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One of the challenges in integrating nanomechanical resonators made from van der Waals materials in optoelectromechanical technologies is characterizing their dynamic properties from vibrational displacement. Multiple calibration schemes using optical interferometry have tackled this challenge. However, these techniques are limited only to optically thin resonators with an optimal vacuum gap height and substrate for interferometric detection. Here, we address this limitation by implementing a modeling-based approach

Whether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan’s National Health Insurance, we performed propensity score matching analyses to evaluate the risk of adverse outcomes in patients with or without AS undergoing noncardiac surgery between 2008 and 2013. We also compared the perioperative risk of AS patients undergoing general anesthesia or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for postoperative mortality and major complications. The matching procedure generated 9741 matched pairs for analyses. AS was significantly associated with 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03–1.67), acute renal failure (aOR 1.42, 95% CI 1.12–1.79), pneumonia (aOR 1.16, 95% CI 1.02–1.33), stroke (aOR 1.14, 95% CI 1.01–1.29), and intensive care unit stay (aOR 1.38, 95% CI 1.27–1.49). Compared with neuraxial anesthesia, general anesthesia was associated with increased risks of acute myocardial infarction (aOR 3.06, 95% CI 1.22–7.67), pneumonia (aOR 1.80, 95% CI 1.32–2.46), acute renal failure (aOR 1.82, 95% CI 1.11–2.98), and intensive care (aOR 4.05, 95% CI 3.23–5.09). The findings were generally consistent across subgroups. AS was an independent risk factor for adverse events after noncardiac surgery. In addition, general anesthesia was associated with greater postoperative complications in AS patients compared to neuraxial anesthesia. This real-world evidence suggests that neuraxial anesthesia should not be contraindicated in patients with AS.

Background Little was know about the association between the CHA2DS2-VASc score and postoperative outcomes. Our purpose is to evaluate the effects of CHA2DS2-VASc score on the perioperative outcomes in patients with atrial fibrillation (AF). Methods We identified 47,402 patients with AF over the age of 20 years who underwent noncardiac surgeries between 2008 and 2013 from claims data of the National Health Insurance in Taiwan. The CHA2DS2-VASc score was used to evaluate postoperative complications, mortality and the consumption of medical resources by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results Compared with patients with a CHA2DS2-VASc score of 0, patients with scores ≥ 5 had an increased risk of postoperative septicemia (OR 2.76, 95% CI 2.00–3.80), intensive care (OR 2.55, 95% CI 2.12–3.06), and mortality (OR 2.04, 95% CI 1.14–3.64). There was a significant positive correlation between risk of postoperative complication and the CHA2DS2-VASc score (P Conclusion The CHA2DS2-VASc score was highly associated with postoperative septicemia, intensive care, and 30-day mortality among AF patients. Cardiologists and surgical care teams may consider using the CHA2DS2-VASc score to evaluate perioperative outcome risks in patients with AF.

Effects of high- ${k}$ gate stacks and plasma treatments on electrical and reliability characteristics of FinFET were comprehensively studied in this work. A higher ON-current, higher ON-/OFF-current ratio, smaller subthreshold swing (S.S.), lower gate leakage current, and better reliability characteristics in FinFETs are simultaneously achieved by a HfO2/ZrO2/HfO2 gate stack. The improvement can be attributed to its higher ${k}$ -value, fewer oxide traps, and oxygen vacancy in gate stack. A higher ON-current of FinFET can be obtained with an F-based plasma treatment, which, however, also induces a larger gate leakage current. A plasma treatment with F- and N-based ambient on gate stack is shown to obtain a higher ON-current and acceptable gate leakage in FinFET. Furthermore, a larger ON-current, higher ON-/ OFF-current ratio, and a smaller S.S. in FinFET can be achieved with a TiO2 stacked gate dielectric.

The operation characteristics of polycrystalline Si (poly-Si) gate-all-around (GAA) junctionless (JL) charge-trapping (CT) flash memory devices with the Zr-based stacked trapping layer were studied in this work. Devices with the Si3N4/ZrO2 stacked trapping layer show enhanced erasing speeds and comparable retention characteristics in comparison to Si3N4/HfO2 due to many shallow energy traps and smaller valance band offset in the ZrO2 layer. By inserting Al2O3 between Si3N4 and ZrO2 trapping layer, the retention and endurance characteristics are improved. The erasing speed can be further improved by a Zr-rich oxide layer near the tunneling oxide since the energy barrier can confine more injected electrons near the tunneling oxide. The retention characteristic can be improved without sacrificing the erasing speed because some of the shallow traps can be passivated by NH3 plasma treatment on ZrO2. Hence, the ZrO-based stacked trapping layer is very promising for the poly-Si GAA JL CT flash devices for nonvolatile memory applications.

The influence of physician specialty on the outcomes of kidney diseases (KDs) remains underexplored. We aimed to compare the complications and mortality of patients with admissions for KD who received care by nephrologists and non-nephrologist (NN) physicians. We used health insurance research data in Taiwan to conduct a propensity-score matched study that included 17,055 patients with admissions for KD who received care by nephrologists and 17,055 patients with admissions for KD who received care by NN physicians. Multivariable logistic regressions were conducted to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for 30-day mortality and major complications associated with physician specialty. Compared with NN physicians, care by nephrologists was associated with a reduced risk of 30-day mortality (OR 0.29, 95% CI 0.25–0.35), pneumonia (OR 0.82, 95% CI 0.76–0.89), acute myocardial infarction (OR 0.68, 95% CI 0.54–0.87), and intensive care unit stay (OR 0.78, 95% CI 0.73–0.84). The association between nephrologist care and reduced admission adverse events was significant in every age category, for both sexes and various subgroups. Patients with admissions for KD who received care by nephrologists had fewer adverse events than those who received care by NN physicians. We suggest that regular nephrologist consultations or referrals may improve medical care and clinical outcomes in this vulnerable population.

