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Patients with end-stage renal disease (ESRD) are at a higher mortality risk compared with the general population. Previous studies have described a relationship between mortality and patients with ESRD, but the data on standardized mortality ratio (SMR) corresponding to different causes of death in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) are limited. This study was designed as a nationwide population-based retrospective cohort study. Incident dialysis patients between January 2000 and December 2015 in Taiwan were included. Using data acquired from the Taiwan Death Registry, SMR values were calculated and compared with the overall survival. The results showed there were a total of 128,966 patients enrolled, including 117,376 incident HD patients and 11,590 incident PD patients. It was found that 75,297 patients (58.4%) died during the period of 2000–2017. The overall SMR was 5.21. The neoplasms SMR was 2.11; the endocrine, nutritional, metabolic, and immunity disorders SMR was 13.53; the circulatory system SMR was 4.31; the respiratory system SMR was 2.59; the digestive system SMR was 6.1; and the genitourinary system SMR was 27.22. Therefore, more attention should be paid to these diseases in clinical care.

In patients with chronic hemodialysis (HD), both abnormal thrombotic and bleeding events are commonly observed. Uremic platelet dysfunction is one of the important attributing factors. Moreover, HD may also result in aggregation dysfunction of platelets during the therapeutic procedure. However, how the HD process affects platelet and coagulation function is unknown and dialyzer membrane flux could have an impact on it. We aimed to compare the impacts of low-flux and high-flux HD on the platelet function of patients undergoing chronic HD. This was a cross-sectional study conducted in the HD unit of E-Da hospital in Taiwan. A total of 78 patients with maintenance HD three times per week for more than one year, including 40 with high- and 38 with low-flux hemodialysis, were recruited. Their platelet functions were evaluated using an in vitro platelet function analyzer (PFA-100) before and after the HD session. Of the 78 patients undergoing HD, 60 (76%) had prolonged pre-dialysis collagen/epinephrine (CEPI) and collagen/adenosine diphosphate closure times. Those receiving low-flux dialyzer had a significant increase in CEPI closure time (pre-dialysis 212.3 ± 62.1 seconds. post-dialysis 241.5 ± 64.3 seconds, P = .01), but not collagen/adenosine diphosphate closure time, after HD. After adjusting confounding factors, only the low-flux dialyzer demonstrated an independent association with the prolonged CEPI closure time after HD therapy (odds ratio = 23.31, 95% CI: 1.94-280.61, P = .01). We observed that impaired platelet aggregation is prevalent in patients undergoing chronic HD. Therefore, the use of low-flux dialyzers may further worsen platelet aggregation after dialysis. Patients with uremic bleeding diathesis should take precautions. We suggest that further studies using flow cytometry should be conducted to explore the mechanism of dialysis flux and platelet activity during HD.

Fong-Yu Cheng,1 Yuan-Yow Chiou,2,3 Shih-Yuan Hung,4,5 Tsun-Mei Lin,6 Hao-Kuang Wang,7 Chi-Wei Lin,8 Hung-Hsiang Liou,9 Min-Yu Chang,5 Hsi-Hao Wang,5 Yi-Che Lee4,5,10 1Department of Chemistry, Chinese Culture University, Taipei, Taiwan; 2Department of Pediatrics, National Cheng Kung University Hospital, Tainan, Taiwan; 3Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 5Division of Nephrology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan; 6Department of Laboratory Medicine, E-DA Hospital, Kaohsiung, Taiwan; 7Department of Neurosurgery, E-DA Hospital, Kaohsiung, Taiwan; 8Department of Medical Education, E-DA Hospital, Kaohsiung, Taiwan; 9Division of Nephrology, Department of Internal Medicine, Hsin-Jen Hospital, New Taipei City, Taiwan; 10Division of Nephrology, Department of Internal Medicine, E-DA Dachang Hospital, Kaohsiung, TaiwanCorrespondence: Yi-Che LeeDivision of Nephrology, Department of Internal Medicine, E-DA Hospital/I-Shou University, No.1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, Taiwan, R.O.CTel +886-7-6150011 Ext 5121Email pipijer@gmail.comPurpose: Vitamin D3 is useful for the treatment of peritoneal dialysis (PD)-related peritoneal damage, but its side effects, such as hypercalcemia and vascular calcification, limit its applicability. Thus, we developed vitamin D-loaded magnetic nanoparticles (MNPs) and determined their therapeutic efficacy and side effects in vivo.Materials and Methods: Alginate-modified MNPs were combined with 1α, 25 (OH)2D3 to generate vitamin D-loaded nanoparticles. The particles were conjugated with an antibody against peritoneum-glycoprotein M6A (GPM6A). The particles’ ability to target the peritoneum was examined following intraperitoneal administration to mice and by monitoring their bio-distribution. We also established a PD animal model to determine the therapeutic and side effects of vitamin D-loaded MNPs in vivo.Results: Vitamin D-loaded MNPs targeted the peritoneum better than vitamin D3, and had the same therapeutic effect as vitamin D3 in ameliorating peritoneal fibrosis and functional deterioration in a PD animal model. Most importantly, the particles reduced the side effects of vitamin D3, such as hypercalcemia and body weight loss, in mice.Conclusion: Vitamin D-loaded MNPs could be an ideal future therapeutic option to treat PD-related peritoneal damage.Keywords: peritoneal dialysis, nanoparticles, vitamin D, fibrosis

Introduction: Stroke remains a leading cause of death worldwide. Stroke in young adults is an important issue, gaining extra attention in recent years. This study aims to investigate the mortality after stroke in young adults in Taiwan. Patients and methods: This is a registry- and population-based study in Taiwan of patients aged 20–50 years with first-ever stroke between 1999 and 2012, with follow-up until January 1, 2022. Patients and mortalities were identified through Taiwan National Health Insurance database. Results: The study population included 65,097 patients with stroke (mean age, 42.6 ± 6.6 years; 30.5% woman). There were 23,481 (36.1%) intracranial hemorrhage, 37,522 (57.6%) ischemic stroke, and 4094 (6.3%) stroke not otherwise specified. At the end of follow-up, a total of 18,248 deaths (28.0%) occurred during a median follow-up of 9.8 years (interquartile range, 6.4–13.7 years). Conclusion: Taiwan young adults who were 30-day survivors of first-ever stroke have significantly higher long-term mortality rates when compared to other population-based studies.

