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Chia (Salvia hispanica L.), originated in central and southern Mexico and Guatemala, is an emerging industry crop due to its high content of omega‐3 fatty acids and dietary fiber in its seeds. The seeds also have a high concentration of proteins and essential amino acids, and are becoming a promising source of bioactive peptides. Polymorphic DNA markers are essential tools to analyse genetic diversity and to accelerate genetic improvement. However, in chia, polymorphic and codominant DNA markers are still lacking. In this study, fourteen polymorphic microsatellites were identified from DNA sequences and were characterized. The average allele number was 4.8 while the expected and observed heterozygosity was 0.24 and 0.34, respectively. The average probability of identity (PI) was 0.50 while the combined PI was 9 × 10–6. These first 14 microsatellites in chia are useful in genetic analysis and traceability. These 14 polymorphic microsatellites were used in analysing genetic diversity and population relationships in six cultivars originating in Mexico, Australia and Bolivia. Results showed that allelic diversity and gene diversity were low and ranged from 2.79 to 3.64 and 0.27 to 0.38, respectively. The Mexico black cultivar showed the highest allelic (3.64) and gene diversity (0.38). The six cultivars were closely related with high identity (≥ 0.893). Taken together, these chia cultivars contain low genetic variation. Therefore, to initiate a breeding program for improving traits, it is essential to use seeds from multiple cultivars to enlarge genetic variation in the founder population.

With the renewal of many neutron science instruments and the commissioning of new neutron facilities, there is a rising demand for improved neutron beam monitoring systems with reduced beam perturbations and higher counting rate capability. Fission chambers are the most popular beam monitors; however, their use on some instruments may be prevented by the background generated by fast neutrons emitted during neutron captures in 235U and by neutrons scattered in the material of the fission chamber. Multitube detectors, on the other hand, offer a good alternative with minimum beam perturbations. The purpose of this paper is to report and analyse the results of the measurements performed with several Multitubes used for beam monitoring. We show that the transparency of Multitube beam monitors is 97.6 +/-0.4 %, and that their detection efficiency is uniform, with a deviation from the mean value < 0.7%. A counting rate reduction of 10% due to pile-up effects is measured at a rate of 550 kHz. In addition to neutron beam intensity monitoring, the Multitube can be configured for 1-dimensional or 2-dimensional localisation. We present the preliminary results of these additional functionalities., 15 pages, 16 figures

To determine denosumab's effectiveness for fracture prevention among postmenopausal women with osteoporosis in East Asia, the risk of fracture was compared between patients continuing denosumab therapy versus patients discontinuing denosumab after one dose. The real-world effectiveness was observed to be consistent with the efficacy demonstrated in the phase III trial.After therapeutic efficacy is demonstrated for subjects in global clinical trials, real-world evidence may provide complementary knowledge of therapeutic effectiveness in a heterogeneous mix of patients seen in clinical practice. This retrospective cohort study was conducted to compare the fracture risk in real-world clinical care received in Taiwan and Hong Kong between a treatment cohort (patients receiving denosumab 60 mg subcutaneously every 6 months) versus an off-treatment cohort (patients discontinuing after 1 dose of denosumab, which has no known clinical benefit) among real-world postmenopausal women.This study included 38,906 and 2,835 postmenopausal women receiving denosumab in Taiwan and Hong Kong, respectively. The primary endpoint was hip fracture, and secondary endpoints were clinical vertebral and nonvertebral fractures. Propensity-score-matched analysis, adjusting for known covariates, was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs). The robustness of findings was evaluated with a series of sensitivity and quantitative bias analyses.In this study, 554 hip fractures were included in the primary Taiwan population analysis. The crude incidence rate was 0.9 per 100 person-years in the treatment cohort (n = 25,059) and 1.7 per 100 person-years in the off-treatment cohort (n = 13,847). After adjusting for prognostic differences between cohorts, denosumab reduced the risk of hip fractures by 38% (HR = 0.62, CI:0.52-0.75). Risk reductions of similar magnitude were observed for the secondary endpoints and for the analysis of the smaller Hong Kong population.The effectiveness of denosumab for fracture reduction among real-world postmenopausal women with osteoporosis was consistent with the efficacy demonstrated in a global clinical trial.EnCePP registration number: EUPAS26372; registration date: 12/11/2018.

Interactions among sensory information are important for generating a coherent percept of the external world. Facilitation and inhibition effects in cross-modal perception have been widely studied for decades. The present study tried to confirm the interaction effects between sensory information in a bimodal context and explore these influences when part of the sensory information was presented without participants' subjective awareness. A total of 40 undergraduate participants were recruited in this mixed design study. Participants were required to count the flashing of the black circle (visual task) or the presentation frequency of the beep sound (auditory task) with the presence of either congruent or incongruent sensory signals in the background. Participants in the explicit group generally performed more accurately and also faster with the congruent stimuli than with the incongruent stimuli. Performance accuracy in the visual task in the implicit group was affected by the non-target sound signals which were presented beneath participants' subjective awareness. The better performance yielded in the auditory task than in the visual task was explained by the appropriateness of the auditory stimulation to the task nature. In addition, the supportive findings regarding processing without awareness should be interpreted with caution.

Influenza virus haemagglutinin (HA) and neuraminidase (NA) are involved in the recognition and modulation of sialic acids on the cell surface as the virus receptor. Although the balance between two proteins functions has been found to be crucial for viral fitness, the interplay between the proteins has not been well established. Herein we present evidence for interplay between influenza HA and NA, which may affect the balance between two glycoprotein functions. NA enzymatic activities against sialoglycans were promoted by the presence of HA, which is in accordance with the level of co-existing HA. Such activity enhancement was lost when the HA-receptor binding properties were abolished by low-pH treatment or by mutations at the HA receptor binding domain. Sialidase activities of NA-containing virus-like particles and native influenza viruses were detected using different NA-assays and sialic acid substrates. Most pronounced HA-mediated NA enhancement was found when intact virions were confronted with multivalent surface-anchored substrates, which mimics the physiological conditions on cell membranes. Using recombinant viruses with altered HA bindings preference between α2,3- and α2,6-linked sialic acids, we also found that NA function against different substrates is correlated with the HA-receptor specificity. The effect of HA-receptor specificities on NA functions, together with the HA-mediated NA enhancement, may play a role in virus evasion of the mucus barrier, as well as in cross-species adaptation. Our data also indicate the importance of using multivalent substrates in future studies of NA functions.

