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Upper tract urothelial carcinoma (UTUC) is relatively rare in Western countries. The impact of programmed death-ligand 1 (PD-L1) expression on UTUC remains unclear because previous studies have focused on bladder UC. We investigated the association of PD-L1 expression with clinicopathological features and prognosis in patients with UTUC. We retrospectively reviewed the patients with UTUC that we treated at our institute from 2013 to 2018. In total, 105 patients with UTUC undergoing radical nephroureterectomy were analyzed to evaluate the PD-L1 expression on representative whole-tissue sections using the Combined Positive Score (CPS; Dako 22C3 pharmDx assay). A PD-L1 CPS ≥ 10 was considered positive. Among the 105 UTUC cases, 17.1% exhibited positive PD-L1 expression. A CPS ≥ 10 was significantly associated with higher tumor stage (≥ T2, p = 0.034) and lymph node invasion at diagnosis (p = 0.021). A multivariable analysis indicated that a CPS ≥ 10 was an independent prognostic predictor of shorter cancer-specific survival (hazard ratio [HR] = 4.59, 95% confidence interval [CI] = 1.66 − 12.7, p = 0.003) and overall survival (HR = 2.51, 95% CI = 1.19 − 5.27, p = 0.015). A PD-L1 CPS ≥ 10 in UTUC was associated with adverse pathological features and independently predicted worse cancer-specific and overall survival.

With the development of such technologies as embedded systems, cloud databases and hardware components, detection of cognitive in the elderly can be made more convenient and accurate. This work develops a novel cognitive assessment interactive embedded system, which consists of a micro-controller unit (MCU), organic light-emitting diode (OLED) modules and a client identification circuit. The reliability of the proposed system is demonstrated in visuospatial memory tests. With its combination of OLED modules and pressable components, the elderly can use the system to perform testing under a flashing light source sequence with tactile feedback. To identify the various pattern arrangements in the Corsi block tapping task (CBTT), the client identification circuit in the proposed system is implemented to compute the number of OLED lighting devices on each column of the wooden base. The data that are collected from each subject will be transferred to cloud servers through a smart phone APP via wireless networks to eliminate recording errors by the experimenter. The functionality of the spatial working memory is verified in experiments that involve the proposed OLED, a computerized version of the CBTT, and 24 participants. Experimental results reveal that the difference in memory span between young and elderly groups is significant, F(1, 92) = 214, p

As technology advanced, new e-health solutions are evolved to empower people to manage their care at home. This study explored the needs for disease management in activity tracking using photo diary through older adults' subjective perspective. It further aimed to suggest which lifestyle measures, symptoms and behaviours would be meaningful to include in such a digital diseases care management program for technology design. Both photo diary and focus group discussion were used, 11 older adults with multiple metabolism-related chronic diseases (Mean age, 72.5 ± 6.14 years) were recruited and asked to carry out the photo diary to trace their living situation and needs using a tablet camera. A focus group discussion was applied to identify the needs of chronic disease management, based on the results of living context tracing. Five themes, regular physical activity, smart management of healthy behaviors, healthy diet, regular daily routine and social connection, were identified by content analysis from photo diary and the focus group discussion. The results indicated that the photo diary program can raise awareness and promotes positive behavior changes. It is believed that the E-approach can be applied to the effectively enhance older adults' self-management by monitoring their health status and their daily routine activities.

Aims Intravesical prostatic protrusion (IPP) is associated with the degree of benign prostatic obstruction. We evaluated the effects of Mirabegron, a selective β3 adrenoceptor agonist, on overactive bladder (OAB) in male patients with different degrees of IPP. Methods About 185 male patients ≥40 years with lower urinary tract symptoms were recruited from a tertiary referral center. OAB was defined by the overactive bladder symptom score (OABSS) urgency score of ≥2 and sum score of ≥3. IPP was measured in the midsagittal section using transrectal ultrasound and patients were divided into IPP ≤5 mm and IPP >5 mm groups. Outcomes were assessed at the baseline, 4, and 12 weeks. Results About 104 patients (56.2%) were diagnosed with OAB and received Mirabegron (50 mg) daily use. Both IPP groups (≤5 and >5 mm) had similar baseline OABSS and International Prostate Symptom Scores (IPSS). Four-week Mirabegron usage was associated with significant decreases in both symptom score measurements, OABSS: IPP ≤5 mm -27.4% and IPP >5 mm -19.7% (P = .419) and IPSS: -32% and -22.5% (P = .202), respectively. Urgency, urge incontinence, and nocturia sub-scores were decreased in both groups, -26.3% and -27.4% (P = .690), 53.3% and 46.2% (P = .916), and 20.8% and 15.4% (P = .958). Effects were maintained at 12 weeks. We found no significant improvement in the frequency sub-score in either group. One patient stopped medication because of intolerable hypertension. Most frequent adverse event was increased residual urine (≥50 mL higher than baseline), IPP ≤5 mm 9.2% and IPP >5 mm 5.1% (P = .707), but no case had acute urinary retention. Conclusions Mirabegron is an effective drug to treat male OAB regardless of IPP grade.

