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Abstract Current genome-wide association studies (GWAS) for kidney function lack ancestral diversity, limiting the applicability to broader populations. The East-Asian population is especially under-represented, despite having the highest global burden of end-stage kidney disease. We conducted a meta-analysis of multiple GWASs (n = 244,952) on estimated glomerular filtration rate and a replication dataset (n = 27,058) from Taiwan and Japan. This study identified 111 lead SNPs in 97 genomic risk loci. Functional enrichment analyses revealed that variants associated with F12 gene and a missense mutation in ABCG2 may contribute to chronic kidney disease (CKD) through influencing inflammation, coagulation, and urate metabolism pathways. In independent cohorts from Taiwan (n = 25,345) and the United Kingdom (n = 260,245), polygenic risk scores (PRSs) for CKD significantly stratified the risk of CKD (p

Abstract Few studies have explored the association between residential noise exposure and burnout. In this study, we investigated the association between residential noise exposure and burnout prevalence among 5416 health-care workers in Taiwan from 2012 to 2017. Burnout was evaluated using the Mandarin version of the Copenhagen Burnout Inventory by considering both continuous and binary measures. We applied ordinary Kriging models to calculate the annual average residential noise exposure at an individual level. Multivariable linear regression models and logistic regression models were employed. Restricted cubic splines were used to explore dose–response relationships. The median age of the health-care workers was 31.5 years. In the multivariable linear regression models, exposure to residential noise (per 1 dBA) was associated with increases in personal burnout and work-related burnout scores by 1.59 ± 0.25 and 1.38 ± 0.20, respectively. In the multivariable logistic regression models, the adjusted odds ratios were 1.24 (95% confidence interval [CI]: 1.16, 1.32) for personal burnout and 1.19 (95% CI: 1.13, 1.26) for work-related burnout per 1-dBA increase in residential noise exposure. Linear dose–response associations of burnout with residential noise level were detected. Our findings suggest that exposure to residential noise may increase the risk of burnout among health-care workers.

Primary cardiac angiosarcoma is a rare and aggressive malignancy with a poor prognosis. This case report highlights the challenges in diagnosing and managing such tumors, especially when complicated by cardiac tamponade. We present the case of a 52-year-old male with primary cardiac angiosarcoma, initially presenting with cardiac tamponade, which led to the subsequent diagnosis of an aggressive tumor. Prompt recognition and interdisciplinary collaboration facilitated timely intervention, resulting in successful surgical resection and favorable short-term outcomes. However, the overall prognosis remains poor due to the aggressive nature of the disease. This case underscores the importance of early recognition, comprehensive diagnostic evaluation, and aggressive multimodal treatment strategies.

Abstract Background and Objectives Nintedanib, a tyrosine kinase inhibitor, is integral in slowing pulmonary fibrosis progression in chronic fibrotic interstitial lung disease (ILD). However, the occurrence of adverse drug reactions (ADRs) often limits its use, leading to treatment discontinuation, typically within 3–12 months. Discontinuation adversely affects patient outcomes. The study investigated whether aggressive ADR management can prolong nintedanib therapy and improve patient outcomes. Methods This retrospective, single-center study enrolled Taiwanese patients with chronic fibrotic ILD who were treated with nintedanib from January 2016 to December 2022 in Kaohsiung Chang Gung Memorial Hospital. Patients were categorized into those who discontinued treatment within 180 days and those continuing beyond. Management of ADRs was identified through concurrent prescriptions for symptoms such as nausea, vomiting, diarrhea, or hepatic dysfunction. Baseline demographics, comorbidities, pulmonary function tests, and instances of acute exacerbation were analyzed. Results The study enrolled 94 patients, with 71 (75.5%) experiencing ADRs. Among these, 41 (43.6%) discontinued nintedanib within 180 days. The administration of medications for managing nausea/vomiting [17 (41.5%) versus 36 (67.9%), p = 0.0103] and diarrhea [12 (29.3%) versus 33 (62.3%), p = 0.0015] was less frequent in the discontinued group compared with the continued group. Additionally, a higher incidence of acute exacerbation was observed in the discontinued group (34.1% versus 20.8%, p = 0.016). Conclusion Aggressive management of ADRs may enhance patient tolerance to nintedanib, potentially prolonging treatment duration and improving outcomes in chronic fibrotic ILD.

Understanding the release behaviour of nanodrugs is a crucial step to better assess and control therapeutic outcomes and unfavourable side effects. Herein, we report a systematic study comparing the release kinetics and thermodynamics of paclitaxel (PTX) from supramolecularly assembled sub-micron particles based on natural macromolecules such as zein, whey, casein, bovine serum albumin (BSA) and conventional stabilizers such as pluronic F-127 (poloxamer 407), and β-cyclodextrin (β-CD) to gain insights into the role of carrier chemistry. For this purpose, nanomedicines with statistically indifferent sizes —in the range of 191.0 ± 0.8 nm (BSA) to 243.3 ± 11.6 nm (zein) were prepared (p > 0.05). The zeta potential values ranged from −3.2 ± 1.1 mV (pluronic F-127) to −17.2 ± 1.8 mV (whey) in phosphate buffered saline. The type of nanocarrier significantly influenced the long-term steady-state plateau of the release, resulting in a cumulative release of 70.3 ± 2.0 % of PTX from casein (the highest) and 46.8 ± 4.7 % of PTX from zein (the lowest). Time-resolved release data were analysed with various kinetical models, encompassing zero-order, first-order, Higuchi, Peppas-Sahlin, and Korsmeyer-Peppas kinetics. The analysis revealed that the Korsmeyer-Peppas model best captured the data. For these nanomedicines, the half-life of the encapsulated drugs was found to be 106.4 ± 31.3 h (zein), 4.7 ± 1.2 h (whey), 10.7 ± 1.8 h (pluronic F-127), 6.4 ± 0.9 h (casein), 10.8 ± 3.2 h (β-CD), and 4.0 ± 1.0 h (BSA). TEM characterization revealed differences in the macromolecular arrangement of the active ingredient within these nanocarriers, in addition to the structural differences among the various encapsulating agents. These differences manifested as variations in the internal nanostructures, leading to the creation of distinct microenvironments that could either facilitate or impede the movement of PTX molecules through the encapsulant matrices. In clinical settings, such fine details of nanocarrier design are important: by choosing the most appropriate nanocarrier (or their mixtures), clinicians can fine-tune drug administration to obtain the intended therapeutic window while mitigating the risk of potential negative reactions.

Objective: We describe a rare case of uterine mesothelial cysts mimicking ovarian cysts in a primipara patient with a history of Cesarean section. Case report: A 39-year-old female patient with history of Cesarean section presented with dysmenorrhea. Sonography revealed that a hypoechoic and anechoic multicystic complex, which was located on the right side of the pelvic cavity, had infiltrated the adjacent posterior wall of the uterus, and it was preoperatively misdiagnosed as ovarian cysts with suspected endometrioma. Laparoscopic surgery revealed multiple cystic lesions filled with clear yellow fluid on the posterior uterine wall instead of the adnexa. Laparoscopic uterine cystectomy was performed, and the patient's recovery was uneventful. Pathohistological and immunohistochemical examinations confirmed the diagnosis of uterine mesothelial cysts. Conclusion: Uterine mesothelial cysts should be considered in the differential diagnosis of pelvic lesions. Increasing the awareness of this rare disease can contribute to improved evaluation, decision-making, and disease management.

