Search

Data on predictors and time to relapse in patients with psoriasis who discontinue therapy in a real-world setting are scarce.To investigate predictors of relapse after withdrawal of ustekinumab in patients with psoriasis.This study screened 500 patients with psoriasis who received ustekinumab (669 treatment episodes) between 2011 and 2018. Overall, 202 patients (accounting for 304 treatment episodes) who had responded to therapy and were withdrawn from ustekinumab treatment were included.The cumulative probabilities of being relapse-free at 6, 12, 18, 24, and 36 months after withdrawal from ustekinumab treatment were 49.3%, 12.6%, 5.3%, 4.7%, and 1.6%, respectively. Multivariate regression analyses with a generalized estimating equation showed that after adjustments, biologic-naive status, maximum improvement in Psoriasis Area and Severity Index during ustekinumab treatment, time to achieve a 50% improvement in baseline Psoriasis Area and Severity Index score after initiation of ustekinumab, family history of psoriasis, chronic kidney disease, and immunosuppressant use while not taking ustekinumab were significant predictors of time to relapse following discontinuation of ustekinumab.Nonrandomized allocation of duration of treatment and follow-up.Given the high rates of relapse, withdrawal of ustekinumab from patients with well-controlled psoriasis cannot be recommended.

One of the challenges in integrating nanomechanical resonators made from van der Waals materials in optoelectromechanical technologies is characterizing their dynamic properties from vibrational displacement. Multiple calibration schemes using optical interferometry have tackled this challenge. However, these techniques are limited only to optically thin resonators with an optimal vacuum gap height and substrate for interferometric detection. Here, we address this limitation by implementing a modeling-based approach

Whether aortic stenosis (AS) increases perioperative risk in noncardiac surgery remains controversial. Limited information is available regarding adequate anesthetic techniques for patients with AS. Using the reimbursement claims data of Taiwan’s National Health Insurance, we performed propensity score matching analyses to evaluate the risk of adverse outcomes in patients with or without AS undergoing noncardiac surgery between 2008 and 2013. We also compared the perioperative risk of AS patients undergoing general anesthesia or neuraxial anesthesia. Multivariable logistic regressions were applied to calculate the adjusted odds ratios (aORs) with 95% confidence intervals (CIs) for postoperative mortality and major complications. The matching procedure generated 9741 matched pairs for analyses. AS was significantly associated with 30-day in-hospital mortality (aOR 1.31, 95% CI 1.03–1.67), acute renal failure (aOR 1.42, 95% CI 1.12–1.79), pneumonia (aOR 1.16, 95% CI 1.02–1.33), stroke (aOR 1.14, 95% CI 1.01–1.29), and intensive care unit stay (aOR 1.38, 95% CI 1.27–1.49). Compared with neuraxial anesthesia, general anesthesia was associated with increased risks of acute myocardial infarction (aOR 3.06, 95% CI 1.22–7.67), pneumonia (aOR 1.80, 95% CI 1.32–2.46), acute renal failure (aOR 1.82, 95% CI 1.11–2.98), and intensive care (aOR 4.05, 95% CI 3.23–5.09). The findings were generally consistent across subgroups. AS was an independent risk factor for adverse events after noncardiac surgery. In addition, general anesthesia was associated with greater postoperative complications in AS patients compared to neuraxial anesthesia. This real-world evidence suggests that neuraxial anesthesia should not be contraindicated in patients with AS.

The increasing use of biologics is accompanied by a risk of hepatitis B (HBV) and C virus (HCV) reactivation.To determine the predictors of HBV and HCV reactivation in patients with psoriasis receiving biologics.This study screened 2060 patients with psoriasis (3562 treatment episodes) who were taking biologics from 2009 to 2018. There were 359 patients with psoriasis with HBV (561 treatment episodes) and 61 with HCV infection (112 treatment episodes).During 8809 and 1522 person-months of follow-up, 88 treatment episodes for HBV involved HBV reactivation, and 14 episodes of HCV involved reactivation. The reactivation rate was significantly higher in treatment episodes of chronic HBV infection than in that of occult HBV (34.3% vs 3.2%, P = .001) and resolved HBV (34.3% vs 5.0%, P .001). The multivariate analysis revealed that being hepatitis B surface antigen seropositive, being hepatitis B e-antigen seropositive, and tumor necrosis factor-α-inhibitor therapy were risk factors for HBV reactivation, whereas antiviral prophylaxis was effective in reducing the risk of HBV reactivation. No predictors were significantly associated with HCV reactivation.Observational design and a lack of a comparison group.Patients with psoriasis on biologics have a risk of HBV and HCV reactivations, particularly those who are seropositive for hepatitis B surface antigen and hepatitis B e-antigen and undergoing tumor necrosis factor-α-inhibitor therapy.

Background Little was know about the association between the CHA2DS2-VASc score and postoperative outcomes. Our purpose is to evaluate the effects of CHA2DS2-VASc score on the perioperative outcomes in patients with atrial fibrillation (AF). Methods We identified 47,402 patients with AF over the age of 20 years who underwent noncardiac surgeries between 2008 and 2013 from claims data of the National Health Insurance in Taiwan. The CHA2DS2-VASc score was used to evaluate postoperative complications, mortality and the consumption of medical resources by calculating adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Results Compared with patients with a CHA2DS2-VASc score of 0, patients with scores ≥ 5 had an increased risk of postoperative septicemia (OR 2.76, 95% CI 2.00–3.80), intensive care (OR 2.55, 95% CI 2.12–3.06), and mortality (OR 2.04, 95% CI 1.14–3.64). There was a significant positive correlation between risk of postoperative complication and the CHA2DS2-VASc score (P Conclusion The CHA2DS2-VASc score was highly associated with postoperative septicemia, intensive care, and 30-day mortality among AF patients. Cardiologists and surgical care teams may consider using the CHA2DS2-VASc score to evaluate perioperative outcome risks in patients with AF.

We propose and demonstrate an approach that utilizes field-effect transistors (FETs) for the real-time detection of interactions between molecules. In this approach, FET-based sensors utilize two unique functions, high charge sensitivity and high photon responsivity. We use these transistors to detect the changes in molecular charge and photon absorption associated with the binding of antibody and antigen molecules. For comparison with enzyme-linked immunosorbent assay (ELISA), we adopt an ELISA sandwich structure immobilized on the FET surface to detect neutrophil gelatinase-associated lipocalin (NGAL). Using this technique, we detect NGAL quantitatively with a sensitivity of 0.1 pg mL−1 and

Effects of high- ${k}$ gate stacks and plasma treatments on electrical and reliability characteristics of FinFET were comprehensively studied in this work. A higher ON-current, higher ON-/OFF-current ratio, smaller subthreshold swing (S.S.), lower gate leakage current, and better reliability characteristics in FinFETs are simultaneously achieved by a HfO2/ZrO2/HfO2 gate stack. The improvement can be attributed to its higher ${k}$ -value, fewer oxide traps, and oxygen vacancy in gate stack. A higher ON-current of FinFET can be obtained with an F-based plasma treatment, which, however, also induces a larger gate leakage current. A plasma treatment with F- and N-based ambient on gate stack is shown to obtain a higher ON-current and acceptable gate leakage in FinFET. Furthermore, a larger ON-current, higher ON-/ OFF-current ratio, and a smaller S.S. in FinFET can be achieved with a TiO2 stacked gate dielectric.

