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Targeted temperature management (TTM) has been recommended for post-resuscitation care of cardiac arrest (CA) patients who remain comatose. However, the differences between cardiogenic and non-cardiogenic causes need further investigation. Thus, this study aimed to investigate the difference in outcomes between cardiogenic and non-cardiogenic CA patients receiving TTM.The TIMECARD registry established the study cohort and database for patients receiving TTM between January 2013 and September 2019. A total of 543 patients were enrolled, with 305 and 238 patients in the cardiogenic and non-cardiogenic groups, respectively.Compared with the non-cardiogenic group, the cardiogenic group had higher proportion of initial shockable rhythm, better survival (cardiogenic: 45.9%; non-cardiogenic: 30.7%, P = 0.0017), and better neurologic performance at discharge. In the cardiogenic group, witnessed collapse (OR = 0.31, 95% CI: 0.13-0.72), and coronary intervention (OR = 0.45, 95% CI: 0.24-0.84) were positive predictors for overall outcome. Mean arterial pressure65 mmHg led to poor outcome regardless in the cardiogenic (OR = 3.31, 95% CI: 1.46-7.52) or non-cardiogenic group (OR = 2.39, 95% CI: 1.06-5.39).Patients with cardiogenic CA post TTM had better survival and neurologic performance at discharge than those without cardiogenic CA. Cardiogenic etiology was a potential predictor of better cardiac arrest survival, but it was not an independent risk factor for overall outcome after adjusting for potential covariates. In the cardiogenic group, better outcomes were reported in patients with witnessed collapse, bystander cardiopulmonary resuscitation, as well as those receiving coronary intervention.

Background Post-resuscitation hemodynamic level is associated with outcomes. This study was conducted to investigate if post-resuscitation diastolic blood pressure (DBP) is a favorable prognostic factor. Methods Using TaIwan Network of Targeted Temperature ManagEment for CARDiac Arrest (TIMECARD) registry, we recruited adult patients who received targeted temperature management in nine medical centers between January 2014 and September 2019. After excluding patients with extracorporeal circulation support, 448 patients were analyzed. The first measured, single-point blood pressure after resuscitation was used for analysis. Study endpoints were survival to discharge and discharge with favorable neurologic outcomes (CPC 1–2). Multivariate analysis, area under the receiver operating characteristic curve (AUC), and generalized additive model (GAM) were used for analysis. Results Among the 448 patients, 182 (40.7%) patients survived, and 89 (19.9%) patients had CPC 1–2. In the multivariate analysis, DBP > 70 mmHg was an independent factor for survival (adjusted odds ratio [aOR] 2.16, 95% confidence interval [CI, 1.41–3.31]) and > 80 mmHg was an independent factor for CPC 1–2 (aOR 2.04, 95% CI [1.14–3.66]). GAM confirmed that DBP > 80 mmHg was associated with a higher likelihood of CPC 1–2. In the exploratory analysis, patients with DBP > 80 mmHg had a significantly higher prevalence of cardiogenic cardiac arrest (p = 0.015) and initial shockable rhythm (p = 0.045). Conclusion We found that DBP after resuscitation can predict outcomes, as a higher DBP level correlated with cardiogenic cardiac arrest.

Background and PurposeTargeted temperature management (TTM) is associated with decreased mortality and improved neurological function after cardiac arrest. Additionally, studies have shown that bystander cardiopulmonary resuscitation (BCPR) doubled the survival of patients with out-of-hospital cardiac arrest (OHCA) compared to patients who received no BPCR (no-BCPR). However, the outcome benefits of BCPR on patients who received TTM are not fully understood. Therefore, this study aimed to investigate the outcome differences between BCPR and no-BCPR in patients who received TTM after cardiac arrest.MethodsThe Taiwan Network of Targeted Temperature Management for Cardiac Arrest (TIMECARD) multicenter registry established a study cohort and a database for patients receiving TTM between January 2013 and September 2019. A total of 580 patients were enrolled and divided into 376 and 204 patients in the BCPR and no-BCPR groups, respectively.ResultsCompared to the no-BCPR group, the BCPR group had a better hospital discharge and survival rate (42.25 vs. 31.86%, P = 0.0305). The BCPR group also had a better neurological outcome at hospital discharge. It had a higher average GCS score (11.3 vs. 8.31, P < 0.0001) and a lower average Glasgow–Pittsburgh cerebral performance category (CPC) scale score (2.14 vs. 2.98, P < 0.0001). After undertaking a multiple logistic regression analysis, it was found that BCPR was a significant positive predictor for in-hospital survival (OR = 0.66, 95% CI: 0.45–0.97, P = 0.0363).ConclusionsThis study demonstrated that BCPR had a positive survival and neurological impact on the return of spontaneous circulation (ROSC) in patients receiving TTM after cardiac arrest.

Objective. Heavy calcifications remain formidable challenges to PCI, even for well-experienced operators. However, rotational atherectomy (RA)-induced coronary perforations (CPs) still could not be obviated. This study was to explore incidence and mechanisms of RA-induced CP in real-world practice. Knowing why CPs occur in RA should help operators avert such mishaps. Method. Patients who received coronary RA from April 2010 to December 2019 with keywords related to perforations were retrieved from database. The procedure details, angiography, and clinical information were reviewed in detail. Results. A total of 479 RAs were performed with 11 perforations in 10 procedures among 9 patients documented. The incidence of RA-induced CP was 2.1%. The RA vessels were distributed in different territories, including first diagonal branch. Most CPs could be treated conservatively, but prolonged profound shock predisposed to poor outcome. CPs caused by rotawire tip occurred in 18.2% of cases, inappropriately sized burrs in 18.2% of cases, and rotawire damage with subsequent transection and perforation in another 18.2% of cases. A total of 5 (45.5%) perforations were caused by unintended and unnoticed bias cutting into noncalcified plaques (4, 36.4%) or through calcified vessel wall (1, 9.1%). The mechanisms for certain CPs were unique and illustrated in diagrams. Conclusion. CPs due to RA occur in certain percentage of patients. The mechanisms for CPs are diverse. Wire damage with subsequent transection could occur due to inappropriately repetitive burr stress on the wire body. A significant portion was due to unintended and unnoticed bias cutting into noncalcified plaque or through calcified vessel wall.

