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BACKGROUND Studies investigating the modulators of mortality benefit conferred by peri-angioplasty glycoprotein IIb/IIIa inhibitors in ST-elevation myocardial infarction (STEMI) are still lacking.Methods and Results:A prospective database (n=1,025) of consecutive cases undergoing primary percutaneous coronary intervention for STEMI was retrospectively analyzed. For patients in Killip class I, II or III, IV, the multivariate-adjusted hazard ratios of 30-day all-cause mortality associated with adjunctive tirofiban were 3.873 (95% CI 0.504-29.745; P=0.193), 0.550 (95% CI 0.188-1.609; P=0.275), and 0.264 (95% CI 0.099-0.704; P=0.008), respectively. The P value for a linear trend was 0.032. Patients who had a body mass index (BMI) within 22.9-25.0 kg/m2had a significant benefit from tirofiban (adjusted HR 0.344; 95% CI 0.145-0.814; P=0.015) compared to other BMI groups. The P value for a quadratic trend was 0.012. A novel Killip-BMI score (KBS = 2.5 × Killip category - | BMI - 24 |) was calculated to select the beneficial population. A KBS ≥2 was associated with significant mortality benefit, whereas a KBS

Objective This study aimed to determine whether neonatal hyperbilirubinemia is associated with a risk of autism spectrum disorder (ASD) using a large population-based cohort.Study Design This retrospective cohort study used data from the children's database (2000–2012) of the National Health Insurance Research Database (1996–2012) in Taiwan. We included neonates who were born between 2000 and 2004 and aged Results A total of 67,017 neonates were included. The neonates with hyperbilirubinemia were associated with 1.28-fold increased risk of ASD (HR = 1.28, 95% confidence interval [CI]: 1.05–1.57) compared with those without hyperbilirubinemia. In subanalysis to determine how phototherapy and exchange transfusion treatment for hyperbilirubinemia were associated with ASD showed no association between treatment and ASD, suggesting the lack of a dose-response effect of hyperbilirubinemia on the risk of ASD. Boys had a nearly six-fold higher risk of ASD than girls (HR = 5.89, 95% CI: 4.41–7.86). Additionally, neonates born with preterm birth and low birth weight were associated with a risk of ASD (HR = 1.46, 95% CI: 1.00–2.13).Conclusion We did not observe a dose-response effect of hyperbilirubinemia on ASD, but neonatal hyperbilirubinemia may be an independent risk factor for ASD if there is a residual confounding by other perinatal complications. Therefore, this study does not support a causal link between neonatal hyperbilirubinemia exposure and the risk of ASD.

ASML’s extreme ultraviolet (EUV) lithography machines have found widescale adoption in 5 and 3 nm logic nodes and leading-edge DRAM nodes. The tool operates by generating 13.5nm light from a tin plasma source, which is then directed through multiple optics and reflected off the EUV photomask and down to the wafer surface. In the EUV tool, tin and other contaminants are generated, and because no protective pellicle is used in EUV photo-lithography, any contaminate on the EUV photomask will become a defect on the wafer. EUV photomasks therefore need frequent cleaning compared to a traditional photolithography process, which would employ a protective pellicle. Herein, we report on the development of an EUV photomask cleaning solution that was designed to remove Sn, SnO2, and other contaminates from a mask surface without damaging the mask’s tantalum absorber and ruthenium capping layers. Our mask cleaning solution extends photomask lifetime and can improve operational performance and quality control.

We report a case of canine adenocarcinoma with multi-organ metastasis in which colonies of adenocarcinoma cells grew upon aerobic bacterial culture of pleural effusion. Stained agar colonies were highly similar to rare suspicious cells seen on cytologic examination of the pleural effusion, as well as rare cells seen on cytologic examination of pancreatic and gastric wall fine-needle aspirates. Cells from colonies growing on agar media were mildly immunoreactive for cytokeratin. Histologic examination of tissues obtained at autopsy revealed pancreatic adenocarcinoma with vascular invasion and nodal, gastric, pulmonary, and pleural metastasis.

