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Background: Pediatric intraspinal space-occupying lesions are relatively uncommon. However, these lesions can result in neurological disabilities due to misdiagnosis and delayed treatment. The main goal of the present study is to evaluate the clinical and radiological features and treatment options of pediatric intraspinal space-occupying lesions in order to improve the clinical recognition and management. Methods: Clinical data of 27 children with intraspinal space-occupying lesions who underwent surgery treatment in a tertiary-care hospital between 2010 and 2018 were retrospectively reviewed and analyzed. Results: Of these 27 patients, 14 (51.85%) were girls and 13 (48.15%) were boys. The most common age group affected was 10~14 years (62.96%, 9 girls and 8 boys in this age group). The mean age was 10.11 years old. Pain and weakness were the most common clinical symptoms. Preoperative magnetic resonance imaging (MRI) identified intramedullary (10 cases, 37.04%), intradural extramedullary (10 cases, 37.04%) and extradural (7 cases, 25.92%) lesions, respectively. The majority of the lesions were intraspinal tumors (23 cases, 85.19%). The histological diagnosis of tumors included embryonic residual tumors (6 cases, 22.22%), ependymoma (5 cases, 18.52%), primitive neuroectodermal tumors (PNET) (3 cases, 11.11%), schwannomas (2 cases, 7.4%), ganglioneuroma (1 case, 3.7%), Ewing’s sarc (1 case, 3.7%), B-cell non Hodgkin lymphoma (1 case, 3.7%), Hodgkin lymphoma (1 case, 3.7%), chondrosarcoma (1 case, 3.7%), ganglioglioma (1 case, 3.7%), and glioma (1 case, 3.7%). Conclusions: The incidence of pediatric intraspinal space-occupying lesions is low, and the clinical manifestation is lack of specificity. The prognosis for children with malignant tumors is poor and surgical resection is still the primary treatment option.

Background Connexin 43 (Cx43) plays a central role in the inflammatory response and wound healing. Targeting Cx43 expression reduces inflammation in a variety of injuries. The expression pattern of Cx43 has not been described for many inflammatory skin diseases. Objectives To describe the expression patterns of Cx43 in eczema, psoriasis, Steven‐Johnson syndrome/toxic epidermal necrolysis. Methods Archival skin biopsies from patients with eczema, psoriasis, and Steven‐Johnson syndrome/toxic epidermal necrosis were identified and examined, with sister sections stained for Cx43 and imaged by confocal microscopy. All samples were compared to age and site‐matched normal skin controls. Results Epidermal Cx43 is reduced in acute eczema, absent in regions of spongiosis, and is highly elevated in subacute and chronic eczema. In plaque psoriasis, Cx43 is overexpressed in areas with psoriasiform hyperplasia with a fish‐scale‐like appearance but is lost in regions surrounding neutrophil microabscesses. Cx43 staining is strong in the neutrophils within these microabscesses. In SJS/TEN, Cx43 expression is elevated in areas bordering normal tissue but is rapidly lost in areas of keratinocyte necrosis. Conclusions Dynamic changes in Cx43 levels are seen in inflammatory skin diseases and may represent future potential therapeutic targets., Connexin 43 (Cx43) plays a central role in the inflammatory response and wound healing. Targeting Cx43 expression reduces inflammation in a variety of injuries. Here we examine the changes in Cx43 protein levels in the epidermis in eczema, psoriasis, Steven‐Johnson Syndrome/Toxic Epidermal necrolysis.

Background: This study aimed to describe biomarkers using the comprehensive index of biomarker (CIB) based on consistency rate in both case control (Youden index, Yen) and cohort study (Crc) to determine the efficacy of a biomarker. Methods: The CIB is the geometric mean of Yen and Crc. The simulated data were generated to observe CIB features of sensitivity, specificity, and receiver operating characteristic (ROC) analysis for biomarkersResults: CIB was found to be related to the CRC values ROC analysis. The higher Spe could indicate better diagnostic power and the higher Sen could indicate better joint action for biomarkers with the same Yen. Although Yen is the common index used to evaluate the effectiveness of a biomarker, unfortunately, the Yen value was significantly larger than CIB value under the moderate Spe, showing overestimation.Conclusion: The CIB with combination of consistency in both case control and cohort study could be more reasonable. The CIB could provide a better understanding of the power of a biomarker and would be better at evaluating biomarkers from new systems or concepts.

