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The demands of the technologies of the future such as autonomous vehicles, Internet of Things and mixed reality require communications platforms equipped to handle huge quantities of data. Higher frequency communication bands are attractive but have limitations in terms of data loss particularly during wireless transmission. Free-space optical (FSO) communication, which transmits optical signals through free-space by modulating laser light, is one option for better wireless signal delivery. Here we report a platform combining multiple transmission media of 40-km single-mode fibre, with 1.2-km FSO communication, and short range (0.5-2 m) radio-frequency wireless. We demonstrate sufficiently low bit error rates and error vector magnitudes at sub-terahertz frequencies, satisfying the requirement of 5 G new radio communications applications.

To determine whether combined transoral robotic surgery and postoperative oropharyngeal rehabilitation are effective for reducing the severity of obstructive sleep apnea.A quasi-experimental study enrolled participants without blinding between May 2019 and April 2021.Single-center study at National Cheng Kung University Hospital.Patients with moderate to severe obstructive sleep apnea who were otherwise healthy were recruited from the ear, nose, and throat department at National Cheng Kung University Hospital. The group undergoing transoral robotic surgery with oropharyngeal rehabilitation (n = 18) received a 12-week intervention consisting of home-based rehabilitation exercises following surgery; the transoral robotic surgery group (n = 17) received surgery only; and the control group (n = 15) received conservative treatment, such as continuous positive airway pressure therapy or other oral appliance therapy. Polysomnography data and tongue muscle performance were measured before and after the interventions.The group that underwent transoral robotic surgery with oropharyngeal rehabilitation exhibited significantly improved tongue protrusion strength as compared with the transoral robotic surgery-only group, as well as significantly improved apnea-hypopnea index in the supine position vs the control group.In this study, we demonstrated the synergistic effects of transoral robotic surgery and postoperative oropharyngeal rehabilitation for adult patients with obstructive sleep apnea. Objective records should be used to monitor home-based rehabilitation exercises and examine the lasting synergistic effects.

The utilization rate of respite care in Taiwan is low, and past studies that evaluated the effects of in-home respite care on caregiver burden are few. This two-wave panel study used Taiwan’s long-term care plan 1.0 database and included 2342 care recipient–caregiver dyads who used home services to examine the impact of in-home respite care on caregiver burden. Propensity score matching was used to select 323 in-home respite service users matched with 646 nonusers as control groups (1:2 matching). The mixed effect model was applied to estimate the effects of receiving in-home respite care on caregiver burden. Results showed that compared with those of nonusers, caregiver burden scores of service users decreased significantly after receiving in-home respite care for more than 14 days (adjusted B = −0.14, SE = 0.05). The government should prioritize increasing the number of days of in-home respite care for those in need to reduce the caregiver burden.

A bi-directional fiber-free-space optical (FSO)-fifth-generation (5G) millimeter-wave (MMW)/5G new radio (NR) sub-THz convergence with intensity-modulated downlink 40 Gbit/s/100 GHz 5G NR sub-THz signals ( x - and y -polarizations), and phase-modulated uplink 10 Gbit/s/28 GHz and 10 Gbit/s/24 GHz 5G MMW signals is established practicably, by adopting a parallel/orthogonally polarized dual-carrier mechanism, phase modulators, and remote injection locking distributed feedback laser diodes (DFB LDs) for demonstration. It is a pioneering work to realize a bi-directional fiber-FSO-5G MMW/5G NR sub-THz convergence for providing high downlink/uplink traffic capacity with accepted transmission performance. Through 20 km single-mode fiber transmission, 500 m free-space link, and 1 m/4 m RF wireless transport, impressively low bit error rate of 10−9 and accepted PAM4/NRZ eye diagrams are acquired. Such established bi-directional fiber-FSO-5G MMW/5G NR sub-THz convergence accelerates a feasible solution that can afford high traffic capacity with qualified transmission performance, and develops the state achieved by the incorporation of optical fiber network with FSO-5G MMW/5G NR sub-THz convergence. It discloses a brilliant convergence developed for bi-directional high-speed and long-reach transmission with given transmission performance.

Childhood cancer may be related to maternal health in pregnancy. Maternal anemia is a common condition in pregnancy, especially in low-income countries, but the association between maternal anemia and childhood cancer has not been widely studied.To examine the potential relation between maternal anemia during pregnancy and childhood cancers in a population-based cohort study in Taiwan.We examined the relationship between maternal anemia and childhood cancer in Taiwan (N = 2160 cancer cases, 2,076,877 noncases). Cases were taken from the National Cancer Registry, and noncases were selected from birth records. Using national health registries, we obtained maternal anemia diagnoses. We estimated the risks for childhood cancers using Cox proportional hazard analysis.There was an increased risk of cancers in children born to mothers with nutritional anemia (hazard ratio (HR): 1.32, 95% CI 0.99, 1.76). Iron deficiency anemia (HR: 1.30, 95% CI 0.97-1.75) carried an increased risk, while non-nutritional anemias were not associated with childhood cancer risk.Our results provide additional support for screening for anemia during pregnancy. Adequate nutrition and vitamin supplementation may help to prevent some childhood cancer.

