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Bidirectional communication of the microbiota–gut–brain axis is crucial in stroke. Recanalization therapy, namely intravenous thrombolysis (IVT) and endovascular thrombectomy (EVT), are recommended for eligible patients with acute ischemic stroke (AIS). It remains unclear whether gut microbiota metabolites, namely trimethylamine N-oxide (TMAO) and short-chain fatty acids (SCFAs), can predict the prognosis after recanalization therapy. This prospective study recruited patients with AIS receiving IVT, EVT, or both. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale (mRS) scores were used to assess the severity and functional outcomes of AIS, respectively. A functional outcome of mild-to-moderate disability was defined as a mRS score of 0–3 at discharge. Plasma TMAO and SCFA levels were measured through liquid chromatography with triple-quadrupole mass spectrometry. Fifty-six adults undergoing recanalization therapy for AIS were enrolled. Results showed that TMAO levels were not associated with stroke severity and functional outcomes, while isovalerate levels (one of the SCFAs) were negatively correlated with NIHSS scores at admission and discharge. In addition, high isovalerate levels were independently associated with a decreased likelihood of severe disability. The study concluded that an elevated plasma isovalerate level was correlated with mild stroke severity and disability after recanalization therapy for AIS.

Background The aim of this study was to determine the actual state of the photosynthetic apparatus and exhibit distinguishable differences in the chlorophyll fluorescence (ChlF) components in different seedling ages of M. oiwakensis plants subjected to different light intensity (LI). Potted 6-month-old greenhouse seedlings and field collected 2.4-year-old seedlings with 5 cm heights were selected and randomly separated into seven groups for photosynthesis measurements illuminated with 50, 100 (assigned as low LI), 300, 500, 1,000 (as moderate LI), 1,500 and 2,000 (as high LI) μmol m–2 s–1 photosynthetic photon flux density (PPFD) treatments. Results n 6-month-old seedlings, as LI increased from 50 to 2,000 PPFD, the values of non-photochemical quenching and photo-inhibitory quenching (qI) increased but potential quantum efficiency of PSII (Fv/Fm) and photochemical efficiency of photosystem II (ΦPSII) values decreased. High electron transport rate and percentage of actual PSII efficiency by Fv/Fm values were observed in 2.4-year-old seedlings at high LI conditions. Furthermore, higher ΦPSII was detected under low LI conditions, with lower energy-dependent quenching (qE) and qI values and photo-inhibition % decreased as well. However, qE and qI increased as ΦPSII decreased and photo-inhibition% increased under high LI treatments. Conclusions These results could be useful for predicting the changes in growth and distribution of Mahonia species grown in controlled environments and open fields with various combinations of varying light illuminations, and ecological monitoring of their restoration and habitat creation is important for provenance conservation and helps to formulate better conservation strategies for the seedlings.

Mobile robot is widely utilized in various fields such as navigation control, obstacle avoidance and object carrying. For keeping away from obstacles to avoid collision and preventing object carrying from dropping down, we propose a state manager (SM) designed to assist the mobile robots so that they can switch operation between wall-following carrying (WFC) and toward goal carrying (TGC) by different external condition. In this controlling model, interval type-2 recurrent fuzzy cerebellar model articulation controller (IT2RFCMAC), embedded with a modified evolutionary optimization and dynamic grouping differential evolution (DGDE), is implemented for WFC and TGC. By adopting reinforcement learning strategy, mobile robots equip with adaptively wall-following control to make cooperative carrying control in real.

Arbuscular mycorrhizal (AM) fungi influence the plant establishment after disturbances, however, there were no reports on the succession of soil AM fungal communities after earthquakes. This study was carried out to monitor the changes of AM fungal species composition during plant succession after earthquakes. After a major earthquake, the ‘Chi-Chi’ event of 1999, a total of 4238 AM fungal spores belonging to 13 species were recorded. Higher AM fungal spore density was found in the crest area of the affected mountainside and the AM fungal community was significantly different between the crest and valley area. Scutellospora nigra, Acaulospora scrobiculata and Acaulospora tuberculata were dominant in the early succession stage. Glomus ambisporum, Glomus deserticola and Acaulospora mellea were more abundant in the late successional stage. These results demonstrated the dynamics of AM fungal community during succession and vegetation recovery.

