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A better understanding the mechanisms driving plant biomass allocation in different ecosystems is an important theoretical basis for illustrating the adaptive strategies of plants. To date, the effects of habitat conditions on plant biomass allocation have been widely studied. However, it is less known how plant community traits and functions (PCTF) affect biomass allocation, particularly in alpine grassland ecosystems. In this study, community-weighted means (CWM) were calculated at the community level using five leaf functional traits, and the relationships between PCTF and biomass trade-offs were explored using correlation analysis, variation partitioning analysis and structural equation modeling. We found that the trade-off values were greater than zero in both alpine meadow (AM) and alpine steppe (AS) across the Tibetan Plateau, with different values of 0.203 and 0.088 for AM and AS, respectively. Moreover, the critical factors determining biomass allocation in AS were species richness (SR; scored at 0.69) and leaf dry matter content of CWM (CWMLDMC, scored at 0.42), while in AM, the key factors were leaf dry matter content (CWMLDMC, scored at 0.48) and leaf carbon content of CWM (CWMLC, scored at −0.45). In particular, both CWMLDMC and SR in AS, as well as CWMLDMC and CWMLC in AM were primarily regulated by precipitation. In summary, precipitation tends to drive biomass allocation in alpine grasslands through its effects on PCTF, hence highlighting the importance of PCTF in regulating plant biomass allocation strategies along precipitation gradients.

An electrochemical trifluoromethylative cyclization of N-cyanamide alkenes and alkynes is presented, which afforded (bis)-C,N-trifluoromethylated cyclic amidines, azines and amides with selective multiple bond formations in a controllable manner.

Purpose 68Ga-prostate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is valuable for detecting primary and recurrent prostatic lesions. This study aimed to evaluate the efficacy of 68Ga-PSMA-11 PET/CT as a triage tool for prostate biopsy (PSMA-TB) and compare with transrectal ultrasound-guided biopsy (TRUS-GB) for the diagnosis of clinically significant prostate cancer (csPCa). Methods This single-centre study randomly allocated 120 patients with elevated serum prostate-specific antigen (PSA) levels (> 4 ng/ml) to PSMA-PET or TRUS group. Patients with PSMA-avid lesions (SUVmax ≥ 8.0) underwent PSMA-TB via a single-puncture percutaneous transgluteal approach (n = 25), whilst patients with negative PSMA-PET underwent systematic TRUS-GB (n = 35). All patients in the TRUS group underwent TRUS-GB directly (n = 60). Results PCa and csPCa were detected in 26/60 (43.3%) and 24/60 (40.0%) patients in the PSMA-PET group and 19/60 (31.6%) and 15/60 (25.0%) in the TRUS group, respectively. In the PSMA-PET group, the detection rate of PCa and csPCa were significantly higher in PSMA-PET-positive than negative patients (PCa, 23/25 (92.0%) vs 3/35 (8.6%), P P P ; csPCa, 20/25 (80.0%) vs 15/60 (25.0%), P P Conclusions 68Ga-PSMA-11 PET/CT is a feasible imaging technique that may serve as a triage tool for prostate biopsy, and may improve the detection rate of csPCa compared with TRUS-GB, especially in patients with serum PSA 4.0–20.0 ng/ml.

A copper-catalyzed alkene-trifluoromethylation-triggered nitrile insertion/remote functionalization relay process has been achieved, in which "interrupted" remote 1