Disease of the lower limb musculoskeletal system is one of the most common diseases in elders. The use of interactive somatosensory games (ISGs) in rehabilitation has been widely used. Most relevant studies have focused on efficacy, while only a few have investigated the difficulties, willingness, and requirements of elderly people in playing the game. Therefore, this study is to design an ISG that is focused on lower-limb rehabilitation and to explore whether the designed ISG can enhance the willingness and motivation of elders to undergo rehabilitation. In this study, 15 elders (5 males and 10 females with average age of 78 years) with degenerative joint disease were recruited to participate in our pretest-posttest design experiments. First, the subjects completed a five-minute pre-test questionnaire after a one-minute traditional rehabilitation (TR). Second, they completed a five-minute post-test questionnaire after a one-minute interactive somatosensory game rehabilitation (ISGR). The average experiment time for each subject was 25 min. We used a t-test to analyze the data. According to the result, there are significant differences in four factors (i.e., interest (t=-6.89, p

Graphical abstract, A compact beam-position monitor was constructed using a linear contact image sensor attached to a plastic scintillator and tested using a 230 MeV proton beam. The results indicate that the beam position can be obtained in real-time, and the beam position with a precision of up to 0.03 mm. The compactness and high precision of the device hold considerable potential for it to be used as a beam-position monitor and offline, daily quality assurance monitor in hadron therapy. • The method can provide a high precision and high resolution beam position for flash irradiation in particle therapy in real-time. • The method using contact image sensor with scintillator does not require a long focal length for camera and it is free of image distortion. • The method can be integrated into medical particle accelerator for feedback control and daily quality assurance.

We demonstrate fluorescent Fe embedded magnetic nanodiamonds by ion implantation and two-step annealing. The diamond characteristics with a highly ordered core and a graphite surface layer are maintained after the implantation process. After the two-step annealing process, a bright red fluorescence associated with nitrogen-vacancy centers is observed. These new fluorescent magnetic nanodiamonds can be used as a dual-function in vivo tracer with both optical visibility and magnetic resonance imaging capabilities. They are potentially useful for the more advanced in vivo biological and medical applications.

Mesenchymal stem cells (MSCs) are widely considered to be an attractive cell source for regenerative therapies, but maintaining multipotency and self-renewal in cultured MSCs is especially challenging. Hence, the development and mechanistic description of strategies that help promote multipotency in MSCs will be vital to future clinical use. Here, using an array of techniques and approaches, including cell biology, RT-quantitative PCR, immunoblotting, immunofluorescence, flow cytometry, and ChIP assays, we show that the extracellular domain of epithelial cell adhesion molecule (EpCAM) (EpEX) significantly increases the levels of pluripotency factors through a signaling cascade that includes epidermal growth factor receptor (EGFR), signal transducer and activator of transcription 3 (STAT3), and Lin-28 homolog A (LIN28) and enhances the proliferation of human bone marrow MSCs. Moreover, we found that EpEX-induced LIN28 expression reduces the expression of the microRNA LET7 and up-regulates that of the transcription factor high-mobility group AT-hook 2 (HMGA2), which activates the transcription of pluripotency factors. Surprisingly, we found that EpEX treatment also enhances osteogenesis of MSCs under differentiation conditions, as evidenced by increases in osteogenic markers, including Runt-related transcription factor 2 (RUNX2). Taken together, our results indicate that EpEX stimulates EGFR signaling and thereby context-dependently controls MSC states and activities, promoting cell proliferation and multipotency under maintenance conditions and osteogenesis under differentiation conditions.