Introduction Periodic surveys on tobacco use patterns and other aspects of tobacco use among school-going adolescents in Malaysia provide information on the effectiveness of anti-smoking measures implemented. However, such information is limited in Malaysia. We investigated the prevalence of smoking and other related aspects among middle-secondary school students in Malaysia from the years 2003-2016 to fill this gap. Methods We analyzed data from the Global Youth Tobacco Survey (GYTS) 2003, GYTS 2009, and the Tobacco and Electronic Cigarette Survey among Malaysia Adolescents (TECMA) 2016. The surveys employed multistage sampling to select representative samples of adolescents attending secondary school in Malaysia. Data were collected using a pre-validated self-administered anonymous questionnaire adopted from the GYTS. Results Between 2003 and 2016, major changes occurred in which there were reductions in the prevalence of ever smoking, current smoking, and susceptibility to smoking. Reductions were also observed in exposure to SHS in public places and in the home. The proportion of school-going adolescents who support a ban on smoking in public places increased between 2013 to 2016, and there was a significant reduction in the proportion of respondents that were offered 'free' cigarettes by tobacco company representatives. However, there was no difference in the proportion of adolescents who initiated smoking before the age of 10 years and current smokers seeking advice to quit smoking across the time period. Conclusions Our study indicates that the smoking policies and measures have been effective in reducing smoking prevalence, secondhand smoke exposure, and access to cigarettes, among school-going adolescents in Malaysia. However, measures to reduce smoking initiation and increase smoking cessation need to be strengthened to reduce the burden of smoking-related diseases in Malaysia in the long-term.

Recently, mobile edge computing has received widespread attention, which provides computing infrastructure via pushing cloud computing, network control, and storage to the network edges. To improve the resource utilization and Quality of Service, we investigate the issue of task offloading for End-EdgeCloud orchestrated computing in mobile networks. Particularly, we jointly optimize the server selection and resource allocation to minimize the weighted sum of the average cost. A cost minimization problem is formulated underjoint the constraints of cache resource and communication/computation resource of edge servers. The resultant problem is a Mixed-Integer Non-linear Programming, which is NP-hard. To tackle this problem, we decompose it into simpler subproblems for server selection and resource allocation, respectively. We propose a low-complexity hierarchical heuristic approach to achieve server selection, and a Cauchy-Schwards Inequality based closed-form approach to efficiently determine resource allocation. Finally, simulation results demonstrate the superior performance of the proposed scheme on reducing the weighted sum of the average cost in the network.

BACKGROUND Glomerulonephritis commonly causes kidney failure. Immunosuppressant treatment may be diabetogenic, but data on hyperglycaemia in glomerulonephritis treated with usual clinical care are scant. AIM To assess the epidemiology, risk factors and outcomes for new-onset diabetes among patients with glomerular disease (NODAG). METHODS A single-centre retrospective cohort of nondiabetic adults diagnosed with glomerulonephritis between January 2011 and July 2015. Clinical, laboratory and pharmacotherapy data were retrieved from electronic medical records. Using modified American Diabetes Association criteria, the primary outcome of NODAG was present if fasting venous glucose was ≥7 mmol/L for at least two readings, HbA1c was ≥6.5% or if patient required antidiabetic medications. Secondary outcomes were end-stage renal disease, cardiovascular disease and death. RESULTS NODAG occurred in 48 patients (10.7%); 22 required antidiabetic medication at median 6.2 (interquartile range 1.7, 20.0) months after glomerulonephritis diagnosis. Patients with NODAG had higher prebiopsy fasting glucose, greater proteinuria and lower fasting high-density lipoprotein cholesterol levels. Methylprednisolone and cyclophosphamide were more commonly used among patients with NODAG. In multivariate logistic regression, greater proteinuria (odds ratio 1.08 (95% confidence interval 1.01, 1.16), P = 0.02) and methylprednisolone use (odds ratio 4.02 (95% confidence interval 1.76, 9.18), P = 0.001) were significantly associated with NODAG, independent of the triglyceride/high-density lipoprotein cholesterol ratio as a surrogate measure of insulin resistance. Median follow up was 39.6 (26.9, 57.2) months. Secondary outcomes were not significantly different in patients with and without NODAG. CONCLUSION Proteinuria and methylprednisolone were associated with incident diabetes among patients with glomerular disease treated with usual care. At-risk patients should be appropriately counselled and monitored for hyperglycaemia.

