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The objective of this study is to comprehensively characterize persistent organic pollutants (POPs) in seawater at Kaohsiung Harbor, focusing on their concentrations, partitioning behaviors, and profiles in both particle and liquid phases. We analyzed 100 L seawater for each sample, finding total dioxin-like toxicity (PCDD/Fs + PCBs + PBDD/Fs) ranging from 0.00936 to 0.167 pg WHO-TEQ/L, with PCDD/Fs accounting for 68 % of total toxicity. POPs predominantly appeared in the particle phase, observed in over 80 % of samples, except for PCBs. The observed correlations between particulate matter (PM) and chlorinated POPs at sites receiving river effluents suggest shared pollution sources. The liquid partition of PCDD/Fs, PCBs, and PBDEs in the seawater shows an inverse relationship with log Kow and a direct proportionality with solubility, particularly above 0.1 μg/L. Furthermore, PBDEs in seawater can transform into PBDD/Fs upon UV light exposure, highlighting another potential pathway for the persistence and spread of these harmful contaminants in the environment. These findings emphasize the need for field-based investigations to assess PBDF formation in aquatic environments and underscore the importance of stronger mitigation strategies, including better wastewater treatment and stricter discharge regulations to reduce POPs in marine ecosystems., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

The abundance and fate of microplastics (MPs) in wastewater treatment plants (WTPs) has been reported extensively. However, in the wastewater, the extent to which hazardous chemicals such as persistent organic pollutants (POPs) accumulated by MPs not been clearly explored. In this study, MPs was sampled from influents and effluents in WTPs to characterize POPs in sorption within MPs. The highest concentrations of PCDD/Fs, PBDD/Fs, PBDEs, and PCBs in sorption within MPs from untreated influents were 5310, 2310, 5,220,000, and 22,700 pg/g, respectively. The most toxic congener, 1,2,3,7,8-PeCDD, accounts for up to 32.3 % of the contribution to PCDD/Fs within MPs. Furthermore, the concentration of PCDD/Fs within MPs from untreated influents could be up to 27.7 times higher than that in microplastic pellets on the coastal beach. This study highlights the quantitative evidence of the POPs within MPs present in untreated influents., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Objectives: This study evaluates the prognostic impact of the new grading system for lung adenocarcinoma, stratified by lymphadenectomy extent., Materials and Methods: We analyzed 1258 lung adenocarcinoma patients who underwent curative resections between 2006 and 2017. We analyzed overall survival (OS), cancer-specific survival (CSS), and recurrence-free survival (RFS) across tumor grades and lymphadenectomy extent, categorized as IASLC-R0 (complete resection) or R(un) (uncertain resection)., Results: The median age of cohort was 63 and 41.9 % were male. The majority had undergone lobectomy. The distribution of tumors was 274 grade 1, 558 grade 2, and 426 grade 3 cases. After a median follow-up time of 102 months, the 10-year OS/CSS/RFS rates worsened significantly across grade 1-3: 92.4/99.3/92.3 %, 77.8/87.5/71.7 %, and 63.6/70.2/52.0 %, respectively (p < 0.001). Multivariate Cox regression analysis identified grade 3, R(un) lymphadenectomy, higher Charlson Comorbidity Index, smoking history, thoracotomy, higher pathology stage, and angiolymphatic invasion as independent prognostic factors for lower OS, CSS, and RFS. Furthermore, grade 3 patients benefited significantly from IASLC-R0 lymphadenectomy, showing significantly better OS and RFS than those who underwent R(un) lymphadenectomy (p = 0.007 for OS, p = 0.001 for RFS, post-propensity score matching). Among grade 3 tumors underwent R0 or R(un) resections found the incidence rates of local, distant, and simultaneous local and distant recurrence were 8.5 % vs 13.7 %, 11.0 % vs 12.2 %, and 11.0 % vs 20.6 %, respectively., Conclusion: Surgical outcomes for lung adenocarcinoma have declined across grades 1-3. IASLC-R(un) treatment worsens OS and RFS in grade 3. Intensive monitoring and adjuvant therapy should be considered when patients with grade 3 lung adenocarcinoma undergo R(un) lymphadenectomy., Competing Interests: Declaration of competing interest There is no conflict of interest., (Copyright © 2024 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.)

Autophagy is a vital cellular process responsible for digesting various cytoplasmic organelles. This process plays a crucial role in maintaining cell survival and homeostasis, especially under conditions that cause nutrient deficiency, cellular damage, and oxidative stress. Neuroangiostrongyliasis is an infection caused by the parasitic nematode Angiostrongylus cantonensis and is considered as an emerging disease in many parts of the world. However, effective therapeutic strategies for neuroangiostrongyliasis still need to be further developed. In this study, we investigated the effects of benzaldehyde treatment on autophagy and sonic hedgehog (Shh) signaling in A. cantonensis-infected mice and its mechanisms. First, we found autophagosome generation in the central nervous system after A. cantonensis infection. Next, benzaldehyde combined with albendazole treatment reduced eosinophilic meningitis and upregulated the expression of Shh signaling- and autophagy-related molecules in A. cantonensis-infected mouse brains. In vitro experiments demonstrated that benzaldehyde could induce autophagy via the Shh signaling pathway in A. cantonensis excretory-secretory products (ESPs)-treated mouse astrocytes. Finally, benzaldehyde treatment also decreased lipid droplet accumulation and increased cholesterol production by activating the Shh pathway after ESPs treatment. In conclusion, these findings suggested that benzaldehyde treatment could alleviate brain damage by stimulating autophagy generation through the Shh signaling pathway., Competing Interests: Declaration of competing interest The authors declare no competing financial interests., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: We investigated the effects of combination therapy albendazole and doxycycline in Angiostrongylus cantonensis-infected mice during early and late treatment., Materials and Methods: C57BL/6 and BALB/c mice were divided into five groups: (i) uninfected, (ii) infected with A. cantonensis, (iii) infected + 10 mg/kg albendazole, (iv) infected + 25mg/kg doxycycline, and (v) infected + 10 mg/kg albendazole + 25 mg/kg doxycycline. We administered drugs in both early treatments started at 7-day post infections (dpi) and late treatments (14 dpi) to A. cantonensis-infected C57BL/6 and BALB/c mice. To assess the impact of these treatments, we employed the Morris water maze test to evaluate spatial learning and memory abilities, and the rotarod test to measure motor coordination and balance in C57BL/6 mice. Additionally, we monitored the expression of the cytokine IL-33 and GFAP in the brain of these mice using western blot analysis., Results: In this study, A. cantonensis infection was observed to cause extensive cerebral angiostrongyliasis in C57BL/6 mice. This condition significantly affected their spatial learning and memory abilities, as assessed by the Morris water maze test, as well as their motor coordination, which was evaluated using the rotarod test. Early treatment with albendazole led to favorable recovery outcomes. Both C57BL/6 and BALB/c mice express IL-33 and GFAP after co-therapy. The differences of levels and patterns of IL-33 and GFAP expression in mice may be influenced by the balance between pro-inflammatory and anti-inflammatory signals within the immune system., Conclusions: Combination therapy with anthelmintics and antibiotics in the early stage of A. cantonensis infection, in C57BL/6 and BALB/c mice resulted in the death of parasites in the brain and reduced the subsequent neural function damage and slowed brain damage and neurobehavior impairment. This study suggests a more effective and novel treatment, and drug delivery method for brain lesions that can decrease the neurological damage of angiostrongyliasis patients., Competing Interests: Declaration of Competing Interest The authors declare that they have no competing interests., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Coxsackievirus B3 (CVB3), one serotype of enteroviruses, can induce fatal myocarditis and hepatitis in neonates, but both treatment and vaccine are unavailable. Few reports tested antivirals to reduce CVB3. Several antivirals were developed against other enterovirus serotypes, but these antivirals failed in clinical trials due to side effects and drug resistance. Repurposing of clinical drugs targeting cellular factors, which enhance viral replication, may be another option. Parasite and cancer studies showed that the cellular protein kinase B (Akt) decreases interferon (IFN), apoptosis, and interleukin (IL)-6-induced STAT3 responses, which suppress CVB3 replication. Furthermore, miltefosine, the Akt inhibitor used in the clinic for parasite infections, enhances IL-6, IFN, and apoptosis responses in treated patients, suggesting that miltefosine could be the potential antiviral for CVB3. This study was therefore designated to test the antiviral effects of miltefosine against CVB3 in vitro and especially, in mice, as few studies test miltefosine in vitro, but not in vivo. In vitro results showed that miltefosine inhibited viral replication with enhanced activation of the cellular transcription factor, STAT3, which is reported to reduce CVB3 both in vitro and in mice. Notably, STAT3 knockdown abolished the anti-CVB3 activity of miltefosine in vitro. Mouse studies demonstrated that miltefosine pretreatment reduced CVB3 lethality of mice with decreased virus loads, organ damage, and apoptosis, but enhanced STAT3 activation. Miltefosine could be prophylaxis for CVB3 by targeting Akt to enhance STAT3 activation in the mechanism, which is independent of IFN responses and hardly reported in pathogen infections., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Although a benign intracranial tumor, craniopharyngioma treatment has always been considered a challenging clinical problem. Recently, BRAF V600E mutation in the pathogenesis of papillary craniopharyngioma (PCP) has been further revealed. Thus, BRAF inhibitors (BRAFi) serve as an applicable treatment for patients with PCP., Methods: Two patients with recurrent PCP were treated with combined BRAFi dabrafenib (150 mg, orally twice daily) and MEK inhibitors (MEKi) trametinib (2 mg, orally twice daily). A follow-up exceeding 2 years was conducted. We meticulously scrutinized the treatment's safety and efficacy profiles by delving into existing literature., Results: One patient harboring a solid tumor achieved a complete tumor response devoid of any adverse events and encountered no recurrence over 2 years subsequent to discontinuation. Moreover, within a mere month of commencing targeted therapy, the tumor demonstrated observable shrinkage. This finding substantiates the considerable potential inherent in targeted therapy for PCP cases marked by the somatic BRAF V600E mutation., Conclusions: Under specific conditions, individuals diagnosed with PCP can attain a complete tumor response following combined treatment with BRAFi/MEKi., (Copyright © 2023 The Authors. Published by Elsevier Inc. All rights reserved.)

