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Jia-Jie Zhong,1 Chia-Hung Tsai,2 Wen-Ying Lee3 1Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Division of Infectious Disease, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 3Department of Pathology, Chi Mei Medical Center, Tainan, TaiwanCorrespondence: Jia-Jie Zhong, Department of Internal Medicine, Chi Mei Medical Center, No. 901, Zhonghua Road, Yongkang Dist, Tainan, Taiwan, Email we1122128@gmail.comAbstract: Herpes simplex virus type 1 (HSV1) pneumonia presents diagnostic challenges due to there being no gold-standard criteria currently. Specimens from bronchoalveolar lavage can increase specificity, and cytohistological examination can prove virus infection. Patients with high viral load have been reported with poor outcomes and benefited from antiviral agent. We describe an 80-year-old man with severe pneumonia who initially showed improvement without antiviral therapy, despite viral inclusion bodies on sputum cytology and positive HSV1 polymerase chain reaction from sputum, though subsequent clinical deterioration due to Pseudomonas aeruginosa infection necessitated intensive care. This case highlights the complexities of diagnosing and managing HSV1 pneumonia, emphasizing the importance of integrating clinical suspicion, radiological imaging, and laboratory tests for timely therapeutic decisions in critically ill patients.Keywords: herpes simplex virus type 1, pneumonia, sputum cytology, polymerase chain reaction, antiviral therapy

Chia-Hung Tsai,1,* Yu-Chin Chen,2,* Po-Yu Chen,3 Chih-Cheng Lai,4,5 Hung-Jen Tang,1 Yin-Ching Chuang,6 Chi-Chung Chen,6,7 Chung-Han Ho,6,8 Wei-Yun Hsu,9,* Tu-Hsuan Chang9,* 1Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 2Department of Pediatrics, Chi Mei Medical Center, Chiali, Tainan, Taiwan; 3Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan; 4Division of Hospital Medicine, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan; 5School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan; 6Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan; 7Department of Food Science, National Chiayi University, Chiayi, Taiwan; 8Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan; 9Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan*These authors contributed equally to this workCorrespondence: Tu-Hsuan Chang; Wei-Yun Hsu, Department of Pediatrics, Chi Mei Medical Center, Tainan, Taiwan, Tel +886-2-281-2811 Ext 57109, Fax +886-6-220-3706, Email a755115@yahoo.com.tw; wyhsu17@gmail.comPurpose: To investigate the antibiotic susceptibility of Escherichia coli isolates in patients diagnosed with intra-abdominal infections (IAIs) in the Asia-Pacific region.Patients and Methods: This study was conducted at 50 medical hospitals across 9 countries/regions as part of the Study for Monitoring Antimicrobial Resistance Trends (SMART) surveillance program from 2014 to 2018. Nonduplicate isolates of aerobic and facultative gram-negative bacilli were collected and processed for further antimicrobial susceptibility testing.Results: A total of 10,709 isolates were collected, with E. coli (n=4737, 44.2%) being the leading pathogen causing IAIs, followed by Klebsiella pneumoniae (n=2429, 22.7%) and Pseudomonas aeruginosa (n=931, 8.7%). Community-associated (CA) E. coli isolates generally exhibited higher susceptibility rates for most antibiotics than hospital-associated (HA) isolates. In countries/regions other than Hong Kong, South Korea, and Singapore, HA isolates displayed lower susceptibility rates for multiple classes (≥ 4) of antibiotics. Among the commonly used antibiotics in IAIs, the overall susceptibility rate for ciprofloxacin was low, with an average of 41.3%. Ceftriaxone susceptibility rates in all selected countries were below 80% starting in 2018, ranging from 23.3% to 75.8%. The cefepime susceptibility rates varied across regions, with consistently reduced susceptibility ranging from 45.5% to 57.8% in India, Thailand, and Vietnam. Piperacillin/tazobactam demonstrated effectiveness against E. coli isolates in almost all countries except India, with a downward trend observed in the Philippines and Taiwan. Carbapenems remained effective against more than 90% of E. coli isolates, except in India.Conclusion: Prudent use of fluoroquinolones and ceftriaxone is advised when treating both CA and HA IAIs in the Asia-Pacific region. The low susceptibility rate of cefepime in India, Thailand, and Vietnam needs careful consideration in its administration. Moreover, the increase in nonsusceptibility to piperacillin/tazobactam in the Philippines and Taiwan poses a potential risk that should be closely monitored.Keywords: intra-abdominal infection, E. coli, antibiotic susceptibility, Asia-Pacific

