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Characterizing flow and transport for earthquake-induced shear canister failure is critical for the performance and safety assessment of radioactive waste geological disposal. The study presents a modeling framework that integrates multiple models to account for fractures produced by shear displacements, evaluate canister failures, and simulate flow and advective transport in a conceptual repository site based on a selected reference case in an offshore island in western Taiwan. The typical KBS-3 disposal concept associated with 500 realizations of the shear-induced fracture properties is employed to quantify the uncertainty of flow and advective transport in the geological disposal site. The radionuclides in canisters are assumed to migrate through the shear-induced fractures surrounding the deposition holes. The results from 500 realizations show that two types of fractures produce a high potential to destroy canisters induced by the shear displacements. The earliest canister failure time influenced by possible shear movements is 0.23 million years for the reference case. The modeling framework identifies five canisters and the associated shear-induced fractures for flow and advective transport simulations. Based on the results of the density-dependent flow fields, the particle tracking algorithm enables the calculations of flow and transport parameters, including equivalent initial flux, equivalent flow rate, path length, travel time, and flow-related transport resistance for the identified five canisters. These parameters are critical for the performance and safety assessments of buffer erosion and canister corrosion near the disposal repository and the far field of the radioactive waste disposal site.

Supplementary Figures 1-4, Tables 1-4, Methods from Coexpression of Oct4 and Nanog Enhances Malignancy in Lung Adenocarcinoma by Inducing Cancer Stem Cell–Like Properties and Epithelial–Mesenchymal Transdifferentiation

This study aims to derive the optimal commission rate paid by the hoteliers to the chartered travel operators in order to maximize the profit of the hoteliers. This study uses the theoretical maximization model of the manufacturer's production theory of economics. The optimum commission rate of the hoteliers paid to the chartered travel operators is derived and has been proven to exist, and its value is never larger than 1/2. The maximization profit of the hotels can be obtained. This article is novel in two respects. First, this article proposes that the commission rate is a decision variable determined by the hoteliers, not a constant as the previous studies assumed. Second, the sales channel issues of the hotel, other than the OTAs, such as the chartered travel industry have hardly been discussed. This article explores the issue of the optimum commission rate paid by the hotels to the chartered travel operators.

This research proposes and tests mechanisms for defining and identifying the critical online consumer reviews that firms could prioritize to optimize their online response strategies, while incorporating the latest artificial intelligence (AI) technology to deal with the overwhelming volume of information. Three sets of analytical tools are introduced: Heuristic Processing, Linguistic Feature Analysis, and Deep Learning-based Natural Language Processing (NLP), to extract review information. Twelve algorithms to classify critical reviews were developed accordingly and empirically tested for their effectiveness. Our econometric analysis of 110,146 online reviews from a chain operation in hospitality industry over seven years identifies six outstanding algorithms. Firm value rating, comment length, valence, and certain consumer emotions, in addition to past comment-response behavior, are found to be superior in predicting incoming review criticality. However, the service attributes such as urgency to reply and the feasibility of actions to take are not as informative.

Background: We investigated the association between taking herbal medicine (HM) containing aristolochic acid (AA) and the risk of primary liver cancer (PLC) among patients with hepatitis C virus (HCV) infection. Methods: This is a prospective study for the long-term follow-up of a nationwide population-based cohort of patients ages 18 years or older diagnosed with HCV infection during 1997 to 2010. A total of 223,467 HCV-infected patients were identified using the National Health Insurance Research Database in Taiwan. The use of HM containing AA was evaluated among patients who had visited traditional Chinese medicine clinics beginning from 1997 to 1 year prior to the diagnosis of PLC or dates censored (2003). We tracked each individual patient from 1997 to 2013 to identify incident cases of PLC since 1999. Results: During the follow-up period of 3,052,132 person-years, we identified 25,502 PLC cases; this corresponded to an overall incidence rate of 835.5 PLCs per 100,000 person-years. The adjusted HRs were 1.21 [95% confidence interval (CI), 1.18–1.24], 1.48 (95% CI, 1.37–1.59), 1.50 (95% CI, 1.34–1.68), and 1.88 (95% CI, 1.61–2.19) for estimated AA usage groups: 1 to 250, 251 to 500, 501 to 1,000, and more than 1,000 mg, respectively, relative to no AA exposure (reference group). Conclusions: The current findings suggest that among HCV-positive patients, increasing exposure to AA poses an increased risk of acquiring PLC. Impact: AA may increase the risk of PLC in HCV-positive populations.

