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In Taiwan, there were only 799 confirmed COVID-19 cases in 2020. The unique backdrop amidst a pandemic and promotion of nonpharmaceutical interventions generated some distinct changes in the epidemiology of common respiratory pathogens. In this study, we aimed to investigate the dynamic changes in respiratory pathogens in children during 2020.We performed a retrospective cohort study at a tertiary hospital in southern Taiwan during 2020. Patients aged 0-18 years who visited the pediatric emergency department were enrolled. Children who presented with clinical symptoms (fever or respiratory illness) and received nasopharyngeal swabs for multiplex polymerase chain reaction (PCR) were included in our analysis. We also compared respiratory syncytial virus (RSV) trends from previous years by PCR and lateral flow immunochromatographic assays from 2017 to 2020.A total of 120 children were tested. The overall detection rate was 55%. With strengthened restrictions, the detection rate dropped from 70% to 30%. However, non-enveloped viruses (rhinovirus/enterovirus and adenovirus) were in constant circulation. Upon easing prevention measures, the detection rate remained above 60%, and an outbreak of an enveloped virus (RSV and parainfluenza virus) was noted. Compared with 2017-2019, the cyclical RSV epidemic was delayed, with a large surge in late 2020.We observed a constant circulation of non-enveloped viruses when strict nonpharmaceutical interventions were employed and a delayed surge of enveloped viruses during the easing of restrictions. Continuous surveillance and monitoring of the evolutionary dynamics of respiratory viruses is important, while easing restrictions requires balanced judgment.

急性間歇性紫質症是一種罕見的遺傳性代謝異常疾病。本案例是一位38歲女性病人，起初反覆性腹痛合併噁心、嘔吐、腹瀉之表現，後續發生癲癇大發作及急性呼吸衰竭，經實驗室檢驗及影像檢查，僅呈現低血鈉、白血球增加，其他無異常發現。由於發現尿液偏褐色，進一步檢驗發現尿液中高胺基酮戊酸、高膽色素原，以及血液中低膽色素原脫胺酶，確診急性間歇性紫質症，經血基質治療後臨床症狀逐漸改善並順利出院。針對此類以腹痛合併癲癇表現的病人，且與低血鈉之徵象並存時，必須將急性紫質症列為鑑別診斷之一，以免延誤治療時機。 Acute intermittent porphyria is a rare genetic metabolic disease. In this case, a 38-year-old female pa-tient who experienced recurrent abdominal pain with nausea, vomiting, and diarrhea, following with epileptic seizures and acute respiratory failure. After the laboratory and image examinations, hypona-tremia and leukocytosis were only noted without other abnormal findings. Because of brownish urine, further laboratory examinations were performed. High level of aminolevulinic acid and porphobilino-gen of urine, and low level of porphobilinogen deaminase of blood were revealed. Acute intermittent purpura was diagnosed eventually. After human hemin treatment, the clinical symptoms gradually im-proved, and the patient was then discharged. For such patient with abdominal pain, refractory epilepsy, and coexisting hyponatremia, acute intermittent purpura should be considered as differential diagnosis for punctual treatment. &nbsp

Staphylococcus argenteus is generally more susceptible to antibiotic treatments than Staphylococcus aureus; however, the study showed that the daptomycin/vancomycin-resistant S. argenteus was isolated from a patient with repeated antibiotic treatments. In this study, the methicillin- and vancomycin-susceptible S. argenteus isolates were used to characterize the phenotypes of S. argenteus after vancomycin passages in vitro.Eleven S. argenteus isolates were used for passaging under different concentrations of vancomycin. The minimal inhibitory concentration (MIC) of vancomycin was determined by the agar dilution assay, and the biofilm mass of the passaged variants was quantified by the crystal violet staining assay and observed under the confocal microscope.The MIC of vancomycin for eight of 11 S. argenteus isolates was increased from ≤2 µg/mL to ≤4-8 µg/mL after vancomycin passages. Two variants with the high-level vancomycin-intermediate (vancomycin MIC ≤8 µg/mL) phenotype were identified, and the parental strains of these variants did not have the heterogeneous vancomycin-intermediate population determined by the population profile analysis. Further, three S. argenteus isolates showed an increase in biofilm production and icaA transcription after the low-dose (2 µg/mL) vancomycin passages.S. argenteus is capable of acquiring a vancomycin-tolerant phenotype and/or converting to a strong biofilm producer after vancomycin passages, which could contribute to the decrease of their antibiotic susceptibility.

