An integrated RF energy-harvesting system with broad input voltage range and high power conversion efficiency.

By 2050, countries around the world are expected to be gradually phasing out fossil fuels and implementing greener energy technologies. In this work, we present a system employing Energy harvesting, a self-powered technology that can recycle energy from the surrounding environment. A high-efficiency radio frequency (RF) energy-harvesting chip was designed and fabricated. With an off-chip antenna and rectifier, the system scavenges ambient RF energy and converts it into usable energy, which is then stored in energy storage elements (such as a supercapacitor or a rechargeable battery). The system can further be implemented as an energy source for charging smart devices. The system-on-chip design consists of a cold start block, a boost converter with maximum power point tracking functionalities, and a charging block. The chip was fabricated using AMS 350 nm technology. Although the system was optimized for harvesting RF energy, it can be easily adapted to harvest other energy sources (i.e., mechanical and thermal energy sources). Using an optimized cold start architecture, the circuit has a cold start voltage of 380 mV. With an improved control strategy of power conversion, the system is capable of continuously charging up to 4.5 V with a broad input voltage range of 100 mV to 10 V and has a peak charging efficiency of 82%.

Kielin/chordin-like protein deficiency aggravates pressure overload-induced cardiac dysfunction and remodeling via P53/P21/CCNB1 signaling in mice.

Targeting cardiac remodeling is regarded as a key therapeutic strategy for heart failure. Kielin/chordin-like protein (KCP) is a secretory protein with 18 cysteine-rich domains and associated with kidney and liver fibrosis. However, the relationship between KCP and cardiac remodeling remains unclear. Here, we aimed to investigate the role of KCP in cardiac remodeling induced by pressure overload and explore its potential mechanisms. Left ventricular (LV) KCP expression was measured with real-time quantitative PCR, western blotting, and immunofluorescence staining in pressure overload-induced cardiac remodeling in mice. Cardiac function and remodeling were evaluated in wide-type (WT) mice and KCP knockout (KO) mice by echocardiography, which were further confirmed by histological analysis with hematoxylin and eosin and Masson staining. RNA sequence was performed with LV tissue from WT and KO mice to identify differentially expressed genes and related signaling pathways. Primary cardiac fibroblasts (CFs) were used to validate the regulatory role and potential mechanisms of KCP during fibrosis. KCP was down-regulated in the progression of cardiac remodeling induced by pressure overload, and was mainly expressed in fibroblasts. KCP deficiency significantly aggravated pressure overload-induced cardiac dysfunction and remodeling. RNA sequence revealed that the role of KCP deficiency in cardiac remodeling was associated with cell division, cell cycle, and P53 signaling pathway, while cyclin B1 (CCNB1) was the most significantly up-regulated gene. Further investigation in vivo and in vitro suggested that KCP deficiency promoted the proliferation of CFs via P53/P21/CCNB1 pathway. Taken together, these results suggested that KCP deficiency aggravates cardiac dysfunction and remodeling induced by pressure overload via P53/P21/CCNB1 signaling in mice.

Impact of SGLT2 inhibitors on patient outcomes: a network meta-analysis.