Aim Increasing demands for care provision to older adults require good physical and mental health among caregivers. Few studies have examined the health status and correlates of quality of life among caregivers of older adults. The present study therefore sought to examine the prevalence of chronic physical conditions, psychological distress, and correlates of physical and mental quality of life among caregivers of older adults (≥60 years) in Singapore. Methods Participants were 285 informal caregivers who were providing care to an older relative. Participants were recruited at the Institute of Mental Health, Singapore, and they completed self-report measures on chronic physical morbidity, psychological distress, and physical and mental quality of life. Multiple regression models were constructed to examine correlates of physical and mental quality of life. Results More than half of the caregivers had at least one chronic physical condition (58.6%) and psychological distress (52.6%). Chronic physical morbidity, psychological distress, and secondary education status were associated with lower physical quality of life. Psychological distress, younger age, primary education status, and more time spent caregiving were associated with lower mental quality of life. Conclusion Poor physical and mental health among caregivers may impair their ability to provide adequate care to older adults with progressive medical needs. It is important for medical practitioners not to neglect the physical and mental health of caregivers through continued assessment of chronic physical morbidity, psychological distress, and quality of life.

Introduction We investigated the prevalence of children's exposure to secondhand smoke (SHS) in the car of their parents/guardians and the associated factors. Methods A self-administered validated questionnaire was used to obtain data from the nationally representative samples of school-going adolescents aged 11-19 years in Malaysia. Prevalence rates were computed and chi-squared tests and multiple logistic regression were conducted. Results Of the participants, 23.3% reported exposure to SHS at least once in the car of their parents/guardians during the last 7 days before the survey. The prevalence and likelihood of SHS exposure were significantly higher in Malays, descendants of natives of Sabah and Sarawak, schools in rural areas, females, and current smokers. However, age group and knowledge on the harmful effects of SHS were not significant after adjusting for confounding effects. Conclusions A substantial proportion of school-going adolescents were exposed to secondhand smoke in the car of their parents/guardians. This highlights the need for effective tobacco control measures to include health promotion and smoke-free car regulations to be introduced to prevent severe health hazards and to reduce smoking initiation among non-smoking adolescents.

Objectives: This study aimed to examine correlations between lumbar kinematics, functional disability and fear avoidance beliefs among adults with nonspecific chronic low back pain (LBP). Methods: This cross-sectional study was conducted between March and December 2014. A total of 32 adults diagnosed with nonspecific chronic LBP were recruited from outpatients attending either an orthopaedic clinic at a university hospital or a private physiotherapy clinic in Malaysia. Lumbar kinematics were measured using sensors attached at the first lumbar (L1) and second sacral (S2) vertebrae levels. The Oswestry Disability Index (ODI) and Fear-Avoidance Beliefs Questionnaire (FABQ) were used to assess degree of functional disability and fear avoidance beliefs, respectively. Results: For maximum range of motion, positive correlations were observed between ODI scores and right lateral flexion and right rotation ( P = 0.01 each), although there was a negative correlation with left rotation ( P = 0.03). With maximum angular velocity, ODI scores were positively correlated with right and left lateral flexion L1 ( P = 0.01 and

Background. Cancer-related fatigue (CRF) is a subjective and distressing symptom, and its associated factors in developing countries remain ambiguous. The goal of this study was to determine the prevalence of and factors associated with CRF among cancer patients in China. Methods. This study was designed as a cross-sectional study to determine the prevalence of and factors associated with CRF among cancer patients in eastern China, regardless of their diagnoses. Data were collected by using a questionnaire survey (including demographic information and brief fatigue inventory) after informed written consent was obtained. A chi-square test was used to analyze the correlations between single categorical factors and CRF, and multiple logistic regression analysis was used to evaluate the associations of potential risk factors with the presence of CRF. Results. Out of a total population of 1,938 cancer patients, 1,749 had completed the study questionnaire; 52.07% (n = 904) reported clinically significant fatigue (score ≥4 on Brief Fatigue Inventory). Four hundred twenty-seven (48.47%) patients younger than age 58 years (the median age) and 475 (55.69%) patients age 58 years or older reported clinically significant fatigue. In multivariate analysis, higher sleep quality (p < .01) was negatively associated with CRF, whereas never engaging in physical exercise (p < .01) and higher clinical stage of cancer (p < .01) were positively associated factors that could increase the odds of CRF. Conclusion. The results of this study suggest that effective management of the two changeable contributing factors of CRF may reduce CRF and thus could be used as references for CRF management.