Peritoneal fibrosis is an important complication of peritoneal dialysis (PD). To investigate and address this problem, an appropriate animal model of PD is required. The present protocol establishes a chlorhexidine gluconate (CG) induced peritoneal fibrosis model that mimics the condition of a patient with PD. Peritoneal fibrosis was induced by intraperitoneal injection of 0.1% of CG in 15% ethanol for 3 weeks (administered every other day), for a total of nine times in male C57BL/6 mice. Peritoneal functional tests were then performed on day 22. After the mice were sacrificed, the parietal peritoneum of the abdominal wall and the visceral peritoneum of the liver were harvested. They were thicker and more fibrotic when analyzed microscopically after Masson's trichrome staining. The ultrafiltration rate decreased, and glucose mass transport indicated a CG-induced increase in peritoneal permeability. The PD model thus established may have applications in improving PD technology, dialysis efficacy, and prolonging patient survival.

Purpose Vitamin D is a novel potential therapeutic agent for peritoneal dialysis (PD)-related peritoneal fibrosis, but it can induce hypercalcemia and vascular calcification, which limits its applicability. In this study, we create nanotechnology-based drug delivery systems to investigate its therapeutics and side effects. Materials and methods 1,2-distearoyl-sn-glycero-3-phosphoethanolamine-N- [amino-(polyethylene glycol)2000] (DSPE-PEG) and L-α-phosphatidylcholine (PC), which packages with 1α,25(OH)2D3, were used to construct vitamin D nanoliposomes. To confirm the function and safety of vitamin D nanoliposomes, peritoneal mesothelial cells were treated with TGF-β1 and the reverse was attempted using vitamin D nanoliposomes. Antibodies (Ab) against the peritoneum-glycoprotein M6A (GPM6A) Ab were conjugated with vitamin D nanoliposomes. These particles were implanted into mice by intraperitoneal injection and the animals were monitored for the distribution and side effects induced by vitamin D. Results Vitamin D nanoliposomes were taken up by the mesothelial cells over time without cell toxicity and it also provided the same therapeutic effect in vitro. In vivo study, fluorescent imaging showed vitamin D nanoliposomes allow specific peritoneum target effect and also ameliorate vitamin D side effect. Conclusion Nanoliposomes vitamin D delivery systems for the prevention of PD-related peritoneal damage may be a potential clinical strategy in the future.

Yu-Ying Wu,1,2 I-Fan Lin,1,3 Po-Yuan Chen,1,2 Cheng-Kai Lin,1,2 Cheng-Chun Wu,1 Cheng-Loong Liang,1,2 Yi-Che Lee,1,4 Chi-Wei Lin,1,5 Wei-Leng Chin,1,5 Hao Kuang Wang1,2,6 1School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 2Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan; 3Division of Infectious Diseases, Department of Internal Medicine, E-Da Hospital, Kaohsiung, Taiwan; 4Department of Nephrology, E-Da Hospital, Kaohsiung, Taiwan; 5Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan; 6Department of Neurosurgery, E-Da Cancer Hospital, Kaohsiung, TaiwanCorrespondence: Hao Kuang WangDepartment of Neurosurgery, E-Da Hospital/ I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City, 82445, TaiwanTel +866-975106080Email ed101393@gmail.comBackground: Osteoporotic fractures are a significant cause of morbidity and mortality affecting population worldwide. All guidelines recommended vertebral fracture assessment by dual-energy X-ray absorptiometry (DXA). This study aimed at evaluation of any associated benefits of screening with DXA in patients who had received vertebroplasty in Taiwan.Methods: Data were obtained from the National Health Insurance Research Database (NHIRD) in Taiwan. We retrospectively compared the data of patients, who were admitted for vertebroplasty, whether they received DXA screening or not. The outcomes of interest were recurrence of spinal fracture and mortality during a follow-up period of 10 years.Results: From this Taiwan national database, the screening rate of osteoporosis in patient who received vertebroplasty was 11.7%. The mean age in the non-DXA screened cohort (n=32,986) was 74.03± 12.21 years (71.98% female). In the DXA screened cohort (n=4361), the mean age was 76.43± 9.19 years (79.91% female). During the 10-year follow-up period, after matching, non-DXA patients had significantly higher mortality rates than their DXA counterparts, which were 42.37% and 37.73% (p-value < 0.0001), respectively. The re-fracture rates between non-DXA and DXA patients were not significantly different at 17.26% and 16.89% (p-value = 0.1766), respectively.Conclusion: The rate of DXA screening before patients receiving vertebroplasty was extremely low, at 11.7%. Our results showed that DXA screening before vertebroplasty in spinal fractures patients had lower mortality. From this national retrospective cohort study, routine screening of osteoporosis in spinal fracture patients can lead to reduction in mortality.Keywords: osteoporosis, vertebroplasty, DXA, mortality

Objective: Stroke in young adults is uncommon, and the etiologies and risk factors of stroke in young adults differ from those in the older populations. Smoker’s paradox is an unexpected favorable outcome, and age difference was used to explain the association between smoking and the favorable functional outcome. This study aimed to investigate the existence of this phenomenon in young stroke patients.Methods: We analyzed a total of 9,460 young stroke cases registered in the nationwide stroke registry system of Taiwan between 2006 and 2016. Smoking criteria included having a past or current history of smoking more than 1 cigarette per day for more than 6 months. After matching for sex and age, a Cox model was used to compare complications, mortality and outcomes between smokers and non-smokers.Results: Smoking was associated with older age, higher comorbidities, and higher alcohol consumption. Smoking patients with NIHSS scores of 11–15 had a worse functional outcome (adjusted OR, 0.81; 95% CI, 0.76–0.87), and smoking cessation would substantially reverse those effects.Conclusion: The smoker’s paradox definitely does not exist, and therefore we continue to strongly advocate the importance of smoking cessation.

