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Objective We present a rare case of well-differentiated papillary mesothelioma (WDPM) found incidentally in a 59-year-old woman with endometrial cancer. Case report A 59-year-old nulliparous obese woman with a past history of hypertension and diabetes mellitus presented with postmenopausal bleeding for 11 months. Two months prior to this admission, an episode of massive vaginal bleeding lasting for a day was noticed by the patient. Hysteroscopy was performed after her visit to our outpatient department. Papillary tumors with active bleeding were found in the uterine cavity. Endometrial biopsy showed adenocarcinoma, endometrioid type characterized by papillary architecture lined by columnar cells with mild nuclear pleomorphism. The patient proceeded to magnetic resonance imaging (MRI), which demonstrated a 6.4 × 5.5 × 4.9 cm intrauterine mass. Her tumor marker levels were elevated (CA 125 87.8 IU/ml, CA19-9160.54 IU/ml). The patient then underwent a staging surgery and final pathology revealed stage IA endometrial cancer. During surgery, multiple nodules were found in the peritoneum, initially considered as tumor metastasis and eventually proved to be WDPM. Conclusion In conclusion, the simultaneous occurrence of WDPM with endometrial cancer is a rare entity. Although no standardized treatment has been established, WDPMs have a relatively favorable prognosis compared to malignant mesotheliomas.

Background The aim of this study is to present our experience of thoracic endovascular aortic repair (TEVAR) for type A intramural hematoma (TAIMH) and retrograde thrombosed type A aortic dissection (rt-TAAD) with the entry tear in the descending aorta or the abdominal aorta and discuss the outcomes. Methods We retrospectively reviewed total 6 patients who underwent TEVAR for TAIMH (n = 2) or rt-TAAD (n = 4) in our hospital between September 2017 and July 2019. The mean age of the patients (5 men and 1 woman) was 74 ± 13 years, and the mean follow-up duration was 13 ± 7 months. Results TEVAR was successfully performed in the acute phase in all patients without relevant complications. After TEVAR, the shrinkage of enlarged thoracic aorta and complete resorptions of the false lumen of the entire thoracic aorta were achieved in 4 patients. In the remaining 2 patients, one had residual thrombosed false lumen of the ascending aorta due to a new development of PAU at the distal aortic arch and another needed additional endovascular intervention for ascending aorta hematoma progression. Late aorta-related adverse event was observed in one patient, who needed open aortic repair. There was no death during follow-up. Conclusions Tear-oriented endovascular aortic repair is a potential option in selected patients of TAIMH and rt-TAAD and has shown favorable immediate outcomes and aortic remodeling. However, the late aorta-related adverse event is not negligible, and their long-term outcome has not been fully clarified. More research is warranted.

High entropy alloys (HEAs) have drawn lots of attentions from researchers and industries because of their outstanding properties, such as high hardness, and good corrosion resistance. Particularly, the refractory high entropy alloy is characterized by its high temperature strength and stable thermal properties. We conducted the magnetron co-sputtering process to grow one V-Nb-Mo-Ta-W and three V-Nb-Mo-Ta-W-Cr-B refractory HEA coatings. The BCC phase of V-Nb-Mo-Ta-W HEA coating was changed into the amorphous-like structures when Cr and B elements were added into the coatings. Oxidation reactions occurred and very complex refractory metal oxides were produced on all HEA coatings when the oxidation was held at 800 °C in air for 1 h. The addition of Cr and B constituents into the V-Nb-Mo-Ta-W coating can provide good oxidation resistance and anti-corrosion performance. The highest hardness of 18.4 ± 0.5 GPa, an excellent corrosion resistance at room temperature, a high hardness of 15.9 ± 1.1 GPa and good thermal stability after 500 °C oxidation test were obtained for the V10.4Nb10.5Mo10.5Ta11.2W10.5Cr16.3B28.6 refractory HEA coating in this study.