Human activities impose significant changes on sedimentation processes and vegetation cover within lake catchments. However, the needed time for an anthropogenically disturbed natural state to be reversed back to its natural state by environmental protection programs is still ambiguous. Here we employ a multi-proxy approach to delineate major environmental disturbances such as logging and forest fires on the catchment in Cueifong Lake, a subtropical subalpine lake in northeastern Taiwan. X-ray Fluorescence (XRF) core scanning, bulk total organic carbon (TOC), bulk total nitrogen (TN), stable carbon isotope (δ 13 C org ) analysis, and macro-charcoal counting were utilized to reconstruct changes in the catchment environment based on a sediment core from Cueifong Lake. The results show that the element content changed distinctly around 1975 CE, which coincided with the onset of profound deforestation in the lake vicinity recorded in historical documents and aerial photos. After the cessation of the logging event, the detrital input increased, accompanied by decreasing C/N ratios and increasing δ 13 C org values. This suggests that increased terrestrial nutrient input promoted algae growth. After the deforestation phase, our results imply a gradual recovery of elemental composition in the catchment environment. By extrapolating the XRF element records, we suggest that it might take >50 years for the sedimentary regime to reach its pre-logging baseline. In contrast to the depositional system, the C/N and δ 13 C org shifted significantly - potentially irreversibly - towards an algae-dominant environment instead of recovering to the pre-logging condition. This could be due to both 1) the changes in the different vegetation species used for reforestation and/or 2) anthropogenically introduced fishes in the 1980s. This study proposes the first assessment of the needed recovery time for subtropical Asian subalpine forests after large-scale logging activity and thus provides an apparent reference for policy decisions on natural resource development and environmental protection., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Purpose: To investigate correlations between clinical and histopathologic characteristics of idiopathic epiretinal membrane (ERM)., Design: Retrospective interventional case series., Participants: In total, 87 eyes from 87 patients with idiopathic ERM who underwent pars plana vitrectomy with peeling of the ERM from 2019 to 2020 were included., Methods: The outcomes of clinical ophthalmic examination, including measurement of best-corrected visual acuity (BCVA) and spectral-domain OCT (SD-OCT), before and after surgery were reviewed. Surgical specimens were fixed in formalin and embedded in paraffin for histologic and immunohistochemical analysis., Main Outcomes Measures: The association between morphological characteristics revealed on SD-OCT images and the cellular composition of the surgically excised ERM demonstrated with immunohistochemical staining were the main outcome measures. Changes in the BCVA and central macular thickness (CMT) were assessed through a comparison of preoperative and postoperative measurements., Results: Based on SD-OCT morphological characteristics in the foveal area, 15 cases were classified into group 1A (mainly outer retinal thickening), 39 into group 1B (more tenting of the outer retina and distorted inner retina), and 33 into group 1C (prominent inner retina thickening). Overall, postoperative final BCVA and CMT at 1 year improved in all groups. Patients who presented with a better initial BCVA exhibited a more favorable final BCVA. Epiretinal membranes in group 1C demonstrated the greatest decrease in CMT compared with those in groups 1B and 1A, but the final CMT did not differ among the groups. A negative correlation between the density of hyalocytes (P = 0.003) and myofibroblasts (P = 0.047) was noted between the 3 groups. Total cell density and glial cell density of the ERMs were strongly associated with poor final BCVA and BCVA improvement., Conclusions: The present study provides new histopathologic information regarding the formation and progression of idiopathic ERM. Glial cell proliferation plays a predominant role in these processes. Epiretinal membranes with high cellularity and glial cell density may cause damage to the retina structure, resulting in poor postoperative visual outcomes. These findings provide additional evidence supporting early surgical intervention in patients with idiopathic ERM reported with visual disturbance., (Copyright © 2022 American Academy of Ophthalmology. Published by Elsevier Inc. All rights reserved.)

The radiologists' role in axillary imaging in the setting of a suspicious breast mass is evolving in light of the Z0011 trial leading to expected practice variation. The purpose of our project was to generate a standardized algorithm guiding the utilization of axillary ultrasound in the setting of a highly suggestive or highly suspicious breast mass (BI-RADS 4C or 5) without a known cancer diagnosis. The algorithm was created with Z0011 practices in mind while reflecting the clinical preferences of our radiology and surgical teams. The four breast surgeons at our academic institution were individually queried regarding their preferred axillary imaging and biopsy approach. The best practices for axillary imaging were then developed in a breast imaging intradepartmental meeting. There was agreement among the surgical group that the presence of suspicious axillary lymph node (s) on ultrasound could be used for treatment planning and patient discussion but would not be used for surgical planning in most cases. They also agreed that an ultrasound-guided core needle biopsy of a suspicious axillary lymph node should be deferred until after surgical consultation. Discussion among our breast radiologists resulted in the consensus that axillary ultrasound in the setting of a BIRADS 4 or 5 mass should be deferred at its initial presentation unless there is palpable lymphadenopathy, suspicious lymph node on mammography, or a tumor is at least stage T3, presumably excluding them from Z0011 criteria. The decision was also made to defer biopsies of suspicious axillary lymph nodes without prior surgical consultation/discussion., (Copyright © 2022 Elsevier Inc. All rights reserved.)

This study experimentally examines the effects of four diesel-gas co-fuels, two engine loads and an aftertreatment on regulated and unregulated emissions from a 6-cylinder natural-aspirated direct-injection heavy-duty diesel engine (HDDE) with an engine dynamometer. Fuel energy of ultra-low-sulfur diesel was substituted with 10% and 20% of gas fuels, including pure H 2 , CH 4 , and two CH 4 -CO 2 blends. The particle number size distributions of volatile and nonvolatile nanoparticles were measured under ambient temperature and after 300 °C heating, respectively. The results show that the gas fuels caused increases of hydrocarbon emission, slight changes of NOx emission, and decreases of opacity. All four gas fuels resulted in elevated emissions of both volatile and nonvolatile nanoparticles at 25% and 75% load, in the range of 29% to 390%. The increased emissions of volatile nanoparticles were variable and without obvious trends. Special attentions should be given to the addition of H 2 under high load, during which significant increases of volatile nanoparticles could be formed not only post-combustion (up to 1376%), but also post-diesel oxidation catalyst plus diesel particulate filter (DOC + DPF). The nonvolatile nanoparticles, on the other hand, could be effectively removed by the retrofitted DOC + DPF, with efficiency >98.2%. A noteworthy fraction of solid particles of sizes <23 nm were found in the exhaust, not being accounted for by current regulatory emission standard., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests., (Copyright © 2022 Elsevier B.V. All rights reserved.)