BACKGROUND: A comprehensive network meta-analysis comparing the effects of individual sodium-glucose cotransporter 2 (SGLT2) inhibitors on patients with and without comorbidities including diabetes mellitus (DM), heart failure (HF), and chronic kidney disease (CKD) has not been previously conducted. METHODS: We searched PubMed, Embase, Cochrane, and ClinicalTrials.gov for randomized controlled trials up to March 28, 2023. Network meta-analysis using a random-effects model was conducted to calculate risk ratios (RRs). Risk of Bias tool 2.0 was used to assess bias, and CINeMA to assess the certainty of evidence. In the subgroup analysis, the SGLT2 inhibitors were classified into highly (dapagliflozin, empagliflozin, and ertugliflozin) and less selective SGLT2 inhibitors (canagliflozin and sotagliflozin). RESULTS: A total of fourteen trials with 75,334 patients were analyzed. Among these, 40,956 had taken SGLT2 inhibitors and 34,378 had not. One of the main results with particular findings was empagliflozin users had a significantly lower risk of all-cause death compared to dapagliflozin users in DM population (RR: 0.81, 95% CI 0.69-0.96). In HF population, sotagliflozin users had a borderline significantly lower risk of CV death or hospitalization for HF (HHF) than dapagliflozin users (RR: 0.90, 95% CI 0.80-1.01). In non-HF population, those who used canagliflozin had a significantly lower risk of CV death or HHF compared with those who used dapagliflozin (RR: 0.75, 95% CI 0.58-0.98). At last, for HF patients, those who used less selective SGLT2 inhibitors had a significantly lower risk of MACEs compared to those who used highly selective SGLT2 inhibitors (RR: 0.75, 95% CI 0.62-0.90). CONCLUSIONS: Our network meta-analysis revealed that empagliflozin users with diabetes experienced a lower risk of dying from any cause than those using dapagliflozin. Additionally, canagliflozin users demonstrated a reduced risk of cardiovascular death or HHF compared to dapagliflozin users in those without HF. In HF patients, less selective SGLT2 inhibitors showed superior CV composite outcomes, even surpassing the performance of highly selective SGLT2 inhibitors. TRIAL REGISTRATION: PROSPERO [CRD42022361906].

Performance of urinary C-C motif chemokine ligand 14 for the prediction of persistent acute kidney injury: a systematic review and meta-analysis.

BACKGROUND: Urinary C-C motif chemokine ligand 14 (CCL14) has been described as an effective marker for delayed recovery of acute kidney injury (AKI), yet its efficacy has been found to vary between different trials. The goal of this research was to assess the predictive performance of urinary CCL14 as a marker for persistent AKI. METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we searched the PubMed, Embase, and Cochrane databases up to April 2023 for studies of adults (> 18 years) that reported the diagnostic performance of urinary CCL14. The sensitivity, specificity, number of events, true positive, and false positive results were extracted and evaluated. Hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the pooled test performance, and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to appraise the quality of evidence. RESULTS: We included six studies with 952 patients in this meta-analysis. The occurrence of persistent AKI among these patients was 39.6% (377/952). The pooled sensitivity and specificity results of urinary CCL14 in predicting persistent AKI were 0.81 (95% CI 0.72-0.87) and 0.71 (95% CI 0.53-0.84), respectively. The pooled positive likelihood ratio (LR) was 2.75 (95% CI 1.63-4.66), and the negative LR was 0.27 (95% CI 0.18-0.41). The HSROC with pooled diagnostic accuracy was 0.84. CONCLUSION: Our results suggest that urinary CCL14 can be used as an effective marker for predicting persistent AKI.

Proenkephalin as a biomarker correlates with acute kidney injury: a systematic review with meta-analysis and trial sequential analysis.

BACKGROUND: Proenkephalin A 119-159 (PENK) is freely filtered in the glomerulus with plasma levels correlating with glomerular filtration rate. Therefore, PENK has been proposed as an early indicator of acute kidney injury (AKI) although its performance is dependent on the clinical setting. This meta-analysis aimed to investigate the correlation between PENK levels and the development of AKI. METHODS: We conducted a comprehensive search on the PubMed, Embase, Cochrane databases, the website ClinicalTrials.gov and Cnki.net until June 26, 2023. Summary receiver operating characteristic (SROC) curves were used to amalgamate the overall test performance. Diagnostic odds ratio (DOR) was employed to compare the diagnostic accuracy of PENK with other biomarkers. Quality of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria. RESULTS: We incorporated 11 observational studies with 3969 patients with an incidence of AKI of 23.4% (929 out of 3969 patients) with the best optimal cutoff value of PENK for early detection of AKI being 57.3 pmol/L. The overall sensitivity and specificity of PENK in identifying AKI were 0.69 (95% CI 0.62-0.75) and 0.76 (95% CI 0.68-0.82), respectively. The combined positive likelihood ratio (LR) stood at 2.83 (95% CI 2.06-3.88), and the negative LR was 0.41 (95% CI 0.33-0.52). The SROC curve showcased pooled diagnostic accuracy of 0.77 (95% CI 0.73-0.81). Interestingly, patients with a history of hypertension or heart failure demonstrated a lower specificity of PENK in correlating the development of AKI. CONCLUSION: Our results indicate that PENK possesses significant potential as a biomarker for the early detection of the development of AKI, using a cutoff point of 57.3 pmol/L for PENK.

