Roles of Baseline Intrinsic Capacity and its Subdomains on the Overall Efficacy of Multidomain Intervention in Promoting Healthy Aging among Community-Dwelling Older Adults: Analysis from a Nationwide Cluster-Randomized Controlled Trial.

BACKGROUND: Impaired intrinsic capacity (IC), which affects approximately 90% of older adults, is associated with a significantly heightened risk of frailty and cognitive decline. Existing evidence suggests that multidomain interventions have the potential to enhance cognitive performance and yield positive effects on physical frailty. OBJECTIVE: To examine roles of baseline IC and its subdomains on the efficacy of multidomain interventions in promoting healthy aging in older adults. DESIGN: a cluster-randomized controlled trial. SETTING AND PARTICIPANTS: 1,054 community-dwelling older adults from 40 community-based clusters across Taiwan. INTERVENTION: A 12-month pragmatic multidomain intervention of exercise, cognitive training, nutritional counseling and chronic condition management. MEASUREMENTS: Baseline IC was measured by 5 subdomains, including cognition (Montreal Cognitive Assessment, MoCA), sensory (visual and hearing impairment), vitality (handgrip strength or Mini-Nutritional Assessment-short form), psychological well-being (Geriatric Depression Scale-5), and locomotion (6m gait speed). Outcomes of interest were cognitive performance (MoCA scores) and physical frailty (CHS frailty score) over a follow-up period of 6 and 12 months. RESULTS: Of all participants (mean age:75.1±6.4 years, 68.6% female), about 90% participants had IC impairment at baseline (2.0±1.2 subdomains). After covariate adjustment using a generalized linear mixed model (GLMM), the multidomain intervention significantly prevented cognitive declines and physical frailty, particularly in those with IC impairment ≥ 3 subdomains (MoCA: coefficient: 1.909, 95% CI: 0.736 ~ 3.083; CHS frailty scores: coefficient = -0.405, 95% CI: -0.715 ~ -0.095). To assess the associations between baseline poor capacity in each IC subdomain and MoCA/CHS frailty scores over follow-up, a 3-way interaction terms (time*intervention*each poorer IC subdomains) were added to GLMM models. Significant improvements in MoCA scores were shown for participants with poorer baseline cognition (coefficient= 1.138, 95% CI: 0.080 ~ 2.195) and vitality domains (coefficient= 1.651, 95% CI: 0.541 ~ 2.760). The poor vitality domain also had a significant modulating effect on the reduction of CHS frailty score after the 6- and 12-month intervention period (6 months: coefficient= -0.311, 95% CI: -0.554 ~ -0.068; 12 months: coefficient= -0.257, 95% CI: -0.513 ~ -0.001). CONCLUSION AND IMPLICATIONS: A multidomain intervention in community-dwelling older adults improves cognitive decline and physical frailty, with its effectiveness influenced by baseline IC, highlighting the importance of personalized strategies for healthy aging.

Comparative Analysis of Intrinsic Capacity Impairments, Determinants, and Clinical Consequences in Older Community-Dwellers in Japan and Taiwan: Longitudinal Studies Showing Shared Traits and Distinct Presentations.

OBJECTIVES: Despite the recognized impact of intrinsic capacity (IC) impairment on healthy aging, international comparisons in different sociocultural contexts are scarce. This study aimed to compare IC impairment among community-dwelling older adults in Japan and Taiwan to explore the context of healthy aging in different countries. DESIGN: Comparative observational study. SETTING: National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) in Japan and Longitudinal Aging Study of Taipei (LAST) in Taiwan. PARTICIPANTS: 794 individuals (age range, 60.0-86.5 years) from NILS-LSA and 1,358 (60.0-96.7 years) from LAST. MEASUREMENTS: IC impairment was evaluated across the domains of locomotion, cognition, vitality, sensory capacity, and psychological well-being. Participants were categorized as having impaired IC or healthy. We investigated associations between IC impairment, falls, and all-cause mortality. RESULTS: IC impairment was present in 54.9% and 37.3% of participants in the NILS-LSA and LAST cohorts, respectively. Male NILS-LSA participants with impaired IC (odds ratio [OR]:1.50, 95% confidence interval [CI]:1.03-2.20), with hearing loss (OR:1.98, 95% CI:1.00-3.90) were more likely to fall. In LAST, impaired locomotion (OR:2.14, 95% CI:1.46-3.14) increased the risk of falls. Men with impaired IC (hazard ratio [HR]; 2.14, 95% CI:1.10-4.15) and visual impairment (HR:2.21, 95% CI:1.15-4.25) and women with impaired psychological well-being (HR:4.94, 95% CI:1.28-18.97) in the NILS-LSA cohort had greater risk for all-cause mortality; however, this was not shown for LAST participants. CONCLUSION: The prevalence and distribution of IC impairment and associated biomarkers differed significantly between participants in Japan and Taiwan. However, the associations with adverse outcomes remained similar, emphasizing the need for tailored interventions for healthy aging.

