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Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS) use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years) and nonelderly ( Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05) fewer (28 (9.2%)) nontransport calls than did the nonelderly (136 (21.4%)). In the transport calls, 276 (35.6%) were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now.

This study is a retrospective, nationwide, matched cohort study to investigate the risk of band keratopathy following end-stage renal disease (ESRD). The study cohort included 94,039 ESRD on-dialysis patients identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM), code 585 and registered between January 2000 to December 2009 at the Taiwan National Health Insurance Research Database. An age- and sex-matched control group comprised 94,039 patients selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient was collected from the index date until December 2011. In total, 230 ESRD patients and 26 controls had band keratopathy (P

The aim was to investigate the circadian and weekly variation in Chinese young patients with acute myocardial infarction (AMI).This was a 10-year retrospective cohort study. We studied patients (18 to45 years of age) with a first attack of AMI from the emergency departments of 3 university teaching hospitals in Taiwan from January 1, 2001, to December 31, 2010. We analyzed patients in the standard circadian fashion using 6-hour intervals (00:01-06:00, 06:01-12:00, 12:01-18:00, and 18:01-24:00). We also did an analysis by day of week.The database had 505 patients with AMI with complete data. The percentage of total AMIs that occurred in the 6-hour intervals were as follows: 00:01 to 06:00, 30.9%; 06:01 to 12:00, 23.4%; 12:01 to 18:00, 25.9%; and 18:01 to 24:00, 19.8%. The percentage of AMIs between 00:01 and 06:00 was significant higher compared with that in the other three 6-hour intervals (df = 3, χ(2) = 91.7, P.001). However, there was no significant weekly variation for these patients in the present study.There was a significant circadian variation with a peak from 00:01 to 06:00 in Chinese young patients with AMI. However, there was no significant weekly variation in these patients. The circadian periodicity may create new possibilities for disease prevention and medication prescription.

The objective of this study is to investigate the role of sympathovagal balance in predicting inhospital mortality by assessing power spectral analysis of heart rate variability (HRV) among patients with nontraumatic subarachnoid hemorrhage (SAH) in an emergency department (ED).A cohort of 132 adult patients with spontaneous SAH in an ED was prospectively enrolled. A continuous 10-minute electrocardiography for off-line power spectral analysis of the HRV was recorded. Using the inhospital mortality, the patients were classified into 2 groups: nonsurvivors (n=38) and survivors (n=94). The HRV measures were compared between these 2 groups of patients.Having compared the various measurements, the very low-frequency component, low-frequency component, normalized low-frequency component (LF%), and low-/high-frequency component ratio (LF/HF) were significantly lower, whereas the normalized high-frequency component was significantly higher among the nonsurvivors than among the survivors. A multiple logistic regression model identified LF/HF (odds ratio, 2.16; 95% confidence interval [CI], 1.18-3.97; P=.013) and LF% (odds ratio, 0.78; 95% CI, 0.69-0.88; P.001) as independent variables that were able to predict inhospital mortality for patients with SAH in an ED. The receiver operating characteristic area for LF/HF in predicting inhospital mortality was 0.957 (95% CI, 0.914-1.000; P.001), and the best cutoff points was 0.8 (sensitivity, 92.1%; specificity, 90.4%).Power spectral analysis of the HRV is able to predict inhospital mortality for patients after SAH in an ED. A tilt in the sympathovagal balance toward depressed sympathovagal balance, as indicated by HRV analysis, might contribute to the poor outcome among these patients.

Introduction This study explored whether post-resuscitation status resembles severe sepsis in terms of autonomic nervous modulation by using heart rate variability (HRV) analysis. Methods Successfully resuscitated nontraumatic out-of-hospital cardiac arrest (OHCA) adult patients in an emergency department were prospectively enrolled as the study group. Age- and sex-matched patients with severe sepsis with and without mechanical ventilation were included as positive controls, while sepsis patients and healthy volunteers were included as negative controls. The HRV measures obtained from 10-minute electrocardiogram were compared among 5 groups of subjects. Results Sixty-four successfully resuscitated OHCA patients were studied. There were no significant differences in all HRV measures (standard deviation of R-R intervals [SDRR], coefficient of variation of R-R intervals [CVRR], total power [TP], very-low-frequency component [VLF], low-frequency component [LF], high-frequency component [HF], normalized LF [LF%], normalized HF [HF%], and LF/HF) among the successfully resuscitated OHCA patients and severe sepsis patients with and without mechanical ventilation. Also, no significant differences in all HRV measures were found between nonsurvivors of OHCA group and nonsurvivors of severe sepsis group. In the nonsurvivors of OHCA group and severe sepsis group, the LF% and LF/HF were significantly lower, whereas the HF and HF% were significantly higher, as compared with the survivors of these 2 groups. Conclusions The autonomic nervous modulation in the initial phase of OHCA patients resembles that of severe sepsis in that both groups of patients have decreased global HRV (TP, SDRR, and CVRR), sympathovagal balance (LF% and LF/HF), and renin-angiotensin-aldosterone modulation (VLF), as compared to healthy subjects.

Cancer has been the leading cause of death in Taiwan since 1982. Physicians have many health-related risk factors which may contribute to cancer, such as rotating night shift, radiation, poor lifestyle, and higher exposure risk to infection and potential carcinogenic drugs. However, the cancer risk in physicians is not clear. In Taiwan's National Health Insurance Research Database, we identified 14,889 physicians as the study cohort and randomly selected 29,778 nonmedical staff patients as the comparison cohort for this national population-based cohort study. Cox proportional-hazard regression was used to compare the cancer risk between physicians and comparisons. Physician subgroups were also analyzed. Physicians had a lower all-cancer risk than did the comparisons (hazard ratio [HR] 0.86, 95% confidence interval [CI] 0.76–0.97). In the sex-based analysis, male physicians had a lower all-cancer risk than did male comparisons (HR 0.82, 95% CI 0.73–0.94); and female physicians did not (HR 1.29, 95% CI 0.88–1.91). In the cancer-type analysis, male physicians had a higher risk of prostate cancer (HR 1.72, 95% CI 1.12–2.65) and female physicians had twice the risk of breast cancer (HR 2.00, 95% CI 1.11–3.62) than did comparisons. Cancer risk was not significantly associated with physician specialties. Physicians in Taiwan had a lower all-cancer risk but higher risks for prostate and breast cancer than did the general population. These new epidemiological findings require additional study to clarify possible mechanisms.