BACKGROUND Community-acquired pneumonia (CAP) is a common infectious disease. Inflammatory reaction and prognosis assessment in adult CAP patients are useful for CAP site of care decisions. Most CAP patients were diagnosed in an out-patient or emergency department, so a simple, cheap and rapidly available measurement to assess inflammatory reaction and prognosis has the prospect of broad application. The aim of this study was to investigate the usefulness of plasma D-Dimer in assessment of inflammatory reaction and prognosis in adult CAP patients. METHODS A retrospective study was conducted. All adult patients with a primary diagnosis of CAP were included and were evaluated by peripheral plasma D-Dimer test. All of the measurement data were analyzed with paired t-test and the enumeration data were analyzed with χ2 test. Correlative factor analysis was performed between D-Dimer levels and serum inflammatory markers (WBC, hs-CRP, PCT) and prognostic indexes (ICU admission and 30-day mortality). Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of D-Dimer in predicting ICU admission and/or 30-day mortality. RESULTS One hundred fifty patients were included. Compared with non-D-Dimer elevated group, serum inflammatory markers (WBC, hs-CRP, PCT) and prognostic indexes (ICU admission and 30-day mortality) were elevated in the D-Dimer elevated group (p < 0.05). D-Dimer had positive correlation with serum inflammatory markers (WBC, hs-CRP, PCT), the rates of ICU admission and 30-day mortality, and scores of CURB-65. The AUC of ROC curve of D-Dimer was 0.880 (95% CI 0.823 to 0.936), the sensitivity was 80.4% and specificity was 79.8%, D-Dimer levels are superior to hs-CRP and PCT in predicting 30-day mortality and/or ICU admission according to AUCs of the ROC curves. CONCLUSIONS Elevated plasma D-Dimer in adult CAP patients is associated with an increased inflammatory reaction and ICU admission and 30-day mortality. It can be a simple, cheap, and rapidly available measurement to assess inflammatory reaction and prognosis in adult CAP patients.

pstrongemBackground/em/strong: Scoring systems including CURB-65 and Pneumonia Severity Index (PSI) and novel or traditional biomarkers including procalcitonin (PCT) and c-reactive protein (CRP) are very significant for understanding the severity and prognosis in community-acquired pneumonia (CAP) patients, while prognostic items are useful for CAP prognostication and point-of-care decisions. The aim of this study was to investigate the usefulness of peripheral blood routine items in predicting ICU admission and 30-day mortality in CAP patients./ppstrongemMethods/em/strong: A retrospective study was conducted. All adult patients with a primary diagnosis of CAP were included and peripheral blood routine tests were evaluated. Univariate analysis and multivariate logistic regression analysis were used to explore association of risk factors with 30-day mortality among CAP patients. Receiver operating characteristic curves (ROC) were used to evaluate the sensitivity and specificity of peripheral blood routine items and compared with CURB-65 scores in predicting ICU admission and/or 30-day mortality./ppstrongemResults/em/strong: One hundred fifty patients were included and compared with non-ICU admission patients. There was a statistically significant difference in age, co-existing illness, RDW, WBC, and CURB-65 scores ranking in ICU admission patients (p0.05). In multivariate logistic regression analysis, we found RDW, WBC, and CURB-65 ≥ 3 scores increased the risk of 30-day mortality by 4.01, 1.65, and 3.43 times, respectively. The area under the curve (AUC) of ROC curves of RDW combined with WBC and CURB-65 was 0.786 (95% CI 0.701 to 0.876) and 0.836 (95% CI 0.764 to 0.908), respectively and the sensitivity was 84.0% and 60.0%, respectively, and the specificity 66.7% and 93.7%, respectively./ppstrongemConclusions/em/strong: Elevated RDW and WBC increased mortality in adult CAP patients, RDW combined with WBC had a better sensitivity than CURB-65 scores in predicting ICU admission and/or mortality in CAP patients./p.