This study proposes an efficient wall-following and navigation control model that includes three control modes, namely w all-f ollowing (WF), t oward-g oal (TG), and b ehavior m anager (BM). To achieve an adaptive controller for WF mode, an efficientr ecurrent f uzzy c erebellar m odel a rticulation c ontroller (RFCMAC) based on d ynamic g roup a rtificial b ee c olony (DGABC) is proposed for implementing reinforcement learning process. The fitness function includes four assessment factors which are defined as follows: (1) maintaining safe distance between the mobile robot and the wall; (2) ensuring successfully running a cycle; (3) avoiding mobile robot collisions; (4) mobile robot running at a maximum speed. Moreover, the BM is used to switch WF mode and TG mode, and is employed as an escape mechanism based on the relationship between the robot and the environment. The experimental results show that the proposed DGABC is more effective than the traditional ABC in WF mode. The proposed control method also obtains a better navigation control than other methods in unknown environments.

Background/Purpose: Infection is the most common cause of death following burn injury. The study was conducted to compare the diagnostic value of serum procalcitonin (PCT) with the other current benchmarks as early predictors of septic shock and bloodstream infection in burn patients. Methods: We included 24 patients admitted to the Burn Unit of a medical center from June 2015 to December 2015 from the Formosa Fun Coast dust explosion. We categorized all patients at initial admission into either sepsis or septic shock groups. Laboratory tests including the worst PCT and C-reactive protein (CRP) levels, platelet (PLT), and white blood cell (WBC) count were performed at

Aim The response to donepezil in patients with Alzheimer's disease varies, and it is important to identify the potential responder before therapy. Cerebral white matter changes (WMC) are frequently observed in older patients, and the effect of WMC on therapeutic response remains controversial. The present study aimed to investigate the relationships between the location of WMC, severe WMC and the response to donepezil. Methods Among 418 patients with Alzheimer's disease receiving donepezil, 196 patients were eligible for analysis. Five brain areas on each side were analyzed using computed tomography scans and the Age-Related White Matter Changes Rating Scale before therapy. The Cognitive Abilities Screening Instrument was used annually. Patients were defined as responders if their baseline Cognitive Abilities Screening Instrument score minus their follow-up Cognitive Abilities Screening Instrument score was ≤0. Results There was no significant difference in demographic data between responder and non-responder groups. Patients in the responder group had significantly less involvement of WMC in the frontal area (P = 0.0213) and nearly a trend for less involvement of WMC in the basal ganglia (P = 0.1103). After adjustment for age, sex, education, polymorphism of apolipoprotein E, hypertension and diabetes, WMC in the frontal area (OR 0.446, P = 0.0139) and basal ganglia (OR 0.243, P = 0.0380) were significantly associated with a reduced therapeutic response. Conclusions Patients with WMC in the frontal area and basal ganglia had significant decreases in their therapeutic response to donepezil. The location of WMC, independent of their severity, might be associated with the therapeutic response in patient with Alzheimer's disease. Geriatr Gerontol Int 2018; 18: 123–129.

A mathematical model based on the V-shaped curve method is proposed for estimating the electric conduction failure probability of Anisotropic Conductive Film (ACF) packages with constant I/O number but different pad array aspect ratios. The overall failure probability takes account of both electrical open (opening event modeled using a Poisson function) and short circuit (bridging event modeled using a box model), and is calculated in accordance with the Inclusion---Exclusion principle of combinatorial mathematics. The results show that for a given set of pad geometry parameters, the failure probability decreases monotonically with an increasing pad array aspect ratio. However, the optimal particle volume fraction (i.e., the particle volume fraction which minimizes the overall probability failure) remains approximately constant as the aspect ratio is increased. Moreover, for an ACF package with a specified I/O number and a given conductive particle size, the failure probability can be reduced by decreasing the pad height, increasing the pad side length, increasing the pad distance, and setting the ACF volume fraction equal to that corresponding to the tip of the V-shaped curve.

