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Cigu wetland consists of industrial salt ponds and lagoon is situated at the coast in the southwestern of Taiwan which is demarcated as Coastal Nature Reserve. The salt ponds experienced declines in bird species diversity and population compared with those within the lagoon area due to the deeper water depths. Different kinds of measures to alter water depths of salt ponds by filling soil are proposed. The hydrodynamic simulations were conducted for studying the hydrodynamic response to proposed reconstruction alternatives. The potential waterbird abundance was then estimated for the alternative recommendation. The methodology proposed in this study can reduce the risk of unexpected results by implementing the reconstruction project directly.

Yi-Chia Su,1 Chip-Jin Ng,1– 3 Liang-Tien Chien,4,5 Li-Heng Tsai,1,2 Cheng-Yu Chien,1,2,6,7 Shou-Chien Hsu1,2,8 1Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; 2Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan; 3Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan; 4Graduate Institute of Management, College of Management, Chang Gung University, Taoyuan, Taiwan; 5Taoyuan Fire Department, Taoyuan, Taiwan; 6Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan; 7Department of Senior Service Industry Management, Minghsin University of Science and Technology, Hsinchu, Taiwan; 8Department of Occupational Medicine, Chang Gung Memorial Hospital, Linkou Branch, Taoyuan, TaiwanCorrespondence: Shou-Chien Hsu, Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, No. 5 Fushing Street, Gueishan District, Taoyuan City, 333, Taiwan, Tel +886-3-3281200 &num; 2505, Fax +886-3-3287715, Email otsuka32@gmail.comPurpose: Various factors, such as event location and response time, influence the outcomes of out-of-hospital cardiac arrest (OHCA). Very few studies have explored the delivery of basic life support (BLS) to patients having OHCA at health clinics or nursing homes—settings with professional BLS providers. Thus, in this study, we compared prognostic and survival outcomes between health clinics, nursing homes, and other public places (eg, workplaces and sports facilities/recreational areas) to offer insights for optimizing OHCA outcomes.Patients: This study included adults who had nontraumatic OHCA in Taoyuan City between January 2017 and December 2022.Methods: We collected data on patient characteristics, emergency medical service parameters, onsite patient management, automated external defibrillator (AED) locations, OHCA prognosis, and survival outcomes. Multivariate analyses were performed to predict survival to discharge (primary outcome) and neurological outcomes at discharge (secondary outcome).Results: During the study period, the numbers of OHCA events at health clinics, nursing homes, and other public places were 158, 208, and 1986, respectively. The mean age of OHCA in health medical clinics, nursing home and other public places were 63.4, 81.5 and 64.7, respectively (P value< 0.001). The proportion of witnessed events, rate of bystander resuscitation, and frequency of AED utilization were the highest for health clinics (53.2% (84/158), 83.4% (132/158), and 13.3% (21/158), respectively, P value< 0.001). The average AED–scene distances and response times were the lowest for health clinics (388.8 m and 5.4 min, respectively). In initial shockable rhythm group, the probabilities of survival to discharge at discharge were the highest for health clinics (aOR=1.41, 95% CI=1.04– 1.81, P value=0.041)) and lowest for nursing homes (aOR=0.84, 95% CI=0.76– 0.93, P value=0.024).Conclusion: Our research shows that OHCA patients at medical health clinics have higher rates of witnessing and bystander CPR and AED usage than other public places. However, while survival rates for patients with shockable rhythms are slightly better at health clinics, the neurological outcomes are not significantly different. The AED–scene distances are too far to be used effectively.Keywords: public access defibrillators, geographic information system, out-of-hospital cardiac arrest, automated external defibrillators, emergency medical services

Abstract Background and Aims Multicomponent exercise interventions are recommended for older adults and for those with chronic diseases. While multiple programs have been tested, no one has yet explored how these programs were developed. This review set out to determine what development steps multicomponent exercise intervention studies that include older adults with multimorbidity have taken. Methods Systematic review and narrative synthesis. Results One hundred and thirty‐eight studies meeting review criteria (Population: adults ≥60 years with multimorbidity; Intervention: exercise interventions with ≥2 components; Comparator: any considered; Outcome: any considered) were retrieved. Most studies (70%) do not report intervention development actions as suggested by available guidance. Notable deviations from recommendations include limited performance of systematic review of previously published evidence, lack of engagement with theory, and few examples of design then refine. Conclusions Exercise interventions for older adults with multimorbidity do not appear to follow best practice in terms of their developing. Disregard of development recommendations risks contributing to research redundancy and/or avoidable waste, as important steps that make sure the intervention is warranted, suitable for the population in question, and tested using optimal methods and outcome measures are overlooked.

