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有些學生在資賦上很好，但學習表現卻不如預期，稱之為低成就學生；有些學生在資賦上低於平均數，但表現卻高於其能力水準，稱之為高成就學生。此兩類型學生剛好是能力與努力差異化的表徵。本研究目的係嘗試透過不同智力／成就組型的分析，來瞭解影響數學學習的相關心理機制，並嘗試探討數學教師能準確辨識低成就學生的比率與相關因素。本研究以 3,530 位國中學生為受試樣本，探討數學科低智商高成就與高智商低成就學生的學習行為構型。經由分析結果顯示：一、「低智商高成就」者占 5.6%、「低智商低成就」者占 4.1%、「高智商高成就」者占 9.5%、「高智商低成就」者占 10.2%；二、「數學能力知覺」與「自我設限」的學習組型可作為區分「低智商高成就」與「高智商低成就」的學生。最後，根據研究結果提出建議，以供教師及未來研究參考。 Some skilled students are deemed underachievers, even though they demonstrate adequate academic performances, because they fail to meet certain expectations. By contrast, some gifted students achieving below-average scores, but having performance capabilities exceeding their skill level, are labeled overachievers. These two categories representing student ability and effort have differences. This study investigated the profiles of underachievers and overachievers in junior high school mathematics by comparing variation patterns to build the foundation for future remedial education. Students from one junior high school were analyzed; the conclusions were as follows: (1) Of 3,530 participating students, 199 (5.6%), 143 (4.1%), 337 (9.5%), and 360 (10.2%) were low intelligence quotient (IQ) – overachievers, low IQ – underachievers, high IQ – overachievers, and high IQ – underachievers, respectively. (2) Perceived math competence and self-debilitating strategies were observed in high IQ – underachievers and low IQ – overachievers. (3) Finally, suggestions for teaching practices and future studies were proposed.

Outcomes of acute type A aortic dissection repair may be improved when VasoRing connectors (VRC [Sunwei Technology, Taipei, Taiwan]) are used to facilitate aortic anastomosis. In the present study, we compared the results of acute type A aortic dissection repair using VRC and conventional suture technique.A total of 68 patients who underwent acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure at our institution were enrolled. Records of patients receiving aorta anastomosis with VRC (n = 33) and conventional suture (n = 35) were retrospectively compared. All the surgical results were collected and analyzed.The results showed that the VRC group exhibited significance in total operative time (326 ± 80 minutes versus 362 ± 34 minutes, p = 0.023), cardiopulmonary bypass time (97 ± 10 minutes versus 134 ± 15 minutes, p0.001), aortic cross-clamp time (97 ± 10 minutes versus 134 ± 15 minutes, p0.001), and circulatory arrest time (15 ± 4 minutes versus 50 ± 8 minutes, p 0.001) compared with the suture group. Use of VRC for aortic anastomosis led to significantly less perioperative blood loss (442 ± 75 mL versus 849 ± 419 mL, p 0.001) compared with conventional suture for aortic anastomosis There was no reoperation for postoperative bleeding in the VRC group whereas reoperation for postoperative bleeding occurred in 20% of the suture group (0% versus 20%, p = 0.011). Postoperative blood loss, amount of blood transfusion, and acute kidney injury requiring hemodialysis were also significantly less in the VRC group than the suture group.Use of VRC shortened operative time and improved bleeding control incorporating standard methods for aortic anastomoses during acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure. Long-term follow-up and randomized comparison are needed to confirm VRC efficacy.

Background Hepatic dysfunction and coagulopathy are common in acute dengue illness. We analyzed the trajectories of the above parameters in the survivors and fatal patients in the outbreak in Tainan, 2015. Methods A retrospective study was conducted using data from a tertiary hospital between January and December 2015. Multilevel modeling (MLM) was used to identify the changes in aminotransferase (AST), alanine aminotransferase (ALT), activated partial thromboplastin time (aPTT), and platelet counts from Day 0 to Day 7 of the onset of dengue infection. The machine-learning algorithm was used by purity measure assumption to calculate the accuracy of serum transaminases and coagulation variables to discriminate between the fatal and survival groups. Results There were 4,069 dengue patients, of which 0.9% died in one week after illness onset (i.e., early mortality). Case fatality rate was the highest for those aged ≥70 years. Both AST and ALT values of the fatal group were significantly higher than those of the survivor group from Day 3 (AST median, 624 U/L vs. 60 U/L, p < 0.001; ALT median, 116 U/L vs. 29 U/L, p = 0.01) of illness onset and peaked on Day 6 (AST median, 9805 U/L vs. 90 U/L, p < 0.001; ALT median, 1504 U/L vs. 49 U/L, p < 0.001). AST ≥ 203 U/L, ALT ≥ 55 U/L, AST2/ALT criteria ≥337.35, or AST/platelet count ratio index (APRI) ≥ 19.18 on Day 3 of dengue infection had a high true positive rate, 90%, 78%, 100%, or 100%, respectively, of early mortality. The platelet counts of the fatal group declined significantly than those of the survivor group since Day 3 of illness onset (median, 19 x103/μl vs. 91 x103/μl, p < 0.01), and aPTT values of the fatal group significantly prolonged longer since Day 5 (median, 68.7 seconds vs. 40.1 seconds, p < 0.001). Conclusions AST, ALT, and platelet counts should be monitored closely from Day 0 to Day 3 of dengue infection, and aPTT be followed up on Day 5 of infection to identify the individuals at risk for early mortality., Author summary Dengue fever (DF) is currently one of the most severe public health problems. Clinical presentations of dengue are diverse and non-specific, often with unpredictable clinical progression and outcome. Hepatic dysfunction and abnormal coagulation factors are common in acute dengue illness, reflected by abnormal alanine aminotransferase (AST), aspartate aminotransferase (ALT), activated partial thromboplastin time (aPTT), and platelet counts. However, there is no information available about the monitoring frequency required, which could help identify those dengue patients who are likely to die, especially during epidemic outbreaks with limited healthcare resources. We examined all the laboratory-confirmed dengue patients who admitted to the major tertiary hospital in Tainan during the 2015 dengue outbreak, and the different trajectories of hepatic function and coagulation factors between survivors and rapidly fatal dengue patients were analyzed. Although there were no differences in AST, ALT, aPTT, and platelet counts between the survivor and fatal groups on the day DF symptoms first appeared, the differences increased from the early stages of infection and became more prominent during the early stages of the illness. The necessity of monitoring the AST, ALT, aPTT, and platelet count frequently during the febrile phase is emphasized by this study.

