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(1) Background: Diabetes mellitus (DM) induces oxidative stress and inflammation with negative effect on pregnancy outcomes. This study aimed to determine whether DM increases the risk of pregnancy loss and to identify other potential risk factors; (2) Methods: We identified female patients diagnosed with DM from 2000–2015 in the Taiwanese National Health Insurance Research Database according to the International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9 CM) code 250. The event was pregnancy loss, defined as ICD-9 CM codes 630–639, which was tracked until 31 December 2015. The control group included 4-fold more non-DM female patients who were matched for age and disease severity. Multivariate Cox regression was employed to determine the risk factors associated with pregnancy loss; (3) Results: The hazard ratio (HR) for the risk of pregnancy loss due to DM was 1.407 (95% confidence interval: 1.099–1.801, p = 0.007), and the risk factors for older age, gynecological disorders and inflammation disorders were included. (4) Conclusions: The study concluded that women with DM have a greater risk of experiencing pregnancy loss. Healthcare providers should proactively manage and educate diabetic patients to reduce their risk of pregnancy loss. Understanding other probable risk factors can help in developing targeted interventions and support systems for women to improve pregnancy outcomes. [ABSTRACT FROM AUTHOR]

(1) Background: Children are the most vulnerable to pollution due to their decreased stature, heightened respiratory rate, and frequent outdoor engagement. PM2.5, nitrogen dioxide (NO2), ozone, and cold weather are associated with pediatric asthma. In this study, we investigated the nexus between air pollution, climate factors, and pediatric asthma emergency room visits (ERVs). (2) Method: Pediatric asthma ERV data for healthcare quality from the Taiwanese National Insurance in the Taipei area were obtained from 2015 to 2019. Air pollution and climate factor data were also collected. Poisson regression was employed to determine the relationships with relative risks (RRs). (3) Results: The incidence of pediatric asthma ERVs decreased, with a crude RR of 0.983 (95% CI: 0.98–0.986, p < 0.001). Fine particulate matter (PM2.5) had an adjusted RR of 1.102 (95% CI: 1.037–1.172, p = 0.002) and a 7.7 µg/m3 increase, and air temperature had an adjusted RR of 0.813 (95% CI: 0.745–0.887, p < 0.001) comparing between the highest and lowest quarter air temperature associated with pediatric asthma ERVs. (4) Conclusions: This inquiry underscores the positive associations of PM2.5 and cold weather with pediatric asthma ERVs. The findings could guide the government to establish policies to reduce air pollution and promote children's health. [ABSTRACT FROM AUTHOR]

Background and Objectives: The coronavirus disease 2019 (COVID-19) pandemic originated in Wuhan, China, in December 2019, the first case diagnosed since January 2020 in Taiwan. The study about the potential impact of the COVID-19 pandemic on event, location, food source, and pathogens of foodborne disease (FBD) is limited in Taiwan. Our aim in this study is to investigate FBD in the context of the COVID-19 pandemic. Materials and Methods: We collected publicly available annual summary data from the FBD dataset in the Taiwan Food and Drug Administration and Certifiable Disease on reported FBD in Taiwan from 2019 to 2020. We used logistic regression to evaluate changes in the occurrence or likelihood of FBD cases and Poisson regression to examine the relative risk (RR) between FBD and climate factors. Results: Similar events occurred in 2019 and 2020, but the total number of FBD cases decreased from 6935 in 2019 to 4920 in 2020. The places where FBD decreased were in schools, hospitals, outdoors, vendors, and exteriors. The top place in FBD shifted from schools to restaurants. The top food source for FBD has changed from boxed food to compound food. Bacillus cereus and Salmonella emerged as the top two observed bacterial pathogens causing FBD. The risk of FBD cases increased with a higher air temperature, with an RR of 1.055 (1.05–1.061, p < 0.001) every 1 °C. Conclusion: The incidence of FBD decreased significantly during the COVID-19 pandemic in Taiwan. This decline may be attributed to protective measures implemented to control the spread of the virus. This shift in locations could be influenced by changes in public behavior, regulations, or other external factors. The study emphasizes the importance of understanding the sources and effectiveness of severe infection prevention policies. The government can use these findings to formulate evidence-based policies aimed at reducing FBD cases and promoting public health. Consumers can reduce the risk of FBD by following safe food handling and preparation recommendations. [ABSTRACT FROM AUTHOR]

