A New Predictive Equation for Estimating Serum Ionized Calcium Levels in Patients on Chronic Hemodialysis.

BACKGROUND Circulating calcium mainly carries out its physiologic function in its ionized form (iCa). Clinically, iCa is usually estimated by multiplying the total calcium (TCa) level by 0.5 in the general population, but this method is not accurate when applied to patients on long-term hemodialysis (CHD). Accordingly, this study aimed to develop a predictive function for iCa in patients on CHD by incorporating TCa and other additional variables. MATERIAL AND METHODS This was a retrospective cross-sectional study consisting of 2 cross-sectional datasets: a derivation set including 469 CHD patients in June 2019, and a validation set including 446 CHD patients in September 2019. The derivation set's data were analyzed using the stepwise model selection of machine learning with 10-fold cross-validation to develop a predictive function for iCa. This predictive function was then applied to the validation set's data, and the predictive function's estimated iCa was compared with the actual laboratory iCa by using the paired-samples t test and intraclass correlation coefficient. RESULTS After analyzing the routine laboratory data parameters of patients in the derivation set, the following 5 variables were included in the predictive function of iCa: blood urea nitrogen, creatinine, phosphate, TCa, and albumin. This predictive function was applied to the validation set to yield an estimated iCa level that was not significantly different from the laboratory-measured iCa level of the validation dataset (P=0.676) with an excellent ICC of 0.905. CONCLUSIONS We developed a new predictive function that accurately measures the iCa in patients on CHD by using routine laboratory data.

Association between trace element concentrations and anemia in patients with chronic kidney disease: a cross-sectional population-based study.

Anemia is common in chronic kidney disease (CKD) and may be affected by trace element concentrations. While the concentrations of trace elements are known to be altered in CKD, the relationship between trace element and hemoglobin concentrations has not been systematically investigated in a large cohort. This study aims to examine associations between trace element concentrations and anemia in patients with CKD. Data from the National Health and Nutrition Examination Survey collected from 2011 to 2014 were used for this analysis. The participants who were more than 20 years old were included. A total of 3057 participants were included; the final cohort was divided into two groups based on CKD status. The concentrations of hemoglobin, iron, zinc, and manganese were significantly lower in participants with than without CKD (all p<0.05). Multivariate analyses showed that in patients without CKD, hemoglobin concentrations correlated positively with iron, zinc, and cadmium (ß=0.005, 0.009, and 0.33, respectively), but correlated negatively with copper levels (ß=-0.002). In patients with CKD, hemoglobin concentrations correlated positively with cadmium and selenium, but negatively with copper levels (ß=0.57, 0.007, and -0.008, respectively). The serum iron concentration was found to correlate positively with zinc, cadmium, and selenium, but negatively with copper and manganese concentrations in the total study population (all p<0.05). The associations between serum concentrations of trace elements and hemoglobin differ between patients with and without CKD. Further investigations are warranted to determine whether patients with CKD have distinct trace element requirements.

Free-electron-laser coherent diffraction images of individual drug-carrying liposome particles in solution.

Using the excellent performances of a SACLA (RIKEN/HARIMA, Japan) X-ray free electron laser (X-FEL), coherent diffraction imaging (CDI) was used to detect individual liposome particles in water, with or without inserted doxorubicin nanorods. This was possible because of the electron density differences between the carrier, the liposome, and the drug. The result is important since liposome nanocarriers at present dominate drug delivery systems. In spite of the low cross-section of the original ingredients, the diffracted intensity of drug-free liposomes was sufficient for spatial reconstruction yielding quantitative structural information. For particles containing doxorubicin, the structural parameters of the nanorods could be extracted from CDI. Furthermore, the measurement of the electron density of the solution enclosed in each liposome provides direct evidence of the incorporation of ammonium sulphate into the nanorods. Overall, ours is an important test for extending the X-FEL analysis of individual nanoparticles to low cross-sectional systems in solution, and also for its potential use to optimize the manufacturing of drug nanocarriers.

Flat-on ambipolar triphenylamine/C60 nano-stacks formed from the self-organization of a pyramid-sphere-shaped amphiphile.

