Search

Purpose This study aims to examine how external and internal conditions drive the impact of circular economy mechanism by decomposing into three policy networks in terms of reduce, reuse and recycle, to better understand the contingency model of climate change and effect of firm size on subsequent performance. Design/methodology/approach Drawing on circular economy network and resource-based view (RBV)-network-resilience strategy framework, a pooled longitudinal cross-sectional data model is developed using a sample of 4,050 Taiwanese manufacturing multinational corporations (MNCs) making foreign direct investment between 2013 and 2018. Structural equation modeling analysis is used to comprehensively examine and investigate each circular economy policy network in the context of climate change and firm size. Post hoc multigroup analysis (MGA) is also conducted. Findings MGA shows that the reduce policy network is positively and negatively related to manufacturing know-how and production size, respectively. The impact of reuse policy network can enhance the competence of large firms. The recycle policy network is more prominent in terms of competence enhancement of climate change. Practical implications MNCs are seeking to build circular economy policy networks to a greater extent, given climate change pressure and guidelines. Originality/value This study adds to the circular economy and RBV-network-related literature on climate change and interactions to enhance performance, echoing the recent call on the sustainability of the circular economy of MNCs.

Candidemia is a life-threatening condition; however, the predictive markers for candidemia and mortality are inadequate in cirrhotic patients. This study was conducted to propose candidate predictors for the occurrence of candidemia and 30-day mortality in hospitalized cirrhotic patients with bloodstream infection (BSI) and review the related literature.Cirrhotic patients with BSI between January 2011 and March 2020 were screened from the databank of a medical center and eligible patients were enrolled. Patients were separated into candidemia and bacteremia groups according to the results of blood cultures. Baseline characteristics, clinical presentation, and biochemistry data were collected at this time, as were microbiological data, medical management, use of antimicrobial agents, and outcome of the patients. The parameters and 30-day mortality were compared between candidemia and bacteremia groups. A combination of the MeSH terms and text terms related to candidemia and cirrhosis was searched in the electronic databases.Four hundred and sixty cirrhotic patients with BSI were enrolled. Thirty-five patients with candidemia (7.6%) were identified. Nosocomial infection, intensive care unit (ICU) admission, antibiotics exposure ≥14 days, white cell count10 K/mm3, and model for end-stage liver disease (MELD) score24 were associated with candidemia. The 30-day mortality was 65.7% in the candidemia group and 37.9% in the bacteremia group (p = 0.001). Nosocomial infection, ICU admission, hepatoma, hepatic encephalopathy, international normalized ratio ≥1.2, platelet ≤150 K/mm3, estimated glomerular filtration rate60 mL/min/1.73m2, and MELD score24 were associated with 30-day mortality. Six studies were identified. The results were consistent with our findings regarding low incidence of candidemia, and relevant risk factors are listed.Candidemia had low incidence but high mortality in hospitalized cirrhotic patients with BSI. New predictors were proposed for the occurrence of candidemia and 30-day mortality in these patients.

Purpose Heterogeneity assessment can be applied for medical imaging analysis. Here, we evaluated first-order and texture analysis (TA) metrics in 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging for classification of metastatic and benign bone lesions in patients with cervical cancer. Methods The data of 18F-FDG PET studies performed on a specific PET/CT system from 2016 to 2018 in patients with cervical cancer were retrieved. The data of bone lesions extracted from studies over 2016–2017 and 2018 were used as training and validation datasets, respectively. Metastatic bone lesions were identified in each dataset, with an equal number of benign bone lesions selected. Cuboid volume of interest (VOI) consisting of 3 × 3 × 5 reconstructed voxels was applied for first-order metrics, and cubic VOI consisting of smaller voxels with trilinear interpolation of standardized uptake value (SUV) was adopted for TA metrics. First-order metrics included the maximum SUV (SUVmax) of lesions and the mean voxel SUV and its standard deviation (SUVsd), skewness, and kurtosis in VOI. In total, 4464 TA metrics based on 62 texture features were evaluated. Logistic regression was used for classification with area under the receiver operating characteristic curve (AUC) as the performance measure. Results From the training and validation datasets, 98 and 42 metastatic bone lesions were identified, respectively. SUVsd demonstrated higher performance than did SUVmax in both the training (AUC .798 vs .732, P = .001) and validation (AUC .786 vs .684, P Conclusion A simple first-order measure of heterogeneity, SUVsd, was found to be superior to SUVmax for the classification of metastatic and benign bone lesions. Multiple hypothesis testing can result in false-positive findings in TA with multiple features and parameters; careful validation is required.

