Proteinuria and Reduced Estimated Glomerular Filtration Rate Independently Predict Risk for Acute Myocardial Infarction: Findings from a Population-Based Study in Keelung, Taiwan.

BACKGROUND: The aim of this study was to evaluate the independent roles of proteinuria and reduced estimated glomerular filtration rate (GFR) in the development of acute myocardial infarction in a northern Taiwanese population. METHODS: We conducted a community-based prospective cohort study in Keelung, the northernmost county of Taiwan. A total of 63,129 subjects (63% women) ≥ 20 years of age who had no history of coronary heart disease were recruited and followed-up. Univariate and multivariate proportional hazards regression analysis was performed to assess the association between proteinuria and estimated GFR and the risk of acute myocardial infarction. RESULTS: There were 305 new cases of acute myocardial infarction (114 women and 191 men) documented during a four-year follow-up period. After adjustment of potential confounding covariates, heavier proteinuria (dipstick urinalysis reading 3+) and estimated GFR of less than 60 ml/min/1.73 m(2) independently predicted increased risk of developing acute myocardial infarction. The adjusted hazard ratio (aHR) of heavier proteinuria for occurrence of acute myocardial infarction was 1.85 [95% confidence intervals (CI), 1.17-2.91, p < 0.01] (vs. the reference group: negative dipstick proteinuria). The aHR of estimated GFR of 30-59 ml/min/1.73 m(2) for occurrence of acute myocardial infarction was 2.4 (95% CI, 1.31-4.38, p < 0.01) (vs. the reference group: estimated GFR ≥ 90 ml/ min/1.73 m(2)), and that of estimated GFR of 15-29 ml/min/1.73 m(2) was 5.26 (95% CI, 2.26-12.26, p < 0.01). CONCLUSIONS: We demonstrated that both heavier proteinuria and lower estimated GFR are significant independent predictors of developing future acute myocardial infarction in a northern Taiwanese population. KEY WORDS: Acute myocardial infarction; Estimated glomerular filtration rate; Proteinuria.

Association of Small-Conductance Calcium-Activated Potassium Channels and Atrial Fibrillation - How Far Have We Gone?

UNLABELLED: Atrial fibrillation (AF) is the most common sustained and most important arrhythmia in clinical practice. The mechanisms underlying AF initiation and maintenance are known to be complex and heterogeneous. The general understanding of the detailed molecular basis of AF is still incomplete. Recently, these is increasing evidence that small conductance calcium-activated potassium (SK) channels are associated with atrial action potential repolarization and the pathogenesis of AF. Although the functional role of SK channels in the genesis of AF is not entirely clear, new insights into the basic pathophysiological mechanism of AF have been provided. Besides, genome-wide association studies also implicate that genes coding for SK channels are related to the risk of developing AF. This article reviews recent work on the association of SK channels and AF, genetic studies of SK channels, and discuss future investigation and developments regarding this field. KEY WORDS: Atrial fibrillation; Genetics; Small conductance calcium-activated potassium channels.

Idiopathic mediastinal fibrosis with involvement of the pulmonary vessels and left main coronary artery.

Idiopathic mediastinal fibrosis (IMF) is an uncommon clinical condition and the manifestations of this disease vary from a relatively benign disorder with minor symptoms to severe pulmonary vascular occlusion leading to mortality, commonly presenting a diagnostic and therapeutic challenge. Here, we present the case of a Taiwanese woman with obstruction of the left pulmonary veins and artery and stenosis of the left main coronary artery (LMCA) resulting from IMF. To our knowledge, this is the first reported case of IMF successfully treated with percutaneous balloon angioplasty with stent placement for the LMCA stenosis.

Significant association of rs13376333 in KCNN3 on chromosome 1q21 with atrial fibrillation in a Taiwanese population.

BACKGROUND: A recent study in individuals of European ancestry demonstrated a significant association of the single nucleotide polymorphism (SNP) rs13376333 in potassium intermediate/small conductance calcium-activated channel, subfamily N, member 3 (KCNN3) on chromosome 1q21 with lone atrial fibrillation (AF), indicating a common genetic basis for AF. The aim of the present study was to investigate whether this association between SNP rs13376333 and AF also exists in Taiwanese subjects. METHODS AND RESULTS: The SNP rs13376333 was compared in 214 lone AF patients (58.3±11.4 years) vs. 214 controls (57.7±13.2 years), and in 322 structural AF patients (69.6±13.7 years) vs. 322 controls (68.4±14.2 years) in a Taiwanese population, in a case-control design. The associations between SNP rs13376333 in KCNN3 and structural or lone AF were significant. In the lone AF group, the frequency of the minor allele of SNP rs13376333 was 8.6% compared with 3.0% in the controls (P<0.001; odds ratio [OR], 3.02; 95% confidence interval [CI]: 1.54-6.29). The frequency of the minor allele of SNP rs13376333 was 6.5% in structural AF patients compared with 3.1% in controls (P=0.004; OR, 2.18; 95%CI: 1.23-3.96). CONCLUSIONS: There are significant associations between SNP rs13376333 and the risk of developing both lone and structural AF in the Taiwanese population. The minor allele frequency of SNP rs13376333 was much lower in the Taiwanese population compared to that in the Caucasian population.

