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With the advance of modern semiconductor technology, the power density of electronic devices significantly increases. The performance of electronic devices is thereby governed by the efficiency of heat dissipation from heat source to heat sink, which requires better thermal management methods. Thermal interface materials (TIMs), placed between the heat source and heat sink, help a conduction pathway by providing a low thermal resistance conduit and eliminating the air gaps between two contact surfaces. However, most of commercially available TIMs show limited performances as they are either thermally conductive but stiff (e.g., metals) or mechanically ductile but with high thermal resistance (e.g., polymers). In this study, we suggest a new type of metal/polymer composite TIMs by combining the advantages from those two materials in order to develop a thermally conductive and mechanically compliant material at a low cost. TIMs are fabricated by using a hydrogen bubble templated electrodeposition method that forms microscale cavities and nanoscale nanofeatures on copper substrate, bi-porous copper (BPCu). The bi-porous copper is then sintered to enhance the structural strength and is infiltrated by polydimethylsiloxane (PDMS) to increase its structural flexibility and durability against mechanical or thermal stresses. Then, the pressure-dependent thermal resistances through the TIMs are measured by assuming one-dimensional thermal conduction. The measurements confirm that the average effective thermal conductivities range from 10–30 W/mK for 80% PDMS filling ratio sample. In addition, mechanical strength augmentations for BPCu/PDMS TIM are discussed, and the result shows mechanical strength enhancement with PDMS infiltration by means of less structure deformation.

N-retinylidene-N-retinylethanolamine (A2E) and other bisretinoids are components of lipofuscin and accumulate in retinal pigment epithelial (RPE) cells&mdash, these adducts are recognized in the pathogenesis of retinal degeneration. Further, blue light-emitting diode (LED) light (BLL)-induced retinal toxicity plays an important role in retinal degeneration. Here, we demonstrate that low-luminance BLL enhances phototoxicity in A2E-laden RPE cells and rats. RPE cells were subjected to synthetic A2E, and the effects of BLL on activation of apoptotic biomarkers were examined by measuring the levels of cleaved caspase-3. BLL modulates the protein expression of zonula-occludens 1 (ZO-1) and paracellular permeability in A2E-laden RPE cells. Early inflammatory and angiogenic genes were also screened after short-term BLL exposure. In this study, we developed a rat model for A2E treatment with or without BLL exposure for 21 days. BLL exposure caused fundus damage, decreased total retinal thickness, and caused neuron transduction injury in the retina, which were consistent with the in vitro data. We suggest that the synergistic effects of BLL and A2E accumulation in the retina increase the risk of retinal degeneration. These outcomes help elucidate the associations between BLL/A2E and angiogenic/apoptotic mechanisms, as well as furthering therapeutic strategies.

PT-peptide is derived from the anti-lipopolysaccharide factor of the swimming crab Portunus trituberculatus. The peptide, consisting of 34 amino acids, contains a lipopolysaccharide binding domain. In this study, we investigated the effect of PT-peptide encapsulated in raw milk-derived extracellular vesicles (EVs), designated as EVs-PT peptide, on immune regulation. The results showed that raw milk-derived EVs efficaciously delivered the PT-peptide into monocytes and elevated immune activity, including reactive oxygen species level, superoxide anion production, and phagocytosis. PT-peptide and EVs-PT peptide also elevated the secretion of cytokines, such as interferon-&gamma, interleukin-6, and tumor necrosis factor-&alpha, in human monocytic THP-1 cells. These results suggest that the PT-peptide could be developed as an immune stimulator.

Red yeast rice (RYR) has been used as an alternative treatment for hyperlipidemia. According to the previous studies, other compounds, besides monacolin K in RYR, may also reduce the serum lipid level. This study aims at examining the efficacy of monacolin K-rich and Gamma-Aminobutyric Acid (GABA)-rich RYR (Monascus pilosus) with regards to treating hyperlipidemia in a randomized control, double-blind clinical trial. In the research, we assigned 50 eligible subjects to monacolin K-rich RYR, GABA-rich RYR and placebo groups ([Formula: see text], 17, 17, respectively). The concentrations of TC, LDL-C, HDL, TG and blood biochemical data were evaluated at different phases: before applying (visit 1), after 1-month (visit 2), 2-month (visit 3), 3-month (visit 4) of providing the intervention and 1-month after ending the test food (visit 5) among three groups. During the 3-month intervention, the serum TC and LDL-C levels decreased significantly in the monacolin K group compared to the baseline and the other two groups. The Serum TG level declined steadily but was not statistically significant. Meanwhile, no marked differences in the serum HDL level were revealed among the three groups. Most safety assessment data had minor variation except two subjects (in monacolin K and GABA group separately) reported elevated liver enzymes. Monacolin K-rich RYR can reduce cholesterol as expected, while the GABA-rich RYR performed non-significant reduction on serum triglyceride. The research results demonstrate that using different concentrations and ratios between monacolin K and GABA could be beneficial for antihyperlipidemia.