Cheng-Kai Lin,1,2 Po-Yuan Chen,1,2 Yu-ying Wu,1,2 Cheng-Chun Wu,1 Han-Jung Chen,1,2 Cheng-Loong Liang,1,2 Yi-Che Lee,1,3 Chi-Wei Lin,1,4 Chao-Ming Hung,1,5,* Hao-Kuang Wang1,2,6,* 1School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 2Department of Neurosurgery, E-Da Hospital, Kaohsiung, Taiwan; 3Department of Nephrology, E-Da Hospital, Kaohsiung, Taiwan; 4Department of Family Medicine, E-Da Hospital, Kaohsiung, Taiwan; 5Department of General Surgery, E-Da Cancer Hospital, Kaohsiung, Taiwan; 6Department of Neurosurgery, E-Da Cancer Hospital, Kaohsiung, Taiwan*These authors contributed equally to this workCorrespondence: Chao-Ming Hung; Hao-Kuang WangDepartment of Neurosurgery, E-Da Hospital/I-Shou University, No. 1, Yida Road, Jiaosu Village, Yanchao District, Kaohsiung City 82445, TaiwanTel +866-975106080Email ed100647@edah.org.tw; ed101393@gmail.comBackground: Statin treatment improves clinical outcomes in patients with ischemic strokes, although there is no evidence regarding the safety of statin therapy in patients with intracerebral hemorrhage (ICH). This study aimed at evaluating the effects of continuing statin treatment after ICH.Methods: Data were obtained from the National Health Insurance Research Database in Taiwan. We retrospectively compared the data of patients with and without statin exposure after ICH. The outcomes of interest were recurrence of hemorrhagic stroke and mortality during a follow-up period of 10 years.Results: During the 10-year follow-up period, the mortality rate was 32.73% in the statin group and 42.77% in the non-statin group. Statin therapy in patients with acute ICH with dyslipidemia can decrease mortality.Conclusion: Statin therapy reduced the risk of 10-year mortality in patients who experienced acute hemorrhagic stroke.Keywords: statin, hemorrhagic stroke, mortality

The association between serious falls and dialysis modality [hemodialysis (HD) and peritoneal dialysis (PD)] is unclear. A nationwide population-based retrospective cohort study with 127,823 end-stage renal disease patients aged over 18 years was conducted with the unmatched cohort of 101,304 HD and 7,584 PD patients retrieved from Taiwan’s National Health Insurance Research Database during 2000–2013. A total of 7,584 HD and 7,584 PD patients matched at 1:1 ratio by propensity score were enrolled to the study. Serious falls were defined by the diagnostic codes, E code, and image studies. Cox regression model and competing-risk model were used for statistical analysis. HD patients were older and had more comorbidities at baseline than PD patients. After matching and adjustment, HD patients had a higher risk of serious falls than PD patients [sHR 1.27 (95% CI 1.06–1.52)]. Females, elders, a history of falls before dialysis, comorbidity with stroke or visual problems, using diuretics, α-blockers, and mydriatics were associated with higher risks of serious falls among dialysis patients. The risk of serious falls was higher in HD patients than PD patients. Health professionals should create age-friendly environments, reduce unnecessary medications, and raise patients’ awareness of falls in daily life.

Using a database that enabled longitudinal follow-up, we assessed the cost, outcome, complications, and readmission rate of ruptured cerebral aneurysms repaired by surgical clipping and endovascular coiling.This study was a retrospective review of data from a series of patients who underwent surgical clipping or endovascular coiling of ruptured cerebral aneurysms between 1996 and 2013. The medical records and hospital cost data were all examined.A total of 7690 and 1380 cases were treated with clipping and coiling, respectively. Patients treated with clipping had more comorbidities and were older. The average total cost for endovascular coiling was $13,974.3, whereas the average total cost for surgical clipping was $16,581.7. Perioperative (30-day) mortality was 10.7% in patients with coiled aneurysms, compared with 12.6% in those with clipped aneurysms (P = 0.045). After 1 year of follow-up, clipping was associated with a significantly longer length of hospital stay (P0.001) and significantly higher total hospital costs (P0.001).In Taiwan, the total hospital costs for the surgical clipping of cerebral aneurysms were higher than for endovascular coiling, and the surgical results were associated with significant complications. We suggest that the indications for coiling might need to be expanded from the current standards dictated by the guidelines in Taiwan.

Objective Overweight and hyperlipidemia, the two established risk factors for acute ischemic stroke, are paradoxically associated with favorable outcomes. The paradox may be resolved by the concept of protein energy wasting (PEW), in which total cholesterol level and body mass index are used as nutritional indexes for predicting outcomes of chronic kidney disease. Methods Among 12 271 people with acute ischemic stroke and chronic kidney disease, 2086 were defined as being at risk of PEW—with a body mass index Results Based on the propensity score, 2081 PEW participants were matched to the same number of non-PEW control participants. PEW was associated with a higher mortality risk at 3 mo (adjusted hazard ratio, 1.19; 95% confidence interval [CI], 1.02–1.42) and 1 y (adjusted hazard ratio, 1.33; 95% CI1.13–1.52). PEW was also associated with poor functional outcomes (modified Rankin Scale score >2) at 1 mo (adjusted odds ratio, 1.32; 95% CI, 1.08–1.61) and 3 mo (adjusted odds ratio, 1.27; 95% CI, 1.03–1.56). Conclusions According to the PEW-based assessment system, a modest decrease in body mass index and total cholesterol levels suggests malnutrition and is associated with adverse outcomes of acute ischemic stroke.