A giant amphiphile, which is constructed with an amorphous nano-pyramid (triphenylamine, TPA) and a crystalline nano-sphere (C60), was synthesized. Structural characterization indicates that this pyramid-sphere-shaped amphiphile (TPA-C60 ) forms a solvent-induced ordered phase, in which the two constituent units self-assemble into alternating stacks of two-dimensional (2D) TPA and C60 nano-sheets. Due to the complexity of the molecular structure and the amorphous nature of the nano-pyramid, phase formation was driven by intermolecular C60-C60 interactions and the ordered phase could not be reformed from the TPA-C60 melt. Oriented crystal arrays of TPA-C60 , which contain flat-on TPA/C60 nano-stacks, can be obtained via a PDMS-assisted crystallization (PAC) technique. The flat-on dual-channel supramolecular structure of TPA-C60 delivered ambipolar and balanced charge-transport characteristics with an average µe of 2.11 × 10-4 cm2 V-1 s-1 and µh of 3.37 × 10-4 cm2 V-1 s-1. The anisotropic charge-transport ability of the pyramid-sphere-shaped amphiphile was further understood based on the lattice structure and the lattice orientation of TPA-C60 revealed from electron diffraction analyses.

Highly specific in vivo gene delivery for p53-mediated apoptosis and genetic photodynamic therapies of tumour.

Anticancer therapies are often compromised by nonspecific effects and challenged by tumour environments' inherent physicochemical and biological characteristics. Often, therapeutic effect can be increased by addressing multiple parameters simultaneously. Here we report on exploiting extravasation due to inherent vascular leakiness for the delivery of a pH-sensitive polymer carrier. Tumours' acidic microenvironment instigates a charge reversal that promotes cellular internalization where endosomes destabilize and gene delivery is achieved. We assess our carrier with an aggressive non-small cell lung carcinoma (NSCLC) in vivo model and achieve >30% transfection efficiency via systemic delivery. Rejuvenation of the p53 apoptotic pathway as well as expression of KillerRed protein for sensitization in photodynamic therapy (PDT) is accomplished. A single administration greatly suppresses tumour growth and extends median animal survival from 28 days in control subjects to 68 days. The carrier has capacity for multiple payloads for greater therapeutic response where inter-individual variability can compromise efficacy.

Localized surface plasmon-induced emission enhancement of a green light-emitting diode.

The output enhancement of a green InGaN/GaN quantum-well (QW) light-emitting diode (LED) through the coupling of a QW with localized surface plasmons (LSPs), which are generated on Ag nanostructures on the top of the device, is demonstrated. The suitable Ag nanostructures for generating LSPs of resonance energies around the LED wavelength are formed by controlling the Ag deposition thickness and the post-thermal-annealing condition. With a 20 mA current injected onto the LED, enhancements of up to 150% in electroluminescence peak intensity and of 120% in integrated intensity are observed. By comparing this with a similar result for a blue LED previously published, it is confirmed that surface plasmon coupling for emission enhancement can be more effective for an InGaN/GaN QW of lower crystal quality, which normally corresponds to the emission of a longer wavelength.

Relationships between insight and psychosocial adjustment in patients with bipolar I disorder.

OBJECTIVES: The aim of this cross-sectional study was to examine the relationships between insight and psychosocial adjustment in outpatients with bipolar I disorder in clinical remission. METHODS: Using the Schedule of Assessment of Insight (SAI) and its expanded version (SAI-E), we evaluated 50 consecutive patients with bipolar I disorder in remission to determine their level of insight. We also evaluated their psychosocial adjustment using the Community Life Scale. Relationships among psychosocial adjustment, insight, residual affective symptoms, and demographic and clinical characteristics were examined. RESULTS: The results of the multiple regression analysis indicated that having a higher total SAI or SAI-E insight score and having no residual affective symptoms were significantly associated with better psychosocial adjustment in patients with bipolar I disorder. CONCLUSIONS: In this cross-sectional study, better insight and less residual affective symptoms were correlated with good psychosocial adjustment. To address the causality issue, a longitudinal study is needed.

Free radial forearm flap in an adult with hypospadias.

A 22-year-old man presented with a scarred neophallus and complex hypospadias. The local penile skin was inadequate for urethral repair. A 16 cm free radial forearm flap was used for urethral replacement. Microvascular anastomosis allowed this flap to remain viable and functional. One year postoperatively, the patient had satisfactory functional and cosmetic outcomes. A small fistula developed in the course of the proximal anastomosis, and it was successfully repaired. Our case describes the successful use of a free radial forearm flap for urethral reconstruction.

Changes in insight among patients with bipolar I disorder: a 2-year prospective study.