Glaucoma is an eye disorder potentially leading to permanent blindness through the damage of optic nerves at the optic nerve head (ONH). As a critical region of optic nerve damage, the porous Lamina Cribrosa (LC) in the ONH plays a critical role in determining whether optic nerves passing through will experience apoptosis in response to shear stress. The primary cause of shear stress to the LC is the increase in intraocular pressure (IOP). Since morphology governs how mechanical stresses distributes, LC morphology could be an important factor in determining the risks of glaucoma development and progression. The current project aims at investigating how anterior LC surface morphology impacts its response to shear stress caused by IOP. Results of the current study show that steeper LC morphologies could be associated with increased average shear stress on the anterior LC surface. The effect of LC morphology was comparable to that of IOP. This highlights the potential significance of LC morphology on the distribution of IOP-induced shear stress and calls for further investigation in this area.

Objective The objective of this paper is to investigate the incidence rate, risk factors and outcome of osteomyelitis among patients with systemic lupus erythematosus (SLE). Materials and methods We conducted a cohort study using data for patients enrolled in the Taiwan National Health Insurance Database from 2000 to 2012. Patients with SLE and age- and sex-matched controls without SLE were enrolled. Primary endpoint was the first occurrence of osteomyelitis. Risks of osteomyelitis in SLE patients were analyzed with Cox proportional hazards regression models, including age, sex, comorbidities and medications. Results Among 24,705 SLE patients (88.4% women, mean age 35.8 years) with a median follow-up of 9.1 years, 386 patients had osteomyelitis. The incidence rate ratio (IRR) of osteomyelitis in the SLE group vs the control group was 8.52 (95% confidence interval (CI) 7.24–10.05). The SLE group had higher incidence rates of osteomyelitis than the control group, especially in pediatric subgroups (IRR 41.1 95% CI 18.57–107.35). Compared to controls, SLE patients experienced osteomyelitis at a younger age (42.3 vs 58.1 years) but did not have an increased risk of mortality (hazard ratio 0.7; 95% CI 0.21–2.38). Age >60 years, male gender, malignancy within five years, prior bone fracture and higher daily prednisolone dose (>7.5 mg) cumulatively for >180 days increased risk for osteomyelitis. Conclusions SLE patients have a higher IRR of osteomyelitis than controls. Pediatric and elder SLE patients, patients with a history of bone fracture, malignancy within five years and higher-dose glucocorticoid use have a higher risk of osteomyelitis and should be carefully monitored.

Objective The objective of this paper is to identify the risk of complications of real-time ultrasound-guided renal biopsy in adult and pediatric patients with systemic lupus erythematosus (SLE). Materials and methods This retrospective study examined outcomes of 296 renal biopsy procedures in 275 SLE patients. Imaging-confirmed symptomatic hematoma was regarded as a major complication when intervention (blood transfusion, angiographic embolization, or surgery) was required or as a minor complication otherwise. Clinical and laboratory data were compared between groups with or without complications after initial or subsequent renal biopsy. Binary logistic regressions were used to evaluate complication risk of initial renal biopsy. Results Overall complication rate of initial renal biopsy was 8.7% (major: 2.9%, minor: 5.8%). Three patients expired from pulmonary hemorrhage, thrombotic microangiopathy, and pneumonia. Pediatric SLE patients tended to have a higher rate of major complications (12.5%) than adult patients (2.3%). According to multivariable analysis results, elevated serum creatinine (SCr) level (OR 1.45; 95% CI 1.17-1.81 per mg/dl), prolonged prothrombin time (PT) (OR 2.2; 95% CI 1.05-4.62 per second), and thrombocytopenia (OR 4.3; 95% CI 1.56-11.9) increased overall complication risk of initial renal biopsy. Age 18 years (OR 8.43; 95% CI 1.21-58.8), thrombocytopenia (OR 16.4; 95% CI 2.44-110.5), and elevated SCr level (OR 1.97; 95% CI 1.36-2.86 per md/dl) increased risk of major complications. Thrombocytopenia, prolonged PT, and elevated SCr level were associated with complications after subsequent renal biopsy (all p = 0.01). Conclusions SLE patients, particularly patients under 18 years old or with elevated SCr level, prolonged PT, or thrombocytopenia, have an increased risk of complications after initial or subsequent renal biopsy.

H9N2 viruses are the most widespread influenza viruses in poultry in Asia. We evaluated the infection and tropism of human and avian H9 influenza virus in the human respiratory tract using ex vivo respiratory organ culture. H9 viruses infected the upper and lower respiratory tract and the majority of H9 viruses had a decreased ability to release virus from the bronchus rather than the lung. This may be attributed to a weak neuraminidase (NA) cleavage of carbon-6-linked sialic acid (Sia) rather than carbon-3-linked Sia. The modified cleavage of N-acetlylneuraminic acid (Neu5Ac) and N-glycolylneuraminic acid (Neu5Gc) by NA in H9 virus replication was observed by reverse genetics, and recombinant H9N2 viruses with amino acids (38KQ) deleted in the NA stalk, and changing the amino acid at position 431 from Proline-to-Lysine. Using recombinant H9 viruses previously evaluated in the ferret, we found that viruses which replicated well in the ferret did not replicate to the same extent in the human ex vivo cultures. The existing risk assessment models for H9N2 viruses in ferrets may not always have a strong correlation with the replication in the human upper respiratory tract. The inclusion of the human ex vivo cultures would further strengthen the future risk-assessment strategies.

