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Medical technology is undergoing rapid transformations, and the classifications of medical devices have also expanded greatly; therefore, it is necessary to develop appropriate reimbursement policies and pricing mechanisms in a timely manner. This paper aims to introduce the reimbursement coverage and pricing rules for medical devices in Taiwan. In addition, this paper identifies and evaluates available health technology assessments (HTA) and literature on published websites concerning medical device decision-making processes and pricing systems in South Korea and Japan, which are near Taiwan and have similar reimbursement coverage processes. Reimbursement policy and pricing mechanisms are constantly being revised in Taiwan, Japan, and South Korea. Recently, all three countries attempted to establish new reimbursement coverage decision-making and pricing rules, adopting a differentiated approach based on the level of evidence required for the appropriated reimbursement in terms of a feasible evaluation mechanism for providing patients with more effective medical devices. This article is expected to contribute to providing references to new reimbursement coverage decision-making and pricing rules.

Non-alcoholic fatty liver disease and non-alcoholic steatohepatitis are characterized by an increase in hepatic triglyceride content with infiltration of immune cells, which can cause steatohepatitis and hepatic insulin resistance. C-C chemokine receptor 7 (CCR7) is primarily expressed in immune cells, and CCR7 deficiency leads to the development of multi-organ autoimmunity, chronic renal disease and autoimmune diabetes. Here, we investigated the effect of CCR7 on hepatic steatosis in a mouse model and its underlying mechanism. Our results demonstrated that body and liver weights were higher in the CCR7−/− mice than in the wild-type (WT) mice when they were fed a high-fat diet. Further, glucose tolerance and insulin sensitivity were markedly diminished in CCR7−/− mice. The number of invariant natural killer T (iNKT) cells was reduced in the livers of the CCR7−/− mice. Moreover, liver inflammation was detected in obese CCR7−/− mice, which was ameliorated by the adoptive transfer of hepatic mononuclear cells from WT mice, but not through the transfer of hepatic mononuclear cells from CD1d−/− or interleukin-10-deficient (IL-10−/−) mice. Overall, these results suggest that CCR7+ mononuclear cells in the liver could regulate obesity-induced hepatic steatosis via induction of IL-10-expressing iNKT cells.

A single determination of eGFR associates with subsequent mortality risk. Prior decline in eGFR indicates loss of kidney function, but the relationship to mortality risk is uncertain. We conducted an individual-level meta-analysis of the risk of mortality associated with antecedent eGFR slope, adjusting for established risk factors, including last eGFR, among 1.2 million subjects from 12 CKD and 22 other cohorts within the CKD Prognosis Consortium. Over a 3-year antecedent period, 12% of participants in the CKD cohorts and 11% in the other cohorts had an eGFR slope-5 ml/min per 1.73 m(2) per year, whereas 7% and 4% had a slope5 ml/min per 1.73 m(2) per year, respectively. Compared with a slope of 0 ml/min per 1.73 m(2) per year, a slope of -6 ml/min per 1.73 m(2) per year associated with adjusted hazard ratios for all-cause mortality of 1.25 (95% confidence interval [95% CI], 1.09 to 1.44) among CKD cohorts and 1.15 (95% CI, 1.01 to 1.31) among other cohorts during a follow-up of 3.2 years. A slope of +6 ml/min per 1.73 m(2) per year also associated with higher all-cause mortality risk, with adjusted hazard ratios of 1.58 (95% CI, 1.29 to 1.95) among CKD cohorts and 1.43 (95% CI, 1.11 to 1.84) among other cohorts. Results were similar for cardiovascular and noncardiovascular causes of death and stronger for longer antecedent periods (3 versus3 years). We conclude that prior decline or rise in eGFR associates with an increased risk of mortality, independent of current eGFR.

