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Abstract Background While vaccination remains crucial in mitigating the impact of the COVID-19 pandemic, several ocular adverse events has been reported, including Acute Zonal Occult Outer Retinopathy (AZOOR) complex. Case presentation A 31-year-old female presented declined best corrected visual acuity (BCVA) and flashes in both eyes three days following second recombinant mRNA COVID-19 vaccine (Moderna). Fundus autofluorescence (FAF) illustrated speckled hyper-AF lesions surrounding right eye torpedo maculopathy site and hyper-AF lesions in the left macula. The spectral-domain optical coherence tomography delineated inner and outer segment (IS/OS) line disruption; hyperreflective deposits in the outer nuclear layer (ONL); and undetectable interdigitation zone (IDZ). Her BCVA further declined after 3-month observation, thus she received 8-month oral prednisolone and mycophenolate mofetil treatment. Her BCVA recovered; the hype-AF lesions resolved; and the IS/OS line and ONL resumed. Conclusions We present a rare case of AZOOR complex following COVID-19 vaccination inciting from torpedo retinopathy where outer-retinal barrier breaks down.

Background: A fractional carbon dioxide (CO2) laser can improve the appearance of burn scars. In addition, tranexamic acid (TXA) inhibits melanin production for whitening effects. Laser-assisted drug delivery (LADD) technology utilizes lasers to enhance the percutaneous absorption of drugs. Objectives: The purpose of this study was to investigate whether the use of a fractional CO2 laser in combination with TXA can further improve pigmentation in burn scars. Methods: This prospective, randomized, single-blinded, split-body study included patients aged 20 years and older who had burn scars with associated hyperpigmentation for more than 6 months. A total of 12 patients were included between September 1, 2019, and August 31, 2020. For each patient, their pigmented burn scar was divided into two sides along the midline. One scar side received fractional CO2 laser alone, and the other combined fractional CO2 laser and topically applied TXA solution. Treatment sessions were conducted monthly for a total of three times. Photographs were captured at baseline and 3 months after completing the 3 monthly treatment sessions. Four plastic surgeons, blinded to the treatment sides, compared the improvement on both sides of each patient based on the photographs. The patients’ reported satisfaction levels were also recorded. Results: In the physician assessments, both methods showed a noticeable improvement in scar appearance and pigmentation. On a scale of 1 to 10, physicians rated the overall improvement in scar appearance between 4.6 and 5.6 points, while the improvement in overall hyperpigmentation ranged from 6.0 to 6.9 points. The average patient satisfaction score was 8.4 ± 1.6 points. However, there was no significant difference in the improvement of outcomes between the two methods, with or without the addition of TXA treatment. Conclusion: This study shows that fractional CO2 laser treatment significantly improves burn scars and hyperpigmentation. However, adding TXA shows no clear additional benefits. Before making the final conclusion based on the results from the small patient sample size, further research is encouraged to clarify the delivery pathways in applying TXA and explore the mechanisms behind LADD.

The Meishan-Chiayi area of western Taiwan has a large probability of producing a major earthquake in the near future. Historically, one of the largest and most damaging of Taiwan’s earthquakes occurred there. It is, therefore, important to have a well-constrained upper crustal 3-D shear-wave velocity model that can be used to accurately determine ground motion predictions and fault geometry models used in seismic hazard and risk modelling. In this study, we carried out an ambient noise tomography experiment using 100 seismometers deployed with a ∼2 km spacing on a 20 by 20 km grid. The reliable periods of phase velocity from Rayleigh waves are 0.6 to 6.8 s, providing a well-resolved Vs structure from the surface to a depth of around 4 km. The velocity model displays a prominent, roughly northeast-striking change in Vs that follows the projected surface trace of the blind Chiayi thrust. The uplift of relatively higher Vs rocks in its hanging wall, together with a negative to positive change in dVs suggests that it dips gently eastward across the study area. A northward thickening of the lower Vs crust, together with a high negative dVs in the north of the study area is related to an increased thickness of foreland basin rocks across the Meishan fault. The Vs and dVs models provide reasonable evidence that the Meishan fault can be traced at a high angle from its surface rupture to the base of the model at 4 km depth. It cuts the Chiayi thrust.