OBJECTIVES: The aim of this 2-year prospective study was to examine changes in insight among bipolar patients with different clinical courses. METHODS: A cohort of 65 patients with bipolar I disorder in remission was recruited for this study. They received six follow-up assessments over a 2-year period. The Schedule of Assessment of Insight-Expanded version (SAI-E) was used to determine their levels of insight, while the Young Mania Rating Scale (YMRS) and the Hamilton Rating Scale for Depression (HAM-D) were used to determine affective symptoms. Types of changes in insight among bipolar patients were analyzed according to the different clinical courses during the 2-year follow-up period. RESULTS: Insight in consistently stable patients was steady during the 2-year period. Insight decreased during the manic period in patients with only a single manic episode as well as in those with repeated manic episodes. However, insight returned to the pre-episode level for patients with only a single manic episode, but did not for most of the patients with repeated episodes. No changes in insight were observed during depressive episodes for either patients with a single or those with repeated depressive episodes. CONCLUSIONS: The types of insight changes among bipolar patients during the 2-year period were various and depended on the different clinical courses. Frequent mood disturbance episodes may cause patient insight to deteriorate.

Formation of various metal nanostructures with thermal annealing to control the effective coupling energy between a surface plasmon and an InGaN/GaN quantum well.

We demonstrate the variations of the photoluminescence (PL) spectral peak position and intensity through the surface plasmon (SP) coupling with an InGaN/GaN quantum well (QW) by forming Ag nanostructures of different scale sizes on the QW structure with thermal annealing. By transferring an Ag thin film into a nanoisland structure, we can not only enhance the PL intensity, but also adjust the SP dispersion relation and hence red-shift the effective QW emission wavelength. Such an emission spectrum control can be realized by initially coating Ag films of different thicknesses. Although the screening process of the quantum-confined Stark effect, which can result in PL spectrum blue-shift and intensity enhancement, also contributes to the variations of the emission behaviour, it is found that the SP-QW coupling process dominates in the observed phenomena.

Relationships between insight and medication adherence in outpatients with schizophrenia and bipolar disorder: prospective study.

The aim of the present study was to explore the associations between insight and medication adherence at index interview and at 1-year follow-up interview in bipolar and schizophrenic outpatients. The Schedule for Assessment of Insight (SAI) and its expanded version (SAI-E) were used to provide a baseline insight score for 65 bipolar subjects and 74 schizophrenic subjects considered to be in remission or to have minimal psychopathology. Medication adherence of subjects was assessed at index interview and at 1-year follow-up interview, and the association between insight and medication adherence was analyzed cross-sectionally and prospectively. The results of the analysis reveal that in bipolar subjects, the index SAI scores for insight into treatment, mental-health status and psychotic experiences, and total SAI-E were positively correlated with medication adherence at both index and 1-year follow-up interviews. However, in schizophrenic subjects, insight into treatment and total SAI-E correlated positively with medication adherence at index interview but not at 1-year follow-up interview. Medication adherence at index interview could predict medication adherence 1 year later in both bipolar and schizophrenic subjects. These results indicate that the predictive value of insight for medication adherence differs between bipolar and schizophrenic patients, and building insight is an important step for establishing medication adherence in bipolar patients.

Breast reconstruction with a muscle-sparing free transverse rectus abdominis myocutaneous flap: comparison between immediate and delayed groups.

BACKGROUND: Breast reconstruction offers not only physical but also psychological rehabilitation. Autologous tissue transfer is a good option for breast reconstruction. The purpose of this study was to investigate the success rate, complications, and cosmetic outcomes following use of a muscle-sparing free transverse rectus abdominis myocutaneous (TRAM) flap for breast reconstruction. METHODS: Between August 1999 and February 2001, 15 consecutive patients underwent breast reconstruction using a muscle-sparing free TRAM flap after a mastectomy. Ten patients received mastectomies and immediately underwent breast reconstruction using muscle-sparing free TRAM flaps at Chang Gung Memorial Hospital. The remaining 5 patients first received a modified radical mastectomy and then underwent breast reconstruction. RESULTS: The mean age of patients was 43.9 (range, 32 to 50) years. Ten patients (67%) underwent immediate reconstructions, and 5 (23%) underwent delayed reconstructions. The overall success rate was 93.3%. Postoperative complications included 1 abdominal seroma and 1 small area of breast fat necrosis. Six of 10 patients with immediate reconstruction underwent both adjuvant chemotherapy and hormone therapy, while 3 patients received only chemotherapy. None of these adjuvant therapies were delayed by the reconstructive surgery. At a mean follow-up of 26.7 months, no local recurrence had been found, and 93% of patients were satisfied with the esthetic results. CONCLUSIONS: A muscle-sparing free TRAM flap is a good option for breast reconstruction. Both the success rate and patient satisfaction are high. The subsequent adjuvant therapy need not be delayed following immediate reconstruction.