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Cardiovascular (CV) risk factors, such as hypertension, diabetes, and hyperlipidemia are associated with cognitive impairment and risk of dementia in older adults. However, the mechanisms linking them are not clear. This study aims to investigate the association between aggregate CV risk, assessed by the Framingham general cardiovascular risk profile, and functional brain activation in a group of community-dwelling older adults. Sixty participants (mean age: 64.6 years) from the Brain Health Study, a nested study of the Baltimore Experience Corps Trial, underwent functional magnetic resonance imaging using the Flanker task. We found that participants with higher CV risk had greater task-related activation in the left inferior parietal region, and this increased activation was associated with poorer task performance. Our results provide insights into the neural systems underlying the relationship between CV risk and executive function. Increased activation of the inferior parietal region may offer a pathway through which CV risk increases risk for cognitive impairment.

While overweight and obesity are associated with poor health outcomes in the elderly, the biological bases of obesity-related behaviors during aging are poorly understood. Common variants in the FTO gene are associated with adiposity in children and younger adults as well as with adverse mental health in older individuals. However, it is unclear whether FTO influences longitudinal trajectories of adiposity and other intermediate phenotypes relevant to mental health during aging. We examined whether a commonly carried obesity risk variant in the FTO gene (rs1421085 single nucleotide polymorphism) influences adiposity and is associated with changes in brain function in participants within the Baltimore Longitudinal Study of Aging (BLSA), one of the longest-running longitudinal aging studies in the United States. Our results show that obesity-related risk allele carriers of FTO gene show dose-dependent increments in body mass index during aging. Moreover, the obesity-related risk allele is associated with reduced medial prefrontal cortical function during aging. Consistent with reduced brain function in regions intrinsic to impulse control and taste responsiveness, risk allele carriers of FTO exhibit dose-dependent increments in both impulsivity and intake of fatty foods. We propose that a common neural mechanism may underlie obesity-associated impulsivity and increased consumption of high calorie foods during aging.

Energy demand in China is an important issue of global energy. However, the related research is lack of analysis on the spatial diversification of energy demand in China. By adopting time-series data of 31 provincial regions in China from the year 1985 to 2010, this paper attempts to select the optimal regression model by contrast, forecasts energy demand and gap of these provinces in the 12th Five Year and analyzes the spatial characters. This paper finds that the east coast and central uplift regions of China are high-demand and large-gap energy areas. Therefore, more attention should be paid to energy supply in these regions. 2014 WIT Press.

Purpose Diabetes mellitus (DM) is the most common cause of end-stage renal disease and is an important risk factor for morbidity and mortality after dialysis. However, glycemic control among such patients is difficult to assess. The present study examined glycemic control parameters and observed glucose variation after refilling different kinds of fresh dialysate in peritoneal dialysis (PD) patients. Methods A total of 25 DM PD patients were recruited, and continuous glucose monitoring system (CGMS) was applied to measure interstitial fluid (ISF) glucose levels at 5-min intervals for 3 days. Patients filled out diet and PD fluid exchange diaries. The records measured with CGMS were analyzed and correlated with other glycemic control parameters such as fructosamine, albumin-corrected fructosamine (AlbF), glycosylated hemoglobin (HbA1c), and glycated albumin levels. Results There were significant correlations between mean ISF glucose and fructosamine (r = 0.45, P

