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En-Bo Wu,1,* Chia-Chi Hsiao,2,* Kuo-Chuan Hung,3 Chao-Ting Hung,1 Chih-Chun Chen,1 Shao-Chun Wu,1 Jo-Chi Chin,4 I-Wen Chen,3 Sheng-Dean Luo5 1Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Family Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; 3Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan; 4Department of Anesthesiology, Park One International Hospital, Kaohsiung, Taiwan; 5Division of Otolaryngology, Kaohsiung Chang Gung Memorial Hospital and Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Kaohsiung, Taiwan*These authors contributed equally to this workCorrespondence: Sheng-Dean Luo, No. 123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan, Tel +886-7-7317123 (ext. 2788), Email rsd0323@cgmh.org.tw I-Wen Chen, No. 901, Zhonghua Road, Yongkang District, Tainan City, 710, Taiwan, Tel +886-6-2812811, Email mavising@gmail.comPurpose: Ultrasound-guided interscalene nerve block (UISB) is commonly used to alleviate postoperative pain during shoulder arthroscopy. This retrospective observational study aimed to evaluate the intraoperative advantages and analgesic effects of preoperative UISB.Patients and Methods: In this retrospective observational study, a total of 170 patients underwent shoulder arthroscopy at a tertiary medical center in southern Taiwan throughout 2019. After applying the exclusion criteria, 142 of these cases were included, with 74 and 68 in the UISB group and control groups, respectively. The primary outcome was the evaluation of intraoperative morphine milligram equivalent (MME) consumption. Secondary outcomes were sevoflurane consumption, the use of intraoperative antihypertensive drugs, and postoperative visual analog scale (VAS) scores in the post-anesthesia care unit (PACU) and in the ward at 24 h after surgery.Results: Preoperative UISB effectively reduced opioids and volatile gases during surgery, supported by a 48.1% and 14.8% reduction in the median intraoperative MME and sevoflurane concentrations, respectively, and showed less need for antihypertensive drugs. The preoperative UISB group also showed significantly better performance on the VAS in both the PACU and ward.Conclusion: Taken together, the preoperative UISB reduced not only intraoperative MME and sevoflurane consumption but also had satisfactory VAS scores in both the PACU and ward without any symptomatic respiratory complications. In summary, preoperative UISB is a reliable adjuvant analgesic technique and a key factor in achieving opioid-sparing and sevoflurane-sparing anesthesia and multimodal analgesia during shoulder arthroscopy.Graphical Abstract: Keywords: interscalene block, multimodal analgesia, opioid-sparing anesthesia, shoulder arthroscopy, volatile-sparing anesthesia

This meta-analysis was aimed at investigating the effectiveness and safety of phrenic nerve infiltration (PNI) against ipsilateral shoulder pain (ISP) after thoracic surgery.A systematic review and meta-analysis of randomized controlled trials (RCTs).Operating room.Patients undergoing thoracic surgery.PNI.MEDLINE, Cochrane Library, and EMBASE databases were searched from inception through December 2021. The primary outcome was the overall incidence of ISP, with secondary outcomes including incidence and severity of ISP at postoperative 6, 24, and 48 hours. Six RCTs involving 482 patients undergoing thoracic surgery were included. Pooled results found a significantly lower incidence of overall ISP in patients with PNI (ie, 23.6%) compared to those without (ie, 53.2%; risk ratio: 0.46, 95% confidence interval: 0.34-0.61; IThis meta-analysis showed that PNI not only reduced the incidence but also improved the severity of ipsilateral shoulder pain after thoracic surgery with a prophylactic effect lasting up to 48 hours. The limited number of included studies warrants further research to support these findings.