Ching-Hua Tsai, Ting-Min Hsieh, Shiun-Yuan Hsu, Ching-Hua Hsieh Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 83301, TaiwanCorrespondence: Ching-Hua Hsieh, Tel +886-7-7327476, Email m93chinghua@gmail.comIntroduction: The De Ritis ratio, which is the ratio of aspartate aminotransferase (AST) to alanine aminotransferase (ALT), has been suggested as a potential prognostic marker for various diseases. This study aimed to investigate the association between the De Ritis ratio and in-hospital mortality in adult trauma patients.Methods: A total of 17,472 adult trauma patients hospitalized between January 1, 2009, and December 31, 2020, were allocated into groups according to the De Ritis ratio. The normal range of the De Ritis ratio was calculated from 3320 individuals in the National Taiwan Biobank. Statistical analyses were performed using SPSS software.Results: Patients with a De Ritis ratio > 1.6 had a significantly higher in-hospital mortality rate (7.3% vs 1.5%, odds ratio 5.29; Q1–Q3 2.72– 10.30; p < 0.001) and a 2.71-fold higher in-hospital mortality rate (Q1–Q3 1.24– 5.92; p = 0.012), after adjusting for sex, age, comorbidities, consciousness level, and injury severity, than those with a De Ritis ratio within the reference values.Discussion: This study revealed that a De Ritis ratio > 1.6 may serve as an early prognostic tool to identify adult trauma patients at high risk of in-hospital mortality.Keywords: aspartate aminotransferase, AST, alanine aminotransferase, ALT, De Ritis ratio, in-hospital mortality, trauma

Sheng-En Chou,1 Cheng-Shyuan Rau,2 Wei-Ti Su,1 Ching-Hua Tsai,1 Shiun-Yuan Hsu,1 Ching-Hua Hsieh1 1Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanCorrespondence: Ching-Hua Hsieh, Tel +886-7-7327476, Email m93chinghua@gmail.comIntroduction: The albumin-bilirubin (ALBI) grade objectively assesses liver function with better performance than the Child-Pugh and end-stage liver disease scores. However, the evidence is lacking on the ALBI grade in trauma cases. This study aimed to identify the association between the ALBI grade and mortality outcomes in trauma patients with liver injury.Methods: Data from 259 patients with traumatic liver injury at a level I trauma center between January 1, 2009, and December 31, 2021 were retrospectively analyzed. Independent risk factors for predicting mortality were identified using multiple logistic regression analysis. Participants were characterized by ALBI score into grade 1 (≤ − 2.60, n = 50), grade 2 (− 2.60 < and ≤ − 1.39, n = 180), and grade 3 (> − 1.39, n = 29).Results: Compared to survival (n = 239), death (n = 20) was associated with a significantly lower ALBI score (2.8± 0.4 vs 3.4± 0.7, p < 0.001). The ALBI score was a significant independent risk factor for mortality (OR, 2.79; 95% CI, 1.27– 8.05; p = 0.038). Compared with grade 1 patients, grade 3 patients had a significantly higher mortality rate (24.1% vs 0.0%, p < 0.001) and a longer hospital stay (37.5 days vs 13.5 days, p < 0.001).Discussion: This study showed that ALBI grade is a significant independent risk factor and an useful clinical tool to discover liver injury patients who are more susceptible to death.Keywords: trauma, liver injury, mortality, albumin-bilirubin grade, ALBI grade, liver function

Ming-Jen Tsai,1,&ast; Cheng-Han Tsai,2,3,&ast; Ru-Chiou Pan,4 Chi-Feng Hsu,1 Sheng-Feng Sung5,6 1Department of Emergency Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; 2Department of Emergency Medicine, Chiayi Branch, Taichung Veteran’s General Hospital, Chiayi City, Taiwan; 3Department of Information Management, Institute of Healthcare Information Management, National Chung Cheng University, Chiayi County, Taiwan; 4Clinical Data Center, Department of Medical Research, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; 5Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan; 6Department of Nursing, Min-Hwei Junior College of Health Care Management, Tainan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Sheng-Feng Sung, Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan, Tel +886 5 276 5041 Ext 7283, Fax +886 5 278 4257, Email sfusng@cych.org.tw; richard.sfsung@gmail.comPurpose: Taiwan’s national health insurance (NHI) database is a valuable resource for large-scale epidemiological and long-term survival research for out-of-hospital cardiac arrest (OHCA). We developed and validated case definition algorithms for OHCA based on the International Classification of Diseases (ICD) diagnostic codes and billing codes for NHI reimbursement.Patients and Methods: Claims data and medical records of all emergency department visits from 2010 to 2020 were retrieved from the hospital’s research-based database. Death-related diagnostic codes and keywords were used to identify potential OHCA cases, which were ascertained by chart reviews. We tested the performance of the developed OHCA algorithms and validated them on an external dataset.Results: The algorithm defining OHCA as any cardiac arrest (CA)-related ICD code in the first three diagnosis fields performed the best with a sensitivity of 89.5% (95% confidence interval [CI], 88.2– 90.7%), a positive predictive value (PPV) of 90.6% (95% CI, 89.4– 91.8%), and a kappa value of 0.900 (95% CI, 0.891– 0.909). The second-best algorithm consists of any CA-related ICD code in any diagnosis field with a billing code for triage acuity level 1, achieving a sensitivity of 85.6% (95% CI, 84.1– 87.0%), a PPV of 93.6% (95% CI, 92.5– 94.5), and a kappa value of 0.894 (95% CI, 0.884– 0.903). Both algorithms performed well in external validation. In subgroup analyses, the former algorithm performed the best in adult patients, outpatient claims, and during the ICD-9 era. The latter algorithm performed the best in the inpatient claims and during the ICD-10 era. The best algorithm for identifying pediatric OHCAs was any CA-related ICD code in the first three diagnosis fields with a billing code for triage acuity level 1.Conclusion: Our results may serve as a reference for future OHCA studies using the Taiwan NHI database.Keywords: administrative claims data, diagnosis, ICD-9-CM, ICD-10-CM, out-of-hospital cardiac arrest, validation