This retrospective cross-sectional study aimed to evaluate associations between peptic ulcer disease (PUD), bone mineral density, and metabolic syndrome (MetS) and its components in healthy populations. Data were collected from the health examination database of a tertiary medical center in southern Taiwan from January 2015 to December 2016. Subjects who had undergone metabolic factors assessment, upper gastrointestinal endoscopy, and dual energy X-ray absorptiometry scans were enrolled. In total, 5102 subjects were included, with mean age 52.4 ± 12.0 years. Among them, 1332 (26.1%) had PUD. Multivariate logistic regression analysis showed that age (OR 1.03, p < 0.001), male (OR 1.89, p < 0.001), diabetes (OR 1.23, p = 0.004), BMI (OR 1.03, p = 0.001), and GOT (OR 1, p = 0.003) are risk factors for PUD. Regarding MetS parameters, larger waist circumference (OR 1.26, p = 0.001) is associated with PUD, and high triglycerides (OR 1.20, 95% CI 1.01–1.43) is associated with gastric ulcer, while low HDL (OR 1.31, 95% CI 1.07–1.59) and osteoporosis (OR 1.44, 95% CI 1.08–1.91) are associated with duodenal ulcer. In conclusion, central obesity is associated with PUD in a middle-aged healthy population. Subjects with high triglycerides are prone to gastric ulcers, and those with osteoporosis and low HDL are prone to duodenal ulcers.

The purpose of this study was to investigate how pre-hypoxia exposure affected the mitochondrial structure and bioenergetic function of large yellow croaker in responding to Cu stress. Fish were acclimated to normoxia and 3.0 mg DO L−1 for 48 h, then subjected to 0 and 120 μg Cu L−1 for another 48 h. Hypoxic acclimation did not affect mitochondrial ultrastructure and reactive oxygen species (ROS), but reduced oxidative phosphorylation (OXPHOS) efficiency. Cu exposure impaired mitochondrial ultrastructure, increased ROS generation and inhibited OXPHOS efficiency. Compared with Cu exposure alone, hypoxic acclimation plus Cu exposure reduced ROS production and improved OXPHOS efficiency by enhancing mitochondrial respiratory control ratio, mitochondrial membrane potential, and activities and gene expressions of electron transport chain enzymes. In conclusion, hypoxic acclimation improved the mitochondrial energy metabolism of large yellow croaker under Cu stress, facilitating our understanding of the molecular mechanisms regarding adaptive responses of hypoxia-acclimated fish under Cu stress.

Background/Objectives Increased evidence suggests that metabolic syndrome (MetS) is correlated with lung function impairment. This study aimed to explore the associations between MetS risk factors and the lung function. Subjects/Methods The cross-sectional study included 6945 participants attending health examination between 2010 and 2012 in Taiwan. MetS was assessed according to the criteria of National Cholesterol Education Program III. Spirometric parameters were measured to define lung function. The relationships were tested using multiple linear regression and logistic regression analyses. Results The prevalence of MetS was significantly higher in males (16.2%) than females (3.8%). Although the prevalence of restrictive lung disease (RLD) was comparable between genders (20.7 and 21.0%), males with co-existent MetS had a higher prevalence of RLD than females (27.4 vs. 18.0%). Abdominal obesity, indicated by waist circumference (WC) and weight-to-height ratio (WHtR), was the most significant factor associated with lung function decline. Other components of MetS also showed statistically significant relationships, but very weak, with lung function. There was a trend toward an increased prevalence of RLD with the increasing number of MetS scores in males, independent of age, smoking, and body mass index. Conclusions Abdominal obesity was the key component of MetS associated with mechanical effect on lung function impairment in a prime-age adult population. Although RLD was not associated with increased probability of having MetS, the participants with more MetS scores were at a higher risk of losing lung function.