Background and purpose The purpose of this study was to identify the quantitative amount of glucose load, which maintained the blood glucose levels between 100 and 180 mg/dL in patients with and without diabetes mellitus (DM) undergoing living donor liver transplantation (LDLT). Methods and patients The anesthesia records of 477 adult LDLT patients were reviewed retrospectively. The total amount of glucose loads and the changes in blood glucose between groups were compared by using Mann-Whitney U test. One-year patient survival between groups was compared with Pearson’s χ2 test. A P value of Results Eighty patients diagnosed with DM, who were all type II except one, were placed in group 1 (G1); and 397 patients without DM were placed in group 2 (G2). Table 1 shows that G1 received significantly less glucose loads in comparison to G2, but all the measured blood glucose levels, except in the reperfusion phase, were significantly higher in G1 than in G2. Both groups received glucose loads of 0.342 ± 0.191 and 0.774 ± 0.191 mg/kg/min for G1 and G2, respectively. No difference in 1-year survival between groups was observed. Conclusion Patients with DM required significantly lower glucose loads compared to patients without DM.

This paper constructs a financial distress prediction model that includes not only traditional financial variables, but also several important corporate governance variables. Using data from Taiwan, the empirical results show that the best in‐sample and out‐of‐sample prediction models should combine the financial variables with the corporate governance variables. Moreover, the prediction accuracy is higher for the models using dynamic distress threshold values than those with tradition threshold values. Most financial ratios, except for the debt ratio, are higher in financially sound companies than in financial distressed ones. With regard to the corporate governance variables, we find that the CEO/Chairman duality may not result in the outbreak of financial distress, but higher equity pledge ratios of managers (shareholding ratios by board members and insiders) positively (negatively) correlate with financial distress.

Has the eurozone (EZ) really gained from integration? This study applied two econometric frameworks, mGARCH and gMMPI, to test this hypothesis, using panel data that span 1996–2014, a total of 19 years, involving the EZ, EU, G8, G20 and some emerging economies. The empirical outcomes initially showed that the EZ economies experienced neither superior output growth nor a better capital market return than non-EZ economies or the pre-EZ period. They further suggested that each EZ country had a higher degree of risk bearing and, as a group, a greater risk linkage. Moreover, the results indicated that the EZ had a higher productivity gain if the risk premium was counted as part of productivity. Nonetheless, the EZ did not show a substantial productivity gain when the effect of the risk factor was controlled. The ratio of risk bearing to risk premium gain was shown to be 1 to 0.97. The general conclusion is that, other than the risk premium, there was no extra productivity gain for the EZ from taking the risk.

This paper develops a novel method to model the air flow downwash force generated by the quadrotor unmanned aerial vehicle (UAV) and its effect on the neighboring UAVs. Each UAV is shaped by a virtual structure for collision-free path planning. The shape is modified from a standard spherical body to a proposed adaptive cylinder to optimize the path planning while minimizing the downwash impact. The cylinder height varies based on the UAV circumstance and the predicted downwash impact. Furthermore, the downwash model can aid in the cylinder height extreme value appointment. A flock-based path planning algorithm is investigated in this study to compare the spherical UAV shape model with the proposed cylindrical UAV shape model. The UAV with the adaptive cylindrical model is simulated and verified via Gazebo and Robot Operating System (ROS) simulation platform.

Monacolin K is a secondary metabolite of the Monascus species that restrains cholesterol synthesis. Temperature control is an effective method of improving the rate of monacolin K synthesis. Ultraviolet (UV) irradiation and ethylmethane sulfonate (EMS) were employed to mutate the Monascus strain so that it could be studied. After mutation by UV and EMS, the best monacolin K production strain was scanned after the 2 -h UV irradiation treatment. Monascus U-2 is defined as Monascus after UV irradiation for 2 h and generates the maximum production of monacolin K production. In the primary incubation period, monacolin K production of this strain was exceptionally low. Afterwards, cell growth reached the maximum value of 1.1 g/L after incubation for seven days. During the incubation process, the maximum production of monacolin K reached 8437.6 mg/kg by Monascus U-2, and the red pigment was 11.52. In summary, this study shows that the mutated strain U-2 can produce more monacolin K than the mutated strain U-10 and U-EMS.

This study proposes a new measure of systemic risk named CSRISK, which identifies a financial institution's capital shortfall under the worst scenario conditional on a substantial market decline. The CSRISK index requires only public financial data, including accounting and market trading information, which is time and cost effective. The empirical sample consists of 238 US banks over the time period 2003–2013. Overall, we find that it is increasing from 2004 to 2009 and then starts to slightly decrease. This systemic risk measure has the potential to be widely applied in the practical aspects of risk management and macroprudential policy making.