The success in medical and multidisciplinary research has resulted in the longevity in human age. Longevity in human age has caused an increase in the elderly population, and this condition becomes a new phenomenon. The scientific and medical research focusing on the elderly becomes one of the biggest concerns, and cross-disciplinary cooperation to promote the health of the elderly is a global issue. However, many factors are affecting the physical and mental health of the elderly. The reduction in a social circle after retirement is a common problem for the elderly. Smaller social circle makes the elderly isolate and can cause loneliness. In order to reduce the problem, this study proposed a smartphone application called PiChat. This application manages to pair similar photos uploaded to help the elderly found new acquaintance and guidance of the conversation topic to begin. However, emphasizing the ease of use and considering the deterioration of the visual ability of the elderly, this application will lead the elderly to create a new social circle gradually. The preliminary test showed that this application is feasible to anticipate social circle reduction for the baby boomer’s elderly.

Preserving renal function and controlling oncological outcomes are pertinent when managing renal neoplasms. Cryoablation is the recommended treatment only for clinical T1a stage renal tumour. Here, we compared the outcomes of robot-assisted laparoscopic partial nephrectomy (RaPN) and laparoscopic cryoablation (LCA) in the treatment of patients with localised T1-T2 renal tumours. Overall, 86 patients who received RaPN and 78 patients underwent LCA were included in this study. The intraoperative, postoperative, and oncological outcomes in the LCA group were non-inferior to the RaPN group. Moreover, LCA demonstrated shorter operative time (267.45 ± 104.53 min vs. 138.56 ± 45.28 min, p &lt, 0.001), lower blood loss (300.56 ± 360.73 mL vs. 30.73 ± 50.31 mL, p &lt, 0.001), and slight renal function deterioration because of the reduced invasiveness, without compromising on the oncological outcomes.

The aging population significantly is shifting the center of gravity of the people toward older ages and median age. Indonesia, as one of the most populous countries, needs to prepare for this situation. This study tries to explain whether the elderly’s sedentary lifestyle is the consequence of intergenerational interaction patterns. Filial piety was arguably implemented, as the interaction baseline within a family member affects how the intergeneration communicates. This study uses thematic analysis based on the opinions from 16 respondents’ experiences and values with respect to behavior toward the older generation with a specific inclusion criterion. Sampling structures represented younger-generation adults who interacted daily with the elderly older generation, divided by their marital status, residencies, and living area in Indonesia. Through emerging themes, was is found out that the dominant figure in the family is the communication center in the family. The dominant figure might be an authoritative parent or dominant child. This targeted approach is useful to enhance connectivity within family members, potentially implementing the Internet of Healthy Things (IoHT) for the younger elderly to reduce undesirable sedentary lifestyles and to deliver sustainable healthy aging in Indonesian society.

The cultural assets of Taiwan's railway heritage are rich and Taiwanese railway museums have gradually appeared each showcasing somewhat different characteristics through a variety of static or animated presentations. The Taitung old railway station is a historical site and in this pilot study we choose it as a good example to illustrate how to pave the way for an interdisciplinary and cutting-edge cultural creation by applying new technologies, such as virtual reality (VR) and augmented reality (AR), to a historical site. With their powerful advantages, we can reconstruct the historical site to develop the VR and AR simulation systems that provide an interactive environment for people to experience and appreciate the east Taiwan old railway station and railway culture.

BackgroundAnti-thymocyte globulin (ATG) as induction therapy in renal transplantation is facing the dilemma of reducing the incidence of acute rejection (AR) and delayed graft function (DGF) or increasing risks of infection and malignancy. The purpose of this study was to delineate the safety and efficiency of the optimal ATG dosage.MethodsWe retrospectively evaluated 91 deceased donor kidney transplant recipients (KTRs) in our institution between March 2011 and January 2019. The patients were classified into three groups based on induction therapy: (1) Group 1: modest-dose ATG (three mg/kg) intraoperatively (N= 21); (2) Group 2: low-dose ATG (1–1.5 mg/kg) intraoperatively (N= 23); (3) Group 3: basiliximab 20 mg both on day 0 and 4 (N= 47). In Groups 1 and 2, all patients received a daily low-dose program (1–1.5 mg/kg each day) with target dosage of six mg/kg. Induction therapy was combined with standard immunosuppressive regimen consisting of calcineurin inhibitors, mycophenolate/the mammalian target of rapamycin inhibitors and corticosteroids.ResultsThere was no significant difference in patient characteristics among groups. The outcomes of infection rate, biopsy-proven acute rejection, post-transplant diabetes mellitus, graft survival, and patient survival were similar among groups. Compared to the daily low-dose ATG regimen, the intraoperative modest-dose regimen did not cause more dose interruption and hence was more likely to reach the target ATG dosage. The intraoperative modest-dose regimen also seemed to reduce the rate of DGF.DiscussionIn recent years, a trend of using a “lower” dose of ATG has seemed to emerge. Our results suggest intraoperative modest-dose ATG followed by daily low-dose ATG regimen was safe and effective in cadaveric renal transplantations for preventing DGF, AR, and graft loss.