Background: Metabolic disorders such as obesity and diabetes mellitus can cause dysfunction of endothelial cells (ECs) and vascular rarefaction in adipose tissues. However, the modulatory role of ECs in adipose tissue function is not fully understood. Other than vascular endothelial growth factor–vascular endothelial growth factor receptor-mediated angiogenic signaling, little is known about the EC-derived signals in adipose tissue regulation. We previously identified Argonaute 1 (AGO1; a key component of microRNA-induced silencing complex) as a crucial regulator in hypoxia-induced angiogenesis. In this study, we intend to determine the AGO1-mediated EC transcriptome, the functional importance of AGO1-regulated endothelial function in vivo, and the relevance to adipose tissue function and obesity. Methods: We generated and subjected mice with EC-AGO1 deletion (EC-AGO1-knockout [KO]) and their wild-type littermates to a fast food–mimicking, high-fat high-sucrose diet and profiled the metabolic phenotypes. We used crosslinking immunoprecipitation- and RNA-sequencing to identify the AGO1-mediated mechanisms underlying the observed metabolic phenotype of EC-AGO1-KO. We further leveraged cell cultures and mouse models to validate the functional importance of the identified molecular pathway, for which the translational relevance was explored using human endothelium isolated from healthy donors and donors with obesity/type 2 diabetes mellitus. Results: We identified an antiobesity phenotype of EC-AGO1-KO, evident by lower body weight and body fat, improved insulin sensitivity, and enhanced energy expenditure. At the organ level, we observed the most significant phenotype in the subcutaneous and brown adipose tissues of KO mice, with greater vascularity and enhanced browning and thermogenesis. Mechanistically, EC-AGO1 suppression results in inhibition of thrombospondin-1 ( THBS1 /TSP1), an antiangiogenic and proinflammatory cytokine that promotes insulin resistance. In EC-AGO1-KO mice, overexpression of TSP1 substantially attenuated the beneficial phenotype. In human endothelium isolated from donors with obesity or type 2 diabetes mellitus, AGO1 and THBS1 are expressed at higher levels than the healthy controls, supporting a pathological role of this pathway. Conclusions: Our study suggests a novel mechanism by which ECs, through the AGO1-TSP1 pathway, control vascularization and function of adipose tissues, insulin sensitivity, and whole-body metabolic state.

Objective. Patients with advanced renal insufficiency are at high risk of coronary artery disease (CAD) and complex lesions. Treating complex calcified lesion with rotational atherectomy (RA) in these patients might be associated with higher risks and poorer outcomes. This study was set to evaluate features and outcomes of RA in these patients. Method. Consecutive patients who received coronary RA from April 2010 to April 2018 were queried from the Cath Lab database. The procedural details, angiography, and clinical information were reviewed in detail. Results. A total of 411 patients were enrolled and divided into Group A (baseline serum creatinine p < 0.001 ) and had more RCA and LCX but less LAD treated with RA. No difference was found in lesion location, vessel tortuosity, bifurcation lesions, chronic total occlusion, total lesion length, or total lesion numbers between the two groups. Less patients in Group B obtained completion of RA (95.9% vs 99.1%, p = 0.037 ). There was no difference in the incidence of procedural complication or acute contrast-induced nephropathy. Group B patients had more deaths and MACE while in the hospital. The MACE and CV MACE were also higher in Group B patients at 180 days and one year, mostly due to TLR and TVR. Multivariate regression analysis showed that ACS, age, peripheral artery disease (PAD), advanced renal insufficiency, ischemic cardiomyopathy/shock, and high residual SYNTAX score were independent risk factors for in-hospital MACE, whereas ACS, advanced renal insufficiency, ischemic cardiomyopathy/shock, triple-vessel disease, and PAD independently predicted MACE at 6 months. Conclusions. Rotablation is feasible, safe, and could be carried out with very high success rate in very-high-risk patients with advanced renal dysfunction through ESRD without an increase in procedural complication.

BackgroundRotational atherectomy (RA) is an indispensable tool used for calcified lesion preparation in percutaneous coronary intervention (PCI). However, use of RA in the setting of acute myocardial infarction (AMI) is challenged with limited clinical data.ObjectivesThis study aims to retrospectively investigate the procedural results, periprocedural complications, and clinical outcomes of RA in patients with AMI.MethodsAll possible consecutive patients who received RA in AMI from January 2009 to March 2018 in a single tertiary center were analyzed retrospectively. Patients without AMI during the study period were also enrolled for comparison.ResultsA total of 121 patients with AMI (76.0 ± 10.8 years, 63.6% males) and 290 patients without AMI were recruited. Among the AMI group, 81% of patients had non-ST-elevation myocardial infarction (NSTEMI) and 14% presented with cardiogenic shock. RA could be completed in 98.8% of patients in the AMI group and 98.3% in the non-AMI group (p = 1.00). The periprocedural complication rates were comparable between the AMI and non-AMI groups. The risks of in-hospital, 30-day, 90-day, and 1-year cardiovascular major adverse cardiac events (CV MACE) were significantly higher in the AMI group compared with the non-AMI group (in-hospital 13.2 vs. 2.8%, p < 0.001; 30-day 14.2 vs. 4.5%, p < 0.001; 90-day 20.8 vs. 6.9%, p < 0.001; 1-year 30.8 vs. 19.1%, p = 0.01). AMI at initial presentation and cardiogenic shock were predictors for both in-hospital CV MACE and 1-year CV MACE in multivariable binary logistic regression analysis. Other predictors for 1-year CV MACE included serum creatinine level and triple vessel disease.ConclusionRA in patients with AMI is feasible with a high procedural completion rate and acceptable periprocedural complications. Given unstable hemodynamics and complex coronary anatomy, the in-hospital and 1-year MACE rates remained higher in patients with AMI compared with patients without AMI.

