Search

Our aim was to explore the patterns of intrinsic capacity (IC) impairments among community-dwelling older adults and the associations of these different patterns with excessive polypharmacy, potentially inappropriate medications, and adverse drug reactions in a nationwide population-based study.A cross-sectional study included older adults from the Taiwan Integrated Care for Older People (ICOPE) program in 2020.The study subjects comprised 38,308 adults aged 65 years and older who participated in the ICOPE Step 1 screening and assessed six domains of IC following the World Health Organization (WHO) ICOPE approach.Latent class analysis was adopted to identify distinct subgroups with different IC impairments patterns. The associations between different IC impairments patterns and unfavorable medication utilization, including excess polypharmacy (EPP), potentially inappropriate medications (PIMs), and adverse drug reactions (ADRs), were assessed by multivariate logistic regression models.Latent class analysis identified five distinct subgroups with different IC impairment patterns: robust (latent class prevalence: 59.4%), visual impairment (17.7%), physio-cognitive decline (PCD) with sensory impairment (12.3%), depression with cognitive impairment (7.7%), and impairments in all domains (2.9%). Compared to the robust group, all other groups were at higher odds for unfavorable medication utilization. The "depression with cognitive impairment" group (EPP: aOR=4.35, 95% CI 3.52-5.39, plt;0.01; PIMs: aOR=2.73, 95% CI 2.46-3.02, plt;0.01) and the "impairment in all domains" group (EPP: aOR=9.02, 95% CI 7.16-11.37, plt;0.01; PIMs: aOR=3.75, 95% CI 3.24-4.34, plt;0.01) remained at higher odds for EPP and PIMs after adjustment.We identified five distinct impairment patterns of IC, and each impairment pattern, particularly the "depression with cognitive impairment" and "impairment in all domains", was associated with higher odds of EPP and PIMs. Further longitudinal and intervention studies are needed to explore long-term outcomes of different impairment pattern and their reversibility.

A new phenylalkanoid, 1-dehydro-3-hydro-[2]-gingerdione (1), was isolated from the rhizomes of Alpinia galanga (Zingiberaceae). The structure of the new phenylalkanoid was elucidated from chemical and physical evidence.

For gold recovery, a Chinese refractory, high-sulfur gold concentrate was subjected to biooxidation with high pulp density in a single stirred-tank reactor. The flotation concentrate contained 36.9 percent sulfur (S) and 33.9 percent iron (Fe). Different experimental regimes for biooxidation were applied. With a mixed culture and by controlling the amount of addition of the gold ores and the pH of the biooxidation system, maximum iron oxidation of 82.6 percent and sulfur oxidation of 79.3 percent were achieved. The experimental results indicate that the pH control was beneficial to the biooxidation of this concentrate. Approximately 28.4 percent of elemental sulfur (S8) was found in the oxidizing slags. Two dissolution mechanisms of elemental sulfur are proposed: (1) FeS2 → S80 → S2O32− → SO42− and (2) FeS2 → S80 → SO42−. The high pH had a positive effect on the reduction of the S8. The results of thermodynamic analysis indicate that as an oxidant the dissolved oxygen can effectively reduce the Gibbs free energy of the pyrite oxidation process and, compared with the reaction of ferric iron as the single oxidant, the oxidation of pyrite is easier. The efficiency of the gold recovery was related to the iron oxidation as well as the sulfur oxidation. Gold and silver recoveries of 92.4 percent and 66.4 percent, respectively, were achieved.

The font size effect on judgments of learning (JOLs) refers to the fact that people give higher JOLs to large than to small font size words, despite font size having no effect on retention. The effect is important because it spotlights a process dissociation between metacognitive judgments about memory and memory performance itself. Previous research has proposed a fluency theory to account for this effect, but this theory has been contradicted by a recent study which found no difference in response times (RTs) – and hence fluency – in a lexical decision task between large and small words (Mueller, Dunlosky, Tauber, & Rhodes, 2014). In the current research, we further tested the fluency theory by employing a continuous identification (CID) task in Experiment 1 and by explicitly comparing the CID and lexical decision tasks in Experiment 2. We show that lexical decision is an inappropriate instrument for measuring differences in perceptual fluency. The CID task, in contrast, provides direct evidence that the stimulus size effect on JOLs is substantially mediated by perceptual fluency. Experiment 3 found that fluency is at least as important as beliefs about font size in contributing to the font size effect on JOLs.

For the first time, CMOS inverters and 6T-SRAM cells based on vertically stacked gate-all-around complementary FETs (CFETs) are experimentally demonstrated. Manufacturing difficulties of vertically stacked source and drain electrodes of the CFETs have been overcome by using junctionless transistors, thereby reducing the number of lithographic steps required. Furthermore, with post metallization treatments, both the voltage transfer characteristics (VTCs) of CMOS inverters and butterfly curves of SRAM show significant improvements due to the symmetry of nMOS and pMOS threshold voltages. Simulation shows that 3-dimensional CFET inverters have lower input parasitic capacitance than standard 2-dimensional CMOS, leading to reduced gate delay and lower power consumption.