Deaths from COVID-19 are increasing in patients with comorbidities. One of the most common comorbidities is diabetes mellitus. The researchers wanted to see how having diabetes affected the mortality rate of COVID-19 participants. This investigation is a case control observational analytical study. Different types of people, called “cases,” and “controls,” complete the research sample. Each group had 68 responders, for a grand total of 136. Medical records from COVID-19 patients treated at Airlangga University Hospital, Surabaya, between March 2020 and September 2021 serve as the study’s secondary data source. The purpose of this study’s data analysis is to calculate an odds ratio. Patients with COVID-19 with concomitant diabetes mellitus had an increased risk of death, and this risk increased with age, gender, and COVID-19 symptoms. In contrast, education, occupation, and laboratory results were not significantly related to mortality among COVID-19 individuals with concomitant diabetes mellitus (GDA status). The results of this study show that COVID-19 patients with concomitant diabetes mellitus are at a higher risk of death if they are over the age of 65, if they are male, and if they have severe symptoms.

This study aimed to develop and validate the psychometric properties of a novel instrument that measures Indoor Air Pollution Health Literacy (IAPHL). The qualitative phase was conducted to design questions based on the conceptual model of the European Health Literacy Survey Questionnaire. We developed a 38-item instrument covering 12 constructs, that is, four information competencies within three health domains to assess IAPHL. A cross-sectional online video survey of 647 adults aged 20 years and above in Taiwan was conducted. Various measures of validity and reliability coefficients were assessed to indicate the psychometric properties of the IAPHL instrument. The content validity indices for relevance, importance, and clarity of the 38 questions were 0.97, 0.96, and 0.89, respectively. The model fit indices obtained from the confirmatory factor analysis supported the acceptable structures of the theoretically hypothetical 12-factor model (standardized root mean square residual = 0.055; root mean square error of approximation = 0.065). Internal consistency for the instrument showed a Cronbach's alpha of 0.96. The IAPHL instrument developed in this study showed satisfactory validity and reliability and can be used in future fieldwork.

Background: To investigate all-cause and cause-specific mortality in Taiwanese patients with type 1 diabetes. Methods: A cohort of 17,203 patients with type 1 diabetes were identified from Taiwan’s National Health Insurance claims in the period of 1998–2014. Person-years were accumulated for each individual from date of type 1 diabetes registration to date of death or the last day of 2014. Age, sex, and calendar year standardized mortality ratios (SMRs) were calculated with reference to the general population. Results: In up to 17 years of follow-up, 4,916 patients died from 182,523 person-years. Diabetes (30.15%), cancer (20.48%), circulatory diseases (13.14%), and renal diseases (11.45%) were the leading underlying causes of death. Mortality rate (26.93 per 1,000 person-years) from type 1 diabetes in Taiwan was high, the cause of death with the highest mortality rate was diabetes (8.12 per 1,000 person-years), followed by cancer (5.52 per 1,000 person-years), and circulatory diseases (3.54 per 1,000 person-years). The all-cause SMR was significantly elevated at 4.16 (95% confidence interval, 4.04–4.28), with a greater all-cause SMR noted in females than in males (4.62 vs 3.79). The cause-specific SMR was highly elevated for diabetes (SMR, 16.45), followed by renal disease (SMR, 14.48), chronic hepatitis and liver cirrhosis (SMR, 4.91) and infection (SMR, 4.59). All-cause SMRs were also significantly increased for all ages, with the greatest figure noted for 15–24 years (SMR, 8.46). Conclusions: Type 1 diabetes in both genders and all ages was associated with significantly elevated SMRs for all-cause and mostly for diabetes per se and renal disease.

Objective To investigate the level of and covariates associated with ambient air pollution health literacy (AAPHL) among adult residents of Taiwan. Methods With a cross-sectional study design, we conducted telephone interviews using a Chinese version AAPHL scale, which consisted of 24 items assessing 12 subdomains of AAPHL formed by 4 information processing competence matrices (i.e., access, understand, appraise, and apply) and 3 health contexts (i.e., healthcare, disease prevention, and health promotion). The AAPHL was with the lowest and highest score at 1 to 4, respectively. Between September and November 2020, a sample of 1017 and 280 adults was successfully interviewed via home phones and mobile phones, respectively. We employed multiple linear regression models to identify covariates significantly associated with overall and 4 matric-specific AAPHL scores. Results The mean and standard deviation (±SD) of overall AAPHL score was considered as moderate at 2.90 (±0.56), with the highest and lowest metric-specific score for “apply” (3.07 ± 0.59) and “appraise” (2.75 ± 0.66). Lower education was significantly associated with a lower overall score; and living with children Conclusions People in Taiwan had only moderate level of AAPHL; and covariates including education, living arrangement, marital status, and area of living were significantly associated with AAPHL. These covariates should be considered in future educational interventions aiming to improve the AAPHL in the community.