The association between pancreatitis and acute myocardial infarction or stroke remains incompletely understood. This study aimed to evaluate the long-term risk of acute atherosclerotic cardiovascular disease (ASCVD) in people with acute and chronic pancreatitis. Using research database of Taiwan's National Health Insurance, we identified 2678 patients aged ≥ 20 years with newly diagnosed pancreatitis in 2000–2008. A cohort of 10,825 adults without pancreatitis was selected for comparison, with matching by age and sex. Both cohorts were followed from 2000 to the end of 2013, and incident acute ASCVD was identified during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acute ASCVD associated with pancreatitis were calculated. Compared with the comparison cohort, the adjusted HR of acute ASCVD were 1.76 (95% CI 1.47–2.12) and 3.42 (95% CI 1.69–6.94) for people with acute pancreatitis and chronic pancreatitis, respectively. A history of alcohol-related illness (HR 9.49, 95% CI 3.78–23.8), liver cirrhosis (HR 7.31, 95% CI 1.81–29.5), and diabetes (HR 6.89, 95% CI 2.18–21.8) may worsen the risk of acute ASCVD in patients with chronic pancreatitis. Compared with people had no pancreatitis, patients with acute pancreatitis who had alcohol-related illness (HR 4.66, 95% CI 3.24–6.70), liver cirrhosis (HR 4.44, 95% CI 3.05–6.47), and diabetes (HR 2.61, 95% CI 2.03–3.36) were at increased risk of acute ASCVD. However, the cumulative use of metformin was associated with a reduced risk of acute ASCVD in the acute pancreatitis cohort (HR 0.30, 95% CI 0.17–0.50). Compared with the control group, patients with acute or chronic pancreatitis were more likely to have an increased risk of acute ASCVD, while the use of metformin reduced the risk of acute ASCVD. Our findings warrant a survey and education on acute ASCVD for patients with acute and chronic pancreatitis.

Occupational accidents and diseases cause the loss of valuable workers and lead to high healthcare expenses. Because occupational accidents and diseases are ascribed to inadequate working conditions and work environments, they can be prevented through a well-established occupational safety and health management system, which can ensure workers’ health and reduce the expense of healthcare. The study investigated the shortage of work-related occupational safety and health (OSH) measures in medium-sized manufacturing industries. This study mainly focused on qualitative interviews with 15 labor inspectors and 25 business executives from OSH participating to investigate the problems of occupational safety and health in the manufacturing industries in Taiwan. The results of a qualitative study show that the most important problems with OSH management are employers’ negligence and workers’ insufficient knowledge about OSH management. The research results revealed the following eighteen significant shortcomings of OSH management: employers care mostly about production profit and do not care much for OSH, OSH data collection and OSH planning are not suitable for the workplace, many managers of OSH affairs are not qualified, in terms of their professional or academic backgrounds, and the repair of workplaces’ roofs often results in falling accidents, especially before or after a typhoon, because of workers’ failure to use safety belts and/or to follow OSH guidelines. In order to address the shortcomings and bottlenecks, the study also presented recommendations for how to implement and revise the OSH Act and how to research and enhance OSH management. The results of this study will not only supply the Ministry of Labor (Taiwan) with data to plan the strategy of OSH management but also will allow employers and workers to improve OSH management in the workplace in order to prevent the occurrence of occupational accidents.

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) leads to impairment of pulmonary hemodynamics, triggers secondary right heart dysfunction, regularly accompanied by systemic malperfusion, and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD) may also adversely affect CTEPH prognosis. This study aimed to assess how Brain natriuretic peptide (BNP) combined with balloon pulmonary angioplasty (BPA) improve right heart hemodynamics and estimated GFR (eGFR) of CKD in CTEPH patients.MethodsWe retrospectively studied 47 patients with confirmed CTEPH with CKD who were treated with BPA and admitted to the intensive care unit between December 2012 and September 2020. The patient was divided into two groups based on whether to receive recombinant human brain natriuretic peptide treatment (rhBNP). The information of patients between two groups was systematically compared in hospital and follow up. eGFR were assessed at several time points. ResultsFor rhBNP group, eGFR was significantly higher in the two periods of Prior to last BPA and 6-month follow-up. A significantly higher Δ eGFR from baseline to follow-up was observed. There was significant difference on levels of troponin I, NT-proBNP, and right ventricle diameter at follow-up. Conclusion rhBNP combined BPA therapy improves pulmonary and systemic hemodynamics, with positive effects on renal function, which maybe an alternative treatment option for improving clinical outcomes.

The risk and outcomes of diabetes in patients with epilepsy remains unclear. We evaluated these risks using an epilepsy cohort analysis and a diabetes admission analysis. In the epilepsy cohort analysis, we identified 2854 patients with newly diagnosed epilepsy in 2000–2008 from the research data of National Health Insurance in Taiwan. Using Propensity-score matching by sociodemographic factors and medical conditions, we selected 22,832 people without epilepsy as a non-exposed cohort for comparison. Follow-up events of diabetes from January 1, 2000 until December 31, 2013 were ascertained from medical claims. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes associated with epilepsy were calculated using multiple Cox proportional hazard models. In the diabetes admission analysis, we identified 92,438 hospitalized diabetes patients, 930 of whom had a history of epilepsy. Adjusted odds ratios (ORs) and 95% CIs of adverse events after diabetes associated with previous epilepsy were calculated using multiple logistic regressions. The adjusted HR of diabetes in the cohort with epilepsy was 1.31 (95% CI 1.14–1.50) compared to the non-epilepsy cohort. Previous epilepsy was associated with post-diabetes adverse events, such as pneumonia (OR 1.68, 95% CI 1.37–2.07), urinary tract infection (OR 1.83, 95% CI 1.55–2.16), and septicemia (OR 1.34, 95% CI 1.09–1.65). In conclusion, epilepsy was associated with higher risk of diabetes and adverse post-diabetes outcomes. Diabetes prevention and attention to post-diabetes adverse events are needed for this susceptible population.

Due to the fact that previous studies have rarely investigated the recognition rate discrepancy and pathology data error when applied to different databases, the purpose of this study is to investigate the improvement of recognition rate via deep learning-based liver lesion segmentation with the incorporation of hospital data. The recognition model used in this study is H-DenseUNet, which is applied to the segmentation of the liver and lesions, and a mixture of 2D/3D Hybrid-DenseUNet is used to reduce the recognition time and system memory requirements. Differences in recognition results were determined by comparing the training files of the standard LiTS competition data set with the training set after mixing in an additional 30 patients. The average error value of 9.6% was obtained by comparing the data discrepancy between the actual pathology data and the pathology data after the analysis of the identified images imported from Kaohsiung Chang Gung Memorial Hospital. The average error rate of the recognition output after mixing the LiTS database with hospital data for training was 1%. In the recognition part, the Dice coefficient was 0.52 after training 50 epochs using the standard LiTS database, while the Dice coefficient was increased to 0.61 after adding 30 hospital data to the training. After importing 3D Slice and ITK-Snap software, a 3D image of the lesion and liver segmentation can be developed. It is hoped that this method could be used to stimulate more research in addition to the general public standard database in the future, as well as to study the applicability of hospital data and improve the generality of the database.

