Search

In Taiwan, older adults with cognitive impairment who undergo hip-fracture surgery are routinely cared for by family members. This study aimed to determine if nutritional status influenced the effects of a family-centered intervention for older adults with cognitive impairment recovering from hip-fracture surgery.Secondary data analysis of data from a randomized controlled trial was conducted to examine the influences of nutritional status 1 month after hospital discharge on the effects of a family-centered care intervention model, which was designed for older adults with hip fracture and cognitive impairment. Outcomes were compared among participants according to nutrition status (well-nourished/poorly-nourished) and treatment approach (control/intervention).The original study was conducted at a 3000-bed medical center from July 2015 to October 2019.Participants were older adults with cognitive impairment who had undergone hip-fracture surgery. Participants were assessed as poorly-nourished or well-nourished with the Mini-Nutritional Assessment (MNA) 1-month post-discharge and were then randomly assigned to either the intervention group or control group.A family-centered intervention model for family caregivers of older adults with cognitive impairment recovering from hip-fracture surgery was implemented. The intervention was delivered by geriatric nurses, which included instructions for family caregivers in overseeing exercises for strengthening the hip, understanding dietary requirements, and managing behavioral problems associated with cognitive impairment.Outcome measures included activities of daily living (ADLs), instrumental ADLs, hip range of motion, hip muscle strength, depression, measured with the Geriatric Depressive Scale, and physical and mental health related quality of life, measured with the Short Form Survey (SF-36), Taiwanese version. Participants were assessed at 1-, 3-, 6-, and 12-months post-discharge.Most of the 134 participants were assessed as poorly nourished (n = 122); 57 were the control group and 65 received the intervention. For the well-nourished participants (n = 12), four were in the intervention group and eight were controls. There were no significant differences in any outcome variables for poorly nourished participants who received the intervention compared with controls. For the sample of well-nourished participants, those who received the intervention performed significantly better in outcomes of IADLs (b = 1.74, p.05), hip muscle strength (b = 9.64, p.01), and physical health related quality of life (b = 10.47, p.01).The family-centered care intervention was only effective for older adults with cognitive impairment recovering from hip-fracture surgery who were well-nourished at 1 month following hospital discharge, but not for those at risk of malnutrition. Interventions should focus on enhancing nutritional status following hip surgery which could allow the family-centered in-home intervention to be beneficial for more older adults with cognitive impairment recovering from hip-fracture surgery.

Observation of high energy and very high emission from Gamma Ray Bursts (GRBs) is crucial to study the gigantic explosion and the underline processes. With a large field-of-view and almost full duty cycle, the Water Cherenkov Detector Array (WCDA), a sub-array of the Large High Altitude Air Shower Observatory (LHAASO), is appropriate to monitor the very high energy emission from unpredictable transients such as GRBs. Nevertheless, the main issue for an extensive air shower array is the high energy threshold which limits the horizon of the detector. To address this issue a new trigger method is developed in this article to lower the energy threshold of WCDA for GRB observation. The proposed method significantly improves the detection efficiency of WCDA for gamma-rays around the GRB direction at 10-300 GeV. The sensitivity of the WCDA for GRB detection with the new trigger method is estimated. The achieved sensitivity of the quarter WCDA array above 10 GeV is comparable with that of Fermi-LAT. The data analysis process and corresponding fluence upper limit for GRB 190719C is presented as an example.

The main scientific goal of LHAASO-WCDA is to survey gamma-ray sources with energy from 100 GeV to 30 TeV. To observe high-energy shower events, especially to measure the energy spectrum of cosmic rays from 100 TeV to 10 PeV, a dynamic range extension system (WCDA++) is designed to use a 1.5-inch PMT with a dynamic range of four orders of magnitude for each cell in WCDA-1. The dynamic range is extended by using these PMTs to measure the effective charge density in the core region of air shower events, which is an important parameter for identifying the composition of primary particles. The system has been running for more than one year. In this paper, the details of the design and performance of WCDA++ are presented.

We report the discovery of an extended very-high-energy (VHE) gamma-ray source around the location of the middle-aged (207.8 kyr) pulsar PSR J0622+3749 with the Large High-Altitude Air Shower Observatory (LHAASO). The source is detected with a significance of 8.2σ for E25 TeV assuming a Gaussian template. The best-fit location is (right ascension, declination) =(95.47°±0.11°,37.92°±0.09°), and the extension is 0.40°±0.07°. The energy spectrum can be described by a power-law spectrum with an index of -2.92±0.17_{stat}±0.02_{sys}. No clear extended multiwavelength counterpart of the LHAASO source has been found from the radio to sub-TeV bands. The LHAASO observations are consistent with the scenario that VHE electrons escaped from the pulsar, diffused in the interstellar medium, and scattered the interstellar radiation field. If interpreted as the pulsar halo scenario, the diffusion coefficient, inferred for electrons with median energies of ∼160 TeV, is consistent with those obtained from the extended halos around Geminga and Monogem and much smaller than that derived from cosmic ray secondaries. The LHAASO discovery of this source thus likely enriches the class of so-called pulsar halos and confirms that high-energy particles generally diffuse very slowly in the disturbed medium around pulsars.