Sub-optimal sensitivity and specificity in current allograft monitoring methodologies underscore the need for more accurate and reflexive immunosurveillance to uncover the flux in alloimmunity between allograft health and the onset and progression of rejection. QSant—a urine based multi-analyte diagnostic test—was developed to profile renal transplant health and prognosticate injury, risk of evolution, and resolution of acute rejection. Q-Score—the composite score, across measurements of DNA, protein and metabolic biomarkers in the QSant assay—enables this risk prognostication. The domain of immune quiescence—below a Q-Score threshold of 32—is well established, based on published AUC of 98% for QSant. However, the trajectory of rejection is variable, given that causality is multi-factorial. Injury and subtypes of rejection are captured by the progression of Q-Score. This publication explores the clinical utility of QSant across the alloimmunity gradient of 32–100 for the early diagnosis of allograft injury and rejection.

This article explores whether a learning community can affect students' learning achievement and engagement. Besides, this study also analyzed whether degree centralities of peer interaction affect learning achievement and learning engagement based on social network analysis. While the experimental group combined the English learning system with the online learning community, the control group was simply using the English learning system. The results indicated that the students' engagement from the online learning community were higher than the ones who used the English learning system only, although the learning achievement is not significant difference between these two groups. Moreover, higher interaction learners from the online learning community revealed better performance in learning achievement and student engagement. Other than that, the learners who played the “Center” emerged with a higher learning achievement as well as the students' engagement than the “Periphery” ones. The research provides suggestions for online learning with learning communications as well.

Introduction: Uniportal video-assisted thoracoscopic surgery (VATS) for various pulmonary diseases provides advantages of less postoperative pain and earlier post-operative recovery over traditional open surgery. The inherent limitation of this surgical modality in manipulation of surgical instruments renders intra-operative one-lung ventilation a requisite to increase the substantially restricted working space and thus visibility of the surgical filed. Patient concerns: Patient 1, an 8-month-old, 9-kg, and 70 cm-in-height male infant was diagnosed as congenital pulmonary airway malformation (CPAM) over left lower lobe. Patient 2, a 9-month-old, 8-kg and 72 cm-in-height male infant was diagnosed as CPAM over right lower lobe. Patient 3, an 8-month-old, 8-kg and 67 cm-in-height female infant was diagnosed as CPAM over left lower lobe. This facilitating one-lung ventilation yet was rarely conducted in infants under one year of age for the extremely small body size, the unavailability of dedicated tools, and therein the very tough techniques demanded. Diagnosis: Infants with congenital cystic adenomatoid malformation Interventions: Here we report three infants of less than one year of age in whom one-lung ventilation was successfully achieved by intraluminal use of 5-Fr Fuji Uniblocker Bronchial Blocker devices and in turn assisted the completion of uniportal VATS for congenital cystic adenomatoid malformation in unilateral lungs. Outcomes: Three infants received VATS under uniblocker smoothly. Patient 1 had two episode of balloon dislodgement and desaturation and solved by re-insertion. And he had subglottic tracheal stenosis which treatment with laser coagulation. Patient 2 had overall blood loss 80 ml. Patient 3 had one episode of desaturation after stapling the bronchus and fiberoptic bronchoscope revealed obstruction by blood and secretion which solved by suction. Conclusion: In conclusion, OLV in infants undergoing uniportal VATs could be successfully achieved by Fuji 5 Fr Uniblocker bronchial blockers for as long as 4 hours, as exemplified by our three cases, and balloon poor sealing and dislodgment can be immediately solved by bronchoscope-guided re-positioning without compromising surgical proceeding or outcome.

The homeostasis of vascular endothelium is crucial for cardiovascular health and endothelial cell (EC) aging and dysfunction could negatively impact vascular function. Leveraging transcriptome profiles from ECs subjected to various stimuli, including time-series data obtained from ECs under physiological pulsatile flow vs. pathophysiological oscillatory flow, we performed principal component analysis (PCA) to identify key genes contributing to divergent transcriptional states of ECs. Through bioinformatics analysis, we identified that a long non-coding RNA (lncRNA) RAMP2-AS1 encoded on the antisense of RAMP2, a determinant of endothelial homeostasis and vascular integrity, is a novel regulator essential for EC homeostasis and function. Knockdown of RAMP2-AS1 suppressed RAMP2 expression and caused EC functional changes promoting aging, including impaired angiogenesis and increased senescence. Our study demonstrates an integrative approach to quantifying EC aging based on transcriptome changes, which also identified a number of novel regulators, including protein-coding genes and many lncRNAs involved EC functional modulation, exemplified by RAMP2-AS1.