Improvement of composite kidney outcomes by AKI care bundles: a systematic review and meta-analysis.

INTRODUCTION: Various approaches have been suggested to identify acute kidney injury (AKI) early and to initiate kidney-protective measures in patients at risk or with AKI. The objective of this study was to evaluate whether care bundles improve kidney outcomes in these patients. METHODS: We conducted a systematic review of the literature to evaluate the clinical effectiveness of AKI care bundles with or without urinary biomarkers in the recognition and management of AKI. The main outcomes were major adverse kidney events (MAKEs) consisting of moderate-severe AKI, receipt of renal replacement therapy (RRT), and mortality. RESULTS: Out of 7434 abstracts screened, 946 published studies were identified. Thirteen studies [five randomized controlled trials (RCTs) and eight non-RCTs] including 16,540 patients were eligible for inclusion in the meta-analysis. Meta-analysis showed a lower incidence of MAKE in the AKI care bundle group [odds ratio (OR) 0.73, 95% confidence interval (CI) 0.66-0.81] with differences in all 3 individual outcomes [moderate-severe AKI (OR 0.65, 95% CI 0.51-0.82), RRT (OR 0.63, 95% CI = 0.46-0.88) and mortality]. Subgroup analysis of the RCTs, all adopted biomarker-based approach, decreased the risk of MAKE (OR 0.55, 95% CI 0.41-0.74). Network meta-analysis could reveal that the incorporation of biomarkers in care bundles carried a significantly lower risk of MAKE when compared to care bundles without biomarkers (OR = 0.693, 95% CI = 0.50-0.96), while the usual care subgroup had a significantly higher risk (OR = 1.29, 95% CI = 1.09-1.52). CONCLUSION: Our meta-analysis demonstrated that care bundles decreased the risk of MAKE, moderate-severe AKI and need for RRT in AKI patients. Moreover, the inclusion of biomarkers in care bundles had a greater impact than care bundles without biomarkers.

Epigenetic reprogramming sensitizes immunologically silent EBV+ lymphomas to virus-directed immunotherapy.

Despite advances in T-cell immunotherapy against Epstein-Barr virus (EBV)-infected lymphomas that express the full EBV latency III program, a critical barrier has been that most EBV+ lymphomas express the latency I program, in which the single Epstein-Barr nuclear antigen (EBNA1) is produced. EBNA1 is poorly immunogenic, enabling tumors to evade immune responses. Using a high-throughput screen, we identified decitabine as a potent inducer of immunogenic EBV antigens, including LMP1, EBNA2, and EBNA3C. Induction occurs at low doses and persists after removal of decitabine. Decitabine treatment of latency I EBV+ Burkitt lymphoma (BL) sensitized cells to lysis by EBV-specific cytotoxic T cells (EBV-CTLs). In latency I BL xenografts, decitabine followed by EBV-CTLs results in T-cell homing to tumors and inhibition of tumor growth. Collectively, these results identify key epigenetic factors required for latency restriction and highlight a novel therapeutic approach to sensitize EBV+ lymphomas to immunotherapy.

Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: a systematic review and meta-analysis.