Abstract On 18 September 2022, the MW 6.9 Chihshang earthquake struck the south half of the Longitudinal Valley, Taiwan, and caused severe damage. A precise and rapid report for the distribution of aftershock sequence after a devastating earthquake provides key information for deciphering the seismogenic structure in the source region. The utilization of deep-learning methodologies for earthquake event detection offers a significant acceleration in data analysis. In this study, we use SeisBlue, a deep-learning platform/package, to extract the whole earthquake sequence from September to October 2022, including the MW 6.5 Guanshan foreshock, the MW 6.9 mainshock, over 14,000 aftershocks, and 866 foal mechanisms from two sets of broadband networks. After applying hypoDD for earthquakes, the distribution of aftershock sequence clearly depicts not only the Central Range Fault and the Longitudinal Valley Fault but also several local, shallow tectonic structures that have not been observed along the southern Longitudinal Valley.

Overactive bladder (OAB) significantly impairs quality of life in the elderly. Although the intradetrusor injection of botulinum toxin type A (BoNT-A) is a treatment option, its effects on older adults remain uncertain. This study aimed to evaluate the efficacy and safety of BoNT-A intradetrusor injections in elderly OAB patients through a systematic review and meta-analysis. A comprehensive literature search was conducted using the PubMed, Embase, Cochrane Library, Scopus, and CINAHL databases from inception to 30 May 2024. The primary outcomes were improvements in daily urinary incontinence (UI) episodes and patient-reported outcomes, while the secondary outcomes focused on potential adverse events. Four randomized controlled trials with 803 participants were included. BoNT-A injections significantly reduced daily UI episodes at 4–6 weeks (mean difference [MD]: −3.82; 95% confidence interval [CI]: −6.29 to −1.35) and at 12 weeks (MD: −2.17; 95% CI: −3.22 to −1.12). However, BoNT-A was associated with an increased risk of elevated post-void residual (Risk Difference [RD]: 0.154; 95% CI: 0.058 to 0.251) and urinary tract infection (RD: 0.111; 95% CI: 0.005 to 0.217), with no significant difference observed in the initiation of catheterization or hematuria. Trial sequential analysis confirmed a sufficient sample size and statistical power. In conclusion, while BoNT-A effectively manages OAB in the elderly, careful post-injection monitoring is warranted due to its potential risks.

Background: CpxAR is a two-component system that allows bacteria to reorganize envelope structures in response to extracellular stimuli. CpxAR negatively affects type 1 fimbriae expression in Klebsiella pneumoniae CG43, a hypervirulent strain. The involvement of CpxAR in the regulation of type 3 fimbriae expression was investigated. Methods: cpxAR, cpxA, and cpxR gene-specific deletion mutants were generated. The deletion effects on the expression of type 1 and type 3 fimbriae were analyzed via measuring the promoter activity, mannose sensitive yeast agglutination activity, biofilm formation, and the production of the major pilins FimA and MrkA respectively. RNA sequencing analysis of CG43S3, ΔcpxAR, ΔcpxR and Δfur was employed to study the regulatory mechanism influencing the expression of type 3 fimbriae. Results: Deletion of cpxAR increased type 1 and type 3 fimbrial expression. Comparative transcriptomic analysis showed that the expression of oxidative stress-responsive enzymes, type 1 and type 3 fimbriae, and iron acquisition and homeostasis control systems were differentially affected by cpxAR or cpxR deletion. Subsequent analysis revealed that the small RNA RyhB negatively affects the expression of type 3 fimbriae, while CpxAR positively controls ryhB expression. Finally, the site-directed mutation of the predicted interacting sequences of RyhB with the mRNA of MrkA attenuated the RyhB repression of type 3 fimbriae. Conclusion: CpxAR negatively regulates the expression of type 3 fimbriae by modulating cellular iron levels thereafter activating the expression of RyhB. The activated RyhB represses the expression of type 3 fimbriae by base-pairing binding to the 5′region of mrkA mRNA.

