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It has not been well established whether dietary folate intake reduces the risk of diabetes development. We aimed to clarify the prospective association between dietary folate intake and type 2 diabetes (T2D) risk among 7333 Korean adults aged 40 years or older who were included in the Multi-Rural Communities Cohort. Dietary folate intake was estimated from all 106 food items listed on a FFQ, not including folate intake from supplements. Two different measurements of dietary folate intake were used: the baseline consumption and the average consumption from baseline until just before the end of follow-up. The association between folate intake and T2D risk was determined through a modified Poisson regression model with a robust error estimator controlling for potential confounders. For 29 745 person years, 319 cases of diabetes were ascertained. In multivariable analyses, dietary folate intake was inversely associated with risk of T2D for women, not for men. For women, the incidence rate ratio of diabetes in the third tertile compared with the first tertile was 0·57 (95 % CI 0·38–0·87, Pfor trend=0·0085) in the baseline consumption model and 0·64 (95 % CI 0·43–0·95, Pfor trend=0·0244) in the average consumption model. These inverse associations was found in both normal fasting blood glucose group and impaired fasting glucose group among women. Among non-users of multinutrients and vitamin supplements, the significant inverse association remained. Thus, higher dietary intake of folate is prospectively associated with lower risk of diabetes for women.
To compare the characteristics and risk factors for surgical site infections (SSIs) after total hip arthroplasty (THA) and total knee arthroplasty (TKA) in a nationwide survey, using shared case detection and recording systems.
Retrospective cohort study.
Twenty-six hospitals participating in the Korean Nosocomial Infections Surveillance System (KONIS).
From 2006 to 2009, all patients undergoing THA and TKA in KONIS were enrolled.
SSI occurred in 161 (2.35%) of 6,848 cases (3,422 THAs and 3,426 TKAs). Pooled mean SSI rates were 1.69% and 2.82% for THA and TKA, respectively. Of the cases we examined, 42 (26%) were superficial-incisional SSIs and 119 (74%) were “severe” SSIs; of the latter, 24 (15%) were deep-incisional SSIs and 95 (59%) were organ/space SSIs. In multivariate analysis, a duration of preoperative hospital stay of greater than 3 days was a risk factor for total SSI after both THA and TKA. Diabetes mellitus, revision surgery, prolonged duration of surgery (above the 75th percentile), and the need for surgery due to trauma were independent risk factors for total and severe SSI after THA, while male sex and an operating room without artificial ventilation were independent risk factors for total and severe SSI after TKA. A large volume of surgeries (more than 10 procedures per month) protected against total and severe SSI, but only in patients who underwent TKA.
Risk factors for SSI after arthroplasty differ according to the site of the arthroplasty. Therefore, clinicians should take into account the site of arthroplasty in the analysis of SSI and the development of strategies for reducing SSI.
To evaluate the risk factors for surgical site infection (SSI) after gastric surgery in patients in Korea.
A nationwide prospective multicenter study.
Twenty university-affiliated hospitals in Korea.
The Korean Nosocomial Infections Surveillance System (KONIS), a Web-based system, was developed. Patients in 20 Korean hospitals from 2007 to 2009 were prospectively monitored for SSI for up to 30 days after gastric surgery. Demographic data, hospital characteristics, and potential perioperative risk factors were collected and analyzed, using multivariate logistic regression models.
Of the 4,238 case patients monitored, 64.9% (2,752) were male, and mean age (±SD) was 58.8 (±12.3) years. The SSI rates were 2.92, 6.45, and 10.87 per 100 operations for the National Nosocomial Infections Surveillance system risk index categories of 0, 1, and 2 or 3, respectively. The majority (69.4%) of the SSIs observed were organ or space SSIs. The most frequently isolated microorganisms were Staphylococcus aureus and Klebsiella pneumoniae. Male sex (odds ratio [OR], 1.67 [95% confidence interval (CI), 1.09–2.58]), increased operation time (1.20 [1.07–1.34] per 1-hour increase), reoperation (7.27 [3.68–14.38]), combined multiple procedures (1.79 [1.13–2.83]), prophylactic administration of the first antibiotic dose after skin incision (3.00 [1.09–8.23]), and prolonged duration (≥7 days) of surgical antibiotic prophylaxis (SAP; 2.70 [1.26–5.64]) were independently associated with increased risk of SSI.
Male sex, inappropriate SAP, and operation-related variables are independent risk factors for SSI after gastric surgery.