High entropy alloys (HEA) show outstanding thermodynamic, mechanical or thermal properties as compared with pure metals or binary alloys. Among several kinds of HEAs, the refractory element containing HEAs exhibit relatively high thermal stability and better mechanical properties at elevated temperature. In this study, the V19.2Nb19.4Mo20.3Ta19.5W21.6 high entropy alloy thin films were deposited on the AISI 304 stainless steel substrates by a magnetron sputtering process. The oxidation behavior and electrical conductivities of HEA thin films at different temperatures were evaluated. The body-centered cubic (BCC) structure of HEA thin film can be kept up to 500 °C oxidation, and it transferred to V-Nb-Mo-Ta-W based oxides and then turned to iron contained oxide phases when the oxidation temperature increased to 700 °C. The electrical resistivity of thin film increased with oxidation temperature. The electrochemical impedance spectroscope (EIS) analysis showed that the total apparent resistivity values of 304SS substrate coated with V19.2Nb19.4Mo20.3Ta19.5W21.6 high entropy alloy thin film at 600, 700 and 800 °C were 5.80, 6.91, and 7.71 Ω·cm, respectively. The electrical resistance of the HEA coated sample was contributed by the oxide resistance and interface polarization. Through the electrical property analysis at high temperatures, the HEA thin film can provide a protection layer to the 304SS substrate and kept the sample's high temperature apparent resistivity to a relatively lower value.

The potential use of chromium carbide thin films has been a great interest to academia and industry due to their outstanding properties such as chemical stability, low coefficient of friction, adequate hardness and high wear resistance. In this study, the chromium carbide thin films were fabricated by a magnetron sputtering using different power supply systems, including direct-current (DC), pure high power impulse magnetron sputtering (HiPIMS), and superimposed HiPIMS- middle frequency (MF). The Cr target poisoning status was controlled using a plasma emission monitoring (PEM) system by adjusting the gas flow ratios of Ar and acetylene (C2H2). The morphology and microstructure of thin films were evaluated by scanning electron microscope (SEM) and transmission electron microscope (TEM). The crystallinity of films was studied using an X-ray diffractometer (XRD). The electron probe micro analyzer (EPMA) and X-ray photoelectron spectroscope were used to determine the chemical compositions and binding structures of thin films, respectively. The hardness and residual stress were explored. The results showed that the thin film sample prepared by the superimposed HiPIMS-MF power supply can obtain the maximum hardness of ~27.5 GPa at a PEM set point of 30%, i.e., the target poisoning degree of 70%. The hardening mechanism may be caused by the formation of nanoscale CrC crystallites incorporated into the amorphous CrCx matrix in the thin film, which can be attributed to the Hall-Petch strengthening effect.

Previous studies demonstrated that both diabetes and flunarizine use can increase the risk of parkinsonism. The aim of the current study was to investigate the risk of developing parkinsonism after flunarizine treatment, in a cohort of patients newly diagnosed with type 2 diabetes. We conducted a nested case-control study of a type 2 diabetic cohort from the Taiwan Longitudinal Health Insurance Database 2005 (LHID 2005). Each incident case of parkinsonism, during the period from 2001 to 2013, was randomly matched with 3-10 controls, according to age, sex, calendar year of cohort entry, and the duration of follow-up. Conditional logistic regression was used to estimate the odds ratio (OR) of parkinsonism associated with flunarizine use. The cohort consisted of 44,644 patients with newly diagnosed type 2 diabetes from 2001 to 2013, of whom 464 patients had a parkinsonism event during the follow-up period. The adjusted OR of parkinsonism with relation to flunarizine use was 2.75 (95% confidence interval: 2.26-3.36). There were also duration- and dose-response effects. Compared to those who had not used it, the OR for developing parkinsonism was 1.77 for patients who used flunarizine for less than 1 month. When the exposure period expanded over 3 months, the OR increased to 7.03. Our findings suggested that flunarizine use is a potential risk factor for parkinsonism in patients with newly diagnosed type 2 diabetes, especially when the drug is persistently used for over 3 months.

