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主動脈竇動脈瘤是一種罕見的心臟結構病變，因具非特異性表徵及困難診斷，容易導致高死亡風險。本案例是一位53歲男性患者，因急性胸痛入院治療，藉由實驗室檢查發現心肌酵素升高、D-二聚體升高，心電圖檢查為aVR導程ST段上升、於第I、II、V4~6導程出現ST-T波段變化，初步診斷為左冠狀動脈主幹心肌梗塞，立即行冠狀動脈攝影檢查發現無異常。個案出現胸痛合併心因性休克之症狀，從中排除主動脈剝離、肺栓塞、心包填塞等診斷，深入檢視病史紀錄及影像報告，發現心臟超音波、胸部電腦斷層及冠狀動脈血管攝影檢查有由左流向右心室的瘻管分流，最終確診為主動脈竇動脈瘤破裂。患者緊急接受右冠狀竇動脈瘤修補及主動脈瓣置換手術治療後，胸痛、休克狀況改善且左心室功能恢復，術後預後良好。在面對急性胸痛合併血液動力學不穩定的患者時，除了須考慮症狀相關的疾病診斷外，當聽診發現S1及S2連續性心雜音時，建議將主動脈竇動脈瘤破裂列入考慮，以掌握治療處置之重要時機。 Aneurysm of the sinus of Valsalva is a rare cardiac anomaly due to the nonspecific symptoms and dif-ficult confirmation of diagnosis leading to high mortality. This report describes the case of a 53-year-old man who had suffered from acute chest pain. The electrocardiogram showed the ST segment ele-vation in lead aVR and ST-T wave changes in leads I, II and V4-6. Elevated D-dimer levels and cardi-ac enzymes were also observed. Acute myocardial infarction caused by the left main coronary artery obstruction was initial diagnosed. Coronary angiogram was performed immediately and the result indicated non-obstructive coronary artery. However, cardiogenic shock with persistent chest pain was discovered. Aortic dissection, pulmonary thromboembolism and cardiac tamponade were gradually excluded. Through detailed review and analysis of medical history, physical assessment and image ex-aminations with echocardiography, chest computed tomography and coronary angiogram, a ruptured sinus of Valsalva aneurysm was eventually diagnosed based on image examinations which revealed left-to-right shunt communicating with the right-sided heart chambers. The patient received emergen-cy right coronary sinus aneurysm repairment and aortic valve replacement surgery. Symptoms with chest pain and shock gradually disappeared and left ventricular function was restored postoperatively. The patient demonstrated excellent recovery. In facing relevance diagnostics for patients with acute chest pain and hemodynamic instability, a ruptured sinus of Valsalva aneurysm must be considered to endure best treatment timing if heart auscultation reveals S1 and S2 continuous murmurs. &nbsp

This study examined the reliability of 31phosphorus-magnetic resonance spectroscopy (31P-MRS) to measure parameters of liver metabolic function in the intact animals. These parameters can help us to evaluate the severity and prognosis of liver fibrosis. In addition, 31P-MRS was also used to examine the protective effects of melatonin on liver mitochondria. An animal model of liver fibrosis was established via intraperitoneal administration of thioacetamide (TAA) to rats. Rats were scanned at baseline, week 3 and 6 after TAA treatment, respectively, to measure the longitudinal changes of phosphorus metabolite levels by 31P-MRS at 9.4 T. The results showed a consistent decline in the levels of phosphorus metabolites (inorganic phosphate, α-ATP, γ-ATP and NADH) in rats with fibrosis. Impaired mitochondrial respiration capacity, collagen accumulation and the extent of fibrosis in liver were markedly associated with decreased concentrations of phosphorus metabolites. Melatonin-pretreated mitochondria transferring efficiently prevented TAA-induced liver damage mainly by restoring mitochondrial function. In conclusion, the levels of phosphorus metabolites could serve as the indicators of mitochondrial oxidative capacity and thus provides a novel tool to evaluate mitochondrial integrity in the in vivo condition by using 31P-MRS in the setting of liver fibrosis.

Background and Objectives: Cultural beliefs influence the conceptualization, adaptation, and coping strategies for diseases. This study aimed to investigate the impact of cultural beliefs and customs on the willingness to undergo cataract surgery in Taiwan. Materials and Methods: The data were retrospectively retrieved from the national Longitudinal Health Insurance Database 2000 (LHID2000). From the national database, we enrolled patients that were diagnosed with cataracts and underwent cataract surgery from 2001 to 2010. All the patients were stratified according to their gender and living area. Gender was categorized as male or female, and the living area was classified as urban or rural. We compared the difference in the number of surgeries between stratified patient groups in each Chinese lunar month. Results: The number of cataract surgeries decreased significantly in the seventh and twelfth lunar months for both genders. There was a significant reduction in cataract surgeries in both the urban and rural groups during the seventh lunar month. Interestingly, only the seventh lunar month had an association with sex in different living areas, which meant that in the seventh month, there was a gender-specific difference in the surgical numbers. Conclusions: The Taiwanese population holds a belief that surgical procedures, including cataract surgery, during the lunar ghost month is inauspicious. Citizens tend to avoid elective surgery due to cultural practice, resulting in a decrease in surgical numbers during the period of the Chinese New Year. The authorities should consider these cultural behaviors when developing medical policies and allocating resources. Healthcare providers should be aware of these superstitions and take them into account when providing medical care and advice to patients.