Numerical investigation on the enhanced carrier collection efficiency of Ga-face GaN/InGaN p-i-n solar cells with polarization compensation interlayers.

The impact of the polarization compensation InGaN interlayer between the heterolayers of Ga-face GaN/InGaN p-i-n solar cells is investigated numerically. Because of the enhancement of carrier collection efficiency, the conversion efficiency is improved markedly, which can be ascribed to both the reduction of the polarization-induced electric field in the InGaN absorption layer and the mitigation of potential barriers at heterojunctions. This beneficial effect is more remarkable in situations with higher polarization, such as devices with a lower degree of relaxation or devices with a higher indium composition in the InGaN absorption layer.

Unique clinical features and long term follow up of survivors of sudden cardiac death in an Asian multicenter study.

There has been no long-term clinical follow-up data of survivors or victims of sudden cardiac death (SCD). The Taiwan multi-center sudden arrhythmia death syndrome follow-up and clinical study (TFS-SADS) is a collaborative multi-center study with median follow-up time 43 months. In this cohort, the clinical characteristics of these SADS patients were compared with those with ischemic heart disease (IHD). In this SCD cohort, around half (42%) were patients with IHD, which was different from Caucasian SCD cohorts. Among those with normal heart, most had Brugada syndrome (BrS). Compared to those with SADS, patients with IHD were older, more males and more comorbidities, more arrhythmic death, and lower left ventricular ejection fraction. In the long-term follow-up, patients with SADS had a better survival than those with IHD (p < 0.001). In the Cox regression analysis to identify the independent predictors of mortality, older age, lower LVEF, prior myocardial infarction and history of out-of-hospital cardiac arrest were associated with higher mortality and beta blocker use and idiopathic ventricular fibrillation or tachycardia (IVF/IVT) with a better survival during follow-up. History of prior MI was associated with more arrhythmic death. Several distinct features of SCD were found in the Asia-Pacific region, such as higher proportion of SADS, poorer prognosis of LQTS and better prognosis of IVF/IVT. Patients with SADS had a better survival than those with IHD. For those with SADS, patients with channelopathy had a better survival than those with cardiomyopathy.

Renal Denervation Decreases Susceptibility to Arrhythmogenic Cardiac Alternans and Ventricular Arrhythmia in a Rat Model of Post-Myocardial Infarction Heart Failure.

Several studies have shown the beneficial effect of renal denervation (RDN) in the treatment of ventricular arrhythmia, especially in the setting of heart failure (HF). However, the underlying mechanism of antiarrhythmic effect of RDN is unknown. Arrhythmogenic cardiac alternans, particularly spatially discordant repolarization alternans, characterized by simultaneous prolongation and shortening of action potential duration (APD) in different myocardial regions, is central to the genesis of ventricular fibrillation in HF. Whether RDN decreases the susceptibility to arrhythmogenic cardiac alternans in HF has never been addressed before. The authors used a rat model of post-myocardial infarction HF and dual voltage-calcium optical mapping to investigate whether RDN could attenuate arrhythmogenic cardiac alternans that predisposes to ventricular arrhythmias, as well as the hemodynamic effect of RDN in HF. The HF rats had increased body weights, dilated hearts, and lower blood pressure. The HF rats also had longer ventricular APDs and a delay in the decay of the calcium transient, typical electrophysiological features of human HF. Susceptibility to calcium transient alternans, APD alternans, and spatially discordant APD alternans was increased in the HF hearts. RDN significantly attenuated a delay in the decay of the calcium transient, calcium transient and APD alternans, and importantly, the discordant APD alternans, and thereby decreased the incidence of induced ventricular arrhythmia in HF. RDN did not further decrease blood pressure in HF rats. In conclusion, RDN improves calcium cycling and prevents spatially discordant APD alternans and ventricular arrhythmia in HF. RDN does not aggravate hemodynamics in HF.

Developing an industry-oriented safety curriculum using the Delphi technique.

In this study, we examined the development of industry-oriented safety degree curricula at a college level. Based on a review of literature on the practices and study of the development of safety curricula, we classified occupational safety and health curricula into the following three domains: safety engineering, health engineering, and safety and health management. We invited 44 safety professionals to complete a four-round survey that was designed using a modified Delphi technique. We used Chi-square statistics to test the panel experts' consensus on the significance of the items in the three domains and employed descriptive statistics to rank the participants' rating of each item. The results showed that the top three items for each of the three domains were Risk Assessment, Dangerous Machinery and Equipment, and Fire and Explosion Prevention for safety engineering; Ergonomics, Industrial Toxicology, and Health Risk Assessment for health engineering; and Industrial Safety and Health Regulations, Accident Investigation and Analysis, and Emergency Response for safety and health management. Only graduates from safety programmes who possess practical industry-oriented abilities can satisfy industry demands and provide value to the existence of college safety programmes.