Hydrogen production with high efficiency is a crucial issue for prospective hydrogen economy and carbon emission reduction. Methanol partial oxidation triggered over an h-BN-Pt/Al2O3 catalyst from a cold start in a Swiss-roll reactor with heat recirculation are investigated experimentally. The effects of methanol flow rate (0.5 and 0.6 mL min−1), O2 concentration (21–35 vol%), and O2-to-methanol (O2/M) molar ratio (1.0–3.0) on the performance of methanol partial oxidation are examined. Heat exchange by transferring the excess enthalpy in the product gas to the feed gas is achieved in the reactor where the temperature of the feed gas before entering the catalyst bed can be promoted to around 100 °C. The experimental results indicate that a methanol flow rate of 0.5 mL min−1 leads to more H2 production compared to those obtained with a flow rate of 0.6 mL min−1. In the conducted Swiss-roll reactor, oxygen supply plays an important role in accomplishing the partial oxidation, and the O2/M ratio should be controlled beyond 1.0. By increasing the O2 concentration, the H2 concentration at O2/M = 1.5 increases from 18.5 to 21.8%. However, the H2 yield decreases, resulting from progressively dominant combustion mechanism. At a fixed gas hourly space velocity of 10,000 h−1, the optimal O2/M ratio for H2 production is 2.5, for which the H2 concentration and H2 yield are 23.5% and 1.93 mol (mol methanol)−1, respectively. The highest H2 yield is close to the theoretical result. Overall, methanol partial oxidation along with heat recirculation in the Swiss-roll reactor can efficiently produce H2, and the excess enthalpy recovery in the reactor can improve energy utilization.

The adductor canal block (ACB) is effective for treating postoperative pain during arthroscopic knee surgery, but its impact on anesthesia course and the optimal administration timing are unknown. This retrospective study addressed these questions. The aim of this study was to compare the effects of preoperative ACB and postoperative ACB on anesthesia course and postoperative recovery. We allocated 215 adult patients who underwent arthroscopic knee surgery under sevoflurane anesthesia between January 2019 and December 2019 to three groups. Group A received general anesthesia without ACB, Group B received ACB before general anesthesia induction, and Group C received ACB in the post-anesthesia recovery unit (PACU). Group B consumed significantly less sevoflurane (0.19 mL/kg/h) and milligram morphine equivalents (0.08 MME) intraoperatively than Groups A (0.22 mL/kg/h, 0.10 MME, respectively) and C (0.22 mL/kg/h, 0.09 MME, respectively). Groups B and C had lower visual analogue scale (VAS) scores upon PACU discharge than Group A. Dynamic, but not at-rest VAS scores, were significantly higher in Group A. Opioid consumption was similar in the ward, but Group A requested more intravenous parecoxib for pain relief. Length of hospital stay was similar. Thus, preoperative ACB reduced the amount of volatile anesthetic required and maintained stable hemodynamics intraoperatively. Preoperative or postoperative ACB improved postoperative pain control. Consequently, preoperative ACB is optimal for intraoperative stress suppression and postoperative pain control.

Ultrastructural observation of biological specimens or nanogranules usually requires the use of electron microscopy. Electron microscopy takes a lot of time, requires many steps, and uses many chemicals, which may affect the native state of biological specimens. A novel microchip (K-kit) was used as a specimen kit for in situ imaging of human platelet granules in an aqueous solution using a transmission electron microscope. This microchip enabled us to observe the native human platelet granules very quickly and easily. The protocols included blood collection, platelet purification, platelet granule isolation, sample loading into this microchip, and then observation by a transmission electron microscope. In addition, these granules could still remain in aqueous solution, and only a very small amount of the sample was required for observation and analysis. We used this microchip to identify the native platelet granules by negative staining. Furthermore, we used this microchip to perform immunoelectron microscopy and successfully label &alpha, granules of platelets with the anti-P-selectin antibody. These results demonstrate that the novel microchip can provide researchers with faster and better choices when using a transmission electron microscope to examine nanogranules of biological specimens in aqueous conditions.