Altered autonomic modulation, measured by heart rate variability (HRV), has been found to be associated with dementia risk in the elderly. However, long-term follow-up study evaluating the association between autonomic modulation from middle-age and the incidence of dementia has been limited.This retrospective cohort analyzed data from Taiwan's National Health Insurance Database covering the period from 2001 to 2017, with a linkage to citywide health examinations conducted by Tainan Metropolitan City, Taiwan. We included subjects aged 45-64 years. The mean follow-up period was 15.75 ± 3.40 years. The measurements of HRV included resting heart rate, high frequency (HF), low frequency (LF), standard deviation of normal-to-normal R-R intervals (SDNN), ratio between the 30th and 15th R-R interval after standing up from the supine position (30/15 ratio), ratio between the R-R intervals during expiration and inspiration, and LF/HF ratios. The main study outcome was the incidence of dementia. We performed multivariable Cox proportional hazard regression models to compare the risk of dementia among different HRV subgroups.We included 565 participants with a mean age of 53 (SD: 6) years, of whom 44 % were male. The risk of dementia was significantly increased in association with lower parasympathetic HRV modulation, including SDNN (HR: 3.23, 95% CI: 1.55-6.73) and 30/15 ratio (HR: 3.52, 95%CI: 1.67-7.42). Moreover, the risk of dementia was increased in subjects with higher LF/HF ratios (HR: 2.05, 95% CI: 1.12-3.72).Lower parasympathetic activity and higher sympathetic-vagal imbalance in middle-age were associated with dementia risk.

Background: to compare the 52-week effectiveness and safety between HYAJOINT Plus (HJP) and Durolane in knee osteoarthritis (OA) treatment. Methods: consecutive patients received a single injection of 3 mL HJP or Durolane. The primary outcome was a visual analog scale (VAS) pain measurement at 26 weeks post-injection. Secondary outcomes included other clinical, satisfaction, and safety assessments for 52 weeks. Results: 142 patients were equally randomized. At week 26, the HJP group had less VAS pain than the Durolane group (18.1 ± 9.5 versus 24.4 ± 14.0, p = 0.001). Both groups showed improvement in their VAS pain and stiffness scores, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and total scores for 52 weeks after injection (p < 0.001). However, the HJP group showed lower VAS pain and stiffness scores, reduced WOMAC pain and stiffness scores, a shorter Timed “Up & Go” (TUG) time, and a higher satisfaction score than the Durolane group for 39 weeks (p < 0.05). Only mild and self-limited adverse events occurred (40.8%). Conclusion: While a single injection of either HJP or Durolane is safe and effective for at least 52 weeks, HJP provided superior improvement in terms of VAS pain and stiffness scores, WOMAC pain and stiffness scores, and satisfaction score within 39 weeks of treatment.

A compact T-complementary split-ring resonator (CSRR) antenna was developed. Different from traditional designs, the proposed CSRR functioned not only as a loading structure but also as a radiator....

OBJECTIVE To investigate the association between the risk of stroke and exposure to particulate matter with an aerodynamic diameter less than 2.5 μm (PM2.5) over various exposure periods. METHODS This was a nationwide population-based case-control study in which 10,035 incident patients with a primary diagnosis of ischemic stroke each were matched with two randomly selected controls for sex, age, Charlson Comorbidity Index, year of stroke diagnosis, and level of urbanization. Multiple logistic models adjusted for potential confounders were used to assess the association of PM2.5 with ischemic stroke incidence. RESULTS There were significant short-term, medium-term, and long-term relationships between PM2.5 exposure and ischemic stroke incidence. CONCLUSIONS This study supports existing evidence that PM2.5 should be considered a risk factor for ischemic stroke.

Background: Erector spinae plane block could be a potential alternative to paravertebral block or other analgesic techniques for breast surgery, but the current evidence on erector spinae plane block in breast surgery is conflicting. Objective: To compare the analgesic effectiveness between erector spinae plane block, systemic analgesic, and paravertebral block for breast surgery. Study Design: Meta-analysis. Setting: The literature search was performed from 2016 to August 2020 using the MEDLINE, EMBASE, Cochrane library, and ClinicalTrials.gov databases. Methods: Clinical trials comparing erector spinae plane block to systemic analgesic and paravertebral block were included from the aforementioned databases. Primary outcomes were 24-hour postoperative opioid administration and postoperative pain score. Secondary outcomes were patient satisfaction levels, post-anesthesia care unit and hospital stay, block-related side effects, and opioid-related side effects. Systematic search, critical appraisal, and pooled analysis were performed according to the PRISMA statement. Results: We analyzed 495 cases in 8 randomized controlled trials. Compared with a systemic analgesic, the use of erector spinae plane block resulted in a reduced 24-hour postoperative intravenous morphine equivalent dose by a mean difference of 7.59 mg (P < 0.00001). Compared with paravertebral block, no statistical difference was found in opioid administration. No differences were observed in pain score, opioid-related side effects, or analgesic technique-related complications. Between the trials, heterogeneity existed and could not be evaluated using metaregression owing to inadequate reported data. Limitations: Moderate heterogeneity among the included trials could not be assessed by potential covariates owing to the limited reported data in each trial. Conclusion: Erector spinae plane block is superior to systemic analgesic within 24 hours after breast surgery and can serve as an alternative to paravertebral block with similar analgesic effects. Key words: Erector spinae plane block, paravertebral block, breast surgery, perioperative analgesia, randomized controlled trial, meta-analysis

