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Background: Newborn anogenital distance (AGD) has been associated with prenatal exposure of phthalates. The association between prenatal phthalate exposure and sex steroid hormones in newborns is unclear. Object: This study aimed to examine whether cord-blood sex hormone levels were associated with prenatal phthalate exposure and newborn anogenital distance (AGD). Methods: In the Taiwan Maternal and Infant Cohort Study, we recruited 1,676 pregnant women in their third trimester in 2012–2015 in Taiwan. We determined 11 urinary phthalate metabolites in pregnant women, three maternal and five cord-blood steroid sex-hormone concentrations. Five hundred and sixty-five mother-infant pairs with sufficient data were included. Trained neonatologists measured 263 newborns' AGD. We examined the associations of prenatal phthalate metabolite levels with AGD and hormones using linear regression models and evaluated correlations between maternal and cord-blood sex hormone levels and AGD. Results: Compared with the male newborns exposed to maternal phthalate metabolites at the first tertile, AGD was -3.75, -3.43, and -3.53 mm shorter among those exposed at the median tertile of di-2-ethylhexyl phthalate (DEHP) metabolites, monobenzyl phthalate (MBzP), and monomethyl phthalate (MMP), respectively. Compared with those who had exposed at the first tertile, cord-blood follicle-stimulating hormone (FSH) decreased among male newborns exposed at higher levels of MMP, mono-n-butyl phthalate (MnBP), MBzP and DEHP, and among female newborns exposed at higher levels of MMP, MBzP and mono(2-ethyl-5-hydroxyhexyl) phthalate. However, we did not observe significant correlations of maternal or cord-blood sex steroid hormones with newborns' AGDs. Conclusions: Alterations in cord-blood sex steroid hormone levels were associated with prenatal phthalate exposures, particularly in male newborns. Women aspiring to be pregnant should be alerted of the need of reducing phthalate exposure. [ABSTRACT FROM AUTHOR]

Objective: To assess the trend in prevalence and socioeconomic correlates of diabetes in pregnancy (DIP) in Taiwan from 2007 to 2014. Methods: In all, 1 606 344 pregnancies, including 199 383 DIP (1693 with pre‐pregnancy type 1 diabetes [T1DM], 17 171 with pre‐pregnancy type 2 diabetes [T2DM], and 180 519 with gestational diabetes mellitus [GDM]) were investigated. Logistic regression models were performed to identify the covariates significantly associating with DIP. Results: Over the study period, the prevalence of pre‐pregnancy T2DM increased by 568.44%; the prevalence of T1DM and GDM also increased but with a smaller magnitude. However, only the prevalence of pre‐pregnancy T2DM showed an increase after socioeconomic variables were considered. Compared with immigrant mothers, native‐born mothers had a significantly higher adjusted odds ratio of DIP, particularly pre‐pregnancy T1DM (3.33, 95% confidence interval 1.57–7.05). Additionally, indigenous mothers and those from rural areas had a higher prevalence of pre‐pregnancy T2DM but lower prevalence of GDM. Lower maternal education and income were associated with higher prevalence of pre‐pregnancy T1DM but lower prevalence of pre‐pregnancy T2DM and GDM. Conclusion: Socioeconomic variables largely accounted for the increased secular trend in pre‐pregnancy T1DM and GDM, but the prevalence of pre‐pregnancy T2DM still doubled, which was independent of socioeconomic covariates. Synopsis: Diabetes in pregnancy, particularly pre‐pregnancy type 2 diabetes, has been increasing in Taiwan, and it shows obvious socioeconomic inequality and urban–rural disparity. [ABSTRACT FROM AUTHOR]

Existing broodstock research has ascertained that eggs are heavily influenced by broodstock diet, but there is currently sparse information regarding the time it takes for nutrients to transfer into eggs after broodstock feeding. Thus, our study aimed to quantify this duration of broodstock to egg nutrient transfer by feeding two alternating diets. In 2021, nine California yellowtail (Seriola dorsalis) broodstock were fed alternating diets of commercial pellets (Vitalis Prima: Skretting, Norway) and cutbait (70% sardine and 30% squid). These diets were switched every 41 days and then repeated so each diet was provided twice during the study. Biochemical and biometric data from spawns were collected and statistically analyzed by grouping spawns based on diet type and diet duration. Between diet switches, we observed a selective retention of C18:3n-3 (α-linolenic acid) and C18:2n-6 (linoleic acid) from the Vitalis diet, and C20:5n-3 (eicosapentaenoic acid), from the cutbait diet. Our results showed overall fatty acids from both diets were incorporated by the eggs after 10 to 19 days of feeding. Knowing this timing of nutritional incorporation from broodstock diet to eggs will help significantly improve feed efficiency by providing producers with a specific timeframe to maximize egg quality through dietary modifications or supplements. • The lag period of fatty acid incorporation from broodstock diet to egg was within 19 days. • Specific essential fatty acids were selectively retained by eggs from their previous diets. • Vitalis diet is a potential substitute for a standard cut bait diet in California Yellowtail broodstock. [ABSTRACT FROM AUTHOR]

Background: COVID-19 vaccination is essential. However, no study has reported adverse events (AEs) after ChAdOx1 nCoV-19 vaccination in patients with end-stage renal disease (ESRD) on hemodialysis (HD). This study investigated the AEs within 30-days after the first dose of ChAdOx1 nCoV19 (Oxford-AstraZeneca) in ESRD patients on HD. Methods and findings: A total of 270 ESRD patients on HD were enrolled in this study. To determine the significance of vascular access thrombosis (VAT) post vaccination, we performed a self-controlled case study (SCCS) analysis. Of these patients, 38.5% had local AEs; local pain (29.6%), tenderness (28.9%), and induration (15.6%) were the most common. Further, 62.2% had systemic AEs; fatigue (41.1%), feverishness (20%), and lethargy (19.9%) were the most common. In addition, post-vaccination thirst affected 18.9% of the participants with female predominance. Younger age, female sex, and diabetes mellitus were risk factors for AEs. Five patients had severe AEs, including fever (n = 1), herpes zoster (HZ) reactivation (n = 1), and acute VAT (n = 3). However, the SCCS analysis revealed no association between vaccination and VAT; the incidence rate ratio (IRR)-person ratio was 0.56 (95% CI 0.13–2.33) and 0.78 (95% CI 0.20–2.93) [IRR-event ratio 0.78 (95% CI 0.15–4.10) and 1.00 (95% CI 0.20–4.93)] in the 0–3 months and 3–6 months period prior to vaccination, respectively. Conclusions: Though some ESRD patients on HD had local and systemic AEs after first-dose vaccination, the clinical significance of these symptoms was minor. Our study confirmed the safety profile of ChAdOx1 nCoV-19 in HD patients and presented a new viewpoint on vaccine-related AEs. The SCCS analysis did not find an elevated risk of VAT at 1 month following vaccination. Apart from VAT, other vaccine-related AEs, irrespective of local or systemic symptoms, had minor clinical significance on safety issues. Nonetheless, further coordinated, multi-center, or registry-based studies are needed to establish the causality. [ABSTRACT FROM AUTHOR]