The impact of tumor infiltrating lymphocytes (TILs) on survival was confirmed in various cancer types. Our study aims to investigate the prognostic role of TILs on survival in patients with metastatic urothelial carcinoma (mUC) receiving platinum based chemotherapy. Patients who were diagnosed to have pathologically proved mUC between 1997 and 2016 and received palliative chemotherapy with platinum based regimen were recruited into our study. Kaplan-Meier curves and Cox regression analysis were constructed for overall survival (OS). A total of 259 mUC patients were enrolled into our study with median age 63 years and median follow-up visit 13.5 months. Of these patients, 179 (69%) had intense TILs and 80 (31%) had non-intense TILs. The median OS were 15.7 vs. 6.7 months (P =

We designed an auto organizational menu (AOM) to help children with autism spectrum disorders (ASDs) improve their operational communication ability and make it easier for them to ask for help. A speech-generating device (SGD) with a variety of AOM designs was tested on four children with ASD, and their improvements were assessed to compare the effects of the AOM intervention strategy. A multiple baseline design and withdrawal design were used. The assessment items included: (1) the rate of correct answers for operational communication; (2) the accuracy rate of asking for help; (3) the degree of independent completion. The proposed AOM intervention effectively increased the participants' desire to communicate with others and the accuracy rate of asking for help, improved their involvement in communication, distance, and continuity. The proposed AOM helps children with ASD build sentences by themselves, helps them organize communication with their peers, and helps them ask requesting for help.

Chronic prostatitis/chronic pelvic pain syndrome (CP/ CPPS) has a negative impact on the quality of life, and its etiology still remains unknown. Although many treatment protocols have been evaluated in CP/CPPS, the outcomes have usually been disappointing. Botulinum neurotoxin A (BoNT-A), produced from Clostridium botulinum, has been widely used to lower urinary tract dysfunctions such as detrusor sphincter dyssynergia, refractory overactive bladder, interstitial cystitis/bladder pain syndromes, benign prostatic hyperplasia, and CP/ CPPS in urology. Here, we review the published evidence from animal models to clinical studies for inferring the mechanism of action underlying the therapeutic efficacy of BoNT in CP/CPPS. Animal studies demonstrated that BoNT-A, a potent inhibitor of neuroexocytosis, impacts the release of sensory neurotransmitters and inflammatory mediators. This pharmacological action of BoNT-A showed promise of relieving the pain of CP/CPPS in placebo-controlled and open-label BoNT-A and has the potential to serve as an adjunct treatment for achieving better treatment outcomes in CP/CPPS patients.

Boron neutron capture therapy is a powerful anti-cancer treatment, the success of which depends heavily on the boron delivery agent. Enabling the real-time tracing of delivery agents as they move through the body is crucial to the further development of boron neutron therapy. In this study, we fabricate highly bio-compatible boron-10 embedded nanodiamonds using physical ion implantation in conjunction with a two-step annealing process. The red fluorescence of the nanodiamonds allows their use in fluorescence microscopy and in vivo imaging systems, thereby making it possible to conduct tracking in real time. The proposed fluorescent boron-10 embedded nanodiamonds, combining optical visibility and boron-10 transport capability, are a promising boron delivery agent suitable for a wide range of biomedical applications.

This paper aims to develop an appropriate game interface design for frozen shoulder rehabilitation. The main treatment of frozen shoulder involves diagnose of doctor and proper rehabilitative exercise to break up adhesion and improve the joint mobility and functions. It leads to a problem that whether to do the exercise after the treatments of doctor is all depends on the patient’s motivation and often not execute. To address this, we construct an app game design which can be easily used by mobile platforms in order to enhance the motivations of patients to keep doing regular rehabilitation at home and the results can be uploaded into server for screening by doctor. The prototyping of this game design are conducted and several users are invited into the evaluation process to revise the game design.

