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Over the past decades, the treatment of ST-segment elevation myocardial infarction (STEMI) has been redefined with the incorporation of evidence from multiple clinical trials. Recommendations from guidelines are updated regularly to reduce morbidity and mortality. However, heterogeneous care systems, physician perspectives, and patient behavior still lead to a disparity between evidence and clinical practice. The quality of care has been established and become an integral part of modern healthcare in order to increase the likelihood of desired health outcomes and adhere to professional knowledge. For patients with STEMI, measuring the quality of care is a multifactorial and multidimensional process that cannot be estimated solely based on patients' clinical outcomes. The care of STEMI is similar to the concept of "the chain of survival" that emphasizes the importance of seamless integration of five links: early recognition and diagnosis, timely reperfusion, evidence-based medications, control of cholesterol, and cardiac rehabilitation. Serial quality indicators, reflecting the full spectrum of care, have become a widely used tool for assessing performance. Comprehension of every aspect of quality assessment and indicators might be too demanding for a physician. However, it is worthwhile to understand the concepts involved in quality improvement since every physician wants to provide better care for their patients. This article reviews a fundamental approach to quality care in STEMI.

The prognosis of systemic lupus erythematosus (SLE) is unpredictable. This study aimed to examine the regulatory mechanism of the AHR/TET2/NT5E pathway during SLE progression. The AHR, TET2 and NT5E expression levels were examined in T regulatory cells (Tregs) of patients with SLE. The correlation of AHR, TET2 or NT5E expression levels with the immunosuppressive functions of Tregs was analysed. In patients with SLE, the number of CD4

The cellular process responsible for the degradation of cytosolic proteins and subcellular organelles in lysosomes was termed "autophagy." This process occurs at a basal level in most tissues as part of tissue homeostasis that redounds to the regular turnover of components inside cytoplasm. The breakthrough in the autophagy field is the identification of key players in the autophagy pathway, compounded under the name "autophagy-related genes" (ATG) encoding for autophagy effector proteins. Generally, the function of autophagy can be classified into two divisions: intracellular clearance of defective macromolecules and organelles and generation of degradation products. Therapeutic strategies using stem cell-based approach come as a promising therapy and develop rapidly recently as stem cells have high self-renewability and differentiation capability as known as mesenchymal stem cells (MSCs). They are defined as adherent fibroblast-like population with the abilities to self-renew and multi-lineage differentiate into osteogenic, adipogenic, and chondrogenic lineage cells. To date, they are the most extensively applied adult stem cells in clinical trials. The properties of MSCs, such as immunomodulation, neuroprotection, and tissue repair pertaining to cell differentiation, processes to replace lost, or damaged cells, for aiding cell repair and revival. Autophagy has been viewed as a remarkable mechanism for maintaining homeostasis, ensuring the adequate function and survival of long-lived stem cells. In addition, authophagy also plays a remarkable role in protecting stem cells against cellular stress when the stem cell regenerative capacity is harmed in aging and cellular degeneration. Understanding the under-explored mechanisms of MSC actions and expanding the spectrum of their clinical applications may improve the utility of the MSC-based therapeutic approach in the future.

This study examines the blame avoidance (BA) strategies that may be adopted after policy failures of multiple agencies. A classification of agencies is proposed based on two factors: the amount of actual responsibility that an agency is obliged for, and the extent of an agency’s perceived responsibility. Agencies can thus be classified into four types, which may have different tactical goals and specific BA strategies that contradict other agencies’ goals, thereby leading to a complicated interaction between them. The results show that one of the three related agencies does not adopt suggested BA strategy and therefore fails to avoid blame.