[A study on the mediation effect of insulin use on diabetic retinopathy in a community population].

Objective: To explore the risk factors for diabetic retinopathy (DR) in patients with diabetes and the mediating effect of insulin use on the relationship between glycated hemoglobin (HbA1c) and DR. Methods: Cross-sectional study. Random cluster sampling was conducted using a random number table method. A total of 84 sampling points (including 2 pilot points) were selected from the registered population of patients with type 2 diabetes aged 50 years and above at the Disease Prevention and Control Center in Funing County, Jiangsu Province. Questionnaires and biochemical tests were performed to obtain information on the general characteristics of the participants, medical history, insulin use, and glycated hemoglobin (HbA1c) levels. Ocular examinations, including anterior segment and fundus examinations, were conducted. The participants were divided into two groups, DR (diabetic retinopathy) and non-DR, based on the presence or absence of retinal hemorrhages, hard exudates, cotton wool spots, neovascularization, preretinal or vitreous hemorrhage. Univariate and multivariate logistic regression analyses were performed to identify the influencing factors for DR. The Karlson-Holm-Breen analysis method was used for mediation effect analysis. Results: A total of 2 067 diabetic patients were enrolled, of whom 1 965 completed the survey and 1 802 were included in the statistical analysis, resulting in a response rate of 87.2%. Among them, 660 patients were diagnosed with DR, with a detection rate of 36.63%. The results of multivariate analysis showed that diabetes duration (OR=1.166, 95%CI: 1.138-1.196), family history of diabetes (OR=1.325, 95%CI: 1.001-1.755), insulin therapy (OR=1.995, 95%CI: 1.434-2.777), HbA1c level (OR=1.513, 95%CI: 1.189-1.925), and alcohol consumption (OR=0.712, 95%CI: 0.514-0.985) were independent risk factors for DR. The mediating effect of insulin use accounted for 13.67% of the total effect of HbA1c on DR (P<0.001). Conclusions: The risk factors for DR in patients with diabetes include a history of insulin therapy, longer duration of diabetes, family history of diabetes, alcohol consumption, and high HbA1c levels. Insulin use increases the impact of HbA1c on DR and has a partial mediating effect on DR.

Long-Term Mortality Risk in Older Adults with Sarcopenia: An 11-Year Prospective Cohort Study Comparing AWGS 2014 and AWGS 2019 Guidelines for Enhanced Clinical Utility and Accurate Risk Prediction.

OBJECTIVES: To discern the diagnostic accuracy between the updated diagnostic consensus of the Asian Working Group for Sarcopenia (AWGS) in 2019 (AWGS 2019) and the previous AWGS 2014 guidelines. DESIGN: A prospective population-based cohort study. SETTING AND PARTICIPANTS: The study included 731 older community-dwelling adults aged ≥ 65 years who participated in face-to-face interviews and were followed up for 11-year mortality until 31 Mar 2022. MEASUREMENTS: We utilized a handgrip strength dynamometer to measure participants' muscle strength, while their walking speed was determined by a timed 6-meter walk test at their usual pace. Additionally, muscle mass was measured using dual-energy X-ray absorptiometry scanning. Sarcopenia was defined as the presence of low muscle mass in combination with weakness and/or slowness both by AWGS 2014 and 2019 criteria. RESULTS: The present study followed 731 participants (mean age 73.4 ± 5.4 years, men predominant 52.8%) over a period of 11 years, yielding 5927 person-years and 159 deaths. Prevalence of sarcopenia defined by AWGS 2019 and 2014 criteria were 8.5% and 6.8%, respectively. Sarcopenia defined by AWGS 2019 (HR 1.62, 95% CI 1.04-2.54, p=0.034) but not AWGS 2014 was significantly associated with mortality in community-living older adults after adjusting for potential confounders such as age, sex, education, drinking, disease burden and serum level of testosterone. The study also found that the AWGS 2019 criteria had a better model fitness than AWGS 2014 criteria in predicting mortality. CONCLUSION: AWGS 2019 criteria outperformed AWGS 2014 in identifying sarcopenia risk and predicting mortality. Screening for sarcopenia in older adults may improve health outcomes by identifying those at increased mortality risk.