Poor surface roughness may reduce the safety and the stability of the parts, to analyse the relationship between cutting parameters and surface roughness is significative to increase the machining quality of SiCp/Al composites. In this paper, the influences of tool rake angle, cutting speed and cutting depth on the surface roughness of SiCp/Al composites were studied by the two dimension cutting experiments. The Ra values were measured by using type TR200 roughness machine. The results indicate that tool rake angle and cutting depth are the main parameters which affect the surface roughness while cutting speed has no significant effects on the surface roughness.

Low-cost adsorbents, e.g., cow manure-based carbon, provide alternatives to remove veterinary antibiotic sulfamethazine (SMT) from contaminated water bodies. In this study, the chemical structures and compositions of cow manure (CM) carbonized at 400, 600, and 800 °C (CM400, CM600, and CM800) were examined using elemental analyzer (EA), Brunauer–Emmett–Teller, and spectroscopic techniques. Adsorptions of SMT on CM samples were conducted as functions of pH, hydrophobicity, and ionic strengths. Results of EA and spectroscopic analyses suggested that the raw CM and CM400 samples contained the highest amounts of O-containing groups and aliphatic domains. Amounts of such two chemical groups decreased as carbonization temperatures increased. The specific surface areas and total pore volumes of CM samples increased significantly when the carbonization temperatures exceeded 600 °C. SMT adsorption on CM samples could be described essentially by the pseudo-second-order kinetic, intra-particle diffusion, and Freundlich isotherm models. Low pH and ionic strength were favorable for SMT adsorption in CM samples, particularly for the CM800, because a strong π +–π electron donor–acceptor interaction (π +–π EDA) was formed between SMT and CM surfaces enriched with hydrophobic domains. Further, the high adsorption affinity of SMT to the CM600 and CM800 samples was attributed in part to their larger surface areas and total pore volumes. Generally, CM-based materials carbonized >600 °C showed relatively stable structures and exhibited strong aromatic properties. Moreover, maximum adsorption capacities of SMT on the CM800 sample (37–39 mM/kg) were significantly higher than those of other common adsorbents (0.02–35.93 mM/kg).

In this paper, the influence of valence electron structure parameters on the adiabatic shearing sensitivity has been studied for two grade steels (30CrMnMo and C45E4) as a function of covalent pair number and lattice electron number by empirical electron theory of solids and molecules in high-speed penetration process. The research shows that the adiabatic shearing sensitivity increases with the increase of the covalent electron pair number nA, decreases with the increase of the lattice electron number nl. The nA of each structure unit in 30CrMnMo steel is larger than that in C45E4steel, the nl of each structure unit in 30CrMnMo steel is smaller than that in C45E4steel. Therefore, the adiabatic shearing sensitivity is higher for 30CrMnMo targets damaged by adiabatic shear failure, and yet C45E4 targets were damaged by ductile fracture without any adiabatic shear band. The basis can be provided for appropriately selecting and designing materials with different adiabatic shearing sensitivity by studying the specific alloy elements on the influence of adiabatic shearing sensitivity in valence electron structure level.

Effects of environmental factors on the spatial distribution of five Bupleurum genera were investigated. Eighty seven samples in total in four mountains were collected; 158, 116, 130 and 128 plant species were recorded in Guandi, Wutai, Xiao Wutai and Dongling mountains, respectively. This study has been focused on five particular species (Bupleurum bicaule Helm, Bupleurum scorzonerifolium Willdenow, Bupleurum sibiricum Vest, Bupleurum smithii H.Wolff and Bupleurum chinense DC) not only because of their medicinal properties, but also because of the threat they are subject to. Relations between environmental variables and their influence on these species distribution were analyzed using CANOCO software correlation statistical analysis. The distribution of these five species was found to be differently influenced by environmental variables. However altitude and vegetation type appeared to be the variables which influenced the most Bupleurum distribution in the four surveyed mountains. Preservation of these areas from human disturbance or nevertheless activity controlled by the establishment and strengthening of protected areas could be a solution for a sustainable management. Key words: Bupleurum bicaule, Bupleurum scorzonerifolium, Bupleurum sibiricum, Bupleurum smithii, Bupleurum chinense, environmental variable, canonical correspondence analysis (CCA) multiple species response curves.

Background. Hyperuricemia is associated with the development of new cardiovascular events and chronic allograft nephropathy in patients with decreased allograft function. This study investigates whether hyperuricemia in kidney transplant recipients should be considered as an independent predictor of kidney disease progression after acute allograft dysfunction. Methods. Between September 1, 2010, and December 31, 2012, 124 patients who underwent kidney graft biopsy for acute allograft dysfunction were enrolled. Participants were divided into 2 groups: A hyperuricemic group (n ¼ 57) and a normouricemic group (n ¼ 67). The mean serum uric acid (UA) level was obtained by averaging all measurements, once per month for 3 months, before the study began. Clinical and laboratory data were collected. We investigated the role of hyperuricemia on the composite end point (CEP) of doubling of serum creatinine and graft failure by using Cox regression and Kaplan-Meier plots. Results. Over a mean follow-up of 14.27 months, the hyperuricemic group had a poor cumulative survival and easily reached the CEP of doubling of serum creatinine and graft failure (P ¼ .025) with a first-year cumulative incidence of 29.84% and a secondyear cumulative incidence of 35.09%. Cox regression models revealed that age at biopsy (unadjusted hazard ratio [HR], 1.03; 95% CI, 1.00e1.06), hyperuricemia (HR, 2.24; 95% CI, 1.13e4.46), and interstitial fibrosis and tubular atrophy (IF/TA), including