Background: Human cerebral angiostrongyliasis, induced by Angiostrongylus cantonensis, is an emerging disease in many parts of the world. A. cantonensis is also an important causative agent of eosinophilic meningitis and eosinophilic meningoencephalitis in humans. 3-Hydroxybenzaldehyde (3-HBA) and 4-Hydroxybenzaldehyde (4-HBA) have been shown to increase intracellular antioxidant activity, vasculoprotective potency, wound healing, and cell migration. However, the function of 3-HBA and 4-HBA in mouse astrocytes in response to A. cantonensis young adults excretory-secretory products (ESPs) treatment remains unclear., Methods: Here, we examined the effect of 3-HBA and 4-HBA by real-time qPCR, western blotting, and cell viability assay in astrocytes after A. cantonensis young adults ESPs treatment. The real-time qPCR, western blotting were employed to detect the expression of apoptosis- and Shh pathway-related molecule. The percentage of cell viability was monitored by CCK-8 assay., Results: We demonstrated that expression of apoptosis-related molecules was increased in response to A. cantonensis young adults ESPs treatment. However, the cell viability of astrocytes was elevated by treatment with 3-HBA and 4-HBA. Further investigation found that 3-HBA and 4-HBA activate the Shh signaling pathway and inhibit apoptosis-related molecule expression., Conclusions: These findings were confirmed using A. cantonensis young adults ESPs to activate apoptosis-related pathways in astrocytes. Moreover, 3-HBA and 4-HBA induced a protective phenotype through regulation of apoptosis in response to A. cantonensis young adults ESPs treatment. Hence, 3-HBA and 4-HBA represent potential therapeutic drugs for the treatment of human angiostrongyliasis., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2020 Chang Gung University. Published by Elsevier B.V. All rights reserved.)

Microplastic (MP) pellets were sampled from six sandy beaches around Taiwan in order to investigate the concentrations and compositions of POPs, including: PCDD/Fs, PBDD/Fs, PBDEs, PCBs, PBBs, and their congeners. The concentrations of PCDD/Fs on the surface (C s ) of MP pellets from the six sampling sites were from 1.9 to 14.6 pg∙g -1 , while the overall concentrations within MPs (C t ) were from 95.0 to 1110.6 pg∙g -1 . As PCDD/Fs were adsorbed into the inner part of MPs, a ratio of the total concentrations to surficial concentration of MPs (C t /C s ) was as high as 355.2 times. The C t /C s of other POPs were also significant, such as PBDEs being found up to 8068 times, which could be attributed to artificial addition during manufacturing processes as flame-retardant substances. Primary compositions of PCDD/Fs, PBDD/Fs, and PBDEs on the MPs in our POP congener analysis were all found containing species with higher number of chlorine or bromine, which were adsorbed on the MP surface more easily due to their relative higher K OW ., (Copyright © 2021 Elsevier B.V. All rights reserved.)

In 2017 the World Health Organization listed carbapenem-resistant K. pneumoniae as a critical priority for developing a novel antimicrobial agent. Here we report on our investigation of the antibacterial efficacy of silver nanoparticles (AgNPs), confined to a mesostructured material and designated as an Ag/80S bioactive nanocomposite, against carbapenem-resistant K. pneumoniae. Results from a textural analysis indicate a 7.5 nm mesopore size and 307.6 m 2 /g surface area for Ag/80S. UV-Vis spectrum and transmission electron microscope images of Ag/80S revealed a uniform AgNP size distribution with an approximately 3.5 nm average. ICP-MS analysis demonstrated a significantly higher silver content in TSB (a protein-rich environment) compared to ultrapure water, suggesting a controllable release of Ag/80S and thus designated as the inspired Ag/80S. Minimum inhibitory concentration (MIC) values against 16 K. pneumoniae isolates ranged from 0.25 to 0.5% (2.5 to 5.0 mg/ml). NIH 3T3 fibroblast viability at 0.25% exceeded 80% and at 0.5% just under 70%, suggesting low cytotoxicity. Mechanistic study results indicate that the inspired Ag/80S attached to and deformed bacterial cells and induced a time-dependent accumulation of reactive oxygen species, leading to bacterial death. Further, inspired Ag/80S significantly extended median survival time in a Caenorhabditis elegans animal model infected with carbapenem-resistant K. pneumoniae ATCC BAA-1705. Combined, we found a novel Ag/80S which could prevent aggregation of AgNP and control its release via a specific environment for medical use against carbapenem-resistant K. pneumoniae., (Copyright © 2021 Elsevier B.V. All rights reserved.)

(2S, 3R)-4-methylsulfonylphenylserine [(2S, 3R)-MPS], a key chiral precursor for antibiotics florfenicol and thiamphenicol, could be asymmetrically synthesized by l-threonine transaldolase (LTTA) coupled with an acetaldehyde elimination system. The low efficiency of acetaldehyde elimination system blocked further accumulation of (2S, 3R)-MPS. To address this issue, strengthening acetaldehyde elimination system and enzyme self-assembly strategy were combined to accelerate biosynthesis of (2S, 3R)-MPS. The new multi-enzyme cascade with intensified acetaldehyde elimination system BL21 (PsLTTAD2/ScADH/BtGDH) could produce (2S, 3R)-MPS with a titer of 157.6 mM, 1.7-folds than that produced by the original system BL21 (PsLTTAD2/ApADH/CbFDH). Moreover, self-assembly of PsLTTAD2 and ScADH by respective fusion of SpyTag and SpyCatcher were carried out to develop a self-assembled multi-enzyme cascade BL21 (ST-PsLTTAD2/SC-ScADH/BtGDH). As a result, the yield of (2S, 3R)-MPS was up to 248.1 mM with 95% de. As far as we knew, that represented the highest yield of (2S, 3R)-MPS by enzymatic synthesis, and therefore was a promising and green route for industrial production of this valuable compound., (Copyright © 2021 Elsevier Inc. All rights reserved.)

We studied the correlations between egg geometrical parameters (i.e., egg shape index, sphericity, geometric mean diameter, surface area, and volume) and eggshell qualities, or the organic matrix in eggshell. Eggs were collected from 5 poultry breeds belonging to 3 species (commercial Hy-line Brown Chicken, Shaoxing Duck, Jinding Duck, Taihu Goose, and Zhedong White Goose). The geometrical parameters showed high variation among 3 species of poultry, and even between breeds in the same species. The five geometrical parameters were grouped into 2 sets, one contained shape index and sphericity, the other comprised geometric mean diameter, surface area, and volume. The parameters in the same set can be perfectly fitted to one another. Egg weight, shell membrane weight, and calcified shell weight were significantly correlated with geometric mean diameter, surface area, and volume. In accordance with false discovery rate-adjusted P value, both shell membrane relative weight and calcified shell thickness showed no significant correlations with any of the geometrical parameters. However, the correlations between geometrical parameters and other shell variables (calcified shell weight, shell relative weight, calcified shell thickness uniformity, and eggshell breaking strength) depend on breed. Both constitutive proportions and percentage contents of 3 eggshell matrix components (acid-insoluble, water-insoluble, and both acid and water facultative-soluble matrix) had no effects on egg shape and size. The correlations between the amounts of various shell matrix, egg shape and size depend on breed or species. This study provides a methodology and the correlation between geometrical parameters and eggshell qualities, and between geometrical parameters and organic matrix components in calcified shells., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To explore intergenerational differences on key factors of food parenting practices (FPPs) related to home eating behavior of schoolchildren., Design: In-depth interviews with social recognition theory-based semistructured interviews conducted from December 2016 to January 2017., Participants: Primary caregivers of elementary schoolchildren from 23 households (16 parents, 14 grandparents) in 4 remote areas of Hualien, Taiwan., Phenomenon of Interest: Factors related to FPPs hindering micronutrient-dense food group consumption by schoolchildren in a remote area., Setting: In-depth interviews were conducted at participants' houses., Analysis: Interviews were audiorecorded and transcribed verbatim. Inductive thematic analysis was performed to elicit studied phenomenon., Results: Routine family meals provided adequate staple, protein, and vegetables but inadequate whole grains, dairy, fruits, and nuts. More parents provided breakfast composed of pan-fried and semiprocessed products made of refined flour and sugary beverages. Both parents and grandparents had ambiguous nutrition concepts and inconsistent FPPs but in different aspects. They both reflected expectations for assistance from local schools for nutrition and FPPs education to shape up healthy eating behavior of children., Conclusions and Implications: Study findings pinpoint the strength and barriers of FPPs for primary caregivers. Implementing integrated nutrition education programs tailored for empowering nutrition literacy and FPPs is suggested to enhance the healthy eating behavior of schoolchildren in a remote area., (Copyright © 2020 The Authors. Published by Elsevier Inc. All rights reserved.)