Simple Summary: Ketamine, an N-Methyl-D-aspartate receptor antagonist, acts as a quick-acting and general anesthetic for human and animal anesthesia. In recent years, ketamine has been widely abused among young people and commonly abused in combination with other drugs. Continued use of ketamine will damage mental status and cognitive function. Some abusers will suffer from ketamine-related cystitis (KC) and experienced severe lower urinary tract symptoms, such as frequent urination, hematuria, urinary incontinency, and bladder pain. The etiology of KC is still uncertain and therefore no definite treatment has been established. This review article focuses on current evidence of molecular pathophysiology and possible therapies for KC. Ketamine was first synthesized as a clinical medicine for anesthesia in 1970. It has been used as a recreational drug because of its low cost and hallucination effect in the past decade. Part of ketamine abusers may experience ketamine-related cystitis (KC) and suffer from lower urinary tract symptoms, including urinary frequency, urgency, and severe bladder pain. As the disease progression, a contracted bladder, petechial hemorrhage of the bladder mucosa, and ureteral stricture with hydronephrosis may occur. The pathophysiology of KC is still uncertain, although several hypotheses have been raised. Cessation of ketamine abuse is critical for the management of KC to prevent progressive disease, and effective treatment has not been established. Research has provided some theoretical bases for developing in vitro experiments, animal models, and clinical trials. This review summarized evidence of molecular mechanisms of KC and potential treatment strategies for KC. Further basic and clinical studies will help us better understand the mechanism and develop an effective treatment for KC. [ABSTRACT FROM AUTHOR]

In this paper, we report an in situ optical microscopy study of lateral growth of xenon (Xe) hydrate thin films on mica at sub-zero temperatures. The interactions between a solid surface and water molecules can strongly affect the alignment of water molecules and induce ice-like ordered structures within the water layer at the water-surface interface. Mica was chosen as a model surface to study the surface effect of hydrophilic sheet silicates on the lateral growth of Xe hydrate films. Under the experimental conditions, the lateral growth of Xe hydrate films was measured to be at an average rapid rate of ~200 µm/s and 400 µm/s under two different pressures of Xe. Mass transfer estimation of the Xe-water system revealed that the increasing trend of lateral film growth rates followed the increase in the net mass flux and aqueous solubility of Xe. However, as the supercooling temperature increased, the trend of lateral film growth rates attained a plateau region where little change in the rate was observed. This unique feature in the lateral film growth trend, the fast lateral growth kinetics, and the short induction time for hydrate film growth hinted at the assistance of the mica surface to aid the lateral growth process of Xe hydrate films at low Xe mass flux and at a low degree of subcooling. A mechanism based on the reported structured water layer at the interface on mica was proposed to rationalize a postulated surface-promotional effect of mica on the nucleation and lateral growth kinetics of Xe hydrate films. [ABSTRACT FROM AUTHOR]

Background: The optimal radiotherapy dose for locally advanced cervical esophageal squamous cell carcinoma (C-ESqCC) treated with definitive concurrent chemoradiotherapy (dCCRT) is unclear. Here, we aimed to compare the survival of those treated with high dose versus standard dose via a population based approach. Methods: Eligible C-ESqCC patients diagnosed between 2011 and 2017 were identified via the Taiwan Cancer Registry. We used propensity score (PS) weighting to balance observable potential confounders between groups. The hazard ratio (HR) of death and incidence of esophageal cancer mortality (IECM) were compared between high (60-70 Gy) and standard dose (50-50.4 Gy). We also evaluated the outcome in supplementary analyses via alternative approaches. Results: Our primary analysis consisted of 141 patients in whom covariates were well balanced after PS weighting. The HR of death when high dose was compared with standard dose was 0.65 (95% confidence interval [CI]: 0.4-1.03, p = 0.07). The HR of IECM was 0.74 (p = 0.45). The HR of OS remained similarly insignificant in supplementary analyses. Conclusions: We observed a trend in favor of high radiotherapy dose versus standard dose for C-ESqCC treated with dCCRT in this population-based nonrandomized study. Further studies are needed to confirm the findings of the study. [ABSTRACT FROM AUTHOR]

BsYetJ is a bacterial homolog of transmembrane BAX inhibitor-1 motif-containing 6 (TMBIM6) membrane protein that plays a key role in the control of calcium homeostasis. However, the BsYetJ (or TMBIM6) structure embedded in a lipid bilayer is uncharacterized, let alone the molecular mechanism of the calcium transport activity. Herein, we report structures of BsYetJ in lipid nanodiscs identified by double electron-electron resonance spectroscopy. Our results reveal that BsYetJ in lipid nanodiscs is structurally different from those crystallized in detergents. We show that BsYetJ conformation is pH-sensitive in apo state (lacking calcium), whereas in a calcium-containing solution it is stuck in an intermediate, inert to pH changes. Only when the transmembrane calcium gradient is established can the calcium-release activity of holo-BsYetJ occur and be mediated by pH-dependent conformational changes, suggesting a dual gating mechanism. Conformational substates involved in the process and a key residue D171 relevant to the gating of calcium are identified. Our study suggests that BsYetJ/TMBIM6 is a pH-dependent, voltage-gated calcium channel. [ABSTRACT FROM AUTHOR]

A device design technique for boosting output resistance (Rout) characteristics of long-channel halo-doped nMOSFETs for replacement gate (RMG) high-k/metal gate (HK/MG) devices is proposed based on numerical simulations. We show that the self-aligned halo-compensated channel implant (HCCI) that is carried out after dummy poly gate removal provides compensation for the conventional halo doping. This can be utilized to mitigate the magnitude of potential drop beyond saturation at the drain end so that the long-channel Rout can be boosted relative to the conventional halo-doped device. In addition, we achieve an improved Vt roll-off behavior, an advantage to hot carrier injection (HCI) characteristics at high voltage operation, and the lowered short-channel drain-induced barrier lowering (DIBL) and intrinsic delay via the optimization of the source/drain (S/D) doping profile. HCCI technique can be implemented using a process flow that is compatible with the RMG HK/MG system-on-chip (SoC) technology in the mass production. [ABSTRACT FROM AUTHOR]

[Display omitted] • 10 gas and 18-waveband spectroscopy sensors assembled to a freshness sensing box. • Machine learning modeling, MLR, PLSR, SVR were applied for freshness prediction. • Fish freshness was correctly predicted by sensing box with similar results to HPLC. • MLR model offered good prediction power with low RMSE 1.47 and high R2 0.93. Estimating the freshness of fish is a crucial aspect linked to its overall quality. In our research, a rapid freshness sensing system was designed for predicting the freshness of grouper (Epinephelus coioides) fillets throughout their storage period. This system incorporated ten gas sensors (assembled as e-nose) and 18-wavebands spectroscopy chip. Grouper fillet each was placed inside of the sensing device and stored at a temperature of 10 ± 2℃ for a duration of 72 h with sensor signal acquired hourly. In total 292 data points were collected. The true freshness of the grouper fillets represented by K value and total volatile basic nitrogen (T-VBN), was determined by HPLC and colorimetric method. Machine learning algorithms, including multiple linear regression (MLR), partial least squares regression (PLSR), and support vector regression (SVR), were employed to construct predictive models based on the data form both sensors and instrumental analysis. Among these models, MLR observed superior performance in predicting K value and T-VBN, achieving root mean square errors (RMSE) of 5.959 and 1.473, along with R2 of 0.914 and 0.932, respectively. The sensing system exhibited great predicting capabilities for assessing fish freshness. [ABSTRACT FROM AUTHOR]

Objectives: To examine the risk of recurrence in adults who survived first-episode severe sepsis for at least 3 months.Design: A matched cohort study.Setting: Inpatient claims data from Taiwan's National Health Insurance Research Database.Subjects: We analyzed 10,818 adults who survived first-episode severe sepsis without recurrence for at least 3 months in 2000 (SS group; mean age, 62.7 yr; men, 54.7%) and a group of age/sex-matched (1:1) population controls who had no prior history of severe sepsis. All subjects were followed from the study entry to the occurrence of end-point, death, or until December 31, 2008, whichever date came first.Interventions: None.Measurements and Main Results: Primary end-point was severe sepsis that occurred after January 1, 2001 (the study entry). Relative risk of the end-point was assessed using competing risk regression model. During the follow-up period, severe sepsis and death occurred in 35.0% and 26.5% of SS group and in 4.3% and 18.6% of controls, respectively, representing a covariate-adjusted sub-hazard ratio of 8.89 (95% CI, 8.04-9.83) for the risk of recurrence. In stratified analysis by patient characteristics, the sub-hazard ratios ranged from 7.74 in rural area residents to 23.17 in young adults. In subgroup analysis by first-episode infection sites in SS group, the sub-hazard ratios ranged from 4.82 in intra-abdominal infection to 9.99 in urinary tract infection.Conclusions: Risk of recurrence after surviving severe sepsis is substantial regardless of patient characteristics or infection sites. Further research is necessary to find underlying mechanisms for the high risk of recurrence in these patients. [ABSTRACT FROM AUTHOR]