Background: Cefazolin is in vitro active against wild isolates of Escherichia coli, Klebsiella species, and Proteus mirabilis (EKP), but clinical evidence supporting the contemporary susceptibility breakpoint issued by the Clinical and Laboratory Standards Institute (CLSI) are limited. Methods: Between 2010 and 2015, adults with monomicrobial community-onset EKP bacteremia with definitive cefazolin treatment (DCT) at two hospitals were analyzed. Cefazolin minimum inhibitory concentrations (MICs) were correlated with clinical outcomes, including primary (treatment failure of DCT) and secondary (30-day mortality after bacteremia onset, recurrent bacteremia, and mortality within 90 days after the end of DCT) outcomes. Results: Overall, 466 bacteremic episodes, including 340 (76.2%) episodes due to E. coli, 90 (20.2%) Klebsiella species, and 16 (3.6%) P. mirabilis isolates, were analyzed. The mean age of these patients was 67.8 years and female-predominated (68.4%). A crude 15- and 30-day mortality rate was 0.7% and 2.2%, respectively, and 11.2% experienced treatment failure of DCT. A significant linear-by-linear association of cefazolin MICs, with the rate of treatment failure, 30-day crude mortality, recurrent bacteremia or 90-day mortality after the DCT was present (all γ = 1.00, p = 0.01). After adjustment, the significant impact of cefazolin MIC breakpoint on treatment failure and 30-day crude mortality was most evident in 2 mg/L (>2 mg/L vs. ≤2 mg/L; adjusted hazard ratio, 3.69 and 4.79; p < 0.001 and 0.02, respectively). Conclusion: For stabilized patients with community-onset EKP bacteremia after appropriate empirical antimicrobial therapy, cefazolin might be recommended as a definitive therapy for cefazolin-susceptible EKP bacteremia, based on the contemporary CLSI breakpoint.

Background Endovascular therapy has become the first-line treatment for most peripheral artery diseases, but re-entry into the true lumen is not always possible, particularly in some cases of chronic total occlusion (CTO). We previously reported a novel hybrid Viabahn-assisted bypass (VAB) technique to facilitate revascularization of the femoro-popliteal CTO. This study assessed the midterm results of VAB technique.Methods and Results:Between January 2013 and April 2017, 440 patients received femoro-popliteal intervention and 17 of them (mean age, 76.2 years; 11 male patients) were treated using the VAB technique. The technical success was 100%. The mean follow-up period was 27.4±14.4 months (range, 6-50 months). Two patients underwent major amputation at 6 and 11 months postoperatively, but they died of acute myocardial infarction and of sepsis, respectively. Another 3 patients received re-intervention because of edge stenosis of the Viabahn stent graft. Another patient had acute Viabahn thrombosis and was treated using open thrombectomy. The primary and secondary patency rates at 12 months were both 88.2%, and at 24 months they were 69.2% and 84.6%, respectively. Conclusions The VAB technique could be a safe and feasible alternative treatment for long femoro-popliteal CTO when conventional treatments fail. The technical success is high, and the midterm patency rates are acceptable.

The present study aimed to isolate Aeromonas from fish sold in the markets as well as in sushi and seafood shops and compare their virulence factors and antimicrobial characteristics with those of clinical isolates. Among the 128 fish isolates and 47 clinical isolates, Aeromonas caviae, A. dhakensis, and A. veronii were the principal species. A. dhakensis isolates carried at least 5 virulence genes, more than other Aeromonas species. The predominant genotype of virulence genes was hlyA lip alt col ela in both A. dhakensis and A. hydrophila isolates, alt col ela in A. caviae isolates, and act in A. veronii isolates. A. dhakensis, A. hydrophila, and A. veronii isolates more often exhibited hemolytic and proteolytic activity and showed greater virulence than A. caviae isolates in Caenorhabditis elegans and the C2C12 cell line. However, the link between the genotypes and phenotypes of the studied virulence genes in Aeromonas species was not evident. Among the four major clinical Aeromonas species, nearly all (99.0%) A. dhakensis, A. hydrophila, and A. veronii isolates harbored blaCphA, which encodes a carbapenemase, but only a minority (6.7%, 7/104) were nonsusceptible to carbapenem. Regarding AmpC β-lactamase genes, blaAQU-1 was exclusively found in A. dhakensis isolates, and blaMOX3 was found only in A. caviae isolates, but only 7.6% (n = 6) of the 79 Aeromonas isolates carrying blaAQU-1 or blaMOX3 exhibited a cefotaxime resistance phenotype. In conclusion, fish Aeromonas isolates carry a variety of combinations of virulence and β-lactamase resistance genes and exhibit virulence phenotypes and antimicrobial resistance profiles similar to those of clinical isolates. IMPORTANCEAeromonas species can cause severe infections in immunocompromised individuals upon exposure to virulent pathogens in the environment, but the characteristics of environmental Aeromonas species remain unclear. Our study showed that several pathogenic Aeromonas species possessing virulence traits and antimicrobial resistance similar to those of Aeromonas isolates causing clinical diseases were present in fish intended for human consumption in Tainan City, Taiwan.

Background/purpose: Legionella pneumophila had been recognized as a pathogen for both healthcare-associated and community-acquired pneumonia. We aimed to evaluate clinical features and outcomes of patients with Legionnaires' disease at a tertiary medical center in southern Taiwan. Methods: From January 2005 to December 2013, a retrospective study of adult cases of Legionnaires' disease was conducted in a 1200-bed tertiary hospital. Their medical records were reviewed for further evaluation and analysis. Results: A total of 61 cases of Legionnaires' disease were identified during the study period. Their mean age was 61.1 years, with male predominance (43, 70.5%). Among them, 30 (49.2%) had healthcare-associated pneumonia (HCAP), 20 (32.8%) had community-acquired pneumonia, and notably 11 (18.0%) were caregivers. Patients with healthcare-associated pneumonia tend to have higher Charlson comorbidity scores than those with community-acquired pneumonia (3.6 ± 2.4 vs. 1.9 ± 1.9, p = 0.008) and caregivers (0.5 ± 0.5, p

Purpose: To report a retrospective analysis of risk factors for edge restenosis after Viabahn stent-graft treatment of superficial femoral artery (SFA) occlusive disease and determine any protective effect of drug-coated balloons (DCBs) used at the time of stent-graft implantation. Methods: Between October 2011 and July 2016, 110 patients (mean age 73.3±7.6 years; 78 men) were treated with the Viabahn stent-graft for long SFA occlusions. Thirty-eight (34.5%) patients had DCB reinforcement at the distal edge of the stent-graft. For analysis, the population was divided into groups of no edge stenosis patients (n=88; mean lesion length 22.4±4.2 cm) and edge stenosis patients (n=22; mean lesion length 23.5±5.7 cm). The clinical outcomes, ankle-brachial indices, computed tomography angiography findings, and patency were compared at a minimum of 12 months. Logistic regression analysis was employed to determine risk factors for edge stenosis; the results are presented as the odds ratio (OR) and 95% confidence interval. Results: No differences in clinical or procedural characteristics were identified except the higher incidence of diabetes (p=0.008) and greater need for retrograde access (p=0.033) in the edge stenosis group. DCB reinforcement reduced the incidence of edge stenosis (p=0.021) and target lesion revascularization (TLR; p=0.010) and resulted in a significantly higher 1-year primary patency rate (92.1% vs 76.4%, p=0.042). However, multivariate analysis revealed only poor distal runoff (OR 0.31, 95% CI 0.11 to 0.83, p=0.020) as a predictor of edge stenosis. Conclusion: The risk of edge stenosis after Viabahn implantation was higher in patients with poor distal runoff. DCB reinforcement over the distal edge reduced edge stenosis, decreased 1-year TLR, and improved 1-year primary patency.

