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The major treatment for perforated peptic ulcers (PPU) is surgery, and several scoring systems have been reported to predict morbidity and mortality after surgery. However, it remains unclear which patient should receive nonoperative management instead of surgery. This study aimed to generate a scoring system for surgeons to identify patients with PPU who may be too weak to undergo surgery and without any survival benefit. We extracted the admission data of adult (≥ 18 years) patients with PPU disease from the NHIRD database. They were randomly divided into an 80% model derivation cohort and a 20% validation cohort. Multivariate analysis with a logistic regression model was applied to generate the scoring system, PPUMS. The scoring system was then applied to the validation group. The PPUMS score ranged from 0 to 8 points, composite with age ( 80: 3 points), and five comorbidities (congestive heart failure, severe liver disease, renal disease, history of malignancy, and obesity: 1 point each). In the derivation group, patients with PPUMS > 4 had a 45.9% in-hospital mortality rate and similar in-hospital mortality risk in the operation group [traditional laparotomy: odds ratio (OR) = 0.729, p = 0.320, laparoscopy: OR = 0.772, p = 0.697] and the non-operation group. In the validation group, patients with PPUMS > 4 points had a 36.9% mortality rate and similar mortality risk in the operation group (traditional laparotomy: OR = 0.353, p = 0.093, laparoscopy: no applicable) and non-operation group. PPUMS is a good predictor of mortality risk in patients with PPU and with various underlying diseases or comorbidities. Surgical management is suggested for patients with PPU with PPUMS ≤ 4 points because of lower mortality risk. However, in patients with PPUMS > 4 points, surgery may have limited benefit due to the high mortality rate compared to nonoperative treatment.

Esophagojejunostomy is a challenging step in laparoscopic gastrectomy. Although the overlap method is a safe and feasible approach for esophagojejunostomy, it has several technical limitations. We developed novel modifications for the overlap method to overcome these disadvantages. Forty-eight consecutive gastric cancer patients underwent totally laparoscopic total gastrectomy or laparoscopic proximal gastrectomy with double-tract reconstruction at our institution from January 2019 to April 2020 using the overlap method with the following modifications. The esophagus was initially rotated by 90° counterclockwise, followed by transection of two-thirds of the esophageal diameter. The unstapled esophagus was then transected with a harmonic ultrasonic scalpel to enable esophagostomy at the posterior side of the esophagus. A side-to-side esophagojejunostomy was then formed at the posterior side of the esophagus using an endoscopic linear stapler through the right lower trocar. The common entry hole was closed via hand sewing method using V-Loc suture. This procedure was termed “esophagus two-step-cut overlap method.” Only one patient suffered from esophagojejunal anastomotic leakage but subsequently recovered after conservative treatment. Patients did not experience anastomotic bleeding or stricture. Our modified overlap method provides satisfactory surgical outcomes and overcomes several technical limitations, such as entering the false lumen of the esophagus, unnecessary pollution caused by nasogastric tube, and unintended left crus stapling during anastomosis.

Background: Gastrointestinal stromal tumor (GIST) involving the esophagogastric junction (EGJ) is a relatively rare but thorny problem. It represents a dilemma between complete resection and impairment of quality of life (QOL) for loss of cardiac sphincter or even the whole stomach. Thus, emergence of function preserving gastrectomy is necessary and may provide partial solution to this hot potato. Here, we would like to introduce a method which successfully settle this matter through a clinical case. Case presentation: A 46-year-old male complaining of a progressive dysphagia. A huge GIST with 120mm in diameter was diagnosed by enhanced CT scan and pathological exam. Imatinib mesylate (IM) was initially prescribed, the tumor was shrank to a large extent while drug resistance emerged 6 months after therapy, leaving a mass approximately 90mm in diameter. We applied a method of vagus preserving proximal gastrectomy (VP-PG) and esophagogastrostomy with double-flap technique (DFT) for the patient. The operation was smooth and postoperative courses within a 12-months follow-up were uneventful. The patient had no digestive symptoms but slight leucopenia due to IM toxicity during this medication period. Conclusion: We consider that the application of VP-PG and DFT subsequent to neoadjuvant therapy with IM is likely to be an effective and feasible option for GISTs with EGJ involvement.

