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The pushover procedure is extended to obtain the seismic response estimates of asymmetrical buildings. The proposed procedure includes some of the three dimensional effects caused by the torsional responses of these buildings. New features of the procedure are the use of elastic dynamic analyses of the building to obtain the target displacements and the shape of load distribution in pushover analysis for the different lateral load resisting elements. By means of examples it is shown that the procedure leads to good estimates of the floor displacements, interstorey drifts, maximum column and beam ductility demands of the edge frames of a seven storey reinforced concrete asymmetrical building with ductile moment resisting frames. Since the proposed procedure only requires two dimensional inelastic analysis programs that are already available and have been used extensively by the design profession, it is a practical way to extend the pushover procedure to analyze asymmetrical buildings.

Aims To investigate the usefulness of the additional measurement of HbA1c, compared with performing only the oral glucose tolerance test (OGTT), in identifying participants at increased cardiometabolic risk, in an urban Chinese population. Methods All participants from the fourth visit of the population-based Hong Kong Cardiovascular Risk Factors Prevalence Study, without known diabetes, were included. All had their glycaemic status assessed by OGTT and HbA1c, according to American Diabetic Association 2010 criteria. Results Based on OGTT criteria alone, 3.5% of the study cohort (N = 1300) had diabetes and 19.2% had prediabetes. Based on HbA1c criteria only, 6.2% had diabetes and 61.2% had prediabetes. The measurement of HbA1c, in addition to the OGTT, increased the proportion of participants with diabetes to 7.8% and with prediabetes to 65.3%. Subjects with prediabetes having raised HbA1c but normal glycaemia (N = 600) had waist circumference, systolic blood pressure, fasting glucose, insulin resistance index (HOMA–IR), Gutt Index and Framingham 10-year cardiovascular risk scores intermediate between those with both normal HbA1c and glycaemia (N = 350), and those with impaired fasting glucose and/or impaired glucose tolerance (N = 249; all P

To describe a method to reduce the external radiation exposure emitted from the patient after liver-directed radioembolization usingA lead-lined blanket of lead equivalence of 0.5 mm was used to cover the patient abdomen immediately after theThe radiation exposures measured at the radiologist chest and hand positions have been significantly reduced with the lead-lined blanket in place. The radiologist, performing puncture site pressing at the end of radioembolization procedure, would receive an average hand dose of 1.95 μSv and body dose under his own lead apron of 0.30 μSv for an averageBy placing a lead-lined blanket on the patient abdominal region after

Aims/hypothesis: Hypoadiponectinaemia and raised C-reactive protein (CRP) level are obesity-related biomarkers associated with glucose dysregulation. We evaluated the combined use of these two biomarkers in predicting the deterioration of glycaemia in a prospective study after a median of 5.4 years. Methods: In total 1,288 non-diabetic participants from the Hong Kong Cardiovascular Risk Factor Prevalence Study-2, with high-sensitivity CRP (hsCRP) and total adiponectin levels measured were included. OGTT was performed in all participants. Two hundred and six participants had deterioration of glycaemia at follow-up, whereas 1,082 participants did not. Results: Baseline age, hsCRP and adiponectin levels were significant independent predictors of the deterioration of glycaemia in a Cox regression analysis after adjusting for baseline age, sex, BMI, hypertension, triacylglycerols, 2 h post-OGTT glucose and homeostasis model assessment of insulin resistance index (all p < 0.01). The introduction of hsCRP or adiponectin level to a regression model including the other biomarker improved the prediction of glycaemic progression significantly in all participants, especially in women (all p < 0.01). The combined inclusion of the two biomarkers resulted in a modest improvement in model discrimination, compared with the inclusion of either one alone. Among participants with impaired fasting glucose/impaired glucose tolerance (IFG/IGT) at baseline, hsCRP and adiponectin levels were not predictive of progression or improvement of glycaemic status. Conclusions/interpretation: Adiponectin and hsCRP levels are independent factors in predicting the deterioration of glycaemia, supporting the role of adiposity-related inflammation in the development of type 2 diabetes. Their combined use as predictive biomarkers is especially useful in women, but not in participants with IFG/IGT. © 2011 The Author(s)., published_or_final_version, Springer Open Choice, 21 Feb 2012

Adipocyte fatty acid-binding protein (A-FABP) is an adipokine shown to have adverse metabolic and proinflammatory effects, and contributes to atherosclerosis in mice. However, its role in cardiovascular diseases in humans remains to be established. In this case-control study, we investigated the association of serum A-FABP with ischemic stroke, and examined its association with early mortality.Serum A-FABP was measured, using ELISA, in 306 subjects with acute ischemic stroke and 306 age-, sex-, and body mass index-matched controls. All controls were free of cardiovascular diseases. Serum A-FABP was also measured in another 60 ischemic stroke subjects who died within 3 months of acute stroke.Serum A-FABP was higher in subjects with ischemic stroke as compared to controls (19.6 ng/mL [14.3-28.4 ng/mL] vs 15.2 ng/mL [10.6-23.6 ng/mL] in men and 32.4 ng/mL [24.5-45.7 ng/mL] vs 22.0 ng/mL [14.3-34.0 ng/mL] in women, stroke vs control, p0.001). On logistic regression analyses with the model including hypertension, diabetes, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglyceride, lipid-lowering treatment, smoking, and A-FABP, serum A-FABP was independently associated with stroke (odds ratio 2.10, 95% confidence interval 1.50-2.94, p0.001), and the associations of A-FABP with ischemic stroke were additive to conventional risk factors, as demonstrated on likelihood ratio tests (p0.001). Furthermore, high serum A-FABP was associated with increased 3-month mortality in ischemic stroke subjects (odds ratio 2.65, 95% confidence interval 1.18-5.96, p=0.018), independent of age and NIH Stroke Scale score.Serum A-FABP was significantly associated with ischemic stroke in our case-control study, and may serve as a useful prognostic indicator for early mortality.