We reviewed and synthesized the existing empirical research on correlates of two types of subjective career plateau (SCP): (1) hierarchical plateau (HP) and (2) job content plateau (JCP). Based on 126 independent samples, we found positive relationships between potential antecedents (career adaptability, person-environment fit, psychological capital, and workplace support) and SCPs, as well as relationships between SCPs and a variety of work outcomes. Specifically, SCPs were positively associated with counterproductive work behavior, job insecurity, psychological distress and turnover intentions but negatively associated with career satisfaction, extra-role performance, in-role performance, job involvement, job satisfaction, mentoring support of one's proteges, organizational commitment, and work engagement. SCPs were also related to other covariates, including age, gender, job tenure, race, and role ambiguity. Effect sizes were generally smaller for HP than for JCP, except for job insecurity and psychological distress. Finally, the scale used to measure SCP moderated some of these relationships. We discuss the theoretical and practical implications of these findings.

Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients.From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013.Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of 120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of 120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively.Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or 120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.

This study presents an integrated off-ramp control model that incorporates the impact of ramp queue spillback on the freeway mainline in design of the off-ramp intersection’s signal plan. The proposed model consists of a mesoscopic traffic module to capture the complex interrelations between the freeway mainline’s traffic state and the lane-changing maneuvers triggered by off-ramp queue spillback, and a local signal optimization module to maximize the total benefit for both the freeway and intersection in the vicinity of an interchange. Using the simulation–optimization solution logic, the proposed model will first estimate the off-ramp queue length, produced from the signal module, to assess the resulting impacts on the freeway mainline, and then feed such impacts back to the control objective to iteratively search for the optimal cycle length and phase durations with the genetic algorithm. To assess the effectiveness of the proposed model, this study has conducted a two-stage evaluation, where the first stage uses the extensive field data to confirm the reliability of its freeway queue impact module and the second stage focuses on evaluating the benefits of accounting for the queue impacts on the freeway in design of the off-ramp signal plan under various traffic scenarios. The results from extensive tests have confirmed that the proposed model can effectively minimize the likelihood of causing off-ramp queues to spill back to the freeway mainline, and the failing to incorporate such impacts in design of the off-ramp signal will contribute significantly to the formation of freeway bottlenecks in the interchange area.

A high-performance self-powered ZnO-based photodetector is developed by enhancing piezopotential through alloying with Mg. An n-MgxZn1-xO thin film (x=0.05 and 0.2) with a strong c axis preferred orientation in the wurtzite phase is grown on a p-type Si substrate by magnetron co-sputtering. The piezotronics and piezo-phototronics properties are studied by determining the dependence of electrical and optical characteristics of preferentially orientated MgxZn1-xO thin films on strain. The performance of the self-powered photodetectors increases with Mg content due to the increase of the piezoelectric coefficient by the alloying process, and thus an enhanced piezopotential. In addition, the photosensing results show that the piezo-phototronic effect can boost the output current density and voltage of the self-powered photodetector by more than 100%. The sensitivity of the photodetector with Mg0.20Zn0.80O is over 6-fold greater than that of the photodetector with Mg0.05Zn0.95O. The results demonstrate a strong dependence on Mg content in MgxZn1-xO for the piezo-phototronic effect. The developed material is thus a promising candidate for ultra-high-sensitivity photodetectors.