Endoscopic submucosal dissection (ESD) has become the standard treatment for superficial esophageal squamous cell neoplasia (SESCN); however, local recurrence still occurs occasionally even in patients who meet the current curative criteria. Esophageal ducts of the submucosal gland may serve as a pathway for the spread of SESCN to a deeper layer. However, the clinical impact of ductal involvement (DI) in patients undergoing ESD has yet to be investigated.We consecutively enrolled patients with SESCN who were treated with ESD. The resected specimens were meticulously reviewed in multiple section slices for the presence and resected margins of DI, and their correlations with clinical factors were evaluated.A total of 210 lesions were analyzed, of which 78 (37.1%) presented with DI. The presence of submucosal invasion, lymphovascular invasion (LVI), and DI were indicators of worse prognosis (P .05). Deep extended DIs were misdiagnosed as deep submucosal invasive cancer in 4 cases (2%). Of the 185 patients who met the criteria for curative ESD (ie, R0 resection and no deep submucosal invasion or LVI), 11 (5.9%) developed local recurrence/metastasis during a mean follow-up of 55.2 months (range, 6 to 140) months. Compared with patients with without DI, patients with DI had worse recurrence-free survival (P = .008, log-rank test) and a higher local risk of recurrence (12.7% vs 2.5%) after curative ESD (hazard ratio, 4.20; P = .038).A precise histological assessment of DI in SESCN is crucial after ESD, given that DI is common and associated with worse outcome. Whether total removal of esophageal glands/ducts can improve outcome requires future study.

In this study, a hierarchical mesoporous VO2/graphene@NiS2 hybrid aerogel is synthesized through the sol–gel and hydrothermal growth approaches. The resultant VO2/graphene@NiS2 hybrid aerogel electrode offers a high specific capacitance up to 1280.0 F g–1 (142.22 mAh g–1) at a current density of 1 A g–1 and exhibits an outstanding cycling performance. The distinguished electrochemical performance of the VO2/graphene@NiS2 electrode is attributable to the synergistic effect among VO2 particles, graphene networks, and NiS2 nanoflakes, which not only increases the specific surface area and conductivity but also gives extra pseudocapacitance to the VO2/graphene@NiS2 hybrid aerogel electrode. In addition, a high-performance all-solid-state asymmetric supercapacitor (SC) is successfully assembled by using the novel 3D interconnected VO2/graphene@NiS2 hybrid aerogel as the positive electrode, graphene aerogel as the negative electrode, and PVA/KOH gel as the electrolyte. The assembled VO2/graphene@NiS2 hybrid aer...

This paper presents a corrosion assessment of copper spent nuclear fuel disposal canisters in crystalline rock, using hydrogeological modeling. A simplified approach is considered, to avoid complex and time-consuming computer simulations. This simplified case is presented as a base case, with changes in the hydrogeological parameters presented as variant cases. The results show that in Taiwan’s base case, decreasing the hydraulic conductivity of the rock or decreasing the hydraulic conductivity of dikes results in a shorter transport path for sulfide and an increase in corrosion depth. However, the estimated canister failure time is still over one million years in the variant cases.

Both aristolochic acid (AA) exposure and diabetic can increase risk of certain cancers,whetherAAexposureincreases cancer risk in diabetic patientsisunknown. The purpose of this study was to investigate the association between the use of Chinese herbal products containing AA and the risk of cancer in diabetic patients.A cohort study was conducted using the National Health Insurance Research Database in Taiwan. Patients older than 18 years who were diagnosed with diabetes between 1997 and 2010 were enrolled in our cohort. The use of Chinese herbal products containing AA was recorded from the beginning of 1997 until the ban of herbs containing AA in November 2003. Patients were individually tracked to identify cancer incidence between 1997 and 2013. Only patients who visited traditional Chinese medicine clinics between 1997 and 1 year before the end of follow-up were included in the cohort to ensure comparability. Cox proportional hazards regression was used to calculate the hazard ratio for the association between the use of Chinese herbal products containing AA and the occurrence of cancer.Among the 430 377 male and 431 956 female patients with diabetes enrolled in our cohort, 37 554 and 31 535 cancer diagnoses were recorded during the study period, respectively. The use of AA-containing herbal products was associated with a significantly higher risk of liver, colorectum, kidney, bladder, prostate, pelvis, and ureter cancer in a dose-dependent manner. An increased risk of extrahepatic bile duct cancer in women was also associated with AA exposure at doses of more than 500 mg.Association between AA exposure and the risk of some cancers were found in this study. AA exposure might increase risk of kidney,bladder,pelvis, ureter,liver,colorectum,andprostatecancer in all patientsandextrahepatic bile duct cancerin women.