Objective: This study investigated the effects of severe hypoglycemia on risks of all-cause mortality and cardiovascular disease (CVD) incidence in patients with type 1 diabetes mellitus (T1DM).Research Design and Methods: Two nested case-control studies with age- and sex-matched control subjects and using the time-density sampling method were performed separately within a cohort of 10,411 patients with T1DM in Taiwan. The study enrolled 564 nonsurvivors and 1,615 control subjects as well as 743 CVD case subjects and 1,439 control subjects between 1997 and 2011. History of severe hypoglycemia was identified during 1 year, 1-3 years, and 3-5 years before the occurrence of the study outcomes. Conditional logistic regression analyses were performed to estimate the odds ratio (OR) and 95% CI of the study outcomes.Results: Prior severe hypoglycemic events within 1 year were associated with higher risks of all-cause mortality and CVD (adjusted OR 2.74 [95% CI 1.96-3.85] and 2.02 [1.35-3.01], respectively). Events occurring within 1-3 years and 3-5 years before death were also associated with adjusted ORs of 1.94 (95% CI 1.39-2.71) and 1.68 (1.15-2.44), respectively. Significant dose-gradient effects of severe hypoglycemia frequency on mortality and CVD were observed within 5 years.Conclusions: Although the CVD incidence may be associated with severe hypoglycemic events occurring in the previous year, the risk of all-cause mortality was associated with severe hypoglycemic events occurring in the preceding 5 years. Exposure to repeated severe hypoglycemic events can lead to higher risks of mortality and CVD. [ABSTRACT FROM AUTHOR]

Background: Antimicrobial therapy for intra‐abdominal infections is often inappropriately prolonged. An intervention addressing factors influencing the duration of intravenous antibiotic use was undertaken. This study reports the antibiotic prescribing patterns before and after the intervention and a qualitative analysis of the experience of the intervention. Methods: Quantitative: A retrospective audit of patients with complicated intra‐abdominal infection before and after a multifaceted persuasive intervention was performed. Qualitative: Semi‐structured interviews were performed to evaluate which elements of the intervention were perceived to be effective. Results: An intervention including collaborative inter‐specialty and inter‐professional educational meetings, and education of all professional streams was undertaken. Quantitative: Twenty‐three patients before and 22 patients after the intervention were included. The total duration of antibiotics decreased significantly following the intervention (9.2 versus 6.6 days P = 0.02). The duration of intravenous antibiotics did not change significantly (5.4 versus 4.5 days, P = 0.06). Qualitative: Eighteen health‐care professionals participated. Thematic analysis indicated that a collaborative approach between senior surgical and infectious disease specialists in the pre‐intervention stage led to perceived ownership and leadership of the intervention by the surgical team, which was thought critical to the success of the intervention. Conversely, the ability of nurses and pharmacists to influence antibiotic practice was considered limited and a poster promoting the intervention was perceived as ineffective. Conclusion: Consultant leadership and specialty ownership of the process were perceived to be critical in the success of the intervention. Antibiotic stewardship programs which address social factors may have greater efficacy to optimize antimicrobial prescribing. [ABSTRACT FROM AUTHOR]

Peripheral intravenous cannula (PIVC) insertion is one of the most common invasive procedures performed in neonates and is frequently associated with adverse events. There are no studies in the neonatal population looking at the possibility of reducing the risk of PIVC-related complications by elective replacement of PIVC. A randomised, non-blinded, control trial was conducted in a tertiary level neonatal unit in Melbourne, Australia, to examine rates of extravasation in neonates with elective replacement of PIVC as compared to standard practice. Neonates born at 32 weeks of gestation or more were randomly assigned to have their PIVC replaced electively (every 72-96 h) or when clinically indicated in a 1:1 allocation ratio after parental consent. Primary outcome studied was rate of extravasation. Secondary outcomes included rates of phlebitis, leakage or spontaneous dislodgement of PIVC. One hundred thirteen infants were enrolled. Extravasation was noted in 33 (60%) of standard practice group vs. 28 (48.3%) of elective replacement (RR 0.80, CI 0.57-1.13, p = 0.21) infants. Time to first extravasation was similar between the groups (hazard ratio 0.69, CI 0.42-1.15). Extravasation events per 1000 IV hours were also similar between groups. Similar results were seen by both intention to treat and per protocol analyses. There was an increase in leaking rates (HR1.98, CI 1.03-3.81, p = 0.04) in the elective group, while phlebitis and spontaneous dislodgement rates were similar to standard group.Conclusion: Elective replacement of PIVC in neonates is not associated with reduction in extravasation rates.Trial registration: This trial has been registered with the Australian and New Zealand Clinical Trials Register. Identifier: ACTRN12615000827538. What is Known: • The reported incidence of extravasation injury is as high as 70% in the neonatal and paediatric population and has an association with cannula dwell time. • Adult studies have done to look at the possibility of reducing intravenous cannula-related complications with routine replacement of the cannulas but no similar studies have been done in the neonatal population. What is New: • Routine replacement of intravenous cannula in neonates between 72 and 96 h of use does not reduce the rate of extravasation injuries. • There might be some added complications associated with such a practice. [ABSTRACT FROM AUTHOR]

To obtain the angiotension-I converting enzyme inhibitor (ACEI), a fusion ACEI polypeptide encoded with 8 DNA sequences of GPL, GPM, IKW, IVY, IRPVQ, IWHHT, IYPRY and IAPG, which were selected and designed and cloned into pGAPZαC and then transformed into Pichia pastoris SMD1168H. After 3 days induction, the fraction with highest ACEI activity was expressed and purified using a Ni Sepharose™ 6 Fast Flow. The IC50 of recombinant ACEI polypeptide was 88.2 μM. A 128-fold increase of ACEI activity (0.69 μM) was obtained after pepsin digestion, which was equivalent to 0.022 μM of captopril. Reverse phase HPLC indicated all the 8 peptides contained in ACEI-hydrolysate after pepsin digestion. [ABSTRACT FROM AUTHOR]

This paper presents an interdisciplinary study that combines natural language processing and psycholinguistics research. The latent Dirichlet allocation (LDA) model was used for semantic relatedness computation to enable an understanding of the mechanisms and processes through which humans encode and retrieve lexical units. To test the similarity of the output of the topic model and human word association, the ＂Time-limited Multiple Divergent Thinking Test of Word Associative Strategy＂ (TLM-DTTWAS) was used to collect data and conduct tests with three food-related stimulus words. A total of 101 subjects took the tests, producing 4,251 words. The empirical results were analyzed on two levels: (1) by the expert word association classification: taxonomic and script proposed by Ross and Murphy (1999); (2) followed by the associative hierarchy theory of Mednick (1962), to sort the vocabulary test results into two associative hierarchies, ＂steep＂ and ＂flat.＂ The analysis indicated that human word association displays randomness, as well as generalization and continuity. After the experimental text was passed through the LDA latent semantic model which demonstrated highly significant correlation. This was a whole new attempt to train a data science model to make inference and prediction of human concept association which could be very useful in teaching as well as commercial applications. [ABSTRACT FROM AUTHOR]