Obstructive sleep apnea is a medical syndrome with multifactorial pathophysiology. Surgery can be the primary treatment option when anatomic factors are identified with narrowing at specific or general levels of pharyngeal airway. The surgeries are directed to the etiologic anatomic structure to achieve greatest effectiveness. Body weight, Mallampati scale, and tonsil grade are key evaluations to select effective surgical procedures. Surgical weight reduction, maxillomandibular advancement, and pharyngeal soft tissue surgeries are considered for the patient with obesity, maxillomandibular retrognathism, and tonsillar hypertrophy, respectively. Tailored surgical planning can meet the patients needs for airway, esthetics, and normal Angle's occlusion.

Introduction: Glioblastoma multiforme (GBM) is the most aggressive glioma, and its diffuse nature makes resection of it difficult. Moreover, even with the administration of postoperative radiotherapy and chemotherapy, prolonged remission is often not achieved. Hence, innovative or alternative treatments for GBM are urgently required. Traditional Chinese herbs and their functional components have long been used in the treatment of various cancers, including GBM. The current study investigated the antitumor activity of Wedelia chinensis and its major functional components, luteolin and apigenin, on GBM. Materials and Methods: MTT assay, Transwell migration assay, and flow cytometry analysis were adopted to assess the cell viability, invasive capability, and cell cycle. Immunofluorescence staining and Western blotting were used to detect the expressions of apoptotic and autophagy-related signaling molecules. Results: The W. chinensis extract (WCE) significantly inhibited the proliferation and invasive ability of both GBM8401 and U-87MG cells in a dose-dependent manner. Moreover, differential effects of WCE on GBM8401 and U-87MG cells were observed: WCE induced apoptosis in GBM8401 cells and autophagy in U-87MG cells. Notably, WCE had significant effects in reducing the cell survival and invasive capability of both GBM8401 and U-87MG cells than the combination of luteolin and apigenin. Conclusions: Taken together, these findings indicate the potential of using WCE and the combination of luteolin and apigenin for GBM treatment. However, further investigations are warranted before considering recommending the clinical use of WCE or the combination of luteolin and apigenin as the standard for GBM treatment.

Direct-plated-copper (DPC) aluminum nitride (AlN) substrate with a high thermal conductivity can provide a good alternative to conventional aluminum oxide (Al2O3) substrate for better heat dissipation in the high-power module applications. However, the DPC AlN substrate suffers AlN crack initiating at the edge corner of Cu film during thermal cycling, due to the higher thermal expansion coefficient mismatch with copper material. This study is to resolve the AlN crack problem of DPC AlN substrate during thermal cycling and further to provide important parameters for mechanical design for ensuring good thermal reliability. Prior to the analysis, the out-of-plane deformation measurement of a Cu-AlN bi-material plate subject to the solder reflow heating and cooling is conducted for evaluating the material property of the plated Cu film and residual stresses induced from the manufacturing and solder reflow process. The results show the hysteresis and Bauschinger-like behaviors for the Cu-AlN plate during the solder-reflow heating and cooling. It is also found from the validated finite element simulation that the Cu-film wedge angle, length, and thickness significantly affect the maximum 1st principal stress of AlN during thermal cyclic loading, and the predicted failure mode and location based on the maximum 1st principal stress is consistent with experimental observation. The other factors, such as single-side and double-side Cu-film (sandwich-structure-alike) substrates, length difference of Cu films, and the nonlinear property of Cu film will be presented and discussed in detail as well.

Stock enhancement is a method for replenishing depleted wild finfish populations by supplementing them with hatchery-raised fish. In Taiwan, silver sea bream (Rhabdosargus sarba) is a predominant commercial species involved in stock enhancement projects. Although management agencies conduct stock enhancement projects, there are a lot of private releases without records. Stock enhancement is performed by the private aquaculture sector without accurate genetic records, potentially leading to unintended consequences for wild populations. We analyzed the genetics of 459 wild and 701 hatchery-reared specimens from nine batches produced by various hatcheries. Wild and hatchery-reared samples could be considered two separate clades by using a set of stable and informative microsatellite markers including type I (from gene introns and 3&prime, UTR) and type II markers (randomly picked up from genome). Type I microsatellite markers could more sensitively reflect the loss of genetic diversity more than type II markers in the domestication process. All specimens were considered native by using mtDNA COI and microsatellites. The genetic composition of the wild population is relatively simple, and the estimated low contribution rate of the hatchery stock (1.3&ndash, 10.9%, 6&ndash, 50/459) indicated a weak but significant genetic effect of stock enhancement. Therefore, establishing standards for the stock enhancement of silver sea bream for more effective supplementation of wild populations is imperative.