In this study, aluminum gallium nitride (AlGaN) thin films are used as the piezoelectric layers to fabricate solidly mounted resonators (SMR) for high frequency acoustic wave devices. AlGaN film is deposited on a Bragg reflector, composed of three pairs of Mo and SiO2 films, through a reactive radio frequency (RF) magnetron co-sputtering system at room temperature. The optimized deposition parameters of AlGaN film have a sputtering power of 175 W for Al target, sputtering power of 25 W for GaN target, N2 flow ratio (N2/Ar + N2) of 60%, and sputtering pressure of 10 mTorr. The obtained AlGaN film has a smooth surface, uniform crystal grains, and strong c-axis orientation. The contents of Al and Ga in the AlGaN film, analyzed by energy dispersive X-ray spectroscopy (EDS) are 81% and 19%, respectively. Finally, the frequency response s11 of the obtained SMR device shows that the center frequency is 3.60 GHz, the return loss is about −8.62 dB, the electromechanical coupling coefficient (kt2) is 2.33%, the quality factor (Q) value is 96.93 and the figure of merit (FoM) value is 2.26.

Early integration of palliative care for terminally ill cancer and non-cancer patients improves quality of life. However, there are sparse data on results of palliative care consultation services (PCCS) between cancer and non-cancer patients. In this 9-year observational study, data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill cancer and non-cancer patients who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in outcomes of PCCS, including duration of PCCS, the awareness of disease of patients and families before and after PCCS, status of PCCS termination, and DNR declaration before and after PCCS among cancer and non-cancer patients throughout study period. In total, 5223 cancer patients and 536 non-cancer patients received PCCS from 2011 to 2019. The number of people who received PCCS increased stably over the decade, both for cancer and non-cancer patients. The average duration of PCCS for cancer and non-cancer patients was 21.4 days and 18.4 days, respectively. Compared with non-cancer patients, cancer patients had longer duration of PCCS, less DNR declaration (82% vs. 98%, respectively), and more transfers to the palliative care unit (17% vs. 11%, respectively), or for palliative home care (12% vs.8%, respectively). Determinants of late referral to PCCS includes age (OR 0.992, 95% CI 0.987–0.996), DNR declaration after PCCS (OR 1.967, 95% CI 1.574–2.458), patients’ awareness after PCCS (OR 0.754, 95% CI 0.635–0.895), and status of PCCS termination. This 9-year observational study showed that the trend of PCCS among cancer and non-cancer patients had changed over the duration of the study, and early integration of PCCS to all patients is essential for both cancer and non-cancer patients.

Purpose Heterogeneity assessment has been applied in medical imaging analysis. We aim to evaluate first-order and texture analysis (TA) metrics in 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) imaging for classification of metastatic and benign bone lesions in patients with cervical cancer.Materials and Methods: 18F-FDG PET studies for cervical cancer patients performed on a specific PET/CT system from 2016 to 2018 were retrieved. Bone lesions extracted from studies in 2016-2017 were used as the training dataset and those in 2018 as the validation dataset. Metastatic bone lesions were identified in each dataset, with an equal number of benign bone lesions selected. Cuboid volume of interest (VOI) consisting of 3 by 3 by 5 reconstructed voxels was defined for first-order metrics and cubic VOI consisting of smaller voxels with trilinear interpolation of standardized uptake value (SUV) was adopted for TA metrics. First-order metrics included maximum SUV (SUVmax) of lesion and mean, standard deviation (SUVsd), skewness and kurtosis of voxel SUV in VOI. A total of 4464 TA metrics based on 62 texture features were evaluated. Logistic regression was used for classification with area under the receiver operating characteristic curve (AUC) as the performance measure.Results: From the training and validation datasets, 98 and 42 metastatic bone lesions were identified respectively. SUVsd achieves a better performance than SUVmax in both training (AUC .798 vs .732, P < .001) and validation (AUC .786 vs .684, P < .001) datasets. Top-performing TA metrics achieved significantly better performance in the training dataset but failed to retain this advantage in the validation dataset.Conclusion: This study identified a simple first-order measure of heterogeneity, SUVsd, to be superior to SUVmax in the classification of metastatic and benign bone lesions. The effect of multiple hypothesis testing can result in false-positive findings in TA with multiple features and parameters and careful validation is needed.