ObjectiveLoss-of-function mutations in genes generating reactive oxygen species (ROS), such asNOX1, are associated with IBD. Mechanisms whereby loss of ROS drive IBD are incompletely defined.DesignROS measurements and single-cell transcriptomics were performed on colonoids stratified byNOX1genotype and TNFα stimulation. Clustering of epithelial cells from human UC (inflamed and uninflamed) scRNASeq was performed. Validation of M cell induction was performed by immunohistochemistry using UEA1 (ulex europaeus agglutin-1 lectin) and in vivo with DSS injury.ResultsTNFα induces ROS production more in NOX1-WT versus NOX1-deficient murine colonoids under a range of Wnt-mediated and Notch-mediated conditions. scRNASeq from inflamed and uninflamed human colitis versus TNFα stimulated, in vitro colonoids defines substantially shared, induced transcription factors; NOX1-deficient colonoids express substantially lower levels of STAT3 (signal transducer and activator of transcription 3), CEBPD (CCAAT enhancer-binding protein delta),DNMT1(DNA methyltransferase) andHIF1A(hypoxia-inducible factor) baseline. Subclustering unexpectedly showed marked TNFα-mediated induction of M cells (sentinel cells overlying lymphoid aggregates) in NOX1-deficient colonoids. M cell induction by UEA1 staining is rescued with H2O2and paraquat, defining extra- and intracellular ROS roles in maintenance of LGR5+ stem cells. DSS injury demonstratedGP2(glycoprotein-2), basal lymphoplasmacytosis and UEA1 induction in NOX1-deficiency. Principal components analyses of M cell genes and decreased DNMT1 RNA velocity correlate with UC inflammation.ConclusionsNOX1 deficiency plus TNFα stimulation contribute to colitis through dysregulation of the stem cell niche and altered cell differentiation, enhancing basal lymphoplasmacytosis. Our findings prioritise ROS modulation for future therapies.

Background. Embedding mirror therapy within a virtual reality (VR) system may have a superior effect on motor remediation for chronic stroke patients. Objective. The objective is to investigate the differences in the effects of using conventional occupational therapy (COT), mirror therapy (MT), and VR-based MT (VR-MT) training on the sensorimotor function of the upper limb in chronic stroke patients. Methods. This was a single-blinded randomized controlled trial. A total of 54 participants, including chronic stroke patients, were randomized into a COT, MT, or VR-MT group. In addition to 20-minute sessions of task-specific training, patients received programs of 30 minutes of VR-MT, 30 minutes of MT, and 30 minutes of COT, respectively, in the VR-MT, MT, and COT groups twice a week for 9 weeks. The Fugl-Meyer motor assessment for the upper extremities (FM-UE; primary outcome), Semmes-Weinstein monofilament, motor activity log, modified Ashworth scale, and the box and block test were recorded at pre-treatment, post-intervention, and 12-week follow-up. Results. Fifty-two participants completed the study. There was no statistically significant group-by-time interaction effects on the FM-UE score (generalized estimating equations, (GEE), P = .075). Meanwhile, there were statistically significant group-by-time interaction effects on the wrist sub-score of the FM-UE (GEE, P = .012) and the result of box and block test (GEE, P = .044). Conclusions. VR-MT seemed to have potential effects on restoring the upper extremity motor function for chronic stroke patients. However, further confirmatory studies are warranted for the rather weak evidence of adding VR to MT on improving primary outcome of this study. Clinical trial registration: NCT03329417.

Web logs have been widely used to represent the web page visits of online users. However, we found that web logs in Chrome’s browsing history only record 57% of users’ visited websites, i.e., nearly half of a user’s website visits are not recorded. Additionally, 5.1% of the visits recorded in the web log occur because of unconscious user actions, i.e., these page visits are not initiated from users. We created a Google Chrome plugin and recruited users to install the plugin to collect and analyze the conscious URL visits, unconscious URL visits, and “missing” URL visits (i.e., the visits unrecorded in the traditional web log). We reported the statistics of these behaviors. We showed that sorting popular website categories based on traditional web logs differs from the rankings obtained when including missing visits or excluding unintentional visits. We predicted users’ future behaviors based on three types of training data – all the visits in modern web logs, the intentional visits in web logs, and the intentional visits plus missing visits in web logs. The experimental results indicate that missing visits in web logs may contain additional information, and unintentional visits in web logs may contain more noise than information for user modeling. Consequently, we need to be careful of the observations and conclusions derived from web log analyses because the web log data could be an incomplete and noisy dataset of a user’s visited web pages.

Aluminum alloy (Al6061) sheet micro-hole processing is extensively used in smartphones, tablet PC, and smart wearable devices. The micro-hole processing is commonly performed using laser, micro drilling, microstamping, micro discharge, and chemical etching technologies. Micro-stamping technology is characterized by precision and rapid processing, but the precision positioning of the punch head and lower die is one of the major difficulties in micro-hole stamping, especially in manufacturing array micro-holes. This study used stamping without die technology. This technology uses an array punch head to punch the lower die holes on the base, then performs array micro-hole stamping. The experimental results show that a micro-hole array with 37 micro-holes were successfully manufactured and can be reproduced many times. Tapered array micro-holes with a high aspect ratio can be manufactured using this stamping without die technology; the micro-hole depth can be 260μm, the inlet diameter is 116μm, and the outlet diameter is 25μm. This study has successfully developed the feasibility of array micro-hole stamping technology.