Sixty-seven patients with first acute ischemic stroke onset between 3 to 7 days and 25 age- and sex- matched controls were analyzed for the performance of a resting-state functional MRI to investigate whether the functional connectivity (FC) of the motor network in acute ischemic stroke is independently associated with functional outcomes. The FC of cortical motor network and default mode network was analyzed. The FC was compared between controls, patients with favorable outcomes (modified Rankin Scale, mRS ≤1), and patients with unfavorable outcomes (mRS ≥2) at 3 months. Of the 67 patients, 23 (34%) exhibited unfavorable outcomes. In multivariate analysis, the FC between ipsilesional primary motor cortex (M1) and contralesional dorsal premotor area (PMd) ≤0.63, were independently associated with unfavorable outcomes (odds ratio = 6.32, P = 0.032), whereas the FC of default mode network was not different between groups. The interhemispheric FC of the motor network is an independent predictor of functional outcomes in patients with acute ischemic stroke.

It was suspected that aristolochic acid-induced mutations may be associated with hepatitis B virus (HBV), playing an important role in liver carcinogenesis. The purpose of this study was to investigate the association between the use of Chinese herbs containing aristolochic acid and the risk of hepatocellular carcinoma (HCC) among HBV-infected patients. We conducted a retrospective, population-based, cohort study on patients older than 18 years who had a diagnosis of HBV infection between January 1, 1997 and December 31, 2010 and had visited traditional Chinese medicine clinics before one year before the diagnosis of HCC or the censor dates. A total of 802,642 HBV-infected patients were identified by using the National Health Insurance Research Database in Taiwan. The use of Chinese herbal products containing aristolochic acid was identified between 1997 and 2003. Each patient was individually tracked from 1997 to 2013 to identify incident cases of HCC since 1999. There were 33,982 HCCs during the follow-up period of 11,643,790 person-years and the overall incidence rate was 291.8 HCCs per 100,000 person-years. The adjusted hazard ratios (HRs) were 1.13 (95% confidence interval [CI], 1.11-1.16), 1.21 (95% CI, 1.13-1.29), 1.37 (95% CI, 1.24-1.50) and 1.61 (95% CI, 1.40-1.84) for estimated aristolochic acid of 1-250, 251-500, 501-1,000 and more than 1,000 mg, respectively, relative to no aristolochic acid exposure. Our study found a significant dose-response relationship between the consumption of aristolochic acid and HCC in patients with HBV infection, suggesting that aristolochic acid which may be associated with HBV plays an important role in the pathogenesis of HCC.

Neural activity varies continually from moment to moment. Such temporal variability (TV) has been highlighted as a functionally specific brain property playing a fundamental role in cognition. We sought to investigate the mechanisms involved in TV changes between two basic behavioral states, namely having the eyes open (EO) or eyes closed (EC) in vivo in humans. To these ends we acquired BOLD fMRI, ASL, and [18F]-fluoro-deoxyglucose PET in a group of healthy participants (n = 15), along with BOLD fMRI and [18F]-flumazenil PET in a separate group (n = 19). Focusing on an EO- vs EC-sensitive region in the occipital cortex (identified in an independent sample), we show that TV is constrained in the EO condition compared to EC. This reduction is correlated with an increase in energy consumption and with regional GABAA receptor density. This suggests that the modulation of TV by behavioral state involves an increase in overall neural activity that is related to an increased effect from GABAergic inhibition in addition to any excitatory changes. These findings contribute to our understanding of the mechanisms underlying activity variability in the human brain and its control.

Endothelial dysfunction is a risk factor for osteonecrosis of femoral head (ONFH) and venous thromboembolism (VTE) [defined as deep venous thrombosis (DVT) or pulmonary embolism (PE)]. However, the risk of unprovoked VTE in non-traumatic ONFH patients remains unclear.We investigated the relationship between ONFH and VTE using Taiwan National Health Insurance Research Database (NHIRD). Between 1997 and 2010, a total of 1514 non-traumatic ONFH patients were identified from 1,000,000 general populations after excluding initially concomitant diagnoses of DVT and PE, and subjects undergoing lower limb surgery within one year since enrollment. The comparison group (n = 15,140) without ONFH was set up by matching study cohort with age, gender, income and urbanization in a 1:10 ratio. Subjects diagnosed with VTE within one year after surgery were also excluded.The patients with non-traumatic ONFH had significantly higher frequency of unprovoked VTE, including DVT, than general population (1.19 vs. 0.5%, p 0.0007), whereas the frequency of PE was similar between these two groups (p = 0.4922). The cumulative incidence of VTE and DVT was also remarkably higher in the ONFH than non-ONFH group (all p 0.001). After adjusting for age, gender, medications and comorbidities with multivariate analysis, the ONFH patients had a 2.3-fold increase in risk of DVT compared with non-ONFH counterparts (95% CI 1.28 to 4.13, p = 0.0053). Apart from ONFH, age 65 years and hypertension were also identified as risk factors for DVT occurrence.The incidence and risk of unprovoked VTE were significantly increased in the non-traumatic ONFH population.