Recently, there has been growing interest in the hierarchical assemblies of zwitterionic betaine amphiphiles across various fields due to their utility as stimuli-responsive materials. Herein, we systematically investigate the binary supramolecular assembly of zwitterionic amido betaines and diamines to determine how alkyl chain length of amido betaines (CnDAB) and amine degree of diamines influence their relaxation dynamics of the resultant coacervates. To this end, we synthesized five CnDAB molecules with systematically varying carbon chain lengths (n = 12, 14, 16, 18, and 20) and conjugated them with three different diamines (ethylenediamine, EDA; n,n'-dimethylethylenediamine, DMEDA; and n,n,n',n'-tetramethylethylenediamine,TMEDA). We employed rheology to compare the bulk properties and relaxation dynamics of these assemblies as well as to gain insight into their responsiveness to pH stimulus. All betaine/diamine co-assemblies for all pH values showed shear-thinning behavior while the onset of shear thinning behavior showed some variation for the shear rate inducing such an onset. By changing molecular architecture of co-assembling pairs, zero-shear viscosity values varied from ∼10−1 Pa s to ∼103 Pa s at a concentration of 100 mM CnDAB and 50 mM diamine in water. Four-order-of-magnitude difference in viscosity with small changes in molecular architecture and pH indicates that precise tuning of the rheological properties is possible simply by controlling the self-assembly tendencies and nano-to-micro scale aggregation morphologies through bi-molecular design. Out of 15 different combinations of betaine and diamine pairs studied, the primary amine EDA conjugated with C18DAB resulted in the highest degree of pH-controlled viscosity changes (i.e., highest pH-responsivity). Below 16-carbon alkyl chains on the betaines, pH responsiveness mostly disappeared. Overall, this systematic study brings new insights into the molecular structure-property relationships of amido betaine/diamine systems, which are widely used in diverse sets of applications and fields.

Human action recognition has recently attracted much attention in computer vision research. Its applications are widely found in video surveillance, human-computer interaction, entertainment, and autonomous driving. In this study, we developed a system for evaluating online music performances. This system conducts experiments to assess performance of playing the erhu, the most popular traditional stringed instrument in East Asia. Mastering the erhu poses a challenge, as players often struggle to enhance their skills due to incorrect techniques and a lack of guidance, resulting in limited progress. To address this issue, we propose hybrid models based on graph convolutional networks (GCN) and temporal convolutional networks (TCN) for action recognition to capture spatial relationships between different joints or keypoints in a human skeleton, and interactions between these joints. This can assist players in identifying errors while playing the instrument. In our research, we use RGB video as input, segmenting it into individual frames. For each frame, we extract keypoints, encompassing both image and keypoint information, which serve as input data for our model. Leveraging our innovative model architecture, we achieve an impressive accuracy rate exceeding 97% across various classes of hand error modules, thus providing valuable insights into the assessment of musical performances and demonstrates the potential of AI-based solutions to enhance the learning and correction of complex human actions in interactive learning environments.

BackgroundTriage is the process of accurately assessing patients’ symptoms and providing them with proper clinical treatment in the emergency department (ED). While many countries have developed their triage process to stratify patients’ clinical severity and thus distribute medical resources, there are still some limitations of the current triage process. Since the triage level is mainly identified by experienced nurses based on a mix of subjective and objective criteria, mis-triage often occurs in the ED. It can not only cause adverse effects on patients, but also impose an undue burden on the health care delivery system. ObjectiveOur study aimed to design a prediction system based on triage information, including demographics, vital signs, and chief complaints. The proposed system can not only handle heterogeneous data, including tabular data and free-text data, but also provide interpretability for better acceptance by the ED staff in the hospital. MethodsIn this study, we proposed a system comprising 3 subsystems, with each of them handling a single task, including triage level prediction, hospitalization prediction, and length of stay prediction. We used a large amount of retrospective data to pretrain the model, and then, we fine-tuned the model on a prospective data set with a golden label. The proposed deep learning framework was built with TabNet and MacBERT (Chinese version of bidirectional encoder representations from transformers [BERT]). ResultsThe performance of our proposed model was evaluated on data collected from the National Taiwan University Hospital (901 patients were included). The model achieved promising results on the collected data set, with accuracy values of 63%, 82%, and 71% for triage level prediction, hospitalization prediction, and length of stay prediction, respectively. ConclusionsOur system improved the prediction of 3 different medical outcomes when compared with other machine learning methods. With the pretrained vital sign encoder and repretrained mask language modeling MacBERT encoder, our multimodality model can provide a deeper insight into the characteristics of electronic health records. Additionally, by providing interpretability, we believe that the proposed system can assist nursing staff and physicians in taking appropriate medical decisions.

Abstract Reactive oxygen species (ROS) have been recognized as prevalent contributors to the development of inner retinal injuries including optic neuropathies such as glaucoma, non‐arteritic anterior ischemic optic neuropathy, traumatic optic neuropathy, and Leber hereditary optic neuropathy, among others. This underscores the pivotal significance of oxidative stress in the damage inflicted upon retinal tissue. To combat ROS‐related challenges, this study focuses on creating an injectable and tissue‐adhesive hydrogel with tailored antioxidant properties for retinal applications. GelCA, a gelatin‐modified hydrogel with photo‐crosslinkable and injectable properties, is developed. To enhance its antioxidant capabilities, curcumin‐loaded polydopamine nanoparticles (Cur@PDA NPs) are incorporated into the GelCA matrix, resulting in a multifunctional nanocomposite hydrogel referred to as Cur@PDA@GelCA. This hydrogel exhibits excellent biocompatibility in both in vitro and in vivo assessments, along with enhanced tissue adhesion facilitated by NPs in an in vivo model. Importantly, Cur@PDA@GelCA demonstrates the potential to mitigate oxidative stress when administered via intravitreal injection in retinal injury models such as the optic nerve crush model. These findings underscore its promise in advancing retinal tissue engineering and providing an innovative strategy for acute neuroprotection in the context of inner retinal injuries.

Post-harvest losses of fruits due to decay and concerns regarding microbial food safety are significant within the produce processing industry. Additionally, maintaining the quality of exported commodities to distant countries continues to pose a challenge. To address these issues, the application of bioactive compounds, such as essential oils, has gained recognition as a means to extend shelf life by acting as antimicrobials. Herein, we have undertaken an innovative approach by nano-encapsulating cinnamon-bark essential oil using whey protein concentrate and imbibing nano-encapsulates into food-grade wax commonly applied on produce surfaces. We have comprehensively examined the physical, chemical, and antimicrobial properties of this hybrid wax to evaluate its efficacy in combatting the various foodborne pathogens that frequently trouble producers and handlers in the post-harvest processing industry. The coatings as applied demonstrated a static contact angle of 85 ± 1.6°, and advancing and receding contact angles of 90 ± 1.1° and 53.0 ± 1.6°, respectively, resembling the wetting properties of natural waxes on apples. Nanoencapsulation significantly delayed the release of essential oil, increasing the half-life by 61 h compared to its unencapsulated counterparts. This delay correlated with statistically significant reductions (p = 0.05) in bacterial populations providing both immediate and delayed (up to 72 h) antibacterial effects as well as expanded fungal growth inhibition zones compared to existing wax technologies, demonstrating promising applicability for high-quality fruit storage and export. The utilization of this advanced produce wax coating technology offers considerable potential for bolstering food safety and providing enhanced protection against bacteria and fungi for produce commodities.