The Effectiveness of Frailty Intervention for Older Patients with Frailty during Hospitalization.

OBJECTIVES: This study aims to assess the effectiveness of a multidomain intervention program on the change in functional status of hospitalized older adults. DESIGN: This single-arm, prospective, non-randomized interventional study investigates the efficacy of a multidomain interventional program including cognitive stimulation activity, simple exercises, frailty education, and nutrition counseling. SETTING AND PARTICIPANTS: At a tertiary hospital in southern Taiwan, 352 eligible patients were sequentially enrolled. Included patients were aged ≥65 years (mean age, 79.6 ± 9.0 years; 62% male), scored 3-7 on the Clinical Frailty Scale (CFS), and were hospitalized in the geriatric acute ward. INTERVENTION: Those receiving standard care (physical rehabilitation and nutrition counseling) during January-July 2019 composed the historical control group. Those receiving the multidomain intervention during August-December 2019 composed the intervention group. MEASUREMENTS: The primary outcome was the change in activities of daily life (ADL) and frailty status, as assessed by Katz Index and Clinical Frailty Scale, with using the generalized estimating equation model. The length of hospital stay, medical costs, and re-admission rates were secondary outcomes. RESULTS: Participants undergoing intervention (n = 101; 27.9%) showed greater improvements in the ADL and CFS during hospitalization (ADL adjusted estimate, 0.61; 95% CI, 0.11-1.11; p = 0.02; CFS adjusted estimate, -1.11; 95% CI, -1.42- -0.80; p < 0.01), shorter length of hospital stay (adjusted estimate, -5.00; 95% CI, -7.99- -2.47; p < 0.01), lower medical costs (adjusted estimate, 0.58; 95% CI, 0.49-0.69; p < 0.01), and lower 30- and 90-day readmission rates (30-day adjusted OR [aOR], 0.12; 95% CI, 0.27-0.50; p < 0.01; 60-day aOR, 0.04; 95% CI, 0.01-0.33; p < 0.01) than did controls. CONCLUSIONS: Participation in the multidomain intervention program during hospitalization improved the functional status and decreased the hospital stay length, medical costs, and readmission rates of frail older people.

[Epidemiology of uncorrected refractive errors in type 2 diabetics aged 50 and above in Funing County, China: the Jiangsu Diabetic Eye Study].

Objective: To estimate the prevalence of uncorrected refractive errors among people aged 50 years and above in Funing county, Jiangsu province. Methods: Randomly cluster sampling was used in selecting individuals aged ≥50 years in 82 clusters from Funing County Center for Disease Prevention and Control. Uncorrected refractive error was defined as an improvement of at least 2 lines in best corrected visual acuity compared with presenting visual acuity in the better eye. The mean±standard deviation was used to describe the continuous data, and the rate or composition ratio was used to represent the classified data. Univariate and multivariate logistic regression analyses were used to analyze the prevalence of uncorrected refractive errors in different ages, genders, educational levels, durations of diabetes and levels of glycosylated hemoglobin. Statistical significance was defined as P<0.05. Results: A total of 2 067 persons were enumerated, and 1910 (92.4%) participants were in the statistical analyses. The prevalence of uncorrected refractive error was 25.63%. The prevalence of uncorrected refractive error for myopia only, hyperopia only, astigmatism only, myopia with astigmatism and hyperopia with astigmatism was 72.55% (37/51), 46.77% (58/124), 17.81% (13/73), 63.95% (94/147) and 51.98% (100/194), respectively. The results showed that the older age, level of glycosylated hemoglobin, myopia and lens state were the independent influencing factors of uncorrected refractive error. The odds ratio (OR) for people aged 70 to<80 years and ≥80 years was 1.81 and 1.90, respectively, with statistical significance compared to people younger than 60 years. Compared with the level of glycosylated hemoglobin less than 5.6%, the OR with glycosylated hemoglobin from7.1% to 8.0% and more than 10% was 1.84 (P<0.05) and 1.82 (P<0.05), respectively. The OR of myopia, low myopia, moderate myopia and high myopia was 2.98 (P<0.01), 6.94 (P<0.01), 42.43 (P<0.01) and 77.85 (P<0.01), respectively. The OR of opacity of the eye lens was 7.60 (P<0.01). Conclusions: Uncorrected refractive error is one of the important causes of visual impairment in diabetic patients aged 50 and above in Funing county, Jiangsu province; the important influencing factors were age, glycosylated hemoglobin concentration, myopia and lens status. Relevant health departments should popularize the eye health for diabetic patients and conduct regular optometry and fundus examination. (Chin J Ophthalmol, 2021, 57: 757-765).

