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AbstractObjectives Hypermetabolism is associated with clinical prognosis of cancer patients. The aim of this study was to explore the association between basal metabolic rate (BMR) and postoperative clinical outcomes in gastric cancer patients.Methods We collected data of 958 gastric cancer patients admitted at our center from June 2014 to December 2018. The optimal cutoff value of BMR (BMR ≤1149 kcal/day) was obtained using the X-tile plot. Logistic and Cox regression analyses were then performed to evaluate the relevant influencing factors of clinical outcomes. Finally, R software was utilized to construct the nomogram.Results A total of 213 patients were defined as having a lower basal metabolic rate (LBMR). Univariate and multivariate analyses showed that gastric cancer patients with LBMR were more prone to postoperative complications and had poor long-term overall survival (OS). The established nomogram had good predictive power to assess the risk of OS in gastric cancer patients after radical gastrectomy (c-index was 0.764).Conclusions Overall, LBMR on admission is associated with the occurrence of postoperative complications in gastric cancer patients, and this population has a poorer long-term survival. Therefore, there should be more focus on the perioperative management of patients with this risk factor before surgery.

Abstract Because of the water scarcity in many regions, different methods have been implemented to address this problem. The desalination technique is known as a practical solution among them. However, brine from the desalination process, which contains high concentrations of salts, minerals, and chemicals, will cause environmental harm to the sea, soil, and groundwater if it is not properly treated. Therefore, recovering critical resources from brine is essential for reducing brine disposal. This study aims to apply two hydrometallurgy systems, namely ion exchange and ionic liquid extraction, to circulate rubidium resources from brine. Dowex G26 resin was employed in the ion exchange system, and the adsorption isotherm model and saturated adsorption capacity were explored initially. The optimal parameters such as pH value, L/S ratio (liquid/solid), adsorption period, and adsorption temperature will then be investigated. In the ionic liquid extraction process, the t-BAMBP/C2mimNTf2 system (4-tert-Butyl-2-(α-methylbenzyl) phenol/1-ethyl-3-methylimidazolium bis(trifluoromethyls​ulfonyl)​imide) was used, and the parameters including pH value, concentrations of t-BAMBP, (O + I)/A ratio (organic + ionic liquid/aqueous), extraction time, and extraction temperature will be optimized as well. The results reveal that adsorption capacity and extraction efficiencies were 14.3 mg g− 1 and 86%, respectively. Furthermore, suitable reagents, including HCl and HNO3, were applied to desorb and strip rubidium from the Dowex G26 and t-BAMBP/C2mimNTf2 systems. To sum up, environmental hazards of desalination brine and rubidium resources can be reduced and recovered through the two different extraction systems.

IntroductionPatients with renal insufficiency are more prone to postoperative complications (PCs). Studies have shown that minor changes in serum creatinine (SCr), immediately post-surgery, can aid in assessing patients’ renal function. This study aimed to explore the relationship between the changes in SCr and PCs in patients with gastric cancer (GC).Materials and methodsWe prospectively collected data regarding the SCr of 530 GC patients, within 2 weeks before surgery and within 24 hours after surgery in our hospital (2014–2016). The patients were divided into three groups according to the level of SCr change after surgery: reduced (10%) creatinine groups. Univariate and multivariate logistic analysis were performed to evaluate its correlation with short-term PCs in the patients. The R language was used to construct a nomogram.Results83, 217, and 230 patients were assigned to the elevated, reduced, and normal SCr groups, respectively. Multivariate analysis showed that the reduced and elevated SCr groups were independently associated with the occurrence of PCs and severe postoperative complications (SPCs), respectively. Additionally, postsurgical SCr change, age, hypoalbuminemia, total gastrectomy, combined resection, and laparoscopy, were independently related to PCs. Combining the above influential factors, the predictive model can distinguish patients with PCs more reliably (c-index is 0.715).ConclusionPost-surgery, reduced SCr is a protective factor for PCs, while elevated serum creatinine is an independent risk factor for SPCs. Our nomogram can identify GC patients with high risks of PCs.

Abstract The China Seismo-Electromagnetic Satellite (CSES), with a sun-synchronous orbit at 507 km altitude, was launched on 2 February 2018 to investigate pre-earthquake ionospheric anomalies (PEIAs) and ionospheric space weather. The CSES probes manifest longitudinal features of four-peak plasma density and three plasma depletions in the equatorial/low-latitudes as well as mid-latitude troughs. CSES plasma and the total electron content (TEC) of the global ionosphere map (GIM) are used to study PEIAs associated with a destructive M7.0 earthquake and its followed M6.5 and M6.3/M6.9 earthquakes in Lombok, Indonesia, on 5, 17, and 19 August 2018, respectively, as well as to examine ionospheric disturbances induced by an intense storm with the Dst index of − 175 nT on 26 August 2018. Anomalous increases (decreases) in the GIM TEC and CSES plasma density (temperature) frequently appear specifically over the epicenter days 1–5 before the M7.0 earthquake and followed earthquakes, when the geomagnetic conditions of these PEIA periods are relatively quiet, Dst: − 37 to 19 nT. In contrast, TEC and CSES plasma parameter anomalies occur globally in the southern hemisphere during the storm days of 26–28 August 2018. The CSES ion velocity shows that the electric fields of PEIAs associated with the M7.0 earthquake are 0.21/0.06 mV/m eastward and 0.11/0.10 mV/m downward at post-midnight/post-noon on 1–3 August 2018, while the penetration electric fields during the storm periods of 26–28 August 2018 are 0.17/0.45 mV/m westward/downward at post-midnight of 02:00 LT and 0.26/0.26 mV/m eastward/upward at post-noon of 14:00 LT. Spatial analyses on CSES plasma discriminate PEIAs from global effects and locate the epicenter of possible forthcoming large earthquakes. CSES ion velocities are useful to derive PEIA- and storm-related electric fields in the ionosphere.