Objective Endothelial dysfunction and inflammation are pathogenic mechanisms common to systemic sclerosis (SSc) and atherosclerosis. This study was undertaken to examine the relationship between coronary atherosclerosis, as assessed by the coronary artery calcium score (CACS), and conventional cardiovascular and disease-specific risk factors in SSc patients. Methods The CACS was measured by computed tomography, and cardiovascular risk factors were examined in SSc patients and compared with controls matched for age, sex, and glycemic status. Disease activity score, antiphospholipid antibodies, high-sensitivity C-reactive protein level, and erythrocyte sedimentation rate were measured in SSc patients. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were determined. Results We recruited 53 SSc patients (50 women and 3 men) and 106 controls. The patients had a mean ± SD age of 53.1 ± 12.9 years and a median disease duration of 9 years. Compared to controls, SSc patients had significantly lower low-density lipoprotein (LDL) cholesterol levels (P = 0.001), high-density lipoprotein cholesterol levels (P = 0.01), diastolic blood pressure, waist circumference, and body mass index and were more likely to be receiving vasodilators (all P < 0.001). There was a significantly higher proportion of SSc patients among subjects with more severe coronary calcification (CACS ≥101) compared to those with lesser severity (CACS

Recent large-scale genome-wide association studies identified novel genetic variants associated with obesity and body mass index (BMI) in addition to the well-described FTO and MC4R genetic variants.This study aimed to examine 13 previously reported obesity and/or BMI-associated loci for associations with obesity in Chinese.This was a cross-sectional case-control study in 470 obese cases (BMIor =27.5 kg/m(2)) and 700 normal-weight controls (18.5or = BMIor = 23.0 kg/m(2)).A significant association with obesity could be replicated (one tailed P0.05) in seven of the 13 single-nucleotide polymorphisms (SNPs) in the case-control study. These included GNPDA2 rs10938397 (P = 7.3 x 10(-4)); FTO rs8050136 (P = 8 x 10(-4)); MC4R rs17782313 (P = 1.2 x 10(-3)); KCTD15 rs29941 (P = 8 x 10(-3)); SFRS10-ETV5-DGKG rs7647305 (P = 0.023); SEC16B-RASAL2 rs10913469 (P = 0.041); and NEGR1 rs3101336 (P = 0.046). Combined genetic risk scores were calculated, and we observed ORs ranging from 1.17 to 1.23 for each unit increase in the genetic risk scores. Associations with obesity-related quantitative traits were analyzed separately for cases and controls. KCTD15 SNP rs29941 (P = 1 x 10(-3)) was significantly associated with fasting glucose in the control group, whereas only the FTO SNP rs8050136 was associated with BMI (P = 3.5 x 10(-3)) in the obese group. However, in an extension study of 1938 subjects from the population-based Hong Kong Cardiovascular Risk Factors Prevalence Study, rs8050136, rs10938397, and rs17782313 showed significant associations with BMI.We have succeeded in replicating, in a Chinese population, the associations with obesity in seven SNPs reported in recent genome-wide association studies. Further functional and fine-mapping studies to elucidate the roles of these putative obesity-related genes and genetic variants are warranted.

The purpose of this prospective study was to evaluate the efficacy and complications associated with the use of 4-Fr single-lumen non-valved peripherally inserted central venous catheters (PICC) for the infusion of long-term antibiotics. Forty-four non-valved PICC were inserted using micropuncture technique by interventional radiologists. Six patients were lost to unrelated death or follow up. The remaining 38 patients (24 men and 14 women; mean age 54.79 years) were analysed. Catheters were placed under ultrasound guidance using micropuncture technique and subsequently advanced over guidewire through peel-away sheath under fluoroscopic guidance. Doppler ultrasound was used before PICC removal in order to detect possible complications. All non-valved PICC were flushed with 5 ml of heparinized saline before and after each antibiotic infusion. Efficacy was evaluated and analysed on the average duration of catheter patency and whether any complication was present. Procedural success rate was 100% in our patient population. Seven patients had complications necessitating early PICC removal with the average patency duration of 44 days (95% confidence interval 7.79-80.21 days), whereas an average indwelling patency duration of the remaining 31 patients with no complication was 30.58 days (95% confidence interval 25.74-35.43 days). Total complication rate was calculated to be 5.58 incidences per 1000 catheter days. Complication rate associated with the placement and use of 4-Fr non-valved PICC for antibiotic therapy was observed to be low when compared with other studies using valved and non-valved PICC for various infusates.

Interfering with the activation of receptor for AGE (RAGE) by using a soluble form of the AGE receptor (sRAGE) prevents or ameliorates the vascular complications of diabetes in experimental studies. Relatively little is known about factors that influence endogenous circulating sRAGE in humans. We investigated the impact of improving glycaemic control on serum total sRAGE and endogenous secretory RAGE (esRAGE), a splice variant of sRAGE, and compared the effect of rosiglitazone with that of sulfonylurea. A randomised, open-label, parallel group study was performed with 64 participants randomised to receive add-on therapy with either rosiglitazone or sulfonylurea. Serum total sRAGE and esRAGE and metabolic parameters were measured before and after 6 months of treatment. At 6 months, both rosiglitazone and sulfonylurea resulted in a significant reduction in HbA1c, fasting glucose and AGE. However, significant increases in total sRAGE and esRAGE were only seen in the rosiglitazone group. As a result, serum esRAGE was higher in the rosiglitazone group than in the sulfonylurea group at 6 months (p

Recent studies have shown that for many reinforced concrete lateral force-resisting elements (LFRE) stiffness is dependent on strength, and as a result strength assign-ment to these elements would affect both the strength and stiffness distributions in a structure. As a consequence, stiffness distribution cannot be considered known prior to strength assignment. This implies that in assigning strength to LFRE, the designer has the ability not only to prescribe the strength distribution, but also indirectly control the stiffness distribution in the structure. In this paper, a study is made on the seis-mic performance of a number of single-story structures to reconfirm that the “balanced CV-CR location” criterion, previously suggested by the writers, constitutes a desirable strength/stiffness distribution for minimising torsional response of asymmetric reinforced concrete structures.

