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BackgroundFracture Risk Assessment Tool (FRAX) and bone turnover markers (BTMs) predict fractures in the general population. However, the role of FRAX and BTMs in predicting mortality remains uncertain in hemodialysis (HD) patients.MethodsOne hundred and sixty-four HD patients stratified by low or high risk of 10-year fracture probability using FRAX. High risk of fracture was defined as 10-year probability of hip fracture ≥3% or major osteoporotic fracture ≥20%. The association of high risk of fracture and BTMs with all-cause mortality and cardiovascular (CV) mortality were evaluated using multivariate-adjusted Cox regression analysis.ResultsEighty-five (51.8%) patients were classified as high risk of fracture based on FRAX among 164 HD patients. During a mean follow-up period of 3.5 ± 1.0 years, there were 39 all-cause deaths and 23 CV deaths. In multivariate-adjusted Cox regression, high risk of fracture based on FRAX was independently associated with all-cause mortality [hazard ratio (HR): 2.493, 95% confidence interval (CI): 1.026–6.056, p = 0.044) but not with CV mortality (HR: 2.129, 95% CI: 0.677–6.700, p = 0.196). There were no associations between BTMs and mortality risk. Furthermore, lower geriatric nutritional risk index (GNRI) was significantly associated with increased CV mortality (HR: 0.888, 95% CI: 0.802–0.983, p = 0.022) after adjusting by confounding variables.ConclusionHigh risk of fracture using FRAX was an independent predictor of all-cause mortality in patients undergoing HD. FRAX, rather than BTMs, has an important role of prognostic significance in HD patients.

Objective To compare outcome after noncardiac surgery between HF patients with reduced versus preserved ejection fraction. Summary of background data HF patients who undergo major noncardiac surgery have higher risks of morbidity and mortality compared to the general population. However, it is unclear whether HF subtypes confer different risk. Methods This retrospective study included HF patients, 45 years or older, who underwent noncardiac surgery from January 1, 2010 to September 30, 2015 in the Nationwide Readmissions Database. Multivariable logistic regression models were used to provide adjusted rates of postoperative outcomes. Hospital-level clustering and Nationwide Readmissions Database sampling weights were applied to all models. Results Of the weighted 296,057 HF patients [HF with reduced ejection fraction (HFrEF) 48.1%; HF with preserved ejection fraction (HFpEF) 51.9%] who underwent noncardiac surgery, 41.1% had cardiopulmonary complications, 55.7% had noncardiopulmonary complications and 5.4% died during hospitalization. Thirty-day readmission rates for the weighted 232,852 HF patients was 21.5%. The adjusted odds ratios of cardiopulmonary and noncardiopulmonary complications, in-hospital mortality and 30-day readmission for HFrEF compared to HFpEF patients were 1.01 [95% confidence interval (CI), 0.99-1.04], 1.05 (95% CI, 1.02-1.07), 1.27 (95% CI, 1.21-1.34), and 1.08 (95% CI, 1.05-1.12), respectively. Conclusions HFrEF patients have increased risks of noncardiopulmonary complications, mortality, and readmission after noncardiac surgery. These findings suggest that targeted perioperative care for HF subtypes may be crucial for the growing population of HF patients undergoing noncardiac surgery. Despite cardiopulmonary complications not being statistically different between HF subtypes, given the high occurrence rate, any intervention to decrease the rate would be clinically meaningful.

An efficient scheme for the synthesis of 1,1-cyclopentylenylbisphenol (bisphenol CP) has been developed starting from dicyclopentadiene, a C5 byproduct from the petroleum cracking process. The synthetic steps leading to bisphenol CP consist of mostly isomerization and addition reactions, which are higher in their atom-economy efficiencies than those based upon condensation reactions. In addition, alkoxylation by cyclic carbonates converted bisphenol CP into ethoxylated and propoxylated ether diols. The transformation of hydroxyl functional groups from bisphenols to alkoxylated alcohols increased the reactivity of their hydroxyl groups toward isocyanates, as evidenced by achieving >3 times higher molecular weights of the segmented polyurethanes (PUs) in GPC analysis using alkoxylated diols as chain extenders instead of bisphenols. In addition, the incorporation of five-membered cardo-type groups onto the PU side chains through alkoxyl diols of bisphenol CP also significantly enhances the phase mixing of th...

This study aimed to investigate the performance of innovative and traditional cardiometabolic indices, including body mass index (BMI), waist circumference (WC), Chinese visceral adiposity index (CVAI), visceral adiposity index, lipid accumulation product, a body shape index (ABSI), body roundness index, conicity index (CI), triglyceride-glucose (TyG) index, TyG-BMI, and TyG-WC, in estimating atherosclerotic cardiovascular disease (ASCVD) risk in 3143 Taiwanese adults aged 20–79 years. Elevated 10-year ASCVD risk was defined as ≥7.5% using the Pooled Cohort Equations. The performance of different indices in estimating elevated ASCVD risk was assessed by receiver operating characteristic (ROC) curves. In multivariate-adjusted logistic regression analyses, all cardiometabolic indices (p-value &lt, 0.001) were significantly associated with elevated ASCVD risk in both genders, except for ABSI and CI in women. In particular, CVAI had the largest area under the curve (AUC) in men (0.721) and women (0.883) in the ROC analyses. BMI had the lowest AUC in men (0.617), while ABSI had the lowest AUC in women (0.613). The optimal cut-off value for CVAI was 83.7 in men and 70.8 in women. CVAI performed best among various cardiometabolic indices in estimating elevated ASCVD risk. CVAI may be a reliable index for identifying people at increased risk of ASCVD.

Double-lumen central venous catheter (CVC) is a rapid access technique for hemodialysis (HD) when an arteriovenous fistula or graft is not available. A variety of procedure-related complications have been reported, such as infection and pneumothorax, but serious cardiac complications are relatively less mentioned. We report a uremic woman with preexisting left bundle branch block who required emergent HD and received jugular double-lumen CVC insertion, which was complicated by short-duration ventricular tachycardia followed by complete atrio-ventricular block and bradycardia. Pharmacological management did not reverse heart rate and rhythm. External pacing was not applied because she remained hemodynamically stable in the course of HD. Heart rate returned to sinus rhythm with left bundle branch block 4 hours later and did not recur through the whole admission period. We speculate that the transient arrhythmia might have been induced by mechanical contact with the ventricular wall during the procedure with the guided metallic wire. In conclusion, physicians responsible for CVC catheterization should pay more attention to patients with preexisting cardiac arrhythmia to prevent such technical mistakes from transpiring.

Double-lumen central venous catheter (CVC) is a rapid access technique for hemodialysis (HD) when an arteriovenous fistula or graft is not available. A variety of procedure-related complications have been reported, such as infection and pneumothorax, but serious cardiac complications are relatively less mentioned. We report a uremic woman with preexisting left bundle branch block who required emergent HD and received jugular double-lumen CVC insertion, which was complicated by short-duration ventricular tachycardia followed by complete atrio-ventricular block and bradycardia. Pharmacological management did not reverse heart rate and rhythm. External pacing was not applied because she remained hemodynamically stable in the course of HD. Heart rate returned to sinus rhythm with left bundle branch block 4 hours later and did not recur through the whole admission period. We speculate that the transient arrhythmia might have been induced by mechanical contact with the ventricular wall during the procedure with the guided metallic wire. In conclusion, physicians responsible for CVC catheterization should pay more attention to patients with preexisting cardiac arrhythmia to prevent such technical mistakes from transpiring.