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Introduction: Cardiovascular (CV) events are the major cause of morbidity and mortality associated with blood pressure (BP) in hemodialysis (HD) patients. BP varies significantly during HD treatment, and the dramatic variation in BP is a well-recognized risk factor for increased mortality. The development of an intelligent system capable of predicting BP profiles for real-time monitoring is important. Our aim was to build a web-based system to predict changes in systolic BP (SBP) during HD. Methods: In this study, dialysis equipment connected to the Vital Info Portal gateway collected HD parameters that were linked to demographic data stored in the hospital information system. There were 3 types of patients: training, test, and new. A multiple linear regression model was built using the training group with SBP change as the dependent variable and dialysis parameters as the independent variables. We tested the model’s performance on test and new patient groups using coverage rates with different thresholds. The model’s performance was visualized using a web-based interactive system. Results: A total of 542,424 BP records were used for model building. The accuracy was greater than 80% in the prediction error range of 15%, and 20 mm Hg of true SBP in the test and new patient groups for the model of SBP changes suggested the good performance of our prediction model. In the analysis of absolute SBP values (5, 10, 15, 20, and 25 mm Hg), the accuracy of the SBP prediction increased as the threshold value increased. Discussion: This databae supported our prediction model in reducing the frequency of intradialytic SBP variability, which may help in clinical decision-making when a new patient receives HD treatment. Further investigations are needed to determine whether the introduction of the intelligent SBP prediction system decreases the incidence of CV events in HD patients.

本文描述一位血液透析個案接受腎移植後出現急性排斥之護理經驗，照護期間為2020年1月6日至2020年1月31日。筆者藉由會談、傾聽、觀察、身體評估、病歷查閱等技巧收集資料，確立有急性疼痛、潛在危險性感染、焦慮等健康問題。運用Watson關懷照護理論，與個案建立良好的護病關係，提供個別性護理。針對術後急性疼痛，提供疼痛緩解技巧，如：呼吸控制等，並合併藥物介入，達到疼痛控制；潛在危險性感染風險，著重加強傷口照護，及出院後預防感染居家護理，加上雙重血漿置換後導致白蛋白低於正常值，更運用跨團隊會診營養師，提供高蛋白等營養攝取資訊；當對未來出現不確定，及對不熟悉的治療產生焦慮不安時，除給予治療前詳細介紹外，更運用關懷、聆聽、信仰等，加強其心理與靈性支持，增加個案的自信和希望，使其能以正向態度開始新生活。期望藉由此經驗分享在照護類似個案時，能提供更適切的護理照顧，作為日後臨床照護之參考。 This study describes the experience of providing nursing care to a hemodialysis patient who experienced acute rejection following a kidney transplant. The period of care lasted from January 6, 2020 to January 21, 2020. Data was collected through conversations, listening sessions, observations, physical assessments, and medical record reviews. The patient was found to be suffering from health problems such as acute pain, a potential risk of infection, and anxiety. Watson’s theory of human caring was applied to establish a strong nurse-patient relationship and to provide personalized nursing care. The patient’s acute postoperative pain was managed and controlled by means of pain alleviation methods such as respiratory control and medication treatment-based interventions. The patient’s potential risk of infection was managed by focusing on the implementation of wound care as well as infection prevention measures at the patient’s home after discharge. Furthermore, since the patient’s albumin level was lower than normal following a double filtration plasmapheresis, a multidisciplinary team was formed, and the patient consulted with a dietician who provided nutritional recommendations such as having a high protein diet. When the patient expressed uncertainty about the future or felt anxious about unfamiliar treatments, the team not only thoroughly described the treatments beforehand, but also enhanced the mental and spiritual support that they provided by expressing concern about, listening to, and placing faith in the patient, with the purpose of boosting the patient’s self-confidence and sense of hope. As a result the patient was able to begin a new life with a positive attitude. This experience is expected to serve as a reference for providing more appropriate nursing care plans for similar patients in clinical settings in the future. &nbsp

BackgroundFew studies have addressed early-stage kidney disease and preclinical cardiac structural and functional abnormalities from a large-scale Asian population. Further, the extent to which measures of myocardial function and whether these associations may vary by testing various formulas of renal insufficiency remains largely unexplored.ObjectiveTo explore the associations among renal function, proteinuria, and left ventricular (LV) structural and diastolic functional alterations.DesignA cross-sectional, retrospective cohort study.SettingRegistered data from a cardiovascular health screening program at MacKay Memorial Hospital from June 2009 to December 2012.ParticipantsAsymptomatic individuals.MeasurementsRenal function was evaluated in terms of estimated glomerular filtration rate (eGFR) by both MDRD and CKD-EPI formulas and severity of proteinuria, which were further related to cardiac structure, diastolic function (including LV e’ by tissue Doppler), and circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) level.ResultsAmong 4942 participants (65.8% men, mean age 49.4 ± 11.2 years), the mean CKD-EPI/MDRD eGFR was 90.6 ± 15.7 and 88.5 ± 16.9 ml/min/1.73m2, respectively. Lower eGFR, estimated either by the MDRD or CKD-EPI method, and higher proteinuria were significantly associated with lower LV e’ and higher NT-proBNP (all pinteraction <0.05).LimitationsProteinuria was estimated using a urine dipstick rather than more accurately by the urine protein-to-creatinine ratio. Also, pertaining drug history and clinical hard outcomes were lacking.ConclusionBoth clinical estimate of renal insufficiency by eGFR or proteinuria, even in a relatively early clinical stage, were tightly linked to impaired cardiac diastolic relaxation and circulating NT-proBNP level. Elevation of NT-proBNP with worsening renal function may be influenced by impaired myocardial relaxation.

