Background Sarcopenia is a geriatric syndrome characterized by loss of muscle mass and muscle function. As the population ages, there is a growing worldwide interest in the intersection of sarcopenia and heart failure (HF). However, estimates of the prevalence of sarcopenia in HF vary widely because of difference in diagnostic criteria. Although the Asian Working Group of Sarcopenia (AWGS) has announced a consensus on the diagnostic criteria of sarcopenia in Asian people, the prevalence and prognostic impact of sarcopenia based on AWGS criteria in patients with HF remains unclear. Purpose The aim of this study was to investigate the prevalence and predictive value of sarcopenia identified according to AWGS definition in non-dependent elderly patients with HF. Methods This study was a prospective, single-center cohort study in Japan. We consecutively enrolled 274 patients, aged 65 years or older, hospitalized due to acute HF or acute exacerbation of chronic HF and who were able to walk at least 20 m at discharge. Patients with severe cognitive or psychiatric disorders were excluded. Patients with implantable cardiac pacemaker or cardioverter defibrillator were also excluded because skeletal muscle mass was estimated by using bioimpedance analysis. At hospital discharge, we collected data on age, gender, left ventricular ejection fraction, brain natriuretic peptide, estimate glomerular filtration rate, body mass index and sarcopenia. Sarcopenia was diagnosed according to the AWGS criteria: low skeletal muscle index (<7.0 kg/m2 in men, <5.7 kg/m2 in women) and either slow usual walking speed (<0.8 m/s) or low handgrip strength (<26 kg in men, <17 kg in women). Study outcome was rehospitalization for worsening HF within 180 days after discharge. We assessed the independent association between sarcopenia and HF rehospitalization by using multivariate Cox proportional hazards regression analysis. Results In this study, a total of 199 patents (43.4%) fulfilled sarcopenia criteria at discharge. During follow-up, 57 patients (20.8%) readmitted for HF. Kaplan-Meier survival curves showed that patients with sarcopenia had significantly lower event-free survival than those without sarcopenia (Figure). After adjusting for other prognostic factors, sarcopenia was independently associated with HF rehospitalization (hazard ratio: 2.31, 95% confidence interval: 1.20–4.53). Conclusion Based on AWGS criteria, sarcopenia is highly prevalent even among non-dependent elderly HF patients, and is an independent strong predictor of rehospitalization for worsening HF. AWGS criteria for sarcopenia may be useful for risk prediction in HF.
Mobile devices, including smart phones and tablets, are increasing in complexity and require ever greater amounts of memory storage. In the past the challenge of higher memory densities and increase functionality has been met through miniaturization of device features, but as we reach the physical limits of feature size, packaging is being relied on more and more to achieve the necessary higher densities in memory and additional device functionality. Thin dies reduce overall package height, however, to achieve high memory densities in low profile packages the die attach material must have an even, thin bond line thickness. DAF (Die Attach Film) is an excellent solution. LINTEC developed an all new DDAF (Dicing Die Attach Film) with thinner DAF for CE (Cool Expansion) process. Conventional tape has a large area of exposed DAF surface which creates the risk of wafer and / or equipment contamination if DAF flies off during the CE process. We developed an all-new tape structure which is compatible with the SD (Stealth Dicing) and CE processes. The structure consists of DAF, IB (Intermediate Basefilm), and dicing tape. The diameter of the DAF and IB is close to the wafer diameter size to significantly reduce the risk of DAF separation and ejection during CE. We considered IB to improve DAF separation and it was found that a thinner IB layer is a good approach to separate DAF effectively. We can adjust adhesion between the DAF and the IB by changing the material properties of the IB, as an effective means to control die-fly and pick-up.
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