Cytomegalovirus (CMV) infection is one of the most common persistent viral infections in humans worldwide and is epidemiologically associated with many adverse health consequences during aging. Previous studies yielded conflicting results regarding whether large, CMV-specific T-cell expansions maintain their function during human aging. In the current study, we examined the in vitro CMV-pp65-reactive T-cell response by comprehensively studying five effector functions (i.e., interleukin-2, tumor necrosis factor-α, interferon-γ, perforin, and CD107a expression) in 76 seropositive individuals aged 70 years or older. Two data-driven, polyfunctionality panels (IL-2-associated and cytotoxicity-associated) derived from effector function co-expression patterns were used to analyze the results. We found that, CMV-pp65-reactive CD8+ and CD4+ T cells contained similar polyfunctional subsets, and the level of polyfunctionality was related to the size of antigen-specific response. In both CD8+ and CD4+ cells, polyfunctional cells with high cytotoxic potential accounted for a larger proportion of the total response as the total response size increased. Notably, a higher serum CMV-IgG level was positively associated with a larger T-cell response size and a higher level of cytotoxic polyfunctionality. These findings indicate that CMV-pp65-specific CD4+ and CD8+ T cell undergo simultaneous cytotoxic polyfunctionality maturation during aging.

This chapter considers the relationship of disorders to brain function. It begins by defining executive functions and their importance to prosocial behavior and independent functioning. It then describes how these functions develop concomitantly with prefrontal brain growth through childhood and adolescence and decline in late life. Next it reviews specific mental disorders that arise during these developmental windows and the executive dysfunctions common to those disorders. The disorders considered include attention deficit hyperactivity disorder, schizophrenia, depression, generalized anxiety disorder, Huntington's disease, Parkinson's disease, and possibly Alzheimer's disease. The chapter concludes by highlighting the importance of imaging and biomarkers, methods that will continue to elucidate brain-behavior relationships and so aid early detection, prognosis, and treatment.

The 2009 influenza pandemic provided an opportunity to observe dynamic changes of the hemagglutinin (HA) and neuraminidase (NA) of pH1N1 strains that spread in two metropolitan areas--Taipei and Kaohsiung. We observed cumulative increases of amino acid substitutions of both HA and NA that were higher in the post-peak than in the pre-peak period of the epidemic. About 14.94% and 3.44% of 174 isolates had one and two amino acids changes, respective, in the four antigenic sites. One unique adaptive mutation of HA2 (E374K) was first detected three weeks before the epidemic peak. This mutation evolved through the epidemic, and finally emerged as the major circulated strain, with significantly higher frequency in the post-peak period than in the pre-peak (64.65% vs 9.28%, p

Left ventricular (LV) diastolic dysfunction has great effects on the left atrium (LA). A recently developed electromechanical interval (PA-TDI), which was determined as the time interval from the initiation of P wave deflection to the peak of local lateral LA tissue Doppler imaging signal, was reported to be associated with LA electrophysiological properties. The goal of our study was to evaluate the association between the PA-TDI interval and LV diastolic function.A total of 224 consecutive patients were enrolled. LV diastolic dysfunction was defined as either (i) impaired relaxation: E/A ratio0·75 and E/E' ratio10, (ii) pseudonormal pattern: 0·75 ≤ E/A ratio1·5 and E/E' ratio10 or (iii) restrictive pattern: E/A ratio ≥ 1·5 and E/E' ratio10. The PA-TDI intervals were measured and compared between patients with and without diastolic dysfunction. Fifty-six per cent of the study population had abnormal diastolic function. The PA-TDI interval was significantly longer in the diastolic dysfunction group than that in the normal group (147·8 ± 18·2 vs. 130·4 ± 17·0 ms, P0·01). In patients with diastolic dysfunction, the PA-TDI intervals became progressively longer as the diastolic dysfunction progressed from impaired relaxation (141·2 ± 11·4 ms), pseudonormal pattern (147·6 ± 18·0 ms) to restrictive pattern (164·1 ± 20·9 ms). The PA-TDI interval was significantly longer in patients with LV diastolic dysfunction than those without it. Its prolongation may reflect the severity of atrial remodelling because of the abnormal diastolic function of LV.