Purpose of the study The risk of bone fracture is high in patients with chronic kidney disease (CKD), and aggressive treatment to reduce fragility fracture risk is the major strategy. However, the outcomes of osteoporosis medications in patients with CKD remain unclear. Study design Patients with stage 3–5 CKD during 2011–2019 were enrolled. Patients were divided into two groups based on receiving osteoporosis medications (bisphosphonates, raloxifene, teriparatide or denosumab) or not. Two groups were matched at a 1:1 ratio by using propensity scores. The outcomes of interest were bone fractures, cardiovascular (CV) events and all-cause mortality. Cox proportional hazard regression models were applied to identify the risk factors. Additional stratified analyses by cumulative dose, treatment length and menopause condition were performed. Results and conclusions 67 650 patients were included. After propensity score matching, 1654 patients were included in the study and control group, respectively. The mean age was 70.2±12.4 years, and 32.0% of patients were men. After a mean follow-up of 3.9 years, the incidence rates of bone fracture, CV events and all-cause mortality were 2.0, 1.7 and 6.5 per 1000 person-months, respectively. Multivariate analysis results showed that osteoporosis medications reduced the risk of CV events (HR, 0.35; 95% CI, 0.18 to 0.71; p = 0.004), but did not alleviate the risks of bone fracture (HR, 1.48; 95% CI, 0.73 to 2.98; p = 0.28) and all-cause mortality (HR, 0.93; 95% CI, 0.67 to 1.28; p = 0.65). Stratified analysis showed that bisphosphonates users have most benefits in the reduction of CV events (HR, 0.26; 95% CI, 0.11 to 0.64; p = 0.003). In conclusion, osteoporosis medications did not reduce the risk of bone fractures, or mortality, but improved CV outcomes in patients with CKD.

As all kinds of self-contained display products have become popular, various technologies for improving printing applications have gradually been ignored or even stagnated. However, the number of printed matters in life has not decreased. Every day our lives are full of various printed materials, such as newspapers, magazines, leaflets, product packaging, and so on. The waste and pollution caused by printing technology are usually recessive, and not everyone values it. Unfortunately, people often overlook the waste of resources and environmental pollution caused by the manufacturing process, ink, toner, and printers. The method proposed in this paper uses a color difference model to find a manner that is not easy to notice by the human eye to save ink. The proposed method considers feasibility and practicability, and users can quickly find suitable settings for their applications. Also, through the actual printed pictures, the experimental results show that only 67.57% of the original ink consumption is required to obtain an equivalent print quality that is difficult to perceive by the human eye. Our proposed method will benefit the printing industry and reduce ink consumption on consumer printers, contributing to cost control and being nature-friendly.

The study used trait-state-occasion TSO models to explore longitudinal personality stability in young adolescents with the onset of depressive symptoms and to quantify time-invariant and time-varying personality components in predicting the course of depressive symptoms. A total of 326 young clinical adolescents were recruited from high schools, and only 290 adolescents (112 boys; 178 girls) were followed up for 4 time points. Personality measures were implemented twice each year with an interval of 6 months, providing four assessment waves (T1 to T4); depression measures were administered at the initial stage (T1) and the third wave (T3), respectively. The results showed that five domains of personality in adolescents with depressive symptoms were largely characterized by the stable trait factor (65%-81%). The average autoregressive effects across the four waves were significant for all Big Five personality domains except openness. Moreover, excluding time-varying variance, conscientiousness, extraversion and agreeableness were negatively associated with T1 depressive symptoms; however, only the latter two domains retained significant relationships in the second year of intervention. An elevated level of neuroticism was consistently associated with higher levels of depressive symptoms over interventions. Trait factors of extraversion, agreeableness and neuroticism were associated with depressive symptoms in early adolsecnets, providing some implications for clinical practitioners.

Background/Objectives The purpose of this study was to present an association between the treatment response of diabetic macular edema (DME) to intravitreal ranibizumab (IVR) injections and different morphology patterns using spectral domain optical coherence tomography (SD-OCT). Subjects/Methods This retrospective study included 216 eyes of 142 subjects who received IVR for DME and were observed for at least 2 years. Medical charts and SD-OCT images of consecutive patients were reviewed at baseline, 1, 3, 6, 12, and 24 months after first IVR treatment. The OCT patterns were characterized as diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). All patients were classified into four groups based on the OCT findings. Results For a total of 216 eyes, 36 eyes were classified into the DRT group, 76 in the CME group, 42 in the SRD group, and 62 in the VMIA group. There were significant central macula thickness (CMT) improvements in all groups at the 1st month and the 2nd year, except for the DRT group at the 2nd year. Patients with OCT findings of hyperreflective dots (HRDs), metabolic parameters of hyperlipidemia, and coronary artery disease (CAD) had significantly less improvements in CMT at 2-year follow-up (P=0.029, 0.007

This study applied trait-state-occasion (TSO) modelling to investigate the extent to which inter-individual differences in personality were accounted for by time-invariant and time-varying factors during adolescence. The participants were 753 high school students, and only 661 students were followed for 4 years. The mean age in the first year was 15.23 years and 52.8% were females. The results showed that the full TSO model had the best representation of adolescent personality, and the means of the proportions of variance explained by trait factors for the Big Five ranged between 56% and 83%, suggesting that inter-individual differences in personality are mainly accounted for by stable trait variance over the course of adolescence. Furthermore, the five dimensions of personality differed not only in the amounts of trait variance but also in the stability of time-varying factors. These findings have significant implications for personality research.

