[Improving the Rate of Eating Safety Guidance Implementation Among the Elderly].

BACKGROUND & PROBLEM: The provision by nurses of effective swallowing assessments and eating safety guidance improves eating safety in the elderly. The authors of this study found that elderly clients experienced a high proportion of aspiration pneumonia after choking episodes and that the rate of implementation of eating safety guidance among these clients by nursing staff was only 64.6%. The problems identified included a lack of education and training related to eating safety for the elderly, inconsistent health education methods, oral health education only, lack of unified health education content, and lack of proper health education guidance aids. PURPOSE: To raise the rate of implementing eating safety guidance among the elderly from 64.6% to 90.0%. RESOLUTION: The project included promoting an eating safety guidance workflow for the elderly using cross-team collaboration, using human body models and food models, promoting oral healthcare and oral exercises, using multilingual instructional leaflets and videos on eating safety and hygiene education, promoting a treasure hunting activity to the elderly related to eating safely using a food texture selection chart, and implementing a workshop on simulated eating safety scenarios. RESULTS: After project implementation, the eating safety guidance implementation rate increased from 64.6% to 92.1%, demonstrating that the intervention measures achieved remarkable results. CONCLUSIONS: Formulating care procedures and cooperating across teams to draft concrete and feasible improvement measures effectively increased the rate of eating safety guidance implementation for elderly clients by nursing staff.

Pyruvate in reduced osmolarity oral rehydration salt corrected lactic acidosis in sever scald rats.

BACKGROUND: A novel pyruvate-based oral rehydration salt (Pyr-ORS) was demonstrated of superiority over bicarbonate- or citrate-based one to preserve organ function and correct lactic acidosis in rehydration of lethal shock in animals. This study further compared these effects between low-osmolar Pyr-ORS and equimolar citrate-based counterpart. METHODS: Eighty rats, using a fatal burn shock model, were randomized into four groups (two subgroups per group: n = 10): the sham group (group SR), Pyr-ORS group (group PR), WHO-ORS III group (group CR), and no rehydration group. ORS was delivered by manual gavage during 24 h following burns. Oral administration consisted of half of counted volume in the initial 8 h plus the rest in the later 16 h. Systemic hemodynamics, visceral organ surface blood flow, organ function, and metabolic acidosis were determined at 8 h and 24 h after burn. Another set of rats with identical surgical procedures without tests was observed for survival. RESULTS: Survival was markedly improved in the groups PR and CR; the former showed a higher survival rate than the latter at 24 h (40% versus 20%, P < 0.05). Systemic hemodynamics, visceral blood flow, and function of heart, liver, and kidney were greatly restored in group PR, compared with group CR (all P < 0.05). Hypoxic lactic acidosis was efficiently reversed in group PR, instead of group CR, (pH 7.36 versus 7.11, base excess 2.1 versus -9.1 mmol/L, lactate 4.28 versus 8.18 mmol/L; all P < 0.05) at 24 h after injury. CONCLUSIONS: Pyruvate was advantageous over citrate in low-osmolar ORS for protection of organs and survival; pyruvate, but not citrate, in the ORS corrected hypoxic lactic acidosis in rats subjected to lethal burn shock in 24 h.

Deficiency of Psgl-1 accelerates bleomycin (BLM)-induced lung fibrosis and inflammation in mice through activating PI3K/AKT.

Pulmonary fibrosis is a disease characterized by unremitting fibrosis accumulation in the lung, causing respiratory failure eventually. Presently, the immunological mechanism underlying pulmonary fibrosis still remains unclear. P-selectin glycoprotein ligand-1 (Psgl-1) is a leukocyte ligand that regulates recruitment and activation of multiple cell types, which is associated with phosphatidylinositol 3-kinase (PI3K)/AKT signaling pathway activation. In the present study, we attempted to clarify the AKT activation induced by Psgl-1 knockout in mice with bleomycin (BLM)-induced pulmonary fibrosis. The findings indicated that after BLM induction, myeloid Psgl-1-deficient mice exhibited enhanced transforming growth factor-ß 1 (TGF-ß1), α-SMA and various Collagen accumulation in comparison to the wild type mice, resulting in accelerated morbidity and declined survival rate. Further, Psgl-1-knockout mice showed decreased number of macrophages and T-cells responding to BLM treatment after assays of the alveolar lavage and cell composition in the lung. Notably, abnormal macrophage polarization was observed in Psgl-1-deficient mice, accompanied with enhanced cytokines secretion after BLM induction. The findings here possibly referred to an uncontrollable wound healing related to Psgl-1 knockout, which modulates inflammatory response and macrophage phenotypes, leading to fibrosis enhancement ultimately. However, further experiments are still necessary to characterize the precise molecular mechanism of Psgl-1 in mice fibrosis.