This study proposed a wearable device capable of recognizing six human daily activities (walking, walking upstairs, walking downstairs, sitting, standing, and lying) through a deep learning algorithm. Existing wearable devices are mainly watches or wristbands, and almost none are to be worn on the waist. Wearable devices in the forms of watches and wristbands are unfriendly to patients who are critically ill, such as patients undergoing dialysis. Patients undergoing dialysis have artificial blood vessels on their arm, and they cannot perform intense exercise. For this type of users, general hand wearable devices cannot correctly identify wearers' activities. Therefore, we proposed a waist wearable device and these types of daily life activities to assess their exercise. The hardware of the wearable device consisted of an inertial sensor, which included a microcontroller, a three-axis accelerometer, and a three-axis gyroscope. The activity recognition algorithm of the software used motion signals acquisition, signal normalization, and a feature learning method. The feature learning method was based on a 1D convolutional neural network that automatically performed feature extraction and classification from raw data. One part of the experimental data was from the dataset of the University of California (UCI), and the other part was recorded by this study. To capture the data recorded, the wearable inertial sensing device was attached to the waists of 21 experimental participants who performed six common movements in a laboratorial environment, and the subsequent records were collected to verify the validity of the proposed deep learning algorithm in relation to the inertial sensor of the wearable device. For the six common activities in the UCI dataset and the data recorded, the recognition rates in the training sample reached 98.93% and 97.19%, respectively, and the recognition rates in the testing sample were 95.99% and 93.77%, respectively.

Esophagojejunostomy is a challenging step in laparoscopic gastrectomy. Although the overlap method is a safe and feasible approach for esophagojejunostomy, it has several technical limitations. We developed novel modifications for the overlap method to overcome these disadvantages.Forty-eight consecutive gastric cancer patients underwent totally laparoscopic total gastrectomy or laparoscopic proximal gastrectomy with double-tract reconstruction at our institution from January 2019 to April 2020 using the overlap method with the following modifications. The esophagus was initially rotated by 90° counterclockwise, followed by transection of two-thirds of the esophageal diameter. The unstapled esophagus was then transected with a harmonic ultrasonic scalpel to enable esophagostomy at the posterior side of the esophagus. A side-to-side esophagojejunostomy was then formed at the posterior side of the esophagus using an endoscopic linear stapler through the right lower trocar. The common entry hole was closed via hand sewing method using V-Loc suture. This procedure was termed "esophagus two-step-cut overlap method."Only one patient suffered from esophagojejunal anastomotic leakage but subsequently recovered after conservative treatment. Patients did not experience anastomotic bleeding or stricture.Our modified overlap method provides satisfactory surgical outcomes and overcomes several technical limitations, such as entering the false lumen of the esophagus, unnecessary pollution caused by nasogastric tube, and unintended left crus stapling during anastomosis.

In this paper, the FEM simulation package FLUX2D is utilized as a tool to design a proportional solenoid for the hydraulic proportional suspension damper. The hydraulic proportional suspension damper can be used in vehicle semi-active suspension system due to its adjustable output damping force. In addition, the proportional solenoid plays the most significant role to achieve such a variable output damping force. From previous literatures, three different structures of proportional solenoid will be discussed in this paper. The first one utilizes the stepped conical armature design. Its advantages include low cost, easy manufacturing. However, the limited available linear stroke as well as the poor linearity are its major faults. The second structure uses a special tube consisting of three metal rings that are welded together. Between two magnetic steel rings, there is a non-magnetic copper ring serving to guide the magnetic flux and to produce a linear force/stroke relation. Clearly, higher cost and complex manufacturing process are its major disadvantages. However, larger available linear stroke and good linearity are two promising advantages. In this paper, the third design of proportional solenoid is adopted. The construction of the proportional solenoid is divided into several parts. After assembling these parts together, a ring of air gap with a well-designed geometrical shape exists which can be used to replace the non-magnetic copper ring. Without the copper ring, the expensive and complex welding process can be omitted. Meanwhile, the large available linear stroke as well as good linearity are both preserved. Finally, an experimental test device for measuring the force/stroke relation of proportional solenoid is implemented in this study. It is observed that the simulation results agree quite well with the experimental results.