Background: Target temperature management (TTM) is a recommended therapy for patients after cardiac arrest (PCA). The TaIwan Network of Targeted Temperature ManagEment for CARDiac Arrest (TIMECARD) registry was established for PCA who receive TTM therapy in Taiwan. We aim to determine the variables that may affect neurologic outcomes in PCA who undergo TTM. Methods: We retrieved demographic variables, resuscitation variables, and cerebral performance category (CPC) scale score at hospital discharge from the TIMECARD registry. The primary outcome was a favorable neurologic outcome, defined as a CPC scale of 1 or 2 at discharge. A total of 540 PCA treated between January 2014 and September 2019 were identified from the registry. Univariate and multivariate analyses were performed to identify significant variables. Results: The mortality rate was 58.1% (314/540). Favorable neurologic outcomes were noted in 117 patients (21.7%). The factors significantly influencing the neurologic outcome (p

Supplemental Digital Content is available in the text, Rationale: Type A aortic dissection (TAAD) is a life-threatening disorder yet it is hard to diagnose. The dissection might extend to the coronary artery causing ST-segment elevation myocardial infarction (STEMI). Physicians might not recognize this particularly early in its presentation and patients proceed to receive the primary percutaneous coronary intervention. We present such a case and found that the marked pressure difference between the radial and ascending aortae could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. Patient concerns: A 58-year-old male was presented to our emergency department for the complaint of left side chest pain that lasted for an hour with concomitant hypotension. STEMI was diagnosed at that time. Diagnosis: The emergent primary percutaneous intervention was performed. When the diagnostic catheter was advanced to the ascending aorta, the systolic aorta pressure became 20 mm Hg higher than radial systolic pressure. Due to the abnormally large pressure differential between the peripheral radial artery and central ascending aorta, TAAD was suspected. Interventions: After angiography and computer tomography confirmed the diagnosis of TAAD, the patient was sent for emergent surgery. Outcomes: The patient was died because of extensive dissection and shock. Lessons: We present such a case and found that the marked pressure difference between the radial and ascending aortae during catheterization could be a useful clue for diagnosing the aortic dissection-related myocardial infarction. This clue had hinted our speedy examination of the occluded coronary artery and dissection flap, and led to an early and accurate diagnosis.

OBJECTIVES To evaluate the outcomes of rotational atherectomy for heavily-calcified side branches of coronary bifurcation lesions. BACKGROUND Side-branch (SB) preservation is clinically important but technically challenging in heavily-calcified non-left main true bifurcation lesions. SB rotational atherectomy (SB RA) is sometimes mandatory but the clinical outcomes are not well studied. METHODS We retrospectively studied the outcomes of patients who underwent RA at our institute for heavily calcified, balloon-uncrossable or-undilatable SB lesions over an approximately 5-year period (January 2011 to September 2016). RESULTS Two hundred and forty-four patients underwent main vessel only RA (SB-MV + RA group) and another 48 patients underwent SB RA (SB + MV ± RA group) for 49 side branches. The demographic variables were comparable between the two groups. However, patients underwent SB RA experienced more SB perforations and greater acute contrast-induced nephropathy (CIN). Among the SB RA patients, 30 (62.5%) underwent RA for both SB and MV (SB + MV + RA subgroup), whereas the other 18 underwent SB only RA (SB + MV-RA subgroup). Patients in these two subgroups could be completed with similar procedural, fluoroscopic durations, and contrast doses. The long-term MACE rate of SB RA was 27.1% over a mean follow-up period of 25.1 months with no differences between the two subgroups. CONCLUSIONS RA for SB preservation in complex and heavily-calcified bifurcation lesions was feasible with high success rate and quite favorable long-term outcomes in the drug-eluting stent (DES) era. Given the higher rates in SB perforation and acute CIN, we recommend that SB RA should be conducted by experienced operators.

Complicated type B dissection is associated with a high mortality rate due to malperfusion syndrome or progression of the dissection for which aggressive therapy with an endovascular or surgical intervention is recommended. Herein, we present a patient who received a successful percutaneous rescue intervention after three days of renal ischemia caused by a complicated type B dissection. This type of rescue of percutaneous intervention with branch vessel stenting appears to be useful in treating malperfusion syndrome caused by aortic dissection, even after a period of organ ischemia.

Background. To evaluate the acute angiographic and intermediate-term clinical results of patients with non-left main (LM) coronary artery bifurcation disease (CABD) treated with BVS, as compared with those treated with DES, using the jailed semi-inflated balloon technique (JSIBT) for side branch (SB) protection and provisional stenting. Methods and Results. Sixty-eight patients with non-LM CABD who had undergone provisional one-stent implantation with SB protection by JSIBT between January 2015 and December 2017 were retrospectively enrolled. Among them, 20 patients received Absorb BVS implantation and 48 patients received DES implantation. Patients in the BVS group were younger and had higher BMI, total cholesterol, low-density lipoprotein cholesterol, and hemoglobin but had lower serum creatinine and lower prevalence of prior PCI and MI. No SB balloon rupture/entrapment occurred in either group. The incidence of SB dissection/occlusion and SB in need of rewiring or stenting was rare in both groups and showed no significant difference between them. Postinterventional TIMI flow significantly increased in both groups. The intermediate-term clinical outcomes were good in terms of incidence of target lesion failure, target lesion revascularization, target vessel revascularization, myocardial infarction, and all-cause death in both groups. Conclusion. The use of JSIBT for treating CABD with modern BVS can provide SB protection as similar as those with DES, even with higher incidence of acute SB dissection/occlusion. The immediate angiographic results and acute and intermediate-term clinical outcomes were also similar in both groups. Our study results demonstrate that JSIBT might be a safe and alternative SB protection tool for BVS in patients with complex CABD.