Pyruvate alleviates lipid peroxidation and multiple-organ dysfunction in rats with hemorrhagic shock.

OBJECTIVE: Pyruvate can reduce lipid peroxidation, which plays a critical role in organ injury, in various models. However, it is not fully understood if this inhibition occurs in resuscitation of hemorrhagic shock (HS). This study examines effects of pyruvate Ringer solution (PR) in this respect in rats. METHODS: Rats, subjected to 45% blood loss, were randomly allocated to the 3 groups (n = 18): HS with no fluid resuscitation (group NR), HS resuscitated with lactated Ringer solution (LR) (group LR), and HS resuscitated with PR (group PR). Mean arterial pressure, plasma levels of thiobarbituric acid reactive substances (TBARS), and superoxide dismutase were measured at various time points until 360 minutes after hemorrhage. Visceral organs were harvested at the end for evaluations of the TBARS, antioxidant enzyme, and tissue water content. Other 54 rats with identical procedures without sampling were documented for 24-hour survival rates (n = 18) after fluid resuscitation. RESULTS: Pyruvate Ringer solution significantly increased mean arterial pressure and decreased blood TBARS levels after lethal HS. It also reduced TBARS concentrations and glutathione peroxidase activities but significantly enhanced glutathione reductase activities in most organs and greatly improved the ratios of reduced glutathione over oxidized glutathione in various organs in group PR, compared to group LR. Furthermore, PR significantly improved various organ function and water contents relative to LR. Group PR showed a more than 2-fold higher 24-hour survival rate of group LR. CONCLUSIONS: Pyruvate Ringer solution alleviated organ edema and injury and prompted survival partially through inhibition of lipid peroxidation in various organs in severe HS rats.

Attitudes toward and use of complementary and alternative medicine among Hispanic and white mothers.

CONTEXT: Complementary and alternative medicine (CAM) use has become more prevalent in the United States. Little is known, however, regarding the ethnic and language differences of mothers as related to their beliefs about and use of CAM. OBJECTIVE: This study intended to examine the differences in CAM beliefs and use in English- and Spanish-speaking Hispanic and white mothers of children undergoing surgery. DESIGN: The research team employed a cross-sectional survey design. SETTING: Mothers were recruited from the Children's Hospital of Orange County (CHOC) in Southern California, and they completed the study's surveys on the day of their children's outpatient surgery. PARTICIPANTS: A total of 206 mothers participated: (1) 42 English-speaking, non-Hispanic white (ESW) women; (2) 92 English-speaking Hispanic (ESH) women; and (3) 72 Spanish-speaking Hispanic (SSH) women. OUTCOME MEASURES: Participants completed (1) the Holistic and Complementary and Alternative Medicine Questionnaire (HCAMQ), which captured beliefs about holistic health measures and about the validity of CAM; and (2) a checklist identifying past and present use of 27 different CAM therapies. RESULTS: The research team analyzed and controlled for demographic differences using linear regression, and the analysis revealed significant group differences in CAM use (P < .0001). ESW mothers and ESH mothers used more CAM than SSH mothers (P = .02). No significant differences were observed between groups for CAM related beliefs. CONCLUSIONS: After controlling for socioeconomic status, the research team found that SSH mothers used less CAM compared to ESH and ESW mothers. Employment of culturally specific measures of CAM use may be necessary to understand fully the differences in CAM use between Spanish- and English-speaking mothers as well as to understand the medical conditions that prompt CAM use.

