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Summary Mechanoreceptors are essential components of the somatosensory system that convert received mechanical signals into electrical signals that can be sent to the brain. These receptors provide the ability to sense a variety of stimuli from the external environment, including touch, vibration, and heat. Mechanoreceptors do not convert signals monotonically; in addition, several fundamental characteristics are embedded in mechanoreceptors, including thresholds and adaptation properties. In this study, we proposed and experimentally demonstrated a van der Waals stacking field-effect transistor (VS-FET), which was inspired by an FET with a floating gate structure, to realize the important characteristics of mechanoreceptors. The VS-FET can not only demonstrate the fundamental biological functions but also produce other unique properties such as fatigue and accommodation. We also integrated an artificial touch receptor with an array of the proposed VS-FET to demonstrate the feasibility of these devices experimentally in artificial humanoid systems.

Background Stroke is a major risk factor for osteoporosis and fractures. No study has evaluated the association between diuretic use and risk of vertebral fracture in stroke patients, although a considerable proportion of stroke patients are prescribed diuretics for hypertension. Our study aimed to investigate whether treatment with thiazides or loop diuretics affects the risk of vertebral fracture after stroke. Methods A population-based propensity score-matched retrospective cohort study was conducted using the Taiwan National Health Insurance Research Database. Patients with a new diagnosis of stroke between 2000 and 2011 were included. After propensity score matching, 9468 patients were included in the analysis of the effect of thiazides, of who 4734 received thiazides within 2 years after stroke. To analyze the loop diuretic effect, 4728 patients were included, of who 2364 received loop diuretics. Cox proportional hazards regression models were used to calculate hazard ratios (HRs) of vertebral fractures among patients according to thiazide or loop diuretic use within 2 years following stroke. Sensitivity analyses based on the duration of thiazide or loop diuretic use were further conducted. Results There was no significant difference in vertebral fracture risk between thiazide users and non-users (adjusted HR [aHR] = 1.14, 95% confidence interval [CI] = 0.88–1.47, p = 0.316). Loop diuretic users had a significantly higher vertebral fracture risk than non-users (aHR = 1.45, 95% CI = 1.06–1.98, p = 0.019). However, the sensitivity analysis revealed that short-term thiazide use (exposure duration p = 0.039). Only short-term loop diuretic users had significantly higher risk of vertebral fracture (aHR = 1.56, 95% CI = 1.11–2.20, p = 0.011). The other two subgroups with longer exposure duration in analyses for both thiazides and loop diuretics revealed no significant effect. Conclusions Short-term thiazide or loop diuretic use was associated with an increased risk of vertebral fracture after stroke. Further prospective clinical trials are required to confirm this finding.

A considerable proportion of stroke survivors are prescribed with proton pump inhibitors (PPIs). Our study indicated that PPI use is associated with an increased risk of osteoporosis, hip fracture, and vertebral fracture in stroke patients. The risk tends to increase as the cumulative doses of PPIs increase.A considerable proportion of stroke survivors are prescribed with proton pump inhibitors (PPIs). Our study investigated the association between PPI use and the risk of osteoporosis and fracture among stroke survivors.A population-based propensity-matched retrospective cohort study was conducted using the National Health Insurance Research Database in Taiwan. Patients diagnosed with a new stroke between 2000 and 2012 were identified. After propensity score matching, 10,596 patients were enrolled, and 5298 patients were each assigned to the PPI user and non-user groups. Hazard ratios (HRs) were calculated for the risk of osteoporosis, hip fracture, and vertebral fractures according to PPI use or non-use. Sensitivity analyses were conducted to evaluate the dose effects of PPI.PPI use after stroke was associated with an increased risk of osteoporosis, hip fracture, or vertebral fracture, with an adjusted HR (aHR) of 1.28 (P 0.001). The aHRs were also significant for each outcome: osteoporosis, 1.26 (P 0.001); hip fracture, 1.18 (P = 0.048); vertebral fracture, 1.33 (P 0.001). A pattern of dose effect was identified. For any event (osteoporosis/hip fracture/vertebral fracture), the aHR for PPI use of 1-90, 91-365, and 365 cDDDs was 1.22 (P 0.001), 1.27 (P 0.001), and 1.66 (P 0.001), respectively. For each outcome, the highest dose was associated with the highest risk, with aHR of 1.79 (P 0.001), 1.41 (P = 0.039), and 1.82 (P 0.001) for osteoporosis, hip fracture, and vertebral fracture, respectively. Age- and sex-stratified analyses revealed similar patterns.PPI use is associated with an increased risk of osteoporosis, hip fracture, and vertebral fracture in stroke patients.