BACKGROUND Endothelial dysfunction has been identified as an etiologic factor for osteonecrosis of the femoral head (ONFH) and major adverse cardiovascular and cerebrovascular events (defined as major cardiovascular disease [CVD] and cerebrovascular accident [CVA]). However, the incidence of major adverse cardiovascular and cerebrovascular events in patients with nontraumatic ONFH and any association between the two diagnoses remain unclear. QUESTIONS/PURPOSES We compared a large cohort of patients with nontraumatic ONFH and a matched control group without this diagnosis and (1) examined the frequency and hazard ratio (HR) of major adverse cardiovascular and cerebrovascular events in both groups adjusted for age, sex, socioeconomic status, and associated comorbidities (which we defined as the adjusted HR), (2) determined whether any association of ONFH and major adverse cardiovascular and cerebrovascular events was stable after adjusting for confounding variables, and (3) compared the occurrence of major adverse cardiovascular and cerebrovascular events with time in both groups. METHODS A population-based cohort with a 14-year dataset period (1997-2010) from the Taiwan National Health Insurance Research Database was used for this retrospective study. The database includes a greater than 99.5% Asian population randomly selected from more than 23 million citizens and foreigners residing in Taiwan for longer than 6 months. A total of 1562 patients with nontraumatic ONFH were identified from a population of one million patients in the database after excluding initially concomitant diagnoses of major CVD and CVA. The comparison group (n = 15,620) without ONFH was analyzed in a one-to-10 ratio by matching the study cohort based on age, sex, income, and urbanization. RESULTS The patients with ONFH had a higher frequency of major adverse cardiovascular and cerebrovascular events than their counterparts without ONFH (19% versus 14%; p < 0.001). The patients with ONFH had 1.34- and 1.27-fold adjusted HRs for occurrence of major CVD and CVA as compared with the normal population (95% CI, 1.11-1.61, p = 0.002, and 95% CI, 1.09-1.47, p = 0.002, respectively). Sensitivity analysis showed a consistent association between ONFH and major adverse cardiovascular and cerebrovascular events after controlling for potentially relevant confounding variables such as hypertension and diabetes. After adjusting for potential confounders including surgery and medications, ONFH remained independently associated with major CVD (adjusted HR, 1.51, 95% CI 1.09-2.03, p = 0.026) and CVA (adjusted HR, 2.44, 95% CI 1.69-3.51, p < 0.001), apart from age older than 65 years and traditional atherosclerotic risk factors. The cumulative incidence of major adverse cardiovascular and cerebrovascular events also was higher in the ONFH group than the non-ONFH group (30.3% vs 23.1% at the end of followup, p < 0.001). CONCLUSIONS Patients with ONFH have a strong association with major adverse cardiovascular and cerebrovascular events as compared with the normal population, suggesting a potential common pathway involving endothelial dysfunction. In view of this association in the relatively young population with ONFH, it is important to closely monitor these patients, treat relevant comorbidities early, and investigate preventative measures for these major adverse events. LEVEL OF EVIDENCE Level III, prognostic study.

Perfluoroalkyl acids (PFAAs) are synthetic chemicals with ability to repel oils and water, and have been widely used in many industrial and household applications such as adhesives and water- and stain-repellent surfaces to nonstick coatings. Animal studies have shown that PFAAs have immunotoxic effects. However, few epidemiological studies have investigated the effects of PFAAs on infectious diseases occurrence. We examined the relationship between prenatal exposure to PFAAs and prevalence of infectious diseases up to 4 years of life. A total of 1558 mother-child pairs, who were enrolled in the Hokkaido Study on Environment and Children's Health, were included in this data analysis. Eleven PFAAs were measured in maternal plasma taken at 28–32 weeks of gestation using ultra-performance liquid chromatography coupled to triple quadrupole tandem mass spectrometry. Participant characteristics were obtained from medical birth records and self-administered questionnaires during pregnancy and after delivery. Physicians' diagnosis of common infectious diseases including otitis media, pneumonia, respiratory syncytial virus infection, and varicella up to 4 years were extracted from the mother-reported questionnaires. The number of children who developed infectious diseases up to 4 years of age was as follows: otitis media, 649 (41.4%); pneumonia, 287 (18.4%); respiratory syncytial virus infection, 197 (12.6%); varicella 589 (37.8%). A total of 1046 (67.1%) children had at least one of the diseases defined as total infectious diseases. After adjusting for appropriate confounders, PFOS levels in the highest quartile were associated with increased odds ratios (ORs) of total infectious diseases (Q4 vs. Q1 OR: 1.61; 95% CI: 1.18, 2.21; p for trend = 0.008) in all children. In addition, perfluorohexane sulfonate (PFHxS) was associated with a higher risk of total infectious diseases only among girls (Q4 vs. Q1 OR: 1.55, 95% CI: 0.976, 2.45; p for trend = 0.045). We found no association between infectious diseases and other examined PFAAs. Our findings suggest that prenatal exposure to PFOS and PFHxS may associated with infectious diseases occurrence in early life. Therefore, prenatal exposure to PFAAs may be immunotoxic for the immune system in offspring.