We explore flexoelectro-optic effect in polymer stabilized cholesteric liquid crystals (CLC) with uniform lying helix texture. A method to enlarge the flexoelectric response of the CLC mixture is demonstrated by mixing two nematic liquid crystal host materials with large and small effective flexoelastic coefficients. By a choice of material composition of CLC mixture, a large angle of flexoelectrically driven in-plane rotation of helical axis with a submillisecond response time is obtained. Our findings will be useful for material design of future CLC mixtures for applications in flexoelectro-optic displays. [ABSTRACT FROM AUTHOR]

OBJECTIVE: Immune checkpoint inhibitors (ICIs) are a major advance in cancer treatment, but their payment benefits are unclear, resulting in financial risk. In Taiwan, the National Health Insurance Administration (NHIA) has adapted risk-sharing mechanisms to cover ICIs by collecting and assessing real-world evidence, such as case registration data, to adjust benefit packages for each medication, increase payment benefits of ICIs, and enable national health insurance sustainability. PATIENTS AND METHODS: This nationwide, multicenter, retrospective cohort study assessed the real-world use, effectiveness, and safety of ICIs reimbursed by the NHIA for treating multiple advanced cancers in Taiwan. We obtained data mainly from the NHIA Immune Checkpoint Inhibitor Registry Database. RESULTS: Between April 1, 2019, and March 31, 2020, 1644 patients received at least one dose of ICIs. The overall response rate (RR) was 29.1%. The metastatic urothelial carcinoma of patients ineligible for chemotherapy showed the highest RR. The estimated median progression-free survival (PFS) was 2.8 months (95% confidence interval [CI]=2.7-3 months), and renal cell carcinoma showed the longest PFS. The median PFS was reached in patients with most cancers except classic Hodgkin's lymphoma, which had a small sample size. The estimated survival probability was 50%. CONCLUSIONS: Under the national registration tracking system, Taiwan's high-cost drug policy has enabled access to new medicines and maximized patient benefits. [ABSTRACT FROM AUTHOR]

This is the case of a 45-year-old male who presented with dysuria and gross hematuria. Ultrasonography and computed tomography revealed an enormous pelvic cystic lesion and a right nephromegaly but an invisible left kidney. Using the imaging findings, the patient was diagnosed with Zinner syndrome. Transperitoneal laparoscopic excision of the cyst was performed for symptom relief. At post-treatment, the symptoms disappeared, and sexual function remained. Seminal vesicle cysts have been commonly reported in previous studies but rarely in this case. Furthermore, most previous studies have documented surgical excision of

The COVID-19 outbreak has altered how visitors live, including in the tourism sector. The current study investigates tourist behavior in virtual tourism during the COVID-19 pandemic using the framework of the theory of planned behavior (TPB) and behavior intention. The study included 217 people who utilized virtual tourism for tourists’ during the COVID-19 pandemic. The data are analyzed using Structural Equation Modelling Partial Least Squares (SEM-PLS). According to the findings, the TPB framework, such as attitude toward virtual tourism, subjective norms, and perceived behavior control, have a favorable and substantial influence on satisfaction. Satisfaction with virtual tourism significantly influences attitude change and willingness to visit the actual tourist destination. The study’s implications relate to marketers and stakeholders to provide virtual tourism as a promotion tool of a destination in Indonesia for tourists during the pandemic or crises.

The adipose-derived hormone leptin acts via its receptor (LepRb) in the brain to control energy balance. A potentially unidentified population of GABAergic hypothalamic LepRb neurons plays key roles in the restraint of food intake and body weight by leptin. To identify markers for candidate populations of LepRb neurons in an unbiased manner, we performed single-nucleus RNA-Seq of enriched mouse hypothalamic LepRb cells, identifying several previously unrecognized populations of hypothalamic LepRb neurons. Many of these populations displayed strong conservation across species, including GABAergic Glp1r-expressing LepRb (LepRbGlp1r) neurons, which expressed more Lepr than other LepRb cell populations. Ablating Lepr from LepRbGlp1r cells provoked hyperphagic obesity without impairing energy expenditure. Similarly, improvements in energy balance caused by Lepr reactivation in GABA neurons of otherwise Lepr-null mice required Lepr expression in GABAergic Glp1r-expressing neurons. Furthermore, restoration of Glp1r expression in LepRbGlp1r neurons in otherwise Glp1r-null mice enabled food intake suppression by the GLP1R agonist, liraglutide. Thus, the conserved GABAergic LepRbGlp1r neuron population plays crucial roles in the suppression of food intake by leptin and GLP1R agonists.