Aims: This study was conducted to investigate potential link between type 2 diabetes mellitus (T2DM) and epilepsy, and the role of severe hypoglycaemia (SH) might play in the relationship.Methods: This was a cohort study based on Taiwan's National Health insurance claims. Totally 751,792 people with T2DM and 824,253 matched controls were identified in 2002-2003 and followed to incidence of epilepsy or end of 2011. We used Cox proportional hazard model to relate epilepsy incidence to separate and joint effects of T2DM and SH. A possible mediation effect of SH on the association between T2DM and epilepsy was analyzed.Results: Over a 10-year follow-up, patients with T2DM had a higher incidence rate of epilepsy than controls (35.0 vs 21.9 per 10,000 person-years). After controlling for potential confounders including SH, T2DM increased the hazard of epilepsy by some 50%. The stratified analysis further indicated that T2DM (hazard ratio (HR)=1.44, 95% confidence interval (CI) = 1.40-1.47), and SH (HR = 2.22, 95% CI = 1.76-2.81) were both independent risk factors for epilepsy. SH did not modify but mediated 12% of the association between T2DM and epilepsy.Conclusion: Our findings supported that SH may increase the risk of epilepsy, and that T2DM may increase risk of epilepsy independent of SH. [ABSTRACT FROM AUTHOR]

To obtain the angiotension-I converting enzyme inhibitor (ACEI), a fusion ACEI polypeptide encoded with 8 DNA sequences of GPL, GPM, IKW, IVY, IRPVQ, IWHHT, IYPRY and IAPG, which were selected and designed and cloned into pGAPZαC and then transformed into Pichia pastoris SMD1168H. After 3 days induction, the fraction with highest ACEI activity was expressed and purified using a Ni Sepharose™ 6 Fast Flow. The IC50 of recombinant ACEI polypeptide was 88.2 µM. A 128-fold increase of ACEI activity (0.69 µM) was obtained after pepsin digestion, which was equivalent to 0.022 µM of captopril. Reverse phase HPLC indicated all the 8 peptides contained in ACEI-hydrolysate after pepsin digestion. [ABSTRACT FROM AUTHOR]

Aims: To investigate whether type 2 diabetes mellitus (T2DM) increases the risk of developing chronic obstructive pulmonary disease (COPD).Methods: This population-based cohort study used Taiwan's National Health insurance claim data to investigate the association of T2DM with the risk of COPD. A total of 716,623 pairs of people (patients with T2DM and their age-, sex-, and calendar year-matched controls) were identified in 2002-2003 and were followed until the occurrence of newly-diagnosed COPD or the end of 2011. Cox proportional hazard models were used to relate COPD incidence to T2DM.Results: People with T2DM experienced a higher incidence rate of COPD than controls (159.6 vs 122.7 per 104 person-years). After controlling for confounders, T2DM significantly increased the hazard of COPD (hazard ratio [HR] = 1.15, 95% confidence interval = 1.14-1.16). Stratified analysis indicated that the association between T2DM and COPD was slightly greater in women than in men (HR, 1.15 vs. 1.11) and in people aged <65 years than in people aged ≥65 years (HR, 1.17 vs. 1.05 in men; 1.16 vs. 1.13 in women).Conclusions: Our findings demonstrated a modest association of T2DM with the risk of developing COPD, possibly shedding light into the adverse effects of hyperglycemia on pulmonary function. [ABSTRACT FROM AUTHOR]

Sodium-ion battery is the most promising alternative to lithium-ion battery for the similar chemical properties to lithium and low cost due to the earth abundance of sodium. Red phosphorus (RP) is regarded as a potential candidate for sodium-ion batteries because it has the highest theoretical capacity (∼2600 mA h/g), but commercially available RP is electrochemical inactivity with sodium as a result of the insulating nature. Among the P-based anodes for SIBs, they were all in the form of carbon−P composites. Herein, we report that commercial RP mixed with appropriate amount of iron developed by high-energy ball milling can deliver a reversible capacity of 1642 mA h g −1 over 30 cycles. EIS measurement results indicated that Fe content composites has higher sodium diffusion coefficient. When utilized as a sodium ion battery anode, 9.1% Fe-adding RP composites exhibited the best electrochemical performance achieved 1582, 1419, 884 and 676 mA h g −1 specific desodiation capacity at 0.2, 0.6, 1, 6 and 10 A g −1 current density in rate capability tests. This study opens a new approach to activate the sodium-ion storage of phosphorus, which will enable phosphorus-related materials to be used in more innovative energy storage systems. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to measure and analyze the Sn-1Ag-0.5Cu solder joints under high speed ball impact test (BIT) conditions. In this study, the ball impact test was conducted at impact velocity of 300 mm/s on package-level solder joints with 0.3 mm ball diameter, bonded individually on substrate pads of Ni/Au, OSP and Ni/Pd/Au surface finishes at elevated temperature of 25, 50, 75, 100 and 125 °C, respectively. The experimental results show that Ni/Pd/Au surface finish at room temperature has higher intermetallic compound (IMC) strength performance than Ni/Au and OSP. These three different substrate surface finishes, however, tend to have quite similar IMC strength performance at elevated operation temperature. The board-level drop test reliability of TFBGA 14 mm × 14 mm 409 L for these surface finishes were also performed at room temperature. The trends of BIT results are in good agreement to board-level drop test reliability. A three-dimensional finite element analysis (FEA) model was established to analyze the transient structural responses in the solder joint for determining the maximum impact toughness capacity. The effects of temperature on solder joint material yield stress and IMC strength on the impact characteristics were investigated. [ABSTRACT FROM AUTHOR]

Background: Screening for colorectal cancers outside the recommended guidelines presents a considerable burden to resource management in many public hospitals. The aim of this study is to evaluate the frequency, indications and outcomes for repeat colonoscopy performed within 5 years of a negative colonoscopy. Methods: A retrospective review of all colonoscopies at Nambour Hospital in 2008 was performed to identify those with a negative colonoscopy. The charts of patients undergoing repeat colonoscopy at the same institution within 5 years of a negative colonoscopy were examined further, and data obtained regarding indications and outcomes of subsequent colonoscopies. Results: A total of 616 colonoscopies were identified, 427 (69.3%) were negative for adenoma and carcinoma. Of these patients, 74 (17.3%) underwent a repeat colonoscopy at Nambour Hospital within 5 years. Eighteen out of 74 (24.3%) were outside guideline recommendation. Overall, one patient (1.4%) had cancer and 11 patients (14.9%) had polyps detected at repeat colonoscopy. Most of the polyps detected had low‐risk features and were detected in the fourth and fifth years of the study period. Conclusion: The yield of a second colonoscopy within 5 years of a good‐quality negative colonoscopy is low but not zero. In the absence of new concerning symptoms or other risk factors, patients can be reassured and guidelines adhered to. [ABSTRACT FROM AUTHOR]