// Pey-Jium Chang 1, 2, 3 , Yao-Hsu Yang 4, 5, 6, 7 , Pau-Chung Chen 6, 8 , Lee-Wen Chen 9, 10 , Shie-Shan Wang 10 , Ying-Ju Shih 1 , Li-Yu Chen 1 , Chi-Jen Chen 5 , Chien-Hui Hung 1 and Chun-Liang Lin 2, 3 1 Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan, Taiwan 2 Department of Nephrology, Chang-Gung Memorial Hospital, Chiayi, Taiwan 3 Kidney and Diabetic Complications Research Team (KDCRT), Chang-Gung Memorial Hospital, Chiayi, Taiwan 4 Department of Traditional Chinese Medicine, Chang-Gung Memorial Hospital, Chiayi, Taiwan 5 Center of Excellence for Chang Gung Research Datalink, Chang-Gung Memorial Hospital, Chiayi, Taiwan 6 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan 7 School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan 8 Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan 9 Department of Respiratory Care, Chang-Gung University of Science and Technology, Chiayi, Taiwan 10 Department of Pediatric Surgery, Chang-Gung Memorial Hospital, Chiayi, Taiwan Correspondence to: Pey-Jium Chang, email: peyjiumc@mail.cgu.edu.tw Chun-Liang Lin, email: linchunliang@adm.cgmh.org.tw Keywords: Kaposi’s sarcoma, diabetes, KSHV, high glucose, lytic replication Received: February 13, 2017 Accepted: June 18, 2017 Published: July 28, 2017 ABSTRACT Patients with diabetes are generally prone to pathogen infection and tumor progression. Here, we investigated the potential association between diabetes and Kaposi’s sarcoma (KS), a tumor linked to infection with Kaposi’s sarcoma-associated herpesvirus (KSHV). By using Taiwan’s National Health Insurance Research Database, we found that diabetes is statistically associated with increased risk of KS in a case-control study. Since a high level of blood sugar is the hallmark of diabetes, we determined whether high glucose promotes both KSHV reactivation and infection, which are crucial for KS pathogenesis. Our results showed that high glucose significantly increases lytic reactivation of KSHV but not Epstein-Barr virus, another related human oncogenic gammaherpesvirus, in latently infected cells. Activation of the transcription factor AP1 by high glucose is critically required for the onset of KSHV lytic reactivation. We also demonstrated that high glucose enhances susceptibility of various target cells to KSHV infection. Particularly, in endothelial and epithelial cells, levels of specific cellular receptors for KSHV entry, including integrin α3β1 and xCT/CD98, are elevated under high glucose conditions, which correlate with the enhanced cell susceptibility to infection. Taken together, our studies implicate that the high-glucose microenvironment may be an important predisposing factor for KS development.

// Pei-Hsun Sung 1 , Hsin-Ju Chiang 2 , Yao-Hsu Yang 3, 4, 5 , Chi-Jen Chen 5 , John Y. Chiang 6, 7 , Hon-Kan Yip 1, 8, 9, 10 1 Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 2 Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 3 Department for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 4 Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan 5 Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan 6 Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan 7 Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan 8 Institute for Translational Research in Biomedicine, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 9 Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan 10 Department of Nursing, Asia University, Taichung, Taiwan Correspondence to: Hon-Kan Yip, email: han.gung@msa.hinet.net Keywords: autosomal-dominant polycystic kidney disease, acute myocardial infarction, Asian, Taiwanese, population-based cohort study Received: August 24, 2016 Accepted: December 01, 2016 Published: December 27, 2016 ABSTRACT Cardiovascular complications are the leading causes of death in patients with autosomal-dominant polycystic kidney disease (ADPKD) in the Western countries. However, theprevalence and risk of acute myocardial infarction (AMI) in patients with ADPKD remain unknown, especially in Asian population. We utilized the data from Taiwan National Health Insurance Research Database (NHIRD) to perform a population-based cohort study (1997-2008). A total of 2062 patients with ADPKD were selected from one million of general population after excluding those patients with age less than 18 years old, receiving renal replacement therapy, and concomitant diagnoses of AMI. Additionally, we set up those patients without ADPKD as comparison group by matching study cohort with age, gender, income and urbanization with 1:10 ratio (n=20620). The results showed that although the prevalence of AMI in ADPKD patients in Taiwan was lower than those in the United States (2.91% v.s. 6%, p =0.0567), the Taiwanese ADPKD group had significantly higher prevalence of AMI as compared with the non-ADPKD group (2.91% v.s. 0.97%, p