Studies involving nanomechanical motion have evolved from its detection and understanding of its fundamental aspects to its promising practical utility as an integral component of hybrid systems. Nanomechanical resonators’ indispensable role as transducers between optical and microwave fields in hybrid systems, such as quantum communications interface, have elevated their importance in recent years. It is therefore crucial to determine which among the family of nanomechanical resonators is more suitable for this role. Most of the studies revolve around nanomechanical resonators of ultrathin structures because of their inherently large mechanical amplitude due to their very low mass. Here, we argue that the underutilized nanomechanical resonators made from multilayered two-dimensional (2D) materials are the better fit for this role because of their comparable electrostatic tunability and larger optomechanical responsivity. To show this, we first demonstrate the electrostatic tunability of mechanical modes of a multilayered nanomechanical resonator made from graphite. We also show that the optomechanical responsivity of multilayered devices will always be superior as compared to the few-layer devices. Finally, by using the multilayered model and comparing this device with the reported ones, we find that the electrostatic tunability of devices of intermediate thickness is not significantly lower than that of ultrathin ones. Together with the practicality in terms of fabrication ease and design predictability, we contend that multilayered 2D nanomechanical resonators are the optimal choice for the electromagnetic interface in integrated quantum systems.

Objective Urticaria is a mast cell-related disease caused severe itching and the lifetime prevalence of urticaria is about 20% in general population. Our purpose is to evaluate risk of urticaria in geriatric stroke patients received influenza vaccination (IV). Methods In a cohort of 192,728 patients with newly diagnosed stroke aged over 65 years obtained from 23 million people in Taiwan's National Health Insurance between 2000 and 2008, we identified 9890 stroke patients who received IV and 9890 propensity score-matched stroke patients who did not receive IV. Controlling for immortal time bias, both the IV and non-IV groups were followed for one year. Urticaria events were identified during the follow-up period. We calculated the adjusted rate ratios (RRs) and 95% confidence intervals (CIs) of the one-year risk of urticaria associated with IV. Results During the follow-up period of one year, stroke patients with IV had a significantly higher risk of urticaria compared with non-IV stroke patients (RR 1.81, 95% CI 1.47-2.23). An increased risk of urticaria in stroke patients with IV was noted in both sexes, patients 65-84 years of age, patients with comorbid medical conditions, and various time intervals of follow-up. Vaccinated stroke patients with hemorrhage (RR 4.00, 95% CI 1.76-9.10) and those who received intensive care (RR 5.14, 95% CI 2.32-11.4) had a very high risk of urticaria compared with those without IV. Conclusion Receiving IV may be associated with an increased risk of urticaria in stroke patients. We could not infer the causality from the current results because of this study's limitations. Future investigations are needed to evaluate the possible mechanism underlying the association between IV and urticaria.

Objective To evaluate the complications, mortality, and medical expenditures after nonurological surgical procedures in patients with chronic kidney disease (CKD). Methods Using claims data of Taiwan's National Health Insurance, we conducted a matched cohort study of 35,643 patients with CKD who underwent nonurological surgeries in 2008-2013. By using a propensity-score matching procedure, 35,643 non-CKD patients were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with CKD. Results The results showed that patients with CKD had higher risks of postoperative septicemia (OR: 1.78, 95% CI: 1.68-1.89), pneumonia (OR: 1.60, 95% CI: 1.48-1.73), stroke (OR: 1.34, 95% CI: 1.24-1.44), and in-hospital mortality (OR: 2.17, 95% CI: 1.90-2.47) compared with non-CKD patients. Longer hospital stays and higher medical expenditures after nonurological surgical procedures were noted in CKD patients. The association between CKD and postoperative adverse events was significant in both sexes, all of the age groups, and the other subgroups. Histories of myocardial infarction, epilepsy, and ages greater than 70 years were factors that were significantly associated with postoperative adverse events. Conclusion Compared with non-CKD patients, surgical patients with CKD exhibited more adverse events, with risks of in-hospital mortality that were approximately 2-fold higher after nonurinary surgery. These findings suggest an urgent need to revise the protocols for postoperative care in this population.

Shu-Wen Weng,1,* Ta-Liang Chen,2–4 Chun-Chieh Yeh,5,6 Hsin-Long Lane,7 Chien-Chang Liao,2–4,8,* Chun-Chuan Shih7,9 1Department of Chinese Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; 2Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 3Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 4Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 5Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 6Department of Surgery, University of Illinois, Chicago, IL, USA; 7School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan; 8School of Chinese Medicine, China Medical University, Taichung, Taiwan; 9Program for the Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan *These authors contributed equally to this work Objective: To compare the long-term risk of epilepsy in stroke patients who use Bu Yang Huan Wu Tang (BYHWT) and those who do not. Methods: In the Taiwanese national insurance claims data, we identified newly diagnosed stroke patients receiving inpatient care in the years 2000–2004. Using propensity score-matched pairs to balance the baseline characteristics, we selected eligible stroke patients who did (n=8,971) and did not (n=8,971) receive BYHWT. These two groups were followed up until the end of 2009 to track the occurrence of epilepsy. We used Cox proportional hazard models to calculate the adjusted HRs and 95% CIs for post-stroke epilepsy during the follow-up period according to BYHWT use. Results: Compared with the control group, stroke patients with BYHWT had a reduced risk of epilepsy during the 5–9 years of the follow-up period (HR 0.69, 95% CI 0.61–0.77). The association between BYHWT and reduced post-stroke epilepsy was significant in various subgroups of stroke patients. There was a dose-dependent decrease in the frequency of epilepsy with increasing quantities of BYHWT use from 1 package (HR 0.77, 95% CI 0.66–0.90) to ≥6 packages (HR 0.52, 95% CI 0.42–0.65). Conclusion: Stroke patients who received BYHWT therapy had a reduced long-term risk of epilepsy, and the beneficial effect could be observed in various subgroups. However, future clinical trials will be necessary to corroborate the present findings and identify the biochemical mechanism involved. Keywords: stroke, epilepsy, Bu Yang Huan Wu Tang, long-term risk

The impact of heart failure (HF) on postoperative outcomes is not completely understood. Our purpose is to investigate complications and mortality after noncardiac surgeries in people who had HF. In the analyses of research data of health insurance in, we identified 32,808 surgical patients with preoperative HF and 32,808 patients without HF undergoing noncardiac surgeries. We used a matching procedure with propensity score and considered basic characteristics, coexisting diseases, and information of index surgery between patients with and without HF. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for complications and mortality after noncardiac surgeries in patients with HF were analyzed in multivariate logistic regressions. HF increased the risks of postoperative acute myocardial infarction (OR 2.51, 95% CI 1.99–3.18), pulmonary embolism (OR 2.46, 95% CI 1.73–3.50), acute renal failure (OR 1.97, 95% CI 1.76–2.21), intensive care (OR 1.93, 95% CI 1.85–2.01), and 30-day in-hospital mortality (OR 1.80, 95% CI 1.59–2.04). Preoperative emergency care, inpatient care, and injections of diuretics and cardiac stimulants due to heart failure were also associated with mortality after surgery. Patients with HF had increased complications and mortality after noncardiac surgeries compared with those without HF. The surgical care team may consider revising the protocols for perioperative care in patients with HF.

