Search

Solid-state circuit breaker (SSCB) with high efficiency and high gravimetric power density is required for electrified aircraft propulsion (EAP). A cryogenically cooled gallium nitride (GaN) device-based SSCB module is developed for the EAP system to achieve a higher power density than existing SSCBs. The SSCB module is suitable for medium voltage direct current (MVdc) applications and is designed with low-weight modular cold plates. Each module is rated for 750 V, 100 A, and can interrupt a fault current of 1 kA at cryogenic temperature. The SSCB module structure design, thermal interface design, modular cold plate design, and insulation design are discussed. The developed SSCB module prototype achieves a power density of 329 kW/kg and an efficiency of 99.93%. Experimental results of interrupting a fault of 1 kA and insulation test of the SSCB module are provided to validate its operation.

Neuromyelitis optica spectrum disorder (NMOSD) is an uncommon antibody-mediated disease of the central nervous system. Its classic presentation includes long segments of spinal cord inflammation, optic neuritis with or without intractable vomiting, and hiccups. Here, we described a case of a 39-year-old woman with an atypical presentation of vertigo, which was finally diagnosed as NMOSD by a positive serum aquaporin-4 antibody.

This study introduces a SiGe/Si superlattice (SL) ferroelectric omega field-effect transistor (Fe- $\Omega $ FET). The ferroelectric characteristics of the developed TiN/ Fe-hafnium–zirconium oxide (HZO)/SL metal–insulator– semiconductor (MIS) capacitor were confirmed through grazing incidence x-ray diffraction (GIXRD) analysis at different temperatures. Fe-HZO usage improved the device performance, achieving subthreshold slopes (SS) of SS $_{\text {min,n}}$ = 62.4 mV/dec and SS $_{\text {min,p}}$ = 71.1 mV/dec, drain-induced barrier lowering (DIBL) values of DIBLn = 26.4 mV/V and DIBLp = 37.6 mV/V, and a high ON–OFF current ratio exceeding $1.0\times 10^{{7}}$ . Compared to the device with HfO2 as a gate insulator with channel width ( $\text{W}_{\text {CH}}{)}$ = 30 nm and gate length ( $\text{L}_{\text {G}}{)}$ = 60 nm, the performance of the developed device was greatly improved. The voltage transfer characteristic (VTC) and voltage gain of SiGe/Si SL Fe- $\Omega $ FET complementary metal–oxide–semiconductor (CMOS) inverter were also demonstrated, with a maximum gain of 111.4 V/V. In addition, the simulation of a state-of-the-art SiGe/Si SL Fe- $\Omega $ FET was investigated. These results indicate that SiGe/Si SL Fe- $\Omega $ FETs exhibit remarkable subthreshold properties and mitigate the short-channel effect.

Secret Image Sharing (SIS) is the technology that shares any given secret image by generating and distributing $n$ shadow images in the way that any subset of $k$ shadow images can restore the secret image. However, in the existing SIS schemes, the shadow images will be easily tampered and corrupted during the communication, which will pose serious security issues. Recently, blockchain has emerged as a promising paradigm in the field of data communication and information security. To securely communicate and effectively protect the secret image data in wireless networks, we propose a Blockchain-based Secure and Efficient Secret Image Sharing (BC-SESIS) scheme with outsourcing computation in wireless networks. In the proposed BC-SESIS scheme, the shadow images are encrypted and stored in the blockchain to prevent them from being tampered and corrupted. The identity authentication-enabled smart contract is deployed to achieve the $(k,n)$ threshold for secret image restoring. Furthermore, to reduce the computational burden of smart contract and users, an efficient outsourcing computation method is designed to outsource the restoring task, which is securely implemented by agent miners in the encryption domain. Theoretical analysis and extensive experiments demonstrate that the BC-SESIS scheme can achieve desirable communication security and high computational efficiency in the wireless networks.

