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Abstract Free-space optical communications hold promising advantages, including a large bandwidth, access to license-free spectrum, high data rates, quick and simple deployment, low power consumption, and relaxed quality requirements. Nevertheless, key technical challenges remain, such as a higher transmission efficiency, a lower transmission loss, and a smaller form factor of optical systems. Here, we demonstrate the viability of circular-polarization-multiplexed multi-channel optical communication using metasurfaces alongside a photonic-crystal surface-emitting laser (PCSEL) light source at wavelength of 940 nm. Through the light manipulation with metasurface, we split the linearly polarized incidence into left and right circular polarizations with desired diffraction angles. Such orthogonal polarization states provide a paradigm of polarization division multiplexing technique for light communication. The PCSEL light source maintains a low divergence angle of about 0.373 degrees after passing through an ultra-thin metasurface without further bulky collimator or light guide, making end-to-end (E2E) and device-to-device (D2D) communications available in a compact form. Both light source and modulated polarized light exhibit a − 3 dB bandwidth over 500 MHz, with successful 1 Gbit/s transmission demonstrated in eye diagrams. Our results affirm that metasurface effectively boosts transmission capacity without compromising the light source's inherent properties. Future metasurface designs could expand channel capacity, and its integration with PCSEL monolithically holds promise for reducing interface losses, thereby enhancing efficiency.

Abstract Background The successful management of patients infected with coronavirus disease 2019 (COVID-19) with inhaled ciclesonide has been reported, however few studies have investigated its application among hospitalized patients. Methods This retrospective cohort study enrolled all adult patients admitted to our hospital with confirmed COVID-19 infection from May to June 2021. Critical patients who received mechanical ventilation within 24 h after admission and those who started ciclesonide more than 14 days after symptom onset were excluded. The in-hospital mortality rate was compared between those who did and did not receive inhaled ciclesonide. Results A total of 269 patients were enrolled, of whom 184 received inhaled ciclesonide and 85 did not. The use of ciclesonide was associated with lower in-hospital mortality (7.6% vs. 23.5%, p = 0.0003) and a trend of shorter hospital stay (12.0 (10.0–18.0) days vs. 13.0 (10.0–25.3) days, p = 0.0577). In subgroup analysis, the use of inhaled ciclesonide significantly reduced mortality in the patients with severe COVID-19 infection (6.8% vs. 50.0%, p

BackgroundThe aim of our study was to externally validate the predictive capability of five developed coronavirus disease 2019 (COVID-19)-specific prognostic tools, including the COVID-19 Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), Shang COVID severity score, COVID-intubation risk score-neutrophil/lymphocyte ratio (IRS-NLR), inflammation-based score, and ventilation in COVID estimator (VICE) score.MethodsThe medical records of all patients hospitalized for a laboratory-confirmed COVID-19 diagnosis between May 2021 and June 2021 were retrospectively analyzed. Data were extracted within the first 24 h of admission, and five different scores were calculated. The primary and secondary outcomes were 30-day mortality and mechanical ventilation, respectively.ResultsA total of 285 patients were enrolled in our cohort. Sixty-five patients (22.8%) were intubated with ventilator support, and the 30-day mortality rate was 8.8%. The Shang COVID severity score had the highest numerical area under the receiver operator characteristic (AUC-ROC) (AUC 0.836) curve to predict 30-day mortality, followed by the SEIMC score (AUC 0.807) and VICE score (AUC 0.804). For intubation, both the VICE and COVID-IRS-NLR scores had the highest AUC (AUC 0.82) compared to the inflammation-based score (AUC 0.69). The 30-day mortality increased steadily according to higher Shang COVID severity scores and SEIMC scores. The intubation rate exceeded 50% in the patients stratified by higher VICE scores and COVID-IRS-NLR score quintiles.ConclusionThe discriminative performances of the SEIMC score and Shang COVID severity score are good for predicting the 30-day mortality of hospitalized COVID-19 patients. The COVID-IRS-NLR and VICE showed good performance for predicting invasive mechanical ventilation (IMV).

Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous clinical syndrome with multiple underlying mechanisms and comorbidities that leads to a variety of clinical phenotypes. The identification and characterization of these phenotypes are essential for better understanding the precise pathophysiology of HFpEF, identifying appropriate treatment strategies, and improving patient outcomes. Despite accumulating data showing the potentiality of artificial intelligence (AI)-based phenotyping using clinical, biomarker, and imaging information from multiple dimensions in HFpEF management, contemporary guidelines and consensus do not incorporate these in daily practice. In the future, further studies are required to authenticate and substantiate these findings in order to establish a more standardized approach for clinical implementation.

Targeted temperature management (TTM) is often considered to improve post-cardiac arrest patients’ outcomes. However, the optimal timing to initiate cooling remained uncertain. This retrospective analysis enrolled all non-traumatic post-cardiac arrest adult patients with either out-of-hospital cardiac arrest (OHCA) or in-hospital cardiac arrest (IHCA) who received TTM from July 2015 to July 2021 at our hospital. The values of time delay before TTM and time to target temperature were divided into three periods according to optimal cut-off values identified using receiver operating characteristic curve analysis. A total of 177 patients were enrolled. A shorter time delay before TTM (pre-induction time) was associated with a lower survival chance at 28 days (32.00% vs. 54.00%, p = 0.0279). Patients with a longer cooling induction time (>440 minis) had better neurological outcomes (1.58% vs. 1.05%; p = 0.001) and survival at 28 days (58.06% vs. 29.25%; p = 0.006). After COX regression analysis, the influence of pre-induction time on survival became insignificant, but patients who cooled slowest still had a better chance of survival at 28 days. In conclusion, a shorter delay before TTM was not associated with better clinical outcomes. However, patients who took longer to reach the target temperature had better hospital survival and neurological outcomes than those who were cooled more rapidly. A further prospective study was warranted to evaluate the appropriate time window of TTM.

The revised post-Cardiac Arrest Syndrome for Therapeutic hypothermia (rCAST) score was proposed to predict neurologic outcomes and mortality among out-of-hospital cardiac arrest (OHCA) patients. However, it has rarely been validated outside Japan. Therefore, this study aimed to investigate this issue. All adult patients admitted to our medical intensive care unit for targeted temperature management (TTM) between July 2015 and July 2021 were enrolled. Their medical records were retrieved, and rCAST scores were calculated. A total of 108 post-cardiac arrest syndrome (PCAS) patients who received TTM were analyzed. According to the rCAST score, 49.1%, 50.0%, and 0.9% of the patients were classified as low, moderate, and high severity, respectively. The areas under the curves for the rCAST score were 0.806 (95% confidence interval [CI]: 0.719–0.876) and 0.794 (95% CI: 0.706–0.866) to predict poor neurologic outcomes and mortality at day 28, respectively. In contrast to the original report, only low-severity patients had favorable neurologic outcomes. The rCAST score showed moderate accuracy in our OHCA patients with PCAS who received TTM to predict poor neurologic outcomes and mortality at day 28.

Summary: Background: The bronchodilation test is used to detect reversible airways obstruction, which is important for diagnosing asthma. Since asthma activity is influenced by seasons, with higher activity in the spring and fall, this study aimed to determine if the FEV1 response to bronchodilation is season-dependent. Methods: All enrolled asthmatic patients underwent pulmonary function testing. Bronchodilation was assessed by measuring FEV1 change (ΔFEV1) before and after inhalation of fenoterol 0.4 mg delivered by metered-dose inhaler with a spacer. Results: There were 348 adult patients with positive bronchodilator test (ΔFEV1 > 12% and 200 mL). In the younger population (n = 223 aged

Summary: Background: This study aimed to evaluate outcomes of patients and the difference between geriatric and young patients readmitted to the medical intensive care unit. Methods: From January 1, 2011 to December 31, 2013, 117 medical ICU readmissions were included. Results: The study population had a mean Charlson comorbidity score of 7.2 and stayed 12.3 days in the ward before ICU readmission. The most common cause for readmission was respiratory disease in 49 (41.9%) patients, and the average readmission duration was 10.1 days. There were 74 patients (63.2%) who survived. Among the survivors, only 50 were discharged from the hospital. The overall mean duration of hospital stay was 51.5 days. Those who survived the hospital course were younger (64.1 vs. 75.6 years) and had a higher coma score (10.2 vs. 7.5), lower Charlson score (6.4 vs. 8.6), and lower APACHE II score (24.4 vs. 31.3) (p

