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Purpose This study was to investigate the association between the use of Sodium-glucose Cotransporter-2 inhibitors (SGLT2i) or angiotensin receptor-neprilysin inhibitor (ARNI; ie, Sacubitril + valsartan, Product name ENTRESTO) and the risk of atherosclerotic cardiovascular disease (ASCVD) in patients with coexisting diabetes and heart failure. Specifically, the study compared outcomes between patients using SGLT2i or valsartan + sacubitril and those not using these medications. Methods This study utilized data from the National Health Insurance Research Database (NHIRD) from 2017 to 2018. The case group consisted of 8691 patients with coexisting diabetes and heart failure who did not use SGLT2i or Entresto, while the control group consisted of 8691 patients with coexisting diabetes and heart failure who used SGLT2i or Entresto. The primary outcome was ASCVD, including a composite of cardiovascular death and hospitalization for worsening heart failure. Secondary outcomes included all-cause death, cause of cardiovascular death, and recurrence of heart failure, non-fatal myocardial infarction, non-fatal stroke (including ischemic stroke and hemorrhagic stroke) and new renal replacement therapy. Results The study found that the use of SGLT2 inhibitors or ARNI was associated with a lower risk of ASCVD in patients with coexisting diabetes and heart failure. Conclusion The study suggests that the use of SGLT2 inhibitors, alone or in combination with Entresto, may be effective in reducing the risk of ASCVD and its associated adverse outcomes in patients with diabetes and heart failure. This finding has important implications for the management of these conditions.

Abstract To evaluate birth outcomes in women with hypertensive disorders of pregnancy (HDP) and gestational diabetes mellitus (GDM), we used insurance data of Taiwan to evaluate 11 adverse neonatal outcomes of infants born to women with HDP (N = 7775) and with both HDP and GDM (HDP/GDM) (N = 1946), comparing to women with neither disorder (N = 19,442), matched by age. The impacts of preeclampsia/eclampsia were also evaluated. Results showed that Caesarean section delivery was near 1.7-fold greater in the HDP/GDM and HDP groups than in comparisons. The preterm delivery rates were more than threefold greater in HDP/GDM group and HDP group than in comparisons with adjusted odds ratios (aORs) of 4.84 (95% confidence interval (CI) 4.34–5.40) and 3.92 (95% CI 3.65–4.21), respectively, followed by jaundice (aORs 2.95 (95% CI 2.63–3.33) and 1.90 (95% CI 1.76–2.06)), and small gestation age (SGA) (aORs 6.57 (95% CI 5.56–7.75) and 5.81 (95% CI 5.15–6.55)). Incidence rates of birth trauma, patent ductus arteriosus, atrial septal defect, respiratory distress syndrome, and neonatal hypoglycemia were also higher in the HDP/GDM and HDP groups than in the comparison group. Most adverse outcomes increased further in women with preeclampsia or eclampsia. In conclusion, women with HDP are at elevated risks of adverse neonatal outcomes. Risks of most adverse outcomes increase further for women with both HDP and GDM. Preeclampsia or eclampsia may also contribute to these outcomes to higher risk levels. Every pregnant woman with these conditions deserves specialized prenatal care.

Abstract Background Pharmacists hold to their promise to foster, implement and promote the health of the population and to prevent disease, given their knowledge, skills, and proximity to the locals. The objective of this study was to foster equality and cost-effectiveness in the distribution and sale of masks to all Taiwanese citizens, in response to the COVID-19 pandemic. Methods All 6336 special community pharmacies participating in the NHI (National Health Insurance) served as mask-selling sites. Access to masks by citizens was determined and controlled, based on the weekly rationing of the number of purchasable masks per citizen and the last digit of their NHI card number. Masks were available on different weekdays for holders of cards ending with odd and even numbers, except on Sundays, when everyone was eligible to buy a mask. Results Implementing the program has provided equal access to masks for all citizens across Taiwan. It has stabilized the pricing of masks and mitigated the public’s anxiety of a perceived likely market shortage. Conclusion The community pharmacy-based approach to the distribution of prevention face masks to citizens represents a new and innovative engagement of pharmacists in public health promotion and protection initiatives. Community pharmacies can greatly improve the efficiency, reliability, and cost-saving of the distribution of public health resources to local communities, especially in the face of an epidemic.