Association of caveolin-1 genotypes with renal cell carcinoma risk in Taiwan.

The alteration of caveolin-1 (Cav-1) during carcinogenesis is of great interest and its over-expression in the tumor cell cytoplasm can predict a poor prognosis of renal cell carcinoma (RCC). However, whether the over-expression in RCC is associated with inherited polymorphism is not clear. In this hospital-based case-control study, the association of Cav-1 genotypes with RCC risk in a central Taiwanese population was investigated. Ninety-two patients with RCC and five hundred and eighty of age/gender-matched healthy controls were recruited and genotyped for six polymorphic sites at Cav-1, C521A (rs1997623), G14713A (rs3807987), G21985A (rs12672038), T28608A (rs3757733), T29107A (rs7804372), and G32124A (rs3807992). The results showed that there were statistically different distributions of the genotypic (P = 0.0170 and 0.0011) and allelic (P = 0.0033 and 0.0352) frequencies for the Cav-1 G14713A and T29107A polymorphisms among RCC patients and control subjects, respectively. As for the haplotype analysis, subjects carrying "GG/AT or GG/AA" at Cav-1 G14713A/T29107A showed a 2.06-fold increased odds ratio of RCC compared to those with GG/TT, while those of any other combinations were of unaltered odds ratios. In conclusion, this is the first report providing evidence showing that Cav-1 genotype is associated with RCC. The results showed that the G allele of the Cav-1 G14713A and the A allele of the Cav-1 T29107A are risky genetic factors for RCC susceptibility and the combinative GG/AT or GG/AA haplotype at Cav-1 G14713A/T29107A can serve as one of the RCC predictors for Taiwanese.

Intraoperative transcutaneous electroacupoint stimulation on early postoperative fatigue in patients with Parkinson's disease undergoing deep brain stimulation surgery.

Background: In this clinical trial, we evaluated the effects of transcutaneous electroacupoint stimulation (TEAS) on postoperative fatigue (POF) in Parkinson disease (PD) patients undergoing deep brain stimulation (DBS) surgery. Methods: A total 60 PD patients undergoing DBS surgery were enrolled. They were randomized to receive either electrical stimulation [alternative frequency 2/10 Hz, dense and disperse, intensity adjusted to the maximum tolerated by the participants (6-15 mAmp)] via surface electrodes (TEAS group) or surface electrodes only without electrical stimulation (Con group) at bilateral Zusanli and Sanyinjiao acupuncture points. All participants received their assigned intervention (TEAS or Con) during the 1st stage of surgery [(except during microelectrode recording (MER)] and the entire 2nd stage of surgery. Intraoperative anesthetic requirements were adjusted based on bispectral index (BIS) monitor. POF was assessed by Christensen fatigue scales (ChrFS), along with Quality of Recovery-15 (QoR-15) and mini-mental state examination (MMSE) postoperatively over a 7-day-period. We recorded the usage of rescue analgesics and anti-emetics. Results: Fifty-nine patients' datasets were included for final analyses. Fewer patients in TEAS experienced severe POF (defined as ChrFS ≥6) at T3 than those in the Con group (TEAS vs. Con: 7 vs. 22, p < 0.001). During the 1st stage of surgery, more patients in Con group required dexmedetomidine infusion (TEAS vs. Con: 2 vs. 6; P < 0.01). Total dosages of propofol and remifanil during the 2nd stage of surgery were TEAS vs. Con: 374.7 ± 61.2 vs 421.5 ± 81.9; p < 0.001 and 572.3 ± 82.0 vs. 662 ± 148.2; P < 0.001, respectively. Postoperative rescue analgesics (TEAS vs. Con: 2 vs. 6; P < 0.001) were used less in the TEAS group. TEAS patients reported better POF, MMSE and QoR15 scores than those in the Con group during most of the assessment period. Conclusions: Intraoperative TEAS decreased the severity of POF, reduced intraoperative anesthetic requirements and facilitated post-DBS recovery in this group of PD patients.