Polyps seen and not removed during colonoscope insertion are sometimes unable to be found during withdrawal. We aimed to evaluate whether additional inspection and polypectomy during insertion increases adenoma detection rate (ADR) compared with inspection and polypectomy entirely during withdrawal.A total of 421 patients aged ≥ 45 years and undergoing colonoscopy were prospectively randomized to receive inspection and polypectomy during both insertion and withdrawal (study group) or inspection and polypectomy entirely during withdrawal (control group). The primary outcome was the ADR. Secondary outcomes included other adenoma-related parameters and procedure-related measures.Baseline demographics, procedure indications, preparation quality, total procedure time, sedative doses, colonoscopy difficulty, and patient discomfort were similar between the groups. The insertion time was significantly longer in the study group (11.1 ± 4.8 vs 6.2 ± 4.7 min, P 0.0001). The withdrawal time was significantly longer in the control group (29.2 ± 9.8 vs 23.1 ± 7.9 min, P 0.0001). There was no significant difference in the ADR (63.5% [study group] vs 68.1% [control group]), the mean adenoma per procedure (1.6 ± 2.0 vs 1.9 ± 2.4), or the mean adenoma per positive procedure (2.5 ± 2.0 vs 2.7 ± 2.5) between groups. The proximal colon ADR was significantly higher in the control group compared with the study group (56.2% vs 46.0%, P = 0.041).Additional inspection and polypectomy during colonoscope insertion did not improve ADR compared with inspection and polypectomy entirely during withdrawal. These results do not support an additional role for routine inspection during insertion (clinical trial registration number: NCT03444090).

Goal The goal of this study was to estimate the risk of renal injury after the use of 3-L polyethylene glycol (PEG) before outpatient colonoscopy. Background Population-based studies showed that the use of PEG was associated with renal injury, but this association has not been confirmed by prospective study. Study Patients ≥40 years of age with an estimated glomerular filtration rate ≥30 mL/min were screened for enrollment. Laboratory data were collected before, during, and after the colonoscopies. Patients with a ≥30% increase in baseline serum creatinine levels were followed until a peak level was detected. Renal injury included acute renal dysfunction (ARD) and acute kidney injury (AKI), defined as a 30% to 49% increase and ≥50% increase in creatinine levels compared with the baseline, respectively. Results A total of 1163 patients (mean age, 55.7 y) completed the study. Baseline and first postcolonoscopy laboratory data were obtained an average of 17.0 days before and 17.3 days after the colonoscopies were performed, respectively. Renal injury was identified in 32 patients; 26 patients (2.2%) had ARD, and 6 patients (0.5%) had AKI. All patients with renal injury recovered fully during follow-up. In the subgroup analysis, the use of nonsteroidal anti-inflammatory drugs (NSAIDs) before colonoscopy was statistically associated with the development of AKI (odds ratio, 6.5; 95% confidence interval, 1.2-35.5; P=0.03). Conclusions This prospective study showed that the use of PEG was associated with a small risk of renal injury. NSAIDs use was statistically associated with AKI in the context of colonoscopy for which PEG was used for bowel preparation.

Backgrounds Myofunctional therapy has been reported to be a valid adjunct treatment to OSA, but compliance was mentioned as an issue. We performed a prospective study on age matched randomized children submitted to myofunctional therapy (MFT) or to a functional device used during sleep (passive MFT). Methods 110 children 4 to 16 were recruited for the study, 54 children were in the MFT group [A] while 56 were in the “nocturnal device” group [B]. Clinical evaluation, polysomnography and cephalometric X-Rays were performed at baseline, 6 months and 12 months, with clinical follow-up at 3 months. Results MFT group show very important absence of compliance, at six months only 23 subjects participated and only 10/23 had been compliant with treatment. None came back for research investigation at 12 months. 48/56 of passive MFT children ended the research protocol at 12 months. Comparison of baseline to 6 and 12 months data showed that all children with passive MFT improved (PSG and cephalometrics) and had nasal breathing during sleep at 1 year, and no negative effect of device were noted. The 10 children compliant with MFT showed clear improvement of sleep related breathing with also changes at cephalometric –X–rays. Conclusion Compliance is a major problem of MFT, and MFT will have to take into consideration the absolute need to have continuous parental involvement in the procedure. Passive MFT gives many more positive results, but potential negative effects of device on other jaw will have to be continuously evaluated.