Objective Alterations in psychomotor dimension cut across different psychiatric disorders, such as schizophrenia (SCZ) and bipolar disorder (BD). This preliminary study aimed to investigate the organization of intrinsic brain activity in the subcortical-cortical sensorimotor system in SCZ (and BD) as characterized according to psychomotor dimension. Method In this resting-state functional magnetic resonance imaging (fMRI) study, functional connectivity (FC) between thalamus and sensorimotor network (SMN), along with FC from substantia nigra (SN) and raphe nuclei (RN) to basal ganglia (BG) and thalamic regions, were investigated by using an a-priori-driven and dimensional approach. This was done in two datasets: SCZ patients showing inhibited psychomotricity (n = 18) vs. controls (n = 19); SCZ patients showing excited psychomotricity (n = 20) vs. controls (n = 108). Data from a third dataset of BD in inhibited depressive or manic phases (reflecting inhibited or excited psychomotricity) were used as control. Results SCZ patients suffering from psychomotor inhibition showed decreased thalamus-SMN FC toward around-zero values paralleled by a concomitant reduction of SN-BG/thalamus FC and RN-BG/thalamus FC (as BD patients in inhibited depression). By contrast, SCZ patients suffering from psychomotor excitation exhibited increased thalamus-SMN FC toward positive values paralleled by a concomitant reduction of RN-BG/thalamus FC (as BD patients in mania). Conclusions These findings suggest that patients exhibiting low or high levels of psychomotor activity show distinct patterns of thalamus-SMN coupling, which could be traced to specific deficit in SN- or RN-related connectivity. Notably, this was independent from the diagnosis of SCZ or BD, supporting an RDoC-like dimensional approach to psychomotricity.

Objective In this era of digitized health records, there has been a marked interest in using de-identified patient records for conducting various health related surveys. To assist in this research effort, we developed a novel clinical data representation model entitled medical knowledge-infused convolutional neural network (MKCNN), which is used for learning the clinical trial criteria eligibility status of patients to participate in cohort studies. Materials and Methods In this study, we propose a clinical text representation infused with medical knowledge (MK). First, we isolate the noise from the relevant data using a medically relevant description extractor; then we utilize log-likelihood ratio based weights from selected sentences to highlight “met” and “not-met” knowledge-infused representations in bichannel setting for each instance. The combined medical knowledge-infused representation (MK) from these modules helps identify significant clinical criteria semantics, which in turn renders effective learning when used with a convolutional neural network architecture. Results MKCNN outperforms other Medical Knowledge (MK) relevant learning architectures by approximately 3%; notably SVM and XGBoost implementations developed in this study. MKCNN scored 86.1% on F1metric, a gain of 6% above the average performance assessed from the submissions for n2c2 task. Although pattern/rule-based methods show a higher average performance for the n2c2 clinical data set, MKCNN significantly improves performance of machine learning implementations for clinical datasets. Conclusion MKCNN scored 86.1% on the F1 score metric. In contrast to many of the rule-based systems introduced during the n2c2 challenge workshop, our system presents a model that heavily draws on machine-based learning. In addition, the MK representations add more value to clinical comprehension and interpretation of natural texts.

To evaluate the age effect on working memory (WM) performance and functional activation after mild traumatic brain injury (MTBI).This study was approved by the local research ethics committee. All participants provided written informed consent. N-back WM cerebral activation was assessed with functional magnetic resonance (MR) imaging in 13 younger (mean age, 26.2 years ± 2.9; range, 21-30 years) and 13 older (mean age, 57.8 years ± 6.6; range, 51-68 years) patients with MTBI and 26 age- and sex-matched control subjects. Two functional MR images were obtained within 1 month after injury and 6 weeks after the initial study. Group comparison and regression analysis were performed among postconcussion symptoms, neuropsychologic tests, and WM activity in both groups.In younger patients, initial hyperactivation was seen in the right precuneus and right inferior parietal gyrus (P = .047 and P = .025, respectively) in two-back greater than one-back conditions compared with younger control subjects, whereas in older patients, hypoactivation was seen in the right precuneus and right inferior frontal gyrus (P = .013 and P =.019, respectively) compared with older control subjects. Increased WM activity was associated with increased postconcussion symptoms in the right precuneus (r = 0.57; P = .026) and right inferior frontal gyrus (r = 0.60; P = .019) and poor WM performance in the right precuneus (r = -0.55; P = .027) in younger patients at initial studies but not in older patients. At follow-up examinations, partial recovery of activation pattern and decreased postconcussion symptoms (P = .04) were observed in younger patients but not in older patients.The different manifestations of postconcussion symptoms at functional MR imaging between younger and older patients confirmed the important role of age in the activation, modulation, and allocation of WM processing resources after MTBI. These findings also supported that younger patients have better neural plasticity and clinical recovery than do older patients.