A flexible bidirectional fiber-free-space optical (FSO)-fifth-generation (5G) wireless convergent system with 1-Gb/s/4.5-GHz sub-6 GHz and 10-Gb/s/28-GHz millimeter-wave (MMW) (downstream), as well as 10-Gb/s/24-GHz MMW (upstream) 5G hybrid data signals is built, employing a vertical cavity surface emitting laser (VCSEL)-based wavelength selector and a remotely injection-locked distributed feedback laser diode (DFB LD) for presentation. It is the first to adopt a VCSEL-based wavelength selector to adaptively provide 5G applications and an injection-locked DFB LD to perform a phase modulation-to-intensity modulation transformation with an optical-to-electrical conversion. Good bit error rate performance and acceptable eye diagrams are achieved over 25 km single-mode fiber transport, 600 m FSO link, and 10 m/4 m RF wireless transmission. Such demonstrated fiber-FSO-5G wireless convergent system is a promising one toward optical-based long-haul networks at comparatively high-speed operations. It exhibits an excellent convergence not only due to its development for incorporating optical fiber with optical/5G wireless networks, but also due to its enhancement for flexible two-way high-speed and long-haul communications.

Hepatitis B virus (HBV) infection has been proposed to play a role in the development of Sjögren's syndrome. However, to date, there are no reports on the risk of SS in HBV-infected patients following nucleos(t)ide analogue therapy. Due to Taiwan has higher prevalence of HBV infection and therapy was well recorded in the Taiwan's single-payer national health insurance database, we hypothesized that a long-term retrospective analysis of the risk of Sjögren's syndrome in HBV-infected patients following nucleotide therapy will increase our understanding of Sjögren's syndrome development following HBV infection. We identified 26,147 adults diagnosed with HBV infection between 1997 and 2012 in claims data. Finally, a total of 3268 HBV-infected patients who ever received nucleotide therapy (treated cohort) were frequency-matched on age and sex at 1:4 ratios to select a control group of 13,072 counterparts without therapy (untreated cohort). To identify Sjögren's syndrome risk, competing risk analysis adjusted for all covariates was performed. The risk was significantly lower in the treated cohort (15-year cumulative incidence, 2.4%; 95% confidence interval [CI], 1.4%-3.7%) than in the untreated cohort (7.1%; 95% CI, 2.5%-15.2%) (p = .015), and the adjusted HR was 0.6 (95% CI, 0.41-0.88; p = .009). Multivariable stratified analysis further verified the consistent associations between nucleoside therapy and risk reduction of Sjögren's syndrome across all strata. Our finding suggests that HBV infection treated with nucleotides is associated with lower risk of Sjögren's syndrome, implying a potential role of HBV infection in the development of Sjögren's syndrome.

Background: Chronic obstructive pulmonary disease (COPD) is a lung disease caused by the occurrence of airflow limitation in the lungs and also causes 60% of all deaths in Indonesia. Purpose: This study aimed to analyze the risk factors that affect the incidence of COPD in Indonesia. Methods: This study was conducted in July–August 2019 in Indonesia as an analytic research study with a cross-sectional design, using data from the Indonesia Family Life Survey-5. The sample consisted of respondents aged >15 years, giving a total of 34,231 respondents. Data analysis was partially carried out using the chi-square test to analyze the relationships between the variables. Results: The majority of respondents were female, were aged 40 years (p = 0.02; PR = 1.20; 95% CI = 1.02–1.41), male gender (p = 0.01; PR = 1.26; 95% CI = 1.07–1.49), smoking (p = 0.01; PR = 1.22 ; 95% CI = 1.03–1.44), first smoking age < 40 years (p = 0.02; PR = 1.22; 95% CI = 1.03–1.44), residence in urban areas (p = 0.01; PR = 1.43; 95% CI = 1.20–1.70), being underweight (p = 0.01; PR = 2.17; 95% CI = 1.76–2.66). Conclusions: The risk factors that affect the incidence of COPD include being aged >40 years, being male, smoking, taking up smoking when aged

To investigate the overall and sex-age-specific absolute and relative risks of motorcycle collisions at road traffic accidents among patients with type 2 diabetes.A cohort study in Taiwan was conducted by following 989,495 patients with type 2 diabetes and the same number of matched controls recruited between 2010 and 2012 to the end of 2016. Collision events by motorcycle driver victims were identified from the Police-reported Traffic Accident Registry. Overall and sex-age-specific incidence rates of collision involving motorcycle driver victims were estimated under Poisson assumption. The Cox proportional hazard regression models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of collision in association with type 2 diabetes.Over an up to 7 years of follow-up, patients with type 2 diabetes had a higher incidence rate of motorcycle collision than controls at 1.16 and 0.89 per 100 person-years, respectively, which represented a significantly elevated HR of 1.28 (95% CI 1.27-1.30) after adjusting for potential confounders including various diabetic complications. The elevated HR was similarly seen in both men and women patients, and was significantly decreasing with increasing age regardless of sex. Little evidence supported the dose-response relationship between duration of type 2 diabetes and motorcycle collision risk.After adjustment for common diabetic complications and comorbidities that could impair driving performance, patients with type 2 diabetes still suffered from increased risk of motorcycle collisions, regardless of sex, but was more evident in younger than in older patients.