The hydrophilic microfluidic chip that can self-actuate fluidic flow effectively with no extra pump is an important device for bio lab-on-a-chip (LOC) application. Polydimethylsiloxane (PDMS) is a common material for bio-microfluidic chip but suffers from hydrophobic surface problem. In this article, the surface modification of PDMS material for long-term hydrophilicity improvement has been studied by O 2 plasma and polyethylene glycol (PEG) coating. Three kinds of surface treatment namely the O 2 plasma treatment, PEG coating and O 2 plasma followed by PEG coating were performed for hydrophilic enhancement on pristine PDMS. The contact angle measurement was used for examining hydrophilic duration after treatment. The contact angle of pristine PDMS is hydrophobic around 100° ± 3°. Using only O 2 plasma treatment made the contact angle of PDMS below 10° initially but its hydrophobicity recovered quickly after 2 h that hindered practical application. Adding PEG coating on the O 2 plasma treated PDMS surface can make hydrophilic behavior retained longer than 400 h. The Fourier transform infrared spectrometer and contact angle variation were used for identifying the evolution of hydrophilicity enhancement. The cross-form microchip was used for testing the self-driven flow of rhodamine droplet into the microchannel successfully. This method is low-cost, disposable and easy to integrate with the microfluidic LOC system.

Aim To evaluate the relationship between dipeptidyl peptidase-4 inhibitor (DPP4i) treatment and chronic rhinosinusitis (CRS) in diabetic patients. Methods We used the Longitudinal Health Insurance Database for this population-based and population-matched cohort design study. Chi-square and Wilcoxon rank-sum tests were used to evaluate the association between categorical and continuous variables, respectively. The Kaplan–Meier method with the log-rank test was used to estimate the risk of CRS and DPP4i users. Results A total of 6198 diabetic patients were included in this cohort study. DPP4i users had a lower risk of developing CRS. The risk of CRS was significantly lower in women, patients with a Diabetes Complications Severity Index score higher than 4, patients with comorbidities, and patients with higher cumulative defined daily dose in the DPP4i group. Conclusion The results of our study demonstrate that the use of DPP4i treatment could decrease CRS risk in diabetic patients in Taiwan.

Mitomycin C (MMC) is often used to prevent postoperative corneal haze and subconjunctival fibrosis in ocular surgery. It also affects the motility and viability of the residual ocular cells, including corneal stromal cells. Extracellular matrix metalloproteinase-9 (MMP-9) contributes to the promotion of cell movement in macrophage and cancer cells, but the intracellular role of MMP-9 remained unclear. Herein, we illustrated the novel role of intracellular MMP-9 in MMC-suppressed cell migration using isolated human corneal fibroblasts (HCFs). In HCFs, MMC enhanced intracellular MMP-9 at transcriptional and protein levels. Using co-immunoprecipitation analysis, we confirmed that MMC enhanced the association between intracellular MMP-9 and inactive FAK/paxillin (PXN) complexes, i.e. PXN without phospho-tyrosine 118 (pY118) and FAK without phospho-tyrosine 397 (pY397). To verify the role of intracellular MMP-9 in migration, its gene was directly isolated from HCFs and highly expressed in HCFs by a lentivirus-based pseudovirus system with encephalomyocarditis virus (EMCV)-driven enhanced green fluorescent protein (GFP) as the MMP-9-IG-versus IG-expressing cells. Compared with the IG-expressing cells, higher intracellular MMP-9 expression in the MMP-9-IG-expressing HCFs proliferated and migrated more slowly. Phosphorylation of FAK at Y397 and PXN at both Y31 and Y118 were significantly less in the MMP-9-IG-expressing HCFs. These suggested that MMC-upregulated intracellular MMP-9 clutched inactive FAK/PXN complexes at focal adhesion sites to form a new "inactive" trimer, prohibited FAK/PXN complexes phosphorylation and retarded corneal fibroblast migration.

Background:Sarcopenia is an essential issue in elderly or chronically ill subjects, and a recent surge of research on sarcopenia in patients with rheumatoid arthritis (RA) has emerged; however, the results remains controversial.Objectives:To assess the prevalence and risk factors of sarcopenia in patients with RA.Methods:We searched the studies investigating the prevalence and risk factors of sarcopenia in PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), AiritiLibrary, Chinese Electronic Periodicals Service (CEPS) and China National Knowledge Infrastructure (CNKI) Database from inception to October 5, 2019. Effects regarding prevalence and the associated risk factors were extracted and evaluated by random-effect model. Sensitivity analysis was performed for the effects.Results:After searching, twenty studies containing 3,663 RA subjects were identified, and the pooled prevalence was 35%, among which the prevalence in male and female were 39.8% and 33.3% respectively. Twelve studies reported various risk factors, and therein which had been mentioned in more than two studies were included for meta-analysis, yielding age (odds ratio [OR] 1.168, 95% confidence interval [CI] 1.032-1.322, P =0.014), female (OR 4.438, 95% CI 1.857-10.605, P < 0.001), CRP (OR 1.797, 95% CI 1.422-2.272, P < 0.001), HAQ (OR 1.756, 95% CI 1.235-2.496, P=0.002) and RF seropositivity (OR 1.935, 95% CI 1.335-2.804, P < 0.001) were significantly associated with sarcopenia in subjects with RA. There was no alteration of the results after removal any of studies in sensitivity analysis.Conclusion:Our meta-analysis demonstrated the prevalence and associated risk factors of sarcopenia in RA. More research was still warranted to clarify the relationship.References:[1]Ngeuleu A, Allali F, Medrare L, Madhi A, Rkain H, Hajjaj-Hassouni N. Sarcopenia in rheumatoid arthritis: prevalence, influence of disease activity and associated factors. Rheumatol Int. 2017;37:1015-20.[2]Torii M, Hashimoto M, Hanai A, Fujii T, Furu M, Ito H, et al. Prevalence and factors associated with sarcopenia in patients with rheumatoid arthritis. Mod Rheumatol. 2019;29:589-95.Disclosure of Interests:None declared