Introduction Transient cortical blindness (TCB) is a rare complication after angiography and is proposed to be related to contrast extravasation. We present the first case of TCB after angiography that was evaluated using serial arterial spin-labeling magnetic resonance perfusion (ASLMRP) and susceptibility-weighted imaging (SWI). Case report A 65-year-old woman with dyslipidemia who had been treated for left vertebral artery dissection 3 months previously presented with dizziness and right hemiparesis. Magnetic resonance imaging of the brain revealed suspected dissection of the V4 segment of the left vertebral artery. Cerebral angiography was performed using a total of 46 mL of nonionic contrast material. Approximately 3 hours after the procedure, the patient started complaining of a slight headache and nausea along with bilateral cortical blindness. The 6-hour ASLMRP and SWI of the brain, respectively, revealed hypoperfusion and increased oxygen extraction fraction in the bilateral occipital lobes. The patient gradually regained vision over the next 12 hours, and follow-up ASLMRP and SWI revealed normal perfusion and normal SWI findings, respectively. Conclusions Hypoperfusion on ASLMRP and increased oxygen extraction fraction on SWI results derived for a patient presenting with TCB were demonstrated. Thus, we hypothesize that endothelin-related vasoconstriction is a pathophysiologic mechanism for TCB. To the best of our knowledge, this report is the first to describe ASLMRP and SWI findings in TCB after angiography.

To compare the frequency of microbleeds identified by susceptibility-weighted MRI (SWMRI) in patients with mild traumatic brain injury (mTBI) and normal controls, and correlate these findings with neuropsychological tests.Research ethics committee approval and patient written informed consents were obtained. One hundred eleven patients with mTBI without parenchymal hemorrhage on CT and conventional MRI received SWMRI as well as a digit span and continuous performance test. One hundred eleven healthy volunteers without history of traumatic brain injury were enrolled as the control group and received conventional MRI with additional SWMRI study. We analyzed the number and location of microbleeds in both groups.Twenty-six patients with mTBI and 12 control subjects presented microbleeds on SWMRI (p = 0.0197). Sixty microbleeds were found in 26 patients with mTBI and 15 microbleeds in 12 control subjects. The mTBI group showed notably more microbleeds in the cortex/subcortical region (52 microbleeds, 86.7%, vs 3 microbleeds, 20%; p0.0001). Conversely, the control group showed more microbleeds in the central brain (9 microbleeds, 60%, vs 3 microbleeds, 5%; p0.0001). There was no statistical difference in number of microbleeds in the cerebellum and brainstem (p = 0.2598 and p = 0.4932, respectively). Patients with mTBI who had detected microbleeds had lower digit span scores than the patients with negative SWMRI findings (p = 0.017).Presence of mTBI-related microbleeds showed a neuropsychological defect on short-term memory function, indicating that the presence of microbleeds could be a possible severity biomarker for mTBI. Addition of the SWMRI technique to the MRI protocol for patients with mTBI is recommended.

No reliable imaging sign predicting cerebral hyperperfusion after intracranial arterial stenting (IAS) had been described in the literature. This study evaluated the effect of fluid-attenuated inversion recovery vascular hyperintensities (FVHs), also called hyperintense vessel sign on T2-weighted fluid-attenuated inversion recovery (T2-FLAIR) MR images, in predicting significant increase in cerebral blood flow (CBF) defined by arterial spin labeling (ASL) after IAS. We reviewed ASL CBF images and T2-FLAIR MR images before (D0), 1 day after (D1), and 3 days after (D3) IAS of 16 patients. T1-weighted MR images were used as cerebral maps for calculating CBF. The changes in CBF values after IAS were calculated in and compared among stenting and nonstenting vascular territories. An increase more than 50% of CBF was considered as hyperperfusion. The effect of FVHs in predicting hyperperfusion was calculated. The D1 CBF value was significantly higher than the D0 CBF value in stenting vascular, contralateral anterior cerebral artery, contralateral middle cerebral artery, and contralateral posterior cerebral artery (PCA) territories (all P

Polylactic acid (PLA)-based composite has been widely used in tissue engineering. To modify the material’s properties, inorganic substances have been used to form nanoparticle-PLA composites. The aim of this study is to develop a novel magnetic biodegradable composite. Nanoscale magnetite (Fe3O4) was incorporated into a poly-L-lactide (PLLA) matrix with proportions of 0%, 5%, 10%, and 15% (w/w). Injection molding was carried out to produce the nano-magnetite-PLLA composite samples. X-ray diffraction (XRD), differential scanning calorimetry (DSC), superconducting quantum device (SQUID), and three-point bending were performed to test the physical properties of the magnetite-PLLA composite. The results showed that the magnetite-PLLA composite exhibited typical ferromagnetic hysteresis loops. The addition of nanoscale magnetite significantly increased the magnetic flux density of the PLLA composite. These results suggest that the magnetite-PLLA composite has the potential to be used for future applications in tissue engineering.