Background: To evaluate the correlation between carpal tunnel pressure (CTP) and the clinical presentations, and to explore the possible predictors for the postoperative recovery pattern in patients with carpal tunnel syndrome (CTS). Materials and Methods: Consecutive patients with idiopathic CTS following percutaneous ultrasound-guided carpal tunnel release (UCTR) were enrolled. CTP was measured preoperatively and immediately after operation. The Boston Carpal Tunnel Questionnaire (BCTQ) and the cross-sectional area (CSA) of median nerve were recorded preoperatively and at 1, 3, and 12 months postoperatively. Results: 37 patients (37 hands; 8 men and 29 females; median age, 59.0 years) were enrolled. CTP significantly decreased immediately from 40.0 (28.0–58.0) to 13.0 (8.0–20.0) mmHg after UCTR. BCTQ scores significantly improved at 1 month postoperatively, and the improvement trend persisted until 12 months postoperatively (p < 0.001). Preoperative CTP was positively correlated with preoperative CSA and preoperative BCTQ scores (p < 0.05, all). Using group-based trajectory modeling, all patients were categorized into the “gradual recovery” or “fast recovery” group. Higher preoperative CTP was significantly associated with a faster recovery pattern (odds ratio: 1.32). Conclusions: Preoperative CTP was well correlated with the clinical presentations and might be a useful predictor for the postoperative clinical recovery pattern.

Few countries required people living in collective facilities to undergo quarantine during the COVID-19 pandemic, which could lead to more psychological effects than quarantine at home or hotels. This study assessed the changes in depression, anxiety, and quality of life (QOL) among residents of a collective quarantine facility in central Taiwan.Between April and November 2020, 660 collective quarantine facility residents participated in the survey conducted on the first and last days of the 14-day quarantine period. Questionnaires of Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder (GAD-7), and WHO quality of life (WHOQOL)-BREF were used to measure depression and anxiety symptoms, and QOL, respectively. Linear regression model with generalization estimation equation method was for estimating the differences in depression, anxiety, and QOL between two surveys and to test the changes of associations between them over time.PHQ-9 and WHOQOL-BREF scores showed no significant changes, but GAD-7 score decreased during quarantine (p = 0.011, Cohen's d = -0.11). Both PHQ-9 and GAD-7 were negatively associated with overall and domain-specific WHOQOL-BREF scores on both the first and last days of quarantine. Such associations did not significantly vary with time, except for the association between PHQ-9 and environmental domain WHOQOL-BREF score, being stronger on the first day than on the last day of quarantine (p = 0.041, η2 = 0.0021).A significant decrease in anxiety among quarantined individuals over a 14-day quarantine period was found. While depression was negatively associated with overall QOL, the strength of association between depression and environmental domain QOL decreased over the period.

Arsenic in drinking water has been recognized as carcinogenic to humans and can cause solid cancers of lung, urinary bladder, and skin. Positive associations have also been reported between arsenic ingestion and cancers of kidney, liver and prostate. Nevertheless, arsenic trioxide has been used successfully in the treatment of acute promyelocytic leukemia. Therefore, arsenic might play different roles in the carcinogenesis of solid cancers and hematologic malignancies. The relationship between arsenic in drinking water and the incidences of hematologic malignancies has not been fully investigated. We established a cohort of Taiwanese population and assorted 319 townships of Taiwan into two exposure categories using 0.05 mg/L as the cutoff. Then, we linked these data to the Taiwan Cancer Registry and computed standardized incidence ratios (SIRs) of lymphoma and leukemia by sex, exposure category and time period. The trend of changes in the SIRs over time was assessed, from 1981–1990 to 1991–2000 and then to 2001–2010. We found that in both lymphoma and leukemia, the higher exposure category was associated with lower SIRs in both men and women. In terms of time trends, the SIRs in both lymphoma and leukemia showed increasing trends in both sexes, while exposure to arsenic in drinking water decreased over time. The arsenic level in drinking water was negatively associated with the incidences of lymphoma and leukemia in both men and women. This study supports the dual effects of arsenic on carcinogenesis, with a potential protective effect against hematologic malignancies.

A bidirectional free-space optical (FSO) communication through a 600-m free-space transmission is built, employing a phase modulation (PM) scheme and a remotely injection-locked distributed feedback laser diode (DFB LD) for presentation. With optimum injection locking, a DFB LD is excellent for duplex transceiver operations. An injection-locked DFB LD not only operates as a PM-to-intensity modulation converter with an optical detector, but also functions as an upstream optical carrier. To be the first one of employing a remotely injection-locked DFB LD to detect a phase-modulated 25-Gb/s/25-GHz four-level pulse amplitude modulation (PAM4) passband signal, the DFB LD with remote injection locking is successfully intensity-modulated with an upstream 25-Gb/s non-return-to-zero (NRZ) signal. Good bit error rate performance and clear PAM4/NRZ eye diagrams show that this FSO communication can use a remotely injection-locked DFB LD to detect the downstream phase-modulated PAM4 signal and concurrently deliver an upstream intensity-modulated NRZ signal. This bidirectional 25-Gb/s/25-GHz (downstream)/25-Gb/s (upstream) FSO communication is prominent due to its enhancement in two-way high-speed optical wireless communications.

