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Human leukocyte antigen (HLA)-B27 is the genetic marker for ankylosing spondylitis (AS). Here, we generated induced pluripotent stem cells (iPSCs) from peripheral blood mononuclear cells of a male AS patient carrying HLA-B27 with syndesmophyte formation by using the Sendai-virus delivery system. The resulting iPSCs had a normal karyotype, expressed pluripotent markers, and could differentiate into three germ layers. This cellular model will provide a platform for studying pathological mechanisms of new bone formation in HLA-B27 positive AS patients.

Purpose:. The purpose of this study is to demonstrate the feasibility and safety of the Senhance robotic system in urologic surgeries. Materials and methods:. Patients were included prospectively from July 2018 to December 2020. The exclusion criteria included severe cardiopulmonary diseases and previous extensive abdominal surgeries. Institutional approval and informed consent were obtained. We used the Clavien-Dindo classification system to evaluate the complications that occurred within 30 days after surgery. Common technical and mechanical events encountered were also recorded. Results:. A total of 173 patients were recruited. The median age was 65 (58–74) years, and the median body mass index was 24.7 (16.5–35.6) kg/m2. Seventeen (9.8%) patients had previously undergone abdominal surgeries. Eighty-three (48%) cases had total extraperitoneal hernioplasty and 32 (18.5%) cases radical prostatectomy, which were the largest 2 surgeries in our study. Sixty-one (35.3%) patients received surgeries due to malignancy. The median docking time was 5 (1–35) minutes. There were 28 (16.2%) cases with grade I complications and 9 (5.2%) cases with grade II complications. Only one case of a grade IIIb complication occurred during radical prostatectomy. No grade IV complications or mortalities were noted. Robotic arm collisions and forces exceeding the limit were the most commonly encountered problems intraoperatively. Conclusion:. In our initial experiences, the Senhance robotic system was feasible in oncologic and nononcologic urologic surgeries and had acceptable outcomes. The haptic feedback system is unique and requires a learning period. This system may serve as an alternative tool for robotic urologic surgeries.

Abstract Structural flexibility is a critical issue that limits the application of metal-organic framework (MOF) membranes for gas separation. Herein we propose a mixed-linker approach to suppress the structural flexibility of the CAU-10-based (CAU = Christian-Albrechts-University) membranes. Specifically, pure CAU-10-PDC membranes display high separation performance but at the same time are highly unstable for the separation of CO2/CH4. A partial substitution (30 mol.%) of the linker PDC with BDC significantly improves its stability. Such an approach also allows for decreasing the aperture size of MOFs. The optimized CAU-10-PDC-H (70/30) membrane possesses a high separation performance for CO2/CH4 (separation factor of 74.2 and CO2 permeability of 1,111.1 Barrer under 2 bar of feed pressure at 35°C). A combination of in situ characterization with X-ray diffraction (XRD) and diffuse reflectance infrared Fourier transform (DRIFT) spectroscopy, as well as periodic density functional theory (DFT) calculations, unveils the origin of the mixed-linker approach to enhancing the structural stability of the mixed-linker CAU-10-based membranes during the gas permeation tests.

Background: The prevalence of rectal chlamydia among men who have sex with men (MSM) without human deficiency virus infection (non-HIV) remains uncertain in Taiwan, and rectal lymphogranuloma venereum (LGV) among MSM has never been reported in the Far East. Material and methods: From January 2020 to April 2022, MSM coming for anonymous voluntary counseling and testing, for pre-exposure prophylaxis, and for antiretroviral therapy were enrolled. All participants submitted his fecal samples and completed a QR-code questionnaire. Medical records of those who took regular medical visits for HIV were recorded. Multiplex polymerase chain reaction (PCR) was performed for all fecal samples, and ompA gene sequencing was therefore performed for each Chlamydia-positive fecal sample. Results: Among 341 MSM during 2020–2022 in southern Taiwan, 21 (6.2%) had rectal chlamydia infection. Risk factors of rectal chlamydia included co-infection with rectal gonorrhea (adjusted odds ratio [AOR] 6.78, 95% confidence interval [CI] 1.44–31.91, P = 0.015) and multiple sexual partners (AOR 1.373, 95% CI 1.002–1.882, P = 0.048). Further ompA gene sequencing from 19 Chlamydia-positive fecal samples revealed that the prevalent genotypes or genovariants were Da (26.3%) and L2b (26.3%), followed by B (21.1%), J (14.3%), and G (9.5%). All cases of rectal LGV genovariant L2b presented as acute proctitis with diarrhea, anal pain, or discharge and were treated successfully with prolonged treatment of doxycycline. Conclusions: Rectal gonorrhea and multiple sexual partners are risk factors for rectal chlamydia. Clinicians in Taiwan should be aware of the emerging threat of rectal LGV among MSM with acute proctitis.

