Search

Background Although the medial joint space width (MJSW) is commonly used for radiographic evaluation of knee osteoarthritis, the changes in knee joint space width (JSW) during weight bearing after medial opening-wedge high tibial osteotomy (MOWHTO) remain unclear. This study aimed to depict how medial and lateral JSWs and convergence angles change gradually after MOWHTO. Methods We retrospectively followed up 81 MOWHTO cases for over 45 months on average. Pre- and postoperative mechanical axes were recorded. The JSWs and convergence angles were measured preoperatively, immediately postoperatively, and 3–6, 9–12, and 21–24 months postoperatively. Patient-reported outcomes were measured using a visual analogue scale (VAS). Results The mean mechanical femoral-tibial angle improved from 8.1° varus to 2.4° valgus. At the aforementioned times, the respective mean values of MJSW were 2.6, 3.5, 3.8, 4.0, and 4.2 mm; mean convergence angles were 4.8°, 2.9°, 2.2°, 2.1°, and 1.9°; and the mean VAS scores were 7.2, 7.8, 4.8, 1.4, and 1.3. The MJSW continued to increase significantly in the first year postoperatively and then plateaued for a minimum of 2 years follow up after MOWHTO. The convergence angle decreased significantly in the first 6 months postoperatively and was then maintained. Conclusions The MJSW, convergence angle, and VAS scores continued to improve through weight bearing during the first year after MOWHTO and were maintained for at least 2 years. Thus, JSW measurement may be an easy and representative way of radiographically monitoring the effect of MOWHTO.

Toward finding low-cost electrocatalysts with high catalytic properties to replace noble metals as high efficient electrocatalysts in electrochemical hydrogen evolution reaction (HER) of total water splitting plays a vital role to approach the green and sustainable energy supply. Here, we demonstrate the direct growth of novel copper phosphide coated with amorphous carbon, namely heterostructured a-C/Cu3P peapod nanowires from chemically synthesized copper nanowires (Cu NWs) followed by a chemical vapor phosphorization reaction (CVPR) process at a low temperature of 400 °C. The heterostructured a-C/Cu3P peapod nanowires exhibit a superior electrocatalytic activity by a lower overpotential of 287 mV at a current density of 10 mA cm−2 with a low Tafel slope of 72 mV dec−1 and excellent stability over 1000 cycles. The superior electrocatalytic performance can be explained by the superior contact of the electrolyte with active sites on the heterostructured a-C/Cu3P due to the high surface area of peapod nanowire structure covered by defective edges of graphene with the encapsulated amorphous carbon layer, which can tremendously enhance electrical conductivity at the surface.

Morphine is widely used for the treatment of severe pain. This analgesic effect is mediated principally by the activation of μ-opioid receptors (MOR). However, prolonged activation of MOR also results in tolerance, dependence, addiction, constipation, nausea, sedation, and respiratory depression. To address this problem, we sought alternative ways to activate MOR – either by use of novel ligands, or via a novel activation mechanism. To this end, a series of compounds were screened using a sensitive CHO-K1/MOR/Gα15 cell-based FLIPR® calcium high-throughput screening (HTS) assay, and the bithiazole compound 5a was identified as being able activate MOR in combination with naloxone. Structural modifications of 5a resulted in the discovery of lead compound 5j, which could effectively activate MOR in combination with the MOR antagonist naloxone or naltrexone. In vivo, naloxone in combination with 100 mg/kg of compound 5j elicited antinociception in a mouse tail-flick model with an ED50 of 17.5 ± 4 mg/kg. These results strongly suggest that the mechanism by which the 5j/naloxone combination activates MOR is worthy of further study, as its discovery has the potential to yield an entirely novel class of analgesics.

The effects of influenza vaccination (IV) on stroke outcomes are unclear. The purpose of this study is to evaluate the outcomes after stroke in elderly individuals who have received an IV.We used Taiwan's National Health Insurance Research Database 2000-2009 claims data to conduct a nested stroke cohort study including 148,909 hospitalized stroke patients aged 66 years and older. Using a matching procedure by propensity score, we selected 25,248 stroke patients with IV and 25,248 stroke patients without IV for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs of post-stroke complications and in-hospital mortality associated with IV.Stroke patients with IV had significantly lower risks of post-stroke pneumonia (OR = 0.79; 95% CI, 0.74-0.83), septicemia (OR = 0.78; 95% CI, 0.70-0.86), urinary tract infection (OR = 0.87; 95% CI, 0.83-0.92), and 30-day in-hospital mortality (OR = 0.60; 95% CI, 0.54-0.67) compared with non-IV stroke patients. Vaccinated stroke patients also had shorter hospital stays (p 0.0001) and less medical expenditures (p 0.0001) during stroke admission than the control group. Lower rates of post-stroke adverse events in patients with IV were noted in both sexes of all age groups with various types of stroke.Stroke patients with IV showed fewer complications and lower mortality compared with non-IV patients. These findings suggest the urgent need to promote IV for this susceptible population of stroke patients.

Background and aims The risk of stroke in epileptic patients and the impact of epilepsy history on stroke patients’ outcome have not been studied completely. Our purpose is to evaluate whether patients with epilepsy have increased risk of stroke or post-stroke mortality. Methods In Study I, we conducted a retrospective cohort study of 6746 patients with newly diagnosed epilepsy and 26,984 persons without epilepsy between 2000 and 2008, in the database of National Health Insurance in Taiwan. The incidences and risks of stroke during the follow-up period were compared between cohorts until the end of 2013. In Study II, we conducted a nested cohort study of 484,990 hospitalized patients with newly diagnosed stroke between 2000 and 2009. We compared the short-term mortality and complications during stroke admission between stroke patients with previous epilepsy and those without epilepsy. Results The epileptic cohort had an increased stroke risk (hazard ratio [HR] 2.24, 95% CI 2.02 to 2.49). The relationship between epilepsy and stroke risk remains significant in every age group and both sexes. Among hospitalized stroke patients, history of epilepsy was associated with complications, including pneumonia (odds ratio [OR] 1.08, 95% CI 1.00 to 1.18), urinary tract infection (OR 1.16, 95% CI 1.08 to 1.26), and longer stay (p Conclusions Epileptic patients face increased stroke risk and adverse outcomes of stroke admission. It is necessary to develop a prevention strategy for stroke in epileptic patients.

