Troponins, Acute Coronary Syndrome and Renal Disease: From Acute Kidney Injury Through End-stage Kidney Disease

The diagnosis of acute coronary syndromes (ACS) is heavily dependent on cardiac biomarker assays, particularly cardiac troponins. ACS, particularly non-ST segment elevation MI, are more common in patients with acute kidney injury, chronic kidney disease (CKD) and end-stage kidney disease (ESKD), are associated with worse outcomes than in patients without kidney disease and are often difficult to diagnose and treat. Hence, early accurate diagnosis of ACS in kidney disease patients is important using easily available tools, such as cardiac troponins. However, the diagnostic reliability of cardiac troponins has been suboptimal in patients with kidney disease due to possible decreased clearance of troponin with acute and chronic kidney impairment and low levels of troponin secretion due to concomitant cardiac muscle injury related to left ventricular hypertrophy, inflammation and fibrosis. This article reviews the metabolism and utility of cardiac biomarkers in patients with acute and chronic kidney diseases. Cardiac troponins are small peptides that accumulate in both acute and chronic kidney diseases due to impaired excretion. Hence, troponin concentrations rise and fall with acute kidney injury and its recovery, limiting their use in the diagnosis of ACS. Troponin concentrations are chronically elevated in CKD and ESKD, are associated with poor prognosis and decrease the sensitivity and specificity for diagnosis of ACS. Yet, the evidence indicates that the use of high-sensitivity troponins can confirm or exclude a diagnosis of ACS in the emergency room in a significant proportion of kidney disease patients; those patients in whom the results are equivocal may need longer in-hospital assessment

Large-Signal Simulation of 94 GHz Pulsed Silicon DDR IMPATTs Including the Temperature Transient Effect

In this paper large-signal modeling and simulation has been carried to study the frequency chirping due to temperature transients and the large-signal power and efficiency of pulsed silicon Double-Drift Region (DDR) Impact Avalanche Transit Time (IMPATT) device operating at 94 GHz. A large-signal simulation method based on non-sinusoidal voltage excitation incorporating the transient thermal effect has been developed by the authors. Results show that the device is capable of delivering a peak pulsed power output of 17.5 W with 12.8% efficiency when the voltage modulation is 60%. The maximum junction temperature rise is 350.2 K for a peak pulsed bias current of 6.79 A with 100 ns pulsewidth and 0.5 percent duty cycle; whereas the chirp bandwidth is 8.3 GHz

Global monopole in scalar tensor theory

The well known monopole solution of Barriola and Vilenkin (BV) resulting from the breaking of a global SO(3) symmetry is extended in general relativity along with a zero mass scalar field and also in Brans-Dicke(BD) theory of gravity.In the case of BD theory, the behaviour of spacetime and other variables such as BD scalar field and the monopole energy density have been studied numerically.For monopole along with a zero mass scalar field, exact solutions are obtained and depending upon the choice of arbitary parameters, the solutions either reduce to the BV case or to a pure scalar field solution as special cases.It is interesting to note that unlike the BV case the global monopole in the BD theory does exert gravitational pull on a test particle moving in its spacetime.Comment: 12 pages LaTex, 3 postscript figures, Communicated to Class.Quant.Gra

Spherical collapse with heat flow and without horizon

We present a class of solutions for a heat conducting fluid sphere, which radiates energy during collapse without the appearance of horizon at the boundary at any stage of the collapse. A simple model shows that there is no accumulation of energy due to collapse since it radiates out at the same rate as it is being generated.Comment: RevTeX, 3 page