Background In chronic type B aortic dissection, late distal stent graft–induced new entry (SINE) has a possible negative role in long-term aortic remodeling. This study aimed to investigate the impact of SINE occurrence on survival by evaluating true and false lumen remodeling in thoracic and abdominal segments at midterm surveillance. Methods This study enrolled 65 patients with chronic type B aortic dissection (DeBakey type IIIb), who had received hybrid thoracic endovascular aortic repair (TEVAR) and had completed surveillance for at least 3 years. The 3-year survival rate was 84.7%. The patients were classified into non-SINE (n = 47) and SINE (n = 18) groups. Serial computed tomography scans were used to analyze volumetric change, true and false lumens, and thrombus volume from arch to aortic bifurcation level. Results The SINE event occurred at a median of 22.5 months. In the SINE group, there was a significant interruption of the abdominal true lumen expansion in the second year (median 0.01 [interquartile range (IQR), –0.03 to 0.12] in the non-SINE group versus median –0.04 [IQR, –0.12 to 0.04] in the SINE group; p = 0.014). There was a significantly worse thoracic false lumen remodeling in the SINE group compared with the non-SINE group in the third year after the SINE event occurred (median 0 [IQR, –0.09 to 0.05] in the non-SINE group versus median 0.06 [IQR, 0 to 0.13] in the SINE group; p = 0.038). Conclusions For chronic aortic dissection, late occurrence of distal SINE could influence abdominal true lumen expansion and thoracic false lumen shrinkage. Early reintervention for distal SINE could improve aortic remodeling in chronic aortic dissection.

Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

This research investigates the psychological capital (PsyCap), subjective well-being (SWB), and self-compassion (SC) components of mental health in a comparative study of overseas Chinese students (OCS) and Taiwanese students in a multicultural context. The participants in the study, which focuses broadly on the recent direction in psychology of positive psychology, were 1347 students from universities and colleges in Taiwan, including 362 Malaysian OCS, 213 Hong Kongese and Macanese OCS, and 772 Taiwanese students. A questionnaire using items from PsyCap, SC, and SWB was administered to the participants. The results of hierarchical regression analysis showed that the level of SC is more relevant for the influence of PsyCap on SWB in the range of PsyCap high scores than it is in the range of PsyCap scores at the low end, and SC is less relevant for the influence of PsyCap on depression at the high end of the PsyCap scale. The findings of the study offer useful insights and implications for researchers and practitioners who investigate well-being and the prevention and alleviation of depression and the specific relationships between PsyCap, SWB, and SC.

Introduction: Vogt–Koyanagi–Harada (VKH) disease is a multisystemic disorder characterized by intraocular inflammation associated with serous retinal detachment, optic disc edema, uveitis, and vitritis, and is often associated with neurologic and cutaneous manifestations. Diagnosis can be assisted by fluorescein angiography and optical coherence tomography that can help evaluate changes in the retina. Therapy relies mainly on the use of corticosteroids, administrated through oral or intravenous high-dose pulses, and immunosuppressants. The purpose of our study was to assess the outcome of VKH disease with bilateral panuveitis treated with dexamethasone intravitreal implant. Patient concerns: Two patients without underlying disease had severe vision deterioration, eye pain, following flu-like symptoms. Diagnosis: At initial diagnosis, macular edema and sub-retinal fluid lobulated accumulation were noted under SD-OCT exam. FAG revealed multiple pinpoint leakage around macula and pooling of dye within sub-retinal space. Interventions: All two patients received intravenous pulse methylprednisolone at the diagnosis, followed by oral prednisolone and cyclosporine. One patient received bilateral eye dexamethasone intravitreal implant two weeks after diagnosis, while the other received left eye dexamethasone intravitreal implant at the time of diagnosis. Outcomes: Vision and macular structure recovered more rapidly after receiving dexamethasone implants in the short-term follow-up. All macular structures recovered to normal, and vision recovered to 20/20 in both eyes. One patient, receiving bilateral dexamethasone implant, didn’t relapse during the 13-month follow-up; the other, receiving left eye dexamethasone implant, didn’t relapse during the 6-month follow-up. None of them required intravenous high-dose steroids again. Conclusion: VKH disease is a multisystemic disorder; intravenous pulse steroid therapy and oral prednisolone can control systemic inflammation. In addition to systemic prednisolone treatment of VKH disease in the acute phase, dexamethasone implants can enhance short-term and long-term control of intraocular anti-inflammation.

Background Superior vena cava (SVC) syndrome is a major complication that occurs when a growing lung malignancy compresses the SVC extrinsically. Current treatment options include radiotherapy or chemotherapy to shrink the tumor or endovascular stenting of the SVC to restore flow. Herein, we report a case series treated in a single institution to demonstrate the safety, effectiveness, and outcomes of salvage and primary stenting for malignant SVC obstruction. Methods A total of 12 male patients with malignant superior vena cava obstruction caused by lung cancer underwent SVC stenting from October 2009 to May 2015. Data were reviewed retrospectively, including demographic and clinical characteristics, procedural details, and outcomes. Results Seven patients had received radiotherapy prior to SVC stenting, while the other five patients received stenting as first-line therapy for SVC syndrome. Only one patient experienced initial symptomatic improvement after radiotherapy, and symptoms of SVC syndrome recurred one year later. Wallstents ® (Boston Scientific, Natick MA, USA) were used in all patients. Preoperatively, the mean narrowest SVC diameter measured by CT was 2.16 mm (0–5.5 mm). Technical success was achieved in all patients without complications such as pulmonary embolism, rupture or bleeding. Postoperative mean narrowest SVC diameter measured by CT during follow-up was 11.17 mm (8–13.5 mm). Symptoms of SVC syndrome such as arm and face swelling and dyspnea improved within 1–5 days in all patients. After median follow-up duration of 11.5 months, only one patient presented recurrent SVC syndrome due to in-stent thrombosis two months after stenting. Conclusion Salvage SVC stenting remains a safe and effective treatment for patients with SVC obstruction after failure of radiotherapy and chemotherapy. Primary stenting may be considered at initial presentation of SVC syndrome to improve patients' quality of life.

We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients.From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013.Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of 120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of 120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively.Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or 120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.