Knowledge about astronomy is an important part of natural science; however, students taking the course of observing the outer space and stars cannot efficiently engage in the activity that poor learning outcome results from the limits of time, place, weather, and flat teaching materials. Although simulation software or paper-based planispheres have been applied to support astronomy learning, students cannot clearly understand the three-dimensional nature of astronomical concepts. Recently, due to the rapid advancement of technology, augmented reality (AR) is applied more and more to education. With the support of AR, classrooms are provided with real-and-virtual-combined learning equipment for students to reach the goal of visualizing complicated space relationships and abstract conception. It seems to bring a new opportunity for astronomy learning. However, although there have been studies on applications of augmented reality, few of them are concerned about empirical investigation on astronomical observation. This study therefore aims to establish an augmented-reality learning system on mobile devices and compare the differences among learning aids of a paper-based planisphere, computer simulation, and augmented reality on cognitive learning achievement and stargazing skill on astronomical instruction. Three classes of elementary students, in total, 87 students, participated in this study. One class used augmented reality on mobile devices to conduct astronomical observation, another class used simulation, and the other class used paper-based planispheres. The results indicate that augmented reality was effective in improving astronomy knowledge and stargazing skill.

The use of central venous port access is increasing due to the requirements of multimodal intravenous therapy.1 However, catheter malposition in smaller veins can lead to vein thrombosis, phlebitis and pain. Herein, we report our experience with the use of percutaneous interventions to correct migrated port catheter malposition. Minimally invasive percutaneous interventional correction of malposition could be an alternative to extraction and re-implantation of malpositioned port catheters.

Computer programming is basic knowledge in the digital age and becoming an critical subject during recent years. However, learning to programme is not an easy topic as supported by many researchers. During the development of information technology, many online learning systems have been developed and proven their positive effect on students learning. However, few studies have geared toward supporting its use in programming courses with peer-interaction. Therefore, this study aimed to develop an online learning system named Peer-Interaction Programming Learning System. The system was developed and being used by many programming classes both in Vietnam and Taiwan. In this paper, we reported on the design of the system and its user interface, discussed our motivation and underlying teaching philosophy.

Background Percutaneous coronary intervention for coronary artery bifurcation disease (CABD) remains challenging. In patients of CABD with situations that two-stent strategy is needed, the culotte technique is a widely used method and also as the majority at out institution. We sought to take a look of the clinical outcomes of our culotte stenting patients. Methods This retrospective study analyzed 238 consecutive CABD patients who underwent culotte two-stent technique at a tertiary medical center between July 2008 and November 2015. Results Culotte technique was used in 238 lesions in 238 patients. Of these patients, all DES were implanted for culotte two-stent technique. Most of these patients were elderly, male gender, ACS on admission and multiple vessel disease. The bifurcation lesions were mostly located at left coronary artery (51.3%), categorized as true bifurcation lesion (92%) and calculated less than 70 degree of bifurcation angle (74.4%). During a medium 3.27-year follow up, the angle of bifurcation lesion ≥70° and body mass index were positively independent predictors for target lesion failure (TLF), diabetes mellitus was an independent predictor of target vessel revascularization, and statin therapy for hyperlipidemia, hemoglobin and EF were negatively independent factors associated to total mortality. The rates of in-hospital and total mortalities were 4.2 and 17.6%. Conclusion In this cohort of CABD patients with most left main and left anterior descending artery lesions treated by culotte stenting, the procedural success rate was high and the intermediate clinical outcomes were acceptable. (Reviewer #1, Comment #1) Bifurcation angle (≥ 70°) is an inherently independent predictor of TLF and other two-stent strategy replaced needed to be considered in this situation.

This study seeks to investigate the effects of web-based computer programming learning, equipped with Questions and Answers, on students whose majors are not computer science. The proposed system allows five types of questions to be generated: essay, multiple-choice, fill-in-the-blank, true-false, and coding. It is found that spending time to complete given tasks by interacting with questions is a significant predictor. Furthermore, academic performance is significantly correlated with participating in fill-in-the-blank, essay, and coding questions. Findings are also stated that there were no differences between academic performance and engagement regarding gender.

Patient initials or identifier number C.C., 1661642F ### Relevant clinical history and physical exam 84 Y/O, Male Admitted on 2015/8/8 due to chest pain and tightness Past history ### Relevant test results prior to catheterization ![Figure][1] ![Figure][1] ### Relevant

A 25-year-old previously healthy male presented to our emergency room with acute chest pain and ventricular arrhythmia-related cardiac arrest. ST elevation myocardial infarction was diagnosed and coronary angiography revealed diffuse critical narrowing from the proximal to the distal left anterior descending artery. Diffuse intramural hematoma was demonstrated on intravascular ultrasound. Two stents were placed to cover the whole dissection length and flow was successfully restored. Spontaneous coronary artery dissection can be a fatal event and could be mistaken for atherosclerotic plaque or coronary spasm rather than luminal compression on coronary angiography and intravascular imaging is helpful in this condition.

In recent years, Computer programming has become a critical subject, and it is a basic literacy in the digital age. However, learning programming skills is not an easy task as supported by many studies. On the other hand, many studies have concluded that student question generation has a positive effect on students learning, but few studies have geared toward supporting its use in programming classes. Therefore, this study aimed to develop a programming learning system named Peer-Interaction Programming Learning System based on a question generation strategy. The system was built by adding and intergrading learning assistance functions by system initiative into existing open-source QaA system. The usability of the system was examined for an undergraduate computer science course: Introduction to Computer Programming (n = 33). In this paper, we reported the design of the system and its user interface, identified several related systems, discussed our motivation and underlying teaching philosophy.