Terrible triad of the elbow injury is difficult to manage, and the role of the coronoid process in instability is very important. We describe a simple, modified suture technique to fix a coronoid process fragment using suture anchor fixation.Eight patients (three female and five male) with coronoid process injuries with the fragment involving50% of the total height (Regan-Morrey type I/II) in terrible triad of elbow injury were included. Patients were treated operatively via a lateral Kocher's approach, and coronoid process fractures were repaired with a single pulley double-strand suture technique. Structures were addressed in a sequential fashion-the coronoid process, radial head, lateral ulnar collateral ligament.All patients were treated with the single pulley double-strand anchor suture technique and the coronoid process fragment was found to be in good contact with the original avulsion site using the method. The final Mayo Elbow Performance Score was excellent (90) in six patients and good (between 85 and 89) in two patients after operation 6 months.The single pulley double-strand suture tie method using a suture anchor is a less invasive and simpler fixation method for the repair of coronoid process fractures in patients with terrible triad of the elbow injuries and results in good outcomes.

Since the pandemic of COVID-19 has intensely struck human society, small animal model for this infectious disease is in urgent need for basic and pharmaceutical research. Although several COVID-19 animal models have been identified, many of them show either minimal or inadequate pathophysiology after SARS-CoV-2 challenge. Here, we describe a new and versatile strategy to rapidly establish a mouse model for emerging infectious diseases in one month by multi-route, multi-serotype transduction with recombinant adeno-associated virus (AAV) vectors expressing viral receptor. In this study, the proposed approach enables profound and enduring systemic expression of SARS-CoV-2-receptor hACE2 in wild-type mice and renders them vulnerable to SARS-CoV-2 infection. Upon virus challenge, generated AAV/hACE2 mice showed pathophysiology closely mimicking the patients with severe COVID-19. The efficacy of a novel therapeutic antibody cocktail RBD-chAbs for COVID-19 was tested and confirmed by using this AAV/hACE2 mouse model, further demonstrating its successful application in drug development., Author summary Upon the emergence of new infectious disease, animal model becomes a pivotal tool for study of disease mechanism and development of therapeutics. In this study, we propose a versatile approach that allows rapid generation of mouse model for novel infectious disease once the receptor of the pathogen is identified. We demonstrated this approach by generating a mouse model for COVID-19 in a month’s time. These mice were capable of recapitulating severe COVID-19 in patients, and successfully applied in the development of a therapeutic antibody cocktail for the disease. This not only suggests the usefulness of this mouse model for the research on COVID-19, but also exhibit the utility of the proposed approach for establishing animal model for infectious disease.

The rapid spread of coronavirus disease (COVID-19) in many countries has caused inconvenience in conducting daily life activities, and even deaths. Dexamethasone is a corticosteroid applied in clinical medicine since 1957, especially in immune therapy fields. Herein, we present the characteristics of Dexamethasone, from molecular mechanisms such as genomic and nongenomic pathways by cellular signal regulations, to clinical applications in various phases of the disease. During COVID-19 pandemic, Dexamethasone given to patients who required oxygen or ventilation therapy showed improved life efficacy.