Background Sleep-related breathing disorders (SRBD) not only adversely impact cardiovascular and pulmonary functions but also reduce the quality of life. This study attempted to investigate the severity and related factors of SRBD among human immunodeficiency virus (HIV)-infected people with sleep complaints. Methods A cross-sectional study was conducted among HIV-infected people with Pittsburgh Sleep Quality Index (PSQI) values above 5 points. SRBDs were defined as Apnea-Hypopnea Index (AHI) over 5 events/hour by full channel home-based polysomnography (PSG). An AHI greater than 30 was categorized as moderate to severe apnea. All of the participants were asked to rate the severity of their snoring, complete a snore outcomes survey (SOS) and complete the PSQI. Multiple logistic regression analysis was conducted to examine the associated factors of severity of SRBD among HIV-infected people. Results Of 54 male HIV-positive patients with sleep complaints, 34 subjects (62.96%) were diagnosed with SRBDs, and 29.63% were categorized as having moderate to severe SRBD. SOS score was significantly associated with HIV patients with moderate to severe SRBD (adjusted odds ratio = 0.93, 95% CI: 0.87-1.00, p = 0.045). Conclusions SRBDs is highly prevalent in male HIV-infected people with sleep complaints. Intensive snoring was one of the indicators associated with the occurrence of moderate to severe SRBDs among HIV-infected people. Healthcare professionals should include snoring screening in the regular course of clinical HIV care.

Pregnancy‐associated cancer (PAC), defined as cancers diagnosed during pregnancy or the first year after delivery, affects one to two in every 1000 pregnancies. Although PAC is expected to be a growing issue, information about PAC in the Asian population is still scarce. Women with cancer diagnosed at the age of 16–49 years between 2001 and 2015 were selected from the Taiwan Cancer Registry and linked with the National Birth Reporting Database to identify PAC patients. We compared the overall survival of patients with PAC to patients without pregnancy. Among 126,646 female cancer patients of childbearing age, 512 were diagnosed during pregnancy, and 2151 during the first postpartum year. Breast cancer was the most common PAC (N = 755, 28%). Compared with patients without pregnancy in the control group, patients with cancers diagnosed during pregnancy and the first postpartum year generally had more advanced stages (odds ratio 1.35 and 1.36, 95% confidence interval [CI] 1.02–1.77 and 1.18–1.57, respectively). For all cancer types combined and controlled for the stage, age, and year of diagnosis, patients with PAC had similar overall survival with those in the control group, with a hazard ratio (HR) of 1.07 (95% CI 0.80–1.41) for the pregnancy group and HR 1.02 (95% CI 0.88–1.18) for the postpartum group. The diagnosis of breast cancer during the first postpartum year was linked with shorter survival (HR 1.34, 95% CI 1.05–1.72). In contrast, patients with postpartum lymphoma (HR 0.11, 95% CI 0.02–0.79) and cervical cancer (HR 0.40, 95% CI 0.20–0.82) had better prognosis. In general, the diagnosis of cancer during pregnancy or the first postpartum year does not affect the survival of patients with most cancer types. Exceptions include the worse prognosis of postpartum breast cancer and the better outcome of postpartum lymphoma and cervical cancer., A national population‐based study of patients with pregnancy‐associated cancers from Taiwan showed various impacts of pregnancy on the outcome of patients with different types of cancer.

A full-duplex self-recovery optical fibre transport system is proposed on the basis of a novel passive single-line bidirectional optical add/drop multiplexer (SBOADM). This system aims to achieve an access network with low complexity and network protection capability. Polarisation division multiplexing technique, optical double-frequency application and wavelength reuse method are also employed in the transport system to improve wavelength utilisation efficiency and achieve colourless optical network unit. When the network comprises a hybrid tree–ring topology, the downstream signals can be bidirectionally transmitted and the upstream signals can continuously be sent back to the central office in the reverse pathways due to the remarkable routing function of the SBOADM. Thus, no complicated optical multiplexer/de-multiplexer components or massive optical switches are required in the transport system. If a fibre link failure occurs in the ring topology, then the blocked network connections can be recovered by switching only a single optical switch preinstalled in the remote node. Simulation results show that the proposed architecture can recover the network function effectively and provide identical transmission performance to overcome the impact of a breakpoint in the network. The proposed transport system presents remarkable flexibility and convenience in expandability and breakpoint self-recovery.

Background The epidemiology of diabetes and idiopathic cardiomyopathy have limited data. We investigated the overall and the age-, sex-, and urbanization-specific incidence and relative hazard of idiopathic cardiomyopathy in association with type 2 diabetes and various anti-diabetic medications used in Taiwan. Methods A total of 474,268 patients with type 2 diabetes were identified from ambulatory care and inpatient claims in 2007–2009 from Taiwan’s National Health Insurance (NHI) database. We randomly selected 474,266 age-, sex-, and diagnosis date-matched controls from the registry of NHI beneficiaries. All study subjects were linked to ambulatory care and inpatient claims (up to the end of 2016) to identify the possible diagnosis of idiopathic cardiomyopathy. The person-year approach with Poisson assumption was used to estimate the incidence, and Cox proportional hazard regression model with Fine and Gray’s method was used to estimate the relative hazards of idiopathic cardiomyopathy in relation to type 2 diabetes. Results The overall incidence of idiopathic cardiomyopathy for men and women patients, respectively, was 3.83 and 2.94 per 10,000 person-years, which were higher than the corresponding men and women controls (2.00 and 1.34 per 10,000 person-years). Compared with the control group, patients with type 2 diabetes were significantly associated with an increased hazard of idiopathic cardiomyopathy (adjusted hazard ratio [aHR]: 1.60, 95% confidence interval [CI]: 1.45–1.77] in all age and sex stratifications except in those men aged > 64 years. Patients with type 2 diabetes aged Conclusions In Taiwan, diabetes increased the risk of idiopathic cardiomyopathy in both sexes and in all age groups, except in men aged > 64 years. Younger patients were vulnerable to have higher HRs of idiopathic cardiomyopathy. Some anti-diabetic medications may reduce the risks of cardiomyopathy.