Background and Aim: After endoscopic submucosal dissection (ESD) for esophageal neoplasms, some patients would have the diagnosis of submucosal (pT1b) cancers. How to manage these patients appropriately after the ESD has not been well elucidated. The aim of this study is to report the outcomes of the patients with pT1b esophageal cancers, with or without adjuvant therapy after the ESD. Patients and Methods: This is a retrospective observational study. Between May 2013 and November 2017, 23 patients (25 lesions) undergoing ESD with the results of pT1b esophageal squamous cell carcinomas were enrolled in this study. After the ESD, our protocol was to give the patients adjuvant therapy (surgery or chemoradiotherapy) for the following criteria: positive vertical resection margins,lymphovascular (LV) invasion in the resected specimens, and SM2 cancers (tumor invasion to submucosa deeper than 200 μm). Those patients did not meet the criteria or refused adjuvant therapy were followed-up closely. Results: The mean patient age was 56.3 year (range, 45-75 year). The mean resected specimen length was 4.6 cm (range, 1.5-9.5 cm). The en block resection rate for the ESD was 100%. Four patients had positive vertical resection margins, resulting in an en blockplus R0 resection rate of 82.6% (19/23). Four other patients had LV invasion in the resected specimens. These eight patients (34.8%) were regarded as incomplete treatment by the ESD and seven of them received adjuvant therapy. None had tumor recurrence during the mean follow-up of 30.1 months. Two of the remaining 15 patients with R0 resection without LV invasion eceived adjuvant therapy based on the protocol. The other 13 patients received close observations only, including 11 patients with SM2 cancers. None had tumor recurrence during the mean follow-up of 23.6 months. Conclusions: ESD with/without adjuvant therapy based on the final pathological results may be an alternative treatment for patients with pT1b esophageal cancers.

Endoscopic retrograde cholangiopancreatography (ERCP) is an important procedure for treatment of biliary and pancreatic diseases. In patients with normal anatomy, a conventional duodenoscope is used for all therapeutic ERCP procedures with a success rate that exceeds 95% [1, 2]. However, performing ERCP in patients with surgically altered anatomy remains a major challenge to endoscopists [3]. Although this is a known problem since the early 1970s, the interest to use ERCP for biliopancreatic disorders in patients with surgically altered anatomy has increased because of the global rise in bariatric surgery and the development of new endoscopes.

To determine the toxic effects of long-term topical usage of fluorometholone (FLM) on ganglion cells using a direct in vivo retinopathological Brown Norway (BN) rat model. The BN rat retinal model was investigated with a minimum of 3 rats and a maximum of 4 rats per group. Rats received vehicle and 0.02% FLM suspension via topical administration 3 times a day for 28 days. The fundus images and retinal vessels were detected on days 1, 14, and 28 using Micron III retinal imaging microscope and fundus fluorescein angiography (FFA). For retinal structures, spectral-domain optical coherence tomography (SD-OCT) images were taken after FFA on days 1, 14, and 28 using an SD-OCT Imaging System. For retinal function, electrical signal transduction of photoreceptors and bipolar cells was determined by electroretinographic (ERG) recording on days 1 and 28 and IOP detection. At the end of the experiment on day 28, immunohistochemistry and TUNEL assay were performed to investigate apoptosis in ganglion cells. Total retina and nerve fiber layer (NFL) to the inner plexiform layer (IPL) were significantly thinner following 28 days of FLM treatment. Hematoxylin and eosin stain showed that there were NFL and ganglion cell layer deformations in the FLM group. With FLM treatment, TUNEL assay showed approximately a 4.68-fold increase in apoptotic cells. Moreover, FLM decreased ERG b-wave amplitude by about 56%. Using ophthalmofundoscopy devices, after 28 days of topical administration, FLM decreased NFL-IPL and total retina thickness. This suggests that long-term FLM induces adverse effects with respect to ganglion cell apoptosis.

Roux-en-Y reconstructions can be divided into intact papilla of Vater and bilioenteric anastomosis (BEA) with respect to endoscopic retrograde cholangiography (ERC). Double-balloon enteroscopy-assisted ERC (DBE-ERC) may produce different results between the two populations but lacks studies.Forty-seven patients with Roux-en-Y anastomosis undergoing 73 procedures of DBE-ERC were enrolled between July 2007 and August 2013. There were 14 patients with intact papilla of Vater (group A) and 33 patients with BEA (group B). The effectiveness of DBE-ERC, including data of reaching the blind end, performance of ERC, results of endoscopic therapies, and follow-up were retrospectively analyzed and compared between the two groups.For reaching the blind end, the success rate was not different between the groups (85.7% vs. 81.8%, p = 0.7), but the mean procedure time was significantly shorter for group A (28 min vs. 52 min, p = 0.01). For ERC, the success rate was not different between the groups (91.7% vs. 96.3%, p = 0.53), but the mean procedure time was significantly longer for group A (28.4 min vs. 4 min, p0.001). All endoscopic therapies could be successfully performed in both groups. No group A patients and five (23.8%) group B patients developed recurrent biliary stricture/stones requiring interventions during a mean follow-up period of 26.1 months.DBE-ERC was effective for both populations with biliary disorders. Reaching the blind end was more difficult but ERC was easier for patients with BEA in terms of procedure time rather than success rates.