Background and Purpose: Periodic limb movements of sleep (PLMS) are usually comorbid with hypertension, tachycardia, and coronary arterial diseases, which are also risk factors for cerebrovascular accidents (CVA). However, evidence about the relationship between CVA and PLMS is still weak. The aim of this study was to investigate (1) the prevalence of CVA in patients with PLMS, and (2) the severity of PLMS in patients with or without CVA through a meta-analysis. Methods: The electronic databases of PubMed, Embase, ScienceDirect, ClinicalKey, Cochrane Library, ProQuest, Web of Science, and ClinicalTrials.gov were searched. The inclusion criteria were (1) articles investigating comorbidity between PLMS and CVA, and (2) clinical trials in humans. Results: This meta-analysis included (1) 9,823 patients with PLMS and 9,416 controls from 5 studies to analyze the prevalence of CVA in PLMS, and (2) 158 patients with PLMS with CVA and 88 PLMS controls without CVA from 3 studies to analyze the severity of PLMS with and without CVA. The results showed (1) significantly higher comorbidity rates of CVA in the patients with PLMS than in the controls without PLMS (OR 1.267, p = 0.019), and (2) higher PLM index in the patients with CVA than in the controls (Hedges’ g = 0.860, p = 0.001; means difference: 4.435, p = 0.016). Conclusions: The results revealed (1) a worse severity of PLMS in the patients with CVA, and (2) increased prevalence of CVA in the patients with PLMS. Based on our results, the patients had a higher prevalence of CVA within 8 years of a diagnosis of PLMS compared to those without PLMS by about 1.3-fold. Whether (1) patients with PLMS receiving treatment have a similar incidence of stroke to those without PLMS, and (2) secondary stroke prevention can lower the severity of PLMS or whether those with severe PLMS have a higher risk of stroke is still inconclusive. Future studies investigating the prevalence of CVA in patients with PLMS should use a follow-up period of over 8 years.

Summary Donor operation in adult living donor liver transplantation is associated with significant postoperative morbidity. To avoid laparotomy wound complications and shorten postoperative recovery, laparoscopic liver graft harvest has been developed recently. However, to determine the cut point of bile duct is challenging. Herein, we report the application of totally laparoscopic approach for right liver graft harvest in a donor with trifurcation of the bile duct. A19-year-old man volunteered for living donation to his father who suffered from hepatitis B virus-related cirrhosis of liver and hepatocellular carcinoma. The graft was 880 mL with a single right hepatic artery and portal vein. The graft to recipient weight ratio was 1.06. The middle hepatic vein was preserved for the donor and the liver remnant was 42.3%. Two branches of middle hepatic veins were > 5 mm in diameter and needed reconstruction with cryopreserved allograft. Ductoplasty using laparoscopic intracorporeal suture technique was done to achieve single orifice of the graft bile duct. The postoperative course was uneventful for the donor. This report adds evidence of the feasibility of pure laparoscopic right donor hepatectomy and describes the necessary steps for bile duct division in donors with trifurcation of bile duct.

Background: Community-onset urinary tract infections (CoUTIs) are the most common bacterial infections, and a decline in antibiotic susceptibility causes many clinical challenges. Adequate empiric antibiotic treatment can decrease unnecessary hospital stays and complications, while reducing the antimicrobial resistance progression. Methods: From October 2014 to April 2015, we retrospectively enrolled patients who were at least 18 years old and required hospitalization for CoUTIs. Demographic variables of these patients, and uropathogens and their antimicrobial susceptibilities were evaluated. Results: In total, 457 patients were enrolled in this study. Their mean age was 71.9 years, and 35.2% of the patients were male. Escherichia coli (54.5%) was the most common uropathogen, followed by Klebsiella pneumoniae (13.1%), Enterococcus spp. (7.1%), Pseudomonas aeruginosa (4.6%), and Proteus mirabilis (3.5%). Bacteremia was present in 25.2% of patients. Diabetes mellitus and acute kidney injury at admission were risk factors for CoUTIs with concomitant bacteremia. Among the UTI-associated bloodstream strains, E. coli (53.1%) was also the most predominant pathogen, followed by K. pneumoniae (11.3%), Staphylococcus aureus (6.1%), and P. mirabilis (4.3%). The overall susceptibility of cefazolin was 62.8%, ceftriaxone 71.4%, ceftazidime 82.8%, flomoxef 82%, cefepime 94.5%, ampicillinâsulbactam 41.6%, piperacillinâtazobactam 85%, levofloxacin 65.2%, trimethoprimâsulfamethoxazole 61.5%, imipenem 92.3%, gentamicin 76.1%, and amikacin 97.5%. Cefazolin-susceptible isolates could be found more frequently among patients who are less than 65 years of age and without diabetes mellitus, had no UTI episode in the past year, and have no bacteremia risk. Patients with nasogastric tube retention more commonly experienced antimicrobial resistance to all the third-generation cephalosporins. Conclusion: Third-generation cephalosporins effectively treated CoUTIs. However, patients with nasogastric tube retention more commonly experienced cephalosporin resistance. Cefepime, imipenem, and amikacin may be used in patients with higher antimicrobial resistance. In selected patients, cefazolin may still be an adequate drug of choice for CoUTIs. Keywords: antibiotic susceptibility, cefazolin, community onset, third-generation cephalosporin, urinary tract infection