BACKGROUND The 23-valent pneumococcal polysaccharide vaccine (PPSV23) is indicated for adults who have a high risk of pneumonia; however, its effectiveness in patients with prostate cancer who are at a risk of pneumonia because of age and cancer treatments, including androgen-deprivation therapy, is unknown. METHODS Between 2000 and 2010, 38,735 patients with prostate cancer were diagnosed in Taiwan. After exclusions and exact matching for age, previous pneumonia, and influenza vaccination, 2188 vaccinated patients and 2188 unvaccinated patients were recruited. The incidence density of all-cause bacterial pneumonia hospitalizations was analyzed. RESULTS Over 7 years of follow-up, patients who received the PPSV23 had a significantly lower incidence density, with 142.8 per 1000 person-years versus 162.0 per 1000 person-years for unvaccinated patients. More patients in the vaccinated cohort were never hospitalized for pneumonia compared with those in the unvaccinated cohort (64.2% vs 62.2%, respectively). After adjusting for the Charlson comorbidity index, cancer treatment modalities, and socioeconomic levels, the risk of pneumonia-related hospitalization in the PPSV23 vaccination cohort was 0.48 times lower than that in the unvaccinated cohort (adjusted incidence rate ratio, 0.48; P = .046). For patients who received the influenza vaccination, subgroup analysis demonstrated that PPSV23 vaccination significantly decreased the risk (adjusted incidence rate ratio, 0.45; P < .001). Compared with unvaccinated controls, PPSV23-vaccinated patients had a lower cumulative incidence for the first occurrence of pneumonia-related hospitalization (34.49% vs 36.36%; P = .178) and higher overall survival (47.5% and 42.3%, respectively; P < .001). CONCLUSIONS Vaccination of elderly patients who have prostate cancer with the relatively common and inexpensive PPSV23 can decrease the risk of pneumonia and prolong survival.

Background Acute exacerbation (AE) of COPD may be accompanied by the deterioration of cardiovascular comorbidities, as evidenced by the increased incidence of acute cardiovascular events. Research Question The goal of this study was to determine whether preceding AE might be associated with mortality of cardiovascular events. Study Design and Methods Using a health insurance research database in Taiwan, patients with COPD were identified who experienced first-time acute myocardial infarction (AMI; n = 26,442), ischemic stroke (n = 54,959), and intracranial hemorrhage (ICH; n = 14,893) over a 13-year period. In each cohort, 4,356, 6,655, and 1,727 patients, respectively, had been hospitalized for AE within the previous year prior to the index cardiovascular events, and patients with COPD but without hospitalization for AEs constituted the control subjects. ORs of 90-day mortality and hazard ratios (HRs) of overall mortality during follow-up in relation to hospitalization for an AE and the frequency of hospitalization for AEs (ie, 1 and ≥ 2 hospitalizations for AEs) were estimated with adjustment for potential confounders. Results Hospitalization for an AE was independently associated with 90-day mortality of AMI (OR, 1.33; 95% CI, 1.24-1.43), ischemic stroke (OR, 1.46; 95% CI, 1.36-1.56), and ICH (OR, 1.19; 95% CI, 1.06-1.32). Hospitalization for an AE was associated with overall mortality of AMI (HR, 1.23; 95% CI, 1.19-1.27), ischemic stroke (HR, 1.29; 95% CI, 1.26-1.33), and ICH (HR, 1.19; 95% CI, 1.13-1.26). In addition, compared with control subjects, patients with more frequent hospitalizations for AEs exhibited significant trends at higher risk of 90-day and overall mortality of AMI, ischemic stroke, and ICH. Finally, these results were consistent with propensity score matching-based estimates. Interpretation Preceding hospitalization for AEs is associated with 90-day and overall mortality of cardiovascular events in COPD.