Background High stress levels and shift work probably trigger migraine in healthcare professionals (HCPs). However, the migraine risk differences between HCPs and the general population is unknown. Methods This nationwide population-based cohort study used Taiwan’s National Health Insurance Research Database. Physicians (50,226), nurses (122,357), and other HCPs (pharmacists, technicians, dietitians, rehabilitation therapists, social workers, etc.) (45,736) were enrolled for the study cohort, and randomly selected non-HCPs (218,319) were enrolled for the comparison cohort. Conditional logistical regression analysis was used to compare the migraine risks. Comparisons between HCPs and between physician specialties were also done. Results Physicians, nurses, and other HCPs had higher migraine risks than did the general population (adjusted odds ratio [AOR]: 1.672; 95 % confidence interval [CI]: 1.468–1.905, AOR: 1.621; 95 % CI: 1.532–1.714, and AOR: 1.254; 95 % CI: 1.124–1.399, respectively) after stroke, hypertension, epilepsy, anxiety, depression, and insomnia had been adjusted for. Nurses and physicians had higher migraine risks than did other HCPs (AOR: 1.303; 95 % CI: 1.206–1.408, and AOR: 1.193; 95 % CI: 1.069–1.332, respectively). Obstetricians and gynecologists had a lower migraine risk than did other physician specialists (AOR: 0.550; 95 % CI: 0.323–0.937). Conclusion HCPs in Taiwan had a higher migraine risk than did the general population. Heavy workloads, emotional stress, and rotating night shift sleep disturbances appear to be the most important risk factors. These findings should provide an important reference for promoting occupational health in HCPs in Taiwan.

An interesting heterostructure field-effect transistor (HFET) based hydrogen sensing system is developed and demonstrated. Even at a low hydrogen concentration of 15 ppm H 2 /air, the studied sensor still exhibits high sensitivity at room temperature. Furthermore, a simple sensing system is also designed and reported. In contrast to conventional hydrogen measurement, the detecting system consists of a hydrogen sensor and some sensing circuits. This proposed hydrogen detection system is based on the micro-controller with advantages of low cost, fast response, portable, and easy operation. From experimental results, the proposed system is shown to be good for use.

A local Maxwellian thermostat for the multiparticle collision dynamics algorithm is proposed. The algorithm is based on a scaling of the relative velocities of the fluid particles within a collision cell. The scaling factor is determined from the distribution of the kinetic energy within such a cell. Thereby the algorithm ensures that the distribution of the relative velocities is given by the Maxwell-Boltzmann distribution. The algorithm is particularly useful for non-equilibrium systems, where temperature has to be controlled locally. We perform various non-equilibrium simulations for fluids in shear and pressure-driven flow, which confirm the validity of the proposed simulation scheme. In addition, we determine the dynamic structure factors for fluids with and without thermostat, which exhibit significant differences due to suppression of the diffusive part of the energy transport of the isothermal system.

Susceptibility analysis for predicting earthquake-induced landslides has most frequently been done using deterministic methods; multivariate statistical methods have not previously been applied. In this study, however, we introduce a statistical methodology that uses the intensity of earthquake shaking as a landslide triggering factor. This methodology is applied in a study of shallow earthquake-induced landslides in central western Taiwan. The results show that we can accurately interpret landslide distribution in the study area and predict the occurrence of landslides in neighboring regions. This susceptibility model is capable of predicting shallow landslides induced during an earthquake scenario with similar range of ground shaking, without requiring the use of geotechnical, groundwater or failure depth data.

Introduction: Renal infarction is a rare and easily missed disease. There is even less meaningful information on renal infarction in the Asian population. Thus, the aim of this study was to clarify the clinical characteristics of the disease in Asian patients. Clinical Picture: Over a period of 10 years, 38 Chinese patients with renal infarction diagnosed by contract-enhanced CT or angiography were enrolled in this study. Their demographic data, clinical characteristics, laboratory and image results, risk factors or suspected causes, treatment and final outcomes were retrospectively reviewed. The results were also compared with the analogous Western data. The mean age of the sample population was 60.8 ± 17.6 years, with patients aged over 50 years and males predominating. The most common symptoms/signs were abdominal (57.9%) and flank pain/tenderness (50%). Only 23.7% of patients had suffered previous thromboembolic events such as coronary or peripheral artery diseases, or cerebral infarction. Cardiogenic factors, such as atrial fibrillation, intra-cardiac thrombus, infective endocarditis and valvular heart disease, were the main causes of renal infarction (57.9%). The most common laboratory abnormalities were elevated serum LDH (92.1%) and proteinuria (76.3%). Only half of the cases involved haematuria at initial presentation. Treatment and Outcome: One-third of the sample suffered renal impairment after the renal infarction. Overall mortality rate during admission was 13.2% (n = 5). The cause of death was usually not the renal infarction itself but rather the underlying disease and its complications. There was no difference in outcome for anticoagulation treatment with or without thrombolytics. Compared to their Western counterparts, the proportion of males (71.1% versus 48.3%) and bilateral renal infarctions (31.6% versus 12.4%) were significantly higher, and the percentage of leukocytosis (50% versus 85%) significantly lower in our Asian patients. Conclusion: Clinical presentation of renal infarction is usually non-specific and differs for Asian and Western populations. In our Asian patients, the most common clinical characteristics were abdominal pain/tenderness, flank pain/tenderness, elevated serum LDH and proteinuria. Early diagnosis and treatment are imperative because of the high rate of renal impairment and associated mortality. If this disease is suspected, contrast-enhanced CT is suggested to exclude or confirm renal infarction and anticoagulation alone is currently the favored treatment. Key words: Asian, Renal infarction, Taiwan