For the first time, binary lithium-reactive zinc diphosphide (ZnP2) nanowires were synthesized via bismuth-seed growth at 400 °C via a solvothermal route. The synthesized ZnP2 nanowires are single crystals with diameters ranging from 10 to 50 nm and have a precise orthorhombic structure without impurity phases. From SEM and HRTEM images, the lengths of the nanowires over several micrometers could be observed. The effect of reaction parameters, including temperature and seed to precursor ratio, on the quality of reaction products has been systematically investigated. We used ZnP2 nanowires as an anode material for lithium batteries since ZnP2 has a much higher theoretical capacity of 1581 mA h g−1 than that of commercial graphite (372 mA h g−1). The capacity of the first discharge cycle was 1415 mA h g−1 at 0.3C (1C = 1581 mA h g−1) with high Coulombic efficiency up to 89%. The discharge capacity was maintained at 1066 mA h g−1 after 500 cycles, showing good capacity retention and long lifespan. With these merits and excellent electrochemical performance, ZnP2 nanowires clearly are a promising anode material for lithium ion batteries. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the association of admissions for diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) with ambient temperature and season, respectively in patients with diabetes mellitus (DM), after excluding known co-morbidities that predispose onset of acute hyperglycemia events. This was a time series correlation analysis based on medical claims of 40,084 and 33,947 episodes of admission for DKA and HHS, respectively over a 14-year period in Taiwan. These episodes were not accompanied by co-morbidities known to trigger incidence of DKA and HHS. Monthly temperature averaged from 19 meteorological stations across Taiwan was correlated with monthly rate of admission for DKA or HHS, respectively, using the ‘seasonal Autoregressive Integrated Moving Average’ (seasonal ARIMA) regression method. There was an inverse relationship between ambient temperature and rates of admission for DKA ( β = − 0.035, p < 0.001) and HHS ( β = − 0.016, p < 0.001), despite a clear decline in rates of DKA/HHS admission in the second half of the study period. We also noted that winter was significantly associated with increased rates of both DKA ( β = 0.364, p < 0.001) and HHS ( β = 0.129, p < 0.05) admissions, as compared with summer. On the other hand, fall was associated with a significantly lower rate of HHS admission ( β = − 0.016, p < 0.05). Further stratified analyses according to sex and age yield essentially similar results. It is suggested that meteorological data can be used to raise the awareness of acute hyperglycemic complication risk for both patients with diabetes and clinicians to further avoid the occurrence of DKA and HHS. [ABSTRACT FROM AUTHOR]

It is generally recognized that repeat apheresis increases the risk for iron deficiency, thus may impact on the blood homeostasis. With regard to donor vigilance, we clarified the mid- to long-term effects of plateletapheresis by comparing the most frequent donors with the first-time ones in hematological and biochemical tests. Levels of erythropoietin (EPO), hemoglobin (Hb) and ferritin were analyzed in double-unit (500 mL whole blood or 6 × 1011 apheresis platelets) donations in three male cohorts, with identifiers of first-time whole-blood donors (n = 30), first-time platelet donors transited from maximal whole blood to apheresis (n = 30) and frequent donors subjected to extreme plateletpheresis (n = 90), respectively. According to the number of donations, the last earnest cohort, who donate almost 24 times a year, was further subdivided into three groups– casual (76–120 life-time donations in 5 years), mediocre (121–168 within 7 years) and enthusiastic (≥169 within 7 years and a month). Regardless of the donation experience in whole blood or plateletpheresis, iron deficiency (serum ferritin concentrations <15 μg/L) was identified in all earnest cohorts. The ferritin means were significantly lower in plateletpheresis groups, with the lowest values in the enthusiastic group. EPO levels showed a significant inverse correlation with ferritin (p = 0.015, r = –0.224). Long-term earnest donors had the lowest iron stores accompanied by a later thrombocytosis and a final increase in EPO was revealed. Regular ferritin screens are crucial to ensure a high level of donor health protection. [ABSTRACT FROM AUTHOR]

Background: Certain factors originating from the perinatal and childhood periods are suspected of contributing to the recent increasing trend of childhood type 1 diabetes (T1D) incidence. This study sought to investigate the relationships between various perinatal and childhood risk factors and T1D incidence in young children (<10 years). Methods: We used a nested case-control design based on 1 478 573 live births born in 2000-05 in Taiwan. Cases were 632 incident cases of T1D between 2000 and 2008. Ten matched controls for each case were randomly selected. Information on various perinatal risk factors was also identified from claim data. Multiple conditional logistic regression was employed to estimate odds ratio (OR) and 95 confidence interval (CI) of T1D. Results: Childhood infection was significantly associated with an increased risk of T1D (OR = 1.46, 95% CI = 1.23-1.73). Increased risk of T1D was also noted in children born to younger mothers (<25 years) (OR = 1.94, 95% CI = 1.34-2.81), older fathers (>30 years) (OR = 1.56 (95% CI = 1.16-2.10) to 1.57 (95% CI = 1.19-2.05), mothers with Caesarean section (CS) (OR = 2.35, 95% CI = 1.52-3.64), and mothers with gestational diabetes mellitus (OR = 4.36, 95% CI =2.76-7.77). Fathers with T1D (OR = 7.36, 95% CI = 1.02-57.21) or type 2 diabetes (OR = 1.54, 95% CI = 1.04-2.26) were observed to substantially increase the risk of offspring T1D. Conclusions: Certain modifiable perinatal factors such as infection and CS may predispose incidence of T1D in young children. [ABSTRACT FROM AUTHOR]

Objective To evaluate the contributing factors for fever after tubeless percutaneous nephrolithotomy (PCNL). Methods Between May 2009 and December 2013, 395 tubeless PCNLs were performed at our hospital. After stone extraction, the bleeding points were cauterized for hemostasis to enable tubeless modification. In patients with troublesome bleeding after cauterization, oxidized regenerated cellulose (Surgicel) strips were used to tamponade the access tract to facilitate bleeding control. The contributory factors for fever were evaluated by a retrospective chart review. Results Forty-four patients (11.7%) developed fever after tubeless PCNL. There was no difference in gender, age, and body mass index in the development of fever. Episodes of febrile or septic urinary tract infection before PCNL were found to have occurred in 35 patients, but the incidence of postoperative fever was not significantly higher in these patients. There is no significant difference in the mean stone size in fever and nonfever patients. Complete staghorn stones were noted in 40 patients, and their fever rate was not significantly higher than patients with nonstaghorn stone. The operation time is not significantly higher in the group with urinary tract infection. Patients with postoperative fever had a high incidence of residual stones than the remaining patients (38.9% vs 20.4%). There was no significant difference in incidence of postoperative fever in patients with struvite stones than patients with nonstruvite stones. In patients who received Surgicel packing, the incidence of fever was not significantly higher. Conclusion Incomplete stone extraction is a major contributing factor for the development of fever after tubeless PCNL. [ABSTRACT FROM AUTHOR]

Background: The management of high anal fistula is often complicated and challenging. In spite of numerous new techniques, the advancement flap technique remained an integral procedure in its management. The purpose of this study was to determine the long-term outcome of advancement flap procedures for high anal fistulas. Methods: A retrospective review of patients who have undergone an advancement flap procedure for high anal fistula of cryptoglandular origin from June 2003 to April 2012 was performed. Patients were contacted via telephone to evaluate their continence status using the Wexner score. Results: Sixty-one patients with a median age of 48 (range, 19-74) years and a median follow-up of 6.5 (range, 1-59) months were evaluated. Fifty-three (86.9 %) patients had successful surgery while 8 (13.1 %) failed the procedure. Four of them underwent subsequent surgery. Of the 53 patients who had a successful procedure, 27 were successfully contacted for a telephone interview. Twenty-one (77.8 %) of them reported a Wexner score of '0'. Two (7.4 %) patients had a Wexner score of <4, another 2 had a score of '4' and '10', while the last 2 patients had a score of >10. Conclusion: Advancement flap procedure is effective in the management of high anal fistulas with an acceptable success rate. The majority of the patients experienced good anal continence. [ABSTRACT FROM AUTHOR]

Our previous studies have demonstrated that epidermal growth factor (EGF) can induce cell migration through the induction of cysteine-rich protein 61 (Cyr61) in human anaplastic thyroid cancer (ATC) cells. The aim of the present study was to determine the inhibitory effects of combined treatment with the peroxisome proliferator-activated receptor-γ (PPARγ) ligand troglitazone and the cholesterol-lowering drug lovastatin at clinically achievable concentrations on ATC cell migration. Combined treatment with 5 μM troglitazone and 1 μM lovastatin exhibited no cytotoxicity but significantly inhibited EGF-induced migration, as determined using wound healing and Boyden chamber assays. Cotreatment with troglitazone and lovastatin altered the epithelial-to-mesenchymal-transition (EMT) -related marker gene expression of the cells; specifically, E-cadherin expression increased and vimentin expression decreased. In addition, cotreatment reduced the number of filopodia, which are believed to be involved in migration, and significantly inhibited EGF-induced Cyr61 mRNA and protein expression as well as Cyr61 secretion. Moreover, the phosphorylation levels of 2 crucial signal molecules for EGF-induced Cyr61 expression, the cAMP response element-binding protein (CREB) and extracellular signal-regulated kinase (ERK), were decreased in cells cotreated with troglitazone and lovastatin. Performing a transient transfection assay revealed that the combined treatment significantly suppressed Cyr61 promoter activity. These results suggest that combined treatment with low doses of troglitazone and lovastatin effectively inhibits ATC cell migration and may serve as a novel therapeutic strategy for metastatic ATC. [ABSTRACT FROM AUTHOR]