The aim of this paper is to investigate the effect of BDNF-TrKB pathway on AOH by accessing its regulatory role in retinal ganglion cell apoptosis.Acute ocular hypertension (AOH) model in rats was established by anterior chamber perfusion to increase intraocular tension. Rats were randomly divided into AOH group, control group and k252a group, with ten rats in each group. Rats were sacrificed 72 h after animal procedures and eyeballs were harvested. HE staining was used to observe retinal structural changes at different time points. Immunohistochemical staining was used to observe the BDNF-positive cells in retinal tissues. TUNEL staining was conducted to measure apoptosis of retinal ganglion cells. Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) and Western blot were performed to detect mRNA and protein levels of BDNF, TrKB, PI3K and ERK1 in retinal tissues, respectively.HE and TUNEL staining showed significant pathological changes and abundant apoptotic cells in rat retina of AOH group and k252a group compared with those of the control group (p0.05). The number of survived retinal ganglion cells in the AOH group was lower than that of the control group (p0.05). K252a group had the lowest number of survived retinal ganglion cells. Immunohistochemical results showed that BDNF was rarely expressed in rat retinal tissues of the control group, which was remarkably pronounced in the AOH group and k252a group. The number of BDNF-positive cells in the k252a group was higher than that in the AOH group (p0.05). RT-PCR and Western blot indicated that mRNA and protein levels of relative genes in BDNF-TrKB and PI3K/ERK1 pathways were upregulated in AOH group (p0.05), but were significantly downregulated in k252a group (p0.05).BNDF-TrKB pathway exerts a protective effect on retina against acute ocular hypertension by reducing retinal cell apoptosis.

As the comparative pathophysiology of perinatal infection in the fetus and newborn is uncertain, this study contrasted the cerebral effects of endotoxemia in conscious fetal sheep and newborn lambs. Responses to intravenous bacterial endotoxin (lipopolysaccharide, LPS) or normal saline were studied on three consecutive days in fetal sheep (LPS 1 μg/kg, n = 5; normal saline n = 5) and newborn lambs (LPS 2 μg/kg, n = 10; normal saline n = 5). Cerebro‐vascular function was assessed by monitoring cerebral blood flow (CBF) and cerebral vascular resistance (CVR) over 12 h each day, and inflammatory responses were assessed by plasma TNF alpha (TNF‐α), nitrate and nitrite concentrations. Brain injury was quantified by counting both resting and active macrophages in the caudate nucleus and periventricular white matter (PVWM). An acute cerebral vasoconstriction (within 1 h of LPS injection) occurred in both the fetus (ΔCVR +53%) and newborn (ΔCVR +63%); subsequently prolonged cerebral vasodilatation occurred in the fetus (ΔCVR −33%) in association with double plasma nitrate/nitrite concentrations, but not in the newborn. Abundant infiltration of activated macrophages was observed in both CN and PVWM at each age, with the extent being 2–3 times greater in the fetus (P

The Janus activated kinase 2 (JAK2)/signal transducer and the activator of transcription 3 (STAT3) pathway are involved in many physiological processes, such as cell survival, inflammation, development, proliferation and differentiation. Increasing evidence has shown that this pathway also has neuron-specific functions in the central nervous system. In this study, the functional significance of the JAK2/STAT3 signaling pathway in nerve cell apoptosis in rats with white matter injury was evaluated.The rat model of white matter injury was established by ligating bilateral common carotid arteries, and the changes of the JAK2 and STAT3 phosphorylation in hippocampal neurons were evaluated using the immunohistochemistry. In addition, the effects of JAK2 inhibitor AG490 and STAT3 small interfering ribonucleic acids (siRNAs) on the expression of phosphorylated-JAK2 (pJAK2), STAT3 messenger RNAs (mRNAs) and pSTAT3 in hippocampal neurons of white matter injury rats were studied. The effects of both on cerebral infarction volume and neuron apoptosis in white matter injury rats were also investigated.The expression of pJAK2 and pSTAT3 were significantly increased after white matter injury in rats (p0.05). JAK2 inhibitor AG490 markedly decreased the phosphorylation of JAK2 and STAT3 in hippocampal neurons in the model group (p0.05). STAT3 siRNAs remarkably reduced the expression levels of STAT3 mRNA and protein in hippocampus neurons in the model group (p0.05), while having no effect on the expression level of pJAK2 protein. AG490 and STAT3 siRNAs notably attenuated the volume of cerebral infarction in the model group, as well as reduced neuron apoptosis after white matter injury.The inhibition of the JAK2/STAT3 signaling pathway contributed to reducing the volume of cerebral infarction and neuron apoptosis in rats with white matter injury.