Carotid artery stenting is commonly used to treat carotid artery stenosis. However, carotid in-stent restenosis remains a challenging problem. Herein, we report a difficult case of recurrent severe carotid in-stent restenosis with total contralateral internal carotid artery occlusion treated with repeat drug-eluting balloon inflations. The outcome after one year of follow-up showed a good result.

With the increased use of intravascular catheters and devices, they have become the major non-malignant cause of superior vein cava (SVC) syndrome. We report a patient with liver cirrhosis who had received a peritoneovenous drainage catheter for refractory ascites, and then developed SVC syndrome because of concomitant occlusions of both the SVC and the drainage catheter. The patient regained patency of both the occluded vessel and the drainage catheter through percutaneous transluminal venoplasty, and there was dramatic improvement of clinical symptoms and good performance of the drainage catheter. Percutaneous intervention may be a feasible and effective therapy for SVC syndrome and intra-catheter thrombosis-related dysfunction.

Background Eosinophilic myocarditis encompasses a variety of etiologies and the prognosis varies. For patients with a hypersensitive response to medications, high-dose corticosteroids and discontinuation of culprit medications are the main treatments. Case presentation We reported a young man with biopsy-proven eosinophilic myocarditis which was possibly induced by Chinese herbal medicine. His heart failure and left ventricular hypertrophy improved soon after low-dose corticosteroid. Conclusion Low-dose corticosteroid may be effective in selected patients with eosinophilic myocarditis. Early echocardiographic follow-up is mandatory for evaluation of the clinical response. Electronic supplementary material The online version of this article (doi:10.1186/s12872-017-0547-9) contains supplementary material, which is available to authorized users.

Band selection (BS) is one of the important topics in hyperspectral image data analysis. How to search the representative bands that can effectively represent the image with lower inter-band redundancy is an long-term issue. Recently, the sparse representation (SR) was used to solve BS problem, called SR-BS. It aimed to find a set of representative bands that can represent the whole bands based on the minimization of reconstructed error in SR. However, those SR-BS methods suffer from an issue about higher complexity in the optimization process, even though the greedy strategy, such as orthogonal matching pursuit (OMP) algorithm, is used to accelerate them. Another issue is that the bands selected by SR-BS may not be really complementary since the homogeneity of adjacent spectral bands is not considered. To make SR-BS more efficient, in this paper, we model the BS problem as group sparse representation (GSR) problem where the dictionary matrix (i.e., all spectral bands) are pre-clustered to several non-overlapping groups based on the spectral similarity. Later, we adopt group orthogonal matching pursuit (GOMP) algorithm to solve the optimization problem. We named the proposed approach as GOMP-BS. Since GOMP-BS picks bands under group structure, it not only reaches higher computational efficiency but also makes the selected bands more less redundant. The experiments show that GOMP-BS achieves higher classification performance when the number of selected bands is low and requires less computation time than OMP-based methods.

STEM is an acronym that refers to the academic disciplines of science, technology, engineering and mathematics. The term is typically used in schools to improve competitiveness in science and technology development. The purpose of this study is to develop instructional design based on 6E’s STEM and investigates its impact on participants’ knowledge. The participants were 48 junior high school students, and a quasi-experimental research design was employed. The course is about concept instruction and the assembly of quadcopters. The content of online discussion was analyzed through the quantitative content analysis and the lag sequential analysis. The experimental results indicated that the STEM based instructional design not only enhanced students’ learning achievement, but also improved their discussion quality.

The purpose of this project was to investigate the effects of virtual versus physical manipulation using a simulation-based laboratory activity (SBL) and a microcomputer-based laboratory activity (MBL). Both the SBL and the MBL used computers to collect, graph, and analyze data. A major difference was that the MBL allowed the students to manipulate physical materials, whereas in the SBL activity they manipulated virtual materials. In this quasi-experimental design, two 11th-grade classes (N = 68) at an urban public high school in Taipei were assigned to the SBL and MBL settings. The participants conducted the Boyle's law experiment without having done any relevant prior experiment. Their science concepts, performance of inquiry tasks, and attitudes toward the SBL/MBL were examined by pre- and postconceptual tests, an inquiry-based lab manual, and postlaboratory interviews. The results showed that both groups performed equally well and had remarkable gains in their pre- to posttest learning achievement. Nevertheless, physical manipulation may have contributed to inquiry practices such as creating practical ideas for conducting and improving the experiment and interpreting the data and may have increased the enjoyment of the laboratory. This study concludes that virtual manipulation is as effective as physical manipulation in learning physics concepts, but that the former gives learners some naive expectations and induces certain learning strategies that seem to lead to mindless planning and conducting of experiments and hinders them from generating ideas to improve experiments.

BACKGROUND: Desensitization with intravenous immune globulin (IVIG) and rituximab improves transplantation rates. It is unclear if desensitization increases the risk of polyomavirus BK (BKV) viremia. Here, BKV viremia in HLA-sensitized patients after desensitization with IVIG and rituximab was analyzed. METHODS: Baseline characteristics and outcomes were compared in the desensitized group (N=187) and the non-desensitized group (N=284). Surveillance for BKV viremia was done at 1, 2, 3, 6, 9, and 12 months posttransplant. Univariable and multivariable analyses were performed. RESULTS: BKV viremia was observed in 20% of the desensitized and 10% of the non-desensitized (P

The purpose of this study was to analyze how mobile technologies were incorporated and implemented in an outdoor learning activity. Two classes of primary school students participated in the experiment. Using activity theory as an analytical framework, it is found that underlying tensions provided rich insights into system dynamics and that technological affordances could be limited by mismatches between the Tools themselves, and between Tools and the ways that were used by learners or arranged by the instructor. The subtle human factors present in the use of technologies should be carefully considered. The influence of mobile devices on learner experiences in experiential learning is also thoroughly discussed.