Objective To determine the predictive capability of heart rate variability (HRV) measures of patients with sepsis in the ED for in-hospital death. Methods This was a prospective, observational study. A consecutive cohort of patients visiting the ED of a university teaching hospital who met the criteria of sepsis over a 6-month period were enrolled in this study. General demographics, vital signs, laboratory data, and Mortality in Emergency Department Sepsis score were obtained in the ED; the in-patient medical record was reviewed; and a series of continuous 10-minute electrocardiographic signals were recorded for off-line HRV analysis to assess the in-hospital mortality of the patients. Results One hundred thirty-two patients aged 27 to 86 years who met the inclusion criteria were enrolled. According to the in-hospital outcome, the patients were categorized into 2 groups: nonsurvivors (n = 10) and survivors (n = 122). The baseline HRV measures, including SDNN, TP, VLFP, LFP, and LFP/HFP ratio, of nonsurvivors were significantly lower, whereas the nHFP was significantly higher, than those of survivors. Multiple logistic regression model identified SDNN and nHFP as the significant independent variables in the prediction of in-hospital mortality for ED patients with sepsis. The receiver operating characteristic area for SDNN and nHFP in predicting the risk of death was 0.700 and 0.739, respectively. Conclusions Heart rate variability measures, especially the SDNN and nHFP, may be used as valuable predictors of in-hospital mortality in patients with sepsis attending the ED.

The nonequilibrium hydrodynamic correlations of a Multiparticle-Collision-Dynamics (MPC) fluid in shear flow are studied by analytical calculations and simulations. The Navier-Stokes equations for a MPC fluid are linearized about the shear flow and the hydrodynamic modes are evaluated as an expansion in the momentum vector. The shear-rate dependence and anisotropy of the transverse and longitudinal velocity correlations are analyzed. We demonstrate that hydrodynamic correlations in shear flow are anisotropic, specifically, the two transverse modes are no longer identical. In addition, our simulations reveal the directional dependence of the frequency and attenuation of the longitudinal velocity correlation function. Furthermore, the velocity autocorrelation functions of a tagged fluid particle in shear flow are determined. The simulations results for various hydrodynamic correlations agree very well with the theoretical predictions., Comment: 8 pages, 5 figures

ST elevation myocardial infarction (STEMI), one main type of acute myocardial infarction with high mortality, requires percutaneous coronary intervention (PCI) with balloon inflation. Current guidelines recommend a door-to-balloon (D2B) interval (i.e., starts with the patient's arrival in the emergency department and ends when PCI with a catheter guidewire and balloon inflation crosses the culprit lesion) of no more than 90 min. However, promptly implementing PCI requires coordinating various medical teams. Checklists can be used to ensure consistency and operating sequences when executing complex tasks in a clinical routine. Developing an effective D2B checklist would enhance the care of STEMI patients who need PCI. Mobile information and communication technologies have the potential to greatly improve communication, facilitate access to information, and eliminate duplicated documentation without the limitations of space and time. In a research project by the Chi Mei Medical Center, "Developing a Mobile Electronic D2B Checklist for Managing the Treatment of STEMI Patients Who Need Primary Coronary Intervention," a prototype version of a mobile checklist was developed. This study describes the research project and the four phases of the system development life cycle, comprising system planning and selection, analysis, design, and implementation and operation. Face-to-face interviews with 16 potential users were conducted and revealed highly positive user perception and use intention toward the prototype. Discussion and directions for future research are also presented.

Background Predicting the neurological sequelae of carbon monoxide poisoning (COP) has not been well studied. We investigated the independent predictors of neurological sequelae in patients with COP and combined these predictors to predict the prognosis. Methods This study was conducted at four hospitals in Shandong Province, China. Data were retrospectively collected from 258 patients with COP between November 1990 and October 2011. Thirty-day neurological sequelae were the primary endpoints. Results A lack of pupil reflex and a loss of consciousness appear to be independent predictors for neurological sequelae in patients with COP. The presence of either one had a sensitivity of 77.0% (95% confidence interval [CI]: 69.3–83.2), a specificity of 47.1% (95% CI: 38.3–56.0), positive predictive value (PPV) of 62.9% (95% CI: 55.2–70.1), and a negative predictive value (NPV) of 63.6% (95% CI: 52.6–73.4). With both predictors present, the sensitivity was 11.5% (95% CI: 6.9 to 18.3), the specificity was 99.2 (95% CI: 94.7–100.0), the PPV was 94.1% (95% CI: 69.2–99.7), and the NPV was 49.0% (95% CI: 42.5–55.5). Conclusions The risk for neurological sequelae apparently increased with the number of independent predictors. In patients with both predictors, the risk for neurological sequelae was 94.1%. Almost all (99.2%) patients with neither predictor had no neurological sequelae. This finding may help physicians make decisions about and dispositions for patients with COP. For patients with a higher risk, earlier treatment and more appropriate utilization of health care services, including hyperbaric oxygen, should be considered.

Multiparticle collision dynamics (MPC), a particle-based mesoscale simulation technique for com- plex fluid, is widely employed in non-equilibrium simulations of soft matter systems. To maintain a defined thermodynamic state, thermalization of the fluid is often required for certain MPC variants. We investigate the influence of three thermostats on the non-equilibrium properties of a MPC fluid under shear or in Poiseuille flow. In all cases, the local velocities are scaled by a factor, which is either determined via a local simple scaling approach (LSS), a Monte Carlo-like procedure (MCS), or by the Maxwell-Boltzmann distribution of kinetic energy (MBS). We find that the various scal- ing schemes leave the flow profile unchanged and maintain the local temperature well. The fluid viscosities extracted from the various simulations are in close agreement. Moreover, the numerically determined viscosities are in remarkably good agreement with the respective theoretically predicted values. At equilibrium, the calculation of the dynamic structure factor reveals that the MBS method closely resembles an isothermal ensemble, whereas the MCS procedure exhibits signatures of an adi- abatic system at larger collision-time steps. Since the velocity distribution of the LSS approach is non-Gaussian, we recommend to apply the MBS thermostat, which has been shown to produce the correct velocity distribution even under non-equilibrium conditions., 12 pages, 5 figures in Phys. Rev. E, 2015

