABI)-form device. The aim of this study was to investigate whether bPEP/bET was a useful predictor for overall and cardiovascular mortality in hemodialysis patients. We enrolled 212 hemodialysis patients in one regional hospital. The bPEP and bET were measured using an ABI-form device. The mean follow-up period was 28.3+/-5.7 months. The relative mortality risk was analyzed by Cox-regression methods. Twenty-two deaths were recorded in 212 patients (10.4%). In a multivariate analysis, the bPEP/bET (hazard ratio [HR], 1.055; P=0.047) and serum creatinine level (P=0.029) were positively and negatively associated with overall mortality, respectively. In addition, increased bPEP/bET (HR, 1.080; P=0.017), increased fasting glucose (P=0.046) and decreased serum creatinine level (P=0.004) were independent predictors for cardiovascular mortality. Our findings show that bPEP/bET, a surrogate of left ventricular systolic function, is a useful predictor for overall and cardiovascular mortality in hemodialysis patients. Screening hemodialysis patients by means of bPEP/bET may help to identify a high-risk group for increased mortality.
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False elevation of blood glucose levels measured by GDH-PQQ-based glucometers occurs during all daily dwells in peritoneal dialysis patients using icodextrin.
Perit Dial Int
PUBLISHED: 02-26-2010
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False elevation of blood glucose levels measured by glucose dehydrogenase pyrroloquinoline quinone (GDH-PQQ)-based glucose self-monitoring systems; glucometer) in peritoneal dialysis (PD) patients using icodextrin solution has been well documented. However, adverse hypoglycemic events caused by misreadings for blood glucose are still being reported. We aimed to study blood glucose levels measured simultaneously using different methods in PD patients with switching of icodextrin, and throughout daily exchanges either using icodextrin or not.
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Prevalence and risk factors for CKD in spouses and relatives of hemodialysis patients.
Am. J. Kidney Dis.
PUBLISHED: 02-13-2010
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A higher prevalence of chronic kidney disease (CKD) has been found in genetic relatives of patients with end-stage renal disease. However, the risk of CKD in nongenetic spouses of patients with end-stage renal disease is still unknown.
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Early nephrology referral is associated with prolonged survival in hemodialysis patients even after exclusion of lead-time bias.
Am. J. Med. Sci.
PUBLISHED: 02-11-2010
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Early nephrology referral (ER) has been suggested to lower morbidity and mortality in dialysis patients, but the nature of the association has been criticized as possibly because of lead-time bias. This study aims to evaluate if ER is associated with improved survival of hemodialysis patients when the lead-time bias is excluded.
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Association of hepatitis C and B virus infection with CKD in an endemic area in Taiwan: a cross-sectional study.
Am. J. Kidney Dis.
PUBLISHED: 01-13-2010
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Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections may lead to nephropathy. However, the association between different types of viral hepatitis and chronic kidney disease (CKD) is not well established.
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Quality of life predicts risks of end-stage renal disease and mortality in patients with chronic kidney disease.
Nephrol. Dial. Transplant.
PUBLISHED: 12-27-2009
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Quality of life (QOL) may be associated with morbidity and survival in end-stage renal disease (ESRD), and is considered to be an important outcome measure for patients with chronic kidney disease (CKD). However, the prognostic role of QOL for survival in CKD remains unclear. We studied the relationship between QOL and risks of ESRD and mortality in CKD patients.
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The preparation of silver nanoparticle decorated silica nanowires on fused quartz as reusable versatile nanostructured surface-enhanced Raman scattering substrates.
Nanotechnology
PUBLISHED: 12-03-2009
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We introduce a platform, comprised of silver nanoparticle decorated silica nanowires (SiONWs) dispersed on fused quartz substrates, for high sensitivity surface-enhanced Raman scattering (SERS) measurements using both frontal (through the analytes) and back-face (through the transparent substrate) excitation. Quasi-quantitative SERS performances on the specialized substrate, vis-à-vis a silver deposited bare fused quartz plate, showed: (i) the suitability of the Ag modified SiONW substrate for frontal as well as back-face excitation; (ii) a wider detection range with high sensitivity to Rhodamine 6G; and (iii) good underwater metal-oxide adhesion of the specialized substrates. Capable of surviving ultrasonic cleaning, the substrate introduced is one of the few reusable low-cost Ag-based nanostructured SERS substrates, requiring only a simple silver reload process (the silver mirror reaction).
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Planned creation of vascular access saves medical expenses for incident dialysis patients.
Kaohsiung J. Med. Sci.