Wei-Ti Su,1 Ching-Hua Tsai,1 Chun-Ying Huang,1 Sheng-En Chou,1 Chi Li,1 Shiun-Yuan Hsu,1 Ching-Hua Hsieh2 1Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, TaiwanCorrespondence: Ching-Hua HsiehDepartment of Plastic Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, TaiwanTel +886-7-7327476Email m93chinghua@gmail.comBackground: The Geriatric Nutritional Risk Index (GNRI) is a simple and objective screening tool for clinicians to screen patients’ nutritional status based on serum albumin level and their weight and height. The original study had divided patients based on GNRI into quartiles of nutritional risk for death: a no-risk group (GNRI > 98), a low-risk group (GNRI 92– 98), a moderate-risk group (GNRI 82 to < 92), and a major-risk group (GNRI < 82). Given that the patients generally sustained traumatic brain injury (TBI) in an acute condition, the study aimed to explore whether GNRI presents a prognostic value for the mortality outcome of these patients.Methods: From January 1, 2009, to December 31, 2019, 581 elderly patients with moderate to severe TBI, which was defined as sustaining a head Abbreviated Injury Scale ≥ 3, was included in the study population. The collected data included age, sex, body mass index, serum albumin levels at admission, preexisting comorbidities, Glasgow Coma Scale, and Injury Severity Score. The primary outcome in the comparison was in-hospital mortality.Results: Multivariate logistic regression analysis revealed that GNRI, ESRD, and ISS were significant independent risk factors for mortality in patients with moderate to severe TBI. When subgrouping the study population into four nutritional risk categories according to the quartile deviation as Q1 (GNRI < 85, n = 145), Q2 (GNRI 85 to < 93.8 n = 145), Q3 (GNRI 93.8 to 103, n = 145), and Q4 (GNRI > 103, n = 146), Q1 patients had a significantly longer LOS in hospital (25.2 days vs 18.6 days, respectively; p = 0.004) and higher mortality rate (28.3% vs 11.7%, respectively; p < 0.001) than Q4 patients. The mortality rate was significantly higher in Q1 patients than in Q4 patients (OR, 2.8; 95% CI, 1.14– 6.78; p = 0.021).Conclusion: This study revealed that the GNRI is a significant independent risk factor and a promising simple assessment tool for mortality in elderly patients with moderate to severe TBI.Keywords: elderly, malnutrition, mortality, Geriatric Nutritional Risk Index, GNRI, trauma, traumatic brain injury, TBI

Chen-Lin Kang,1– 3 Tsair-Fwu Lee,1,4,5 Shan-Ho Chan,2 Shyh-Chang Liu,3 Jui-Chu Wang,6 Cheng-Hsiang Tsai,1 Kuan-Cho Liao,1 Fu-Min Fang,1 Liyun Chang,7 Chun-Chieh Huang1,8 1Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Medical Imaging and Radiology, Shu-Zen Junior College of Medicine and Management, Kaohsiung, Taiwan; 3Department of Information Engineering, I-Shou University, Kaohsiung, Taiwan; 4Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan; 5Biomedical Engineering, Kaohsiung Medical University, Kaohsiung, Taiwan; 6Department of Anatomical Pathology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 7Department of Medical Imaging and Radiological Sciences, I-Shou University, Kaohsiung, Taiwan; 8Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, TaiwanCorrespondence: Chun-Chieh HuangDepartment of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital, No 123, Dapi Road, Niaosong Dist., Kaohsiung 833, TaiwanTel +886 9 75056110Fax +886 7 7322813Email cgukinace@gmail.comPurpose: Maintaining immobilization to minimize spine motion is very important during salvage stereotactic ablative radiation therapy (SABR) for recurrent head and neck cancer. This study aimed to compare the intrafractional motion between two immobilization methods.Patients and Methods: With a spine tracking system for image guiding, 9094 records from 41 patients receiving SABR by CyberKnife were obtained for retrospective comparison. Twenty-one patients were immobilized with a thermoplastic mask and headrest (Group A), and another 20 patients used a thermoplastic mask and headrest together with a vacuum bag to support the head and neck area (Group B). The intrafractional motion in the X (superior-inferior), Y (right-left), Z (anterior-posterior) axes, 3D (three-dimensional) vector, Roll, Pitch and Yaw in the two groups was compared. The margins of the planning target volume (PTV) to cover 95% intrafractional motion were evaluated.Results: The translational movements in the X-axis, Y-axis, and 3D vector in Group A were significantly smaller than in Group B. The rotational errors in the Roll and Yaw in Group A were also significantly smaller than those in Group B; conversely, those in the Pitch in Group A were larger. To cover 95% intrafractional motion, margins of 0.96, 1.55, and 1.51 mm in the X, Y and Z axes, respectively were needed in Group A, and 1.06, 2.86, and 1.34 mm, respectively were required in Group B.Conclusion: The immobilization method of thermoplastic mask and head rest with vacuum bag did not provide better immobilization than that without vacuum bag in most axes. The clinical use of 2 mm as a margin of PTV to cover 95% intrafractional motion was adequate in Group A but not in Group B.Keywords: stereotactic ablative radiation therapy, CyberKnife, intrafractional motion, immobilization method, head and neck cancer