Recently, a new type of lighting source, deep ultraviolet light-emitting diode (LED), has appeared in the markets of space purification and surface sterilization. In this paper, a new type of electronic lighting driver for supplying a deep-ultraviolet LED sterilization lamp is proposed and developed. The main circuit combines a buck converter and a flyback converter into a single-stage single-switch buck-flyback AC-DC power converter with power factor correction. In addition, the proposed electronic lighting driver leverages a wide bandgap SiC Schottky diode as the output diode to lower the power diode losses and recycles the energy stored in the leakage inductance of the transformer in order to improve the circuit efficiency. The magnetizing inductor inside the presented AC-DC power converter is designed to operate in discontinuous conduction mode (DCM), which naturally enables power factor correction (PFC). A single-stage prototype driver with a power rating of 3.6 W (90 V/40 mA) was developed and implemented for providing a deep ultraviolet LED disinfection and sterilization lamp. Experimental results show that the measured power factor (PF) is greater than 0.9 and the measured total harmonic distortion (THD) of the input current is less than 18% at an input utility voltage of 110 V. Furthermore, the measured output voltage ripple factor is less than 1% and the output current ripple factor is less than 4%. In addition, the proposed single-stage electronic lighting driver for supplying a deep ultraviolet LED disinfection and sterilization lamp achieves high circuit efficiency (greater than 90%), low circuit component count, and low circuit cost. [ABSTRACT FROM AUTHOR]

A novel ac/dc LED driver with power factor correction and soft-switching functions is proposed. The circuit topology mainly consists of two modified single-ended primary inductance converters (SEPIC) with interleaved operation. The first half stage of SEPIC operates like a boost converter and the second half stage operates like a buck–boost converter. Each boost converter is designed to operate in discontinuous current mode (DCM) to function as a power factor corrector (PFC). The two buck–boost converters that share a commonly coupled inductor are designed to operate at near boundary conduction mode (BCM). Without using any active clamping circuit, auxiliary switch or snubber circuit, the active switches can achieve zero-voltage switching on, and all diodes achieve zero-current switching off. First, operation modes in steady state are analyzed, and the mathematical equations for design component parameters are derived. Finally, a prototype circuit of 180 W rated power was built and tested. Experimental results show satisfactory performance of the proposed circuit. [ABSTRACT FROM AUTHOR]

Diastolic dysfunction, a prevalent condition characterized by impaired relaxation and filling of the left ventricle, significantly contributes to heart failure with preserved ejection fraction (HFpEF). Galectin-3, a β-galactoside-binding lectin, has garnered attention as a potential biomarker and mediator of fibrosis and inflammation in cardiovascular diseases. This comprehensive review investigates the impact of galectin-3 on diastolic dysfunction. We explore its molecular mechanisms, including its involvement in cellular signaling pathways and interaction with components of the extracellular matrix. Evidence from both animal models and clinical studies elucidates galectin-3's role in cardiac remodeling, inflammation, and fibrosis, shedding light on the underlying pathophysiology of diastolic dysfunction. Additionally, we examine the diagnostic and therapeutic implications of galectin-3 in diastolic dysfunction, emphasizing its potential as both a biomarker and a therapeutic target. This review underscores the significance of comprehending galectin-3's role in diastolic dysfunction and its promise in enhancing diagnosis and treatment approaches for HFpEF patients. [ABSTRACT FROM AUTHOR]

