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A unique approach for assessing the compressive strength (CS) of high-performance concrete (HPC) incorporating blast furnace slag (BFS) and fly ash (FA) has been created using support vector regression (SVR) analytics. In order to identify crucial SVR methodology variables that could be adjusted for improved performance, the Henry gas solubility optimization (HGSO) and Cuckoo search optimization (CSO) algorithms were both employed in this study. The recommended methods were developed utilizing 1030 experiments and eight inputs, including the CS as the forecasting objective, admixtures, aggregates, and curing age as the main mix design component. The results were then contrasted with those from related literature. The estimate results suggest that combined HGSO-SVR and CSO-SVR analysis might perform extraordinarily well in estimating. The Root mean square error value for the HGSO - SVR decreased remarkably when compared to the CSO - SVR. As can be seen from the comparisons, the HGSO - SVR that was built beats anything previously published. In conclusion, the suggested HGSO - SVR analysis might be determined as the proposed system for forecasting the CS of HPC improved with FA and BFS.

Hsisosuchus, with three known species, was the most common genus of crocodyliforms in the Sichuan Basin during the Jurassic. However, the overall shape of the ventral trunk shield of osteoderms has not been clarified due to the lack of complete specimens. A new specimen of Hsisosuchus recently recovered from the Upper Jurassic of Yunnan has the nearly complete ventral trunk shield preserved. This specimen provides an example for the first time for us to understand the shape and the way of the arrangement of the osteoderms in the ventral trunk shield in the genus. Compared with the articulated part of the ventral trunk shield preserved in two of the three species of the genus, the osteoderms of the ventral trunk shield of the new specimen are different in both shape and way of arrangement, indicating that the pattern of the ventral trunk shield is not constant within Hsisosuchus. With no skull and much of the postcranial skeleton poorly preserved as well as no corresponding element that can be used to compare with all the three species, the new specimen was considered as an indeterminate species of Hsisosuchus, awaiting more materials to clarify the problem.

En-Bo Wu,1,* Chia-Chi Hsiao,2,* Kuo-Chuan Hung,3 Chao-Ting Hung,1 Chih-Chun Chen,1 Shao-Chun Wu,1 Jo-Chi Chin,4 I-Wen Chen,3 Sheng-Dean Luo5 1Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 3Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; 4Department of Anesthesiology, Park One International Hospital, Kaohsiung, Taiwan; 5Division of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Kaohsiung, Taiwan*These authors contributed equally to this workCorrespondence: Sheng-Dean Luo, No. 123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 (ext. 2788), Email rsd0323@cgmh.org.tw I-Wen Chen, No. 901, Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan, Tel +886-6-2812811, Email mavising@gmail.comPurpose: Ultrasound-guided interscalene nerve block (UISB) is commonly used to alleviate postoperative pain during shoulder arthroscopy. This retrospective observational study aimed to evaluate the intraoperative advantages and analgesic effects of preoperative UISB.Patients and Methods: In this retrospective observational study, a total of 170 patients underwent shoulder arthroscopy at a tertiary medical center in southern Taiwan throughout 2019. After applying the exclusion criteria, 142 of these cases were included, with 74 and 68 in the UISB group and control groups, respectively. The primary outcome was the evaluation of intraoperative morphine milligram equivalent (MME) consumption. Secondary outcomes were sevoflurane consumption, the use of intraoperative antihypertensive drugs, and postoperative visual analog scale (VAS) scores in the post-anesthesia care unit (PACU) and in the ward at 24 h after surgery.Results: Preoperative UISB effectively reduced opioids and volatile gases during surgery, supported by a 48.1% and 14.8% reduction in the median intraoperative MME and sevoflurane concentrations, respectively, and showed less need for antihypertensive drugs. The preoperative UISB group also showed significantly better performance on the VAS in both the PACU and ward.Conclusion: Taken together, the preoperative UISB reduced not only intraoperative MME and sevoflurane consumption but also had satisfactory VAS scores in both the PACU and ward without any symptomatic respiratory complications. In summary, preoperative UISB is a reliable adjuvant analgesic technique and a key factor in achieving opioid-sparing and sevoflurane-sparing anesthesia and multimodal analgesia during shoulder arthroscopy.Graphical Abstract: Keywords: interscalene block, multimodal analgesia, opioid-sparing anesthesia, shoulder arthroscopy, volatile-sparing anesthesia

A novel photo-induced strategy for oxidation of organosilanes to access silanols, promoted by a photoactive charge-transfer complex (CTC) between sodium benzenesulfinate and molecular O2, has been developed.