Chemical forensics is a new field that collects and attributes chemical information of physical evidence to their sources. Ideally, from a chemical forensic analysis, one can identify chemical signatures of physical evidence and use them to classify or trace the source of it. Headspace chemical forensics is a subdiscipline of chemical forensics which attempts to detect origins or characteristics of physical evidence from headspace chemical signatures. To demonstrate the concept of headspace chemical forensics, marijuana samples with known levels of tetrahydrocannabinol (THC) and cannabidiol (CBD) were analyzed by heated headspace solid phase micro extraction coupled with gas chromatography/mass spectrometry (HHS-SPME-GC/MS). Headspace chemical features representing phytocannabinoid profiles were selected based on retention time zones of total ion chromatogram (TIC). With this feature selection, variations of TICs collected from different botanical structures in the same group of marijuana variety was minimized before learning process. This analytical platform of headspace chemical analysis combining with machine learning algorithm provided a nearly non-destructive way to classify marijuana varieties without an analyst’s interpretation of chromatograms. The model was able to distinguish marijuana varieties with satisfactory performance. The experimental results demonstrated that headspace chemical analysis approach is a promising analytical platform for chemical forensics. The combination of headspace chemical analysis and machine learning data processing schemes offers a great potential to improve the scope of current forensic analysis of marijuana evidence.

Twenty five novel chemical analogs of the previously reported Aurora kinase inhibitor BPR1K653 (1-(4-(2-((5-chloro-6-phenylfuro[2,3-d]pyrimidin-4-yl)amino)ethyl)phenyl)-3-(2-((dimethylamino)methyl)phenyl)urea) have been designed, synthesized, and evaluated by Aurora-A and Aurora-B enzymatic kinase activity assays. Similar to BPR1K653, analogs 3b-3h bear alkyl or tertiary amino group at the ortho position of the phenylurea, and showed equal or better inhibition activity for Aurora-B over Aurora-A. Conversely, preferential Aurora-A inhibition activity was observed when the same functional group was moved to the meta position of the phenylurea. Compounds 3m and 3n, both of which harbor a tertiary amino group at the meta position of the phenylurea, showed 10–16 fold inhibition selectivity for Aurora-A over Aurora-B. The in vitro kinase inhibition results were verified by Western blot analysis, and indicated that compounds 3m and 3n were more than 75-fold superior in inhibiting T-loop autophosphorylation of Aurora-A (Thr288), compared to Aurora-B (Thr232) in HCT116 colon carcinoma cells. The computational docking analysis suggested that the tertiary amine at the meta position of the phenylurea formed a more stable interaction with residues in the back pocket of Aurora-A than in Aurora-B, a possible explanation for the observed discrepancy in the selectivity. These results support an alternative small molecule design strategy targeting the back pocket of Aurora kinases for selective isoform inhibition.

Graded 2D perovskite capping shells with continuously upshifting valence bands, produced by tailored dimensional engineering, can effectively extract holes from 3D perovskite cores. Real-space observation of electronic structures will fully reveal the operating mechanisms of 2D/3D hybrid perovskite solar cells (PSCs). Here, for the first time, light-modulated scanning tunneling microscopy visualizes the cross-sectional band alignment across 2D (C4H9NH3)2(CH3NH3)n-1PbnI3n+1/3D CH3NH3PbI3 stacked perovskites. By systematically analyzing their electronic configuration, the mixed-dimensional perovskite band structure along the vertical 3D-to-2D direction can be spatially resolved. Remarkably, the electric field in the 2D perovskite is larger under light illumination than under dark conditions, resulting in an increase in the concentration of holes and electrons distributed in the 2D and 3D perovskites, respectively. Benefiting from this electronic reconstruction, charge recombination is suppressed, thereby significantly promoting the 2D/3D PSC performance. Moreover, our method opens an avenue for direct, local mapping of optoelectronic device energy levels.

Botryococcus braunii , a green colonial microalga, is a prodigious producer of liquid hydrocarbon oils that can be used as renewable feedstocks for producing combustion engine fuels. The B race of B. braunii mainly produces the triterpene hydrocarbons known as botryococcenes, which have over twenty known structures. Minor hydrocarbons in the B race include the triterpene methylsqualenes. Here we report an examination of the molecular structure for ten botryococcenes and five methylsqualenes using Raman spectroscopy and density functional theory (DFT) calculations in an effort to distinguish between these structurally similar molecules by spectroscopic approaches. The DFT calculations show that these molecules have between 243 and 271 vibrational frequencies. A comparison of the experimental Raman spectroscopy and DFT calculations indicates several spectral regions such as those for ν(C C) stretching, CH 2 /CH 3 bending, and ring bending can be used to distinguish between these molecules. In an extension of this analysis, a broadband coherent anti-Stokes Raman spectroscopy (BCARS) analysis was used to clearly distinguish between several botryococcenes isomers.

The relationship between stroke and diabetes is not completely understood. This study evaluated diabetes risk and post-diabetes adverse events in patients with stroke.We identified 10,255 adults, newly diagnosed with stroke from 2000 to 2005, using the Taiwan's National Health Insurance Research Database. A comparison cohort of 41,020 adults without stroke was randomly selected from the same dataset, frequency matched by age and sex. Diabetes events from 2000 to 2013 were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% CIs were calculated for diabetes associated with stroke. A nested cohort study of 33,437 patients with inpatient care for diabetes between 2008 and 2013 was conducted to calculate the adjusted odds ratios (ORs) and 95% CIs for adverse events after diabetes, in patients with and without stroke.During 489,561 person-years of follow-up, there were 10,742 newly diagnosed diabetes cases. The incidence of diabetes for people with and without stroke was 43.9 and 17.8 per 1000 person-years, respectively (p 0.0001). Compared to that for people without stroke, the adjusted HR for diabetes was 2.69 (95% CI 2.56-2.82) for stroke patients. The ORs of post-diabetes pneumonia, urinary tract infection, and mortality associated with stroke were 1.35 (95% CI 1.17-1.55), 1.52 (95% CI 1.36-1.70), and 1.71 (95% CI 1.27-2.29), respectively.We provide evidence that the consequences of stroke are not limited to the neurological defect, but evoke diabetes and a plethora of associated medical, psychological and social impacts the physician must be strongly aware of if evaluating and treating stroke patients.