Background: The study investigated the effectiveness of dexamethasone injections for reducing the occurrence of postextubation airway obstruction (PEAO). Methods: One hundred and thirty-eight patients who were intubated for ≥ 48 hours with a cuff-leak volume (CLV) < 110 mL were treated with low-dose dexamethasone (5 mg; n = 41), high-dose dexamethasone (10 mg; n = 42), or placebo (normal saline; n = 43) injection every 6 hours for a total of four doses on the day preceding extubation. CLV was measured before the first injection, 1 hour after each injection, and 24 hours after the fourth injection. Extubation was performed 24 hours after the last injection. PEAO was recorded within 48 hours postextubation. Results: Administration of dexamethasone resulted in a significant increase in absolute CLV and change of CLV relative to baseline tidal volume occurred (p

Primary tumors of the heart and major vessels are rare. Angiosarcoma is the most frequent malignant tumor of the heart and usually involves the right atrium. Angiosarcoma originating from the pericardium is extremely rare and only several cases have been reported to date. The current study presents a case of primary angiosarcoma of pericardium with cardiac tamponade. After surgical treatment to relieve symptoms, the patient refused further therapies and died 3 months after diagnosis.

The insulin sensitizers, thiazolidinediones (TZDs), have been used as anti-diabetic drugs since the discovery of their ability to alter insulin resistance through transactivation of peroxisome proliferator-activated receptors (PPARs). However, their side effects in hepatitis, cardiovascular diseases, and bladder cancer resulted in some selling restrictions in the USA and Europe. Here, we found that the potential impact of TZDs on the prostate cancer (PCa) progression might be linked to the TR4 nuclear receptor expression. Clinical surveys found that 9% of PCa patients had one allele TR4 deletion in their tumors. TZD increased cell growth and invasion in PCa cells when TR4 was knocked down. In contrast, TZD decreased PCa progression in PCa cells with wild type TR4. Mechanism dissection found that the Harvey Rat Sarcoma (HRAS) oncogene increased on TZD treatment of the TR4 knocked-down CWR22Rv1 and C4-2 cells, and interruption with HRAS inhibitor resulted in reversal of TZD-induced PCa progression. Together, these results suggest that TZD treatment may promote PCa progression depending on the TR4 expression status that may be clinically relevant since extra caution may be needed for those diabetic PCa patients receiving TZD treatment who have one allele TR4 deletion.

Background: The aim of the study was to assess the characteristics of and outcomes for very elderly patients (≥ 80 years) with prolonged mechanical ventilation (PMV) under the mandatory integrated delivery system (IDS) in Taiwan. Method: This was a retrospective observational study conducted in a step-down respiratory care center (RCC) among adult patients aged > 45 years on prolonged mechanical ventilation (≥ 21 days) between January 2006 and December 2008. Results: A total of 288 patients (63 aged 45–65 years, 115 aged 66–79 years, and 110 aged ≥ 80 years) were included in the study. There were more female patients in the oldest group (p

Comprehensive knowledge of the left atrium (LA) and its pathophysiology has emerged as an important clinical and research focus in the heart failure (HF) arena. Although studies on HF focusing on investigating left ventricular remodeling are numerous, those on atrial structural and functional changes have received comparatively less attention. Studies on LA remodeling have recently received increasing attention, and LA pressure (LAP) has become a novel target for advanced monitoring and is a potential therapeutic approach for treating HF. Various devices specifically designed for the direct measurement of LAP have been developed to optimize HF treatment by reducing LAP. This review focuses on LA hemodynamic monitoring and effective LAP decompression.