Prognostic Impact of Delirium in Older People With/Without Dementia: A Retrospective Cohort Study in Taiwan.

OBJECTIVES: To elucidate the hypothetically different interactions between delirium and post-discharge prognostic indicators in elderly hospital inpatients with versus without dementia. DESIGN: Retrospective cohort study of claims data by Taiwan National Health Insurance beneficiaries between 2002-2013. SETTING: Records of public hospital admissions in the Taiwan National Health Insurance Research database. PARTICIPANTS: Propensity-score matched subgroups of patients with delirium superimposed on dementia (n = 922) versus dementia alone (n = 922), delirium alone (n = 680) versus neither delirium nor dementia (n = 680). MEASUREMENTS: Mortality, emergency department visits, readmissions, and psychotropic drug use, within 30, 180, and 365 days of discharge, were analyzed using multivariate proportional hazards or logistic regression analyses. RESULTS: Delirium superimposed on dementia was not associated with increased post-discharge mortality, or emergency department visits, but significantly increased the risk of readmissions at 365-day follow-up (adjusted HR, 95% CI: 1.26, 1.01-1.56). However, delirium without dementia was significantly associated with increased post-discharge mortality, emergency department visits and readmissions at 180 days and 365 days (respective adjusted HRs: mortality, 1.63 and 1.79; adjusted ORs: emergency department visits, 1.89 and 1.81; readmissions, 1.47 and 1.53). Delirium in patients both with dementia and without, was associated with six-fold higher likelihood of in-hospital psychotropic drug use, and doubled post-discharge psychotropic drug usage. CONCLUSIONS: The obvious association between in-hospital delirium and worsened long-term prognosis, irrespective of dementia, raises awareness to warrants proactive and multimodal prevention and intervention strategies. Furthermore, the mechanisms about different influence of delirium for patients with/without dementia need to be further explored.

[Jiangsu Diabetic Eye Disease Study：epidemiological survey of blindness and moderate or severe visual impairment in people with type 2 diabetes over 50 years old in Funing County].

Objective: To investigate the prevalence, causes and risk factors of moderate or severe visual impairment and blindness in people with type 2 diabetes over 50 years old in Funing County, Yancheng. Methods: This is a cross-sectional study. Using cluster random sampling, 84 survey sites were selected, and eye examination was performed on people with type 2 diabetes over 50 years old who were registered with the chronic disease information center of Funing County Center for Disease Control and Prevention in Yancheng, Jiangsu. The prevalence of moderate or severe visual impairment and blindness were calculated by different ages and genders. The causes of blindness and visual impairment were determined, and their influencing factors were analyzed by univariate and multivarite logistic regression. Results: A total of 2 067 people were investigated in this study, and 1 909 people were included. The response rate was 92.4%. Based on PVA, the prevalence of blindness and moderate to severe visual impairment was 5.29% (95%CI: 4.29%-6.30%) and 18.54% (95%CI: 16.80%-20.29%). The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, systolic blood pressure and nuclear opacity. The prevalence of moderate or severe visual impairment was related to age, gender, educational level, diabetes treatment, exercise, and glycated hemoglobin. The prevalence of blindness and moderate to severe visual impairment was 3.67% (95%CI: 2.82%-4.51%) and 9.80% (95%CI: 8.46%-11.13%) based on BCVA. The prevalence of blindness was related to age, marital status, education, duration of diabetes, history of diabetic nephropathy, exercise and systolic blood pressure, while the prevalence of moderate or severe visual impairment was related to age, educational level, diabetes treatment and nuclear opacity. The primary cause of blindness and visual impairment is cataract, followed by diabetic retinopathy. Conclusions: The prevalence of moderate or severe visual impairment and blindness in people with type 2 diabetes in Funing County is relatively high. Attention should be paid to the prevention of blindness in this population. (Chin J Ophthalmol, 2020, 56: 593-599).

