Trends in hip fracture rates in Taiwan: a nationwide study from 1996 to 2010

There was an initial increase and a later decrease in hip fracture rates in Taiwan between 1996 and 2010 (457.9 to 390.0 fractures per 100,000 people per year). Mortality rates decreased but re-emerged later (2.26 to 1.91 deaths per 100 hip fracture admissions). The turning point for change in trends was 2003.

INTRODUCTION

Fractures of the proximal femur remain a major cause of mortality and morbidity. We aimed to examine recent trends in hip fracture rates, in-hospital mortality rates, and length of hospital stay (LOS) due to hip fractures in people aged 55 and over in Taiwan.

METHODS

This is a time-trend study. We used data from the National Health Insurance Research Database between 1996 and 2010 in Taiwan. Insurants aged 55 and over were included. The outcome measures were age-adjusted hip fracture rates, age-adjusted in-hospital mortality rates, and LOS due to hip fractures. We classified hip fractures into femoral neck, trochanteric, and subtrochanteric fractures.

RESULTS

We identified 250,919 hospitalizations for hip fractures. The total number of hip fractures increased steadily from 12,479 to 19,841 cases. There was a trend towards initial increase and then later decrease in hip fracture rates (from 457.9 to 390.0 fractures per 100,000 people per year). LOS decreased by 46.5 % (17.53 to 9.38 days). By contrast, mortality rates for hip fractures decreased initially, but re-emerged later with a total decrement of 15.5 % (2.26 to 1.91 deaths per 100 hip fracture admissions). Women outnumbered men in all types of hip fractures, but men had higher in hospital mortality rates. LOS was similar between genders and among age groups. The turning point for change in trends was year 2003.

CONCLUSIONS

While LOS shortened gradually since 1996, the absolute number of hip fractures in Taiwan continues to rise. There is still room for improvement in reducing mortality due to hip fractures.

Measurement and simulation of the response function of time of flight enhanced diagnostics neutron spectrometer for beam ion studies at EAST tokamak

The 2.5 MeV TOFED (Time-Of-Flight Enhanced Diagnostics) neutron spectrometer with a double-ring structure has been installed at Experimental Advanced Superconducting Tokamak (EAST) to perform advanced neutron emission spectroscopy diagnosis of deuterium plasmas. This work describes the response function of the TOFED spectrometer, which is evaluated for the fully assembled instrument in its final layout. Results from Monte Carlo simulations and dedicated experiments with pulsed light sources are presented and used to determine properties of light transport from the scintillator. A GEANT4 model of the TOFED spectrometer was developed to calculate the instrument response matrix. The simulated TOFED response function was successfully benchmarked against measurements of the time-of-flight spectra for quasi-monoenergetic neutrons in the energy range of 1-4 MeV. The results are discussed in relation to the capability of TOFED to perform beam ion studies on EAST.

Scintillator-based fast ion loss measurements in the EAST

A new scintillator-based fast ion loss detector (FILD) has been installed on Experimental Advanced Superconducting Tokamak (EAST) to investigate the fast ion loss behavior in high performance plasma with neutral beam injection (NBI) and ion cyclotron resonance heating (ICRH). A two dimensional 40 mm × 40 mm scintillator-coated (ZnS:Ag) stainless plate is mounted in the front of the detector, capturing the escaping fast ions. Photons from the scintillator plate are imaged with a Phantom V2010 CCD camera. The lost fast ions can be measured with the pitch angle from 60° to 120° and the gyroradius from 10 mm to 180 mm. This paper will describe the details of FILD diagnostic on EAST and describe preliminary measurements during NBI and ICRH heating.

Operation of bolometer system using Pt foil on SiN substrate detector for EAST tokamak

The foil resistive bolometer diagnostic on experimental advanced superconducting tokamak has been upgraded partly with a new generation of detectors. The new detectors have faster response time. However, the microwave interference is still a serious issue for the bolometer system. The system response to microwave is tested, and the test results show that the closed Wheatstone bridge circuit in the detector is the most sensitive component to high power microwave field. Simulation results of microwave transmission by the high frequency structure simulator software and shielding design are also presented.

