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Chia-Jung Chen,1 Hanoch Livneh,2 Wei-Jen Chen,1,3– 5 Yu-Han Wang,5 Ming-Chi Lu,6,7 Chia-Chou Yeh,1,4 Chieh-Tsung Yen,8 Tzung-Yi Tsai9– 11 1Department of Chinese Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; 2Rehabilitation Counseling Program, Portland State University, Portland, OR, USA; 3Graduate Institute of Sports Science, National Taiwan Sport University, Taoyuan, Taiwan; 4School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan; 5Center of Sports Medicine, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; 6Division of Allergy, Immunology and Rheumatology, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; 7School of Medicine, Tzu Chi University, Hualien, Taiwan; 8Department of Neurology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; 9Department of Nursing, Tzu Chi University of Science and Technology, Hualien, Taiwan; 10Department of Medical Research, Dalin Tzu Chi Hospital, The Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; 11Department of Environmental and Occupational Health, College of Medicine, National Cheng Kung University, Tainan, TaiwanCorrespondence: Chieh-Tsung Yen; Tzung-Yi Tsai, Tel +886-5-2648000-5003 ; +886-5-2648000-3209, Fax +886-5-2648006, Email dm335164@tzuchi.com.tw; dm732024@tzuchi.com.twPurpose: The systemic inflammation is believed to provide an outline of the association between rheumatoid arthritis (RA) and endometriosis. This retrospective cohort study aimed to explore the association of Chinese herbal medicine (CHM) use with the prevention of endometriosis onset in women diagnosed with RA.Methods: We utilized the claims data from the National Health Insurance of Taiwan from 2000 to 2009 and excluded individuals diagnosed with endometriosis before being diagnosed with RA, using age at clinical diagnosis. After selection and propensity-score matching, a total of 5992 females aged ≧20 years old and with newly diagnosed RA but without endometriosis at baseline were included, which contained 2996 CHM users and 2996 non-CHM users. All of them were followed until the end of 2013 to measure the incidence of endometriosis.Results: During the study period, we noticed that CHM users had a substantially lower incidence of endometriosis compared to non-CHM users (2.54 vs 5.19 per 1000 person-years). Use of CHM correlated significantly with a lower endometriosis likelihood even after adjusting for potential covariates, with the adjusted hazard ratio of 0.47 (95% confidence interval, 0.35– 0.65). A longer duration of CHM use was associated with a reduction in endometriosis risk, especially in those using CHM for more than 730 days. Uses of several herbal products may be associated with a lower risk of endometriosis, like Ge-Gen, Da-Huang, Huang-Qin, Ye-Jiao-Teng, Chuan-Niu-Xi, Shu-Jing-Huo-Xue-Tang, Du-Huo-Ji-Sheng-Tang, Ge-Gen-Tang, Shao-Yao-Gan-Cao-Tang, Ping-Wei-San, Gan-Lu-Yin, and Dang-Gui-Nian-Tong-Tang.Conclusion: Taken together, adding CHM to conventional therapy may reduce the incidence of endometriosis in women with RA. The therapeutic mechanisms and safety of these natural products may be a direction for future clinical studies.Keywords: endometriosis, rheumatoid arthritis, Chinese herbal medicines, propensity score match

Background Artificial intelligence of things (AIoT) may be a solution for predicting adverse outcomes in emergency department (ED) patients with pneumonia; however, this issue remains unclear. Therefore, we conducted this study to clarify it. Methods We identified 52,626 adult ED patients with pneumonia from three hospitals between 2010 and 2019 for this study. Thirty-three feature variables from electronic medical records were used to construct an artificial intelligence (AI) model to predict sepsis or septic shock, respiratory failure, and mortality. After comparisons of the predictive accuracies among logistic regression, random forest, support-vector machine (SVM), light gradient boosting machine (LightGBM), multilayer perceptron (MLP), and eXtreme Gradient Boosting (XGBoost), we selected the best one to build the model. We further combined the AI model with the Internet of things as AIoT, added an interactive mode, and implemented it in the hospital information system to assist clinicians with decision making in real time. We also compared the AIoT-based model with the confusion-urea-respiratory rate-blood pressure-65 (CURB-65) and pneumonia severity index (PSI) for predicting mortality. Results The best AI algorithms were random forest for sepsis or septic shock (area under the curve [AUC] = 0.781), LightGBM for respiratory failure (AUC = 0.847), and mortality (AUC = 0.835). The AIoT-based model represented better performance than CURB-65 and PSI indicators for predicting mortality (0.835 vs. 0.681 and 0.835 vs. 0.728). Conclusions A real-time interactive AIoT-based model might be a better tool for predicting adverse outcomes in ED patients with pneumonia. Further validation in other populations is warranted.