Osteosarcoma is recognized as the most common primary malignant bone tumor, the 5-year disease-free survival rate in patients with metastatic or recurrent disease is below than 30%. Drug resistance and toxic side effects limit the therapeutic efficacy of osteosarcoma. Therefore, it is urgent to develop new drugs for osteosarcoma treatment. Muscarinic 3 (M3) acetylcholine receptor (AChR) has been demonstrated in nonneurocrest-derived malignancies such as colon, prostate, lung, and ovarian carcinomas. Hence, targeted regulation of M3 AChR may be a possible mechanism for treating tumors. Aclidinium bromide has anti-tumoral properties in several tumors, namely gastric cancer and glioma. In this study, we intended to investigate whether aclidinium bromide, a novel M3 AChR antagonist, had effects on osteosarcoma cells proliferation and migration.The viability of U2 OS cells was detected by cell counting kit-8 (CCK-8) assay. The migration and invasion capabilities were measured by transwell invasion and migration assays. The cell apoptosis rate was tested by Annexin V-fluorescein isothiocyanate (FITC)/Propidum iodide (PI) staining and flow cytometry. Key apoptosis-related and phosphatidylinositol-3-kinase (PI3K)/protein kinase B (AKT) signaling pathway-associated were assessed by Western blot analysis.Aclidinium bromide markedly decreased the OD value of U2 OS cells 48 h and 72 h after treatment. The number of positive crystal violet staining cells significantly decreased after treatment with aclidinium bromide. Treatment with aclidinium bromide significantly increased cell apoptosis rate, accompanied by the expression of anti-apoptotic protein Bcl-2 decreased, the expression of pro-apoptotic protein Active caspase-3 and Bax significantly increased in U2 OS cells treated with aclidinium bromide. Additionally, aclidinium bromide suppressed the PI3K/AKT signaling pathway in U2 OS cells.Therefore, the current study reveals that aclidinium bromide might inhibit osteosarcoma cell growth by regulating the PI3K/AKT signaling pathway, which suggests aclidinium bromide is a potential chemotherapeutic agent for osteosarcoma.

Desmoglein-2 (Dsg2) plays a crucial role in the assembly and adhesion of desmosomes. The absent or aberrant expression of Dsg2 was reported to be associated with the progression of varies human cancers. However, the expression of Dsg2 in hepatocellular carcinoma (HCC) and its association with tumor prognosis is still unknown. The aim of this study was to evaluate the expression level of Dsg2 in HCC and of the correlation between Dsg2 expression and clinicopathological variables.A total of 104 patients diagnosed with HCC were enrolled in this study. Real time-quantitative PCR (RT-qPCR) and Western blot were performed to determine the expression level of Dsg2 in HCC tumor tissues and matched noncancerous tissues. Cell proliferation and cell cycle were measured by cell counting kit-8 (CCK-8) assay and flow-cytometry assay, respectively.Our results revealed that Dsg2 expression was significantly higher in HCC tumor tissues than in matched noncancerous tissues (p0.01), positively correlated with tumor size (p = 0.035) and tumor stage (p = 0.021). Univariate and multivariate analyses demonstrated Dsg2 expression was an independent prognostic factor for overall survival. Meanwhile, we found knockdown the expression of Dsg2 using small interfering RNA (siRNA) could efficiently impaired HCC cell proliferation rate and cell cycle progression (p0.05).Taken together, our results suggest that increased Dsg2 expression was associated with tumor progression in HCC and may function as a promising biomarker for unfavorable prognosis of HCC.

In order to significantly reduce the synthesis temperature, polytetrafluoroethylene was employed to induce the solid state synthesis of titanium carbide from elemental reactants. According to differential thermal analysis and X-ray diffraction results, titanium carbide can be synthesised successfully at the temperature as low as 825 K from Ti/C mixture with 3 wt-% polytetrafluoroethylene addition. The field emission scanning electron microscopy image showed that the size of the as-prepared titanium carbide particle was smaller than 150 nm.

Summary Body weight is determined via both metabolic and hedonic mechanisms. Metabolic regulation of body weight centres around the ‘body weight set point’, which is programmed by energy balance circuitry in the hypothalamus and other specific brain regions. The metabolic body weight set point has a genetic basis, but exposure to an obesogenic environment may elicit allostatic responses and upward drift of the set point, leading to a higher maintained body weight. However, an elevated steady‐state body weight may also be achieved without an alteration of the metabolic set point, via sustained hedonic over‐eating, which is governed by the reward system of the brain and can override homeostatic metabolic signals. While hedonic signals are potent influences in determining food intake, metabolic regulation involves the active control of both food intake and energy expenditure. When overweight is due to elevation of the metabolic set point (‘metabolic obesity’), energy expenditure theoretically falls onto the standard energy–mass regression line. In contrast, when a steady‐state weight is above the metabolic set point due to hedonic over‐eating (‘hedonic obesity’), a persistent compensatory increase in energy expenditure per unit metabolic mass may be demonstrable. Recognition of the two types of obesity may lead to more effective treatment and prevention of obesity.