Secretion of leptin from adipocytes communicates body energy status to the brain by activating the leptin receptor long form (LRb). LRb regulates energy homeostasis and neuroendocrine function; the absence of LRb in db/db mice results in obesity, impaired growth, infertility and diabetes. Tyr 1138 of LRb mediates activation of the transcription factor STAT3 during leptin action. To investigate the contribution of STAT3 signalling to leptin action in vivo, we replaced the gene encoding the leptin receptor (lepr) in mice with an allele coding for a replacement of Tyr 1138 in LRb with a serine residue (lepr(S1138)) that specifically disrupts the LRb-STAT3 signal. Here we show that, like db/db mice, lepr(S1138) homozygotes (s/s) are hyperphagic and obese. However, whereas db/db mice are infertile, short and diabetic, s/s mice are fertile, long and less hyperglycaemic. Furthermore, hypothalamic expression of neuropeptide Y (NPY) is elevated in db/db mice but not s/s mice, whereas the hypothalamic melanocortin system is suppressed in both db/db and s/s mice. LRb-STAT3 signalling thus mediates the effects of leptin on melanocortin production and body energy homeostasis, whereas distinct LRb signals regulate NPY and the control of fertility, growth and glucose homeostasis.

Recent studies have shown that for many lateral force-resisting elements (LFRE) stiffness is dependent on strength, and as a result strength assignment to these elements would affect both the strength and stiffness distributions in a structure. Consequently, stiffness distribution cannot be considered known prior to strength assignment. This paper presents a yield displacement distribution-based strength assignment strategy that does not require the knowledge of stiffness distribution prior to strength assignment. It is shown that structural systems with their center of rigidity (CR) and center of strength (CV) located on the opposite sides of the center of mass (CM) will have small torsional responses under seismic excitation. Copyright © 2003 John Wiley Sons, Ltd.

Objective:To describe a method to reduce the external radiation exposure emitted from the patient after liver-directed radioembolization using 90Y glass microspheres, to quantitatively estimate the occupational dose of medical personnel providing patient care to the patient radioembolized with the use of the method and to discuss radiation exposure to patients who are adjacent if the patient radioembolized needs hospitalization.Methods:A lead-lined blanket of lead equivalence of 0.5 mm was used to cover the patient abdomen immediately after the 90Y radioembolization procedure, in order to reduce the radiation emitted from the patient. The interventional radiologist used a rod-type puncture site compressor for haemostasis to avoid direct contact with possible residual radioactivity at the puncture site. Dose rates were measured at the interventional radiologist chest and hand positions during puncture site pressing for haemostasis with and without the use of the blanket. The measurement results were applie...

Serum leptin levels are decreased in patients with acromegaly and rise after GH is normalized by surgical treatment. We have evaluated the effect of Sandostatin® LAR® on leptin levels in acromegalic patients since there are recent data to suggest that somatostatin, in addition to its GH lowering effect, also reduces serum leptin levels in humans. Nineteen patients with active acromegaly were studied. Eleven patients received monthly injection of Sandostatin® LAR® and eight patients underwent transsphenoidal surgery. Serum concen-trations of leptin, GH, IGF-1 and insulin were measured before and after treatment. Serum leptin concentrations were lower in patients with active acromegaly than controls matched for age, sex and body mass index (BMI) [2·79 µg/l (2·60) vs. 4·41 µg/l (5·07); median (inter-quartile range); P

In order to mitigate the effect of torsion during earthquakes, most seismic codes of the world provide design guidelines for strength distribution based on the traditional perception that element stiffness and strength are independent parameters. Recent studies have pointed out that for an important class of widely used structural elements such as reinforced concrete flexural walls, stiffness is a strength-dependent parameter. This implies that the lateral stiffness distribution in a wall-type system cannot be defined prior to the assignment of elements' strength. Consequently, stiffness eccentricity cannot be computed readily and the current codified torsional provisions cannot be implemented in a straightforward manner. In this study, an alternate guideline for strength distribution among lateral force resisting elements is presented. To develop such a guideline, certain issues related to the dynamic behaviour of asymmetric wall-type systems during a damaging earthquake were examined. It is shown that both stiffness and strength eccentricity are important parameters affecting the seismic response of asymmetric wall-type systems. In particular, results indicate that torsional effects can be minimized by using a strength distribution that results in the location of the centre of strength CV and the centre of rigidity CR on the opposite sides of the centre of mass CM. Copyright © 2001 John Wiley & Sons, Ltd.

A new finite element model for reinforced concrete beam-column joints is proposed. The model considers the effects of bond-slip and shear deformations in the joint panel region. The problems associated with modeling bond-slip of anchored reinforcing bars are discussed. The proposed bond-slip model is examined at the element level by comparing its predictions with other analytical and experimental results. The ability of the model to simulate bond deterioration and eventual pullout of anchored reinforcing bars under severe cyclic excitation is demonstrated. This model is incorporated into the global beam-column joint element. Further comparisons are made between the predictions of the proposed beam-column joint model and other analytical and experimental results under reversed cyclic loading to show the validity of the model to describe the bond-slip behavior of the joints.Key words: bond, bond-slip, finite element, beam-column, reinforced concrete, cyclic.