Background/purpose: Two urease operons were identified in Klebsiella pneumoniae CG43, ure-1 and ure-2. This study investigates whether a differential regulation of the expression of ure-1 and ure-2 exists and how urease activity influences the acid stress response and expression of type 1 and type 3 fimbriae. Methods: The ureA1 and ureA2 gene specific deletion mutants were constructed. Promoter activity was assessed using a LacZ reporter system. The sensitivity to acid stress was determined by assessing the survival after pH 2.5 treatment. The influence on type 1 and type 3 fimbriae expression was assessed using western blotting and mannose-sensitive yeast agglutination and biofilm formation assay, respectively. Results: Bacterial growth analysis in mM9-U or modified Stuart broth revealed that ure-1 was the principal urease system, and ure-2 had a negative effect on ure-1 activity. Deletion of the fur or nac gene had no apparent effect on the activity of Pure1, Pure2-1, and Pure2-2. The Pure2-2 activity was enhanced by deletion of the hns gene. ureA1 deletion increased acid stress sensitivity, whereas the deleting effect of ureA2 was notable without hns. Deletion of ureA1 or ureA2 significantly induced the expression of type 1 fimbriae but decreased MrkA production and biofilm formation. Conclusion: ure-1 is the primary expression system in K. pneumoniae CG43, while ure-2 is active in the absence of hns. Impairment of urease activity increases the sensitivity to acid stress, and the accumulation of urea induces the expression of type 1 fimbriae but represses type 3 fimbriae expression.

BackgroundDuring flight, G force compels blood to stay in leg muscles and reduces blood flow to the heart. Cardiovascular responses activated by the autonomic nerve system and strengthened by anti-G straining maneuvers can alleviate the challenges faced during G loading. To our knowledge, no definite cardiac information measured using a mobile health device exists for analyzing G tolerance. However, our previous study developed the cardiac force index (CFI) for analyzing the G tolerance of military aircrew. ObjectiveThis study used the CFI to verify participants’ cardiac performance when walking and obtained a formula for predicting an individual’s G tolerance during centrifuge training. MethodsParticipants from an air force aircrew undertook high-G training from January 2020 to December 2022. Their heart rate (HR) in beats per minute and activity level per second were recorded using the wearable BioHarness 3.0 device. The CFI was computed using the following formula: weight × activity / HR during resting or walking. Relaxed G tolerance (RGT) and straining G tolerance (SGT) were assessed at a slowly increasing rate of G loading (0.1 G/s) during training. Other demographic factors were included in the multivariate regression to generate a model for predicting G tolerance from the CFI. ResultsA total of 213 eligible trainees from a military aircrew were recruited. The average age was 25.61 (SD 3.66) years, and 13.1% (28/213) of the participants were women. The mean resting CFI and walking CFI (WCFI) were 0.016 (SD 0.001) and 0.141 (SD 0.037) kg × G/beats per minute, respectively. The models for predicting RGT and SGT were as follows: RGT = 0.066 × age + 0.043 × (WCFI × 100) – 0.037 × height + 0.015 × systolic blood pressure – 0.010 × HR + 7.724 and SGT = 0.103 × (WCFI × 100) − 0.069 × height + 0.018 × systolic blood pressure + 15.899. Thus, the WCFI is a positive factor for predicting the RGT and SGT before centrifuge training. ConclusionsThe WCFI is a vital component of the formula for estimating G tolerance prior to training. The WCFI can be used to monitor physiological conditions against G stress.