Cancer is a global issue in recent decade. Despite this alarming increase in the incidence of cancer, to date, whether the risk of developing cancer differs among peritoneal dialysis (PD) and hemodialysis (HD) patients is still uncertain. In this retrospective cohort study, data were obtained from the National Health Insurance Research Database of Taiwan, which provides coverage to almost 99% of the nation's population. After matching, a total of 4491 (or 3369) incident PD patients and 8982 (or 6738) incident HD patients between 2000 and 2009 were enrolled from the database. In addition, 22,455 (or 16,845) nondialysis patients were selected as a control group. The patients were monitored for the occurrence of cancer until 2010, and their data were analyzed using several different models. In general, the results showed that the risks of hepatocellular, kidney, bladder, extra kidney/bladder urinary tract, and thyroid cancers were higher in dialysis patients. We also compared the risk of cancer between two dialysis groups by using the HD patients as the reference group. The result showed that there is no significant different for each cancer risk between two dialysis groups. In conclusion, dialysis patients had a higher risk of certain types of cancer than those in the nonuremia group. However, there was no significant difference in the cancer risk between the two dialysis groups when compared directly.

A green 2 × 2 micro light-emitting diode ( μ - LED ) array with nanostructured grating patterns grown on a semipolar (20-21)-oriented gallium nitride (GaN) buffered layer on (22-43)-oriented sapphire substrate is specially transistor-outline can (TO-can) packaged with a sub-miniature-A (SMA) connector for high-speed data communication beyond 5 Gbit/s. Through a specific design for suppressing the quantum-confined Stark effect (QCSE) in the green 2 × 2 μ - LED array with a low polarization-related electric field and flat quantum well band diagram, the green 2 × 2 μ - LED array exhibits a turn-on voltage of 2.5 V and output power of 0.3 mW at 1 A / cm 2 . The green 2 × 2 μ - LED array also reveals a wavelength shift from 543 nm to 537 nm smaller than that of conventional devices grown on c -plane buffered GaN substrate due to the inhibited QCSE. The 50 µm emission aperture of the green 2 × 2 μ - LED array ensures a lower capacitance for a larger − 3 dB modulation bandwidth, which exhibits − 1 dB power compression at a larger bias under high-speed operation, as it is less affected by the high resistance of the single μ - LED element. With a specific TO-can+SMA package, the green 2 × 2 μ - LED array exhibits maximal data rates exceeding 1.5 Gbit/s for the non-return-to-zero on–off keying format and beyond 5.02 Gbit/s for the bit-loaded discrete multitone (BL-DMT) format, which is very promising for optical wireless communication. As the sampling rate increases from 4 GSa/s to 16 GSa/s, the μ - LED array’s received signal-to-noise ratio (SNR) improves dramatically from 15.4 dB to 12.2 dB. The SNR remains about 15.4 dB, with a matching bit-error ratio (BER) of 2.7 × 10 − 3 , whereas the 10-fold oversampling of the eight-ray quadrature amplitude modulation orthogonal frequency-division multiplexing (8-QAM OFDM) data stream with 16 GSa/s appears to reduce the SNR by − 3 dB , resulting in a decoded BER of 3.3 × 10 − 3 . The green 2 × 2 μ - LED array has demonstrated greater potential in data transmission beyond 5 Gbit/s using the BL-DMT algorithm for future applications in domains of visible light communication or optical wireless communication when packaged with handed mobile devices.

The aggregation and deposition of transactivation response DNA-binding protein 43 (TDP-43) in neurons and astrocytes is characteristic in a number of neurodegenerative diseases including Alzheimer's disease, frontotemporal lobar degeneration, and amyotrophic lateral sclerosis. Nevertheless, the exact role of TDP-43 in astrocytes is unknown. Recently, TDP-43 was identified in neurons but not astrocytes after traumatic brain injury (TBI) in humans. In the present study, we evaluated TDP-43 expression and proteolysis in astrocytes in a rat model of TBI. We assessed TDP-43 fragment expression, astrocyte morphology, neuronal population numbers, and motor function after TBI with or without intracerebroventricular administration of a caspase-3 inhibitor. Motor dysfunction was observed after TBI in potential association astrocytic TDP-43 short fragment mislocalization and accumulation, astrogliosis, and neuronal loss. Notably, caspase-3 inhibition prevented these changes after TBI. Our findings suggest that TDP-43 proteolysis in astrocytes is related to astrogliosis and subsequent neuronal loss in TBI, and that TDP-43 may be an important therapeutic target for preventing motor dysfunction after TBI.

Focal segmental glomerulosclerosis (FSGS) is a leading cause of end-stage kidney disease that requires immunosuppressive treatment as therapy. Few studies have been specifically designed to assess the efficacy of cyclosporine (CSA) in patients with steroid-resistant FSGS. This study investigated the efficacy of CSA-based therapy in steroid-resistant FSGS.Medline, Cochrane, EMBASE, and Google Scholar databases were searched through April 30, 2014 using the keywords "cyclosporine", "steroid-resistant", "focal segmental glomerulosclerosis", and "FSGS". Studies with an adult and children with steroid-resistant primary FSGS treated with CSA-based therapy with or without steroid use were included. Complete, partial, and overall remission were the primary outcomes. Change in proteinuria, serum creatinine, and estimated glomerular filtration rate (eGFR) following treatment were secondary outcomes.Seven randomized controlled trials with a total of 373 patients were included. Five studies were included in the meta-analysis to assess complete, partial, and overall remission of FSGS. Compared with other treatments, CSA-based therapy resulted in a significantly greater partial remission rate (p = .018), but complete (p = .226) or overall remission rate (p = .050). CSA-based therapy also resulted in similar change in proteinuria (p = .084), serum creatinine (p = .772), and eGFR (p = .155) compared with other therapy. Study limitations included small sample size and heterogeneity in age and comparative treatments across the studies.Cyclosporin-based treatments provided a significantly better partial remission rate as compared with other therapies.