Background: This prospective study was designed to investigate whether myocardial triglyceride (TG) content from proton magnetic resonance spectroscopy (MRS) and left ventricular (LV) function parameters from cardiovascular magnetic resonance imaging (CMR) can serve as imaging biomarkers in predicting future major cardiovascular adverse events (MACE) and readmission in patients who had been hospitalized for acute heart failure (HF). Methods: Patients who were discharged after hospitalization for acute HF were prospectively enrolled. On a 3.0 T MR scanner, myocardial TG contents were measured using MRS, and LV parameters (function and mass) were evaluated using cine. The occurrence of MACE and the HF-related readmission served as the endpoints. Independent predictors were identified using univariate and multivariable Cox proportional hazard regression analyses. Results: A total of 133 patients (mean age, 52.4 years) were enrolled. The mean duration of follow-up in surviving patients was 775 days. Baseline LV functional parameters&mdash, including ejection fraction, LV end-diastolic volume, LV end-diastolic volume index (LVEDVI), and LV end-systolic volume (p &lt, 0.0001 for all), and myocardial mass (p = 0.010)&mdash, were significantly associated with MACE. Multivariable analysis revealed that LVEDVI was the independent predictor for MACE, while myocardial mass was the independent predictor for 3- and 12-month readmission. Myocardial TG content (lipid resonances &delta, 1.6 ppm) was significantly associated with readmission in patients with ischemic heart disease. Conclusions: LVEDVI and myocardial mass are potential imaging biomarkers that independently predict MACE and readmission, respectively, in patients discharged after hospitalization for acute HF. Myocardial TG predicts readmission in patients with a history of ischemic heart disease.

The mortality of patients with ST-segment elevation myocardial infarction (STEMI) and refractory cardiogenic shock (RCS) is high. Extracorporeal membrane oxygenation (ECMO) before percutaneous coronary intervention (PCI) has shown some favorable results, but this may delay door-to-balloon (D2B) time. Whether the benefit surpasses the risk of longer D2B time remains controversial.From January 2005 to December 2014, there were 46 patients with STEMI RCS who received ECMO and PCI. Comparison was made between patients whose ECMO were setup before (n = 12) and after (n = 34) the coronary angiography.There were no significant differences on the baseline characteristics. The ECMO before PCI group had significantly better six-month survival (58.3% vs. 14.7%, p = 0.006), and the benefit persisted to the end of two-year follow-up (41.7% vs. 11.8%, p = 0.045). The rates of neurological, vascular, or bleeding complications were not different between the groups. ECMO before PCI was associated with a nonsignificant increase of median D2B time (30 min) and decrease of patients achieving D2B time 90 min (9.1% vs. 32.0%). After adjusting for GRACE score, gender, D2B time, complete revascularization, ECMO before PCI and shock index 0.8 before PCI were significantly associated with six-month survival.In STEMI RCS patients, ECMO before PCI improves both short- and long-term outcomes, even if it nonsignificantly increases the D2B time. Our data suggests that ECMO before PCI is a reasonable and safe strategy in this particularly-ill population.

Background This study aims to observe the effectiveness and safety of idarucizumab in dabigatran-treated patients with severe bleeding or requiring surgery in Taiwan. Methods and Results In Taiwan, 11 dabigatran-treated patients developed severe bleeding, fracture that needed surgery, and acute ischemic stroke requiring thrombolysis. These patients were treated with idarucizumab and obtained adequate hemostasis. Our experiences reconfirmed the efficacy and safety of idarucizumab in Asian patients. Conclusions Idarucizumab improves safety in dabigatran-treated patients. Continued education about the availability and appropriate use of idarucizumab is necessary in Asia.