Background and study aims: Data on double-balloon enteroscopy (DBE)-assisted endoscopic retrograde cholangiopancreatogrphy (ERCP) in patients with Billroth II gastrectomy and the use of endoscopic papillary large-balloon dilation (EPLBD) for the removal of common bile duct stones in Billroth II anatomy are limited. The aims of the study were to evaluate the success of DBE-assisted ERCP in patients with Billroth II gastrectomy and examine the efficacy of EPLBD ( ≥ 10 mm) for the removal of common bile duct stones. Patients and methods: A total of 77 patients with Billroth II gastrectomy in whom standard ERCP had failed underwent DBE-assisted ERCP. DBE success was defined as visualizing the papilla and ERCP success as completing the intended intervention. The clinical results of EPLBD for the removal of common bile duct stones were analyzed. Results: DBE was successful in 73 of 77 patients (95 %), and ERCP success was achieved in 67 of these 73 (92 %). Therefore, the rate of successful DBE-assisted ERCP was 87 % (67 of a total of 77 patients). The reasons for ERCP failure (n = 10) included tumor obstruction (n = 2), adhesion obstruction (n = 2), failed cannulation (n = 3), failed stone removal (n = 2), and bowel perforation (n = 1). Overall DBE-assisted ERCP complications occurred in 5 of 77 patients (6.5 %). A total of 48 patients (34 male, mean age 75.5 years) with common bile duct stones underwent EPLBD. Complete stone removal in the first session was accomplished in 36 patients (75 %); mechanical lithotripsy was required in 1 patient. EPLBD-related mild perforation occurred in 2 patients (4 %). No acute pancreatitis occurred. Conclusions: DBE permits therapeutic ERCP in patients who have a difficult Billroth II gastrectomy with a high success rate and acceptable complication rates. EPLBD is effective and safe for the removal of common bile duct stones in patients with Billroth II anatomy.

Displacement of the mandibular proximal segments is inevitable in surgical correction of the asymmetric mandible. The aim of the present study was to assess the outcomes of jaw motion analysis (JMA) in relation to the changes in the mandibular proximal segments after orthognathic surgery (OGS).The present retrospective cohort study investigated the surgical changes using the cone-beam computed tomography records and the mandibular function with JMA and a temporomandibular joint (TMJ) examination. The predictor variables were the 3-dimensional (3D) changes in the proximal segments on the deviated and nondeviated sides. The outcome variables were the JMA data obtained 6 months after OGS. The Pearson correlation test was performed to assess the relationship between the surgical changes and the outcome of JMA.Twenty-one adult patients with skeletal Class III malocclusion and mandibular deviation greater than 4 mm were included in the present study. The change of the ramus axis to the coronal plane on the deviated side correlated negatively with the laterotrusive movement of the mandible toward the deviated side (r = -0.452, P.05). The changes in the distance from the condyles to the midsagittal plane and the angulation of the ramus axis to midsagittal plane on the nondeviated side correlated negatively with the condyle range of retrusion on both sides. However, the increase in the angulation of the ramus axis to the midsagittal plane on the nondeviated side correlated positively with the angle of the horizontal condylar movement in laterotrusion on the deviated side (r = 0.458, P.05).3D model visualization enabled us to clearly detect the changes in the proximal segments after OGS. A relationship between the condylar range of motion and skeletal changes in the proximal segments in patients with Class III malocclusion was observed, mainly on the deviated side of the mandible.

Excluding tracheostomy, maxillomandibular advancement (MMA) is the most effective surgical treatment for obstructive sleep apnoea (OSA). However, the anticipated facial changes may prevent acceptance of this procedure by patients with bimaxillary protrusion, a common feature of Asian faces. We therefore developed a modified MMA technique for such cases, consisting of anterior segmental osteotomies together with standard Le Fort I and bilateral sagittal split osteotomies. A prospective study of 20 consecutive Taiwanese adults with moderate-to-severe OSA who underwent modified MMA and postsurgical orthodontics was undertaken to evaluate the efficacy with regard to OSA and the postoperative facial appearance and dental occlusion. After modified MMA, the mean apnoea-hypopnoea index decreased from 41.6±19.2 n/h to 5.3±4.0 n/h (P

Background/Aims: Two-liter polyethylene glycol (PEG) is the most commonly used bowel-cleansing regimen in Taiwan, but its efficacy is unsatisfactory. The aim of this study was to compare 2-liter and 3-liter PEG in terms of their impact on colonoscopy quality among an average-risk population. Methods: Two-liter PEG was provided between August 2012 and May 2013, while 3-liter PEG was provided between June 2013 and March 2014. A split-dose regimen was provided for morning colonoscopy and a same-day regimen was provided for afternoon colonoscopy. The level of bowel cleansing was prospectively scored. Results: A total of 407 consecutive subjects completed the 2-liter regimen, and another 407 consecutive subjects completed the 3-liter regimen. The 3-liter group had a significantly higher rate of excellent or good preparations, equivalent to a Boston bowel preparation scale of ≥7, than the 2-liter group (90 vs. 73%, p < 0.0001). More subjects in the 3-liter preparation group compared with the 2-liter group had overall adenoma (70 vs. 54%, p < 0.0001), proximal adenoma (47 vs. 35%, p = 0.0006), sessile serrated adenoma (28 vs. 6%, p < 0.0001), and advanced adenoma (21 vs. 9%, p < 0.0001). Conclusions: Three-liter PEG provided better cleansing quality and higher adenoma detection rate than 2-liter PEG.