Wafer-level chip-scale packages (WLCSPs) have become subject to the same drive for miniaturization as all electronic packages. The I/O count is increasing and ball pitch is shrinking at the expense of trace pitch and in turn, current densities are increasing. This leads to current crowding and Joule heating in the vicinity of solder joints and under bump metallurgy (UBM) structures where resistance values change significantly. These phenomena are responsible for structural damage of redistribution line (RDL)/UBM and UBM/solder interconnects due to ionic diffusion or electromigration. In this work, sputtered Al and electroplated Cu RDLs were examined and quantified by three-dimensional electrothermal coupling analysis. Results provide a guideline for estimating maximum allowable currents and electromigration lifetime. [ABSTRACT FROM AUTHOR]

Background: Ureteral stricture is a complication of several etiologies including idiopathic retroperitoneal fibrosis, infection, radiotherapy, instrumentation, and surgical procedures. A variety of techniques have been reported for management. The transureteroureterostomy and bladder flap have been the standard procedures for repairing distal ureteral defects of unilateral ureter. Bilateral ureteral stricture is an uncommon condition that challenges usual reconstructive procedures. It is a difficult task to reconstruct the complex situation of bilateral ureteral strictures. Case presentation: A 54-year-old female underwent concurrent chemoradiotherapy for stage IVB squamous cell carcinoma of cervix. Subsequently, she had stricture of bilateral distal ureters with bilateral hydroureteronephrosis which was found by computed tomography. The renal function deteriorated during the follow-up period. She had periodic change of double-J stents and percutaneous nephrostomy. However, the renal function still deteriorated. We performed a combined Y-shaped common channel transureteroureterostomy with Boari flap to reconstruct bilateral long-segment ureteral strictures. The patient recovered uneventfully. Conclusion: Reconstruction of bilateral ureteral strictures is a difficult treatment. We developed a modified technique for the complex situation of bilateral ureteral strictures. To our knowledge, this has not been previously reported in the scientific literature and it is a feasible procedure to treat bilateral long-segment ureteral strictures. [ABSTRACT FROM AUTHOR]

Introduction Myofibromas are benign mesenchymal neoplasms that can present as solitary and multicentric lesions. They can occur in several locations and can occur at any age from neonates to elderly patients. However, most of the lesions are found in neonates and babies. It rarely occurs in adults. Case presentation A 29-year-old Taiwanese man presented with persistent dull chest pain in his right lateral chest wall for 2 weeks. A chest X-ray showed a faint patchy opacity over the periphery of his right upper lung zone. Computed tomography and magnetic resonance imaging showed a lobulated mass at the intercostal space between his right fifth and sixth ribs with contrast enhancement and bone invasion. Malignancy could not be excluded. A percutaneous needle aspiration biopsy failed due to technique issues, so he underwent a thoracotomy and the tumor was excised with Marlex mesh repairs for the thoracic defect. Pathology confirmed a myofibroma without malignancy. He recovered uneventfully and no local recurrence was detected at the 1-year follow-up examination. Conclusions Chest wall myofibroma presenting with chest pain has never been reported in adults. It is a challenge to differentiate myofibroma from malignancy in chest wall preoperatively, such as seen in our patient. To the best of our knowledge, this has not been previously reported in the scientific literature. Although myofibroma rarely occurs in the chest wall and adults, it must be suspected in any chest wall tumor presenting with chest pain. [ABSTRACT FROM AUTHOR]

OBJECTIVES: Physicians generally have higher disease awareness and easier access to medical care, which may help them reduce risk of developing severe sepsis and associated mortality when they suffer from acute infection. However, the opposite situation may occur due to the presence of potential barriers to healthcare in physicians. We aim to examine the risk of severe sepsis and associated mortality in physicians. DESIGN: A matched cohort study. SETTING: Registry of medical professionals and inpatient and outpatient claims data from Taiwan's National Health Insurance Research Database. SUBJECTS: Physicians (n = 29,697) in Taiwan and a group of persons who were demographically and socioeconomically matched (1:1 ratio) and without any medical education and background. All subjects were followed from the index date (January 1, 2000) to the occurrence of endpoint, withdrawal, or December 31, 2008, whichever date came first. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Primary outcome was development of severe sepsis. Secondary outcome was 90-day mortality following severe sepsis. The overall incidence density of severe sepsis was lower in physicians than in controls (3.25 vs 3.90 per 1,000 person-years, p < 0.001). According to the Cox regression model, severe sepsis develops in physicians 24% less likely than controls after baseline covariates were adjusted (adjusted hazard ratio, 0.76; 95% CI, 0.68-0.85). The 90-day mortality rates were similar between physicians and controls with severe sepsis (46.5% vs 45.7%, p = 0.72). However, after controlling for the baseline and additional covariates, the risk of death was significantly lower in physicians than in controls (adjusted hazard ratio, 0.82; 95% CI, 0.71-0.95). CONCLUSIONS: These findings support the hypothesis that physicians are less likely than controls to develop or die of severe sepsis, implying that medical knowledge, higher disease awareness, and easier healthcare access in physicians may help reduce their risk of severe sepsis and associated mortality. [ABSTRACT FROM AUTHOR]

Objectives: Physicians generally have higher disease awareness and easier access to medical care, which may help them reduce risk of developing severe sepsis and associated mortality when they suffer from acute infection. However, the opposite situation may occur due to the presence of potential barriers to healthcare in physicians. We aim to examine the risk of severe sepsis and associated mortality in physicians. Design: A matched cohort study. Setting: Registry of medical professionals and inpatient and outpatient claims data from Taiwan's National Health Insurance Research Database. Subjects: Physicians (n = 29,697) in Taiwan and a group of persons who were demographically and socioeconomically matched (1:1 ratio) and without any medical education and background. All subjects were followed from the index date (January 1, 2000) to the occurrence of endpoint, withdrawal, or December 31, 2008, whichever date came first. Interventions: None. Measurements and Main Results: Primary outcome was development of severe sepsis. Secondary outcome was 90-day mortality following severe sepsis. The overall incidence density of severe sepsis was lower in physicians than in controls (3.25 vs 3.90 per 1,000 person-years, p <0.001). According to the Cox regression model, severe sepsis develops in physicians 24% less likely than controls after baseline covariates were adjusted (adjusted hazard ratio, 0.76; 95% Cl, 0.68-0.85). The 90-day mortality rates were similar between physicians and controls with severe sepsis (46.5% vs 45.7%, p = 0.72). However, after controlling for the baseline and additional covariates, the risk of death was significantly lower in physicians than in controls (adjusted hazard ratio, 0.82; 95% Cl, 0.71-0.95). Conclusions: These findings support the hypothesis that physicians are less likely than controls to develop or die of severe sepsis, implying that medical knowledge, higher disease awareness, and easier healthcare access in physicians may help reduce their risk of severe sepsis and associated mortality. [ABSTRACT FROM AUTHOR]