This paper presents a data-hiding scheme, which hides the secret data in VQ compressed images using multiple codebooks. The secret data are hidden in the codebook indices after the VQ image compression is completed. The secret data can be extracted from the codebook indices when the decoding of the compressed image is performed. According to the experimental results, the hiding capacity and image quality outperform Jo and Kim's scheme. In other words, the proposed scheme is proved to be capable of supporting high hiding capacity and good image quality.

This study aimed to establish response curves between broiler chicken growth parameters and artificial light periods, as opposed to optimizing a lighting regimen for broiler production. Medium-growing broiler chickens were illuminated for periods of 12, 14, 16, 18, 20, 22, or 24 h each day. The BW of the broilers were significantly influenced by light periods (0.05). Moreover, BW responded to light periods in a linear fashion, suggesting that long light periods result in greater BW. In addition, a linear relationship was found between feed intake and light periods. However, the relationship between shank length and light period was quadratic. When the light period was too short (12 h) or too long (24 h), the light stimulus did not enhance shank growth in the broiler chickens (0.05). In addition, a quadratic relationship between the quantity of abdominal adipose tissue and light period suggested that the quantity of abdominal adipose decreases when the period of the light stimulus was too short or too long (0.05). Moreover, a broken-stick analysis suggested that the triiodothyronine (T3) concentration in the blood was minimally affected beyond 18 h ( = 0.267), although a quadratic relationship was found between the period (from 18 to 24 h) and T3 concentrations in the blood. The response curves established in the present study will be valuable for designing future lighting regimes for medium-growing broiler strains.

This research investigates the aqueous toxicity occurring during color formation due to ozonation in a semi-batch reactor. The tested mono-substituted aromatic compounds were aniline, phenol (-NH2' -OH, electron-donating group), nitrobenzene and benzoic acid (-NO2' -COOH, electron-withdrawing group). The results revealed that the aqueous toxicity of the Microtox assay from oxidized samples during the early stage of ozonation increased when the color formation was observed, except in the case of nitrobenzene under high pH conditions. Toxicity typically reached a peak at or near the moment of maximum color intensity. Ozonation of these aromatic compounds showed a large increase in toxicity, and the 50% effective concentration (EC50) expressed as chemical oxygen demand (COD) (mg 1(-1)) decreased to 1.4 (aniline), 1.2 (benzoic acid), 0.8 (phenol) and 0.6 (nitrobenzene) orders-of-magnitude. Moreover, the aromatic compounds with an electron-donating group promoted color formation more than did the electron-withdrawing group substituted compounds.

Summary: A questionnaire survey of Australian neonatologists was conducted to ascertain their antenatal counselling and resuscitation practices, and attitudes towards life support in the extremely preterm infant. This study showed that in antenatal parental counselling, whether a paediatrician was given the opportunity to participate depends on the gestation at the time of the threatened preterm delivery. The counselling employed almost invariably covered mortality and morbidity. The obstetrician's opinion was considered to be of utmost importance. Both financial and moral obligations were found to be of little importance in counselling and resuscitation. Only one-third of institutions had guidelines for limiting resuscitation. The onus remained on the neonatologists concerning which infant to resuscitate, and the level of the resuscitation to be conducted. In Australia, resuscitation at birth was restricted to infants of 23 weeks' gestation or above, and neonatologists did not believe the legal system has a role to play in limiting or mandating resuscitation of extremely preterm infants. Neither were they concerned with the threat of litigation when they decide to limit resuscitation. The majority of neonatologists agreed with their institution's approach to life support in extremely preterm infants. One grey area was the question of withholding assisted feeding in an infant for which the decision to withdraw life support has been made. Australia lacked a current consensus policy on selective non-treatment. The establishment of national guidelines would be helpful to aid Australian obstetricians and neonatologists in their clinical practice.

Nitrogen incorporated amorphous carbon (a-C:N) films on silicon (111) wafer, quartz, and Ti/C substrates with nitrogen concentration up to 20 at. % are prepared by filtered arc deposition. The nitrogen concentration and area density of the films were measured by Rutherford backscattering. The electrical properties of the films were investigated by Hall electrical measurements. The optical properties of the films were characterized by ultraviolet–visible and infrared reflection spectrometry. Results indicate that the optical band gap and area density of a-C:N films decrease with increasing nitrogen pressure, accompanied with an increase of nitrogen concentration and reflectivity of the films. Furthermore, the influence of nitrogen concentration on the optical band gap of the films is discussed. The dielectric constant, refractive index and absorption coefficient of a-C:N films in infrared region were investigated. The results indicate that the optical constants of a-C:N show considerable variation with wav...