Purpose Focusing on social network services (SNS), the purpose of this paper is to propose a research model to investigate individuals’ SNS usage facilitators and inhibitors from the perspective of individuals’ media system dependency (MSD) and privacy concerns. Design/methodology/approach The research model will be tested with data collected from online users of Facebook. The survey yielded a total of 403 responses for the data analysis which was conducted by measurement and structural models. Findings The findings indicate that SNSs members strive for understanding, orientation, and play dependencies which facilitate their satisfaction and social presence, and subsequently fosters their continuance intention toward the SNS. In addition, the members’ privacy concerns decrease satisfaction and social presence online. Originality/value First, this study has contributed to the authors’ understanding of an individual’s SNS facilitators and inhibitors from the theoretical perspective (i.e. MSD theory and privacy concerns). Second, satisfaction is a strong antecedent of continuance intention and would dilute the effect of social presence on an individual’s SNS continuance intention.

Background: Diagnosis of spontaneous intracranial hypotension (SIH) relies on the ability of medical staff to recognize cerebrospinal fluid (CSF) leakage at the spine. However, difficulties with interobserver discrepancy sometimes occurred while reading magnetic resonance myelography (MRM) because clear image definition was lacking. In this study, we tried to determine which pattern of CSF distribution is more reliable for diagnosis of CSF leakage by using MRM. Methods: From January 2012 to August 2014, 19 SIH patients and 27 healthy controls (HC) were recruited into our study; 10 of the 19 patients were recovered (SIH-R) after treatment. Whole spine MRM was performed using the 3D-SPACE (three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions) sequence, and interpreted by two experienced neuroradiologists. Two 4-point classification systems of CSF distribution were used to evaluate the three-dimensional maximum intensity projection (3D MIP) and the thin-slice axial multiplanar reconstruction (MPR) images, respectively. Results: The interobserver agreement between the two readers interpreting the 3D MIP and thin-slice axial MPR MRM were moderate to good (κ=0.60–0.78). Grade 3 of 3D MIP and Type D of axial MPR MRM were only noticed in the SIH. Overall, Grade 3 of MIP and Type D of MPR showed significant difference (p 70%. Conclusion: Grade 3 on 3D MIP and Type D on axial MPR MRM were definite criteria of MRM for localizing CSF leakage, and Type C in the T-spine was a probable leakage sign with high sensitivity and NPV.

The purpose of this study was to determine factors associated with entire aortic remodeling after thoracic endovascular aortic repair (TEVAR) in patients with type B dissection. The patients with type B (IIIb) dissections who underwent TEVAR from 2006 to 2013 with minimum of 2 years of follow-up computed tomography data were retrospectively reviewed. Based on the status of false lumen remodeling of entire aorta, patients were divided into three groups: complete regression, total thrombosis, and inadequate regression with patent abdominal false lumen. A total of 90 patients (72 males, 18 females; mean age 56.6 ± 16.4 years) were included and divided into the complete regression (n = 22), total thrombosis (n = 18), and inadequate regression (n = 50) groups. Multivariate logistic regression analysis indicated that dissection extension to iliac arteries, increased preoperative number of dissection tear over abdominal aorta, and decreased preoperative abdominal aorta bifurcation true lumen ratio, as compared between the inadequate and complete regression groups, were associated with a persistent false lumen (odds ratio = 33.33, 2.304, and 0.021; all, p ≤ 0.012). Comparison of 6, 12, and 24 months postoperative data revealed no significant differences at any level, suggesting that the true lumen area ratio might not change after 6 months postoperatively. Increased preoperative numbers of dissection tear around the abdominal visceral branches, dissection extension to the iliac arteries, and decreased preoperative true lumen area ratio of abdominal aorta are predictive of entire aortic remodeling after TEVAR in patients with type B dissection. III.

The proper proximal landing zone is a key element for success of endografting in thoracic aortic pathology. If coverage of innominate artery is unavoidable for safe proximal landing, arch debranching surgery is necessary to recruit supra-aortic blood flow before endografting. However, calcified or adhesive ascending aorta makes it difficult to clamp ascending aorta for anastomosis in the first step of arch debranching surgery. We present a novel “no clamp complete parachute technique” to complete this challenging anastomosis.

In selected cases of endovascular aortic repair (EVAR) of an abdominal aortic aneurysm, such as patients with tortuous proximal aortic neck, achieving a successful cannulation can sometimes be difficult. Herein, we described a novel cross-wire technique to help overcome such anatomical variations. During the EVAR procedure among our 5 cases, the main body of the Gore Excluder Stent Graft was deployed through an ipsilateral guidewire. Because of a large angle between the contralateral guidewire and the contralateral short limb of the main body, a successful traditional cannulation was unfeasible. Therefore, the contralateral guidewire was cannulated into the ipsilateral long limb, and the ipsilateral guidewire was cannulated into the contralateral short limb. The contralateral and ipsilateral iliac limb components of the stent graft were deployed through the ipsilateral and contralateral guidewires, respectively. All 5 patients receiving this technique during EVAR of an abdominal aortic aneurysm were free of mortality or any kind of complication at the 1-year follow-up. In conclusion, the cross-wire technique might be safe and effective for EVAR of an abdominal aortic aneurysm when a traditional cannulation is unachievable in selected cases without creating additional percutaneous access or using extra devices.

The disinfection efficiencies of two chemical disinfectants, chlorine dioxide and weak acid hypochlorous water (WAHW), were examined in the soiled room and dishwashing room of a hospital infectious disease ward in Taiwan. The investigations were conducted in two seasons, namely winter and summer, in order to examine the correlation between the bioaerosol concentration and the environmental factors. In addition, a single-daily disinfection mode (SM) and a twice-daily disinfection mode (TM) were applied in this study. The results showed that the bacteria and fungi colony counts were strongly correlated with the temperature. Both disinfectants reduced the bacteria and fungi concentrations in the considered rooms. However, of the two disinfectants, the ClO2 showed a stronger disinfection effect than the WAHW. It means that when using ClO2 as the disinfectant, the disinfection efficiency of the TM treatment mode is significantly better than that of the SM treatment mode. But, when using WAHW as the disinfectant, no significant difference is found between the disinfection efficiencies of the two methods. Overall, the results showed that the application of ClO2 twice daily provided the most effective means of satisfying the Taiwan EPA guidelines for the indoor air quality of hospital medical wards.