Background. The optimal dose and concentration of analgesic efficacy of ropivacaine (RPV) and bupivacaine (BPV) for postoperative pain relief in paediatric abdominal surgery patients is still unclear. Therefore, this meta-analysis compared the efficacy of these analgesics, their administered modes (ultrasound-guided RSB versus LAI) for postoperative pain relief, and side effects. Methods. Three databases, PubMed, Embase, and Cochrane Database of Systematic Reviews, were exhaustively searched with predefined keywords. Eight randomized clinical trials and retrospective studies were selected. Analgesic effect, postoperative pain score, level of side effect, applied dose, and concentration of drug were analysed. Results. Drug dose ranged from 0.5–2.5 mL/kg of 0.2 to 0.5% concentrations. Male participant for RSB and LAI treatment groups varied from 40–62% and 25–83%, respectively. Mean age of RSB and LAI groups ranged from 3.8–11.65 years and 4.3–11.27 years, respectively. Our meta-analysis revealed that RSB could reduce total opioid use postoperatively (WMD = −0.02, 95% CI: −0.02, −0.02), with I2 value of 15%. We found that the RPV (0.25%, 2.5 ml/kg) was optimal in suppressing the pain. Its lower concentration (0.2%) was ineffective, whereas higher one (0.375%) seems to increase risk of systemic toxicity. Similarly, BPV (0.25%, 2.5 mg/kg) efficaciously reduced the pain score, while its lower concentration was ineffective. The combined postoperative pain score in the RPV-treated group was found to be significantly reduced ( p < 0.01 ) with I2 value of 85% indicating high heterogeneity. Conclusion. Both RPV and BPV were significantly effective in reducing postoperative pain score. It appears that RSB could be a preferred choice to deliver analgesia, due to reduced opiate dose requirement and improved clinical safety without significant postoperative adverse events.

Cancer is one of the common diseases. Quantitative biomarkers extracted from standard-of-care computed tomography (CT) scan can create a robust clinical decision tool for the diagnosis of hepatocellular carcinoma (HCC). According to the current clinical methods, the situation usually accounts for high expenditure of time and resources. To improve the current clinical diagnosis and therapeutic procedure, this paper proposes a deep learning-based approach, called Successive Encoder-Decoder (SED), to assist in the automatic interpretation of liver lesion/tumor segmentation through CT images. The SED framework consists of two different encoder-decoder networks connected in series. The first network aims to remove unwanted voxels and organs and to extract liver locations from CT images. The second network uses the results of the first network to further segment the lesions. For practical purpose, the predicted lesions on individual CTs were extracted and reconstructed on 3D images. The experiments conducted on 4300 CT images and LiTS dataset demonstrate that the liver segmentation and the tumor prediction achieved 0.92 and 0.75 in Dice score, respectively, by as-proposed SED method.

BackgroundAcute kidney injury (AKI) following wasp stings is a serious and common health hazard, however the early prediction remains challenging. The study aimed to establish a model to predict AKI following wasp stings and validate it.MethodsIn the multicenter prospective cohort study, 508 patients with wasp stings from Jul 2015 to Dec 2019 were randomly divided into the training set (n = 381) and validation set (n = 127) for internal and external validation. A model that based on the multivariable logistic regression analysis was utilized to predict the probability of AKI following wasp stings by a predictive formula and a nomogram. The performances of the model were assessed by using the area under the curve (AUC) and accuracy (ACC) of the receiver operating characteristic curve. The calibration curves were utilized for estimating the consistency between the actual observed outcome and the nomogram predicted AKI probability. Decision curve analysis (DCA) demonstrated the net benefit associated with the use of the nomogram-derived probability for the prediction of AKI following wasp stings.Results Number of stings, hemoglobin (HB) < 110 g/dl, total bilirubin (TBI) > 34 mg/dl, alanine transaminase (ALT) > 40 U/L and activated partial thromboplastin time (APTT) > 47 s were demonstrated as the independent risk factors for AKI following wasp stings (all P value < 0.05) and were incorporated into the model. The performances of the model were validated (AUC = 0.912, ACC = 0.869 and AUC = 0.936, ACC = 0.898 in the training set and validation set respectively). The predictive formula and nomogram of the model could be utilized to predict the AKI following wasp stings, which having sufficient accuracies, good predictive capabilities and good net benefits.ConclusionIn conclusion, we proved that number of stings, HB < 110 g/dl, TBI > 34 mg/dl, ALT > 40 U/L and APTT > 47 s were independence risk factors for AKI following wasp stings. The predictive formula and the individual nomogram of the model might serve as promising predictive tools to assess the probability of the AKI following wasp stings.

IntroductionLimited information was available regarding the perioperative outcomes in patients with and without use of metformin. This study aims to evaluate the complications and mortality after major surgery in patients with diabetes who use metformin.Research design and methodsUsing a real-world database of Taiwan’s National Health Insurance from 2008 to 2013, we conducted a matched cohort study of 91 356 patients with diabetes aged >20 years who used metformin and later underwent major surgery. Using a propensity score-matching technique adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 91 356 controls who underwent surgery but did not use metformin were selected. Logistic regression was used to calculate the ORs with 95% CIs for postoperative complications and 30-day mortality associated with metformin use.ResultsPatients who used metformin had a lower risk of postoperative septicemia (OR 0.94, 95% CI 0.90 to 0.98), acute renal failure (OR 0.87, 95% CI 0.79 to 0.96), and 30-day mortality (OR 0.79, 95% CI 0.71 to 0.88) compared with patients who did not use metformin, in both sexes and in every age group. Metformin users who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR 0.60, 95% CI 0.59 to 0.62) and lower medical expenditures (pConclusionsAmong patients with diabetes, those who used metformin and underwent major surgery had a lower risk of complications and mortality compared with non-users. Further randomized clinical trials are needed to show direct evidence of how metformin improves perioperative outcomes.

