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Whether metformin use might affect the risk of non-Hodgkin lymphoma (NHL) remained to be answered. A total of 610,089 newly diagnosed type 2 diabetes patients with 2 or more times of prescription of antidiabetic drugs during 1999–2009 were enrolled from Taiwan's National Health Insurance database. They were followed up for NHL incidence until December 31, 2011. Both intention-to-treat and per-protocol analyses were conducted. Cox regression incorporated with the inverse probability of treatment-weighting using propensity scores was used to estimate hazard ratios. There were 414,783 metformin initiators and 195,306 non-metformin initiators within the initial 12-month of prescriptions of antidiabetic drugs. After a median follow-up of 5.07 years in metformin initiators and 6.78 years in non-metformin initiators, 1076 and 755 patients were diagnosed of new-onset NHL, respectively. The respective incidence was 47.74 and 57.68 per 100,000 person–years and the hazard ratio for metformin initiators versus non-metformin initiators was 0.849 (95% confidence interval 0.773–0.932) in the intention-to-treat analysis. In the per-protocol analysis, the hazard ratio was 0.706 (95% confidence interval 0.616–0.808). Sensitivity analyses after excluding patients with irregular follow-up, with an extension of minimal observation periods of 24 or 36 months, with incretin-based therapies, or in patients enrolled during 2 different periods (i.e., 1999–2003 and 2004–2009) consistently showed a lower risk among metformin initiators in both the intention-to-treat and the per-protocol analyses. Metformin use is associated with a lower risk of NHL compared with non-metformin antidiabetics. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study aimed to investigate whether metformin can affect risk of chronic obstructive pulmonary disease (COPD) in type 2 diabetes (T2D) patients. Methods T2D patients newly diagnosed during 1999–2005 were enrolled from the reimbursement database of Taiwan's National Health Insurance system and followed up to 31 December 2011. Analyses were conducted in an unmatched cohort (92,272 ever-users and 10,697 never-users of metformin) and a propensity score (PS) matched pair cohort (10,697 ever-users and 10,697 never-users). Cox regression incorporated into the inverse probability of treatment weighting using the PS was used to estimate hazard ratios (HRs). Results In the unmatched cohort, 2573 never-users and 13,840 ever-users developed COPD with respective incidences of 5994.64 and 3393.19 per 100,000 person-years. The overall HR was 0.560 (95% confidence interval [CI]: 0.537–0.584). HRs for the first (< 25.27 months), second (25.27–55.97 months) and third (> 55.97 months) tertiles of cumulative duration were 1.021 (0.975–1.070), 0.575 (0.548–0.603) and 0.265 (0.252–0.280), respectively. Analyses of the matched cohort showed an overall HR of 0.643 (0.605–0.682), with HRs of 1.212 (1.122–1.309), 0.631 (0.578–0.689) and 0.305 (0.273–0.340) for the respective tertiles. Conclusion A reduced risk of COPD is observed in metformin users with T2D. [ABSTRACT FROM AUTHOR]

Background and Aim: Hyperuricemia (HUA) is associated with the prevalence of metabolic syndrome (MetS) and cardiovascular risks in various populations. HUA is also able to induce cardiomyocyte hypertrophy in mouse models. However, the dose-response effects of serum uric acid (SUA) on the prevalence of MetS and electrocardiographic left ventricular hypertrophy (LVH) are unclear.Methods and Results: We retrospectively collected data from 18,932 individuals who underwent an annual health examination between 1/1/2016 and 12/31/2016. We excluded those with systemic diseases or missing questionnaires. The primary study endpoints were the prevalence of MetS and LVH, which were defined by the criteria for the Taiwanese population and the "SPRINT" trial. The cohort consisted of 17,913 individuals with a mean age of 31.2 years (SD 7.4) and a mean body mass index of 24.6 kg/m2 (SD 3.6); 87.1% of the individuals were men. The prevalence rates of HUA, MetS, and LVH were 29.5%, 9.4%, and 0.32%, respectively, in the overall study population. The HUA group was predominantly male and had significantly poorer lifestyle choices and greater laboratory cardiometabolic biomarker values than did the normouricemic group. However, the frequencies of physical activity were comparable between the two groups. After adjusting for confounders, SUA was associated with MetS (OR:1.473, 95% CI:1.408-1.540, P < 0.001) and LVH (OR:1.301, 95% CI:1.064-1.591, P = 0.01).Conclusion: We demonstrated that the dose-response effects of SUA are associated with the prevalence of MetS and electrocardiographic LVH in healthy individuals from Taiwan. Based on this evidence, future studies should investigate urate-lowering therapy and cardiovascular benefits in individuals with HUA (ClinicalTrials.gov number NCT03473951). [ABSTRACT FROM AUTHOR]