Policy makers and payers increasingly hold health systems accountable for spending and quality for their attributed beneficiaries. Low-value care—medical services that offer little or no benefit and have the potential for harm in specific clinical scenarios—received outside of these systems could threaten success on both fronts. Using national Medicare data for fee-for-service beneficiaries ages sixty-five and older and attributed to 595 US health systems, we describe where and from whom they received forty low-value services during 2017–18 and identify factors associated with out-of-system receipt. Forty-three percent of low-value services received by attributed beneficiaries originated from out-of-system clinicians: 38 percent from specialists, 4 percent from primary care physicians, and 1 percent from advanced practice clinicians. Recipients of low-value care were more likely to obtain that care out of system if age 75 or older (versus ages 65–74), male (versus female), non-Hispanic White (versus other races or ethnicities), rural dwelling (versus metropolitan dwelling), more medically complex, or experiencing lower continuity of care. However, out-of-system service receipt was not associated with recipients’ health systems’ accountable care organization status. Health systems might improve quality and reduce spending for their attributed beneficiaries by addressing out-of-system receipt of low-value care—for example, by improving continuity.

Aims‘HER2-low’ breast cancer is an emerging issue as the clinical trials for anti-HER2 antibody–drug conjugates (trastuzumab deruxtecan) are making progress. A reliable method to identify HER2-low cancers is needed. This study aimed to evaluate immunohistochemistry (IHC) and in situ hybridisation (ISH) in detecting HER2-low status.MethodsWe evaluated the HER2 ISH data grouped by the IHC consensus in proficiency tests (PTs), and compared the HER2 ISH results between HER2 IHC scored 0 (IHC-0) and IHC scored 1+ (IHC-1+) tumours from in-house tissue microarrays (TMAs). Since benign/normal glands have HER2 expression and ideally should not be affected by targeted therapy, we evaluated HER2 ISH results in peritumoural benign glands of 52 breast cancers as reference values.ResultsNone of the 565 tissue cores in PTs achieved an 80% participant agreement of IHC-1+. In PTs and in-house TMAs, HER2signals of the IHC-1+cores (median: 2.6 and 2.0, respectively) were significantly higher than those of IHC-0 cores (median: 2.0 and 1.7, respectively). But the ranges of HER2signals had a considerable overlap between IHC-1+and IHC-0 cores. The HER2signals and HER2:CEP17 ratios of peritumoural benign glands exhibited normal distributions, and their upper bounds of the 95% reference intervals were 2.10 and 1.30, respectively.ConclusionsCurrent HER2 testing algorithms are unsatisfactory in detecting HER2-low cases. Using ISH to detect tumour with HER2signals and HER2:CEP17 ratio higher than the upper bound of the benign glands can be an alternative method.

Introduction: Sepsis is characterized by a dysregulated host response to infection that leads to multiple organ dysfunction and often complicated with metabolic acidosis. However, the associations between serum total carbon dioxide level (TCO2) and long-term clinical outcomes in sepsis survivors remains unknown. Methods: A total of 7212 sepsis survivors aged ≥ 20 years who were discharged from January  1, 2008 to December 31, 2018 were included in our analyses. The sepsis survivors were further divided into high TCO2(≥ 18 mmol/L) and low TCO2(< 18 mmol/L) groups, comprising 5023 and 2189 patients, respectively. The following outcomes of interest were included: all-cause mortality, myocardial infarction, ischemic stroke, hospitalization for heart failure, ventricular arrhythmia, and end-stage renal disease (ESRD). Results: After propensity score matching, the low TCO2group was at higher risks of all-cause mortality (hazard ratio [HR] 1.28, 95% confidence interval [95% CI] 1.18–1.39), myocardial infarction (HR 1.83, 95% CI 1.39–2.43), and ESRD (HR 1.38, 95% CI 1.16–1.64) than the high TCO2group. The results remained similar after considering death as a competing risk. Conclusion: Patients discharged from hospitalization for sepsis have higher risks of worse long-term clinical outcomes. Physicians may need to pay more attention to sepsis survivors whose TCO2was low.

Lung cancer is the global leading cause of cancer death. Taiwan initiated several health policies including smoking cessation, precision therapy, and low-dose computed tomography (LDCT) screening in 1997. We aimed to investigate the effect of public policies on lung cancer survival.