Background/Aims: Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate in hepatitis B surface antigen (HBsAg)-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort. Methods: From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcome and factors associated with HBVr were analyzed. Results: After a median follow-up period of 3.3 years, 21 patients developed HBVr, among whom 17 patients were positive for hepatitis B core antibody (anti-HBc) and four were negative. Thirteen patients had clinical hepatitis flare, while eight patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, undetectable serum hepatitis B surface antibody level at rituximab initiation and a higher average rituximab dose were associated with a higher HBVr rate. There was no significant difference in the HBVr risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBVr (4/368, 1.1%) compared with those who received vaccination (0/126, 0%). Conclusions: In HBV endemic areas where occult HBV is prevalent, anti-HBc-negative patients, may still be at risk for HBVr after rituximab exposure. HBVr may still be considered in HBsAg-negative patients developing abnormal liver function after rituximab exposure, even in patients with negative anti-HBc.

Background: Neutrophil extracellular traps (NETs) play important roles in sepsis and deep-seated infections, but whether NET formation correlates with clinical outcomes of patients with streptococcal bloodstream infections (BSIs) is unclear. Methods: We analyzed serum levels of complexes of myeloperoxidase and DNA (MPO-DNA) in patients with streptococcal-BSIs. In vitro assay of NET induction by serum from BSI patients was performed. Results: MPO-DNA values for the Streptococci-BSI group (n = 59) were significantly higher than those for healthy controls (p 1.87 μg/mL) were higher in abscess-prone streptococcal groups (streptococcus milleri group) (72.2% vs. 52.5%, p = 0.02). For patients with BSIs due to highly infective endocarditis (IE)-prone pathogens, the values of serum MPO-DNA were also higher in patients diagnosed of IE compared to their counterparts (p = 0.009). Notably, serum from patients with leukopenia could induce higher amounts of in vitro NET formation, despite having low MPO-DNA levels, suggesting that NET formation could be influenced by WBC counts. Therefore, we combined WBC counts with MPO-DNA to predict all-cause 30-day mortality in patients with commensal streptococcal-BSIs. The mortality risk was lowest among patients who had neither high MPO-DNA levels nor abnormal WBC counts (p = 0.058). Furthermore, this group of patients also had a favorable composite outcome consisting of major adverse cardiovascular events (MACE) and all-cause mortality (p = 0.026). Conclusion: Together, these study data suggested that serum MPO-DNA can be a biomarker for predicting a composite outcome consisting of MACE and all-cause mortality in patients with commensal streptococcal-BSIs.

Abstract Malaria parasites such as Plasmodium falciparum have exerted formidable selective pressures on the human genome. Of the human genetic variants associated with malaria protection, beta thalassaemia (a haemoglobinopathy) was the earliest to be associated with malaria prevalence. However, the malaria protective properties of beta thalassaemic erythrocytes remain unclear. Here we studied the mechanics and surface protein expression of beta thalassaemia heterozygous erythrocytes, measured their susceptibility to P. falciparum invasion, and calculated the energy required for merozoites to invade them. We found invasion-relevant differences in beta thalassaemic cells versus matched controls, specifically: elevated membrane tension, reduced bending modulus, and higher levels of expression of the major invasion receptor basigin. However, these differences acted in opposition to each other with respect to their likely impact on invasion, and overall we did not observe beta thalassaemic cells to have lower P. falciparum invasion efficiency for any of the strains tested.