Background:Infectious disease is one of the leading causes of mortality in systemic lupus erythematosus (SLE). Among these infections, invasive fungal infection (IFI) carries high mortality rate (25-70%), but the literature of IFI in SLE is limited.Objectives:To investigate the epidemiology and risk factors of invasive fungal infection and its subtypes, including candidiasis, aspergillosis, and cryptococcosis, in SLE patients.Methods:All patients with newly diagnosed SLE between 1997-2012 were enrolled from Taiwan National Health Insurance Research Database, with an age- and sex-matched non-SLE control group in a ratio of 1:10. IFI was identified by ICD9 codes1from discharge record and validated by use of systemic anti-fungal agents. The incidence rate (IR), incidence rate ratio (IRR), cause mortality rate of IFI and its subtypes were compared. A Cox multivariate model with time-dependent covariates was applied to analyse the independent risk factors of IFI.Results:A total of 269 951 subjects (24 541 SLE and 245 410 control) were included. There were 445 episodes of IFI in SLE group. Candida was the most common pathogen (52.8%), followed by cryptococcus and aspergillus. The IR of IFI in SLE was 20.83 per 10,000 person-years with an IRR of 11.1 (95% CI 9.8-12.6) compared to the control (figure 1). Kaplan-Meier curve also disclosed a lower IFI-free survival in SLE (figure 2). The all-cause mortality rate was similar between SLE and the control (26.7 vs 25.7%). In SLE, treatment with mycophenolate mofetil (HR=2.24, 95% CI 1.48-3.37), cyclosporin (HR=1.65, 95% CI 1.10-1.75), cyclophosphamide (HR=1.37, 95% CI 1.07-1.75), oral daily dose of steroid>5 mg prednisolone (HR=1.26, 95% CI 1.01-1.58), and intravenous steroid therapy (HR=29.11, 95% CI 23.30-36.37) were identified as independent risk factors of IFI. Similar analyses were performed for subtypes of IFI. Distinctive risk factors were found between different subtypes of IFI (table 1).Conclusion:SLE patients have a higher risk of IFI. Intravenous steroid therapy is the most important risk factor of IFI. This study provides crucial information for risk stratification of IFI in SLE.References:[1] Winthrop KL, Novosad SA, Baddley JW, et al. Opportunistic infections and biologic therapies in immune-mediated inflammatory diseases: consensus recommendations for infection reporting during clinical trials and postmarketing surveillance. Ann Rheum Dis. 2015 Dec; 74(12):2107-2116.Disclosure of Interests:None declared

The polydimethylsiloxane (PDMS) is widely applied to prototyping of various categories by coating or molding due to bio-compatibility, transparency, and flexibility. However, the native hydrophobicity and short-time recovery after O2 plasma treatment for the microfluidic chip are the defects in self-driven capillary pumping and long-term stability. Good optical transparency is necessary for backlight experiment observation. In addition, the self-bond in dual-tone PDMS-to-PDMS casting leads to a separation problem during demolding, which prevents rapid prototyping application. In this article, the coating of polyethylene glycol (PEG) with molecular weights (MW) of 6000 and 1000 denoted as PEG6000 and PEG1000 on PDMS is investigated as an anti-stiction layer for rapid prototyping as well as for the surface modification on the hydrophilicity and backlight optic property of PDMS for the microfluidic chip application. The contact angles of both PEG6000 and PEG1000 coated PDMS after 21 days are 42.6° and 41.7°, respectively, for good hydrophilicity; however, the pure O2-PDMS without PEG coating after 1.5 h has hydrophobic recovery to 78.7°. After PDMS-to-PDMS demolding, the PEG6000 coated PDMS has some broken area on the surface, while the PEG1000-PDMS keeps a whole smooth surface. Regarding transparency, the PEG1000-PDMS has a higher transmittance of about 55–70% near to the PDMS of 65–78% in visible wavelength, but the PEG6000-PDMS one is vague about 15%. It is attributed to PEG1000 of much smaller molecules with a lower light scattering and absorbance compared to PEG6000. The PEG1000-PDMS of good hydrophilicity, transparency, and anti-stiction properties makes it a good candidate for the capillary-driven microfluidic chip application.

The initial stage of host cell infection by influenza A viruses (IAV) is mediated through interaction of the viral haemagglutinin (HA) with cell surface glycans. The binding requirement of IAVs for Galβ(1,4)Glc/ GlcNAc (lactose/lactosamine) glycans with a terminal α(2,6)-linked (human receptors) or α(2,3)-linked (avian receptors) N-acetylneuraminic residue commonly found on N-glycans, is well-established. However the role and significance of sialylated Galβ(1,3)GalNAc (core 1) epitopes that are typical O-glycoforms in influenza virus pathogenesis remains poorly detailed. Here we report a multidisciplinary study using NMR spectroscopy, virus neutralization assays and molecular modelling, into the potential for IAV to engage sialyl-Galβ(1,3)GalNAc O-glycoforms for cell attachment. H5 containing virus like particles (VLPs) derived from an H5N1 avian IAV strain show a significant involvement of the O-glycan-specific GalNAc residue, coordinated by a EQTKLY motif conserved in highly pathogenic avian influenza (HPAI) strains. Notably, human pandemic H1N1 influenza viruses shift the preference from ‘human-like’ α(2,6)-linkages in sialylated Galβ(1,4)Glc/GlcNAc fragments to ‘avian-like’ α(2,3)-linkages in sialylated Galβ(1,3)GalNAc without involvement of the GalNAc residue. Overall, our study suggests that sialylated Galβ(1,3)GalNAc as O-glycan core 1 glycoforms are involved in the influenza A virus life cycle and play a particularly crucial role during infection of HPAI strains.