Objective It has been reported that intrinsic apoptosis is associated with the progression of bladder cancer (BC). Recent evidence suggests that polyribonucleotide nucleotidyltransferase 1 (PNPT1) is a pivotal mediator involved in RNA decay and cell apoptosis. However, the regulation and roles of PNPT1 in bladder cancer remain largely unclear. Methods The upstream miRNA regulators were predicted by in silico analysis. The expression levels of PNPT1 were evaluated by real-time PCR, Western blotting, and immunohistochemistry (IHC), while miR-183-5p levels were evaluated by qPCR in BC cell lines and tissues. In vitro and in vivo assays were performed to investigate the function of miR-183-5p and PNPT1 in apoptotic RNA decay and the tumorigenic capability of bladder cancer cells. Results PNPT1 expression was decreased in BC tissues and cell lines. Overexpression of PNPT1 significantly promoted cisplatin-induced intrinsic apoptosis of BC cells, whereas depletion of PNPT1 potently alleviated these effects. Moreover, oncogenic miR-183-5p directly targeted the 3′ UTR of PNPT1 and reversed the tumor suppressive role of PNPT1. Intriguingly, miR-183-5p modulated not only PNPT1 but also Bcl2 modifying factor (BMF) to inhibit the mitochondrial outer membrane permeabilization (MOMP) in BC cells. Conclusion Our results provide new insight into the mechanisms underlying intrinsic apoptosis in BC, suggesting that the miR-183-5p-PNPT1 regulatory axis regulates the apoptosis of BC cells and might represent a potential therapeutic avenue for the treatment of BC.

Background and Aims: Previous studies have implied that insulin resistance (IR) could represent a major underlying abnormality leading to cardiovascular disease (CVD). The aim of this study was to evaluate the relationships between IR (estimated by the homeostasis model assessment of IR (HOMA-IR) index) and CVD risk among middle-aged and elderly Taiwanese individuals. Methods: In this cross-sectional, community-based study, a total of 320 participants were interviewed to collect demographical parameters and blood samples. The recruited participants were divided into tertiles according to their levels of HOMA-IR. The Framingham risk score (FRS) was calculated according to the 2008 general CVD risk model from the Framingham Heart Study. Results: The HOMA-IR index was significantly correlated with the FRS, with a Pearson&rsquo, s coefficient of 0.22. In the multiple logistic regression model, a higher HOMA-IR level was significantly associated with a high FRS (FRS &ge, 20%) (highest tertile vs. lowest tertile of HOMA-IR, crude OR = 3.69, 95% CI = 1.79&ndash, 7.62), even after adjusting for smoking, fasting plasma glucose (FPG), and systolic blood pressure (SBP) (highest tertile vs. lowest tertile of HOMA-IR, adjusted OR = 11.51, 95% CI = 2.55&ndash, 51.94). The area under the receiver operating characteristic curve for the HOMA-IR index as the predictor of high FRS was 0.627, and the optimal HOMA-IR cutoff value was 1.215 (sensitivity = 83.6%, specificity = 42.9%). Conclusions: We considered that HOMA-IR is an independent factor but that it cannot be used solely for evaluating the CVD risk due to the low AUC value. Further prospective cohort studies are warranted to better assess the relationship between CVD risk and insulin resistance.

The combination of single-pixel-imaging and single-photon-counting technology can achieve ultrahigh-sensitivity photon-counting imaging. However, its applications in high-resolution and real-time scenarios are limited by the long sampling and reconstruction time. Deep-learning-based compressive sensing provides an effective solution due to its ability to achieve fast and high-quality reconstruction. This paper proposes a sampling and reconstruction integrated neural network for single-photon-counting compressive imaging. To effectively remove the blocking artefact, a subpixel convolutional layer is jointly trained with a deep reconstruction network to imitate compressed sampling. By modifying the forward and backward propagation of the network, the first layer is trained into a binary matrix, which can be applied to the imaging system. An improved deep-reconstruction network based on the traditional Inception network is proposed, and the experimental results show that its reconstruction quality is better than existing deep-learning-based compressive sensing reconstruction algorithms.