Summary Purpose To validate a conceptual short-form health literacy 12 items questionnaire (HL-SF12) in patient populations. Methods A cross-sectional study was conducted via a convenient sample of 403 patients from three departments of a community general hospital in the northern Taiwan. Patients' health literacy was assessed with a validated HL-SF12, derived from the full scale, the European Health Literacy Survey Questionnaire (HLS-EU-Q), as well as a single-item from Chew's Set of Brief Health Literacy Question. A reference population in Northern Taiwan ( n =928) via the HLS-EU-Q in 2013–2014 was used as a reference to compare the health literacy between that of the general public and the patients. Data was analyzed by confirmatory factor analysis (CFA), internal consistency analysis, correlation analysis, and linear regression models. Results Patients' health literacy assessed with the HL-SF12 was shown with high internal consistency (Cronbach α=.87), and moderately correlated with the single-item from Chew's Set of Brief Health Literacy Question, with satisfactory item-scale convergent validity (item-scale correlation ≥ .40), without floor/ceiling effect, and with satisfactory goodness of fit indices of the three-factor construct model for most of the patients. Their health literacy was significantly positively associated with female gender, higher income, and more often watching health-related TV programs. On the other hands, patients were reported with significantly higher healthcare health literacy than the general public, but not in general health literacy, disease prevention health literacy, or health promotion health literacy. Conclusion The comprehensive HL-SF12 was a valid and easy to use tool for assessing patients' health literacy in the hospitals to facilitate healthcare providers in enhancing patients' health literacy and healthcare qualities.

ObjectivesTo investigate the association between benzodiazepine (BZD) use and the risk of chronic-onset poststroke pneumonia.DesignPopulation-based propensity-matched retrospective cohort study.SettingTaiwan’s National Health Insurance Research Database.ParticipantsPatients newly diagnosed with stroke between 2000 and 2012 were identified and, after propensity score matching, 7516 patients were enrolled. Among these, 3758 patients received BZDs after stroke while 3758 did not.Outcome measuresHRs for developing pneumonia over 1 month after stroke according to BZD use were assessed using Cox proportional hazards regression models. Analyses according to cumulative defined daily doses (cDDDs) of BZDs and stratification for age and sex were also performed.ResultsDuring a mean follow-up time of 4.4 years, 1027 patients in the BZD cohort and 478 patients in the non-BZD cohort developed pneumonia over 1 month after stroke. Patients using BZDs after stroke had a higher pneumonia risk than did those not using BZDs (52.2vs32.6 per 1000 person-years, adjusted HR (aHR)=2.21, 95% CI (CI)=1.97 to 2.48, p365 cDDDs of BZDs were 2.28 (95% CI=2.01 to 2.58; pConclusionsBZD use is associated with an increased risk of chronic-onset poststroke pneumonia.

ObjectivesThis study aimed to investigate the association between thiazide use and the risk of hip fracture after stroke.SettingA population-based, propensity-matched cohort study was conducted on the basis of Taiwan’s National Health Insurance Research Database.ParticipantsPatients with newly diagnosed ischaemic stroke between 2000 and 2011 were included. After propensity score matching, 7470 patients were included, of whom 3735 received thiazides and 3735 did not.Outcome measuresHRs for developing hip fractures within 2 years after stroke were calculated using Cox proportional hazards regression model with adjustments for sociodemographic and coexisting medical conditions.ResultsOverall, patients using thiazides after stroke had a lower risk of hip fracture than those not using thiazides (8.5 vs 13.9 per 1000 person-years, adjusted HR=0.64, 95% CI 0.46 to 0.89, p=0.007). Further sensitivity analysis based on the duration of thiazide use revealed that the risk of hip fracture tended to decrease as the duration of exposure of thiazides increased. However, the effect was significant only in patients with long-term use of thiazides (using thiazides for >365 days within 2 years after stroke), with a 59% reduction in the risk of hip fracture when compared with patients not using thiazide (adjusted HR=0.41, 95% CI 0.22 to 0.79, p=0.008).ConclusionsThe long-term use of thiazides is associated with a decreased risk of hip fracture after stroke.