Intra-arterial thrombectomy (IAT) is a novel surgery that may restore cerebral blood flow in patients with ischemic stroke and lower the risks of permanent brain damage and disability. Because the process of preoperative preparation for IAT is complicated, error rates for this process have been reported in previous studies to be as high as 100%. Although these errors did not result in serious damage to patients, the risk to patient safety remains. Therefore, reducing the error rate for IAT preoperative preparation is necessary to improve patient safety.To reduce the rate of IAT preoperative preparation error in an emergency room.This project applied healthcare failure mode and effect analysis (HFMEA) to evaluate the potential risks of IAT preoperative preparation in an emergency room. Based on the resultant hazard score, critical preventive measures were adopted, including creating a quick response code consent form, designing order packages, developing a checklist form, modifying stroke operating procedures and policies, planning suitable education content for staffs, developing criteria for evaluating preoperative preparation procedures, and installing vital signs equipment.After implementation of these measures, the hazard scores of 13 out of the 16 potential failure causes decreased to8, and the progress rate was 81.3%. The follow-up error rate for preoperative preparation was 0% in October 2019, which fulfilled the goal of this project.Preoperative preparation for IAT is complicated and time-consuming. In this project, HFMEA was introduced to ensure that preoperative preparation was accomplished in a complete and timely manner. Based on the results, after implementation, preparation work was effectively completed and operations were performed on schedule. Other hospitals may consider using this tool to evaluate potential risks to patient safety and to develop solutions to improve the quality of healthcare processes.運用醫療失效模式與效應分析降低急診室動脈內取栓術術前準備缺失率.動脈內取栓術為治療缺血性腦中風病人並幫助血管再灌流的新穎手術方式；能減少腦損傷和失能的風險。鑑於本單位動脈內取栓術術前準備過程複雜造成缺失率高達100%；雖皆為幾近錯失（near-miss），但仍有病人安全之疑慮，因此選用醫療失效模式與效應分析（healthcare failure mode and effects analysis, HFMEA）檢視單位動脈內取栓術術前準備流程，找出高風險因子，執行預防措施及因應策略，確保病人安全。.降低急診室動脈內取栓術術前準備缺失率。.本專案依照HFMEA之五步驟進行，執行日期2019年4月1日–10月31日，依潛在失效原因進行危害指數計算與決策樹分析並擬定行動方案：製作同意書quick response code、設計醫令套餐、制定查核表、修訂同意書與程序書、舉辦在職教育、建立稽核制度與增購設備。.原16項潛在失效原因的有13項危害指數均降低至8分以下進步率為81.3%；持續追蹤本單位2019年12月，動脈取栓術術前準備缺失率為0%，顯示有達成專案之目的。.本專案運用HFMEA建構動脈內取栓術執行流程安全策略，執行的結果是完備術前準備過程，且病人沒有發生手術延遲。建議國內各醫院能針對病人安全之高風險流程進行檢測及改善，以提升病人的照護品質。.

In traditional Chinese medicine, the skin reflects the health of body organs. A skin whitening agent, named seven whitening creams (also called Chi-Bai-San), has been used since ancient times in China. Chi-Bai-San reduces melanin and helps to reduce wrinkles.We aimed to determine the skin-whitening ability and safe dose of the seven compounds in Chi-Bai-San.A common use for Chinese medicine is decocted in water. To mimic the function of Chi-Bai-San apply in clinical, we boiled all seven compound in water, respectively. These single recipe extractions and a mixture of these seven items were used in zebrafish embryo and B16F10 melanoma cell to identify the anti-melanogenesis function.Chi-Bai-San comprises Bai-Lian (Ampelopsis japonica), Bai-Ji (Bletilla striata), Bai-Zhi (Angelica dahurica), Bai-Zhu (Atractylodes macrocephala), Bai-Shau (Paeonia lactiflora), Fu-Ling (Wolfiporia cocos), and Jen-Ju-Fen (Pearl powder). All components were extracted by heating in distilled water. The supernatant was collected after centrifugation. The extracted components were introduced into zebrafish embryos at different doses to determine the safe dose. B16F10 melanoma cells were treated with the final dose of each component and the component mixture. Melanin content and tyrosinase activity were assessed in zebrafish and B16F10 cells. Chi-Bai-San and its components were exposed to α MSH-induced B16F10 cells, and detected for mechanism of anti-melanogenesis pathway.Most compounds were not toxic at a low dose (0.1 mg/ml), except A. macrocephala, which resulted in a survival rate of only 30% at 72 hpf. The final dose of A. dahurica, P. lactiflora, W. cocos, and pearl was 1 mg/ml; that of A. japonica was 0.5 mg/ml; and that of A. macrocephala and B. striata was 0.1 mg/ml. Chi-Bai-San markedly decreased melanin content 37.47% in zebrafish embryos. Further, Chi-Bai-San abolished tyrosinase activity and MITF-mediated tyrosinase expression by down regulating the upstream transcription factors ZEB2, β-catenin, and CREB2 in α MSH-induced B16F10 cells. Additionally, Chi-Bai-San might reduce melanosome secretion from melanocytes.Our findings indicate that safety and efficacy of heat-extracted Chi-Bai-San, which can reduce αMSH-induced melanin production by inhibiting the key role of melogenic-related transcription factor and promote the synergic effect of seven types of traditional Chinese herbal medicines.