Background: Our objective was to assess the viability and oncological security of a gasless, transaxillary single-incision endoscopic procedure for performing total thyroidectomy and bilateral central neck dissection (TT + BCND). This study focused on patients diagnosed with bilateral papillary thyroid microcarcinoma (PTMC). Method: Between April 2020 and November 2021, 22 patients with bilateral PTMC underwent single-incision, gasless, transaxillary endoscopic TT + BCND. The patients’ clinicopathologic characteristics, surgical completeness and complications were analyzed. Result: Single-incision, gasless, transaxillary endoscopic TT + BCND was successful performed in all patients. The median (IQR) total surgical time was 143 (85–160) min. Only two patients experienced transient unilateral RLN palsy or transient hypocalcemia. All these complications resolved within 1 month after surgery. The median duration of hospital stay after surgery was 4 (3–4.5) days. The median hospitalization expense for these patients was 3848 (3781–4145) USD. The median number of lymph node yielded was 10.5 (8–15). The cosmetic outcomes were well-received by all individuals. Conclusion: In certain cases, gasless, transaxillary endoscopic TT + BCND procedure performed through a single incision proved to be a secure alternative for managing bilateral PTMC.

Calcium carbonate (CaCO3) particles have attracted increasing attention as a promising material for drug delivery systems. In this study, coral remains were utilized as a raw material for a novel drug carrier. A series of pre-treatment and parameter experiments were conducted to synthesize sub-micron spherical CaCO3 particles. The CaCO3 particles exhibited uniform size distribution, with the minimum mean size being only 344 nm. The effects on the CaCO3 crystal phases and particle sizes were also discussed in this study. Drug loading experiments were also conducted to assess the feasibility of the CaCO3 drug carrier. We loaded TRITC-Dextran into CaCO3 particles for the simulation experiments. The loading capacity reached up to 9.6 wt.%, which was as high as common drug carriers such as liposomes. In this study, we aimed not only to tackle the local environmental issues caused by coral remains, but also to synthesize a suitable drug carrier for cancer therapy using the outstanding properties and low cost of CaCO3.

BackgroundEndoscopic thyroidectomy (ET) via gasless unilateral axillary (GUA) approach has been widely implemented worldwide. Based on our concept of mesothyroid excision in open surgery, we proposed a novel anatomy-based five-settlement method in ET via the GUA approach. This preliminary report aimed to explore the efficacy and safety of this method in patients with papillary thyroid carcinoma (PTC).MethodsPTC patients who underwent endoscopic ET and unilateral central compartment neck dissection (CCND) via GUA approach with the five-settlement method at the Department of General Surgery, Nanfang Hospital, Southern Medical University from March 2020 to December 2021 were retrospectively collected. The data included general clinicopathological characteristics, surgical information (including duration, complication, and clinicopathological features), and hospital stay information, and other medical records were documented.ResultsIn total, 521 patients underwent lobectomy and CCND under the GUA approach with the five-settlement method. The mean number of lymph nodes yielded (LNY) and positive lymph nodes (PLN) was 5.7 ± 4.3 (range, 1–30) and 1.0 ± 1.8 (range, 0–12), respectively. The incidence of transient recurrent laryngeal nerve injury was 1.1%. Chyle leakage and Horner’s syndrome respectively occurred in one patient (0.2%). Five (0.9%) patients developed a hematoma. No severe complications or conversion to open surgery have occurred.ConclusionThe five-settlement method could be implemented safely and efficiently in ET+CCND via the GUA approach in selected PTC patients.

Background and Objective: The International Map of Axial Spondyloarthritis (IMAS) explores the physical, psychological, and social experiences of patients with axial spondyloarthritis (axSpA). This initiative is now being expanded to Taiwan as the Taiwanese Map of Axial Spondyloarthritis (TMAS). We aim to provide rheumatologists with insights into the perspectives of Taiwanese patients, enabling physicians to better understand the unmet needs of these patients and optimize their management. Materials and Methods: The TMAS is a cross-sectional study gathering data through an online survey of axSpA patients, promoted by the Ankylosing Spondylitis Caring Society of R.O.C. (ASCARES), conducted from July 2017 to March 2018 by Ipsos, and analyzed by the Health & Territory Research (HTR) group of the University of Seville. The questionnaire includes 99 questions that cover domains such as patient profile, diagnosis, habits/lifestyle, employment status, physical/psychological health status, social support, use of healthcare services, and treatments. Results: A total of 112 axSpA patients were included in this survey. The mean age was 38.6 years and 75.0% were male. The average diagnostic delay was 3 years, and 19.6% reported extra-articular manifestations. Out of the 49 respondents who reported HLA-B27 information, 35 were HLA-B27-positive. The disease burden was high, with a mean BASDAI score of 4.9 and 75.9% having a mild to moderate degree of spinal stiffness. Furthermore, they were socially and psychologically burdened, with 88.4% experiencing work-related issues and 25.9% suffering from anxiety. Conclusions: The TMAS sheds light on the overall perspective of axSpA patients in Taiwan. The TMAS shows shorter diagnostic delay compared to patients from the EMAS. However, high disease activity and significant psychological distress still trouble the patients, causing functional impairments and even leading to career failures. Understanding the perspective of axSpA patients can help rheumatologists adjust treatment strategies to their unmet needs and improve their disease outcomes.

Purpose Readmission is one of the measures of quality of care and potential costs. This study aimed to determine whether lactate dehydrogenase (LDH) is associated with an increased risk of 30-day readmission in gastric cancer. Methods We performed a retrospective study of patients who underwent radical gastrectomy for gastric cancer at our institution between July 2014 and May 2018. Balanced cohorts were created by propensity score matching (PSM) with a 1:1 ratio to generate the elevated LDH (ELDH) group (n = 151) and the low LDH group (Control) (n = 302). To determine the incidence, causes, and risk factors of 30-day readmission, subgroup analyzes were performed and used to develop an efficient prediction model. Results A total of 788 patients met the criteria to be included in the study. The cutoff value for serum LDH was 215.5. After PSM, a total of 302 patients were matched in pairs (ELDH group, n = 151, Control group, n = 151). ELDH levels had a higher risk of readmission (p = 0.005, Odds ratio 3.768, 95% confidence interval 1.493–9.510). The pre-match 30-day readmission rate was 7.2 percent, and common causes of post-match readmission included infection-related symptoms, gastrointestinal symptoms, and gastrointestinal bleeding. Conclusions Patients with preoperative ELDH levels, postoperative complications, and high preoperative American Society of Anesthesiologists Scores had a higher risk of readmission 30 days after surgery.