Thoracolumbar fractures are among the most common type of traumatic spine fractures. Surgical treatment is necessary if stability or neurological function is impaired.1 Restoration of the vertebral column stability and decompression of the spinal canal are the main goals of surgical treatment.2 Posterior short-segment fixation has the advantage of using a less extensive approach with less blood loss and complications without compromising the quality of stabilization, and spares healthy mobile segments in fusion, and thus preserves mobility.3 Traditional short-segment fixation (TSSF) is a widely used technique in the treatment of unstable thoracolumbar fractures. It not only provides distraction and compression forces that facilitate 3-dimensional correction and firm fixation, but it also preserves motion segments.4 It can offer several advantages: immediate stability, restoration of the vertebral height and deformity angle, and prevention of late neurological injury.5 However, TSSF has been associated with a high rate of failure.6 The latter is usually associated with implant failure and loss of reduction of kyphosis. Posterior fixation including the fractured vertebra (PFFV) is a novel idea used to overcome the shortcomings of TSSF. The technique avoids the suspension effect and quadrilateral effect, dispensing the internal fixing load and reducing the correction degree losses and internal fixation fractures, and it shows good efficacy in clinical application.7 However, there are still only a few randomized controlled studies7 and the relevant theory requires further investigation. The purpose of this study is to compare the clinical effectiveness of PFFV and TSSF in the treatment of thoracolumbar fracture.

Introduction The continuous monitoring of smoking prevalence and its associated factors is an integral part of anti-smoking programmes and valuable for the evaluation of the effectiveness of anti-smoking measures and policies. This study aimed at determining prevalence of smoking and identifying socio-demographic factors associated with smoking among adults in Malaysia aged 15 years and over. Methods This is a cross-sectional study with a representative sample of 21 445 adults in Malaysia, aged 15 years and over, selected via a stratified, two-stage proportionate-to-size sampling method. Data were obtained from face-to-face interviews by trained research assistants, using a standard validated questionnaire. Multivariable logistic regression was performed to determine socio-demographic factors associated with smoking among Malaysians. Results The overall prevalence of smoking was 22.8% (95% CI: 21.9-23.8%), with males having a significantly higher prevalence compared to females (43.0%, 95% CI: 41.1-44.6 vs 1.4%, 95% CI: 1.1-1.7). The highest smoking prevalence was observed among other ethnicities (35.7%), those aged 25-44 years (59.3%), and low educational attainment (25.2%). Males, those with lower educational attainment and Malays were significantly associated with smoking. Conclusions The prevalence of smoking among Malaysians, aged 15 years and over, remains high despite the implementation of several anti-smoking measures over the past decades. Specially tailored anti-smoking policies or measures, particularly targeting males, the Malays, younger adults and those with lower educational attainment, are greatly warranted to reduce the prevalence of smoking in Malaysia.

Background Previous studies showed improvement in heart function by injecting bone marrow mesenchymal stem cells (BMSCs) after AMI. Emerging evidence suggested that both the number and function of BMSCs decline with ageing. We designed a randomized, controlled trial to further investigate the safety and efficacy of this treatment. Methods Patients with ST-elevation AMI undergoing successful reperfusion treatment within 12hours were randomly assigned to receive an intracoronary infusion of BMSCs (n=21) or standard medical treatment (n=22) (the numbers of patients were limited because of the complication of coronary artery obstruction). Results There is a closely positive correlation of the number and function of BMSCs vs. the cardiac function reflected by LVEF at baseline (r=0.679, P=0.001) and at 12-month follow-up (r=0.477, P=0.039). Six months after cell administration, myocardial viability within the infarct area by 18-FDG SPECT was improved in both groups compared with baseline, but no significant difference in the BMSCs compared with control groups (4.0±0.4% 95%CI 3.1–4.9 vs. 3.2±0.5% 95%CI 2.1–4.3, P=0.237). 99mTc-sestamibi SPECT demonstrated that myocardial perfusion within the infarct area in the BMSCs did not differ from the control group (4.4±0.5% 95%CI 3.2–5.5 vs. 3.9±0.6% 95%CI 2.6–5.2, P=0.594). Similarly, LVEF after 12 and 24months follow-up did not show any difference between the two groups. In the BMSCs group, one patient suffered a serious complication of coronary artery occlusion during the BMSCs injection procedure. Conclusions The clinical benefits of intracoronary injection of autologous BMSCs in acute STEMI patients need further investigation and reevaluation.