Chien-Fu Yeh,1–3,* Tung‐Yueh Chuang,4,* Yu-Wen Hung,5 Ming-Ying Lan,2,3 Ching-Han Tsai,4 Hao-Xiang Huang,4 Yung-Yang Lin1,4,6–8 1Institute of Brain Science, National Yang-Ming University, Taipei 11221, Taiwan; 2Department of Otorhinolaryngology, National Yang-Ming University, Taipei 11221, Taiwan; 3Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei 11217, Taiwan; 4Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; 5Institute of Cellular and System Medicine, National Health Research Institutes, Miaoli County 35053, Taiwan; 6Institute of Physiology, National Yang-Ming University, Taipei 11221, Taiwan; 7Institute of Clinical Medicine, National Yang-Ming University, Taipei 11221, Taiwan; 8Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan*These authors contributed equally to this workCorrespondence: Yung-Yang LinDepartment of Critical Care Medicine, Taipei Veterans General Hospital, No. 201, Sec. 2, Shipai Rd., Taipei 11217, TaiwanTel +886-2-2871-2121Fax +886-2-2875-7890Email g2000kev@gmail.comBackground: Ischemic stroke triggers inflammatory responses and oxidative stress in the brain, and microglia polarization affects the degree of neuroinflammation. It has been reported that the inhibition of soluble epoxide hydrolase (sEH) activity protects brain tissue. However, the anti-inflammatory and antioxidative effects of sEH inhibition in the ischemic brain are not fully understood. This study aimed to investigate the effects of a selective sEH inhibitor, 12-(3-adamantan-1-yl-ureido)-dodecanoic acid (AUDA), after ischemic stroke.Methods: Adult male rats with middle cerebral artery occlusion (MCAO) were administered with AUDA or a vehicle. Behavioral outcome, infarct volume, microglia polarization, and gene expression were assessed.Results: Rats treated with AUDA showed better behavioral outcomes and smaller infarct volumes after MCAO. After AUDA treatment, a reduction of M1 microglia and an increase of M2 microglia occurred at the ischemic cortex of rats. Additionally, there was an increase in the mRNA expressions of antioxidant enzymes and anti-inflammatory interleukin-10, and pro-inflammatory mediators were decreased after AUDA administration. Heme oxygenase-1 was mainly expressed by neurons, and AUDA was found to improve the survival of neurons.Conclusion: The results of this study provided novel and significant insights into how AUDA can improve outcomes and modulate inflammation and oxidative stress after ischemic stroke.Keywords: ischemic stroke, microglia polarization, middle cerebral artery occlusion, soluble epoxide hydrolase, anti-inflammation, antioxidant