Background The prognostic impact of perineural invasion (PNI) in patients with esophageal cancer who receive neoadjuvant chemoradiotherapy (nCRT) remains unclear. Methods A thorough pathological review of PNI was performed on post-nCRT esophagectomy specimens obtained from non-ypT0 patients with esophageal squamous cell carcinoma (ESCC). When PNI was identified, it was classified according to the presence or absence of penetration through the nerve sheath (i.e., PNI surrounding the nerve sheath [PNI-SS] versus PNI penetrating through the nerve sheath [PNI-TS]). The impact of PNI on overall survival (OS) was assessed in combination with clinical and pathological risk factors. Results A total of 177 eligible patients were identified between 1998 and 2008. PNI was identified in 43.5% (77/177) of participants. Of them, 33 and 44 had PNI-SS and PNI-TS, respectively. The 5-year OS rate of patients with PNI-TS was significantly lower (6.7%) than that observed in those without PNI (30.6%, P < 0.001). However, the 5-year OS observed in the latter group did not differ significantly from that of patients with PNI-SS (26%, P = 0.68). Multivariate analysis identified PNI-TS (hazard ratio [HR] = 1.965, P = 0.02), LVI (HR = 1.514, P = 0.048), and ypN2 stage (HR = 2.39, P = 0.007) as independent adverse prognostic factors for OS. Conclusions The presence of PNI-TS after nCRT is associated with poor survival. A thorough assessment of distinct PNI patterns (i.e., PNI-TS versus PNI-SS) should be part of the routine post-nCRT histopathological work-up of ESCC patients. [ABSTRACT FROM AUTHOR]

Background The association between metformin and colorectal cancer (CRC) has rarely been investigated in Asian populations. Methods This retrospective cohort study included patients with newly diagnosed type 2 diabetes during 1999–2005, recruited from Taiwan's National Health Insurance database. A total of 169,601 patients (original cohort: 153,270 ever-users and 16,331 never-users of metformin) and a subgroup of 1:1 propensity-score-matched pairs of 16,331 ever-users and 16,331 never-users (matched cohort) were followed up to 31 December 2011. Cox regression was constructed with the inverse probability of treatment-weighting, using propensity scores, and was used to estimate hazard ratios (HRs). Results In the original cohort, the incidence of CRC was 242.9 and 480.9 per 100,000 person-years, respectively, in ever- and never-users. The overall HR [0.50, 95% confidence interval (CI): 0.45–0.56] suggested a significantly lower risk in metformin users, while compared with never-users, the HR (95% CI) for the first (<27.1 months), second (27.1–58.1 months) and third (>58.1 months) tertiles of cumulative duration of metformin therapy was 0.86 (0.76–0.98), 0.51 (0.45–0.59) and 0.26 (0.23–0.30), respectively. Analyses in the matched cohort showed similar findings with an overall HR of 0.62 (0.53–0.74), and a tertile analysis HR of 1.02 (0.81–1.28), 0.70 (0.56–0.89) and 0.32 (0.23–0.43), respectively. Re-analyses using more stringent diagnoses of CRC and cumulative duration as a continuous variable have consistently supported a protective effect with metformin use. Conclusion Metformin is associated with a lower frequency of CRC. [ABSTRACT FROM AUTHOR]

Background The purpose of this study was to investigate the prognosis and its predictors in patients with esophageal squamous cell carcinoma (ESCC) who achieve major histopathological response (MaHR) after neoadjuvant chemoradiotherapy (nCRT). Methods We examined a total of 187 ESCC patients who achieved MaHR following nCRT and survived the perioperative period. MaHR was defined as either absence or <10% vital residual tumor cells (VRTC) in the resected esophagus without nodal involvement. Univariate and multivariate analyses were used to identify factors significantly associated with overall survival (OS). Results At the time of analysis, 113 patients (60.4%) were dead (5-year OS = 48%; median survival time = 54.8 months). The amount of VRTC (1–10% versus 0% VRTC; hazard ratio [HR] = 1.9, P < 0.001) and the thoroughness of histopathological examination (standard [≤ 4 tumor blocks] versus thorough [> 4 tumor blocks], HR = 1.57; P = 0.013) were independent predictors of OS in multivariate analysis. A stepwise increase in OS was observed in the following groups: patients with 1–10% VRTC identified by the standard protocol, patients with 1–10% VRTC identified by the thorough protocol, patients with 0% VRTC identified by the standard protocol, and patients with 0% VRTC identified by the thorough protocol (5-year OS rates = 20%, 40%, 50%, and 62%, respectively, P < 0.001). Conclusions In ESCC patients who achieve MaHR after nCRT, the presence of microscopical residual disease and the thoroughness of histopathological examination are associated with survival. [ABSTRACT FROM AUTHOR]