This work develops spatial conditioned Latin hypercube sampling (scLHS), a novel advance on conditioned Latin hypercube sampling (cLHS) [Minasny and McBratney, Computers & Geosciences (2006) 1378–1388]. The difference between cLHS and scLHS is that the latter introduces variograms of ancillary variables into the objective function of the optimization procedure that selects sampling locations. The improvement of scLHS was evaluated by applying both scLHS and cLHS to simulated samples of multiple heavy metals (Cr, Cu, Ni, and Zn) in the soil of Changhua County in Taiwan. Simulation was done by using sequential indicator simulation (SIS), which generated 1000 realizations of spatial distributions of the heavy metals, based on existing sample data, to represent the real distributions of heavy metals. The results of the Ripley K analysis show that the locations of samples obtained by both approaches were not significantly spatially segregated. The sampling results show that the declustering of sample locations may dominate the optimization process in cLHS and scLHS. Statistical analysis indicated that compared with cLHS, the means, standard deviations and contamination proportions of scLHS samples captured more efficiently the variability of the SIS realizations. Moreover, the experimental variograms of scLHS samples, especially for small sample sizes, captured the experimental variograms of the SIS realizations more efficiently. Therefore, the use of the scLHS approach is recommended as a novel alternative sampling approach without the need for a reconnaissance survey to increase the efficiency of capturing the spatial structures of soil heavy metals and delineating contaminated sites.

The integrated photoluminescence intensity of Ge with GeO 2 micro hemispheres increases by a factor of more than 10 as compared to bare Ge. Decreasing the surface reflectance, the total internal reflection, and the surface recombination velocity by the formation of the micro hemispheres is responsible for the enhancement. The decrease of the surface recombination velocity and the total internal reflection to increase the light extraction by micro hemispheres also enhance the electroluminescence of Ge metal–insulator–semiconductor light emitting diodes.

Summary This study investigated the hydrogeochemical and mineralogical characteristics of arsenic-contaminated and humic-substance-enriched aquifers in the Chianan Plain, Taiwan, which is an endemic area for blackfoot disease (BFD). Factorial analysis (FA) was used to evaluate the hydrochemical characteristics of 83 groundwater samples in the Chianan Plain, and 462 geological core samples obtained from 9 drilling wells were collected to analyze their arsenic and iron contents. The major mineral phases and chemical components were determined using X-ray diffraction (XRD), X-ray photoelectron spectroscopy (XPS), and scanning electron microscopy and energy dispersive spectrometry (SEM–EDS). Partition of arsenic among various hosting solids in sediments was determined by sequential extraction. The results of FA showed that the hydrochemical characteristics of the groundwater samples could be grouped by 4 factors: salinization, arsenic, sulfide, and iron. Arsenic was positively correlated with alkalinity, dissolved organic/inorganic carbon, and fluorescence intensity [humic acids, (HAs)]. As(V) has a higher chelating affinity with HAs than does As(III), resulting in higher As(V) concentrations distributed throughout the reducing environment. High levels and correlations of As and HAs may cause BFD in the Chianan Plain. No correlation was found between the measured and calculated redox potentials of the various redox couples. The As(III)/As(V) was under a chemical non-equilibrium condition. The vertical distribution of the sedimentary As (solid phase) typically increased with depth, but the aqueous As concentrations were higher in the second aquifer (depth of 80–120 m). Arsenic content (solid phase) was higher in the clay/silt sediments and marine formations. The major minerals identified by XPS and SEM–EDS were goethite, hematite, magnetite, pyrite, and siderite, agreeing with the SI values calculated by PHREEQC. Arsenic content was strongly correlated with sulfur (weight%; R 2 = 0.76, p R 2 = 0.44–0.75; p (s) and Fe (s) in the sediments was found in the transitions in the marine and non-marine formations, especially in the fine grains. The chelation of humic complex, competition for sorption sites of organic carbon, reduction dissolution of Fe oxides are mainly responsible for the groundwater As mobility in the Chianan Plain, especially for the marine sequence.