Operation characteristics of polycrystalline germanium (poly-Ge) tri-gate junctionless (JL) charge-trapping (CT) flash memory devices with stacked tunneling layer were studied in this work. The programming speeds of poly-Ge tri-gate JL flash device with GeOx/Al2O3/SiO2 tunneling layer are faster than those with GeOx/Al2O3 or GeOx/SiO2 ones, thanks to the modified electric field in the tunneling layer. Better retention characteristics are also achieved due to a larger barrier height and physical thickness, because Ge diffusion is effectively suppressed by adding an Al2O3 between GeOx and SiO2, which can improve the quality of tunneling layer. A poly-Ge CT flash device fabricated with low-temperature process is promising for embedded memory in Ge CMOS or 3D IC.

Aim We aimed to evaluate the long-term risk of dementia in patients with periodontitis and its associated factors. Materials and methods Using Taiwan's National Health Insurance Database, we identified 56,018 patients aged ≥50 years with newly diagnosed periodontitis in 2000-2008. A cohort of 56,018 adults without periodontitis was selected for comparison, with matching by age and sex. Both cohorts were followed from 2000 to the end of 2013, and incident dementia was identified during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of dementia associated with periodontitis were calculated in the multivariate regressions. Results Periodontitis was associated with dementia risk (HR: 1.79, 95% CI: 1.67-1.93), and the association between periodontitis and dementia risk was significant in men, women, and people aged more than 60 years. Among patients with periodontitis, the use of statins (HR: 0.78, 95% CI: 0.71-0.87), metformin (HR: 0.53, 95% CI: 0.44-0.62), and influenza vaccination (HR: 0.67, 95% CI: 0.61-0.74) were associated with a reduced risk of dementia, while diabetes, mental disorders, and stroke were major significant risk factors. Conclusions Periodontitis was a risk factor for dementia, while the use of statins and metformin may reduce the risk of dementia.

The operation characteristics of polycrystalline Si (poly-Si) gate-all-around (GAA) junctionless (JL) charge-trapping (CT) flash memory devices with the Zr-based stacked trapping layer were studied in this work. Devices with the Si3N4/ZrO2 stacked trapping layer show enhanced erasing speeds and comparable retention characteristics in comparison to Si3N4/HfO2 due to many shallow energy traps and smaller valance band offset in the ZrO2 layer. By inserting Al2O3 between Si3N4 and ZrO2 trapping layer, the retention and endurance characteristics are improved. The erasing speed can be further improved by a Zr-rich oxide layer near the tunneling oxide since the energy barrier can confine more injected electrons near the tunneling oxide. The retention characteristic can be improved without sacrificing the erasing speed because some of the shallow traps can be passivated by NH3 plasma treatment on ZrO2. Hence, the ZrO-based stacked trapping layer is very promising for the poly-Si GAA JL CT flash devices for nonvolatile memory applications.

Objective Urticaria is a mast cell-related disease caused severe itching and the lifetime prevalence of urticaria is about 20% in general population. Our purpose is to evaluate risk of urticaria in geriatric stroke patients received influenza vaccination (IV). Methods In a cohort of 192,728 patients with newly diagnosed stroke aged over 65 years obtained from 23 million people in Taiwan's National Health Insurance between 2000 and 2008, we identified 9890 stroke patients who received IV and 9890 propensity score-matched stroke patients who did not receive IV. Controlling for immortal time bias, both the IV and non-IV groups were followed for one year. Urticaria events were identified during the follow-up period. We calculated the adjusted rate ratios (RRs) and 95% confidence intervals (CIs) of the one-year risk of urticaria associated with IV. Results During the follow-up period of one year, stroke patients with IV had a significantly higher risk of urticaria compared with non-IV stroke patients (RR 1.81, 95% CI 1.47-2.23). An increased risk of urticaria in stroke patients with IV was noted in both sexes, patients 65-84 years of age, patients with comorbid medical conditions, and various time intervals of follow-up. Vaccinated stroke patients with hemorrhage (RR 4.00, 95% CI 1.76-9.10) and those who received intensive care (RR 5.14, 95% CI 2.32-11.4) had a very high risk of urticaria compared with those without IV. Conclusion Receiving IV may be associated with an increased risk of urticaria in stroke patients. We could not infer the causality from the current results because of this study's limitations. Future investigations are needed to evaluate the possible mechanism underlying the association between IV and urticaria.

The influence of physician specialty on the outcomes of kidney diseases (KDs) remains underexplored. We aimed to compare the complications and mortality of patients with admissions for KD who received care by nephrologists and non-nephrologist (NN) physicians. We used health insurance research data in Taiwan to conduct a propensity-score matched study that included 17,055 patients with admissions for KD who received care by nephrologists and 17,055 patients with admissions for KD who received care by NN physicians. Multivariable logistic regressions were conducted to calculate adjusted odds ratios (ORs) with 95% confidence intervals (CIs) for 30-day mortality and major complications associated with physician specialty. Compared with NN physicians, care by nephrologists was associated with a reduced risk of 30-day mortality (OR 0.29, 95% CI 0.25–0.35), pneumonia (OR 0.82, 95% CI 0.76–0.89), acute myocardial infarction (OR 0.68, 95% CI 0.54–0.87), and intensive care unit stay (OR 0.78, 95% CI 0.73–0.84). The association between nephrologist care and reduced admission adverse events was significant in every age category, for both sexes and various subgroups. Patients with admissions for KD who received care by nephrologists had fewer adverse events than those who received care by NN physicians. We suggest that regular nephrologist consultations or referrals may improve medical care and clinical outcomes in this vulnerable population.

The association between pancreatitis and acute myocardial infarction or stroke remains incompletely understood. This study aimed to evaluate the long-term risk of acute atherosclerotic cardiovascular disease (ASCVD) in people with acute and chronic pancreatitis. Using research database of Taiwan's National Health Insurance, we identified 2678 patients aged ≥ 20 years with newly diagnosed pancreatitis in 2000–2008. A cohort of 10,825 adults without pancreatitis was selected for comparison, with matching by age and sex. Both cohorts were followed from 2000 to the end of 2013, and incident acute ASCVD was identified during the follow-up period. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of acute ASCVD associated with pancreatitis were calculated. Compared with the comparison cohort, the adjusted HR of acute ASCVD were 1.76 (95% CI 1.47–2.12) and 3.42 (95% CI 1.69–6.94) for people with acute pancreatitis and chronic pancreatitis, respectively. A history of alcohol-related illness (HR 9.49, 95% CI 3.78–23.8), liver cirrhosis (HR 7.31, 95% CI 1.81–29.5), and diabetes (HR 6.89, 95% CI 2.18–21.8) may worsen the risk of acute ASCVD in patients with chronic pancreatitis. Compared with people had no pancreatitis, patients with acute pancreatitis who had alcohol-related illness (HR 4.66, 95% CI 3.24–6.70), liver cirrhosis (HR 4.44, 95% CI 3.05–6.47), and diabetes (HR 2.61, 95% CI 2.03–3.36) were at increased risk of acute ASCVD. However, the cumulative use of metformin was associated with a reduced risk of acute ASCVD in the acute pancreatitis cohort (HR 0.30, 95% CI 0.17–0.50). Compared with the control group, patients with acute or chronic pancreatitis were more likely to have an increased risk of acute ASCVD, while the use of metformin reduced the risk of acute ASCVD. Our findings warrant a survey and education on acute ASCVD for patients with acute and chronic pancreatitis.