背景：思覺失調症是值得社會關注的常見慢性精神疾病。過去許多研究均發現歌唱有助於促進人的心理健康，其中也包括宗教歌曲. 然而，很少人從療效因子的角度去看唱宗教歌曲對慢性思覺失調症患者心理健康的助益. 本文的目的即是從療效因子的角度去比較自由歌唱團體跟基督宗教歌曲歌唱團體對思覺失調病人的助益。方法：本研究之收案對象主要為新北市某兩家精神科康復之家共38位思覺失調症患者，分別接受較具結構化之歌唱團體治療介入、曲目以基督教勵志歌曲為素材，並也讓他們從事非結構化的一般自由歌唱團體，例如卡拉ok。經過八週後，使用療效因子問卷分析這兩種歌唱團體所分別發揮的療效因子之差異。結果：結果發現病人對於12個療效因子的感受皆是較具結構化、以基督教勵志歌曲為素材之歌唱團體治療高於自由歌唱活動，且皆達統計上的顯著值。若比較性別對於音樂治療團體療效因子之影響，發現女性病人在對於「宣洩」這個療效因子的感受比男性強，且達統計上之顯著值。而教育程度對所發揮的療效因子在本研究中並無影響，但年齡對於發展社交技巧、灌輸希望、存在性因子這三個療效因子呈負相關，並達統計上的顯著值。結論：本研究發現較具結構化、以基督教勵志歌曲為素材之歌唱團體治療可比自由放任式的歌唱團體更容易產生療效因子，可供未來研究或臨床做參考。 Background and purpose: Schizophrenia is a serious contemporary mental illness, and many previous investigations have demonstrated that singing is beneficial to people’s mental health, including religion songs. However, few investigations have utilized therapeutic factors to study the benefits of group religion song singing to pa-tients with chronic schizophrenia. The purpose of this investigation is to compare the therapeutic factors between Christian song singing group and free-style singing group of patients with schizophrenia. Methods: This investigation gathered 38 patients with chronic schizophrenia, living at two residential institutions for psychiatric rehabilita-tion, as research subjects. They participated in two singing groups: Christian song singing group, and a general singing group. The differences in therapeutic factors be-tween the two singing groups were analyzed using a therapeutic-factors assessment tool after eight weeks of study. Results: Analytical results show that patients felt more favorably about group religion song singing than about general free-style singing ac-tivity for all 12 therapeutic factors. Additionally, female patients tend to experience “catharsis” more than their male counterparts in therapeutic singing groups. Education level has no influence on therapeutic factors, and age is negatively correlated to three therapeutic factors, namely developing socializing techniques, instillation of hope and existential factor. Conclusion: This study concludes that group religion song singing offers more therapeutic benefits than general free-style group singing for schizophre-nia patients. The latter group therefore is worthy of further promotion. &nbsp

Panfacial fractures are challenging for craniofacial surgeons. Aside from involving multiple subunits, they also lack the reliability of a useful landmark of the facial skeleton. Properly, reducing and fixing palatal fracture to re-establish the premorbid maxillary dental arch is important. This was a retrospective study conducted from 2015 to 2020. All patients underwent computed tomography (CT) scan for surgical planning of orthognathic surgery due to either esthetic or occlusion concerns. The classification of occlusion was recorded as class I, II, and III. The parameters measured on CT were the distance between the midpoint of the supra-orbital foramen/notch (IS), mesio-buccal cusp tips (IB), central fossa (IC), palatal cusp tips (IP), and the midpoint of the palatal marginal gingiva (IM) of the bilateral maxillary first molars. The IS was compared with the IB, IC, IP, and IM. The results were analyzed by using one-way repeated measurement analysis of variance. Eighty-seven patients (36 men and 51 women) were included in the study. There were 13 patients of class I malocclusion, 8 of class II malocclusion, and 66 of class III malocclusion. The IS was comparable to the IC in all three groups. The IS can predict the IC, regardless of the patient's occlusion, and can be subsequently used to decide the width of maxillary dental arch in panfacial fracture management. Further studies are necessary to obtain more definite results.

Aims: Progression of disease within 24 months (POD24) is associated with poor survival in some subtypes of lymphoma.The aim is to identify high-risk patients with localized extranodal natural killer/T-cell lymphoma (ENKTL) and to define clinical factors associated with the risk of early recurrence after antitumor treatment. Methods: The authors retrospectively analyzed 330 cases with localized ENKTL, of which 89 experienced POD24. Results: The 5-year overall survival of the POD24 group was extremely inferior to that of the non-POD24 group. Risk factors for POD24 were Eastern Cooperative Oncology Group performance status ≥2, response evaluation (non-complete remission) after first-line treatment and elevated lactate dehydrogenase concentrations. Also, higher Epstein–Barr virus DNA titer was related to POD24. Based on these data with or without the availability of Epstein–Barr virus DNA, the authors conducted two nomograms to predict POD24, which showed good accuracy with high C statistics. Conclusion: The results showed that POD24 could serve as a marker to identify patients whose medical needs were unmet in ENKTL.

Nanomaterials (NMs) inevitably adsorb proteins in blood and form "protein corona" upon intravenous administration as drug carriers, potentially changing the biological properties and intended functions. Inspired by anti-adhesion properties of natural proteins, herein, we employed the one-bead one-compound (OBOC) combinatorial peptide library method to screen anti-adhesion peptides (AAPs) against proteins. The library beads displaying random peptides were screened with three fluorescent-labeled plasma proteins. The nonfluorescence beads, presumed to have anti-adhesion property against the proteins, were isolated for sequence determination. These identified AAPs were coated on gold nanorods (GNRs), enabling significant extension of the blood circulating half-life of these GNRs in mice to 37.8 h, much longer than that (26.6 h) of PEG-coated GNRs. In addition, such AAP coating was found to alter the biodistribution profile of GNRs in mice. The bioinspired screening strategy and resulting peptides show great potential for enhancing the delivery efficiency and targeting ability of NMs.