Severe liver failure causes coagulopathy and high bleeding risk. Albumin dialysis with Molecular Adsorbent Recirculating System (MARS) (Gambro, Lund, Sweden) is useful for treatment. However, anticoagulation during its use is of uncertain value. We omitted heparin-saline priming and intradialytic heparin and examined its effects. Albumin dialysis was performed in critically ill patients with intermittent circuit saline flushes (2664 ± 2420 mL per treatment). A total of 12 patients (M : F = 10:2; age 49 ± 9 years) were thus treated: 6 for fulminant hepatic failure and 6 for acute-on-chronic liver failure. The overall hospitalization duration was 31 ± 30 days. A total of 44 treatment sessions were performed (average 8 ± 7 sessions per patient). Prescribed versus achieved MARS duration were 13 ± 3 versus 11 ± 4 h, P

The use of adult stem cells is limited by the quality and quantity of host stem cells. It has been demonstrated that Wharton’s jelly–derived mesenchymal stem cells (WJMSCs), a primitive stromal population, could integrate into ischemic cardiac tissues and significantly improve heart function. In this randomized, controlled trial, our aim was to assess the safety and efficacy of intracoronary WJMSCs in patients with ST-elevation acute myocardial infarction (AMI). In a multicenter trial, 116 patients with acute ST-elevation MI were randomly assigned to receive an intracoronary infusion of WJMSCs or placebo into the infarct artery at five to seven days after successful reperfusion therapy. The primary endpoint of safety: the incidence of adverse events (AEs) within 18 months, was monitored and quantified. The endpoint of efficacy: the absolute changes in myocardial viability and perfusion of the infarcted region from baseline to four months, global left ventricular ejection fraction (LVEF) from baseline to 18 months were measured using F-18-fluorodeoxyglucose positron emission computed tomography (F-18-FDG-PET) and 99mTc-sestamibi single-photon emission computed tomography (99mTc-SPECT), and two-dimensional echocardiography, respectively. During 18 months follow-up, AEs rates and laboratory tests including tumor, immune, and hematologic indexes were not different between the two groups. The absolute increase in the myocardial viability (PET) and perfusion within the infarcted territory (SPECT) was significantly greater in the WJMSC group [6.9 ± 0.6 % (95 %CI, 5.7 to 8.2)] and [7.1 ± 0.8 % (95 %CI, 5.4 to 8.8) than in the placebo group [3.3 ± 0.7 % (95 %CI, 1.8 to 4.7), P

This study was conducted to evaluate the efficacy and safety of rituximab and Bortezomib in relapsed or refractory indolent B cell non-Hodgkin's lymphoma (NHL). Treatments consisted of rituximab 375 mg/m(2), i.v. on days 1, 8, 15, and 22 of cycle 1 and on day one of cycles 2-5, bortezomib 1.6 mg/m(2), given by intravenous injection (3-s to 5-s bolus) on days 1, 8, 15, and 22 of a maximum of five cycles. The primary end points were the overall survival (OS) and progression-free survival (PFS). Secondary endpoints included response rate (ORR; CR) and toxicities. From January 2008 to December 2010, 60 successive patients at Tianjin cancer hospital lymphoma department were enrolled in this study. All patients were recurrent or refractory indolent B cell NHL, including follicular lymphoma grades 1-2 (n = 35), small lymphocytic lymphoma/chronic lymphocytic leukemia (LL/CLL; n = 16) and marginal zone lymphoma (n = 9). The median follow-up time was 30 months (range 12-48). The overall response rate was 70.0 %, with a CR/CRu rate of 31.7 %. The 2-year OS and PFS of all patients were 75.0 and 41.0 %, respectively. Grade 3-4 neutropenia and thrombocytopenia occurred in 10 and 3.3 % of patients, respectively. Higher IPI and refractory disease were independently associated with worse survival and PFS. RB chemotherapy in patients with refractory or relapsed indolent B cell NHL was effective with low toxicity.