Objective The objective of this paper is to analyze the clinical features, outcomes, mortality risk factors, and all-cause mortalities of invasive aspergillosis (IA) in patients with systemic lupus erythematosus (SLE). Methods Medical records were reviewed to identify SLE patients with IA from January 2006 to June 2017, at Taipei Veterans General Hospital, Taiwan. A total of 6714 SLE patients were included. Clinical/laboratory parameters and treatment outcomes were analyzed. Results Four patients (19.0%) had definite and 17 had probable (81.0%) IA. Seven patients (33.3%) survived and 14 died (66.7%). Concurrently, there were 19 pneumonias (90.5%), 17 cases of other infections (81.0%), eight bacteremia (38.1%), nine cytomegalovirus (CMV, 42.7%) and six Candida (28.6%) infections. In all 55 blood cultures, 38 (69.1%) yielded gram-negative bacilli, of which carbapenem-resistant A. baumannii accounted for eight (21.1%); 17 (30.9%) yielded gram-positive cocci, of which methicillin-resistant S. aureus accounted for six (35.3%); and vancomycin-resistant Enterococcus accounted for four (23.5%). Daily steroid dose ≥ 20 mg (hazard ratio (HR) 2.00), recent pulse steroid therapy (HR 2.80), azathioprine (HR 2.00), rituximab (HR 2.00), plasmapheresis (HR 2.00), acute respiratory distress syndrome (HR 2.00), concurrent infections (HR 5.667) and CMV viremia (HR 1.75) were higher in the fatality group. All p values were less than 0.05. Septic shock ( n = 7, 50% in the fatality group) is the most common cause of mortality. Conclusions High daily steroid dosing, recent pulse steroid therapy, azathioprine, rituximab, concurrent infections, and CMV viremia were mortality risk factors for IA in SLE.

Aims A high rate of suicide has been reported in patients who sustain fractures, but the association remains uncertain in the context of other factors. The aim of this study was to examine the association between fractures and the risk of suicide in this contextual setting. Patients and Methods We performed a case-control study of patients aged 40 years or older who died by suicide between 2000 and 2011. We included patients’ demographics, physical and mental health problems, and socioeconomic factors. We performed conditional logistic regression to evaluate the associations between fractures and the risk of suicide. Results We included a total of 34 794 patients who died by suicide and 139 176 control patients. We found that fractures as a homogenous group (adjusted odds ratios (aOR), 1.48; 95% confidence interval (CI) 1.43 to 1.53), and specifically pelvic (aOR 2.04; 95% CI 1.68 to 2.47) and spinal fractures (aOR 1.53; 95% CI 1.43 to 1.64), were associated with a higher risk of suicide. In addition, we found that patients who had a lower income, had never married, had lower levels of educational attainment, or had coexistent physical and mental conditions such as anxiety, mood disorders, and psychosis-related disorders had a higher risk of suicide. Conclusion Fractures, specifically those of the hip and spine, were associated with an increased risk of suicide. The findings suggest that greater clinical attention should be given to this risk in patients with fractures, especially for those with additional risk factors. Cite this article: Bone Joint J 2018;100-B:780–6.

Background Sjogren’s syndrome is an autoimmune disease that involves several organs. In the latest classification criteria, salivary minor gland is one of the major factor contributing to the diagnosis. Ultrasonography is a non-invasive, easy accessible tool in evaluation the contour and structure of salivary glands, which have been shown to have efficacy in monitoring the disease status of Sjogren’s syndrome as well as in diagnosis the disease. Otherwise, salivary flow rate is another component of classification criteria, and its association with disease activity remains to be elucidated. Objectives To investigate the efficacy of salivary gland ultrasonography and salivary flow rate in patients with Sjogren’s syndrome and Sicca symptoms. Methods Total 97 patients of primary or secondary Sjogren’s syndrome, and patients with sicca symptoms were enrolled. Ultrasonography was performed at parotid and submandibular glands with 13–16MHz linear probe. Each gland was scored from 0 to 4. Minor salivary gland biopsy results were examined by pathologist with Chisholm-Mason grade. Unstimulated salivary flow rate was recorded first, and stimulated salivary flow rate was tested after 5 min of sugar-free chewing gum stimulation. Patients‘ symptoms were recorded by ESSPRI questionnaires. Results Total 56 primary Sjogren’s Syndrome, 10 secondary Sjogren’s Syndrome, and 31 patients with sicca symptoms were enrolled. Significant correlations were noted between unstimulated salivary flow rate and minor gland biopsy (p=0.029), stimulated salivary flow rate and biopsy (p=0.006), salivary gland ultrasonography and minor gland biopsy (p Conclusions Both salivary gland ultrasonography and salivary flow rate correlated with the severity of salivary minor gland biopsy. The stimulated salivary flow rate had better correlations with the biopsy result than unstimulated flow, and it also correlated with patients’ self-reported dryness symptoms. Salivary gland ultrasonography had correlations with symptoms of patient. These non-invasive methods may play roles in evaluation of the disease activity. Disclosure of Interest None declared

Indirect real estate (IRE) returns are often shown to lead direct real estate (DRE) returns. Apart from differences in liquidity, transaction costs, and management skills, the DRE market is also less complete than the IRE market—when negative shocks arrive, one can only short IRE (e.g., real estate stocks or REITs), but not DRE. This study investigates if short sales in the IRE market convey any information to the DRE market. Based on high-frequency (weekly) property price data in Hong Kong from 2000 to 2012, we find that short sales in the IRE market led DRE returns, even after controlling for the lagged IRE returns in a VAR model. This supports an information spillover mechanism in which the DRE market learns private information that is not reflected in IRE returns. The spillover effect, however, weakened after the recent global financial crisis because the increased uncertainty over the credibility of individual firms made short sales more reflective of firm-specific information than real estate market fundamentals.