Background/PurposeIdentification of risks of mortality for carbapenem-resistant Acinetobacter baumannii (CRAB), with early implementation of an appropriate therapy, is crucial for the patients' outcome. The aim of this study was to survey mortality risk factors in 182 patients with CRAB bacteremia in a medical center in Taiwan.MethodsA total of 182 isolates of CRAB bacteremia were collected from 2009 to 2012 in Mackay Memorial Hospital, Taipei, Taiwan These isolates were identified by using the genotypic method. Risk of attributable mortality analysis was carried out with a Cox proportional hazards model.ResultsThe 182 CRAB isolates belonged to 38 different pulsotypes. The attributable mortality rate of the 182 patients was 58.24%. The risk factors for attributable mortality included intensive care unit stay [hazard ratio (HR): 2.27; p = 0.011], an Acute Physiology and Chronic Health Evaluation II score of >20 (HR: 2.19; p

Pancreatic cancer is the eighth leading cause of cancer-related deaths in Taiwan. Pancreatic cancer has a poor prognosis. Diagnosis of early-stage pancreatic cancer, which can be defined based on resectability, size, or curability, will improve survival. Diagnostic tools for pancreatic cancer include transabdominal ultrasonography, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography (ERCP), and endoscopic ultrasound (EUS). We report the case of a 48-year-old man who presented with progressively yellowing skin. An CT imaging study did not reveal the pancreatic lesion. Further imaging with EUS was performed to search for the organic lesion causing an abrupt distal common bile duct stricture, and a heterogeneous hypoechoic tumor located at the uncinate process was identified. The patient underwent a Whipple operation because malignancy could not be ruled out. The final pathological result was moderate to poorly differentiated adenocarcinoma.

Higher levels of genetic diversity were reported among the central populations of many mangrove species (Avicennia, Rhizophora, Bruguiera, Ceriops, Xylocaprus and Sonneratia) in the Indo-West Pacific (IWP) than those in the range limits. Interestingly, the highest proportions of variation were coming from individuals, and in some cases, among populations based on hierarchical analysis of molecular variance (AMOVA). Molecular data suggest that Malay Peninsula was considered as the undisputed geographic barrier causing genetic differentiation among populations in the IWP region. This strong genetic structuring produced divergence among mangrove populations of Indian Ocean and South China Sea. A cryptic barrier was also observed by distinct genetic clusters between South China Sea and Southwestern Pacific using high resolution markers such as chloroplast DNA (cpDNA) intergenic spacers and nuclear loci. It was surmised that the rise of the Sunda Shelf after sea level drop in the past glaciation periods resulted in limited gene flow, and to a greater extent, isolation by genetic drift among populations between the two sub-regions. Populations at the distribution margin having high genetic diversity were likely attained by the introgression of varieties due to sea level oscillations. The recent geo-climatic changes that raised awareness to species extinction, will likely affect vulnerable mangroves either to genetic bottlenecks or worse extinction. Previous literature claimed that overexploitation of mangroves will also push them to extinction. Therefore, this review on the current genetic diversity studies can provide insights for conservation strategies in the light of combined human and physical forces that impact these mangrove species.

Ethnopharmacological relevance The use of traditional Chinese medicine (TCM) was high in stroke patients but limited information was available on whether TCM is effective on post-stroke outcomes. The aim of this study is to compare the outcomes of stroke patients with and without receiving adjuvant TCM therapy. Materials and methods Using Taiwan's National Health Insurance Research Database, we conducted a nationwide cohort study and selected hospitalized stroke patients receiving routine care with (n=1734) and without (n=1734) in-hospital adjuvant TCM therapy by propensity score matching procedures. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of poststroke complications and mortality associated with in-hospital adjuvant TCM therapy were calculated. The use of medical resource was also compared between stroke patients with and without adjuvant TCM therapy. Results Compared with hospitalized stroke patients receiving routine care alone, hospitalized stroke patients receiving routine care and adjuvant TCM therapy exhibited decreased risks of urinary tract infection (HR 0.82, 95% CI 0.68-1.00), pneumonia (HR 0.60, 95% CI 0.47-0.76), epilepsy (HR 0.67, 95% CI 0.49-0.96), gastrointestinal hemorrhage (HR 0.68, 95% CI 0.47-0.98), and mortality (HR 0.37, 95% CI 0.19-0.70) within 3 months after stroke admission. The corresponding 6-month HRs for urinary tract infection, pneumonia, gastrointestinal hemorrhage, and mortality were 0.83, 0.63, 0.64, and 0.40, respectively. Less use and expenditure of hospitalization were found in those received adjuvant TCM therapy. Conclusions Hospitalized stroke patients who received routine care and adjuvant TCM therapy exhibited reduced adverse outcomes after admission within a 6-month follow-up period.

Background Factors associated with poststroke adverse events were not completely understood. The purpose of this study was to investigate whether stroke patients with previous pressure ulcers had more adverse events after stroke. Methods Using the claims data from Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study matched by propensity score. Three thousand two first-ever stroke patients with previous pressure ulcer and 3002 first-ever stroke patients without pressure ulcer were investigated between 2002 and 2009. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of complications and 30-day mortality after stroke associated with previous pressure ulcer were calculated in the multivariate logistic regressions. Results Patients with pressure ulcer had significantly higher risk than control for poststroke urinary tract infection (OR: 1.56, 95% CI: 1.38-1.78), pneumonia (OR: 1.35, 95% CI: 1.16-1.58), gastrointestinal bleeding (OR: 1.31, 95% CI: 1.04-1.66), and epilepsy (OR: 1.84, 95% CI: 1.83-1.85). Stroke patients with pressure ulcer had increased 30-day poststroke mortality (OR: 2.01, 95% CI: 1.55-2.61), particularly in those treated with debridement (OR: 2.87, 95% CI: 1.85-4.44) or high quantity of antibiotics (OR: 4.01, 95% CI: 2.10-7.66). Pressure ulcer was associated with poststroke mortality in both genders and patients aged 60 years or older. Conclusions This study showed increased poststroke complications and mortality in patients with previous pressure ulcer, which suggests the urgent need for monitoring stroke patients for pressure ulcer history.