The actin cytoskeleton drives formation of membrane protrusions that promote cell–cell fusion. Chuang et al. now find that the invadosome scaffold protein Tks5 is required for myoblast fusion. Tks5 regulates the assembly of dynamin-2 around actin bundles, thus strengthening the stiffness of the invadosome to propel cell–cell fusion., Skeletal muscle development requires the cell–cell fusion of differentiated myoblasts to form muscle fibers. The actin cytoskeleton is known to be the main driving force for myoblast fusion; however, how actin is organized to direct intercellular fusion remains unclear. Here we show that an actin- and dynamin-2–enriched protrusive structure, the invadosome, is required for the fusion process of myogenesis. Upon differentiation, myoblasts acquire the ability to form invadosomes through isoform switching of a critical invadosome scaffold protein, Tks5. Tks5 directly interacts with and recruits dynamin-2 to the invadosome and regulates its assembly around actin filaments to strengthen the stiffness of dynamin-actin bundles and invadosomes. These findings provide a mechanistic framework for the acquisition of myogenic fusion machinery during myogenesis and reveal a novel structural function for Tks5 and dynamin-2 in organizing actin filaments in the invadosome to drive membrane fusion.

Cervical lymph node enlargement as the first and sole manifestation of IgG4-related disease (IgG4-RD) is rare and is often difficult to distinguish from lymphoma. Here, we report a case of a 63-year-old man initially presenting with bilateral posterior neck masses. Ultrasonography revealed multiple matted, ovoid, homogenous, hypoechoic, and enlarged lymph nodes below the right parotid gland. In addition, there was heterogeneous echotexture with small and indistinct hypoechoic nodules over bilateral parotid and submandibular glands which suggested sclerosing sialadenitis. Pathology of the tissues obtained by core needle biopsy revealed reactive hyperplasia, but a diagnosis of lymphoma could not be excluded. Subsequently, excisional biopsy and serological tests were done. The diagnosis of IgG4-RD was confirmed due to marked elevation of serum IgG4 levels and pathological evidence of IgG+ and IgG4+ plasma cell infiltration in the lymph node specimen. The patient's neck masses subsided gradually after 1 week of oral steroid therapy. The differential diagnosis of IgG4-RD should always be considered when sclerosing sialadenitis is presented with cervical lymphadenopathy.

Backgrounds Early integration of palliative care for terminally ill non-cancer patients improves quality of life. However, there are scanty data on Palliative Care Consultation Service (PCCS) among non-cancer patients. Methods In this 9-year observational study Data were collected from the Hospice-Palliative Clinical Database (HPCD) of Taichung Veterans General Hospital (TCVGH). Terminally ill non-cancer patients with 9 categories of diagnoses who received PCCS during 2011 to 2019 were enrolled. Trend analysis was performed to evaluate differences in categories of diagnosis throughout study period, duration of PCCS, patient outcomes, DNR declaration, awareness of disease by patients and families before and after PCCS. Results In total, 536 non-cancer patients received PCCS from 2011 to 2019 with an average age of 70.7 years. The average duration of PCCS was 18.4 days. The distributions of age, gender, patient outcomes, family’s awareness of disease before PCCS, and patient’s awareness of disease after PCCS were significantly different among the diagnoses. Organic brain disease and Chronic kidney disease (CKD) were the most prevalent diagnoses in patients receiving PCCS in 2019. For DNR declaration, the percentage of patients signing DNR before PCCS remained high throughout the study period (92.8% in 2019). Patient outcomes varied according to the disease diagnoses. Conclusion This 9-year observational study showed that the trend of PCCS among non-cancer patients had changed over the duration of the study. An increasing number of terminally ill non-cancer patients received PCCS during late life, thereby increasing the awareness of disease for both patients and families, which would tend to better prepare terminally ill patients for end-of-life as they may consider DNR consent. Early integration of PCCS into ordinary care for terminally non-cancer patients is essential for better quality of life.