Background Hypertension disorders are relatively common in pregnant women and often persist in the postpartum period. Few studies are available regarding the self-management of postpartum hypertension via the eHealth system. This study aimed to develop a self-management eHealth system for women with postpartum hypertension during the postpartum period. Methods We adopted a multi-platform system for this research, not only for use on the web interface but also on smartphones. The proposed system possessed three features: (1) the population was limited to postnatal women with hypertension; (2) a self-care record, which allowed postnatal women to keep track of their blood pressure, pulse, weight, medication record, exercise record, and risk factor assessment; and (3) through this system, nurse-midwives could keep track of postnatal women’s health status maintaining the complete record and could communicate directly with the users if their health monitor values reach beyond normal range. Results Thirty-nine postnatal women with postpartum hypertension were recruited to the study. A survey to evaluate the usability and satisfaction of the proposed e-health application system was completed by these women. The usability rate of the system reached 92.4% (46.2% satisfied and 46.2% strongly satisfied), which suggested that the system was helpful to the users. The satisfaction rate of the system reached 94.9% (43.6% satisfied and 51.3% strongly satisfied), which suggested that the system was acceptable to the users. Conclusion This proposed system has been developed completely with user experience and professional advice from experts. Postnatal women could gain important postpartum-related knowledge and access their related health records and other information easily via their smartphones or computers. During the postpartum period, an eHealth application system can effectively assist women with hypertension to manage their blood pressure and related postnatal healthcare issues.

Regulatory T (Treg) cells are instrumental in establishing immunological tolerance. However, the precise effector mechanisms by which Treg cells control a specific type of immune response in a given tissue remains unresolved. By simultaneously studying Treg cells from different tissue origins under systemic autoimmunity, here we show that IL-27 is specifically produced by intestinal Treg cells to regulate Th17 immunity. Selectively increased intestinal Th17 responses in mice with Treg cell-specific IL-27 ablation led to exacerbated intestinal inflammation and colitis-associated cancer, but also helped protect against enteric bacterial infection. Furthermore, single-cell transcriptomic analysis has identified a CD83+TCF1+Treg cell subset that is distinct from previously characterized intestinal Treg cell populations as the main IL-27 producers. Collectively, our study uncovers a novel Treg cell suppression mechanism crucial for controlling a specific type of immune response in a particular tissue, and provides further mechanistic insights into tissue-specific Treg cell-mediated immune regulation.

The emergence and spread of multidrug-resistant bacteria highlight the need for new antibacterial interventions. A screening of 24 newly synthesized dibenzoxazepines identified a small molecule compound, SW14, with potent inhibitory activity against intracellular multidrug-resistant and fluoroquinolone-resistant strains of

Objective: Quantifying muscle tone is often based on a tester’s subjective judgment in clinical settings. There is, however, a lack of suitable tools that can be used to objectively assess muscle tone. This study thus introduces a reliable, clinically-feasible device, called the Arm Circumference Motor Evaluation System (ACMES), for quantifying the muscle tone of upper limbs without using mechanical torque transducers. Methods: While the ACMES conducts continuously passive arm circumduction motions, the voltage and current of the driving motor is transduced into torque values via a least square approximation. A torque sensor and springs with different spring constants were used for the validity and reliability test in the first part of this study. Fifteen healthy adults and two patients who had experienced a stroke participated in the second part, which was a clinical experiment used to examine the in-vivo test-retest reliability and to explore the inspection differences between healthy and patient participants. Results: The results showed that the ACMES has high validity (R2: ~0.99) and reliability (R2: 0.96~0.99). The reliability of the ACMES used on human subjects was acceptable (R2: 0.83~0.85). The various muscle tone patterns could be found among healthy and stroke subjects via the ACMES. Conclusion: Clinically, abnormal muscle tone, which seriously affects motion performance, will be found in many diagnoses, such as stroke or cerebral palsy. However, objectively and feasibly measuring abnormal tone in modern clinical settings is still a challenging task. Thus, the ACMES was developed and tested to verify its feasibility as a measurement system for detecting the mechanical torque associated with muscle tone.

Calix[4]arene 1 with 25,27-diisoxazolylchloroanthryl groups is a chromogenic and fluorogenic sensor for Cu2+ with a LOD of 1.67 μM by fluorescence. Calix[4]diquinone was obtained in high yield through the redox reaction of ligand 1 with Cu(ClO4)2.

Di(1-adamantyl)phosphine oxide (SPO-Ad: Ad2P(V)(=O)H), a stable tautomer of di(1-adamantyl)phosphinous acid (PA-Ad: Ad2P(III)-OH), was employed to synthesize two new PA-Ad-coordinated complexes, POPd-Ad and POPd2-Ad. POPd-Ad was easily transformed from POPd2-Ad in acetonitrile, and the [M – H]− ion of the deprotonated POPd-Ad was observed in the electrospray ionization-mass spectrum of POPd2-Ad. Both complexes are effective precatalysts for the Suzuki reaction of aryl chlorides. The reduction of Pd(II) in POPd-Ad and POPd2-Ad by arylboronic acid was examined, and the ideal Pd-to-PA ratio in the Suzuki reaction was found to be 1:1. The effect of temperature on the catalytic yields was studied to examine the possible ligation state of the active species and the dimer-to-monomer process of POPd2-Ad. Mononuclear and mono-ligated Pd species was assumed to be catalytically active. The electronic and steric effects of PA-Ad were slightly better than those reported for PA-tBu (tBu2P(III)-OH). Density functional theory calculations were performed to evaluate the formation of mono-ligated and mononuclear Pd species from POPd-Ad and POPd2-Ad. Furthermore, the reaction time and catalyst loading could be reduced for the reported POPd1-tBu precatalyst using the optimized reaction conditions for POPd-Ad. The complexes synthesized in this extensive study will complement the existing SPO-coordinated POPd series of precatalysts.