The clustering behavior of a compartmentalized monodisperse granular gas with the addition of one heavy intruding particle is investigated experimentally. Depending on the number of particles, the presence of a heavy intruder leads to three population states: a homogeneous state, an expelled clustering state, and a fully clustering state. These states are found to be consistent with the clustering of a purely monodisperse granular gas in an asymmetric compartmentalized structure. We obtain an exact relation between the size of an intruder and the elevation of the compartment bottom. This relation quantifies the particle-expelling ability of a heavy intruder, and suggests that the one-intruder system is a type of asymmetric system with an intruder-size-related asymmetrical index ξ. Under the framework of the flux model, a Ç -associated S function is proposed to quantitatively reproduce the experimental results. [ABSTRACT FROM AUTHOR]

The consumption of cetacean meat is geographically common and often of undetermined sustainability. Besides, it can expose humans to contaminants and zoonotic pathogens. The illegality of possessing cetacean meat was likely under-reported in some countries due to lack of attention paid by the officials although DNA analysis of market products helped to show such practices. We developed two monoclonal antibodies against synthetic peptides of myoglobin (Mb) for constructing a rapid immune colloidal gold strip. Only cetacean Mb is capable of binding to both antibodies and presents positive signal while the Mb from other animals can bind only 1 of the antibodies and presents negative result. The strip for cetacean meat would be an applicable and cost-effective test for field inspectors and even the general public. It contributes to increase the reporting capacity and coverage of illegal cetacean meat possession, which has implications for global cetacean conservation and public health. [ABSTRACT FROM AUTHOR]

IL-6 and sonic hedgehog (Shh) signaling molecules are considered to maintain the growth of cancer stem cells (CSCs). Resveratrol, an important integrant in traditional Chinese medicine, possesses certain antitumor effects. However, the mechanisms on regulating acute myeloid leukemia (AML) are unclear. This study first used human subjects to demonstrate that the plasma levels of IL-6 and IL-1β in AML patients were higher and lower, respectively, than healthy donors. The expression of Shh preproproteins, and C- and N-terminal Shh peptides increased in bone marrow and peripheral blood mononuclear cells isolated from AML patients, and the plasma N-Shh secretion was greater. To further clarify the effect of IL-6 and resveratrol in Shh signaling, human AML HL-60 cells were tested. IL-6 upregulated Shh and Gli-1 expression and was accompanied by an increase of cell viability. Resveratrol significantly decreased CSC-related Shh expression, Gli-1 nuclear translocation, and cell viability in IL-6-treated HL-60 cells and had synergistic effect with Shh inhibitor cyclopamine on inhibiting cell growth. Conclusions. IL-6 stimulated the growth of AML cells through Shh signaling, and this effect might be blocked by resveratrol. Further investigations of Shh as a prognostic marker and resveratrol as a therapeutic drug target to CSCs in AML are surely warranted. [ABSTRACT FROM AUTHOR]

ABSTRACT Background and objective: Population-based data on pleural infections are limited. This study describes the temporal trends in the incidence, management and outcomes of pleural infections in Taiwan. Methods: The Taiwan National Health Insurance Research Database was used to analyse data on 26 385 patients with a first episode of pleural infection between 1997 and 2008. Results: During the study period, the median age of the patients increased from 60 to 65 years. The majority of patients were men (75%); this proportion remained constant over time. The standardized annual incidence of pleural infection increased from 5.2 per 100 000 in 1997 and reached a plateau of 8.4 to 9.6 per 100 000 between 2002 and 2008. Over time, there was an increase in the use of computed tomography (from 47.3% in 1997-1998 to 59.4% in 2007-2008), pigtail catheters (from 1.5% to 18.9%), fibrinolytics (from 0.9% to 9.3%) and surgery (from 27.7% to 33.6%), to treat pleural infections. Furthermore, the use of life-support resources, including haemodialysis, mechanical ventilation and intensive care, also increased by 3.1%, 11.0% and 12.8%, respectively. Median hospital charges per patient increased by 63.6% over the 12 years. Although the proportion of patients with organ dysfunction (i.e. severe sepsis) increased from 26.5% to 47.7%, 30-day mortality decreased from 15.0% to 13.1% ( P-value for trend = 0.001). Conclusions: These findings suggest that advances in the management of pleural infections and subsequent severe sepsis may have led to a reduction in the risk of short-term mortality in Taiwan. [ABSTRACT FROM AUTHOR]

OBJECTIVE--Diabetes may increase the risk of acute pancreatitis (AP). We aimed to further investigate whether diabetes may also adversely affect outcomes of patients with AP. RESEARCH DESIGN AND METHODS--In this retrospective cohort study, we compared 18,990 first-attack AP with diabetes to 37,980 matched control subjects from Taiwan's National Health Insurance Research Database between 2000 and 2009. Primary outcomes were development of severe AP, defined by a modified Atlanta classification scheme, and hospital mortality. Analyses were performed using univariable and multivariable logistic regression model with generalized estimating equations accounting for hospital clustering effect. RESULTS--After baseline characteristics were adjusted, AP patients with diabetes had a higher risk of a severe attack than their nondiabetic counterparts (adjusted odds ratio [OR] 1.21, 95% CI 1.16-1.26). When severity criteria were analyzed individually, diabetic AP patients had a 58% higher risk of intensive care unit admission and a 30% higher risk of local complications, but a 16% lower risk of gastrointestinal bleeding, than AP patients without diabetes. The risk of organ failure at least one system) was similar between the two groups. Conversely, AP patients with diabetes were associated with a lower risk of hospital mortality (adjusted OR 0.77, 95% CI 0.65-0.91). CONCLUSIONS--Although diabetes may adversely affect the disease process of AP, it seems to protect patients from AP-related mortality. [ABSTRACT FROM AUTHOR]

Abstract: Crystalline dandelion-like antimony (III) sulfide (Sb2S3) nanowires were synthesized by a PEG-assisted solvothermal process. The orthorhombic crystal structure and dandelion-like multi-branched nanowire morphology were revealed by X-ray diffractometry (XRD) and scanning electron microscopy (SEM) respectively. High-resolution transmission electron microscopy (TEM) identified that the highly crystalline Sb2S3 nanowires grew along the [001] direction with individual wire diameter of 195±52nm. The band gap of the Sb2S3 nanowires was measured to be ca. 1.67eV. A combination of PEG-templated assembly and crystal splitting mechanism was likely responsible for the growth of the observed nanowire dandelion structures. [Copyright &y& Elsevier]

Background: We investigated the relation between hospital volume and outcome in patients with severe acute pancreatitis (SAP). The determination is important because patient outcome may be improved through volume-based selective referral. Methods: In this cohort study, we analyzed 22,551 SAP patients in 2,208 hospital-years (between 2000 and 2009) from Taiwan's National Health Insurance Research Database. Primary outcome was hospital mortality. Secondary outcomes were hospital length of stay and charges. Hospital SAP volume was measured both as categorical and as continuous variables (per one case increase each hospital-year). The effect was assessed using multivariable logistic regression models with generalized estimating equations accounting for hospital clustering effect. Adjusted covariates included patient and hospital characteristics (model 1), and additional treatment variables (model 2). Results: Irrespective of the measurements, increasing hospital volume was associated with reduced risk of hospital mortality after adjusting the patient and hospital characteristics (adjusted odds ratio [OR] 0.995, 95% confidence interval [CI] 0.993-0.998 for per one case increase). The patients treated in the highest volume quartile (≥14 cases per hospital-year) had 42% lower risk of hospital mortality than those in the lowest volume quartile (1 case per hospital-year) after adjusting the patient and hospital characteristics (adjusted OR 0.58, 95% CI 0.40-0.83). However, an inverse relation between volume and hospital stay or hospital charges was observed only when the volume was analyzed as a categorical variable. After adjusting the treatment covariates, the volume effect on hospital mortality disappeared regardless of the volume measures. Conclusions: These findings support the use of volume-based selective referral for patients with SAP and suggest that differences in levels or processes of care among hospitals may have contributed to the volume effect. [ABSTRACT FROM AUTHOR]

The article presents a study which examined the trend of severe sepsis in Taiwan from 1997 to 2006. The researchers analyzed the age-standardized yearly incidence rates and proportion of patients who were enrolled in the Taiwan National Health Insurance program due to this medical condition. They found that the severity and incidence of the disease in the country are improving.