Summary Purpose The impact of epilepsy following different subtypes of stroke is unclear. The aim of this study was to evaluate the risk of post-stroke epilepsy with different stroke subtypes. Methods A total of 4126 stroke patients and 24,756 age- and sex-matched controls were retrieved from the Longitudinal Health Insurance Database 2005, a major dataset of the National Health Insurance Research Database, from 2000 to 2003. All were then individually tracked to their last medical visit up to five years from 30 days after their first-ever stroke incident to identify those who developed epilepsy. Results Among the 4126 stroke patients, 72.2% had ischemic stroke, 14.7% had intracerebral hemorrhage (ICH), 2.3% had subarachnoid hemorrhage (SAH), 2.0% had other and unspecified intracranial hemorrhage (OIH), including subdural hemorrhage and epidural hemorrhage, and 8.9% had multiple stroke subtypes. The adjusted hazard ratio for the development of epilepsy was 11.5 (95% CI 8.2–16.2) for the patients with stroke compared to the controls. 2.6% of the patients with stroke developed epilepsy during the 5-year follow-up period. The rate of post-stroke epilepsy was highest in patients with multiple subtypes (7.7%), followed by ICH (4.3%), SAH (4.2%), OIH (2.5%) and ischemic stroke (1.6%). Conclusion Stroke patients had a significantly higher risk of developing epilepsy than the controls. The risk of post-stroke epilepsy was higher in patients with hemorrhagic stroke than ischemic stroke.

Background Diabetes is associated with an increased risk of developing dementia. However, data on the patients with newly diagnosed type 2 diabetes are limited. Objective To investigate the relationship between newly diagnosed type 2 diabetes and the risk of developing dementia, ischemic stroke and intracranial hemorrhage after disease diagnosis and the interrelationship between dementia and the stroke events. Method Data were collected from the National Health Insurance Research Database of Taiwan. The study cohort included 3717 patients newly diagnosed with type 2 diabetes and 37,170 age- and sex-matched comparison patients from the same period. All patients were tracked for 7 years following their index visit in 2000–2001. Result After adjusting for potential confounders, dementia risk was approximately 63% higher (hazard ratio [HR], 1.63; 95% CI, 1.33–1.99) among newly diagnosed type 2 diabetic patients than among comparison subjects. Newly diagnosed type 2 diabetes also increased the risk of developing ischemic stroke but not intracranial hemorrhage. About 43.6% of diabetic patients who developed dementia also had ischemic stroke during the follow-up period, higher than the rate 29.6% in the comparison group. Conclusion This study shows that newly diagnosed type 2 diabetes is associated with a 63% higher future risk of dementia during the 7-year follow-up period. The high dementia and ischemic stroke overlap rate in the diabetic study group suggests vascular events play an important role in the pathogenesis of developing dementia.

The reported complication rates of the distal radius fractures vary widely from 6% to 80%. Unlike damage to neural and tendinous structures, vascular complications have been extremely rare. We described an unusual case of distal radius fracture complicated with digital gangrenes because of occlusion of radial and ulnar arteries.

The definition and clinical significance of vertebral artery hypoplasia (VAH) remain inconclusive. VAH has been proposed as a predisposing factor of posterior circulation ischemic stroke. The aim of this study was to determine a best cut-off diameter of vertebral artery (VA) for VAH and to investigate if unilateral VAH is associated with a decrease in net vertebral flow volume. Retrospective data of 1000 presumably healthy subjects free of cerebrovascular disease or apparent carotid atherosclerosis were analysed. We found that a VA diameter

A number of hypotheses have been postulated to explain the development of syringomyelia associated with Chiari I malformation. However, the mechanism of syrinx development is still poorly understood. Furthermore, the outcomes of current surgical procedures have been variable. There is evidence that the syringomyelia can spontaneously resolve, and this may warrant a more conservative approach to monitor the progression of neurological deficits. In this paper, we present a patient with spontaneous regression of syringomyelia. The current aetiological theories are discussed.

Traumatic intracranial aneurysms are uncommon and represent fewer than 1% of all cerebral aneurysms. They may develop after blunt or penetrating head injuries and can present both diagnostic challenges and surgical difficulties. Because traumatic aneurysms are fragile and prone to rupture, early diagnosis with cerebral angiography and prompt treatment are essential. We present two patients with traumatic aneurysms and discuss their aetiology, classification, clinical presentations, diagnosis, and treatment options.