近年來許多研究都指出木材有助於降低室內溫度，提升室內環境品質，更有益於居住使用者的身體健康，但目前卻缺乏木構造對於改善熱能的效益多寡的研究，無法驗證木構造所改善之實際效益。此外，目前台灣建造木構造之建築價格比鋼筋混凝土貴了1.5倍左右，這些因素均使木構造建築在台灣建築產業無法像鋼筋混凝土構造相同普及，對於一般民眾、建築產業選擇木構造做為建材使用之誘因不足。台灣近年於政策中開始推廣綠建材，推行多項鼓勵綠建材標章申請的措施與多方進行綠建材觀念之推廣宣導，企圖創造綠色環境。然而，台灣習慣性經常使用高耗能及高傳導係數的材料來建構房屋，接著再陸續研究許多降溫與節能的節能綠建築技術，除了增加營運成本以外，也製造額外的耗能與碳排量，這種現象與全球的發展趨勢背道而馳。因此，改造現有的建築材料，以滿足台灣現在和未來的熱舒適性、生活方式、能源效率等對應氣候減緩的問題，是必須思考的課題。木構造建築具有輕質量、永續性等優點，但同時存在耐震、防火等需持續改善的問題，而鋼筋混凝土構造則具有高強度、剛性、造價成本低、跨度較大等優勢。而台灣地區氣候潮濕、悶熱，若居住於複合式木構造住宅可以隔絕地面的濕氣，也可以減少害蟲入侵住宅等情況，同時對於室內具有調節溫濕度的功能，增加環境與居住者之熱舒適。 故本研究嘗試提出台灣高雄地區發展複合式木構造之可能性，在符合相同空調容積的前提之下，模擬可能的住宅型態樣式進行耗能差異及回收年限，再透過生命週期評估於使用維護階段進行環境衝擊的比較。因此本研究將透過EnergyPlus以及SimaPro軟體來進行模擬，比較高雄平地型地區的鋼筋混凝土與複合式木構造連棟式街屋之建築物使用階段日常使用耗能以及廢氣處理階段環境衝擊，期望作為台灣木構造建築未來發展的新選擇。 Greenhouse gas emissions increase global temperature and cause abnormal climate changes, which led to global warming. Due to the rise of environmental awareness, many countries have successfully implemented energy conservation and carbon reduction policies to curb the speed of global warming and reduce the carbon footprint. There are around 60% houses constructed by reinforced concrete buildings in Taiwan. It leads almost 70% of the energy use of the buildings from the consumption of air conditioners in residential and commercial buildings, which shows that the impact of the construction industry on the environment is very serious. Also, to reduce the heat transfer conductivity of reinforced concrete buildings, Taiwan has studied many international building materials for building insulation performance in recent years. In response to the problem of the climate change, the development of new regulations and materials, leads the development of construction to hybrid construction methods in Taiwan. The hybrid structure of wood construction combines the advantage of rigidity, sustainability and enhance efficiency. At the same time, the international community is actively discussing the possibility of future development of wood construction cities Therefore, this study attempts to propose the possibility of developing hybrid wood construction in Kaohsiung, Taiwan. The energy consumption of Reinforced Concrete and Hybrid wood construction are simulated under the premise of meeting the same air-conditioning volume. Also, through the life cycle assessment for the daily use and maintenance session, environmental impacts and carbon emission are calculated. EnergyPlus and SimaPro software are used for simulation It is expected that a new choice for the future development of wooden construction would be proposed. &nbsp

Background A reconstructive challenge in patients with class IIId maxillary defect is how to obliterate the defect and restore a patent nasal airway. The current strategy using the single anterolateral thigh (ALT) fasciocutaneous flap for reconstruction may result in permanent mouth breathing. As the ALT flap was a common option in reconstruction processes, this study aimed to evaluate the benefits of vastus lateralis (VL) muscle-chimeric double skin paddle ALT flap in simultaneous defect and nasal airway reconstruction. Methods This study included 21 patients with class IIId maxillary defect who underwent free ALT flap reconstruction (n = 11, single ALT flap group; n = 10, VL muscle-chimeric double skin paddle ALT flap (chimeric ALT flap) group) at the China Medical University Hospital from August 2015 to September 2019. Associated parameters collected for analysis included gender, age, body mass index (BMI), operative time, hospitalization, clinical stage, preoperative treatment, flap/defect size, comorbidities, postoperative RT, mouth breathing and short/long term complications. Results No significant differences were observed in age, BMI, hospitalization, clinical stage, preoperative treatment, defect size, comorbidities, and postoperative RT between the two groups; however, the chimeric ALT flap group as dominated by male patients (p = 0.009), and had longer operative times (12.1 h vs. 10.1 h, p = 0.002) and larger flap sizes (180 cm2 vs. 96.7 cm2, p = 0.013). Compared with the chimeric ALT flap group, the single ALT flap group suffered from permanent mouth breathing. Conclusion Nasal airway reconstruction should be considered in patients with class IIId maxillary defect. Compared to the single ALT flap, the chimeric ALT flap is a superior reconstructive option for patients with class IIId maxillary defect, although a longer surgical duration and larger flap size are required.