Successful renal transplantation (RT) improves quality of life and patient survival. Advances in immunosuppressants for RT have improved the prevention and treatment of acute rejection as well as reduced the risk of chronic graft damage, but immunodeficiency may render patients vulnerable to opportunistic infections. We conducted this study to compare the difference in tuberculosis (TB) infection rates between a single institution and a national database of RT recipients in Taiwan. There were 153 patients with TB (3.2%) among 4,835 RT recipients in the database during the period 2000-2009, with a higher prevalence of men (P = .018) and diabetes patients (P = .029). In our institution's registry, 33 patients (2.7%) developed 35 episodes of TB infection among 1,209 RT recipients, but there were no significant differences in general characteristics among different subgroups. Interestingly, the use of cyclosporine was significantly more frequent in RT recipients with TB than in those without in both the national database and in our institution. In contrast, TB infection was negatively correlated with the use of tacrolimus (TAC) and mycophenolate (MPA). RT recipients with TB infection had poor survival (P = .0013) and low graft survival (P = .0003). Taken together, analyses of the national database and the RT patients in our institution revealed that the use of long-term cyclosporine-based immunosuppressive agents was associated with a greater risk of developing post-transplantation TB compared with that of other immunosuppressive agents, but the chronicity and accumulation effect of TAC and MPA should be observed despite the negative correlation found herein. In conclusion, post-transplantation TB is a serious health threat and one of the major causes of death among RT recipients, and a high index of suspicion to ensure early diagnosis and prompt initiation of treatment for TB is crucial. The use of optimal immunosuppressive agents to minimize acute rejection, monitoring of high-risk recipients, prompt diagnosis, and appropriate treatment are required to manage TB infection in endemic areas such as Taiwan.

Hyperuricemia may be associated with the development of new cardiovascular events and graft loss in renal transplant recipients. This study was conducted to clarify whether hyperuricemia is a persistently independent predictor of long-term graft survival and patient outcome.Renal allograft recipients (n = 880) who underwent transplantation from December 1999 to March 2013 were included. Participants were divided into 2 groups: a hyperuricemic group (n = 389) and a normouricemic group (n = 491). The mean serum uric acid (UA) level was obtained by averaging all measurements, once per month for 3 months, before the study began. Clinical and laboratory data were collected. We investigated the role of hyperuricemia in the primary endpoint of graft failure by using time-varying analysis and Kaplan-Meier plots. All-cause mortality in renal transplant recipients was also surveyed.During a mean follow-up of 43.3 ± 26.3 months, the major predisposing factors in the 389 patients with hyperuricemia were male predominance (62.98%), high entry serum UA (7.70; range 6.70-8.80 mg/dL), more hypertension (92.29%), previous hemodialysis mode (29.56%), hepatitis C infection (24.42%), more frequent use of UA-lowering agents (43.44%), and use of more drugs for inducing high serum UA (17.74%). After 12 months, the hyperuricemic group had persistently high serum UA (7.66 ± 2.00 vs 6.17 ± 1.60 mg/dL, P.001) and poor renal function (serum creatinine 2.96 ± 3.20 vs 1.61 ± 1.96 mg/dL, P.001) compared with the normouricemic group. Survival analysis showed the hyperuricemic group had poorer graft survival (60.47%) than the normouricemic group (75.82%, P = .0069) after 13-year follow-up. However, there was no difference in all-cause mortality between the 2 groups.Persistently high serum UA seems to be implicated in elevation of serum creatinine, which could increase the risk for allograft dysfunction.

Metabolic syndrome (MS) is a common complication in renal transplant (RTx) recipients. This study aimed to explore the alterations and interrelationship of various adipokines in RTx recipients with and without MS.RTx recipients followed at our hospital were randomly selected for the cross-sectional study of MS. The modified Adult Treatment Panel III criteria adopted for Asian populations were used to define MS. Overnight fasting blood samples were obtained for determination of adipokines, including adiponectin, leptin, resistin, and visfatin. Univariate and multivariate logistic regressions were performed to determine parameters that were associated with serum adipokine levels. Pearson correlation analysis was performed between adipokines.A total of 280 RTx recipients were enrolled for the study. Seventy-three cases (26.1%) fulfilled the criteria of MS. A significantly higher serum leptin level was found in MS patients (16.61 ± 13.90 vs 8.00 ± 7.42 μg/mL; P.0001). There was no significant difference in serum levels of adiponectin, resistin, and visfatin between the 2 groups. Serum adiponectin level was positively correlated with serum resistin (r = 0.422; P.0001) and visfatin levels (r = 0.224; P.0001). Serum resistin level was positively correlated with serum visfatin level. All but serum visfatin level were negatively correlated with estimated glomerular filtration rate. Univariate logistic regression revealed the following variables to be associated with serum leptin level: metabolic syndrome, sex, body weight, waist circumference, body mass index (BMI), hypertension, serum creatinine, fasting blood sugar, HbA1c, serum triglyceride, and uric acid. Multivariate analysis revealed that sex, body weight, BMI, and serum creatinine were associated with serum leptin level.Compared with RTx recipients without MS, patients with MS were associated with significantly higher serum leptin levels and similar adiponectin, resistin, and visfatin levels. A close interrelationship was also found in the serum levels of these adipokines.