Separation is one of the important pretreatment processes during detection in lab-on-a-chip. In this reported work, polydimethylsiloxane (PDMS) on a glass microchip with a combination of the spiral channel and backward facing step structure was designed to optimise the separation of suspended particles without any extra active powers of the electric or magnetic field. The spiral microfluidic chip was fabricated first by the foil-assisted CO2 laser ablated polymethylmethacrylate (PMMA) master mould, followed by repetitive PDMS moulding and then bonded to a glass substrate. The CO2 laser ablation of PMMA in air normally generated poor surface quality comprising bulges and scorches. The metal-foil-assisted laser ablation can effectively improve the above defects with conducting cover protection. The average height of the bulges was reduced from 5.0 to 1.5 μm and the channel width was reduced from 230 to 120 μm. The finished separation chips were operated at various syringe-controlled flow rates of 5–20 µL/min to test the performance. A high separation efficiency of about 99% could be achieved within a certain flow range of less than 15 µL/min under the simple structure with low-cost and time-saving.

Despite the huge and growing global burden of hepatocellular carcinoma (HCC), high-quality population-based studies of HCC prevalence and outcomes are scarce.To analyze trends and predictors of hospital resource utilization and mortality rates in a population of patients who had received HCC surgery.This population-based patient cohort study retrospectively analyzed 23,107 patients who had received surgical treatment for HCC from 1998 to 2009.The prevalence rate of surgical treatment in HCC patients significantly increased by 167.4% from 4.857 per 100,000 persons in 1998 to 12.989 per 100,000 persons in 2009 (P0.001). Age, gender, Deyo-Charlson co-morbidity index score, hospital volume, surgeon volume, digestive system disease, hepatitis type and liver cirrhosis were significantly associated with HCC surgical outcomes (P0.05). Over the 12-year period analyzed, the estimated mean hospital treatment cost increased 9.4% whereas mean length of stay (LOS) decreased 25.3%. The estimated mean overall survival time after HCC surgery was 40.9 months (SD 1.2 months), and the overall in-hospital 1-, 3-, and 5-year survival rates were 97.2%, 79.9%, 61.1%, and 54.6%, respectively.These population-based data reveal that the prevalence of HCC has increased, especially in older patients. Additionally, hospital treatment costs for HCC have increased despite decreases in LOS. These analytical results should be applicable to most countries with relatively small populations. Additionally, healthcare providers and patients should recognize that attributes of both the patient and the hospital may affect outcomes.

Incorporation of layers of noble metals in non-van der Waals layered materials may be used to form novel layered compounds. Recently, we demonstrated a high-temperature-induced exchange process of Au with Si in the layered phase Ti

Background Randomized controlled trials on the post-admission use of statins in sepsis patients have not shown a survival benefit. Whether preadmission use of statins would confer any beneficial effects in sepsis patients has not been well studied. Methods We conducted a population-based cohort study on a national health insurance claims database between 1999 and 2011. Sepsis patients were identified by ICD-9 codes compatible with the third International consensus definitions for sepsis. Use of statin was defined as the cumulative use of any statin for more than 30 days before the indexed sepsis admission. We determined the association between statin use and sepsis outcome by multivariate-adjusted Cox proportional hazard models and propensity score matched analysis. To minimize baseline imbalance between statin users and non-statin users, we matched/adjusted for social economic status, comorbidities, proxies for healthy lifestyle, health care facility utilization, and use of medications. Results We identified 52 737 sepsis patients, of which 3599 received statin treatment. Statins use was associated with a reduced 30-day mortality after multivariable adjustment (HR 0.86, 95% CI, 0.78–0.94) and propensity score matching (HR, 0.88; 95% CI, 0.78–0.99). On subgroup analysis, the beneficial effects of statins were not significant in patients receiving ventilator support or requiring ICU admission. Conclusions In this national cohort study, preadmission statin therapy before sepsis development was associated with a 12% reduction in mortality when compared with patients who never received a statin. There were no consistent beneficial effects of statins in all patient subgroups.

Background Patients with polymyositis and dermatomyositis (PM/DM) are characterized by chronic muscle weakness due to autoimmune-mediated myositis and are usually treated with corticosteroids initially. PM/DM patients prone to develop osteoporosis and subsequent fractures but are rarely investigated. Objectives To explore the incidence rate (IR) and risk factors of osteoporotic fractures (OFs) among adult PM/DM patients. Methods We conducted a cohort study by utilizing the Taiwan National Health Insurance database. PM/DM patients and respective age- and gender-matched cohort without PM/DM were enrolled. The primary endpoint was the initial event of OFs. We used the Cox proportional hazard model to study the risk factors of OFs in the PM/DM cohort. Results Among 2391 PM/DM patients (67.8% female, mean age: 49.5 years) followed for a mean (SD) of 6.1 (5.0) years, 116 developed vertebral fractures, 32 had hip fractures, and 14 experienced radius fractures (IR: 8.18, 2.20, and 0.96 per 1000 person-years, respectively, Table 1). Compared with the matched cohort, the PM/DM patients had higher IR ratios (IRRs) (95% CIs) of OFs at all age groups at enrollment: 3.27 (2.19 to 4.81, p 5 mg are associated with OFs. Conclusions Adult PM/DM patients had a high IR of vertebral and hip fractures. Patients who were female, advanced age, having certain comorbidities, and exposed to corticosteroid exhibited a higher risk. Disclosure of Interest None declared

Background Psoriatic arthritis (PsA) contributes to enormous burden of disease and thus early correct diagnosis and adequate therapeutic management are essential for physicians in practice; however, There have been several studies highlighting the inadequate diagnosis and suboptimal therapies for PsA worldwide and physicians generally report difficulties in managing psoriasis. Objectives To analyze the real-world clinical practice of PsA in Taiwan, and assess physicians9 adopted methods and difficulties of diagnosis, therapeutic consideration and strategy, in addition to rationales for biologic agents and unmet needs. Methods A nationwide cross-sectional observational study in Taiwan was conducted by means of the face-to-face in depth interviews with the 80 physicians, composed of 50 rheumatologists and 30 dermatologists, from November 2014 to January 2015. Results The major adopted diagnostic examinations for PsA are arthritis performance, psoriasis and nail dystrophy, roentgenological studies, personal and family history; however, more dermatologists rely on RF for initial diagnosis ( p Conclusions The nationwide study is the first survey for real-world clinical practice of PsA in Asia and provides detailed messages about the diagnostic difficulties and therapeutic consideration, especially rationales and unmet needs on current biologic therapies, which may offer possible directions for new drug development. We also made interdisciplinary comparison, hence in order to improve comprehensive care. References Liu JT, Yeh HM, Liu SY, Chen KT. Psoriatic arthritis: Epidemiology, diagnosis, and treatment. World J Orthop 2014;5:537–43. van de Kerkhof PC, Reich K, Kavanaugh A, et al. Physician perspectives in the management of psoriasis and psoriatic arthritis: results from the population-based Multinational Assessment of Psoriasis and Psoriatic Arthritis survey. J Eur Acad Dermatol Venereol 2015;29:2002–10. Disclosure of Interest None declared