BACKGROUND AND PURPOSE Studies on using antiplatelet agents for secondary prevention in ischaemic stroke patients with renal dysfunction are limited. The Taiwan Stroke Registry database was used to compare the efficacy of antiplatelet agents. METHODS From the Taiwan Stroke Registry data, 39 174 acute ischaemic stroke patients were identified and were classified into three groups by antiplatelet agent: aspirin, clopidogrel and dual antiplatelet therapy (DAPT) with a combination of aspirin and clopidogrel. The re-stroke incidence and 1-year mortality were stratified by estimated glomerular filtration rate (eGFR) levels at admission: ≥90, 60-89 and

Background Being woman is associated with higher survival rates after transcatheter aortic valve replacement (TAVR) despite the increase in periprocedural complications. The left ventricle (LV) remodelling process that follows TAVR is considered to play an important role. We aim to investigate whether gender difference affects the process of LV remodelling after TAVR. Materials and Methods A total of 100 patients (50 men and 50 women) after TAVR were enrolled. Echocardiography was performed at baseline before the TAVR procedure and repeated upon discharge, and at three, nine and 12 months post‐TAVR. Results Women exhibited an early regression of LV mass and the LV mass index (LVMi) decreased 12.0% from 148.3 ± 48.0 to 130.5 ± 43.7 g/m2 at just a median of 17 days after the procedure (P

Background To compare the efficacy, safety, and results of Viabahn versus bare-metal stents (BMS) in chronic total occluded (CTO) long femoropopliteal lesions. Methods From April 2009 to August 2014, a total 97 patients (71.2 ± 9.7, 45-90 years old, 70 males) with occluded femo-ropopliteal lesions underwent Viabahn (55 patients) or BMS (42 patients) implantation. The clinical findings, procedural factors, and overall outcomes were collected and analyzed. Results The average lesion length was 22.1 ± 4.8 cm in the Viabahn group and 17.8 ± 3.3 cm in the BMS group. Both groups had a 100% technical success rate. Although there was no difference between the groups in complication, mortality, and major amputation rates, the Viabahn group had a significantly better average post-operative ankle brachial index (ABI) at 1-year and 2-year follow-ups. The Viabahn group also had significantly less in-stent restenosis (ISR) and target lesion revascularization (TLR) compared with the BMS group. Nevertheless, the two groups shared similar 2-year primary patency rates (63.6% vs. 50.0%, p = .178) and 2-year secondary patency rates (85.5% vs. 81.0%, p = .554). Conclusion Both Viabahn and BMS were efficient treatments for long femoropopliteal CTO lesions. However, the Viabahn group had significantly improved results compared with the BMS group in TLR and ISR, but the difference was not sufficient enough to result in different primary and secondary patency rates.

The human pathogen Aeromonas has been clinically shown to cause gastroenteritis, wound infections, septicemia, and urinary tract infections. Most human diseases have been reported to be associated with four species of bacteria: Aeromonas dhakensis, Aeromonas hydrophila, Aeromonas veronii, and Aeromonas caviae. The model organism Caenorhabditis elegans is a bacterivore that provides an excellent infection model by which to study the bacterial pathogenesis of Aeromonas. Here, we introduce three different experiments to study Aeromonas infection using a C. elegans model, including survival, liquid toxicity, and muscle necrosis assays. The results of the three methods determining the virulence of Aeromonas were consistent. A. dhakensis was shown to be the most toxic among the 4 major Aeromonas species causing clinical infections. These methods are shown to be a convenient way to evaluate the toxicity among and within Aeromonas species and contribute to our understanding of the pathogenesis of Aeromonas infection.

Introduction. The 2015 dengue outbreak in southern Taiwan caused substantial mortality rates in the elderly. We analyzed here the causes of death among adults with dengue. Methods. The retrospective study was conducted at a medical center in Tainan from the 1st of August to 31th of December in the year 2015. The detection of the dengue NS1 antigen IgM or viral RNA in patients' blood were used to diagnose dengue. Clinical courses and causes of death were retrieved from chart reviews by two intensivists. Results. There were 4,488 cases of dengue diagnosed in the study hospital, and these cases had an in-hospital case fatality rate of 1.34% (60 cases). Of these, the mean age was 73 years and gender did not predict outcome. Twenty-eight (46.7%) cases died of severe dengue, and 29 (48.3%) deaths were possibly caused by dengue-related complications, which were mostly secondary infections (24 cases). Most of the families of fatal case (70%) signed do-not-resuscitate (DNR) orders prior to the patients' death. When the dengue epidemic peaked, 13 cardiac arrest events, including out-of-hospital (5 events) and in-hospital (8) cardiac arrests at the emergency department, occurred within four weeks of the dengue epidemic. Notably, in half (7) of these cases, the patients did not search for medical aid prior to experiencing cardiac arrest. Of the 40 cases that had early death (occurring within one week after hospitalization), 60% died of severe dengue. In contrast, 50% of the 20 deaths that occurred later than one week after hospitalization were related to hospital-acquired infections, mainly pneumonia. Conclusion. The elderly that experience dengue fever may die of severe dengue early or die of secondary infections later. Cardiac arrests can also occur unpredictably at the first aids, which highlight the need of professional and patient education regarding the danger signs that are related to severe dengue in an epidemic setting.

The human pathogen Aeromonas has been clinically shown to cause gastroenteritis, wound infections, septicemia, and urinary tract infections. Most human diseases have been reported to be associated with four species of bacteria: Aeromonas dhakensis, Aeromonas hydrophila, Aeromonas veronii, and Aeromonas caviae. The model organism Caenorhabditis elegans is a bacterivore that provides an excellent infection model by which to study the bacterial pathogenesis of Aeromonas. Here, we introduce three different experiments to study Aeromonas infection using a C. elegans model, including survival, liquid toxicity, and muscle necrosis assays. The results of the three methods determining the virulence of Aeromonas were consistent. A. dhakensis was shown to be the most toxic among the 4 major Aeromonas species causing clinical infections. These methods are shown to be a convenient way to evaluate the toxicity among and within Aeromonas species and contribute to our understanding of the pathogenesis of Aeromonas infection.

Aim: The ability to predict outcomes can help clinicians to better triage and treat stroke patients. We aimed to build prediction models using clinical data at admission and discharge to assess predictors highly relevant to stroke outcomes. Methods: A total of 37,094 patients from the Taiwan Stroke Registry (TSR) were enrolled to ascertain clinical variables and predict their mRS outcomes at 90 days. The performances (i.e., the area under the curves (AUCs)) of these independent predictors identified by logistic regression (LR) based on clinical variables were compared. Results: Several outcome prediction models based on different patient subgroups were evaluated, and their AUCs based on all clinical variables at admission and discharge were 0.85-0.88 and 0.92-0.96, respectively. After feature selections, the input features decreased from 140 to 2-18 (including age of onset and NIHSS at admission) and from 262 to 2-8 (including NIHSS at discharge and mRS at discharge) at admission and discharge, respectively. With only a few selected key clinical features, our models can provide better performance than those previously reported in the literature. Conclusion: This study proposed high performance prognostics outcome prediction models derived from a population-based nationwide stroke registry even with reduced LR-selected clinical features. These key clinical features can help physicians to better focus on stroke patients to triage for best outcome in acute settings.

Spruce is the commonly-used tonewood for the top plate of violin-family instruments, such as violins and cellos. The wood properties can critically determine the acoustic quality. It’s been shown the wood of famous old instruments differ from modern ones due to chemical treatment and aging. To reveal the differences microscopically in both spatial and spectral domains, a two-photon hyperspectral system has been applied to investigate the autofluorescence and second harmonic generation within wood samples. Not only the cellular structures were observed through optical sectioning, but the spectral variations were revealed among different age wood samples and different cellular structures.