The Adverse Effects of Physical Restraint Use among Older Adult Patients Admitted to the Internal Medicine Wards: A Hospital-Based Retrospective Cohort Study.

OBJECTIVES: To evaluate the negative effect of physical restraint use on the hospital outcomes of older patients. DESIGN: A retrospective cohort study. SETTING: Internal medicine wards of a tertiary medical center in Taiwan. PARTICIPANTS: Subjects aged 65 years and over who were admitted during April to Dec 2017 were recruited for study. MEASUREMENTS: Demographic data, geriatric assessments (polypharmacy, visual impairment, hearing impairment, activities of daily living before and after admission, risk of pressure sores, change in consciousness level, mood condition, history of falls in the previous year, risk of malnutrition and pain) and hospital conditions (admission route, department of admission, length of hospital stay and mortality) were collected for analysis. RESULTS: Overall, 4,352 participants (mean age 78.7±8.7 years, 60.2% = male) were enrolled and 8.3% had physical restraint. Results of multivariate logistic regression showed that subjects with physical restraints were at greater risk of functional decline (adjusted odds ratio 2.136, 95% confidence interval 1.322-3.451, p=0.002), longer hospital stays (adjusted odds ratio 5.360, 95% confidence interval 3.627-7.923, p<0.001) and mortality (adjusted odds ratio 4.472, 95% confidence interval 2.794-7.160, p<0.001) after adjustment for covariates. CONCLUSION: The use of physical restraints during hospitalization increased the risk of adverse hospital outcomes, such as functional decline, longer length of hospital stay and mortality.

Predictive Effect of Malnutrition on Long-Term Clinical Outcomes among Older Men: A Prospectively Observational Cohort Study.

OBJECTIVES: To determine whether nutritional status can predict 3-year cognitive and functional decline, as well as 4-year all-cause mortality in older adults. DESIGN: Prospectively longitudinal cohort study. SETTING AND PARTICIPANTS: The study recruited 354 men aged 65 years and older in the veteran's retirement community. MEASURES: Baseline nutritional status was evaluated using the Mini-Nutritional Assessment-Short Form (MNA-SF). Cognitive function and Activities of Daily Living (ADL) function were determined by the Mini-Mental State Examination (MMSE) and the Barthel Index, respectively. Three-year cognitive and functional decline were respectively defined as a >3 point decrease in the MMSE scores and lower ADL scores than at baseline. Univariate and multivariable logistic regression analyses were conducted to identify nutritional status as a risk factor in poor outcome. The Kaplan-Meier method and Cox proportional regression models were used to estimate the effect of malnutrition risk on the mortality. RESULTS: According to MNS-SF, the prevalence of risk of malnutrition was 53.1% (188/354). Multivariate logistic regression found risk of malnutrition significantly associated with 3-year cognitive decline (Adjusted odds ratio [OR] 2.07, 95% Confidence Interval [CI] 1.05-4.08, P =0.036) and functional decline (Adjusted OR 1.83, 95% CI 1.01-3.34, P =0.047) compared with normal nutritional status. The hazard ratio (HR) for all-cause mortality was 1.8 times higher in residents at risk of malnutrition (Adjusted HR 1.82, 95% CI 1.19-2.79, P =0.006). CONCLUSIONS: Our results provide strong evidence that risk of malnutrition can predict not only cognitive and functional decline but also risk of all-cause mortality in older men living in a veteran retirement's community. Further longitudinal studies are needed to explore the causal relationship among nutrition, clinical outcomes, and the effect of an intervention for malnutrition.

[Validation and optimization of the indicator system of risk assessment for mechanical cuts].

Objective: To validation and optimization the indicator system of risk assessment for mechanical cuts. Methods: The risk assessment index system of mechanical cutting injury established earlier was used to assess the risk of mechanical cutting injury in 40 cases of mechanical cutting injury registered from January 2015 to December 2017 and 40 similar positions without accidents in the same period. The multiple stepwise regression analysis was used to screen the indicator system, and to adjust the weight coefficient of each index. The total coincidence rate and Kappa value were compared between before and after optimization respectively. Results: The new index system has 3 first-class indicators, 10 second-class indicators and 14 three-class indicators, fewer than the old index system which has 3 first-class indicators, 10 second-class indicators, 34 three-class indicators. There three indicators have revamped in the first-class. The total of coincidence rates of the new and old indicator systems were 67.50% and 90.00%, the difference was statistically significant (P<0.01). The Kappa value were 0.35 and 0.80, respectively. Conclusion: The evaluation results with new indicator systems is more consistent with the actual hazard detection the the old indicator systems, and scientific, reasonable and practical, and the indicator system of risk assessment for mechanical cuts can be used for the risk assessment of mechanical cutting injuries.