Gate dielectric leakage current becomes a serious concern as the gate oxide thickness of metal–oxide–semiconductor field-effect-transistors is less than 3 nm. This thin oxide can conduct significant leakage current by various tunneling mechanisms and degrade circuit performance. A mathematical method of modeling the gate leakage current I G is presented in this work. Both the shallow trench isolation effect and the source–drain extension effect on I G are included. With suitably chosen transistor dimensions, the parameter extraction can be performed using the devices’ mask drawn size, and the troublesome effective device length and width are not necessary in this model. The extracted parameters and their temperature dependence were used to predict I G of devices with other different dimensions.

Sub-micron yttria-stabilized zirconia (YSZ) electrolyte layer was prepared by a liquid state deposition method and with an average thickness of 0.5 μm to improve the performance of the anode-supported solid oxide fuel cell (SOFC). The YSZ precursors, containing yttrium and zirconium species and an additive, poly-vinyl-pyrrolidone (PVP), were spin-coated on a Ni/YSZ anode substrate. Several properties, including crystalline phases, microstructures, and current–voltage (I–V) characteristics, were investigated. The thin film of 4 mol% Y2O3-doped ZrO2 (4YSZ) consisted of cubic, tetragonal, and a trace of monoclinic phases, and showed a crack-free layer after sintering at 1300 °C. The anode supported SOFC, which consists of the Ni–YSZ anode, 4YSZ electrolyte, and Pt/Pd cathode, showed power densities of 477 mW/cm2 at 600 °C, and 684 mW/cm2 at 800 °C. Otherwise, the surface cracks of the other YSZ-coated samples (e.g. 8YSZ) can be repaired by a multi-coating method.

Several tasks were tried to prepare crack-free mullite films on silica substrates. Basically, a sol containing TEOS (Tetraethylorthosilicate) and boehmite colloid was used for spin coating on silica substrate. The formulation of the sols was kept in stoichiometric composition 3Al2O3·2SiO2, or contained a crack-limiting agent, Polyvinylpyrrolidone (PVP). These films were then treated up to 1300°C. The properties of the sols and the dried films were characterized by rheometer, various thermal analysis techniques (DTA, TGA and TMA), also by XRD, SEM and TEM. The mullite film shows randomly oriented grains in sizes from 0.1 μm to a few micrometers. The films still contain fine θ- and δ-Al2O3 particles after being treated at 1280°C for 1 h.

Background and Purpose— Asian patients with cerebrovascular diseases have more intracranial atherosclerosis and less extracranial carotid artery stenosis compared with white patients. We systemically evaluated the distribution of carotid arterial lesions in Chinese patients with transient monocular blindness (TMB), which was rarely reported. Methods— We prospectively evaluated 105 consecutive patients with TMB. All of the patients received ocular and physical examinations, blood tests for coagulation function and autoimmune diseases, and ultrasonography of cervical and intracranial arteries. All of the carotid lesions were confirmed by magnetic resonance angiography or cerebral angiography. Results— Of the 36 (34.3%) patients with significant carotid stenosis (≥50%), 16 (15.2%) had extracranial carotid stenosis; 17 (16.2%) had carotid siphon stenosis; and 3 (2.9%) had both. The duration, onset, and patterns of visual loss were not different between patients with and without carotid arterial lesion. Conclusions— This study signified the importance of carotid siphon stenosis as a probable underlying etiology for TMB in Chinese patients.

We describe structure-based design, synthesis and biological evaluation of a series of novel inhibitors bearing a pyrazole (compounds 3a-h ) or a thiazole moiety (compounds 4a-e) as the P3 ligand. We have also explored Boc-β-amino-L-alanine as a novel P2 ligand. A number of inhibitors have displayed β-secretase inhibitory potency. Inhibitor 4c has shown po tent BACE1 inhibitory activity, Ki = 0.25 nM, cellular EC50 of 194 nM and displayed good selectivity over BACE2. A model of 4c was created based upon the X-ray structure of 2-bound β-Secretase which revealed critical interactions in the active site.