Summary: Oral squamous cell carcinoma (OSCC) is one of the most common cancers in geographic regions where betel quid (BQ) chewing is prevalent; OSCC is an extremely malignant neoplasm whose prognostic factors are multiple and complex. The purpose of this study was to assess clinicopathological prognostic factors and treatment outcomes in 698 consecutive OSCC patients who had undergone surgery as the primary treatment in an area with a high prevalence of both betel quid chewing and tobacco smoking. The prognostic factors were predicted using Cox’s proportional-hazards regression model, and the survival rate was calculated using Kaplan–Meier analysis. The median followup for all patients was 44months. The 5-year cumulative overall, disease-specific, and locoregional control survival rates were 61%, 62%, and 46%, respectively. Multivariate analysis showed that the lower level of nodal metastasis, advanced stage, tumor thickness >7mm, and treatment failures were independent risk factors of overall survival. Furthermore, history of alcohol drinking, lower level of nodal metastasis, advanced stage, poor cell differentiation, and treatment failures were independent predictors of poor disease-specific survival. However, we did not find any significant factor that affected locoregional recurrence. Due to the high frequencies of locoregional recurrence and second primary cancer, our findings emphasize that aggressive surgical excision, adjuvant treatments according to clinicopathological prognostic factors and close surveillance are important to the survival of OSCC patients in an area with a high prevalence of betel quid chewing and tobacco smoking. [Copyright &y& Elsevier]

Background: The proportional distributions of various skin and soft tissue infections (SSTIs) with/without intensive care are unclear. Among SSTI patients, the prevalence and significance of complicating factors, such as comorbidities and infections other than skin/soft tissue (non-SST infections), remain poorly understood. We conducted this population-based study to characterize hospitalized SSTI patients with/without intensive care and to identify factors associated with patient outcome. Methods: We analyzed first-episode SSTIs between January 1, 2005 and December 31, 2007 from the hospitalized claims data of a nationally representative sample of 1,000,000 people, about 5% of the population, enrolled in the Taiwan National Health Insurance program. We classified 18 groups of SSTIs into three major categories: 1) superficial; 2) deeper or healthcare-associated; and 3) gangrenous or necrotizing infections. Multivariate logistic regression models were applied to identify factors associated with intensive care unit (ICU) admission and hospital mortality. Results: Of 146,686 patients ever hospitalized during the 3-year study period, we identified 11,390 (7.7%) patients having 12,030 SSTIs. Among these SSTI patients, 1,033 (9.1%) had ICU admission and 306 (2.7%) died at hospital discharge. The most common categories of SSTIs in ICU and non-ICU patients were "deeper or healthcare-associated" (62%) and "superficial" (60%) infections, respectively. Of all SSTI patients, 45.3% had comorbidities and 31.3% had non- SST infections. In the multivariate analyses adjusting for demographics and hospital levels, the presence of several comorbid conditions was associated with ICU admission or hospital mortality, but the results were inconsistent across most common SSTIs. In the same analyses, the presence of non-SST infections was consistently associated with increased risk of ICU admission (adjusted odds ratios [OR] 3.34, 95% confidence interval [CI] 2.91-3.83) and hospital mortality (adjusted OR 5.93, 95% CI 4.57-7.71). Conclusions: The proportional distributions of various SSTIs differed between ICU and non-ICU patients. Nearly onethird of hospitalized SSTI patients had non-SST infections, and the presence of which predicted ICU admission and hospital mortality. [ABSTRACT FROM AUTHOR]

The article presents a case study of a man suffering from intra-abdominal metastatic melanoma. The man had a short history of epigastric pain, weight loss, anorexia and lethargy. The initial histopathological reports found evidence of persistent atypical melanocytic hyperplasia. Several deposits of melanoma were found in the small bowel.

The article focuses on incidence of second primary malignancies following breast cancer in Taiwan. Topics discussed include breast cancer is the most common female cancer in Taiwan, it has become an increasingly survivable disease resulting in a large population of long-term survivors, patients were at highest risk of developing kidney cancer after breast cancer and higher risk of developing second primary malignancies such as kidney cancer and thyroid gland cancer.

Patterned micro- and nanostructured surfaces have received increasing attention because of their ability to tune the hydrophobicity and hydrophilicity of their surfaces. However, the mechanical properties of these studied surfaces are not sufficiently robust for load-bearing applications. Here we report transparent nanocrystalline ZrO 2films possessing combined properties of hardness and complete wetting behavior, which are expected to benefit tribology, wear reduction, and biomedical applications where ultrahydrophilic surfaces are required. This ultrahydrophilic behavior may be explained by the Wenzel model. [ABSTRACT FROM AUTHOR]

CD52 antigen (Campath-1) is expressed in high density by lymphocytes and monocytes. Campath-1H or alemtuzumab, a human anti-CD52, has been shown to be effective in T-cell malignancies; however, there is very limited information on CD52 expression in T-cell lymphoma (TCL). This study retrospectively investigated 97 TCL cases by immunohistochemistry using paraffin sections to elucidate the CD52 expression rates in various TCL sub-types. Fourteen cases of angioimmunoblastic T-cell lymphoma (AITL) were excluded as there were no reliable criteria to differentiate whether the CD52-positive cells were neoplastic T-cells, which are usually small-sized, or the usually abundant, small-to-large residual/reactive B-cells in this lymphoma sub-type. In the remaining 83 tumors, CD52 was expressed in 29 (35%) tumors including 8/17 (47%) NK/T-cell lymphomas, 14/35 (40%) unspecified peripheral TCLs and 4/18 (22%) anaplastic large cell lymphomas. There was no statistical significance in CD52 expression in terms of patient age, gender, nodal vs extra-nodal presentation or tumor sub-types. The authors recommend performing CD52 immunostaining for future clinical trials of alemtuzumab on TCL patients and to correlate the staining results with treatment outcome. [ABSTRACT FROM AUTHOR]

Viruses are attractive building blocks for nanoscale heterostructures, but little is understood about the physical principles governing their directed assembly. In situ force microscopy was used to investigate organization of Cowpea Mosaic Virus engineered to bind specifically and reversibly at nanoscale chemical templates with sub-30 nm features. Morphological evolution and assembly kinetics were measured as virus flux and inter-viral potential were varied. The resulting morphologies were similar to those of atomic-scale epitaxial systems, but the underlying thermodynamics was analogous to that of colloidal systems in confined geometries. The 1 D templates biased the location of initial cluster formation, introduced asymmetric sticking probabilities, and drove 1D and 2D condensation at sub-critical volume fractions. The growth kinetics followed a t1/2 law controlled by the slow diffusion of viruses. The ability of poly(ethylene glycol) (PEG) to induce the lateral expansion of virus clusters away from the 1D templates suggests a significant role for weak interactions. [ABSTRACT FROM AUTHOR]

Abstract: Solder bumps serve as electrical paths as well as structural support in a flip-chip package assembly. Owing to the differences of feature sizes and electric resistivities between a solder bump and its adjacent traces, current densities around the regions where traces connect the solder bump increase in a significant amount. This current crowding effect along with the induced Joule heating would accelerate fatigue failure due to electromigration. In this paper we apply the three-dimensional electrothermal coupling analysis to investigate current crowding and Joule heating in a flip-chip package assembly carrying different constant electric currents under different ambient temperatures. Experiments are conducted to calibrate temperature-dependent electric resistivities of solder alloy, Al trace, and Cu trace, and to verify the numerical model by comparing calculated and measured maximum temperatures on the die surface. Through the electrothermal coupling analysis, effects of current crowding and Joule heating induced by different solder bump structures are examined and compared. [Copyright &y& Elsevier]