Chi-Wen Chou,1,2 Ya-Wen Cheng,3 Chung-Hung Tsai1 1Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; 2Department of Orthopedics Surgery, National Taiwan University Hospital Yun-Lin Branch, Yun-Lin, Taiwan; 3Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei, TaiwanObjective: Bamboo is distributed worldwide, and its different parts are used as foods or as a traditional herb. Recently, antitumoral effects of bamboo extracts on several tumors have been increasingly reported; however, antitumoral activity of bamboo extracts on osteosarcoma remains unclear. In the present study, we investigated effects of an aqueous Phyllostachys edulis leaf extract (PEE) on osteosarcoma cells and the underlying mechanism of inhibition. Methods: The growth of human osteosarcoma cell lines 143B and MG-63 and lung fibroblast MRC-5 cells was determined by MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) assay. Apoptosis was demonstrated using TUNEL (terminal deoxynucleotidyl transferase dUTP nick end labeling) assay and flow cytometric analysis. Phosphorylation and protein levels were determined by immunoblotting. Results: After treatment with PEE, viability of 143B and MG-63 cells was dose-dependently reduced to 36.3%±1.6% of control values, which were similar to AICAR (5-aminoimidazole-4-carboxamide 1-β-D-ribofuranoside) treatments. In parallel, ratios of apoptotic cells and cells in the sub-G1 phase were significantly increased. Further investigation showed that PEE treatments led to activation of caspase cascades and changes of apoptotic mediators Bcl2, Bax, and p53. Consistently, our results revealed that PEE activated adenosine monophosphate-activated protein kinase (AMPK) signaling, and the AMPK activation was associated with the induction of apoptotic signaling. Conclusion: Our results indicated that PEE suppressed the growth of 143B and MG-63 cells but moderately affected MRC-5 cells. PEE-induced apoptosis may attribute to AMPK activation and the following activation of apoptotic signaling cascades. These findings revealed that PEE possesses antitumoral activity on human osteosarcoma cells by manipulating AMPK signaling, suggesting that PEE alone or combined with regular antitumor drugs may be beneficial as osteosarcoma treatments.Keywords: bamboo, antitumor, AMPK, Bcl2, Bax

Aims: The study aims were to determine autoantibodies associated with type 1 diabetes (T1D), celiac disease (CD) and autoimmune thyroid disease (AITD) in individuals living with type 2 diabetes (T2D) compared to T1D and matched controls. Methods: Individuals with T1D and T2D were randomly identified in health-care registers. Blood was collected through home-capillary sampling and autoantibodies associated with either T1D against glutamic acid decarboxylase (GADA), insulin (IAA), insulinoma antigen-2 (IA-2A), and zinc transporter 8 (ZnT8A), CD against tissue transglutaminase (tTGA) or AITD against thyroid peroxidase (TPOA) were determined in an automated, multiplex Antibody Detection by Agglutination-PCR (ADAP) assay. Results: GADA were detected in 46 % (88/191) of T1D and increased to 6.2 % (23/372) in T2D compared to 2.6 % (7/259) of controls (p = 0.0367). tTGA was low (1.1–2.6 %) and not different in between the study cohorts, nonetheless, in T1D tTGA was associated to islet autoantibodies. TPOA was more frequent in T1D, 27.1 % (53/191), compared to either T2D, 14.8 % (55/372; p = 0.0002) or controls, 14.3 % (37/259) (p = 0.0004). Overall, TPOA was more frequent in GADA positive (34.8 %; 8/23) than negative (13.5 %; 47/349; p = 0.0053) T2D individuals. Conclusion: It’s suggested that analyzing GADA and TPOA may refine the autoimmune landscape in individuals clinically classified as T2D.

Maritime Autonomous Surface Ships (MASS) have brought a transformative wave in the marine industry, yielding unprecedented operational advancements and efficiency gains. However, this paradigm shift has concurrently raised substantial cybersecurity concerns that demand meticulous attention to mitigate the impact of attacks on MASS stability. This study presents a comprehensive examination of the cybersecurity landscape, shedding light on prevalent issues concerning the data independence, integrity, and connectivity of MASS. The effectiveness of existing defense strategies against both inbound and outbound cyberattacks, focusing on attack detection and classification, is rigorously scrutinized. This analysis encompasses regulatory frameworks, encryption methods, intrusion detection systems, and a systematic approach to identifying and categorizing cyber threats. Additionally, the study anticipates future developments in cyber threats and proposes innovative solutions to fortify MASS defenses against potential cybersecurity vulnerabilities. To align with cybersecurity standards, this paper integrates challenges, possible solutions, and future advancements in a structured and cohesive manner, ensuring a thorough understanding of the intricate cybersecurity ecosystem surrounding Maritime Autonomous Surface Ships.

Aims: The objective was to compare anxiety, depression, and quality of life (QoL) in individuals living with type 1 (T1D) and type 2 (T2D) diabetes with matched controls during the second wave of the COVID-19 pandemic. Methods: Via randomization, individuals living with diabetes T1D (n = 203) and T2D (n = 413), were identified during February-July 2021 through health-care registers. Population controls (n = 282) were matched for age, gender, and residential area. Questionnaires included self-assessment of anxiety, depression, QoL, and demographics in relation to SARS-CoV-2 exposure. Blood was collected through home-capillary sampling, and SARS-CoV-2 Nucleocapsid (NCP) and Spike antibodies (SC2_S1) were determined by multiplex Antibody Detection by Agglutination-PCR (ADAP) assays. Results: Younger age and health issues were related to anxiety, depression, and QoL, with no differences between the study groups. Female gender was associated with anxiety, while obesity was associated with lower QoL. The SARS‑CoV‑2 NCP seroprevalence was higher in T1D (8.9 %) compared to T2D (3.9 %) and controls (4.0 %), while the SARS‑CoV‑2 SC2_S1 seroprevalence was higher for controls (25.5 %) compared to T1D (16.8 %) and T2D (14.0 %). Conclusions: A higher SARS‑CoV‑2 infection rate in T1D may be explained by younger age and higher employment rate, and the associated increased risk for viral exposure.

