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Purpose Cluster analysis has been proposed to examine phenotypic heterogeneity in chronic obstructive pulmonary disease (COPD). The aim of this study was to use cluster analysis to define COPD phenotypes and validate them by assessing their relationship with mortality. Methods Male subjects with COPD were recruited to identify and validate COPD phenotypes. Seven variables were assessed for their relevance to COPD, age, FEV.sub.1 % predicted, BMI, history of severe exacerbations, mMRC, SpO.sub.2, and Charlson index. COPD groups were identified by cluster analysis and validated prospectively against mortality during a 4-year follow-up. Results Analysis of 332 COPD subjects identified five clusters from cluster A to cluster E. Assessment of the predictive validity of these clusters of COPD showed that cluster E patients had higher all cause mortality (HR 18.3, p < 0.0001), and respiratory cause mortality (HR 21.5, p < 0.0001) than those in the other four groups. Cluster E patients also had higher all cause mortality (HR 14.3, p = 0.0002) and respiratory cause mortality (HR 10.1, p = 0.0013) than patients in cluster D alone. Conclusion COPD patient with severe airflow limitation, many symptoms, and a history of frequent severe exacerbations was a novel and distinct clinical phenotype predicting mortality in men with COPD., Author(s): Chiung-Zuei Chen[sup.1] , Liang-Yi Wang[sup.2] , Chih-Ying Ou[sup.1] , Cheng-Hung Lee[sup.1] , Chien-Chung Lin[sup.1] , Tzuen-Ren Hsiue[sup.1] Author Affiliations: (1) Division of Chest Medicine, Department of Internal Medicine, National [...]

The moderator effect of retention in care on late presenters in HIV patients has not been well evaluated. A nationwide cohort study focusing on HIV-infected patients with new engagement in care was conducted by using the Taiwan National Health Insurance Research Database. Retention in care was defined based on the healthcare utilization in the first year after engaging in HIV care. Then, the impact of late presentation, retention in care, and their interaction on the risk of subsequent hospitalizations due to opportunistic infections (OIs-hospitalizations) in the second year were examined. More than half (59.38%) of the total patients (n = 9112) were retained in care in the first year, 8.63% were late presenters, and 110 (1.21%) patients had subsequent hospitalization in the second year. Late presentation and non-retention were independent predictors of OIs-hospitalizations in the second year (OR: 2.58 and OR: 3.27, respectively) and the interaction between them was statistically significant (non-retention in care × late presentation, OR: 3.82). This study showed that retention in care in the first year is a moderator providing a stronger protective effect for late presenters than early presenters. Our findings call for policymakers to develop different strategies for early or late presenters. [ABSTRACT FROM AUTHOR]

Aiming at the constraint of operation times of all switches and the inefficiency of harmony search algorithm, the improved optimal fuzzy C-means clustering technology and the improved harmony search algorithm were proposed. The former was applied to classify the operation state in a time interval according to load data that the dynamic reconfiguration of distribution network was converted to the multiple static reconfigurations that take the corresponding cluster center as the representative load. The latter was applied to solve the static reconfiguration. The optimal network structure at any time was determined by the corresponding cluster center's reconfiguration result, at the same time, the reconfiguration time and the operated switches were known. On the basis of IEEE-33bus system's load data, one day's load data was constructed and the dynamic reconfiguration was carried out. The results indicate that the proposed method can strictly limit operation times of switches and improve the efficiency of harmony search algorithm. [ABSTRACT FROM AUTHOR]

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Objective: This study examined the additional therapeutic effects of electroacupuncture for patients with first-ever ischaemic stroke., Design: Randomized controlled study., Subjects: A total of 63 patients with first-ever ischaemic stroke., Methods: The study and control groups underwent a conventional rehabilitation program, with the former receiving an additional 8 courses of electroacupuncture over a period of one month. Therapeutic effects were assessed by the Fugl-Meyer Assessment for motor performance and the Functional Independence Measure (FIM) for the independence of functional performance at 2 and 4 weeks after treatment, and 3 months and 6 months after stroke., Results: For total Fugl-Meyer Assessment score, improvement was more significant for the study group relative to the control group at 2 weeks (16.2 vs 10.6; p = 0.047) and 4 weeks after treatment (27.4 vs 17.1; p = 0.005), and at 3 months after the stroke (34.7 vs 21.8; p = 0.009). The Fugl-Meyer Assessment scores improved significantly, especially in upper-limb motor function for the study group. There was no statistically significant between-group difference in total FIM score improvement., Conclusion: Electroacupuncture can improve motor function, especially in upper-limb motor function, for patients with first-ever ischaemic stroke.