Objective Radiotherapy (RT) for head and neck cancer (HNC) within 7 days of tooth extraction is contraindicated because it may increase the risk of osteoradionecrosis of the jaw (ORNJ). However, delayed RT could compromise survival in patients with HNC. By using a national health care database, we reviewed the contraindications and analysed other risk factors for ORNJ. Design A retrospective cohort study. Setting By using Taiwan's National Health Insurance Research Database, 5,062 HNC patients with at least one tooth extraction 1-21 days before the first RT day (index day) and without any extractions during or after RT from 2000 to 2013 were included. The patients were divided into two groups according to the time of tooth extraction before the index day: 1-7 days and 8-21 days. Participants Taiwanese patients with head and neck cancer. Main outcomes measure Univariate and multivariate Cox proportional hazard regression models were used to evaluate the risk factors of ORNJ. Results The overall incidence of ORNJ in the included patients was 1.03% (mean follow-up duration, 4.07 ± 3.01 years; range, 1.00-13.99 years). Tooth extraction within 7 days before RT was not associated with increased ORNJ risk (hazard ratio [HR] = 0.734; p = 0.312). Significant risk factors for ORNJ included oral cancer (adjusted HR = 3.961), tumour excision surgery within 3 months before RT (adjusted HR = 3.488), and mandibulectomy within 3 months before RT (adjusted HR = 5.985; all p Conclusion In a mean follow-up of 4 years, tooth extraction within 7 days before RT for HNC treatment did not increase the ORNJ risk compared with tooth extraction 7-21 days before RT.

Deep cement mixed (DCM) soil columns have been widely utilized to improve soft soil to support embankments or seawalls. However, the influence of the time-dependent behavior of the soft soil on the performance of DCM column-supported embankments is not well understood. In this study, the finite element (FE) model was established to investigate the creep effects on settlements and load transfer mechanisms of the soft soil improved by DCM columns under embankment load. Comparisons were conducted for the cases of the soft soil with or without creep. The parametric analysis demonstrated that the area replacement ratio and Young's modulus of the DCM column can largely influence the long-term behaviors of the DCM column-improved composite ground. The numerical results were also compared with the results calculated by German design method (EBGEO) and British design method (BS 8006). Regarding the vertical stress taken by the DCM column, EBGEO method provides a lower limit while BS 8006 method provides an upper limit.

This study analyzed early childhood preservice teachers’ specific components of self-efficacy to provide a more exhaustive comprehension of the relationships among STEM self-efficacy, pedagogical belief, and the self-reported need for professional development (PD). The participants were undergraduate or graduate preservice teachers recruited from the early childhood education department of a university in Taiwan. The research used instruments including the Teacher STEM Self-efficacy Scale, Teacher STEM Pedagogical Belief Scale, and Need for PD Scale to collect the data. In total, 150 preservice preschool teachers completed the survey. MANOVA and structural equation modeling were used to analyze the data. The results revealed that preservice teachers’ scores on STEM self-efficacy and the three components of self-efficacy were positively correlated with their STEM pedagogical beliefs and self-reported need for PD. Furthermore, affective attitude predicted teachers’ need for PD directly or indirectly through STEM pedagogical belief. In addition, the result indicated that STEM pedagogical belief acted as an intermediary in the association between the two components of self-efficacy (“cognitive concept” and “affective attitude”) and the self-reported need for PD. However, STEM pedagogical belief cannot mediate the relationship between the “equipped skill” component of self-efficacy and the self-reported need for PD. Preservice preschool teachers who had STEM teaching experience, reported interests in STEM, or participated in STEM-related activities had higher levels of STEM self-efficacy in terms of cognitive concept, affective attitude, and equipped skill. Based on these findings, the researchers provide suggestions for future research and practical implications in teacher development program.

In this paper, a new simplified method (de-coupled method) is presented for calculating consolidation settlements of a soft soil layer with creep under multi-staged loadings. All equations of this ...

The existing differential item functioning (DIF) detection approaches relying on item difficulty or item discrimination are limited for understanding the associates of DIF items, and consequently, DIF items were conventionally either deleted or ignored. Given the importance of minimizing DIF items in test construction, teachers or testing practitioners need more information regarding possible associates of DIF items. Using an example of a teacher-made mathematics achievement test, this study aimed to examine how the Poly-BW indices (power, defenselessness, disturbance, and hint) contributed to the properties of gender-related DIF items. Data from a 34-item mathematics achievement test that involved 1,439 seventh-grade students from Taiwan (51.01% boys and 48.99% girls) showed that the differences of the defenselessness (mp) and power (cp) indices between men and women served as salient predictors of the DIF measures estimated by the Poly Simultaneous Item Bias Test (Poly-SIBTEST) procedure and with satisfactory accuracy of hit rates. Items with relatively large defenselessness for men were likely to present male-favoring DIFs, whereas items with relatively large power for men were likely to present female-favoring DIFs. The Poly-BW indices yielded directions for modifying items for teachers in practice.

The Big Three Perfectionism Scale (BTPS) is one of commonly used measures for assessing individuals' perfectionism. The main purpose of this current study was to assess the psychometric properties of the Big Three Perfectionism Scale (BTPS) within the framework of the Rasch model. The sample consisted of 502 adolescents (53% males and 47% females). This study revealed were several important findings. First, adolescents interpreted the categories of the rating scales of the BTPS as intended and items demonstrated good targeting with the operating ranges from - 4.79 to 4.47 logits for rigid perfectionism, from - 3.84 to 3.76 logits for self-critical perfectionism and from - 4.04 to 3.92 logits for narcissistic perfectionism. Second, rigid perfectionism, self-critical perfectionism and narcissistic perfectionism exhibited unidimensionally, providing justification for the use of summed scores for each scale. Third, the average item difficulty of facets was different within each scale, with the facets of self-worth contingencies, socially prescribed perfectionism and other-oriented perfectionism being more difficult to endorse in their belonging scale. Fourth, there were no DIF items across sex, suggesting that items in three scales functioned equally across boys and girls. Fifth, rigid perfectionism (r = 0.15) and self-critical perfectionism (r = 0.55) were positively associated with neuroticism, but self-critical perfectionism (r = - 0.24) and narcissistic perfectionism (r = - 0.29) were negatively related with agreeableness. Finally, sex moderated the associations between rigid perfectionism and neuroticism. In sum, the findings in this study enhance psychometric properties of the BTPS.