To the Editor: We read with great interest the recent paper1 on renal biopsy findings among Indigenous Australians, a nationwide survey involving 1026 biopsies in which the authors compared the biopsy pattern among the Indigenous population living in remote/very remote (R/VR) areas with those living in the city and the non-Indigenous Australians. Referring to the prevalence of primary glomerulonephritis (GN), it was reported that IgA nephritis was well represented among all Indigenous biopsies though lower proportion among the R/VR aborigines. Substantial numbers of Indigenous people had diffuse proliferative GN, including higher proportion of post-infectious GN. The proportions of membranous GN were lower in the R/RV biopsies. This biopsy pattern of Indigenous Australians is reminiscent of the biopsy patterns of many countries in the 1980s. It is in marked contrast to the present day patterns in which the prevalence of diffuse proliferative GN, including post-infectious GN, is low and the prevalence of membranous GN is high.2 We have reported the biopsy prevalence in Singapore over three decades from the 1970s to 2000s where diffuse proliferative GN had decreased from 32 to 7% and membranous GN has increased from 3 to 11%. Australia and the rest of the developed world have reported similar findings nationwide. We would suggest that the pattern of primary GN among the Indigenous biopsies is a reflection of the socioeconomic conditions prevailing among the R/VR Aborigines compared with those living in the city. This is a trend reflecting the degree of development of the R/VR population in less developed housing facilities with exposure to parasitic, bacterial, and other infective agents predisposing to mesangial proliferative GN, consistent with the hygiene hypothesis.3

An integrated model for gear pair that combines the dynamic load with the mixed elastohydrodynamic lubrication (EHL) theory is proposed in this paper covering the film squeeze effect as well as the friction force generated from the rough surfaces. Comparisons between the two models of load which are, respectively, based on minimum elastic potential energy (MEPE) criterion and dynamic motion equations built up in this paper are discussed. The results show that at low speed the loads calculated by the two models are similar. However, with increasing speed, the load exhibits dynamic characteristics gradually and reaches the highest value at resonant speed. Besides, the effects of the helix angle and the lubricant viscosity are also analyzed. Increasing the ambient viscosity could intensify the film stiffness and viscous damping. Gear with larger helix angle could weaken the impact phenomenon at the shift points where one tooth-pair disengages. Moreover, it is symmetric with regard to the pressure and film thickness across the face width for spur gear. Differently, the pressure for helical gear has a higher value at the dedendum of pinion where the film becomes thinner. In addition, speeding up the pinion would generally result in higher dynamic load and film pressure but thicker film thickness.

To the Editor: We read with great interest the above article,1 in which the authors had accrued data from a population survey of chronic kidney disease (CKD) in a rural population in Sri Lanka. Our experience in Singapore in the 1970s2 was very similar to the Sri Lankan study in which Lim et al.2 conducted a community survey of the population. The prevalence of proteinuric CKD was also low, i.e., 0.63%.

The aim of this study was to compare coronary artery plaque burden, composition, distribution, and the degree of coronary artery stenosis in diabetic and nondiabetic patients with known or suspected coronary artery disease (CAD). The study group consisted of 594 patients with known or suspected CAD, including 122 diabetics, who underwent multidetector computed tomographic coronary angiography and traditional invasive coronary artery angiography. Coronary artery calcium scores were compared in different age subgroups. Noncalcified plaque, calcified plaque, and mixed plaque were analyzed by coronary segment on computed tomographic coronary angiography, as well as the degree of coronary stenosis on coronary artery angiography. Obstructive vessels were compared between the 2 groups. Total coronary artery calcium score was higher in patients with diabetes compared to those without (378.4 ± 613.0 vs 226.0 ± 408.4, p = 0.003). The percentage of patients with coronary artery calcium scores >400 among diabetics (22.1%) was higher than among nondiabetics (14.2%) (p = 0.032). Diabetics had a higher percentage of coronary segments with noncalcified plaque, calcified plaque, and mixed plaque than nondiabetics (35.3% vs 26.2%, p

Background: Continuous venovenous hemofiltration (CVVH) in renal failure is compromised by circuit clotting. We hypothesized that adverse circuit pressures are predictive of clotting in circuits that last less than 24 h during predilution, anticoagulant-free CVVH. Methods: This was a single-center retrospective study of 63 CVVH circuits of 13 critically ill intensive care unit patients with severe renal failure. Circuits were categorized into ‘clotters’ (C) or ‘nonclotters’ (NC), if spontaneous clotting occurred at Results: Effluent pressures and pre-filter pressures were more adverse in NC compared to C starting from 6 and 4 h before spontaneous clotting, respectively. Arterial pressures and return pressures were not significantly different in C versus NC. Blood flow rate settings, hemofiltration fluid replacement and effluent drainage rates in C versus NC were comparable. Conclusion: Real-time circuit pressure readings seem to offer only potentially limited prognostic value in predicting circuit clotting.