The use of communication strategies is one of the core components that constitute communicative competence. However, the problem-oriented conceptualization of L2 strategic behavior has been widely criticized as it does not give sufficient attention to the social nature of communication and learning. This study thus makes an attempt to re-conceptualize communication as a mediated activity that focuses on the process and goal of communication. Eight EFL junior high school learners in Taiwan participated in this study. Empirical data were collected from an oral elicitation task, and then triangulated by retrospective comments derived from stimulated recall interviews and semi-structured interviews with the participants. The data were coded with Dörnyei and Scott's (1995) taxonomy of communication strategies and mapped onto a sociocultural framework of mediation for analysis. The findings showed that the use of strategies was at times problem-oriented for avoiding or solving communication breakdowns. Nevertheless, what seemed more significant was that interlocutors also made efficient choices of strategies according to the context and aim of the task. It is rightly the purpose of this paper to develop an enriched view of L2 strategic competence that acknowledges both the problem-oriented and goal-oriented nature of communication.

Energy dispersive extended X-ray absorption fine structure (EDE) has been applied to Pd nanoparticle nucleation at a liquid/liquid interface under control over the interfacial potential and thereby the driving force for nucleation. Preliminary analysis focusing on Pd K edge-step height determination shows that under supersaturated conditions the concentration of Pd near the interface fluctuate over a period of several hours, likely due to the continuous formation and dissolution of sub-critical nuclei. Open circuit potential measurements conducted ex-situ in a liquid/liquid electrochemical cell support this view, showing that the fluctuations in Pd concentration are also visible as variations in potential across the liquid/liquid interface. By decreasing the interfacial potential through inclusion of a common ion (tetraethylammonium, TEA+) the Pd nanoparticle growth rate could be slowed down, resulting in a smooth nucleation process. Eventually, when the TEA+ ions reached an equilibrium potential, Pd nucleation and particle growth were inhibited.

With the advent of high-throughput and imaging core level spectroscopies (including X-ray absorption spectroscopy, XAS, as well as electron energy loss spectroscopy, EELS), automated data processing, visualisation and analytics will become a necessity. As a first step towards these objectives we examined the possibilities and limitations of a simple automated XANES peak fitting procedure written in MATLAB, for the parametrisation of XANES features, including ionisation potentials as well as the energies and intensities of electronic transitions. Using a series of Au L3-edge XANES reference spectra we show that most of the relevant information can be captured through a small number of rules applied to constrain the fits. Uncertainty in this strategy arises mostly when the ionisation potential (IP) overlaps with weak electronic transitions or features in the continuum beyond the IP, which can result in ambiguity through multiple equally good fits.

The mechanism of the Brust–Schiffrin gold nanoparticle synthesis has been investigated through the use of ion transfer voltammetry at the water/1,2-dichloroethane (DCE) solution interface, combined with X-ray absorption fine structure (XAFS) of the reaction between [AuCl4]− and thiol (RSH) in homogeneous toluene (TL) solution. Ion transfer calculations indicate the formation of [AuCl2]− at RSH/Au ratios from 0.2–2 with a time-dependent variation observed over several days. At RSH/Au ratios above 2 and after time periods greater than 24 h, the formation of Au(I)SR is also observed. The relative concentrations of reaction products observed at the liquid/liquid interface are in excellent agreement with those observed by XAFS for the corresponding reaction in a single homogeneous phase. BH4– ion transfer reactions between water and DCE indicate that the reduction of [AuCl4]− or [AuCl2]− to Au nanoparticles by BH4– proceeds in the bulk organic phase. On the other hand, BH4– was unable to reduce the insoluble [Au(I)SR]n species to Au nanoparticles. The number and size of the nanoparticles formed was dependent on the concentration ratio of RSH/Au, as well as the experimental duration because of the competing formation of the [Au(I)SR]n precipitate. Higher concentrations of nanoparticles, with diameters of 1.0–1.5 nm, were formed at RSH/Au ratios from 1 to 2.