First results from gamma ray diagnostics in EAST Tokamak

Gamma ray diagnostics has been developed in the EAST tokamak recently. Six BGO scintillator detectors are arranged on the down-half cross-section and pointed at the up-half cross-section of plasma, with space resolution about 15 cm and energy range from 0.3 MeV to 6 MeV. Three main gamma ray peaks in the energy spectra have been observed and are identified as the results of nuclear reactions ²⁰⁷Pb(n, n')^207mPb, H(n, γ) D, and D(p, γ)³He, respectively. Upgrading of the system is in progress by using LaBr3(Ce) scintillator, fast photo-multiplier tubes, and a fully digital data acquisition system based on high sample frequency digitizers with digital pulse processing algorithms.

Awareness and use of nonoccupational post-exposure prophylaxis among men who have sex with men in Vancouver, Canada

OBJECTIVES

Nonoccupational post-exposure prophylaxis (nPEP) is a strategy to reduce the risk of HIV infection in those with high-risk exposure. This study characterized nPEP awareness among gay, bisexual and other men who have sex with men (MSM) in Metro Vancouver, British Columbia, Canada after a pilot nPEP programme established in 2012.

METHODS

Momentum Health Study participants were MSM aged ≥16 years recruited via respondent-driven sampling (RDS) who completed a computer-assisted self-interview. Stratifying patients by HIV status, we used multivariable logistic regression with backward selection to identify factors associated with nPEP awareness. All analyses were RDS-adjusted.

RESULTS

A total of 51.9% (112 of 173) of HIV-positive and 48.5% (272 of 500) of HIV-negative participants had heard of nPEP. Only 3% (five of 106) of HIV-negative participants who reported recent high-risk sex used nPEP. Generally, nPEP awareness was higher for participants who engaged in sexual activities with increased HIV transmission potential. Factors associated with greater awareness among HIV-negative participants included recent alcohol use, higher communal sexual altruism, previous sexually transmitted infection diagnosis, and greater perceived condom use self-efficacy. Other factors associated with greater awareness among HIV-negative participants included white race/ethnicity, gay sexual identity, more formal education, lower personal sexual altruism, and Vancouver residence. Greater nPEP awareness among HIV-positive participants was associated with greater perceived agency to ask sexual partners' HIV status and more frequently reporting doing so, a higher number of lifetime receptive sex partners, and greater access to condoms.

CONCLUSIONS

Following implementation of an nPEP pilot programme, nPEP awareness among HIV-negative MSM was 51% and use was 3%. These data support the need to expand access to and actively promote nPEP services.

Next-generation sequencing with a myeloid gene panel in core-binding factor AML showed KIT activation loop and TET2 mutations predictive of outcome

Clinical outcome and mutations of 96 core-binding factor acute myeloid leukemia (AML) patients 18–60 years old were examined. Complete remission (CR) after induction was 94.6%. There was no significant difference in CR, leukemia-free-survival (LFS) and overall survival (OS) between t(8;21) (N=67) and inv(16) patients (N=29). Univariate analysis showed hematopoietic stem cell transplantation at CR1 as the only clinical parameter associated with superior LFS. Next-generation sequencing based on a myeloid gene panel was performed in 72 patients. Mutations in genes involved in cell signaling were associated with inferior LFS and OS, whereas those in genes involved in DNA methylation were associated with inferior LFS. KIT activation loop (AL) mutations occurred in 25 patients, and were associated with inferior LFS (P=0.003) and OS (P=0.001). TET2 mutations occurred in 8 patients, and were associated with significantly shorter LFS (P=0.015) but not OS. Patients negative for KIT-AL and TET2 mutations (N=41) had significantly better LFS (P<0.001) and OS (P=0.012) than those positive for both or either mutation. Multivariate analysis showed that KIT-AL and TET2 mutations were associated with inferior LFS, whereas age ⩾40 years and marrow blast ⩾70% were associated with inferior OS. These observations provide new insights that may guide better treatment for this AML subtype.

Ruthenium(ii)-polypyridyl zirconium(iv) metal-organic frameworks as a new class of sensitized solar cells

A series of Ru(ii)L2L' (L = 2,2'-bipyridyl, L' = 2,2'-bipyridine-5,5'-dicarboxylic acid), RuDCBPY, -containing zirconium(iv) coordination polymer thin films have been prepared as sensitizing materials for solar cell applications. These metal-organic framework (MOF) sensitized solar cells, MOFSCs, each are shown to generate photocurrent in response to simulated 1 sun illumination. Emission lifetime measurements indicate the excited state quenching of RuDCBPY at the MOF-TiO2 interface is extremely efficient (>90%), presumably due to electron injection into TiO2. A mechanism is proposed in which RuDCBPY-centers photo-excited within the MOF-bulk undergo isotropic energy migration up to 25 nm from the point of origin. This work represents the first example in which a MOFSC is directly compared to the constituent dye adsorbed on TiO2 (DSC). Importantly, the MOFSCs outperformed their RuDCBPY-TiO2 DSC counterpart under the conditions used here and, thus, are solidified as promising solar cell platforms.