Background and aims Systemic lupus erythematosus (SLE) patients are susceptible to herpes simplex virus (HSV) infection, which is occasional but often leading to overwhelming disease such as encephalitis and keratitis. However, only few attempts have been made at the associated incidence and risk factors. Methods We enrolled SLE patients from the Taiwanese National Health Insurance research database between 1997 and 2012. We compared the incidence rate (IR) of severe HSV infection, including viral septicemia, meningoencephalitis, ocular infection, visceral infection and those with complications after infection, with those of non-SLE cohort. We also evaluated the risk factors of severe HSV infection by means of Cox multivariable proportional hazards model. Results A total of 1 22 520 subjects (24 504 SLE patients and 98 016 age- and gender-matched subjects as control group) were analysed and revealed a significantly higher IR of severe HSV infection in SLE (Incidence rate ratio=3.52, p Conclusions A higher risk of severe HSV infection was observed in SLE patients The risk factors for severe HSV infection were age over 18, previous skin infection, intravenous steroid pulse therapy and an oral daily steroid dose over 7.5 mg.

In patients with systemic lupus erythematosus (SLE), low bone mineral density (BMD) is associated with increased age, prolonged disease, low body mass index (BMI), and overlap with rheumatoid arthritis (RA). Elevated fibroblast growth factor (FGF)-23 in cyclosporine A (CsA) users with SLE are associated with decreased active vitamin D and osteocalcin.The objective of this study was to investigate the steroid and CsA effect on bone metabolism and serum FGF-23 in SLE patients.Seventy-two SLE patients and 10 age- and sex-matched healthy individuals underwent blood tests for bone metabolic biomarkers and FGF-23, and lumbar spine dual-energy X-ray absorptiometry for BMD.Comparisons between patients and controls were made in premenopausal women/men younger than 50 years and postmenopausal women/men older than 50 years separately. SLE patients had more frequent low Z-score (≤-2.0, 8.5 vs. 0%), osteopenia (-2.5T-score-1.0, 52 vs. 50%), and osteoporosis (T-score≤-2.5, 12 vs. 0%), than the healthy age-compatible counterparts. BMD was significantly lower in patients with advanced age, longer disease duration, lower BMI, and overlap with RA (all p0.05 by multiple linear regression analyses). Serum FGF-23 was significantly higher and 1,25-dihydroxyvitamin D (1,25(OH)2D3) lower in SLE patients treated with glucocorticoid and CsA than in those not taking both of them (p=0.027 and 0.002, respectively). The cumulative dose of glucocorticoid was inversely correlated with serum intact parathyroid hormone (r=-0.299, p=0.011), C-terminal telopeptide of type I collagen (r=-0.581, p0.001), and osteocalcin (r=-0.648, p0.001). FGF-23 and the cumulative dose of CsA were positively correlated (r=0.38, p=0.001) and both were negatively correlated with 1,25(OH)2D3 (r=-0.266, p=0.016 and r=-0.55, p0.001) and osteocalcin (r=-0.234, p=0.034 and r=-0.274, p=0.02).SLE patients treated with glucocorticoid and CsA exhibited markedly decreased bone turnover. Those taking CsA had higher serum FGF-23 associated with suppression of 1,25(OH)2D3 and bone formation. Such high-risk patients necessitate regular screening of osteoporosis.

To compare multimodal imaging in detecting lacquer cracks in highly myopic eyes, and to correlate these findings with those of spectral-domain optical coherence tomography (SD-OCT).An observational case series study. Patients with a refractive error worse than -8 diopters and lacquer cracks were recruited. The rates of detection of the lacquer cracks using multimodal imaging including near-infrared reflectance (NIR) imaging, fundus autofluorescence (FAF) imaging, and fluorescence angiography (FA) were compared. The characteristic findings of multimodal imaging were correlated with those of SD-OCT.NIR imaging was more sensitive (92.9%) in detecting lacquer cracks than either FAF (12.5%) or FA (67.9%). Lacquer cracks showed hyperreflectance on NIR, and they were consistently associated with a continuous retinal pigment epithelium-Bruch's membrane complex, thinner choroid, and acoustic shadows on SD-OCT.NIR imaging is superior to blue laser light (FAF and FA) imaging in detecting lacquer cracks. SD-OCT in combination with NIR located primary pathological lacquer cracks in the intact retinal pigment epithelium-Bruch's membrane complex as well as thinner choroid. These findings indicate that multimodal cSLO and SD-OCT imaging allow for detecting of lacquer cracks in highly myopic eyes.

Objective The objective of our study was to determine the incidence rates and risk factors of aortic aneurysm and aortic dissection among patients with systemic lupus erythematosus (SLE) using a nationwide population-based data set. Methods We conducted a retrospective cohort study using data from the Taiwan National Health Insurance database. Patients with SLE and age-, sex- and comorbidity-matched control patients without SLE were identified. The primary endpoint was the first occurrence of aortic aneurysm or aortic dissection. The incidence rate ratios (IRRs) were calculated based on a 95% confidence interval (CI). A Cox proportional-hazards model was used to evaluate the risk factors for aortic aneurysm and aortic dissection in the SLE cohort. Results Among the 15,209 patients with SLE (89.9% women and mean age of 38.3 years), 20 developed aortic aneurysm and 13 developed aortic dissection (overall incidence rate, 4.26 per 10,000 person-years). Compared with the control patients, the overall IRR for developing aortic aneurysm or aortic dissection was 3.34 (95% CI, 1.71–6.91; p Conclusion Aortic aneurysm and aortic dissection occur at higher rates in SLE patients than in people without SLE and a longer disease duration is associated with a higher risk of these rare vascular complications.