A new ammonia (NH3) gas sensor, based on the incorporation of platinum nanoparticles (Pt NPs) and an amorphous In-Ga-Zn-O (a-IGZO) thin film, is fabricated by thermal evaporation (TE) and sputtering approaches. Due to the increased specific surface area and remarkable catalytic activity of Pt NPs, excellent ammonia sensing properties, including a very high sensing response of 1467 (in 1000 ppm NH3/air gas at 250 °C), an extremely low detecting level of 1 ppm NH3/air, a relatively low optimum operating temperature of 250 °C, and a relatively fast sensing speed, are obtained. In addition, the studied Pt NP/a-IGZO device exhibits the advantages of a simple structure, easy fabrication, and a high selectivity towards ammonia gas. The studied device is, therefore, promising for high-performance ammonia sensing applications.

Objective This study investigated predisposing factors of distal stent graft-induced new entry (SINE). Methods Data from November 2006 to May 2012 were abstracted retrospectively from the records of 73 patients with complicated type B aortic dissection who had received stent graft treatment in our institution. Diameters of the true and false lumen, area and circumference of the true lumen, prestent and poststent oversize, taper, and mismatch ratio were recorded and analyzed to see if there were any significant differences between the SINE (n = 19) and non-SINE (n = 54) population and between those in whom the initial endograft was inserted from the proximal thoracic aorta (n = 49) or the distal thoracic aorta (n = 24). Results A distal-first sequence of stent graft deployment produced significantly fewer instances of distal SINE. The area oversizing ratio of the distal end of the stent graft was greater in the SINE vs non-SINE groups (3.76 ± 1.7 vs 2.63 ± 2.57; P = .002) and in the proximal-first vs distal-first deployment sequence groups (3.67 ± 2.57 vs 1.39 ± 0.90; P Conclusions Minimizing the preprocedure distal oversizing ratio with a distal small graft-first procedure could reduce the risk of late distal SINE for Stanford type B aortic dissection. Furthermore, the area ratio is a potentially more sensitive modality for size assessment and prediction of distal SINE occurrence.

Background/PurposeAeromonas and Vibrio are important water-borne pathogens causing substantial morbidity and mortality in cirrhotic patients in Taiwan, but the differences in clinical manifestations of Aeromonas and Vibrio bacteremia have not been reported in detail.MethodsFrom January 2003 to September 2013, cirrhotic patients with monomicrobial Aeromonas or Vibrio bacteremia at a medical center in Taiwan were included in this study.ResultsThe study population consisted of 77 cirrhotic patients with Aeromonas bacteremia and 48 patients with Vibrio bacteremia. Both pathogens clustered during the summer season; Vibrio bacteremia was more correlated with higher temperatures (Vibrio: r2 = 0.95, p

Background This study was conducted to test the hypothesis that elevated blood pressure at the early stage is associated with unfavorable outcome in acute ischemic stroke patients with stenosis of less than 50% of the culprit artery. Methods Patients with acute ischemic stroke onset within 48 hours and stenosis of less than 50% of the culprit artery from a prospective stroke registry were analyzed. A modified Rankin Scale score of 1 or lower at 3 months was defined as a favorable late outcome. Univariate and multivariate logistic regression analyses were used to analyze the association between hemodynamic parameters and outcome. Results One hundred thirty-six patients fulfilled the selection criteria. Patients with favorable outcome had lower pulse pressure at emergency department (ED) triage, lower systolic blood pressure (SBP) at 24 hours, lower pulse pressure at 24 hours, and lower heart rate (HR) at 24 hours. The univariate logistic regression analysis showed that history of stroke, elevated SBP at 24 hours, elevated HR at 24 hours, elevated pulse pressure at 24 hours, and higher National Institutes of Health Stroke Scale score at ED triage were associated with a less favorable late outcome. Two separate models of multivariate logistic regression analyses showed that pulse pressure at ED triage and pulse pressure at 24 hours, respectively, were significantly associated with less favorable outcome. Conclusions Elevated pulse pressure at the early stage is independently associated with unfavorable late outcome in acute ischemic stroke patients with culprit artery stenosis less than 50%.

本研究旨在探討教師知識管理與教學效能的實際效果，藉由統合2004 至2013 年的27 篇博碩士論文的研究數據，探討教師知識管理與教學效能兩變項的相關性、調節變項的影響、及跨變項間相關作用的結果。研究方法上採用後設分析，研究結果指出，教師知識管理與教學效能的平均效應量為.85，表示具有正相關且高度效應量。根據研究結果，提出實務建議與未來研究建議。 The purpose of this study is to explore the effects of teachers’ knowledge management for teaching effectiveness. Researcher analyzed mean correlations, moderators’ effect, and correlation across the two variables which are teachers’ knowledge management and teaching effectiveness by collecting data consisted of 27 theses published in 2004-2014. Meta-analysis was used to examine the effects of teachers’ knowledge management on teaching effectiveness. The main conclusions are as follows: There are significant positive correlation and high effect size (which reaches to 0.85) between teachers’ knowledge management and teaching effectiveness. According to the results of the study, some practical suggestions are made for further studies.

Background and purpose The optimal dose of alteplase for acute ischemic stroke among geriatric patients is unclear. We aimed to assess the efficacy and safety of a low-dose (0.6 mg/kg) and standard-dose (0.9 mg/kg) alteplase for varying severity of Asian geriatric stroke patients. Methods The favorable functional outcome on day 90 after stroke onset, and the symptomatic intracranial hemorrhage (SICH) rate following 24–36 h of intravenous alteplase were measured. The baseline NIHSS of 4–8, 9–13, ≥14 were defined as mild, moderate, and high severity, respectively. Results Totally, 249 geriatric patients treated with low-dose (n = 108) and standard-dose (n = 141) alteplase. Compared to standard-dose alteplase, low-dose alteplase had decrease in favorable functional outcome (22.2% versus 34.8%), and no difference in SICH rates was observed. For mild severity patients, the mortality was significantly increased with standard-dose alteplase (the NNT/NNH = 22.9/8.0 for mild severity, the NNT/ NNH = 15.0/14.7 for moderate severity, and the NNT/NNH = 13.5/19.6 for high severity). Conclusions Standard-dose and low-dose alteplase were comparable in reducing major disability, but low-dose alteplase for mild stroke showed much reduced mortality on day 90 for octogenarians.