Adsorbent made by carbonization of biomass under oxygen-limited conditions has become a promising material for wastewater treatment owing to its cost-effective, simple, and eco-friendly processing method. Ultrasound is considered a green technique to modify carbon materials because it uses water as the solvent. In this study, a comparison of Reactive Black 5 (RB5) adsorption capacity between biochar (BC) generated by pyrolysis of water bamboo (Zizania latifolia) husks at 600 °C and ultrasound-assisted biochar (UBC) produced by pyrolysis at 600 °C assisted by ultrasonic irradiation was performed. UBC showed a greater reaction rate and reached about 80% removal efficiency after 4 h, while it took 24 h for BC to reach that level. Scanning electron microscope (SEM) images indicated that the UBC morphology surface was more porous, with the structure of the combination of denser mesopores enhancing physiochemical properties of UBC. By Brunauer, Emmett, and Teller (BET), the specific surface areas of adsorbent materials were analyzed, and the surface areas of BC and UBC were 56.296 m2/g and 141.213 m2/g, respectively. Moreover, the pore volume of UBC was 0.039 cm3/g, which was higher than that of BC at 0.013 cm3/g. The adsorption isotherms and kinetics revealed the better fits of reactions to Langmuir isotherm and pseudo-second-order kinetic model, indicating the inclination towards monolayer adsorption and chemisorption of RB5 on water bamboo husk-based UBC.

Background This study assessed the performance of visceral adiposity index and body shape index in predicting diabetes mellitus (DM) risk and compared their predictive ability to that of body mass index and waist circumference. Methods Among 8249 consecutive subjects who attended the Nationwide Health Check Up System for Senior Citizens (≥ 65 years) between 2008 and 2018, we examined the associations of several adiposity indices with DM risk and explored gender differences. Results Among all adiposity indicators, Chinese visceral adiposity index (CVAI) demonstrated the highest discriminatory ability for diabetes mellitus with area under receiver operating characteristic curves (AUC) of 0.65, 0.68, and 0.66 for men, women, and all participants, respectively, and optimal cut-offs set as 126.09 in men and 117.77 in women. Compared with body shape index (ABSI), both CVAI and VAI were strongly associated with baseline DM (adjusted OR: 4.85, 95% CI: 4.05–5.82 and 4.22, 95% CI: 3.53–5.05 for 4th vs 1st quartile groups by CVAI and VAI, P Pinteraction Conclusions Our population-based data demonstrated that Chinese visceral adiposity index may serve as a superior clinical indicator of diabetes when compared with conventional anthropometric indices among older adult Chinese, especially in women.

In this study, piezoelectric zinc oxide (ZnO) thin film was deposited on the Pt/Ti/SiNx/Si substrate to construct the FBAR device. The Pt/Ti multilayers were deposited on SiNx/Si as the bottom electrode and the Al thin film was deposited on the ZnO piezoelectric layer as the top electrode by a DC sputtering system. The ZnO thin film was deposited onto the Pt thin film by a radio frequency (RF) magnetron sputtering system. The cavity on back side for acoustic reflection of the FBAR device was achieved by KOH solution and reactive ion etching (RIE) processes. The crystalline structures and surface morphologies of the films were analyzed by X-ray diffraction (XRD) and field emission scanning electron microscope (FE-SEM). The optimized as-deposited ZnO thin films with preferred (002)-orientation were obtained under the sputtering power of 80 W and sputtering pressure of 20 mTorr. The crystalline characteristics of ZnO thin films and the frequency responses of the FBAR devices can be improved by using the rapid thermal annealing (RTA) process. The optimized annealing temperature and annealing time are 400 °C and 10 min, respectively. Finally, the FBAR devices with structure of Al/ZnO/Pt/Ti/SiNx/Si were fabricated. The frequency responses showed that the return loss of the FBAR device with RTA annealing was improved from −24.07 to −34.66 dB, and the electromechanical coupling coefficient (kt2) was improved from 1.73% to 3.02% with the resonance frequency of around 3.4 GHz.