Summary Background Remote cardiac rhythm monitoring and diagnosis has been well incorporated in the telehealth service model. The prevalence and incidence of abnormal ventricular beats, based on utilizing a symptom-driven portable remote electrocardiography (ECG) device, remains less well explored. Methods We studied 339 consecutive study participants, which included 192 individuals from outpatient clinics who were enrolled via a symptom-driven protocol; 147 participated in a heart rhythm screening program. All participants underwent 24-hour data transfer using a handheld portable electrocardiogram (ECG) device (DailyCare Biomedical Inc., Taoyuan City, Taiwan) with automatic ECG wavelet data extraction software (InstantCheck, version 4.0; DailyCare Biomedical Inc., Taoyuan City, Taiwan). Results Among 1152 data transferred (98.4% success rate), we noticed 32.5% of the study participants had evidence of cardiac arrhythmias with permanent or paroxysmal atrial fibrillation (AF) constituting 50.9% of arrhythmias. Individuals with a history of heart failure (odds ratio [OR], 3.37; 95% confidence interval [CI], 1.69–6.74), diabetes (OR, 3.03; 95% CI, 1.67–5.49), and cardiovascular disease (OR, 3.71; 95% CI, 2.05–6.7) had a higher AF risk. Both populations had an age-related increase in AF, even in multivariate models (OR, 1.72; 95% CI, 1.31–2.24 per +decade). Conclusion The handheld ECG device shows clinical feasibility with high rate for AF detection with a similar trend toward a higher prevalence with aging from different settings. These data suggested that portable ECG device via remote care system may aid in clinical diagnosis, therapeutic interventions, or patient referral for cardiac arrhythmias.

Background/purpose The purpose of this study is to describe clinical characteristics of Salmonella bacteremia in adult patients and analyze ciprofloxacin-nonsusceptible isolates. Methods A total of 101 Salmonella blood isolates from adult patients were collected from January 2011 to December 2013 in MacKay Memorial Hospital. Eight ciprofloxacin-nonsusceptible Salmonella blood isolates were screened for carbapenemase and other β lactamase genes. Isolates were examined by PCR for the quinolone resistance-determining region (QRDR) of all subunits for DNA gyrase ( gyrA and gyrB ) genes and topoisomerase IV ( parC and parE ) genes. Results There were 22 (21.78%) S. enterica serovar B, 5 (4.95%) S. enterica serovar C 1 , 7 (6.93%) S. enterica serovar C 2, 65 (64.36%) S. enterica serovar D, and 2 (1.98%) S. enterica serovar Typhi ( S. typhi ) isolates. β-lactamase gene screening and sequencing yielded only one bla CMY-2 -positive isolate. In multivariate risk factor analysis, renal insufficiency [odds ratio (OR) 3.774; p = 0.020] and heart disease (OR 2.922; p = 0.027) were more common among elderly patients (≥65 years). Independent risk factors for ciprofloxacin-nonsusceptible strains included S. enterica serovar C 2 (OR 28.430; p = 0.032), renal insufficiency (OR 13.927; p = 0.032), and immunosuppression agent usage (OR 60.082; p = 0.006). 87.50% (7/8) of isolates had gyrA mutation, 62.50% (5/8) had parC mutation, and none had gyrB and parE mutations. Isolates with both Ser83Phe/Asp87Asn gyrA and Thr57Ser/Ser80Ile parC mutation genes were highly ciprofloxacin-resistant (minimum inhibitory concentration ≥4 mg/L). Conclusions Elderly patients with renal insufficiency and heart disease were at risk for Salmonella bacteremia. Those for ciprofloxacin-nonsusceptible strains included S. enterica serovar C 2 , renal insufficiency, and immunosuppression agent usage. The 8 ciprofloxacin-nonsusceptible isolates carried gyrA and parC mutations, which cause resistance that poses a major concern.

We have designed and synthesized certain novel oxime- and amide-bearing coumarin derivatives as nuclear factor erythroid 2 p45-related factor 2 (Nrf2) activators. The potency of these compounds was measured by antioxidant responsive element (ARE)-driven luciferase activity, level of Nrf2-related cytoprotective genes and proteins, and antioxidant activity. Among them, (Z)-3-(2-(hydroxyimino)-2-phenylethoxy)-2H-chromen-2-one (17a) was the most active, and more potent than the positive t-BHQ in the induction of ARE-driven luciferase activity. Exposure of HSC-3 cells to various concentrations of 17a strongly increased Nrf2 nuclear translocation and the expression level of Nrf2-mediated cytoprotective proteins in a concentration-dependent manner. HSC-3 cells pretreated with 17a significantly reduced t-BOOH-induced oxidative stress. In the animal experiment, Nrf2-mediated cytoprotective proteins, such as aldo-keto reductase 1 subunit C-1 (AKR1C1), glutathione reductase (GR), and heme oxygenase (HO-1), were obviously elevated in the liver of 17a-treated mice than that of control. These results suggested that novel oxime-bearing coumarin 17a is able to activate Nrf2/ARE pathway in vivo and are therefore seen as a promising candidate for further investigation.

In the context of global advocacy for sustainable development, how to reduce the consumption of resources through sustainable use of goods is an important issue. Although people can get what they need through the exchange of second-hand goods, the pre- and perceptual processes that trigger the willingness to exchange need to be clarified. This study found that perceived depreciation leads to a decrease in exchange reference prices and perceived transaction costs, while product scarcity increases exchange reference prices and perceived transaction costs. Second, the exchange reference prices and psychological premiums help to increase the traders’ willingness to exchange. Finally, when barterers have higher perceived transaction costs, they are more likely to engage in exchanges without being affected by transaction costs. However, for traders in platform industry, it is necessary to provide commodity information to meet the needs of the barter, and to provide a product scarcity identification mechanism to help the barter to set the transaction reference price. Moreover, it is necessary to provide a communication platform for both parties to further determine the value of the goods, so as to facilitate the exchange of goods between the two parties. (The research findings are based on the conclusions of this paper).