The increasing carbon emissions from various fossil fuels have led to the search for efficient and clean energy sources to replace them. Proton exchange membrane fuel cells (PEMFCs) are a promising alternative, but the use of platinum as a catalyst material poses challenges due to its limited resources and low abundance. This study proposes an efficient method for platinum recovery while retaining spent membranes. The membrane and catalyst were separated using isopropanol, and the spent membrane was dissolved in a 50% ethanol solution to prepare the precursor for subsequent membrane regeneration. Hydrochloric acid (HCl) was used as the leaching agent, and the experimental parameters such as HCl concentration, H2O2 concentration, contact time, and operating temperature were optimized to achieve the highest platinum leaching rate. Finally, through isothermal leaching experiments, the leaching mechanism was investigated using the shrinking core model, indicating the involvement of both surface chemical and inner diffusion mechanisms in the platinum leaching process, primarily controlled by the inner diffusion mechanism. Under optimal conditions, the platinum leaching rate was about 90%, and the activation energy of the reaction was calculated to be 6.89 kJ/mol using the Arrhenius equation.

Abstract The risk of bisphosphonate-related osteonecrosis of the jaw (BRONJ) in primary Sjogren syndrome (pSS) has rarely been explored. To explore the association between BRONJ and pSS, we conducted a population-based propensity-score-matched cohort study using Taiwan’s National Health Insurance Research Database, including pSS patients receiving antiosteoporotic therapy and patients without pSS receiving antiosteoporotic therapy. A 1:4 matched-pair cohort based on propensity score was created. The stratified Cox proportional hazards model compared the risk of BRONJ in the pSS and non-pSS groups. In the study, 23,280 pSS patients and 28,712,152 controls were enrolled. After matching, 348 patients with pSS receiving antiosteoporotic drugs and 50,145 without pSS receiving antiosteoporotic drugs were included for analysis. The risk of developing BRONJ was 1.96 times higher in pSS patients compared with non-pSS patients after adjustment for age, sex, and comorbidities. No dose–response effect was observed in the bisphosphonate-treated pSS cohorts, documented as the cumulative defined daily doses of either

Abstract Objectives The data concerning the association between Tx and ADs remain unclear and are scarce. This study was undertaken to investigate whether people with Tx are more likely to develop ADs, compared to those without Tx. Methods Individuals who received Tx between 2002 and 2015 were identified and matched on age and sex with individuals without Tx. We performed multivariate and stratified analysis using the Kaplan–Meier method and Cox proportional hazards models in order to estimate the association between Tx and the risk of developing ADs. Results A total of 2550 thymectomized (Txd) patients and 24,664.941 non‐Txd comparison subjects were selected from NHIRD. Tx‐MG (myasthenia gravis) as compared with general population (nonTx‐nonMG), adjusted hazard ratio (aHR) were higher for incident Addison disease (aHR = 10.40, 95% CI 1.01–107), autoimmune hemolytic anemia (aHR = 21.54, 95% CI 2.06–14.8), Hashmoto thyroiditis (aHR = 5.52, 95% CI 1.34–34.7), ankylosing spondylitis (aHR = 2.73, 95% CI 1.09–6.84), rheumatoid arthritis (aHR = 5.25, 95% CI 1.79–15.47), primary Sjogren syndrome (pSS) (aHR = 3.77, 95% CI 1.30–11.0), and systemic lupus erythemtoasus (aHR = 10.40). Tx‐nonMG as compared with general population, aHR were higher for incident autoimmune hemolytic anemia (aHR = 25.50), Hashmoto thyroiditis (aHR = 6.75) and systemic lupus erythematosus (SLE) (aHR = 13.38). NonTx‐MG as compared with general population, aHR were higher for incident Hashmoto thyroiditis (aHR = 6.57), pSS (aHR = 4.50), SLE (aHR = 17.29), and systemic vasculitis (aHR = 25.86). Interpretation In conclusion, based on a retrospective cohort study throughout Taiwan, patients with Tx have a higher risk of new onset ADs than patients without Tx.

ObjectiveTo compare changes in bone mineral density (BMD) in rheumatoid arthritis (RA) patients receiving three-year conventional synthetic disease-modifying anti-rheumatic drugs (csDMARD), tumor necrosis factor-α inhibitors (TNFi), and abatacept.MethodsPatients with RA were recruited from September 2014 to February 2021. Dual-energy X-ray absorptiometry was used to measure BMD at the femoral neck (FN), total hip (TH), and lumbar spine (L1-4) at enrollment and three years later. Changes in the BMD of each regimen group were analyzed. Multiple ordinary least squares regression was used with the dependent variables to develop a model to predict the change in BMD.ResultsA total of 752 participants were enrolled and 485 completed the three-year follow-up period. Of these, 375 (Group I), 84 (Group II), and 26 (Group III) participants received csDMARDs, TNFi, and abatacept therapy, respectively. Considering both type of therapy and completion of the follow-up period, participants were divided into groups A (csDMARDs, n = 104), B (TNFi, n = 52), and C (abatacept, n = 26). Compared to baseline, BMD decreased significantly at FN (p = 0.003) and L1-4 (p = 0.002) in Group A and at L1-4 (p = 0.005) in Group B, but remained stable at all sites in Group C. In terms of regression-adjusted percent change in BMD, there was a significant difference seen at all measured sites between group C compared to both groups A and B (+0.8%, -2.7%, -1.8% at FN; +0.5%, -1.1%, -1.0% at TH; +0.8%, -2.0%, -3.5% at L1-4, respectively; all p < 0.05). Anti-osteoporosis therapy had a BMD-preserving effect in RA.ConclusionCompared with csDMARDs and TNFi, abatacept may have a better BMD-preserving effect in RA. Anti-osteoporosis therapy can prevent systemic bone loss irrespective of RA therapy.