Treatment for extensive aortoiliac occlusive disease (AIOD) includes endovascular interventions, hybrid procedures and surgical reconstruction. This study evaluated the short-term outcomes of endovascular and hybrid procedures in patients with Trans-Atlantic Inter-Society Consensus II (TASC-II) D AIOD lesions.From January 2013 to June 2015, 41 patients with TASC-II D AIOD lesions who underwent revascularization at our institute were retrospectively included. Nineteen underwent endovascular procedures and 22 underwent hybrid procedures with a postoperative surveillance program for at least 1 year. Patient demographics and short-term outcomes were analyzed.The procedural success rate in all patients was 100%. The accumulative postoperative complication rate was 20.2%, and the major complication was acute kidney injury (14.6%). The time of freedom from target lesion revascularization was 18.9 months. The primary patency rates in the endovascular group were 89.5% and 84.2% at 1 and 2 years, respectively, compared to 95.5% at 1 and 2 years in the hybrid group; however, the difference was not significant (p = 0.234). The secondary patency rates were 94.7% and 93% at 1 and 2 years, respectively, in the endovascular group, and 95.5% and 94% at 1 and 2 years, respectively, in the hybrid group; however, the differences was not significant (p = 0.916).Our study revealed that endovascular and hybrid procedures are favorable treatment choices for patients with TASC-II D AIOD lesions. In patients with multilevel steno-occlusive lesions, hybrid procedures improved distal runoff flow and reduced the complexity of endovascular procedures.

Cefazolin is traditionally active against Escherichia coli, Klebsiella species, and Proteus mirabilis (EKP) isolates. The Clinical and Laboratory Standards Institute (CLSI) has twice updated cefazolin susceptibility breakpoints for EKP since 2010, but its role in the definitive treatment of cefazolin-susceptible EKP bacteremia remains debated. To assess its efficacy as a definitive agent, the 8-year cohort study consisted of 941 adults with monomicrobial cefazolin-susceptible EKP bacteremia, based on the CLSI criteria issued in 2019, was retrospectively established in a medical center. Based on the definitive antimicrobial prescription, eligible patients were categorized into the cefazolin (399 patients, 42.4%) and broader-spectrum antibiotic (BSA) (542, 57.6%) groups. Initially, fewer proportions of patients with fatal comorbidities (the McCabe classification) and the critical illness (a Pitt bacteremia score &ge, 4) at the onset and day 3 of the bacteremia episode were found in the cefazolin group, compared to the BSA group. After propensity-score matching, no significant difference of patient proportions between the cefazolin (345 patients) and BSA (345) groups was observed, in terms of the elderly, types and severity of comorbidities, bacteremia severity at the onset and day 3, major bacteremia sources, and the 15-day and 30-day crude mortality. In early outcomes, lengths of time to defervescence, intravenous (IV) antimicrobial administration, and hospitalization were similar in the two matched groups, lower costs of IV antimicrobial administration were observed in the cefazolin group. Notably, for late outcomes, lower proportions of post-treatment infections caused by antimicrobial-resistant pathogens (ARPs) and post-treatment mortality rates were evidenced in the cefazolin group. Conclusively, cefazolin is definitively efficacious and cost-effective for adults with community-onset cefazolin-susceptible EKP bacteremia in this one-center study, compared to BSAs. However, a prospective multicenter study should be conducted for external validation with other communities.

Objectives Our objective was to examine the role of the provisional extension to induce complete attachment (PETTICOAT) aortic dissection repair technique with bare metal stents (BMSs) in abdominal remodeling of residual DeBakey type I aortic dissection. Methods We retrospectively reviewed the records of patients with chronic aneurysm formation and residual DeBakey type I aortic dissection (ie, original acute aortic dissection DeBakey type I after primary surgical open repair) who underwent arch reoperation with frozen elephant trunk replacement or endovascular debranching with or without an abdominal BMS between December 2006 and December 2016. We analyzed diameters and volumes in 3 dimensions for the true and false lumens of the thoracic and abdominal aorta as well as the thrombosis percentage of the false lumen between the non-BMS (non-PETTICOAT) and BMS (PETTICOAT) groups. Results Forty-seven patients who had completed at least 1 year of follow-up were included. The non-BMS (without abdominal BMS) and BMS groups had significant differences in abdominal true lumen diameter and volumetric change at the first postoperative examination and at the examination 1 year after surgery (26.8 mL, median [19.4-34.1 mL, interquartile range (IQR)]) in non-BMS vs 42.5 mL, median [31.1-57.9 mL, IQR]) in BMS (postoperative survey [F test, 33.775; P = .000]) and (30.1 mL, median [20.5-34.1 mL, IQR] in non-BMS vs 46.6 mL, median [31.3-57.4 mL, IQR]) in BMS (12-month survey [F test, 14.001; P = .001]). The abdominal false lumen thrombosis percentage was higher in the BMS group than in the non-BMS group (25.6%, median [16.4%-58.9%, IQR] in non-BMS vs 54.0%, median [36.7%-65.3%, IQR] in the BMS group (F test, 6.318; P = .016). Conclusions Following reintervention for chronic residual DeBakey type I aortic dissection, PETTICOAT abdominal dissection BMS effectively expanded the thoracic and abdominal true lumen and augmented false lumen thrombosis percentage during the first postoperative year.

Innate immunity is the primary defense mechanism against infection in metazoans. However, aberrant upregulation of innate immune-signaling pathways can also be detrimental to the host. The p38 MAPK/PMK-1 innate immune-signaling pathway has been demonstrated to play essential roles in cellular defenses against numerous infections in metazoans, including Caenorhabditis elegans. However, the negative regulators that maintain the homeostasis of this important innate immune pathway remain largely understudied. By screening a focused RNAi library against the kinome of C. elegans, we identified RIOK-1, a human RIO kinase homolog, as a novel suppressor of the p38 MAPK/PMK-1 signal pathway. We demonstrated that the suppression of riok-1 confers resistance to Aeromonas dhakensis infection in C. elegans. Using quantitative real time-PCR and riok-1 reporter worms, we found the expression levels of riok-1 to be significantly upregulated in worms infected with A. dhakensis. Our genetic epistasis analysis suggested that riok-1 acts on the upstream of the p38 MAPK/pmk-1 genetic pathway. Moreover, the suppression of riok-1 enhanced the p38 MAPK signal, suggesting that riok-1 is a negative regulator of this innate pathway in C. elegans. Our epistatic results put riok-1 downstream of skn-1, which encodes a p38 MAPK downstream transcription factor and serves as a feedback loop to the p38 MAPK pathway during an A. dhakensis infection. In conclusion, riok-1 is proposed as a novel innate immune suppressor and as a negative feedback loop model involving p38 MAPK, SKN-1, and RIOK-1 in C. elegans.