Best disease (BD), also termed Best vitelliform macular dystrophy (BVMD), is a juvenile-onset form of macular degeneration and central visual loss. In this report, we generated an induced pluripotent stem cell (iPSC) line, TVGH-iPSC-012-04, from the peripheral blood mononuclear cells of a female patient with BD by using the Sendai virus delivery system. The resulting iPSCs retained the disease-causing DNA mutation, expressed pluripotent markers and could differentiate into three germ layers. We believe that BD patient-specific iPSCs provide a powerful in vitro model for evaluating the pathological phenotypes of the disease.

This study examines the impact of relationship investment on relationship quality in dental technology. In addition, it explores the moderating effects between relationship investment and relationship quality by using customer attachment to different dentists' styles. The study collects 202 questionnaires from dentists in Taiwan. This study uses hierarchy regression analysis to test hypotheses. The empirical results show that 1) relationship investment has a significantly positive effect on relationship quality; and 2) that customer attachment has a moderating effect on relationship investment and relationship quality. Both attachment anxiety and attachment avoidance have significantly negative effects on relationship quality. However, only attachment anxiety has a significantly moderating effect on relationship investment and relationship quality. Keywords: Relationship Investment, Relationship Quality, Dental Technology, Attachment Style To cite this document: Hui-Chen Chang, Lin-Ju Cheng, Yi-Ching Tsai, and Hung-Chun Lai, "The Relationship between Relationship Investment, Relationship Quality, and Attachment Styles", Contemporary Management Research, Vol.14, No.1, pp. 3-20, 2018. Permanent link to this document: http://dx.doi.org/10.7903/cmr.18017

“Hayashi Fumiko is a representative female writer in the Showa Era of Japan. She is famous for her maiden work "Wanderers" and other series of works which depict the unrestrained women and the relationship between psychological distress. As a child, she wandered around Kyushu with her mother as a meta-cognitive, which made her form a life-long love and personality for traveling and wandering. She not only has many domestic and foreign travel experiences, but also combines these precious travel notes with the creation of her works to form her own writing characteristics. By analyzing the relationship between Hayashi Fumiko's travel experience and her works, this paper explores the significance of travel for feminist literature.”

In addition to the definition of "Ji Xing Literature", this essay will make an overview of the contents of the complete works of the literature published in Japan before and after the war. Through the above process, the specific content of Japanese literary literature, especially the national and regional trends visited by Japanese writers was clarified. Due to the lengths limited of the paper, this essay focus on only eleven writers to examine the relationship between travel experience as travel essay and creation as fiction for exploring the travel experience and creation of other Japanese writers in the future.

Aims: Activation of glomerular mesangial cells (MCs) and functional changes of renal tubular cells are due to metabolic abnormalities, oxidative stress, and matrix accumulation in the diabetic nephropathy (DN). Aryl hydrocarbon receptor (AhR) activation has been implicated in DN. In this study, we investigated the role of AhR in the pathophysiological processes of DN using AhR knockout (AhRKO) and pharmacological inhibitor α-naphthoflavone mouse models. Results: The increased blood glucose, glucose intolerance, MC activation, macrophage infiltration, and extracellular matrix (ECM) accumulation were significantly attenuated in AhRKO mice with diabetic inducer streptozotocin (STZ) treatment. AhR deficiency by genetic knockout or pharmacological inhibition also decreased the induction of cyclooxygenase-2 (COX-2)/prostaglandin E2 (PGE2), lipid peroxidation, oxidative stress, NADPH oxidase activity, and N-ɛ-carboxymethyllysine (CML, a major advanced glycation end product) in STZ-induced diabetic mice....