This cross-sectional study aimed to investigate the associations between high-sensitivity C-reactive protein (hs-CRP) and renal impairment (RI) among middle-aged and elderly people. We collected and analyzed demographic, anthropometric, metabolic, and renal function data in a community-based population in Northern Taiwan. We excluded subjects with acute inflammation from this study and defined RI as the presence of urinary albumin&ndash, creatinine ratio 30&ndash, 300 mg/g or an estimated glomerular filtration rate of &lt, 60 mL/min/1.73 m2. There were 131, 125, and 125 participants in the low (&le, 0.80 mg/L), middle (0.81&ndash, 1.76 mg/L), and high (&gt, 1.77 mg/L) hs-CRP tertiles, respectively. hs-CRP exhibited significantly positive correlations with body mass index, waist circumference, systolic blood pressure, triglyceride, and fasting plasma glucose, and a negative correlation with high-density lipoprotein. The prevalence and odds ratio of RI significantly increased across hs-CRP tertiles from low to high, and this trend remained significant after adjusting for the conventional cardiometabolic risk factors. hs-CRP &ge, 1.61 mg/L in the total group and &ge, 2.03 mg/L in the elderly group accurately predicted RI (p = 0.01 and 0.03, respectively). These findings suggest that we should carefully evaluate the renal function for at-risk individuals with hs-CRP elevation.

Body composition (BC) parameters are associated with cardiometabolic diseases in children, however, the importance of BC parameters for predicting pediatric hypertension is inconclusive. This cross-sectional study aimed to compare the difference in predictive values of BC parameters and conventional anthropometric measures for pediatric hypertension in school-aged children. A total of 340 children (177 girls and 163 boys) with a mean age of 8.8 &plusmn, 1.7 years and mean body mass index (BMI) z-score of 0.50 &plusmn, 1.24 were enrolled (102 hypertensive children and 238 normotensive children). Significantly higher values of anthropometric measures (BMI, BMI z-score, BMI percentile, waist-to-height ratio) and BC parameters (body-fat percentage, muscle weight, fat mass, fat-free mass) were observed among the hypertensive subgroup compared to their normotensive counterparts. A prediction model combining fat mass &ge, 3.65 kg and fat-free mass &ge, 34.65 kg (area under the receiver operating characteristic curve = 0.688, sensitivity = 66.7%, specificity = 89.9%) performed better than BMI alone (area under the receiver operating characteristic curve = 0.649, sensitivity = 55.9%, specificity = 73.9%) in predicting hypertension. In conclusion, BC parameters are better than anthropometric measures in predicting pediatric hypertension. BC measuring is a reasonable approach for risk stratification in pediatric hypertension.

Background: Metabolic syndrome (MetS), a prevalent health condition in Taiwan, places individuals at higher risk of cardiovascular disease, diabetes, and stroke. Therefore, the identification of risk factors associated with MetS is crucial. Nevertheless, only limited studies about MetS have been conducted among indigenous peoples in Taiwan; these studies identified a high prevalence of MetS among an indigenous population, which encouraged us to investigate further. Thus, our study aims to determine the prevalence of MetS among the indigenous Taiwanese population and to explore the relationship between MetS and associated risk factors, especially serum alanine transaminase (ALT). Methods: This is an observational, population-based, cross-sectional study that was conducted in remote villages of an indigenous community in northern Taiwan between 2010 and 2015. A total of 454 participants, 47.36% male and 52.64% female, were eligible for analysis. The participants underwent anthropometric assessment and measurements of blood pressure, serum triglyceride levels, fasting plasma glucose levels, serum HDL-C levels and serum ALT levels. MetS was defined based on the revised NCEP/ATPIII criteria from Taiwan Health Promotion Administration. Results: A total of 454 participants were included in the analysis. There were 277 people with MetS and 177 people without. The prevalence of MetS was 61.01%. The average age was 49.50 years old. People with MetS had a significantly higher ALT level (average 31.21±25.00 U/L vs. 23.29±15.98 U/L, p36 U/L) had a tendency towards a higher prevalence of MetS (76.7% vs. 57.3%, p=0.001) than those with normal ALT levels (≤36 U/L). The adjusted odds ratio (OR) of abnormal ALT levels for MetS was 2.58 (95% CI=1.23-5.44, p=0.01). The area under the ROC curve (AUC) of the ALT level was 0.63 (95% CI=0.58-0.68, p36 U/L) were associated with an increased risk of MetS.