This paper aims to provide a thorough study on the effectiveness of the transformation-based ensemble defence for image classification and its reasons. It has been empirically shown that they can enhance the robustness against evasion attacks, while there is little analysis on the reasons. In particular, it is not clear whether the robustness improvement is a result of transformation or ensemble. In this paper, we design two adaptive attacks to better evaluate the transformation-based ensemble defence. We conduct experiments to show that 1) the transferability of adversarial examples exists among the models trained on data records after different reversible transformations; 2) the robustness gained through transformation-based ensemble is limited; 3) this limited robustness is mainly from the irreversible transformations rather than the ensemble of a number of models; and 4) blindly increasing the number of sub-models in a transformation-based ensemble does not bring extra robustness gain., The 27th ACM Conference on Computer and Communications Security (CCS) Workshop, AISec 2020

AIM To evaluate outcomes after major surgery in children and adolescents with intellectual disability. METHOD We used 2004 to 2013 claims data from Taiwan's National Health Insurance programme to conduct a nested cohort study, which included 220 292 surgical patients aged 6 to 17 years. A propensity score matching procedure was used to select 2173 children with intellectual disability and 21 730 children without intellectual disability for comparison. Logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the postoperative complications and 30-day mortality associated with intellectual disability. RESULTS Children with intellectual disability had a higher risk of postoperative pneumonia (OR 2.16, 95% CI 1.48-3.15; p

The study protocol was reviewed and approved by National Taiwan University Hospital (201605118RINB); National Taiwan University Hospital, Hsin-Chu branch (103-082-E); Chang Gung Memorial Hospital, Linkou and Taipei branches (104-7463B, 104-7317B), and China Medical University Hospital (CMUH107-REC2-160). This work has not been published previously and is not under consideration for publication elsewhere, its publication has been approved by all authors, and if accepted, it will not be published elsewhere, including electronically in the same form, in English or in any other language, without the written consent of the copyright-holder.

The utilization of traditional Chinese medicine is a common therapeutic approach for stroke patients in Chinese population, but little is known about the effect of Bu Yang Huan Wu Tang (BYHWT) on post-stroke diabetes.We aimed to evaluate the risk of diabetes in stroke patients who used BYHWT.A retrospective cohort study based on a real-world database was conducted.Newly diagnosed stroke patients receiving inpatient care from 2000 to 2004 were identified using a large-scale insurance database in Taiwan. Propensity score matching was used to select eligible stroke patients who did (n = 9849) and did not (n = 9849) receive BYHWT. These two groups were followed up until the end of 2009 to track incident diabetes. Cox proportional hazard models were used to calculate the adjusted hazard rations (HRs) and 95% confidence intervals (CIs) for post-stroke diabetes associated with BYHWT during the follow-up period.Stroke patients who used BYHWT had a reduced incidence of diabetes (14.1% vs. 19.0%, p0.0001) and reduced risk of diabetes (HR 0.77; 95% CI 0.72 to 0.83) compared with the control group. The association between BYHWT and reduced risk of post-stroke diabetes was significant across sexe, age group, and stroke subtype. Additionally, the use of BYHWT was associated with a reduced risk of post-stroke diabetes even after excluding the initial three months of diabetes cases in the sensitivity analysis.Stroke patients who received BYHWT therapy had a reduced risk of diabetes, and a positive effect was observed in various subgroups. However, future clinical trials will be necessary to validate the present findings and identify the biochemical mechanism involved.

OBJECTIVES In the Asian population, patterns and risk factors for de novo malignancies after solid-organ transplant are not well understood. MATERIALS AND METHODS Insurance claims from Taiwan's National Health Institute Research Database from 1997 to 2011 revealed 687 deceased-donor heart transplant recipients, 5038 kidney transplant recipients (50% living related-donor, 50% deceased-donor transplants), and 2127 liver transplant recipients (mainly living related-donor transplants, 30% deceased-donor transplants). During the follow-up period, rates of malignancy incidence were calculated with standardization based on national age, sex, and year-specific incidence. We used multivariate regression analyses to determine risk factors of posttransplant de novo malignancies. RESULTS Compared with the general population, several de novo cancers were more common posttransplant (P < .05): lung cancer (2.6-fold), non-melanoma skin cancer (5.8-fold), and non-Hodgkin lymphoma (5.4-fold) in heart recipients; transitional cell carcinoma (31.4-fold), renal cell carcinoma (37.3-fold), and non-Hodgkin lymphoma (3.6-fold) in kidney recipients; and gastric cancer (3.0-fold) and lymphatic-hematopoietic malignancy (4.5-fold) in liver recipients. Independent risk factors for posttransplant malignancy in kidney transplant recipients were increased age, female, hepatitis B virus, and mycophenolate use (adjusted hazard ratio 1.5; 95% confidence interval, 1.2-1.8; P < .001). In liver transplant recipients, old age was an independent risk factor. Kidney transplant recipients without diabetes or hypertension had higher risk of transitional cell carcinoma (adjusted hazard ratio 3.0; 95% confidence interval, 2.1-4.4; P < .001) and renal cell carcinoma (adjusted hazard ratio 1.9; 95% confidence interval, 1.1-3.3; P < .05). CONCLUSIONS Regional endemic epidemiologic factors play significant roles in the development of de novo cancers, particularly in kidney transplant recipients due to causes of renal failure other than diabetes and hypertension. Each regional organ transplant program should tailor and establish its surveillance protocol based on epidemiologic data. However, the type and intensity of surveillance require further and long-term investigations in this patient cohort.

Objective: The study intended to use narrative medicine study for interdisciplinary collaboration to let medical and healthcare students have a chance to interact with one another and listen to patients&rsquo, stories to enhance students&rsquo, reflective thinking, communication, empathy, and narrative medicine writing skills. Methods: A fifteen-week quasi-experimental design was used to examine the learning outcomes of the intervention. Two groups of students were randomly assigned as the experimental group (33 students) and the control group (32 students). Before and after the intervention, both groups had to fill in a Reflective Thinking Scale for Healthcare Students and Providers (RTS-HSP), Patient&ndash, Healthcare Provider Communication Scale (P-HCS), Empathy Scale in Patient Care (ES-PC), and Analytic Narrative Medicine Writing Scoring Rubric (ANMWSR). Results: The findings showed that on the reflective thinking scale, experimental group students had significantly higher reflective thinking posttest scores in &ldquo, reflective skepticism,&rdquo, &ldquo, empathetic reflection,&rdquo, and &ldquo, critical open-mindedness,&rdquo, but not in &ldquo, self-examination.&rdquo, As for patient&ndash, healthcare provider communication, they had significantly higher posttest scores in all &ldquo, perception of trust and receptivity,&rdquo, patient-centered information giving,&rdquo, rapport building,&rdquo, facilitation of patient involvement&rdquo, factors. As for empathy, they had significant higher posttest scores in &ldquo, behavioral empathy&rdquo, affective empathy,&rdquo, intelligent empathy.&rdquo, In narrative medical writing skills, they had significant higher posttest scores in the &ldquo, attention &rarr, representation &rarr, affiliation,&rdquo, depth of reflection,&rdquo, focus and context structure,&rdquo, ideas and elaboration&rdquo, sections, but not in the &ldquo, language and conventions&rdquo, section. Conclusion: The findings suggest that narrative medicine is worth recommending for interdisciplinary collaboration for healthcare education.