STUDY OBJECTIVES: Peritoneal dialysis (PD) is a renal replacement therapy. One concern is whether patients on PD have a higher risk of sleep apnea (SA) due to intra-abdominal pressure increase and worsened ultrafiltration capacity. Despite this concern, to date, whether the risk of SA differs between PD, hemodialysis (HD), and groups without uremia is still uncertain. METHODS: In this retrospective cohort study, data were obtained from the National Health Insurance Research Database of Taiwan. This database enrolled almost all patients on dialysis in the country. A total of 7,645 incident patients on PD and 38,225 incident patients on HD were enrolled. In addition, 38,225 patients without uremia were selected as the comparison cohort. Individuals were monitored for the occurrence of SA until 2013. RESULTS: The results showed that patients on PD, regardless of sex, all had a higher risk of SA than non-dialysis groups. In contrast, the risk of SA in patients on HD was not significantly different from that of patients without uremia. We also compared the risk of SA between patients on PD and HD directly. The results showed that male patients on PD had a significantly higher risk of SA risk than male patients on HD. However, the risk of SA did not differ between female patients on PD and HD. CONCLUSIONS: Patients on PD should receive regular SA assessments and that an increased awareness and a higher index of suspicion for SA should be maintained in these patients, especially male patients. CITATION: Lee YC, Hung SY, Wang HK, Lin CW, Wang HH, Chang MY, Wu CF, Sung JM, Chiou YY, Lin SH. Male patients on peritoneal dialysis have a higher risk of sleep apnea. J Clin Sleep Med. 2019;15(7):937–945.

As the deep convolutional neural network (DCNN) has achieved success in many artificial intelligence areas, most of the major commercial and academic research Institutes continue renewing the architecture of deep learning hardware accelerators to meet the requirements for high performance, low power and adaptability to various neural networks. Since the affordable on-chip storage cannot accommodate the whole data of even a convolutional layer in modern DCNNs, the computation process of a convolutional layer has to be partitioned into multiple pieces and then scheduled to processing elements on accelerators. This workload scheduling is required to be considered simultaneously with hardware architecture, and the design and configuration parameters are so complicated that design exploration can be difficult in traditional register-transfer level. In this paper, we propose a virtual platform for DCNN accelerator design. Compared to RTL implementation, the proposed model has a worst-case error of 97–99%, with 3000–13000 x simulation speedup.

Traumatic brain injury (TBI) is a major risk factor for dementia. Recently, TBI has also been suggested as a risk factor for frontotemporal dementia (FTD), and plasma immunoreactivity to the TAR-DNA binding protein 43 (TDP-43) has been observed in both patients with acute TBI and long-term survivors of this condition. We used a population-based study to estimate and compare the risk of FTD in individuals with and without TBI. Furthermore, we used a rat model of TBI to show that increased TDP-43 proteolysis following TBI produces FTD-like impairments, including abnormal limb-clasping, and impaired performances in the Morris water maze. We recruited 24,585 patients who received ambulatory or hospital care for TBI and 122,925 patients without TBI for this study. Each individual was investigated for 4years to evaluate FTD development, and data were analyzed by Cox proportional hazard regression. In the TBI rat model, behavior and TDP-43 inclusions were assessed following intracranial administration of a caspase-3 inhibitor or vehicle. FTD was more likely to occur in the TBI group than in the group without TBI (adjusted hazard ratio, 4.43; 95% confidence interval, 3.85-5.10; P

We report a homojunction gallium nitride (GaN) p-i-n rectifier fabricated on free-standing GaN substrates with the breakdown voltage $>800$ V and low specific on-resistance ( $R_{\mathrm{{\scriptscriptstyle ON}}}A$ ). At 298 K, $R_{\mathrm{{\scriptscriptstyle ON}}}A$ is 0.28 $\text{m}\Omega $ -cm $^{2}$ at the current density ( $J$ ) of 2.5 kA/cm $^{\vphantom {R^{R^{}}}2}$ and the corresponding Baliga’s figure of merit is $>2.5$ GW/cm $^{2}$ . At a given temperature, $R_{\mathrm{{\scriptscriptstyle ON}}}A$ values decrease with $J$ due to conductivity modulation in the drift region. The ambipolar lifetime ( $\tau _{a})$ is also determined by open-circuit voltage decay measurement. The value for $\tau _{a }$ is 9.6 ns at 298 K and it monotonically increases to 22 ns at 448 K. The reverse $I$ – $V$ measurement reveals the reverse leakage current mechanism is mainly attributed to a field-assisted ionization process from deep-level centers in the space-charge region. The analysis of $T$ – $I$ – $V$ curve yields the Poole-Frenkel coefficient ( $\sim 3.1\times 10^{-4} ~\text {eV} \cdot \text {V}^{-1/2}\cdot {\rm cm}^{-1/2})$ and a deep-level trap ( $\sim 0.7$ eV) at zero bias.

Background Pre-sensitization to human leukocyte antigen (HLA) is closely related to the prognosis of renal transplantation. Concerning the risk factors for HLA sensitization, most studies focused only on selected transplant candidates. Methods All patients with end-stage renal disease (ESRD) in a single teaching hospital and a group of healthy subjects were enrolled for the tests of panel-reactive antibodies (PRA). Results A total of 1177 subjects were recruited, including 289 ESRD patients (140 hemodialysis, 98 peritoneal dialysis, and 51 pre-dialysis) and 888 healthy volunteers. The prevalence of PRA positivity (for either type I or II HLA) for ESRD patients was higher than for healthy subjects (23.2% vs. 12.8%, p = 0.000). Only pregnancy and transfusion showed independent correlations with PRA positivity, and not ESRD itself. The PRA-positive ESRD patients were prone to be female, have histories of pregnancy, transfusion, no hepatitis B, and use of graft shunt for dialysis. Multivariate analyses showed that pregnancy and time interval of the latest transfusion had independent correlations with PRA positivity. The time interval of less than 1 year had the highest odds ratio 10.06 (p = 0.000). Conclusions Pregnancy and recent transfusion, not ESRD itself or dialysis modality, remain the independent risk factors for HLA sensitization.