Background/PurposeAlcohol use may have negative impacts on hepatitis C virus (HCV) treatment due to low adherence, and racial differences can influence HCV sustained virological response (SVR) rate between East Asian and European ancestry. The objective of this study is to confirm the influence of alcohol consumption and racial differences on HCV treatment outcome in aboriginal and nonaboriginal people of southeastern Taiwan.MethodsIn this retrospective cohort study, a total of 195 patients were treated with peginterferon-alpha once weekly plus ribavirin for 24 weeks. The efficacy analysis was performed based on the SVR rate for patients who received at least one dose of the study medication or who completed treatment. The endpoints were denoted by virological response rate including the influences of alcohol use, HCV genotype, serum level of HCV virological load, and racial differences.ResultsNo differences were observed in the baseline clinical characteristics between drinkers and nondrinkers, but a significant difference was noted in the body mass index between aboriginal and nonaboriginal populations (28.3 vs. 25.8; p

GaSb/GaAs quantum dots (QDs) and quantum rings (QRs) are investigated. By using periodical growth interrupts, precise coverage control can be achieved for GaSb QD growth by using a single Ga source. With direct As irradiation to the substrate surface during the post soaking time, the soaking time can be effectively reduced while full ring morphologies and room-temperature QR luminescence can still be obtained by using this method.

article i nfo Background: Advanced age is associated with left ventricular (LV) remodeling and impaired diastole. The associ- ation among aging, mitral leaflet closure (EF slope), cardiac structures, and diastolic indices in an asymptomatic Taiwanese population is largely unknown. Methods: We studied 8103 asymptomatic participants (49.5 ± 11.6 years, 38.2% women) from a health evalua- tion cohort (2004-2012) in a tertiary center in Taiwan. Echo-derived LV structure/function, and M-mode based EFslope(mm/s)andserumNT-proBNPlevelwere obtained.TheassociationbetweenEFslope andtheotherclin- ical or echo-based parameters was investigated. Results: Average values for EF slope among various age groups in the Taiwanese population were determined for both genders. Advanced age was associated with reductions in EF slope (adjusted estimate: −0.35/per decade). Reduced EF slope was associated with older age, higher blood pressure and greater body mass index in multi- variate models (all p b 0.05). Reduced EF slope was correlated with greater cardiac concentricity, abnormal E' and E/E' (AUROC: 0.74 and 0.77, respectively, both p b 0.05) and elevated NT-proBNP (Coef: 5.98 pg/mL, per −10 mm/s EF slope, 95% CI: 7.82 to 4.17, p b 0.001). EF-slope also clearly discriminated individuals with abnor- mal estimated LV filling (E/Ecategorized by b8, ≥ 8& b15, ≥15, ANOVA p b 0.001). Conclusions: EF-slope reduction in the asymptomatic Taiwanese population was correlated with age, several unfavorable LV remodeling, and impaired diastolic function parameters, and EF-slope can be an effective clinical diagnostic tool for identifying poor Eand elevated LV filling pressure. In addition, our data provided reference values for EF-slope in various age groups. © 2015 Published by Elsevier Ireland Ltd. This is an open access article under the CC BY-NC-ND license

Background: The present study aimed to explore the attitude and knowledge toward hospice palliative care among medical caregivers in Taiwan. Methods: A cross-sectional questionnaire survey was conducted among medical staff attending a hospice palliative care conference. Results: Overall, 163 of 232 questionnaires were valid. Based on the results, 54.9% of opinions on who has the right to sign a Hospice Palliative Care Declaration for an autonomous patient was consistent with the Taiwan Hospice Palliative Care Article; 91.4% of opinions on whether a life-sustaining therapy has been authorized to withhold was consistent with the article, compared with only 28.3% of opinions on whether a life-sustaining therapy has been authorized to withdraw. The capability of medical staff to provide these three procedures was varied (Cochran's Q = 121.150, p 32.5 years (odds ratio = 0.41; 95% confidence interval, 0.22–0.90; p 9 years (odds ratio = 0.52; 95% confidence interval, 0.27–0.97; p

We report a novel in situ patterning method that generates hierarchical nanoporous gold (NPG) structures such as sub-micron NPG disks and microscale NPG patterns during dealloying for the first time. Our patterning method also enables the quantification of dealloying rate by scanning electron microscopy (SEM) without the need for depth-resolving imaging modalities. As potential applications, we demonstrate that the hierarchical NPG dot arrays are effective for surface-enhanced Raman scattering (SERS) and metal-enhanced fluorescence (MEF), both are highly sensitive molecular sensing techniques.

Acute colonic pseudo-obstruction is characterized by the signs and symptoms of a mechanical obstruction of the small or large bowel in the absence of a mechanical cause. It occurs in association with a wide spectrum of clinical conditions. This case illustrates an atypical presentation of this disease. Despite its rarity, meningoencephalitis should be considered in the differential diagnosis of acute colonic pseudo-obstruction accompanied with acute urine retention, especially in patients with predisposing factors.