This study presents a state-of-the-art soft and biocompatible transducer capable of detecting vessel inner-wall pressure for biomedical applications. The device includes a 3D electroactive polymer core element encapsulated by polydimethylsiloxane with an ellipsoidal structure. The device produces a voltage output when its sensing mechanism experiences different pressures, resulting in deformation at different orientations. Thus, it can be employed to detect the pressure exerted by inner vessel walls of different stiffness values. The output voltage is induced by the strain experienced by the sensing mechanism of the device without the need for any external electrical power source. The core element, which is made of an ionic polymer-metal composite, possesses a unique hollow design; this allows a catheter to pass through, and the core element can be anchored at an arbitrary position on the catheter. We also demonstrate that the fabricated device can be integrated with a medically used percutaneous transluminal angioplasty balloon catheter to form a smart sensing module. This module can detect different levels of fat accumulation around the inner wall of a blood vessel phantom. Evaluating vessel blockage and stiffness using the signals acquired from the developed device is discussed., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Introduction: Whether combining Chinese herbal medicines (CHMs) and chemotherapy to treat patients with advanced non-small-cell lung cancer (NSCLC) has clinical benefits has yet to be confirmed. A meta-analysis was performed to address the efficacy of CHM in patients with advanced NSCLC., Methods: Seven databases, including PubMed, MEDLINE, Cochrane Library, Embase, CINAHL Plus with Full Text (EBSCO), WANFANG DATA and the Chinese National Knowledge Infrastructure (CNKI), were systematically searched for available literature through March10, 2020. A meta-analysis was conducted to generate combined risk ratios(RRs) with 95 % confidence intervals (CIs) for objective response rates (ORRs), disease control rates (DCRs), and 1-year overall survival (OS) rates, and a random-effects model was used to estimate the standardized mean differences (SMDs) with 95 % CI for quality or life (QOL), median survival time (mST) and progression-free survival (PFS)., Results: Reports of 14 randomized controlled trials involving 1451 patients were included in the analysis. Among them, 739 patients received CHMs, and 712 patients received chemotherapy alone. The ORR (RR = 1.37, 95 % CI [1.20-1.58], p =  .000), DCR (RR = 1.13, 95 % CI [1.07-1.21], p = 0.000), QOL (SMD = 1.47; 95 % CI [0.30-2.64]; p = 0.014), mST (SMD = 1.62; 95 % CI [1.15-2.08];p =  .000), and 1-year OS rate (RR = 1.24, 95 % CI [1.05-1.47], p = 0.01) were higher in patients with NSCLC who received CHMs than in those who received only chemotherapy. However, the CHM group was not found to have a higher median PFS (SMD = 1.27, 95 % CI [-0.22-2.78], p =  .095) than the chemotherapy group. Publication bias for ORR and DCR was indicated by funnel plot. For the efficacy endpoint, no evidence of a lack of robustness was found, according to the sensitivity analysis. These results must be interpreted with caution due to differences in the designs of the trials and patients' characteristics, and also due to the presence of missing data., Conclusions: Our study found that higher ORR, DCR, QOL, mST and 1-year OS rate were associated with CHM use as an adjuvant to chemotherapy. Although these results require further confirmation, CHMs apparently have potential therapeutic value for patients with advanced NSCLC., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Background: Enterovirus-D68 (EV-D68) has been endemic in Taiwan for some years with a small number of positive cases. Detailed information about respiratory presentation is lacking. This study characterized the clinical course in children admitted to the medical center and regional hospital in Taichung during 2015., Methods: Retrospective chart review of patients with confirmed EV-D68 infection admitted to the medical center and regional hospital in Taichung with respiratory symptoms in the second half of 2015. Past medical history, clinical presentation, management, and course in hospital were collected and analyzed. Simple demographic data and clinical symptoms were also collected from patients confirmed with EV-D68 infection who visited clinics in Taichung., Results: Six children were included. Two patients had a prior history of asthma or recurrent dyspnea, and one had other preexisting medical comorbidities. One child was admitted to the pediatric intensive care unit. All the patients were cured. Cough, rhinorrhea, tachypnea and fever were the most common clinical symptoms among inpatients, while influenza-like illness (ILI) was prevalent in outpatients., Conclusion: EV-D68 infection resulted in respiratory presentations of asthma-like illness in the hospitalized pediatric population. Patients with a prior history of asthma or recurrent dyspnea appear to be more severely affected., (Copyright © 2019. Published by Elsevier B.V.)

Herein the sulfur/nitrogen contained groups, serving as the "hooks" for electrochemical determination of Hg(II), were assembled on the reduced graphene oxide (hereafter SN-rGO) via a one-step facile hydrothermal method. The thiourea acts as a precursor for sulfur/nitrogen doping and partial reduction of graphene oxide. The SN-rGO was used to modify the glassy carbon electrode (GCE) for electrochemical detection of Hg(II) by square wave anodic stripping voltammetry (SWASV). The sulfur/nitrogen doping significantly improves the Hg(II) complexation by SN-rGO due to the creation of multifunctional groups on the graphene nanosheet. The SN-rGO modified electrode has excellent sensitivity (20.48 μA/μM) and limit of detection (LOD 8.93 nM) for Hg(II) detection. The newly developed Hg(II) sensing electrode possesses minimal interference for other ions typically found in natural waters. Therefore, it can be used for routine water quality monitoring. The fabrication of the SN-rGO electrode is rapid and low cost; hence, it offers a potential platform for environmental monitoring of toxic metal ions., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Herein, combined with the outstanding adsorption ability of flower-like MoS 2 with ultra-thin nanosheets and the good electrical conductivity of reduced graphene oxide (rGO), a sensitive and anti-interference electrochemical sensing interface for the analysis of Pb(II) was constructed by using MoS 2 /rGO nanocomposite modified glassy carbon electrode (MoS 2 /rGO-GCE). The stripping behavior of Pb(II) was estimated using square wave anodic stripping voltammetry (SWASV), a high sensitivity of 50.80 μA μM -1 was achieved, and the limit of detection (LOD) was determined to be 0.005 μM (3σ method). The reasons for the excellent electrochemical performance of MoS 2 /rGO-GCE toward Pb(II) is that the excellent adsorption capacity and electrical conductivity, and the redox reaction of Pb(II) occurs directly on the surface of the MoS 2 /rGO nanocomposite. Moreover, series interference experiments were systematically conducted, the sensitivity of Pb(II) has no obvious change in the presence of other coexist heavy metal ions. In addition, an intriguing interference phenomenon between Pb(II) and Cu(II) was found. When Cu(II) exists in the solution, two stripping peaks of Pb(II) were observed, this phenomenon can be explained that the form of PbCu alloy or intermetallic compounds during the preconcentration process. Further experiments indicated that the proposed method has good stability and reproducibility. Finally, the accurate detection result of Pb(II) in wastewater sample gathered from Wangxiaoying wastewater treatment plant were obtained., (Copyright © 2019 Elsevier B.V. All rights reserved.)

Background: The neonatal changes of corpus callosum or cerebellar volume in preterm infants have been shown to link with abnormal mentality and motor disability in early childhood. This study aims to predict the long-term neurological outcomes by measuring these changes on neonatal brain ultrasound in preterm infants., Methods: Our cohort consisted of infants aged below 32 weeks' gestation with very low birth body weights who completed neuro-assessments at 5 years of age. Corpus callosum or cerebellar vermis were measured at 28-30 weeks and at 37-40 weeks gestational age in premature infants with cerebral palsy (CP), mental retardation (MR) and normal control premature infants., Results: There are 12 patients in MR group, 12 in CP group and 27 patients as controls for final analysis. There was no significant difference in other factors between study groups except lower gestational age (P = 0.043) in CP group. Respiratory distress syndrome was more common in MR group (P = 0.037) and cystic periventricular leukomalacia was more common in CP group (P < 0.001) than controls. After adjusting for sex and birth body weight, the MR group had smaller cerebellar vermis area at 37-40 gestational weeks (P = 0.002) than controls. They also reduced the growth of corpus callosum area (difference = -0.12 ± 0.16, P = 0.029) and cerebellar vermis area (difference = 1.10 ± 0.44, P = 0.020) from 28 to 30 gestational weeks to 37-40 gestational weeks compared with controls (difference = 0.03 ± 0.15, 1.92 ± 0.70, respectively). In contrast, the CP group had reduced the growth of corpus callosum body (difference = -0.02 ± 0.18, P = 0.034) compared with controls (difference = 0.03 ± 0.04). They subsequently had smaller body thickness of corpus callosum (0.10 ± 0.02, P = 0.015) at 37-40 gestational weeks than controls (0.14 ± 0.04)., Conclusions: Serial monitoring corpus callosum and cerebellar vermis size in early life of very preterm babies may predict the motor or mentality neurological outcome at 5 years of age., (Copyright © 2018. Published by Elsevier B.V.)