The traditional closed-channel polydimethylsiloxane (PDMS) capillary mixer without a delay valve generally encounters backflow problems. In this article, the design of a polyethylene glycol (PEG) coated PDMS mixing meander channel for long-term capillary-actuating with a delay valve and open surface is investigated using numerical analysis and flow-visualization experiments. The self-driven open-surface PEG-PDMS meander mixer exhibits a high mixing extent of more than 90%. The simulation and experiments of the triggering delay valve evidence that two fluids can merge together before the meander channel and then flow into the mixing unit to eliminate the backflow problem. It also enhances an efficient mixing. In addition, the open-surface channel shows a lower channel depth for self-actuating compared to the closed one. In terms of simulation, the mixing extent of both blue and red inks at the position just after the delay valve is about 43% and enhanced to 92% at about 10 mm mixing length after the delay valve. In terms of experiments, the ImageJ analyzed mixing extent is enhanced from about 57% to 96% of mixing extent within the meander channel at the same position. The experiment is in a good agreement with the simulation result.

The planar micromixers merit easy integration with the microsystem but encounter the problems of high pressure drop and long mixing length for high mixing efficiency over 90 %. In this article, an advanced branched rhombic micromixer (BRM) have been designed and investigated by 3D numerical simulations and experiments. Polydimethylsiloxane (PDMS) molding process was used for chip fabrication of the experiment. The CFD-ACE+ software was applied for modeling simulations. Simulation results showed that this optimum geometry design of four-mixing-unit BRM with the branch position at 700 μm high and 100 μm wide can effectively improve the mixing efficiency over 95 % at Reynolds number (Re) 120 with a rather low pressure drop about 9,000 Pa and a short mixing length of 5.5 mm as well. The high mixing efficiency at low pressure drop is attributed to the greatly increased contact interface area and chaotic-convection vortices as well as the low flow resistance with branched channels. The mixing verification is performed by the flow visualization system via the popular rhodamine B dye (10 mM) added DI method for PDMS BRM chips.

ObjectiveTo explore the role of far infrared (FIR) radiation therapy for hemodialysis (HD) access maintenance after percutaneous transluminal angioplasties (PTA).MethodsThis was a prospective observational study. Eligible patients were those who received repeated PTA with the last PTA successfully performed within 1 week before the study enrollments. Consecutively enrolled patients undergoing successful HD treatments after PTA were randomly assigned to the FIR-radiated group or control group without radiation. FIR-radiated therapy meaning 40-minute radiation at the major lesion site or anastomosed site three times a week was continued until an end-point defined as dysfunction-driven re-PTA or the study end was reached.ResultsOf 216 participants analyzed, including 97 with arteriovenous grafts (AVG) (49 FIR-radiated participants and 48 control participants) and 119 with arteriovenous fistulas (AVF) (69 FIR-radiated participants and 50 control participants), the FIR-radiated therapy compared with free-radiated usual therapy significantly enhanced PTA-unassisted patency at 1 year in the AVG subgroup (16.3% vs. 2.1%; p

In recent years, the emerging bio-chip technology has used external powered pumps for fluidic pumping and mixing. The short-term capillary-driven micromixers with complex mixing structures also showed large potential for mixing devices. This reported work demonstrates the long-term capillary-driven meander micromixer with the planar design, short mixing distance and power-free rapid fluid, transport functions which is compared with conventional syringe pump micormixers. The surface property of various materials was verified by contact angle measurement. Both intrinsic hydrophilic materials of glass and JSR photoresist were good candidates and selected for fabricating the capillary-driven meander micromixer using simple photolithography, laser ablation and low-temperature bonding technology without chemical etching and without the deposition process. The design and simulation of such an effective capillary-driven micromixer have been performed for understanding the geometry effect on flow and mixing behaviour. The glass–JSR–glass capillary-driven meander micromixer can improve mixing efficiency up to over 95% at a short distance of only 8 mm, and has potential for the application of power-free microfluidic chip fabrication and bio-medical examination in the future.

This study reports the results of simulating a fire that occurred in a semiconductor factory in Taiwan in 2005. Based on the Fire Dynamics Simulator (FDS), this research investigated the risk factors involved in the semiconductor factory after undergoing the fire, and assessed the hazards caused by smoke. A factory fire of such magnitude shuts down operation and is damaging to the local society, economy, and the environment. The findings of this research are intended to enhance the engineering of the plant and mitigate the factors that negatively influenced the evacuation of people during the actual fire, to reduce risk and loss of the property fire. This paper provides specific parameters and quantitative data regarding planning and design, to serve as a reference for formulating countermeasures for the fire protection of industrial factories in Taiwan.

Summary An increase in yellowfin tuna (Thunnus albacares) catch by danish seine fisheries around the subsurface fish aggregating devices (FADs) in southern Taiwan waters has been a concern of local government and environmental groups. However, the attraction mechanism of aggregating tunas at the subsurface FADs is still poorly understood. The objective of this study is to examine the fine-scale vertical and horizontal movements of juvenile yellowfin tunas around a subsurface FAD. In total, 53 tunas (35–81 cm fork length) were tagged with ultrasonic telemetry tags and released at a subsurface FAD in the waters off Shiao-Liu-Chiu Island, southwestern Taiwan from October 2008 to December 2009. These tunas stayed at the subsurface FAD for up to 31 days, with daytime vertical movement depths averaging 60–80 m at a maximum depth of 250 m. At night, the tuna gathered at a shallow depth of 40 m. The mean depth of vertical movement in the daytime is significantly different from that of the nighttime (P