Background: Despite research demonstrating that those who use e-cigarettes, also known as vaping, express an interest in quitting, evidence-based vaping cessation interventions are lacking. The purpose of this study was to examine the feasibility and preliminary outcomes of an mHealth vaping cessation intervention. Methods: Adults (N?=?51) who were vaping nicotine were recruited online and enrolled in a 6-week mHealth intervention combining nicotine replacement therapy (NRT), self-guided cognitive behavioral therapy (CBT), and coaching support through telephone and asynchronous messaging. Feasibility and self-reported 7- and 30-day abstinence were assessed at baseline and 1-month postquit date. Results: The majority of participants completed treatment (45/51) and found the intervention helpful in supporting their vaping behavior change objectives. At 1-month postquit date, 48.9% (22/45) of study completers reported 7-day point prevalence abstinence and 28.8% (13/45) reported continuous 30-day abstinence. Conclusions: Findings provide preliminary support for an mHealth intervention approach to vaping cessation combining remote CBT-based coaching with NRT.

Hippocampal oxytocin receptor (OXTR) signaling is crucial for discrimination of social stimuli to guide social recognition, but circuit mechanisms and cell types involved remain incompletely understood. Here, we report a role for OXTR-expressing hilar mossy cells (MCs) of the dentate gyrus in social stimulus discrimination by regulating granule cell (GC) activity. Using a Cre-loxP recombination approach, we found that ablation of Oxtr from MCs impairs discrimination of social, but not object, stimuli in adult male mice. Ablation of MC Oxtr increases spontaneous firing rate of GCs, synaptic excitation to inhibition ratio of MC-to-GC circuit, and GC firing when temporally associated with the lateral perforant path inputs. Using mouse hippocampal slices, we found that bath application of OXTR agonist [Thr4,Gly7]-oxytocin causes membrane depolarization and increases MC firing activity. Optogenetic activation of MC-to-GC circuit ameliorates social discrimination deficit in MC OXTR deficient mice. Together, our results uncover a previously unknown role of MC OXTR signaling for discrimination of social stimuli and delineate a MC-to-GC circuit responsible for social information processing.

Abstract The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus emerged in late 2019 leading to the COVID‐19 disease pandemic that triggered socioeconomic turmoil worldwide. A precise, prompt, and affordable diagnostic assay is essential for the detection of SARS‐CoV‐2 as well as its variants. Antibody against SARS‐CoV‐2 spike (S) protein was reported as a suitable strategy for therapy and diagnosis of COVID‐19. We, therefore, developed a quick and precise phase‐sensitive surface plasmon resonance (PS‐SPR) biosensor integrated with a novel generated anti‐S monoclonal antibody (S‐mAb). Our results indicated that the newly generated S‐mAb could detect the original SARS‐CoV‐2 strain along with its variants. In addition, a SARS‐CoV‐2 pseudovirus, which could be processed in BSL‐2 facility was generated for evaluation of sensitivity and specificity of the assays including PS‐SPR, homemade target‐captured ELISA, spike rapid antigen test (SRAT), and quantitative reverse transcription polymerase chain reaction (qRT‐PCR). Experimentally, PS‐SPR exerted high sensitivity to detect SARS‐CoV‐2 pseudovirus at 589 copies/ml, with 7‐fold and 70‐fold increase in sensitivity when compared with the two conventional immunoassays, including homemade target‐captured ELISA (4 × 103 copies/ml) and SRAT (4 × 104 copies/ml), using the identical antibody. Moreover, the PS‐SPR was applied in the measurement of mimic clinical samples containing the SARS‐CoV‐2 pseudovirus mixed with nasal mucosa. The detection limit of PS‐SPR is calculated to be 1725 copies/ml, which has higher accuracy than homemade target‐captured ELISA (4 × 104 copies/ml) and SRAT (4 × 105 copies/ml) and is comparable with qRT‐PCR (1250 copies/ml). Finally, the ability of PS‐SPR to detect SARS‐CoV‐2 in real clinical specimens was further demonstrated, and the assay time was less than 10 min. Taken together, our results indicate that this novel S‐mAb integrated into PS‐SPR biosensor demonstrates high sensitivity and is time‐saving in SARS‐CoV‐2 virus detection. This study suggests that incorporation of a high specific recognizer in SPR biosensor is an alternative strategy that could be applied in developing other emerging or re‐emerging pathogenic detection platforms.

Plain language summary An enlarged heart occurs during various medical conditions and can result in early death. However, it is unclear whether this is also the case in patients with chronic kidney disease (CKD). Although the size of the heart can be measured on chest X-rays, this process is time consuming. We used artificial intelligence to quantify the heart size of 3117 CKD patients based on their chest X-rays within hours. We found that CKD patients with an enlarged heart were more likely to develop end-stage kidney disease or die. This could improve monitoring of CKD patients with an enlarged heart and improve their care.

Turbulence of collisionless magnetized plasmas is ubiquitous in space as well as laboratory plasmas, and as such is subject to intense study. The authors present experimental evidence of the existence of entropy cascade by direct visualization of entropy distribution in the phase-space of turbulence in laboratory experiments.

Various applications would benefit from the ability to continuously measure biomolecules. Here the authors describe a biosensing technology based on the free diffusion of biofunctionalized particles hovering over a sensor surface, which enables monitoring of analytes (pM-µM) over long timespans.

Abstract Background Controlling excess biomass accumulation and clogging is important for maintaining the performance of gas biofilters and reducing energy consumption. Interruption of bacterial communication (quorum quenching) can modulate gene expression and alter biofilm properties. However, whether the problem of excess biomass accumulation in gas biofilters can be addressed by interrupting bacterial communication remains unknown. Results In this study, parallel laboratory-scale gas biofilters were operated with Rhodococcus sp. BH4 (QQBF) and without Rhodococcus sp. BH4 (BF) to explore the effects of quorum quenching (QQ) bacteria on biomass accumulation and clogging. QQBF showed lower biomass accumulation (109 kg/m3) and superior operational stability (85–96%) than BF (170 kg/m3; 63–92%) at the end of the operation. Compared to BF, the QQBF biofilm had lower adhesion strength and decreased extracellular polymeric substance production, leading to easier detachment of biomass from filler surface into the leachate. Meanwhile, the relative abundance of quorum sensing (QS)-related species was found to decrease from 67 (BF) to 56% (QQBF). The QS function genes were also found a lower relative abundance in QQBF, compared with BF. Moreover, although both biofilters presented aromatic compounds removal performance, the keystone species in QQBF played an important role in maintaining biofilm stability, while the keystone species in BF exhibited great potential for biofilm formation. Finally, the possible influencing mechanism of Rhodococcus sp. BH4 on biofilm adhesion was demonstrated. Overall, the results of this study achieved excess biomass control while maintaining stable biofiltration performance (without interrupting operation) and greatly promoted the use of QQ technology in bioreactors. Graphical Abstract Video Abstract