Hospital-based child protection teams play an important role in the multidisciplinary assessment, treatment, care, and rehabilitation of abused children and their families. However, the process by which these teams are built and promoted has not been explored adequately in the literature.This study was developed to examine the process used to promote child protection team case management and to evaluate the related results.An action research model was adopted in this study. The participants and the investigator were members of a child protection team at a medical center in southern Taiwan. Qualitative and quantitative assessments were used to identify problems related to organizational structure, intervention procedures, and evaluation effectiveness. Thereafter, the study program was implemented, and the results were evaluated. Content analysis of the qualitative data, including transcribed interviews with external benchmark members and members of the hospital's team and text entries from the investigator's reflective journal, was conducted. Quantitative data, including monitoring indicators for team case management, were analyzed using descriptive statistics.Three important concepts emerged related to changes in the promotion of case management by hospital child protection teams. These included formulation of a team operation model through visits to benchmark hospitals, establishment of the case management and monitoring mechanism based on team consensus, and expansion of collaboration with external agencies through the establishment of a child and adolescent protection medical regional integration center. The results of the promotion process were affected by factors that included member willingness, teamwork, hospital support, and national policy.Use of the hospital child protection team case management model developed in this study was shown to facilitate the provision of consultation services, integrate the opinions and resources of experts from various fields, and allow the timely provision of acute care, follow-up family environment support, and social resources required by children and their family members. These measures help prevent the reoccurrence of child abuse and enable children to grow up healthily and free from violence.

Objective: Environmental factors, eating habits, and different ages might affect the profiles of allergy sensitization. The purpose of this study was to survey the different profiles of allergen sensitization in different ages in eastern Taiwan. Materials and Methods: We analyzed the allergic patients who had allergen sensitization examinations by the Phadiatop (atopy screen; IBT Laboratories, Lenexa, KS, USA) and the Pharmacia CAP System method at Haulien Tzu Chi Hospital from January 2010 to December 2015. Results were compared in different ages. Results: A total of 15,455 patients were analyzed. The food and aeroallergen screen sensitization rate of children was significantly higher than that of adults (44.0% vs. 9.9% and 61.9% vs. 52.2% P < 0.05). Children had statistically significantly higher cow milk allergen-specific sensitization rate than that of adults (32.9% vs. 5.8% P < 0.05). The higher sensitization of shrimp occurred in adults than children. (33.6% vs. 24.8% P < 0.05). Conclusion: Our data demonstrate that children have higher cow milk allergy sensitization and adults have higher sensitization of shrimp.

The early detection of child abuse is essential for children at risk. Healthcare professionals working at hospitals and in the community are often the first to encounter suspected cases of child abuse. Therefore, an accurate identification of child abuse is critical for intervention. However, there is no consensus on the best method to screen for child abuse.This systematic review was designed to evaluate the relevant psychometric properties and critically appraise the methodological quality of child abuse screening tools used by healthcare providers with children less than 18 years old.We searched the Cochrane Library, MEDLINE, Embase, CINAHL, Education Resources Information Center, PubMed, Airiti Library, and OpenGray databases for studies on screening tools used to identify abuse in children published through October 2019 in English or Chinese. Information regarding populations, assessment methods, and accuracy parameters were extracted. Study quality was assessed using the COnsensus-based Standards for the selection of health Measurement INstruments checklist and Grading of Recommendation, Assessment, Development, and Evaluation criteria.Nine hundred thirty-nine abstracts and 23 full-text articles were reviewed for eligibility, and 15 screening tools for child abuse used by healthcare providers were identified. Screening tools often assess the presence of more than one form of abuse, but no single tool covered all forms. Of these, 10 tools screened for a single, discrete type of abuse, including nine physical abuse screening tools (three abusive head trauma tools) and one sexual abuse tool. Eighty percent (n = 12) of the screening tools had a moderate-to-high quality of evidence based on the Grading of Recommendation, Assessment, Development, and Evaluation criteria. However, none of these screening tools achieved an adequate level of evidence based on the COnsensus-based Standards for the selection of health Measurement INstruments checklist.In this systematic literature review, 15 assessment tools of child abuse used by healthcare providers were identified, of which nine screened for physical abuse. Screening tools must be valid, succinct, user-friendly, and amenable for use with children at every point of care in the healthcare system. Because of the paucity of informative and practical studies in the literature, findings related to the quality of child abuse screening tools were inconclusive. Therefore, future research should focus on the use of screening tools in the healthcare system to identify effective screening interventions that may help healthcare providers identify child abuse cases as early as possible.