// Pei-Hsun Sung 1 , Yao-Hsu Yang 2,3,7 , Hsin-Ju Chiang 4 , John Y. Chiang 5,6 , Chi-Jen Chen 7 , Chien-Ting Liu 8 , Cheuk-Man Yu 9 and Hon-Kan Yip 1,10,11,12 1 Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan 2 Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi, Taiwan 3 Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan 4 Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan 5 Department of Computer Science and Engineering, National Sun Yat-Sen University, Kaohsiung, Taiwan 6 Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan 7 Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi, Taiwan 8 Department of Hematology-Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan 9 Director of Heart Centre, Hong Kong Baptist Hospital and Honorary Clinical Professor, The Chinese University of Hong Kong, Hong Kong, China 10 Institute for Translational Research in Biomedicine, Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University, College of Medicine, Kaohsiung, Taiwan 11 Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan 12 Department of Nursing, Asia University, Taichung, Taiwan Correspondence to: Hon-Kan Yip, email: // Keywords : autosomal-dominant polycystic kidney disease, aortic aneurysm, aortic dissection, population-based cohort study Received : December 05, 2016 Accepted : February 07, 2017 Published : March 17, 2017 Abstract Although cardiovascular complications are the most common cause of death in patients with autosomal-dominant polycystic kidney disease (ADPKD), the incidence and risk of aortic aneurysm and dissection (AAD) in ADPKD remains unclear due to limited data and insufficient cases. We utilized the data from Taiwan National Health Insurance Research Database (NHIRD) to do a population-based cohort study (1997-2008). After excluding those patients with age

BackgroundThe purpose of this study was to investigate the association between the use of herbal medicine containing aristolochic acid (AA) and the risk of cancers among patients with diabetes.MethodsWe conducted a population-based cohort study on patients older than 18 years who had a diagnosis of diabetes (ICD-9 codes 250) between January 1, 1997 and December 31, 2010. To ensure comparability, we included only patients with diabetes who had visited traditional Chinese medicine clinics between January 1, 1997 and one year before the diagnosis of cancer or the censor dates. The use of herbal medicine containing AA was identified from January 1, 1997 to October 31, 2003 (the ban of herbs containing AA in November 2003). Each patient was individually tracked to identify incident cases of cancer (140–208) between January 1, 1999 and December 31, 2013.FindingsA total of 4 30 377 male and 4 31 956 female patients with diabetes were identified by using the National Health Insurance Research Database in Taiwan. There were 37 554 and 31 535 cancers during the follow-up period. AA use increased the risks of incident liver (155.0), kidney (189.0), pelvis and ureter (189.1, 189.2), and bladder (188) cancer in male patients with diabetes in a dose-dependent relationship. Similarly, there were increased risks of incident liver, pelvis and ureter, and bladder cancer in female diabetic patients in a dose-dependent manner.InterpretationOur study suggests that AA exposure plays an important role in the carcinogenesis of liver, kidney, pelvis, ureter, and bladder cancers in patients with diabetes.

Background Lower back pain is a very common symptom and treatment strategies vary according the severity and duration of illness. Surgical approaches are becoming increasingly popular with the advent of new and less invasive technologies; however, treatment outcomes are not yet well established on a population-based level. Taiwan's National Health Insurance Research Database (NHIRD) is longitudinal and includes 98% of the population since its inception in 1995. The database includes the ICD 9.0 codes (International Classification of Diseases) of all patients with lower back pain and lumbar surgery; furthermore, all the prescriptions. Methods As part of a population-based cohort study of one million participants randomly selected from the NHIRD, we analyzed changes in prescription of analgesics 1 year before and 1 year after lumbar surgery; comorbidities, such as diabetes, asthma, osteoporosis, arthritis, depression and anxiety were also analyzed as covariates. A total of 3916 cases were enrolled in final analysis. Results Post-operatively, the defined daily dosage (DDD) of analgesics decreased from a median DDD of 50.0 to a median of 14.2. In a multivariate model analysis, female, older age, anxiety and asthma were the significant factors for unfavorable outcome (defined by dosage of analgesics decreased less than 50% after surgery). Conclusions The analgesics significantly decreased for patients received lumbar surgeries, implying the decreased of pain. In addition, co-morbidity factors were identified by the failure for analgesics reduction, such as female, older age, anxiety and asthma. For patients with lower back pain, these factors should be considered before receiving lumbar surgeries.