BACKGROUND: Obesity, common condition among patients with coronavirus disease 2019 (COVID-19), contributes to illness severity during hospitalization. To date, knowledge on the prevalence, risk of hospital and intensive care units (ICU) admissions and mortality is limited. Therefore, systematic review and meta-analysis were conducted using a preferred reporting items for systematic reviews and meta-analyses guideline. AIM: The study aimed to address the prevalence, risk of hospital and ICU admissions and mortality among patients with COVID-19 and obesity. METHODS: The Newcastle–Ottawa scale was used to assess the quality of a study. Primary outcomes were the prevalence and risk of hospitalization, and secondary outcomes were the risk of ICU admissions and mortality risk. Mantel–Haenszel with random effects was applied, and the effect measure was odds ratio (OR) with 95% confidence interval (CI). RESULTS: Nine studies were included in the systematic review, and only four studies for meta-analysis. Among 29,776 patients with COVID-19, obesity was identified as the second-highest comorbidity. The prevalence rates of obesity and severe obesity among patients with COVID-19 were 26.1% and 15.5%, respectively. Obesity resulted in significantly increased risk of hospital admission (OR = 1.99, 95% CI = 1.12–3.53, p = 0.02) and ICU admission (OR = 1.77, 95% = CI 1.52–2.06, p < 0.00001). Severe obesity had a significantly increased risk of ICU admission (OR = 1.79, 95% CI = 1.42–2.25, p < 0.00001). The mortality rate of patients with COVID-19 and obesity was about 30.5% (438/1,434), and 19.7% (2,777/14,095) of them recovered from COVID-19. CONCLUSION: Obesity poses as nearly twice the risk of hospital and ICU admissions, and severe obesity contributes to almost twice the risk of ICU admissions.

Purpose This study was aimed toward developing a lightweight assisting tenodesis-induced-grip exoskeleton robot (TIGER) and to examine the performance of the TIGER in stroke patients with hemiplegia. Methods This was a single-blinded, randomized control trial with pre-treatment, immediate post-treatment, and 12-week follow-up assessments. Thirty-four stroke patients were recruited and randomized to either an experimental or control group, where each participant in both groups underwent 40 min of training. In addition to a 20-min bout of regular task-specific motor training, each participant in the experimental group received 20 min of TIGER training, and the controls received 20 min of traditional occupational therapy in each treatment session. Primary outcomes based on the Fugl-Meyer Motor Assessment of Upper Extremity (FMA-UE) were recorded. Results Thirty-two patients (94.1%) completed the study: 17 and 15 patients in the experimental and control groups, respectively. Significant beneficial effects were found on the total score (ANCOVA, p = 0.006), the wrist score (ANCOVA, p = 0.037), and the hand score (ANCOVA, p = 0.006) for the FMA-UE in the immediate post-treatment assessment of the participants receiving the TIGER training. Conclusion The TIGER has beneficial effects on remediating upper limb impairments in chronic stroke patients. Clinical trial registration: ClinicalTrials.gov; identifier NCT03713476Implications for rehabilitationBased on use-dependent plasticity concepts, robot training with the more distal segments of the upper extremities has a beneficial effect in patients with chronic stroke.A novel lightweight assisting tenodesis-induced-grip exoskeleton robot (TIGER) system using a mechanism involving musculotendinous coordination of the wrist and hand was proposed in this study.Between-group differences in changes in the upper limb motor performance were observed in the experimental group as compared to patients in the control group. For patients with chronic stroke, receiving 20 min of TIGER training in conjunction with 20 min of task-specific motor training led to clinically important changes in motor control and functioning of the affected upper limb.

Summary An important goal of clinical genomics is to be able to estimate the risk of adverse disease outcomes. Between 5% and 10% of individuals with ulcerative colitis (UC) require colectomy within 5 years of diagnosis, but polygenic risk scores (PRSs) utilizing findings from genome-wide association studies (GWASs) are unable to provide meaningful prediction of this adverse status. By contrast, in Crohn disease, gene expression profiling of GWAS-significant genes does provide some stratification of risk of progression to complicated disease in the form of a transcriptional risk score (TRS). Here, we demonstrate that a measured TRS based on bulk rectal gene expression in the PROTECT inception cohort study has a positive predictive value approaching 50% for colectomy. Single-cell profiling demonstrates that the genes are active in multiple diverse cell types from both the epithelial and immune compartments. Expression quantitative trait locus (QTL) analysis identifies genes with differential effects at baseline and week 52 follow-up, but for the most part, differential expression associated with colectomy risk is independent of local genetic regulation. Nevertheless, a predicted polygenic transcriptional risk score (PPTRS) derived by summation of transcriptome-wide association study (TWAS) effects identifies UC-affected individuals at 5-fold elevated risk of colectomy with data from the UK Biobank population cohort studies, independently replicated in an NIDDK-IBDGC dataset. Prediction of gene expression from relatively small transcriptome datasets can thus be used in conjunction with TWASs for stratification of risk of disease complications.