Abstract To compare the frequency and clinical significance of familial and de novo chromosomal inversions during prenatal diagnosis. This was a retrospective study of inversions diagnosed prenatally in an Asian population by applying conventional GTG-banding to amniocyte cultures. Data from 2005 to 2019 were extracted from a single-center laboratory database. The types, frequencies, and inheritance patterns of multiple inversions were analyzed. Pericentric variant inversions of chromosome 9 or Y were excluded. In total, 56 (0.27%) fetuses with inversions were identified in the 15-year database of 21,120 confirmative diagnostic procedures. Pericentric and paracentric inversions accounted for 62.5% (35/56) and 37.5% of the inversions, respectively. Familial inversions accounted for nearly 90% of cases, and de novo mutation was identified in two pericentric and two paracentric cases. Inversions were most frequently identified on chromosomes 1 and 2 (16.1% of all inversions), followed by chromosomes 6, 7, and 10 (8.9% of all cases). The indications for invasive testing were as follows: advanced maternal age (67.3%), abnormal ultrasound findings (2.1%), abnormal serum aneuploidy screening (20.4%), and other indications (10.2%). The mode of inheritance was available for 67.9% of cases (38/56), with 89.5% of inversions being inherited (34/38). A slight preponderance of inheritance in female fetuses was observed. Three patients with inherited inversions opted for termination (two had severe central nervous system lesions and one had thalassemia major). Gestation continued for 53 fetuses, who exhibited no structural defects at birth or significant developmental problems a year after birth. Our study indicates that approximately 90% of prenatally diagnosed inversions involve familial inheritance, are spreading, and behave like founder effect mutations in this isolated population on an island. This finding can help to alleviate anxiety during prenatal counseling, which further underscores the importance of parental chromosomal analysis, further genetic studies, and appropriate counseling in cases where a nonfamilial inversion is diagnosed.

An effective bearing fault diagnosis model based on machine learning is proposed in this study. The model can separate into three stages: feature extraction, feature selection, and classification. In the stage of feature extraction, multiresolution analysis (MRA) and fast Fourier transform (FFT) are applied to extract the features from the raw signal measured from the rotating machine. In the second stage, a powerful feature selection method is proposed and utilized in the stage of feature selection. The new feature selection method is based on grey wolf optimization (GWO) and heap-based optimizer (HBO) with new strategies combined. Finally, support vector machine (SVM) and linear discriminant analysis (LDA) are used as the classifier independently. To verify the capability of the proposed model, four different datasets are applied to test the model in this study, respectively University of California Irvine (UCI) benchmark dataset, bearing dataset, Case Western Reserve University (CWRU) benchmark dataset, and Machinery Failure Prevention Technology (MFPT) benchmark dataset. The proposed method is compared with the existing methods and can certify the robustness with the experiment results.

With the rapid outbreak of the coronavirus disease 2019 (COVID-19) pandemic, considerable concerns about the safety of systemic treatments of immune-mediated dermatologic disorders has been raised by dermatologists and their patients. We aimed to perform a rapid review of latest American and European guidelines on the use of systemic treatments in patients with immune-mediated dermatologic disorders and confirmed COVID-19 infection and to provide recommendations to inform practice. Based on the current limited guidelines and evidence, systemic corticosteroids should not be abruptly discontinued and the lowest effective dose should be continued. Systemic immunosuppressants (including methotrexate, cyclosporine, azathioprine, cyclophosphamide, and leflunomide), biologics, and sulfasalazine should be withheld in patients with confirmed COVID-19 infection. Whether to continue Janus kinase inhibitors should be determined following a shared decision-making process between dermatologists and patients after considering patients' medical conditions and risk for severe COVID.

Background: Cardiovascular disease (CVD) is a serious health concern worldwide, and half of the cases of CVD occur in Asia. Because hypertension or high blood pressure has been confirmed to be an important risk factor for CVD, controlling blood pressure is helpful for CVD prevention. Although many studies have shown a sex difference in the impact of blood pressure on the risk of CVD, the risk threshold of blood pressure remained the same for both sexes in the latest global guidelines. Objective: The study aimed to evaluate sex differences in the effect of increased blood pressure on the risk of CVD in Asian populations. Methods: In this study, we performed a systematic review via PubMed, Embase, and MEDLINE to select studies conducted with Asian populations published before 30 June 2021. Results: Six female and eleven male effect sizes for CVD risk from six articles were identified. The unadjusted pooled effect size for CVD risk per 10-mmHg increase in systolic blood pressure was estimated to be 1.20 for females (95% confidence interval: [1.10, 1.32]) and 1.19 for males (95% confidence interval: [1.11, 1.27]). Furthermore, using meta-regression to adjust for the significant effect of smoking, we showed that the impact of a 10-mmHg systolic blood pressure increase on CVD risk among females was 1.232 times that among males, corresponding to a significant sex difference (95% confidence interval: [1.065, 1.426]; 'P' = 0.02). In summary, the effect of an increased systolic blood pressure on the risk of CVD in females was significantly higher than that in males in the Asian population.

Membrane transporters translocate molecules across cell membranes and are involved in a variety of cellular processes. However, there is still no label-free technique for measuring the transport kinetics of non-charged species through membrane transporters. Here, we develop a new method based on surface plasmon resonance (SPR) and plasmon-waveguide resonance (PWR) to measure transporter function and ligand binding simultaneously. The PWR/SPR-combined sensor chip comprises a silica layer with micron-sized pores on a thin gold film, and the geometry allows the appearance of two independent plasmonic modes. The electromagnetic enhancement regions of the SPR-associated mode and the PWR-associated mode are localized inside the pore directly above the gold film and outside the pore above the silica layer, respectively, and can be used to detect refractive index or environmental changes in the corresponding regions. We deposited cell membrane vesicles onto the sensor chip to form pore-spanning cell membrane patches containing transporters of interest. Only species transported across the membrane can enter into the pore region and be detected by the SPR-associated mode, while ligand binding above the membrane can be detected by the PWR-associated mode. We used glucose transporters in HeLa cell membranes to demonstrate that the platform can be used to study how inhibitor binding can influence transport behaviors. More importantly, we successfully measured the glucose transport kinetics across the membrane. The obtained kinetic parameters of glucose transporters were comparable to those reported in studies using radiolabeled glucose, suggesting that this new label-free method can accurately characterize the membrane transport kinetics.

This study explores whether team-organization fit (T-O fit) and team-job fit (T-J fit) play a mediating role between team personality, team job satisfaction, and team performance. Conscientiousness and openness to experience are common antecedents of team personality. Additionally, T-O fit and T-J fit are derived from person-environment fit theory, which is used to discuss the interaction between team members and the environment that affects behavior. The research purpose is to understand the factors that affect job satisfaction and performance from a team perspective. This is different from previous studies based on an individual perspective. The research object of this study has 365 respondents from 81 teams in different industries, and the structural equation modeling is applied to the empirical analysis. The research results show that T-J fit has a significant mediating effect on team personality and team job satisfaction. The team job satisfaction has also a significant mediating effect on team personality and team performance. Therefore, when team members recognize their work, they work harder to achieve team job satisfaction and performance. This study suggests that companies not only pay attention to the work abilities of employees, but also understand the fit between them and their jobs.