BACKGROUND: Several biomarkers have been proposed to predict the occurrence of acute kidney injury (AKI); however, their efficacy varies between different trials. The aim of this study was to compare the predictive performance of different candidate biomarkers for AKI. METHODS: In this systematic review, we searched PubMed, Medline, Embase, and the Cochrane Library for papers published up to August 15, 2022. We selected all studies of adults (> 18 years) that reported the predictive performance of damage biomarkers (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP)), inflammatory biomarker (interleukin-18 (IL-18)), and stress biomarker (tissue inhibitor of metalloproteinases-2 × insulin-like growth factor-binding protein-7 (TIMP-2 × IGFBP-7)) for the occurrence of AKI. We performed pairwise meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) individually. Hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the pooled test performance, and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to appraise the quality of evidence. RESULTS: We identified 242 published relevant studies from 1,803 screened abstracts, of which 110 studies with 38,725 patients were included in this meta-analysis. Urinary NGAL/creatinine (diagnostic odds ratio [DOR] 16.2, 95% CI 10.1-25.9), urinary NGAL (DOR 13.8, 95% CI 10.2-18.8), and serum NGAL (DOR 12.6, 95% CI 9.3-17.3) had the best diagnostic accuracy for the risk of AKI. In subgroup analyses, urinary NGAL, urinary NGAL/creatinine, and serum NGAL had better diagnostic accuracy for AKI than urinary IL-18 in non-critically ill patients. However, all of the biomarkers had similar diagnostic accuracy in critically ill patients. In the setting of medical and non-sepsis patients, urinary NGAL had better predictive performance than urinary IL-18, urinary L-FABP, and urinary TIMP-2 × IGFBP-7: 0.3. In the surgical patients, urinary NGAL/creatinine and urinary KIM-1 had the best diagnostic accuracy. The HSROC values of urinary NGAL/creatinine, urinary NGAL, and serum NGAL were 91.4%, 85.2%, and 84.7%, respectively. CONCLUSIONS: Biomarkers containing NGAL had the best predictive accuracy for the occurrence of AKI, regardless of whether or not the values were adjusted by urinary creatinine, and especially in medically treated patients. However, the predictive performance of urinary NGAL was limited in surgical patients, and urinary NGAL/creatinine seemed to be the most accurate biomarkers in these patients. All of the biomarkers had similar predictive performance in critically ill patients. Trial registration CRD42020207883 , October 06, 2020.

Nomenclature and diagnostic criteria for acute kidney injury - 2020 consensus of the Taiwan AKI-task force.

Acute kidney injury (AKI) is a common syndrome that has a significant impact on prognosis in various clinical settings. To evaluate whether new evidence supports changing the current definition/classification/staging systems for AKI suggested by the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline, the Taiwan AKI-TASK Force, composed of 64 experts in various disciplines, systematically reviewed the literature and proposed recommendations about the current nomenclature and diagnostic criteria for AKI. The Taiwan Acute Kidney Injury (TW-AKI) Consensus 2020 was established following the principles of evidence-based medicine to investigate topics covered in AKI guidelines. The Taiwan AKI-TASK Force determined that patients with AKI have a higher risk of developing chronic kidney disease, end-stage renal disease, and death. After a comprehensive review, the TASK Force recommended using novel biomarkers, imaging examinations, renal biopsy, and body fluid assessment in the diagnosis of AKI. Clinical issues with regards to the definitions of baseline serum creatinine (sCr) level and renal recovery, as well as the use of biomarkers to predict renal recovery are also discussed in this consensus. Although the present classification systems using sCr and urine output for the diagnosis of AKI are not perfect, there is not enough evidence to change the current criteria in clinical practice. Future research should investigate and clarify the roles of the aforementioned tools in clinical practice for AKI.

Essential Roles of the Histone Demethylase KDM4C in Renal Development and Acute Kidney Injury.

BACKGROUND: Lysine demethylase 4C (KDM4C) is a nuclear protein that is essential for histone modification and acts as an important regulator of several transcription factors. Previous studies have shown that KDM4C may also play a role in mediating stress responses. The purpose of this study was to examine the roles of KDM4C in kidney development and acute kidney injury (AKI). METHODS: The effect of KDM4C on kidney development was assessed by comparing the kidney phenotype between 96 zebrafish embryos treated with kdm4c-morpholino oligonucleotide and 96 untreated zebrafish embryos. We further examined whether KDM4C is essential for maintaining cell survival in AKI. Cultured human renal tubular cells were used for the in vitro study. Wild-type and Kdm4c knockout mice (C57BL/6NTac-Kdm4ctm1a(KOMP)Wtsi) were divided into a sham group and model group, and then subjected to ischemic reperfusion kidney injury (IRI-AKI). Blood samples and kidneys were collected at different time points (day 3, day 7, day 14, and day 28) and were processed for in vivo studies (n = 8 in each group). RESULTS: Kdm4c knockdown significantly decreased zebrafish embryo survival and impaired kidney development. The in vitro study showed that KDM4C inhibition by JIB04 significantly increased cellular apoptosis under oxidative stress conditions. KDM4C knockdown cells had impaired autophagy function under stress conditions. The IRI-AKI mice study showed that KDM4C protein levels dynamically changed and were significantly correlated with HIF-1α levels in AKI. Kdm4c-/- mice had significantly more severe renal impairment and increased kidney fibrosis than the wild-type mice. Cytokine array results also indicated that the kidneys of Kdm4c-/- mice had increased inflammation in AKI compared with the wild-type mice. Further RNA sequence analysis revealed that KDM4C may regulate transcription factors related to mitochondrial dynamics and function. CONCLUSIONS: Our study suggests that KDM4C may play a critical role in regulating mitochondria, which is related to a protective effect on maintaining cell survival in AKI.