A procedure is presented to extend the static torsional provisions of the Eurocode 8 (EC8) to asymmetrical multi-storey buildings. It is shown that even if the conditions in Annex A of EC8 are satisfied, the static torsional provision will not be effective to compensate for the effect of torsion unless the building possesses a minimum level of torsional stiffness. By means of examples, it is shown that this minimum torsional stiffness condition can be specified in the Code using the mean stiffness radius of gyration of the building calculated based on the proposed procedure as an index.

Summary Removal of unwanted intravascular foreign body is a useful but infrequent procedure carried out by interventional radiologists. We study a patient who had a long guidewire left in her body following central venous catheter placement by a surgeon. The guidewire was later found in situ, with both intravascular and extravascular components in continuity. We successfully removed the guidewire without causing any complications. Standard interventional techniques, Amplatz gooseneck snare (Microvena, White Bear Lake, MN, USA) and 6-Fr Multipurpose catheter were used.

This article is a state-of-the-art review of the simplified inelastic analytical procedure commonly referred to as the ‘pushover analysis’ to estimate the seismic response of buildings. The basic steps of a pushover analysis are outlined. The choices available to users in each step are discussed and past studies involving the pushover procedure are briefly reviewed. Finally, the accuracy of the method compared to inelastic dynamic analysis is presented using examples.

Open Access Journal, BACKGROUND: Obesity is closely associated with various cardiovascular diseases (CVDs). Adipose tissue inflammation and perturbation of adipokine secretion may contribute to the pathogenesis of CVD. This study aimed to evaluate whether the 2 most abundant adipokines, adipocyte-fatty acid binding protein (A-FABP) and adiponectin, are independent risk factors predisposing to CVD. METHOD AND RESULTS: We investigated prospectively the 12-year development of CVD in relation to the baseline levels of A-FABP and adiponectin in a population-based community cohort comprising 1847 Chinese subjects recruited from the Hong Kong Cardiovascular Risk Factors Prevalence Study 2 (CRISPS 2) cohort without previous CVD. Baseline serum levels of A-FABP, adiponectin, and C-reactive protein (CRP), an established biomarker predictive of CVD, were measured. In all, 182 (9.9%) of the 1847 Chinese subjects developed CVD during a median follow-up of 9.4 years. The CVD group had more traditional risk factors, higher baseline levels of A-FABP and CRP (both P, link_to_OA_fulltext

Background Cytokines released from adipose tissues induce chronic low-grade inflammation, which may enhance cancer development. We investigated whether indices of obesity and circulating adipokine levels could predict incident cancer risk. Materials and Methods This longitudinal community-based study included subjects from the Hong Kong Cardiovascular Risk Factors Prevalence Study (CRISPS) study commenced in 1995-1996 (CRISP-1) with baseline assessments including indices of obesity. Subjects were reassessed in 2000-2004 (CRISPS-2) with measurement of serum levels of adipokines including interleukin-6 (IL-6), soluble tumor necrosis factor receptor 2 (sTNFR2; as a surrogate marker of tumor necrosis factor-α activity), leptin, lipocalin 2, adiponectin and adipocyte-fatty acid binding protein (A-FABP). Incident cancer cases were identified up to 31 December 2011. Results 205 of 2893 subjects recruited at CRISPS-1 had developed incident cancers. More of the subjects who developed cancers were obese (22.1 vs 16.1%) or had central obesity (36.6 vs 24.5%) according to Asian cut-offs. Waist circumference (adjusted HR 1.02 [1.00-1.03] per cm; p=0.013), but not body mass index (adjusted HR 1.04 [1.00-1.08] per kg/m2; p=0.063), was a significant independent predictor for incident cancers after adjustment for age, sex and smoking status. 99 of 1899 subjects reassessed at CRISPS-2 had developed cancers. Subjects who developed cancers had significantly higher level of hsCRP, IL-6, sTNFR2 and lipocalin 2. After adjustment for conventional risk factors, only IL-6 (HR 1.51, 95% CI 1.18-1.95) and sTNFR2 (HR 3.27, 95%CI 1.65-6.47) predicted cancer development. Conclusions Our data supported the increased risk of malignancy by chronic low grade inflammation related to central obesity.

A brief history of the detailing changes following different Japanese earthquakes is presented. The design steps for reinforced concrete structures, as prescribed in the 1981 Japanese building code, are described. Observations on the damage and the collapse of reinforced concrete structures caused by the 1995 Hyogo-ken Nanbu earthquake are reported. Failures occurred in older structures built before the improved 1981 code. Deficiencies observed include discontinuities due to the change between composite steel and reinforced concrete construction and reinforced concrete construction in columns, poor detailing of transverse reinforcement in columns, lack of transverse reinforcement in beam–column joints, insufficient amount of vertical and horizontal reinforcement in walls, presence of significant torsional eccentricities, abrupt changes in stiffness over the height of buildings, and the use of "short" columns or "short" beams exhibiting high shear-to-moment ratios. The excellent performance of structures designed using the 1981 Japanese code is described. Key words: earthquake, Kobe, concrete structures, codes, damage, design.

A parametric study is carried out to evaluate the seismic displacements at the flexible edge of torsionally unbalanced (TU) structural systems. Guidelines are provided to estimate these displacements so that they can be incorporated in the formulation of the displacement-based seismic design approach for the design of TU buildings. The ability of three code procedures to estimate the flexible-edge displacement is examined to show that not all procedures lead to conservative estimates. Finally, it is shown that elastic spectrum analysis incorporating accidental torsion effect is a viable means to estimate the flexible-edge displacements.

The main change in the torsional provisions of the 1991 edition of the \IUniform Building Code\N (UBC) from the 1979 UBC edition is the need to amplify the accidental eccentricity for torsionally flexible structural systems. This paper evaluates the consequences of the change on the strength design requirement and the ductility demand on the edge lateral force-resisting elements in torsionally unbalanced structural systems, which are designed based on the two editions of the UBC code. The major improvement of the 1991 UBC is its ability to limit the additional ductility demand on the stiff-edge element of a torsionally unbalanced system to an acceptable level, even when the system is torsionally flexible.