Previous work has shown in iPSC derived neurons that synaptic impairments are associated with a 4bp DISC1 deletion. Here the authors demonstrate a role for the PDE4 signalling pathway in these synaptic impairments.

The thermal stability of (Mg0.95Ni0.05)2TiO4 dielectric ceramics has been improved by mixing with CaTiO3 phases owing to higher positive temperature coefficients. The pure (Mg0.95Ni0.05)2TiO4 and the mixture phase systems of CaTiO3-modified (Mg0.95Ni0.05)2TiO4 were verified by XRD diffraction patterns to ensure the crystallite of different phases. The microstructures of the CaTiO3-modified (Mg0.95Ni0.05)2TiO4 were observed by SEM and EDS to investigate the relation between element ratios and grains. As a result, it can be seen that the thermal stability of the CaTiO3-modified (Mg0.95Ni0.05)2TiO4 can be effectively enhanced, compared with the pure (Mg0.95Ni0.05)2TiO4. Moreover, the radio frequency dielectric performances of CaTiO3-modified (Mg0.95Ni0.05)2TiO4 dielectric ceramics are strongly dependent upon the density and the morphology of the specimens. The champion sample with the ratio of (Mg0.95Ni0.05)2TiO4 and CaTiO3 of 0.92:0.08 showed an εr value of 19.2, an Qf value of 108,200 GHz, and a τf value of −4.8 ppm/°C, which may encourage (Mg0.95Ni0.05)2TiO4 ceramics to broaden the range of novel applications and match the requirements of 5G or next-generation communication systems.

Hsin-Chou Yang et al. examine population structure in several genomic databases and identify that pharmacogenetic loci are enriched for markers of genetic ancestry. Their results suggest that genetic ancestry must be carefully considered in population pharmacogenetics studies.

The milkfish, Chanos chanos, is an important aquaculture species that can be cultured in freshwater (FW) and seawater (SW) ponds because of its high euryhalinity. In winter, cold snap leading to high mortality of this tropical species is a critical issue for the aquaculture industry in Taiwan. Under hypothermal stress, however, changes in energy supply for osmoregulation of this euryhaline species is intriguing. In this study, we used an antibody against glycogen phosphorylase (GP) to identify glycogen-rich (GR) cells distributed adjacent to the mitochondria-rich (MR) ionocytes in milkfish gills. Glucose transporter 1 (GLUT1), which plays a major role in energy supply, was also identified and localized in GR cells. Moreover, the expression of indicators of aerobic metabolism and energy production, citrate synthase (CS) and cytochrome c oxidase (COX), were analyzed in gills of FW- and SW-acclimated milkfish to reveal different strategies of energy utilization under hypothermal stress. When exposed to a low-temperature environment, SW individuals used branchial glycogen and lactate to match the energy demands of aerobic metabolism in ionocytes, and elevated aerobic capacity to support and maintain normal functions in gills. However, branchial glycogen mainly localized in the GR cells of FW milkfish was not utilized under hypothermal stress. Meanwhile, a similar level of branchial COX activity and COXIV protein abundance at low temperatures between FW and SW milkfish indicated similar energy requirements in gills. This suggested that another source, but not branchial glycogen, maintained the energy demand in FW milkfish. The present study illustrated differential energy supply strategies in gills between SW- and FW-acclimated milkfish for osmoregulation under low temperatures.

Abstract Background The management for subacute or chronic fistula after bariatric surgery is very complicated and with no standard protocol yet. It is also an Achilles’ heel of all bariatric surgery. The aim of this case report is to describe our experience in managing this complication by percutaneous embolization, a less commonly used method. Case presentation A 23-year-old woman with a body mass index of 35.7 kg/m2 presented with delayed gastric leak 7 days after laparoscopic sleeve gastrectomy (LSG) for weight reduction. Persistent leak was still noted under the status of nil per os, nasogastric decompression, and parenteral nutrition for 1 month; therefore, endoscopic glue injection was performed. The fistula tract did not seal off, and the size of pseudocavity enlarged after gas inflation during endoscopic intervention. Subsequently, we successfully managed this subacute gastric fistula via percutaneous fistula tract embolization (PFTE) with removal of the external drain 2 months after LSG. Conclusions PFTE can serve as one of the non-invasive methods to treat subacute gastric fistula after LSG. The usage of fluoroscopy-visible glue for embolization can seal the fistula tract precisely and avoid the negative impact from gas inflation during endoscopic intervention.

Abstract Nanoelectronics of two-dimensional (2D) materials and related applications are hindered with critical contact issues with the semiconducting monolayers. To solve these issues, a fundamental challenge is selective and controllable fabrication of p-type or ambipolar transistors with a low Schottky barrier. Most p-type transistors are demonstrated with tungsten selenides (WSe2) but a high growth temperature is required. Here, we utilize seeding promoter and low pressure CVD process to enhance sequential WSe2 growth with a reduced growth temperature of 800 °C for reduced compositional fluctuations and high hetero-interface quality. Growth behavior of the sequential WSe2 growth at the edge of patterned graphene is discussed. With optimized growth conditions, high-quality interface of the laterally stitched WSe2-graphene is achieved and characterized with transmission electron microscopy (TEM). Device fabrication and electronic performances of the laterally stitched WSe2-graphene are presented.

Purpose: To compare the effect of unloading knee brace with physical therapy (PT) in Asian patients with osteoarthritis (OA) of the knee. Method: This is a non-random, two-group comparative study. Patients with medial compartment knee OA (n = 41) were assigned to either the brace group (n = 20) or PT group (n = 21). Patients in the brace group were fitted with an unloading knee brace for three months and the PT group received a 60-min session of physiotherapy over the affected knee, three times a week, for three months. The primary outcome measures were the pain visual analogue scale (VAS) and the Western Ontario McMaster University Osteoarthritis Index (WOMAC); the second outcome measures were the 36-item Short-Form Health Survey (SF-36) and patient's satisfaction. The patients were evaluated at baseline, and at one month and three months. Results: Group comparison showed no significant difference regarding pain VAS, WOMAC, SF-36, and patient's satisfaction, except stiffness in WOMAC (P = .006) and social functioning in SF-36 (P = .007). Time and group interaction revealed significant differences only in general health (P = .007) and mental health (P = .006) of SF-36. Within-group comparison found that pain VAS and WOMAC decreased significantly at one months and three months in both groups. Conclusion: The effect of brace fitting in patients with knee OA was similar to that of physical therapy. A Western-made unloading knee brace is acceptable in some Asian people with knee OA. Clinical trial registration number: NCT02712710. Keywords: Knee osteoarthritis, Knee brace, Therapeutic exercise, Treatment

Peripheral arterial disease (PAD) results in insufficient flow to lower extremities. Aerobic exercise provides health benefits for individuals with PAD, but basic science behind it is still debated. Twenty-one PAD patients aged about 70 years with female/male as 7/14 were recruited. Among them, 11 were randomized to have supervised cycling training (SCT) and 10 to receive general healthcare (GHC) as controls. SCT participants completed 36 sessions of SCT at the first ventilation threshold within 12 weeks and the controls received GHC for 12 weeks. Ankle-brachial index (ABI), 6-min walk test (6MWT), peak oxygen consumption (V˙O2peak), minute ventilation (V˙E), minute carbon dioxide production (V˙CO2), erythrocyte rheology, including the maximal elongation index (EImax) and shear stress at 50% of maximal elongation (SS1/2), and the Short Form-36 (SF-36) questionnaire for quality of life (QoL) were assessed before and 12 weeks after initial visit. SCT significantly decreased the SS1/2 as well as SS1/2 to EImax ratio (SS1/2/EImax) and increased the erythrocyte osmolality in the hypertonic region as well as the area under EI-osmolality curve. The supervised exercise-induced improvement of erythrocyte deformability could contribute to the increased peripheral tissue O2 delivery and was possibly related with increased V˙O2peak. The physiological benefit was associated with significantly increased ABI, 6-min walking distance, cardiorespiratory fitness, and SF-36 score. However, no significant changes in aerobic capacity and erythrocyte rheological properties were observed after 12-week of GHC. In conclusion, SCT improves aerobic capacity by enhancing erythrocyte membrane deformability and consequently promotes QoL in PAD patients.