Ultrafast, Non-Equilibrium and Transient Heating and Sintering of Nanocrystals for Nanoscale Metal Printing.

The carrier excitation, relaxation, energy transport, and conversion processes during light-nanocrystal (NC) interactions have been intensively investigated for applications in optoelectronics, photocatalysis, and photovoltaics. However, there are limited studies on the non-equilibrium heating under relatively high laser excitation that leads to NCs sintering. Here, the authors use femtosecond laser two-pulse correlation and in-situ optical transmission probing to investigate the non-equilibrium heating of NCs and transient sintering dynamics. First, a two-pulse correlation study reveals that the sintering rate strongly increases when the two heating laser pulses are temporally separated by <10 ps. Second, the sintering rate is found to increase nonlinearly with laser fluence when heating with ≈700 fs laser pulses. By three-temperature modeling, the NC sintering mechanism mediated by electron induced ligand transformation is suggested. The ultrafast and non-equilibrium process facilitates sintering in dry (spin-coated) and wet (solvent suspended) environments. The nonlinear dependence of sintering rate on laser fluence is exploited to print sub-diffraction-limited features in NC suspension. The smallest feature printed is ≈200 nm, which is ≈» of the laser wavelength. These findings provide a new perspective toward nanomanufacturing development based on probing and engineering ultrafast transport phenomena in functional NCs.

Accelerated versus standard initiation of renal replacement therapy for critically ill patients with acute kidney injury: a systematic review and meta-analysis of RCT studies.

BACKGROUND: Acute kidney injury (AKI) is a common yet possibly fatal complication among critically ill patients in intensive care units (ICU). Although renal replacement therapy (RRT) is an important supportive management for severe AKI patients, the optimal timing of RRT initiation for these patients is still unclear. METHODS: In this systematic review, we searched all relevant randomized controlled trials (RCTs) that directly compared accelerated with standard initiation of RRT from PUBMED, MEDLINE, EMBASE, and Cnki.net published prior to July, 20, 2020. We extracted study characteristics and outcomes of being free of dialysis, dialysis dependence and mortality. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. RESULTS: We identified 56 published relevant studies from 1071 screened abstracts. Ten RCTs with 4753 critically ill AKI patients in intensive care unit (ICU) were included in this meta-analysis. In our study, accelerated and standard RRT group were not associated with all-cause mortality (log odds-ratio [OR]: - 0.04, 95% confidence intervals [CI] - 0.16 to 0.07, p = 0.46) and free of dialysis (log OR: - 0.03, 95% CI - 0.14 to 0.09, p = 0.65). In the subgroup analyses, accelerated RRT group was significantly associated with lower risk of all-cause mortality in the surgical ICU and for those who received continuous renal replacement therapy (CRRT). In addition, patients in these two subgroups had higher chances of being eventually dialysis-free. However, accelerated initiation of RRT augmented the risk of dialysis dependence in the subgroups of patients treated with non-CRRT modality and whose Sequential Organ Failure Assessment (SOFA) score were more than 11. CONCLUSIONS: In this meta-analysis, critically ill patients with severe AKI would benefit from accelerated RRT initiation regarding all-cause mortality and being eventually free of dialysis only if they were surgical ICU patients or if they underwent CRRT treatment. However, the risk of dialysis dependence was increased in the accelerated RRT group when those patients used non-CRRT modality or had high SOFA scores. All the literatures reviewed in this study were highly heterogeneous and potentially subject to biases. Trial registration CRD42020201466, Sep 07, 2020. https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201466 .