Objective The aim of this retrospective study is to evaluate and compare the incidence of acute kidney injury (AKI), defined as increase serum creatinine (SCr) of 0.3 mg/dl or increase in SCr to ≥1.5 times from baseline within 48 hour, in adult living donor liver transplantation patients performed with total cross clamp vs side clamp of the inferior vena cava (IVC). Methods and Patients Sixty adult living donor liver transplantation (LDLT) patients were divided into 2 groups: 30 patients in total IVC clamping (G1) and 30 in IVC side clamping (G2) during the anhepatic phase. Patients’ characteristic, hemodynamic changes in percentage (%) as a result of different methods of IVC clamping, urine output during anhepatic phase were compared by using the Student t test, and the incidence of AKI were compared by using the χ2 test between groups. P value Results The negative impact of the 2 different ways of IVC clamping was significantly more severe in G1 compared to G2; consequently, the urine output of G1 was significantly less than G2. Although there was significantly more urine output of G2 during the anhepatic phase, the incidence of the postoperative AKI between groups was similar. Conclusion The side clamp of the IVC had a significantly less negative impact on the hemodynamic parameters and provided sufficient urine output during the anhepatic phase (2.24 ± 3.17 vs 0.39 ± 0.33 mL/kg/h) compared to the total clamp of the IVC. But this favorable data did not protect the patient suffering from postoperative AKI in LDLT.

Hydrogen production from a two-stage reaction, namely, the ethanol steam reforming (ESR) followed by the water gas shift reaction (WGSR), is experimentally investigated in this study. A Ni/Al2O3 catalyst and a Fe/Cr2O3 catalyst are employed to trigger the ESR and WGSR, respectively, and four operating parameters, including the feed liquid flow rate, water-to-carbon (H2O/C) molar ratio, ESR temperature, and WGSR temperature, are taken into account. To analyze the impact of the operating parameters upon the chemical reactions and maximize the H2 yield from ethanol, the Taguchi method considering the four factors along with three levels is adopted. The results suggest that the influences of the factors on the H2 yield are ranked by H2O/C ratio > ESR temperature > WGSR temperature > liquid flow rate. In light of the optimal operation suggested by the Taguchi approach, ethanol is completely consumed and the maximum H2 yield is 4.26 mol/(mol C2H5OH). This value accounts for around 73% of theoretical H2 yield based on thermodynamic analysis. Meanwhile, the CO2 concentration in the product gas is enriched to 21.77%, whereas the CO one is as low as 0.81%. These evidences reveal that the two-stage reaction can reach the requirement of high H2 yield along with low CO formation, and is conducive to CO2 capture.

This paper reports a thermoplastic microfiltration chip designed for operation in a high-pressure environment. Preventing leakage and ensuring a heterogeneous bond between the commercial membrane and thermoplastic substrate are two issues crucial to the performance of such devices. A commercial polycarbonate membrane was tightly bonded to the PMMA substrates by applying a novel two-step UV adhesive bond, and a ring-shape structural feature was created around the microchannel using a micromilling machine to facilitate sealing and improve bonding strength. Evaluation results were as follows: (1) the inclusion of a ring-shape structural feature in conjunction with two-step UV adhesive bond proved highly effective in the prevention of leakage and significantly increasing bonding strength to 13 bars; (2) widening the ring cavity structure led to an increase in bonding strength; however, the benefits diminished when the width of the ring exceeded 5.5 mm; (3) wider microchannels increased filtering efficiency, but reduced the bonding strength because of a reduction in bonding area; (4) fluorescence particles were successfully separated from silicon oil when the pressure within the top microchannel exceeded 5 bars at a flow rate of 0.1 ml/min.