Additive effect of the metabolic syndrome score to the conventional CHADS2 score for the thromboembolic risk stratification of patients with atrial fibrillation.

BACKGROUND: The CHA2DS2-VASC scoring scheme may not be better than the CHADS2 scoring scheme in predicting thromboembolic risk for patients with atrial fibrillation (AF) in Asians. Metabolic syndrome is associated with an increased risk of thrombosis. OBJECTIVE: To evaluate whether metabolic syndrome offers incremental information over the CHADS2 scheme in predicting thromboembolic risk for patients with AF in the Taiwanese population. METHODS: The study population consisted of 721 consecutive patients with AF who had been followed up for a median of 10.8 years. Thromboembolic end points were defined as ischemic stroke/transient ischemic accident and peripheral embolisms. Clinical factors associated with thromboembolic end points were identified by Cox regression analysis. Different scoring systems were compared by receiver operating characteristic (ROC) analysis. RESULTS: We found that components in the CHADS2 scheme were associated with an increased risk of thromboembolism. The CHA2DS2-VASC scheme did not provide information additional to that provided by the CHADS2 scheme on thromboembolism risk (ROC area: 0.670 vs 0.665; P > .05). Metabolic syndrome components were also associated with increased risk of thromboembolism. The incident thromboembolic rate increased incrementally when metabolic syndrome score increased. Additional metabolic syndrome components provide additional information to the CHADS2 scheme on thromboembolism risk (ROC area: 0.670 vs 0.729; P = .034). We therefore proposed a new scoring scheme called CHADS2-MS scoring scheme. In patients with low to intermediate CHADS2 scores (0-1), the use of the CHADS2-MS score may additionally identify patients with high-risk AF for future thromboembolism. CONCLUSIONS: We, for the first time, demonstrated that metabolic syndrome components were associated with thromboembolic risk in Taiwanese patients with AF. In addition to the conventional CHADS2 scheme, the calculation of the CHADS2-MS score provides additional information on stroke risk assessment.

Renin-angiotensin system gene polymorphisms predict the risk of stroke in patients with atrial fibrillation: a 10-year prospective follow-up study.

BACKGROUND: Little evidence is available regarding the impact of genetic polymorphisms on the risk of stroke in patients with atrial fibrillation (AF). Angiotensin II plays a pathophysiologic role in prothrombotic atrial endocardial remodeling. OBJECTIVE: The purpose of this study was to investigate the effect of polymorphisms of renin-angiotensin system genes on the incidence of stroke in a prospective cohort of patients with AF. METHODS: A total of 712 AF patients were longitudinally followed-up for 10.3 ± 2.7 years. Eight polymorphisms of renin-angiotensin system genes were genotyped. RESULTS: Patients carrying the G-6 allele in the promoter of the angiotensinogen gene, which was associated with higher promoter activity, were more likely to develop stroke than were noncarriers (hazard ratio 2.54, 95% confidence interval [1.26-5.12], P = .009 after adjustment for CHADS2 score). G-6A polymorphism provides information additional to CHADS2 on stroke risk prediction (C-statistic 0.672 vs. 0.724, P = .039). In haplotype analysis, angiotensinogen gene promoter haplotypes containing -217G/-6G, which was associated with the highest promoter activity, were associated with an increased risk of stroke (P = .004). G-217/G-6 haplotype carriers were even more likely to develop stroke than were noncarriers (hazard ratio 2.78, 95% confidence interval 1.37-5.64, P = .003 after multivariable adjustment). In pharmacogenetic analysis, the increased risk of stroke in subjects carrying G-6 was eliminated by concomitant treatment with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker (P = .012 for interaction). CONCLUSION: In addition to the CHADS2 score, angiotensinogen gene polymorphisms may be considered an additional genetic predictor of stroke in patients with AF. Genotyping of the angiotensinogen gene is helpful to determine which AF patients may benefit from treatment with an angiotensin-converting enzyme inhibitor or angiotensin II receptor blocker.

Developing a competency model for safety professionals: correlations between competency and safety functions.

INTRODUCTION: Personal competency is an important factor influencing individual performance. The objective of this study was to develop a competency model of safety professionals and investigate the factors contributing to their competency to achieve greater safety performance. METHOD: In this study, 299 participants (153 safety professionals and 146 safety educators) completed self-administered questionnaires. The response rate was 75%. RESULTS: The results of exploratory factor analysis and cluster analysis revealed that the competency scale for safety professionals comprised five factors. Additionally, the factor "safety and health training and management" explained most of the variance in the competency. The multivariate analysis of variance (MANOVA) results showed that the respondents' perception of professional competency was significantly influenced by the following factors: occupation, age, job tenure, level of education, and work status. Additionally, the Pearson product-moment correlation coefficient analysis indicated that a safety professional's perceived competencies and safety functions were positively correlated. IMPACT ON INDUSTRY: This study discusses possible reasons for the influence of the factors previously mentioned and explains how the results can contribute to the development of safety competencies and curricula.