Objective: This study investigated the medical care costs of stroke type between age-matched cohorts with and without dysmenorrhea using the National Health Insurance Research Database (NHIRD).Methods: We collected all 66,048 women with dysmenorrhea and 66,048 women without dysmenorrhea whose age (15-44-year-old) and index year (from 1997 to 2013) were matched for comparison. We assessed the incidence and compared the risk of stroke and stroke subtype in two cohorts. The proportional distributions of stroke subtypes by age between the two cohorts were compared among the women with stroke, and their hospitalization rate was also estimated. In addition, medical cost, length of stay, and the medical cost within 30 days after stroke were compared between the two cohorts.Results: The stroke risk in dysmenorrhea was greater than comparisons (HR = 1.26, 95% CI = 1.11–1.42). Proportionally, hemorrhagic stroke (HS) significantly decreased with age in both cohorts, whereas ischemic stroke (IS) significantly increased with age when both cohorts were combined. The dysmenorrhea cohort had a higher portion of transient cerebral ischemia (TIA) stroke than comparisons (31.3 vs. 24.2%, p = 0.01) and a lower risk of hospitalization for IS (OR = 0.48, 95% CI = 0.21–0.69). Among the four-stroke subtypes, the cost of care for TIA was the least (US$157 ± 254). The average cost for stroke care was not significantly different between women with and without dysmenorrhea.Conclusion: The hospitalization rate and medical costs of TIA are lower than other types. All women should prevent and treat TIA as soon as possible to avoid recurrence or progression to major stroke events and reduce medical costs, regardless of whether they have dysmenorrhea.

Objective Dysmenorrhea is among the most common type of gynecological problem, affecting young women across the globe. This study assessed the comparative risk of stroke associated with the use of nonsteroidal anti-inflammatory drugs (NSAIDs) and non-NSAIDs in women with dysmenorrhea while taking into account the following factors such as age, history of pregnancy, NSAIDs uses and its duration of use, and selected comorbidities. Methodology We used a quantitative research approach based on a comparative case-control study design. The study data was selected from the Longitudinal Health Insurance Database (LHID) 2000, of the Taiwan National Health Research Institutes. Among the estimated 23.4 million insured Taiwanese, who were covered by the Taiwan health insurance system, in the 2000 registry of beneficiaries, one million individuals were randomly selected from the database. A total of 24,955 females suffering from dysmenorrhea were selected for the study. Out of those 3238 (13%) participated in the study group and 21,717 (87%) were randomly distributed into the controls group. Women in the age range, 15–49 years, who did not have any history of stroke, hysterectomy, and/or ovariectomy, were included in the study. A comparative proportional distribution analysis was used for data analysis. Results Age and use of NSAIDs and its duration of usage were factors associated with an increased incidence of stroke. The stroke incidence rate was 12.77 per 10,000 person-years, and 1.83-fold higher in NSAIDs use cohort than in comparisons with adjusted hazard ratio (aHR) of 1.47 (95% CI = 0.93–2.32). Among women with dysmenorrhea use of NSAIDs, the stroke incidence increased to 2.29-fold (aHR 95% CI = 1.36–3.84) in those use for ≧24 days per month and to 0.51-fold (aHR 95% CI = 0.13–2.10) in those use for 6–12 days per month. Conclusions Women with dysmenorrhea who use NSAIDs have a higher risk of stroke. Especially young women, the risk of stroke is further increased, and the longer the medication, the higher the risk of stroke. Every woman with symptoms of dysmenorrhea deserves specialized outpatient treatment and care.

BACKGROUND:Insufficient sleep is a common health and safety risk factor in high-impact workplaces where workers are required to take rotating shifts. However, studies on sleepiness-related risks and incidents, particularly among emergency medical services (EMS) workers are limited. OBJECTIVE:This study sought to investigate the prevalence of sleepiness and related workplace incidents among EMS workers. METHODS:This study utilized a cross-sectional survey design on a convenient sample of 500 EMS workers from 41 EMS squads across Taiwan. Data were collected using structured online questionnaires on workplace sleepiness and related safety incidents based on the Epworth Sleepiness Scale (ESS) and a modified 25-item EMS Safety Inventory respectively. RESULTS:With a response rate of 79.8% (n = 399), 36.9% of the respondents were identified as having mild daytime sleepiness, while 39.2% of the respondents were identified as having excessive daytime sleepiness. Multivariate analysis indicated that not only was working on rotating shifts the main cause of the high ESS scores among EMS workers, but also that higher ESS scores increased their risk of sustaining a workplace injury. Furthermore, ill-at-work incidents were associated with an increased risk of workplace-related injuries. CONCLUSION:Overall, the findings indicated a correlation among working on rotation shifts, the prevalence of sleepiness, and a higher risk of workplace injury among EMS workers.