May Measurement Month 2019: an analysis of blood pressure screening results from Taiwan.

To bolster the awareness of high blood pressure (BP) and to monitor the trend of hypertension control rate. Similar to May Measurement Month (MMM) 2017 and 2018 campaigns, we conducted the MMM 2019 campaign in 643 community pharmacies across Taiwan, and recruited adults aged 20 years or over in May and June of 2019. After filling in an anonymous questionnaire regarding medical history and lifestyle habits and having 10-min sitting rest, pharmacists took triplicate upper-arm BP readings on participants using an automated oscillometric sphygmomanometer. The means of the second and third BP readings were used as the screening BP estimates. Hypertension was defined if one of the followings was met: use of antihypertensive medications, systolic BP ≥140 mmHg, or diastolic BP ≥90 mmHg. Controlled BP was defined as BP of <140/90 mmHg. Of the 24 851 participants enrolled (mean age, 55.8 ± 15.2 years), 12 427 (50.0%) were women. Among 12 351 (49.7%) participants with hypertension, 10 463 (84.7%) were aware of their high BP, and 10 142 (82.1%) received antihypertensive medications. While 59.2% of all hypertensive participants had controlled BP, the BP control rate was 72.0% in treated hypertensive participants. MMM campaigns offer a feasible way to monitor the trends in both awareness and control of hypertension. This nationwide annual BP screening campaign, from 2017 to 2019, demonstrated continued improvement in hypertension control in Taiwan.

Effect of Oleamine on Microwave-Assisted Synthesis of Cesium Lead Bromide Perovskite Nanocrystals.

Herein, we reported a simple microwave-assisted method for synthesizing uniform CsPbBr3 and Cs4PbBr6 perovskite nanocrystals (PeNCs). The phase structure, photoluminescence (PL) emission, and quantum yield (QY) of CsPbBr3 PeNCs can be tuned by changing the radiation time and power of the microwave. The optimized CsPbBr3 PeNCs showed a high PLQY of up to 87%. The transformation from green-luminescent three-dimensional (3D) CsPbBr3 PeNCs to nonluminescent zero-dimensional (0D) Cs4PbBr6 PeNCs was easily realized by adjusting the amount of oleamine (OAm) and oleic acid (OA), and the changes in morphology and phase structure during the transformation process were studied by a microwave-assisted technique. Meanwhile, the optical properties of Cs4PbBr6 PeNCs were revealed by monitoring the changes in absorption and emission spectra. Furthermore, through first-principles calculations based on density functional theory (DFT), the luminescene origination of as-prepared PeNCs was further explained. In this work, we controlled the phase transition from CsPbBr3 to Cs4PbBr6 through a simple method, which provides a strategy for other types of perovskite phase transitions.

Thermal Perception Abnormalities Can Predict Diabetic Kidney Disease in Type 2 Diabetes Mellitus Patients.

BACKGROUND: Previous studies have illustrated clinical associations between diabetic peripheral neuropathy (DPN) and diabetic kidney disease (DKD). Quantitative sensory testing (QST) can accurately detect thermal perception abnormalities and aid in the early diagnosis of asymptomatic small-fiber DPN in patients with type 2 diabetes. The aim of this study was to determine the predictive value of thermal perception abnormalities by QST to detect DKD. METHODS: We prospectively enrolled 432 patients with type 2 diabetes (50.2% male, mean age 57.2 years, and average duration of diabetes 9.9 years) at our hospital between 2016 and 2017. Demographic and clinical data of the patients were recorded and analyzed. Diagnosis and staging of DKD were determined by urinary albumin excretion rate and estimated glomerular filtration rate. The presence of thermal perception abnormalities was determined by QST. Multiple logistic regression and receiver operating characteristic (ROC) analyses were performed to investigate the relationships between thermal perception abnormalities and DKD in these patients. RESULTS: In multiple regression analysis, abnormal cold perception in the lower limbs was associated with an increased risk of advanced DKD. Area under the ROC curve analysis revealed that four-limb cold perception abnormalities had the best discriminatory power (0.741 ± 0.053) to predict advanced DKD. CONCLUSIONS: Our results demonstrate the value of using thermal perception abnormalities to identify patients with type 2 diabetes also at risk of DKD.