BACKGROUND De novo donor HLA-specific (dnDSA) and non-HLA antibodies including antiangiotensin type 1 receptor antibodies (AT1R-abs) have been associated with antibody-mediated rejection (AMR) and decreased graft survival as well as cellular-mediated rejection (CMR) and early onset of microvasculopathy in heart transplantation. The aim of our study was to determine the impact of anti-AT1R-ab and anti-donor HLA-specific antibody (DSA) on clinical outcomes. METHODS Pretransplant and posttransplant sera from 200 recipients transplanted between May 2007 and August 2011 were tested for DSA (Luminex-based single antigen bead assay) and AT1R-ab (enzyme-linked immunosorbent assay). Two cutoff levels (≥ 17 and ≥ 12 units) were used to define high and intermediate binding of AT1R-ab. Clinical parameters examined were 5-year AMR/CMR (≥ grade 2), coronary artery vasculopathy, and survival. RESULTS At 2 years after transplant, freedom from AMR and/or CMR was 95.4% for those with no DSA (n=175), 66.9% for those with dnDSA (n=19), and 25% for those with DSA at transplant (n=6) (P

A number of studies have reported on treatment outcomes of coronary stenting (PCI) for multivessel coronary artery diseases (MVD), and compared them with the conventional coronary artery bypass grafting (CABG). However, the clinical outcomes of robot-assisted CABG (R-CABG) in comparison with PCI in MVD patients have not been investigated. We recruited retrospectively MVD patients receiving R-CABG and PCI with drug-eluting stents for all vessels in one stage between January 2005 and December 2013 at our institution with at least 3 years of outcomes were retrospectively recruited and analyzed. A total of 638 MVD patients were studied. Among them, 281 received R-CABG, and 357 received PCI. Similar complete revascularizations were achieved in both groups (R-CABG: 40.2%, PCI: 41.5%, P = .751). The residual stenosis was 4.1 ± 4.4 in the R-CABG group, and comparably 3.5 ± 3.7 in the PCI group (P = .077). Patients in the R-CABG group were younger, with more severe coronary artery disease (CAD) and had more background risk factors. The in-hospital and long-term mortalities as well as the incidence of TLR, myocardial infarction (MI), stroke were all similar between groups. But the incidence of TVR and any revascularization were lower in the R-CABG group. The long-term mortality was predicted by age, left ventricular ejection fraction, and chronic kidney disease, but not by the revascularization modality, completeness of revascularization, nor residual SYNTAX scores. The last 3 factors were not predictors of long-term TLR, TVR, MI, and stroke. The in-hospital and long-term survival rates of MVD were similar for both the R-CABG and PCI groups. But the R-CABG group had rates of TVR and any revascularization lower than PCI. Revascularization modality, completeness of revascularization, and residual SYNTAX scores were not predictors of in-hospital and long-term mortalities, MI, and stroke in real-world practice. R-CABG was associated with lower rates of TLR and TVR, and is likely a safe and effective treatment and an alternative choice of PCI for MVD patients who have low surgical risks.

The effect of Internet usage on interpersonal relationship has attracted researchers for decades. Much research indicated that the Internet usage is harmful to the interpersonal relationship. Yet with the quick evolution of Internet functions, Internet provides more channels in latest years for conducting interpersonal interactions, which makes researchers argue that Internet usage can enhance interpersonal relationships. In sum, the past research findings were inconsistent. To explain the contradiction, this study explored the effect on the interpersonal relationships in terms of peer, parent-child, teacher-student, and net-friend from the gender difference and various Internet usage perspectives. Data were gathered from 444 college students for structural equation modeling analysis. The results of this study revealed that Internet usage on social interaction and information seeking can positively affect all kinds of interpersonal relationships. Online game playing can enhance net-friend relationship, but is harmful to teacher-student relationship. Surprisingly, video watching can positively affect peer and parent-child relationships. Besides, through the intermediation of higher game playing, males have lower extent of teacher-student relationship and higher level of net-friend relationship. Contrarily, through the intermediation of lower video watching, males have lower extent of peer relationship and parent-child relationship. This proposed model may more clarify the association of Internet usage and interpersonal relationship than past research.

This study aims to discuss whether game-based learning with the integration of games and digital learning could enhance not only the flow experience in learning but achieve the same flow experience in pure games. In addition, the authors discovered that whether the game-based learning could make learners to reveal higher cognitive load. The effects of computer-assisted learning, computer games, and computer-assisted learning on the fifth-grade students are compared. The results showed that game-based learning is able to promote and achieve the same flow experience in games as well as increase the learners’ cognitive load. However, repeatedly using such software would not present significant difference on cognitive load.

Band selection (BS) is one of the important topics in hyperspectral image data analysis. How to search the representative bands that can effectively represent the image with lower inter-band redundancy remains an issue. This paper develops a sparse-based BS (SpaBS) method which can find those bands in a sequential order. We make an assumption that each band is a linear combination of a set of representative bands, and formulate the BS problem as a sparse regression model where the dictionary matrix and query data matrix are the image itself. We adopt the strategy of group orthogonal matching pursuit (OMP) to efficiently estimate each non-zero row in the coefficient matrix without using any sophisticated optimization tools. The proposed approach, named as SpaBS-OMP, can select band in a progressive manner so that it is applicable to progressive data analysis under data transmission. The experiments show that SpaBS-OMP achieves more favorable classification performance than the traditional methods when the number of selected bands is low.