Studies show a strong association between dementia and lower urinary tract symptoms (LUTS). The aim of this study was to investigate whether LUTS are a risk factor for cognitive impairment. We enrolled 50-year-old and older subjects with LUTS (LUTS[+]) (n=6801) and controls without LUTS (LUTS[−]) (n=20,403) from Taiwan’s National Health Insurance Research Database. LUTS, dementia, and other confounding factors are defined by International Classification of Diseases, Ninth Revision, Clinical Modification Codes. Participants were recruited from 2000 to 2004 and then followed up until death or the end of 2011. The outcome was the onset of dementia, which was assessed using Poisson regression analysis, Cox hazards models, and Kaplan-Meier survival curves. The incidence of dementia was significantly higher in the LUTS[+]group than in the LUTS[−]group (124.76 versus 77.59/1000 person-years). The increased risk of dementia related to LUTS remained significant after adjustment for potential confounders (adjusted hazard ratio (AHR): 1.61, 95% confidence interval (CI) 1.47–1.76,P<0.0001) and higher than that related to cerebrovascular disease (AHR: 1.43, 95% CI 1.26–1.61,P<0.0001). The outcome suggests the need for early screening and appropriate intervention to help prevent cognitive impairment of patients with LUTS.

The 1999 Chi-Chi, Taiwan, earthquake triggered numerous landslides throughout a large area in the Central Range, to the east, southeast, and south of the fault rupture. Among them are two large rock avalanches, at Tsaoling and at Jih- Feng-Erh-Shan. At Jih-Feng-Erh-Shan, the entire thickness (30-50 m) of the Mio- cene Changhukeng Shale over an area of 1 km 2 slid down its bedding plane for a distance of about 1 km. Initial movement of the landslide was nearly purely trans- lational. We investigate the effect of surface-normal acceleration on the initiation of the Jih-Feng-Erh-Shan landslide using a block slide model. We show that this ac- celeration, currently not considered by dynamic slope-stability analysis methods, significantly influences the initiation of the landslide.

Three-component mixtures of hard spheres have been investigated by Monte Carlo (MC) simulations and semi-empirical equations of state (EOS). Symmetric and dissymmetric size distributions have been studied. The polydispersity is limited to values below 10%. The pressure of the fluid phase is found to be quite accurately described by the analytical EOS of Mansoori et al. As for the solid phase, MC simulations show that the substitutionally disordered fcc structure is mechanically stable up to a polydispersity of the order of 8%. An EOS based on a free volume-type approximation is proposed. Its expression is found to be independent of the shape of the size distribution function. Using these two EOS, the cloud–shadow points for the melting transition have been computed. The phase coexistence is found to terminate at a polydispersity of about 4%.

Hospice and palliative care has been recognized as an essential part of emergency medicine; however, there is no consensus on the optimal model for the delivery of hospice and palliative care in the emergency department (ED). Therefore, we conducted a novel implementation in a tertiary medic

OBJECTIVES The health benefits of breastfeeding are widely recognized. The World Health Organization recommends exclusive breastfeeding for six months after birth and for two years or longer together with nutritionally adequate complementary foods. To respond to the needs of industry, employed breastfeeding mothers must adapt to the rotating night shift (RNS). However, the RNS is associated with a higher risk of health problems in career women. We investigated the relationship between the RNS and breast milk volume. METHODS Mothers who used a breastfeeding room while working at a technology company in Taiwan voluntarily participated in this study from March 1 through April 30, 2013. We compared two groups: breastfeeding mothers on (RNS(+)) and not on a RNS (RNS(-)) to determine independent predictors for breast milk volume. We analyzed data from 109 participants: RNS(+) group n=56; RNS(-) group n=53. RESULTS There was no significant difference in daily milk collection volume between the groups. Daily milk collection frequency and exclusive breastfeeding were independent predictors for a daily breast milk collection volume >350 ml. CONCLUSIONS The RNS may not affect the breast milk volume. This result may help the government and employers make policies more appropriate for supporting employed breastfeeding mothers.

In this paper, we provide a scheme to compute the absolute free energy of a smectic-$A$ phase via the ``indirect method.'' The state of interest is connected through a three-step reversible path to a reference state. This state consists of a low-density layer of rods coupled to two external fields maintaining these rods close to the layer's plane and oriented preferably normal to the layer. The low-density free energy of the reference state can be computed on the basis of the relevant second virial coefficients between two rods coupled to the two external fields. We apply this technique to the Gay-Berne potential for calamitics with a parameter set leading to stable isotropic (I), nematic (N), smectic-$A$ (SmA), and crystal (Cr) phases. We locate the I-SmA phase transition at low pressure and the sequence of phase transitions I-N-SmA along higher-pressure isobars and we establish the location of the I-N-SmA triple point. Close to this triple point, we show that the N-SmA transition is clearly first order. Our results are compared to the coexistence lines of the approximate phase diagram elucidated by de Miguel et al. [J. Chem. Phys. 121, 11183 (2004)] established through the direct observation of the sequence of phase transitions occurring along isobars under heating or cooling sequences of runs. Finally, we discuss the potential of our technique in studying similar transitions observed on layered phases under confinement.

Chromium hypersensitivity (chromium-induced allergic contact dermatitis) is an important issue in occupational skin disease. Hexavalent chromium (Cr (VI)) can activate the Akt, Nuclear factor κB (NF-κB), and Mitogen-activated protein kinase (MAPK) pathways and induce cell death, via the effects of reactive oxygen species (ROS). Recently, cell death stimuli have been proposed to regulate the release of inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-1 (IL-1). However, the exact effects of ROS on the signaling molecules and cytotoxicity involved in Cr(VI)-induced hypersensitivity have not yet been fully demonstrated. N-acetylcysteine (NAC) could increase glutathione levels in the skin and act as an antioxidant. In this study, we investigated the effects of NAC on attenuating the Cr(VI)-triggered ROS signaling in both normal keratinocyte cells (HaCaT cells) and a guinea pig (GP) model. The results showed the induction of apoptosis, autophagy and ROS were observed after different concentrations of Cr(VI) treatment. HaCaT cells pretreated with NAC exhibited a decrease in apoptosis and autophagy, which could affect cell viability. In addition, Cr (VI) activated the Akt, NF-κB and MAPK pathways thereby increasing IL-1α and TNF-α production. However, all of these stimulation phenomena could be inhibited by NAC in both of in vitro and in vivo studies. These novel findings indicate that NAC may prevent the development of chromium hypersensitivity by inhibiting of ROS-induced cell death and cytokine expression.