The graphene paper fabricated through an electrochemical exfoliation and filtration process provides high quality and massive graphene sheets in an ink form synthesised using artificial graphite as starting material. The product is mainly composed of bilayer and few layer graphene. Their lateral size can be up to >10 μm, and the quality determined by Raman spectroscopy is better than reduced graphene oxide. The cross-plane and in-plane thermal conductivity of the graphene paper can reach 5·5 and 3300 W m−1 K−1 measured by the direct method and the thermoelectric method respectively. [ABSTRACT FROM AUTHOR]

Objective: To explore the role of far infrared (FIR) radiation therapy for hemodialysis (HD) access maintenance after percutaneous transluminal angioplasties (PTA). Methods: This was a prospective observational study. Eligible patients were those who received repeated PTA with the last PTA successfully performed within 1 week before the study enrollments. Consecutively enrolled patients undergoing successful HD treatments after PTA were randomly assigned to the FIR-radiated group or control group without radiation. FIR-radiated therapy meaning 40-minute radiation at the major lesion site or anastomosed site three times a week was continued until an end-point defined as dysfunction-driven re-PTA or the study end was reached. Results: Of 216 participants analyzed, including 97 with arteriovenous grafts (AVG) (49 FIR-radiated participants and 48 control participants) and 119 with arteriovenous fistulas (AVF) (69 FIR-radiated participants and 50 control participants), the FIR-radiated therapy compared with free-radiated usual therapy significantly enhanced PTA-unassisted patency at 1 year in the AVG subgroup (16.3% vs. 2.1%; p < .01), but not the AVF subgroup (25.0% vs. 18.4%; p = .50), and this accounted for the overall improved patency rates (21.4% vs. 10.3%; p = .02). Conclusions: This study suggests FIR-radiated therapy improves PTA-unassisted patency in patients with AVG who have undergone previous PTA. [Copyright &y& Elsevier]

Abstract: Background and aims: The association between inflammation and left ventricular (LV) diastolic dysfunction in continuous ambulatory peritoneal dialysis (CAPD) and non-CAPD patients is not established. The objective of this study was to test the above association and whether inflammation interacts with CAPD to increase LV diastolic dysfunction risks. Methods and results: 120 subjects with normal creatinine levels and 101 CAPD patients were recruited. Echocardiographic parameters were assessed in all patients. The participants were classified as having LV diastolic dysfunction by echocardiographic findings including mitral inflow E/A ratio < 1, deceleration time > 220 cm/s, or decreased peak annular early diastolic velocity in tissue Doppler imaging. Blood was sampled at the baseline for measurement of inflammation markers, including tissue necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6). Subjects with LV diastolic dysfunction had higher proinflammation cytokines levels in both groups. Inflamed markers correlated significantly with echocardiography parameters for LV diastolic dysfunction in patients receiving CAPD. In a multivariate regression analysis adjusting for all the factors associated with LV diastolic dysfunction, inflammation is still significantly associated with left ventricular diastolic dysfunction (TNF-alpha, OR: 2.6, 95% CI: 2.0–3.35, p < 0.001; IL-6, OR: 1.26, 95% CI: 1.25–1.26, p = 0.01). In addition, the interaction of CAPD and inflammation significantly contributed to the development of LV diastolic dysfunction (CAPD∗ TNF-α: OR: 1.45, 95% CI: 1.13–1.79, P = 0.004). Conclusion: We found inflammation plays a vital role for LV diastolic dysfunction especially in CAPD patients. A synergistic effect between CAPD and inflammation, especially TNF-α, would further aggravate LV diastolic dysfunction. [Copyright &y& Elsevier]