Euryhaline teleosts can survive in environments with different salinities. Cortisol is an important hormone for acclimation to seawater (SW) of euryhaline teleosts. Osmotic stress transcription factor 1 (OSTF1), also called the transforming growth factor-beta stimulated clone 22 domain 3 (tsc22d3), was first reported in tilapia as an acute response gene and protein under hyperosmotic stress, and it is regulated by cortisol. To date, most studies on OSTF1 have focused on freshwater inhabitants, such as tilapia, medaka, and catadromous eel. The expression of OSTF1 and the correlation between OSTF1 and cortisol in marine inhabitant euryhaline teleosts, to our knowledge, remain unclear. This study reveals the changes in the expression levels of branchial OSTF1, plasma cortisol levels, and their correlation in the marine inhabitant milkfish with ambient salinities. The two sequences of milkfish TSC22D3 transcripts were classified as OSTF1a and OSTF1b. Both genes were expressed universally in all detected organs and tissues but were the most abundant in the liver. Similar gene expression levels of ostf1a and ostf1b were found in SW- and fresh water (FW)-acclimated milkfish gills, an important osmoregulatory organ. Within 12 hours of being transferred from FW to SW, the gene expression level of ostf1b increased significantly (4 folds) within 12 h, whereas the expression level of ostf1a remained constant. Moreover, cortisol levels increased rapidly after being transferred to a hyperosmotic environment. After an intraperitoneal injection of cortisol, the gene expression levels of ostf1a and ostf1b were elevated. However, under hyperosmotic stress, ostf1a gene expression remained stable. Overall, the results revealed that ostf1b was the primary gene in milkfish responding to hypertonic stress, and cortisol concentration increased after the transfer of milkfish from FW to SW. Furthermore, cortisol injection increased the expression of ostf1a and ostf1b. As a result, factors other than cortisol may activate ostf1b in milkfish gills in response to an environmental salinity challenge.

Background and Objectives: Health-related physical fitness reduces the risk of chronic disease, promotes quality of life, and has enormous economic benefits considering the global health care costs resulting from obesity. However, relatively limited information is available regarding the dose–response relationship between scientific physical fitness and obesity risk. This study aimed to determine the associations of scientific physical fitness with body mass index (BMI) distribution and overweight/obesity risk among adults aged 23–64 years in Taiwan. Materials and Methods: We conducted a cross-sectional study and reviewed data derived from the Scientific Physical Fitness Testing Program, Sports Administration, Ministry of Education, Taiwan. Responses from 16,939 participants from the database (7761 men and 9178 women, aged 23–64 years) were collected in this study. Each participant completed a series of scientific physical fitness measurements, including cardiorespiratory fitness (3 min progressive knee-up and step [3MPKS] test), muscular fitness (hand grip strength), and flexibility (sit-and-reach test). Anthropometric measurements included body height, weight, and BMI. The quartiles of scientific physical fitness results were identified as the dependent variable in the multiple linear and multiple logistic regression analysis to determine the associations of the scientific physical fitness measurements with BMI distribution and overweight/obesity risk, as well as the dose–response relationship. Results: The 3MPKS test was significantly associated with BMI (quartile 1 (Q1): β = 1.900; quartile 2 (Q2): β = 1.594; quartile 3 (Q3): β = 1.079 for men, and Q1: β = 1.454; Q2: β = 0.882; Q3: β = 0.555 for women), overweight (Q1: odds ratio (OR) = 2.117; Q2: OR = 2.056; Q3: OR = 2.063 for men, and Q1: OR = 3.036; Q2: OR = 2.542; Q3: OR = 1.959 for women), and obesity (Q1: OR = 6.530; Q2: OR = 5.747; Q3: OR = 3.557 for men, and Q1: OR = 3.238; Q2: OR = 1.431 for women) risk compared with quartile 4 (Q4) as the reference group with a dose–response relationship. In addition, relative hand grip strength was significantly associated with BMI (Q2: β = −0.922; Q3: β = −1.865; Q4: β = −3.108 for men, and Q2: β = −1.309; Q3: β = −2.161; Q4: β = −2.759 for women), overweight (Q2: OR = 0.806; Q3: OR = 0.697; Q4: OR = 0.278 for men, and Q2: OR = 0.667; Q3: OR = 0.398; Q4: OR = 0.228 for women), and obesity (Q1: OR = 0.528; Q2: OR = 0.206; Q3: OR = 0.049 for men, and Q1: OR = 0.351; Q2: OR = 0.129; Q3: OR = 0.051 for women) risk compared with Q1 as the reference group with a dose–response relationship. Conclusions: Higher levels of performance of the 3MPKS and relative grip strength tests were associated with lower BMI and overweight/obesity risk in both sexes. However, the sit-and-reach test was only partially related to BMI and overweight/obesity risk in both sexes. Cardiorespiratory fitness and muscular fitness were effective predictors of BMI distribution and overweight/obesity risk in Taiwanese adults.

Danazol is a treatment option for autoimmune hemolytic anemia (AIHA) and immune thrombocytopenia (ITP). Three patients with AIHA and eight patients with ITP between 2008 and 2022 were enrolled in the Rheumatology Outpatient Clinic of Chang Gung Memorial Hospital, Kaohsiung. Those patients were refractory or intolerant to conventional therapy and were treated with danazol. All the patients received an initial dose of danazol (200–400 mg). The observation period was 6 months. Three patients (100%) with AIHA and six (75%) with ITP achieved treatment response after 6 months of danazol therapy. The dose of glucocorticoid for responders could be reduced to ≤5 mg/day of prednisolone, and the immunosuppressants, except hydroxychloroquine and azathioprine for systemic lupus erythematosus, could be discontinued. Adverse events were acne in two (18.2%) patients and transient dose-related liver function impairment in one (9.1%) patient in the current series. Danazol therapy appears to be a favorable alternative for refractory AIHA and ITP by altering the erythrocyte membrane to resist osmotic lysis and protecting platelets against complement-mediated lysis. In this report, we also performed a literature review and searched the PubMed/Cochrane Library for articles published from 1984 to January 2022 on danazol therapy for patients with AIHA and ITP.