Occupational accidents and diseases cause the loss of valuable workers and lead to high healthcare expenses. Because occupational accidents and diseases are ascribed to inadequate working conditions and work environments, they can be prevented through a well-established occupational safety and health management system, which can ensure workers’ health and reduce the expense of healthcare. The study investigated the shortage of work-related occupational safety and health (OSH) measures in medium-sized manufacturing industries. This study mainly focused on qualitative interviews with 15 labor inspectors and 25 business executives from OSH participating to investigate the problems of occupational safety and health in the manufacturing industries in Taiwan. The results of a qualitative study show that the most important problems with OSH management are employers’ negligence and workers’ insufficient knowledge about OSH management. The research results revealed the following eighteen significant shortcomings of OSH management: employers care mostly about production profit and do not care much for OSH, OSH data collection and OSH planning are not suitable for the workplace, many managers of OSH affairs are not qualified, in terms of their professional or academic backgrounds, and the repair of workplaces’ roofs often results in falling accidents, especially before or after a typhoon, because of workers’ failure to use safety belts and/or to follow OSH guidelines. In order to address the shortcomings and bottlenecks, the study also presented recommendations for how to implement and revise the OSH Act and how to research and enhance OSH management. The results of this study will not only supply the Ministry of Labor (Taiwan) with data to plan the strategy of OSH management but also will allow employers and workers to improve OSH management in the workplace in order to prevent the occurrence of occupational accidents.

BackgroundChronic thromboembolic pulmonary hypertension (CTEPH) leads to impairment of pulmonary hemodynamics, triggers secondary right heart dysfunction, regularly accompanied by systemic malperfusion, and subsequently alter glomerular filtration rates (GFR). Chronic kidney disease (CKD) may also adversely affect CTEPH prognosis. This study aimed to assess how Brain natriuretic peptide (BNP) combined with balloon pulmonary angioplasty (BPA) improve right heart hemodynamics and estimated GFR (eGFR) of CKD in CTEPH patients.MethodsWe retrospectively studied 47 patients with confirmed CTEPH with CKD who were treated with BPA and admitted to the intensive care unit between December 2012 and September 2020. The patient was divided into two groups based on whether to receive recombinant human brain natriuretic peptide treatment (rhBNP). The information of patients between two groups was systematically compared in hospital and follow up. eGFR were assessed at several time points. ResultsFor rhBNP group, eGFR was significantly higher in the two periods of Prior to last BPA and 6-month follow-up. A significantly higher Δ eGFR from baseline to follow-up was observed. There was significant difference on levels of troponin I, NT-proBNP, and right ventricle diameter at follow-up. Conclusion rhBNP combined BPA therapy improves pulmonary and systemic hemodynamics, with positive effects on renal function, which maybe an alternative treatment option for improving clinical outcomes.

The risk and outcomes of diabetes in patients with epilepsy remains unclear. We evaluated these risks using an epilepsy cohort analysis and a diabetes admission analysis. In the epilepsy cohort analysis, we identified 2854 patients with newly diagnosed epilepsy in 2000–2008 from the research data of National Health Insurance in Taiwan. Using Propensity-score matching by sociodemographic factors and medical conditions, we selected 22,832 people without epilepsy as a non-exposed cohort for comparison. Follow-up events of diabetes from January 1, 2000 until December 31, 2013 were ascertained from medical claims. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of diabetes associated with epilepsy were calculated using multiple Cox proportional hazard models. In the diabetes admission analysis, we identified 92,438 hospitalized diabetes patients, 930 of whom had a history of epilepsy. Adjusted odds ratios (ORs) and 95% CIs of adverse events after diabetes associated with previous epilepsy were calculated using multiple logistic regressions. The adjusted HR of diabetes in the cohort with epilepsy was 1.31 (95% CI 1.14–1.50) compared to the non-epilepsy cohort. Previous epilepsy was associated with post-diabetes adverse events, such as pneumonia (OR 1.68, 95% CI 1.37–2.07), urinary tract infection (OR 1.83, 95% CI 1.55–2.16), and septicemia (OR 1.34, 95% CI 1.09–1.65). In conclusion, epilepsy was associated with higher risk of diabetes and adverse post-diabetes outcomes. Diabetes prevention and attention to post-diabetes adverse events are needed for this susceptible population.

Due to the fact that previous studies have rarely investigated the recognition rate discrepancy and pathology data error when applied to different databases, the purpose of this study is to investigate the improvement of recognition rate via deep learning-based liver lesion segmentation with the incorporation of hospital data. The recognition model used in this study is H-DenseUNet, which is applied to the segmentation of the liver and lesions, and a mixture of 2D/3D Hybrid-DenseUNet is used to reduce the recognition time and system memory requirements. Differences in recognition results were determined by comparing the training files of the standard LiTS competition data set with the training set after mixing in an additional 30 patients. The average error value of 9.6% was obtained by comparing the data discrepancy between the actual pathology data and the pathology data after the analysis of the identified images imported from Kaohsiung Chang Gung Memorial Hospital. The average error rate of the recognition output after mixing the LiTS database with hospital data for training was 1%. In the recognition part, the Dice coefficient was 0.52 after training 50 epochs using the standard LiTS database, while the Dice coefficient was increased to 0.61 after adding 30 hospital data to the training. After importing 3D Slice and ITK-Snap software, a 3D image of the lesion and liver segmentation can be developed. It is hoped that this method could be used to stimulate more research in addition to the general public standard database in the future, as well as to study the applicability of hospital data and improve the generality of the database.

Studies involving nanomechanical motion have evolved from its detection and understanding of its fundamental aspects to its promising practical utility as an integral component of hybrid systems. Nanomechanical resonators’ indispensable role as transducers between optical and microwave fields in hybrid systems, such as quantum communications interface, have elevated their importance in recent years. It is therefore crucial to determine which among the family of nanomechanical resonators is more suitable for this role. Most of the studies revolve around nanomechanical resonators of ultrathin structures because of their inherently large mechanical amplitude due to their very low mass. Here, we argue that the underutilized nanomechanical resonators made from multilayered two-dimensional (2D) materials are the better fit for this role because of their comparable electrostatic tunability and larger optomechanical responsivity. To show this, we first demonstrate the electrostatic tunability of mechanical modes of a multilayered nanomechanical resonator made from graphite. We also show that the optomechanical responsivity of multilayered devices will always be superior as compared to the few-layer devices. Finally, by using the multilayered model and comparing this device with the reported ones, we find that the electrostatic tunability of devices of intermediate thickness is not significantly lower than that of ultrathin ones. Together with the practicality in terms of fabrication ease and design predictability, we contend that multilayered 2D nanomechanical resonators are the optimal choice for the electromagnetic interface in integrated quantum systems.