Segregation of confined ionic liquids inducing the formation of super-micropores in the silica matrix

Super-microporous silica with highly-branched framework and disordered worm-like pore formed by the segregation of confined ionic liquid.

A fixed denture for a child with epidermolysis bullosa simplex

AIM

To report the caries treatment and delivery of a fixed denture for a 3-year-old girl with epidermolysis bullosa simplex (EBS).

CASE REPORT

EBS is manifested on the skin or mucous membranes where skin separation is easily induced by trauma. Full- mouth rehabilitation under in-patient general anaesthesia was performed to the patient in conjunction with proper pre- and postoperative care. A fixed denture was fabricated and installed to replace the extracted teeth without later causing irritation on the mucosa. The prosthesis restored aesthetics and provided comfort without imposing the burden of compliance on the patient.

CONCLUSION

Aided by meticulous pre- and postoperative care and oral hygiene reinforcement, comprehensive dental treatment coupled with fixed denture delivery can greatly improve the life quality and aesthetics for children with EBS.

Male-specific association of the APC rs383830 T allele with the risk of coronary heart disease

APC is a tumor suppressor gene that is involved in the processes of cell migration and adhesion, transcriptional activation, and apoptosis. The goal of this study was to evaluate the contribution of the APC rs383830 polymorphism to coronary heart disease (CHD) in Han Chinese. A total of 783 patients with CHD and 737 controls were tested in the current association study. Although our study did not identify an association between the APC rs383830 polymorphism and CHD, a breakdown analysis by gender indicated there was a significant contribution of the rs383830 T allele to the risk of CHD in males (P = 0.046, odds ratio = 1.267, 95% confidence interval = 1.004-1.598). In conclusion, our study suggested a male-specific association of the APC rs383830 polymorphism with CHD.

Design of the radiation shielding for the time of flight enhanced diagnostics neutron spectrometer at Experimental Advanced Superconducting Tokamak

A radiation shielding has been designed to reduce scattered neutrons and background gamma-rays for the new double-ring Time Of Flight Enhanced Diagnostics (TOFED). The shielding was designed based on simulation with the Monte Carlo code MCNP5. Dedicated model of the EAST tokamak has been developed together with the emission neutron source profile and spectrum; the latter were simulated with the Nubeam and GENESIS codes. Significant reduction of background radiation at the detector can be achieved and this satisfies the requirement of TOFED. The intensities of the scattered and direct neutrons in the line of sight of the TOFED neutron spectrometer at EAST are studied for future data interpretation.

Light output function and assembly of the time-of-flight enhanced diagnostics neutron spectrometer plastic scintillators for background reduction by double kinematic selection at EAST

The 2.5 MeV neutron spectrometer TOFED (Time-Of-Flight Enhanced Diagnostics) has been constructed to perform advanced neutron emission spectroscopy diagnosis of deuterium plasmas on EAST. The instrument has a double-ring structure which, in combination with pulse shape digitization, allows for a dual kinematic selection in the time-of-flight/recoil proton energy (tof/Ep) space, thus improving the spectrometer capability to resolve fast ion signatures in the neutron spectrum, in principle up to a factor ≈100. The identification and separation of features from the energetic ions in the neutron spectrum depends on the detailed knowledge of the instrument response function, both in terms of the light output function of the scintillators and the effect of undesired multiple neutron scatterings in the instrument. This work presents the determination of the light output function of the TOFED plastic scintillator detectors and their geometrical assembly. Results from dedicated experiments with γ-ray sources and quasi-monoenergetic neutron beams are presented. Implications on the instrument capability to perform background suppression based on double kinematic selection are discussed.

Design of a magnetic shielding system for the time of flight enhanced diagnostics neutron spectrometer at Experimental Advanced Superconducting Tokamak

The novel neutron spectrometer TOFED (Time of Flight Enhanced Diagnostics), comprising 90 individual photomultiplier tubes coupled with 85 plastic scintillation detectors through light guides, has been constructed and installed at Experimental Advanced Superconducting Tokamak. A dedicated magnetic shielding system has been constructed for TOFED, and is designed to guarantee the normal operation of photomultiplier tubes in the stray magnetic field leaking from the tokamak device. Experimental measurements and numerical simulations carried out employing the finite element method are combined to optimize the design of the magnetic shielding system. The system allows detectors to work properly in an external magnetic field of 200 G.