Introduction: Infections are a leading cause of mortality in patients with systemic lupus erythematosus (SLE). Among various infections, invasive fungal infections (IFIs) have a particularly high mortality rate; however, studies examining IFIs in patients with SLE are limited. Methods: Patients diagnosed as having SLE between 1997 and 2012 were enrolled from Taiwan’s National Health Insurance Research Database along with age- and sex-matched non-SLE controls at a ratio of 1:10. IFIs were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification codes and validated by the prescriptions of systemic antifungal agents. The incidence rate (IR), incidence rate ratio (IRR), and all-cause mortality rate of IFIs and its subtypes were analyzed. A Cox multivariate regression model with time-dependent covariates was applied to analyze independent risk factors for IFIs. Results: A total of 24,541 patients with SLE and 245,410 non-SLE controls were included. We observed 445 IFI episodes in the SLE cohort, with an all-cause mortality rate of 26.7%. Candida spp. (52.8%) was the most common pathogen, followed by Cryptococcus spp. (18.2%) and Aspergillus spp. (18.2%). The IR of IFIs in the SLE cohort was 20.83 per 10,000 person-years, with an IRR of 11.1 [95% confidence interval (CI): 9.8–12.6] relative to the non-SLE controls. Juvenile patients with SLE aged ⩽18 years had the highest IRR of 47.2 (95% CI: 26.9–86.8). Intravenous steroid therapy administered within 60 days (hazard ratio: 29.11, 95% CI: 23.30–36.37) was the most critical risk factor for overall IFIs and each of the three major fungal pathogens. Distinct risk factors were found among different IFI subtypes. Conclusion: Patients with SLE had a higher risk of IFIs, especially juvenile patients. Intravenous steroid therapy is the most critical risk factor for IFIs. This study provides crucial information for the risk stratification of IFIs in SLE. Plain Language Summaries Patients with systemic lupus erythematosus and physicians treating this patient group should be aware of the risk of invasive fungal infections. Invasive fungal infections (IFIs) are a severe complication with a high mortality rate among patients with systemic lupus erythematosus (SLE); however, studies on this topic are scant. We performed a nationwide population-based study in Taiwan to estimate the incidence and mortality of and risk factors for IFIs. We found an incidence rate of 20.83 per 10,000 person-years for IFIs, with a mortality rate of 26.7%. Juvenile patients aged ⩽18 years had the highest relative risk of IFIs. Although candidiasis was the most common IFI, cryptococcosis and aspergillosis should be concerned in juvenile patients as well. Intravenous steroid therapy was the most critical risk factor for all IFIs, and different immunosuppressive agents posed different risks in patients for acquiring certain fungal pathogens. Our findings provide pivotal epidemiological information and indicate risk factors for IFIs in patients with SLE. Age and exposure to specific immunosuppressants and steroids might help predict the risk of IFIs. Because the manifestation of these infections is sometimes indistinguishable from a lupus flare, physicians should be aware of this fatal complication, especially when patients are not responsive to immunosuppressive therapy. Early recognition, implication of diagnostic tools, and empirical antimicrobial agents can be the key to treating patients with IFIs. Additional studies are required to develop a risk management program for patients with SLE.

Background: The roles of plasma cell-free (pcf) mitochondrial DNA (mtDNApcf) and nuclear DNA (nDNApcf) in the pathogenesis of systemic lupus erythematosus (SLE) remain unclear. We analyzed the relative copies of mtDNApcf and nDNApcf and investigated their association with the levels of plasma 8-hydroxy-2’-deoxyguanosine (8-OHdG), plasma malondialdehyde (MDA) and mRNA of leukocyte C-type lectin domain family 5 member A (CLEC5A) in SLE patients. Methods: A total of 80 SLE patients and 43 healthy controls (HCs) were enrolled. Their plasma samples were subjected to the measurements of mtDNApcf copies, nDNApcf copies, 8-OHdG and MDA, respectively. Their leukocytes were analyzed for CLEC5A mRNA expression. Results: SLE patients had higher nDNApcf copies (2.84 ± 1.99 vs. 2.00 ± 0.88, p = 0.002), lower mtDNApcf copies (4.81 ± 6.33 vs. 9.83 ± 14.20, p = 0.032), higher plasma 8-OHdG (0.227 ± 0.085 vs. 0.199 ± 0.041 ng/mL, p = 0.016), lower plasma MDA (3.02 ± 2.20 vs. 4.37 ± 2.16 μM, p = 0.001) and similar leukocyte CLEC5A mRNA expression levels (1.21 ± 1.17 vs. 1.26 ± 1.05, p = 0.870), as compared with those of HCs. Among the HCs, SLE patients with SLE Disease Activity Index (SLEDAI) ≤8, and SLE patients with SLEDAI >8, their respective mtDNApcf copies decreased stepwisely (9.83 ± 14.20 vs. 6.28 ± 7.91 vs. 3.19 ± 3.35, p = 0.054). The nDNApcf copies of HCs, SLE patients without nephritis, and SLE patients with nephritis were increased stepwisely (2.00 ± 0.88 vs. 2.63 ± 1.74 vs. 3.16 ± 2.34, p = 0.043). Among SLE patients, higher nDNApcf copies were associated with higher levels of plasma 8-OHdG (p < 0.001) but lower plasma MDA (p = 0.019). Among HCs but not SLE patients, higher nDNApcf copies (p = 0.013) or lower mtDNApcf copies (p < 0.001) were related to higher levels of leukocyte CLEC5A mRNA expression. Conclusions: Higher nDNApcf, lower mtDNApcf, increased ROS-elicited oxidative DNA damage and dysregulated leukocyte CLEC5A expression might be implicated in the pathogenesis of SLE.

BackgroundPrevious study revealed proton pump inhibitors (PPIs) have an effect on gut microbiota. Alteration of the microbiome causes changes of the host immune system and then induces the development of autoimmune diseases (ADs). This study aimed to explore the possible association between PPIs use and ADs.MethodsThis study was conducted using data from the Taiwan National Health Insurance Research Database in the period between 2002 and 2015. We performed multivariate and stratified analysis through the Kaplan-Meier method and Cox proportional hazard models to estimate the association between proton pump inhibitor use and the risk of autoimmune diseases.ResultsOf the 297,099 patients treated with PPI identified, the overall mean (SD) age was 49.17 (15.63) years and 56.28% of the subjects was male. As compared with the non-PPI group, the adjusted hazard ratio (aHR) were higher for incident organ specific ADs such as Graves disease (aHR=3.28), Hashmoto thyroiditis (aHR=3.61), autoimmune hemolytic anemia (aHR=8.88), immune thrombocytopenic purpura (aHR=5.05) Henoch-Schonlein pupura (aHR=4.83) and Myasthenia gravis (aHR=8.73). Furthermore, the adjusted hazard ratio (aHR) were also higher for incident systemic ADs such as ankylosing spondylitis (aHR=3.67), rheumatoid arthritis (aHR=3.96), primary Sjogren syndrome (aHR=7.81), systemic lupus erythemtoasus (aHR=7.03). systemic vasculitis (aHR=5.10), psoriasis (aHR=2.57), systemic scleroderma (aHR=15.85) and inflammatory myopathy (aHR=37.40). Furthermore, we observed no dose-dependent effect between PPI use and the risk of ADs.ConclusionsOur retrospective population-based cohort study showed that the prescription of proton pump inhibitors is associated with a higher risk of ADs.