Purpose: Digital breast tomosynthesis (DBT) has been shown to increase conspicuity of some mammographic findings, particularly architectural distortion (AD). The purpose of this retrospective study was to determine the positive predictive value of AD on diagnostic DBT, and evaluate associations between AD characteristics and histopathologic outcomes., Methods: This IRB-approved, HIPAA-compliant study included diagnostic DBT exams performed between 1/2014 and 12/2015 that demonstrated AD. Imaging characteristics of AD, corresponding ultrasound and MRI exams, and pathology results were reviewed. Fisher's exact tests and a two-tailed t-test were performed., Results: Seventy-seven cases of AD were visualized in 68 patients (ages 36-78 years, mean 54 years). Core biopsy of 74 cases of AD yielded malignant pathology in 26/74 (35%) tissue samples. Among 48/74 (65%) non-malignant cases of AD, 25 demonstrated a high-risk lesion, including radial scar in 20, with no upgrades to malignancy among 20 high-risk lesions that underwent surgical excision. Among 23 non high-risk causes of benign AD, stromal fibrosis was most common, present in 12 biopsy specimens. Associations between imaging characteristics of AD on DBT and histopathologic outcome were not statistically significant (one-view visualization 3/13 malignant, 10/13 benign, P = 0.52; DBT-only finding 1/11 malignant, 10/11 benign, P = 0.09). Of 48 cases with an ultrasound correlate, 22/48 (46%) were malignant versus 4/26 (15%) cases without an ultrasound correlate (P = 0.01)., Conclusions: AD on diagnostic DBT was malignant in over one-third of cases. The presence of an ultrasound correlate was associated with malignancy., (Copyright © 2019. Published by Elsevier Inc.)

Introduction: Women are entering the subspecialty of pediatric urology at an accelerated rate. Gender differences affecting fellowship and job selection have been identified in other fields of medicine., Objective: The objective of this study was to understand gender differences in pediatric urology fellowship and job selection and how they may affect the workforce., Study Design: A 47-question electronic survey consisting of questions regarding demographics, residency training, and factors influencing fellowship and job selection was distributed to current fellows and recent graduates in pediatric urology in May 2017., Results: A total of 111 recent and current fellows were contacted, and 72% completed the survey (55% female [F] and 45% male [M]; 61% current fellows and 39% recent fellows). Respondents rated factors important in choosing pediatric urology on a scale of 1-5 (1, not important and 5, extremely important), and the top three for both genders were 1-working with children, 2-influential mentors, and 3-bread and butter cases such as inguinal orchiopexy. During residency, 93% of respondents reported having influential mentors in pediatric urology. However, mentorship was more important in fellowship choice for males than females (3.6 F, 4.1 M; P-value = 0.048), and 45% reported having only male mentors. Rating factors important in job choice on a scale of 1-5, respondents reported the top factors as 1-rapport with partners/mentorship (4.5), 2-geography/family preferences (4.3), and 3-participation in mentoring/teaching (3.8). Although most job selection criteria were rated similarly between genders, females rated call schedule higher than males (3.5 F, 2.9 M, P-value = 0.009). Although most females and males (79% of F, 78% of M, P-value = 0.868) sought primarily academic positions, a smaller proportion of females accepted academic positions (52% of F, 72% of M, P-value 0.26), and females reported lower satisfaction regarding the availability of jobs on a scale of 1-5 (1, very dissatisfied and 5, very satisfied; 3.1 F, 3.7 M; P-value = 0.034), particularly in academic positions (3.1 F, 3.7 M; P-value = 0.06). This difference was more pronounced in current fellows than recent graduates and may represent a worsening trend., Conclusion: Although significant gender differences in fellowship and job selection may exist in other fields, we found that women and men choose pediatric urology fellowships and jobs using similar criteria, which include work-life balance. Gender differences exist in the influence of mentors, indicating a need for more female mentors. While men and women sought similar types of jobs, women were less satisfied with the availability of jobs, particularly academic jobs, than men, which warrants further investigation., (Copyright © 2018 Journal of Pediatric Urology Company. Published by Elsevier Ltd. All rights reserved.)

Background: Little is known about the relationship between C-reactive protein (CRP) and long-term mortality after acute myocardial infarction (AMI) in diabetic patients. The current study aimed to examine whether CRP levels are associated with for long-term all-cause, cardiovascular, and cardiac mortality in AMI patients with diabetes and those without separately., Methods: The cohort study included 663 diabetic and 1853 non-diabetic patients with AMI. The median follow-up time was 1045 days (2.9 years)., Results: According to the median concentration of serum CRP (8.95 mg/l), the patients were divided into two groups. The low CRP level group (<8.95 mg/l) served as a reference. In diabetic patients with AMI, the adjusted hazard ratios (HRs) for long-term all-cause, cardiovascular, and cardiac mortality were 1.62 (P = 0.027), 1.91 (P = 0.008), and 2.08 (P = 0.007), respectively. In non-diabetic patients with AMI, the adjusted hazard ratios (HRs) for long-term all-cause, cardiovascular, and cardiac mortality were 1.72 (P < 0.001), 1.8 (P < 0.001), and 1.78 (P = 0.001), respectively., Conclusions: Regardless of whether patients had diabetes or not, CRP value is an independent predictor of long-term, all-cause, cardiovascular, and cardiac mortality after AMI., (Copyright © 2018 Elsevier B.V. All rights reserved.)

FliA is known to be a sigma factor that regulates bacterial flagella gene expression. Accumulating evidence suggests that FliA is involved in bacterial behavior other than motility. To elucidate the contribution of FliA to Pseudomonas aeruginosa pathophysiology, we analyzed the biological properties and gene expression profiles of a ΔfliA mutant. Transcriptome analysis results demonstrated that the expression levels of flagella biogenesis genes decreased dramatically in the mutant; consequently, the ΔfliA mutant failed to synthesize flagella and exhibited reduced motility. The ΔfliA mutant displayed stronger hemolytic and caseinolytic activities, as well as pyocyanin production. The expression of type 6 secretion system-II genes and interbacterial competition activity was decreased in the ΔfliA mutant. Direct evidence of fliA participation in virulence was obtained from analysis of hypervirulent strain B136-33. Adhesion to and cytotoxicity toward mammalian cells and penetration through cell layers were noted; furthermore, the colonization ability of the fliA::Tn5 mutant in the intestines of laboratory mice was compromised. Notably, the fliA-overexpressing strain displayed phenotypes similar to that of the fliA-defective strain, indicating that optimal FliA levels are critical to bacterial physiology. Our findings indicate that FliA plays diverse roles in P. aeruginosa, not only in flagella biosynthesis, but also in pathophysiology., (Copyright © 2018 Institut Pasteur. Published by Elsevier Masson SAS. All rights reserved.)

Background: To evaluate the association of serum albumin (SA) with long-term all-cause, cardiovascular, and cardiac mortality in patients with first-onset acute myocardial infarction (AMI)., Methods: The cohort study enrolled 2305 patients with first-onset AMI. The median follow-up was of 1088days (3years). Impacts of SA on long-time mortality after AMI were determined using multivariate Cox proportional hazard regression analysis with backward selection., Results: The patients were divided into three categories by SA tertiles (≤3.62, 3.63-4.08, >4.08g/dl). High tertile group was used as reference, the adjusted HRs for all-cause death were 1.21 (P=0.338) and 1.74 (P=0.003) for intermediate and low tertile, respectively (p-for-trend=0.001); The equivalent values for cardiovascular death were 1.13 (P=0.588) and 1.64 (P=0.022), respectively (p-for-trend=0.009); The corresponding values for cardiac death were 1.07 (P=0.806) and 1.59 (P=0.048), respectively (p-for-trend=0.022). Moreover, adjusted HRs per 1-g/dl decrease in SA concentrations were 1.66 (P=0.001) for all-cause death, 1.47 (P=0.024) for cardiovascular death, and 1.61 (P=0.012) for cardiac death., Conclusions: Low SA level (≤3.62g/dl) on admission was an independent predictor of long-term all-cause, cardiovascular, and cardiac mortality in patients with first-onset AMI. There was a dose-response relationship between decreased SA concentrations and increased long-term all-cause, cardiovascular, and cardiac mortality., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Few studies have been performed up to now on the emission factors and congener profiles of persistent organic pollutants (POPs) emitted from off-road diesel engines. This investigation elucidates the emission factors and congener profiles of various POPs, namely polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), polychlorinated biphenyl (PCBs), polybrominated dibenzo-p-dioxins and polybrominated dibenzofurans (PBDD/Fs) and polybrominated diphenyl ethers (PBDEs), in the exhausts of a diesel generator fueled with different waste cooking oil-based biodiesel (WCO-based biodiesel) blends. The PCDD/Fs contributed 87.2% of total dioxin-like toxicity (PCDD/Fs+PCBs+PBDD/Fs) in the exhaust, while the PCBs and PBDD/Fs only contributed 8.2% and 4.6%, respectively. Compared with petroleum diesel, B20 (20vol% WCO-based biodiesel+80vol% diesel) reduced total toxicity by 46.5% for PCDD/Fs, 47.1% for PCBs, and 24.5% for PBDD/Fs, while B40 (40vol% WCO-based biodiesel+60vol% diesel) reduced it by 89.5% for PCDD/Fs, 57.1% for PCBs, and 63.2% for PBDD/Fs in POP emission factors. The use of WCO-based biodiesel not only solves the problem of waste oil disposal, but also lowers POP emissions from diesel generators., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Background: It has been reported that physical activity is limited in children with asthma. The aims of this study were to compare and quantify the physical activity levels between asthmatic children and their healthy peers. Factors associated with limitation of physical activity in asthmatic children were also investigated., Methods: A total of 120 asthmatic children and 262 age-matched healthy controls were enrolled in this study. Clinical phenotype including severity and lung function were obtained from medical records. A questionnaire addressing physical activity, asthma diagnosis, symptoms, parental health beliefs, physician's advice and, community resources was accomplished by children and their parents. The physical activity levels of children with and without asthma were compared. Factors that might limit the activity level were analyzed., Results: Children with asthma were less active than their peers. The significant difference was between normal controls and moderate-to-severe asthmatic children, but not children with mild asthma. Among children with asthma, physical activity was associated with the severity level but not parental health beliefs, physician's advice, or the convenience for physical activity. Children with moderate or severe persistent asthma were more likely to be inactive., Conclusion: Children with asthma had a lower level of physical activity, particularly those with moderate-to-severe asthma. To achieve an appropriate level of physical activity, improvement of asthma management and control is considered important., (Copyright © 2016. Published by Elsevier B.V.)