Background: This study aimed to quantify the prevalence of chronic kidney disease (CKD) and associated metabolic risk factors in a middle-aged and elderly population in Guishan District, Taoyuan City, Taiwan. Methods: This cross-sectional study enrolled residents aged 50-90 years living in one community. All subjects received a standardized personal interview, including a structured questionnaire, anthropometric measurements, and blood samples collected for laboratory testing. CKD was defined as the presence of kidney damage (urine albumin-creatinine ratio ≥30mg/g) or estimated glomerular filtration rate (eGFR)

Background Coronavirus disease 2019 (COVID-19) has no confirmed specific treatments. However, there might be in vitro and early clinical data as well as evidence from severe acute respiratory syndrome and Middle Eastern respiratory syndrome that could inform clinicians and researchers. This systematic review aims to create priorities for future research of drugs repurposed for COVID-19. Methods This systematic review will include in vitro, animal, and clinical studies evaluating the efficacy of a list of 34 specific compounds and 4 groups of drugs identified in a previous scoping review. Studies will be identified both from traditional literature databases and pre-print servers. Outcomes assessed will include time to clinical improvement, time to viral clearance, mortality, length of hospital stay, and proportions transferred to the intensive care unit and intubated, respectively. We will use the GRADE methodology to assess the quality of the evidence. Discussion The challenge posed by COVID-19 requires not just a rapid review of drugs that can be repurposed but also a sustained effort to integrate new evidence into a living systematic review. Trial registration PROSPERO 2020 CRD42020175648 Supplementary Information The online version contains supplementary material available at 10.1186/s13643-021-01693-7.

ObjectivesThe study aimed to investigate the association of insulin resistance (IR), which was estimated by the homoeostasis model assessment for IR (HOMA-IR), with albuminuria and renal function impairment in a general Chinese population.DesignA retrospective cross-sectional study.Setting and participantsA total of 13 742 adults (age: ≥18 years) who underwent a health check-up at a hospital in Southeast China during 2013–2014 were enrolled. 216 subjects were excluded due to lack of enough fasting time, be pregnant, have chronic diseases influencing metabolic functions or have glomerulonephritis, renal cancer, kidney transplant. Eventually, 7552 men and 5974 women were included for the present analysis.Primary outcome measuresThe association of HOMA-IR with albuminuria and renal function impairment were analysed. The HOMA-IR cut-off value for detecting albuminuria and renal function impairment were determined.ResultsAn increase in the HOMA-IR quartile was significantly associated with the prevalence of albuminuria and renal function impairment in all men and women aged >45 years. The multivariable logistic regression analyses revealed a significant association of the HOMA-IR with albuminuria and renal function impairment in subjects aged >45 years of the fourth quartiles compared with those of the first quartile after adjusting for potential confounders (albuminuria: men OR, 2.39; 95% CI 1.51 to 3.79, p=0.001; renal function impairment: men OR, 2.30; 95% CI 1.50 to 3.51; p45 years and 1.86 in women aged >45 years.ConclusionsOur study revealed that HOMA-IR was significantly associated with albuminuria and renal function impairment in individuals aged >45 years.

Background An optimized protocol to help dispatchers identify potential cases of cardiac arrest and provide phone instructions for cardiopulmonary resuscitation (CPR) may increase the provision of bystander CPR, further improving the survival rate and neurological outcomes. Objective We assessed a revised dispatcher-assisted (DA)-CPR protocol with a continuous quality-improvement feature in a county fire department-based emergency medical services system. Methods This was a before-and-after intervention prospective study conducted in Taoyuan City, Taiwan. The participants were out-of-hospital cardiac arrest (OHCA) patients from November 2014 to February 2016. Interventional quality control started in August 2015. Approximately 10% of the telephone calls from these OHCA patients were reviewed. Results In total, 66 and 64 cases were included in the before- and after-intervention groups, respectively. No significant differences were observed in sex, age, day, and time of events, or languages spoken by the callers. After the intervention, we found significant improvements in the rates at which cardiac arrests were recognized (54.5% vs. 68.8%; p = 0.007) and normal breathing was checked (51.5% vs. 76.6%, p = 0.003). Moreover, the frequency with which DA-CPR was provided by the dispatchers improved significantly (50.0% vs. 72.7%; p = 0.046). Significant improvement in patient outcomes was observed with regard to 24-h survival (7.6% vs. 20.3%, p = 0.036) but not with regard to survival to discharge (3.0% vs. 10.9%, p = 0.076). Conclusions The study found this DA-CPR protocol, which includes continuous quality control, is promising as it improved the successful recognition of cardiac arrests.