To meet the expectation of customers during experience era, it is important to understand their perceptions of different brands. To achieve this, this study aimed to investigate the relationship among brand experiences, self-concept congruence, customer satisfaction, and brand preference. This study used Tablet PC users as the research objects and collected empirical data through online questionnaires. Structural Equation Model (SEM) was used to validate models, and hierarchical regression was used to test the hypothesis. The results of this study showed that brand experience has a significant positive effect on brand preference, brand experience has a significant positive effect on customer satisfaction, and self-concept congruence has a positive effect on brand preference. In addition, self-concept congruence has positive effect on customer satisfaction and brand preferences. These results show that through a comprehensive brand experience, companies could enhance brand preferences and purchase intentions of customers. Keywords: Brand Experiences, Self-Concept Congruence, Customer Satisfaction, Brand Preference To cite this document: Yi-Ching Tsai, Hui-Chen Chang, and Kung-Chung Ho, "A Study of the Relationship among Brand Experiences, Self-Concept Congruence, Customer Satisfaction, and Brand Preference", Contemporary Management Research, Vol.11, No.2, pp.97-116, 2015. Permanent link to this document: http://dx.doi.org/10.7903/cmr.12970

Aging is a critical factor to influence the functional performance during daily life. Without an appropriate posture control response when experiencing an unexpected external perturbation, fall may occur. A novel six-degree-of freedom platform with motion control protocol was designed to provide a real-life simulation of unexpected disturbance in order to discriminate the age-related changes of the balance control and the recovery ability. Twenty older adults and 20 healthy young adults participated in the study. The subjects stood barefoot on the novel movable platform, data of the center of mass (COM) excursion, joint rotation angle and electromyography (EMG) were recorded and compared. The results showed that the older adults had similar patterns of joint movement and COM excursion as the young adults during the balance reactive-recovery. However, larger proximal joint rotation in elderly group induced larger COM sway envelop and therefore loss of the compensatory strategy of posture recovery. The old adults also presented a lower muscle power. In order to keep an adequate joint stability preventing from falling, the EMG activity was increased, but the asymmetric pattern might be the key reason of unstable postural response. This novel design of moveable platform and test protocol comprised the computerized dynamic posturography (CDP) demonstrate its value to assess the possible sensory, motor, and central adaptive impairments to balance control and could be the training tool for posture inability person.

The threshold for switching mobile phone numbers between different mobile communication service providers has largely decreased since the government lifted the ban on mobile phone number portability service. Users can convert their mobile communication service from their current provider to others while maintaining their existing phone numbers. The demand for mobile communication services has been increasing, along with the popular sales of smartphones and tablet PCs. However, more and more complaints have emerged in response to system service failures, employee service mistakes, and the sales promotion activities offered from competitors, which could destroy the trading relationship. These factors will lead to the customers’ intentions of complaining and switching to another service provider. This study aims to explore the relationship between destructive factors in trading relations, service providers’ relationship-recovery policies, and the outcome of customer default. Empirical data were collected from mobile service users through online questionnaires. Using the general linear model (GLM) to test the research hypotheses, the results showed that (1) the relationship-destroying factors including service system failures and personnel service errors positively impact customers’ complaining and switching intentions and (2) the financial and psychological recovery policies might decrease the customers’ complaining intention. Finally, this research also offers mobile communication services providers with strategic implications in customer relationship management. Keywords: Relationship-destroying factors, relationship recovery, customer response To cite this document: Hui-Chen Chang, Yi-Ching Tsai, and Sheng-Yuan Hsu, "The Effects of Relationship-Destroying Factors on Customer Relationships: Relationship Recovery as the Moderator", Contemporary Management Research, Vol.9, No.4, pp.369-388, 2013. Permanent link to this document: http://dx.doi.org/10.7903/cmr.11261