Abstract The occurrence of gastrointestinal metastasis from lung carcinoma is rare. Compared with non‐small cell lung cancer (NSCLC), small cell lung cancer more commonly results in this sort of metastasis. Here, we report an unusual case of NSCLC initially without evidence of distant metastasis that developed into gastric metastasis five months after the initial diagnosis, despite the primary lung cancer having a partial response to radiotherapy and chemotherapy. Serial radiological examinations and endoscopic biopsies of the gastric tumor confirmed that it was a metastatic carcinoma originating from the lung. The patient received a total gastrectomy for gastric metastasis due to repeated gastrointestinal bleeding.

Welding and relevant studies are indispensable to employ high-entropy alloys for practical applications. In this study, Al0.3CoCrCu0.3FeNi high-entropy alloy with single FCC phase was used to make “bead-on-plate” friction stir welds at different rotational speeds, and the effects on microstructure and mechanical properties were studied. Several banded structures containing oxide or nitride particles were observed in the stir zone (SZ), and the chemical wear of the polycrystalline cubic boron nitride tool was confirmed. The microhardness distribution of the welds showed higher hardness in the SZ because of grain refinement and the presence of deformed grains. The electron backscattered diffraction results suggested that the high-entropy alloy with low stacking-fault energy experienced recrystallization during friction stir welding, which was similar to other conventional materials with low stacking-fault energy.

By color-converting the violet laser diode (VLD) with a cadmium selenide and zinc sulfide (CdSe/ZnS) core-shell-quantum dot (QD) doped polydimethylsiloxane (PDMS) film, the VLD + CdSe/ZnS core-shell-QD transferred white-light with improved color rendering index (CRI) is demonstrated for high-speed indoor visible lighting communication. To facilitate hue saturation value (HSV) of the VLD + CdSe/ZnS core-shell-QD white-lighting module, dual-sized CdSe/ZnS core-shell-QDs with two luminescent wavelengths centered at 515 and 630 nm are doped into the PDMS. The CdSe/ZnS core-shell-QD doped PDMS phosphor with the optimized thickness of 2.5 mm serves as the beam divergent color-converter, which not only excites red (R) and green (G) fluorescence to detune the correlated color temperature (CCT) and CRI of the mixed red/green/violet (RGV) white-light, but also remains the residual VLD signal for data transmission. With a divergent angle of 127°, such a VLD + CdSe/ZnS core-shell-QD can deliver cold white-light with a CCT of 6389 K and a CRI of 63.3 at Commission International de l’Eclairage coordinate of 0.3214, 0.2755. Most important, the residual VLD light component is relatively weak with its wavelength out of the peak optical sensitivity region of the human retina centered at 441 nm. The directly encoded VLD + CdSe/ZnS core-shell-QD white light successfully carries the 16-quadrature amplitude modulation (QAM) discrete multitone data, which supports the maximal transmission data rate of 9.6 Gbit/s with a bit error ratio (BER) of 3.59 × 10−3.

Acute lung injury (ALI) presents high mortality and morbidity clinically and by far no effective preventive strategy has been established. Extract of Ginkgo biloba leaves, EGb 761, is a complex mixture that possesses several clinical beneficial effects such as anti-oxidation, anti-inflammation, anti-tumor, and cardioprotective property. With EGb 761 pretreatment, both lipopolysaccharide (LPS)-induced protein leakage and neutrophil infiltration, and LPS-induced inflammatory responses including increased myeloperoxidase (MPO) activity, lipid peroxidation, and metalloproteinase (MMP)-9 activity, were inhibited; LPS-suppressed activation of antioxidative enzymes (AOE) were reversed; and not only the phosphorylation of NF-κB but also the degradation of its inhibitor, IκB, were suppressed. These results suggested that the protection mechanism of EGb 761 is by inhibition of NFκB activation, possibly via the up-regulation of antioxidative enzymes. More studies are needed to further evaluate whether EGb 761 is a suitable candidate as an effective dietary strategy to reduce the incidence of endotoxin-induced ALI. [ABSTRACT FROM AUTHOR]