Abstract Background The etiology of Kawasaki disease (KD) is still unknown; perinatal factors may have role with few studies. This study was aim to survey the perinatal factors and clinical outcome of KD, including coronary artery lesion (CAL) formation and intravenous immunoglobulin (IVIG) treatment response. Methods We enrolled a total of 185 KD patient–caregiver dyads in this study using questionnaires. The questionnaire included two categories: children’s characteristics, which consisted of age at disease onset, gender, gestational age at delivery, birth body weight, delivery methods, and breastfeeding status, and caregivers’ characteristics, which consisted of parents or not, education levels, maternal age at giving birth, total number of offspring, and family income. We analyzed the association of these factors with CAL formation and IVIG treatment response of KD. Results KD patients with CAL formation had a higher maternal age than non-CAL patients (32.49 ± 3.42 vs. 31.01 ± 3.92 years, p = 0.016). We also found that maternal age ≥ 32 years group had a higher rate of having KD patients with CAL (39/81 vs. 24/74, odds ratio 1.935, 95% confidence interval [1.007, 3.718], p = 0.047). The maternal age ≥ 35 years group had a higher rate of having KD patients with IVIG resistance (6/31 vs. 6/116, odds ratio 4.400, 95% confidence interval [1.309, 14.786], p = 0.01). There was no significant difference in either CAL formation or IVIG resistance in KD with regard to patient’s age at disease onset, gestational age, birth body weight, delivery methods, breastfeeding, caregiver type, caregivers’ education level, total number of offspring, or family income (p > 0.05). Conclusions This study is the first to report that maternal age is significantly associated with CAL formation and IVIG resistance in KD. We hypothesize that a maternal age less than 32 years would benefit KD offspring.

Four new species of Aleurodiscus sensu lato with echinulate basidiospores are described from East Asia: A. alpinus, A. pinicola, A. senticosus, and A. sichuanensis. Aleurodiscus alpinus is from northwest Yunnan of China where it occurs on Rhododendron in montane habitats. Aleurodiscus pinicola occurs on Pinus in montane settings in Taiwan and northwest Yunnan. Aleurodiscus senticosus is from subtropical Taiwan, where it occurs on angiosperms. Aleurodiscus sichuanensis is reported from southwest China on angiosperms in montane environments. Phylogenetic relationships of these four new species were inferred from analyses of a combined dataset consisting of three genetic markers, viz. 28S, nuc rDNA ITS1-5.8S-ITS2 (ITS), and a portion of the translation elongation factor 1-alpha gene, TEF1.

Abstract Background Polymorphisms have been identified to predispose to NAFLD. Here, we accessed the seven polymorphisms of rs1260326, rs780094 in GCKR, rs2954021 near TRIB1, rs2228603 in NCAN, rs58542926 in TM6SF2, rs12137855 near LYPLAL1, and rs10883437 near CPN1 on NAFLD susceptibility in the Uygur population. Material and methods We collected 620 samples (317 NAFLD and 303 controls) for this case-control study. Meta-analysis was performed using Stata Software. Results Our data detected that the rs1260326 (T vs. C: OR = 1.27, 95% CI = 1.01–1.59) and rs780094 (T vs. C: OR = 1.30, 95% CI = 1.04–1.63) were significantly associated with the susceptibility to NAFLD in Uygur population. The rs1260326 and rs780094 T/T genotype are significantly associated with soda, egg, and soybean intakes in the consumption group with twice or more in a week. Furthermore, a significant haplotype effect of rs1260326/T- rs780094/T was found (OR = 1.29, 95% CI: 1.03–1.62) compared with CC haplotype. An additional meta-analysis using 4352 cases and 10,168 controls established that rs780094 (OR = 1.21, 95%CI: 1.14–1.28) is significantly associated with NAFLD. Finally, among the 4 case-control studies on rs1260326, including 712 NAFLD and 658 controls, significant associations were found in Asian, liver biopsy, adult and pediatric groups. Conclusion Collectively, both our case-control study and meta-analysis confirm a significant association between rs780094 and NAFLD. Additionally, our results suggest Asian-specific, liver biopsy-specific, adult-specific and pediatric-specific associations between the rs1260326 and NAFLD. Moreover, the rs1260326 and rs780094 T/T genotype are significantly associated with food habits, such as soda, egg, and soybean.

Background: In most countries, large cerebral artery occlusion is identified as the leading cause of disability. In 2015, five large-scale clinical trials confirmed the benefit of intra-arterial thrombectomy. However, thrombectomy is a highly technical and facility-dependent procedure. Primary stroke centers need to transfer patients to comprehensive stroke centers to perform thrombectomy. The time-lapse during interhospital transfer would decrease the chance of the patient's proper recovery. Communication barriers also contribute to this delay.Aims: We used a smartphone application to overcome communication barriers between hospitals. We aimed to shorten the door-to-puncture time of interhospital transfer patients.Methods: We began using a smartphone application, “LINE,” to facilitate interhospital communication on May 01, 2018. We carried out retrospective data analyses for all the transfer patients (n = 351), with the primary outcome being the door-to-puncture time in our comprehensive stroke center (China Medical University Hospital). We compared the three periods: May 01 to Dec 31, 2017 (before the use of the smartphone application); May 01 to Dec 31, 2018 (the 1st year of using the smartphone application); and May 01 to Dec 31, 2019 (the 2nd year of using the smartphone application). We also compared the transfer data with non-transfer thrombectomies in the same period.Results: We compared 2017, 2018, and 2019 data. The total number of transfer patients increased over the years: 63, 113, 175, respectively. The mean door-to-puncture time decreased significantly, going from 109, through 102, to 92 min. Meanwhile, the mean door-to-puncture time in non-transfer patients were 140.3, 122.1, and 129.3 min. The main reason of time saving was the change of the way of communication, from point-to-point interhospital communication to hub-to-spoke interhospital communication.Conclusions: We used this smartphone application to enhance interhospital communication, changed from the point-to-point to hub-to-spoke method. It made us overcome the communication barrier and build up interhospital connection, thus shortening the door-to-puncture time. Our experience demonstrated the importance of close communication and teamwork in hyperacute stroke care, especially in interhospital transfer for thrombectomy.

Capillary leak syndrome (CLS) is a severe complication of allogeneic hematopoietic stem cell transplantation (HSCT) characterized by weight gain, generalized edema, hypotension, and hypoalbuminemia. The primary pathogenesis is injury of the capillary endothelium resulting in a loss of intravascular fluid into the interstitial space. Treatment is limited to vascular endothelial growth factor withdrawal and systemic corticosteroids. We report two cases with CLS where weight gain, ascites, and hypotension developed after neutrophil engraftment following allogeneic HSCT. We obtained serial electrolytes, blood urea nitrogen, creatinine, and albumin from these patients. Ultrasound with Doppler tracing performed on both patients showed no reversal of portal venous flow. Issues addressed were the restoration of regular hydration by hydroxyethyl starch (HES) solutions, together with systemic corticosteroids and forced diuresis. Tetrastarch was administered 10 and 20 days, respectively. Both patients recovered without sequelae. CLS is a frequent complication after allogeneic HSCT. The effects of HES on CLS merit further consideration and prospective study.

Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.