In the present study, we synthesized biodiesel from soybean oil through a transesterification reaction catalyzed by lithium carbonate. Under the optimal reaction conditions of methanol/oil molar ratio 32:1, 12 % (wt/wt oil) catalyst amount, and a reaction temperature of 65 °C for 2 h, there was a 97.2 % conversion to biodiesel from soybean oil. The present study also evaluated the effects of methanol/oil ratio, catalyst amount, and reaction time on conversion. The catalytic activity of solid base catalysts was insensitive to exposure to air prior to use in the transesterification reaction. Results from ICP-OES exhibited non-significant leaching of the Li2CO3 active species into the reaction medium, and reusability of the catalyst was tested successfully in ten subsequent cycles. Free fatty acid in the feedstock for biodiesel production should not be higher than 0.12 % to afford a product that passes the EN biodiesel standard. Product quality, ester content, free glycerol, total glycerol, density, flash point, sulfur content, kinematic viscosity, copper corrosion, cetane number, iodine value, and acid value fulfilled ASTM and EN standards. Commercially available Li2CO3 is suitable for direct use in biodiesel production without further drying or thermal pretreatment, avoiding the usual solid catalyst need for activation at high temperature.

Genetic variations may affect posttransplantation metabolic syndrome and diabetes mellitus (PTDM), which is associated with greater morbidity and progressive impairment of both patient and graft survivals. The aim of this study was to evaluate several candidate gene polymorphisms for their association with the risk of developing PTDM.In April 1999, we enrolled 278 renal transplant participants, including 251 subjects free of diabetes and 27 with PTDM. We studied several candidate gene polymorphisms associated with diabetes: 4G/5G polymorphism of plasminogen activator inhibitor 1 (PAI-1) at -675; C/T polymorphism of interleukin-1beta (IL-1β) at -511; G/C polymorphism of IL-6 at 174; polymorphic XbaI of Glucose transporter 1 (GLUT1); and C/T polymorphism of methylenetetrahydrofolate redutase (MTHFR) at 677.The PTDM group had an older mean age (47.6 ± 9.8 years), greater predominance of men (77.8%), higher number of chronic diseases (CDN ≥2, 96.3%), and more patients using tacrolimus-based immunosuppression (44.4%; P.05). Using model A, a simple logistic regression, we observed that patients with the IL-6 G/G genotype experienced a lower risk of developing PTDM (odds ratio [OR], 0.08; 95% confidence interval [CI] 0.01-0.86), and multiple logistic regression models B and C, after adjusting for different variables, confirmed this observation (model B: OR, 0.05; 95% CI, 0.00-0.66). The IL-6 G/G genotype showed a borderline effect in model C (OR, 0.02; 95% CI, 0.00-1.16). There were no significant differences between the 2 groups in genotype variations of PAI-1, IL-1β, GLUT-1, and MTHFR.The G/G genotype of IL-6 may play an important role to lower the risk for PTDM development.

Objectives Kidney transplantation (KT) is associated with increased incidence of hypertension, hyperlipidemia, metabolic syndrome, and posttransplant diabetes mellitus that promote the development of coronary artery calcification (CAC). The aim of the current study was to elucidate the extent of CAC and its risk factors among KT patients. Methods A cross-sectional study was performed to evaluate the severity of CAC in our KT patients. Multidetector computed tomography was performed to assess the coronary artery calcium score (CACS). Patients were further stratified according to the CACS as: group 1: 0–10, group 2: 11–100, group 3: 101–300, group 4: 301–1000, and group 5: >1000. Clinical as well as demographic data were compared among groups. Linear regression analysis was performed to determine factors that were associated with CAC. Results A total of 99 patients were enrolled in the study. The mean age was 53.5 ± 11.8 years and duration of follow-up post-KT was 11.2 ± 5.9 years. The distribution of CACS in groups 1 through 5 was: 41.4%, 20.2%, 11.1%, 15.2%, and 12.1%, respectively. A significantly higher CACS was found in males, patients with pretransplant diabetes mellitus, older current age, older age at KT, hypertension, higher body weight, higher fasting plasma sugar level and lower high-density lipoprotein (HDL) cholesterol. Twenty-nine (29.3%) patients fulfilled criteria for metabolic syndrome (MS). The CACS was significantly higher in patients with MS than in those without MS. An incremental CACS was found to be correlated with increasing number of MS components (P = .003). Multivariate linear regression revealed that female gender, current age, hypertension, and HDL cholesterol were associated with CAC. Conclusion KT was associated with high CACS in a significant proportion of patients with long-term follow-up. Several risk factors were identified. Some of them were potentially treatable and should be taken into consideration in the management of KT recipients.