In this paper, a design of dual-layer Blu-ray recordable (DL BD-R) disc without silver or silver alloy semi-reflective layer is introduced. Five potential dielectric reflector materials, including the AlN, BN, Nb2O5, TiO2 and ZnS-SiO2 are evaluated and tested to compensate the reflectivity of layer 1 after removing the metallic semi-reflective layer. With the help of optical simulation software, reflectivity in both layers could be optimized by fine tuning thickness of each material and the recording performance was examined in each condition. Furthermore, a simplified layer 1 stack was proposed and evaluated. The disc with only Nb2O5 layer as semi-reflector in layer 1 can achieve the desired performance of 6× recording speed and provide the benefit of better mass production from the simplified practical film structure point of view.

This paper addresses a novel competitive facility location problem about a firm that intends to enter an existing decentralized supply chain comprised of three tiers of players with competition: manufacturers, retailers and consumers. It first proposes a variational inequality for the supply chain network equilibrium model with production capacity constraints, and then employs the logarithmic-quadratic proximal prediction–correction method as a solution algorithm. Based on this model, this paper develops a generic mathematical program with equilibrium constraints for the competitive facility location problem, which can simultaneously determine facility locations of the entering firm and the production levels of these facilities so as to optimize an objective. Subsequently, a hybrid genetic algorithm that incorporates with the logarithmic-quadratic proximal prediction–correction method is developed for solving the proposed mathematical program with an equilibrium constraint. Finally, this paper carries out some numerical examples to evaluate proposed models and solution algorithms.

Lithiation-exfoliation produces single to few-layered MoS2 and WS2 sheets dispersible in water. However, the process transforms them from the pristine semiconducting 2H phase to a distorted metallic phase. Recovery of the semiconducting properties typically involves heating of the chemically exfoliated sheets at elevated temperatures. Therefore, it has been largely limited to sheets deposited on solid substrates. Here, we report the dispersion of chemically exfoliated MoS2 sheets in high boiling point organic solvents enabled by surface functionalization and the controllable recovery of their semiconducting properties directly in solution. This process connects the scalability of chemical exfoliation with the simplicity of solution processing, ultimately enabling a facile method for tuning the metal to semiconductor transitions of MoS2 and WS2 within a liquid medium.

Gastric cancer is the second cause of death from cancer worldwide and its prevalence and mortality rates are still very high in developed countries. Interleukin-10 (IL10) is a pleiotropic cytokine produced by macrophages which can suppress and stimulate the immune response in tumorigenesis signaling. However, the contribution of IL10 genomic variants to gastric cancer is still largely unknown. In the present study, we aimed at investigating the role of IL10 genotypes in gastric cancer risk. The promoter single nucleotide polymorphisms on IL10, A-1082G (rs1800896), T-819C (rs3021097) and A-592C (rs1800872), were genotyped by polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method among 716 Taiwanese people (358 patients gastric cancer and 358 cancer-free controls). The results showed that there was a significant difference between the patient and control groups in the genotypic frequency distribution of IL10 A-1082G genotypes (p=0.0004). In addition, those carrying the G allele were found to have a higher risk for gastric cancer compared with those with the A allele (p=3.19×10(-5)). Furthermore, personal cigarrete smoking habits enhanced the gastric cancer risk for those IL10 A-1082G AG and GG carriers. In conclusion, AG and GG genotype at IL10 A-1082G, together with smoking, synergistically contribute to individual susceptibility for gastric cancer in Taiwan.

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