Background Mismatch negativity (MMN) reflects the functional integrity of sensory memory function. With the advantages of independence of individual's focused attention and behavioral cooperation, this neurophysiological signal is particularly suitable for investigating elderly with cognitive decline such as amnestic mild cognitive impairment (aMCI). However, the existing results remain substantially inconsistent whether these patients show deficits of MMN. In order to reconcile the previous disputes, the present study used magnetoencephalography combined with distributed source imaging methods to determine the source‐level magnetic mismatch negativity (MMNm) in aMCI. Methods A total of 26 healthy controls (HC) and 26 patients with aMCI underwent an auditory oddball paradigm during the MEG recordings. MMNm amplitudes and latencies in the bilateral superior temporal gyrus, inferior frontal gyrus, and inferior parietal lobule (IPL) were compared between HC and aMCI groups. The correlations of MMNm responses with performance of auditory/verbal memory tests were examined. Finally, MMNm and its combination with verbal/auditory memory tests were submitted to receiver operating characteristic (ROC) curve analysis. Results Compared to HC, patients with aMCI showed significantly delayed MMNm latencies in the IPL. Among the patients with aMCI, longer MMNm latencies of left IPL were associated with lower scores of Chinese Version Verbal Learning Test (CVVLT). The ROC curve analysis revealed that the combination of MMNm latencies of left IPL and CVVLT scores yielded a moderate accuracy in the discrimination of aMCI from HC at an individual level. Conclusions Our data suggest dysfunctional MMNm in patients with aMCI, particularly in the IPL., This study uses MEG to compare source‐level magnetic mismatch negativity (MMNm) in healthy elderly and patients with amnestic mild cognitive impairment (aMCI). Patients with aMCI show MMNm prolongation in the inferior parietal lobule, and such a deficit correlates with poorer verbal learning test.

Tendon injuries lead to tendon stiffness, which impairs skeletal muscle movement. Most studies have focused on patellar or Achilles tendons by using ultrasound elastography. Only a few studies have measured the stiffness of hand tendons because their thickness is only 1–2 mm, rendering clinical ultrasound elastography unsuitable for mapping hand tendon stiffness. In this study, a high-frequency ultrasound shear elastography (HFUSE) system was proposed to map the shear wave velocity (SWV) of hand flexor tendons. A handheld vibration system that was coaxially mounted with an external vibrator on a high-frequency ultrasound (HFUS) array transducer allowed the operators to scan hand tendons freely. To quantify the performance of HFUSE, six parameters were comprehensively measured from homogeneous, two-sided, and three-sided gelatin phantom experiments: bias, precision, lateral resolution, contrast, contrast-to-noise ratio (CNR), and accuracy. HFUSE demonstrated an excellent resolution of $147~\mu \text{m}$ to distinguish the local stiffness of thin phantom (thickness: 1.2 mm) without compromising bias, precision, contrast, CNR, and accuracy, which has been noted with previous systems. Human experiments involved four patients with hand tendon injuries who underwent ≥2 months of rehabilitation. Using HFUSE, two-dimensional SWV images of flexor tendons could be clearly mapped for healthy and injured tendons, respectively. The findings demonstrate that HFUSE can be a promising tool for evaluating the elastic properties of the injured hand tendon after surgery and during rehabilitation and thus help monitor progress.

This investigation aimed to explore deep learning (DL) models' potential for diagnosing

Two reagent-controlled regiodivergent annulation protocols for Achmatowicz products with vinylogous nucleophiles have been developed, which furnished a series of bicyclic cyclopenta[ib/i]pyrans and 8-oxabicyclo[3.2.1]octane derivatives in 28-90% yields. Plausible mechanisms were proposed to involve either Pd-catalyzed Tsuji-Trost allyl-allyl coupling and concomitant Michael cyclization or quinine-promoted cascade stepwise [5 + 2] cycloaddition and intramolecular Michael cyclization.

Calix[4]arene 1, with two lower-rim isoxazolylchloroanthracene groups, is shown to be not only a chromogenic but also a fluorogenic chemodosimeter for the selective sensing of Cu

Since April 2022, waves of Omicron cases have surfaced in Taiwan and spread throughout the island. Using high-throughput sequencing of the SARS-CoV-2 genome, we have analyzed 2405 PCR-positive swab samples from 2339 individuals and identified the Omicron BA.2.3.7 variant as a major lineage within the recent community outbreak in Taiwan.