Acute kidney disease and acute kidney injury biomarkers in coronary care unit patients.

BACKGROUND: Acute kidney disease (AKD) describes acute or subacute damage and/or loss of kidney function for a duration of between 7 and 90 days after exposure to an acute kidney injury (AKI) initiating event. This study investigated the predictive ability of AKI biomarkers in predicting AKD in coronary care unit (CCU) patients. METHODS: A total of 269 (mean age: 64 years; 202 (75%) men and 67 (25%) women) patients admitted to the CCU of a tertiary care teaching hospital from November 2009 to September 2014 were enrolled. Information considered necessary to evaluate 31 demographic, clinical and laboratory variables (including AKI biomarkers) was prospectively recorded on the first day of CCU admission for post hoc analysis as predictors of AKD. Blood and urinary samples of the enrolled patients were tested for neutrophil gelatinase-associated lipocalin (NGAL), cystatin C (CysC) and interleukin-18 (IL-18). RESULTS: The overall hospital mortality rate was 4.8%. Of the 269 patients, 128 (47.6%) had AKD. Multivariate logistic regression analysis revealed that age, hemoglobin, ejection fraction and serum IL-18 were independent predictors of AKD. Cumulative survival rates at 5 years of follow-up after hospital discharge differed significantly (p < 0.001) between subgroups of patients diagnosed with AKD (stage 0A, 0C, 1, 2 and 3). The overall 5-year survival rate was 81.8% (220/269). Multivariate Cox proportional hazard analysis revealed that urine NGAL, body weight and hemoglobin level were independent risk factors for 5-year mortality. CONCLUSIONS: This investigation confirmed that AKI biomarkers can predict AKD in CCU patients. Age, hemoglobin, ejection fraction and serum IL-18 were independently associated with developing AKD in the CCU patients, and urine NGAL, body weight and hemoglobin level could predict 5-year survival in these patients.

May Measurement Month 2018: an analysis of blood pressure screening results from Taiwan.

To raise awareness of hypertension in the general population, we have held an annual community-based nationwide campaign for blood pressure (BP) screening. The 2018 May Measurement Month (MMM) campaign in Taiwan followed a similar protocol as the 2017 MMM campaign. We recruited adults aged 20 years and older at about 800 community pharmacies across Taiwan. After a 10-min seated rest, volunteers-consisting of community pharmacists-took three BP readings using automated BP devices. The means of the 2nd and 3rd BP readings were used as the screening BP estimates. Hypertension was defined as current use of antihypertensive medications, or the screening BP of ≥140/90 mmHg. Of the 15 365 enrolled participants with a mean age of 56.8 ± 16.4 years, 53.3% were women. After imputation, we found 48.1% of the individuals had hypertension. Among participants with hypertension, 83.7% were aware, 55.0% had controlled BP, and 81.3% were medically treated, of whom 67.7% had controlled BP (<140/90 mmHg). In contrast to the global results, our results showed that the participants with diabetes mellitus, prior myocardial infarction, or stroke had higher BP than those without these comorbidities. The annual campaign experience enables us to establish a feasible approach to raising awareness and to assessing the management of hypertension in the general population. Whether the regular annual BP screening campaign makes a lasting effect on hypertension-related disease burden awaits verification.

Prevalence, Treatment, Control and Monitoring of Hypertension: A Nationwide Community-Based Survey in Taiwan, 2017.