Geosynthetics and deep cement mixed (DCM) soil columns have been widely used to improve soft soil grounds in many countries and regions. This paper presents an experimental study on a geosynthetic-reinforced sand fill over marine clay with or without DCM columns under different loadings. Two tests were conducted on the sand fill reinforced with fixed-end and free-end geosynthetics over marine clay under three-stage local loading to investigate the effects of the boundary conditions of geosynthetic reinforcement on reducing settlements. It is observed that the fixed-end geosynthetic sheet is more effective in reducing settlements than the free-end condition under identical local loading. Another test was conducted on the fixed-end geosynthetic-reinforced sand fill over the marine clay improved by DCM columns under single-stage uniform loading. The vertical stresses on the marine clay and on the DCM columns, as well as the tensile strains of the geosynthetic sheet in the overlying sand fill, were measured. The results revealed that the stress concentration ratio increases with an increase in consolidation settlements, and the maximum tensile strain of the geosynthetic sheet occurs near the edge rather than at the center of the top surface of the DCM columns. Keywords: Settlement, Geosynthetic, Reinforcement, Deep cement mixed soil columns

Cinnamomum insularimontanum is an endemic species of Taiwan. Although most Cinnamomum plants have significant biological activity, the bioactivity investment of C. insularimontanum is rare. Since inflammation plays an important role in many diseases, anti-inflammatory compounds can be developed into healthcare products. Therefore, we first conducted a study on the anti-inflammatory activity of C. insularimontanum leaves. First, we examined the antiinflammation activity of essential oil from C. insularimontanum leaves, and it revealed potent anti-inflammatory activity. A total of 23 volatile compounds were identified in C. insularimontanum leaves’ essential oil by using GC/MS analysis. Among them were 1,8-cineole (35.94%), α-eudesmol (6.17%), pinene (7.55%), sabinene (5.06%), and isobornyl acetate (4.81%). According to previous studies, 1,8-cineole might be an anti-inflammation principal compound of C. insularimontanum leaves. Next, the ethanolic extracts of C. insularimontanum leaves also exhibited good anti-inflammatory activity. Two bioactive compounds, isoburmanol (F1) and burmanol (F2), were isolated from the ethyl acetate soluble fraction by using the bioactivity-guided separation protocol and spectroscopic analysis. F1 was obtained from C. insularimontanum for the first time, and F2 was isolated for the first time from natural resources. Both F1 and F2 could inhibit the production of nitric oxide (NO), and the IC50 values were 14.0 μM and 43.8 μM, RAW 264.7 cells after induction of lipopolysaccharide. Furthermore, F1 and F2 also revealed significant inhabitation effects on iNOS and COX-2 protein expression. The anti-inflammation activity of F1 and F2 was different from the common pathway of inhibiting NF-κB. Both of them could inhibit the production of NO and PGE2 by directly inhibiting the AP-1 (c-Jun) protein and then inhibiting the downstream iNOS and COX-2. Although both F1 and F2 possessed significant anti-inflammatory activity, the activity of F1 was better than F2. Through molecular docking simulation analysis, the results show that F1 and F2 interact with AP-1, inhibit the binding of AP-1 to DNA, and cause AP-1 to fail to transcribe the related factors of inflammation. The binding ability of AP-1 and F1 was stronger than F2, and that is the reason why F1 exhibited better activities in both downstream proteins and inflammatory cytokines. Based on the results obtained in this study, the essential oil and F1 and F2 isolated from C. insularimontanum leaves have good anti-inflammatory activities, and it is expected to be used as a reference for the development of medical care products in the future.

The Brillouin optical time domain analysis (BOTDA) technology is gaining immense popularity and increasingly being utilised to measure strains in geotechnical structures. The deformations are usually determined by recording strains of selected points, from which the precaution and early warning of instability can be obtained. The errors of the measured strains using BOTDA are related to uncertainties in different connection methods and accumulated errors of the network in the monitoring zone. In this study, a network theory was derived first to measure the deformations of a geotechnical structure in two-dimensional (2D) condition. Next, two physical models (one with four nodes and the other with eight nodes) were established. The performance of the calculated deformations using the network theory based on the measured strains from BOTDA was examined and analysed by comparing the preset displacements from micrometres. From the test results, it is found that the stress concentration at the connection, which has a direct impact on the measured data, can be effectively reduced when using the rubber gasket. There is a good agreement between the calculated deformations and the preset displacements. The accumulated errors are less than 6% for three groups of relative stable nodes, which demonstrates that the proposed network theory can be well utilised in various fields and practical applications that require high precision.

BackgroundInfluenza is a major contributor to global disease burden. Vaccination recommendations specifically target populations at increased risk of serious influenza sequelae. The aim of this study is to conduct a systematic review and meta-analysis to evaluate the effectiveness of different quality improvement interventions to increase vaccination rates in high-risk populations.MethodsRandomized and nonrandomized studies with concurrent control groups will be identified. Interventions to increase vaccination rates will be categorized by strategy type. Overall intervention effects will be calculated using random effects models. Study quality will be assessed using a modified Cochrane Risk of Bias tool.

(1) Background: To investigate the correlation between therapeutic outcome and morphologic changes for diabetic macular edema (DME) after intravitreal injection of ranibizumab (IVIR). (2) Methods: This retrospective study included 228 eyes received IVIR for DME. Each participant was traced for two years after the initial IVIR, while the data of ophthalmic examination, optical coherence tomography (OCT) image, and systemic diseases were collected. The study population was categorized into different subgroups according to the existence of OCT morphologic change and the initial OCT morphologic pattern, including diffuse retinal thickening (DRT), cystoid macular edema (CME), serous retinal detachment (SRD), and vitreomacular interface abnormalities (VMIAs). The primary outcomes were the baseline best-corrected visual acuity (BCVA) and central macular thickness (CMT) during a two-year study period. The distribution of OCT morphologic change and its relation to primary outcome were analyzed. (3) Results: Comparing the 42 eyes (18.4%) with OCT morphological changes to another 186 eyes (81.6%) without such alteration, the former showed a poorer baseline BCVA (0.84 ± 0.39 vs. 0.71 ± 0.36, p = 0.035), worse final BCVA (0.99 ± 0.44 vs. 0.67 ± 0.30, p = 0.001), and thicker final CMT (354.21 ± 89.02 vs. 305.33 ± 83.05, p = 0.001). Moreover, the VMIA developed in 14.9% of all DME patients presenting the most common morphologic change among DRT, CME, and SRD. Besides, the presence of stroke was independently correlated to the morphologic change (adjusted odds ratio [aOR]: 6.381, 95% confidence interval (CI): 1.112–36.623, p = 0.038). (4) Conclusions: The change of OCT morphology in DME patients receiving IVIR was correlated to worse structural and visual outcome while the formation of VMIA most commonly occurred after initial treatment.