Background: The clinical features and outcomes of cytomegalovirus (CMV) diseases in patients with systemic lupus erythematosus (SLE) are unknown. We analyzed such data from a medical center in Taiwan. Methods: We retrospectively reviewed the medical records of patients with SLE who were diagnosed with CMV diseases between 2006 and 2016 in Taipei Veterans General Hospital Taiwan. Clinical and laboratory parameters and treatment outcomes were analyzed. Results: The study enrolled 56 eligible patients with CMV diseases and separated them into survival (n = 24) and mortality (n = 32) groups. All cases showed a significantly high incidence of pneumonitis (71.43%). The patients in the mortality group had a higher SLE disease activity index (SLEDAI)-2000 (p = 0.009), more cases of recent methylprednisolone pulse therapy (p = 0.013) and pancytopenia (p = 0.001), stronger evidence of CMV infection demonstrated by polymerase chain reaction (PCR) in blood (p

Background/purpose: To investigate the Janus kinase-1 and 3 (JAK-1 and 3) expression in peripheral blood mononuclear cells (PBMCs) in ankylosing spondylitis (AS). Methods: The levels of JAK-1 and JAK-3 mRNA in PBMCs, CD3+ T cells and CD14+ monocytes were measured by RT-PCR in 52 AS patients and 31 healthy controls (HCs). The demographic features, BASDAI, BASFI, HLA-B27, ESR, CRP and serum immunoglobulin A (IgA) level were recorded and correlated with the JAK-1 & JAK-3 transcripts in patients and HCs as appropriate. Results: JAK-1 and JAK-3 expression in PB CD3+ T cells plus CD14+ monocytes was significantly higher in AS patients than in HCs (p 4) and BASFI (>4) than ESR or CRP in AS patients. Conclusion: In AS, JAK-1 expression in PB cells rather than ESR or CRP might be regarded as a bio-marker for monitoring disease activity and functional index in AS. These findings have also suggested that JAK-1 and JAK-3 expression may play a role in the inflammatory processes in patients with AS. Keywords: Ankylosing spondylitis, Janus kinase (JAK), Acute-phase reactant

In our previous study, we have shown that CRLF1 can promote proliferation and metastasis of papillary thyroid carcinoma (PTC); however, the mechanism is unclear. Herein, we investigated whether the interaction of CRLF1 and MYH9 regulates proliferation and metastasis of PTC cells via the ERK/ETV4 axis. Immunohistochemistry (IHC), qPCR, and Western blotting assays were performed on PTC cells and normal thyroid cells to profile specific target genes. In vitro assays and in vivo assays were also conducted to examine the molecular mechanism. Results showed that CRLF1 directly bound MYH9 to enhance the stability of CRLF1 protein. Inhibition of MYH9 in PTC cells overexpressing CRLF1 significantly reversed malignant phenotypes, and CRLF1 overexpression activated ERK pathway, in vitro, and in vivo. RNA-sequencing revealed that ETV4 is a downstream target gene of CRLF1, which was up-regulated following ERK activation. Moreover, it was revealed that ETV4 is highly expressed in PTC tissues and is associated with poor prognosis. Finally, the ChIP assays showed that ETV4 induces the expression of matrix metalloproteinase 1 (MMP1) by binding to its promoter on PTC cells. Altogether, our study demonstrates that CRLF1 interacts with MYH9, promoting cell proliferation and metastasis via the ERK/ETV4 axis in PTC.

Objectives: The present study aimed to explore the association between spleen density and post-operative outcomes of patients after curative gastrectomy.Methods: From June 2014 to December 2015, we conducted a retrospective study to analyze pertinent clinical data from gastric cancer patients who underwent gastrectomy at the First and the Second Affiliated Hospital of Wenzhou Medical University. Spleen density was determined via computed tomography scans. Univariate and multivariate analyses were performed to determine the risk factors associated with post-operative outcomes after gastric cancer surgery.Results: Three hundred and ninety five patients were included, of whom 98 (24.8%) were defined as having a diffuse reduction of spleen density based on diagnostic cutoff values (spleen density ≤43.89 HU). Multivariate analysis revealed diffuse reduction of spleen density as an independent risk factor for post-operative complications and long-term overall survival.Conclusions: Spleen density can predict severe postoperative complications and long-term overall survival in gastric cancer patients. As an imaging evaluation method, spleen density is a novel tool can be used in clinical as a prognostic predictor for patients with gastric cancer.

Copper thiocyanate (CuSCN) has been gradually utilized as the hole injection layer (HIL) within optoelectronic devices, owing to its high transparency in the visible range, moderate hole mobility, and desirable environmental stability. In this research, we demonstrate quantum dot light-emitting diodes (QLEDs) with high brightness and current efficiency by doping 2,3,5,6-tetrafluoro-7,7,8,8-tetracyanoquinodimethane (F4TCNQ) in CuSCN as the HIL. The experimental results indicated a smoother surface of CuSCN upon F4TCNQ doping. The augmentation in hole mobility of CuSCN and carrier injection to reach balanced charge transport in QLEDs were confirmed. A maximum brightness of 169,230 cd m−2 and a current efficiency of 35.1 cd A−1 from the optimized device were received by adding 0.02 wt% of F4TCNQ in CuSCN, revealing promising use in light-emitting applications.