The devastating Chichi earthquake in Taiwan in 1999 highlighted the importance of disaster prevention and relief operations. In response to the challenge of extreme events and compound disasters, the National Science and Technology Center for Disaster Reduction (NCDR) contributes to operations at the Central Emergency Operation Center (CEOC) of Taiwan by providing integrated information and timely suggestions, and it delivers a common operational picture to central and local governments through a decision support system. This study was undertaken to explore the emergency response towards the reconnaissance of earthquake disasters in Taiwan to illustrate how resilient cities ensure rapid crisis response with a focus on the NCDR disaster response decision support system. This study examines the decision support system used following the 2016 ML6.6 Meinong earthquake. The results demonstrate that the first line of relief for the emergency response commander is data-driven decision-making.

Antimicrobial drug resistance is one of the major threats to global health. It has made common infections increasingly difficult or impossible to treat, and leads to higher medical costs, prolonged hospital stays and increased mortality. Infection rates due to multidrug-resistant organisms (MDRO) are increasing globally. Active agents against MDRO are limited despite an increased in the availability of novel antibiotics in recent years. This guideline aims to assist clinicians in the management of infections due to MDRO. The 2019 Guidelines Recommendations for Evidence-based Antimicrobial agents use in Taiwan (GREAT) working group, comprising of infectious disease specialists from 14 medical centers in Taiwan, reviewed current evidences and drafted recommendations for the treatment of infections due to MDRO. A nationwide expert panel reviewed the recommendations during a consensus meeting in Aug 2020, and the guideline was endorsed by the Infectious Diseases Society of Taiwan (IDST). This guideline includes recommendations for selecting antimicrobial therapy for infections caused by carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Enterobacterales, and vancomycin-resistant Enterococcus. The guideline takes into consideration the local epidemiology, and includes antimicrobial agents that may not yet be available in Taiwan. It is intended to serve as a clinical guide and not to supersede the clinical judgment of physicians in the management of individual patients.

As the backbone of supply chain operations, efficient freight road transportation and warehousing play a crucial role in facilitating business connectivity and ensuring smooth operations. Despite their significance, there remains a gap in understanding the efficiency levels of third-party logistics (3PL) companies in this specific area. To address this gap, this study employs the Data Envelopment Analysis (DEA) model to evaluate the relative efficiency of 3PL companies operating in Vietnam, a country that is positioning logistics as one of the spearhead service industries for the future. Drawing data from practical sources, our analysis encompasses various input and output variables. The findings reveal that 6 out of 13 3PL companies achieved overall efficiency. While many previous studies in this area overlook the slack of both input and output variables, this research conducts a thorough analysis. Through slack variables analysis, inefficient 3PL companies can identify which resources need to be reduced. Furthermore, this research provides valuable insights for policymakers and practitioners seeking to optimize logistics operations and enhance business connectivity in the region. Additionally, it offers actionable recommendations for improving logistics efficiency and delineates future research avenues, thus furnishing practical insights for enhancing the performance of logistics firms in emerging markets like Vietnam.

Although the link between hepatic steatosis and lung function has been confirmed, the focus has largely been on central airways. The association between hepatic steatosis and increased peripheral airway resistance has not yet been explored. Hepatic steatosis and increased peripheral resistance are connected with immunity dysregulation. High neutrophil-to-lymphocyte ratio (NLR) and low lymphocyte-to-monocyte ratio (LMR) have been recognized as indicators of immunity dysregulation. In this study, the association between hepatic steatosis and increased peripheral airway resistance was evaluated, and the effect of immunity dysregulation (high NLR/low LMR) on the increased peripheral airway resistance among patients with hepatic steatosis was explored. In this retrospective study, chest or abdomen CT scans and spirometry/impulse oscillometry (IOS) from 2018 to 2019 were used to identify hepatic steatosis and increased central/peripheral airway resistance in patients. Among 1391 enrolled patients, 169 (12.1%) had hepatic steatosis. After 1:1 age and abnormal ALT matching was conducted, clinical data were compared between patients with and without hepatic steatosis. A higher proportion of patients with hepatic steatosis had increased peripheral airway resistance than those without hepatic steatosis (52.7% vs 40.2%, P = .025). Old age, high body mass index, history of diabetes, and high NLR/low LMR were significantly correlated with increased peripheral airway resistance. The presence of hepatic steatosis is associated with increased peripheral airway. High NLR/low LMR is an independent associated factor of increased peripheral airway resistance in patients with hepatic steatosis. It is advisable for patients with hepatic steatosis to regularly monitor their complete blood count/differential count and undergo pulmonary function tests including IOS.