We report state-of-the-art d.c. and RF performance of GaN/InGaN npn DHBTs grown by the MOCVD technology on sapphire substrates. The fabricated GaN/InGaN HBTs achieved a collector current density greater than 50 kA/cm2 and a d.c. current gain of 60 at the collector voltage of 13 V. A open-base collector-emitter breakdown voltage of greater than 90 V was measured. Using the same layer structure and device fabrication techniques, we also demonstrated state-of-the-art RF performance of GaN/InGaN HBTs with fT greater than 8 GHz and fmax greater than 1.8 GHz at the collector current density of 11 kA/cm2. These d.c. and RF measurement results demonstrated the capability and feasibility of III-N HBTs for high-power circuit applications.

We report ultra-high-power performance on npn GaN/InGaN double heterojunction bipolar transistors (DHBTs) that is directly grown on a free-standing (FS) GaN substrate. Measured common-emitter current gain (hfe) reaches 80. A quasi-static I–V measurement shows that JC > 141 kA/cm2 and a power density of 3.05 MW/cm2 can be achieved for DHBTs grown on an FS-GaN substrate. When the temperature is increased to 250 °C, a GaN/InGaN DHBT shows hfe = 43 and the offset voltage is reduced from 0.8 V at the room temperature to 0.3 V. Similarly, the knee voltage is reduced from 5.2 V at room temperature to 2.75 V at 250 °C. In this particular device, breakdown voltage (BVCEO) increases from 90 V at room temperature to 157 V at 250 °C.

A step-graded Al x Ga 1- x N electron blocking layer (EBL) is introduced to the InGaN -based edge-emitting blue-violet laser diode (LD) structure to suppress the undesired built-in interface polarization charges. When compared to a conventional abrupt Al 0.18 Ga 0.82 N EBL design, the step-graded Al x Ga 1- x N EBL design may help reduce the electron accumulation at the edge of the active region and hence improve the quantum efficiency in LD operation. The effects of the step-graded Al x Ga 1- x N EBL on the fabricated device performance are also investigated. LDs with the step-graded Al x Ga 1- x N EBL demonstrated significantly reduced threshold current density and increased slope efficiency under the continuous-wave operation.

There is currently no cure for gene mutation-caused autosomal dominant polycystic kidney disease (ADPKD). Over half of patients with ADPKD eventually develop kidney failure, requiring dialysis or kidney transplantation. Current treatment modalities for ADPKD focus on reducing morbidity and mortality from renal and extrarenal complications of the disease. MicroRNA has been shown to be useful in treating ADPKD. This study combines anti-miRNA plasmids and iron oxide/alginate nanoparticles for conjugation with antikidney antibodies. These nanocomposites can specifically target renal tubular cells, providing a potential treatment for ADPKD. Magnetic resonance imaging and in vivo imaging system results show effective targeting of renal cells. Anti-miRNA plasmids released from the nanocomposites inhibit cell proliferation and cyst formation in the PKD cellular and animal models. The results suggest the novel combination of the anti-miRNA plasmids and nanomaterials provides potential clinical implications for ADPKD treatment.

We report high performance npn GaN/InGaN double heterojunction bipolar transistors (DHBTs) that was directly grown on sapphire substrates with high common-emitter current gain (>40) at collector current density (JC) > 5 kA/cm2. A study on the emitter sizing effect shows that the perimeter-dependent recombination current density changes from 1.5×10-6 to 6.1×10-4 A/cm as JC increases from 5 A/cm2 to 100 A/cm2. The fabricated multi-fingered DHBTs show similar surface recombination current density and a current gain of > 23 at JC > 100 A/cm2 is also achieved (© 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

In recent years, attention has been focused on the anti-cancer properties of pure components, an important role in the prevention of disease. Andrographolide (Andro), the major constituent of Andrographis paniculata (Burm. F.) Nees plant, is implicated towards its pharmacological activity. To investigate the mechanism basis for the anti-tumor properties of Andro, Andro was used to examine its effect on cell-cycle progression in human colorectal carcinoma Lovo cells. The data from cell growth experiment showed that Andro exhibited the anti-proliferation effect on Lovo cells in a time- and dose-dependent manner. This event was accompanied the arrest of the cells at the G1-S phase by Andro at the tested concentrations of 0-30 microM. Cellular uptake of Andro and Andro was confirmed by capillary electrophoresis analysis and the intracellular accumulation of Andro (0.61+/-0.07 microM/mg protein) was observed when treatment of Lovo cells with Andro for 12h. In addition, an accumulation of the cells in G1 phase (15% increase for 10 microM of Andro) was observed as well as by the association with a marked decrease in the protein expression of Cyclin A, Cyclin D1, Cdk2 and Cdk4. Andro also inducted the content of Cdk inhibitor p21 and p16, and the phosphorylation of p53. Further immunoprecipitation studies found that, in response to the treatment, the formation of Cyclin D1/Cdk4 and Cyclin A/Cdk2 complexes had declined, preventing the phosphorylation of Rb and the subsequent dissociation of Rb/E2F complex. These results suggested Andro can inhibit Lovo cell growth by G1-S phase arrest, and was exerted by inducing the expression of p53, p21 and p16 that, in turn, repressed the activity of Cyclin D1/Cdk4 and/or Cyclin A/Cdk2, as well as Rb phosphorylation.