Association of New-Onset Diabetes Mellitus in Older People and Mortality in Taiwan: A 10-Year Nationwide Population-Based Study.

OBJECTIVE: Older patients with diabetes mellitus are at a higher risk of developing diabetic macro- and micro-vascular complications and cardiovascular diseases than younger diabetes mellitus patients. However, older diabetes mellitus patients are very heterogeneous in their clinical characteristics, diabetes mellitus-related complications and age at disease onset. This study aimed to evaluate the all-cause mortality rates and adverse health outcomes among older adults with new-onset diabetes mellitus through a nationwide population-based study. DESIGN: A retrospective cohort study. SETTING: 2001-2011 data of the National Health Insurance database. POPULATION: Nationally representative sample of Taiwanese adults aged 65 years and older with propensity score-matched controls. MAIN OUTCOME MEASURES: All-cause mortality and adverse health outcomes. RESULTS: During the study period, 45.3% of patients in the diabetes mellitus cohort and 38.8% in the non-diabetes mellitus cohort died. The adjusted relative risk for mortality in the diabetes mellitus cohort compared to the non-diabetes mellitus cohort was 1.23 (95% Confidence Interval [CI]=1.16-1.30) for males and 1.27 (95%CI=1.19-1.35) for females. During the follow-up period, 8.9% of the diabetes mellitus cohort and 5.8% of the non-diabetes mellitus cohort developed cardiovascular diseases; the diabetes mellitus cohort had an adjusted relative risk of cardiovascular complications compared to the non-diabetes mellitus cohort of 1.54 (95%CI=1.36-1.75) for men and 1.70 (95%CI=1.43-2.02) for women. The adjusted relative risk of mortality in the patients with hypoglycemia compared to non-hypoglycemia patients in the diabetes mellitus cohort was 2.33 (95%CI=1.81-3.01) for men and 2.73 (95%CI=2.10-3.52) for women after adjustment for age, Charlson comorbidity index, acute coronary syndrome, respiratory disease, cancer, infectious disease and nervous system disease at baseline. CONCLUSIONS: New-onset diabetes in older adults is associated with an increased risk of mortality, and hypoglycemia is an important marker of this association. Individualized care plans stratified by age at onset, duration of disease, comorbidity and functional status, as well as hypoglycemia avoidance, would benefit the management of diabetes in older adults.

Mass Spectrometry of Nanoparticles is Different.

Secondary ion mass spectrometry, SIMS, is a method of choice for the characterization of nanoparticles, NPs. For NPs with large surface-to-volume ratios, heterogeneity is a concern. Assays should thus be on individual nano-objects rather than an ensemble of NPs; however, this may be difficult or impossible. This limitation can be side-stepped by probing a large number of dispersed NPs one-by-one and recording the emission from each NP separately. A large collection of NPs will likely contain subsets of like-NPs. The experimental approach is to disperse the NPs and hit an individual NP with a single massive cluster (e.g., C-60, Au-400). At impact energies of ~1 keV/atom, they generate notable secondary ion (SI) emission. Examination of small NPs (≤20 nm in diameter) shows that the SI emission is size-dependent and impacts are not all equivalent. Accurate identification of the type of impact is key for qualitative assays of core or outer shell composition. For quantitative assays, the concept of effective impacts is introduced. Selection of co-emitted ejecta combined with rejection (anticoincidence) of substrate ions allows refining chemical information within the projectile interaction volume. Last, to maximize the SI signal, small NPs (≤5 nm in diameter) can be examined in the transmission mode where the SI yields are enhanced ~10-fold over those in the (conventional) reflection direction. Future endeavors should focus on schemes acquiring SIs, electrons, and photons concurrently.

High prevalence of cutaneous manifestations in the elderly with diabetes mellitus: an institution-based cross-sectional study in Taiwan.