Background: Geriatric patients with COVID-19 have had poor clinical outcomes globally, especially during the first wave of the pandemic. In Taiwan, the first wave of the COVID-19 pandemic occurred from May to July 2021. This retrospective study aimed to compare the characteristics and outcomes between geriatric and younger patients with COVID-19 infection. Methods: A total of 257 confirmed COVID-19 cases who were hospitalized from May to June 2021 were included. Their characteristics and outcomes, including in-hospital mortality, use of mechanical ventilation, and hospital stay, were collected for analysis. Results: There were 98 elderly patients (aged ≥ 65 years, median, 72.5 (interquartile range, 69.0-78.0) years) and 159 younger patients (aged < 65 years, median 55.0 (46.0-60.0) years). The elderly patients had a significantly higher Charlson comorbidity score (4.0 (3.0-5.0) vs. 1.0 (1.0-2.0), p < 0.001), and significantly higher D-dimer, procalcitonin, ferritin, and creatinine levels, but lower albumin level than the younger patients. The elderly group also had higher in-hospital mortality (7.1% vs. 1.9%, p < 0.05), were more likely to develop severe disease (83.7% vs. 67.9%, p < 0.01), and had a longer hospital stay (15.0 (11.0-23.0) vs. 12.0 (9.0-16.5) days, p < 0.001). Nevertheless, the elderly patients did not have a higher risk of using high-flow nasal cannulas (17.3% vs. 15.1%, p = 0.63) or mechanic ventilation (23.5% vs. 17.0%, p = 0.20). Conclusion: Elderly COVID-19 patients had significant higher risks of severe disease, mortality, and longer duration of hospitalization, possible due higher rates of comorbidities and pro-inflammatory status. [ABSTRACT FROM AUTHOR]

Background: To evaluate the feasibility, baseline characteristics, and satisfaction of patients receiving telemedicine care during the coronavirus 2019 (COVID-19) pandemic in Taiwan. Methods:We retrospectively analyzed patients during the COVID-19 pandemic between May 2021 and December 2021 in a tertiarymedical center in northern Taiwan. Information on the distribution of physician divisions, patients' clinical characteristics, and patterns of prescription use in telemedicine care was analyzed. Data were extracted from both the ordinary outpatient department (OPD) and nursing home systems. Results: A total of 6587 patients (55.8% female, mean age: 57.3 ± 25.8 years) included in our telemedicine care conducted during the pandemic COVID-19 epidemic. Those who were older, female, and patients of Internal Medicine and Family Medicine utilized telemedicine more frequently than ordinary OPD, with a high refill prescription rate (82.6%) and low mail-back prescription use (35.9%). Patients of Family Medicine comprised the majority (40.3%) of nursing home telemedicine, with lower refill prescription use (37.3%). Overall satisfaction was high regarding telemedicine care, physicians professionalism, and medical problem solving (98.3% and 97.7%, respectively). Conclusion: Older age, female sex, and potentially more health conditions were associated with higher willingness to access telemedicine. We identified medical divisional and disease-based differences in prescription patterns. [ABSTRACT FROM AUTHOR]

Background: Coronavirus disease 2019 (COVID-19) can cause acute respiratory failure and acute respiratory distress syndrome (ARDS). The prone position (PP) is widely used in patients with severe hypoxemia due to ARDS as it improves oxygenation. The aim of this study was to investigate whether improvements in gas exchange and lung mechanics with the PPwere associated with survival in ventilated COVID-19 patients. Methods: Fourteen ventilated patients who were placed in the PP were included from May to June 2021. Clinical manifestations and lung mechanics parameters were collected. Results: The overall intensive care unit (ICU) mortality rate was 42.9%. Nonsurvivors were older (p = 0.014) and had higher Charlson comorbidity index (2.1 ± 1.5 vs. 4.8 ± 2.4, p = 0.035) and Sepsis-related Organ Failure Assessment (SOFA) (3.3 ± 1.0 vs. 7.3 ± 3.5, p = 0.019) scores compared to survivors. There was no difference in PaO2/FiO2 (P/F ratio) at baseline between the survivors and nonsurvivors. The improvement in P/F ratio (p = 0.0037) and reduction in driving pressure (Pdrive) (p = 0.046) on the second day after first PP were correlated with lower mortality. Significant predictors of successfully stopping prone treatment included a reduction in Pdrive at the first hour, lower tidal volume (Vt) at the fourth hour, and P/F ratio improvement on the second day after PP. Conclusion: Improvement in P/F ratio and reduction in driving pressure on the second day after PP were correlated with reduced mortality. Three parameters could predict successful resumption of the supine position. [ABSTRACT FROM AUTHOR]

Objective: The Val158Met polymorphism of the catechol-O-methyltransferase gene has been demonstrated to be associated with prefrontal executive function explaining 4% of variance in perseverative errors on the Wisconsin Card Sorting [...]