Background and aims Because the sex difference in outcomes of fracture was incompletely understood, we evaluated the post-fracture complications and mortality of female and male patients. Methods We conducted a nationwide study of 498,586 fracture patients who received inpatient care using Taiwan’s National Health Insurance Research Database 2008–2013 claims data. Female and male fracture patients were selected for comparison by using a propensity-score matching procedure. Age, low income, types of fracture, fracture with surgery, several medical conditions, number of hospitalization and emergency visits were considered as potential confounding factors. Multivariate logistic regressions were used to calculate the adjusted odds ratios (OR), the 95% CI of post-fracture complications and 30-day in-hospital mortality differences between women and men. Results Male patients had a higher risk of post-fracture pneumonia (OR 1.96, 95% CI 1.83–2.11), acute renal failure (OR 1.85, 95% CI 1.60–2.15), deep wound infection (OR 1.63, 95% CI 1.51–1.77), stroke (OR 1.58, 95% CI 1.49–1.67), septicemia (OR 1.51, 95% CI 1.42–1.61), acute myocardial infarction (OR 1.38, 95% CI 1.09–1.75) and 30-day in-hospital mortality (OR 1.69, 95% CI 1.48–1.93) compared with female patients. However, a lower risk of post-fracture urinary tract infection (OR 0.69, 95% CI 0.65–0.72) was found in men than in women. Male patients also had longer hospital stays and higher medical expenditures due to fracture admission than did the female patients. Higher rates of post-fracture adverse events in male patients were noted in all age groups and all types of fractures. Conclusion We raised the possibility that male patients showed more complications and higher mortality rates after fracture admission compared with female patients, with the exception of urinary tract infections.

[This corrects the article DOI: 10.1371/journal.pone.0231374.].

Background The relationship between chronic obstructive pulmonary disease (COPD) and perioperative outcomes remains incompletely understood. Our purpose is to evaluate the features of postoperative adverse outcomes for geriatric surgical patients with COPD receiving non-thoracic surgeries. Aim To evaluate the potential impact of COPD history on the outcome after general surgery. Design A retrospective cohort study with matching procedure by propensity score. Methods We conducted a nationwide study of 15 359 COPD patients aged 65 years and older who received major non-thoracic surgeries in 2008-2013 from the Taiwan National Health Insurance Research Database. Comprehensive matching procedure with propensity score were used to select 15 359 surgical patients without COPD for comparison. Major postoperative complications and 30-day in-hospital mortality were evaluated among patients with and without COPD by calculating adjusted odds ratios (ORs) and 95% CIs. Results Patients with COPD had significantly increased risk for postoperative complications, including pneumonia (OR = 90.3; 95% CI: 60.3-135), septicemia (OR = 3.11; 95% CI: 2.82-3.43), acute renal failure (OR = 2.53; 95% CI: 2.11-3.02), pulmonary embolism (OR = 2.74; 95% CI: 1.52-4.96), and 30-day postoperative mortality (adjusted OR = 2.09; 95% CI: 1.76-2.50), compared with surgical patients without COPD. Longer length of hospital stay and higher medical expenditures were also noted in COPD patients than those without COPD. Conclusions Geriatric patients with COPD showed significantly higher postoperative adverse outcome rates with risk of 30-day mortality nearly twofold when compared with patients without COPD. Our findings remind surgical care team pay more attention to this specific population.

Background The impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood. Our purpose is to identify risk factors for mortality in ICU patients with liver cirrhosis. Methods Using reimbursement claims from Taiwan’s National Health Insurance Research Database from in 2006–2012, 1,250,300 patients were identified as having ICU stays of more than 1 day, and 37,197 of these had liver cirrhosis. With propensity score-matching for socioeconomic status, pre-existing medical conditions, and cirrhosis-related morbidities, 37,197 ICU patients without liver cirrhosis were selected for comparison. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of cirrhosis associated with 30-day, ICU, and one-year mortality were calculated. Results Compared with control, cirrhotic patients had higher 30-day mortality (aOR 1.60, 95% CI 1.53 to 1.68), particularly those with jaundice (aOR 2.23, 95% CI 2.03 to 2.45), ascites (aOR 2.32, 95% CI 2.19 to 2.46) or hepatic coma (aOR 2.21, 95% CI 2.07 to 2.36). Among ICU patients, liver cirrhosis was also associated with ICU mortality (aOR 144, 95% CI 1.38 to 1.51) and one-year mortality (aOR 1.40, 95% CI 1.35 to 1.46). Associations between cirrhosis of liver and increased 30-day mortality were significant in both sexes and every age group. Conclusions Liver cirrhosis was associated with 30-day mortality in ICU patients. Jaundice, ascites, hepatic coma, more than 4 admissions due to cirrhosis, and more than 30 days of hospital stay due to cirrhosis were exacerbated factors in cirrhotic ICU patients.

Although previous studies have shown that health checks may improve several risk factors for chronic diseases, the effect of preoperative health checks on postoperative recovery in surgical patients remains unknown. We aimed to investigate the association between preoperative use of mammography and the risk of perioperative complications. We conducted a matched cohort study of 152,411 patients aged &ge, 47 years who received mammography screening and later underwent major surgery from 2008 to 2013. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 152,411 controls who underwent surgery but were not screened were selected. We collected patients&rsquo, characteristics and medical conditions from claims data of Taiwan&rsquo, s National Health Insurance. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative complications and in-hospital mortality associated with mammography screening. Patients receiving mammography prior to major surgery had significantly lower risks of perioperative complications, including pneumonia, septicemia, acute renal failure, stroke, urinary tract infection, deep wound infection, acute myocardial infarction, intensive care unit stay, and 30 day in-hospital mortality (OR 0.45, 95% CI 0.38&ndash, 0.53). The association was consistent across each stratum of age, number of hospitalizations, emergency visits, and comorbidities. In conclusion, preoperative use of mammography was strongly associated with fewer perioperative complications and less in-hospital mortality after major surgeries. The evidence provided by this study justifies the implementation of preoperative health checks in clinical practice.