A 25-year-old female presented with alternating diarrhea and constipation for 6 months with nonbloody, culturenegative diarrhea associated with body weight loss. Before these symptoms, she had noted one episode of severe periumbilical abdominal pain, vomiting, and diarrhea combined with fever. The fever subsided quickly but intermittent abdominal pain, fullness, and change of bowel habit (alternating diarrhea and constipation) was found. She accepted esophageal-gastrodudenal endoscopy and colonoscopy examination, which appeared normal. She was told she had irritable bowel syndrome and accepted oral medicine treatment in the local hospital. She noted body weight loss of 15 kg within half a year. Liquid stool passage with greenish and whitish material presented, and amenorrhea was also noted for half a year. Physical examination revealed focal tenderness over the epigastria without

Background This study evaluated the risk of acute myocardial infarction (AMI) and mortality among patients with systemic lupus erythematosus (SLE) in two nationwide retrospective cohort studies. Methods Using Taiwan's National Health Insurance Research Database, we conducted a retrospective cohort study and identified 1207 adults newly diagnosed with SLE in 2000–2004. Non-SLE cohort consisted of 9656 adults without SLE, frequency-matched for age and sex and randomly selected from the same data set. Events of AMI were considered as outcome during the follow-up period between 2000 and 2008. Another nested cohort study of 6900 patients with AMI receiving cardiac surgeries was conducted to analyze the impact of SLE on post-AMI mortality. Results During the follow-up period, there were 52 newly diagnosed AMI cases. The incidences of AMI for SLE cohort and non-SLE cohort were 2.10 and 0.49 per 1000person-years, respectively, with an adjusted hazard ratio (HR) of 5.11 (95% confidence interval [CI] 2.63–9.92). For females, the adjusted HR of AMI associated with SLE was as high as 6.28 (95% CI 2.67–14.7). Further analyses in the nested cohort showed that SLE was significantly associated with post-AMI mortality (odds ratio, 2.60; 95% CI 1.09–6.19). Conclusion Patients with SLE had higher risk of AMI compared with non-SLE control, and this risk was more significant in females. In addition, SLE is an independent risk factor for post-AMI mortality.

Summary Background This research investigated the effect of drinking Roselle tea and cranberry juice in preventing asymptomatic bacteriuria in home care patients with long-term indwelling catheter. Methods The research participants were divided into three groups: Roselle tea group, cranberry juice group, and control group. Urinalysis, urine culture, and biochemical blood tests were performed for all patients. The research lasted for 6 months, and the aforementioned three tests were conducted prior to, 3 months after, and 6 months after the research had started. We compared the effect of drinking cranberry juice and Roselle tea in reducing urinary tract infection. Results The results of the urinalysis, urine culture, and biochemical blood tests in the three groups did not show any significant difference. Furthermore, Roselle tea and cranberry juice did not effectively reduce urinary tract infection as compared with the control group in patients with long-term indwelling catheter. Conclusion Based on our results, neither Roselle tea nor cranberry juice was able to reduce the frequency of asymptomatic bacteriuria. It is inferred that cranberry juice or Roselle tea can only be used in ordinary day health care for the urinary tract.

The μ-opioid receptor (MOR) is the major opioid receptor targeted by most analgesics in clinical use. However, the use of all known MOR agonists is associated with severe adverse effects. We reported that the 1-phenyl-3,6,6-trimethyl-1,5,6,7-tetrahydro-4H-indazol-4-ones are novel opioid receptor agonists. Subsequent structural modification resulted in the potent MOR/KOR (κ-opioid receptor) agonists 19, 20, and 21. Testing the analgesic effect of these in WT B6 mice (tail-flick test) gave ED50 values of 8.4, 10.9, and 26.6 mg/kg, respectively. The 1-phenyl-3,6,6-trimethyl-1,5,6,7-tetrahydro-4H-indazol-4-one core could be addressed in 1 or 2 synthetic steps with moderate to high percent of yield. In the adenylyl cyclase assay, compound 19 displayed a MOR/KOR agonist profile, with IC50 values of 0.73 and 0.41 μM, respectively. Current results suggest that compound 19 is a promising lead to go further development and in vitro/in vivo adverse effects studies.

A novel class of phenyl benzenesulfonylhydrazides has been identified as potent inhibitors of indoleamine 2,3-dioxygenase (IDO), and their structure–activity relationship was explored. Coupling reactions between various benzenesulfonyl chlorides and phenylhydrazides were utilized to synthesize the sulfonylhydrazides bearing various substituents. Compound 3i exhibited 61 nM of IC50 in enzymatic assay and 172 nM of EC50 in the HeLa cell. The computational study of 3i suggested that the major interactions between 3i and IDO protein are the coordination of sulfone and heme iron, the hydrogen bonding and hydrophobic interactions between 3i and IDO. This novel class of IDO inhibitor provides a new direction to discover effective anti-cancer agents.

Background/PurposeLanyu Island is a closed environment inhabited by the Yami people, Taiwan's smallest and most primitive tribe. This study assessed the prevalence and risk factors of Helicobacter pylori infection among Lanyu Island residents.MethodsA cross-sectional study was conducted among the inhabitants of Lanyu Island, using the 13C urea breath test to determine the prevalence of H. pylori. All study participants completed a form requesting demographic data and anthropometric measurements and a questionnaire evaluating socioeconomic characteristics and personal habits. Multiple logistic regression analyses were used to identify independent factors of H. pylori infections, and a two-sided p

Patients with mucopolysaccharidoses (MPS) often have hearing loss. However, the characterization of hearing loss by pure-tone audiometry (PTA) in this rare disease population and its relationship to age and treatment is limited.PTA was performed in 39 patients with MPS (29 males and 10 females; 3 with MPS I, 21 with MPS II, 9 with MPS IVA, and 6 with MPS VI; median age, 11.9 years; age range, 4.4-34.2 years). The degree of hearing loss was classified by the age-independent World Health Organization (WHO) clinical guidelines.Hearing loss by PTA was present in 85% (33/39) of patients and was categorized as mild (26-40 dB) in 18%, moderate (41-60 dB) in 36%, severe (61-80 dB) in 23%, and profound (≥81dB) in 5%. Among the patients with hearing loss, 33% were classified as mixed type (conductive and sensorineural), 30% as pure conductive type, 27% as pure sensorineural type, and 9% were undefined. The means of the right and left ear hearing thresholds at 2000 and 4000 Hz by air conduction (AC) and at 500, 1000, 2000, and 4000 Hz by bone conduction (BC) were all positively correlated with age (p0.05). In the 6 patients with MPS II or VI who underwent follow-up PTA after ventilation tube insertion and enzyme replacement therapy for 1.9 to 8.5 years, all showed improvements in AC and BC of the better ear, as well as in the air-bone gap.Hearing impairment is common in MPS. Early otolaryngological evaluation and intervention are recommended. These findings and the follow-up data can be used to develop quality of care strategies for patients with MPS.