Introduction: The psychomotor skill of cardiopulmonary resuscitation emphasized the importance of high-quality chest compression. This investigation examined the effect of self-debriefing and the different materials of debriefing during hands-on cardiopulmonary resuscitation practice for healthcare providers. Methods: This was a randomized controlled trial of a cardiopulmonary resuscitation training program involving emergency medical technicians in northern Taiwan. Participants were blinded to the study purpose and were allocated randomly using the black envelope method. All participants completed a 2-min pre-test of hands-only cardiopulmonary resuscitation using a manikin. Those who were allocated to the control group received self-debriefing with knowledge of pre-test result. Those who were allocated to the experimental group received self-debriefing with an additional biomechanical information of performance of chest compression. A post-test was performed 30 min after the pre-test. Results: A total of 88 participants were enrolled with 44 in each group. There was significant difference of cardiopulmonary resuscitation quality after self-debriefing among all participants (pre- vs post-test adequate rate, 54.7% vs 67.5%, p = 0.028; adequate depth, 41.2% vs 69.5%, p Conclusion: Self-debriefing improved hands-only cardiopulmonary resuscitation quality whether or not biomechanical information of performance of chest compression was given.

Background/Aims: Acute rejection (AR) is a major complication post renal transplantation, with no widely-accepted non-invasive biomarker. This study aimed to explore the expression profiles of long non-coding RNAs (lncRNAs) in the peripheral blood (PB) of renal transplant recipients and their potential diagnostic values. Methods: The genome-wide lncRNA expression profiles were analyzed in 150 PB samples from pediatric and adult renal transplant (PRTx and ARTx) cohorts. The diagnostic performance of differentially expressed lncRNA was determined using receiver operator characteristic curve, with area under the curve (AUC) and 95% confidential interval (CI). Finally, a risk score was constructed with logistical regression model. Results: A total of 162 lncRNAs were found differentially expressed in PRTx cohort, while 163 in ARTx cohort. Among these identified lncRNAs, 23 deregulated accordingly in both cohorts, and could distinguish AR recipients from those without AR. Finally, a risk score with two most significant lncRNAs (AF264622 and AB209021) was generated and exhibited excellent diagnostic performance in both PRTx (AUC:0.829, 95% CI:0.735-0.922) and ARTx cohorts (AUC: 0.889, 95% CI: 0.817-0.960). Conclusion: A molecular signature of two lncRNAs in PB could serve as a novel non-invasive biomarker for the diagnosis of AR in both pediatric and adult renal transplant recipients.

Background Loss of muscle mass was reported to be associated with metabolic syndrome (MetS), but little is known about the gender difference. Thus, the aim of this study was to evaluate the relationship between lower muscle mass and MetS and determine whether there was any gender difference or not. Methods A total of 394 middle-aged and elderly Taiwanese adults (138 males and 256 females) were enrolled and completed our health survey. They were stratified into three groups according to appendicular skeletal muscle mass divided by weight. Participants distributed into the lower tertile were defined as people having lower muscle mass. MetS was defined using the Adult Treatment Panel III Asian diagnostic criteria. Multivariate logistic regression analysis was performed to assess the association between muscle and MetS. Results We found an inverse association between MetS and muscle mass in both males and females. Participants with lower muscle mass had a higher risk of MetS in univariate analysis. The same results were observed when adjusted for age and when also adjusted for living condition factors. However, after additional adjustment for potential confounders and HOMA-IR, we only found it to be statistically significant in the female group (OR in male = 3.60; 95% CI = 0.62–20.83, p = 0.153; OR in female = 3.03; 95% CI = 1.16–7.94, p = 0.024). Conclusions We examined the relationship between lower muscle mass and metabolic syndrome in a middle-aged and elderly Taiwanese population. We found that lower muscle mass was associated with the risk of metabolic syndrome in the aged, particularly in females.

