Our findings indicate that DOAC are as likely as warfarin to prevent all strokes and systemic embolic events without increasing risk of major bleeding events among AF patients with kidney impairment. These findings should encourage physicians to prescribe DOAC in AF patients with CKD without fear of bleeding. The major limitation is that the results of this study chiefly reflect CKD stage G3. Application of the results to CKD stage G4 patients requires additional investigation. Furthermore, we could not assess CKD stage G5 patients. Future reviews should assess participants at more advanced CKD stages. Additionally, we could not conduct detailed analyses of subgroups and sensitivity analyses due to lack of data.
To examine the effects of connectivity among pores of almost the same size and of different size and geometry
on adsorption hysteresis and pore criticality, we measured the temperature dependence of the adsorption−desorption isotherm of nitrogen onto MCM-48 and SBA-16 materials, respectively, with well-defined three-dimensional networks of cylindrical pores and cagelike pores, over a wide temperature range of T/T
c = 0.43
to 0.90. The results for MCM-48 strongly suggest that interconnections among pores of almost the same size
and geometry do not have a significant effect on the adsorption hysteresis and pore criticality. For SBA-16
with well-defined ink-bottle pores, capillary condensation in the hysteretic isotherms takes place near the
equilibrium, whereas capillary evaporation from large cavities is delayed. The classical concept of pore blocking
is not supported by the experimental isotherms for SBA-16, because the delayed desorption is not concerned
with emptying of the small channels. The hysteresis shrinks with increasing temperature and eventually
disappears well below the bulk critical temperature, in disagreement with the classical concept of pore blocking.
Aim: After the Great East Japan Earthquake, over 160,000 residents near the Fukushima Daiichi Nuclear Power Plant were forced to evacuate due to a nuclear accident. Health problems in these evacuees have since become major issues. We examined the association between evacuation and incidence of metabolic syndrome (METS) among residents in Fukushima.Methods: We conducted a cohort study among residents aged 40–74 years without METS at the time of the disaster in Fukushima. Among 20,269 residents who met the inclusion criteria before the disaster, 8,547 residents (3,697 men and 4,850 women; follow-up proportion: 42.2%) remained available for follow-up examinations after the disaster by the end of March 2013. The main outcome was incidence of METS, defined by guidelines from the Japanese committee, using data from the Comprehensive Health Check before and after the disaster. We divided participants by evacuation status and compared outcomes between groups. Using a logistic regression model, we estimated the odds ratio for incidence of METS, adjusting for potential confounders, age, gender, waist circumference, exercise habit, and alcohol consumption.Results: Incidence of METS was higher in evacuees (men 19.2%, women 6.6%) than in non-evacuees (men 11.0%, women 4.6%). Evacuees had higher body mass index, waist circumference, triglycerides, and fasting plasma glucose after the disaster than non-evacuees. We found a significant association between evacuation and incidence of METS (adjusted odds ratio 1.72, 95% confidence interval; 1.46–2.02).Conclusion: This is the first study to demonstrate that evacuation after a disaster is associated with increased incidence of METS.
the geriatric nutritional risk index (GnRi) and creatinine (cr) index are indexes often used as nutritional surrogates in patients receiving hemodialysis. However, few studies have directly compared the clinical characteristics of these two indexes. We investigated 3,536 hemodialysis patients enrolled in the Japan DOPPS phases 4 and 5. The primary outcome was all-cause mortality and the main exposures were the GNRI and Cr index. We confirmed and compared the association between these indexes and mortality risk as estimated by a multivariable-adjusted cox proportional hazards model. During the median 2.2-year follow-up period, 414 patients died of any cause. In the multivariable-adjusted model, lower GnRi and cr index were both associated with increased risk of all-cause mortality, and these associations were further confirmed by restricted cubic spline curves. The predictability of all-cause mortality, as represented by the c-statistic, was comparable between the two indexes. furthermore, baseline nutritional surrogates that corresponded with lower GnRi or cr index values were comparable between the two indexes. Given that calculating the GnRi is simpler than calculating the cr index, our data suggest that the GnRi may be preferable to the cr index for predicting clinical outcomes in patients undergoing maintenance hemodialysis.Malnutrition is highly prevalent in patients receiving maintenance hemodialysis 1-3 . Inflammation often coexists with malnutrition. Because these two pathologies synergistically promote clinically important complications, including atherosclerotic diseases, they are now jointly recognized by the integrated term "malnutrition-inflammation-atherosclerosis (MIA) syndrome" or "malnutrition-inflammation complex/cachexia syndrome (MICS)" 4,5 . Identification of objective markers that both reflect MIA syndrome and can be used for daily evaluation of nutritional and inflammatory status in this population is now urgently required.A wide variety of nutritional and inflammatory markers and tools have been reported for the evaluation of MIA syndrome or MICS in hemodialysis patients. Because these markers and indexes are insufficient when used alone, many clinicians use them in combination in clinical practice. These include subjective global assessment (SGA); malnutrition-inflammation score (MIS); serum levels of albumin, creatinine (Cr), and C-reactive protein (CRP); body mass index (BMI); normalized protein catabolic rate (nPCR); interleukin-6; geriatric nutritional risk index (GNRI); Cr index; Objective Score of Nutrition on Dialysis (OSND); simple protein energy wasting score; Subjective Global Assessment-Dialysis Malnutrition Score (SGA-DMS); bioelectrical impedance analysis (BIA); and dual energy X-ray absorptiometry (DEXA) 3,5-15 . Of these, the GNRI and Cr index are often used to evaluate nutritional status in hemodialysis patients 9,10 . The GNRI is calculated by serum albumin level and BMI, while the Cr index is determined by age, gender, Kt/V for urea, and pre-dialysis serum Cr level. Thes...
investigate the association of the national health guidance intervention in Japan with population health outcomes. DESIGN, SETTING, AND PARTICIPANTS This cohort study used a regression discontinuity design that included men aged 40 to 74 years who participated in the national health screening program in Japan from April 2013 to March 2018. EXPOSURES Assignment to the national health guidance intervention (counseling on healthy lifestyle and appropriate clinical follow-up for individuals found to have waist circumference of 85 cm or greater with 1 or more cardiovascular risk factors during annual national health screening program). MAIN OUTCOMES AND MEASURES Changes in obesity status (body weight, body mass index, waist circumference), and cardiovascular risk factors (blood pressure, hemoglobin A 1c level, and low-density lipoprotein cholesterol level) 1 to 4 years after screening.
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