Summary Heterotopic pancreas is a congenital anomaly characterized by the presence of ectopic pancreatic tissue far from the pancreas. The treatment of heterotopic pancreas may include expectant observation, endoscopic resection, or surgery. The aim of this study was to describe the technique of cap-assisted endoscopic mucosal resection for the management of heterotopic pancreas of the stomach. Two patients, a 41-year-old woman and a 31-year-old man, were referred to us for the management of gastric subepithelial lesions. Endoscopic ultrasound was used in the female patient to disclose two small hypoechoic lesions arising from the submucosal layer. Cap-assisted endoscopic mucosal resection was performed in both patients without complications. Histopathological examination of the resected specimens showed heterotopic pancreatic tissue in the submucosal layer. Our technique is a suction, snaring, and cut method. This method does not need a special cap with a shallow circumferential lip on the inside and the snare does not need to be pre-looped. This technique allowed a histopathological confirmation of the suspected diagnosis in both patients.

Summary Discharge planning is an interdisciplinary approach to provide continuity of care; it is a process that includes identification, assessment, goal setting, planning, implementation, coordination, and evaluation. Discharge planning has been viewed as a major way to enhance a smooth transition for patients from the hospital to home or other chronic care units and as a solution to solve problems associated with postdischarge care. The promotion of discharge planning began in the United States in the 1960s. Nursing scholars from Taiwan learned about the concept of discharge planning from the United States in the early 1980s and subsequently introduced it to Taiwanese medical institutions in 1985. A policy to promote discharge planning in Taiwan was announced by the Executive Yuan, Department of Health in 1993. Following the healthcare reforms in 1995, discharge planning has since been strongly promoted. Studies concerning discharge planning in Taiwan showed some promising results, including increased satisfaction of patients and their families, improved preparation of caregivers, and improved quality of life for patients. However, patients receiving interdisciplinary discharge planning services were still in the minority. There was no standard evaluation procedure for interdisciplinary discharge planning, and a high percentage of patients thought that hospitals handled the postdischarge long-term care services referral procedure inadequately. Despite the positive attitudes toward discharge planning, many physicians still demonstrate an unsatisfactory level of knowledge and behaviors with regard to discharge planning. To enhance the implementation of discharge planning, a standard evaluation procedure for interdisciplinary discharge planning and improved physician awareness concerning the importance of discharge planning are needed. In Taiwan, the improvement of discharge planning in the foreseeable future is promising with the accreditation of the procedure and the participation of doctors in efforts to ensure the continuity of postdischarge care for patients.

SummaryDischarge planning is an interdisciplinary approach to continuity of care and a process that includes identification, assessment, goal setting, planning, implementation, coordination, and evaluation. Effective discharge planning supports the continuity of health care; it is described as “the critical link between treatment received in hospital by the patient, and post-discharge care provided in the community.” The structure of discharge planning is classified into: (1) informal (ordinary) discharge planning and (2) formal (specialized, structured) discharge planning. Many studies showed that discharge planning may increase patient satisfaction, and some studies showed reduced hospital length of stay and reduced readmission to hospital, but no evidence that it reduced health-care costs. A structured discharge planning tailored to the individual patient probably reduces hospital length of stay and readmission rates for older people admitted to hospital with a medical condition, but the impact of discharge planning on mortality, health outcomes, and cost remains uncertain.

Summary Background The decision to perform surgery on older patients often presents as an ethical dilemma. The purpose of this study is to investigate the impact of comorbidities on the clinical outcomes of older rectal cancer surgery patients, with the goal of enabling healthcare professionals to evaluate the risk of surgery for the treatment of cancer in older patients with comorbid chronic disease. Methods This study included 320 patients >60 years of age who were treated from 2004–2009 at a medical center in northern Taiwan. Logistic regression and Cox proportional hazards regression were used to determine if various chronic diseases (e.g., hypertension, diabetes, cardiovascular disease, cerebrovascular disease) increase the risk of in-hospital complications and 1-year mortality. Results In the multivariate analysis, the risk of in-hospital complications for diabetic patients was 3.43 times that of nondiabetic patients (95% confidence interval [CI]: 1.13–10.37). For patients with cerebrovascular disease, the risk was 4.99 times that of those without cerebrovascular disease (95% CI: 1.30–19.07). In addition, patients ≥80 years of age demonstrated significantly higher 1-year mortality rates (HR = 3.49, 95% CI:1.18–10.30). However, a history of hypertension, diabetes, cardiovascular disease, or cerebrovascular disease was not a significant predictor of 1-year mortality. Conclusion Older patients with comorbidities are at a higher risk of in-hospital complications following rectal cancer surgery, whereas the presence of comorbidities did not show a significant adverse effect on 1-year mortality in the present study. We suggest using population-based data to establish effective therapeutic strategies for treating each comorbidity.

This study has investigated the effect of gender, cold and warm immersion on hand skin temperature, grip MVC, EMG, and discomfort. In this study, twelve male and twelve female participants immersed their hands in a cold water tank for 40 min followed by warm water immersion for 15 min, during which all performance measures were collected. Structural equation model was applied to examine relationship among skin temperature, gender, anthropometrics, and MVC. The results indicate that the cold immersion had an enormous effect on skin temperature, which subsequently affected the MVC. Gender had significant impact on skin temperature and MVC, and MVC was also affected by palm length. Due to adaptation, participants experienced greater discomfort at the beginning of the cold immersion and the discomfort diminished after 4 min. During warm immersion, the EMG resumed its baseline after 15 min which indicates that the muscle performance was fully recovered after 15 min of warm immersion. Relevance to industry Statement indicating the relevance of the findings for ergonomics practice. Performance of the workers exposed to different temperature conditions is a common problem in industries. This study was designed to test the MVC, EMG, thermal discomfort sensation and hand skin temperature response to cold and warm immersion of the human forearm. The result can help to protect workers who work in cold immersion occupations such as fisherman, fish filleters, and divers.