Perioperative transcutaneous electrical acupoint stimulations as part of an enhanced recovery after surgery protocol for living donors undergoing nephrectomy: A randomized, controlled clinical trial.

Objective: Living kidney donors (LKDs) experience perioperative anxiety. We designed the following study to evaluate the anxiolytic effect of transcutaneous electrical acupoint stimulation (TEAS) during the perioperative period in a group of LKDs undergoing laparotomy nephrectomy. Methods: LKDs were randomly assigned to either the TEAS or control group. Participants in the TEAS group received 30min of intervention (6-15 mA, 2-100 Hz), at Yintang (EX-HN-3), bilateral Taichong (LR3) and Neiguan (PC6) one day before surgery (D0), before induction of anesthesia (D1) and one day after surgery (D2). The participants in the control group received the same placement of electrodes but without electrical stimulation. Venous blood was collected before each intervention. Anxiety levels and recovery profiles were recorded. Results: LKDs in the TEAS group had lower anxiety level than those in the control group at D1, D2 and three days after surgery (D3). The percentage differences were: 33.3%, 25.0%, and 22.2%; [95% confidence interval (CI), (-55.1%, -11.6%), (-47.4%, -2.6%), and (-42.3%, -2.2%); P = 0.005, P = 0.034, and P = 0.035; respectively]. LKDs who received TEAS had better sleep quality and short-term recovery profiles than those in the control group. The plasma levels of 5-hydroxytryptamine (5-HT) and melatonin (MT) in the TEAS group were significantly higher than those in the control group at D1 and D2 (5-HT: P = 0.001, and P < 0.001; MT: P = 0.006, and P = 0.001). At the 3-month follow up, fewer LKDs in the TEAS group had incisional pain when compared to the control group (P = 0.032). Conclusions: Perioperative TEAS decreased perioperative anxiety and facilitated postoperative recovery in the LKDs, and potential decreased the development of chronic pain. Trial Registration: Registered at ChiCTR2000029891, http://www.chictr.org.cn/listbycreater.aspx.

[Contribution Analysis of External Source Pollution Load and Environmental Capacity Estimation of Reservoirs in Central Yunnan Plateau].

To explore the source of the pollution load and its contribution rate in the upper reaches of the plateau reservoir and to analyze the water environment capacity of the reservoir, we selected the Chaishitan Reservoir in the Yunnan Plateau as the research object, applied the pollutant discharge coefficient method to estimate the source of external pollution in the upstream basin of the reservoir, used the simultaneous monitoring data of hydrology and water quality to calculate pollution load into the reservoir, and used the eutrophication model to calculate the maximum capacity of TN and TP in the reservoir under different water quality target scenarios. The results showed that:① the main characteristic pollutants in Chaishitan Reservoir and the above basin were TN and TP. ② COD and TP in the upper reaches of the reservoir mainly came from rural non-point source pollution, with contribution rates of 49.40% and 50.11%, respectively; NH4+-N and TN mainly came from urban domestic pollution sources, with contribution rates of 45.76% and 33.77%, respectively. Among the contributions of rural non-point source pollution, the contribution rates of COD and TP in Luliang District were 34.82% and 36.82%, respectively. The contributions of COD, NH4+-N, TN, and TP to urban domestic pollution were the highest in Qilin District, all of which were up to 65%. ③ The inflows of COD, NH4+-N, TN, and TP were 28050.90, 2465.16, 4680.54, and 870.93 t·a-1, respectively. The inflow of TN and TP pollution load was 4637.80 t·a-1 and 125.04 t·a-1, respectively. ④ When the target of water quality was Class Ⅲ, and the requirements of the Water Function Zoning of Yunnan province were met, the environmental capacities of TN and TP were 1102.62 t·a-1 and 54.85 t·a-1, respectively. Rural non-point source pollution and urban domestic pollution sources were the main sources of pollution in the upper reaches of Chaishitan Reservoir, which were priority control sources. These research results can provide a scientific theoretical basis for pollution source treatment in the plateau reservoir basin.

Pericardial effusion as a crucial presentation of Erdheim-Chester disease in a hemodialysis patient: an overlooked diagnosis.