Background Metabolic syndrome (MS) is thought to be a risk marker for cardiovascular diseases in the general population and in patients with chronic kidney disease. This study investigated whether the presence of MS also modifies cardiovascular (CV) outcomes among non-diabetic patients undergoing long-term peritoneal dialysis (PD). Methods We enrolled 280 patients from a medical centre in North Taiwan who began PD between January 1999 and December 2005 and followed them until December 2009. MS was defined by the modified National Cholesterol Educational Programme (Adult Treatment Panel III) criteria. All parameters and biochemical data were collected by chart review. Patient outcomes (overall and CV death, fatal or non-fatal CV events) were recorded during the follow-up period. Survival was analysed by the Kaplan-Meier method, and the influence of MS and its components on outcomes were analysed by Cox regression models. Results The average follow-up period was 49.2 months. Non-diabetic patients with MS had worse outcomes than those without MS or at risk for MS, but better than their diabetic counterparts. By multivariate analysis, MS was independently associated with increased risk for CV death (hazard ratio, HR = 13.27) and fatal or non-fatal CV events (HR = 10.50). Among five MS components, hypertriglyceridaemia, low high-density lipoprotein levels and hyperglycaemia were significant risk factors for adverse CV outcomes. Conclusions MS is a potent risk marker for adverse CV outcomes in non-diabetic patients on PD. Timely interventions targeting specific component of this syndrome may be required in this subset of patients.

Background Fetuin A, a predictor of mortality in dialysis patients, is associated with vascular calcification and atherosclerosis in hemodialysis (HD) patients. Whether it predicts arteriovenous (AV) access patency is unknown. This study aimed to investigate the association between fetuin A and AV access patency in HD patients. Study Design Prospective observational study. Setting & Participants 238 prevalent HD patients (127 women and 111 men; mean age, 60 ± 12 years) were followed up for AV access patency for 32 months. Predictors Tertiles of baseline circulating fetuin A levels, corresponding to 0.15-0.25, 0.26-0.32, and 0.33-0.51 g/L. Outcome The major outcome was loss of unassisted AV access patency, defined as AV access thrombosis or need for intervention. Measurements Fetuin A and other markers of inflammation. Results 100 patients had loss of AV access patency (42%) on follow-up. Patients in the lowest fetuin A tertile had the worst AV access patency (log-rank test, χ 2 = 8.68; P = 0.01). Using Cox proportional hazards regression with patients in the lowest fetuin A tertile as reference, patients in the intermediate tertile had an HR of 0.49 (95% CI, 0.29-0.82), whereas those in the highest fetuin A tertile had an HR of 0.43 (95% CI, 0.25-0.75) for loss of AV access patency. Similarly, considering patients using AV fistulas or grafts separately, patients in the highest fetuin A tertile had less risk of losing AV access patency than patients in the other tertiles (HR, 0.40 [95% CI, 0.19-0.84] for patients with AV fistulas and HR, 0.25 [95% CI, 0.10-0.65] for patients with AV grafts). Limitations Focus on the patency of prevalent rather than new AV access in maintenance hemodialysis patients. Conclusions Fetuin A deficiency is associated with a higher risk of loss of AV access patency in either native AV fistulas or AV grafts in HD patients.

We have developed a new method to produce thin-entrance-window Silicon Drift Detectors. To produce the desired thin-entrance-window a double implantation was used. This implantation consists of Boron ions (dose of 1×1014/cm2 at 10 keV) plus a second implant of Phosphorus ions (with a dose of 4×1012/cm2 at 50 keV or dose of 9×1011/cm2 at 80 keV) through 500 A of silicon dioxide. The second Phosphorus implantation compensates for the tail portion of the Boron ion implantation, so that the net Boron ion distribution will result in a thinner “dead” silicon layer and an elevated electric field near the silicon surface. We will compare test results from this newly developed thin-window with those from our previous development, where the thin junction was created using a single implantation of Boron ions (dose of 1×1014/cm2 at 10 keV) through a 500 A thick silicon dioxide. All testing was done in the U3C beam line at the National Synchrotron Light Source at Brookhaven National Laboratory.