In this study, corrugated variations in part thickness designed to match the various mold temperature differences between the mold core and mold cavity sides, along with their effects on part warpage, were investigated. Part thickness was varied in a pitched manner and thickness reductions of 10%, 20%, 30%, and 40% of the original part thickness were implemented. The results show that when there is a mold temperature difference between core and cavity, using a corrugated thickness reduction design can greatly reduce or even eliminate part warpage. For a uniform thickness part molded under unbalanced cooling, the thermal neutral axis (where the maximum melt temperature is located) will deviate from the gap center toward the mold wall side with the higher temperature. Variation in thickness will pull the deviated thermal neutral axis back to the center line leading to a reduction in part warpage.

A live-view GPS navigation system ensures that a user's cognitive map is consistent with the navigation map.

In this study, we report the micro-injection molding of ultra-thin parts (100, 250, and 500 µm). The results show that the flow resistance increases as the cavity becomes thinner. The melt front is not symmetric when filling a four-cavity ultra-thin part and filling the eight-cavity mold under a low temperature. If we increase the mold temperature or cavity thickness, the melt front becomes symmetric. Finally, we construct the operation windows of molding for three kinds of plastics (PS, PMMA, PC) and provide a molding range based on mold temperature and injections speed. Meanwhile, the relationship between the thickness and the operation windows are also investigated. The thinner the cavity is, the smaller the operation window is. We need to increase the injection speed significantly for molding the ultra-thin parts with micro-features on both surfaces which are 60 µm in thickness. Furthermore, we succeed in molding 30 µm ultra-thin parts in this experiment. Copyright © 2009 John Wiley & Sons, Ltd.

In this work, the degradation mechanism of N-channel poly-silicon thin-film transistor (poly-Si TFT) has been investigated under dynamic voltage stress at room temperature. The ON-current of TFT is degraded to as low as 0.3 times of the initial value after 1000 s stress. On the other hand, both the sub-threshold swing and threshold voltage kept well during the AC stress. The current crowding effect was rapidly increased with increasing of stress duration. However, comparing the initial and degraded characteristics at rising temperature, namely, 150 ◦ C, the ON-current of TFT only decrease to 75% of the initial value after 1000 s AC stress. It depicts that creation of effective trap density in tail-states of poly-Si film is responsible for the electrical degradation of poly-Si TFT. At high temperature, electron has enough energy to pass the energy barrier created by ac stress and the degradation is less obvious. © 2009 Published by Elsevier B.V.

Background Cystinosis is a rare autosomal recessive disease caused by a defect in lysosomal cystine. The intracellular cystine accumulation causes damage in multiple organs and renal failure. We retrospectively evaluated the outcomes and complications of patients with nephropathic cystinosis after renal transplantation (RT) in Taiwan. Methods Only 2 nephropathic cystinosis patients (siblings) had RT out of the 1,196 RTs in our hospital over the past 30 years. The younger sister received a living-related RT from her mother. The elder sister received a second cadaveric RT owing to chronic allograft rejection one-half year before. Results They were diagnosed with cystinosis at ages 5 and 9 years, and received allografts at ages 13.4 (younger) and 19.8 and 26.4 (elder) years. They each experienced 1 episode of acute rejection at 6 months after the first RT. The elder sister suffered from obstructive nephropathy with progressive graft failure at age 26.4 years and was treated for vulvar condyloma and carcinoma in situ of cervix. The second graft kidney then maintained good kidney function. The younger sister delivered a girl without complication during gestation, and her renal function also remained good. At latest follow-up, they both had crystalline keratopathy and nephropathy, but no other system involvement. Conclusions The extrarenal complications with nephropathic cystinosis are high. These 2 siblings had only have ocular involvement without further cysteamine therapy. However, long-term follow-up is required to monitor development of complications and determine their prognoses.