Electrochemical gold nucleation and nanoparticle growth at a liquid/liquid interface were examined in situ by combined X-ray fluorescence (XRF) mapping with a microfocus X-ray beam and X-ray absorption fine structure (XAFS) spectroscopy. Gold deposition was achieved by reduction of [AuCl4]− with tri-p-tolylamine at a water/1,2-dichlorobenzene interface using a windowless liquid/liquid interface system formed from the contact of aqueous and organic phase droplets. The combination of XRF and XAFS, with a spatial resolution of approximately 70 μm, provided chemical speciation information near the interface under gold deposition conditions. Analysis of the X-ray absorption near-edge structure (XANES) reveals evidence for the presence of Au(I) species as a reduction intermediate, concomitant with a buildup of metallic gold at the interface. Cyclic voltammetry indicates the presence of two ion transfer peaks at the liquid/liquid interface, which are assigned to the transfer of [AuCl4]− and [AuCl2]−. Finally ex situ TEM analysis shows that the resultant nanoparticles have an average size between 3 and 4 nm. In line with this particle size, the XAFS indicates bulk-like structure.

This study assesses gender differences in wayfinding in environments with global or local landmarks by analyzing both overall and fine-grained measures of performance. Both female and male participants were required to locate targets in grid-like virtual environments with local or global landmarks. Interestingly, the results of the two overall measures did not converge: although females spent more time than males in locating targets, both genders were generally equivalent in terms of corrected travel path. Fine-grained measures account for different aspects of wayfinding behavior and provide additional information that explains the divergence in overall measures; females spent less time traveling away from the target location, a higher proportion of time not traversing, and made more rotations when stopping than males did. Rather than unequivocally supporting male superiority in wayfinding tasks, both the overall and fine-grained measures partially indicate that males and females are differentially superior when using global and local landmark information, respectively. To summarize, males moved faster than females but did not necessarily navigate the spatial surroundings more efficiently. Each gender showed different strengths related to wayfinding; these differences require the application of both overall and fine-grained measures for accurate assessment. © 2012 Elsevier Ltd.

Mg-1.0wt%Zn-2.0wt%Y alloy powders were produced by gas atomization, and subsequently sintered by spark plasma sintering (SPS). The SPSed Mg-1.0wt%Zn-2.0wt%Y alloy, which showed a microstructure of well-bonded grains containing nano-sized powders of approximately 100 nm in diameter, was coated by a plasma electrolytic oxidation (PEO) method. Microstructure, mechanical properties and corrosion properties of PEO coatings were investigated and compared to those of normally sintered Mg-1.0wt%Zn-2.0wt%Y and cast Mg-1.0wt%Zn alloys. All coatings consisted of MgO and Mg2SiO4. The micro-hardness and friction coefficient of coatings on the SPSed Mg-1.0wt%Zn-2.0wt%Y alloy were higher than those on normally sintered Mg-1.0wt%Zn-2.0wt%Y and cast Mg-l.0wt%Zn alloys. However, the corrosion resistance in 3.5% NaCl solution for the SPSed Mg-1.0wt%Zn-2.0wt%Y alloy was between that for normally sintered Mg-1.0wt%Zn-2.0wt%Y alloy and cast Mg-1.0wt%Zn alloy.

The purpose of this study was to evaluate the influences of tropical weather on patients with different ovarian responses in the treatment of assisted reproductive technology.Six-hundred fourty-seven women underwent their first treatment cycles were retrospectively analyzed. Patients received embryo transfer either 3 days or 5 days after oocyte retrieval, depending on the number and quality of embryos on day-2.Significant correlations were demonstrated in the top quality embryo rates of day-3 and day-5 embryo transfers with temperature, humidity, and atmosphere pressure. The cumulative light hours negatively correlated with the implantation and pregnancy rates of day-3 embryo transfer (-.282 and -.282, respectively), while they positively correlated with those of day-5 embryo transfer (.225 and .224, respectively).These results clearly suggest that weather may exert influences on the outcome of assisted reproductive technology. Patients with different ovarian responses or blastocyst culture and transfer may modify weather influences.