Residual renal function (RRF) at the initiation of peritoneal dialysis (PD) therapy can predict patient outcome. However, RRF declines with time at variable rates in different patients. This study was performed to compare the impact of baseline RRF and the rate of RRF decline on patient survival and on death-censored technique survival after initiation of long-term PD.We enrolled 270 patients with sufficient urine amount (daily urine volume100 mL) from a medical centre in North Taiwan who began PD between January 1996 and December 2005 and followed them until December 2007. The study population was stratified by the decline rate of RRF into a fast, intermediate and slow decline group. The Kaplan-Meier survival analysis was used to determine patient survival and technique survival. The Cox regression model was used to identify factors associated with patient outcome. The proportional odds polychotomous logistic regression model was used to identify variables associated with rapid decline of RRF.During an average follow-up period of 45 months, 50 (18.5%) deaths, 67 (24.8%) death-censored technique failures (transfer to haemodialysis) and 43 (15.9%) renal transplantations occurred. The median rate of RRF decline was 0.885 mL/min/1.73 m(2) per year. Survival analysis showed that patients with fast RRF decline had worse survival and increased risk of technique failure. The multivariate Cox regression model confirmed that the rate of RRF decline was an independent factor associated with patient and technique survival and was a more powerful prognostic factor than basal RRF. Variables associated with a rapid decline of RRF were larger body mass index, presence of diabetes, prior history of congestive heart failure, use of diuretics, peritonitis episodes and hypotensive events.Our data indicate that the rate of decline of RRF is a more powerful prognostic factor than baseline RRF associated with all-cause mortality and technique failure in patients on long-term PD. To prevent accelerated loss of RRF, it is imperative that every effort be made to avoid overdiuresis, peritonitis and hypotensive episodes, especially in those with diabetes, obesity and congestive heart failure.

⋄ ObjectiveLoss of residual renal function (RRF) in peritoneal dialysis (PD) patients is a powerful predictor of mortality. The present study was conducted to determine the predictors of faster decline of RRF in PD patients in Taiwan.⋄ MethodsThe study enrolled 270 patients starting PD between January 1996 and December 2005 in a single hospital in Taiwan. We calculated RRF as the mean of the sum of 24-hour urea and creatinine clearance. The slope of the decline of residual glomerular filtration rate (GFR) was the main outcome measure. Data on demographic, clinical, laboratory, and treatment parameters; episodes of peritonitis; and hypotensive events were analyzed by Student t-test, Mann–Whitney U-test, and chi-square, as appropriate. All variables with statistical significance were included in a multivariate linear regression model to select the best predictors ( p < 0.05) for faster decline of residual GFR.⋄ ResultsAll patients commencing PD during the study period were followed for 39.4 ± 24.0 months (median: 35.5 months). The average annual rate of decline of residual GFR was 1.377 ± 1.47 mL/min/m2. On multivariate analysis, presence of diabetes mellitus ( p < 0.001), higher baseline residual GFR ( p < 0.001), hypotensive events ( p = 0.001), use of diuretics ( p = 0.002), and episodes of peritonitis ( p = 0.043) independently predicted faster decline of residual GFR. Male sex, old age, larger body mass index, and presence of coronary artery disease or congestive heart failure were also risk factors on univariate analysis.⋄ ConclusionsOur results suggested that diabetes mellitus, higher baseline residual GFR, hypotensive events, and use of diuretics are independently associated with faster decline of residual GFR in PD patients in Taiwan.