Dynamic analysis is in general accepted as the best method to obtain the seismic load distribution for buildings with a setback. However, most building codes require the base shear obtained by dynamic analysis to be calibrated by the static base shear obtained using the code's equivalent static load procedure. In obtaining the code static base shear, two issues often arise among the design professionals. First, it is unclear whether the code static base shear is applicable for buildings with setbacks because the period prescribed by the code to be used in the base shear formula is in general not pertinent to buildings with setbacks. Second, it is uncertain whether the higher mode period should be used in computing the base shear when the modal weight of a higher mode is larger than that of the fundamental mode — a case often encountered in designing buildings with setbacks. This paper is an attempt to resolve the above issues. For the first issue, modification factors were derived for adjusting the code period formula so that it can provide a more reasonable estimate for the period of a building with a setback. For the second issue, it was demonstrated in this paper that for cases where the modal weight of a higher mode is larger than that of the fundamental mode, using the higher mode period for base shear calculation will result in unnecessarily conservative design. Key words: earthquake, seismic, irregular buildings, setback, dynamic analysis.

This paper evaluates the inelastic seismic response of torsionally unbalanced structural systems with strength distributed using elastic response spectrum analysis. The structural model is a single mass torsionally unbalanced system with lateral load resisting elements spanning in two principal directions. The element strength is distributed based on elastic response spectrum analysis and three different approaches to incorporate accidental torsion are considered: (a) without incorporating accidental torsion; (b) by applying static floor torques; (c) by shifting the location of the centre of mass. The seismic input is bidirectionally applied at the base of the model. It is shown that the inelastic responses depend strongly on the torsional stiffness of the system. For a torsionally stiff system, the torsional response leads to a decrease in the stiff edge displacement; however, for a torsionally flexible system, it tends to increase the stiff edge displacement. Using response spectrum analysis without including accidental torsion may lead to excessive additional ductility demand on the stiff edge element. With accidental torsion effect incorporated, the response spectrum analysis will give a strength distribution such that there will be no excessive additional ductility demands on the lateral load resisting elements.

A study is carried out to evaluate the seismic load distribution in buildings with eccentric setback subjected to lateral loading in a direction perpendicular to the setback. Such loading causes both translational and torsional deformations. Since buildings with eccentric setback possess significant irregularities both height-wise and plan-wise, both the static and the dynamic approaches are used in this study to examine the limitations of the static approach when applied to this class of structures. It is shown that the static approach cannot simulate the higher modal contribution, nor can it simulate the inertial floor torques caused by the first mode of vibration. Consequently, the static approach leads to an underestimation of edge frame shears. However, by modifying the static approach as is done in the Canadian code (National Building Code of Canada, 1990) one can obtain load distributions in eccentric buildings that are similar to that using dynamic analysis. Based on the work of Goel and Chopra, it is further shown that implementation of the Canadian code procedure for seismic load distribution involving torsion can be simplified greatly. As a result, this procedure can be implemented efficiently in design offices to cover a wide class of buildings, including buildings with eccentric setbacks. Key words: seismic, buildings, torsion, setback, irregularity, code.

Pigment epithelium-derived factor (PEDF) is secreted from the adipose tissue. It circulates at high concentrations, and was reported to play a causal role in obesity-induced insulin resistance and metabolic dysfunctions in mice. Previous cross-sectional studies also demonstrated plasma PEDF concentration correlated positively with systolic blood pressure (BP) and pulse pressure, and inversely with small artery elasticity. Here we investigated the relationship of plasma PEDF concentration with BP and incident hypertension in a 10-year prospective study.Baseline plasma PEDF concentrations were measured by ELISA in 520 Chinese subjects, aged 51 ± 12 years, followed up long-term from the population-based Hong Kong Cardiovascular Risk Factor Prevalence Study. The association between plasma PEDF concentration and BP was investigated in both cross-sectional and prospective studies, using multiple linear regression and path analyses. Cox proportional hazards analysis was used to determine whether baseline PEDF concentration was independently related to the subsequent development of hypertension over 10 years.Baseline plasma concentrations of PEDF were higher in men (P0·001), and were directly related to systolic BP at 2 and 5 years, and to diastolic BP at 2 years, after adjustment for covariates. Of the 386 normotensive subjects at baseline, high baseline PEDF concentration was predictive of incident hypertension, independent of the effects of age, sex, baseline BP and obesity parameters (hazard ratio: 1·135; 95% CI: 1·039-1·241; P = 0·005).Our data suggest that plasma PEDF concentration is significantly associated with BP, and incident hypertension. PEDF may be involved in the pathogenesis of hypertension in humans.

OBJECTIVE To investigate whether circulating levels of fibroblast growth factor 21 (FGF21), which previously has been shown to be elevated in obesity, could predict the development of type 2 diabetes in a 5.4-year, population-based, prospective study. RESEARCH DESIGN AND METHODS Baseline plasma FGF21 levels were measured using an enzyme-linked immunosorbent assay in 1,900 subjects from the Hong Kong Cardiovascular Risk Factor Prevalence Study (CRISPS). The prospective association of FGF21 with diabetes development over 5.4 years was analyzed using multiple logistic regression. RESULTS At baseline, plasma levels of FGF21 increased progressively with worsening dysglycemia from normal glucose tolerance, through prediabetes, to diabetes (global trend, P < 0.001). Of 1,292 subjects without diabetes at baseline, a high baseline FGF21 level was a strong independent predictor for diabetes development (odds ratio 1.792; P < 0.01), together with waist circumference and fasting plasma glucose levels. CONCLUSIONS Plasma FGF21 levels were significantly increased in subjects with prediabetes and diabetes and predicted the development of diabetes in humans.