The anti-melanogenic activity of essential oils of Alpinia nantoensis and their bioactive ingredients were investigated in vitro. Treatment with leaf (LEO) and rhizome (REO) essential oils of A. nantoensis, significantly reduced forskolin-induced melanin production followed by down-regulation of tyrosinase (TYR) and tyrosinase related protein-1 (TRP-1) expression at both transcriptional and translational levels. Further studies revealed that down-regulation TYR and TRP-1 were caused by LEO/REO-mediated suppression of Microphthalmia-associated transcription factor (MITF), as evidenced by reduced nuclear translocation of MITF. Also, we found that LEO/REO induce the sustained activation of ERK1/2, which facilitate subsequent proteasomal degradation of MITF, as confirmed by that LEO/REO failed to inhibits MITF activity in ERK1/2 inhibitor treated cells. In addition, a significant increase of ubiquitinated MITF was observed after treatment with LEO and REO. Furthermore, the chemical composition of LEO and REO were characterized by gas chromatography-mass spectrometry (GC-MS) resulted that camphor, camphene, α-pinene, β-pinene, isoborneol and D-limonene were the major compounds in both LEO and REO. Further studies revealed that α-pinene and D-limonene were the active components responsible for the anti-melanogenic properties of LEO and REO. Based on the results, this study provided a strong evidence that LEO and REO could be promising natural sources for the development of novel skin-whitening agents for the cosmetic purposes.

Background and Aims To evaluate the association of osteoporosis medications and outcomes of patients at risk of CKD. Method We included patients with stage 3-5 CKD from three Taipei Medical University-affiliated hospitals between January 1, 2011 and August 31, 2016. Patients were divided into two groups based on whether they received osteoporosis medications (bisphosphonates, raloxifene, teriparatide, or denosumab) and then matched at a 1:1 ratio by using propensity scores. The outcomes of interest were bone fractures, cardiovascular (CV) events, and all-cause mortality. Cox proportional hazard regression models were applied to identify the risk factors. Results A total of 39128 patients with CKD were included. After propensity score matching, 763 patients were in the study and control groups, respectively. The mean age of patients was 71.9 ± 12.5 years, and 34.4% of patients were men. After a median follow-up of 2.9 years, the incidence rates of bone fracture, CV events, and all-cause mortality were 10.4%, 7.5%, and 7.5%, respectively. Multivariate analysis results indicated that osteoporosis treatment was note associated with reduced risks of bone fracture (HR 0.85; 95% CI 0.43–1.68; P = 0.65), CV events (HR 0.82; 95% CI 0.56–1.20; P = 0.30), and all-cause mortality (HR 0.74; 95% CI 0.51–1.08; P = 0.12). Subgroup analysis demonstrated only patients with CKD stage 3 who received osteoporosis medications associated with better survival. Conclusion Osteoporosis medications did not reduce bone fractures, CV events or mortality in patients with CKD. Improved overall survival was observed in patients with CKD stage 3.

This study investigates primarily the use of Computational Thinking in teaching mathematical concepts of Perimeter and Area. For those 3rd and 4th Grade students with learning disabilities, specifically, the extent to which their construction and understanding of mathematical concepts and their development of computational thinking are explored. For these reasons, the experimental research method is the one-group pretest-posttest design that we adopted which was conducted with 26 students, identified as learning disabilities by the committee for Identification and Placement of Gifted and Disabled Student. Data collected are analyzed with the Paired Sample t-test to comparison of these students in their learning outcomes and difference in aspects of construction of mathematical concepts and development of computational thinking after teaching. We find this teaching method enhances the learning outcomes and performance in the Math unit of Perimeter and Area and the performance of the development of computational thinking of these students after the intervention (160 minutes).

The authors consecutively assessed various arterial pulse‐wave velocity (PWV) indices and ankle‐brachial index (ABI) by an automatic device (VP2000, OMRON Health Care Co. Ltd., Kyota, Japan) in outpatients with ≥ 1 cardiovascular risk. PAD was defined as ABI ≤ 0.9. Among 2309 outpatients (mean age 62.4 years), worse renal function was associated with higher brachial‐ankle PWV, heart‐carotid PWV, heart‐femoral PWV (hf‐PWV), and lower ABI (all P