Background/Purpose: To analyze the real-world clinical practice for the treatment of psoriatic arthritis (PsA) and to assess physicians' prescription, difficulties in diagnosis, therapeutic strategy, rationales for biologic therapies and unmet needs in Taiwan. Methods: We conducted a nationwide cross-sectional observational study by face-to-face in depth interviews with 50 rheumatologists and 30 dermatologists who took care of patients with PsA. Results: The major procedures for recognizing PsA included joint, skin and nail examinations, radiographic imaging, and medical history. More dermatologists established the diagnosis when psoriatic patients with arthritis didn't present with rheumatoid factors (p

To verify the pre-earthquake ionospheric anomaly (PEIA), statistical analyses are implemented on the relationship between the total electron content (TEC) of global ionosphere map (GIM) and 62 M ≥ 6.0 earthquakes in China during 1998 - 2015. A median-based method together with z test is employed to determine the criteria and/or characteristics of TEC anomalies related to earthquakes. It is found that the GIM TEC significantly decreases at 18:00 - 22:00 UT (universal time, post-midnight to pre-dawn) 4 - 5 days before 37 6.0 ≤ M < 6.5 earthquakes, at 01:00 - 04:00 UT (morning) 3 - 6 days before 18 6.5 ≤ M < 7.0 earthquakes, and 04:00 - 10:00 UT (pre-noon to afternoon) 3 - 5 days; but increases 08:00 - 12:00 UT (late afternoon to early evening), 18 - 20 days before 7 M ≥ 7.0 earthquakes. The receiver operating characteristic (ROC) curve is used to compare the TEC anomaly-based method with some competitive alternatives for predicting the earthquakes under study. We found, based on possible TEC anomalies, that the observed PEIAs are significantly earthquake-related. Moreover, the results of regression analyses show that the PEIA strength is associated with the magnitude of earthquakes.

This study investigated GPS TEC fluctuations over the high-latitude site, Tromsø, Norway (69.66°N, 18.94°E), in the solar minimum 2007 - 2008. The TEC fluctuation index Fp that defined by Mendillo et al. (Radio Science 2000) was adopted to quantify TEC fluctuations, in which 50 ≤ Fp < 200 and Fp ≥ 200 respectively represent moderate and strong irregularities. The investigations include the seasonal and temporal variation of Fp; the correlation between Fp and the magnetic indices Kp and AE; the comparisons between Fp and the ionospheric electron density observed by the Tromsø incoherent scatter radar and COSMIC. The results are that Fp ≥ 50 occurred frequently in all seasons but Fp ≥ 200 occurred more frequently in the equinoctial months; Fp ≥ 50 mainly occurred in 18 - 04 LT, and maximized around 22 LT in the equinoctial months. The linear correlation between Fp and Kp was poor but that between Fp and AE was moderate. The maximal Fp and the percentages of Fp ≥ 50 and Fp ≥ 200 increased with Kp and AE; Fp ≥ 200 is nearly negligible when Kp < 4. The high electron density structure that resulted from the auroral activity caused Fp ≥ 50 when it located in the E region or extended from the E region to the F region. The findings are that Fp ≥ 50 at auroral region mainly relates to the auroral activity. The Fp seasonal variation can be explained by the effect of sunlight and the geometry of the magnetotail. Occurrence of irregularities and their maximal intensity are increased with Kp and AE. Strong irregularities almost only occur in the magnetic disturbance period. Irregularities in the E region or in the E and F regions both can cause Fp ≥ 50.

Tin anode slime is a by-product of the tin electrolytic refining process. This study investigated a route to separate Sn, Sb, Bi, and Cu from tin anode slime after leaching with hydrochloric acid. In the solvent extraction process with tributyl phosphate, Sb and Sn were extracted into the organic phase. Bi and Cu were unextracted and remained in the liquid phase. In the stripping experiment, Sb and Sn were stripped and separated with HCl and HNO3. Bi and Cu in the aqueous phase were also separated with chemical precipitation procedure by controlling pH value. The purities of Sn, Sb, Cu solution and the Bi-containing solid were 96.25%, 83.65%, 97.51%, and 92.1%. The recovery rates of Sn, Sb, Cu, and Bi were 76.2%, 67.1%, and 96.2% and 92.4%.

Pathological lymphangiogenesis is associated with various eye diseases. Here the authors show that a carbohydrate-binding protein, galectin-8, promotes pathological lymphangiogenesis in the eye by regulating the crosstalk among VEGF-C, podoplanin and integrin pathways, and thus may represent a useful therapeutic target.

50 billion cubic meters of brine every year creates ecological hazards to the environment. In order to reuse brine efficiently, rubidium and cesium were recovered in this experiment. On the other hand, the main impurities which were needed to be eliminated in brine were lithium, sodium, potassium, calcium, and magnesium. In the procedure, seawater was distilled and evaporated first to turn into simulated brine. Perchloric acid was then added into simulated brine to precipitate potassium perchlorate which could reduce the influence of potassium in the extraction procedure. After that, t-BAMBP and ammonia were separately used as extractant and stripping agent in the extraction and stripping procedures to get rubidium hydroxide solutions and cesium hydroxide solutions. Subsequently, they reacted with ammonium carbonate to get rubidium carbonate and cesium carbonate. In a nutshell, this study shows the optimal parameters of pH value to precipitate potassium perchlorate. Besides, pH value in the system, the concentration of t-BAMBP and ammonia, organic phase/aqueous phase ratio (O/A ratio), reaction time, and reaction temperature in solvent extraction step were investigated to get high purities of rubidium carbonate and cesium carbonate.

The atmospheric Kelvin wave has been widely studied due to its importance in atmospheric dynamics. Since a long-term climatological study is absent in the literature, we have employed the two-dimensional fast Fourier transform (2D-FFT) method for the 40-year long-term reanalysis of the dataset, ERA-Interim, to investigate the properties of Kelvin waves with wavenumbers 1 (E1) and 2 (E2) at 6–24 days wave periods over the equatorial region of ±10° latitude between a 15 and 45 km altitude during the period 1979–2019. The spatio-temporal variations of the E1 and E2 wave amplitudes were compared to the information of stratospheric quasi-biennial oscillation (QBO), and the wave amplitudes were found to have an inter-QBO cycle variation that was related to sea surface temperature and convections, as well as an intra-QBO cycle variation that was caused by interactions between the waves and stratospheric mean flows. Also, the E1 waves with 6–10 day periods and the E2 waves with 6 days period were observed to penetrate the westerly regime of QBO, which has a thickness less than the vertical wavelengths of those waves, and the waves could further propagate upward to higher altitudes. In a case study of the period 2006–2013, the wave amplitudes showed a good correlation with the Niño 3.4 index, outgoing longwave radiation (OLR), and precipitation during 2006–2013, though this was not the case for the full time series. The present paper is the first report on the 40-year climatology of Kelvin waves, and the morphology of Kelvin waves will help us diagnose the anomalies of wave activity and QBO in the future.