Background Due to a lack of evidence from large-scale epidemiological studies by far on this issue, whether there is a link between Angelica sinensis exposure and breast cancer risk remained inconclusive. Methods We conducted a population-based case-control study using Taiwan’s National Health Insurance claim data, in which all breast cancer patients newly diagnosed between 2005 and 2008 were employed as the case group (n = 34,262) and a random sample of non-breast cancer individuals selected from 1-million beneficiaries registered in 2005 was served as the control group. For fair comparability, we employed the time density sampling method to select controls who were matched to case on date of breast cancer diagnosis and age with a case/control ratio of 1/3 (n = 102,786). Results We found that the use of Angelica sinensis presents a weakly but significantly protective effect on breast cancer (adjusted odds ratio (aOR) 0.95, 95% confidence interval (CI) 0.93–0.98), with a significant dose-gradient relationship. We also noted a stronger association with breast cancer with initial use of Angelica sinensis at a longer time before breast cancer diagnosis, and found that the seemingly protective effect of Angelica sinensis was more obvious among women who had initial use at 47–55 years (aOR 0.93, 95% CI 0.88–0.98). Conclusion This population-based case-control study revealed that exposure to Angelica sinensis showed a weakly but significantly protective effect on breast cancer risk, which could ease people’s concern over the potential carcinogenic effect from exposure to Angelica sinensis., Graphical abstract Image 105054, Highlights • Angelica sinensis was associated with a weakly protective effect on breast cancer. • The methodological strengths included population-based and a fairy large sample size. • Provide further insight to the link between phytohormone in TCM and breast cancer.

This work presents two wideband coplanar-waveguide bandpass filters using open-circuited stubs (Design 1) and short-circuited stubs (Design 2), respectively. The electrical lengths of stubs were ac...

Background Physical and social environments may influence cognition health in older adults. However, evidence regarding physical and social environments linked to dementia is lacking, especially in Asia. This study aims to explore the influence of physical and social environments on the incidence of dementia through a population-based case-control design in Taiwan. Methods We identified 26,206 incident cases with dementia aged≧65 years in 2010, with the same no. of controls from National Health Insurance claims. Environmental measures were collected from government statistics including three physical environments and three social environments. Multilevel logistic regression was used to estimate the odds ratios (ORs) and 95% confidence intervals (CI) of the association between dementia incidence and the environmental measures at the township level. Results We observed a significant reduction of 12% in the odds ratios of dementia in areas with higher availability of playgrounds and sport venues (OR 0.88, 95% CI 0.81–0.95), after controlling for individual and other environmental characteristics. Community center availability was also significantly associated with an 8% decreased odds for dementia (OR 0.92, 95% CI 0.87–0.99), but the association was not significant after further consideration of individual-level characteristics. Although higher odds of dementia were found in areas with high median annual family income (OR 1.14, 95% CI 1.04–1.25), such a significant relationship did not appear in the full model. Conclusions Our study suggests that specific physical and social environmental features have different influences on the risk of dementia. Public health interventions may consider these environmental aspects for preventing dementia incidence.

BACKGROUND An unconventional risk factor, "dysfunction of hemodialysis vascular access", was demonstrated to be associated with subsequent major adverse cardiovascular events (MACE) in our previous study. However, applying this suggestion in a clinical scenario may be not intuitive. A group-based trajectory model was applied to further recognize those patients with the highest risks for MACE.Methods and Results:In a cohort of patients who received hemodialysis from 2001 to 2010, we identified 9,711 cases that developed MACE in the stage of stable maintenance dialysis, and 19,422 randomly selected controls matched to cases on age, gender and duration of dialysis. Events of vascular access dysfunction in the 6-month period before MACE for cases and index dates for controls were evaluated. By group-based trajectory modeling, patients according to their counts of vascular access dysfunction in each month over the 6-month period prior to MACE or index dates were categorized. There were 26,744 patients in group 1 (no dysfunction), 650 in group 2 (escalating dysfunction) and 1,739 in group 3 (persistent dysfunction). Logistic regression analysis indicated that patients in group 3 had the highest chance of subsequent MACE (odds ratio 2.47, in comparison with group 1) after controlling for all the available potential confounders. CONCLUSIONS Uninterrupted clusters of vascular access dysfunction are associated with a higher risk of subsequent MACE.

Four-switch current sensorless control for three-phase four-switch converter with power factor correction (PFC) function is presented in this letter. In comparison with conventional multiloop control methods, the proposed control strategy requires sensing of two line voltages and two capacitor voltages only to achieve PFC function. As there is no sensing current, the proposed sensorless control scheme reduces the cost and complexity of design. The performance of the proposed control is validated by its implementation in digital signal processing (DSP) TMS320F28335, and the result shows that the proposed scheme is able to provide comparable PFC performance without sensing current.

A wavelength-division-multiplexing (WDM) four-level pulse amplitude modulation (PAM4) free-space optical (FSO)–underwater wireless optical communication (UWOC) integrated system with a channel capacity of 100 Gb/s is proposed and attainably demonstrated. Analytic results reveal that 1.8-GHz 405-nm blue-violet-light and 1.7-GHz 450-nm blue-light laser diodes (LDs) with two-stage light injection and optoelectronic feedback techniques are competently adopted for 100 Gb/s PAM4 signal transmission through a 500-m free-space transmission with 5-m clear ocean underwater link. Combining dual-wavelength WDM scenario with PAM4 modulation, the channel capacity of FSO–UWOC integrated systems is significantly enhanced with an aggregate transmission rate of 100 Gb/s (25 Gbaud PAM4/wavelength × 2 wavelengths). With doublet lenses in FSO, laser beam reducer and transmissive spatial light modulator in UWOC, a sufficiently low bit error rate of 10−9 and acceptable PAM4 eye diagrams are acquired. This demonstrated 100 Gb/s PAM4 FSO–UWOC integrated system with a WDM scenario is advantageous for the enhancement of a high-speed optical wireless link with long-reach transmission.