Molecular dynamics (MD) simulations are performed in this study to investigate the mechanical properties of Cu/Zr multilayer nanofilms (MNFs) during tensile and compression tests. The results reveal slip behavior in the tensile test and the phase transformation process in the compression test, where the former only occurs in the Cu film during the tensile test and the latter only occurs in the Zr film during the compression test. In addition, the effects of temperature, growth orientation, and layer number are investigated. Keywords: Molecular dynamics simulations, Phase transformation, Cu/Zr multilayer nanofilms, Tensile test, Compression test

BackgroundDysmenorrhea and stroke are health problems affecting women worldwide in their day-to-day lives; however, there is limited knowledge of the stroke risk in women with dysmenorrhea, and there have been no studies assessing the specific distribution of stroke subtypes. This case-control study assessed stroke subtypes by age and the role of comorbidities in women with dysmenorrhea.Methods and findingsData obtained between 1997 and 2013 from Taiwan's health insurance database identified 514 stroke cases and 31,201 non-stroke controls in women with dysmenorrhea aged 15-49 years. Proportional distributions of subtypes and odds ratios (ORs) of stroke associated with comorbidities by age and subtype were measured. We found that the stroke risk in dysmenorrheal patients increased with age, and that hypertension was nine-fold more prevalent in the stroke cases than in the controls and was associated with an adjusted OR of 4.53 (95% confidence interval (CI) = 3.46-5.92) for all stroke cases. Moreover, the proportion of hemorrhagic stroke was greater than that of ischemic stroke in younger dysmenorrheal patients between 15-24 years old (50.5% vs. 11.4%), whereas this was reversed in those aged 30-49 years old (16.1% vs. 21.0%). Overall, 25.3% of the stroke cases consisted of transient cerebral ischemia and 31.3% were other acute but ill-defined cerebrovascular diseases, in which the prevalence increased with age for both types of strokes. Hypertension was the comorbidity with the highest OR associated with each subtype stroke; diabetes, hyperlipidemia, arrhythmia, and thyroid disease were also comorbidities that were significantly associated with ill-defined cerebrovascular diseases.ConclusionsThe stroke type varies by age in dysmenorrheal patients, and hypertension is the most important comorbidity associated with all types of stroke; therefore, more attention for stroke prevention must be paid to women with dysmenorrhea, particularly when combined with comorbidities.

BackgroundGout is independently associated with increased risk of type 2 diabetes mellitus (T2DM). Urate-lowering therapy (ULT) might be beneficial in lowering the risks of T2DM. Therefore, we conducted a nested case-control study to evaluate the associations between ULT and T2DM.MethodsThis study retrieved the data of 29,765 gout patients from the period of 1998-2010 by using data from Taiwan's National Health Insurance Research Database. Controls (n = 59,530) were matched at a 1:2 ratio by age, sex, and region. Multivariate Cox proportional hazards regression were performed to examine the dose-dependent relationship between ULT and T2DM.ResultsThe adjusted Hazard ratio (HR) for the association of T2DM with allopurinol or benzbromarone exposure was 1.17 (95% confidence interval (CI) 1.07-1.28) and1.09 (95% CI 1.03-1.15), respectively. The HR for the cumulative allopurinol dose was 0.87 (95% CI 0.71-1.07) for patients with dose ≤1.3 mg/day and was 1.31 (95% CI 1.13-1.52) for those with a dose >15.2 mg/day. Similarly, the HR for the cumulative benzbromarone dose was 0.85(95% CI 0.75-0.96) for patients with a dose ≤1.3 mg/day and 1.42 (95% CI 1.30-1.55) for patients with a dose>9.4 mg/day, respectively. Moreover, the average exposure dose of >100 mg/day for allopurinol and >100 mg/day for benzbromarone was associated with a 1.28-fold (95% CI 1.11-1.48) and 1.47-fold (95% CI 1.23-1.76) T2DM risk respectively. The HR for patients in aged >50 years group with cumulative dose ≤1.3 mg/day of allopurinol or benzbromarone had lower risk of T2DM (HR = 0.74, 95% CI 0.58-0.94 for allopurinol; HR = 0.79, 95% CI 0.69-0.90 for benzbromarone).ConclusionGout patients with prolonged ULT and a high dose of ULT were associated with a significant increase in T2DM risk. Although gout patients with age greater than 50 years and a lower dose of ULT may be beneficial in lowering T2DM risk, further clinical studies need to be confirmed these associations.