Merkel cell carcinoma (MCC) is a highly aggressive neuroendocrine skin cancer with profound but poorly understood resistance to chemotherapy, which poses a significant barrier to clinical MCC treatment. Here we show that ATP-binding cassette member B5 (ABCB5) confers resistance to standard-of-care MCC chemotherapeutic agents and provide proof-of-principle that ABCB5 blockade can inhibit human MCC tumor growth through sensitization to drug-induced cell cytotoxicity. ABCB5 expression was detected in both established MCC lines and clinical MCC specimens at levels significantly higher than those in normal skin. Carboplatin- and etoposide-resistant MCC cell lines exhibited increased expression of ABCB5, along with enhanced ABCB1 and ABCC3 transcript expression. ABCB5-expressing MCC cells in heterogeneous cancers preferentially survived treatment with carboplatin and etoposide in vitro and in human MCC xenograft-bearing mice in vivo. Moreover, patients with MCC also exhibited enhanced ABCB5 positivity after carboplatin- and etoposide-based chemotherapy, pointing to clinical significance of this chemoresistance mechanism. Importantly, ABCB5 blockade reversed MCC drug resistance and impaired tumor growth in xenotransplantation models in vivo. Our results establish ABCB5 as a chemoresistance mechanism in MCC and suggest utility of this molecular target for improved MCC therapy., (Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.)

This study examines the emissions of polychlorinated diphenyl ethers (PCDEs) during the start-up processes of a municipal solid waste incinerator (MSWI). Both normal and modified emission control start-ups were tested. Fifteen samples were taken from the flue gas with increasing furnace temperature. Peak PCDE concentrations of 1.48-10.3 ng/Nm(3) were observed at 8-11 h after the start of combustion, when the furnace temperature was in the range of 267-440 °C, that also needed for PCDD/F formation by de novo synthesis. The PCDE emissions could thus, be reduced by current control techniques. Furthermore, the modified control strategies inhibited PCDE formation at the beginning of combustion, and led to an 86% reduction in the maximum PCDE concentration. The overall start-up emissions were calculated as 1.01-3.08 mg, while the annual PCDE emissions with one start-up operation were found to be 7.48-9.64 mg. However, total PCDE emissions will increase by 12-69% if the number of start-up runs increases to between two and eight times per year. Consequently, the prevention of the unnecessary start-ups and advanced activation of the related emission control system are both efficient ways to reduce PCDE emissions., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: The anti-inflammatory and cardiovascular protective effects of statin for patients with systemic lupus erythematosus (SLE) are not clear. We tested the hypothesis that statin use is associated with reduced mortality and morbidity in SLE patients with hyperlipidemia., Methods: We included 4095 patients with SLE and hyperlipidemia from the entire population using the Taiwan National Health Insurance Research Database between 1997 and 2008. A total of 935 matching sets (1:2) of patients who had never used lipid-lowering medications and statin users were included in the nested matched cohort. Cox proportional hazards regression was used to calculate the hazard ratios (HR) and 95% confidence intervals (CI) for the association between statin and all-cause mortality, coronary artery disease (CAD), cerebrovascular disease (CVD) and end-stage renal disease (ESRD), conditional for matching sets in the matched cohort., Results: The multivariate adjusted hazard ratios (HR) for statin users, as compared with patients had never used lipid-lowering medications, were 0.67 (95% CI, 0.54 to 0.83) for death from any cause. High-dose statins (>365 cumulative defined daily dose) significantly reduced risk of all-cause mortality (HR 0.44, 95% CI 0.32 to 0.60); CAD (HR 0.20, 95% CI 0.13 to 0.31); CVD (HR 0.14, 95% CI 0.08 to 0.25); and ESRD (HR 0.22, 95% CI, 0.16 to 0.29), with similar results in the nested matched study., Conclusion: Statin therapy in SLE patients with hyperlipidemia may reduce the risk of mortality, cardiovascular disease and ESRD. The effect of statins needs to be demonstrated in large prospective studies with long-term follow-up., (Copyright © 2015. Published by Elsevier Ireland Ltd.)

Three biodiesels and two aftertreatments were tested on a heavy-duty diesel engine under the US FTP transient cycle and additional four steady engine loads. The objective was to examine their effects on the gaseous and particulate emissions, with emphasis given to the organic and elemental carbon (OC and EC) in the total particulate matter. Negligible differences were observed between the low-sulfur (B1S50) and ultralow-sulfur (B1S10) biodiesels, whereas small reductions of OC were identified with the 10% biodiesel blend (B10). The use of diesel oxidation catalyst (DOC1) showed moderate reductions of EC and particularly OC, resulting in the OC/EC ratio well below unity. The use of DOC plus diesel particulate filter (DOC2+DPF) yielded substantial reductions of OC and particularly EC, resulting in the OC/EC ratio well above unity. The OC/EC ratios were substantially above unity at idle and low load, whereas below unity at medium and high load. The above changes in particulate OC and EC are discussed with respect to the fuel content, pollutant removal mechanisms and engine combustion conditions. Overall, the present study shows that the carbonaceous composition of PM could change drastically with engine load and aftertreatments, and to a lesser extent with the biodiesels under study., (Copyright © 2015 Elsevier B.V. All rights reserved.)

This article reports a novel multifunctional mussel-inspired zwitterionic catecholic assembly to form a photoresponsive biointerface. The assembly is the combination of the antifouling sulfobetaine and photocleavable o-nitrophenyl moieties into a molecule, becoming sulfobetaine nitrodopamine (SB-nDA). We demonstrated the formation of a compact thin SB-nDA film on TiO₂ by using the pH transition approach. The film thickness, surface wettability and elemental composition were characterized using ellipsometry, contact angle goniometer, atomic force microscopy and X-ray photoelectron spectroscopy, respectively. The SB-nDA thin films can effectively resist adhesion of both Gram-positive Staphylococcus epidermidis and Gram-negative Pseudomonas aeruginosa by more than 95% relative to bare TiO₂. Quartz crystal microbalance with dissipation (QCM-D) sensor was employed for protein fouling tests, showing the comparable antifouling property of SB-nDA with thiol- or silane-based surface ligands. More importantly, the spatiotemporal control over the bioinertness by UV irradiation has been studied with bacterial and protein adsorption. Therefore, the catecholic chemistry can be used for programmable tailoring of interfacial properties, permitting potential application in light-guided targeting for nanomedicine., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Popliteal artery entrapment syndrome (PAES) is an increasingly encountered disorder that typically presents as claudication in young and active individuals. However, despite the increased recognition, accurate preoperative diagnosis can be difficult. The objective of this study was to describe the surgical assessment and outcomes of patients treated for PAES., Methods: Retrospective case series of all patients managed surgically for a diagnosis of PAES at the San Antonio Military Medical Center from 2005 to 2013., Results: Over 8 years, PAES was surgically treated in 25 consecutive limbs of 15 patients (mean age, 35; range, 21-49) in a military tertiary medical center. Type III was the most common variant (n = 13, 52%), followed by type VI (n = 7, 28%). Most patients presented with class I or II ischemia (88%), with anterolateral symptoms (56%), and were referred by orthopedics (66%). Diagnostic work-up included stress ankle-brachial indices, magnetic resonance imaging (MRI) and provocative angiography. Sixty-three percent of limbs with negative MRI demonstrated findings consistent with either type III or V PAES. Tendon release was used in those with types III and V, whereas liberal myectomy was used in those with types I, II, or VI. Two patients required revascularization. At a median follow-up of 126 days (range, 25 days-7 years), 83% of patients with type III demonstrated partial resolution of symptoms. Only 27% of patients without an identifiable muscle slip had clinical improvement., Conclusions: Despite modern imaging, open surgical exploration remains the definitive diagnostic modality for PAES. Patients with a muscular or tendinous slip identified intraoperatively have the best clinical outcomes. Those with no identifiable muscle slip (functional entrapment) are less likely to demonstrate clinical improvement. Further evaluation on outcomes in the management in PAES is warranted., (Published by Elsevier Inc.)