The Taiwan Cancer Registry (TCR) is a nationwide population-based registry that collects the data of patients with newly diagnosed cancer from hospitals with ≥50 beds. TCR data are high quality in terms of completeness and timeliness. However, accuracy is also a crucial quality indicator. This study evaluated the accuracy rates of selected 55 major items in the long-form TCR data between 2014 and 2016 with 700 reported cases randomly selected from 25 long-form-reporting hospitals. We calculated the accuracy rates of the reported data by employing a reabstracted chart review. Among the 55 items, the accuracy rates of 38 (69%) were at least 95%, those of 10 (18%) were between 90% and 95%, those of 5 (9%) were between 85% and 90%, and the remaining 2 (4%) were between 80% and 85%. This demonstrates a high degree of accuracy in the TCR long-form data.

Until now, there are no approved treatment against COVID-19. Hydroxychloroquine (HCQ) was hypothesized to be active against SARS-CoV2 via antiviral and anti-inflammatory effect; however, HCQ for COVID-19 in clinical use remained debating. In this preliminary report, we presented six patients with mild to moderate COVID-19. They were treated with HCQ for 14 days from the day of COVID-19 diagnosis. Serial viral load from respiratory specimens were performed every other day. Cytokine profile was checked before HCQ initiation and on the 14th day of HCQ treatment. All patients receiving HCQ completed 14-day course without complication. Among the six patients, the mean duration from symptom onset to last detectable viral load was 34 ± 12 days, which was similar to those without specific treatment in previous reports. Low level of interferon-gamma was noted in all patients of different stage of infection and three patients had elevation of IL-17 level. Prolonged virus shedding is still observed regardless HCQ. The impact of HCQ on cytokine kinetics remained unclear; however, IL-17 could be an inflammatory marker for disease status monitor and a potential therapeutic target.

Abstract Background Unintentional introgression from genetically modified (GM) oilseed rape (Brassica napus) to a relative is inevitable in the open field. A feasible and practical strategy for restricting the spread of GM offspring is to set a reasonable isolated distance between GM B. napus and the relatives. To define the isolated distance, a pollen donor/recipient pair is a prerequisite to conducting the field trial of pollen flow. However, because the cultivation of GM B. napus is prohibited in Taiwan, it is difficult to obtain relevant information. Thus, this study explored the morphological and genetic characteristics of five varieties of B. napus (donor), three varieties of B. rapa (recipient), and the 15 corresponding F1 hybrids, aiming to construct phenotypic data and genetic variation data and to select the most appropriate pollen donor/recipient for future field trials of pollen flow. Results The genome size of all F1 hybrids estimated using flow cytometry showed intermediate DNA content between B. napus and B. rapa varieties. Most of the F1 hybrids had intermediate plant height and blooming period, and the rosette leaves type and colors resembled those of B. napus varieties. The results of sequence-related amplified polymorphism (SRAP) showed an average of 9.52 bands per primer combination and 67.87 polymorphic bands among the F1 hybrid population. Similarity and cluster analyses revealed higher similarity between F1 hybrids and B. napus varieties than between F1 hybrids and B. rapa varieties. Furthermore, we identified a specific 1100-bp band (LOC106302894) in F1 hybrids and B. napus varieties but not in B. rapa varieties. Conclusions The rosette leaves and the DNA marker LOC106302894 observed in F1 hybrids are consistent phenotypic and genetic characteristics that can be used to identify the presence of unintentional hybridization from B. napus to B. rapa in Taiwan. Due to the prohibition of GM crop cultivation, the hybridization system of non-GM Brassica species in this study can be utilized as a mimic scheme to conduct pollen flow trials, thus facilitating the determination of the proper isolated distance.