The center-of-mass dynamics of star polymers in dilute solution is analyzed by hybrid mesoscale simulations. The fluid is modeled by the multiparticle collision dynamics approach, a particle-based hydrodynamic simulation technique, which is combined with molecular dynamics simulations for the polymers. Star polymers of various functionalities are considered. We determine the center-of-mass velocity correlation functions, the corresponding mean square displacements, and diffusion coefficients. The velocity correlation functions exhibit a functionality-dependent and structure-specific intermediate time regime, with a slow decay. It is followed by the long-time tail t(-3/2), which is solely determined by the fluid. Infinite-system-size diffusion coefficients are determined from the velocity correlation function by a combination of simulation and analytical results, as well as from the center-of-mass mean square displacement for various systems sizes and extrapolation. In terms of the hydrodynamic radius, the star polymer hydrodynamic diffusion coefficient exhibits the same universal system-size dependence as a spherical colloid. The functionality dependence of the ratio of hydrodynamic radii and the radii of gyration agrees well with experimental predictions.

OBJECTIVE Hyperglycemic crisis is one of the most serious diabetes-related complications. The increase in the prevalence of diabetes in the geriatric population leads to a large disease burden, but previous studies of geriatric hyperglycemic crisis were focused on acute hyperglycemic crisis episode (HCE). This study aimed to delineate the long-term mortality risk after HCE. RESEARCH DESIGN AND METHODS This retrospective national population-based cohort study reviewed, in Taiwan’s National Health Insurance Research Database, data from 13,551 geriatric patients with new-onset diabetes between 2000 and 2002, including 4,517 with HCE (case subjects) (ICD-9 code 250.1 or 250.2) and 9,034 without HCE (control subjects). The groups were compared and followed until 2011. RESULTS One thousand six hundred thirty-four (36.17%) case and 1,692 (18.73%) control subjects died (P < 0.0001) during follow-up. Incidence rate ratios (IRRs) of death were 2.82 times higher in case subjects (P < 0.0001). The mortality risk was highest in the first month (IRR 26.56; 95% CI 17.97–39.27) and remained higher until 4–6 years after the HCE (IRR 1.49; 95% CI 1.23–1.81). After adjustment for age, sex, selected comorbidities, and monthly income, the mortality hazard ratio was still 2.848 and 4.525 times higher in case subjects with one episode and two or more episodes of hyperglycemic crisis, respectively. Older age, male sex, renal disease, stroke, cancer, chronic obstructive pulmonary disease, and congestive heart failure were independent mortality predictors. CONCLUSIONS Patients with diabetes had a higher mortality risk after HCE during the first 6 years of follow-up. Referral for proper education, better access to medical care, effective communication with a health care provider, and control of comorbidities should be done immediately after HCE.

The geriatric population (aged ≥65 years) accounts for 12-24% of all emergency department (ED) visits. Of them, 10% have a fever, 70-90% will be admitted and 7-10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality.We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point.A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were.The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever.

Breast cancer is the most common cancer in women worldwide; thus, the prolongation of survival, and the incidence and risk factors, including radiotherapy, for developing secondary malignancies are important. We compared the incidence of secondary and new primary cancers in women with breast cancer (CAPos) and well-matched for age, geographic region, and monthly income cancer-free controls (CANeg). The risk for secondary cancers with and without radiotherapy was also compared in CAPos women. We enrolled 2422 CAPos patients and CANeg 12,110 controls. In a 4-year follow-up, the secondary cancers risk was significant in the CAPos group (adjusted hazard ratio [AHR]: 1.59; 95% confidence interval [CI]: 1.17–2.18). Only the risk of uterine cancer was significant compared with the controls (AHR: 6.30; 95% CI: 2.28–17.38). CAPos patients and

The femoral vein is the most popular location for temporary catheterization during emergency hemodialysis. Common complications are infection, thrombosis, arterial puncture, and groin hematoma. We report herein a patient with femoral vein perforation and prevesical hematoma.

Objective: We present a case of acute intestinal infarction in a pregnant woman with chronic idiopathic mesenteric vein thrombosis (MVT) under regular anticoagulation treatment. Case Presentation and Intervention: The condition of the 26-year-old woman who was diagnosed with chronic idiopathic MVT after detailed investigation was stable after receiving regular anticoagulation with warfarin. One year later, she presented with a 7-day episode of intermittent epigastric pain. Acute intestinal infarction and concomitant 7-week pregnancy were diagnosed. To preserve her life, a dilation and curettage procedure and emergency laparotomy with bowel resection were performed. Ten days later, she was discharged, having made a good recovery. Conclusion: Although pregnancy was not the primary cause of chronic MVT, it did play a role in inducing the acute intestinal infarction. This case indicates that pregnant patients with known chronic idiopathic MVT should be counseled about the high risk of acute mesenteric thrombosis. This case also serves to remind physicians that there should always be a high level of suspicion of intestinal infarction in patients with an acute abdomen who are in a hypercoagulable state.

SUMMARY Central line placement is a common technique in emergency and critical care. Although it is not a very difficult procedure, severe complications sometimes occur. We present a very rare complication of distal guidewire migration to the superior vena cava while performing femoral venous catheterization in an elderly patient. The problems of human errors are discussed and precautions are proposed. (International Journal of Gerontology 2008; 2(3): 133-135)

Aims/Introduction: Hyperglycemic crises without a history of diabetes have not been well studied. We compared the clinical characteristics of patients with and without a history of diabetes, and evaluated the glycated hemoglobin levels. Materials and Methods: Consecutive adult patients (aged >18 years) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled if they met the criteria for a hyperglycemic crisis. Patients were separated into those without and those with a history of diabetes. The 30-day mortality was the primary end-point. Results: We enrolled 295 patients who made 330 visits to the ED. Patients without a history of diabetes made up 24.5% (81/330) of the hyperglycemic crises. Patients without a history of diabetes were more prone than patients with a history of diabetes to be younger and male, and to have better consciousness and renal function, more significant diabetic signs and symptoms (e.g., thirst, polydipsia, polyuria and bodyweight loss), higher blood sugar, and less opportunity of infection and mortality. Most of the patients (93.8%, 76/81) had glycated hemoglobin of ≥6.5%. Conclusions: The present study delineates the clinical characteristics of patients with hyperglycemic crises, but without a history of diabetes. Most patients had glycated hemoglobin ≥6.5%, which raises the argument of using this biomarker for routine screening of diabetes.