The use of an implantable cardioverter-defibrillator (ICD) has a proven capacity to prevent sudden cardiac death (SCD), and can also improve survival duration in well-selected patients. The goal of the present study was to investigate the long-term prognosis and predictors of mortalities among ICD recipients in Taiwan.From 1998 to 2009, 238 consecutive patients who experienced SCDs or life-threatening ventricular tachyarrhythmias without correctable causes and received ICD implantations in 3 medical centers (Taipei, Taichung and Kaohsiung Veterans General Hospital) were enrolled in this study. The clinical endpoint was defined as the occurrence of all-cause mortality during the follow-up.The mean age of the patients was 63.0 ± 15.3 years, and 76.5% of them were male. Ischemic cardiomyopathy was the leading cause for the ICD implantations (39.1%). During the mean follow-up duration of 36.8 ± 29.8 months, there were 48 patients (20.2%) who died. Patients with structural heart diseases had a higher mortality rate than those without such diseases. Additionally, old age, low left ventricular ejection fraction (LVEF) and a history of diabetes mellitus (DM) were significant predictors of mortality. The optimal cutoff values for age (70 years) and LVEF (40%) in predicting mortality were further identified using the receiver operating characteristic curves.Based on the ICD registry from 3 medical centers in Taiwan, the annual mortality rate was around 6.6% and was higher in those patients with structural heart diseases. We observed that old age, low LVEF and a history of DM were significant predictors of mortality.Implantable cardioverter-defibrillator; Mortality; Predictor; Taiwan.

In this chapter, an IP-based design for power reduction on a one-dimension, lifting-based discrete wavelet transform (DWT) is presented. The prototype architecture is coded in VerilogHDL and simulated using Quartus-II to verify the function. Based on this prototype architecture, a low-power operator (adder and subtractor) IP, which is designed based on a full-custom design methodology, plays a role in replacing the main operations. The simulation result shows that power consumption can be reduced by 16.31 %. The architecture can be used as an independent IP core of a wavelet-based application.

The phase instability of bismuth perovskite (BiMO 3 ), where M is a ferromagnetic cation, is exploited to create self-assembled magnetic oxide nanocrystal arrays on oxide supports. Conditions during pulsed laser deposition are tuned so as to induce complete breakdown of the perovskite precursor into bismuth oxide (Bi 2 O 3 ) and metal oxide (M-O x ) pockets. Subsequent cooling in vacuum volatizes the Bi 2 O 3 leaving behind an array of monodisperse nanocrystals. In situ refl ective high energy electron diffraction beam is exploited to monitor the synthesis in real-time. Analysis of the patterns confi rms the phase separation and volatization process. Successful synthesis of M-O x , where M = Mn, Fe, Co, and Cr, is shown using this template-free facile approach. Detailed magnetic characterization of nanocrystals is carried out to reveal the functionalities such as magnetic anisotropy as well as larger than bulk moments, as expected in these oxide nanostructures.

The characteristics of institutional investors are that they hold massive funds and possess investment expertise; therefore, these investors are expected to have an influence on corporate governance. This study explores the supervising effect of active and passive institutional investors on company’s earnings management in Taiwan, and whether the supervising effect differs between family and non-family-controlled companies or not. The empirical results show that institutional investors are significantly related to earnings management in both family and non-family-controlled companies. Moreover, active investors have more impact on earnings management than passive ones in family-controlled companies. Institutional investors, especially active investors, have been shown to have significant governance effect; therefore, companies are encouraged to attract institutional investors to enhance corporate governance.

BACKGROUND Immunomodulatory protocols including intravenous immunoglobulin/rituximab (IVIG/R) are employed to decrease anti-human leukocyte antigen (HLA) antibody levels for patients broadly sensitized to HLA and increase chances for transplantation with a compatible deceased donor (DD). The aim of our study was to identify the optimal antibody levels allowing for selection of compatible DDs for these sensitized patients. METHODS From January 2006 to December 2009, 108 patients broadly sensitized to HLA who had reached the top of the DD waitlist were treated with IVIG/R. Antibody levels were monitored monthly by Luminex-based single-antigen bead assay. The antigens identified to produce positive complement-dependent cytotoxicity crossmatches (XMs; >200,000 standard fluorescence intensity [SFI]/10,000 median fluorescence intensity [MFI]) were determined to be unacceptable and entered into the United Network for Organ Sharing database generating the calculated panel reactive antibody (CPRA). The mean CPRA (mCPRA) for this group was more than 80. DDs were selected based on T-cell flow XMs (FXMs) less than 250 MCS and B-cell FXMs less than 300 mean channel shifts (MCS). RESULTS Monthly Luminex-based single-antigen assays showed that the IVIG/R therapy decreased antibody levels for a period of 30 to 120 days. Of the 108 patients treated, 80 (74%) were transplanted and 28 (26%) were not (mCPRA 96 ± 11). Forty-two (53%) patients were transplanted with a positive FXM; 28 (35%) patients (mCPRA 84 ± 25) were transplanted with a negative FXM; and 10 patients (12%; mCPRA 90 ± 19) received zero HLA ABDR mismatched grafts. CONCLUSIONS After therapy, careful selection of acceptable DD involves the antibody profiling strength and XM results. These approaches provide patients broadly sensitized to HLA with an opportunity for compatible DD transplantation.