Erdheim-Chester disease (ECD) is a rare non-Langerhans cell histiocytosis whose hallmark is tissue infiltration by CD68-positive, CD1a-negative and usually S-100 protein-positive foamy non-Langerhans histiocytes and mononuclear cells. Here, we report a hemodialysis (HD) patient who presented with fever and pericardial effusion. We performed pericardiocentesis with pericardial biopsy and the histological findings indicated ECD. We administered intravenous methylprednisolone pulse therapy (250 mg/d) followed by oral prednisolone (50 mg/d). The patient's fever gradually subsided and there was no recurrence of pericardial effusion. This is the first report of an HD patient with ECD. We suggest that ECD be considered in the differential diagnosis of new HD patients who present with pericardial effusion, especially when this did not improve following increased dose of HD.

Association of response to hepatitis B vaccination and survival in dialysis patients.

BACKGROUND: The status of immunocompromised patients is well recognized in end stage renal disease (ESRD). As described recently, this acquired immune dysfunction in the uremic milieu may be one of the main pathogenic factors for mortality in ESRD. The aim of this study was to determine the relationship between the immune response following a hepatitis B vaccination (HBV vaccination) and the survival of maintenance dialysis patients. METHODS: A total of 156 patients (103 on hemodialysis and 53 on continuous ambulatory peritoneal dialysis) were recruited. After receiving a full dose of the HBV vaccination, all patients were followed up for to 5 years to evaluate the association of patient survival, cause of mortality, and immune response. RESULTS: The response rate to the hepatitis B vaccination was 70.5%. There was no significant association between the immune response and the 5-year survival rate (p =0.600) or between the post-vaccination anti-HBs titers and the 5-year survival rate (p = 0.201). The logistic prediction model with the coefficient as non-response following HBV vaccination, diabetes mellitus, old age, and low albumin level could significantly predict infection-cause mortality (sensitivity = 0.842, specificity = 0.937). CONCLUSION: There was no significant association between the immune response to HBV vaccination and the 5-year survival rate. However, non-response following HBV vaccination might be associated with infection-cause mortality in dialysis patients.

[Application progress of laser-induced breakdown spectroscopy for surface analysis in materials science field].

As a truly surface analytical tool, laser-induced breakdown spectroscopy (LIBS) was developed in recent ten years, and in this paper, fundamental theory, instrumentation and it's applications in material science are reviewed in detail. Application progress of elemental distribution and depth profile analysis are mainly discussed in the field of metallurgy, semiconductor and electronical materials at home and abroad. It is pointed out that the pulse energy, ambient gas and it's pressure, and energy distribution of laser beam strongly influence spatial and depth resolution, and meanwhile a approach to improving resolution considering analytical sensitivity is provided. Compared with traditional surface analytical methods, the advantage of LIBS is very large scanning area, high analytical speed, and that conducting materials or non-conducting materials both can be analyzed. It becomes a powerful complement of traditional surface analytical tool.

Histone deacetylase inhibitor attenuates intestinal mucosal injury in fatally scalded rats.

Background: Severe burns, trauma and shock can cause intestinal epithelial barrier dysfunction, which can lead to intestinal endotoxemia and even sepsis and multi-organ dysfunction. Many studies have shown that histone deacetylase inhibitors (HDACIs) can improve cell tolerance to hypoxia and inflammation, thus protecting the functions of important organs in the body, and at the same time, inhibiting the degradation of tight junction (TJ) proteins, protecting the intercellular barrier, and reducing tissue edema and organ damage. However, the mechanism is unclear. Methods: Eighty male Sprague-Dawley rats (weighing 280-300 g) with a 50% total body surface area full-thickness dermal burn were randomly assigned to 4 groups (20 rats/group): sham control (SC group), scald + normal saline (SN group), scald + 2-methyl-2pentenoic acid (2M2P group), and scald + valproic acid (VPA group). After scalding, we measured the following parameters at various time intervals postburn injury: intestinal mucosal injury score, diamine oxidase (DAO) activity, intestinal protein expression of acetyl histone H3 at K9 (Ac-H3K9), hypoxia inducible factor 1α (HIF-1α), erythropoietin (EPO), zonula occludens-1 (ZO-1), endothelial nitric oxide synthase (eNOS) content, nitric oxide (NO) content, and intestinal mucosal blood flow (IMBF). Results: Intestinal mucosa showed significant morphologic injury at 4 and 8 hours after scalding that was attenuated by VPA. DAO activity in the VPA group was significantly decreased compared with the other scald groups. At 4 and 8 hours after scalding, VPA enhanced Ac-H3K9 and ZO-1 expression and decreased HIF-1α and EPO expression in the intestine compared with the other scald groups. At 4 and 8 hours after scalding, eNOS and NO protein content and IMBF in the VPA group were markedly increased compared with the other scald groups. Conclusions: HDACIs attenuated intestinal mucosal injury in fatally scalded rats. This may have involved VPA enhancing Ac-H3K9 and ZO-1 expression, inhibiting HIF-1α and EPO expression and inducing eNOS and NO increments.