Unplanned patient readmission (UPRA) is frequent and costly in healthcare settings. No indicators during hospitalization have been suggested to clinicians as useful for identifying patients at high risk of UPRA. This study aimed to create a prediction model for the early detection of 14-day UPRA of patients with pneumonia. We downloaded the data of patients with pneumonia as the primary disease (e.g., ICD-10:J12*-J18*) at three hospitals in Taiwan from 2016 to 2018. A total of 21,892 cases (1208 (6%) for UPRA) were collected. Two models, namely, artificial neural network (ANN) and convolutional neural network (CNN), were compared using the training (n = 15,324, ≅70%) and test (n = 6568, ≅30%) sets to verify the model accuracy. An app was developed for the prediction and classification of UPRA. We observed that (i) the 17 feature variables extracted in this study yielded a high area under the receiver operating characteristic curve of 0.75 using the ANN model and that (ii) the ANN exhibited better AUC (0.73) than the CNN (0.50), and (iii) a ready and available app for predicting UHA was developed. The app could help clinicians predict UPRA of patients with pneumonia at an early stage and enable them to formulate preparedness plans near or after patient discharge from hospitalization.

Background Predicting outcomes in older patients with influenza in the emergency department (ED) by machine learning (ML) has never been implemented. Therefore, we conducted this study to clarify the clinical utility of implementing ML. Methods We recruited 5508 older ED patients (≥65 years old) in three hospitals between 2009 and 2018. Patients were randomized into a 70%/30% split for model training and testing. Using 10 clinical variables from their electronic health records, a prediction model using the synthetic minority oversampling technique preprocessing algorithm was constructed to predict five outcomes. Results The best areas under the curves of predicting outcomes were: random forest model for hospitalization (0.840), pneumonia (0.765), and sepsis or septic shock (0.857), XGBoost for intensive care unit admission (0.902), and logistic regression for in-hospital mortality (0.889) in the testing data. The predictive model was further applied in the hospital information system to assist physicians’ decisions in real time. Conclusions ML is a promising way to assist physicians in predicting outcomes in older ED patients with influenza in real time. Evaluations of the effectiveness and impact are needed in the future.

Additional file 1.

Background Hyperglycemic crises are associated with high morbidity and mortality. Previous studies proposed methods for predicting adverse outcome in hyperglycemic crises, artificial intelligence (AI) has however never been tried. We implemented an AI prediction model integrated with hospital information system (HIS) to clarify this issue. Methods We included 3,715 patients with hyperglycemic crises from emergency departments (ED) between 2009 and 2018. Patients were randomized into a 70%/30% split for AI model training and testing. Twenty-two feature variables from their electronic medical records were collected, and multilayer perceptron (MLP) was used to construct an AI prediction model to predict sepsis or septic shock, intensive care unit (ICU) admission, and all-cause mortality within 1 month. Comparisons of the performance among random forest, logistic regression, support vector machine (SVM), K-nearest neighbor (KNN), Light Gradient Boosting Machine (LightGBM), and MLP algorithms were also done. Results Using the MLP model, the areas under the curves (AUCs) were 0.808 for sepsis or septic shock, 0.688 for ICU admission, and 0.770 for all-cause mortality. MLP had the best performance in predicting sepsis or septic shock and all-cause mortality, compared with logistic regression, SVM, KNN, and LightGBM. Furthermore, we integrated the AI prediction model with the HIS to assist physicians for decision making in real-time. Conclusions A real-time AI prediction model is a promising method to assist physicians in predicting adverse outcomes in ED patients with hyperglycemic crises. Further studies on the impact on clinical practice and patient outcome are warranted.

Background A big-data-driven and artificial intelligence (AI) with machine learning (ML) approach has never been integrated with the hospital information system (HIS) for predicting major adverse cardiac events (MACE) in patients with chest pain in the emergency department (ED). Therefore, we conducted the present study to clarify it. Methods In total, 85,254 ED patients with chest pain in three hospitals between 2009 and 2018 were identified. We randomized the patients into a 70%/30% split for ML model training and testing. We used 14 clinical variables from their electronic health records to construct a random forest model with the synthetic minority oversampling technique preprocessing algorithm to predict acute myocardial infarction (AMI) Results Predicting MACE using the random forest model produced areas under the curves (AUC) of 0.915 for AMI Conclusions An AI real-time prediction model is a promising method for assisting physicians in predicting MACE in ED patients with chest pain. Further studies to evaluate the impact on clinical practice are warranted.