Spousal clustering of diabetes merits attention. Whether old-age vulnerability or a shared family environment determines the concordance of diabetes is also uncertain. This study investigated the spousal concordance of diabetes and compared the risk of diabetes concordance between couples and noncouples by using nationally representative data.A total of 22,572 individuals identified from the 2002-2013 National Health Insurance Research Database of Taiwan constituted 5,643 couples and 5,643 noncouples through 1:1 dual propensity score matching (PSM). Factors associated with concordance in both spouses with diabetes were analyzed at the individual level. The risk of diabetes concordance between couples and noncouples was compared at the couple level. Logistic regression was the main statistical method. Statistical data were analyzed using SAS 9.4. C&RT and Apriori of data mining conducted in IBM SPSS Modeler 13 served as a supplement to statistics.High odds of the spousal concordance of diabetes were associated with old age, middle levels of urbanization, and high comorbidities (all P < 0.05). The dual PSM analysis revealed that the risk of diabetes concordance was significantly higher in couples (5.19%) than in noncouples (0.09%; OR = 61.743, P < 0.0001).A high concordance rate of diabetes in couples may indicate the influences of assortative mating and shared environment. Diabetes in a spouse implicates its risk in the partner. Family-based diabetes care that emphasizes the screening of couples at risk of diabetes by using the identified risk factors is suggested in prospective clinical practice interventions.

Capsaicin (8-methyl-N-vanillyl-6-noneamide), which is an active component in red chili peppers, is used as a chemopreventive agent that shows favorable cytotoxicity against cancer cells. Accumulating evidence indicates that capsaicin preferentially inhibits a tumor-associated NADH oxidase (tNOX, ENOX2) that is ubiquitously expressed in cancer but not in non-transformed cells. This attenuates cancer cell growth by inducing apoptosis. The capsaicin-mediated inhibition of tNOX was recently shown to prolong the cell cycle. However, the molecular events underlying this regulation have not yet been investigated. In the present study, we used a cellular thermal shift assay (CETSA) to detect “target engagement” of capsaicin and its consequent impact on cell cycle progression. Our results indicated that capsaicin engaged with tNOX and triggered the proteasomal degradation of tNOX, which leads to the inhibition of NAD+-dependent SIRT1 deacetylase. Ultimately, the acetylation levels of c-Myc and p53 were enhanced, which suppressed the activation of G1 cyclin/Cyclin-dependent kinase complexes and triggered cell cycle arrest in cancer cells. The results obtained when tNOX was overexpressed in non-cancer cells validated its importance in cell cycle progression. These findings provide the first molecular insights into the regulatory role of tNOX and the anti-proliferative property of capsaicin in regulating the cell cycle of bladder cancer cells.

Pure word deafness (PWD) is a rare disorder characterized by impaired verbal comprehension sparing discrimination and recognition of nonverbal sounds with relatively normal spontaneous speech, writing, and reading comprehension. Etiologies of this syndrome are varied, and there are rare reports about brain tumor with PWD in children. We report a case of medulloblastoma presented with PWD in a 7-year-old girl. She visited our outpatient clinic because of English dictation performance deterioration. PWD was diagnosed by the otolaryngologist after examinations. Posterior fossa tumor and obstructive hydrocephalus were shown in the magnetic resonance imaging of the brain. The diagnosis of medulloblastoma was then made by pathology.

Bladder cancer is one of the most frequent cancers among males, and its poor survival rate reflects problems with aggressiveness and chemo-resistance. Recent interest has focused on the use of chemopreventatives (nontoxic natural agents that may suppress cancer progression) to induce targeted apoptosis for cancer therapy. Capsaicin, which has anti-cancer properties, is one such agent. It is known to preferentially inhibit a tumor-associated NADH oxidase (tNOX) that is preferentially expressed in cancer/transformed cells. Here, we set out to elucidate the correlation between tNOX expression and the inhibitory effects of capsaicin in human bladder cancer cells. We showed that capsaicin downregulates tNOX expression and decreases bladder cancer cell growth by enhancing apoptosis. Moreover, capsaicin was found to reduce the expression levels of several proteins involved in cell cycle progression, in association with increases in the cell doubling time and enhanced cell cycle arrest. Capsaicin was also shown to inhibit the activation of ERK, thereby reducing the phosphorylation of paxillin and FAK, which leads to decreased cell migration. Finally, our results indicate that RNA interference-mediated tNOX depletion enhances spontaneous apoptosis, prolongs cell cycle progression, and reduces cell migration and the epithelial-mesenchymal transition. We also observed a downregulation of sirtuin 1 (SIRT1) in these tNOX-knockdown cells, a deacetylase that is important in multiple cellular functions. Taken together, our results indicate that capsaicin inhibits the growth of bladder cancer cells by inhibiting tNOX and SIRT1 and thereby reducing proliferation, attenuating migration, and prolonging cell cycle progression.