In this study, a biodegradable binder, hydroxypropyl methyl cellulose (HPMC), was used for the first time to mix with persulfate powder for developing novel persulfate-releasing tablets to remediate trichloroethylene (TCE)-contaminated groundwater. To obtain feasible parameters for the preparation of persulfate tablets, different pressures, HPMC/tablet mass ratios, and persulfate dosages were evaluated. The results showed that the persulfate tablet released 2868 mg-persulfate/day for 12 days under the optimal manufacturing parameters of HPMC/tablet mass ratio of 0.5 and pressure of 4.90 × 10

Tube feeding (TF) is commonly used for patients with severe swallowing disturbance, and patients with chronic dysphagia are often provided with a long-term nasogastric tube (NGT). However, nationwide epidemiological data on long-term NGT placement are limited. The present study identified the prevalence and outcomes of patients with long-term NGT placement in Taiwan. Data were obtained from the Longitudinal Health Insurance Database. Patients with NGT placement for more than 3 months between 2000 and 2012 were enrolled in this cohort study. An NGT cohort of 2754 patients was compared with 11,016 controls matched for age, sex, residential area, and comorbidities. The prevalence rate of long-term NGT reached 0.063% in 2005 and then remained stable at 0.05–0.06%. The major causes of NGT placement were stroke (44%), cancer (16%), head injury (14%), and dementia (12%). Men (63%) were more likely to have long-term NGT placement than women (37%). The adjusted hazard ratios were 28.1 (95% CI = 26.0, 30.3) for acute and chronic respiratory infections; 26.8 (95% CI = 24.1, 29.8) for pneumonia, 8.84 (95% CI = 7.87, 9.93) for diseases of the esophagus, stomach, and duodenum; and 7.5 (95% CI = 14.7, 20.8) for mortality. Patients with NGT placement for more than 6 months had a higher odds ratio (1.58, 95% CI = 1.13, 2.20) of pneumonia than those with NGT placement for less than 6 months. Only 13% and 0.62% of the patients underwent rehabilitation therapy and percutaneous endoscopic gastrostomy, respectively. Long-term NGT use was associated with a higher risk of comorbidities and mortality. Stroke was the main illness contributing to long-term NGT use. Further interventions are necessary to improve the negative effects of long-term TF.

The thermophoretic motion of a spherical particle suspended in a gaseous medium possessing a uniform temperature gradient is analytically studied for a small but nonzero Peclet number . The Knudsen...

In this study, a 3.5-GHz solidly mounted resonator (SMR) was developed by doping scandium in aluminum nitride to form AlScN as the piezoelectric thin film. Molybdenum (Mo) of 449 nm thickness and silicon dioxide (SiO2) of 371 nm thickness were used as the high and low acoustic impedance films, respectively, which were alternately stacked on a silicon substrate to form a Bragg reflector. Then, an alloy target with atomic ratio of 15% Sc was adopted to deposit the piezoelectric AlScN thin film on the Bragg reflector, using a radio frequency magnetron sputtering system. The characteristics of the c-axis orientation of the AlScN thin films were optimized by adjusting sputtering parameters as sputtering power of 250 W, sputtering pressure of 20 mTorr, nitrogen gas ratio of 20%, and substrate temperature of 300 °C. Finally, a metal top electrode was coated to form a resonator. The X-ray diffraction (XRD) analysis showed that the diffraction peak angles of the AlScN film shifted towards lower angles in each crystal phase, compared to those of AlN film. The energy dispersive X-ray spectrometer (EDX) analysis showed that the percentage of scandium atom in the film is about 4.5%, regardless of the sputtering conditions. The fabricated resonator exhibited a resonance frequency of 3.46 GHz, which was a small deviation from the preset resonance frequency of 3.5 GHz. The insertion loss of −10.92 dB and the electromechanical coupling coefficient of 2.24% were obtained. As compared to the AlN-based device, the AlScN-based resonator exhibited an improved electromechanical coupling coefficient by about two times.

A simple chemical route is utilized to decorate ZnO nanoparticles (NP) on the coral-like Cu2O nanowires (NW) surface as a p-n heterojunction photocathode for photoelectrochemical (PEC) hydrogen production. The SEM and TEM results confirm the morphology and structure of coral-like Cu2O NW/ZnO NP nanocomposite; meanwhile, the EDS and XPS results display the chemical binding and composition of Cu2O and ZnO materials. Electrochemical impedance measurements demonstrate that the coral-like Cu2O NW/ZnO NP achieves fast charge transfer. Notably, the p-Cu2O NW/n-ZnO NP photocathode can achieve the highest photocurrent of −3.4 mAcm−2 and its IPCE values significantly show the 1.5-fold enhancement compared to pristine p-Cu2O NW, ascribing the efficient separation efficiency of photogenerated electron-hole pairs and greater PEC activity.