// Pei-Chen Wu 1,2,* , Vin-Cent Wu 3,* , Cheng-Jui Lin 1,4,5 , Chi-Feng Pan 1 , Chih-Yang Chen 1 , Tao-Min Huang 6 , Che-Hsiung Wu 7 , Likwang Chen 8 , Chih-Jen Wu 1,4,9,10 and The NRPB Kidney Consortium 11 1 Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan 2 Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan 3 Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan 4 Department of Medicine, Mackay Medical College, Taipei, Taiwan 5 Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan 6 Department of Internal Medicine, National Taiwan University Hospital Yun-Lin Branch, Douliou, Taiwan 7 Division of Nephrology, Taipei Buddhist Tzu Chi General Hospital, Buddhist Tzu Chi University, Taipei, Taiwan 8 Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan 9 Graduate Institute of Medical Sciences and Department of Pharmacology, College of Medicine, Taipei Medical University, Taipei, Taiwan 10 Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan 11 NRPB, National Research Program for Biopharmaceuticals, ROC, Taiwan * These authors have contributed equally to this work Correspondence to: Chih-Jen Wu, email: // Keywords : meglitinide, diabetes mellitus, hypoglycemia, chronic kidney disease, mortality Received : January 21, 2017 Accepted : April 14, 2017 Published : April 27, 2017 Abstract The safety of short-acting meglitinides in diabetic patients with advanced chronic kidney disease (CKD) has not been widely reported. Diabetic patients with advanced CKD who had a serum creatinine level of > 6 mg/dL a hematocrit level of ≦ 28% and received erythropoiesis-stimulating agent treatment between 2000 and 2010, were included in this nationwide study in Taiwan. The outcomes of interest were defined as hypoglycemia and long-term mortality. The risks of hypoglycemia and death were analyzed using Cox proportional hazards models, with end-stage renal disease and anti-diabetic drugs as time-dependent variables. Fresh users and matched non-users of meglitinides (both n = 2,793) were analyzed. The use of meglitinides increased the risk of hypoglycemia (HR, 1.94, p 62 and ≤ 33 years from the generalized additive model. This study suggests that the use of short-acting meglitinides could be associated with increased risk of hypoglycemia in diabetic patients with advanced CKD, especially in patients aged > 62 and ≤ 33 years. Meglitinide combined with insulin will increase hypoglycemia in patients with advanced CKD.

The growth of large-area epitaxial transition metal dichalgogenides (TMDCs) are of central importance for scalable integrated device applications. Different methods have been developed to achieve large-sized high quality films. However, reliable approaches for centimeter-sized or even wafer-level epitaxial growth of TMDCs are still lacking. Here we demonstrate a new method to grow inch-sized epitaxial WSe2 films on SiO2/Si substrates at a much lower temperature with high repeatability and scalability. High quality crystalline films are achieved through direct selenization of a tungsten film with platinum as the underlayer. The self-assembled PtSe2 buffer layer, formed during selenization, assists epitaxial growth of WSe2. Using fabricated WSe2 films, excellent performance memory devices are demonstrated. As a member of the TMDC family, our findings based on WSe2 may also be applied to other TMDC materials for large-scale production of high quality TMDC films for various applications.

BACKGROUND Cardiovascular (CV) events are the major cause of morbidity and mortality associated with blood pressure (BP) in hemodialysis (HD) patients. BP varies significantly during HD treatment, and the dramatic variation in BP is a well-recognized risk factor for increased mortality. It is important to develop an intellectual system capable of predicting BP profiles for real-time monitory. OBJECTIVE Our aim was to build a web-based system to predict the systolic blood pressure (SBP) change during hemodialysis process. METHODS This study was based on a large stream of HD parameters collected from a dialysis equipment connected to the Vital Info Portal gateway and linked with the demographic data stored in the hospital information system. The data set was divided into three groups - training, test and new patients. The training group was useful to build a multiple linear regression model, in which the SBP change was the dependent variable and the dialysis parameters and demographic data were the independent variables. We used the test and new patient groups to evaluate the model performance using coverage rates in different thresholds. A web-based interactive system based on the model was built for visualizing the prediction performance. RESULTS A total of 542,424 BP records were used in the model building. The accuracy was greater than 80% in the prediction error range of 15%, and 20mmHg of true SBP in the test and new patient groups for the SBP change model suggested a good performance of our prediction model. In the case of absolute SBP values (5, 10, 15, 20 and 25 mmHg), the accuracy of SBP prediction increased as the threshold value augmented. CONCLUSIONS This database supported the application of our prediction model in reducing the frequency of intradialytic SBP variability, and therefore, it could aid in the clinical decision when a new patient undertakes HD treatment. Whether the introduction of SBP prediction intelligent system can lower CV events in HD patients, it needs further investigations.

The deep cement mixing (DCM) technique is an in-situ ground improvement method to stabilize and solidify soft clay ground. To facilitate the practical design of DCM, it is necessary to establish the relationship between the strength and stiffness of cement treated soil with governing factors first. In this study, the influence of different seawater and cement contents on the strength and stiffness of cement stabilized Hong Kong marine deposits (HKMD) was investigated by a series of unconfined/confined compression tests. According to the experimental results, an attempt was made to predict the unconfined compressive strength (UCS), qu, by using a simple empirical equation based on water/cement ratio (w/c). The correlation between the strength and secant modulus of improved HKMD was obtained. Importantly, a linear relationship between small-strain (e

In recent decades, conventional electric instruments have been widely adopted to monitor rupture failure of trees by measuring the longitudinal strains of tree trunks. However, the good measurement accuracy is compromised by the significant difference in stiffness of the sensing element and tree trunks. Besides, the reliability of electric instruments under harsh environments, especially extreme weathers, such as thunderstorms and typhoons, is also doubtful. In this study, a novel strain gauge based on fiber Bragg grating (FBG) sensing technology was developed specifically for measuring the strain distribution of tree trunks under static or dynamic loading. The main principle of the design of the strain gauges is presented in detail. The laboratory calibration proves that the FBG-based strain gauges in polyoxymethylene (POM) and polylactic acid (PLA) backings show a better performance than those made of metal. To test the performance of this novel FBG-based strain gauge, a set of transducers were installed at different heights of a Celtis sinensis. Firstly, a pull test on this tree trunk was conducted to validate the good performance of the novel strain gauge when the tree is subjected to static loading. Secondly, the good dynamic performance of the novel strain gauge is proved by successfully recording the dynamic motion of a tree trunk during a typhoon. Furthermore, a monitor system relied on the FBG-based strain gauges is conceived to assess the resilience of urban ecosystems formed by trees to extreme weather events.