Manufacturing firms can facilitate their shipping and logistics operations via cooperation by adopting collaborative supply chain transportation. Moreover, in Chinese culture, guanxi is considered crucial for fostering close partnerships. This study empirically examines the relationships between supply chain information integration (SCII), collaborative transportation management (CTM) through interaction and collaboration between trading partners and carriers (supply chain CTM), logistics performance, and guanxi in manufacturing industries. In total, 152 usable responses from the manufacturing industry were collected using a questionnaire. A structural equation model (SEM) was used to evaluate the hypotheses. The results indicate that SCII is significantly positively related to supply chain CTM and logistics performance. While supply chain CTM is significantly positively related to logistics performance for manufacturing firms, guanxi has a significant moderating effect between SCII and supply chain CTM. The moderating effect of guanxi on manufacturing firms' supply chain CTM and logistics performance was not found in this study.

Supplemental Digital Content is available in the text.Determining the primary origin of a malignant effusion remains a common challenge for cytopathologists. Although immunohistochemical (IHC) markers are available for most primary sites, ideal IHC markers for metastatic gastric adenocarcinoma and pancreatic ductal adenocarcinoma are lacking, and related interpretation is often hindered by mesothelial cells. We recently revealed that claudin-18 IHC staining is useful for identifying the stomach and pancreas as the primary sites of metastatic adenocarcinoma. Thus, we assessed the use of claudin-18 IHC staining in 111 cell blocks obtained from various metastatic cancers and specimens negative for malignancy. Positive membranous claudin-18 staining was noted in all 10 (100%) metastatic pancreatic ductal adenocarcinomas, 9 (90%) of 10 gastric adenocarcinomas, and 1 (9%) of 11 nonmucinous lung adenocarcinomas. The cases of metastatic mucinous carcinomas of lung origin (1 case) and ovarian origin (1 case) were also positive for claudin-18. The other remaining 89 cases showed variable cytoplasmic staining on some cells (73 cases) or complete absence of staining (16 cases). After normalization to the tumor frequency, the sensitivity and specificity for identifying the stomach or pancreas as primary tumor sites in ascites were 95% (confidence interval: 0.83-0.99) and 99% (confidence interval: 0.94-1), respectively. In conclusion, membranous claudin-18 staining is a useful marker for metastatic gastric adenocarcinoma and pancreatic ductal adenocarcinoma in effusion specimens.

Objective: Chemical investigation of the extract of sponge-derived fungus, Aspergillus niger, was performed by liquid chromatography coupled with QExactive mass spectrometry for the first time. Method: A total number of 444 constituents were detected, 288 of which were identified positively or tentatively by the comprehensive utilization of accurate molecular weight and fragmentation information acquired from quadrupole orbitrap mass spectrometry. The identified compounds were divided into several types, namely, organic acid, alkaloid, saccharide, amino acid and cyclopeptide, terpenoid, polyketone, phenylpropanoid and other types of compounds. Systematic diagnostic ions and featured fragment patterns were summarized for each type, based on which 8 novel compounds belonging to the same type were characterized. Results: This work provided a rapid approach for the research of micro constituents in a complex analyte. Furthermore, the anti-tumor activity of the extract was evaluated on two different cell lines-Bel-7402 and Hela-S3 in vitro. The tumor-inhibitory effect of the Aspergillus niger extract was confirmed and may be mainly derived from its pro-apoptotic action. Moreover, the extract exerted more significant cytotoxicity in Bel-7402 cells than Hela-S3 cells, indicative of its selectivity on specific tumor cells. Conclusion: The evidence suggested that the Aspergillus niger extract may potentially serve as a remedy for the prevention and therapy of hepatic and breast carcinoma.