Objective There is lack of scientific evidence regarding the effectiveness of prehospital triage systems. This study compared the two-level Taiwan Prehospital Triage System (TPTS) with the five-level Taiwan Triage and Acuity Scale (TTAS) at ED arrival regarding the prediction of patient outcomes and the utilisation of medical resources. Design This was a retrospective cohort study. Adult patients transported via the emergency medical service (EMS), who arrived at the ED of a medical centre in northern Taiwan during the study period were enrolled. TTAS acuity levels 1–2 were considered comparable to the designation of ‘emergent’ by the prehospital TPTS system. The outcomes were analysed by comparing TPTS and TTAS by acuity levels. Results Among 4430 enrolled patients, 25.2% and 74.8% were classified as emergent and non-emergent by TPTS; 44.1% and 55.9% were classified as levels 1–2 and levels 3–5 by TTAS. Of the TPTS emergent patients, 15.2% were classified as TTAS levels 3–5, whereas 30.4% of TPTS non-emergent transports were classified as TTAS levels 1–2 at the ED. TTAS levels 1–2 showed better predictability than TPTS emergent level for hospitalisation rate with a sensitivity of 70.3% (95% CI 68.3% to 72.2%) versus 41.1% (95% CI 39.0% to 43.2%), and a negative predictive value of 74.8% (95% CI 73.4% to 76.0%) versus 62.6% (95% CI 61.7% to 63.5%). Conclusion The current prehospital triage system is insufficient and inappropriate in classifying patients transported to the ED. The present study offers supporting evidence for the introduction of a five-level triage system to prehospital EMS systems.

// Chang-Cheng Zhou 1,* , Wen-Tao Yao 1,* , Yu-Zheng Ge 1 , Lu-Wei Xu 1 , Ran Wu 1 , Xiao-Fei Gao 2 , Kai-Wei Song 1 , Xiao-Min Jiang 2 , Min Wang 1 , Wen-Juan Huang 3 , Yun-Peng Zhu 1 , Liang-Peng Li 4 , Liu-Hua Zhou 1 , Zhong-Le Xu 1,5 , Sheng-Li Zhang 1 , Jia-Geng Zhu 1 , Wen-Cheng Li 1 and Rui-Peng Jia 1 1 Department of Urology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 2 Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 3 Department of Nephrology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 4 Department of Cardiothoracic Surgery, Nanjing First Hospital, Nanjing Medical University, Nanjing, China 5 Department of Radiology, Nanjing First Hospital, Nanjing Medical University, Nanjing, China * These authors have contributed equally to this work Correspondence to: Rui-Peng Jia, email: // Yu-Zheng Ge, email: // Keywords : remote ischemic conditioning, contrast-induced acute kidney injury, randomized controlled trial, meta-analysis, trial sequential analysis Received : December 21, 2016 Accepted : May 12, 2017 Published : May 23, 2017 Abstract Objective: We conducted this meta-analysis to examine the effect of remote ischemic conditioning (RIC) on contrast-induced acute kidney injury (CI-AKI) in patients undergoing intravascular contrast administrationon. Methods: Pubmed, Embase, and Cochrane Library were comprehensively searched to identify all eligible studies by 15th March, 2017. Risk ratio (RR) and weighted mean difference with the corresponding 95% confidence intervals (CI) were used to examine the treatment effect. The heterogeneity and statistical significance were assessed with Q-test and Z-test, respectively. Results: A total of 16 RCTs including 2175 patients were eventually analyzed. Compared with the control group, RIC could significantly decrease the incidence of CI-AKI (RR=0.58; 95% CI: 0.46, 0.74; P < 0.001), which was further confirmed by the trial sequential analysis. Subgroup analyses showed that remote ischemic preconditioning (RIPrC) and remote ischemic postconditioning (RIPoC) were both obviously effective, and perioperative hydration might enhance the efficiency of RIC. RIC also significantly reduced the major adverse cardiovascular events within six months. Conclusion: RIC, whether RIPrC or RIPoC, could effectively exert renoprotective role in intravascular contrast administration and reduce the incidence of relevant adverse events.