OBJECTIVE. The objective of our study was to identify sonographic biomarkers predicting or indicating eventual malignant transformation of pathologically confirmed cirrhotic nodules. MATERIALS AND METHODS. Thirty-nine consecutive patients with 44 pathologically confirmed cirrhotic nodules (mean size, 17.5 ± 8.5 [SD] mm) who initially underwent contrast-enhanced ultrasound examination at detection and then underwent follow-up conventional ultrasound every 3-4 months thereafter were retrospectively included. Malignant transformation was identified on the basis of noninvasive diagnostic criteria for hepatocellular carcinoma or rebiopsy. Malignant transformation biomarkers were identified from clinical and sonographic variables and the performance thereof was evaluated using ROC curves. RESULTS. Fourteen nodules (31.8%) had eventual malignant transformation after a median follow-up time of 26.7 months. At initial detection, nodule size (hazard ratio [HR], 1.07; p = 0.019) and a contrast arrival time difference between the nodule and liver of more than 0.5 second (HR, 4.35; p = 0.011) were independent predictors for malignant transformation. The area under the ROC curve (Az) of initial nodule size (Az = 0.64, p = 0.131) and contrast arrival time difference between the nodule and liver (Az = 0.66, p = 0.029) improved after combining the two (Az = 0.75, p = 0.002). During follow-up, echogenicity change (p = 0.044), absolute growth rate (p < 0.001), and relative growth rate (p < 0.001) correlated with malignant transformation. Sensitivity analysis revealed that an absolute growth rate of 5 mm or greater in 6 months or a relative growth rate of 30% or greater in 6 months could be considered as threshold growth for identifying malignant transformation (specificity, 100.0%; positive predictive value, 100.0%). The absence of both echogenicity change and threshold growth was highly accurate in excluding malignant transformation (sensitivity, 100.0%; negative predictive value, 100.0%). CONCLUSION. The contrast arrival time difference between the nodule and liver at initial detection was useful in stratifying eventual malignant transformation risk for cirrhotic nodules. During follow-up, growth rate and echogenicity change correlated with malignant transformation; threshold growth on ultrasound may be considered a potential major feature in noninvasive diagnostic criteria of hepatocellular carcinoma.

Chi-Chun Huang,1 Hsin-Yi Chen,1 Ruei-Hsin Chang,1 Pen-An Liao,2 Heng-Hui Lien,3,4 Chih-Sheng Hung,5 Sien-Sing Yang,1,3 Jui-Ting Hu1,3 1Liver Center, Cathay General Hospital Medical Center, Taipei, Taiwan; 2Department of Radiology, Cathay General Hospital Medical Center, Taipei, Taiwan; 3School of Medicine, Fu-Jen Catholic University College of Medicine, Taipei, Taiwan; 4Department of Surgery, Cathay General Hospital Medical Center, Taipei, Taiwan; 5Department of Gastroenterology, Cathay General Hospital Medical Center, Taipei, Taiwan Background: Sorafenib is an oral tyrosine kinase inhibitor that is indicated for advanced hepatocellular carcinoma (HCC). The aim of the present study was to determine the clinical outcomes of HCC patients receiving sorafenib in real-life clinical setting in comparison with formal clinical trials.Methods: Patients diagnosed with advanced HCC between 2007 and 2015 at single institute were retrospectively enrolled and evaluated for survival and tolerability following sorafenib treatment. Overall survival (OS) and duration of treatment (TTP) were examined by different stratifications including age, gender, etiology, liver functions, and severities.Results: A total of 67 advanced HCC patients were enrolled for analysis. Of the 67 eligible patients, 66 patients (99%) were diagnosed as Barcelona Clinic Liver Cancer stage C and 45 (67%) were Child-Pugh A. Chronic hepatitis B virus infection was the main etiology (67%), followed by hepatitis C virus infection (12%) and alcohol liver disease (8%). The median duration of treatment was 3.0 months (95% CI 2.6–3.4 months) and median OS was 8.0 months (95% CI 5.0–11.0 months). By multivariate analysis, female gender (HR =2.462, 95% CI 1.126–5.387, P=0.024), Child-Pugh C (HR =3.913, 95% CI 1.063–14.410, P=0.04), extrahepatic spread (HR =2.123, 95% CI 1.122–4.015, P=0.021), and combined other therapies (HR =0.410, 95% CI 0.117–0.949, P=0.037) were the independent predictors of OS.Conclusion: OS of advanced HCC patients treated with sorafenib was longer than that reported in the Asia-Pacific trial study. Impaired hepatic functions are associated with the shorter survival in real-life setting. Keywords: advanced hepatocellular carcinoma, sorafenib, liver function, tumor burden