Increased adipose tissue macrophages contribute to obesity-induced metabolic syndrome. Heme oxygenase-1 (HO-1) is a stress-inducible enzyme with potent anti-inflammatory and proangiogenic activities in macrophages. However, the role of macrophage HO-1 on obesity-induced adipose inflammation and metabolic syndrome remains unclear. Here we show that high-fat diet (HFD) feeding in C57BL/6J mice induced HO-1 expression in the visceral adipose tissue, particularly the stromal vascular fraction. When the irradiated C57BL/6J mice reconstituted with wild-type or HO-1+/- bone marrow were fed with HFD for over 24 weeks, the HO-1+/- chimeras were protected from HFD-induced insulin resistance and this was associated with reduced adipose macrophage infiltration and angiogenesis, suggesting that HO-1 affects myeloid cell migration toward adipose tissue during obesity. In vivo and in vitro migration assays revealed that HO-1+/- macrophages exhibited an impaired migration response. Chemoattractant-induced phosphorylation of p38 and focal adhesion kinase (FAK) declined faster in HO-1+/- macrophages. Further experiments demonstrated that carbon monoxide and bilirubin, the byproducts derived from heme degradation by HO-1, enhanced macrophage migration by increasing phosphorylation of p38 and FAK, respectively. These data disclose a novel role of hematopoietic cell HO-1 in promoting adipose macrophage infiltration and the development of insulin resistance during obesity. [ABSTRACT FROM AUTHOR]

Background/purpose: Nuclear localization of β-catenin is known to associate with malignant transformation of many squamous cell carcinomas. The aim of this study was to compare β-catenin expression in normal human oral epithelium and areca quid chewing associated oral squamous cell carcinomas (OSCCs) and further to explore the potential mechanisms that may lead to induce β-catenin expression.Methods: A total of 40 areca quid chewing-associated OSCCs and 10 normal oral tissue biopsy samples without areca quid chewing were analyzed by immunohistochemistry. The oral epithelial cell line GNM cells were challenged with arecoline, a major areca nut alkaloid, by using Western blot analysis. Furthermore, extracellular signal-regulated protein kinase inhibitor PD98059, glutathione precursor N-acetyl-l-cysteine (NAC), tyrosine kinase inhibitor herbimycin-A, p38 inhibitor SB203580, and phosphatidylinositaol 3-kinase inhibitor LY294002 were added to find the possible regulatory mechanisms.Results: β-catenin expression was significantly higher in OSCC specimens than that in normal oral epithelial specimens (p < 0.05). It was demonstrated that normal oral epithelium showed only membranous staining for β-catenin, and membranous staining was lost or reduced with an increase in cytoplasmic/nuclear staining in OSCCs. Arecoline was found to elevate β-catenin expression in a dose-dependent manner (p < 0.05). The addition of PD98059, NAC, herbimycin-A, SB203580, and LY294002 markedly inhibited the arecoline-induced β-catenin expression (p < 0.05).Conclusion: β-catenin expression is significantly upregulated in areca quid chewing-associated OSCC. The localization of β-catenin expression is correlated with the tumor size and clinical stage. In addition, β-catenin expression induced by arecoline is downregulated by PD98059, NAC, herbimycin-A, SB203580, and LY294002. [ABSTRACT FROM AUTHOR]

Changes in head and neck anatomy during radiation therapy (RT) produce setup uncertainties of nasopharyngeal cancer (NPC) irradiation. We retrospectively analyzed image guidance data to identify clinical predictors of setup errors.

With the improvement of people’s living quality, more attention has been paid in food safety and quality. This is especially true for perishable agricultural and dairy products. It is quite often that customers receive poor or broken products due to mistakes or wrong ways in transportation. This leads customers the unsatisfied for companies’ products are relatively low. To solve the above problem, this paper proposes a new approach of using frequent closed sequential mining technology to analysis logistics data for helping companies to track the possible transportation problems. The approach consists of several important steps: RFID-enabled raw data collection, frequent sequential patterns mining, and patterns analysis. The experiment shows the proposed analysis method can discover many inside transportation service causes.

This commentary relates Fukui’s (2015) note on weak vs. strong generation to two aspects of quantification in Chinese: quantifier scope and the syntactic licensing conditions of noninterrogative wh-expressions. It is shown that the phenomena under discussion echo Fukui’s (2015) view that only strong generation allows for a deeper understanding of natural language and that dependencies are to be distinguished structurally.

This study proposes an image colour analysis tool that could help graphic/product designers to understand colour distribution and colour appearance of a series product. The analysis method is in accordance with the CIELab uniform colour space created by the International Commission on Illumination (CIE) in 1976. Based on the analysis method used in a previous study of the oil paintings, 370 oil paintings were analysed. The results demonstrated that using simple colour difference formula could reveal the images’ numerical colour distribution (Tsai, 2019). The focus of this study is twofold: to understand the colour appearance of product design and to check the rationality and reliability of the analysis tool. The analysis tool this study proposes could also be useful in providing the product designers with easy analysis and understanding of the colour distribution of images.