Hydraulic fracturing of unconventional reservoirs has seen a boom in the last century, as a means to fulfill the growing energy demand in the world. The fracturing fluid used in the process plays a substantial role in determining the results. Hence, several research and development efforts have been geared towards developing more sustainable, efficient, and improved fracturing fluids. Herein, we present a dynamic binary complex (DBC) solution, with potential to be useful in the hydraulic fracturing domain. It has a supramolecular structure formed by the self-assembly of low molecular weight viscosifiers (LMWVs) oleic acid and diethylenetriamine into an elongated entangled network under alkaline conditions. With less than 2 wt% constituents dispersed in aqueous solution, a viscous gel that exhibits high viscosities even under shear was formed. Key features include responsiveness to pH and salinity, and a zero-shear viscosity that could be tuned by a factor of ~280 by changing the pH. Furthermore, its viscous properties were more pronounced in the presence of salt. Sand settling tests revealed its potential to hold up sand particles for extended periods of time. In conclusion, this DBC solution system has potential to be utilized as a smart salt-responsive, pH-switchable hydraulic fracturing fluid.

This study aimed at the development of an algorithm for the computational optimization of free-piston Stirling engines. The design algorithm includes an optimization method and two compatible strategies. The optimization method is an improved version of traditional conjugate gradient method and is named the variable-step simplified conjugate gradient method (VSCGM). The free-piston Stirling engine is operable only in narrow-bounded parameter regions. Using the present approach, the operable variable combinations can be found efficiently. Two compatible strategies, the wake-up and backward-comparison strategies, are integrated with the VSCGM. The present design algorithm can handle multiple-parameter optimization with more flexible objective function definitions. Meanwhile, it features faster convergence as compared with the traditional conjugate gradient methods. Moreover, the feasibility of the VSCGM and the two compatible strategies is demonstrated in two test cases. It was found that the present approach can optimize the ten designed variables simultaneously, and the optimal designs can be yielded in a finite number of iterations. The results show that the inoperable initial designs were successfully optimized to reach a high power output.

Previous studies have suggested that the topical mechanistic target of rapamycin (mTOR) inhibitors may be effective in treating facial angiofibromas in patients with tuberous sclerosis complex (TSC). Various concentrations of topical sirolimus for TSC have been tested, but their comparative efficacy and safety remained unclear. To assess the effects of topical mTOR inhibitors in treating facial angiofibromas, we conducted a systematic review and network meta-analysis (NMA) and searched MEDLINE, Embase, and Cochrane Library for relevant randomized controlled trials on 14 February 2022. The Cochrane Collaboration tool was used to assess the risk of bias of included trials. Our outcomes were clinical improvement and severe adverse events leading to withdrawal. We included three trials on 261 TSC patients with facial angiofibromas. The NMA found when compared with placebo, facial angiofibromas significantly improved following the application of various concentrations of topical sirolimus (risk ratio being 3.87, 2.70, 4.43, and 3.34 for 0.05%, 0.1%, 0.2%, and 1%, respectively). When compared with placebo, all concentrations of topical sirolimus did not differ in severe adverse events leading to withdrawal. The ranking analysis suggested topical sirolimus 0.2% as the most effective drug. In conclusion, topical sirolimus 0.05–1% are effective and safe in treating facial angiofibromas in patients with TSC, with topical sirolimus 0.2% being the most effective.

Background and aim Appropriate sedation is important to the success of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA). Dexmedetomidine is a sedative agent that operates via the α2 adrenergic agonist, which provides sleep-like sedation with little respiratory suppression. This study compared the efficacy and safety of dexmedetomidine sedation with propofol in cases of EBUS-TBNA. Methods Patients requiring EBUS-TBNA were randomly assigned dexmedetomidine sedation (D, n=25) or propofol sedation (P, n=25). Vital signs, diagnostic yield and the bispectral index (BIS) were recorded throughout the bronchoscopic procedure and recovery period. The tolerance and cooperation of the patients were evaluated using questionnaires. Measurements and results The lowest mean arterial blood pressure in group D (79.2±9.9 versus 72.5±12.9 mmHg, p=0.049) exceeded that in group P, the lowest heart rate was lower (60.9±10.2 versus 71.4±11.8 beats·min−1, p=0.006) and the mean BIS during sedation was significantly higher (84.1±8.3 versus 73.6±5.7, p

Abstract The development of SnO2 and TiO2 polycrystalline nanofiber devices (PNFDs) has been widely researched as a method of protecting humans from household air pollution. PNFDs have three significant advantages. The nanofibers before the annealing process are polymer‐rich materials, which can be used as particulate material (PM) filters. The multiporous nanofibers fabricated by the annealing process have numerous defects that can serve as generation‐recombination centers for electron–hole pairs, enabling the PNFDs to serve as multiple‐wavelength light (from 365 to 940 nm) detectors. Lastly, the numerous surface/interface defects can drastically enhance the toxic gas detection ability. The toxic gas detection range of PNFDs for CO(g) and NO(g) is from 400 to 50 ppm and 400 to 50 ppb, respectively. Quick response times and recovery properties are key parameters for commercial applications. The recovery time of NO(g) detection can be improved from 1 ks to 40 s and the PNFD operating temperature lowered to 50 °C. These results indicate that SnO2 and TiO2 PNFDs have good potential for commercialization and use as toxic gas and photon sensors in daily lives.

Microencapsulation plays an important role in biomedical technology owing to its particular and attractive characteristics. In this work, we developed ropivacaine and dexamethasone loaded poly(D, L-lactide-co-glycolide) (PLGA) microparticles via electrospraying technique and investigated the release behavior of electrosprayed microparticles. The particle morphology of sprayed particles was assessed using scanning electron microscopy (SEM). The in vitro drug release kinetics were evaluated employing an elution method, and the in vivo pharmaceutical release as well as its efficacy on pain relief were tested using an animal activity model. The microscopic observation suggested that sprayed microparticles exhibit a size distribution of 5–6 µm. Fourier-transform infrared spectrometry and differential scanning calorimetry demonstrated the successful incorporation of pharmaceuticals in the PLGA particulates. The drugs-loaded particles discharged sustainably high concentrations of ropivacaine and dexamethasone at the target region in vivo for over two weeks, and the drug levels in the blood remained low. By adopting the electrospraying technique, we were able to prepare drug-embedded polymeric microparticles with effectiveness and with a sustainable capability for postoperative pain control.

This work reported on the fabrication and investigation of a mixed matrix hollow fiber membrane (MMHFM) by incorporating commercially available alumina particles into a polyetherimide (PEI) polymer matrix. These MMHFMs were prepared by the dry-wet spinning technique. Accordingly, optimizing the spinning parameters, including the air gap distance and flow rate ratio, is key to determining the gas separation performance. However, there are few studies regarding the effect of the filler dimensions. Consequently, three sizes of alumina particles, 20 nm, 30 nm, and 1000 nm, were respectively added into the PEI phase to examine the influence of filler size on gas permeation property. Moreover, the permeation properties of lower hydrocarbons (i.e., ethane and propane) were also measured to evaluate potential for emerging applications. The results indicated the as-synthesized membrane exhibited a remarkable hydrogen permeance of 1065.24 GPU, and relatively high separation factors of 4.53, 5.77, and 5.39 for H2/CO2, H2/C2H6, and H2/C3H8, respectively. This resulted from good compatibility between the larger fillers and the PEI polymer, as well as a reduction in the finger-like voids. Overall, the MMHFM in this work was deemed to be a promising candidate to separate hydrogen from gas streams, based on the comparison of the separation performance against other reported studies.