To the Editor: We read with great interest the article by Garcia-Garcia,1 which reviews the key link between poverty and chronic kidney disease (CKD), where the authors stated that disadvantaged people from low-resource ethnic minority and/or indigenous and socially disadvantaged backgrounds suffer from marked increases in the burden of unrecognized or untreated CKD. It was stated that even in developed countries ethnic minorities bear a disproportionate burden of CKD. The article reported that in the United Kingdom, the rates of untreated end-stage renal disease are higher in ethnic minority groups with increasing social deprivation. Similarly, in Singapore, the CKD prevalence is higher among Malays and Indians compared with Chinese, with socioeconomic and behavioral factors accounting for 70–80% of the excess risk.

To the Editor: We read with great interest the article by Kim-Mitsuyama and the commentary by Briasoulis and Bakris in the recent issue of Kidney International.1, 2 Both the authors and the commentators have attributed the more optimal blood pressure (BP) control in the chronic kidney disease (CKD) patients on combination therapy with angiotensin II receptor blocker (ARB) and calcium channel blocker (CCB) as the main factor contributing to the prevention of cardiovascular events compared with those on high-dose ARB. In patients without CKD, the incidence of primary events was the same in both groups, suggesting that decreased eGFR was the independent risk factor for cardiovascular events.

To the Editor: We have read the report of the ISN Global Outreach Programme,1 which confirms that, for the less developed countries compared with the more developed ones, chronic glomerulonephritis (GN) and not diabetic nephropathy (DiabNx) is still the leading cause of end-stage renal failure (ESRF).

Small computers incorporating hard disc memory, multiple high resolution monitors and the small computer systems interface (SCSI) can be used for low-cost filmless radiography. A system has been constructed which can perform all of the functions required of a small clinic or field hospital including scheduling, reporting, image acquisition and display, image annotation, image storage and transmission, and control of peripheral devices. The peripheral devices include an optical card reader/writer, an optical disc reader/writer, a SCSI to DIN/PACS port, an Ethernet port and a SCSI to a long distance telephone/computer port, the Integrated Services Digital Network (ISDN) port. Individual patient optical data cards may be prepared, all images and reports may be archived in a small optical disc in the computer, other image sources may be coupled to the system via the DIN/PACS port, data may be exchanged with the local DIN via the Ethernet port and with distant sites via the ISDN port. The small optical data cards, about the size of a credit card, are used for individual patient images and reports. An independent viewer may be used to display the contents of the cards. The result is a complete "filmless and paperless" medical imaging system. The system was developed on Contract DAMD17-88C-8058 with the US Army Medical Research and Development Command.

Congenital cytomegalovirus is the most frequent, yet under-recognised, infectious cause of newborn malformation in developed countries. Despite its clinical and public health importance, questions remain regarding the best diagnostic methods for identifying maternal and neonatal infection, and regarding optimal prevention and therapeutic strategies for infected mothers and neonates. The absence of guidelines impairs global efforts to decrease the effect of congenital cytomegalovirus. Data in the literature suggest that congenital cytomegalovirus infection remains a research priority, but data are yet to be translated into clinical practice. An informal International Congenital Cytomegalovirus Recommendations Group was convened in 2015 to address these questions and to provide recommendations for prevention, diagnosis, and treatment. On the basis of consensus discussions and a review of the literature, we do not support universal screening of mothers and the routine use of cytomegalovirus immunoglobulin for prophylaxis or treatment of infected mothers. However, treatment guidelines for infected neonates were recommended. Consideration must be given to universal neonatal screening for cytomegalovirus to facilitate early detection and intervention for sensorineural hearing loss and developmental delay, where appropriate. The group agreed that education and prevention strategies for mothers were beneficial, and that recommendations will need continual updating as further data become available.