We investigated the cardiovascular disease risk and mortality in end-stage renal disease (ESRD) patients. A total of 12,535 patients with ESRD undergoing incident dialysis were enrolled, 4,153 (33.13 %) of whom had osteoporosis. The osteoporosis group was associated with a significantly higher risk of coronary artery disease, congestive heart failure, stroke, and mortality. In this study, we aimed to investigate the risk of cardiovascular disease and mortality in a sample of end-stage renal disease patients with osteoporosis. We conducted this retrospective cohort study of incident dialysis patients with and without osteoporosis to evaluate the risk of overall mortality and cardiovascular complications including stroke, coronary heart disease, and congestive heart failure between the two groups. A total of 12,535 patients with ESRD undergoing incident dialysis were enrolled, 4,153 (33.13 %) of whom had osteoporosis, from the National Health Insurance Research Database of Taiwan for the years 1998 through 2011. The osteoporosis group had more comorbidities than the group without osteoporosis including hypertension, hyperlipidemia, mental disorders, and hepatitis C infection. After adjusting for age, gender, and related comorbidities, the osteoporosis group was associated with a significantly higher risk of coronary artery disease (hazard ratio (HR) = 1.32, 95 % confidence interval (CI) = 1.20–1.45) which was significant in both genders (women, HR = 1.35, 95 % CI = 1.20–1.50; men HR = 1.27, 95 % CI = 1.06–1.52) and all age groups (≤49 years HR = 1.41, 95 % CI = 1.16–1.70; >49 years HR = 1.30, 95 % CI = 1.16–1.45). Similar results were observed for the outcomes of congestive heart failure, stroke, and mortality. The results showed that osteoporosis was significantly associated with the subsequent risk of cardiovascular events in patients with ESRD. When encountering patients with ESRD and osteoporosis, physicians should be alert to the subsequent cardiovascular risk in incident dialysis patients to prevent the subsequent occurrence of these adverse events.

In this study, The Fenton process was applied as a pretreatment method to treat industrial wastewater containing 4-nitrophenol (4-NP). The effect of oxidant dosages on the decomposition of 4-NP and the reaction kinetics were investigated. More than 99% of 4-NP was readily decomposed when the reaction was carried out at oxidant concentrations of 5 mM H2O2 and 5 mg/L Fe2+ for 2 hours. The total nitrogenous compounds and the nitrogen gas evolved, accounted for 88% of the initial nitrogen concentration. However, the maximum DOC removal efficiency was 30.6%; and only 1/3 of 4-NP was mineralized to carbon dioxide by the Fenton process. 4-NP degradation profiles fitted well into a pseudo first-order kinetic equation; degradation rate constant (min-1) of 4-NP increased from 4.3×10-3 to 66.1×10-3 with increasing dosages of H2O2 and Fe2+. In addition, the t value was calculated for studying the significance of simulation by the t-test. It was found that the t value was greater than the value for 99% confidence. This result suggested that the 4-NP decomposition profile could be described by the pseudo first-order kinetic equation. Biodegradability of 4-NP before and after the reaction was 0.018 and 0.594, respectively.

Metabolic syndrome (MS) may affect patient and graft survival in renal transplant recipients. However, the evolution of MS during prospective follow-up remains uncertain.Renal transplant patients were recruited for a study of MS in 2010 and then prospectively followed for 2 years. The modified Adult Treatment Panel III criteria adopted for Asian populations were used to define MS.A total of 302 cases (male:female = 154:148) with a mean duration of 10.5 ± 5.7 years after transplantation were enrolled. At initiation, 71 cases (23.5%) fulfilled the criteria of MS. At the end of follow-up, 11 cases had died and 21 had graft failure. Nine cases had insufficient data for reclassification. The remaining 261 cases completed a 2-year follow-up, and the prevalence of MS was 26.1% at the end of study. Of these, 7.79% (18 cases) of patients without MS had developed new-onset MS. Conversely, 16.9% (12 cases) with MS were free from MS at the end of study (P = .362). Patients with MS were associated with older age (57.1 ± 10.4 vs 52.6 ± 12.4 y; P = .006), more chronic allograft nephropathy (17.4% vs 7.1%; P = .01), proteinuria (22.5% vs 10.8%; P = .012), and use of more antihypertensive agents (1.49 ± 0.86 vs 0.80 ± 0.98; P.0001). There was no significant change in serum creatinine in each subgroup.The status of MS in renal transplant patients is dynamic. MS patients were associated with more chronic allograft nephropathy and proteinuria.

Patient survival among kidney transplant (KTx) recipients has improved remarkably in the past decades. The most common causes of death are cardiovascular disease in the West; in Taiwan, the answer remains uncertain.From 1983 to 2012, KTx patients who underwent transplantation and were followed at our hospital were recruited for the study. For comparison, patients were stratified according to the transplant time as group 1, 1983-1989 (the initial era); group 2, 1990-1998 (the cyclosporine era); and group 3, 1999-2012 (the modern era, in which tacrolimus and mycophenolate mofetil were available).A total of 520 KTx patients (male:female ratio of 285:235) were performed in our hospital during the study period. A progressive improvement in patient survival rates (P.0001) was noted among the 3 groups. At a mean follow-up duration of 9.55 ± 8.20 years, 83 recipients had died. Overall, the most common cause of death was infection (44.6%), followed by cardiovascular disease (21.7%), malignancy (12.0%), and hepatic failure (10.8%). Infection was the main cause of death in groups 1 and 2 (44.1% and 52.6%, respectively) but not in Group 3 (18.2%), although this trend did not reach statistical significance. Death owing to cardiovascular diseases became the most common cause of death (27.3%) in the modern era (group 3).The pattern of mortality among Taiwanese KTx patients has changed over the past 30 years. Infection is no longer the commonest cause of death.