Background: Influences of nutritional status on hip fractured persons with diabetes mellitus (DM) following surgery have not been reported. Aims: To explore the trajectory groups of nutritional status and their influences on post-operative recovery for older persons with hip fracture and DM. Methods: A total of 169 patients with DM and hip fracture from a clinical trial were included in this analysis. Mini Nutritional Assessment was used to assess the nutritional status of the participants. Outcome variables included self-care ability, muscle strength, depressive symptoms, health related quality of life, and cognitive function, which were collected before discharge and 1-, 3-, 6-, 12-, 18-, and 24-months following hospital discharge. Results: Among hip fractured older persons with DM, within two years following surgery there were three nutritional trajectory groups: malnourished (28.3%), at-risk of malnutrition (41.9%) and well-nourished (29.8%). A decline in nutritional status, especially for the malnourished group, was seen in the second year. A better nutritional trajectory was associated with better recovery outcomes, including self-care ability, health related quality of life, cognitive function and less depressive symptoms. Discussion: Close to 30% of hip fractured persons with DM were considered to have a malnourished trajectory over 2 years following surgery. A poor nutritional trajectory was associated with poor mental health and physical recovery. Conclusions: Continuous nutrition assessment during the first 2 years following hip fracture surgery for older persons with DM is important. Development and implementation of interventions targeting the malnourished trajectory group are suggested.

IMPORTANCE: Low-value health care remains prevalent in the US despite decades of work to measure and reduce such care. Efforts have been only modestly effective in part because the measurement of low-value care has largely been restricted to the national or regional level, limiting actionability. OBJECTIVES: To measure and report low-value care use across and within individual health systems and identify system characteristics associated with higher use using Medicare administrative data. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study of health system–attributed Medicare beneficiaries was conducted among 556 health systems in the Agency for Healthcare Research and Quality Compendium of US Health Systems and included system-attributed beneficiaries who were older than 65 years, continuously enrolled in Medicare Parts A and B for at least 12 months in 2016 or 2017, and eligible for specific low-value services. Statistical analysis was conducted from January 26 to July 15, 2021. MAIN OUTCOMES AND MEASURES: Use of 41 individual low-value services and a composite measure of the 28 most common services among system-attributed beneficiaries, standardized to distance from the mean value. Measures were based on the Milliman MedInsight Health Waste Calculator and published claims-based definitions. RESULTS: Across 556 health systems serving a total of 11 637 763 beneficiaries, the mean (SD) use of each of the 41 low-value services ranged from 0% (0.01%) to 28% (4%) of eligible beneficiaries. The most common low-value services were preoperative laboratory testing (mean [SD] rate, 28% [4%] of eligible beneficiaries), prostate-specific antigen testing in men older than 70 years (mean [SD] rate, 27% [8%]), and use of antipsychotic medications in patients with dementia (mean [SD] rate, 24% [8%]). In multivariable analysis, the health system characteristics associated with higher use of low-value care were smaller proportion of primary care physicians (adjusted composite score, 0.15 [95% CI, 0.04-0.26] for systems with less than the median percentage of primary care physicians vs −0.16 [95% CI, –0.27 to –0.05] for those with more than the median percentage of primary care physicians; P < .001), no major teaching hospital (adjusted composite, 0.10 [95% CI, –0.01 to 0.20] without a teaching hospital vs −0.18 [95% CI, –0.34 to –0.02] with a teaching hospital; P = .01), larger proportion of non-White patients (adjusted composite, 0.15 [95% CI, –0.02 to 0.32] for systems with >20% of non-White beneficiaries vs −0.06 [95% CI, –0.16 to 0.03] for systems with ≤20% of non-White beneficiaries; P = .04), headquartered in the South or West (adjusted composite, 0.28 [95% CI, 0.14-0.43] for the South and 0.22 [95% CI, 0.02-0.42] for the West compared with −0.09 [95% CI, –0.26 to 0.08] for the Northeast and −0.44 [95% CI, –0.60 to –0.28] for the Midwest; P < .001), and serving areas with more health care spending (adjusted composite, 0.23 [95% CI, 0.11-0.35] for areas above the median level of spending vs −0.24 [95% CI, –0.36 to –0.12] for areas below the median level of spending; P < .001). CONCLUSIONS AND RELEVANCE: The findings of this large cohort study suggest that system-level measurement and reporting of specific low-value services is feasible, enables cross-system comparisons, and reveals a broad range of low-value care use.