Perioperative Acupuncture Optimizes Surgical Outcomes: Theory, Clinical Practice and Future Perspectives.

A growing body of evidence supports the use of perioperative acupuncture as part of an enhanced postsurgical recovery protocol. Data from both clinical trials and animal studies has shown that the integration of acupuncture into perioperative patient care leads to a reduction of perioperative complications such as preoperative anxiety, intraoperative hemodynamic instability, postoperative pain, postoperative cognitive dysfunction, and postoperative nausea and vomiting in surgical patients. Despite these favorable outcomes, perioperative acupuncture has yet to be widely adopted in current anesthesia practice. This review summarized data from clinical perioperative acupuncture studies and cites recent discoveries regarding the anatomical location and characteristics of acupoint(s), acupuncture stimulation techniques, and treatment practice protocols, as well as identified the areas of deficiency in perioperative acupuncture applications. To facilitate acupuncture integration in perioperative care practice, the authors propose to establish a perioperative acupuncture registry which can be used for data mining as well as a resource for studying the underlying mechanisms of acupuncture. Through this acupuncture registry, clinical guidelines and research protocols can be established, additional large/multi-center clinical and pragmatic trials can be easily performed to determine if the integration and expansion of perioperative acupuncture practice is cost-effective.

Norepinephrine and hospital mortality in critically ill patients undergoing continuous renal replacement therapy.

High-dose vasopressor use is associated with increasing mortality in patients with septic shock. We conducted this study to determine if the high-dose of vasopressor used before the initiation of continuous renal replacement therapy (CRRT) is associated with increasing mortality in critically ill patients. We retrospectively reviewed all patients who underwent CRRT in the medical intensive care unit of China Medical University Hospital between 2003 and 2007. The association between mortality and highest vasopressors (dopamine and norepinephrine [NE]) dose used were analyzed using Kaplan-Meier analysis and multivariate Cox regression. A total of 279 patients (170 men and 109 women) treated with CRRT in medical intensive care were reviewed and 237 (84.9%) died. In Kaplan-Meier analysis with log-rank test, dopamine dose of ≥20 µg/kg/min and NE dose of ≥0.3 µg/kg/min were significantly linked to mortality (P = 0.007 and <0.001). In multivariate Cox proportional hazards regression, NE dose of ≥0.3 µg/kg/min, Acute Physiology and Chronic Health Evaluation II score, and low platelet count were independently linked to mortality. The hazard ratios and 95% confidence interval (CI) were 1.771 (95% CI: 1.247-2.516, P = 0.001), 1.035 (95% CI: 1.012-1.058, P = 0.003), and 0.997 (95% CI: 0.996-0.999, P = 0.003), respectively. Critically ill patients treated with very high dose of NE before the initiation of CRRT have a very high mortality rate regardless of the acute kidney injury stage.

Relation of ankle-brachial index to the rate of decline of residual renal function in peritoneal dialysis patients.