Progressive multifocal leukoencephalopathy (PML) is a rare viral demyelinating disease of central nervous system. Immunosuppression is a significant risk factor for the disease. Previously, PML developed more commonly in patients of hematological malignancy and acquired immune deficiency syndrome (AIDS). In the era of biological disease modifying anti-rheumatic drugs, PML is more frequently reported in patients of autoimmune diseases. However, for its rarity and unspecific clinical presentations, accurate diagnosis and immediate immune restoration might be difficult in clinical practice, and the outcome might thus be miserable. Herein we present a 27-year-old lady of systemic lupus erythematosus (SLE) – rheumatoid arthritis overlap syndrome with suspected involvement of central nervous system. Neuropsychiatric SLE was suspected first. However, after intensive immunosuppressive treatment, the condition kept deteriorating. An alternative diagnosis was thus considered. PML was suspected for her immunosuppressive status and suggestive radiological findings, and the diagnosis was confirmed by a polymerase chain reaction of JC virus from cerebrospinal fluid. After restoring the immune status by decreasing the dose of immunosuppressants, the condition of the patient improved significantly. We report this case to raise the importance of clinical alertness for the rare but possibly underdiagnosed disease. Keywords: Antirheumatic agents, Rheumatoid arthritis, Immunosuppressive agents, Progressive multifocal leukoencephalopathy, Systemic lupus erythematosus

The global incidence and prevalence of inflammatory bowel disease (IBD) has increased over the last 2-4 decades, likely because of the adoption of a more “western” lifestyle as well as improved detection and awareness, and Taiwan is no exception. To characterize the increasing burden of IBD, we conducted a comprehensive review of IBD in the existing literature. The following parameters were reviewed: background knowledge and current standard care for IBD, including natural history, epidemiology, pathogenesis, diagnosis, monitoring, and treatment. In addition, new imaging modalities and treatment options such as combined positron emission tomography and magnetic resonance enterography, new biologic agents, small-molecule therapy, biosimilar therapeutics, mesenchymal stem cell transplantation, and fecal microbiota transplantation, all of which have been introduced for IBD management, were reviewed. We also used the hospital-based as well as population-based Taiwan National Health Insurance Research Database to assess Taiwan-specific trends for comparison with global trends. Keywords: Inflammatory bowel disease, 2018, Update

Locating and calculating the number of asbestos-cement corrugated roofing tiles is the first step in the demolition process. In this work, archived image cubes of Taiwan served as the fundamental data source used via machine learning approach to identify the existence of asbestos-cement corrugated roofing tiles with more than 85% accuracy. An adequate quantity of ground-truth data covering all the types of roofs via aerial hyperspectral scan was the key to success for this study. Twenty randomly picked samples from the ground-truth group were examined by X-ray refraction detection to ensure correct identification of asbestos-cement corrugated roofing tiles with remote sensing. To improve the classifying accuracy ratio, two different machine learning algorithms were applied to gather the target layers individually using the same universal training model established from 400 ground-truth samples. The agreement portions within the overlapping layers of these two approaches were labeled as the potential targets, and the pixel growth technique was performed to detect the roofing boundary and create the polygon layer with size information. Exacting images from aerial photos within the chosen polygon were compared to up-to-date Sentinel-1 images to find the temporal disagreements and remove the mismatched buildings, identified as non-asbestos roofs, from the database to reflect the actual condition of present data. This automatic matching could be easily performed by machine learning to resolve the information lag while using archived data, which is an essential issue when detecting targets with non-simultaneous acquired images over a large area. To meet the 85% kappa accuracy requirement, the recurring processes were applied to find the optimal parameters of the machine learning model. Meanwhile, this study found that the support vector machine method was easier to handle, and the convolution neuro network method offered better accuracy in automatic classification with a universal training model for vast areas. This work demonstrated a feasible approach using low-cost and low-resolution archived images to automatically detect the existence of asbestos-cement corrugated roofing tiles over large regions. The entire work was completed within 16 months for an area of 36,000 km2, and the detected number of asbestos-cement corrugated roofing tiles was more than three times the initial estimation by statistics method from two small-area field surveys.