Context: The KCNJ11 E23K variant is associated with type 2 diabetes mellitus (T2DM) in cross-sectional studies, but conflicting findings have been reported from prospective studies. Objective: This study aimed to evaluate whether the E23K variant could predict glycaemic progression in a Southern Chinese population. Methods/Principal Findings: We performed a long-term prospective study on 1912 subjects from the Hong Kong Cardiovascular Risk Factors Prevalence Study (CRISPS). The KCNJ11 E23K variant was associated with the progression to prediabetes after a median interval of 12 years on multinomial logistic regression analysis, even after adjustment for traditional risk factors (OR 1.29, P age, sex, BMI and fasting plasma glucose [FPG] adjusted = 0.02). Based on Cox proportional hazard regression analysis, the E23K variant also predicted incident prediabetes (HR 1.18, P age, sex, BMI and FPG adjusted = 0.021). However, E23K was not associated with the progression to T2DM in either multinomial or Cox regression analysis, and the association of E23K with glycaemic progression to either prediabetes or T2DM was significant only in unadjusted Cox regression analysis (P = 0.039). In a meta-analysis of eight prospective studies including our own, involving 15680 subjects, the E23K variant was associated with incident T2DM (fixed effect: OR 1.10, P = 4×10 -3; random effect: OR 1.11, P = 0.035). Conclusions: Our study has provided supporting evidence for the role of the E23K variant in glycaemic progression in Chinese, with its effect being more evident in the early stage of T2DM, as the subjects progressed from normal glucose tolerance to prediabetes. © 2011 Cheung et al., published_or_final_version

This study evaluates the New Zealand torsional provision in the 1984 and 1992 editions of the New Zealand loading code (NZS 4203) based on the inelastic responses of a single mass model having lateral load resisting elements in two orthogonal directions and subjected to bidirectional base excitations. It is shown that for systems having torsional stiffnesses that exceed a minimum value, the provision in NZS 4203:1984 will restrict the ductility demands on the resisting elements no more than those of a similar but torsionally balanced system. This minimum torsional stiffness depends on the structural eccentricity of the system. For systems with torsional stiffness less than the minimum, the stiff edge elements can experience additional ductility demand because the 1984 edition of the Code permits excessive strength reduction on the stiff edge elements. In the 1992 edition, the Code imposes a minimum torsional stiffness of a structure in the farm of edge displacement ratios. With this new requirement, the danger of additional ductility demand on the stiff edge element is eliminated. Therefore, the torsional provision in the current edition will ensure no additional ductility demands on all lateral force elements caused by torsion.

This paper examines the seismic energy demands on reinforced concrete ductile moment-resisting frames. Three frames having 4, 10 and 18 storeys, representing low, medium and tall frames, were designed to the current Canadian seismic provisions and structural design requirements. Three groups of earthquake records having different frequency contents were selected as input ground motions. The input, hysteretic and damping energies were evaluated for these three frames and correlation was established with other response parameters. The use of equivalent single-degree-of-freedom systems to estimate the energy demands on these frames was examined in order to simplify the computational effort. It is shown that the energy demand concept together with the equivalent single-degree-of-freedom system is a viable design approach for low-rise frames. Additional research to allow for the higher modal effect is required before the same concept can be extended to medium and tall frames.

Single nucleotide polymorphisms (SNPs) in the apolipoprotein A5 gene (APOA5) are associated with hypertriglyceridaemia in our population. We studied the associations of SNPs in APOA5 with the metabolic syndrome (MetS) in the Hong Kong and Guangzhou Chinese.We genotyped five tagging SNPs in 1330 unrelated subjects from the Hong Kong Cardiovascular Risk Factor Prevalence Study cohort with follow-up after a median interval of 6·4 years; 1952 subjects from the Guangzhou Biobank Cohort Study-Cardiovascular Disease Subcohort were used to replicate the findings. The MetS was defined according to the consensus criteria proposed jointly by several organizations in 2009.The SNP rs662799 (-1131TC) was associated with the MetS (odds ratio = 1·47, P = 0·00082) and the number of its components present (regression coefficient = 0·204, P = 4·6 × 10(-5) ) after adjusting for age, sex, smoking, drinking and education in Hong Kong subjects at baseline. Similar association of this SNP was found in Hong Kong subjects at follow-up (P = 0·010 and 0·00021, respectively) and in Guangzhou subjects (P = 0·0041 and 0·017, respectively). The association of rs662799 with the number of the MetS components was significant regardless of age, sex, obesity and alcohol drinking, but almost disappeared after further adjusting for plasma triglycerides.Our results showed that the -1131TC polymorphism in APOA5 was associated with the MetS because of its strong effect on plasma triglycerides. This may partly explain the higher cardiovascular risk in people with this polymorphism.

Pigment epithelium-derived factor (PEDF), a serine protease inhibitor, is secreted from the adipose tissue and circulates at high concentrations. A recent study found that PEDF played a causal role in obesity-induced insulin resistance and metabolic dysfunctions in mice. Here we investigated whether circulating PEDF levels predicted the development of the metabolic syndrome (MetS) in a 10-yr prospective study.Baseline plasma PEDF levels were measured with an ELISA in 520 nondiabetic subjects, recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study cohort. Multiple logistic regression was used to analyze whether PEDF was an independent factor related to the MetS at baseline. The role of PEDF in predicting the development of the MetS over 10 yr was analyzed using Cox regression analysis.Plasma levels of PEDF were significantly higher in men than women. At baseline, sex-adjusted PEDF levels were significantly higher in subjects with MetS (P0.001), and the association remained significant (odds ratio: 1.17, P = 0.015), even after adjustment for covariates. Among the components of the MetS, PEDF was independently associated with hypertriglyceridemia (P = 0.026) and hypertension (P = 0.005). Of the 396 subjects without the MetS at baseline, a total of 80 had developed the MetS over 10 yr. High baseline sex-adjusted PEDF was an independent predictor of the development of the MetS in men (hazard ratio: 1.25, P = 0.034) but not in women.Plasma PEDF was significantly associated with the presence of the MetS and predicted the development of the MetS in Chinese men.