The traditional method of appearance defect detection is to rely on the examiner's personnel senses identification, but people's vision is lack of standard, and it is easy to cause false detection or missed detection due to fatigue or inattention. Therefore, the use of automatic optical inspection equipment, is the use of machine vision instead of human eyes to carry out quality inspection, in addition to improving inspection quality and efficiency, but also reduce the cost of human resources, but the cost of automatic optical inspection (AOI) equipment is not low, for the traditional furniture wood processing, economic factors are the biggest obstacle to implement. Another reason is that there are great differences among length, width and height. Generally, the width is much larger than the height. Therefore, the sheet can be put on the conveyer along the length direction. However, for the narrow side, turning and erecting need fixture. There are many ways to solve problems in traditional industrial engineering, such as DMAIC and 8D methodology. Most of them belong to the vertical mode thinking method. This mechanism design uses the lateral mode thinking method, adopts the five stages of design thinking, and creates the auxiliary mechanism design with the principle of prism reflection, which is simple and solves the procedure operation of avoiding turning over and vertical detection. The design can simultaneously detect the front side, left side and right sides of the wood board, and verify the design performance of high efficiency and low cost.

Operation characteristics of polycrystalline germanium (poly-Ge) tri-gate junctionless (JL) charge-trapping (CT) flash memory devices with bandgap-engineered tunneling layers fabricated by a low- temperature process were studied in this work. The poly-Ge tri-gate JL CT flash memory device with GeO2/Al2O3/SiO2 (GAS) stacked tunneling layer presents the highest programming speed and superior retention performance, due to the optimal bandgap-engineered in tunneling layer. Based on the simulation results, the GAS device has a higher tunneling current and more electrons can be captured in Si 3 N 4 to obtain larger V th shifts. The low-temperature fabrication process for poly-Ge CT flash memory device is promising for embedded memory in monolithic 3D IC.

The impact of heart failure (HF) on postoperative outcomes is not completely understood. Our purpose is to investigate complications and mortality after noncardiac surgeries in people who had HF. In the analyses of research data of health insurance in, we identified 32,808 surgical patients with preoperative HF and 32,808 patients without HF undergoing noncardiac surgeries. We used a matching procedure with propensity score and considered basic characteristics, coexisting diseases, and information of index surgery between patients with and without HF. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) for complications and mortality after noncardiac surgeries in patients with HF were analyzed in multivariate logistic regressions. HF increased the risks of postoperative acute myocardial infarction (OR 2.51, 95% CI 1.99–3.18), pulmonary embolism (OR 2.46, 95% CI 1.73–3.50), acute renal failure (OR 1.97, 95% CI 1.76–2.21), intensive care (OR 1.93, 95% CI 1.85–2.01), and 30-day in-hospital mortality (OR 1.80, 95% CI 1.59–2.04). Preoperative emergency care, inpatient care, and injections of diuretics and cardiac stimulants due to heart failure were also associated with mortality after surgery. Patients with HF had increased complications and mortality after noncardiac surgeries compared with those without HF. The surgical care team may consider revising the protocols for perioperative care in patients with HF.

Objective To evaluate the complications, mortality, and medical expenditures after nonurological surgical procedures in patients with chronic kidney disease (CKD). Methods Using claims data of Taiwan's National Health Insurance, we conducted a matched cohort study of 35,643 patients with CKD who underwent nonurological surgeries in 2008-2013. By using a propensity-score matching procedure, 35,643 non-CKD patients were selected for comparison. Logistic regression was used to calculate the odds ratios (ORs) and the 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with CKD. Results The results showed that patients with CKD had higher risks of postoperative septicemia (OR: 1.78, 95% CI: 1.68-1.89), pneumonia (OR: 1.60, 95% CI: 1.48-1.73), stroke (OR: 1.34, 95% CI: 1.24-1.44), and in-hospital mortality (OR: 2.17, 95% CI: 1.90-2.47) compared with non-CKD patients. Longer hospital stays and higher medical expenditures after nonurological surgical procedures were noted in CKD patients. The association between CKD and postoperative adverse events was significant in both sexes, all of the age groups, and the other subgroups. Histories of myocardial infarction, epilepsy, and ages greater than 70 years were factors that were significantly associated with postoperative adverse events. Conclusion Compared with non-CKD patients, surgical patients with CKD exhibited more adverse events, with risks of in-hospital mortality that were approximately 2-fold higher after nonurinary surgery. These findings suggest an urgent need to revise the protocols for postoperative care in this population.

Background: The association between acupuncture treatment and post-stroke urinary tract infection (UTI) remains incompletely understood. Objective: To compare the long-term risks of UTI among stroke patients treated with or without acupuncture treatment. Methods: This retrospective cohort study was based on data from the National Health Insurance Research Database in Taiwan that included hospitalized stroke patients. We identified 19,286 patients aged 30 years and older who were hospitalized for newly diagnosed stroke between 1 January 2000 and 31 December 2004. Considering immortal time bias, we compared the incidence of UTI during the follow-up period until the end of 2009 in patients with stroke who did and did not receive acupuncture. The adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) of UTI associated with acupuncture were calculated using multivariate Cox proportional hazard regression analysis. Results: Stroke patients who received acupuncture treatment experienced a lower incidence of UTI than those who were not treated with acupuncture (95.4 vs 110.0 per 1000 person-years) with an HR of 0.76 (95% CI: 0.73–0.80). The association between acupuncture treatment and UTI was significant for both sexes and for patients older than 40 years of age, particularly for patients who had no history of medical conditions. Conclusions: In this nationwide retrospective cohort study, we raised the possibility that acupuncture treatment may be associated with a reduced risk of UTI among stroke patients. However, the protective effect associated with acupuncture treatment requires further validation using randomized clinical trials.

The effects of influenza vaccination (IV) on stroke outcomes are unclear. The purpose of this study is to evaluate the outcomes after stroke in elderly individuals who have received an IV.We used Taiwan's National Health Insurance Research Database 2000-2009 claims data to conduct a nested stroke cohort study including 148,909 hospitalized stroke patients aged 66 years and older. Using a matching procedure by propensity score, we selected 25,248 stroke patients with IV and 25,248 stroke patients without IV for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% CIs of post-stroke complications and in-hospital mortality associated with IV.Stroke patients with IV had significantly lower risks of post-stroke pneumonia (OR = 0.79; 95% CI, 0.74-0.83), septicemia (OR = 0.78; 95% CI, 0.70-0.86), urinary tract infection (OR = 0.87; 95% CI, 0.83-0.92), and 30-day in-hospital mortality (OR = 0.60; 95% CI, 0.54-0.67) compared with non-IV stroke patients. Vaccinated stroke patients also had shorter hospital stays (p 0.0001) and less medical expenditures (p 0.0001) during stroke admission than the control group. Lower rates of post-stroke adverse events in patients with IV were noted in both sexes of all age groups with various types of stroke.Stroke patients with IV showed fewer complications and lower mortality compared with non-IV patients. These findings suggest the urgent need to promote IV for this susceptible population of stroke patients.