(1) Background: Effective healthcare collaboration not only improves the outcomes of patients, but also provides benefits to healthcare providers. A patient-centered communication platform, a so-called &ldquo, one-stop platform&rdquo, is necessary to promote interprofessional collaboration (IPC) for optimal patient care. (2) Methods: Chi Mei Medical Center developed a patient-centered computerized platform to fulfill interprofessional collaboration needs. The platform features a spiral-shaped integrated care area and a communication area that allows the medical team to access patients&rsquo, information including the medical care they received within seven days, and veritably shows whether the team members have read communication messages. After pilot adoption, an online survey was conducted. (3) Results: A one-stop IPC platform was implemented and promoted for patient care. The online survey revealed that medical team members have high positive appraisal of the platform. It also pointed out that resistance to change among the medical team still has a significant impact on behavioral intention. (4) Conclusions: The interprofessional collaboration platform was recognized by the medical teams of Chi Mei Medical Center as an effective and convenient tool for assisting clinical decision making. However, actions to reduce user resistance to change and encourage collaboration among team members still need to be continued. Shared decision making within physicians and patients will be valuable to develop in the platform in the future.

Healthcare Artificial Intelligence (AI) has the greatest opportunity for development. Since healthcare and technology are two of Taiwan’s most competitive industries, the development of healthcare AI is an excellent chance for Taiwan to improve its health-related services. From the perspective of economic development, promoting healthcare AI must be a top priority. However, despite having many breakthroughs in research and pilot projects, healthcare AI is still considered rare and is broadly used in the healthcare setting. Based on a medical center in Taiwan that has introduced a variety of healthcare AI into practice, this study discussed and analyzed the issues and concerns in the development and scaling of medical AIs from the perspective of various stakeholders in the healthcare setting, including the government, healthcare institutions, users (healthcare workers), and AI providers. The present study also identified critical influential factors for the deployment and scaling of healthcare AI. It is hoped that this paper can serve as an important reference for the advancement of healthcare AI not only in Taiwan but also in other countries.

Background & objectives: Scrub typhus is a chigger-borne disease caused by Orientia tsutsugamushi. The immunological reactions to O. tsutsugamushi infection are not completely understood. In this study, we investigated the response of dendritic cells (DCs) to a major 56-kDa scrub typhus antigen Sta56. Methods: Monocyte-derived human DCs were incubated with different concentrations of recombinant Sta56 and analyzed for maturation based on phagocytic capacity, the ability to induce T-cell proliferation, expression of surface markers, cytokine secretion and activation of toll-like receptor (TLR)-dependent signalling pathways. Results: Treatment of DCs with Sta56 induced cell surface expression of CD80, CD83, CD86 and MHC Class II increased the production of interleukin-12 (IL-12) p40, IL-12 p70 and IL-10 and decreased DC phagocytic capacity. Furthermore, Sta56 increased the ability of DCs to activate T-cell proliferation and interferon-γ secretion. TLR4-specific antibodies neutralized Sta56-elicited effects on DC maturation, suggesting direct interaction between Sta56 and TLR4. Moreover, Sta56 activated nuclear factor (NF)-κB and p38 mitogen-activated protein kinase (MAPK) signalling as evidenced by decrease in Sta56-induced cytokine production and surface marker expression by specific inhibitors helenalin and SB203580, respectively, and increase in IκBα and p38 phosphorylation and NF-κB-DNA binding. Interpretation & conclusions: Our results showed that the surface antigen of O. tsutsugamushi activated DCs through interaction with TLR4 and activation of MAPK and NF-κB signalling, suggesting Sta56 as a potential candidate molecule for the development of vaccine against scrub typhus.

Uware is a virtualization-based approach to effectively improve the UHPC application design.Uware is an alternative approach to minimize the overhead and to develop a middleware.The approach relies on contention management and zero copy buffer mechanism to from isolation model. Display Omitted In ubiquitous high-performance computing (UHPC), performing concurrent services is an important task of middleware. Because a major development effort is not easily achieved, isolating a virtual machine (VM) may be a helpful solution but will likely suffer from additional overhead costs. This challenge can also be resolved by reusing the device driver. However, these solutions are difficult to implement without the VM technique. In this study, we present an alternative approach to minimizing overhead and develop a middleware called userspace virtualized middleware (Uware). Instead of bypassing the VM, the proposed approach depends on userspace transparency and contention management to shift the VM concept into middleware. We introduce two strategies to enhance the system adaptively: comprehensive restructuring by simplifying the VM memory mechanism and implementing zero-copy buffers to reuse devices. The result demonstrates that Uware is feasible and could be applied in a broad variety of UHPC.