Seismic areas in Canada are classified into three categories for three different combinations of acceleration and velocity seismic zones (Za v, Za = Zv, and Za > Zv), and ground motions in different zonal combination areas are expected to have different frequency characteristics. The National Building Code of Canada specifies different levels of seismic design base shear for short-period buildings located in areas with different zonal combinations. The specification of seismic design base shear for long-period buildings is directly tied to zonal velocity, irrespective of seismic zonal combination. This paper evaluates the seismic performance of both high-rise long-period and low rise short-period reinforced concrete ductile moment-resisting frame buildings located in seismic regions having Za v, Za = Zv, and Za > Zv. Two frame buildings have 10 and 18 storeys were used as structural models for high-rise buildings, while a set of four-storey buildings were used to represent low-rise buildings. All buildings were designed to the current Canadian seismic provisions and concrete material code. Three groups of earthquake records were selected as representative ground motions in the three zonal combination regions. The inelastic responses of the designed buildings to the three groups of ground motions were analyzed statistically. The results indicate that the distribution of inelastic deformations is significantly different for high-rise frame buildings situated in seismic regions with Za v, Za = Zv, and Za > Zv. Inelastic deformation is concentrated in the lower storeys for high-rise buildings located in Za v areas, whereas significant inelastic deformation can develop in the upper storeys for high-rise buildings situated in Za > Zv regions. The use of three different levels of seismic design base shear for short-period structures improves the consistency of ductility demands on low-rise buildings situated in the three different zonal combination regions. Despite the use of appropriate design base shears for different seismic regions, the ductility demands for these low-rise buildings are relatively high. To avoid excessive ductility demands, it is suggested that the seismic strengths for low-rise short-period buildings should not be significantly reduced from their elastic design base shears. Key words: earthquake, ground motion, seismic, design, reinforced concrete, frame buildings, beams, columns, ductility.

This paper highlights the changes of the seismic provisions in the 1990 edition of the National Building Code of Canada (NBCC) and provides the reasons and interpretations for these changes. The major changes include load factor for earthquake load, base shear formula, force modification factor in place of structural coefficient, story drift estimation, design and anchorage force for parts of portions of building, importance factor, foundation factor, and top concentrated force on structure. A comparison of the base shear calculated according to NBCC-1985 and NBCC-1990 is given to show that the base shears for most structural systems are similar. The major exceptions are the ductile flex-ural wall systems and the unreinforced masonry system. The base shear is reduced for the former system and increased for the latter system in NBCC-1990. Key words: earthquake, seismic design, code, lateral loading, overstrength.

This paper presents the results of an analytical study of the strength distribution of lateral load resisting elements in torsionally unbalanced systems designed based on codified torsional provisions. It is shown that the element strength can be expressed conveniently as the element strength of a similar but torsionally balanced system multiplied by a strength factor. This strength factor depends on three system parameters, namely, the location of the element relative to the centre of rigidity, and the torsional stiffness and eccentricity of the structure. In addition, it depends on the design coefficients of the code specified design eccentricity expressions. The influence of each of these factors on the element strength distribution is discussed. A new set of values for the design coefficients is proposed. By means of examples, it is shown that the proposed torsional provision is an improvement over those suggested in the National Building Code of Canada and the New Zealand code.

The November 25, 1988, Saguenay earthquake was the most significant seismic event in eastern North America over the last 50 years. Based on strong ground motion records from this earthquake, an analytical study was undertaken to evaluate the seismic design base shear provisions of the National Building Code of Canada for buildings located in the eastern regions of Canada. In light of the observed damage to masonry structures in the epicentral region, emphasis was placed on the evaluation of the codified minimum seismic strength for masonry structural systems. Key words: earthquake, ground motion, seismic design strength, code, masonry, buildings, damage, ductility.

It has been advocated that placenta accreta/percreta should be managed conservatively to avoid massive pelvic bleeding and preserve fertility. Diagnosis of this condition with high-resolution imaging investigations performed during the antenatal period facilitates discussion of management plans with other clinical disciplines (eg interventional radiologists), the patient, and her family. Three cases of placenta praevia with accreta are presented. The three cases were managed by leaving the placenta in-utero after caesarean section, using uterine arterial embolisation to control postpartum haemorrhage only when needed. In all these cases, we succeeded in conserving the uterus without major complications. With improved imaging techniques, accurate antenatal diagnosis of placenta praevia with accreta is now possible. This new approach to conservative management can be considered in order to not only conserve the uterus but also to avoid uncontrolled pelvic haemorrhaging.

We describe two Chinese patients with beta-thalassemia/hemoglobin E disease who developed cerebral infarction due to occlusion or stenosis of their extracranial carotid arteries. The roles of platelet abnormalities and other factors in this condition are discussed.

This paper clarifies the definitions of eccentricity used in two of the approaches to calculate story torsional moments in the design of torsionally unbalanced regular multistory structures. One approach uses the floor eccentricities, in conjunction of the static equivalent loading, to calculate the floor torques. The story torsional moment is then obtained by summing the floor torques above the story. This approach was suggested in the Recommended Lateral Force Requirements and Commentary by the Structural Engineers Association of California. In this approach, the floor eccentricity should be defined as the distance between the generalized center of rigidity and the load resultant at that floor. In the second approach, the story torsional moment is obtained directly as the product of story shear and the story eccentricity, as suggested by Uniform Building Code. In this approach, the story eccentricity should be defined as the horizontal distance between the shear center at the story and the resultant of ...