This study aimed to reduce the length of waiting time for patients undergoing peritoneal dialysis (PD). Long waiting times and over-crowding in the waiting area were two of the most frequent complaints among PD patients at a peritoneal dialysis center. The center carried out a survey to investigate patients' satisfaction with their visit and the length of time they had to wait during their visit. The average waiting time was 88.3 minutes, and the average score for satisfaction was 78. After a Cause-and-Effect diagram analysis, recommendations to improve patient visits were as follows: (1) establish a computerized appointment system, (2) provide designated arrival times, (3) reorganize visit procedures, (4) integrate the pre-visit preparation process, and (5) rearrange the waiting areas. With better processes, patients might obtain thorough evaluations and nursing care while waiting. Two months after the implementation of these proposals, the average waiting time had shortened to 27.4 minutes, and scores for satisfaction had increased to 86, showing the proposed measures to be highly effective.

Background/Aims: Sexual dysfunction in patients undergoing peritoneal dialysis (PD) is highly prevalent, but studies addressing this issue are scarce. This cross-sectional study aims to evaluate sexual dysfunction and the determinants among PD patients. Methods: All chronic PD patients in 8 PD centers were asked to complete a self-reported questionnaire – the International Index of Erectile Function (IIEF) for men and the Index of Female Sexual Function (IFSF) for women – so that sexual function could be assessed. They also answered the Beck Depression Inventory (BDI) to measure depressive symptoms. Results: Among 294 patients invited for study, 54 men (mean age 48.8 ± 10.8 years) and 45 women (mean age 43.6 ± 7.4 years) were willing to and completed the sexual function questionnaires. The median IIEF score in the men was 56.25. The prevalence of erectile dysfunction, identified by the score in erectile domain of IIEF ≤25, was 51.9%. Older age and higher fasting glucose levels were independently associated with a decreased IIEF score. In women, IFSF score (with a median 27) was significant lower than in healthy peri- or postmenopausal control women. Factors of higher BDI score, receiving automated PD, and older age independently associated with a decreased IFSF score. Conclusions: Sexual dysfunction is clinically relevant and multi-dimensional among PD patients. Gender differences exist in the attributing factors of sexual functioning. These warrant more awareness and investigation in the global health care of dialysis patients.

Xanthogranulomatous inflammation is an uncommon, though well-recognized entity that has been described in various organs but mostly commonly in the kidney and gallbladder. There have been few reports of its occurrence in the appendix. We report a 39-year-old man who presented with fever, right lower quadrant abdominal pain and mass. Abdominal computed tomography (CT) revealed diffuse wall thickening over the terminal ileum and cecum with involvement of the mesentery. CT-guided biopsy showed colitis with infiltration of lymphocytes, neutrophils and eosinophils. The patient's illness responded to intravenous antibiotics, but relapsed after switching to oral antibiotics. After the second course of intravenous antibiotics was given without resolution of symptoms, exploratory laparotomy was performed. Although operative findings favored colitis of the cecum, cancer of the cecum could not be completely ruled out. Right hemicolectomy was done and pathology confirmed the diagnosis of xanthogranulomatous appendicitis. This case illustrates that xanthogranulomatous appendicitis may mimic a locally advanced cancer, has a benign course, and can be cured by surgical resection.

A new technique to design the power system stabilizer (PSS) based on single-input fuzzy logic controller (SFLC) is proposed to enhance the damping of a power system A special feature of the SFLC is that it can greatly reduce the number of fuzzy decision rules table to a one-dimensional space. The proposed approach is developed for designing the tuning parameters, of the SFLC PSS by strip-eigenvalue placement based on linear quadratic regulator (LQR) method. that does not involve choosing the weighting matrices. The output feedback SFLC PSS is designed by the minimum excitation error (MEE) criteria. The nonlinear simulation is used to show that the proposed SFLC PSS significantly improves the electromechanical mode oscillations of the power system in a large disturbance and a wide range of operating conditions.

A new bidirectional nondissipative battery equalization scheme for the series battery strings is proposed in this paper. The proposed scheme comprises a converter circuit with an energy transferring capacitor, which can be used to design the bidirectional nondissipative current diverter for the battery balancing system. Simulation and experimental results show that the proposed battery equalization scheme can balance the voltage of the battery strings and increase the equalizing efficiency. Furthermore. the equalization scheme can be designed as a ripple-free converter for improving the input current distortion of the battery charging power system.