Background Systemic hypothermia is considered beneficial to stroke patients. However, many complications ensue. The aim of this study was to evaluate the effect of a new invasive regional cooling device in cerebral ischemic injury in a rat model. Methods After a pilot study confirming the efficiency of the cooling device, 15 adult male Sprague–Dawley rats, weighing 300–400 g, were randomly assigned into three groups: cooling device applied at 14°C and at 26°C, and a sham group. Focal cerebral ischemic injury was achieved by electrocauterization of the left middle cerebral artery through craniectomy and temporal occlusion of both common carotid arteries for 3 hours. Within 30 minutes after the end of ischemic injury, the cooling device was inserted into the rat brain through a stereotactic frame to provide regional hypothermia for 2 hours. The rats were sacrificed immediately after the 2-hour regional hypothermia. Results Although triphenyltetrazolium chloride staining showed smaller ischemic lesions in both the 26°C and 14°C groups compared to the control group, Fluoro Jade C staining showed no neuroprotective effects in the rostrum cerebral cortex in both groups. However, both triphenyltetrazolium chloride and Fluoro Jade C staining indicated significant beneficial effects in the caudal cerebral cortex in rats with cooling device applied at 26°C compared to the 14°C and control groups. Conclusion Our findings indicated that the device can effectively achieve regional hypothermia and could be beneficial for patients with cerebral ischemia during the acute phase.

Objective This study was to investigate the usefulness and limitations of cardiac magnetic resonance imaging (MRI). We compared echocardiography (ECHO) and perfusion scans to evaluate: left ventricular wall scar formation of the myocardium; hypokinesis, akinesis, or dyskinesis of the myocardium; regurgitation of the aortic and mitral valves; post acute myocardial infarction (AMI) ventricular function; and the viable myocardium (ischemia/infarction). Methods Twenty patients received both cardiac MRI and ECHO. Among them, nine patients received perfusion scans. The modalities and methods examined in this study were not the most advanced or updated protocols. Results We compared the results of cardiac MRI with those of ECHO and perfusion scans. We found significant correlations between the interpretations of left ventricular wall morphological change with dynamic images for hypokinesia, akinesia, and dyskinesia of the myocardium. We also found possible correlations between cardiac MRI and perfusion scans regarding their results to produce a “bull's eye target figure” to evaluate severe ischemia and infarctions. Conclusion We found that cardiac MRI provided a useful adjunct to ECHO on interpretations of left ventricular wall morphological change. The correlations between qualitative interpretations of cardiac MRI versus perfusion scan respective to ‘bull's eye target figures’, were found to be moderately matching. There was an unsatisfactory mismatching of correlations between quantitative by manual input and the drawing inaccuracy and an unavoidable error of the post-processing technique of cardiac MRI on ejection fraction (EF) and end systolic volume (ESV).

This study uses social exchange theory to develop a model of the processes linking work–family conflict to job attitudes. This model was tested on a sample of 236 employees in Taiwan's high-technology industry. The regression results revealed that perceived organizational support and leader–member exchange fully mediated the influence of work–family conflict on intentions to quit and affective organizational commitment, and partially mediated work–family conflict's influence on job satisfaction. The implications are discussed in this article.

Internet banking provides users diverse financial service through the Internet. Under the environment of drastic competition, in order to make customers proceed with transactions on the web site, Internet banking not only should provide complete functions of operations but also advance their electronic service quality. The electronic service quality evaluation for Internet banking can be treated as a multiple-criteria decision making (MCDM) problem. As for evaluating the electronic service quality, since the traditional Likert scale cannot deal with uncertain assessments according to human intuition for the service quality evaluation, fuzzy numbers are employed to measure decision-makers' subjective preferences. This paper treats the given hierarchical network with the fuzzy MCDM as a feed-forward neural network and aims to develop a genetic-algorithm-based method to automatically determine degrees of importance of respective criteria. Then, critical criteria for evaluating service quality can be easily identified. In the empirical study, five domestic banks belonging to financial holding companies in Taiwan are selected to find critical criteria. The findings provide useful information to Internet banks for improving the electronic service quality.

This study performs precision positioning of a generic piezoelectric structure against hysteresis effects by finite elements, microscopic hysteresis cancellation and robust H ∞ compensation. The designed control algorithm is expected to be effective in enhancing servo performance of hard disk drives. The precision positioning is accomplished by adding a polarization term into the linear constitutive equations of piezoelectric materials. This polarization term is then described by the well-known Preisach model. Applying basic principles of finite elements and Hamilton’s thoery, the macroscopic governing equations of an arbitrary piezoelectric system in finite elements are obtained. Based on the macro-model, a controller consisting of two parts is designed to perform the precision positioning of a generic piezo-structure. The first part is responsible for direct hysteresis cancellation at the microscopic level, while the second one is a robust H ∞ controller to overcome inevitable cancellation errors. In this way, the control effort is then more effective than the conventional PI and double-lead controller without microscopic hysteresis cancellation. A simple piezoelectric structure of a bender-bimorph cantilever beam is considered for designs and experimental validation. Based on experimental results, the proposed control design is found effective to suppress hysteresis effects as opposed to conventional controllers.