Introduction Traumatic brain injury (TBI) is an important issue in the emergency department. In the United States, the American College of Emergency Physicians (ACEP) published clinical guideline to select patients with mild head injuries for head computed tomography (CT) scans in 2008. The aim of this study was to identify the possible benefits of compliance with these guidelines for mild head injury patients in Taiwan. Method This was a secondary analysis on our previous study published for association of hypertension and head injuries. In our previous study, we collected data about 1290 patients with head injuries who received brain CT scans in the emergency department from September 2012 to August 2013 for a study regarding the association between head injury and hypertension. In present study, we subjected this data to further analysis to try to validate the ACEP clinical policy for mild head injuries. Results Of these 1,290 patients, 154 were found to have brain haemorrhage on the initial brain CT scan, and 5 were in need of neurosurgical intervention. A total of 859 patients met the ACEP guideline criteria, and 117 of these had brain haemorrhages. The sensitivity and specificity of the ACEP guideline to predict brain haemorrhage were 75.97% (95% confidence interval [CI], 68.44% to 82.48%) and 34.68% (95% CI, 31.91% to 37.53%), respectively. In predicting neurosurgical intervention, the sensitivity and specificity of the guideline were 100% (95% CI, 47.82% to 100%) and 33.54% (95% CI, 30.96% to 36.2%), respectively. Conclusion Although adoption of the ACEP clinical policy may reduce the number of brain CT scans in mild head injury patients who may need neurosurgical interventions, it is not a good selection tool in Taiwan.

Background: Clear cell renal cell carcinoma (ccRCC) is the most prevalent histologic subtype of kidney cancers in adults, which could be divided into two distinct subgroups according to the BRCA1 associated protein-1 (BAP1) mutation status. In the current study, we comprehensively analyzed the genome-wide microRNA (miRNA) expression profiles in ccRCC, with the aim to identify the differentially expressed miRNAs between BAP1 mutant and wild-type tumors, and generate a BAP1 mutation-specific miRNA signature for ccRCC patients with wild-type BAP1. Methods: The BAP1 mutation status and miRNA profiles in BAP1 mutant and wild-type tumors were analyzed. Subsequently, the association of the differentially expressed miRNAs with patient survival was examined, and a BAP1 mutation-specific miRNA signature was generated and examined with Kaplan-Meier survival, univariate and multivariate Cox regression analyses. Finally, the bioinformatics methods were adopted for the target prediction of selected miRNAs and functional annotation analyses. Results: A total of 350 treatment-naive primary ccRCC patients were selected from The Cancer Genome Atlas project, among which 35 (10.0%) subjects carried mutant BAP1 and had a shorter overall survival (OS) time. Furthermore, 33 miRNAs were found to be differentially expressed between BAP1 mutant and wild-type tumors, among which 11 (miR-149, miR-29b-2, miR-182, miR-183, miR-21, miR-365-2, miR-671, miR-365-1, miR-10b, miR-139, and miR-181a-2) were significantly associated with OS in ccRCC patients with wild-type BAP1. Finally, a BAP1 mutation-specific miRNA signature consisting of 11 miRNAs was generated and validated as an independent prognostic parameter. Conclusions: In summary, our study identified a total of 33 miRNAs differentially expressed between BAP1 mutant and wild-type tumors, and generated a BAP1 mutation-specific miRNA signature including eleven miRNAs, which could serve as a novel prognostic biomarker for ccRCC patients with wild-type BAP1.