Purpose Diabetes mellitus (DM) is a global pandemic metabolic disorder. In recent years, the amount of medical resources required for the treatment of diabetes has increased as diabetes rates have gradually risen. The combined effects of individual and neighbourhood socio-economic status (SES) on DM survival rates are still not clear, especially in patients of working age. In this paper, we aim to analyze the combined effects of neighbourhood and individual SES on DM survival rates in patients of working age in Taiwan. Methods The study of 23,781 people who were diagnosed with DM by using population—based study between 2002 and 2006. Each sample was followed up for 4 years or as a sensor case. We defined Individual SES and neighbourhood SES by each patient’s job category and household income which characterized as advantaged or disadvantaged. Then we compared the survival rates by SES group used Cox proportional hazards model for adjust risk factors. Results The 4-year overall survival rates of diabetic patients were worst for those with low individual SES who living in advantaged neighbourhoods. After adjustment for patient characteristics, DM patients with high individual SES living in disadvantaged neighbourhoods had the same risk of mortality as those patients with high individual SES living in advantaged neighbourhoods (hazard ratio: 1.11; 95% confidence interval [CI]: 0.81–1.51). The study found that DM patients with low individual SES who live in disadvantaged areas had a greater risk of mortality than those with high SES (odds ratio: 2.57; 95% CI: 2.04–3.24). There were significant differences in survival rates between patients with high individual SES and patients with low individual SES. In contrast, the results did not statistically significant differences in survival rates between advantaged and disadvantaged neighbourhood SES groups. Conclusion DM patients with low individual SES had the worst survival rate, regardless of whether they were living in a high or low SES neighbourhood area. The competitive cause of death, i.e., the fact that complications, rather than DM itself, are often the cause of death, may be the reason for the inverse relationship found between the effects of individual SES and neighbourhood SES on DM survival. We conclude that the socio-economic gradient in survival among DM patients may be the result of differences in access to medical treatment and attributes related to individual SES.

Background Rehabilitation can improve physical activity after stroke. However, patients may be more prone to falls and fractures because of balance and gait deficits. Few reports have studied the relationship between rehabilitation and subsequent fractures after ischemic stroke. Objective To investigate whether post-stroke rehabilitation affects fracture risk. Methods We conducted a population-based retrospective cohort study based on the Taiwan National Health Insurance Research Database. Patients with a newly diagnosed ischemic stroke between 2000 and 2012 were included. After propensity score matching, a total of 8,384 patients were enrolled. Half of the patients (4,192) received post-stroke rehabilitation within 1 month; the other half did not receive any post-stroke rehabilitation. Cox proportional hazards regression model was used to calculate hazard ratios (HRs) for fractures among patients with and without rehabilitation within 1 year after ischemic stroke. Patients were further stratified by sex and age (20–64 and ≥65 years). Results Patients receiving post-stroke rehabilitation had a higher incidence of fracture (6.2 per 100 person-years) than those who did not (4.1 per 100 person-years) after adjustment for sociodemographic and coexisting medical conditions [HR = 1.53, 95% confidence interval (CI) = 1.25–1.87, p < 0.001]. The analyses performed after stratifying for sex and age showed that only older women undergoing rehabilitation had a significantly higher risk of fracture (HR = 1.62, 95% CI = 1.21–2.17, p = 0.001). Conclusion Rehabilitation after ischemic stroke is associated with an increased fracture risk in older women.

BackgroundScabies is a global problem. Transmission of scabies is usually due to direct or indirect contact. Delay in diagnosis may result in the spread of the scabies mite. Prompt diagnosis and treatment are important.MethodsIn this study, we collected data from 52 scabies patients and analyzed the risk factors for scabies with the case-control method.ResultsOur study has revealed that the patients who were bedridden [odds ratio (OR) 6.72, p

Increasing evidence suggests that chronic, low-grade inflammation may be a common soil involving the pathogenesis of metabolic syndrome (MetS) and cardiovascular disease. We examined the association between C-reactive protein (CRP) concentration, an extensively studied biomarker of low-grade inflammation, and the MetS in a representative sample of Chinese adults in Taiwan. We performed a cross-sectional analysis of data from 4234 subjects [mean (±SD) age, 47.1 (±18.2) years; 46.4 % males] who participated in a population-based survey on prevalences of hypertension, hyperglycemia, and hyperlipidemia in Taiwan. CRP levels were measured by the immunoturbidimetric CRP-latex high-sensitivity assay. The MetS was defined by an unified criteria set by several major organizations. Odds ratios (ORs) and 95 % confidence intervals (CIs) were calculated with logistic regression model. Overall, there were 938 subjects with MetS among 4,234 participants, resulting in a prevalence rate of 22.1 %. A significantly progressive increase in the prevalence of MetS across quartiles of CRP was observed (p for trend