Data acquisition system with pulse height capability for the TOFED time-of-flight neutron spectrometer

A new time-of-flight neutron spectrometer TOFED has been constructed for installation at Experimental Advanced Superconducting Tokamak. A data acquisition system combining measurements of flight time and energy from the interaction of neutrons with the TOFED scintillators has been developed. The data acquisition system can provide a digitizing resolution better than 1.5% (to be compared with the >10% resolution of the recoil particle energy in the plastic scintillators) and a time resolution <1 ns. At the same time, it is compatible with high count rate event recording, which is an essential feature to investigate phenomena occurring on time scales faster than the slowing down time (≈100 ms) of the beam ions in the plasma. Implications of these results on the TOFED capability to resolve fast ion signatures in the neutron spectrum from EAST plasmas are discussed.

Monte Carlo simulation of a Bonner sphere spectrometer for application to the determination of neutron field in the Experimental Advanced Superconducting Tokamak experimental hall

To assess the neutron energy spectra and the neutron dose for different positions around the Experimental Advanced Superconducting Tokamak (EAST) device, a Bonner Sphere Spectrometer (BSS) was developed at Peking University, with totally nine polyethylene spheres and a SP9 (3)He counter. The response functions of the BSS were calculated by the Monte Carlo codes MCNP and GEANT4 with dedicated models, and good agreement was found between these two codes. A feasibility study was carried out with a simulated neutron energy spectrum around EAST, and the simulated "experimental" result of each sphere was obtained by calculating the response with MCNP, which used the simulated neutron energy spectrum as the input spectrum. With the deconvolution of the "experimental" measurement, the neutron energy spectrum was retrieved and compared with the preset one. Good consistence was found which offers confidence for the application of the BSS system for dose and spectrum measurements around a fusion device.

Postoperative adverse outcomes after non-hepatic surgery in patients with liver cirrhosis

BACKGROUND

Postoperative adverse outcomes in patients with liver cirrhosis are not completely understood. This study evaluated the association between liver cirrhosis and adverse outcomes after non-hepatic surgery.

METHODS

Reimbursement claims were used to identify patients with preoperative liver cirrhosis who underwent non-hepatic surgery from 2004 to 2007. Control patients without cirrhosis were matched by age, sex, type of surgery and anaesthesia. The adjusted odds ratios (ORs) and 95 per cent confidence intervals (c.i.) of postoperative adverse events associated with liver cirrhosis were analysed by multivariable logistic regression.

RESULTS

Thirty-day mortality rates among 24 282 patients with cirrhosis and 97 128 control patients were 1·2 per cent (299 deaths) and 0·7 per cent (635 deaths) respectively. Liver cirrhosis was associated with postoperative 30-day mortality (OR 1·88, 95 per cent c.i. 1·63 to 2·16), acute renal failure (OR 1·52, 1·34 to 1·74), septicaemia (OR 1·42, 1·33 to 1·51) and intensive care unit admission (OR 1·39, 1·33 to 1·45). Postoperative mortality increased in patients who had liver cirrhosis with viral hepatitis (OR 2·87, 1·55 to 5·30), alcohol dependence syndrome (OR 3·74, 2·64 to 5·31), jaundice (OR 5·47, 3·77 to 7·93), ascites (OR 5·85, 4·62 to 7·41), gastrointestinal haemorrhage (OR 3·01, 2·33 to 3·90) and hepatic coma (OR 5·11, 3·79 to 6·87).

CONCLUSION

Patients with liver cirrhosis had increased mortality and complications after non-hepatic surgery, particularly those with cirrhosis-related clinical indicators.

The resistive bolometer for radiated power measurement on EAST

The resistive bolometer system has been successfully employed on experimental advanced superconducting tokamak for the first time to measure the radiated power of plasma. The bolometer detectors are based on 4 μm thick Pt absorbers deposited on 1.5 μm thick SiN membranes. The system consists of 3 cameras with a total of 48 channels. The detector and the system setup are described in detail. The detector calibration and typical measurement results are presented as well.