Dementia is a common neurological disease that substantially affects public health. A previous study revealed that dementia occurs when the body's immune system attacks the cells of the brain, indicating that dementia may be similar to autoimmune rheumatic diseases (ARDs). In the current retrospective cohort study, we focused on middle-aged ARD patients (45 years or older) to investigate the association between ARDs in middle-aged people and dementia by using a nationwide population-based database in Taiwan.Our study analyzed the medical data of the Taiwanese population from 2001 to 2012, with a follow-up period extending until the end of 2011. We identified middle-aged patients with ARDs by using the Taiwan National Health Insurance Research Database. We selected a comparison cohort from the general population that was randomly frequency-matched by age (in 5-year increments), sex, and index year and further analyzed the dementia risk by using a Cox regression model that considers sex, age, and comorbidities.The study enrolled 34,660 middle-aged ARD patients (77% female, mean age = 59.8 years) and 138,640 controls. The risk of developing dementia was 1.18 times higher for middle-aged patients with ARDs compared with patients without ARDs after adjustment for age, sex, and comorbidities. Among the patients with ARDs, the subgroups with rheumatoid arthritis, systemic lupus erythematosus, and Sjögren syndrome (SS) were associated with a significantly higher dementia risk (adjusted hazard ratio [HR] 1.14, 95% confidence index [CI] 1.06-1.32; adjusted HR 1.07, 95% CI 0.86-1.34; adjusted HR 1.46, 95% CI 1.32-1.63, respectively). Furthermore, primary SS and secondary SS patients had the highest risks of dementia among all the ADR subgroups (adjusted HR 1.35, 95% CI 1.18-1.54; adjusted HR 1.67, 95% CI 1.43-1.95 respectively).This nationwide retrospective cohort study demonstrated that dementia risk is significantly higher in middle-aged patients with ARDs compared with the general population.

Purification of lithium carbonate, in the battery industry, is an important step in the future. In this experiment, the waste lithium-ion batteries were crushed, sieved, leached with sulfuric acid, eluted with an extractant, and finally sulphate solutions were extracted, through selective precipitation. Next, sodium carbonate was first added to the sulphate solutions, to precipitate lithium carbonate (Li2CO3). After that, lithium carbonate was put into the water to create lithium carbonate slurry and CO2 was added to it. The aeration of CO2 and the hydrogenation temperature were controlled, in this experiment. Subsequently, Dowex G26 resin was used to remove impurities, such as the calcium and sodium in lithium carbonate. Moreover, the adsorption isotherms, described by means of the Langmuir and Freundlich isotherms, were used to investigate the ion-exchange behaviors of impurities. After removing the impurities, the different heating rate was controlled to obtain lithium carbonate. In a nutshell, this study showed the optimum condition of CO2 aeration, hydrogenation temperature, ion-exchange resin and the heating rate to get high yields and purity of lithium carbonate.

In recent years, with the increasing research and development of the light-emitting diode (LED) industry, which contains gallium nitride (GaN), it is expected that there will be a large amount of related wastes in the future. Gallium has an extremely high economic value, therefore, it is necessary to establish a recycling system for the GaN waste. However, GaN is a direct-gap semiconductor and with its high energy gap, high hardness, and high melting point, these make it difficult to recycle. Therefore, this study will analyze the physical characteristics of LED wastes containing GaN and carry out various leaching methods to leach the valuable metals from the waste optimally. Different acids are used to find out the best reagent for gallium leaching. Different experimental parameters are discussed, such as the effect of the different acid agents, concentration, pressure, liquid-solid mass ratio, temperature and time, which influence the leaching efficiency of gallium. Finally, acid leaching under high pressure is preferred to leach the GaN waste, and hydrochloric acid is used as the leaching solution because of its better leaching efficiency of gallium. Optimally, the leaching efficiency of gallium can reach 98%.

Mycobacterium-associated lobular panniculitis can mimic a rheumatoid nodule and has been seldom reported in rheumatoid arthritis (RA). We describe a 69-year-old woman with RA who presented initially with fever and an indurated skin lesion on the right thigh. Lobular panniculitis was diagnosed after biopsy and was then treated with prednisolone. After this therapy, pulmonary infiltration developed and was later shown by transbronchial biopsy to be caused by Mycobacterium tuberculosis. The panniculitis skin lesion became smaller after prednisolone therapy and was further improved after antituberculosis drugs were added. Reexamination of the previously biopsied skin tissue disclosed acid-fast bacilli. Reactivation or new infection of M. tuberculosis is a current important issue in RA patients, especially after treatment with disease-modifying anti-rheumatic drugs or antitumor necrosis factor agents. Mycobacterium-associated lobular panniculitis should be included in the differential diagnosis of indurated skin disorder in RA patients, and acid-fast staining or polymerase chain reaction examination of tuberculosis should be performed routinely on biopsied skin tissue.

A 71-year-old man presented with quadriplegia, seizures, dysarthria, motor aphasia and urinary incontinence lasting for several years. The development of proteinuria and increased susceptibility to infections brought the physician's attention to possible underlying autoimmune diseases. Laboratory investigations revealed evidence for systemic lupus erythematosus (SLE) and antiphospholipid syndrome. Imaging studies showed obstructive hydrocephalus. Several courses of methylprednisolone therapies followed by maintenance therapy with low-dose steroid, ventriculoperitoneal shunt, and antihypertensives improved the proteinuria and dysarthria but not the urinary incontinence or dementia. A thromboembolic event in the central nervous system secondary to phospholipid antibodies or lupus activity may represent a pathogenetic basis for hydrocephalus. When encountering a patient with hydrocephalus but without apparent predisposing factors, it is always important to include SLE as a differential diagnosis.

Acute arthritis is a prevalent disease in outpatient clinics and emergency rooms. In the elderly, the symptoms/signs are different from those experienced by young patients. Therefore, the diagnosis and treatment of acute arthritis in the elderly are distinct. Here, we start by examining a case of acute arthritis and then review the literature to learn the principles of managing acute arthritis in the elderly.