Neoadjuvant therapy (NAT) treats early-stage breast cancers, especially triple-negative breast cancers (TNBCs). NAT improves pathological complete response (pCR) rates for different breast cancer patients. Recently, immune checkpoint inhibitors that target programmed death 1 (PD-1) or programmed death ligand 1 (PD-L1) in combination with NAT have shown antitumor activity in patients with early breast cancer. However, the tumor immune microenvironment (TME) in different subtypes of breast cancers, like TNBC, hormone receptor-positive (HR+), and human epidermal growth factor receptor 2 amplified (HER2+) and its changes by NAT remain to be fully characterized. We analyzed pre-NAT tumor biopsies from TNBC (n = 27), HR+ (n = 24), and HER2+ (n = 30) breast cancer patients who received NAT, followed by surgery. The different immune makers (PD-1, PD-L1, CD3, and CD8) of tumor-infiltrating lymphocytes (TILs) were identified with immunofluorescence-based microenvironment analysis. TILs within cancer parenchyma (iTILs) and in cancer stroma (sTILs) were counted separately. We found that PD-L1+ cells in tumor and stroma were significantly higher in TNBC patients than in others. PD-L1+ sTILs were significantly higher in pCR than in non-pCR patients of all the subtypes. The infiltration scores of B-cell memory, T-cell CD4+ memory activated, T-cell follicular helper, and Macrophage M0 and M1 were relatively higher in TNBC patients, indicating immunoreactive TME in TNBC. Analysis of TCGA-BRCA RNA-seq indicated that PD-L1 was highly expressed in TNBC patients compared with HR+ and HER2+ patients. Higher PD-L1 expression in TNBC patients was associated with significantly longer overall survival (OS). Our results demonstrated that PD-L1 expression level of iTILs and sTILs is highest in TNBC among breast cancers. TNBC patients had significantly different immunoreactive TME compared with HR+ and HER2+ patients, suggesting potentially favorable outcomes for immunotherapy in these patients. Also, PD-L1+ could be a powerful predictor of pCR in TNBC patients after NAT.

Interfacility transfer (IFT) in Asian communities is seldom discussed. We aimed to describe the characteristics of IFT in Taiwan and to explore the adequacy of care during transfer.A retrospective, cross-sectional, descriptive study was conducted using standardized, paper-based interfacility ambulance transfer records between 1 January 2018 and 31 January 2018 from Tainan City, Taiwan. The mode of patient care needed was classified as advanced life support (ALS) or basic life support (BLS) cares based on clinical conditions. ALS providers were defined as physicians and EMT-Paramedics, while BLS providers were defined as nurse practitioners, nurses, EMT-1s and EMT-2s.Of the 377 (227 [60.2%] were65 years old; 219 [58.1%] were male) IFTs enrolled in the final analysis, 210 (55.7%) patients met the ALS transfer criteria, with poor consciousness (n = 158), tachypnea (n = 17), tachycardia (n = 5), bradycardia (n = 7), hypertension (n = 12), hypotension (n = 13), hypoxia (n = 4), endotracheal intubation (n = 18), a tracheostomy (n = 25), a precipitous labor (n = 1), and after resuscitation for out-of-hospital cardiac arrest (n = 10) or in-hospital cardiac arrest (n = 3). None of the patients who required ALS care had adequate ambulance staffing. Of the 167 BLS IFTs, 9 (5.4%) patients deteriorated and required ALS care during transportation, which included worsened consciousness (n = 2), tachycardia (n = 1), hypertension (n = 2), hypotension (n = 1), and hypoxia (n = 3). The rates of deterioration during BLS-transferals from the emergency departments, general wards, nursing facilities, and unknown areas were 4.8%, 4.7%, 7.7%, and 7.1%, respectively (p = 0.93).The patient care during IFT in Taiwan is inadequate currently and should warrant attention.

Lymphoma-associated hemophagocytic syndrome (LAHS) is a rare and life-threatening clinical syndrome with rapidly deteriorating health and high mortality. We retrospectively analyzed clinical features and prognostic factors from 117 patients diagnosed with LAHS. The cumulative incidence rate of LAHS was 4.0% (117/2906). Patients were classified into B-cell LAHS (B-LAHS, n = 22) and T/natural killer (NK)-cell LAHS (T/NK-LAHS, n = 95) groups. Patients with T/NK-LAHS were younger and had lower neutrophil counts and fibrinogen values, higher LDH and transaminase levels, and were more likely to develop hemophagocytic syndrome (HPS) during the clinical course than those with B-LAHS. The median survival time for the entire cohort was 57 days, and for the T/NK-LAHS and B-LAHS groups, it was 52 and 154 days, respectively, after the diagnosis of LAHS. Patients with B-LAHS had superior 1-year OS (