Summary Although primary biliary cirrhosis (PBC) is considered a model autoimmune disease, it has not responded therapeutically to traditional immunosuppressive agents. In addition, PBC may recur following liver transplantation, despite the absence of major histocompatibility complex (MHC) matching, in sharp contrast to the well-known paradigm of MHC restriction. We have suggested previously that invariant natural killer T (iNK T) cells are critical to the initiation of PBC. In this study we have taken advantage of our ability to induce autoimmune cholangitis with 2-octynoic acid, a common component of cosmetics, conjugated to bovine serum albumin (2-OA–BSA), and studied the natural history of pathology in mice genetically deleted for CD4 or CD8 following immunization with 2-OA–BSA in the presence or absence of α-galactosylceramide (α-GalCer). In particular, we address whether autoimmune cholangitis can be induced in the absence of traditional CD4 and CD8 responses. We report herein that CD4 and CD8 knock-out mice immunized with 2-OA–BSA/PBS or 2-OA–BSA/α-GalCer develop anti-mitochondrial antibodies (AMAs), portal infiltrates and fibrosis. Indeed, our data suggest that the innate immunity is critical for immunopathology and that the pathology is exacerbated in the presence of α-GalCer. In conclusion, these data provide not only an explanation for the recurrence of PBC following liver transplantation in the absence of MHC compatibility, but also suggest that effective therapies for PBC must include blocking of both innate and adaptive pathways.

Summary: The aim of this study of extremely low birth-weight (ELBW, birth-weight 500–999 g) infants born in Victoria was to determine the changes between 3 distinct eras; 1979-80, 1985-87, and 1991-92, in the proportions who were born outside level 3 perinatal centres (outbom), the proportions of outborn infants who were transferred after birth to a level 3 neonatal unit, the survival rate for outborn infants, and sensorineural impairment and disability rates in outborn survivors. The proportion of ELBW livebirths who were outborn fell significantly over successive eras, from 30.2% (106 of 351) in 1979-80, to 23.0% (129 of 560) in 1985-87, and to 15.6% (67 of 429) in 1991-92. Between 1979-80 and 1985-87, die proportions who were outborn fell predominantly in those of birth-weight from 800–999 g, whereas between 1985-87 and 1991-92 the proportions who were outborn fell predominandy in those of birth-weight 500–799 g. The proportions of outborn infants who were transferred after birth to a level 3 neonatal unit were similar in die 3 eras, at 49.1%, 38.0% and 41.2%, respectively. The survival rates for outborn infants were lower in each era dian for infants born in a level 3 perinatal centre. Only 1 outborn infant not transferred after birth to a level-3 unit survived in any era. The survival rates for infants transferred after birth were similar in the first 2 eras, but rose significantly in 1991-92 (34.6%, 36.7% and 60.7%, respectively). The rates of sensorineural impairments and disabilities in survivors fell significantly between die first 2 eras, and remained low in the last era. It is pleasing that the proportion of tiny babies who were outborn fell significantly over time, reflecting increased referral of high-risk mothers to level 3 perinatal centres before birth. For ELBW outborn infants, survival prospects free of substantial disability are reasonable, but not as good as for those born in level 3 perinatal centres.

A series of Al-doped amorphous silicon oxide films have been grown on p-type silicon (100) substrates by a dual ion beam cosputtering method. Visible electroluminescence (EL) from the devices, made by films with different contents of Al, can be seen with the naked eye under forward bias and reverse bias for films containing sufficient amounts of Al. The EL spectra are found to have a luminescence band peaked at 510 nm (2.4 eV), which is the same result as that obtained from silicon oxide films. With the increase in the amounts of Al, the peak position does not shift, the onset of the bias decreases, and the intensity of EL peak increases. Experiment results show that the doping of Al is beneficial to improving the conduction condition of films while the structure of the films associated with luminescence centers is affected hardly at all.

In this paper, we present a LEIGHTON type oscillation criterion and a STURM type comparison theorem. These results are obtained by using a generalized RICCATI transformation and can be applied in some cases in which classical oscillation results are not applicable.