PUBLISHED: 09-22-2009
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Hospitalization to initiate hemodialysis (HD) through temporary catheterization and subsequent creation of permanent vascular access (VA) is costly. Therefore, we studied the influence of the timing of VA creation on medical expenses, length of stay (LOS) and 1-year primary patency rate in incident HD patients. We analyzed the medical expenses associated with hospitalization and LOS at VA creation in 486 incident HD patients at two hospitals in southern Taiwan. Patients with early VA creation, more than 1 month before HD initiation, were defined as the Planned group (n = 70); less than 1 month as the Delayed group (n = 48); and those with VA creation after the initiation of HD as the Urgent group (n = 368). The Urgent group had the highest inpatient medical expenses and LOS compared with the other two groups. Multiple regression analyses of inpatient medical expenses and LOS showed that the timing of VA creation, the type of VA, marital and employment status and the number of comorbidities were significant factors responsible for the differences between groups. Furthermore, higher inpatient medical expenses and longer LOS in the Urgent group were noted in the arteriovenous fistula and arteriovenous graft subgroups. Kaplan-Meier Survival analysis showed that the 1-year primary patency rate was highest in the Delayed group and lowest in the Planned group, while Cox regression analysis demonstrated that the type of VA, but not the timing of VA creation, was a significant risk factor for VA patency. Arteriovenous graft had a higher risk for occlusion than arteriovenous fistula. In conclusion, planned VA creation before the initiation of HD is associated with lower inpatient medical expenses and shorter LOS, which should be promoted for pre-end-stage renal disease care, but the care for VA should be further emphasized before the progression to end-stage renal disease, and the patency of the VA should be cautiously monitored.
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In-TFT-array-process micro defect inspection using nonlinear principal component analysis.
Int J Mol Sci
PUBLISHED: 09-03-2009
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Defect inspection plays a critical role in thin film transistor liquid crystal display (TFT-LCD) manufacture, and has received much attention in the field of automatic optical inspection (AOI). Previously, most focus was put on the problems of macro-scale Mura-defect detection in cell process, but it has recently been found that the defects which substantially influence the yield rate of LCD panels are actually those in the TFT array process, which is the first process in TFT-LCD manufacturing. Defect inspection in TFT array process is therefore considered a difficult task. This paper presents a novel inspection scheme based on kernel principal component analysis (KPCA) algorithm, which is a nonlinear version of the well-known PCA algorithm. The inspection scheme can not only detect the defects from the images captured from the surface of LCD panels, but also recognize the types of the detected defects automatically. Results, based on real images provided by a LCD manufacturer in Taiwan, indicate that the KPCA-based defect inspection scheme is able to achieve a defect detection rate of over 99% and a high defect classification rate of over 96% when the imbalanced support vector machine (ISVM) with 2-norm soft margin is employed as the classifier. More importantly, the inspection time is less than 1 s per input image.
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A non-fluorescent derivative from derivatizing trans, trans-muconic acid with 2-(2-naphthoxy)ethyl-2-(piperidino)ethanesulfonate.
J Fluoresc
PUBLISHED: 08-20-2009
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trans, trans-Muconic acid (MA) is a polar metabolite of benzene and used as a biomarker for monitoring human exposure to benzene. Because MA is a trace metabolite, sensitive method is required for its detection. In addition, MA is a highly polar compound with dicarboxyl functions that could incur unfavorable adsorption on silica-based stationary phase usually used for separation. To address these problems, we planned to derivatize MA with a fluorescent reagent 2-(2-naphthoxy)ethyl-2-(piperidino)ethanesulfonate to give a naphthoxy derivative of MA for improving detection sensitivity and chromatographic properties. Surprisingly, the resulting derivative shows no fluorescent activity (lambda(ex): 226 nm; lambda(em): 350 nm). The negative results could be used as an instructive example for discussing on fluorescence quenching.
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Comparison of ankle-brachial index and brachial-ankle pulse wave velocity between patients with chronic kidney disease and hemodialysis.
Am. J. Nephrol.
PUBLISHED: 08-06-2009
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Patients with chronic renal failure are highly predisposed to atherosclerosis. However, there is limited data about the direct comparison of atherosclerosis between patients with chronic kidney disease (CKD) and hemodialysis. The aim of this study was to compare ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) between patients with CKD and hemodialysis and thus examined the status of peripheral artery occlusive disease (PAOD) and arterial stiffness between them.
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Adherence to a diabetic care plan provides better glycemic control in ambulatory patients with type 2 diabetes.
Kaohsiung J. Med. Sci.
PUBLISHED: 06-09-2009
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Tight control of blood sugar improves the outcomes for diabetic patients, but it can only be achieved by adhering to a well-organized care plan. To evaluate the effect of a diabetes care plan with reinforcement of glycemic control in diabetic patients, 98 ambulatory patients with type 2 diabetes who visited our diabetes clinic every 3-4 months and who completed four education courses given by certified diabetes educators within 3 months after the first visit, were defined as the Intervention group. A total of 82 patients fulfilling the inclusion criteria for the Intervention group but who missed at least half of the diabetes education sessions were selected as controls. Both groups had comparable mean hemoglobin A1c (HbA1c) levels at baseline, which decreased significantly at 3 months and were maintained at approximately constant levels at intervals for up to 1 year. The HbA1c decrement in the Intervention group was significantly greater than that in the Control group over the 1-year follow-up period (HbA1c change: -2.5 +/- 1.8% vs. -1.1 +/- 1.7%, p < 0.01). The maximal HbA1c decrement occurred during the first 3 months, and accounted for 95.6% and 94.6% of the total HbA1c decrements in the Intervention and Control groups, respectively. In the multiple regression model, after adjustment for age, body mass index, and duration of diabetes, the Intervention group may still have a 12.6% improvement in HbA1c from their original value to the end of 1 year treatment compared with the Control group (p < 0.05). Diabetes care, with reinforcement from certified diabetes educators, significantly improved and maintained the effects on glycemic control in ambulatory patients with type 2 diabetes.
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