Objective To examine expression of androgen receptor (AR), AR cofactors, estrogen (E) receptor α, E receptor β, progesterone receptor, steroid receptor coactivator-1, and aromatase in human luteinized granulosa cells collected during oocyte retrieval. Design Prospective real-time reverse transcriptase-polymerase chain reaction study. Setting Academic medical center. Patient(s) A total of 198 samples were brought into the study. Intervention(s) Patients underwent the long protocol for assisted reproductive technology. Luteinized granulosa cells were collected transvaginally with ultrasound guidance. Quantitative reverse transcriptase-polymerase chain reaction was performed to quantify the mRNA expression of the investigated genes. Main Outcome Measure(s) The expression levels were determined as ratios between the studied genes and the reference gene β-actin. Result(s) There is little AR expression in human luteinized granulosa cells immediately preceding ovulation under controlled ovarian hyperstimulation. All aspirated follicles, despite their antral size, displayed a similar mRNA expression of the investigated genes in the luteinized granulosa cells. Conclusion(s) This study supports the possibility of a transition of androgen action from being an enhancer of follicular differentiation (through the AR) to being a substrate of E synthesis (through aromatase) at the time of oocyte retrieval. The present study also demonstrates no effect of follicular size upon the status of steroid receptor mRNA expression in the luteinized granulosa cells when follicles were at least >1.5 mL.

A 26-year-old nulliparous woman conceived after transfer of three embryos cocultured on a Vero cell monolayer. The ET followed SUZI of epididymal sperm from her husband with congenital absence of vas deferens.

Experimental allergic encephalomyelitis (EAE) is an autoimmune, animal model of multiple sclerosis (MS) in which demyelination and paralysis are evident. Quinolinic acid (QUIN) is a neurotoxin and endogenous N-methyl-D-aspartate receptor agonist formed from tryptophan. The role of neurotoxins in general and QUIN in particular in EAE or MS is unknown. Lewis rats inoculated with myelin basic protein developed signs of EAE by day 12, were killed, and their tissues assayed for QUIN by gas chromatography with mass spectrometry. QUIN levels were significantly elevated in the more caudal regions of the spinal cords of animals with EAE. Brain, serum, and liver levels of QUIN were not altered. In a similar manner, QUIN in mylin basic protein-injected, asymptomatic animals was not different from control animals. The time course for QUIN was similar to the neurological signs of the disorder; however, the initial elevation in QUIN occurred before the appearance of behavioral signs. Last, treatment with the glucocorticoid dexamethasone prevented both the signs of EAE and the elevation in spinal cord QUIN. It is not known whether QUIN contributes to the paralysis in EAE. However, if QUIN is pathogenic in EAE this finding could have therapeutic implications for MS.

Objective To determine if delaying initiation of exogenous gonadotropin administration after pituitary desensitization with gonadotropin-releasing hormone agonist (GnRH-a) is a realistic option to avoid scheduling clinical and laboratory work on weekends/holidays. Design, Patients A review of 57 in vitro fertilization (IVF) cycles in which, after pituitary desensitization with GnRH-a, initiation of gonadotropin administration were delayed in an attempt to avoid off-hour work. Thirty-eight IVF cohort cycles served as control. Setting Tertiary medical center. Results There were no statistically significant differences in ovarian response, dose of gonadotropin required, oocytes and embryos obtained, pregnancy rates, and abortion rates between groups. Eighty-three percent of the delayed cycles had clinical and laboratory work that fell within weekdays. Conclusion Delaying initiation of exogenous gonadotropin administration after pituitary desensitization had no detrimental effects on IVF outcomes. It may be used to avoid scheduling work on weekends/holidays.

A 30-year-old nulliparous woman, who was infertile for greater than 3 years, conceived after the procedures of a simple method of zona cutting, cryopreservation, and ZIFT. This case illustrates: (1) acid medium, chymotrypsin, or sucrose are not needed for the procedure of zona cutting; (2) the zygotes resulting from zona cutting survive through freezing and thawing; and (3) oocyte retrieval can be done concomitant with conservative surgery for endometriosis.