AIM: The aim of this study was to determine whether ankle-brachial index (ABI) predicts the rate of decline of residual renal function (RRF) in peritoneal dialysis (PD) patients. Previous studies demonstrated the importance of loss of RRF in predicting all-cause risk and cardiovascular mortality in PD patients. It is also known that patients with a low ABI value have a greater risk for deteriorating renal function in the general population. The relationship between ABI and the declining rate of RRF in PD patients with an additional dialysis-specific risk factor is uncertain. METHODS: Seventy-four PD patients with RRF of more than 1 mL/min per 1.73 m(2) were analyzed. ABI was used as the surrogate measure of pre-existing cardiovascular disease and atherosclerosis burden to further determine the outcome of RRF in this study. The slope of decline of RRF was used to determine the outcome. RESULTS: Based on the multivariate analysis, only ABI (P < 0.001), diabetes (P = 0.02) and baseline RRF (P = 0.009) independently predicted a faster decline in RRF. A stepwise multiple linear regression analysis demonstrated that ABI was an independent predictor for the slope of decline of RRF (P < 0.001). CONCLUSION: A low ABI is an independent predictor of not only the known atherosclerotic events, but also of the rate of decline of RRF over time in PD patients.

Plasmonically induced transparent magnetic resonance in a metallic metamaterial composed of asymmetric double bars.

We demonstrate that the trapped magnetic resonance mode can be induced in an asymmetric double-bar structure for electromagnetic waves normally incident onto the double-bar plane, which mode otherwise cannot be excited if the double bars are equal in length. By adjusting the structural geometry, the trapped magnetic resonance becomes transparent with little resonance absorption when it happens in the dipolar resonance regime, a phenomenon so-called plasmonic analogue of electromagnetically induced transparency (EIT). This planar EIT-like metamaterial offers a great geometry simplification by combining the radiant and subradiant resonant modes in a single double-bar resonator.

Role of asymmetric environment on the dark mode excitation in metamaterial analogue of electromagnetically-induced transparency.

An otherwise dark magnetic dipole resonance in a split-ring resonator can be excited electrically with a Fano-type profile once the symmetric environment for this resonator is broken with respect to the polarized electric-field direction of incident waves. When this asymmetrically induced narrow resonance coincides with a broad dipolar resonance at an identical frequency regime, the metamaterial analogue of electromagnetically-induced transparency (EIT) window can be formed. We demonstrate that this environmental-asymmetry condition can be introduced dielectrically as well as plasmonically, either resonantly or nonresonantly, which indicates the plasmon coupling between different resonant modes is not responsible for the dark mode excitation. Thus, this result should contribute to the physical understanding on dark-mode excitation pathway for EIT-like phenomenon in plasmonic metamaterials.

Outcome of atrial fibrillation among patients with end-stage renal disease.

BACKGROUND: End-stage renal disease (ESRD) patients are more at risk for atrial fibrillation (AF) than the general population. However, the prognosis in ESRD patients with paroxysmal AF (PaAF), permanent AF (PAF) and paroxysmal AF transformed to permanent AF (TAF) is unknown. METHODS: In this retrospective longitudinal study, all ESRD patients with PaAF, PAF and TAF between January 2001 and December 2007 were reviewed. The development of thromboembolic events (TEE) was analyzed using Kaplan-Meier analysis and Cox regression. RESULTS: A total of 81 patients with PaAF, 49 patients with PAF and 89 patients with TAF were reviewed. Seventy-two (32.9%) patients developed TEE, and 63 (28.8%) patients died in 36.9 +/- 21.9 months. Patient survival was not significantly different between patients with different types of AF (P = 0.728). Patients with PaAF had a significantly lower TEE-free survival compared to patients with PAF (P = 0.036). In multivariate Cox regression, patients with paroxysmal AF were more at risk for TEE (P = 0.045) with a hazard ratio of 1.61 (95% confidence interval: 1.01-2.58). PaAF and congestive heart failure, hypertension, age older than 75 years, diabetes, and previous stroke or transient ischemic stroke (CHADS(2)) score were independently associated with an increase in TEE risk (P = 0.028 and P = 0.03). CONCLUSION: Patient survival is not different in patients with paroxysmal and permanent atrial fibrillation. However, patients with paroxysmal AF are more at risk for the development of TEE than those with permanent AF.