Baroreflex sensitivity (BRS) is abnormal in the prediabetic state. This study was conducted to determine effects of chronic rosiglitazone (RSG), an insulin sensitizer, on BRS in prediabetic hyperglycemic (PDH) rats induced by nicotinamide and streptozotocin. The fasting and postprandial blood glucose levels were 5.6-6.9 and 7.8-11.0 mmol/l, respectively. Rats were treated with RSG or saline for 12 weeks. BRS response to phenylephrine (PE-BRS) or sodium nitroprusside (NP-BRS) was determined by linear regression method. Cardiac sympathetic and parasympathetic influences were determined by autonomic blockades. In the saline-treated PDH rats, PE-BRS was enhanced early at week 4 and became greater at week 12. Abnormalities in NP-BRS and cardiac autonomic influences were found only after week 12. Four weeks of RSG treatment normalized blood glucose levels but not PE-BRS. All altered cardiovascular variables were completely restored by 12 weeks of RSG treatment. The correlation between BRS and blood glucose levels in salinetreated PDH rats was significant at week 12, but no correlation was found in RSG-treated rats. In conclusion, hyperglycemia, even in the prediabetic state, may play a role in BRS abnormalities. RSG treatment early in the prediabetic state may normalize BRS via cardiac autonomic modulation, besides its antihyperglycemic action. [ABSTRACT FROM AUTHOR]

Abstract: This work studies the feasibility of improving the thermal comfort in an electric UXV car cabin through a cooling device. The main components of the device consist of a membrane solar panel, four axial fans, and a rechargeable battery pack. The fans are solely powered by solar energy. The specifications of these components have been carefully examined and matched. The temperature and velocity fields in the cabin were simultaneously solved for through CFD means taking into consideration of the solar irradiation flux. Current results show that the accumulation of solar irradiation energy in the cabin can be effectively removed by the cooling device introduced. [Copyright &y& Elsevier]

The Health Promoting School (HPS) programs in Taiwan were initiated and implemented with funding from Department of Health and Ministry of Education during the initial phase. The purpose of this article was to describe the application of organization development (OD) concept in the administrative assessment of HPS programs and to present results of administrative assessment specifically related to health promoting schools implementation. It is hoped that results from the study will provide useful information for decision making and policy implementation regarding health promoting schools in countries with similar situation. Questionnaire and face-to face interview were conducted based on the school organization development concept. Forty-eight schools from the Phase one health promoting schools were selected to participate in the survey. In addition, one school was selected for face-to face interview. The qualitative assessment included: (1) organization development structure responsible for the implementation of HPS, (2) personnel responsible for the implementation of HPS, (3) community participation, and (4) support and resources for the HPS. Twenty-seven health promoting schools responded to the electronic survey with response rate of 56.3%. Survey results showed that majority of the HPS projects were implemented by personnel within the existing school organization. Eighty-six percent (86%) of the schools had their health education teachers or school nurses implemented the HPS project. Majority of schools (86%) implemented the HPS project with participation of community groups. All schools indicated their HPS project was supported by school administrative organization. On the other hand, 76% of schools indicated they did not have enough time and manpower to carry out the HPS project. Organization development in schools could be a useful tool to assess the implementation of HPS. HPS in Taiwan showed good organization development structure to support their implementation. However, improvement in resource integration and closer partnership with local government and community could be helpful in resolving the problems of time constraints and manpower shortage. [ABSTRACT FROM AUTHOR]

PURPOSE: This study was undertaken to assess local control and toxicity with adjuvant intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy (CCRT) for early stage cervical cancer. PATIENTS AND METHODS: Between June 2004 and February 2007, 54 patients with early stage cervical cancer (stage IB-IIA) with high-risk factors for treatment failure after surgery were treated with adjuvant pelvic IMRT and CCRT. Adjuvant chemotherapy consisted of cisplatin (50 mg/m2) weekly for 4 to 6 courses. All the patients received 50.4 Gy of external beam radiotherapy with IMRT in 28 fractions and 6 Gy of high-dose rate vaginal cuff brachytherapy in 3 insertions. RESULTS: Adjuvant CCRT with IMRT provided good local tumor control in posthysterectomy cervical cancer patients with high-risk pathologic features. The 3-year locoregional control and disease-free survival were 93% and 78%, respectively. Histology and lymph node metastasis were indicators for disease-free survival. Low acute and chronic treatment-related toxicities were noted with IMRT. All the patients completed the radiotherapy treatment without any major toxicity. In terms of chronic toxicity, only 1 patient had grade 3 genitourinary toxicity and none had grade 3 gastrointestinal toxicity. CONCLUSION: Our results indicate that adjuvant CCRT with IMRT technique for adjuvant treatment of early stage cervical cancer is associated with excellent local control and low toxicity. [ABSTRACT FROM AUTHOR]