The springback behavior of an invar sheet and its perforated form were examined in the present study. The mechanical properties for invar sheet and perforated invar-sheet at elevated temperatures were first obtained from tensile tests. The test results suggest that both invar sheet and perforated invar-sheet have favorable formability at temperature higher than 200oC. An analytical model was also established to predict the springback of the invar sheet and its perforated form under bending conditions at various elevated temperatures. In order to verify the predicted results, the V-bending tests were conducted for the invar sheet at various temperatures ranging from room temperature to 300. The experimental data indicate that the springback decreases with the rise in temperature for both invar sheet and perforated invar-sheet. The good agreement between the experimental data and the predicted values confirms the validity of the proposed theoretical model as well.

Background. Peritoneal dialysis (PD) can induce fibrosis and functional alterations in PD patients’ peritoneal membranes, due to long-term unphysiological dialysate exposure, partially occurring via triggering of epithelial-to-mesenchymal transition (EMT) in peritoneal mesothelial cells (MCs). Vitamin D can ameliorate these negative effects; however, the mechanism remains unexplored. Therefore, we investigated its possible links to MCs EMT inhibition.Methods. Peritoneal fibrosis was established in Sprague-Dawley rats by chlorhexidine gluconate (CG) intraperitoneal injection for 21 days, with and without 1α,25(OH)2D3treatment. Morphological and functional evaluation and western blot analysis of EMT marker were performed upon peritoneum tissue.In vitrostudy was also performed in a primary human peritoneal MC culture system; MCs were incubated with transforming growth factor-β1 (TGF-β1) in the absence or presence of 1α,25(OH)2D3. EMT marker expression, migration activities, and cytoskeleton redistribution of MCs were determined.Results. 1α,25(OH)2D3ameliorated CG-induced morphological and functional deterioration in animal model, along with CG-induced upregulation ofα-SMA and downregulation of E-cadherin expression. Meanwhile, 1α,25(OH)2D3also ameliorated TGF-β1-induced decrease in E-cadherin expression, increase in Snai1 andα-SMA expression, intracellular F-actin redistribution, and migration activityin vitro.Conclusion. 1α,25(OH)2D3can ameliorate CG-induced peritoneal fibrosis and attenuate functional deterioration through inhibiting MC EMT.

For a perforated sheet with circular holes, used in shadow masks, the diameter of the circular hole varies through the thickness, and the non-uniform circular holes are arranged in a triangular pattern. In order to simplify the analysis, a perforated sheet with equivalent circular holes of uniform diameter is proposed such that its plastic behavior is similar to that with the given non-uniform circular holes. In this study, a yield criterion is discussed for the perforated sheet with uniform circular holes by employing an equivalent continuum approach, which is then applied to examine the plastic deformation of the perforated sheet with non-uniform circular holes. The analytical results predicted by the theory, including those for the apparent yield stresses and strain ratios, are verified by the results obtained from the finite element analysis and also from experiments.

The successful development of III-V nitride materials systems have led to active research of electronic devices in the past decades. III-nitride (III-N)-based devices have a bandgap engineering flexibility, large energy gap, direct band structure, and high carrier mobility when compared to Si- and SiC -based devices, providing new performance improvement opportunities for high-speed and energy-efficient electronics. In particular, tremendous efforts have been devoted to the quest for heterojunction field effect transistors (HFETs). Today, commercial GaN HFETs are available for microwave power amplifiers and power electronic circuits. On the other hand, bipolar transistors are also essential devices in order to fully exploit the potential of III-N materials systems and the associated semiconductor technologies. For instance, insulated-gate-bipolar transistors would require integrated bipolar transistor and unipolar transistor structures to optimally operate such devices in a vertical current conduction form. The development of III-N bipolar switches in either two-terminal or three-terminal forms have therefore been actively sought. Unfortunately, myriad technological challenges in the growth and the fabrication processing have limited the progress of III-N bipolar transistors for years. These particular device technologies are still in the early stage of the technology development. In this presentation, we will review the development status of III-N bipolar transistor switches and vertical GaN rectifiers. Early development of heterojunction bipolar transistors (HBTs) using AlGaN/GaN heterojunctions was unsuccessful because of the limited current drive and current gain. The GaN/InGaN HBTs, on the other hand, showed promising device performance. We studied optimized epitaxial growth in a metalorganic chemical vapor deposition (MOCVD) reactor, developed a direct-growth (or non-regrowth) mesa-type III-N HBT fabrication processing technology, and achieved state-of-the-art of GaN/InGaN NPN HBT performance.[1],[2],[3],[4] These devices exhibited high-current gain of >100, high current drive density of >100 kA/cm2, and high d.c. power handling capability of > 3 MW/cm2. Small-signal microwave amplification with a cut-off frequency (f T) of 8GHz was also demonstrated experimentally. Similarly, GaN-based rectifiers have been studied in recent years and these devices have reportedly demonstrated switching performance approaching theoretical values. At Georgia Tech, our preliminary study demonstrated that 800-V homojunction GaN PIN rectifiers can achieve a specific on-state resistance of R ON = 2.8 mOhm-cm2. [5]The large turn-on voltage of GaN PIN diodes, however, could be problematic in circuit applications. To address this problem, GaN junction-barrier Schottky (JBS) rectifiers are also under study. Using a nickel as the Schottky contact material and an additional MOCVD regrowth step, our preliminary results demonstrated a GaN JBS diode with a turn-on voltage of ~0.8V, a value similar to typical silicon PN diodes. These results demonstrated the feasibility of using bipolar carrier transport mechanisms and PN junctions in III-N devices for power amplifications and switching circuits. Further device design and processing techniques that help achieve these performance characteristics will be discussed in the conference. [1] Z. Lochner, et. al. , Appl. Phys. Lett. 99 (19), 193501-1–3 (2011). [2] Y. Zhang, et. al. Phys. Stat. Sol. (c) 8 (7–8), 2451–2453 (2011). [3] S. Shen et. al., IEEE Electron Device Lett., 32 (8), 1065–1067 (2011). [4] Y. Lee, et. al. , Physica Status Solidi(a), 209(3), 497-500 (2012). [5] T. Kao, et. al., IEEE Trans. Electron Devices, 62(8) 2679-2683 (2015).