A proactive policy of resuscitation at birth and prompt initiation of intensive care have been shown to be associated with an improvement in the survival of very preterm infants in both institution-based and population-based studies. As a greater percentage of live births were offered intensive care, the survival rate rose progressively in all birth weight and gestation subgroups among extremely low birth weight infants, including those who were born at borderline viability between 23 weeks and 25 weeks of gestational age. Their quality-adjusted survival rate also rose progressively, since the large gains in survival over time had not been offset by significant increases in survival with disability. Cost-effectiveness and cost-utility ratios remained stable overall, with efficiency gains in the smaller infants over time, as more such infants were being born in Level III perinatal centers with the regionalization of perinatal-neonatal healthcare programs. National and international surveys of obstetricians and neonatologists on their perception of viability and their management decisions in extremely preterm infants have shown significant variations on the application use of intensive care in those born extremely preterm. If doctors believe that such infants have little prospect for intact survival, their management would be suboptimal or delayed, thus creating a self-fulfilling prophecy. Both developed and developing countries need to develop appropriate policies for initiating and withdrawing intensive care, taking into consideration their own cultural, social, and economic factors.

Extrauterine growth restriction in preterm infants secondary to suboptimal nutrition is a major problem in neonatal intensive care units. Evidence is emerging that early growth deficits have long-term adverse effects, including short stature and poor neurodevelopmental outcomes. The parenteral route of feeding is essential to maintain nutritional integrity before successful transition to the enteral route of feeding is achieved. Nevertheless, early initiation of enteral feeding in sub-nutritional trophic quantity is vital for promoting gut motility and bile secretion, inducing lactase activity, and reducing sepsis and cholestatic jaundice. Results emerging from over sixty randomized clinical trials are available for providing a template on which feeding protocols can be based. Preterm breast milk expressed from the infant's own mother is the milk of choice. Supplementation with a human milk fortifier is necessary to optimize nutritional intake. Preterm formulas are an appropriate substitute for preterm human milk when the latter is unavailable. There are over ten systematic reviews of randomized controlled trials published by the Cochrane Library that addressed feeding strategies, but most do not address long-term outcome measures of clinical importance. There is an urgent need for large-scale, long-term randomized controlled trials to help evaluate metabolic, growth, and neurodevelopmental responses of preterm infants to earlier and more aggressive nutritional management.

both serum ferritin and aminotransferase level as well as C-peptide level at baseline. Biochemical parameters also measured at baseline. To characterize serum ferritin level variable according to metabolic traits and liver function, we analyzed liver function and beta cell function, respectively. To compensate the gender differences, each subject was analyzed separately by sex. Male subjects were categorized into two groups, Group I (abnormal liver function test group) or Group II (normal liver function group) based on aminotransferase level. Result: Of the 108 subjects (67 men and 41 women), male subjects (n=67) had significantly higher ferritin level (202.6ng/ml vs 87.6ng/ml, p= 0.001) and hemoglobin (Hb) level (13.5g/dl vs 12.2g/dl, p< 0.001) than women (n=41) subjects. However total cholesterol level was lower inmale thanwomen subjects. (158.4mg/dl vs 183.9mg/dl, p= 0.005) Subjects with higher aminotransferase level than 40IU/L were defined Group I (n=17). Group I showed significantly higher serum ferritin level (309.8ng/ml vs 166.1ng/ml, p= 0.01) and basal C-peptide level (1.6ng/ml vs 2.7ng/ml, P = 0.025) than Group II. Multiple linear regression analyses showed that basal C-peptide level (p= 0.005) and total cholesterol level (p =0.015) were independently associated with serum ferritin level, only in women subjects. Also, a significant positive correlation was observed serum ferritin level and basal C-peptide level (r = 0.409, P = 0.012) and waist circumference(r = 0.399, P =0.016) in women subjects. Conclusion: Serum ferritin was significantly increased in male subjects with abnormal liver function and insulin resistance. In women subjects, serum ferritin level was positively associated with metabolic syndrome components, such as waist circumference and insulin resistance.

Institution-based studies from perinatal centers are reporting encouraging survival and developmental outcome in extremely preterm infants, but population-based studies of all such births within a geographical-defined region are necessary to examine the impact of perinatal-neonatal care on the entire community. We have reported that their perinatal mortality and severe disability rate were significantly lower in those born within perinatal centers compared with those born elsewhere. Promotion of "in utero transfer" is associated with a significant improvement in their survival and developmental outcome. Postnatal surfactant therapy, which began a decade ago, saw a doubling of the survival rate for infants born as early as 24-26 weeks, while their severe disability rate remains below 10%. Although surfactant and mechanical ventilation are expensive therapies, the resulting improvement in outcome was responsible for a reduction in the cost per additional quality-adjusted life-year gained.

Detection of people with acute HIV infection (AHI) affords an important opportunity for early HIV treatment and prevention. HIV RNA reverse transcriptase-polymerase chain reaction (RT-PCR) testing with two-stage pooling scheme was used to detect the AHI in specimens collected from sexually transmitted disease (STD) clinic patients in Guangxi, China. A total of 246 HIV RNA tests were required to screen 11 395 samples negative for conventional enzyme immunoassay (EIA) and Western blot assays, and five AHI cases (0.04%, 95%CI 0.02% to 0.10%) with a high viral load (median of 265,677 copies per ml) were detected. The total expenditure for RT-PCR testing reflected an added cost of $2.9 per specimen screened and $6575 per additional case of AHI identified among the study population. This study supports the feasibility of pooled RNA testing in addition to detection of HIV infections among patients at STD clinics in China, but the cost effectiveness should be carefully considered.