Toluene is a widely used industrial organic solvent and is ubiquitous in our environment. The neurobehavioral and neurotoxic effects of toluene are well recognized; however, its genotoxicity is still under discussion. Toluene biotransformation leads to the generation of reactive oxygen species that cause oxidative stress and DNA damages. Individuals with different immunogenetic backgrounds have different sensitivities to toxic chemical exposure. Previous studies have suggested that allergic stimulation may influence the threshold for toluene sensitivity due to the modulation of neurotrophin-related genes. Therefore, we aimed to investigate toluene-induced genotoxicity in different brain regions following acute and chronic exposure in vivo and to further examine whether allergic stimulation may influence the sensitivity to toluene-induced genotoxicity. In this present study, we found that exposure of toluene induced oxidative DNA damages resulting in genotoxicity in different brain regions including cortex, cerebellum, and hippocampus using comet assay. Higher genotoxicity induced by toluene was observed in the hippocampus of control mice compared to OVA-immunized mice. These results provide evidence that toluene-induced genotoxicity may contribute to its neurotoxicity in different immunogenetic individuals.

This paper reports on the development of a cross-domain framework for describing complex design practices. The framework is grounded in studies of two different complex design fields: Synthetic Biology and Swarm Robotics. In the first study, we interviewed practitioners in Synthetic Biology, identifying three essential aspects of complex design problems and practices. The first of these aspects is the characterisation of system complexity, the second is the design objective taken with respect to this complexity, and the third is the design approach applied to realise this objective. In the second study, we interviewed designers in Swarm Robotics, confirming the domain generality of the three aspects identified in the first study and permitting a comparison to be made of how the two fields differ from each other in these aspects. Considered together, the two studies provide the basis for building a cross-domain framework for describing complex design practices. Such a framework is presented here, not to exhaust all possible descriptions of complex design practice but rather to provide a structured yet adaptable way of highlighting the important aspects of these descriptions. Indeed, each aspect of complex design can be can be broken down into different elements depending on the design contexts under consideration. Having such a framework enables designers to identify fundamental similarities and differences both between and within fields.

Molecular weights for rodlike polymers determined by the gel permeation chromatography (GPC) method are in general inflated when polystyrene references are used. In this paper, we have established a set of new empirical parameters, χi, of commonly used fragments including a range of different substituted thiophenes, benzenes, pyridines, ethylenes, ethynylenes as well as butadienes for the calibration of the inflated Mn data obtained by GPC measurements for rodlike oligomers/polymers. The χi parameters are accessed by adjusting the slopes of the plots of Mn relative to the real molecular weights, Mr, for a series of oligomers/polymers of different structural varieties to approximately 1. The calibrated molecular weights, Mc, are calculated based on the equation, Mc = [Σ χiFi]Mn, where Fi stands for the percent of the total number of fragment Φi in an oligomer/polymer, which matches nicely with the Mr of oligomers/polymers. More than 84% of the calibrated Mc values are within 12% deviation from the real mol...

This retrospective study aimed at identifying the predictors of oxygen desaturation (OD) (i.e., SpO2 16.5 events/h) were independent predictors of OD. The algorithm thus developed showed that patients with an average SpO2 16.5 events/h would be at risk of OD under sedation. The predictive accuracy, sensitivity, positive predictive value, and negative predictive value were 84%, 100%, 83%, 100%, respectively.For patients with OSA, average SpO2 and AHI-REM may enable clinicians to predict the occurrence of oxygen desaturation under deep sedation. Future large-scale studies are needed to validate the findings.

In 2007, the Clean Air Act officially included greenhouse gases, making fossil fuel power plants the first of key industries regulated by the Environmental Protection Agency. How do we measure the impact of the regulations on these power plants&rsquo, productivity? Previous studies that attempt to answer this question have provided inadequate answers because their samples cover the periods only up to 2007, and they often use greenhouse gases as the only proxy for the undesirable output. This paper collects data from 133 fossil fuel power plants in the United States and covers 2004 to 2013. These power plants are divided into Sun Belt and Frost Belt based on their geographical locations. To measure the undesirable outputs, we used both carbon dioxide and toxic emissions as the proxies. The estimation model includes the construction of a generalized common stochastic frontier (metafrontier) and a Malmquist productivity index. We used the index to measure the change in productivity for the power plants before and after the implementation of the regulation. The results indicate that, since regulation in 2007, the overall production efficiency of the power plants has declined incessantly while productivity has seen a sustained downward trend despite two surges in growth.