Earlier detection and intervention for chronic renal allograft injury (CRAI) remain major challenges for transplantation physicians. Endocan plays a key role in the regulation of cell adhesion, inflammatory disorders, and tumor progression. We conducted this cross-sectional study of 97 renal transplant (RT) recipients with mean RT duration of 7.0 ± 5.7 years to determine whether Endocan could be a diagnostic and prognostic marker. The patients' mean age was 43.6 ± 13.2 years, and 55.7% (54/97) were male. Higher Endocan levels were found in more advanced chronic kidney disease (CKD) stages in a dose-dependent manner. Interestingly, the Endocan ≥ 643.19 pg/mL group had higher creatinine (Cr; 1.2 ± 0.4 vs 1.6 ± 1.1 mg/dL; P = .029) and lower estimated glomerular filtration rate (eGFR; 67.8 ± 23.8 mL/min vs 54.4 ± 22.0; P = .006) than the Endocan643.19 pg/mL group after 3 months of follow-up, respectively. Linear regression analysis found tumor necrosis factor (TNF)-α correlated well with Endocan. To elucidate the response of endothelium activation, we stimulated human umbilical vein endothelial cells (HUVECs) with TNF-α in vitro, and found the levels of Endocan (P = .022) and transforming growth factor (TGF)-β1 (P = .034) increased with time, but interleukin (IL)-10 decreased (P = .013). In summary, Endocan may reflect the degree of endothelial cell injury in renal allografts, and showed a trend of elevation in late-stage CKD. An in vitro study demonstrated TNF-α-activated HUVECs secreted high levels of Endocan and TGF-β1, which could lead to a better understanding of the role of endothelium in immune balance. In conclusion, Endocan may have potential as a useful long-term indicator of CRAI in RT recipients, but further study is needed to verify our findings.

The geological disposal of high-level radioactive waste (hereinafter referred to "geological disposal") is a long-term, complex, and systematic scientific project, whose data and information resources in the research and development ((hereinafter referred to "R&D") process provide the significant support for R&D of geological disposal system, and lay a foundation for the long-term stability and safety assessment of repository site. However, the data related to the research and engineering in the sitting of the geological disposal repositories is more complicated (including multi-source, multi-dimension and changeable), the requirements for the data accuracy and comprehensive application has become much higher than before, which lead to the fact that the data model design of geo-information database for the disposal repository are facing more serious challenges. In the essay, data resources of the pre-selected areas of the repository has been comprehensive controlled and systematic analyzed. According to deeply understanding of the application requirements, the research work has made a solution for the key technical problems including reasonable classification system of multi-source data entity, complex logic relations and effective physical storage structures. The new solution has broken through data classification and conventional spatial data the organization model applied in the traditional industry, realized the data organization and integration with the unit of data entities and spatial relationship, which were independent, holonomic and with application significant features in HLW geological disposal. The reasonable, feasible and flexible data conceptual models, logical models and physical models have been established so as to ensure the effective integration and facilitate application development of multi-source data in pre-selected areas for geological disposal.

Uremic toxins are considered cardiovascular and mortality risk factors in chronic kidney disease (CKD) patients. Both p-cresol and indoxyl sulfate have been shown to induce oxidative stress in vitro and subsequent endothelial dysfunction in uremic patients. Our study evaluated the levels of p-cresol and indoxyl sulfate, and whether they contribute to the progression of CKD in transplant recipients.We retrospectively evaluated 95 patients who had received a transplant from February 1987 to June 2010 in our center; the recipients had a mean transplant duration of 5.3 ± 4.9 years and a mean age of 47.8 ± 14.1 years. Among them, 56.8% (54/95) were male. Patients with glomerular filtration rate (GFR) ≥ 60 mL/min/1.73 m(2) were selected for group 1 (n = 35), and those with GFR60 mL/min/1.73 m(2) were selected for group 2 (n = 60). Demographic and clinical data were compared between groups. Serum and urine levels of p-cresol and indoxyl sulfate were also obtained.Baseline serum p-cresol and indoxyl sulfate levels were significantly higher in advanced CKD stages (P = .001 and.0001, respectively). Patients at advanced CKD stages (group 2) had lower serum levels of hemoglobin and albumin (P.0001), but higher levels of total cholesterol, triglyceride, and uric acid levels (P = .04, .04 and .001, respectively). Body mass index, C-reactive protein, and serum calcium and phosphate levels showed no significant differences between groups. The cut-off value for serum p-cresol between groups was 1.28 umol/L (P = .01), and that for the indoxyl sulfate level was 0.98 umol/L (P = .0001).The serum p-cresol and indoxyl sulfate levels were significantly higher in advanced CKD stages in transplant recipients. To evaluate the use of serum p-cresol and indoxyl sulfate levels as a predictive tool for survival, larger clinical studies are needed.