The introduction and development of the advanced practice registered nurse (APRN) is a global trend in nursing. However, the development of APRNs in Taiwan remains uncertain and lacks necessary consensus.This research study aimed to explore the views and suggestions of nursing experts in industry, government, and academia regarding the development of APRNs (clinical nurse specialists, case managers, certified clinical registered nurse anesthetists, and certified nurse-midwives) in Taiwan.Data were collected from March to August 2017. Sixty-four experts participated in one of six focus group discussions held in northern, central, and southern Taiwan. These group discussions were recorded and transcribed verbatim with the consent of the participants. Content analysis was used to analyze the transcribed data.The comments and suggestions raised during the discussions were categorized into four major themes: professional development of necessity, core competencies, accreditation, and future promotion-related issues. Each theme was further divided into several subthemes.The opinions of relevant experts regarding the current status of development of the roles, practical scope, and management and suggestions for APRNs were summarized to facilitate the future development of APRNs in Taiwan in terms of education, core competencies, certification, and practical scope. Furthermore, the results may be referenced in the establishment of a nursing consensus model and as a basis for promoting APRNs.蛻變的白衣天使—進階護理師的發展與突破.發展進階護理師制度為全球趨勢，然而台灣進階護理制度的發展仍處於妾身未明階段，亟需凝聚護理界共識。.本研究旨在探討產官學界護理專家對台灣發展進階護理師（臨床護理專家、個案管理師、註冊麻醉護理師、註冊助產護理師）的看法與建言。.資料收集時間為2017年3月至8月。總計64位專家分別參與北、中、南6場的焦點團體討論，所有內容皆經研究對象同意錄音與繕打成逐字稿後轉製成文本，並以內容分析法進行資料分析。.產官學界之護理專家對台灣發展進階護理師的意見與建議可歸納為四項主題：發展需求、核心能力、認證與未來推動相關議題，每一主題皆區分出數個次主題。.本研究結果彙整護理產官學專家對台灣發展各類進階護理角色功能、執業範疇與管理之現況意見，以及對台灣未來發展各類進階護理角色在教育、核心能力、證照與執業範疇等之建議，可作為建立護理共識模式的視窗及未來推動進階護理師制度的依據。.

Background Few studies have implied the incidence of diaphragmatic hernia (DH) after spontaneous pneumothorax (SP) with unknown mechanisms. The current study aimed to identify whether there is an association between the DH and SP. Methods We selected 46,897 patients with SP (SP cohort) and 46,897 without SP (non-SP matched cohort) from the National Health Insurance Database. Patients were frequency matched according to age, sex, and index year. The incidence of DH and its association with SP were assessed after stratifying different characteristics and comorbidities. Statistical analysis including chi-square test, t-test, cox proportional hazard model, and Kaplan–Meier method were used. Results The results suggested there were significant associations between SP and DH, especially in the subgroup of patients with older age (aged 40–64 years: 2.61-fold in adjusted hazard ratio (aHR), 95% confidence interval (CI): 1.27–5.36; aged > 65 years: 1.97-fold in aHR, 95% CI 1.43–2.71), male sex (2.11-fold in aHR, 95% CI 1.56–2.85), hypertension (2.05-fold in aHR, 95% CI 1.30–3.23), diabetes mellitus (2.58-fold in aHR, 95% CI 1.37–4.86), and smoking-related disease (1.86-fold in aHR, 95% CI 1.28–2.71). The SP cohort has significantly correlated with DH within 5-year follow-up ( Conclusions The SP cohort had a higher incidence of DH than the non-SP matched cohort. A prospective study of indications based on the findings of the current research should be performed.

Objective To investigate the effects of perturbation-based pinch task training on the sensorimotor performance of the upper extremities of patients with chronic stroke via a novel vibrotactile therapy system. Design A single-blinded randomized controlled trial. Setting A university hospital. Participants Patients with chronic stroke (N=19) randomly assigned into either an experimental group or a control group completed the study. Interventions In addition to 10 minutes of traditional sensorimotor facilitation, each participant in the experimental group received 20 minutes of perturbation-based pinch task training in each treatment session, and the controls received 20 minutes of task-specific motor training twice a week for 6 weeks. Main Outcome Measures The scores for the primary outcome, Semmes-Weinstein monofilament (SWM), and those for the secondary outcomes, Fugl-Meyer Assessment (FMA), amount of use, quality of movement (QOM) on the Motor Activity Log (MAL) scale, and box and block test (BBT), were recorded. All outcome measures were recorded at pretreatment, post treatment, and 12-week follow-up. Results There were statistically significant between-group differences in the training-induced improvements revealed in the SWM results (P=.04) immediately after training and in the BBT results (P=.05) at the 12-week follow-up. The changes in muscle tone and in the QOM, SWM, and BBT scores indicated statistically significant improvements after 12 sessions of treatment for the experimental group. For the control group, a significant statistical improvement was found in the wrist (P Conclusions This study indicated that the perturbation-based pinch task training has beneficial effects on sensory restoration of the affected thumb in patients with chronic stroke.