We report GaN/InGaN n-p-n double-heterojunction bipolar transistors with the collector current density (JC) >; 16 kA/cm2 and the current gain (β) >; 24 grown on a sapphire substrate. The cutoff frequency (fT) of greater than 5 GHz and the maximum oscillation frequency (fmax) of 1.3 GHz are also measured for a GaN/InGaN heterojunction bipolar transistor at JC = 4.7 kA/cm2.

We report GaN/In0.03Ga0.97N npn double heterojunction bipolar transistors (DHBTs) grown on sapphire substrates for high power applications. High current gain and high power density are obtained using a simple single-growth mesa etching process. A device with an emitter area (AE) of 20×20 µm2 achieves a peak d.c. current gain (β) of 84, a maximum collector current density (JC) of 7.2 kA/cm2 and a maximum power density > 240 kW/cm2. A large-area (AE = 12163 μm2) multi-finger device also shows a peak β = 30, maximum collector current (Ic) = 200 mA and maximum d.c. power = 3.76 W. These values are among the best for the reported III-N HBTs to date (© 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim)

Background Dementia has been associated with an increased risk of hip fracture. However, little research has been conducted on the impact of dementia on wrist or vertebral fracture development. The aim of this study was to investigate whether dementia is a risk factor for different types of fracture in Taiwan. Methods The study sample was drawn from Taiwan’s National Health Insurance Research Database of reimbursement claims, and comprised 1408 patients who visited ambulatory care centers or were hospitalized with a diagnosis of dementia. The comparison group consisted of 7040 randomly selected individuals. Cox proportional hazard regression model was used to examine associations between dementia and the risk of different types of fracture. Results During a 3-year follow-up period, 264 patients with dementia (18.75%) and 1098 patients without dementia (15.60%) developed fractures. Dementia was independently associated with increased risk of hip fracture [adjusted hazard ratio (HR) 1.92, 95% CI 1.48–2.49]. Patients with dementia and osteoporosis had the highest risk of developing hip fracture (adjusted HR 2.27, 95% CI 1.28–4.01). Dementia did not increase wrist fracture or vertebral fracture risk when compared to the control group, even in patients with osteoporosis. Conclusions Individuals with dementia are at greater risk of developing hip fracture, particularly if they also have osteoporosis. Early mental screening programs and health education should be initiated to decrease disability and dependence in patients with dementia.

STUDY OBJECTIVES Sleep apnea (SA) is characterized by apnea during sleep and is associated with cardiovascular diseases and an increase in all-cause mortality. Chronic kidney disease (CKD) is a global health problem that has placed a substantial burden on healthcare resources. However, the relationship between SA and the incidence of CKD is not clear. This study aimed to determine whether SA is an independent risk factor for the development of CKD. DESIGN Retrospective cohort study. SETTING National Health Insurance Research Database (NHIRD) of Taiwan. PATIENTS OR PARTICIPANTS A total of 4,674 adult patients (age ≥ 30 y) in whom SA was newly diagnosed from 2000 to 2010 were included, together with 23,370 non-SA patients as the comparison group. The two groups were frequency-matched for sex, age, and year of receiving medical service. Each individual was followed until 2011. INTERVENTIONS N/A. MEASUREMENTS AND RESULTS These two groups were monitored and observed for the occurrence of CKD. Patients with SA experienced a 1.94-fold increase (95% confidence interval [CI], 1.52-2.46; P < 0.001) in the incidence of CKD, which was independent of sex, age, and comorbid medical conditions. Additionally, they showed a 2.2-fold increase (95% CI, 1.31-3.69; P < 0.01) in the incidence of end-stage renal disease (ESRD). CONCLUSIONS Patients with sleep apnea are at increased risk for chronic kidney disease and end-stage renal disease compared with the general population. As such, screening renal function and treatment of chronic kidney disease is an important issue in patients with sleep apnea.

Four selected die materials commonly used in the cold-forging process were examined in the present study to obtain the relationship between the hardness and the die fatigue life. The die materials were first heat-treated by a developed process to obtain different values of hardness, while the ductility was retained at a favorable level. The material properties of these die materials were then obtained from tension and impact tests. By investigating the experimental data, the relationship between the mechanical properties and the hardness was established. A theoretical model was also proposed in the present study to predict the die fatigue life, considering the mechanical properties of the die material obtained in the experiments and the fatigue total strain as parameters. Since the material properties can be expressed in terms of hardness, it is convenient for a die design engineer to establish a simple guideline for the prediction of the fatigue life of cold-forging dies using the proposed theoretical model.

A cold-extrusion punch used to manufacture sockets undergoes severe impact loading and severe wear in the metal forming process. Failure in the cold-extrusion punch frequently occurs and is difficult to avoid. Owing to the complicated manufacturing process and the lack of service history of the cold-extrusion punch, detecting the major causes of the punch failure is difficult. Therefore, this study analyzes the major causes of the failure of a cold-extrusion punch by initially examining the mechanical properties of the cold-extrusion punch to identify defects in its related performance. Eliminating such defects is necessary to enhance the quality of the cold-extrusion punch. To determine the major causes of failure of the cold-extrusion punch, the characteristics of the failure are compared with those of well-known failure mechanisms, including the macro- and micro-characteristics of failure mechanisms. By closely examining the results of the mechanical properties and the results of the failure analysis of a cold-extrusion punch, this study proposes an effective method to avoid punch failure and prolong the punch life.

The plastic behavior of a perforated sheet with round holes in a triangular pattern depends largely on the hole size of the perforated sheet. This study investigates the plastic behavior of perforated sheets with low ligament ratios. A yield criterion for the perforated sheets is also proposed in terms of apparent stresses by employing the equivalent-continuum approach. The effectiveness of the proposed yield criterion is then demonstrated by comparing the predicted values of apparent yield stresses and apparent strain ratios with results obtained from finite-element analysis and experiment.