Ankle-Brachial Index: A Simple Way to Predict Mortality among Patients on Hemodialysis - A Prospective Study

Background: Ankle-brachial index (ABI) can access peripheral artery disease and predict mortality in prevalent patients on hemodialysis. However, ABI has not yet been tested in incident patients, who present significant mortality. Typically, ABI is measured by Doppler, which is not always available, limiting its use in most patients. We therefore hypothesized that ABI, evaluated by a simplified method, can predict mortality in an incident hemodialysis population. Methodology/Principal Findings: We studied 119 patients with ESRD who had started hemodialysis three times weekly. ABI was calculated by using two oscillometric blood pressure devices simultaneously. Patients were followed until death or the end of the study. ABI was categorized in two groups normal (0.9-1.3) or abnormal (<0.9 and >1.3). There were 33 deaths during a median follow-up of 12 months (from 3 to 24 months). Age (1 year) (hazard of ratio, 1.026; p = 0.014) and ABI abnormal (hazard ratio, 3.664; p = 0.001) were independently related to mortality in a multiple regression analysis. Conclusions: An easy and inexpensive technique to measure ABI was tested and showed to be significant in predicting mortality. Both low and high ABI were associated to mortality in incident patients on hemodialysis. This technique allows nephrologists to identify high-risk patients and gives the opportunity of early intervention that could alter the natural progression of this population.

Controlling chaos in wave-particle interactions

We analyze the behavior of a relativistic particle moving under the influence of a uniform magnetic field and a stationary electrostatic wave. We work with a set of pulsed waves that allows us to obtain an exact map for the system. We also use a method of control for near-integrable Hamiltonians that consists of the addition of a small and simple control term to the system. This control term creates invariant tori in phase space that prevent chaos from spreading to large regions, making the controlled dynamics more regular. We show numerically that the control term just slightly modifies the system but is able to drastically reduce chaos with a low additional cost of energy. Moreover, we discuss how the control of chaos and the consequent recovery of regular trajectories in phase space are useful to improve regular particle acceleration.