Research Objective: We sought to identify initial nontraumatic lower-extremity amputations (ILEAs) and compare rates of ILEAs with different coding algorithms and varying lengths of observation period prior (look-back) to the first observed amputation.Study Design: We used a retrospective design on merged Medicare claims and patient treatment files of the Veteran Healthcare Administration for fiscal years 1998 to 2000 of veterans with diabetes ages 18 years and older. Three different algorithms using least-inclusive to most-inclusive procedure codes and "look-back" periods of 12, 18, and 24 months were used to identify ILEAs.Findings: Overall, 2997 (8.2 per 1000) veterans experienced an amputation in fiscal year 2000. Using 24 months of previous data, the rates of ILEA under the 3 different algorithms I, II, and III were 6.4/1000, 6.2/1000, and 6.0/1000 respectively. Using the most stringent algorithm (III), ILEA rates were 6.6/1000 with 12 months of prior data, 6.2/1000 with 18 months of prior data. Compared with any amputations in fiscal year 2000, 12-, 18-, and 24-month look-back period decreased the ILEA rates by 19%, 24%, and 27%, respectively.Conclusion: These findings highlight the usefulness of administrative data in identifying ILEAs. All 3 algorithms performed comparably well in the detection of ILEAs. The extent of identification was most complete with 24 months prior data, with marginal gains in extending the prior observation period from 18 to 24 months. Policy level analysis should consider reporting ILEAs, in addition to total amputation rates when examining trends and disparities in amputations. [ABSTRACT FROM AUTHOR]

Abstract: The water extract of Anoectochilus formosanus Hayata showed a potent tumor inhibitory activity in BALB/c mice after subcutaneous transplantation of CT-26 murine colon cancer cells. The tumor-inhibition ratios of mice pre-administered with A. formosanus for 2 days before tumor transplantation, and treated further for 12 consecutive days, were 55.4% and 58.9% at the oral dose of 50 and 10mg/mouse per day, respectively. Even for the tumor-bearing mice, after oral administration of the water extract of A. formosanus for 12 consecutive days, the tumor inhibition ratios were still 23.8% and 40.5% at doses of 50 and 10mg/mouse, respectively. Because the low-concentration water extract of A. formosanus does not show direct cytotoxicity in CT-26 tumor cells, we observed further that oral administration of the water extract of A. formosanus may activate murine immune responses, such as stimulating the proliferation of lymphoid tissues and activating the phagocytosis of peritoneal macrophages against Staphylococcus aureus. This study suggests that the antitumor activity of A. formosanus may be associated with its potent immunostimulating effect. It is worth further analyzing the immunomodulating component purified from A. formosanus, and evaluating its potential value for the treatment of human cancers. [Copyright &y& Elsevier]

This paper addresses an integrated information mining techniques for multimedia TV-news archive. The utilizes techniques from the fields of acoustic, image, and video analysis, for information on news story title, newsman and scene identification. The goal is to construct a compact yet meaningful abstraction of broadcast news video, allowing users to browse through large amounts of data in a non-linear fashion with flexibility and efficiency. By using acoustic analysis, a news program can be partitioned into news and commercial clips, with 90% accuracy on a data set of 400 hours TV-news recorded off the air from July 2003 to August of 2004. By applying speaker identification and/or image detection techniques, each news stories can be segmented with an accuracy of 96%. On screen captions or subtitles are recognized by OCR techniques to produce the text title of each news stories. The extracted title words can be used to link or to navigate more related news contents on the WWW. In cooperation with facial and scene analysis and recognition techniques, OCR results can provide users with multimodality query on specific news stories. Some experimental results are presented and discussed for the system reliability and performance evaluation and comparison. [ABSTRACT FROM AUTHOR]

Hydraulic disc brake systems offer various advantages over other braking systems, including a good heat dissipation rate, a high force enlargement ratio and a constant braking force in various environments. However, they have an important defect as the lining pads remain at a small clearance from the disc rotor, occasionally producing judder, noise and power loss when freely running. This study proposes an innovative piston retractor by utilizing the theory of innovative problem solving. The prototype is manufactured and installed in a commercial brake caliper. Experimental results are obtained and demonstrate the feasibility of applying the proposed design in a bicycle hydraulic disc braking system. Retraction performance of the proposed design is superior to a current product with a ring seal as its retractor and another product with a retractor that does not contain an automatic adjustment mechanism. The clearance between the lining pad and disc rotor is successfully kept at a larger value than these products regardless of the pad wear. [ABSTRACT FROM AUTHOR]