The blast percentage in bone marrow (BM) can be evaluated through biopsy and aspiration, which is essential for diagnosing myeloid neoplasms especially for dividing myelodysplastic syndrome (MDS)/acute myeloid leukaemia (AML). However, methods for integrating the results of biopsy and smear have yet to be developed, particularly for cases in which the results fall on both sides of the cut-off value (10% or 20%). We studied 188 cases of MDS/AML initially diagnosed during 2011–2015 by using concomitant BM biopsy and aspiration and used different methods to compare the estimated blast percentages. A linear relationship was noted between the blast percentages estimated through biopsy and smear (R2=0.765). When the blast percentage was classified into four relevant clinical categories (<5%, 5–9%, 10–19%, and ≥20%), the total concordance between the results of the biopsy and smear was 76.1%. Although the prognostic values obtained through biopsy and smear were not significantly different, using the higher blast percentage estimation by biopsy and smear fared better in classifying patients into categories of 10–19% and ≥20% and demonstrated survival significance in both univariate and multivariate analyses. Subgroup analyses demonstrated that BM blast percentages had no prognostic significance when patients underwent intensive chemotherapy. However, blast percentages of ≥10% indicated poor prognosis for patients receiving only supportive care. In conclusion, most of the clinically relevant categories of blast percentages estimated through concomitant BM biopsy and smear were concordant. When the categories were different, the best prognostic prediction method was to select the higher blast percentage determined through biopsy and smear to diagnose MDS/AML.

ABSTRACTA three-dimensional two-phase lattice Boltzmann model is adopted to simulate bubble interactions on a multi-graphics processing unit (GPU) cluster. Both the level of the predicted spurious velocity and Laplace’s law’s satisfaction are used to validate the numerical implementation. The deformation and the terminal velocity of a single-rising bubble are further simulated, and the predicted terminal Reynolds number is contrasted with the available measurement and prediction. Dual-bubble rising at initial in-line and off-line states are also investigated with both uniform and differential bubble radii. For two bubbles of the same size, the trailing bubble suffers a dramatic deformation after entering the wake region generated by the leading bubble. However, this phenomenon is less significant if the larger bubble is placed beneath the smaller bubble. Finally, the present numerical procedure exhibits good scalability for multi-GPU computations.

Purpose: In the past few decades, the concept of corporate social responsibility (CSR) has received substantial interest in the competitive business environment. This study aims to empirically examine the impact of CSR on corporate image, organizational commitment and organizational performance in ocean freight forwarders. Design/methodology/approach: Five critical CSR dimensions were identified based on factor analysis: consumer interests, employee interests, environmental management, disclosure and corporate commitment and sponsorship. Structural equation modelling was subsequently performed to examine the hypothesized relationships among CSR, corporate image, organizational commitment and organizational performance. Findings: Results indicated that CSR had significantly positive effects on corporate image and organizational commitment, whereas corporate image was positively related to organizational commitment and organizational performance, respectively. Organizational commitment was also positively related to organizational performance. However, CSR did not have a significant direct effect on organizational performance. Research limitations/implications: This study intended to conduct a survey on logistics service providers; however, due to the limited availability of research on ocean freight forwarding service providers, the present sample was limited to ocean freight forwarding enterprises. Originality/value: From a theoretical perspective, this study contributes to the field by identifying the important dimensions of CSR and their effects on corporate image, organizational commitment and organizational performance. Particularly, it demonstrated the effect of CSR on ocean freight forwarding employees’ organizational commitment.