Background: Nonalcoholic fatty liver disease (NAFLD), which represents metabolic abnormality and reflects extra visceral fat deposition, has been shown to be a threat to public health and associated with cardiovascular risks. However, data regarding the differences in clinical presentation and related metabolic abnormalities in the aging group population remained scarce in the Taiwanese population. Methods: We subsequently examined 8,658 subjects participating general health evaluation in Mackay Memorial hospital from 2003 to 2007. Baseline characteristics, anthropometrics, medical history, and biochemical markers were all collected. Abdominal ultrasonography was performed in all subjects. Two estimated cardiovascular risk scores were calculated according to criteria of the U.S. National Cholesterol Education Program Adult Treatment Panel III as metabolic score and Framingham risk score. Univariate logistic regression model was used to examine whether the baseline characteristics, anthropometrics, histories, and biochemical markers were independently associated with NAFLD from various age groups (young vs. aging groups) classified by 60 years of age. Respective receiver operating characteristic curves (ROC) with area under the curve were generated to test the capability of both cardiovascular risk scores in NAFLD discrimination from different age groups. Results: Totally 7,204 subjects (mean age: 44.5±11 years, 36% female) were finally enrolled in our study. Subjects with NAFLD were observed to have high body weight, body mass index, and circumferential waist and significantly abnormal biochemical markers accompanying worsening lipid profiles when compared with those without NAFLD in both the young and aging group populations (all p

The liver is the major site of pigment epithelium-derived factor (PEDF) synthesis. Recent evidence suggests a protective role of PEDF in liver cirrhosis. In the present study, immunohistochemical analyses revealed lower PEDF levels in liver tissues of patients with cirrhosis and in animals with chemically induced liver fibrosis. Delivery of the PEDF gene into liver cells produced local PEDF synthesis and ameliorated liver fibrosis in animals treated with either carbon tetrachloride or thioacetamide. In addition, suppression of peroxisome proliferator-activated receptor gamma expression, as well as nuclear translocation of nuclear factor-kappa B was found in hepatic stellate cells (HSCs) from fibrotic livers, and both changes were reversed by PEDF gene delivery. In culture-activated HSCs, PEDF, through the induction of peroxisome proliferator-activated receptor gamma, reduced the activity of nuclear factor-kappa B and prevented the nuclear localization of JunD. In conclusion, our observations that PEDF levels are reduced during liver cirrhosis and that PEDF gene delivery ameliorates cirrhosis suggest that PEDF is an intrinsic protector against liver cirrhosis. Direct inactivation of HSCs and the induction of apoptosis of activated HSCs may be two of the mechanisms by which PEDF suppresses liver cirrhosis.

Summary Drotrecogin alfa, a type of recombinant human activated protein C, has potential to reduce the mortality in severe sepsis, but may simultaneously increase the risk of serious bleeding events. Here, we report an 81-yearold female suffering from emphysematous pyelonephritis who recovered after appropriate management, including antibiotics, percutaneous nephrostomy drainage and administration of activated protein C. This case showed that percutaneous nephrostomy drainage is not an absolute contraindication in the prescribing of activated protein C in patients with severe sepsis.

Changes during project execution frequently require schedule updating and rescheduling. However, few studies have discussed rescheduling issues or implemented rescheduling solutions for construction projects. This study investigates resource-constrained construction rescheduling issues using concepts associated with manufacturing rescheduling. Based on an initial schedule and actual progress, a novel rescheduling optimization model using Constraint Programming (CP) techniques is developed to reschedule projects. Two rescheduling methods: (1) complete regeneration (CR); and, (2) partial rescheduling (PR) while minimizing overall project variation are implemented in the proposed model to demonstrate the model capability and applications. PR requiring additional treatments to decrease overall project variation is performed using a novel constraint-release mechanism. Finally, using a case study, optimization results obtained using two rescheduling methods are analyzed and discussed.

SUMMARY One of the major challenges for intensivists is resolving the conflicting interests in end-of-life care. We reviewed patients' characteristics in an intensive care unit to determine the major barriers of practicing good end-of-life care and the medical ethics involved for the care team to resolve these conflicts. (International Journal of Gerontology 2009; 3(1): 26-30)

Aims: This study aimed to investigate the effect of caffeic acid phenethyl ester (CAPE), an active component isolated from honeybee propolis, in inducing apoptosis in human pancreat

Summary Gallstone ileus is an uncommon cause of small bowel obstruction, accounting for only 1–4% of all intestinal obstructions. In patients with cholelithiasis, only 0.3–0.5% reportedly develop gallstone ileus. However, the condition causes 25% of cases of non-strangulated small bowel obstruction in those over the age of 65 years. We report a patient with gallstone ileus who presented with small bowel obstruction that was initially misdiagnosed. The correct diagnosis was made based on finding an ectopic gallstone on plain abdominal radiography, a cholecystoduodenal fistula, and gallstone impaction in a small bowel follow-through study. [International Journal of Gerontology 2008; 2(1): 18–21]

In various workplaces, gloves are commonly employed to protect the hands with the design rationale of 'the thicker the gloves, the better the protection'. Therefore, the present paper investigated the effects of glove thickness on hand performance and fatigue during two infrequent high-intensity gripping tasks, such as 5-s and sustained tasks. The hand performance was evaluated by maximum volitional contraction (MVC) and its associated time needed to reach the MVC (TMVC), and the total force generation (TFG) during the sustained task. The hand fatigue was assessed by MVC degeneration (DeltaMVC), the shift in time needed to reach the MVC (DeltaTMVC), and the maximal endurance time (MET) associated with the sustained task. Ten female subjects took part in the experiment voluntarily. The four-gloved conditions included bare hand, wearing one layer (Cotton-1), wearing two layers of cotton gloves (Cotton-2), and covering the handle with two layers of cotton glove and exerting with the bare hand (Covered-2). The results indicates that wearing gloves decreased the grip MVC, and the thicker the gloves, the less the grip MVC, but the wearing style did not change the MVC (Cotton-2 MVC was indifferent from Covered-2 MVC). As to muscular fatigue, on the other hand, wearing gloves did not affect DeltaMVC, MET, TMVC, or DeltaTMVC. Due to the greater bare-hand MVC and indifferent MET, bare-hand TFG was better than those conditions with gloves. Finally, the load specified here did not alter TMVC or DeltaTMVC, but the greater the load, the more strength degeneration (DeltaMVC) was induced.