Background: Juvenile dermatomyositis is a rare childhood multisystem autoimmune disease involving primarily the skin and muscles, and it may lead to long-term disability. This study aimed to describe the clinical course of juvenile dermatomyositis and determine if any early clinical or laboratory features could predict outcome., Methods: Medical charts of patients aged ≤18 years and diagnosed with juvenile dermatomyositis (according to the criteria of Bohan and Peter) at the Pediatric Department, National Taiwan University Hospital, between 1989 and 2009 were reviewed. The endpoints for disease assessment were complete clinical response and complete clinical remission. Cox's proportional hazards model was fitted to identify important predictors of complete clinical remission., Results: A total of 39 patients with juvenile dermatomyositis were reviewed. Two-thirds were females, and the mean age at disease onset was 81.97 ± 46.63 months. The most common initial presentations were Gottron's papule (82.1%) and muscle weakness (82.1%). After excluding one patient with an incomplete record, the remaining 31 patients who had muscle weakness were analyzed; among them, 22 (70.97%) achieved complete clinical response, but only six (19.4%) achieved complete clinical remission. Multivariate analysis showed that female sex, negative Gowers' sign at disease onset, and positive photosensitivity at disease onset were favorable factors to achieve complete clinical remission. Moreover, covariate-adjusted survival curves were drawn for making predictions of complete clinical remission. Only 13 (33.33%) patients were symptom free at the end of follow up, whereas the other 26 suffered from different kinds of complications. None of them developed malignancy, but two (5.13%) patients died during the follow-up period., Conclusion: Factors such as male sex and Gowers' sign were unlikely to favor the achievement of complete clinical remission in juvenile dermatomyositis. Certain complications cannot be avoided, and thus more effective treatments and monitoring strategies are needed for better control of juvenile dermatomyositis., (Copyright © 2014. Published by Elsevier B.V.)

Endovascular techniques used in the management of renal artery stenosis (RAS) have unique complications, to include stent facture, thrombosis, aneurysm formation, migration, and in-stent restenosis. Described here is an unusual complication of renal artery obstruction and recurrent hypertension without progressive loss of renal function, secondary to intermittent arterial kinking with respiratory and cardiac motion in a patient with fibromuscular dysplasia. This mechanical complication has implication not only in successful endovascular treatment of RAS, but raises questions regarding the alterations in dynamic motion with the cardio-respiratory cycle in stented visceral arteries in other vascular pathologies requiring renal artery stenting (i.e., juxtarenal or pararenal aortic aneurysms)., (Published by Elsevier Inc.)

This study investigates the atmospheric occurrence of persistent organic pollutants (POPs) over the Pacific Ocean near southern Taiwan and the northern Philippines. We determined sixty-six compounds, including polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs), dioxin-like polychlorinated biphenyls (DLPCBs), polybrominated diphenyl ethers (PBDEs), as well as polychlorinated diphenyl ethers (PCDEs), polybrominated dibenzo-p-dioxins and dibenzofurans (PBDD/Fs), and polybrominated biphenyls (PBBs), in air samples simultaneously collected from the offshore oceanic atmosphere (n=6) and over a rural area (n=2). We calculated the atmospheric World Health Organization 2005 toxic equivalency levels (WHO2005-TEQ), for the total dioxin-like POPs, including PCDD/Fs, DLPCBs, and PBDD/Fs, being 0.00612 pg WHO2005-TEQ/m(3) and 0.0138 pg WHO2005-TEQ/m(3) over the ocean and land, respectively. We found unexpected lower averaged atmospheric PBDE concentrations in the rural area (15.9 pg/m(3)) than over the ocean (31.1 pg/m(3)) due to higher levels of the BDE209 congener, although the difference was not statistically significant. We have compared and reported our field results with previously published datasets over the global oceans, which suggest PCBs and PBDEs are the dominant chemical contaminants in the global oceanic atmosphere among these halogenated POPs (e.g. PCBs and Σdi-hepta PBDEs could be found in the range of 0.09-48.7 and 8.07-94.0 pg/m(3), respectively, including our dataset). However, there are still very few investigations on the global atmospheric levels of PBDD/Fs, PCDEs and PBBs and our data sums to these earlier studies. Finally, we point out that the halogenated POPs originated from Taiwan or the continental East Asia which could easily reach remote ocean sites via atmospheric transport., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Angiostrongylus cantonensis is the most common infectious agent causing eosinophilic meningitis and is present in Taiwan, Thailand and the Pacific islands. Clinical symptoms vary within different endemic regions, and their severity is probably dependent on the number of ingested parasites and the diversity among strains. The experimentally definitive host is the rat, and non-permissive hosts are certain mammals such as humans and mice. In this study, the partial gene sequences of two A. cantonensis strains isolated from five different regions in Taiwan were selected and molecularly analyzed. The internal transcribed spacer gene and cytochrome-c oxidase subunit I gene sequences of the Hualien (H) strain of A. cantonensis differed from those of the Pingtung (P) strain and the other three strains by 19% and 11%, respectively. We analyzed the infectivity, fecundity, and development of the H and P strain in rats and host pathogenicity in mice inoculated with both strains. The number of the emerged first-stage larvae, adult recovery, and average length of adults in Sprague-Dawley rats significantly differed between rats inoculated with the H and P strain. Young adult recovery, average length of young adults, eosinophil counts in the cerebrospinal fluid (CSF), glutathione peroxidase concentration, levels of reactive oxygen species as well as malondialdehyde concentration in the CSF, and the survival of mice significantly differed between BALB/c mice inoculated with the H and P strain. The H strain of A. cantonensis had lower infectivity, delayed fecundity, and poor development in rats, and caused milder pathology and lower mortality in mice than the P strain. These data clearly indicate that the H strain of A. cantonensis is a pathogenically distinct strain with lower infectivity to its definitive host, and causing mild pathogenic symptoms to its non-permissive host., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Objectives: Tissue-based markers improve the accuracy of prediction models in urothelial carcinoma of the bladder (UCB). Current smoking status and cumulative exposure also affect outcomes. To evaluate whether the combination of molecular markers and smoking features further improved the prognostication of patients who underwent radical cystectomy (RC) for UCB., Materials and Methods: A total of 588 patients underwent RC and bilateral lymphadenectomy for UCB from 1995 to 2005. Immunohistochemistry for p53, p21, pRB, p27, Ki-67, and survivin was performed on tissue microarrays from the RC specimen. Smoking features were routinely assessed at diagnosis. Multivariable Cox regression models assessed time to disease recurrence and cancer-specific mortality., Results: Of the 588 patients, 128 were never (22%), 283 former (48%), and 177 current smokers (30%). In total, 227 patients experienced disease recurrence, whereas 190 died of UCB. Smoking status was independently associated with both outcomes (hazard ratio [HR] = 1.48 and 2.62, for former and current vs. never smokers, respectively, P<0.001). All markers were significantly associated with both outcomes (P<0.05) except for survivin. The combination of the 4 cell cycle markers p53, p21, pRB, and p27 increased the discrimination of clinicopathologic model for former and current vs. never smokers with c-indices 0.779 and 0.780, respectively (base model c-indices of 0.741 and 0.740 for former and current vs. never smokers, respectively). The further addition of smoking features and biomarker status improved the discrimination of the model (c-indices of 0.783 and 0.786 for former and current vs. never smokers, respectively)., Conclusions: We confirmed that smoking information and tissue markers status improve prognostication of UCB outcomes after RC; the combination of both reaching the highest level of discrimination., (© 2013 Published by Elsevier Inc.)

Background: The clinical significance of influenza B is frequently overlooked, and reports on influenza B pneumonia in children are limited. Therefore, the clinical features of associated complications have rarely been reported. The aim of this study is to evaluate the clinical characteristics in pediatric patients with influenza B virus-associated pneumonia., Methods: From January 2009 to February 2012, 389 consecutive patients under 18 years old with influenza B virus infection were enrolled into the study. Thirty-four patients were defined as the pneumonia group by clinical symptoms and chest X-ray (CXR) findings, and 90 patients who had laboratory data and normal CXR findings were recruited to form the nonpneumonia group., Results: The age of the patients in the pneumonia group was significantly younger (median of 5.3 vs. 6.6 years). The white blood cell count (median of 7.5 vs. 5.7 × 10(9) cells/L) and C-reactive protein level (median of 21.1 vs. 5.7 mg/L) were higher, but the hemoglobin level was lower (median of 12.6 vs. 13.2 g/dL) in the pneumonia group. The CXR findings revealed that 29.4% of patients had alveolar consolidation, 32.4% had interstitial infiltration, and 38.2% had ground glass opacity. Two of four patients with pleural effusion had a positive bacteria culture, and both of them died., Conclusion: Pneumonia should be considered in pediatric patients with influenza B virus infection presenting with younger age, higher white blood cell count, lower hemoglobin, and higher C-reactive protein level. The CXR findings were varied. Patients with pleural effusion and positive bacterial culture may have more severity of clinical outcome., (Copyright © 2013. Published by Elsevier B.V.)