Graphical Abstract

A predominate azole-resistant Candida tropicalisclade 4 genotype causing candidemia has been detected in not only Taiwan but also China, Singapore, and Australia. It can also be detected on fruit surfaces. In addition to determining distribution and drug susceptibilities of pathogenic yeasts in environments of intensive care units of 25 hospitals in Taiwan, we would also like to investigate whether the azole-resistant C. tropicalisexists in Taiwan's hospital environment.

Tool wear plays a critical role in the machining industry. Worn tools can significantly affect the workpiece's dimensional accuracy. However, with the increasing popularity of operating cutting machines without enough machining background, such as the technician operating the milling machine in a dental clinic, nonprofessionals may not know the tool replacement timings to reduce the production waste caused by the worn tools. If a tool wears too much so that the finished workpiece is dimensionally inaccurate, then rebuilding another workpiece will cost valuable time and resources. On the other hand, if a tool is replaced too early, the cost of purchasing tools will increase. This research aims to address these challenges. The objective of this research was to develop an easy-to-use image-based system for tool wear detection, which was built with inexpensive components and can automatically measure cutting-edge widths of cutting tools using image processing techniques. The practical implication of the proposed tool wear detection system is that it can automatically measure cutting-edge widths at various cutting depths of a tool, which can allow nonprofessionals to understand how much dimensional change has been made before and after the tool is used. The repeatability of the proposed system was only 4µm, which means that the system can effectively detect the width change greater than 8µm at a 95% confidence level. For the 2mm ball end milling tool used in the research, the width difference from a new tool to an end-of-life tool was 57µm. The proposed system can detect the width difference caused by tool wear so that the technician can replace the tool in time using the proposed system.

BLS-type diffuse large B-cell lymphoma (DLBCL) denotes an uncommon, aggressive variant of DLBCL presenting initially in bone marrow, liver and spleen without lymphadenopathy or mass lesion. Patients with BLS-type DLBCL present frequently with haemophagocytic syndrome which often leads to early patient demise. Programmed death ligand 1 (PD-L1) plays a negative regulatory role on effector T cells and is an important target of immunotherapy. Assessment of PD-L1 expression in BLS-type DLBCL may carry therapeutic implications and provide mechanistic insights. Standard immunohistochemical analysis for PD-L1 was performed in seven cohorts for this study: (1) DLBCL-not otherwise specified (NOS) (n=201); (2) Epstein–Barr virus (EBV)-positive DLBCL (n=26); (3) thymic (primary mediastinal) DLBCL (n=12); (4) intravascular LBCL (n=3); (5) high-grade B-cell lymphoma, NOS (n=12); (6) BLS-type DLBCL (n=37); and (7) systemic DLBCL involving bone marrow (n=28). We found that PD-L1 was positive in 12.9% of DLBCL-NOS cases, 46.2% of EBV-positive DLBCL, 91.7% of thymic LBCL, none of intravascular LBCL, 8.3% of high-grade B-cell lymphoma-NOS, and 56.8% of BLS-type DLBCL. By comparison, only 14.3% of bone marrow cases involved by systemic DLBCL were positive for PD-L1 (p<0.001). Interestingly, BLS-type DLBCL more frequently showed activated B-cell phenotype (86.5% vs 65.2%, p=0.010), a high Ki-67 proliferative index (97.1% vs 63.3%, p<0.001), MYC overexpression (90.9% vs 56.2%, p=0.023), presence of haemophagocytic syndrome (86.5% vs 4.0%, p<0.001), and poorer overall survival (p<0.001) than DLBCL-NOS. These data suggest that the poor prognosis of BLS-type DLBCL may be explained by both extrinsic tumour microenvironment factors and intrinsic genetic factors of tumour cells, such as PD-L1-associated inactivation of anti-tumour immunity for the former, and MYC pathway activation-related aggressiveness for the latter.