Blepharoptosis is defined as an abnormal low-lying upper eyelid margin in primary gaze. Without adequate management, the disease may cause amblyopia, strabismus, and astigmatism in children as well as constriction of the upper visual field, blurred vision, increased tearing, fatigue, and frontal headache in adults. In most cases of blepharoptosis, surgical intervention is the primary treatment. However, the risk of recurrence is high, and some complications may occur after the surgical intervention. Although ptosis crutches and magnetic eyelid devices have been reported to be beneficial for managing the disease, many disadvantages must be overcome. To avoid sequelae from the disease and to mitigate the discomfort and complications, this study proposes a novel assistance system. In this system, a controllable permanent electromagnet and a piece of iron sheet affixed to the paralytic upper eyelid were used for elevating the drooping eyelid according to the degree of the eyelid being opened or closed, as estimated by an optical probe. Finally, the performance of the proposed system in detecting eyelid actions and the effect of eyelid elevation were validated. The experimental results showed that the proposed system could effectively detect eyelid closing events and successfully, symmetrically, and synchronously elevate the drooping upper eyelid with a mean correction of 3.5 ± 0.4 mm (range, 2.7 - 4.0 mm) in 14 patients with unilateral blepharoptosis. The proposed system therefore may be applied to patients with unilateral blepharoptosis in the future.

The purpose of this manuscript was to provide a better understanding of patients with intralenticular foreign bodies (FBs) and also to review the reported cases, including clinical presentation, diagnosis, management, and visual outcome. A 50-year-old male was referred to our clinic with suspected intraocular FB. Under slit-lamp examination, a full-thickness corneal wound with localized corneal edema at the temporal lower peri-limbal area was revealed. Seidel test did not indicate any wound leakage. The corresponding iris was depigmented, but there was no penetrating hole. The anterior chamber was deep with cells, but the lens, vitreous, and fundus were normal. B-scan ultrasonography and orbital computed tomography were performed, but no intraocular FB was detected. On the 2nd day, a zonal cortical cataract and posterior subcapsular cataract formed rapidly. Left-eye bare vision dramatically decreased from 20/100 to counting fingers. One month later, the patient received elective extracapsular cataract extraction. A fine metal thread was completely embedded in the lens; the lens and FB were removed together during the operation. The posterior capsule was not injured; an intraocular lens was implanted in the capsular bag. Two months postoperatively, left-eye vision had returned to 20/25. No adverse events were noted during the follow-up period. In addition to the case report, some 28 previously reported cases of intralenticular FB are reviewed here. Patient demographics, time and course of management, and visual outcome are all summarized and compared.

Summary: Background: The frail older population is increasing rapidly. More understanding for the frail status and quality of life (QOL) among older adults is important. Methods: This study was a cross-sectional survey. The Fried Frailty Criteria (FFC), Barthel Index scale, and World Health Organization Quality of Life questionnaire (WHOQOL-BREF) were used as measurements for all participants. In total, 180 frail or pre-frail older adults were recruited and completed all questionnaires. Results: The slow working speed and weakness of grip strength were two significant FFC criteria for lower scores of QOL (t = 2.89, 2.41; p

The authors describe a thermofluidic chip on which microscale islands of controlled temperature are formed within an open fluidic environment. The chip forms part of the authors’ technology for thermally controlled DNA synthesis, whereby the site-specific temperature control enables site-specific addressability of chemical reactions, for example, related to the phosphoramidite cycle. Here, the authors discuss the principle of the chip, supporting the thermal well concept by means of simulations as well as by showing a prototype thermal array device.

The bionator is one of the most commonly used functional appliances in treating Angle Class II division 1 malocclusions. However, the original type of bionator often causes lower incisor flaring and is limited in cases with mild crowding. There is little published literature on treating Angle Class II division 2 malocclusions using bionators. Our group suggested some modifications to the original-type bionator, including addition of an anterior resin cap, upper and lower labial bows, an expansion screw and a posterior resin wedge, to attempt to overcome limitations of the original design. This article shows our results on two male patients, one with an Angle Class II division 1 malocclusion with a large overjet and the other with an Angle Class II division 2 malocclusion. The treatment was completed using a newly modified bionator with no other fixed appliance and resulted in a decrease in facial convexity, a reduced overjet and overbite, ideal interincisal relationships, and a harmonious profile.