Although SiGe super-lattice (SL) buried channel was proposed to enhance carrier mobility in MOSFETs, its application on FinFETs is not reported yet. The electrical characteristics of nFinFETs with SiGe and SiGe SL-like buried channels were studied in this letter for the first time. The results show that the electron mobility of nFinFETs with SiGe buried channel is enhanced by an SL-like structure. A higher ON-state current and ON-state/ OFF-state current ratio are also achieved. However, the sub-threshold swing and reliability characteristics need improvement due to slight degradation of interface quality.

Background and aims The risk of stroke in epileptic patients and the impact of epilepsy history on stroke patients’ outcome have not been studied completely. Our purpose is to evaluate whether patients with epilepsy have increased risk of stroke or post-stroke mortality. Methods In Study I, we conducted a retrospective cohort study of 6746 patients with newly diagnosed epilepsy and 26,984 persons without epilepsy between 2000 and 2008, in the database of National Health Insurance in Taiwan. The incidences and risks of stroke during the follow-up period were compared between cohorts until the end of 2013. In Study II, we conducted a nested cohort study of 484,990 hospitalized patients with newly diagnosed stroke between 2000 and 2009. We compared the short-term mortality and complications during stroke admission between stroke patients with previous epilepsy and those without epilepsy. Results The epileptic cohort had an increased stroke risk (hazard ratio [HR] 2.24, 95% CI 2.02 to 2.49). The relationship between epilepsy and stroke risk remains significant in every age group and both sexes. Among hospitalized stroke patients, history of epilepsy was associated with complications, including pneumonia (odds ratio [OR] 1.08, 95% CI 1.00 to 1.18), urinary tract infection (OR 1.16, 95% CI 1.08 to 1.26), and longer stay (p Conclusions Epileptic patients face increased stroke risk and adverse outcomes of stroke admission. It is necessary to develop a prevention strategy for stroke in epileptic patients.

Shu-Wen Weng,1,* Ta-Liang Chen,2–4 Chun-Chieh Yeh,5,6 Hsin-Long Lane,7 Chien-Chang Liao,2–4,8,* Chun-Chuan Shih7,9 1Department of Chinese Medicine, Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan; 2Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; 3Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital, Taipei, Taiwan; 4Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 5Department of Surgery, China Medical University Hospital, Taichung, Taiwan; 6Department of Surgery, University of Illinois, Chicago, IL, USA; 7School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan; 8School of Chinese Medicine, China Medical University, Taichung, Taiwan; 9Program for the Clinical Drug Discovery from Botanical Herbs, Taipei Medical University, Taipei, Taiwan *These authors contributed equally to this work Objective: To compare the long-term risk of epilepsy in stroke patients who use Bu Yang Huan Wu Tang (BYHWT) and those who do not. Methods: In the Taiwanese national insurance claims data, we identified newly diagnosed stroke patients receiving inpatient care in the years 2000–2004. Using propensity score-matched pairs to balance the baseline characteristics, we selected eligible stroke patients who did (n=8,971) and did not (n=8,971) receive BYHWT. These two groups were followed up until the end of 2009 to track the occurrence of epilepsy. We used Cox proportional hazard models to calculate the adjusted HRs and 95% CIs for post-stroke epilepsy during the follow-up period according to BYHWT use. Results: Compared with the control group, stroke patients with BYHWT had a reduced risk of epilepsy during the 5–9 years of the follow-up period (HR 0.69, 95% CI 0.61–0.77). The association between BYHWT and reduced post-stroke epilepsy was significant in various subgroups of stroke patients. There was a dose-dependent decrease in the frequency of epilepsy with increasing quantities of BYHWT use from 1 package (HR 0.77, 95% CI 0.66–0.90) to ≥6 packages (HR 0.52, 95% CI 0.42–0.65). Conclusion: Stroke patients who received BYHWT therapy had a reduced long-term risk of epilepsy, and the beneficial effect could be observed in various subgroups. However, future clinical trials will be necessary to corroborate the present findings and identify the biochemical mechanism involved. Keywords: stroke, epilepsy, Bu Yang Huan Wu Tang, long-term risk

The SiO2 tunneling and Si3N4/HfO2 trapping layers formed with low temperature (LT) processes on operation characteristics of gate-all-around (GAA) junctionless (JL) charge trapping (CT) flash memory devices were studied in this work. The devices with an Ω-nanowire configuration were also compared. The faster operation speeds and larger memory windows are achieved by a GAA configuration. However, the worse retention characteristics for GAA devices may be caused by the SiO2 and Si3N4 layer with worse step coverage, which are formed by the LT processes. The coverage issues of dielectrics deposited with LT processes in GAA JL CT flash devices need solutions for 3D memory applications.

Langerhans cell histiocytosis (LCH) is a rare histiocytic disorder resulting from dysregulated clonal proliferation of Langerhans cells. Reticulohistiocytosis (RH) is another rare histiocytosis caused by the proliferation of histiocytes other than Langerhans cells. Co-existence of LCH and RH in different organs and in the same skin area has not been reported. We present the case of a 20-year-old woman who initially had co-existing bone LCH and cutaneous RH. After 1 year of chemotherapy with cytarabine, bone LCH significantly improved but cutaneous LCH developed in the same area where cutaneous RH was, resulting in hybrid LCH and RH of the skin. This unique history provides some evidence to support the theory that LCH and RH originate from the same stem cells and subsequently develop into hybrid LCH and RH of the skin in a cytokine environment influenced by chemotherapy. Repeat skin biopsies may be considered for adjusting treatment regimens in LCH patients whenever pre-existing skin lesions progress.

Background The relationship between chronic obstructive pulmonary disease (COPD) and perioperative outcomes remains incompletely understood. Our purpose is to evaluate the features of postoperative adverse outcomes for geriatric surgical patients with COPD receiving non-thoracic surgeries. Aim To evaluate the potential impact of COPD history on the outcome after general surgery. Design A retrospective cohort study with matching procedure by propensity score. Methods We conducted a nationwide study of 15 359 COPD patients aged 65 years and older who received major non-thoracic surgeries in 2008-2013 from the Taiwan National Health Insurance Research Database. Comprehensive matching procedure with propensity score were used to select 15 359 surgical patients without COPD for comparison. Major postoperative complications and 30-day in-hospital mortality were evaluated among patients with and without COPD by calculating adjusted odds ratios (ORs) and 95% CIs. Results Patients with COPD had significantly increased risk for postoperative complications, including pneumonia (OR = 90.3; 95% CI: 60.3-135), septicemia (OR = 3.11; 95% CI: 2.82-3.43), acute renal failure (OR = 2.53; 95% CI: 2.11-3.02), pulmonary embolism (OR = 2.74; 95% CI: 1.52-4.96), and 30-day postoperative mortality (adjusted OR = 2.09; 95% CI: 1.76-2.50), compared with surgical patients without COPD. Longer length of hospital stay and higher medical expenditures were also noted in COPD patients than those without COPD. Conclusions Geriatric patients with COPD showed significantly higher postoperative adverse outcome rates with risk of 30-day mortality nearly twofold when compared with patients without COPD. Our findings remind surgical care team pay more attention to this specific population.