Background/Purpose: Bloodstream infection is a leading cause of mortality among burn patients. This study aimed to evaluate the risk factors, causative pathogens, and the relationship between bloodstream infections and other infections among burn patients from the Formosa Fun Coast Dust Explosion. Methods: This retrospective study evaluated the demographic and clinical characteristics, infection types, causative pathogen(s), and isolates' antibiotic susceptibilities from patients who were hospitalized between June 27 and September 31, 2015. Results: Fifty-eight patients were admitted during the study period (36 males, mean age: 22.6 years). The mean burned total body surface area (TBSA) was 40% for all patients. Eighteen (31%) patients with mean TBSA of 80% had 66 episodes of bloodstream infections caused by 92 isolates. Twelve (18.2%) episodes of bloodstream infections were polymicrobial. Acinetobacter baumannii (19, 20.7%), Ralstonia pickettii (17, 18.5%), and Chryseobacterium meningosepticum (13, 14.1%) were the most common pathogens causing bloodstream infections. A high concordance rate of wound cultures with blood cultures was seen in Staphylococcus aureus (3, 75%) and C. meningosepticum (8, 61.5%) infections. However, no Ralstonia isolate was found in burn wounds of patients with Ralstonia bacteremia. A high concordance rate of central venous catheter cultures with blood cultures was noted in Ralstonia mannitolilytica (5, 62.5%) and Chryseobacterium indologenes (3, 60%) infections. Approximately 21.1% of A. baumannii strains were resistant to carbapenem. All S. aureus isolates were susceptible to methicillin. Conclusions: Waterborne bacteria should be considered in patients of burns with possible water contact. Empirical broad-spectrum antibiotics should be considered for patients who were hospitalized for severe sepsis, or septic shock with a large burn. Antibiotic treatment should be administered based on the specific pathogens and their detection points. Keywords: Burn injury, Bacteremia, Resistance, Gram-negative bacteria, Formosa Fun Coast Dust Explosion

This study developed and effectively implemented an efficient navigation control of a mobile robot in unknown environments. The proposed navigation control method consists of mode manager, wall-following mode, and towards-goal mode. The interval type-2 neural fuzzy controller optimized by the dynamic group differential evolution is exploited for reinforcement learning to develop an adaptive wall-following controller. The wall-following performance of the robot is evaluated by a proposed fitness function. The mode manager switches to the proper mode according to the relation between the mobile robot and the environment, and an escape mechanism is added to prevent the robot falling into the dead cycle. The experimental results of wall-following show that dynamic group differential evolution is superior to other methods. In addition, the navigation control results further show that the moving track of proposed model is better than other methods and it successfully completes the navigation control in unknown environments.

In this paper, a load-balanced cloud service interface is designed and development for coping with a great amount of users in the HiBA (Hierarchical Brokering Architecture) mobile cloud. The load-balanced cloud service interface consists of three core functional modules: the cloud service interface node (CSIN), the CSI Manager, and the CSI Allocation Table, developed to match clients requests to CSINs. We deploy the proposed cloud service interface to the Microsofts public cloud, and conduct integrated tests to a travel application scenario, which show successful load-balanced effect in the mobile cloud environment.