The aim of this study was to evaluate the effects of virtual reality (VR) treadmill training on the balance skills of patients who have had a stroke.A total of 14 patients with strokes were recruited and randomly assigned to receive VR treadmill or traditional treadmill training. The outcome measures that were included for the study were center of pressure (COP) sway excursion, COP maximum sway in anterior-posterior direction, COP maximum sway in medial-lateral direction, COP sway area, bilateral limb-loading symmetric index, the sway excursion values for the paretic foot (sway excursion/P), paretic limb stance time (stance time/P), number of steps of the paretic limb (number of steps/P), and contact area of the paretic foot (contact A/P) during quiet stance, sit-to-stand transfer, and level walking.There were no significant improvements in COP-related measures and symmetric index during the quiet stance, either in the VR treadmill or traditional treadmill training group (P0.05). However, the difference between groups after training in COP maximum sway in medial-lateral direction during the quiet stance was significant (P = 0.038). Traditional treadmill training failed to improve sit-to-stand performance, whereas VR treadmill training improved symmetric index (P = 0.028) and sway excursion (P = 0.046) significantly during sit-to-stand transfer. The changes of symmetric index between groups were markedly different (P = 0.045). Finally, both groups improved significantly in stance time/P, but only VR treadmill training increased contact A/P (P = 0.034) after training during level walking. The difference between groups during level walking was not significant.Neither traditional treadmill nor VR treadmill training had any effect on balance skill during quiet stance, but VR treadmill training improved balance skill in the medial-lateral direction better than traditional training did. VR treadmill training also improved balance skill during sit-to-stand transfers and the involvement of paretic limb in level walking more than the traditional one did.

N(e)-carboxymethyllysine (CML) is an important driver of diabetic vascular complications and endothelial cell dysfunction. However, how CML dictates specific cellular responses and the roles of protein tyrosine phosphatases and ERK phosphorylation remain unclear. We examined whether endoplasmic reticulum (ER) localization of MAPK phosphatase-3 (MKP-3) is critical in regulating ERK inactivation and promoting NADPH oxidase-4 (Nox4) activation in CML-induced endothelial cell injury. We demonstrated that serum CML levels were significantly increased in type 2 diabetes patients and diabetic animals. CML induced ER stress and apoptosis, reduced ERK activation, and increased MKP-3 protein activity in HUVECs and SVECs. MKP-3 siRNA transfection, but not that of MKP-1 or MKP-2, abolished the effects of CML on HUVECs. Nox4-mediated activation of MKP-3 regulated the switch to ERK dephosphorylation. CML also increased the integration of MKP-3 with ERK, which was blocked by silencing MKP-3. Exposure of antioxidants abolished CML-increased MKP-3 activity and protein expression. Furthermore, immunohistochemical staining of both MKP-3 and CML was increased, but phospho-ERK staining was decreased in the aortic endothelium of streptozotocin-induced and high-fat diet-induced diabetic mice. Our results indicate that an MKP-3 pathway might regulate ERK dephosphorylation through Nox4 during CML-triggered endothelial cell dysfunction/injury, suggesting that therapeutic strategies targeting the Nox4/MKP-3 interaction or MKP-3 activation may have clinical implications for diabetic vascular complications.

In this paper, we present a new mathematical model based on a “Vector Space Model” and consider its implications. The proposed method is evaluated by performing several experiments. In these experiments, we classify newspaper articles from the English Reuters-21578 data set, and Taiwanese China Times 2005 data set using the proposed method. The Reuters-21578 data set is a benchmark data set for automatic text categorization. It is shown that FRAM has good classification accuracy. Specifically, the micro-averaged F-measure of the proposed method is 94.5% for English. However, that is 78.0% for Taiwanese. Though the proposed method is language-independent and provides a new perspective, our future work is to improve classification accuracy for Taiwanese.

In our previous paper, we proposed a new classification technique called the Frequency Ratio Accumulation Method (FRAM). This is a simple technique that adds up the ratios of term frequency among categories. However, in FRAM, the use of feature terms is unlimited. In the present paper, we adopt character N-gram as feature terms improving the above-described particularity of FRAM. That is to say, the proposed method is language-independent because it does not depend on the low of grammar by using character N-gram. Therefore, we can classify multi-language into some categories using only one program. Next, the proposed method is evaluated by performing several experiments. In these experiments, we classify newspaper articles from English Reuters-21578, Japanese CD-Mainichi 2002 and Chinese China Times 2005 using FRAM. As a result, we show that it has the good classification accuracy. Specifically, the recall of the proposed method is 87.8% for English, 86.0% for Japanese and 72.8% for Chinese. Although it turned out that Chinese classification accuracy was extremely low in the present experiments compared with English and Japanese, the proposed method is language-independent and provides a new perspective and has excellent potential.