Although Angiostrongylus cantonensis is a parasite of rats, it is an important etiologic agent of eosinophilic meningitis and eosinophilic meningoencephalitis in humans. This study was designed to compare the gene expression in the third- and fifth-stage (L3 and L5) by analysis of expressed sequence tags (ESTs). After removing low quality sequences, vector trimming, clustering and contig assembly, there remained 1437 clusters (285 contigs and 1152 singletons). Among these clusters, 779 (54.2%) showed significant similarity to the known proteins in the non-redundant protein database of GenBank (E-value<1×10(-10)) and species of the best hit sequences mainly belonged to nematodes. These clusters included 869 (60.5%) that were entirely comprised of ESTs from L3 (L3-biased clusters), 518 (36.0%) entirely from L5 (L5-biased clusters) and 50 (3.5%) from both stages (stage-shared clusters). Functional annotations by the Gene Ontology (GO) comparing with the eukaryotic clusters of orthologous groups of proteins (KOG) indicate that the L3-biased clusters significantly related to metabolism and the L5-biased clusters to growth, development, sexual differentiation and reproduction. Moreover, L3 were found to have expressions of metalloproteases, aspartic proteases, and cysteine proteases whereas expressions of cysteine, aspartic and serine proteases were revealed in L5. The results indicate that earlier developmental stages of nematodes may have a gene expression profile towards metabolism and later stages towards growth and development., (© 2013 Elsevier Ireland Ltd. All rights reserved.)

Besides the Waelz process, the submerged arc furnace (SAF) process has also been extensively used to retain metals from ashes and scraps in the metallurgical industry. However, very little is known about the formation and depletion of polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/Fs) from this thermal process. In this study, an electric arc furnace (EAF) dust treatment plant adopting the SAF process was investigated and compared to the plant adopting the Waelz process. The predominant contributor of PCDD/F I-TEQ input was the EAF dusts, accounting for 98.4% of the total. The PCDD/F contents in the generated fly ashes of the SAF were extremely low, as almost all the organic compounds for PCDD/F formation were decomposed by the high operating temperatures (1500-1700 °C) of the SAF. Therefore, the PCDD/F emission factor of the SAF process (46.9 μg I-TEQ/tonne-EAF dust) was significantly lower than that of the Waelz process (840-1120 μg I-TEQ/tonne-EAF dust). Its PCDD/F output/input ratios (0.23 and 0.50 based on mass and toxicity) were also lower than those of the Waelz process plant (0.62 and 1.19). Therefore, the SAF process is superior to the Waelz process in reducing the potential of PCDD/F formation., (© 2013.)

Objective: To clarify the epidemiology of asthma admission in a nationwide survey, we analyze the characteristics of hospitalized patients in Taiwan., Methods: Data regarding asthma-associated hospitalizations were obtained from the National Health Insurance Research Database of Taiwan from January 2001 to December 2002. Patient characteristics in terms of severity, mortality, and cost were stratified by age, gender, and presence of comorbidities., Results: A total of 59,983 hospitalizations with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 493.xx and asthma-related treatment were included in the current analysis. When stratified by age, the number and duration of hospitalizations were distributed in J-shape distribution, with the nadir located in the range of 8-18 years of age. The severity of asthma was found to increase with age (p < 0.001) and was more severe in men compared with women (p < 0.001). The severity of in-hospital patients was significantly greater in subjects with underlying respiratory disease compared to patients with other comorbidities, such as cardiovascular disease and infectious disease. The mortality rates of all hospitalized asthma patients and pediatric hospitalized asthma patients were 0.77% and 0.02%, respectively. The risk factor for mortality of asthma was older age and male gender in multiple regression., Conclusion: The severity of asthma increased after 18 years of age. Increased comorbidities in elderly patients might contribute to asthma severity. The mortality rate was low in pediatric patients and significantly increased in males and the elderly. The above findings suggest that additional effort is required in the treatment of elderly and male asthmatic patients., (Copyright © 2013. Published by Elsevier B.V.)

Merkel cell carcinomas (MCCs) are rare but highly malignant skin cancers associated with a recently described polyomavirus. MCC tumors were infiltrated by T cells, including effector, central memory, and regulatory T cells. Infiltrating T cells showed markedly reduced activation as evidenced by reduced expression of CD69 and CD25. Treatment of MCC tumors in vitro with IL-2 and IL-15 led to T-cell activation, proliferation, enhanced cytokine production, and loss of viable tumor cells from cultures. Expanded tumor-infiltrating lymphocytes showed TCR repertoire skewing and upregulation of CD137. MCC tumors implanted into immunodeficient mice failed to grow unless human T cells in the tumor grafts were depleted with denileukin diftitox, suggesting that tumor-specific T cells capable of controlling tumor growth were present in MCC. Both CD4(+) and CD8(+) FOXP3(+) regulatory T cells were frequent in MCC. Fifty percent of nonactivated T cells in MCC-expressed PD-1, a marker of T-cell exhaustion, and PD-L1 and PD-L2 were expressed by a subset of tumor dendritic cells and macrophages. In summary, we observed tumor-specific T cells with suppressed activity in MCC tumors. Agents that stimulate T-cell activity, block regulatory T cell function, or inhibit PD-1 signaling may be effective in the treatment of this highly malignant skin cancer.

Purpose: Thymidylate synthase (TS) is a potential predictor of outcome after pemetrexed (Pem) in patients with malignant pleural mesothelioma (MPM), and assays measuring TS levels are commercially marketed. The goal of this study was to further evaluate the value of TS and to study another potential biomarker of response, the enzyme, folyl-polyglutamate synthase (FPGS), which activates Pem intracellularly., Methods: Levels of TS and FPGS were semi-quantitatively determined immunohistochemically using H-scores on tissue samples from 85 MPM patients receiving Pem as primary therapy. H-score was correlated with radiographic disease control rate (DCR), time to progression (TTP) and overall survival (OS). In addition, expression levels of TS and FPGS in MPM cell lines were determined using immunoblotting and correlated with their sensitivity to Pem-induced cell death., Results: H-scores from patients with disease control versus progressive disease showed extensive overlap. There were no significant correlations of DCR, TTP, or OS to either TS levels (p = 0.73, 0.93, and 0.59, respectively), FPGS levels (p = 0.95, 0.77, and 0.43, respectively) or the ratio of FPGS/TS using the median scores of each test as cutoffs. There was no correlation between TS or FPGS expression and chemosensitivity of mesothelioma cells to Pem in vitro., Conclusions: Although previous retrospective data suggest that TS and FPGS expression might be potential markers of Pem efficacy in MPM, our data indicate these markers lack sufficient predictive value in individual patients and should not be used to guide therapeutic decisions in the absence of prospective studies.

The purpose of this study was to evaluate the effect of natural clinoptilolite (NCLI) and modified clinoptilolite (MCLI) on broiler performance, gut morphology, and its relation to gut circumstances. A total of two hundred forty 1-d-old male chicks were randomly assigned to 3 treatments, each of which comprised 8 pens of 10 chicks per pen. Birds in the control group were fed the basal diet, whereas those in the experimental groups were fed diets supplemented with NCLI at 2% (NCLI group) or MCLI at 2% (MCLI group) for 42 d. The results showed that compared with the control, supplementation with NCLI or MCLI had no significant (P > 0.05) effects on productive parameters from d 1 to 42. Supplementation with MCLI and NCLI was associated with greater (P < 0.05) villus height in the jejunal and ileal mucosa compared with those areas in the controls from d 1 to 42. However, supplementation with NCLI and MCLI had no significant (P > 0.05) influence on the crypt depth in the jejunal and ileal mucosa compared with those in the controls. Total viable counts of Escherichia coli were significantly (P < 0.05) decreased by MCLI and NCLI from d 1 to 21. The NCLI and MCLI significantly increased the total viable counts of Lactobacillus acidophilus from d 22 to 42. Small intestine and cecal pH values in the MCLI group were found to be lower (P < 0.05) than those in other groups. Total volatile fatty acid concentrations were significantly (P < 0.05) decreased in both experimental groups from d 22 to 42. This study showed that NCLI or MCLI, as feed additives for broilers, had a positive effect on gut parameters by acting on microbial populations of the digestive tract.