Eliminating unnecessary healthcare waste in hospitals and providing better healthcare quality are the core issues of green supply chain management (GSCM). Hence, this study used a hospital&rsquo, s emergency department crowding (EDC) problem to illustrate how to establish an emergency medicine service (EMS) simulation system to obtain a robust parameters setting for solving hospitals&rsquo, EDC and waste problems, thereby increasing healthcare quality. Inappropriate resource allocation results in more serious EDC, more serious EDC results in increasing operating costs. Therefore, in the healthcare system, waste includes inappropriate costs and inappropriate resource allocation. The EMS of a medical center in central Taiwan was the object of the study. In this study, the dynamic Taguchi method was used to set the signal factor, noise factor, and control factors to simulate the EMS system to obtain the optimal parameters setting. The performance was set to Emergency Department Work Index (EDWINC) and system time (waiting time and service time) per patient. The signal factor was set to the number of physicians, the noise factor was set to patient arrival rate, the control factors included persuading Triage 4 and Triage 5 outpatients, checkup process, bed occupation rate in the emergency department (ED), and medical checkup sequence for Triage 4 and Triage 5 patients. This study makes two significant contributions. First, the study introduces the GSCM concept to the healthcare setting to bring green innovation to hospitals. Hospital administrators may hence design better GSCM activities to facilitate healthcare processes to provide better healthcare outcomes. Second, the study applied the dynamic Taguchi method to the EMS and neural network (NN) to construct a computational model revealing the cause (factors) and effect (performances) relationship. In addition, the genetic algorithm (GA), a solution method, was used to obtain the optimal parameters setting of the EDC in Taiwan. Hence, after obtaining the solutions, the unnecessary waste in EDC&mdash, inappropriate costs and inappropriate resource allocation&mdash, is reduced.

Ta-Liang Chen,1,2,* Chao-Shun Lin,2–4 Jui-An Lin,1,2 Chun-Chieh Yeh,5,6 Li-Chin Sung,7 Yi-Cheng Chang,8 Chun-Chuan Shih,9,10,* Chien-Chang Liao2–4,11,12 1Department of Anesthesiology, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 2Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 3Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 4Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 5Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 6Department of Surgery, University of Illinois, Chicago, IL, USA; 7Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; 8Division of Endocrinology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; 9School of Chinese Medicine for Post-Baccalaureate, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 10Ph.D. Program in Clinical Drug Development of Herbal Medicine, College of Pharmacy, Taipei Medical University, Taipei, Taiwan; 11Research Center of Big Data and Meta-Analysis, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; 12School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan*These authors contributed equally to this workCorrespondence: Chien-Chang LiaoDepartment of Anesthesiology, Taipei Medical University Hospital, 252 Wuxing St., Taipei 11031, TaiwanTel +886-2-2737-2181, ext. 8310Fax +886-2-2736-7344Email jacky48863027@yahoo.com.twObjective: This study aimed to evaluate the risk of incident diabetes between people who used lovastatin and red yeast rice (RYR) prescriptions.Methods: A retrospective cohort study was performed to analyze the real-world database of Taiwan’s National Health Insurance. We identified the RYR cohort, which included 34,504 persons age 20 years or older who began their use of a RYR prescription in 2010–2014. A comparison cohort of 34,504 adults beginning the use of lovastatin was selected from the same dataset, which was matched by age and sex. Both cohorts had no diabetes before the use of the medications. Events of incident diabetes in 2000–2015 were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of incident diabetes associated with the use of RYR prescriptions were calculated.Results: The incidences of diabetes for the RYR cohort and the lovastatin cohort were 1.01 and 2.59 per 100 person-years, respectively (P < 0.0001). Compared with the lovastatin cohort, the adjusted HR of incident diabetes was 0.46 (95% CI 0.43–0.50) for people who used RYR prescriptions. The association between reduced incident diabetes and use of RYR prescriptions was significant in various subgroups. There was a dose-response relationship between RYR prescriptions and the reduced risk of incident diabetes.Conclusion: We raised the possibility that people who used RYR prescriptions may have a lower risk of incident diabetes compared with the lovastatin cohort.Keywords: diabetes, lovastatin, red yeast rice, risk

The impact of diabetes on perioperative outcomes remains incompletely understood. Our purpose is to evaluate post-operative complications and mortality in patients with diabetes. Using the institutional and clinical databases of three university hospitals from 2009&ndash, 2015, we conducted a matched study of 16,539 diabetes patients, aged &gt, 20 years, who underwent major surgery. Using a propensity score matching procedure, 16,539 surgical patients without diabetes who underwent surgery were also selected. Logistic regressions were used to calculate the odds ratios (ORs) with 95% confidence intervals (CIs) for post-operative complications and in-hospital mortality associated with diabetes. Patients with diabetes had a higher risk of postoperative septicemia (OR 1.33, 95% CI 1.01&ndash, 1.74), necrotizing fasciitis (OR 3.98, 95% CI 1.12&ndash, 14.2), cellulitis (OR 2.10, 95% CI 1.46&ndash, 3.03), acute pyelonephritis (OR 1.86, 95% CI 1.01&ndash, 3.41), infectious arthritis (OR 3.89, 95% CI 1.19&ndash, 12.7), and in-hospital mortality (OR 1.51, 95% CI 1.07&ndash, 2.13) compared to people without diabetes. Previous admission for diabetes (OR 2.33, 95% CI 1.85&ndash, 2.93), HbA1c &gt, 8% (OR 1.96, 95% CI 1.64&ndash, 2.33) and fasting glucose &gt, 180 mg/dL (OR 1.90, 95% CI 1.68&ndash, 2.16) were predictors for post-operative adverse events. Diabetes patients who underwent surgery had higher risks of infectious complications and in-hospital mortality compared with patients without diabetes who underwent similar major surgeries.

"Big data", characterized by 'volume', 'velocity', 'variety', and 'veracity', being routinely collected in huge amounts of clinical and administrative healthcare-related data are becoming common and generating promising viewpoints for a better understanding of the complexity for medical situations. Taiwan National Health Insurance Research Database (NHIRD), one of large and comprehensive nationwide population reimbursement databases in the world, provides the strength of sample size avoiding selection and participation bias. Abundant with the demographics, clinical diagnoses, and capable of linking diverse laboratory and imaging information allowing for integrated analysis, NHIRD studies could inform us of the incidence, prevalence, managements, correlations and associations of clinical outcomes and diseases, under the universal coverage of healthcare used. Perioperative medicine has emerged as an important clinical research field over the past decade, moving the categorization of the specialty of "Anesthesiology and Perioperative Medicine". Many studies concerning perioperative medicine based on retrospective cohort analyses have been published in the top-ranked journal, but studies utilizing Taiwan NHIRD were still not fully visualized. As the prominent growth curve of NHIRD studies, we have contributed the studies covering surgical adverse outcomes, trauma, stroke, diabetes, and healthcare inequality, etc., to this ever growing field for the past five years. It will definitely become a trend of research using Taiwan NHIRD and contributing to the progress of perioperative medicine with the recruitment of devotion from more research groups and become a famous doctrine.