To date there is no firm conclusion as to the efficacy and safety of ibuprofen compared with indometacin for patent ductus arteriosus (PDA) closure in extremely premature infants.To conduct a randomised controlled trial to better address this problem.119 infants (gestational ageor =28 weeks) with respiratory distress syndrome and PDA confirmed by echocardiography were randomly assigned to receive either indometacin (0.2 mg/kg) or ibuprofen (10 mg/kg), starting at24 hours of life, followed by half these first doses within 48 hours at 24-hour intervals if indicated by echocardiographic PDA flow pattern.The PDA closure rate and the doses of drug (mean (SD)) were similar in both groups: 53/60 (88.3%) and 1.9 (1.5) mg/kg in infants given ibuprofen, and 52/59 (88.1%) and 1.9 (1.7) mg/kg in infants given indometacin. No significant difference was found in the numbers of infants requiring surgical ligation, and the levels of post-treatment serum creatinine and urea nitrogen between the two groups. Although not significantly different, more infants (9/59 (15.3%)) treated with indometacin tended to develop oliguria (1 ml/kg/h) than those treated with ibuprofen (4/60 (6.7%)). There were no significant differences in side effects or complications between the two groups.Ibuprofen is as effective as indometacin for the early-targeted PDA treatment in extremely premature infants, without increasing the incidence of complications. When the echocardiographic PDA flow pattern was used as a guide for PDA treatment, fewer doses of drugs were needed to achieve acceptable closing rates.

Although laryngomalacia is the leading cause of stridor in infancy, vocal cord paralysis, despite its low incidence, is still the second most common cause. However, the etiology of infant vocal cord paralysis is different from that of adults, and the management protocol is controversial. Therefore, we conducted this study to better characterize the cause and outcome of vocal cord paralysis in infants. From January 1997 to December 2003, we treated thirteen infants younger than one year for vocal cord paralysis. Seven infants were idiopathic (idiopathic group), two might be caused by prior surgery (iatrogenic group), two might be caused by central neuropathy (neurological group), and two were born after difficult delivery (obstetrical group). In the idiopathic group, six infants spontaneously recovered and one infant had right-side recovery, but the left side was still paralytic. All infants in the iatrogenic and obstetrical groups spontaneously recovered. However, no infant in the neurological group recovered. Spontaneous recovery occurred in 76.9% of affected infants. More than half (70%) of these spontaneous recoveries occurred within 6 months. In our experience, direct flexible laryngoscopy is mandatory for all infants younger than one year of age presenting with stridor. Except for extreme infants (e. g. bilateral vocal cord paralysis with severe respiratory distress and central neuropathy) who require a temporary tracheotomy to relieve the airway obstruction, we recommend waiting for at least 6 months before proceeding to invasive surgical interventions.

After the analog ECG signal is transferred into digital format, the digital filter can be used to suppress the 60 Hz embedded noise. In this paper, we propose the use of finite impulse response filters with a linear phase property to obtain the noise reduction without introducing the phase distortion. In our design, we use the notch filter with a pole/zero canceling method, the comb notch filter with a pole/zero canceling method and the equiripple notch filter with the usage of the Parks-McClellan algorithm. By the comparison of the transition bandwidth (/spl Delta//spl omega/), stopband attenuation gain (Astop) of these filters, we can learn the frequency response of these filters. Furthermore, we use the mean square error (MSE) to estimate the effect of the digital filters in order to reduce the embedded 60 Hz noise. We compute the mean square error with respect to the order, N, of these filters and plot the relationship of MSE and N. In addition, we find the relationship of the CPU time and N, and we also learn that the CPU time is in proportion to the order, N, of the filters. According to the relations among N, MSE and CPU time, we can find that the advantages and disadvantages of the proposed filters and then choose the best filter for the corresponding conditions.