OBJECTIVE: To investigate whether persistently absent umbilical artery end-diastolic flow in the intrauterine growth-restricted fetus after betamethasone administration is associated with altered perinatal outcomes. METHODS: This is a retrospective cohort study of 92 pregnancies complicated by intrauterine growth restriction (IUGR) and absent end-diastolic flow in which antenatal betamethasone was given. Predefined maternal outcomes (maternal age, gestational age at diagnosis of absent end-diastolic flow, gestational age at delivery, preexisting medical conditions) and neonatal outcomes (including birth weight; perinatal mortality; duration of neonatal intensive care unit admission; requirement for intubation, assisted ventilation, inotropic support; duration of supplemental oxygen, assisted ventilation; respiratory distress syndrome, necrotizing enterocolitis, intraventricular hemorrhage) were analyzed. RESULTS: Betamethasone administration was associated with a transient return of end-diastolic umbilical artery flow in 58 pregnancies (63%) and persistent absent end-diastolic flow in 34 (37%). Persistent absent end-diastolic flow was seen more frequently in women with prepregnancy medical disorders (59% compared with 24%, P

The development of a low-temperature poly-silicon (LTPS) process for thin film transistors (TFT) has led to the potential of embedding integrated circuits on active-matrix liquid-crystal displays. A divide-by-four frequency divider with a wide operation range is realised in 3 µm LTPS TFT technology. The operating frequency range of the divider covers from 1 kHz to 2.8 MHz. The core circuit area of the divider is 0.21 × 2.3 mm.

INTRODUCTION: Absence of the end-diastolic flow (EDF) is associated with adverse neonatal outcome. Administration of β-methasone to women with a pregnancy complicated by absent EDF is associated with the transient return of EDF in up to 70% of cases. OBJECTIVE: We aimed to compare the hospital outcome of preterm infants for whom the absent EDF returned after antenatal administration of β-methasone with those for whom the absent EDF did not return. METHODS: At Monash Medical Center, 80 pregnant women with absent EDF were given 2 intramuscular 11.4-mg doses of β-methasone 24 hours apart. In the majority of pregnancies, EDF returned after β-methasone treatment. The preterm infants born to these 80 pregnant women had their hospital outcome ascertained retrospectively. Statistical analysis was performed by using the χ2 and Mann-Whitney rank-sum tests. RESULTS: The 51 infants for whom the EDF returned were compared with the 29 for whom the EDF did not return. There were no significant differences in their gestational age, birth weight, or resuscitation and ventilation needs. The former group was less acidotic at birth (mean pH: 7.4 vs 7.3 [P < .05]; and mean base excess: −3 vs −5 mmol/L [P < .05]). There was no significant difference in the incidence of respiratory disease, intraventricular hemorrhage, necrotizing enterocolitis, and mortality rates. CONCLUSIONS: Preterm infants born after return of an absent EDF after the administration of antenatal β-methasone were less acidotic at birth, but their hospital morbidity and mortality rates were not significantly improved compared with those for whom the absent EDF did not return.

A proposal and a study of a planar dipole antenna with a multi-arm parasitic element for WiMAX applications are presented. The design of an antenna with rectangular dipole arms, which enable the reception of a single-band frequency, is presented. Furthermore, a multi-arm parasitic element is embedded to enable the operation of dual bands with a 10 dB return loss. The antenna is calibrated for WiMAX applications, which cover the 2.5-2.7, 3.3-3.8 and 5.15-5.85 GHz frequency bands. Details of the proposed antenna configuration and experimental results are discussed.

For stereo vision applications, projective geometry has proved to be a useful tool for solving the rectification problem without camera calibration. However, the criterion of minimisation for projective rectification must be chosen properly in order to avoid unduly geometric distortion. In this paper, an improved algorithm to minimise the distortion by combining a newly developed projective transform with a properly chosen shearing transform is proposed. The emphasis on low geometric distortion makes this method not only appropriate for 3-D reconstruction but also for stereoscopic viewing applications. On the basis of relative modification, this new method contains fewer parameters (6 degrees of freedom) for minimisation, which reduces the processing time, and improves the rectification result. Several different types of image pairs were tested to demonstrate the applicability and reliability of the proposed algorithm visually and quantitatively. Comparisons with other methods are also provided to verify the improvement of this new scheme.