Aim Acute kidney injury (AKI) carries an increasing incidence rate worldwide and increases the risk of developing end-stage renal disease (ESRD) as well as the medical expenses during the post-AKI course. The Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs) has thus launched a nationwide epidemiology and prognosis of dialysis-requiring acute kidney injury (NEP-AKI-D) study, which prospectively enrols critically ill patients with AKI. Through thoroughly evaluating the risk and prognostic factors of AKI, we hope to lower the incidence of AKI and ESRD from the perspective of AKI-ESRD interaction. Methods The CAKs includes 30 hospitals which distribute widely through the four geographical regions (north, middle, south, and east) of Taiwan, and have a 1:1 ratio of medical centres to regional hospitals in each region. The NEP-AKI-D study enrols intensive care unit-based AKI patients who receive dialysis in the four seasonal sampled months (October 2014, along with January, April, and July 2015) in the included hospitals. The collected data include demographic information, pertaining laboratory results, dialysis settings and patient outcomes. The data are uploaded in a centre website and will be audited by on-site principal investigators, computer logic gates, and the CAKs staffs. The outcomes of interest are in-hospital mortality, dialysis-dependency and readmission rate within 90 days after discharge. Conclusion The NEP-AKI-D study enrols a large number of representative AKI patients throughout Taiwan. The results of the current study are expected to provide more insight into the risk and prognostic factors of AKI and further attenuated further chronic kidney disease transition.

This study explored the longitudinal measurement invariance in the Beck Depression Inventory–II (BDI-II) in early adolescents (junior high school students). The participants were 730 early adolescents (330 boys and 400 girls), who were followed up over 3 years (in six waves). To reduce the size of longitudinal model and verify the stability of the findings, the Fall and Spring series data sets were analyzed separately. Each series includes three waves of data with about 1-year apart. It was found that the three-factor model (Negative Attitude, Performance Difficulty, and Somatic Elements) best fitted the data. Results of both data sets provided support for the longitudinal measurement invariance (threshold invariance) of the three-factor model, suggesting that the BDI-II measured the same construct over 3 years. The study also examined the category function of the BDI-II on the basis of the pattern of threshold estimates. Finally, the implications of the findings on the continuing use of the BDI-II are discussed.

Objective Patient-reported outcome measures are increasingly required as metrics for determining the efficacy of depression interventions. However, the scores obtained from self-reports over the course of treatment may be biased because respondents restructured the factors of the depression symptoms (reconceptualization), changed their values of the symptoms in reflecting depression (reprioritization), or adjusted their standards of assessing the levels of symptoms (recalibration). The aim of present study is to assess response shifts on the depression measure. Method This study uses the procedures for assessing longitudinal measurement invariance to evaluate response shift effects on the Beck Depression Inventory II (BDI-II) with 320 early adolescents suffering from depression (43.8% boys and 56.2% girls) over the course of their treatment in the school settings. Results The findings reveal clear signs of response shifts (recalibration) in the BDI-II for depressed students. Compared with the factor scores before treatment, the factor scores after treatment were underestimated, especially on the negative attitude and performance difficulty factors. Conclusions Estimates of treatment efficacy based on observed test scores appear to be confounded by response shifts.

Objective To report prenatal diagnosis of 22q11.2 deletion syndrome with right aortic arch (RAA), left ductus arteriosus, cardiomegaly, and pericardial effusion in the fetus. Case report A 35-year-old woman, gravida 2, para 1, was referred to the hospital at 31 weeks of gestation because of abnormal ultrasound findings and whole-genome array comparative genomic hybridization report. G-banding chromosome analysis revealed a karyotype of 46,XX. Level II ultrasound at 22 weeks of gestation revealed RAA with the presence of the aortic arch on the right side of trachea at three vessels and trachea view, left ductus arteriosus, and mild right side pyelectasis. Cardiomegaly and pericardial effusion were also found 2 months later. Array comparative genomic hybridization detected a 2.743-Mb deletion at 22q11.2 region. Multiplex ligation-dependent amplification detected deletion in the DiGeorge syndrome critical region of chromosome 22 low copy number repeat 22-A–C. Metaphase fluorescence in situ hybridization on lymphocyte in cord blood confirmed deletion in 22q11.2 region. Conclusion Chromosome abnormalities have been found in patients with RAA. Prenatal diagnosis of RAA with or without intracardiac or extracardiac anomalies should include a diagnosis of 22q11.2 deletion syndrome.

Background/Aims: Indoxyl sulfate (IS) is a protein-bound uremic toxin that accumulates in patients with chronic kidney disease (CKD). We explored the effect of IS on human early endothelial progenitor cells (EPCs) and analyzed the correlation between serum IS levels and parameters of vascular function, including endothelial function in a CKD-based cohort. Methods: A cross-sectional study with 128 stable CKD patients was conducted. Flow-mediated dilation (FMD), pulse wave velocity (PWV), ankle brachial index, serum IS and other biochemical parameters were measured and analyzed. In parallel, the activity of early EPCs was also evaluated after exposure to IS. Results: In human EPCs, a concentration-dependent inhibitory effect of IS on chemotactic motility and colony formation was observed. Additionally, serum IS levels were significantly correlated with CKD stages. The total IS (T-IS) and free IS (F-IS) were strongly associated with age, hypertension, cardiovascular disease, blood pressure, PWV, blood urea nitrogen, creatine and phosphate but negatively correlated with FMD, the estimated glomerular filtration rate (eGFR), hemoglobin, hematocrit, and calcium. A multivariate linear regression analysis also showed that FMD was significantly associated with IS after adjusting for other confounding factors. Conclusions: In humans, IS impairs early EPCs and was strongly correlated with vascular dysfunction. Thus, we speculate that this adverse effect of IS may partly result from the inhibition of early EPCs.