Using a single mass monosymmetric model, this paper examines the additional seismic inelastic deformations and displacement caused by structural asymmetry of the model. Stiffness eccentricity and resistance eccentricity are used as measures of asymmetry in the elastic and inelastic range respectively. Seven ways of specifying strength distribution among resisting elements are considered, including code provisions from Canada, Mexico, New Zealand and the United States. These specifications are related t o the model resistance eccentricity. It is shown that when torsional shears are included in the strength design of the elements, the structure in general will have small resistance eccentricity, even if it has large stiffness eccentricity in the elastic range. For structures which are designed with allowance for torsional shears, the ductility demands on the elements are similar to those when the structure is symmetrical. However, the edge displacements can be up to three times that if the system is symmetrical. This finding has significant implications in evaluating adequate separation between buildings to avoid the pounding problem during earthquakes.

Adipocyte fatty acid-binding protein (A-FABP) is abundantly expressed in adipocytes and plays a role in glucose homeostasis in experimental animals. We have previously shown that circulating A-FABP levels are associated with the metabolic syndrome, which confers an increased risk of type 2 diabetes. Here we investigated whether serum A-FABP levels could predict the development of diabetes in a 10-year prospective study.Baseline serum A-FABP levels were measured with an enzyme-linked immunosorbent assay in 544 nondiabetic subjects, recruited from the Hong Kong Cardiovascular Risk Factor Prevalence Study cohort, who were followed prospectively to assess the development of type 2 diabetes. The role of A-FABP in predicting the development of type 2 diabetes over 10 years was investigated using Cox regression analysis.At baseline, serum sex-adjusted A-FABP levels were higher in subjects with impaired glucose tolerance (IGT) or impaired fasting glucose (IFG) (P0.00001 versus normal glucose tolerance) and correlated positively with adverse cardiometabolic risk factors. Over 10 years, 96 subjects had developed type 2 diabetes. High baseline A-FABP was predictive of type 2 diabetes, independent of obesity, insulin resistance, or glycemic indexes (relative risk [RR] 2.25 [95% CI 1.40-3.65]; P = 0.001; above versus below sex-specific median). High A-FABP levels remained an independent predictor of type 2 diabetes in the high-risk IGT/IFG subgroup (adjusted RR 1.87 [1.12-3.15]; P = 0.018).Serum A-FABP was associated with glucose dysregulation and predicted the development of type 2 diabetes in a Chinese cohort.

Polymorphisms of the gene encoding adiponectin (ADIPOQ) have previously been associated with type 2 diabetes in Europid and Japanese subjects, but not in Pima Indians. The aim of this study was to determine the contribution made by ADIPOQ gene variants to glycaemic status in southern Chinese individuals.Sixty unrelated subjects were screened for single-nucleotide polymorphisms (SNPs) in the ADIPOQ gene by direct sequencing. The association of tagging SNPs with the outcome of glycaemic status in 262 subjects with impaired glucose tolerance (IGT) was examined in a 5-year prospective study.We identified 15 polymorphisms in the ADIPOQ gene, ten of them constituting the tagging SNPs. At 5 years, 39.7% of the subjects with IGT had regressed to NGT, 41.2% had persistent IGT or impaired fasting glucose and 19.1% had developed diabetes. Only the T45G polymorphism was associated with persistent hyperglycaemia at 5 years (p=0.001). Haplotypes formed by the addition of other SNPs, as haplotype blocks or pairs, did not confer greater association than T45G alone. On logistic regression analysis, T45G independently predicted persistent hyperglycaemia at 5 years (OR=2.25, 95% CI 1.29-3.95, G carriers vs TT; p=0.005). It also predicted persistent hyperglycaemia in a nested case-control study involving 158 sex- and age-matched controls with persistent NGT (p=0.012, adjusted for BMI), and that of diabetes or glycaemia progression (p0.05) in a meta-analysis that also included two published studies in Europid subjects.Our findings support a significant role of this common ADIPOQ gene polymorphism in predicting glycaemic status in southern Chinese people.

To determine whether preoperative portal vein embolisation improves the operative outcome of patients undergoing extended right-sided hepatic resection for hepatobiliary malignancy.Prospective non-randomised study.University teaching hospital, Hong Kong.Ninety-two patients underwent extended right-sided hepatic resection for hepatobiliary malignancy during a 45-month period (January 2000 to September 2003). Among them, 15 (16%) underwent portal vein embolisation via a percutaneous ipsilateral approach (n=9) or through the ileocolic vein with a mini-laparotomy (n=6). The remaining 77 (84%) patients underwent hepatic resection without portal vein embolisation.Operative morbidity and mortality.Patients undergoing portal vein embolisation were older (69 years vs 55 years; P=0.009), and had significantly worse preoperative renal function (creatinine, 96 micromol/L vs 86 micromol/L; P=0.039) and liver function (bilirubin, 23 micromol/L vs 12 micromol/L; P0.001). Portal vein embolisation resulted in an increase in the future liver remnant of 9% (interquartile range, 7-13%) of the estimated standard liver volume. The operating time for patients receiving portal vein embolisation was significantly longer (medium, 660 min vs 420 min; P0.001) with more complicated surgery performed in terms of concomitant caudate lobectomy and hepaticojejunostomy. There was no hospital mortality in patients who underwent portal vein embolisation whereas five without the treatment died (P=0.587). The operative morbidity of patients who underwent portal vein embolisation and those who did not was 20% and 30%, respectively (P=0.543).In older patients who have worse preoperative liver and renal functions, portal vein embolisation enhances the possibility to perform extended right-sided hepatic resection for hepatobiliary malignancies with potentially lower operative mortality and morbidity.