We report the controllable growth of GaAs quantum complexes in droplet molecular-beam epitaxy, and the optical properties of self-assembled Alalt;subagt;xalt;/subagt;Gaalt;subagt;1-xalt;/subagt;As quantum rings embedded in a superlattice. We found that Ga droplets on a GaAs substrate can retain their geometry up to a maximum temperature of 490alt;supagt;alt;/supagt;C during post-growth annealing, with an optimal temperature of 320alt;supagt;alt;/supagt;C for creating uniform and symmetric droplets. Through controlling only the crystallisation temperature under Asalt;subagt;4alt;/subagt; in the range of 450alt;supagt;alt;/supagt;C to 580alt;supagt;alt;/supagt;C, we can reliably control diffusion, adsorption and etching rates to produce various GaAs quantum complexes such as quantum dots, dot pairs and nanoholes. Alalt;subagt;xalt;/subagt;Gaalt;subagt;1-xalt;/subagt;As quantum rings are also realised within these temperatures via the adjustment of As beam equivalent pressure. We found that crystallisation using Asalt;subagt;2alt;/subagt; molecules in the place of Asalt;subagt;4alt;/subagt; creates smaller diameter quantum rings at higher density. The photoluminescence of Asalt;subagt;2alt;/subagt; grown Alalt;subagt;xalt;/subagt;Gaalt;subagt;1-xalt;/subagt;As quantum rings embedded in a superlattice shows a dominant emission from the quantum rings at elevated temperatures. This observation reveals the properties of the quantum ring carrier confinement and their potential application as efficient photon emitters.

Background Anxiety is commonly experienced during the delivery process and has shown to have adverse effects on maternal and infant health outcomes. Music interventions tend to reduce the effects of anxiety in diverse populations, are low cost, are easily accessible, and have high acceptability. The aim of this review and meta-analysis was to assess the effectiveness of music interventions in reducing anxiety levels among women during labor. Methods Seven databases from inception to the end of December, 2018, without any language or time restriction including Embase, PubMed, the Cochrane Library, the Cumulative Index to Nursing and Allied Health, PsycINFO, Airiti Library, and PerioPath: Index to Taiwan Periodical Literature were searched using key terms related to pregnancy, anxiety, and music. Randomized controlled trials that assessed the effect of music during labor and measured anxiety levels as an outcome were included. Meta-analyses were conducted to assess anxiety reduction following a music intervention compared to that after placebo treatment. Results A total of 14 studies that investigated a total of 1,310 participants were included in this review. The meta-analyses indicated that those in the intervention group had a significant decrease in anxiety scores (standardized mean difference = −2.40, 95% confidence interval (CI) [−3.29 to −1.52], p < 0.001; I2 = 97.66%), heart rate (HR) (difference in means = −3.04 beats/min, 95% CI [−4.79 to −1.29] beats/min, p = 0.001; I2 = 0.00%), systolic blood pressure (SBP) (difference in means = −3.71 mmHg, 95% CI [−7.07 to −0.35] mmHg, p = 0.031; I2 = 58.47%), and diastolic blood pressure (DBP) (difference in means = −3.54 mmHg, 95% CI [−5.27 to −1.81] mmHg, p < 0.001; I2 = 0.00%) as compared to the women in the control group. Conclusions Music interventions may decrease anxiety scores and physiological indexes related to anxiety (HR, SBP, and DBP). Music interventions may be a good non-pharmacological approach for decreasing anxiety levels during labor.

Internalization of macromolecules and membrane into cells through endocytosis is critical for cellular growth, signaling and plasma membrane (PM) tension homeostasis. Although endocytosis is responsive to both biochemical and physical stimuli, how physical cues modulate endocytic pathways is less understood. Contrary to the accumulating discoveries on the effects of increased PM tension on endocytosis, less is known about how a decrease of PM tension impacts on membrane trafficking. Here, we reveal that an acute decrease of PM tension results in phosphatidic acid (PA) production, F-actin and phosphatidylinositol (4,5)-bisphosphate [PI(4,5)P2]-enriched dorsal membrane ruffling and subsequent macropinocytosis in myoblasts. The PA production induced by decreased PM tension depends on phospholipase D2 (PLD2) activation via PLD2 nanodomain disintegration. Furthermore, the ‘decreased PM tension–PLD2–macropinocytosis’ pathway is prominent in myotubes, reflecting a potential mechanism of PM tension homeostasis upon intensive muscle stretching and relaxation. Together, we identify a new mechanotransduction pathway that converts an acute decrease in PM tension into PA production and then initiates macropinocytosis via actin and PI(4,5)P2-mediated processes.