The aim of this study was to compare the outcomes of traditional two-dimensional planning (2DP) and three-dimensional surgical simulation (3DS) in the surgical correction of skeletal class III with facial asymmetry. This retrospective cohort study included 37 consecutive adult Taiwanese patients. Preoperative and postoperative three-dimensional cephalometric measurements were obtained from cone beam computed tomography scans. The outcome variables were the differences in preoperative and postoperative linear and angular measurements and the differences between the two groups after surgery. When the surgical result was compared between the 2DP and 3DS groups, significant differences were found for four cephalometric variables: the distance from gonion on the non-deviated side to the midsagittal plane (MSP), mid-gonion to the MSP, upper first molar on the non-deviated side to the Frankfort horizontal plane, and the yaw angle. In the 3DS group, mandibular symmetry was achieved because the centre between the bilateral gonions was improved, and because there was no significant difference in the horizontal gonion (Go to the MSP) between the deviated and non-deviated sides after surgery. 3DS provides all the necessary information for planned surgical movements for the correction of facial asymmetry; it should be considered during surgical planning to improve surgical outcomes, particularly the achievement of bilateral mandibular contour symmetry.

The genome sequence of nervous necrosis virus strain KS1 isolated from orange-spotted grouper ( Epinephelus coioides ) was cloned and analyzed. The viral genome is composed of two single-stranded positive-sense RNA molecules, RNA1 and RNA2. Phylogenetic analysis shows that the virus strain KS1 belongs to the red-spotted grouper nervous necrosis virus genotype.

This meta-analysis was performed to determine the diagnostic accuracy of 18F-fluorodeoxyglucose positron emission tomography (18F-FDG-PET) in assessing primary cholangiocarcinoma (CCA) and CCA with lymph node and distant metastasis. A literature search for studies reporting the use of 18F-FDG-PET for preoperative work-up/staging in patients with CCA was performed. Diagnostic OR (DOR) was used as an index of diagnostic performance of FDG-PET/CT in predicting primary CCA, lymph node metastases, and distant metastases. The pooled DOR was 9.34 (95% CI 4.27 to 20.42) and the area under the summary receiver operating characteristic (SROC) curve was 0.8643 (SE=0.0362), indicating overall good discriminatory test performance in predicting primary CCA. Subgroup analyses based on the primary tumor site showed better diagnostic performance for intrahepatic CCA (DOR=54.44, 95% CI 13.44 to 220.49), both intrahepatic and extrahepatic CCA (DOR=32.96, 95% CI 1.41 to 768.80) and gallbladder cancer (DOR=12.93, 95% CI 1.97 to 84.80), than for extrahepatic CCA (DOR=2.55, 95% CI 0.71 to 9.20) and hilar CCA (DOR=2.75, 95% CI 0.17 to 43.72). The pooled DOR for the prediction of lymph nodes metastases in 10 studies was 11.34 (95% CI 4.79 to 26.80), with moderate heterogeneity (Cochran Q=15.14, p=0.0872, I2=40.5%). The area under the SROC curve was 0.8584 (SE=0.0729). In conclusion, 18F-FDG-PET and PET/CT were found to be accurate in the evaluation of primary tumors, lymph node metastasis, and distant metastasis in patients with CCA.

Purpose With the advance of image fusion techniques, the creation of 3-dimensional (3D) virtual head and 3D surgical simulations has provided previews of surgical procedures. The aim of this study was to investigate the surgical outcomes in patients receiving orthognathic surgery (OGS) with the guidance of 3D computer-assisted surgical simulation. Patients and Methods The study included 34 consecutive patients (15 men and 19 women; age, 18.1 to 33.0 yr) with skeletal Class III facial asymmetry who underwent bimaxillary OGS. One-week postoperative cone-beam computed tomographic craniofacial images (Ta) were constructed and superimposed on preoperative simulated virtual images (Ts) at the cranial base and surfaces of the frontal and periorbital regions. The 3D cephalometric landmarks were measured relative to 3 reference planes. The outcomes among different experience levels of surgeons also were compared. Results Although the mean values between Ta and Ts were small, statistical differences were observed in the center of maxillary and mandibular incisors and the B point relative to the midline and in the maxillary first molar in vertical distances, sagittal dentoskeletal dimensions, and pitch angles. The root mean square deviations (RMSDL) of measurement variables relative to center landmark accuracy were 1.5 and less than 2 mm at the maxilla and mandible, respectively. RMSDL greater than 2 mm was located at the maxillary first molar in the vertical distance and in the sagittal dimension at the anterior nasal spine and B point. Variables related to centering the midline structures were highly inter-related. The roll angle deviation was associated with centering the midline landmarks. The yaw angle deviation was not associated with midline correction. Conclusion With guidance from 3D surgical simulation, surgeons could achieve similar outcomes to correct facial asymmetry regardless of their years of practice.