A multi-well tracer test was conducted in a volcanic area where is mainly composed of sedimentary rocks units and tuff breccia with attitude of the N46E, 18S. in Northern Taiwan. The distance between the injection well #14 and monitoring wells #-2 and #6 are 236 and 682 m, respectively.A Bimodal breakthrough curve was received from both wells indicating the existence of more than one channel in the system. Surprisingly, the first peak arrives simultaneously at both wells with almost a 3 times difference in distance. A much fast flow between Well #14 and #6 was found. This result matches the local orientation of the formation and may show strong geology control groundwater flow of the region resulting in a preferential flow. With the moment analysis, the difference in communication between the injection well and the two monitoring wells can be depicted by 50% of the flow circulation coming from 25% and 30% storage capacity for Well #2 and Well #6, respectively implying that groundwater flows through more fractures between Well #14 and 6. An obvious tailing breakthrough curve of Well #6 also reflects more fractures than that of Well #2.

Stable isotopes, δ2H and δ18O, of precipitation and groundwater in two adjacent catchments, the north, and south, in the Tatun Volcanic Group, Taiwan were used to characterize the regional groundwater. The results show that the isotopic composition of precipitation exhibits seasonal variations, which suggests different sources of moisture generation for the rainfall in the study area. In general, the north catchment shows more enriched isotopic characteristics than that of the south one. The seasonal variations of precipitation, with lighter in summer, arise from changes in isotopic water vapor composition associated with the seasonal activity of the Asian monsoon which was used in estimating the mean residence time (MRT) of groundwater in the region. The preliminary results show that the average MRT of the study area ranges from 180 to 500 days in the north catchment while it is 180 to 900 days in the south catchment.

A tracer test, involving conservative and reactive, was conducted in a volcanic area in Northern Taiwan to evaluate shallow groundwater characteristics. The distance between injection Well #14 and monitoring Wells #2 and #6 are 236 and 682 m, respectively. A breakthrough curve was received from both wells for conservative tracer, 2,6NDS, while the reactive one was obtained only at Well#6 indicating the existence of heterogeneity in groundwater and fracture distribution in the region. A much fast flow between Well#14 and #6 was found as the first peak arrives at the same time with a 3 times difference in distance. This result matches the local orientation of the formation and may show strong geology control groundwater flow of the region resulting in a preferential flow. However, a chaser influence was identified by an irregularity of breakthrough curves for both wells.

Background Empyema thoracis is a serious infectious disease and is associated with high morbidity and mortality. The perioperative outcomes between culture-positive and culture-negative empyema after thoracoscopic decortication remained controversial, especially since there were no studies that reported the survival outcomes between culture-positive and culture-negative empyema. Methods This single-institute study involved a retrospective analysis. Patients with empyema thoracis who underwent thoracoscopic decortication between January 2012 and December 2021 were included in the study. Patients were grouped into a culture-positive group and a culture-negative group according to culture results obtained no later than two weeks after surgery. Results There were 1,087 empyema patients who received surgery, and 824 patients were enrolled after exclusion. Among these, 366 patients showed positive culture results and 458 patients showed negative results. Longer ICU stays (11.69 vs. 5.64 days, p Conclusions Culture-positive and culture-negative empyema patients who underwent thoracoscopic decortication showed similar short-term and long-term survival outcomes. A higher risk of death was associated with advanced age, a higher CCI score, phase III empyema and a cause other than pneumonia.

Purpose: Indoleamine 2,3-dioxygenase (IDO), an enzyme that degrades tryptophan, is a negative immune regulatory molecule of dendritic cells. IDO-expressing dendritic cells suppress T cell responses and may be immunosuppressive in vivo. We hypothesized that silencing the IDO expression in skin dendritic cells in vivo could elicit antitumor activity in tumor-draining lymph nodes.Experimental Design: The efficiency of IDO-specific small interfering RNA (siRNA) was evaluated in vitro and in vivo. The therapeutic effect was evaluated in MBT-2 murine bladder tumor model and CT-26 colon tumor models.Results: IDO expression was down-regulated in CD11c-positive lymphocytes after IDO siRNA treatment. In vivo skin administration of IDO siRNA inhibited tumor growth and prolonged survival in both tumor models. The number of infiltrated T cells and neutrophils increased at tumor sites, which are correlated with therapeutic efficacy. The T cells may be mainly responsible for the immunologic rejection because the effect was abolished by depletion of CD8-positive T cells. Adoptive transfer of CD11c-positive dendritic cells from vaccinated mice delayed tumor progression. The cancer therapeutic effect was reproducibly observed with another IDO siRNA targeting at different site, suggesting the effect was not due to off-target effect. In a neu-overexpressing MBT-2 tumor model, IDO siRNA enhanced the therapeutic efficacy of Her2/Neu DNA vaccine. Down-regulation of IDO2, an IDO homologue, with siRNA also generated antitumor immunity in vivo.Conclusions: Antitumor immunity can be effectively elicited by physical delivery of siRNAs targeting immunoregulatory genes in skin dendritic cells in vivo, as shown by IDO and IDO2 in this report.