Background. The optimal dose and concentration of analgesic efficacy of ropivacaine (RPV) and bupivacaine (BPV) for postoperative pain relief in paediatric abdominal surgery patients is still unclear. Therefore, this meta-analysis compared the efficacy of these analgesics, their administered modes (ultrasound-guided RSB versus LAI) for postoperative pain relief, and side effects. Methods. Three databases, PubMed, Embase, and Cochrane Database of Systematic Reviews, were exhaustively searched with predefined keywords. Eight randomized clinical trials and retrospective studies were selected. Analgesic effect, postoperative pain score, level of side effect, applied dose, and concentration of drug were analysed. Results. Drug dose ranged from 0.5–2.5 mL/kg of 0.2 to 0.5% concentrations. Male participant for RSB and LAI treatment groups varied from 40–62% and 25–83%, respectively. Mean age of RSB and LAI groups ranged from 3.8–11.65 years and 4.3–11.27 years, respectively. Our meta-analysis revealed that RSB could reduce total opioid use postoperatively (WMD = −0.02, 95% CI: −0.02, −0.02), with I2 value of 15%. We found that the RPV (0.25%, 2.5 ml/kg) was optimal in suppressing the pain. Its lower concentration (0.2%) was ineffective, whereas higher one (0.375%) seems to increase risk of systemic toxicity. Similarly, BPV (0.25%, 2.5 mg/kg) efficaciously reduced the pain score, while its lower concentration was ineffective. The combined postoperative pain score in the RPV-treated group was found to be significantly reduced ( p < 0.01 ) with I2 value of 85% indicating high heterogeneity. Conclusion. Both RPV and BPV were significantly effective in reducing postoperative pain score. It appears that RSB could be a preferred choice to deliver analgesia, due to reduced opiate dose requirement and improved clinical safety without significant postoperative adverse events.

Cancer is one of the common diseases. Quantitative biomarkers extracted from standard-of-care computed tomography (CT) scan can create a robust clinical decision tool for the diagnosis of hepatocellular carcinoma (HCC). According to the current clinical methods, the situation usually accounts for high expenditure of time and resources. To improve the current clinical diagnosis and therapeutic procedure, this paper proposes a deep learning-based approach, called Successive Encoder-Decoder (SED), to assist in the automatic interpretation of liver lesion/tumor segmentation through CT images. The SED framework consists of two different encoder-decoder networks connected in series. The first network aims to remove unwanted voxels and organs and to extract liver locations from CT images. The second network uses the results of the first network to further segment the lesions. For practical purpose, the predicted lesions on individual CTs were extracted and reconstructed on 3D images. The experiments conducted on 4300 CT images and LiTS dataset demonstrate that the liver segmentation and the tumor prediction achieved 0.92 and 0.75 in Dice score, respectively, by as-proposed SED method.

BackgroundAcute kidney injury (AKI) following wasp stings is a serious and common health hazard, however the early prediction remains challenging. The study aimed to establish a model to predict AKI following wasp stings and validate it.MethodsIn the multicenter prospective cohort study, 508 patients with wasp stings from Jul 2015 to Dec 2019 were randomly divided into the training set (n = 381) and validation set (n = 127) for internal and external validation. A model that based on the multivariable logistic regression analysis was utilized to predict the probability of AKI following wasp stings by a predictive formula and a nomogram. The performances of the model were assessed by using the area under the curve (AUC) and accuracy (ACC) of the receiver operating characteristic curve. The calibration curves were utilized for estimating the consistency between the actual observed outcome and the nomogram predicted AKI probability. Decision curve analysis (DCA) demonstrated the net benefit associated with the use of the nomogram-derived probability for the prediction of AKI following wasp stings.Results Number of stings, hemoglobin (HB) < 110 g/dl, total bilirubin (TBI) > 34 mg/dl, alanine transaminase (ALT) > 40 U/L and activated partial thromboplastin time (APTT) > 47 s were demonstrated as the independent risk factors for AKI following wasp stings (all P value < 0.05) and were incorporated into the model. The performances of the model were validated (AUC = 0.912, ACC = 0.869 and AUC = 0.936, ACC = 0.898 in the training set and validation set respectively). The predictive formula and nomogram of the model could be utilized to predict the AKI following wasp stings, which having sufficient accuracies, good predictive capabilities and good net benefits.ConclusionIn conclusion, we proved that number of stings, HB < 110 g/dl, TBI > 34 mg/dl, ALT > 40 U/L and APTT > 47 s were independence risk factors for AKI following wasp stings. The predictive formula and the individual nomogram of the model might serve as promising predictive tools to assess the probability of the AKI following wasp stings.

IntroductionLimited information was available regarding the perioperative outcomes in patients with and without use of metformin. This study aims to evaluate the complications and mortality after major surgery in patients with diabetes who use metformin.Research design and methodsUsing a real-world database of Taiwan’s National Health Insurance from 2008 to 2013, we conducted a matched cohort study of 91 356 patients with diabetes aged >20 years who used metformin and later underwent major surgery. Using a propensity score-matching technique adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 91 356 controls who underwent surgery but did not use metformin were selected. Logistic regression was used to calculate the ORs with 95% CIs for postoperative complications and 30-day mortality associated with metformin use.ResultsPatients who used metformin had a lower risk of postoperative septicemia (OR 0.94, 95% CI 0.90 to 0.98), acute renal failure (OR 0.87, 95% CI 0.79 to 0.96), and 30-day mortality (OR 0.79, 95% CI 0.71 to 0.88) compared with patients who did not use metformin, in both sexes and in every age group. Metformin users who underwent surgery also had a decreased risk of postoperative intensive care unit admission (OR 0.60, 95% CI 0.59 to 0.62) and lower medical expenditures (pConclusionsAmong patients with diabetes, those who used metformin and underwent major surgery had a lower risk of complications and mortality compared with non-users. Further randomized clinical trials are needed to show direct evidence of how metformin improves perioperative outcomes.

This paper aims to provide a thorough study on the effectiveness of the transformation-based ensemble defence for image classification and its reasons. It has been empirically shown that they can enhance the robustness against evasion attacks, while there is little analysis on the reasons. In particular, it is not clear whether the robustness improvement is a result of transformation or ensemble. In this paper, we design two adaptive attacks to better evaluate the transformation-based ensemble defence. We conduct experiments to show that 1) the transferability of adversarial examples exists among the models trained on data records after different reversible transformations; 2) the robustness gained through transformation-based ensemble is limited; 3) this limited robustness is mainly from the irreversible transformations rather than the ensemble of a number of models; and 4) blindly increasing the number of sub-models in a transformation-based ensemble does not bring extra robustness gain., The 27th ACM Conference on Computer and Communications Security (CCS) Workshop, AISec 2020

AIM To evaluate outcomes after major surgery in children and adolescents with intellectual disability. METHOD We used 2004 to 2013 claims data from Taiwan's National Health Insurance programme to conduct a nested cohort study, which included 220 292 surgical patients aged 6 to 17 years. A propensity score matching procedure was used to select 2173 children with intellectual disability and 21 730 children without intellectual disability for comparison. Logistic regression was used to calculate the adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of the postoperative complications and 30-day mortality associated with intellectual disability. RESULTS Children with intellectual disability had a higher risk of postoperative pneumonia (OR 2.16, 95% CI 1.48-3.15; p

The study protocol was reviewed and approved by National Taiwan University Hospital (201605118RINB); National Taiwan University Hospital, Hsin-Chu branch (103-082-E); Chang Gung Memorial Hospital, Linkou and Taipei branches (104-7463B, 104-7317B), and China Medical University Hospital (CMUH107-REC2-160). This work has not been published previously and is not under consideration for publication elsewhere, its publication has been approved by all authors, and if accepted, it will not be published elsewhere, including electronically in the same form, in English or in any other language, without the written consent of the copyright-holder.