In this paper, we investigate the effects of integrity at die-attach/leadframe interface on the thermal resistances of packages. Factors that impact the interface integrity such as leadframe surface finishes, die attach types and thermomechanical stress are addressed. Our goal is to achieve the best thermal performance of power semiconductor packages with optimal conditions.

Multimedia electronic books play an important role now as the demand for creative education is becoming a major trend in elementary schools. Although the textual scripting languages can describe powerful scenarios, users must be skilled with programming ability in order to create multimedia electronic books. For common users such as elementary school teachers, it may not be an easy job for them to produce multimedia electronic books. Thus, innovative ways to create multimedia electronic books must be requested. We propose a visual scenario construction language for electronic books. Using the proposed visual construction approach, one can create animated pictures or motion pictures and use it to describe a presentation scenario instead of writing a large mass of textual programs. Based on the proposed approach, an interactive multimedia electronic book can be produced relatively easy compared with the use of traditional approaches.

The WWW has become a powerful media for knowledge displacement and acquisitions for Internet users. For Internet content providers, the homepage is the common way to let users know where the contents are placed. Currently, there are many homepage design tools available for content providers to make their Web pages, FrontPage Express, Flash, HotDog, to name a few. While making an animated multimedia homepage, most of these design tools have to use their extended programming features such as combing part of the code of JavaScript, or Java program to achieve this goal. For general users, especially for the non-computer professional users, to write Java programs to make an animated multimedia homepage is not an easy job. In this paper, a visual authoring system for general users to make an animated multimedia homepage is proposed. Based on this tool, users can create an animated multimedia homepage at their fingertips without writing any program or code. The proposed authoring tool has been technology transferred to the Best Wise International Computing Cooperation for product development. Examples shown in this paper are created based on the WebFace Maker (a product of the Best Wise International Computing Co.) which is a product developed using the proposed technology.

4.4 mmol/l, blood urea nitrogen 28 mg/dl, creatinine3.1 mg/dl, glucose 91 mg/dl, albumin 2.2 g/dl.Spontaneous bacterial peritonitis is a serious and fre- Asparate aminotransferase (AST) and alanine amino-quent complication in childhood nephrotic syndrome transferase (ALT) were 17 U/l and 5 U/l respectively,[1–3]. This type of complication in adult nephrotic and total bilirubin was 0.1 mg/dl. There was 3+patients is; however, very rare and only three cases protein on urinalysis, and urinary sediments revealedhave been reported to our knowledge [4–6]. In haematuria and 15–20 WBC/high-power field. Totalthese cases, spontaneous bacterial peritonitis usually protein in 24-h collection of urine was 4.675 g/day.occurred when patients were either in relapse or receiv- The patient’s chest X-ray film showed no pathologicaling steroid therapy at the time of diagnosis [1]. We findings. Abdominal paracentesis showed a cloudedobserved a 28-year-old female with spontaneous bac- fluid with 688 WBC/mm3with a diVerential count ofterial peritonitis and chronic renal failure as the initial 64% neutrophils, 30% monocytes, 2% eosinophils,presentations of nephrotic syndrome. and 4% lymphocytes. Ascitic fluid culture grew

By using frequency and time domain dielectric spectroscopy, the polar phase transitions of (Ba 1- x Sr x )TiO 3 ceramics have been studied. Compared with the phase transitions of a ferroelectric crystal, the motion of space charges in ceramic has been obtained as well as lattice softening, excitation of screen charges and motion of ferroelectric domains. Slow effect, which is contributed by ferroelectric domains and space charges, can affect the accurate measurement by frequency domain method. In this paper we describe this influence and explain some experimental results. The reciprocal of frequency domain dielectric constant has a linear softening in the transition of primary structure, but has a parabolic type softening in that of high structure.