Developing a parallel program on Chip multi-processors (CMPs) is a critical and difficult issue. To overcome the synchronization obstacles of CMPs, transactional memory (TM) has been proposed as an alternative control concurrency mechanism, instead of using traditional lock synchronization. Unfortunately, TM has led to seven performance pathologies: DuelingUpgrades, FutileStall, StarvingWriter, StarvingElder, SerializedCommit, RestartConvoy, and FriendlyFire. Such pathologies degrade performance during the interaction between workload and system. Although this performance issue can be solved by hardware, the software solution remains elusive. This paper proposes a priority scheduling algorithm to remedy these performance pathologies. By contrast, the proposed approach can not only solve this issue, but also almost achieve the same performance as hardware transactional memory systems.

Purpose: To report a rare case of ocular penicillium infection presenting as combined rhegmatogenous retinal detachment and serous retinal detachment in an immunocompetent patient. Methods: Case report. Results: A 44 year old male who had newly diagnosed type 2 diabetes mellitus. He had intermittent blurred vision in his left eye for 2 years, but progressed in recent two and half months. He had cataract surgery in the left eye 2 months before visit. Initial examination showed visual acuity was 6/60, traced cell in anterior chamber and pseudophakia. Fundus examination revealed serous retinal detachment OS first, but Shafter sign developed 11 days later. He underwent pars plana vitrectomy plus scleral buckling immediately. The pathology of vitreous biopsy demonstrated the classical picture of Penicillium marneffei. Blood culture showed no fungemia. Under the impression of ocular Penicillium infection, he received systemic intravenous infusion of Amphotericin-B 50 mg/day for 14 days and following oral Itraconazole 400 mg/day for 3 months. Besides, 0.15% Amphotericin-B eye drop was administered for next 3 week. The ocular inflammation was silent down after operation. Final visual acuity was 6/15. He didn't have any ocular recurrence or systemic manifestation during 9 months follow up. Conclusion: P. marneffei has not only emerged as an important fungal pathogen that causes disseminated infection in HIV-infected patients residing in or travelling to endemic area, but localized ocular infection of P. marneffei could also be possible in immunocompetent patients. Hence, ophthalmologists should be aware of any ocular inflammation with patient who travels to or resides in the Southeast Asia.

Hepatitis B virus Ag (HBsAg), a major antigen of hepatitis B virus (HBV), is also a vaccine component for prevention of HBV infection. Dendritic cells (DCs) of HBV carriers reportedly exhibit functional impairment. In this study, the aim was to investigate the effect of HBsAg on activation of human monocyte-derived dendritic cells (MD-DCs), and the subsequent signal transduction pathway. Treatment of MD-DCs with HBsAg resulted in enhanced cell surface expression of cluster of differentiation 80, CD83, CD86 and major histocompatibility complex class II, and increased interleukin (IL)-12 p40, IL-12p70, and IL-10 production. Furthermore, HBsAg treatment of MD-DCs with HBsAg resulted in enhanced T cell-stimulatory capacity and increased T cell secretion of interferon and IL-10. The pathway of MD-DCs activation by HBsAg was further investigated in the present study. Inhibition of nuclear factor (NF)-kappa B (κB) by helenalin and p38 mitogen-activated protein kinase (MAPK) by SB203580 prevented production of IL-12 p40, IL-12 p70, and IL-10. HBsAg also augmented MAPK phosphorylation. Thus, cytokine secretion of human MD-DCs by HBsAg is blocked by inhibition of the NF-κB and p38 MAPK pathways. Likewise, decreased inhibition of kappa B alpha concentrations and MAPK phosphorylation are critical for MD-DC maturation by HBsAg. These findings may provide a strategy for improving the prophylactic and therapeutic efficacy of vaccines and tumor therapies that utilize these pathways.