Internalization of macromolecules and membrane into cells through endocytosis is critical for cellular growth, signaling, and membrane tension homeostasis. Although endocytosis is responsive to both biochemical and physical stimuli, how physical cues modulate endocytic pathways is less understood. In contrary to the accumulating discoveries on effects of increased membrane tension on endocytosis, little is known about how a drop of tension impacts membrane trafficking. Here we reveal that acute reduction of plasma membrane tension results in phosphatidic acid, F-actin and dynamin 2-enriched dorsal membrane ruffling and subsequent macropinocytosis in myoblast. The membrane flaccidity-induced local phosphatidic acid production depends on phospholipase D2 (PLD2) that is activated via lipid raft disruption. Furthermore, the “membrane flaccidity-PLD2-macropinocytosis” pathway is dominant in myotube, reflecting a potential mechanism of membrane tension homeostasis upon intensive muscle stretching and relaxation. Together, we identify a new mechanotransduction pathway which converts acute tension drop into PA production and subsequently initiates macropinocytosis via actin and dynamin activities. Summary We reveal a mechanical induction of macropinocytosis that is elicited by acute decrease of plasma membrane tension, followed by lipid raft destabilization, PLD2 activation and PA production.

Background Pneumonia is a leading cause of hospitalization and death worldwide. However, studies focusing on risk factors of community-acquired pneumonia (CAP) in the home health care (HHC) population remain scarce. Aims This study aimed to evaluate risk factors associated with hospitalization for CAP among HHC patients in Taiwan. Methods This retrospective cross-sectional study extracted data from patients’ electronic medical records between 1 January 2017 and 31 December 2017. Multiple logistic regression analyses were performed to explore factors associated with hospitalization for CAP. Results In total, 598 patients (men/women: 236/362) were included. One hundred ninety-nine patients (33.28%) were hospitalized for pneumonia. Inpatients showed a higher proportion of the following: male sex, functional impairment, hypoalbuminemia, anemia, nasogastric tube use, excessive polypharmacy, stroke, dementia, heart failure, chronic respiratory disease, and chronic liver disease. Furthermore, nasogastric tube use (odds ratio [OR] 3.01, 95% confidence interval [CI] 1.88–4.82), anemia (OR 2.37, 95% CI 1.48–3.80), male sex (OR 2.14, 95% CI 1.43–3.20), chronic respiratory disease (OR 2.09, 95% CI 1.33–3.30), dementia (OR 1.94, 95% CI 1.27–2.97), heart failure (OR 1.69, 95% CI 1.11–2.56), and hypoalbuminemia (OR 1.57, 95% CI 1.03–2.40) significantly increased the risk of hospitalization for CAP. Conclusions Our results revealed risk factors associated with hospitalization for CAP in HHC patients. In addition to chronic diseases, malnutrition is an important risk factor. Caregivers should make prompt assessments and take preventive measures for such patients.

Introduction: Cerebral vasoconstriction is often encountered in the post-CPR phase, which inevitably worsens neurological prognosis. Nitric oxide (NO) confers vasodilatation and anti-apoptotic protective effect, but may cause systemic hypotension. We designed an Au-polymersomes/S-nitrosoglutathione (Au-PLGA/GSNO) nanoparticle that can be selectively triggered by shockwave (SW) to release NO, and investigated its role in mitigating post-CPR cerebral vasoconstriction and apoptotic neuronal injury. Methods: Using an established rat model of asphyxia cardiac arrest and CPR, Au-PLGA/GSNO (7500 PPM, 3.33 mg/kg Au and 42 ug/kg GSNO) was infused into carotid artery together with the same volume of SonoVue 10 min after CPR, with simultaneous stimulation by SW (PiezoWave, 134 mJ/mm 2 ) distal to the infusion site. The blood pressure (BP) was continuously monitored and brain tissue perfusion recorded by OxyFLO probe. Cerebral vasculature was video-taped by CytoCam. The blood was sampled 2 h post-CPR for measurement of nitrate/nitrite. The brain was harvested for measurement of casepase-3, endothelial NO synthase (eNOS) and protein kinase B (Akt). In a subgroup the brain was harvested at 24 h for TUNEL stain. Results: Marked cerebral vasoconstriction was noted after CPR with brain perfusion reduced to about half that of baseline. With infusion of Au-PLGA/GSNO + SonoVue and SW stimulation, the cerebral vasoconstriction was ameliorated and brain perfusion improved to baseline level ( P < 0.05 vs. CPR control), while BP showed no significant difference. The plasma nitrate/nitrite 2 h post-CPR was significantly increased ( P < 0.05). The cleaved caspase-3 of the brain was reduced ( P < 0.001) and TUNEL stain of the CA1 and CA3 regions of hippocampus significantly abrogated. Interestingly, the phosphorylated (P)-eNOS and P-Akt were also increased (both P < 0.001), suggesting reciprocating activation of the upstream Akt-eNOS signaling. Conclusion: Nano Au-PLGA/GSNO with SW-induced release of NO selectively mitigates post-CPR cerebral vasoconstriction and apoptotic neuronal death without systemic hypotension. Being effective and safe, such therapeutic strategy can be applied not only in post-CPR care but in other diseases such as subarachnoid hemorrhage.