Galectins have emerged as potent immunoregulatory agents that control chronic inflammation through distinct mechanisms. Here, we report that treatment with Galectin-8 (Gal-8), a tandem-repeat member of the galectin family, reduces retinal pathology and prevents photoreceptor cell damage in a murine model of experimental autoimmune uveitis. Gal-8 treatment increased the number of regulatory T cells (Treg) in both the draining lymph node (dLN) and the inflamed retina. Moreover, a greater percentage of Treg cells in the dLN and retina of Gal-8 treated animals expressed the inhibitory coreceptor cytotoxic T lymphocyte antigen (CTLA)-4, the immunosuppressive cytokine IL-10, and the tissue-homing integrin CD103. Treg cells in the retina of Gal-8-treated mice were primarily inducible Treg cells that lack the expression of neuropilin-1. In addition, Gal-8 treatment blunted production of inflammatory cytokines by retinal T helper type (TH) 1 and TH17 cells. The effect of Gal-8 on T cell differentiation and/or function was specific for tissues undergoing an active immune response, as Gal-8 treatment had no effect on T cell populations in the spleen. Given the need for rational therapies for managing human uveitis, Gal-8 emerges as an attractive therapeutic candidate not only for treating retinal autoimmune diseases, but also for other TH1- and TH17-mediated inflammatory disorders.

Nature Communications 7: Article number: 11302 (2016); Published: 12 April 2016; Updated: 19 July 2016. In Fig. 6a of this Article the sixth histogram bars were accidentally mislabeled during the production process. The label ‘VEGF-C+anti-β3’ should read ‘VEGF-C+anti-β5’, and ‘Gal-8+anti-β3’ should read ‘Gal-8+anti-β5’.

The trabecular meshwork (TM) cell-matrix interactions and factors that influence Rho signaling in TM cells are thought to play a pivotal role in the regulation of aqueous outflow. The current study was designed to evaluate the role of a carbohydrate-binding protein, galectin-8 (Gal8), in TM cell adhesion and Rho signaling.Normal human TM cells were assayed for Gal8 expression by immunohistochemistry and Western blot analysis. To assess the role of Gal8 in TM cell adhesion and Rho signaling, the cell adhesion and spreading assays were performed on Gal8-coated culture plates in the presence and the absence of anti-β₁ integrin antibody and Rho and Rho-kinase inhibitors. In addition, the effect of Gal8-mediated cell-matrix interactions on TM cell cytoskeleton arrangement and myosin light chain 2 (MLC2) phosphorylation was examined.We demonstrate here that Gal8 is expressed in the TM and a function-blocking anti-β₁ integrin antibody inhibits the adhesion and spreading of TM cells to Gal8-coated wells. Cell spreading on Gal8 substratum was associated with the accumulation of phosphorylated myosin light chain and the formation of stress fibers that was inhibited by the Rho inhibitor, C3 transferase, as well as by the Rho-kinase inhibitor, Y27632.The above findings present a novel function for Gal8 in activating Rho signaling in TM cells. This function may allow Gal8 to participate in the regulation of aqueous outflow.

Human CD93, an epidermal growth factor (EGF)-like domain containing transmembrane protein, is predominantly expressed in the vascular endothelium. Studies have shown that AA4, the homolog of CD93 in mice, may mediate cell migration and angiogenesis in endothelial cells. Soluble CD93 has been detected in the plasma of healthy individuals. However, the role of soluble CD93 in the endothelium remains unclear. Recombinant soluble CD93 proteins with EGF-like domains (rCD93D123, with domains 1, 2, and 3; and rCD93D23, with domains 2 and 3) were generated to determine their functions in angiogenesis. We found that rCD93D23 was more potent than rCD93D123 in stimulating the proliferation and migration of human umbilical vein endothelial cells (HUVECs). Production of matrix-metalloproteinase 2 increased after the HUVECs were treated with rCD93D23. Further, in a tube formation assay, rCD93D23 induced cell differentiation of HUVECs through phosphoinositide 3-kinase/Akt/endothelial nitric oxide synthase and extracellular signal-regulated kinases-1/2 signaling. Moreover, rCD93D23 promoted blood vessel formation in a Matrigel-plug assay and an oxygen-induced retinopathy model in vivo. Our findings suggest that the soluble EGF-like domain containing CD93 protein is a novel angiogenic factor acting on the endothelium.

Clarkson disease, or monoclonal gammopathy-associated idiopathic systemic capillary leak syndrome (ISCLS), is a rare, relapsing-remitting disorder featuring the abrupt extravasation of fluids and proteins into peripheral tissues, which in turn leads to hypotensive shock, severe hemoconcentration, and hypoalbuminemia. The specific leakage factor(s) and pathways in ISCLS are unknown, and there is no effective treatment for acute flares. Here, we characterize an autonomous vascular endothelial defect in ISCLS that was recapitulated in patient-derived endothelial cells (ECs) in culture and in a mouse model of disease. ISCLS-derived ECs were functionally hyperresponsive to permeability-inducing factors like VEGF and histamine, in part due to increased endothelial nitric oxide synthase (eNOS) activity. eNOS blockade by administration of N(?)-nitrol-arginine methyl ester (l-NAME) ameliorated vascular leakage in an SJL/J mouse model of ISCLS induced by histamine or VEGF challenge. eNOS mislocalization and decreased protein phosphatase 2A (PP2A) expression may contribute to eNOS hyperactivation in ISCLS-derived ECs. Our findings provide mechanistic insights into microvascular barrier dysfunction in ISCLS and highlight a potential therapeutic approach. [ABSTRACT FROM AUTHOR]

ZnO nanoparticles (NPs) with excellent optoelectronic properties are widely used as electron transport layers (ETLs) in quantum dot light-emitting diodes (QLEDs). However, the high conductivity of ZnO can lead to charge imbalance and exciton quenching at the emission layer (EML)/ETL interface, seriously limiting the device performance. In this research, three phenylated sulfonate ligands, including sodium benzenesulfonate (SBS), sodium p-toluenesulfonate (STS), and sodium beta-styrenesulfonate (SbSS), were solely introduced onto the ZnO NP surface. Smooth and compact surfaces of ZnO films were obtained after introducing phenylated sulfonate ligands. Additionally, an upward shift in the energy levels of ZnO was observed, leading to a reduction in electron transport and thereby alleviating excess electron injection. The optimized QLED using the SbSS-modified ZnO ETL exhibited the best performance with a maximum luminance of 458 810 cd m-2 and a peak current efficiency of 40.1 cd A-1, which were enhanced by 60.6% and 64.1% compared with those of the control device based on the pristine ZnO ETL. Meanwhile, an extrapolated device lifetime exceeding 1073 hours was anticipated that was 9.3-fold longer than that of the control device. Our experiments demonstrate the impact of phenylated sulfonate molecules on the surface modification of ZnO NPs and the performance of QLEDs, providing valuable insights and support for future developments. [ABSTRACT FROM AUTHOR]