Background Increased myocardial triglyceride (TG) content has been recognized as a risk factor for cardiovascular disease. However, its relation with cardiac function in patients on recovery from acute heart failure (HF) remains unclear. In this cross-sectional study, we sought to investigate the association between myocardial TG content measured on magnetic resonance spectroscopy (1H-MRS) and left ventricular (LV) function assessed on cardiovascular magnetic resonance (CMR) in patients who were hospitalized with HF. Methods A total of 50 patients who were discharged after hospitalization for acute HF and 21 age- and sex-matched controls were included in the study. Myocardial TG content and LV parameters (function and mass) were measured on a 3.0 T MR scanner. Fatty acid (FA) and unsaturated fatty acid (UFA) content was normalized against water (W) using the LC-Model algorithm. The patient population was dichotomized according to the left ventricular ejection fraction (LVEF

A 19-year-old boy with shortness of breath and chest pain after strenuous exercise presented to emergency department . On physical examination, the neck and shoulders appeared to be swollen. There was crepitus on skin palpation. Chest X-ray disclosed diffuse subcutaneous emphysema and pneumomediastinum. CT showed additional finding of air in epidural space. The patient was discharged after 2 days of hospitalisation with conservative treatment uneventfully. Pneumorrhachis is usually caused by abrupt increase in intrathoracic pressure in instance of forceful vomiting, cough or asthma attack in an otherwise healthy young adult. It is usually accompanied with pneumomediastinum. The management of epidural pneumatosis should be tailored according to its primary cause. For most patients with pneumorrhachis associated to a spontaneous pneumomediastinum without neurological symptoms, this condition is generally self-limited. For epidural free air of large volume that causes neurological deficits, surgical laminectomy may be indicated.

A 48-year-old man presented with headache and extreme hypertension. Computed tomography showed diffuse brain stem hypodensity. Magnetic resonance imaging revealed diffuse brain stem vasogenic edema. Hypertensive brain stem encephalopathy is an uncommon manifestation of hypertensive encephalopathy, which classically occurs at parietooccipital white matter. Because of its atypical location, the diagnosis can be challenging. Moreover, the coexistence of hypertension and brain stem edema could also direct clinicians toward a diagnosis of ischemic infarction, leading to a completely contradictory treatment goal.

Refractory cardiogenic shock (RCS) represents the extremely-ill patients with STEMI, whose mortality rate was >60%. Despite the efforts to decrease door-to-balloon (D2B) time in the past decade, recent studies reported little progress on mortality of these patients. Meanwhile, early mechanical

OBJECTIVE: The aim of this article was to assess the usefulness of procalcitonin (PCT) as a marker for predicting dilating (grades III-V) vesicoureteral reflux (VUR) in young children with a first febrile urinary tract infection. METHODS: Children ≤2 years of age with a first febrile urinary tract infection were prospectively evaluated. Serum samples were tested for PCT at the time of admission to a tertiary hospital. All children underwent renal ultrasonography (US), Tc-dimercaptosuccinic acid renal scan, and voiding cystourethrography. The diagnostic characteristics of PCT test for acute pyelonephritis and dilating VUR were calculated. RESULTS: Of 272 children analyzed (168 boys and 104 girls; median age, 5 months), 169 (62.1%) had acute pyelonephritis. There was VUR demonstrated in 97 (35.7%), including 70 (25.7%) with dilating VUR. The median PCT value was significantly higher in children with VUR than in those without (P < 0.001). Using a PCT cutoff value of ≥1.0 ng/mL, the sensitivity and negative predictive value for predicting dilating VUR were 94.3% and 95.4%, respectively, for PCT, and 97.1% and 97.8%, respectively, for the combined PCT and US studies, whereas the positive and negative likelihood ratios were 2.03 and 0.107, respectively, for PCT, and 1.72 and 0.067, respectively, for the combined studies. By multivariate analysis, high PCT values and abnormalities on US were independent predictors of dilating VUR. CONCLUSIONS: PCT is useful for diagnosing acute pyelonephritis and predicting dilating VUR in young children with a first febrile urinary tract infection. A voiding cystourethrography is indicated only in children with high PCT values (≥1.0 ng/mL) and/or abnormalities found on a US.