Background Autism spectrum disorders (ASD) are characterized by a reduced ability to understand the emotional expressions on other people’s faces. Increasing evidence indicates that children with ASD might not recognize or understand crucial nonverbal behaviors, which likely causes them to ignore nonverbal gestures and social cues, like facial expressions, that usually aid social interaction. Objective In this study, we used software technology to create half-static and dynamic video materials to teach adolescents with ASD how to become aware of six basic facial expressions observed in real situations. Methods This intervention system provides a half-way point via a dynamic video of a specific element within a static-surrounding frame to strengthen the ability of the six adolescents with ASD to attract their attention on the relevant dynamic facial expressions and ignore irrelevant ones. Results Using a multiple baseline design across participants, we found that the intervention learning system provided a simple yet effective way for adolescents with ASD to attract their attention on the nonverbal facial cues; the intervention helped them better understand and judge others’ facial emotions. Conclusion We conclude that the limited amount of information with structured and specific close-up visual social cues helped the participants improve judgments of the emotional meaning of the facial expressions of others.

Here we present a simple physical method to prepare magnetic nanodiamonds (NDs) using high dose Fe ion-implantation. The Fe atoms are embedded into NDs through Fe ion-implantation and the crystal structure of NDs are recovered by thermal annealing. The results of TEM and Raman examinations indicated the crystal structure of the Fe implanted NDs is recovered completely. The SQUID-VSM measurement shows the Fe-NDs possess room temperature ferromagnetism. That means the Fe atoms are distributed inside the NDs without affecting NDs crystal structure, so the NDs can preserve the original physical and chemical properties of the NDs. In addition, the ion-implantation-introduced magnetic property might make the NDs to become suitable for variety of medical applications.

This paper is regarding the wearable device design which is based on frozen shoulder game rehabilitation. At present some studies are focus on sensors and rehabilitation outcomes. However the sensors designed without a suitable wearable device and it will influence the sensed results and wear comfort. Thus, this article records the design process of the wearable device, particularly the worn ways and the fabric. The way in which wearable device are worn will be analyzed with the user experience to improve sensing accuracy and comfort. The material in which wearable device are used will be tested with making models. Then the models of the wearable devices are made and tested to find out the design factors which are suitable ergonomic.

Background We analyzed the efficacy of the interface design of speech generating devices on three non-verbal adolescents with autism spectrum disorder (ASD), in hopes of improving their on-campus communication and cognitive disability. The intervention program was created based on their social and communication needs in school. Two operating interfaces were designed and compared: the Hierarchical Relating Menu and the Pie Abbreviation-Expansion Menu. Methods The experiment used the ABCACB multiple-treatment reversal design. The test items included: (1) accuracy of operating identification; (2) interface operation in response to questions; (3) degree of independent completion. Each of these three items improved with both intervention interfaces. Results The children were able to operate the interfaces skillfully and respond to questions accurately, which evidenced the effectiveness of the interfaces. Conclusions We conclude that both interfaces are efficacious enough to help nonverbal children with ASD at different levels.

Objective This study aims to evaluate the operative efficacy and safety of the GreenLight 180-W XPS laser system in comparison to the GreenLight 120-W HPS system used by a single experienced surgeon for the treatment of bladder outlet obstruction caused by an enlarged prostate. Materials and methods We retrospectively compared the patients undergoing GreenLight 180-W XPS (September 2014–September 2015) and GreenLight 120-W HPS (August 2008–September 2009) for lower urinary tract symptoms secondary to benign prostatic hyperplasia by a single experienced surgeon. The patient baseline characteristics, perioperative parameters, and complications were recorded. Prostate size and prostate-specific antigen were also assessed. Functional parameters, including International Prostate Symptom Score, maximum uroflow rate, postvoid residual, and quality of life score, were analyzed in different follow-up periods. Results A total of 130 patients (65 in the HPS and 65 in the XPS group) were included in this study. Intraoperative lasing time was significantly shorter in the XPS group, but the postoperative length of catheterization and hospital stay were comparable in both groups. The number of fibers used during vaporization was significantly less, and only one case required two fibers for prostate vaporization in the XPS group ( p = 0.03). During the follow-up period, there was statistically significant improvement compared with baseline in all functional parameters in each group. However, no significant difference was observed in these parameters between the two groups. The mean percentages of prostate volume reduction were 57% and 41% and those of prostate-specific antigen reduction were 60% and 49%, respectively, in the XPS and HPS groups. Complications were comparable between the two groups. Conclusion The 180-W XPS system displays a shorter lasing time, less laser fiber use, more volume reduction, and a comparable safety profile in comparison with the 120-W HPS system for the treatment of bladder outlet obstruction caused by an enlarged prostate.