Yu, V. Y. H., and Hollingsworth, E. (1979).Aust. Paediatr. J., 15, 152–159. Respiratory failure in Infants weighing 1000 g or less at birth. The prognosis for infants weighing

Twenty-two preterm infants with systemic candidiasis are reported, of which seven cases were presumed to be antenatally acquired and 15 postnatally acquired. All except one were of very low birthweight. Fifteen infants had positive cultures of blood, cerebrospinal fluid or urine and seven had candida pneumonia only. Clinical features included general instability, respiratory deterioration and a necrotizing enterocolitis-like presentation. The incidence of leukocytosis, shift to the left, eosinophilia and thrombocytopenia were not different from those with bacterial infection. The diagnosis was made after death in two infants. In the remaining 20 infants, treatment was initiated between 5 and 97 days of age, with a median delay of 4 days after the first positive cultures were taken. Complications of amphotericin and 5-flucytosine therapy which developed in five infants resolved on cessation of treatment. The mortality rate was 18% and impairment rate among the 17 very low birthweight survivors was 18%. A high index of suspicion is required for systemic candidiasis, especially in infants of less than 1000 g birthweight. If recognized early, effective and safe antifungal therapy is possible with favourable short- and long-term outcome.

This prospective study documents the incidence, clinical features and risk factors for post-haemorrhagic hydrocephalus (PHH) as well as the short-term outcome after serial CSF taps. Serial real-time ultrasound scans were performed on 220 infants: on all admissions less than or equal to 1250 g and on an additional 130 infants with birthweights greater than 1250 g with risk factors for intraventricular haemorrhage (IVH). Based on percentile charts of postnatal increase in ventricular size and head circumference growth rate, PHH was defined as ventricular dilatation greater than 95th centile associated with either a head circumference growth greater than 95th centile or with clinical features of raised intracranial pressure (ICP). Forty-eight (22%) infants were found to have IVH of whom 14 had intracerebral extension of IVH. Sixteen (40%) of 40 infants who survived the acute episode of IVH developed PHH. PHH occurred more commonly in those who survived severe birth asphyxia and/or intracerebral extension of IVH. Fifteen infants who developed clinical features of raised ICP were treated with serial CSF taps. This procedure was effective in a staged treatment for PHH in relieving clinical symptoms and deferring ventriculo-peritoneal (VP) shunting. Morbidity associated with serial CSF taps and VP shunting is minimal. A high red cell count and protein concentration in the CSF at diagnosis of PHH identified all five infants who subsequently required VP shunting.

Forty (49%) of 82 extremely low birthweight (ELBW, less than 1000 g) infants had periventricular haemorrhage (PVH). Ten (12%) had germinal layer haemorrhage (GLH) alone, 16 (20%) had intraventricular haemorrhage (IVH) and 14 (17%) had intracerebral haemorrhage (ICH). Almost all the cases of PVH had developed by 4 days of age. Small-for-gestational age infants (12% of study population) had a significantly lower incidence and severity of PVH than appropriate-for-gestational age infants. Of 94 infants born between 23 and 28 weeks gestation, 45 (48%) had PVH. The PVH incidence was 60% in those of 23-26 weeks and 38% in those of 27-28 weeks. The hospital survival rate of ELBW infants was 69% in those without PVH and 43% in those with PVH; 70% in GLH alone; 50% in IVH and 14% in ICH. Three survivors developed post-haemorrhage hydrocephalus of whom two required ventriculoperitoneal shunting. Five survivors developed periventricular leukomalacia (PVL) evidenced by cysts identified between 3 and 7 weeks of age. A significant decrease in the incidence of PVH occurred over the study period (67% in 1982, 38% in 1983 and 33% in 1984). This decrease was seen for all grades of PVH. The reasons for this decreased incidence are still to be ascertained but this trend suggests that improvements in neonatal intensive care have the potential to improve the neurological outcome of more recent ELBW survivors.

Summary: The survival and impairment rates of 276 inborn singleton infants of 23–28 weeks' gestation were reported according to route of delivery and mode of presentation. The Caesarean section rate was 29% overall, ranging from 13% at 25 weeks to 46% at 28 weeks. In the vertex group, no significant difference in survival or impairment rate was found between Caesarean and vaginal births. In the nonvertex group, Caesarean births had a similar survival rate but a significantly lower impairment rate compared to vaginal births. For Caesarean births, no significant difference in survival or impairment rate was found between vertex and nonvertex groups. In contrast, for vaginal births, the mode of presentation was important: the non-vertex group had a significantly lower survival rate and higher impairment rate compared to the vertex group. We found no evidence to support the use of Caesarean section in extremely preterm infants with vertex presentation, except for recognized maternal or fetal indications. The findings in the non-vertex group indicated that there is a definite need for a randomized clinical trial to investigate the possible benefits of Caesarean section in extremely preterm infants with non-vertex presentation.