This paper presents an approach to work sampling involving a mixture of fixed and random sampling. Fixed-interval sampling is more efficient in terms of providing more precise information for the same number of observations. Random sampling avoids the possibilities of sampling times being anticipated and the sampling schedule coinciding with some rhythm in the sampled process. Using a mixture of fixed and random sampling provides a smooth transition from fixed to random sampling and allows the practitioner to select a mixture level appropriate for his or her purposes. The efficiency of the mixture sampling method is analyzed by using an alternating Poisson process model for the sampled process. The mixture sampling method eliminates the observation-free period after every observation that was provided by the previously proposed delayed-sampling method. Although the mixture sampling method is slightly less efficient than the delayed-sampling method, its advantage is clear when anticipation of observation times is a concern, and it is always more efficient than random sampling.

The clinical utility of leukocytosis in risk assessment for ST-elevation myocardial infarction (STEMI) is still unclear. We aim to demonstrate the prognostic value of leukocyte counts independent from traditional risk factors and the TIMI risk score (TRS) for STEMI and to propose a practical model comprising leukocyte count for early triage in STEMI undergoing primary angioplasty. A prospective database (n = 796) of consecutive STEMI cases receiving primary angioplasty at a tertiary medical center was retrospectively analyzed in the period from February 1, 2007 through December 31, 2012. Primary endpoints were 30-day and 1-year mortality. Propensity score-adjusted Cox regression models and subdivision analysis were performed. Leukocytosis group (n = 306) had higher 30-day mortality (5.9% vs 3.1%, P = 0.048) and 1-year mortality (9.2% vs 5.1%, P = 0.022). After adjustment by propensity score and TRS, leukocyte count (per 103/μL) was an independent predictor of 1-year mortality (HR: 1.086, 95% CI: 1.034–1.140, P = 0.001). Subdivision analysis demonstrated the correlation between leukocytosis and higher 1-year mortality within both high and low TRS strata (divided by 4, the median of TRS). Additionally, 24% (191 out of 796) of patients were characterized by nonleukocytosis and TRS

A modified grating-slit test is shown to measure the full-field aberration at multi fields simultaneously by adding a slit-lens matching array. Experimental results shows sensitivity to observe changing off-axis aberration of a tilt lens.

Objectives: This before–after study investigated the association between an audit program and door-to-balloon times in patients with acute ST-elevation myocardial infarction (STEMI) and explored other factors associated with the door-to-balloon time. Methods: An audit program that collected time data for essential time intervals in acute STEMI was developed with data feedback to both the Department of Emergency Medicine and the Department of Cardiology. The door-to-balloon times for 76 consecutive acute STEMI patients were collected from February 16, 2007, through October 31, 2007, after the implementation of the audit program, as the intervention group. The control group was defined by 104 consecutive acute STEMI patients presenting from April 1, 2006, through February 15, 2007, before the audit was applied. A multivariate linear regression model was used for analysis of factors associated with the door-to-balloon time. Results: The geometric mean 95% CI of the door-to-balloon time decreased from 164.9 (150.3, 180.9) minutes to 141.9 (127.4, 158.2) minutes (p = 0.039) in the intervention phase. The median door-to-balloon time was 147.5 minutes in the control group and 136.0 minutes in the intervention group (p = 0.09). In the multivariate regression model, the audit program was associated with a shortening of the door-to-balloon time by 35.5 minutes (160.4 minutes vs. 195.9 minutes, p = 0.004); female gender was associated with a mean delay of 58.4 minutes (208.9 minutes vs. 150.5 minutes; p = 0.001); posterolateral wall infarction was associated with a mean delay of 70.5 minutes compared to anterior wall infarction (215.4 minutes vs. 144.9 minutes; p = 0.037) and a mean delay of 69.5 minutes compared to inferior wall infarction (215.4 minutes vs. 145.9 minutes; p = 0.044). The use of a glycoprotein IIb/IIIa inhibitor was associated with a 46.1 minutes mean shortening of door-to-balloon time (155.7 minutes vs. 201.8 minutes; p