Objective Probiotics have previously been shown to reduce the severity of atopic disease in infants and children. However, the immunological changes induced by this treatment that might account for the clinical improvement are still unclear. In this study, we examined the effect of Lactobacillus rhamnosus on the clinical symptoms and medication use among children with established allergic rhinitis. We also investigated the effect of probiotics on the white blood cell counts, red blood cell counts, platelet counts, eosinophil counts, and IgE antibody levels. Materials and Methods Atopic children with current rhinitis received 4 × 109 colony forming units/g of L rhamnosus (n = 98) or a placebo (n = 100). Both were given this daily as a powder mixed with food or water. The SCORing Allergic rhinitis index (specific symptoms scores and symptom medication scores), which measures of the extent and severity of allergic rhinitis, was assessed for each patient at the five visits. These five scheduled visits were at 2 weeks before starting the treatment (Visit 0), at the beginning of the treatment (Visit 1), then 4 weeks (Visit 2), 8 weeks (Visit 3), and 12 weeks (Visit 4) after starting the treatment. The white blood cell, red blood cell, platelet, and eosinophil counts as well as the IgE antibody levels of the individuals were evaluated before and after 3 months of treatment. Results The major outcome, indicating the efficacy of L rhamnosus treatment, was no reduction in rhinitis symptoms or drug scores. No significant statistical differences were found between baseline and 3 months for the probiotic and placebo groups when any immunological and blood cell variable was examined. Conclusions Our data demonstrates that L rhamnosus treatment neither reduced rhinitis symptom scores nor altered immunological parameters in symptomatic children.

This study compared lifting strength patterns between experienced workers and novices at various exertion heights. Twenty-one experienced workers and 21 novices were recruited to determine their static-lifting strength under various heights (10–150 cm in increments of 10 cm) using two exertion methods (vertically upward lifting, VUL, and toward body lifting, TBL). Testing posture was also recorded by a motion analysis system for comparing with the corresponding strength values. Results showed that strength during VUL were much higher than strength during TBL at 15 height positions ( p p Relevance to Industry Many studies have established the human strength data based on student participants who do not have experience in manual materials handling. The present findings clearly suggest that lifting strength data collected on novices (e.g., on students) should be carefully applied in the task (re)design at the workplace as their strength profiles and the postures adopted during lifting differ from workers.

Background & objectives: Scrub typhus is a chigger-borne disease caused by Orientia tsutsugamushi. The immunological reactions to O. tsutsugamushi infection are not completely understood. In this study, we investigated the response of dendritic cells (DCs) to a major 56-kDa scrub typhus antigen Sta56. Methods: Monocyte-derived human DCs were incubated with different concentrations of recombinant Sta56 and analyzed for maturation based on phagocytic capacity, the ability to induce T-cell proliferation, expression of surface markers, cytokine secretion and activation of toll-like receptor (TLR)-dependent signalling pathways. Results: Treatment of DCs with Sta56 induced cell surface expression of CD80, CD83, CD86 and MHC Class II increased the production of interleukin-12 (IL-12) p40, IL-12 p70 and IL-10 and decreased DC phagocytic capacity. Furthermore, Sta56 increased the ability of DCs to activate T-cell proliferation and interferon-γ secretion. TLR4-specific antibodies neutralized Sta56-elicited effects on DC maturation, suggesting direct interaction between Sta56 and TLR4. Moreover, Sta56 activated nuclear factor (NF)-κB and p38 mitogen-activated protein kinase (MAPK) signalling as evidenced by decrease in Sta56-induced cytokine production and surface marker expression by specific inhibitors helenalin and SB203580, respectively, and increase in IκBα and p38 phosphorylation and NF-κB-DNA binding. Interpretation & conclusions: Our results showed that the surface antigen of O. tsutsugamushi activated DCs through interaction with TLR4 and activation of MAPK and NF-κB signalling, suggesting Sta56 as a potential candidate molecule for the development of vaccine against scrub typhus.

ST elevation myocardial infarction (STEMI), one main type of acute myocardial infarction with high mortality, requires percutaneous coronary intervention (PCI) with balloon inflation. Current guidelines recommend a door-to-balloon (D2B) interval (i.e., starts with the patient's arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) of no more than 90 min. However, promptly implementing PCI requires coordinating various medical teams. Checklists can be used to ensure consistency and operating sequences when executing complex tasks in a clinical routine. Developing an effective D2B checklist would enhance the care of STEMI patients who need PCI. Mobile information and communication technologies have the potential to greatly improve communication, facilitate access to information, and eliminate duplicated documentation without the limitations of space and time. In a research project by the Chi Mei Medical Center, "Developing a Mobile Electronic D2B Checklist for Managing the Treatment of STEMI Patients Who Need Primary Coronary Intervention," a prototype version of a mobile checklist was developed. This study describes the research project and the four phases of the system development life cycle, comprising system planning and selection, analysis, design, and implementation and operation. Face-to-face interviews with 16 potential users were conducted and revealed highly positive user perception and use intention toward the prototype. Discussion and directions for future research are also presented.