BACKGROUNDS: Diabetes mellitus (DM) is a common endocrine disorder and an increasing epidemic worldwide. Proportional diabetic patients eventually develop cutaneous diseases. OBJECTIVES: This study determined the statistical association of cutaneous manifestations and DM as well as the DM-associated cutaneous manifestations in elderly male residents. METHODS: A cross-sectional study was conducted in a Veterans Home in Taiwan. The cutaneous manifestations and major systemic diseases of the residents were recorded separately. Univariate logistic regression and multivariate analysis after adjustment for age, body mass index and significant major systemic diseases provided odds ratios and P values for the statistical association. RESULTS: A total of 313 male residents (age ≥65 years) were recruited, including 70 (22.4%) with DM. Their most common cutaneous manifestations included fungal infection (77%) and brown spots on the legs (38.3%). Chronic ulcers adjusted odds ratios (AOR 4.90, 95%CI: 1.82-13.19; P = 0.002), brown spots on the legs (AOR 6.82, 95%CI: 3.60-12.89; P < 0.001) and pruritus (AOR 12.86, 95%CI: 4.40-37.59; P < 0.001) were significantly associated with DM. The diabetic residents were inclined to have chronic ulcers, brown spots on the legs and pruritus at a 7.46-fold higher risk (AOR 7.46, 95%CI: 3.86-14.43; P < 0.001). The diabetic residents exhibited marginally higher risks of bacterial infection, scabies, or skin tags. CONCLUSION: The DM-associated cutaneous manifestations were chronic ulcers, brown spots on the legs, and pruritus. By observing clues of diabetic cutaneous features, a more complete condition of diabetic patients can be appreciated. The information is essential for providing appropriate treatment and key nursing points regarding the diabetes-associated skin diseases.

Characterization of individual nano-objects with nanoprojectile-SIMS.

Secondary ion mass spectrometry (SIMS) applied in the event-by-event bombardment/detection mode is uniquely suited for the characterization of individual nano-objects. In this approach, nano-objects are examined one-by-one, allowing for the detection of variations in composition. The validity of the analysis depends upon the ability to physically isolate the nano-objects on a chemically inert support. This requirement can be realized by deposition of the nano-objects on a Nano-Assisted Laser Desorption/Ionization (NALDI™) plate. The featured nanostructured surface provides a support where nano-objects can be isolated if the deposition is performed at a proper concentration. We demonstrate the characterization of individual nano-objects on a NALDI™ plate for two different types of nanometric bacteriophages: Qß and M13. Scanning electron microscope (SEM) images verified that the integrity of the phages is preserved on the NALDI™ substrate. Mass spectrometric data show secondary ions from the phages are identified and resolved from those from the underlying substrate.

MEMS-based flow cytometry: microfluidics-based cell identification system by fluorescent imaging.

This study utilizes MEMS technology to realize a novel low-cost microfluidics-based biochip system for flow-type cell handling. Powered by vacuum pump, the microfluidic driving system enables cells to move in order one by one in the biochip by an effect of sheath flow prefocus. Then, cells are guided to a fluorescent inspection region where two detection tasks such as cell image identification and cell counting are conducted. Currently, the glass-based biochip has been manufactured and all the related devices have been well set up in our laboratory. With this proposed prototype system, typical results about cell separation of yeast cell and PC-3 cell are available and their separated images are also presented, respectively.

A multi-functional online measurement system for neuron-microelectrode interface study.

The goal of this paper is to develop a multifunctional measurement system for neuron-microelectrode interface study by LabVIEW. The system uses a commercial 60-channel microelectrode array (MEA) as an interface platform. These online functions of neuronal stimulation, extracellular potential recording, impedance monitoring, and data storage have been integrated into this system. Two offline analysis functions of wavelet de-noising and artifact removing are also included. The former two online functions are executed respectively by a NI-DAQ card and by a self-made analog frond-end amplifier, and Agilent 4284A LCR meter makes the impedance measurement. We have completed the basic functional verifications on a cultured MEA with PC-12.

A text input system developed by using lips image recognition based LabVIEW for the seriously disabled.

In this paper, we present a text input system for the seriously disabled by using lips image recognition based on LabVIEW. This system can be divided into the software subsystem and the hardware subsystem. In the software subsystem, we adopted the technique of image processing to recognize the status of mouth-opened or mouth-closed depending the relative distance between the upper lip and the lower lip. In the hardware subsystem, parallel port built in PC is used to transmit the recognized result of mouth status to the Morse-code text input system. Integrating the software subsystem with the hardware subsystem, we implement a text input system by using lips image recognition programmed in LabVIEW language. We hope the system can help the seriously disabled to communicate with normal people more easily.