Acute organophosphate (OP) poisoning causing alteration in acid-base equilibrium was reported before. Hence, different acid-base statuses may present in patients with acute poisoning due to OP exposure. This study aims to determine the impact of acid-base interpretation in patients with acute OP poisoning before hospitalization in medical care units and to describe the pattern of mortality with different acid-base statuses.Over a 9-year retrospective study, from July 1996 to August 2005, a total of 82 consecutive patients with acute OP poisoning were admitted to the China Medical University Hospital (Taichung, Taiwan) within 24 hours after exposure to OP and were enrolled into this study.Patients with acute OP poisoning were divided into 4 groups: without acidosis, metabolic acidosis, respiratory acidosis, and mixed acidosis. Overall survival (Kaplan-Meier curves) among groups was statistically significant (P.0001). The mortality rate of acute OP poisoned patients with metabolic acidosis was 25%, and 75% of those patients died of cardiovascular failure. The mortality rate of acute OP poisoning with respiratory acidosis was 50%, and 50% of those patients died of respiratory failure.Acid-base interpretation can be effective in quick diagnosis and prediction of the outcome of patients with acute OP poisoning (without acidosismetabolic acidosisrespiratory acidosismixed acidosis) before hospitalization. Major causes of death are different between the respiratory acidosis and metabolic acidosis groups of patients with acute OP poisoning.

Human herpesvirus 8 (HHV8) has been consistently linked to Kaposi’s sarcoma and many hematological diseases such as pleural effusion lymphoma, multicentric Castleman’s disease, some lymphoproliferative diseases and posttransplantation bone marrow failure. However, whether patients with hematological disorders are at a higher risk of HHV8 infection has not been determined. In this study, indirect immunofluorescence was used to detect antibodies against lytic antigens of HHV8 in 265 patients with hematological disorders. Our data showed that 24.5% of patients (65/265) were seropositive for HHV8 IgG antibody, which was significantly higher than in our general population (p < 0.001). A significantly higher seropositive rate can be found in patients with lymphoma, leukemia, autoimmune cytopenias and myeloproliferative disorders, but not in patients with myeloma or aplastic anemia. No difference in the seropositive rate is associated with gender or age. We conclude that some patients with hematological disorders are at a higher risk of HHV8 infection.

Current trading strategy learning models often proceed in three separate phases, i.e., training, validation, and application (testing). After a specific time span of application, a new learning process is started to adapt the trading strategy to the new environment states. The time span of application is usually fixed and determined according to experiences. This may result in earning losses as compared to the perfect trading strategy which trades at each turning point of the stock price movement. Some learning methods, such as neural networks, are hard to explain intuitively and unstable in some dynamic environment states. Other learning models like simple genetic algorithms result in a single trading rule which is applied for a specific time span without being adapted even when the environment has changed. This paper adopts learning classifier systems (LCSs) technique to provide a dynamic trading strategy learning model (DTSLM), which makes continuous and instant learning while executing real prediction and produces a trading rule set to deal with different environment states. The simulation results show that this model could get a remarkable trading profit.

This paper presents a queuing model for estimating business loss, although business loss is quite difficult to estimate. Balking index and reneging rate are used in the model to represent different configurations of balking behaviour and reneging behaviour respectively for different queuing systems. Using balking index and reneging rate enables decision makers to have the capability to estimate the incurred business loss for different values of balking index, reneging rate and service level. This model is an effective tool for linking the phases of operations management and perceptions management. With this linkage, managers can decide how to utilise these management techniques to reduce business loss and enhance customer satisfaction.