Supplementary Data from A Novel Cancer Therapy by Skin Delivery of Indoleamine 2,3-Dioxygenase siRNA

BackgroundThis study tested whether early left intracoronary arterial (LAD) administration of human bone marrow-derived mesenchymal stem cells (hBMMSCs, called OmniMSCs) in acute ST-segment elevation myocardial infarction (STEMI) of Lee-Sung pigs induced by 90 min balloon-occluded LAD was safe and effective.Methods and resultsYoung male Lee-Sung pigs were categorized into SC (sham-operated control, n = 3), AMI-B (STEMI + buffer/21 cc/administered at 90 min after STEMI, n = 6), and AMI-M [acute myocardial infarction (AMI) + hBMMSCs/1.5 × 107/administered at 90 min after STEMI, n = 6] groups. By 2 and 5 months after STEMI, the cardiac magnetic resonance imaging demonstrated that the muscle scar score (MSS) and abnormal cardiac muscle exercise score in the infarct region were significantly increased in the AMI-B than in the SC group that were significantly reversed in the AMI-M group, whereas the left ventricular ejection function by each month (from 1 to 5) displayed an opposite pattern of MSS among the groups (all p p 80%) was significantly earlier (estimated after 6-h AMI) in the AMI-M group than in the AMI-B group (p p ConclusionEarly intra-LAD transfusion of OmniMSC treatment effectively reduced the infarct size and preserved LV function in porcine STEMI.

Background: Thoracic empyema is a serious infectious disease worldwide. Video-assisted thoracoscopic surgery is strongly recommended as a treatment, and pleural fluid and tissue cultures can be obtained intraoperatively. The combination of a pleural peels tissue culture and a pleural fluid culture improves the positive culture rate. We aimed to investigate the role of sputum cultures to determine the optimal management for improving surgical outcome. Methods: This retrospective study identified 1197 patients with phase II or III thoracic empyema from our institution. Patients who underwent decortication of the pleura from April 2011 to May 2022 with a positive pleural culture were included. Results: There were 225 empyema patients with either a positive pleural fluid culture or a positive pleural peel tissue culture. Of these, 76 patients had positive sputum culture findings during hospitalization. The most common species of pathogens were Pseudomonas aeruginosa (44%) and Klebsiella pneumoniae (16%) in the sputum cultures and Streptococcus spp. (20%) and Staphylococcus aureus(11%) in the pleural cultures. There were 30 patients who had a common pathogen in a sputum culture and in the pleural fluid/tissue culture. Poor outcome measures were found in these patients, including the longer use of antibiotics preoperatively (19.03±37.66 days versus 9.59±27.09 days, p=0.006) and a higher mortality rate during hospitalization (40.0% versus 17.4%, p=0.002). Conclusions: The sputum culture plays an essential role in diagnosis of bacterial empyema and in prediction of surgical outcome. Obtaining the sputum specimen promptly through proper methods helps to improve the survival of empyema patients.

Forest fires are among the most critical natural tragedies threatening forest lands and resources. The accurate and early detection of forest fires is essential to reduce losses and improve firefighting. Conventional firefighting techniques, based on ground inspection and limited by the field-of-view, lead to insufficient monitoring capabilities for large areas. Recently, due to their excellent flexibility and ability to cover large regions, unmanned aerial vehicles (UAVs) have been used to combat forest fire incidents. An essential step for an autonomous system that monitors fire situations is first to locate the fire in a video. State-of-the-art forest-fire segmentation methods based on vision transformers (ViTs) and convolutional neural networks (CNNs) use a single aerial image. Nevertheless, fire has an inconsistent scale and form, and small fires from long-distance cameras lack salient features, so accurate fire segmentation from a single image has been challenging. In addition, the techniques based on CNNs treat all image pixels equally and overlook global information, limiting their performance, while ViT-based methods suffer from high computational overhead. To address these issues, we proposed a spatiotemporal architecture called FFS-UNet, which exploited temporal information for forest-fire segmentation by combining a transformer into a modified lightweight UNet model. First, we extracted a keyframe and two reference frames using three different encoder paths in parallel to obtain shallow features and perform feature fusion. Then, we used a transformer to perform deep temporal-feature extraction, which enhanced the feature learning of the fire pixels and made the feature extraction more robust. Finally, we combined the shallow features of the keyframe for de-convolution in the decoder path via skip-connections to segment the fire. We evaluated empirical outcomes on the UAV-collected video and Corsican Fire datasets. The proposed FFS-UNet demonstrated enhanced performance with fewer parameters by achieving an F1-score of 95.1% and an IoU of 86.8% on the UAV-collected video, and an F1-score of 91.4% and an IoU of 84.8% on the Corsican Fire dataset, which were higher than previous forest fire techniques. Therefore, the suggested FFS-UNet model effectively resolved fire-monitoring issues with UAVs.