This paper is going to review the state-of-the-art of the high-speed 850/940-nm vertical cavity surface emitting laser (VCSEL), discussing the structural design, mode control and the related data transmission performance. InGaAs/AlGaAs multiple quantum well (MQW) was used to increase the differential gain and photon density in VCSEL. The multiple oxide layers and oxide-confined aperture were well designed in VCSEL to decrease the parasitic capacitance and generate single mode (SM) VCSEL. The maximal modulation bandwidth of 30 GHz was achieved with well-designed VCSEL structure. At the end of the paper, other applications of the near-infrared VCSELs are discussed.

In this study, a tour recommendation system based on social media photos is proposed. The proposed recommendation system can generate trip tours considering both the user’s current location and interests. First, we exploited the geotagged photo dataset from social media websites, which includes photo related information such as user ID numbers, timestamps, hashtags, and GPS coordinates. With this information, the second step is to group photos and identify those places that could be considered relevant for travellers using clustering algorithms. The third step characterizes the resulting clusters by grouping them into different categories using latent dirichlet allocation (LDA) topic modelling approach. The last step is the generation of tours using a long-short term memory neural network (LSTM). The experiments show that the proposed system can be efficient to advise future travellers about the places they would be more likely to visit and arrange trips for them.

Tank Model is a kind of simulation of rainfall movement in soil horizon. With the runoff and piping rate, the peak discharge could be effectively calculated. Having 17 rain gauge stations in 13 debris flow events during 1996-2010 as the studied cases, the peak discharge at 12 control points along Chenyulan River is simulated. Furthermore, the data in Neimaopu discharge station is established parameters of Tank Model to estimate the peak discharge in Shenmu Village. By comparing with the parameters of Shueili Station and Japanese Granite, the mean error of the parameter in this study is 51.0%, which is better than those of Japanese Granite 189% and Shueili discharge stations 251%. The parameter in this study appears the highest in allowance analysis, showing that it is more suitable for simulating the peak discharge than the other two. In spite that the percentage of the three parameters is still low, Shenmu Village could be ignored as it locates in the sub-basin of Chenyulan River with few factors. The parameters of Tank Model are applied to transform average rainfall into hydrograph so as to solve the problem of no discharge records when analysing the areas with various debris flow simulation programs.

The singing bowl is used not only for the instrument of Buddhism but also for musical therapy. This work aims to investigate the correlation of vibration modes and percussion sound for singing bowls. A typical singing bowl is first selected to perform finite element analysis (FEA) for theoretical modal analysis (TMA) as well as experimental modal analysis (EMA). Modal parameters of singing bowl, including natural frequencies and mode shapes, can be obtained from analysis and experiment, respectively. Singing bowl FE model can then be updated and verified by adjusting material properties and used to predict structural vibration modes. The percussion sound of singing bowl is also measured to obtain its sound spectrum. The peak frequency response of singing bowl sound can be interpreted and contributed from circular vibration modes of the bowl. With the knowledge of sound generation mechanism for the singing bowl, this work also studies the percussion sound characteristics of seven different sizes of singing bowls. Results show the fundamental frequency and overtone frequencies of singing bowl percussion sound are higher for the smaller size. Interestingly, that the peak resonant frequencies have near the integer ratio relationship makes the singing bowl revealing harmony sound effects. The radiated sound spectrum can be well calibrated and predicted for different sizes of singing bowls. This work shows the analytical and experimental approaches in studying the singing bowl percussion sound that strongly correlated to structural vibration modes and can be adopted for future development of singing bowls.

Abstract There are several traditional and well-developed methods for analyzing the activity of transcription factors, such as EMSA, enzyme-linked immunosorbent assay, and reporter gene activity assays. All of these methods have their own distinct disadvantages, but none can analyze the changes in transcription factors in the few cells that are cultured in the wells of 96-well titer plates. Thus, a new microsphere-based immunoassay to measure the activity of transcription factors (MIA-TF) was developed. In MIA-TF, NeutrAvidin-labeled microspheres were used as the solid phase to capture biotin-labeled double-strand DNA fragments which contain certain transcription factor binding elements. The activity of transcription factors was detected by immunoassay using a transcription factor-specific antibody to monitor the binding with the DNA probe. Next, analysis was performed by flow cytometry. The targets hypoxia-inducible factor-1α (HIF-1α) and nuclear factor-kappa B (NF-κB) were applied and detected in this MIA-TF method; the results that we obtained demonstrated that this method could be used to monitor the changes of NF-κB or HIF within 50 or 100 ng of nuclear extract. Furthermore, MIA-TF could detect the changes in NF-κB or HIF in cells that were cultured in wells of a 96-well plate without purification of the nuclear protein, an important consideration for applying this method to high-throughput assays in the future. The development of MIA-TF would support further progress in clinical analysis and drug screening systems. Overall, MIA-TF is a method with high potential to detect the activity of transcription factors.