Although the profit loss from business resulting from queueing systems is quite difficult to estimate, this paper presents a creative and effective approach to formulating balking loss as waiting cost. The number of balking customers is estimated as the balking index θ multiplied by the expected queue length Lq and the mean arrival rate in that planning period λ. Estimating balking loss enables the decision maker to determine the optimal number of servers by minimising total cost, including service cost and balking loss. The practicality and the incurred benefits of this approach were analysed by using collected data from a fast food restaurant, using the SIPP M/M/S:(FCFS/∞/∞) queueing model. The results showed that this approach is an effective tool for aiding managers in formulating the optimal staffing policies of service systems.

not available at time of printing. Poster Sessions 1: Heart Failure/Myocardial Diseases P-1 Remodeling of Myocardial Gap Junctions and its Correlation with Cardiac Contractility in Diabetic Rats Dong-Feng Yeih1, Pen-Chih Liao1, Ho-Tsung Hsin1, Kuo-Chin Chen1, Ai-Hsian Li1, Yung-Zu Tseng2. 1Department of Cardiology, Far-Eastern Memorial Hospital, Taiwan, 2Department of Cardiology, National Taiwan University, Taiwan Introduction: Gap junctions play an essential role in coupling adjacent cardiomyocytes, ensuring organized propagation of action potential and synchronizing beating in cardiomyocytes. However, it remains unclear that temporal remodeling of myocardial gap junctions and its relation to cardiac contractility in diabetic rats. Methods: Male Wistar rats, weighing 250 to 300 grams, were randomized to injection with either vehicle or streptozotocin (50mg, IP). Invasive hemodynamic studies with simultaneous recordings of left ventricular pressure and aortic flow signals were done at 4, 8 and 12 weeks after injection. Maximal systolic elastance (Emax) and maximum theoretical flow (Qmax) were assessed by curve fitting techniques; protein expression of non-phosphorylated Cx43 (P0) and total amount of Cx43 (T) in the left ventricle by western blotting analysis. Results: Emax was significantly lower in diabetic rats than in controls and Emax was significantly depressed with time in diabetic groups. On the other hand, Qmax was preserved and cardiac output was maintained in diabetic rats. Protein expression of total Cx43 was persistently attenuated in diabetic groups, while P0 was enhanced at 8 and 12 weeks after injection. The ratio of P0 to T was significantly increased with time, which correlated well with the declines in Emax in diabetic rats. Conclusions: Temporal remodeling of myocardial gap junctions, with persistently lower total Cx43 and gradually increased non-phosphorylated Cx43 and the ratio of P0 to T, occurred in the evolution of systolic dysfunction in diabetic rats. P-2 Quantification of Left Ventricular Diastolic Dynamics in Normal and Diseased Myocardium by Speckle-Tracking Echocardiography Kaoru Dohi1, Katsuya Onishi2, Takeshi Takamura1, Emiyo Sugiura1, Hiroshi Nakajima1, Kazuhide Ichikawa1, Masaki Tanabe1, Hiroya Tamada1, Masatoshi Miyahara1, Mashio Nakamura1, Masaaki Ito1. 1Department of Cardiology, Mie University Graduate School of Medicine, Japan, 2Department of Molecular and Laboratory Medicine, Mie University Graduate School of Medicine, Japan Background: The present study aimed to quantify left ventricular (LV) diastolic dynamics and to elucidate their relations to systolic properties in normal and diseased myocardium. Methods: 50 patients with hypertensive LV hypertrophy (LVH: EF 61±8%, QRS 96±16ms), 50 patients with dilated cardiomyopathy (DCM: EF 31±10%, QRS 121±32ms), and 50 normal controls (Control: EF 5±6%, QRS 89±9ms) had echo-study with speckle-tracking strain and strain rate imaging. To quantify LV diastolic relaxation and segmental synchrony, global peak relaxation rate (PRR) during early diastole and standard deviation (SD) of the 18 segmental time-to-PRR (TPRR-SD) were calculated from apical 4-, 2-, and long axis views. To elucidate the relations between diastolic and systolic properties, global peak systolic strain (PSS) and SD of the segmental time-to-peak PSS (TPSS-SD) were also evaluated. Results: LV relaxation and diastolic synchrony were significantly impaired in LVH and was more prominent in DCM (PRR: 0.8±0.3* 1/s in LVH, 0.5±0.2*# 1/s in DCM, and 1.2±0.3 1/s in Control, TPRR-SD: 55±16*ms in LVH, 79±35*# ms in DCM, and 42±13ms in Control, *p < 0.05 vs. Control and #p < 0.05 vs. LVH, respectively). There were strong correlations between PSS and PRR, and TPRR-SD and TPSS-SD (r = 0.83 and r = 0.83, p < 0.05, respectively). Conclusion: Speckle-tracking echocardiography quantified LV diastolic dynamics and exhibited the strong relation to systolic properties.