How hepatatitis C virus (HCV) infection affects the interplay among abundant adipokines in the host remains unclear. A prospective study was conducted with 450 consecutive genotype 1 (G1) and G2 HCV patients who completed a course of anti-HCV therapy and underwent pre-therapy and 24-week post-therapy surveys to assess various profiles and levels of abundant adipokines, including leptin, adiponectin, and plasminogen activator inhibitor-1 (PAI-1). Before anti-HCV therapy, multivariate analyses showed gender to be associated with leptin and adiponectin levels, and BMI with leptin and PAI-1 levels. Among patients with a sustained virological response (SVR, n = 372), associations at 24 weeks post-therapy were as follows: gender and BMI with all adipokine levels; hepatic steatosis and aspartate aminotransferase to platelet ratio index with adiponectin levels; and HOMA-IR and HCV genotype with PAI-1 levels. Paired t-tests revealed increased post-therapeutic PAI-1 levels in G1 SVR patients and decreased adiponectin levels in all SVR patients compared to pre-therapeutic levels. HCV infection may obscure associations between abundant adipokines and metabolic/hepatic profiles. In SVR patients, a higher hierarchical status of PAI-1 versus adiponectin in affecting glucose metabolism was noted at 24 weeks post-therapy. Such genotype-non-specific adiponectin decreases and G1-specific PAI-1 increases warrant careful follow-up of HCV patients after SVR according to viral genotype.

Same-day bidirectional endoscopy (BDE) is a commonly performed procedure, but the optimal sequence for the procedure with moderate conscious sedation is not well established. This study investigated the optimal sequence for same-day BDE under moderate conscious sedation and carbon dioxide insufflation in terms of sedation doses, patient discomfort, and colonoscopy performance.A prospective randomized controlled study of 120 patients who were scheduled for BDE examination was performed. Colonoscopy followed by esophagogastroduodenoscopy (EGD) examination was performed in 60 patients (colonoscopy-EGD group), and EGD followed by colonoscopy examination was performed in another 60 patients (EGD-colonoscopy group). Endoscopists and patients completed a questionnaire to assess objective and subjective discomfort.Baseline demographics, procedure indications, bowel preparation quality, cecal intubation rate/time, colonoscopy withdrawal time, endoscopic interventions, BDE procedure time, colon polyp/adenoma detection rates, patient discomfort, and adverse events were similar between the two study groups. The total doses of fentanyl and midazolam were significantly higher for the colonoscopy-EGD group than for the EGD-colonoscopy group (83.4 ± 17.7 vs 68.7 ± 18.6 μg and 6.3 ± 1.4 vs 5.2 ± 1.3 mg, P 0.0001 and P 0.0001, respectively). The recovery time to discharge was significantly longer for the colonoscopy-EGD group than for the EGD-colonoscopy group (43.5 ± 16.2 vs 34.5 ± 8.9 min, P = 0.0003).Esophagogastroduodenoscopy followed by colonoscopy is the optimal sequence for same-day BDE under moderate conscious sedation and carbon dioxide insufflation. Following this order allows for a reduction of sedation doses and for shorter recovery times.

Nervous necrosis virus (NNV) infection causes viral nervous necrosis, inflicting serious economic losses in marine fish cultivation. Vaccination is the most effective choice for controlling and preventing viral infection. Virus-like particles (VLPs) are considered a novel vaccine platform because they are not infectious and they induce neutralizing antibodies efficiently. In the present study, we investigated the effect of the recombinant orange-spotted grouper NNV (OSGNNV) capsid proteins produced in Escherichia coli and cell-free self-assembled into VLPs on protective immune responses in orange-spotted grouper following immersion, intramuscular injection and oral immunization. We found the OSGNNV VLPs elicited neutralizing antibody with high efficacy, and provided the fish with full protection against OSGNNV challenge. In addition, the cell-free self-assembled OSGNNV VLPs did not contain residual host cell components and was safer compared with the intracellular assembled VLPs. Thus, oral vaccination is a more convenient and preferred route for fish vaccination. Our results show that the fish fed four times with a diet supplemented with 50–200 μg/g OSGNNV VLPs at 7-day intervals have sufficient protection. These findings demonstrate that cell-free self-assembled OSGNNV VLPs have potential as oral vaccines in grouper.

The aryl hydrocarbon receptor (AhR) is a ligand-activated transcription factor that is highly expressed in multiple organs and tissues. Whereas AhR mediates the metabolism of xenobiotic and endogenous compounds, its novel function in cancer epithelial-mesenchymal transition (EMT) remains controversial. Autophagy also participates in tumour progression through its functions in cell homeostasis and facilitates adaptation to EMT progression. In the present study, we found that AhR-regulated autophagy positively modulates EMT in non-small cell lung cancer cells. The motility of A549, H1299, and CL1-5 cells were correlated with different AhR expression levels. Invasive potential and cell morphology also changed when AhR protein expression was altered. Moreover, AhR levels exerted a contrasting effect on autophagy potential. Autophagy was higher in CL1-5 and H1299 cells with lower AhR levels than in A549 cells. Both AhR overexpression and autophagy inhibition decreased CL1-5 metastasis in vivo. Furthermore, AhR promoted BNIP3 ubiquitination for proteasomal degradation. AhR silencing in A549 cells also reduced BNIP3 ubiquitination. Taken together, these results provide a novel insight into the cross-linking between AhR and autophagy, we addressed the mechanistic BNIP3 modulation by endogenous AhR, which affect cancer cell EMT progression.