The ProGlide® vascular closure device (Abbott Vascular, Redwood City, CA, USA) is approved for the closure of arterial punctures (typically 5-21 Fr sheath; maximum outer diameter, 26 Fr). However, a failure rate of about 2-8% is reported. This study was conducted to analyse factors predisposing to failure when the devices were used for the closure of large hole (16-26 Fr) arteriotomies, and to determine the predictive cut off values of predisposing factors.In this retrospective study, the ProGlide® device was used to achieve vascular access site closure in 458 patients undergoing repair of abdominal aortic aneurysm, thoracic aortic aneurysm, type B aortic dissection, or transcatheter aortic valve implantation. The primary endpoint was device failure, defined as inability to achieve common femoral artery (CFA) closure; successful repair, development of acute lower limb ischaemia and haemodynamic compromise; or delayed pseudoaneurysm formation during the follow up period, requiring open repair.Overall, ProGlide® failure occurred in 7.6% of cases. Factors that predisposed to failure included a history of peripheral arterial disease (PAD) (p .001), the presence of CFA calcification (p .001), the depth of the skin puncture site ≥ 33 mm (p .001), body mass index (BMI) of ≥28.7 kg/mFactors such as BMI, history of PAD, the presence of CFA calcification, the depth of the skin puncture site, and sheath size are significantly associated with ProGlide® failure. Hence, careful patient and device selection and operating procedure are paramount to achieve successful outcomes.

Objective Common femoral artery (CFA) occlusive disease remains a debatable site for endovascular therapy, and the outcome of drug-eluting balloon (DEB) angioplasty in treating CFA occlusive disease is largely unknown. This study compared the efficacy, safety, and short-term patency rate of DEB angioplasty and femoral endarterectomy for treatment of CFA occlusive disease. Methods From March 2013 to June 2016, there were 100 patients with symptomatic CFA occlusive disease who were retrospectively reviewed. Forty patients were treated with DEB angioplasty and 60 were treated with femoral endarterectomy. Each patient received regular follow-up. Patency rate, ankle-brachial index, target lesion revascularization, and adverse events were assessed. Results Technical success was 100% in all patients. The DEB group had a lower 1-year primary patency rate (75.0% vs 96.7%; P = .003), but the secondary patency rate was similar between the two groups (97.5% vs 98.3%; P = 1.000). At 2-year follow-up, the primary patency was lower in the DEB group (57.1%) than in the endarterectomy group (94.1%; P = .001), whereas the secondary patency rate had no significant difference (90.5% vs 97.1%; P = 1.000). Both groups had significant improvement in ankle-brachial index. Freedom from target lesion revascularization was lower in the DEB group both at 1 year (75.0% vs 96.7%; P = .003) and at 2 years (57.1% vs 94.1%; P = .001). There was no significant difference in the incidence of complications and adverse events. Conclusions Femoral endarterectomy has a better primary patency rate compared with DEB angioplasty in treating CFA occlusive disease without significant increase in complications. In patients not suitable for endarterectomy, DEB angioplasty provides a similar secondary patency rate and could be considered an alternative treatment.

Background: The risk of recurrent stroke in patients with ischemic stroke with vertebral/basilar artery stenosis remains to be systematically studied. Methods: We analyzed data from Taiwan Stroke Registry (TSR), with stroke registries provided by 59 hospitals. Patients who had diagnosis of ischemic stroke and were categorized into the “large artery atherosclerosis” group by TOAST who underwent CTA, MRA, or catheter- based angiography were identified for the present study. The patients were divided into 3 groups based on the extent of vertebral (VA) and/or basilar artery (BA) stenosis as follows: 0-49%, 50-99%, and 100% (total occlusion). Cox proportional hazards model was used to determine the hazard ratios (HRs) of recurrent stroke within 1 year of index event after adjusting for all relevant risk factors by univariable Cox model. Results: In the TSR data base, 84,831patients were in the ischemic stroke group. Based on TOAST, 20,220 patients were in the large-artery atherosclerosis group. Among these patients, a total of 10,515 were of age 18 or greater who had CTA, MRA or angiographic studies that included VA/BA. There were 6,972 subjects with VA/BA stenosis in the 0-49%, 3,137 in the 50-99% and 406 in the 100% (total occlusion) groups respectively. With VA/BA stenosis in the 0-49% range as the reference, HRs of recurrent stroke in one year by multivariable modeling with adjustment of all relevant risk factors by univariable Cox model was 1. 29 (95% CI, 1.05 - 1.58, p Conclusions: Vertebral or basilar artery stenosis or occlusion was relatively prevalent among patients with ischemic stroke categorized in the large artery artherosclerosis group by TOAST with greater extent of VA/BA stenosis carrying greater risk of recurrent stroke within 1 year after stroke.

Poorly controlled blood glucose was reported to cause deterioration of acute ischemic stroke. In this study, we investigated whether an elevated admission serum glucose level in the 3-h time window of intravenous thrombolysis for acute ischemic stroke determined poor functional outcomes among Chinese population.This was a prospective cohort study. From December 1, 2004 to December 31, 2016, a total of 2370 patients were enrolled and categorized into two cohorts by blood glucose levels of ≥200 and200 mg/dl in the 3 h after stroke onset. The primary objective was to determine whether admission hyperglycemia increased major disability and death at 30 and 90 days, which was defined by a modified Rankin Scale of 3-6. The secondary objective was to determine whether admission hyperglycemia increased the symptomatic intracranial hemorrhage (SICH) at 90 days. The number needed to harm (NNH) and patient expected event rate (PEER) were evaluated for both the primary and secondary objectives.The primary outcome occurred in 216 of 305 patients (70.8%) in the blood glucose ≥200 mg/dl cohort and in 951 of 1587 patients (59.9%) in the blood glucose200 mg/dl cohort at 30 days, and in 191 of 287 patients (66.6%) in the blood glucose ≥200 mg/dl cohort and in 827 of 1517 patients (54.5%) in the blood glucose200 mg/dl cohort at 90 days. Patients with admission hyperglycemia had significantly increased major disability and death at 30 (adjusted relative risk (RR): 1.194 [1.073-1.329], p = 0.0012) and 90 days (adjusted RR: 1.203 [1.079-1.340], p = 0.0008). Admission hyperglycemia increased the risk of the occurrence of SICH by nearly 2-fold (adjusted RR: 1.891 [0.977-3.657], p = 0.0585 with the SITS-MOST criteria and adjusted RR: 1.884 [1.138-3.121], p = 0.0139 with the NINDS criteria). NNH values of admission hyperglycemia in major disability and death at 30 and 90 days were 9 and 10, and NNH values of SICH by the SITS-MOST NINDS criteria were 44 and 34, respectively.The study evidenced the association and temporal relationship of admission hyperglycemia causing deterioration of functional outcomes and increased SICH among Chinese population with acute ischemic stroke treated with intravenous thrombolysis.

Objective: This study was to assess the 30-day and 1-year mortality associated with serum triglyceride levels on admission for patients with acute ischemic stroke using the Taiwan Stroke registry (TSR) data. Patients and methods: From the TSR database, we identified 45931 acute ischemic stroke patients from April 2006 to April 2014 and stratified them into 3 groups by the serum triglyceride level measured on admission: 200 mg/dL, those with triglyceride levels