Keloids are benign, fibroproliferative dermal tumors that typically form owing to abnormal wound healing. The current standard of care is generally ineffective and does not prevent recurrence. To characterize keloid scars and better understand the mechanism of their formation, we performed transcriptomic profiling of keloid biopsies from a total of 25 subjects of diverse racial and ethnic origins, 15 of whom provided a paired nonlesional sample, a longitudinal sample, or both. The transcriptomic signature of nonlesional skin biopsies from subjects with keloids resembled that of control skin at baseline but shifted to closely match that of keloid skin after dermal trauma. Peripheral keloid skin and rebiopsied surrounding normal skin both showed upregulation of epithelial–mesenchymal transition markers, extracellular matrix organization, and collagen genes. These keloid signatures strongly overlapped those from healthy wound healing studies, usually with greater perturbations, reinforcing our understanding of keloids as dysregulated and exuberant wound healing. In addition, 219 genes uniquely regulated in keloids but not in normal injured or uninjured skin were also identified. This study provides insights into mature and developing keloid signatures that can act as a basis for further validation and target identification in the search for transformative keloid treatments.

Wei-Chun Lin,1– 3 Chien-Hsiung Huang,2– 4 Liang-Tien Chien,4,5 Hsiao-Jung Tseng,6,7 Chip-Jin Ng,2,3,8 Kuang-Hung Hsu,2,3,9– 12 Chi-Chun Lin,2,3,13 Cheng-Yu Chien2– 4,13,14 1Department of Emergency Medicine, New Taipei Municipal TuCheng Hospital and Chang Gung University, New Taipei City, Taiwan; 2Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 4Graduate Institute of Management, Chang Gung University, Taoyuan, Taiwan; 5Fire Department, Taoyuan City Government, Taoyuan, Taiwan; 6Department of Statistics and Information Science, Fu Jen Catholic University, New Taipei City, Taiwan; 7Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 8Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan; 9Laboratory for Epidemiology, Chang Gung University, Taoyuan, Taiwan; 10Laboratory for Epidemiology, Department of Health Care Management, Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; 11Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan; 12Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan; 13Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan; 14Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, TaiwanCorrespondence: Cheng-Yu Chien, Department of Emergency Medicine, Chang Gung Memorial Hospital, No. 5 Fushing St., Gueishan Dist, Taoyuan City, Taiwan, Tel +886-3-3281200 &num; 2505, Fax +886-3-3287715, Email rainccy217@gmail.comObjective: The authors performed several tree-based algorithms and an association rules mining as data mining tools to find useful determinants for neurological outcomes in out-of-hospital cardiac arrest (OHCA) patients as well as to assess the effect of the first-aid and basic characteristics in the EMS system.Patients and Methods: This was a retrospective cohort study. The outcome was Cerebral Performance Categories grading on OHCA patients at hospital discharge. Decision tree-based models inclusive of C4.5 algorithm, classification and regression tree and random forest were built to determine an OHCA patient’s prognosis. Association rules mining was another data mining method which we used to find the combination of prognostic factors linked to the outcome.Results: The total of 3520 patients were included in the final analysis. The mean age was 67.53 (± 18.4) year-old and 63.4% were men. To overcome the imbalance outcome issue in machine learning, the random forest has a better predictive ability for OHCA patients in overall accuracy (91.19%), weighted precision (88.76%), weighted recall (91.20%) and F1 score (0.9) by oversampling adjustment. Under association rules mining, patients who had any witness on the spot when encountering OHCA or who had ever ROSC during first-aid would be highly correlated with good CPC prognosis.Conclusion: The random forest has a better predictive ability for OHCA patients. This paper provides a role model applying several machine learning algorithms to the first-aid clinical assessment that will be promising combining with Artificial Intelligence for applying to emergency medical services.Keywords: cardiac arrest, tree-based algorithms, data mining

Background This scoping review aims to provide a summary of the use of three-dimensional (3D) printing in colorectal surgery for the management of complex intestinal fistula and ostomy creation.

Adipose tissue is a promising target for treating obesity and metabolic diseases. However, pharmacological agents usually fail to effectively engage adipocytes due to their extraordinarily large size and insufficient vascularization, especially in obese subjects. We have previously shown that during cold exposure, connexin43 (Cx43) gap junctions are induced and activated to connect neighboring adipocytes to share limited sympathetic neuronal input amongst multiple cells. We reason the same mechanism may be leveraged to improve the efficacy of various pharmacological agents that target adipose tissue. Using an adipose tissue-specific Cx43 overexpression mouse model, we demonstrate effectiveness in connecting adipocytes to augment metabolic efficacy of the β3-adrenergic receptor agonist Mirabegron and FGF21. Additionally, combing those molecules with the Cx43 gap junction channel activator danegaptide shows a similar enhanced efficacy. In light of these findings, we propose a model in which connecting adipocytes via Cx43 gap junction channels primes adipose tissue to pharmacological agents designed to engage it. Thus, Cx43 gap junction activators hold great potential for combination with additional agents targeting adipose tissue.