Peritoneal dialysis (PD) frequently contributes to peritoneal damage which cannot be easily identified without invasive techniques, implying the urgent need for biomarkers and revealing mechanisms. Chronic glomerulonephritis (CGN) is one of the leading causes of receiving dialysis treatment. Here, we attempted to analyze the peritoneal dialysate collected from CGN patients when they receive continuous ambulatory peritoneal dialysis (CAPD) treatment for the first time and after a year to reveal the protein changes that resulted from PD. Proteins were displayed by two-dimensional gel electrophoresis (2DE). Altered gel spots were digested followed by liquid chromatography-tandem mass spectrometry (LC-MS/MS) analysis for protein identification. Eight proteins were found to have differential expression levels between two groups. Their differential expressions were validated by Western blots in other sets of peritoneal dialysates. Proteins identified with higher levels in the first-time dialysate suggested their dominant appearance in CGN patients, while those that showed higher levels in peritoneal dialysate collected after one year may result from initial peritoneal inflammation or changes in the permeability of the peritoneum to middle-sized proteins. All the identified proteins may provide a perceptiveness of peritoneal changes caused by PD and may function as potential biomarkers or drug targets.

Several nomograms for prostate cancer detection have recently been developed. Because the incidence of prostate cancer is lower in Chinese men, nomograms based on other populations cannot be directly applied to Chinese men. We, therefore, developed a model for predicting the probability of a positive initial prostate biopsy using clinical and laboratory data from a Chinese male population. Data were collected from 893 Chinese male referrals, 697 in the derivation set and 196 in the external validation set, who underwent initial prostate biopsies as individual screening. We analyzed age, prostate volume, total prostate-specific antigen (PSA), PSA density (PSAD), digital rectal examinations (DRE) and transrectal ultrasound (TRUS) echogenicity. Logistic regression analysis estimated odds ratio, 95% confidence intervals and P values. Independent predictors of a positive biopsy result included advanced age, small prostate volume, elevated total PSA, abnormal digital rectal examination, and hyperechoic or hypoechoic TRUS echogenicity. We developed a predictive nomogram for an initial positive biopsy using these variables. The area under the receiver-operating characteristic curve for the model was 88.8%, which was greater than that of the prediction based on total PSA alone (area under the receiver-operating characteristic curve 74.7%). If externally validated, the predictive probability was 0.827 and the accuracy rate was 78.1%, respectively. Incorporating clinical and laboratory data into a prebiopsy nomogram improved the prediction of prostate cancer compared with predictions based solely on the individual factors.

Background Infection is the most common precipitating factor and cause of death in patients with hyperglycemic crises. Treating infection-precipitated hyperglycemic crises includes using empiric antibiotics early; correcting dehydration, hyperglycemia, and electrolyte imbalances; and frequent monitoring. Intensive care unit admission, broad-spectrum antibiotics, and even novel therapy for infection may be beneficial for patients with a high risk of mortality. However, these management options are costly and not beneficial for every patient. Selecting high-risk patients who would most likely benefit is more appropriate. We investigated the independent mortality predictors of patients with infection-precipitated hyperglycemic crises to facilitate clinical decision making. Methods This study was conducted in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the Emergency Department between January 2004 and December 2010 were enrolled when they met the criteria of an infection-precipitated hyperglycemic crisis. Thirty-day mortality was the primary endpoint. Results One hundred forty-two patients were enrolled. The infection source did not predict mortality. The presenting variables that were independently associated with 30-day mortality in a multiple logistic regression model were cancer history (odds ratio [OR], 7.4; 95% confidence interval [CI], 2.4-23.2), bandemia (OR, 7.0; 95% CI, 1.6-30.3), and serum creatinine (OR, 1.4; 95% CI, 1.1-1.8). The common sources of infection were the lower respiratory tract (30.3%), urinary tract (49.3%), skin or soft tissue (12.0%), and intra-abdominal (6.3%). Conclusions Cancer history, bandemia, and serum creatinine level are three independent mortality predictors for patients with infection-precipitated hyperglycemic crises. These predictors are both readily available and valuable for physicians making decisions about risk stratification, treatment, and disposition.

Background We investigated independent mortality predictors of hyperglycemic crises and developed a prediction rule for emergency and critical care physicians to classify patients into mortality risk and disposition groups. Methods This study was done in a university-affiliated medical center. Consecutive adult patients (> 18 years old) visiting the emergency department (ED) between January 2004 and December 2010 were enrolled when they met the criteria of a hyperglycemic crisis. Data were separated into derivation and validation sets—the former were used to predict the latter. December 31, 2008, was the cutoff date. Thirty-day mortality was the primary endpoint. Results We enrolled 295 patients who made 330 visits to the ED: derivation set=235 visits (25 deaths: 10.6%), validation set=95 visits (10 deaths: 10.5%). We found 6 independent mortality predictors: A bsent tachycardia, H ypotension, A nemia, S evere coma, C ancer history, and I nfection (AHA.SCI). After assigning weights to each predictor, we developed a P redicting H yperglycemic crisis D eath (PHD) score that stratifies patients into mortality-risk and disposition groups: low (0%) (95% CI, 0-0.02%): treatment in a general ward or the ED; intermediate (24.5%) (95% CI, 14.8-39.9%): the intensive care unit or a general ward; and high (59.5%) (95% CI, 42.2-74.8%): the intensive care unit. The area under the curve for the rule was 0.946 in the derivation set and 0.925 in the validation set. Conclusions The PHD score is a simple and rapid rule for predicting 30-day mortality and classifying mortality risk and disposition in adult patients with hyperglycemic crises.