Background Spindle cell carcinoma (SpCC) is considered to be a rare variant of squamous cell carcinoma (SCC). The behavior of such tumors is unclear. The aim of this study was to elucidate the treatment and outcome of oral and oropharyngeal SpCC. Methods All the medical records of patients with the diagnosis of SpCC in the oral cavity and oropharynx in our hospital from 1994 to 2005 were reviewed. The clinical features, treatments and survival of the patients were evaluated. Results Within the 11-year study period, 18 patients were diagnosed with oral and oropharyngeal SpCC. There were 3 cases of AJCC (American Joint Committee on Cancer) stage I, 3 of stage II, 2 of stage III, 9 of stage IV, and 1 case without definite staging. Twelve patients died of their diseases. The median overall survival time was 8.89 months. The 1-year overall survival rate was 36.7% and the 3-year overall survival rate was 27.5%. In the early stage group, the 1-year and 3-year survival rates were both 100%. In the late stage group, the 1-year survival rate was 9%, and the 3-year survival rate was 0%. The factors influencing overall survival were tumor grade, lymph nodes, metastasis, stage, vascular invasion and distant recurrence. A high local recurrence rate (73.3%) and distant metastasis rate (33.3%) were observed. Conclusion The behavior of SpCC seems to be more aggressive than that of SCC at a similar stage. Setting wider safety margins (> 2 cm) during surgical intervention is suggested. In the case of locoregional recurrence, salvage operation showed some benefit. Seeking an effective chemotherapy protocol is important for the control of distant recurrence.

Background The immune system of newborn is generally depressed by impaired production of Th1-cell associated cytokines, which results in increased susceptibility to intracellular pathogens and poor response to vaccinations. For avoiding abortion, the maternal and fetal immune systems tend to Th2-cell polarizing cytokines. Besides, IL-12p35 is a determining factor of the bioactivity of IL-12, which has an important role in the Th1 response. Recently methylated DNA is known to associate to inhibit transcription. Therefore, we explored the methylation status of CpG sites upstream of the coding sequence of the IL-12p35 gene to determine whether neonatal peripheral blood mononuclear cell (PBMC) synthesis lower level of IL-12 is related to methylated DNA. Results PBMCs from adults expressed higher levels of IL-12p40 (p = 0.303) and IL-12p70 (p = 0.045) and had a strong ability to produce IL-12p35 mRNA (p = 0.01). However, there was no difference in the methylation status of CpG sites in the promoter of IL-12p35 between adults and newborns. Conclusions We found that PBMC synthesis of bioactive IL-12p70 was significantly impaired in the neonatal period, potentially though a reduction in IL-12p35 production. The reeducation in IL-12p35 production might not be due to methylation of the promoter gene. But, the impairment of IL-12p35 expression during the neonatal period might be caused by other epigenetic regulation occurs in the chromatin level.

In a multidatabase system, the participating databases are autonomous. The schemas of these databases may be different in various ways, while the same information is represented. A global query issued against the global database needs to be translated to a proper form before it can be executed in a local database. Since data requested by a query (or a part of a query) is sometimes available in multiple sites, the site (database) that processes the query with the least cost is the desired query processing site. The authors study the effect of differences in schemas on the cost of query processing in a multidatabase environment. They first classify schema conflicts to different types. For each type of conflict, they show how much more or less complex a translated query can become in comparison with the originally user-issued global query. Based on this observation, they propose an analytical method that considers the conflicts between local databases and finds the database(s) that renders the least execution cost in processing a global query. This research introduces a new level of query optimization (termed the schema-level optimization) in multidatabase environments. The results provide a new dimension of enhancement for the capability of a query optimizer in multidatabase systems.