BACKGROUND: Inadequate awareness and control remain the major obstacles for hypertension management worldwide. This observational study intended to assess the current status of hypertension management in Taiwan. METHODS: The Taiwan May Measurement Month (MMM) campaign was a nationwide survey for public alertness to hypertension initiated in 2017 and conducted in local pharmacies. Participants were asked about body habitus, comorbidities, smoking/drinking, use of anti-hypertensive drugs, and frequency of self-measured blood pressure (SMBP) monitoring. Three blood pressure (BP) readings were then measured by trained pharmacists. The mean BP was obtained by averaging all readings. RESULTS: BP recordings were obtained from 49,522 participants (average age, 56.9 ± 16.0 years), of whom 26.1% had an elevated pharmacist-measured BP (≥ 140/90 mmHg). The rate of BP control, defined as pharmacist-measured BP < 140/90 mmHg at the MMM visit, was 63.1% among treated hypertensive participants (n = 21,410). Participants who had uncontrolled hypertension were associated with a higher body mass index, currently smoking/drinking, diabetes, and stroke. More active SMBP monitoring (≥ weekly) was more often implemented in the participants with advanced age and cardiovascular diseases. More active SMBP (≥ weekly) was associated with lower measured BP among treated hypertensive participants but not overall control rate (control rate: 56.4% for ≥ weekly vs. 55.8% for < weekly, p = 0.363). CONCLUSIONS: In the Taiwan MMM 2017, the hypertension control rate surpassed 60% in treated hypertensive participants. Suboptimal BP control was related to cardiovascular risk factors and prior stroke. Treated hypertensives had a lower measured BP but similar hypertension control rate for more active versus less active SMBP.

Higher risk of malignant neoplasms in young adults with end-stage renal disease receiving haemodialysis: A nationwide population-based study.

AIM: Previous investigations have shown that end-stage renal disease (ESRD) is associated with an increased risk of malignancies. The aim of this study was to explore the association between ESRD in patients undergoing maintenance haemodialysis (HD) and the incidence of malignancies according to age. METHODS: We analysed a nationwide cohort retrieved from Taiwan's National Health Insurance Research Database to study the incidence of malignancies in patients who were and were not receiving HD. One million beneficiaries were randomly selected and followed from 2005 to 2013. Of these 1 000 000 patients, 3055 developed ESRD and commenced maintenance HD during this period. For each HD patient, four age-, gender- and diabetes-matched controls were selected from the database (n = 12 220). We further stratified the patients according to age. The study endpoint was the occurrence of malignancy. RESULTS: The incidence rates of malignancy were 6.8% and 4.9% in the HD and control groups, respectively. Competing risk regression analysis indicated that age, HD, male gender and diabetes were associated with an increased risk of malignancy. When further stratified according to age, the odds ratios of developing cancer were 5.8, 1.9, 1.9 and 1.5 among the HD patients aged <40 years, 40-49 years, 50-59 years and 60-69 years, respectively. CONCLUSION: The patients with ESRD who received HD had a significantly higher cumulative risk of malignancy, especially those with a young age. Therefore, specialized cancer screening protocols for young HD patients might help to prolong their lifespan.

May Measurement Month 2017: Results from Taiwan-East Asia.

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. Given the consistent 30% unawareness rate across all hypertension surveys in Taiwan, we collaborated with the International Society of Hypertension to launch the MMM campaign. An opportunistic cross-sectional survey of volunteers aged ≥18 was carried out in May 2017. Blood pressure measurement, the definition of hypertension and statistical analysis followed the standard MMM protocol. Over 1200 community pharmacies joined in this campaign, where participants were recruited to obtain BP measurements using automated oscillometric sphygmomanometers. Triplicate BP readings of right or left brachial artery were obtained after sitting for 10 min. A total of 52 514 individuals were screened during MMM17. After multiple imputation, 28 123 (53.8%) had hypertension. Of individuals not receiving antihypertensive medication, 5226 (17.8%) were hypertensive. Of individuals receiving antihypertensive medication, 8121 (35.7%) had uncontrolled BP. As compared with underweight individuals, adjusted systolic BP and diastolic BP raised by 6.1 and 4.1 mmHg, respectively, in overweight ones; while by 9.4 and 5.6 mmHg, respectively, in obese ones. May Measurement Month(MMM)17 was the largest BP screening campaign undertaken in Taiwan. The substantial numbers of unidentified and uncontrolled hypertensive patients, though lower than prior surveys in Taiwan, are challenging. Whether the continued MMM campaign would raise hypertension awareness at the national level awaits verification.