We report 4 cases of neonatal sepsis caused by Streptococcus gallolyticus. The clinical course was quite similar to early-and late-onset group B streptococcus disease. None of the mothers had group B streptococcus (GBS) colonization on prenatal screening nor received intrapartum antibiotics. We proposed the sporadic distribution of S. gallolyticus sepsis among neonates was partly due to relatively low colonization rate in adults compared with GBS. Species determination of S. gallolyticus may not be available using conventional microbiological methods and may contribute to underestimation or misclassification. In our series, we highlighted the importance of S. gallolyticus as an important pathogen in neonatal sepsis deserving further surveillance.

Background & Aims Recent literature has implicated a key role for mast cells in murine models of colonic inflammation, but their role in human ulcerative colitis (UC) is not well established. A major advance has been the identification of mrgprb2 (human orthologue, MRGPX2) as mediating IgE-independent mast cell activation. We sought to define mechanisms of mast cell activation and MRGPRX2 in human UC. Methods Colon tissues were collected from patients with UC for bulk RNA sequencing and lamina propria cells were isolated for MRGPRX2 activation studies and single-cell RNA sequencing. Genetic association of all protein-altering G-protein coupled receptor single-nucleotide polymorphism was performed in an Ashkenazi Jewish UC case-control cohort. Variants of MRGPRX2 were transfected into Chinese hamster ovary (CHO) and human mast cell (HMC) 1.1 cells to detect genotype-dependent effects on β-arrestin recruitment, IP-1 accumulation, and phosphorylated extracellular signal–regulated kinase. Results Mast cell-specific mediators and adrenomedullin (proteolytic precursor of PAMP-12, an MRGPRX2 agonist) are up-regulated in inflamed compared to uninflamed UC. MRGPRX2 stimulation induces carboxypeptidase secretion from inflamed UC. Of all protein-altering GPCR alleles, a unique variant of MRGPRX2, Asn62Ser, was most associated with and was bioinformatically predicted to alter arrestin recruitment. We validated that the UC protective serine allele enhances β-arrestin recruitment, decreases IP-1, and increases phosphorylated extracellular signal–regulated kinase with MRGPRX2 agonists. Single-cell RNA sequencing defines that adrenomedullin is expressed by activated fibroblasts and epithelial cells and that interferon gamma is a key upstream regulator of mast cell gene expression. Conclusion Inflamed UC regions are distinguished by MRGPRX2-mediated activation of mast cells, with decreased activation observed with a UC-protective genetic variant. These results define cell modules of UC activation and a new therapeutic target.

Three-dimensional printed ankle-foot orthoses (AFO) have been used in stroke patients recently, but there was little evidence of gait improvement. Here, we designed a novel customized AFO with energy storage, named Energy-Storage 3D Printed Ankle-Foot Orthosis (ESP-AFO), and investigated its effects on gait improvement in stroke patients. 12 stroke survivors were recruited (9 females/3 males, age: 55.58 ± 5.9 y/o). Participants were instructed to walk (1) bare foot (BF), with (2) anterior AFO (AAFO), and with (3) ESP-AFO, respectively. Gait analysis by the motion capture system was performed bilaterally (SL: Sound limb; AL: Affected limb). Participant satisfaction and fatigue were also compared. We found that the ESP-AFO significantly increased bilateral gait velocity (SL: ESP-AFO 52.62 ± 19.18 cm/s, BF 47.61 ± 22.78 cm/s; AL: ESP-AFO 52.78 ± 19.57 cm/s, BF 47.31 ± 23.27 cm/s), stride length (SL: ESP-AFO 78.96 ± 19.16 cm, BF 74.89 ± 21.92 cm; AL: ESP-AFO 79.06 ± 17.82 cm, BF 74.08 ± 21.31 cm). ESP-AFO reversed drop-foot in swing phase and created a higher ankle moment at terminal stance. Patients also reported more satisfaction with the ESP-AFO (total satisfaction: ESP-AFO 4.3 ± 0.47, AAFO 3.3 ± 0.62). We demonstrated that the novel custom-made ESP-AFO improved the gait performance with better satisfaction than traditional AFOs did. (Registry number of clinical trial: A-BR-106-005)

Reversing or slowing down the skin aging process is one of the most intriguing areas of focus across the social and scientific communities around the world. While aging is considered a universal and inevitable natural process of physiological decline, the aging of the skin is the most apparent visual representation of an individual's health. Aging skin may be objectively defined by epidermal thinning; increased transepidermal water loss; decreased cutaneous barrier function; loss of elasticity, laxity, and textured appearance; and gradual deterioration of the epidermal immune environment. As the largest structure of the immune system and of the body as a whole, the skin is the most vulnerable barrier of defense against the environment. The skin reflects an individual's exposures, lifestyle habits, and overall health. From an immunological perspective, cytokines and chemokines act as a central character in the communicating of the immunity in skin aging. These cell signaling proteins serve as the intercellular communication link. This review aims to elucidate how cell-cell crosstalk through cytokines and chemokines, and the interplay between host cells, infiltrating immune cells, and exogenous factors contribute to the overall aging skin.