The rapid development of the industrial Internet of Things (IIoT) has transformed manufacturing processes, particularly in industries such as electronics and aerospace. While larger enterprises have successfully implemented IIoT applications to enhance productivity and facilitate smart manufacturing, small and medium-sized enterprises have faced challenges in adopting these technologies owing to financial constraints and limitations in their existing equipment. Therefore, in this paper, we propose to use Raspberry Pi as the hardware basis and the Cheng Shiu University laboratory as the research target. The approach presented in this paper involves integrating open-source packages to design both the programmable logic controller (PLC) publishing pattern and the PLC subscribing pattern. The proposed approach uses a message queuing telemetry transport (MQTT) communication protocol for transmitting Modbus transmission control protocol (TCP) register data and bidirectional data exchange with a remote monitoring system. An MQTT Broker is established to act as a bridge between the monitoring platform and the control system. A Node-RED-based IoT platform is set up to subscribe to topics from the PLC publisher for data collection. Additionally, the human–machine interface (HMI) in the monitoring system utilizes MQTT communication to publish PLC control commands, and a database is implemented for the historical analysis of monitoring data. In this study, we aim to establish a web-based cross-platform monitoring and control system using lowcost integration through Raspberry Pi 4B embedded systems and various communication protocols. The design facilitates the IoT transformation of PLC control systems. This integrated system has broad applications in construction, production equipment, and power system monitoring to achieve power monitoring and energy conservation. [ABSTRACT FROM AUTHOR]

Electric tools have become indispensable in various industries owing to their convenient portability, high energy efficiency, and capability to operate without being constrained by power cords when using batteries. Referring to the currently marketed ST-64 specification gas-powered or compressed-air-powered nail guns commonly used for concrete and steel beams, we propose a linear motor design with superior output power and operational speed for use in electric nail guns. The design process begins with designing and simulating the stator and mover of the motor using Altair Flux 3D finite element analysis software. The stator is a combination of permanent magnets and electromagnetic iron and designed to possess magnetic field properties similar to those of the Halbach magnet array. On the other hand, the mover utilizes permanent magnets with different magnetic field directions to achieve a Halbach magnet array design, resulting in a magnetic field direction opposite to that of the stator. The linear motor, formed by a combination of the stator and mover, is then analyzed and adjusted through Flux 3D finite element analysis to design a short-stroke, high-thrust linear motor leveraging the concentrated magnetic field characteristics of the magnet array. Finally, it is experimentally verified that the linear motor designed in the experiment can achieve an output force of up to an average of 90 N even when using an inferior core, reinforcing the potential and reliability of this design for practical implementation. [ABSTRACT FROM AUTHOR]

With the increase in energy consumption and in view of the reduction of fossil fuels and their destructive effects on the environment, the use of renewable energy systems has been considered. The hybrid system consists of several different sources, which increases the overall efficiency of the system. In this article, a hybrid system connected to the grid has been designed, the purpose of which is to increase performance in order to utilize energy sources, inject power into the grid, and reduce greenhouse gas emissions. For this purpose, different scenarios have been carried out and evaluated. For this purpose, an advanced optimization method based on Non-dominated Sorting Genetic Algorithm II (NSGA-II) has been used. the dimensions of energy resources are estimated for the cost price of 220 dollars, the annual profit in the purchase and sale prices of energy is 275, 310 and 344 dollars, respectively 20, 35 and 50 billion dollars. to evaluate the behavior of the proposed resource model, three scenarios have been arranged. the STD power quality index in the third scenario is lower than the base case. [ABSTRACT FROM AUTHOR]

Environmental concerns and higher energy demand require more energy. Solar and wind are renewable energies. One of the most important and available renewable energy sources is the use of wind and solar sources. This study examines energy generation and battery storage systems for lowering peak load and smoothing a residential substation's load curve. This study aims to present a useful and effective mechanism for improving the design of a hybrid system using solar panels and wind turbines to provide the common peak load and as much actual load demand as possible at the desired location. The proposed method provides the optimal solution after obtaining light radiation, wind speed, and load demand. Training and learning-based algorithms optimize. This study focuses on reducing lifetime costs. Prices and equipment are accurate, and power plant costs include initial and ongoing costs. PSO optimizes Karachi's anemometer and radiation data. The results showed that the network's summer, fall, and winter peak outputs are 12368 kW, 14865 kW, and 77 147 kW; the systems are 68.31 kW, 29.38 kW, and 2337 kW. Using the seasonal average rather than the annual average improves the system's dependability and provides a more accurate response to the desired peak load. Wind and solar hybrid systems connected to the grid can reduce the grid's peak load and total cost over time. [ABSTRACT FROM AUTHOR]