Background Chronic viral hepatitis is no longer a contraindication to renal transplantation (RT), owing to our better understanding of the hepatitis virus. Hepatitis patients may receive RT depending on their response to viral therapy. RT patients with hepatitis generally do not have an inferior prognosis compared with RT patients without the disease. Hepatic stellate cells (HSCs) are activated during chronic viral hepatitis. The role of HSCs in immunoregulatory effects in RT recipients has not been fully elucidated. Methods We recruited 22 RT recipients with chronic viral hepatitis, who composed the chronic liver disease (CLD) group, and 25 disease-free recipients, who served as the control group. We retrieved their clinical data and collected serum to measure cytokine levels. To investigate the immunoregulatory effect of HSCs, we cocultured HSCs with allogeneic antigen-presenting cell–activated T cells (mixed lymphocyte reaction [MLR]) in Transwell plates. Results The liver biopsy disclosed activation HSCs in 1 chronic hepatitis C virus recipient without treatment. Serum monocyte chemoattractant protein-1 (MCP-1) levels in the CLD group (41.6 ± 27.4 pg/mL) were significantly higher than those in the control group (28.1 ± 12.8 pg/mL; P = .008). There were similar levels of transforming growth factor-β1 (TGF-β1). In allogeneic MLR, HSCs inhibited T-cell activation through the soluble factors in the Transwell assays. There was a high level of MCP-1 in the supernates of the HSC group in the allogeneic MLR, but TGF-β1 was lower in HSCs cocultured with MLR than in the control group, except in the early period. Conclusions HSCs may play an immunoregulatory role in chronic viral hepatitis recipients to minimize the effect of immunosuppressants without affecting rejection. The immunomodulatory effects may be attributed to soluble factors in HSCs.

Objectives Adiponectin (APN) is an adipocyte-derived protein that has anti-inflammatory, anti-atherogenic, and insulin-sensitizing effects. Lower serum APN level is associated with various inflammatory and metabolic diseases in the general population. Kidney transplant (KT) recipients are at higher risk for developing several metabolic disorders, including metabolic syndrome (MS). The aim of the current study was to assess the change of APN level in KT recipients with and without MS. Methods Prevalent KT recipients followed at our hospital were enrolled for the cross-sectional study of MS. The modified Adult Treatment Panel III criteria adopted for the Asian population were used to define MS. Overnight fasting blood samples were obtained for biochemistry and APN. APN was assayed with a commercially available enzyme-linked immunosorbent assay (ELISA) kit. The simplified Modification of Diet in Renal Disease (MDRD) equation was used for the calculation of estimated glomerular filtration rate (eGFR). Univariate and multivariate logistic regression were performed to determine parameters that were associated with serum APN level. Results A total of 271 KT recipients (male:female = 133:138), with a mean age of 52.3 ± 12.6 years, were enrolled for the study of MS. The mean duration of follow-up posttransplantation was 9.02 ± 5.91 years. MS was found in 72 of 271 KT recipients (26.6%). Patients with MS were older, had significantly higher body weight, waist circumference, serum creatinine, fasting plasma sugar, and hemoglobin A1c, but lower serum APN level and eGFR than did patients without MS. Univariate logistic regression revealed the following variables were associated with APN level: MS, gender, body weight, body height, waist circumference, body mass index, serum creatinine, fasting blood sugar, triglyceride, high-density lipoprotein (HDL) cholesterol, and eGFR. Multivariate analysis revealed that gender, body weight, serum creatinine, triglyceride, and HDL cholesterol were associated with APN level. Conclusion Our results revealed that KT recipients with MS had significantly lower serum APN levels, even in the presence of lower eGFR, than those without MS.

The chronic shortage of kidneys for transplantation has increased the number of living donations, but demand remains high, which has created a long waiting list of end-stage kidney disease patients. Donors with decreased renal mass may suffer a higher risk of developing proteinuria, hypertension (HTN), and chronic renal disease (CKD) during long-term follow-up.We retrospectively retrieved medical data of living kidney donors at our hospital over the past 28 years.There were 45 male and 60 female donors with a mean donation age of 46.34 ± 12.47 years (range = 20-70y). The mean follow-up duration was 4.67 ± 4.78 years. The serum creatinine (Cr) at donation was 0.93 ± 0.22 mg/dL, while the latest Cr was 1.26 ± 0.45 mg/dL (P.001). The mean age at follow-up was 50.95 ± 14.57 years. At last follow-up, eight subjects (7.6%) displayed HTN requiring treatment, 10 (9.5%), proteinuria and 55.4%, an estimated glomerular filtration rate (eGFR) of less than 60 mL/min, including one with diabetic nephropathy at 10 years after donation who required long-term hemodialysis. Although gender did not correlate with occurrence of HTN, proteinuria, and CKD, the occurrence of CKD was associated with age at donation (P.001, odds ratio [OR] = 1.076), and age at follow-up (P.001, OR = 1.071). HTN donors were older (P = .036, OR = 1.057) with longer follow-up durations (P = .007, OR = 1.166) and had higher Cr values at donation (P = .044, OR = 94.4). Donors with proteinuria were not related to gender, follow-up duration, initial Cr, warm ischemic time, or duration of admission. eGFR was indeed worse after donation (P = .002).Our results indicated a significant proportion of living donors may develop CKD upon long-term follow-up. The factors affecting donor risk of CKD were baseline renal function, older age, and duration after kidney donation.