Highly (111)-oriented nanotwinned copper (nt-Cu) and non-conductive paste (NCP) were employed to fabricate hybrid Cu–Cu bonding. We tailored and correlated the fracture modes, bonding strengths, and microstructures of the joints. A non-flow underfilling process was performed, and low temperature bonding was achieved in a single heat treatment at 180 °C for 120 min without vacuum. We found that under a post-annealing treatment, recrystallization and grain growth occurred. The bonding interfaces were partially removed and the joints were further strengthened. The fracture modes of the hybrid bonding structure were characterized using pull tests and correlated with their bonding properties. Such hybrid Cu–Cu microbumps with high bonding strength and low thermal budget can be widely used for advanced ultra-fine-pitch packaging.

Purpose: The purpose of this study was to evaluate and compare the clinical and radiological outcomes of three different patellar fixation techniques on medial patellofemoral ligament reconstruction (MPFLR) in the treatment of patellar dislocation (PD). Methods: Between 2015 and 2020, 130 patients with recurrent PD who underwent surgical reconstruction were eligible for this retrospective study: 48 patients were treated with the semi‐tunnel bone bridge fixation technique (Group A), 42 patients were treated with the suture anchor fixation technique (Group B) and 40 patients were treated with the transpatellar tunnel fixation technique (Group C). Clinical outcomes included functional outcomes (Kujala, Lysholm and International Knee Documentation Committee scores), activity levels (Tegner activity score and return to sports), physical examinations, patellar re‐dislocation rate and complications. Radiological outcomes included patellar congruence angle, patellar tilt angle, lateral patellar translation and lateral patellar angle. Results: All clinical and radiological outcomes improved significantly in all groups, without any significant difference among these three groups. At the final follow‐up, no re‐dislocation occurred, and all groups achieved a successful return to sports. However, the semi‐tunnel bone bridge and suture anchor fixation techniques showed statistically higher Tegner activity scores (p = 0.004) and shorter time from surgery to return to sports (p = 0.007) than the transpatellar tunnel fixation technique. Conclusion: The three MPFLR patellar fixation techniques achieved favourable and comparable clinical and radiological outcomes in the treatment of PD. Compared with the transpatellar tunnel fixation technique, the semi‐tunnel bone bridge and suture anchor fixation techniques may be more effective with higher activity levels. Level of Evidence: Level III. [ABSTRACT FROM AUTHOR]

An optimal modulation scheme with triple-phase-shift (TPS) control could increase the efficiency in the entire load range for a dual-active-bridge (DAB) converter under wide output voltage range conditions. Therefore, this study proposes a convergent approach to TPS mode selection, coupled with an optimal modulation scheme, ensuring the circuit’s efficiency over the entire range in the realm of a high-power and high-efficiency battery charger for electric vehicles. The convergent approach to TPS mode selection also reduces the numerous cases for small-signal analysis through general average modeling. After verifying the small-signal models under various voltage transfer ratios and load conditions to verify the stability, a converter prototype with a rated power of 15 kW is built and tested. Thus, a peak efficiency of 97.7% can be achieved.

Background: Blood immune cell subset alterations following trauma can indicate a patient′s immune–inflammatory status. This research explored the influence of stress-induced hyperglycemia (SIH) on platelet counts and white blood cell (WBC) subtypes, including the derived indices of the monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), in trauma patients. Methods: We studied 15,480 adult trauma patients admitted from 1 January 1998 to 31 December 2022. They were categorized into four groups: nondiabetic normoglycemia (NDN, n = 11,602), diabetic normoglycemia (DN, n = 1750), SIH (n = 716), and diabetic hyperglycemia (DH, n = 1412). A propensity score-matched cohort was formed after adjusting for age, sex, and comorbidities, allowing for comparing the WBC subtypes and platelet counts. Results: Patients with SIH exhibited significantly increased counts of monocytes, neutrophils, and lymphocytes in contrast to NDN patients. However, no significant rise in platelet counts was noted in the SIH group. There were no observed increases in these cell counts in either the DN or DH groups. Conclusions: Our results demonstrated that trauma patients with SIH showed significantly higher counts of monocytes, neutrophils, and lymphocytes when compared to NDN patients, whereas the DN and DH groups remained unaffected. This underscores the profound association between SIH and elevated levels of specific WBC subtypes.