Background: Epidermal grafting with an automatic harvesting system has been reported as a simple and efficacious procedure for stable vitiligo. However, no prospective cohort study has quantitatively evaluated the color matching and extent of repigmentation in the head and neck area by this method. Objective: To evaluate the color matching and extent of repigmentation after pixel array epidermal grafting by image analysis software and physicians’ naked eye. Methods: Ten Asian patients with head and neck vitiligo lesions stable for at least 6 months were treated with pixel array epidermal grafting with an automatic harvesting system and post-grafting phototherapy. The patients were evaluated 1, 3, and 6 months post grafting for the percentage of repigmentation by blinded physicians’ assessment and image analysis software. The color matching index of repigmentation was evaluated by measuring the melanin index in the grafted area and the juxta non-vitiliginous area. Results: The average blister harvest time was 46.3 ± 9.7 min. The area percentile of repigmentation by the image analysis software were 32.3 ± 26.8, 64.6 ± 29.4, and 76.5 ± 25.9 at 1, 3, and 6 months post grafting, respectively. There were no significant differences between the physicians’ assessments and the results from the image analysis software. The change in the area percentile of repigmentation between 3 and 6 months post grafting was only statistically significant using image analysis software. The grafted area achieved a color match of 83.1 ± 13.4% that of the juxta non-vitiliginous area 6 months after grafting. Three patients had repigmentation of leukotrichia. Conclusion: By quantitative measurement, uniform pixel array micrografts provide a very good extent of repigmentation and color match in the head and neck area. Image analysis software revealed a steady increase in repigmentation after POM3 until POM6, which was not detected by subjective assessment.

Background and aims Limited information is available regarding the association between statins and pressure ulcers. The purpose of this study is to evaluate the beneficial effects of statins on pressure ulcers in stroke patients. Methods Using the claims data of Taiwan's National Health Insurance, we conducted a retrospective cohort study and identified new-onset stroke patients in 2000–2004. The propensity-score matching procedure was used to select eligible stroke patients with (n = 49,919) and without (n = 49,919) the use of statins. These two groups were followed until the end of 2009 to track the occurrence of pressure ulcers. Multivariate Cox proportional hazard models were conducted to calculate adjusted hazard rations (HRs) and 95% confidence intervals (CIs) of pressure ulcer associated with the use of statins. Results Stroke patients who used statins had a reduced risk of pressure ulcers during the follow-up period (HR 0.74, 95% CI 0.71–0.78). The association between statin use and a reduced risk of poststroke pressure ulcers was significant in men (HR 0.73, 95% CI 0.68–0.78), women (HR 0.75, 95% CI 0.71–0.80), and people aged more than 50 years. Use of lovastatin, pravastatin, rosuvastatin, atrovastatin, fluvastatin, and simvastatin was associated with reduced poststroke pressure ulcers. There was a dose-dependent decrease in the frequency of pressure ulcers with increasing quantities of statins used, from 1 prescription to ≥3 prescriptions. Conclusion We raised the possibility that use of statins was associated with reduced risk of pressure ulcers in stroke patients. However, the potential beneficial effect associated with statins requires further validation using randomized clinical trials.

The utilization of traditional Chinese medicine is a common therapeutic approach for stroke patients in Chinese population, but little is known about the effect of Bu Yang Huan Wu Tang (BYHWT) on post-stroke diabetes.We aimed to evaluate the risk of diabetes in stroke patients who used BYHWT.A retrospective cohort study based on a real-world database was conducted.Newly diagnosed stroke patients receiving inpatient care from 2000 to 2004 were identified using a large-scale insurance database in Taiwan. Propensity score matching was used to select eligible stroke patients who did (n = 9849) and did not (n = 9849) receive BYHWT. These two groups were followed up until the end of 2009 to track incident diabetes. Cox proportional hazard models were used to calculate the adjusted hazard rations (HRs) and 95% confidence intervals (CIs) for post-stroke diabetes associated with BYHWT during the follow-up period.Stroke patients who used BYHWT had a reduced incidence of diabetes (14.1% vs. 19.0%, p0.0001) and reduced risk of diabetes (HR 0.77; 95% CI 0.72 to 0.83) compared with the control group. The association between BYHWT and reduced risk of post-stroke diabetes was significant across sexe, age group, and stroke subtype. Additionally, the use of BYHWT was associated with a reduced risk of post-stroke diabetes even after excluding the initial three months of diabetes cases in the sensitivity analysis.Stroke patients who received BYHWT therapy had a reduced risk of diabetes, and a positive effect was observed in various subgroups. However, future clinical trials will be necessary to validate the present findings and identify the biochemical mechanism involved.

OBJECTIVES In the Asian population, patterns and risk factors for de novo malignancies after solid-organ transplant are not well understood. MATERIALS AND METHODS Insurance claims from Taiwan's National Health Institute Research Database from 1997 to 2011 revealed 687 deceased-donor heart transplant recipients, 5038 kidney transplant recipients (50% living related-donor, 50% deceased-donor transplants), and 2127 liver transplant recipients (mainly living related-donor transplants, 30% deceased-donor transplants). During the follow-up period, rates of malignancy incidence were calculated with standardization based on national age, sex, and year-specific incidence. We used multivariate regression analyses to determine risk factors of posttransplant de novo malignancies. RESULTS Compared with the general population, several de novo cancers were more common posttransplant (P < .05): lung cancer (2.6-fold), non-melanoma skin cancer (5.8-fold), and non-Hodgkin lymphoma (5.4-fold) in heart recipients; transitional cell carcinoma (31.4-fold), renal cell carcinoma (37.3-fold), and non-Hodgkin lymphoma (3.6-fold) in kidney recipients; and gastric cancer (3.0-fold) and lymphatic-hematopoietic malignancy (4.5-fold) in liver recipients. Independent risk factors for posttransplant malignancy in kidney transplant recipients were increased age, female, hepatitis B virus, and mycophenolate use (adjusted hazard ratio 1.5; 95% confidence interval, 1.2-1.8; P < .001). In liver transplant recipients, old age was an independent risk factor. Kidney transplant recipients without diabetes or hypertension had higher risk of transitional cell carcinoma (adjusted hazard ratio 3.0; 95% confidence interval, 2.1-4.4; P < .001) and renal cell carcinoma (adjusted hazard ratio 1.9; 95% confidence interval, 1.1-3.3; P < .05). CONCLUSIONS Regional endemic epidemiologic factors play significant roles in the development of de novo cancers, particularly in kidney transplant recipients due to causes of renal failure other than diabetes and hypertension. Each regional organ transplant program should tailor and establish its surveillance protocol based on epidemiologic data. However, the type and intensity of surveillance require further and long-term investigations in this patient cohort.