Hybrid measurement method is proposed to solve the problem that the partial or whole three-dimensional reconstruction accuracy of aviation engine parts is high. The point clouds of the aviation engine part are captured first using contact and non-contact measuring method. Feature-based parametric modeling strategy is adopted to reconstruct the aviation engine part so that it is easy to be modified in the future. Then, the point cloud data obtained by contact measurement and the reconstructed model are registrated to the same coordinate system to detect the deviation. The point cloud registration method is based upon the feature-based registration method and standard Iterative Closest Point (ICP) algorithm, which help to improve the accuracy of registration. According to the result of deviation, the three-dimensional model can be modified. The accuracy of the modified model is controlled within 0.02mm, satisfying the requirement of aviation engine parts. Three-dimensional reconstruction results have verified the feasibility of the method.

Photobacterium damselae subsp. piscicida (Phdp) is the causative agent of fish photobacteriosis (pasteurellosis) in cultured cobia (Rachycentron canadum) in Taiwan. A component was purified from the extracellular products (ECP) of the bacterium strain 9205 by fast protein liquid chromatography (FPLC) and identified as a phospholipase. An N-terminal sequence of 10 amino acid residues, QDQPNLDPGK, was determined by mass spectroscopy (MS) and found to be identical with that of another Phdp phospholipase (GenBank accession no. BAB85814) at positions 21 to 30. The corresponding gene sequence of the phospholipase (GenBank accession no. AB071137) was employed to design primers for amplification of the sequence by the polymerase chain reaction (PCR). The PCR products were transformed into Escherichia coli, and a recombinant protein product was obtained which was purified as a His-tag fusion protein by Ni-metal affinity chromatography. A single 43-kDa band was determined by sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE). Phosphatidylcholine was degraded by this protein to lysophosphatidylcholine and a fatty acid. These products were characterized by thin-layer (TLC) and gas chromatography (GC), respectively, allowing the identification of the protein as a phospholipase A2. The recombinant protein had maximum enzymatic activity between pH 4 and 7, and at 40 °C. The activity was inhibited by Zn2+ and Cu2+, activated by Ca2+ and Mg2+, and completely inactivated by dexamethasone and p-bromophenacyl bromide. A rabbit antiserum against the recombinant protein neutralized the phospholipase A2 activity in the ECP of Phdp strain 9205 and the recombinant protein itself. The recombinant protein was toxic to cobia of about 5 g weight with an LD50 value between 2 and 4 μg protein/g fish. The results revealed phospholipase A2 as a fish toxin in the ECP of Phdp strain 9205.

With the background of large-scale wind power integration grid, in order to reduce wind farm voltage fluctuation and the grid loss, through the scenario analysis method, the objective function model was established to determine the best SVCs compensation capacity and compensation point. Firstly, the initial operation states of the wind power systems were obtained by the Monte Carlo sampling and power flow was calculated to get the reactive power compensation point and its capacity. Then the result of optimization model was calculated by the improved genetic algorithm. IEEE 30 system was taken as an example for the simulation calculation and the calculation results verify the validity of the model.

Artificial immune system has been adopted as a Heuristic Algorithm to solve combinatorial problems for decades. Nevertheless, many of these past applications utilized the benefit of the system but rarely proposed approaches to enhance the overall efficiency. In this paper, we continue what was discussed in the previous research, to develop a self-evolving artificial immune system II by coordinating the T and B cell in the immune system to build a block-based artificial chromosome to shorten the computation time and to improve the performance for problems of different complexities. Through designing Plasma cell and clonal selection, which are relevant to the functioning of the Immune Response, the Immune Response will help the AIS in realizing the global and local searching ability and prevent it from being trapped in local optima. The significant performance shown in the experimental result validates that SEAIS II is effective in solving the permutation flows-hop problems.

Enterprise Resource Planning (ERP) can coordinate the different functions of enterprises and improve the information flows. As for the actual production situation, the ERP may not receive and record the information of equipments in detail, and the manufacturing execution system (MES) may not collect various kind of information between different business functions. Therefore, the ERP integrating the MES may help the enterprise to control the business operation smoothly. This research applied the decision making trial and evaluation laboratory (DEMATEL) and analytic network process (ANP) method for the MES module into ERP system selection. The research results show that the DEMATEL may clarify the relationship and the ANP can compute the weights of criteria of the ERP and MES modules. The research also indicated that there is a high demand in integrating the sales and distribution module (SDM) of ERP into the material management system (MMS) of MES, which may improve the effectiveness of MES.