There is globally increasing prevalence and incidence in end-stage renal disease (ESRD). These patients are frequently reported to have retinal abnormalities and both diseases share some systemic risk factors. Hence, it is clinically relevant to determine whether ESRD is a predictor of retinal artery occlusion (RAO).To investigate the risk of RAO in ESRD patients.A retrospective, nationwide, matched cohort study. The study included 93,766 ESRD patients recruited between 2000 and 2009 from the Taiwan National Health Insurance Research Database. The same number control group included age- and sex-matched patients without ESRD selected from the Taiwan Longitudinal Health Insurance Database, 2000. Data for each patient were collected from the index date until December 2011.The incidence and risk of RAO were compared between the 2 groups. The hazard ratio (HR) for RAO after adjustment for potential confounders was calculated using Cox proportional hazards regression. Kaplan-Meier analysis was used to calculate the cumulative RAO incidence rate.In total, 237 ESRD patients and 73 controls exhibited RAO during follow-up; thus, the RAO incidence rate in ESRD patients was 4.49 times (95% confidence interval (CI), 3.45-5.83) that in the control patients. After adjustment for potential confounders, including diabetes mellitus, hypertension, hyperlipidemia, congestive heart failure, and coronary artery disease, ESRD patients were 2.78 times (95% CI, 2.02-3.84) more likely to develop RAO in cohort for the total sample. Among patients with hypertension, the RAO incidence rate was significantly higher in the ESRD group, and hypertension significantly increased RAO risk even after adjustment for other confounders in the cohort.ESRD increases the risk of RAO, particularly in ESRD patients with hypertension. Therefore, clinicians should educate ESRD patients about RAO and ensure appropriate blood pressure control.

To investigate the risk of nonarteritic anterior ischemic optic neuropathy (NAION) following end-stage renal disease (ESRD). A retrospective, nationwide, matched cohort study. ESRD patients identified by the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 585. The study cohort included 93,804 ESRD patients registered with the Taiwan National Health Insurance Research Database between January 2000 and December 2009. An age- and sex-matched control group comprised 93,804 patients (case:control = 1:1) selected from the Taiwan Longitudinal Health Insurance Database 2000. Information for each patient was collected from the index date until December 2011. The incidence and risk of NAION were compared between the ESRD and control groups. The adjusted hazard ratio (HR) for NAION after adjustment for potential confounders was obtained by a Cox proportional hazard regression analysis. A Kaplan–Meier analysis was used to calculate the cumulative incidence rate of NAION. The incidence of NAION following ESRD. In total, 133 ESRD patients (0.14%) and 51 controls (0.05%) had NAION (P

We review results of the non-equilibrium properties of semidilute polymer solutions under shear flow. A hybrid simulation approach is adopted, combing molecular dynamics simulations and the multiparticle collision dynamics method, which has been shown to fully capture hydrodynamic interactions. The polymers exhibit a shear rate dependent deformation and alignment. In addition, shear thinning is observed, which is related to the finite polymer extensibility. It is characterized by the shear-rate dependent viscosity and the first normal-stress coefficient. The conformational and rheological properties are universal functions of a concentration dependent Weissenberg number. The cyclic dynamics of an individual polymer is described in terms of a shear-rate dependent tumbling time. The tumbling time is tightly linked to the polymer end-to-end vector relaxation time and depends on concentration, which is attributed to screening of hydrodynamic interactions in semidilute solutions.

We described a 14-year-old boy with initial presentation of recurrent intermittent abdominal pain, with subsequent development of jejunojejunum intussusception. The characteristic purpuric skin rash of Henoch-Schonlein purpura appeared later after the surgical manual reduction. When abdominal pain is the single initial manifestation in patients with undiagnosed Henoch-Schonlein purpura, emergency physicians should evaluate if the patient required early surgical intervention such as intussusception or perforation and always keep Henoch-Schonlein purpura as a possibility in mind.

Objective The aim of this study was to investigate if the electrocardiographic (ECG) abnormalities assessed early in the emergency department (ED) are associated with the in-hospital mortality of the patients with spontaneous subarachnoid hemorrhage (SAH). Methods We studied prospectively a cohort of 222 adult patients with spontaneous SAH in an ED. A 12-lead ECG was performed for these patients in the ED. The patients were stratified into nonsurvivors and survivors based on the in-hospital mortality. The clinical characteristics, heart rate, corrected QT interval (QTc) and 7 predefined morphologic abnormalities were compared between these 2 groups of patients. Results Compared with the survivors (n = 178), the nonsurvivors (n = 44) had significantly slower heart rate (75 ± 23 vs 83 ± 16, P = .018) and more prolonged QTc (492 ± 58 vs 458 ± 40, P = .001). There were significantly higher frequency of occurrence of ECG morphologic abnormalities (66% vs 37%, P = .001) and nonspecific ST- or T-wave changes (NSSTTCs; 32% vs 12%, P = .015) in the nonsurvivors compared with those in the survivors. Multiple logistic regression model identified QTc (odds ratio, 1.0; 95% confidence interval, 1.0-1.0; P = .005) and NSSTTC (odds ratio, 3.3; 95% confidence interval, 1.0-10.7; P = .047) as the significant ECG variables associated with in-hospital mortality. Conclusions The occurrence of NSSTTC and prolonged QTc assessed early in the ED are independently associated with the in-hospital mortality in adult patients with spontaneous SAH.

The properties of semidilute polymer solutions are investigated at equilibrium and under shear flow by mesoscale simulations, which combine molecular dynamics simulations and the multiparticle collision dynamics approach. In semidilute solution, intermolecular hydrodynamic and excluded volume interactions become increasingly important due to the presence of polymer overlap. At equilibrium, the dependence of the radius of gyration, the structure factor, and the zero-shear viscosity on the polymer concentration is determined and found to be in good agreement with scaling predictions. In shear flow, the polymer alignment and deformation are calculated as a function of concentration. Shear thinning, which is related to flow alignment and finite polymer extensibility, is characterized by the shear viscosity and the normal stress coefficients.