Background A ‘surgery as needed’ strategy has been proposed for patients with oesophageal cancer who truly achieve a pathological complete response (pCR) following neoadjuvant chemoradiotherapy (nCRT). However, the ability to detect residual disease remains problematic. This study investigated the anatomical locations and pathological characteristics of residual cancer in patients with oesophageal squamous cell carcinoma (SCC) who achieved a near pCR following nCRT. Methods Patients with oesophageal SCC who achieved a near pCR after nCRT were eligible. Near pCR was defined as residual cancer in the resection specimen representing less than 10 per cent of the apparent original tumour area. Results Detailed histopathological reassessment of 76 consecutive patients (mean age 54·4 years) with a near pCR was undertaken. Some 32 patients (42 per cent) with a near pCR had no detectable mucosal lesions. Residual tumour was identified most frequently in the submucosal layer (54, 71 per cent), followed by the mucosa (44, 58 per cent), muscle layer (36, 47 per cent) and adventitia (22, 29 per cent) (P < 0·001). Among patients without ypT1a disease, increasing depth of tumour invasion correlated negatively with the likelihood of mucosal involvement. Of patients with ypT3 disease, 16 of 22 had no detectable cancer located in the mucosa, compared with six of 29 with ypT1b disease (P < 0·001). Conclusion Better tools for predicting pCR are required before considering a ‘surgery as needed’ approach in the management of oesophageal cancer.

Salmonella spp. and Listeria monocytogenes are foodborne pathogens of global importance. We assessed their risks and associated factors in a highly dynamic population of animals. Animal and environmental samples were collected from dairy cattle, sheep, camel and chickens at either the farms or the abattoirs. The pathogens were detected using a combination of bacterial enrichment culture and real-time polymerase chain reaction (PCR). Data on putative risk factors were collect and analysed for their significance of association with these pathogens. Salmonella spp. were detected at higher proportions in sheep faeces and sheep carcasses in comparison to cattle faeces (odds ratio = 2.4 and 2.2, respectively). This pathogen was less common in milk or carcasses samples from cattle or chickens. Sheep and camel carcass samples were highly contaminated with Salmonella spp. Faecal samples from cattle had the most diverse serovars of Salmonella enterica including S. Newport, S. Haifa, S. Kedougou, S. Kentucky, S. Mbandaka and S. Goettingen. Exotic serovars in sheep included S. Eastbourne, S. Chester and S. Kottnus. Serovars that were shed in camel faeces included S. Newport, S. Bovismorbificans and S. Infantis. In all sampled populations, detection of Salmonella spp. was more likely during warmer months than cold months. Listeria monocytogenes was not common in the targeted populations and was detected at a rate of 2.4%, mainly from sheep carcasses. The study highlights the role of food animals as reservoirs of pathogens across boundaries since all feed are imported in that population from different parts of the world.

Background The prognostic value of histologic response for osteosarcoma may have changed with induction chemotherapy schedules over time. We hypothesized that the increased intensity of induction therapy provided on INT0133 compared to the Children's Cancer Group study CCG-782 would diminish the impact of histologic response on the risk of events after definitive surgery. Methods Retrospective analysis was performed for patients aged