As networking has become popular, Web-learning tends to be a trend while designing a tool. Moreover, five-axis machining has been widely used in industry recently; however, it has potential axial table colliding problems. Thus this paper aims at proposing an efficient web-learning collision detection tool on five-axis machining. However, collision detection consumes heavy resource that few devices can support, thus this research uses a systematic approach based on web knowledge to detect collision. The methodologies include the kinematics analyses for five-axis motions, separating axis method for collision detection, and computer simulation for verification. The machine structure is modeled as STL format in CAD software. The input to the detection system is the g-code part program, which describes the tool motions to produce the part surface. This research produced a simulation program with C programming language and demonstrated a five-axis machining example with collision detection on web site. The system simulates the five-axis CNC motion for tool trajectory and detects for any collisions according to the input g-codes and also supports high-performance web service benefiting from C. The result shows that our method improves 4.5 time of computational efficiency, comparing to the conventional detection method., {"references":["","I. Palmer and R. Grimsdale, \"Collision detection for animation using\nsphere-trees,\" Computer Graphics Forum, Vol. 14, no. 2 (1995), pp.\n105-116.","G. Bradshaw and C. O'Sullivan, \"Adaptive Medial-Axis Approximation\nFor Sphere-Tree Construction,\" ACM Translations on Graphics, Vol. 23,\nno. 1 (2004), pp. 1-26.","J. D. Cohen, M. C. Lin, D. Manocha, and M. Ponamgi, \"I-COLLIDE: An\nInteractive and Exact Collision Detection System for Large-Scale\nEnvironments,\" ACM Interactive 3D Graphics Conference (1995), pp.\n189-196.","V. Bergen, \"Efficient Collision Detection of Complex Deformable\nModels Using AABB Trees,\" Journal of Graphics Tools, Vol. 2, no. 4\n(1997), pp.1-14.","S. Gottschalk, M. Lin, and D. Manocha, \"OBB-tree: A Hierarchical\nstructure for Rapid Interference Detection,\" In: Proc. SIGGRAPH (1996),\npp. 171-180.","J. Chang, W. Wang, and M. Kima, \"Efficient Collision Detection Using a\nDual OBB-Sphere Bounding Volume Hierarchy,\" Computer-Aided\nDesign Vol. 42 (2010), pp. 50-57.","R.D. Owston, \"The World Wide Web: A Technology to Enhance\nTeaching and Learning?\", In American Educational Research\nAssociation, 1997.","M.F. Shiratuddin, W. Thabet, \"Virtual office walkthrough using a 3D\ngame engine\", International Journal of Design Computing, Volume 4,\n2002.","M.Woo, J. Neider, T. Davis, D. Shreiner, \"OpenGL Programming Guide:\nThe Official Guide to Learning OpenGL, Version 1.2\", In 3rd\nAddison-Wesley Longman Publishing Co., Inc. Boston, MA, USA 1999.\n[10] Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a\nseverity of disease classification system. Crit Care Med\n1985;13:818-829.\n[11] W.T. Sung, S.C. Ou, Web-based learning in the computer-aided design\ncurriculum, In Journal of Computer Assisted Learning, 18 (2) (2002), pp.\n175–187."]}

To study, we examined the effect of Lactobacillus salivarius on the clinical symptoms and medication use among children with established allergic rhinitis (AR). Double blind, randomized, controlled trial. Hualien Tzu-Chi General Hospital. Atopic children with current allergic rhinitis received 4 × 109 colony forming units/g of Lactobacillus salivarius (n=99) or placebo (n=100) daily as a powder mixed with food or water for 12 weeks. The SCORing Allergic rhinitis index (specific symptoms scores [SSS] and symptom medication scores [SMS]), which measures the extent and severity of AR, was assessed in each subject at each of the visits — 2 weeks prior to treatment initiation (visit 0), at the beginning of the treatment (visit 1), then at 4 (visit 2), 8 (visit 3) and 12 weeks (visit 4) after starting treatment. The WBC, RBC, platelet and, eosinophil counts as well as the IgE antibody levels of the individuals were evaluated before and after 3 months of treatment. The major outcome, indicating the efficacy of Lactobacillus salivarius treatment, was the reduction in rhinitis symptoms and drug scores. No significant statistical differences were found between baseline or 12 weeks in the probiotic and placebo groups for any immunological or blood cell variables. Our study demonstrates that Lactobacillus salivarius treatment reduces rhinitis symptoms and drug usage in children with allergic rhinitis.

This paper presents a new calibration method to overcome the challenges of MEMS inertial sensors for underwater navigation. The MEMS inertial sensor module is composed of an accelerometer, a gyroscope and a circuit of signal process. For navigation estimation, it is easy to be influenced by errors which come from MEMS inertial sensors. In general, the sources of error can be categorized into two groups, deterministic type and stochastic type. The former primarily includes bias errors, misalignment and nonlinearity; the latter contains temperature effect and signal drifting. Subsequently, the linearity calibration is used to modify the deterministic error and the wavelet analysis can suppress the stochastic noise. Therefore, the new calibration method integrated of linearity calibration and wavelet signal processing is utilized to enhance the accuracy and performance of MEMS inertial sensor module. The experimental results demonstrate that the output signal can be corrected suitability by means of the proposed method.