Objective To evaluate outcomes after nonobstetric surgical procedures in pregnant patients. Methods We conducted a retrospective cohort study of 5591 pregnant women who underwent nonobstetric surgical procedures using Taiwan's National Health Insurance Research Database 2008-2012 claims data. Using a propensity score matching procedure, 22,364 nonpregnant women were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs of postoperative complications and in-hospital mortality associated with pregnancy. Results Pregnant women had higher risks of postoperative septicemia (OR=1.75; 95% CI, 1.47-2.07), pneumonia (OR=1.47; 95% CI, 1.01-2.13), urinary tract infection (OR=1.29; 95% CI, 1.08-1.54), and in-hospital mortality (OR=3.94; 95% CI, 2.62-5.92) compared with nonpregnant women. Pregnant women also had longer hospital stays and higher medical expenditures after nonobstetric surgical procedures than controls. Higher rates of postoperative adverse events in pregnant women receiving nonobstetric surgery were noted in all age groups. Conclusion Surgical patients with pregnancy showed more adverse events, with a risk of in-hospital mortality approximately 4-fold higher after nonobstetric surgery compared with nonpregnant patients. These findings suggest the urgent need to revise the protocols for postoperative care for this population.

Prior research had shown that the design of product listing pages has significant influence on the sales volume on an e-commerce website. This study focused on product placement in designing product listing pages; that is, how venders of online stores place their products over the product listing pages for maximization of profit. When trying to increase the sales volume through a better website design, it is imperative to keep a close watch on inventory replenishment so as to reduce business cost. Therefore, this study proposed a visual-attention-dependent demand inventory model for determining the optimal product placement and inventory replenishment decisions that jointly maximize the total profit under the arrangement constraints. This model assumes that visual stimuli such as image size and location have a significant effect on product demand. The substitution effect between products on demand was also examined. Then a genetic algorithms-based search method was employed to solve the model. Finally, the validity of the proposed model was illustrated with example problems.

Background and aims The effects of physician specialty on the outcome of heart disease remains incompletely understood because of inconsistent findings from some previous studies. Our purpose is to compare the admission outcomes of heart disease in patients receiving care by cardiologists and noncardiologist (NC) physicians. Methods Using reimbursement claims data of Taiwan’s National Health Insurance from 2008–2013, we conducted a matched study of 6264 patients aged ≥20 years who received a cardiologist’s care during admission for heart disease. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, and type of heart disease, 6264 controls who received an NC physician’s care were selected. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for complications and mortality during admission for heart disease associated with a cardiologist’s care. Results Patients who received a cardiologist’s care had a lower risk of pneumonia (OR = 0.61; 95% CI, 0.53–0.70), septicemia (OR = 0.49; 95% CI, 0.39–0.61), urinary tract infection (OR = 0.76; 95% CI, 0.66–0.88), and in-hospital mortality (OR = 0.37; 95% CI, 0.29–0.47) than did patients who received an NC physician’s care. The association between a cardiologist’s care and reduced adverse events following admission was significant in both sexes and in patients aged ≥40 years. Conclusion We raised the possibility that cardiologist care was associated with reduced infectious complications and mortality among patients who were admitted due to heart disease.

BACKGROUND The influence of red yeast rice (RYR) on perioperative outcome remains unknown. AIM We aimed to compare the complications and mortality after surgery between patients treated with and without RYR prescription. DESIGN In this surgical cohort study of 3.6 million surgical patients who underwent major inpatient surgeries, 2581 patients who used RYR prescription pre-operatively were compared with 25 810 non-RYR patients selected by matching for age and sex. METHODS Patients' demographics and medical conditions were collected from the claims data of the National Health Insurance in Taiwan. Complications and mortality after major surgeries in association with RYR prescription were investigated by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs) by multiple logistic regression. RESULTS Compared with patients without RYR prescription, patients prescribed RYR had lower risks of post-operative bleeding (OR 0.36, 95% CI 0.15-0.89), pneumonia (OR 0.54, 95% CI 0.36-0.83), stroke (OR 0.66, 95% CI 0.47-0.92) and 30-day in-hospital mortality (OR 0.37, 95% CI 0.15-0.92). Decreased risk of intensive care (OR 0.64, 95% CI 0.54-0.77), shorter length of hospital stay (P

This study examined the occurrence of diabetes and sustainable risk factors in residents aged 30 and above of a community in Taoyuan County, Taiwan. The main purpose of this research was to explore the correlations between related variables and the occurrence of diabetes. The demographic variables, health exam variables, healthy behavior variables, and environmental variables had obvious impacts on the risk of diabetes. As age increased, the risk of developing the disease also increased, higher educational levels lowered risk, while unemployment raised it. Also, analysis of the health exam variables showed that abnormal BMIs, waist-hip ratios, and body fat percentages had significant impacts on individuals&rsquo, risk of diabetes. Moreover, it was found that smoking affected the risk of having diabetes: smokers, particularly male smokers, had a relatively higher risk of developing the disease. Lastly, the results showed that exposure to second-hand smoke did not have a significant effect on the diabetes proportion in the male population. However, a significantly higher proportion of females who had been exposed to second-hand smoke had diabetes.

Background and aims Because the risk and outcomes of stroke in patients with chronic kidney disease (CKD) or end-stage renal disease (ESRD) were unclear, we evaluated these risks using a retrospective cohort study and a nested cohort study. Methods We used Taiwan’s National Health Insurance Research Database to identify 1378 patients aged ≥20 years who had ESRD in 2000–2004. An age- and sex-matched CKD cohort (n = 5512) and a control cohort (n = 11,024) were selected for comparison. Events of incident stroke were considered as outcome during the follow-up period in 2000–2013, and we calculated adjusted hazard ratios (HR) and 95% CIs of stroke associated with CKD or ESRD. We further used matching procedure with propensity score to estimate the risk of stroke for control group, CKD patients, and EDRD patients. A nested cohort study of 318,638 hospitalized stroke patients between 2000 and 2010 also was conducted to analyze the impact of CKD and ESRD on post-stroke mortality. Results Before propensity-score matching, the incidences of stroke for controls, CKD patients and ESRD patients were 6.57, 13.3, and 21.7 per 1000 person-years, respectively. Compared with control group, the adjusted HRs of stroke were 1.49 (95% CI, 1.32–1.68) and 2.39 (95% CI, 1.39–2.87) for people with CKD or ESRD respectively, and were significantly higher in both sexes and every age group. After propensity-score matching, the HRs of stroke for patients with CKD and ESRD were 1.51 (95% CI 1.24–1.85) and 2.08 (95% CI 1.32–3.26), respectively, during the follow-up period. Among hospitalized stroke patients, adjusted rate ratio (RR) of post-stroke mortality in CKD and ESRD cohorts were 1.44 (95% CI, 1.33–1.56) and 2.62 (95% CI, 2.43–2.82) respectively compared with control. Conclusions CKD and ESRD patient groups thus faced significantly higher risk of stroke and post-stroke mortality. Risk factor identification and preventive strategies are needed to minimize stroke risk and post-stroke mortality in these vulnerable patient groups.