Service-oriented dynamic data driven application systems to urban traffic management in resource-bounded environment

With advance in distributed system technology, data has become ubiquitous and its dynamics has increased. Therefore, in this paper we proposed a new framework to integrate dynamic data driven application systems (DDDAS) with service-oriented architecture (SOA) and web services technology to tackle dynamic data issue in a real-time and resource-bounded environment. Nowadays, traffic management in Intelligent Transportation Systems (ITS) has been widely developed in major cities' urban areas around the world to provide more efficient way for solving traffic congestion problem. However, the problems in dynamic traffic management systems such as system flexibility, data standard common interface, transmission of required information, prediction performance, and real-time measurement data are all important issues but not totally supported. An efficient and effective service-oriented dynamic data-driven framework algorithm is designed in this paper to support prediction strategies for traffic management. The simulation results of vehicle navigation show that our algorithm outperforms the Dijkstra algorithm by improving 24.43% in average vehicle travelling time. On the other hand, the results of traffic signal control also show that our algorithm improves the performance in vehicles average number of stops by 43.7%, and 70.62% in average delay time that is compared with the fixed time control method.

Prospective evaluation of seropositive occult hepatitis B viral infection in lymphoma patients receiving chemotherapy

OBJECTIVE. To serially evaluate the viral kinetics of occult hepatitis B virus infection in lymphoma patients and perform a correlation with clinical outcomes. DESIGN. Case series with 1-year follow-up. SETTING. Regional hospital, Hong Kong. PATIENTS. Consecutive patients who were newly diagnosed to have lymphoma in the hospital between 1 April 2007 and 31 March 2008 were tested for hepatitis B (HB) surface (s) antigen (Ag), anti-HBs antibody (Ab) and anti-HB core (c) Ab. Seropositive occult hepatitis B patients as defined by being negative for HBsAg but positive anti-HBsAb and/or anti-HBcAb without a hepatitis B vaccination history were recruited. Serum HBsAg, anti-HBsAb, anti-HBcAb, hepatitis B virus deoxyribonucleic acid (DNA) level, and liver biochemistry were checked at baseline and every 4 weeks during and after chemotherapy until 12 months after the completion of chemotherapy or death. Entecavir was started if patients developed biochemical flare-up of hepatitis B associated with virological rebound. The prevalence and course of hepatitis B virus-related hepatitis, as well as any temporal relationship to viral kinetics and clinical hepatitis, were assessed. RESULTS. Of 47 patients tested, 10 (21%) with lymphoma were seropositive occult hepatitis carriers. Their median baseline hepatitis B virus DNA level was 89 IU/mL (range, <34-807 IU/mL). Virological rebound (as defined by a 10-fold increase in serum hepatitis B virus DNA level from pre-chemotherapy level persisted for 4 weeks) occurred in one of the 10 patients, followed by biochemical reactivation. Whereupon entecavir treatment was started and no liver failure ensued. Regarding the other seropositive occult patients, their serum hepatitis B virus DNA levels fluctuated, but there was no associated biochemical reactivation. CONCLUSION. Detectable baseline serum hepatitis B virus DNA is not uncommon in patients with occult hepatitis B who receive chemotherapy. Transient elevation in serum hepatitis B virus DNA levels does not predict biochemical reactivation, but antiviral treatment might be considered if virological rebound persists.

A synopsis of current care of thalassaemia major patients in Hong Kong

OBJECTIVE

To provide a synopsis of current thalassaemia major patient care in Hong Kong.

DESIGN

Retrospective study.

SETTING

All haematology units of the Hospital Authority in Hong Kong.

PATIENTS

All patients with thalassaemia major with regular transfusion.

RESULTS

To date, there were 363 thalassaemia major patients under the care of the Hospital Authority. Prenatal diagnosis has helped to reduce the number of indigenous new cases, but in recent years immigrant cases are appearing. The patients have a mean age of 23 (range, 1-52) years, and 78% of them are adults. In 2009, they received 18 782 units of blood. This accounted for 9.5% of all blood consumption from the Hong Kong Red Cross. In the past, cardiac iron overload was the major cause of death (65%) and few patients survived beyond the age of 45 years. The availability of cardiac iron assessment by magnetic resonance imaging (T2 MRI) to direct the use of oral deferiprone chelation has reduced the prevalence of heart failure and cardiac haemosiderosis, which should reduce mortality and improve life expectancy.

CONCLUSION

The future for thalassaemia care in Hong Kong is bright. With better transfusion and chelation, it should be possible to avoid growth and endocrine deficiencies in younger patients.