Traditional Chinese medicine (TCM) formulates treatment according to body constitution (BC) differentiation. Different constitutions have specific metabolic characteristics and different susceptibility to certain diseases. This study aimed to assess theYang-Xuconstitution using a body constitution questionnaire (BCQ) and clinical blood variables. A BCQ was employed to assess the clinical manifestation ofYang-Xu. The logistic regression model was conducted to explore the relationship between BC scores and biomarkers. Leave-one-out cross-validation (LOOCV) and K-fold cross-validation were performed to evaluate the accuracy of a predictive model in practice. Decision trees (DTs) were conducted to determine the possible relationships between blood biomarkers and BC scores. According to the BCQ analysis, 49% participants without any BC were classified as healthy subjects. Among them, 130 samples were selected for further analysis and divided into two groups. One group comprised healthy subjects without any BC (68%), while subjects of the other group, named as the sub-healthy group, had three BCs (32%). Six biomarkers, CRE, TSH, HB, MONO, RBC, and LH, were found to have the greatest impact on BCQ outcomes inYang-Xusubjects. This study indicated significant biochemical differences inYang-Xusubjects, which may provide a connection between blood variables and theYang-XuBC.

Generally, effective stresses of saturated soils are determined by subtracting the measured pore-water pressure from the total earth pressure. In this paper, a novel FBG-based effective stress cell (FBG-ESC) for directly measuring effective stress in saturated soils is fabricated. Because of the counteraction of pore-water pressures acting on the front and back surface, the deflection of sensing plate is induced by the average pressure of soil particles only and thus the effective stress is directly measured. The good performance of FBG-ESC in saturated CDG soil under a multi-stage loading has been validated by comparison with the calculated results. Moreover, the FBG-ESC has been applied in a physical model to monitor the evolution of effective stress in saturated clayey soil subjected to complex loadings. The results demonstrate that the FBG-ESC can be also utilized in marine environment.

In normal practice, a multi-stage surcharge loading is applied gradually to achieve a certain strength of soft soils, and thus it is important to study the settlement of soft soils under multi-stage ramp loading. In this study, a new simplified method is developed to calculate the settlement of multi-layer soft soils exhibiting creep subjected to the multi-stage loading under a one-dimensional straining condition. The Zhu and Yin method is utilized to obtain the average degree of consolidation for multi-layer soils under each loading stage. The effects of creep compression on excess pore water pressure and total settlement during consolidation stage are elaborated. Subsequently, two typical projects, Ska-Edeby with 46 years’ recorded settlement data and highway embankment in the Berthierville area, are selected as the typical multi-layer soil profiles. Cases with three different loadings and two different over consolidation ratio (OCR) values are analyzed using the finite element modeling, namely the new simplified method, and the Hypothesis A method. With the use of the results from finite element analysis as the reference, the new simplified method offers a good estimation of the settlement for all the cases and outperforms the Hypothesis A method in terms of accuracy.

Printing industries are ever-improving with new breakthroughs in related technologies to satisfy various marketing requirements. They are capable of providing various value-added services by updating their printing facilities. However, the rapid growth printing requirements are also concomitant environment impact. For example, many volatile organic compounds (VOCs) printing materials are the sources of air pollution. In this paper, an original toner-saving method based on the human perceptual features to curb the negative environmental impacts and decrease material wasting is proposed. In addition, the proposed method is designed for friendly use. By configuring only few parameters, users can select the desired printing quality for varying applications. Furthermore, the proposed method can be applied to cooperate with existing hardware-based toner-saving method to enlarge application scope.

Objectives Cancer of the oral cavity, a well-known global health concern, remains one of most common causes of cancer mortality. Continuity of care (COC), a measurement of the extent to which an individual patient receives care from a given provider over a specified period of time, can help cancer survivors process their experiences of dealing with the illness and recuperation; however, limited research has focused on the survival rate of working-age patients with oral cancer. Methods A total of 14,240 working-age patients (20 0.38) and non-high COC (COCI ≤ 0.38) groups. After propensity-score matching, the mortality risk in the low and intermediate COC groups was also found to be significantly higher than that in the high COC group (aHR = 1.178, 95% CI = 1.074–1.292, p < 0.001 and aHR = 1.189, 95% CI = 1.107–1.277, p = 0.001, respectively). Conclusions In Taiwan, COC and prior dental treatment before RT significantly affected the survival rate of working-age patients with oral cancer. This result merits policymakers’ attention.

Growth-arrest-specific 7 (GAS7) belongs to a group of adaptor proteins that coordinate the actin cytoskeleton. Among human GAS7 isoforms, only GAS7C possesses a Src homology 3 domain. We report here that GAS7C acts as a migration suppressor and can serve as a prognostic biomarker in lung cancer. GAS7C overexpression reduces lung cancer migration, whereas GAS7C knockdown enhances cancer cell migration. Importantly, ectopically overexpressed GAS7C binds tightly with N-WASP thus inactivates the fibronectin/integrin/FAK pathway, which in turn leads to the suppression of F-actin dynamics. In addition, overexpression of GAS7C sequesters hnRNP U and thus decreases the level of β-catenin protein via the β-TrCP ubiquitin-degradation pathway. The anti-metastatic effect of GAS7C overexpression was also confirmed using lung cancer xenografts. Our clinical data indicated that 23.6% (25/106) of lung cancer patients showed low expression of GAS7C mRNA which correlated with a poorer overall survival. In addition, low GAS7C mRNA expression was detected in 60.0% of metastatic lung cancer patients, indicating an association between low GAS7C expression and cancer progression. A significant inverse correlation between mRNA expression and promoter hypermethylation was also found, which suggests that the low level of GAS7C expression was partly due to promoter hypermethylation. Our results provide novel evidence that low GAS7C correlates with poor prognosis and promotes metastasis in lung cancer. Low GAS7C increases cancer cell motility by promoting N-WASP/FAK/F-actin cytoskeleton dynamics. It also enhances β-catenin stability via hnRNP U/β-TrCP complex formation. Therefore, GAS7C acts as a metastasis suppressor in lung cancer.