A high molecular weight, photocurable inorganic-organic hybrid based on ladder-like poly(phenyl6-co-methacrylate4)silsesquioxanes (LPPMA64) was investigated as a flexible display substrate. Photocured free standing films with 40μm thickness showed high transparency (>95%), excellent thermal stability (Td >450°C), and low coefficient of thermal expansion (38ppm/K) without the use of reinforced glass fibers. Furthermore, these ladder-like structured materials did not require any thermal treatment processes due to the negligible amounts of uncondensed groups, thus simplifying manufacturing processing. These novel hybrid films present an alternative to organic plastics as flexible electronic device substrates due to their excellent optical and thermal properties.
The relationship between dietary Zn intake and the risk of atherosclerosis remains unclear, and no epidemiological studies have been reported on the effects of dietary Zn intake on morphological changes in the vascular wall. We examined the relationship between dietary Zn intake and common carotid intima-media thickness (IMT) as a marker of subclinical atherosclerosis among the middle-aged and elderly populations. A cross-sectional analysis of a prospective cohort baseline study was performed with 4564 adults aged 40–89 years and free of clinical CVD. Dietary data were collected by trained interviewers using an FFQ. Common carotid IMT was measured using a B-mode ultrasound imaging technique. Subclinical atherosclerosis was determined using carotid IMT, and defined as >80th percentile of carotid IMT or ≥ 1 mm of carotid IMT. After adjustment for potential confounders, the mean carotid IMT in the low Zn intake group was higher than that in the high Zn intake group. When subclinical atherosclerosis was defined as >80th percentile value of IMT or ≥ 1 mm of carotid IMT, after adjustment for potential confounders, Zn intake was inversely related to subclinical atherosclerosis (5th v. 1st quintile, OR 0·64, 95 % CI 0·45, 0·90, P for trend = 0·069; 5th v. 1st quintile, OR 0·34, 95 % CI 0·16, 0·70, P for trend = 0·005, respectively). In persons free of clinical CVD, dietary Zn intake was inversely correlated with subclinical atherosclerosis. The present findings suggest a putative protective role of dietary Zn intake against the development of atherosclerosis.
Hardness and elastic modulus of micromaterials can be evaluated by analyzing instrumented sharp-tip-indentation load–depth curves. The present study quantified the effects of tip-blunting and pile-up or sink-in on the contact area by analyzing indentation curves. Finite-element simulation and theoretical modeling were used to describe the detailed contact morphologies. The ratio f of contact depth, i.e., the depth including elastic deflection and pile-up and sink-in, to maximum indentation depth, i.e., the depth measured only by depth sensing, ignoring elastic deflection and pile-up and sink-in, was proposed as a key indentation parameter in evaluating real contact depth during indentation. This ratio can be determined strictly in terms of indentation-curve parameters, such as loading and unloading slopes at maximum depth and the ratio of elastic indentation energy to total indentation energy. In addition, the value of f was found to be independent of indentation depth, and furthermore the real contact area can be determined and hardness and elastic modulus can be evaluated from f. This curve-analysis method was verified in finite-element simulations and nanoindentation experiments.
Hardness and elastic modulus can be derived from instrumented sharp indentation curves by considering the effects of materials pile-up and sink-in and tip blunting. In particular, this study quantifies pile-up or sink-in effects in determining contact area based on indentation-curve analysis. Two approaches, finite-element simulation and theoretical modeling, were used to describe the detailed contact morphologies. The ratio of contact depth to maximum indentation depth was proposed as a key indentation parameter and was found to be a material constant independent of indentation load. In addition, this parameter can be determined strictly in terms of indentation-curve parameters, such as loading and unloading slopes at maximum depth and indentation energy ratio. This curve-analysis method was verified by finite-element simulations and nanoindentation experiments.
The nanoindentation technique has great promise in evaluating mechanical properties such as nanohardness and elastic modulus at micrometer or nanometer scales, since sample preparation and testing procedures are very easy. However, the nanohardness and elastic modulus cannot be directly related to basic material flow properties. Here a novel and simple experimental/computational method is proposed to extract stress-strain curves based on finite-element modeling (FEM) of nanoindentation. This method was verified for bulk Al by comparing the stress-strain curves extracted with those obtained from tensile testing, and was applied to Al thin films (0.5 μm and 1 μm) deposited on a Si substrate.
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