Objective: The study intended to use narrative medicine study for interdisciplinary collaboration to let medical and healthcare students have a chance to interact with one another and listen to patients&rsquo, stories to enhance students&rsquo, reflective thinking, communication, empathy, and narrative medicine writing skills. Methods: A fifteen-week quasi-experimental design was used to examine the learning outcomes of the intervention. Two groups of students were randomly assigned as the experimental group (33 students) and the control group (32 students). Before and after the intervention, both groups had to fill in a Reflective Thinking Scale for Healthcare Students and Providers (RTS-HSP), Patient&ndash, Healthcare Provider Communication Scale (P-HCS), Empathy Scale in Patient Care (ES-PC), and Analytic Narrative Medicine Writing Scoring Rubric (ANMWSR). Results: The findings showed that on the reflective thinking scale, experimental group students had significantly higher reflective thinking posttest scores in &ldquo, reflective skepticism,&rdquo, &ldquo, empathetic reflection,&rdquo, and &ldquo, critical open-mindedness,&rdquo, but not in &ldquo, self-examination.&rdquo, As for patient&ndash, healthcare provider communication, they had significantly higher posttest scores in all &ldquo, perception of trust and receptivity,&rdquo, patient-centered information giving,&rdquo, rapport building,&rdquo, facilitation of patient involvement&rdquo, factors. As for empathy, they had significant higher posttest scores in &ldquo, behavioral empathy&rdquo, affective empathy,&rdquo, intelligent empathy.&rdquo, In narrative medical writing skills, they had significant higher posttest scores in the &ldquo, attention &rarr, representation &rarr, affiliation,&rdquo, depth of reflection,&rdquo, focus and context structure,&rdquo, ideas and elaboration&rdquo, sections, but not in the &ldquo, language and conventions&rdquo, section. Conclusion: The findings suggest that narrative medicine is worth recommending for interdisciplinary collaboration for healthcare education.

Background and aims Because the sex difference in outcomes of fracture was incompletely understood, we evaluated the post-fracture complications and mortality of female and male patients. Methods We conducted a nationwide study of 498,586 fracture patients who received inpatient care using Taiwan’s National Health Insurance Research Database 2008–2013 claims data. Female and male fracture patients were selected for comparison by using a propensity-score matching procedure. Age, low income, types of fracture, fracture with surgery, several medical conditions, number of hospitalization and emergency visits were considered as potential confounding factors. Multivariate logistic regressions were used to calculate the adjusted odds ratios (OR), the 95% CI of post-fracture complications and 30-day in-hospital mortality differences between women and men. Results Male patients had a higher risk of post-fracture pneumonia (OR 1.96, 95% CI 1.83–2.11), acute renal failure (OR 1.85, 95% CI 1.60–2.15), deep wound infection (OR 1.63, 95% CI 1.51–1.77), stroke (OR 1.58, 95% CI 1.49–1.67), septicemia (OR 1.51, 95% CI 1.42–1.61), acute myocardial infarction (OR 1.38, 95% CI 1.09–1.75) and 30-day in-hospital mortality (OR 1.69, 95% CI 1.48–1.93) compared with female patients. However, a lower risk of post-fracture urinary tract infection (OR 0.69, 95% CI 0.65–0.72) was found in men than in women. Male patients also had longer hospital stays and higher medical expenditures due to fracture admission than did the female patients. Higher rates of post-fracture adverse events in male patients were noted in all age groups and all types of fractures. Conclusion We raised the possibility that male patients showed more complications and higher mortality rates after fracture admission compared with female patients, with the exception of urinary tract infections.

[This corrects the article DOI: 10.1371/journal.pone.0231374.].

Background The impact of liver cirrhosis on the outcomes of admission to intensive care unit (ICU) is not completely understood. Our purpose is to identify risk factors for mortality in ICU patients with liver cirrhosis. Methods Using reimbursement claims from Taiwan’s National Health Insurance Research Database from in 2006–2012, 1,250,300 patients were identified as having ICU stays of more than 1 day, and 37,197 of these had liver cirrhosis. With propensity score-matching for socioeconomic status, pre-existing medical conditions, and cirrhosis-related morbidities, 37,197 ICU patients without liver cirrhosis were selected for comparison. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) of cirrhosis associated with 30-day, ICU, and one-year mortality were calculated. Results Compared with control, cirrhotic patients had higher 30-day mortality (aOR 1.60, 95% CI 1.53 to 1.68), particularly those with jaundice (aOR 2.23, 95% CI 2.03 to 2.45), ascites (aOR 2.32, 95% CI 2.19 to 2.46) or hepatic coma (aOR 2.21, 95% CI 2.07 to 2.36). Among ICU patients, liver cirrhosis was also associated with ICU mortality (aOR 144, 95% CI 1.38 to 1.51) and one-year mortality (aOR 1.40, 95% CI 1.35 to 1.46). Associations between cirrhosis of liver and increased 30-day mortality were significant in both sexes and every age group. Conclusions Liver cirrhosis was associated with 30-day mortality in ICU patients. Jaundice, ascites, hepatic coma, more than 4 admissions due to cirrhosis, and more than 30 days of hospital stay due to cirrhosis were exacerbated factors in cirrhotic ICU patients.

Although previous studies have shown that health checks may improve several risk factors for chronic diseases, the effect of preoperative health checks on postoperative recovery in surgical patients remains unknown. We aimed to investigate the association between preoperative use of mammography and the risk of perioperative complications. We conducted a matched cohort study of 152,411 patients aged &ge, 47 years who received mammography screening and later underwent major surgery from 2008 to 2013. Using a propensity score matching procedure adjusted for sociodemographic characteristics, medical condition, surgery type, and anesthesia type, 152,411 controls who underwent surgery but were not screened were selected. We collected patients&rsquo, characteristics and medical conditions from claims data of Taiwan&rsquo, s National Health Insurance. Logistic regressions were used to calculate odds ratios (ORs) with 95% confidence intervals (CIs) for postoperative complications and in-hospital mortality associated with mammography screening. Patients receiving mammography prior to major surgery had significantly lower risks of perioperative complications, including pneumonia, septicemia, acute renal failure, stroke, urinary tract infection, deep wound infection, acute myocardial infarction, intensive care unit stay, and 30 day in-hospital mortality (OR 0.45, 95% CI 0.38&ndash, 0.53). The association was consistent across each stratum of age, number of hospitalizations, emergency visits, and comorbidities. In conclusion, preoperative use of mammography was strongly associated with fewer perioperative complications and less in-hospital mortality after major surgeries. The evidence provided by this study justifies the implementation of preoperative health checks in clinical practice.