To assess the ability of mean platelet volume (MPV) to detect acute coronary syndromes (ACS) in Chinese patients within 4emsp14;h of chest pain onset.Consecutive adult Chinese patients who arrived at an emergency department (ED) with acute chest pain (onset within 4emsp14;h) between May and August 2009 were recruited. The MPV was checked for all enrolled patients on arrival at the ED, and further comparisons between the patients in different groups were made.282 patients (136 men and 146 women) were enrolled and 69 were diagnosed as having ACS (24.5%). As compared with the non-ACS group, the ACS group had significantly higher MPV values (10.8±0.86 fl vs 9.8±0.76 fl, p0.001). Moreover, we found that the MPV values were higher in patients with acute myocardial infarction (AMI) (n=28) as compared with patients with unstable angina (UA) (n=41) (11.0±0.79 fl vs 10.6±0.87 fl, p=0.027). Multiple logistic regression analysis yielded the fact that the initial MPV was an independent predictor of ACS attack in patients with acute chest pain (OR 8.866). The corresponding area under the receiver operating characteristic curve (ROC) for MPV in predicting ACS in patients with acute chest pain was 0.800 (95% CI 0.736 to 0.864) and the best cut-off value was 10.35 fl (sensitivity 78.3%; specificity 74.6%).MPV is significantly associated with ACS in patients with acute chest pain and is an early and independent predictor.

Objective To assess the possibility of heart rate variability (HRV) measures as predictors of 24-h mortality in successfully resuscitated patients with out-of-hospital cardiac arrest (OHCA). Methods This prospective cohort study was conducted at a 40-bed emergency department (ED) of a university-affiliated medical centre. Adult patients with OHCA who were successfully resuscitated were consecutively enrolled over an 18-month period. A 10-min electrocardiogram was recorded for retrospective off-line HRV analysis 30–60min after the return of spontaneous circulation and further correlated with 24-h mortality of the patients. Results Sixty-nine patients aged 31–82 years who met the inclusion criteria were enrolled. According to the 24-h mortality, the patients were categorised into non-survivors ( n =28) and survivors ( n =41) groups. The HRV measures were compared between these two groups. The low-frequency power (LFP), normalized LFP (nLFP) and low-/high-frequency power ratio in the non-survivors were significantly lower than those of the survivors, whereas root mean square successive difference, high-frequency power (HFP), HFP/tidal volume, normalized HFP (nHFP), and nHFP/tidal volume in the non-survivors were significantly higher than those of the survivors. Multiple logistic regression model identified nLFP as the independent variable to predict 24-h mortality (odds ratio, 1.354; 95% confidence interval [CI], 1.124–1.632; p =0.001). Receiver operating characteristic area for nLFP in the prediction of 24-h mortality was 0.946 (95% CI, 0.897–0.995; p Conclusions HRV measures, especially the nLFP, may be used as predictors of 24-h mortality for successfully resuscitated patients with OHCA in the ED.

In this study, the width of channel, D, and diffuser angle, α, at given diffuser width whose value is 100μ will be studied for steady and unsteady flow conditions. By means of a series of numerical simulations, some findings for diffuser valve will be reported. The diffuser valve with a channel width of D =300μ and diffuser angle α=60°, is a better geometry because of its outstanding capability on suction production of net volume flow. Besides, the larger the Reynolds number is, the greater the suction amount of net volume flow will be. When the aspect ratio (AR) is approaching to the value of 4, the diffuser valve becomes more effective. An optimal Strouhal number, St(subscript H), based on production of maximum net volumetric flow is 0.338 for D=300μ. These findings will be useful to micropump of diffuser valve.

Many people who have low back pain are likely to be out of work and taking medication and probably make demands on both primary and secondary health care as well as the private sector. Septic diskitis is a rare cause of back pain, accounting for less than 0.01% of cases in the primary care setting (Carragee EJ. Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am. 1997;79:874-80). It has been associated with a high morbidity and mortality in the past. Although it is an unusual complication in a postoperative patient, it is even more rare in a nonoperative patient. It accounts for 2% of all osteomyelitis (Maiuri F, Iaconetta G, Gallicchio B, Manto A, Briganti F. Spondylodiscitis. Clinical and magnetic resonance diagnosis. Spine. 1997;22:1741-6) and may occur spontaneously, after surgery (especially after epidural anesthesia), in the immunosuppressed, and systemic infections. It has the potential to be an orthopedic pitfall in the emergency department because it can be presented with nonspecific symptoms, nonspecific laboratory abnormalities, and nondiagnostic radiographic studies. We present a case of low back pain in a previously healthy individual as a result of spontaneous septic diskitis, which had been initially misdiagnosed in the private sector as herniation of an intervertebral disk.

Prior studies of upper gastrointestinal bleeding (UGIB) and acute myocardial infarction (AMI) are small, and long-term effects of UGIB on AMI have not been delineated. We investigated whether UGIB in patients diagnosed with coronary artery disease (CAD) increased their risk of subsequent AMI. This was a population-based, nested case-control study using Taiwan’s National Health Insurance Research Database. After propensity-score matching for age, gender, comorbidities, CAD date, and follow-up duration, we identified 1,677 new-onset CAD patients with AMI (AMI[+]) between 2001 and 2006 as the case group and 10,062 new-onset CAD patients without (AMI[−]) as the control group. Conditional logistic regression was used to examine the association between UGIB and AMI. Compared with UGIB[−] patients, UGIB[+] patients had twice the risk for subsequent AMI (adjusted odds ratio [AOR] = 2.08; 95% confidence interval [CI], 1.72–2.50). In the subgroup analysis for gender and age, UGIB[+] women (AOR = 2.70; 95% CI, 2.03–3.57) and patients < 65 years old (AOR = 2.23; 95% CI, 1.56–3.18) had higher odds of an AMI. UGIB[+] AMI[+] patients used nonsignificantly less aspirin than did UGIB[−] AMI[+] patients (27.69% vs. 35.61%, respectively). UGIB increased the risk of subsequent AMI in CAD patients, especially in women and patients < 65. This suggests that physicians need to use earlier and more aggressive intervention to detect UGIB and prevent AMI in CAD patients.