Background. To use sonography (US) to measure the interscapular soft-tissue thickness and to determine any correlation with anthropometric indices. Methods. Fifty-five healthy young adults (21 men and 34 women) with a mean age of 22.1 ± 3.0 years (range, 18–35) were enrolled. High-resolution US was used to measure the bilateral soft-tissue thickness near the medial border of the scapula. Anthropometric indices, including body weight, height, and circumferences of chest, waist, and hip, were also measured. Results. On the right side, mean values ± standard deviation for the thickness of the trapezius, rhomboid, and posterior serratus muscles in millimeters were 4.9 ± 1.0, 6.3 ± 2.3, and 3.5 ± 1.4, respectively, for men and 3.4 ± 0.8, 3.8 ± 1.7, and 2.2 ± 1.5, respectively, for women. The thickness of each muscle was significantly greater in men than in women (p < 0.05). For both genders, no significant differences in the soft-tissue thicknesses were found between both sides. Based on the anthropometric indices, body weight was the only significant contributor to the soft-tissue thickness. Conclusions. US is a practical tool for measuring soft-tissue thickness in the interscapular region. Body weight and soft-tissue thickness are closely associated. © 2010 Wiley Periodicals, Inc. J Clin Ultrasound, 2010

Bilateral subthalamic nuclei deep brain stimulation (DBS) has been shown to be effective in treating motor symptoms of Parkinson's disease. Numerous studies confirm the safety and efficacy of DBS. Complications of subthalamic nuclei DBS show a 1.2% risk of symptomatic intracerebral hemorrhage. There are few studies concerning the benefits of rehabilitation after occurrence of intracerebral hemorrhage related to DBS. We report a patient who underwent an inpatient rehabilitation program because of complicated intracerebral hemorrhage after a DBS procedure. We observed significant improvement in locomotion and independence of daily activities after the program. We also review the current literature reporting complications following DBS.

Hot-poured bituminous crack sealing has been widely accepted as a routine preventative maintenance practice. With proper installation, the sealing is expected to extend pavement service life by 3 to 5 years. However, current specifications for selection of crack sealants correlate poorly with field performance; hence, a set of new testing methods, based on sealant rheological and mechanical properties, was developed recently. Measurements of the mechanical properties of crack sealant at low temperatures are among the criteria introduced as part of the developed performance-based guidelines. The main purpose of this study was to identify and validate the low-temperature selection thresholds for the newly developed performance-based guidelines for selecting hot-poured bituminous crack sealants. In this study, selection criteria for crack sealant bending beam rheometer (CSBBR) and crack sealant direct tension tester (CSDTT) tests were identified. Two performance parameters for CSBBR test were used for the selection criteria: stiffness at 240 s and average creep rate (ACR). Both parameters were identified by comparing laboratory testing results with known sealant field performance, obtained from a long-term study in Canada. The selection criterion for the CSDTT test was extendibility, on the basis of field values reported in the literature. The recommended selection criteria were used to predict the field performance of 12 sealants evaluated by the National Transportation Product Evaluation Program (NTPEP). Results showed good correlation between the proposed selection thresholds and NTPEP field sealant performance.

Patients with nephrotic syndrome frequently have renal-vein thrombosis (RVThromb) without overt clinical manifestations. At the onset of the condition only 10% of these patients have acute signs and symptoms such as flank pain, haematuria, proteinuria and a rapid decline of renal function [1]. Patients experiencing severe flank pain, a rapid deterioration of renal function and concomitant pulmonary emboli or multiple thrombi have been successfully managed with thrombolytic agents [3], despite the fact that the risk associated with thrombolytic therapy seems to be greater than that of anticoagulant therapy, which would appear to be a more appropriate choice of treatment. Since low-molecular-weight heparins (LMWHep) have a longer half-life and better bioavailability than unfractionated heparin, they are widely used for treating many clinical conditions [4]. This case report confirms that LMWHep can be used successfully to treat the RVThromb of a nephrotic patient. It also suggests that such therapy may be applied even when thrombolytic or other anticoagulation therapy has previously failed.