Scoliosis, characterized by spine deformity, is most common in adolescent idiopathic scoliosis (AIS). Manual Cobb angle measurement limitations underscore the need for automated tools. This study employed a vertebral landmark extraction method and Feedforward Neural Network (FNN) to predict scoliosis progression in 79 AIS patients. The novel intervertebral angles matrix format showcased results. The mean absolute error for the intervertebral angle progression was 1.5 degrees, while the Pearson correlation of the predicted Cobb angles was 0.86. The accuracy in classifying Cobb angles (<15°, 15–25°, 25–35°, 35–45°, >45°) was 0.85, with 0.65 sensitivity and 0.91 specificity. The FNN demonstrated superior accuracy, sensitivity, and specificity, aiding in tailored treatments for potential scoliosis progression. Addressing FNNs' over-fitting issue through strategies like "dropout" or regularization could further enhance their performance. This study presents a promising step towards automated scoliosis diagnosis and prognosis. [ABSTRACT FROM AUTHOR]

Cafestol, a bioactive compound found in coffee, has attracted considerable attention due to its potential impact on cardiovascular health. This review aims to comprehensively explore the association between cafestol and cardiovascular diseases. We delve into the mechanisms through which cafestol influences lipid metabolism, inflammation, and endothelial function, all of which are pivotal in cardiovascular pathophysiology. Moreover, we meticulously analyze epidemiological studies and clinical trials to elucidate the relationship between cafestol and cardiovascular outcomes. Through a critical examination of existing literature, we aim to provide insights into the potential benefits and risks associated with cafestol concerning cardiovascular health. [ABSTRACT FROM AUTHOR]

An H-bridge inverter with LC (inductor-capacitor) filter output allows the conversion of DC (direct current) power to AC (alternating current) power that has been used in a variety of applications, such as uninterruptible power supplies, AC motor drives, and renewable energy source systems. The fast finite-time sliding mode control (FFTSMC) features acceleration of the system state towards the equilibrium position as well as conserving insensitivity against internal parameter fluctuations as well as external load disturbances falling within the predetermined bounds. However, the FFTSMC would potentially witness chattering or steady-state errors as indefinite margins come to be exaggerated or underestimated. The chattering in the sliding mode control practice is oscillatory defective behavior. It induces inefficient operation, higher switching power losses in the transistor circuits, as well as saturated actuators, thus impairing the inverter's output energy efficiency and raising harmonic distortion. Therefore, this paper presents the H-bridge inverter with LC filter output, which is controlled by a grey prediction fast finite-time sliding mode trajectory tracking. A more highly accurate grey prediction model based on the centered approximation methodology is deployed to vanish the chattering as well as steady-state errors. Taking into account the union of grey prediction and FFTSMC, a feedback-controlled H-bridge inverter with LC filter output allows attaining a highly efficient as well as quality sine-wave output voltage. The presented state-feedback control strategy is robust, less complex, attains more rapid convergence, and is highly accurate. The design process, computer simulation, as well as experimental results of the proposed state-feedback control strategy established that the H-bridge inverter with LC filter output has the capability to exhibit fast dynamic response time as well as good steady-state tracking behavior of the output voltage under step-loading changes and nonlinear loading conditions. [ABSTRACT FROM AUTHOR]

Net-zero carbon reduction has become a global supply chain development trend, and the EU has established CBAM regulations. Industries that fail to effectively reduce carbon emissions will face operational challenges under these regulations. For SMEs, carbon reduction is crucial for sustainable operations. To address this challenge, governments worldwide are formulating relevant policies and investing resources to help SMEs enhance their competitiveness. In Taiwan, the metal industry has an export ratio exceeding 45%, making it a significant global production base for metal products. This study conducted a green operational transformation survey on 230 SMEs in Taiwan's metal industry. The Taiwanese government has devised a comprehensive carbon reduction approach for the metal industry, which includes environmental facilities, digital technology introduction, process and production technology improvement, resource recycling, and energy conversion as strategies and tools for promoting carbon reduction. According to this study, the aforementioned five promotion strategies have become essential tools for SMEs in their carbon reduction efforts. This study utilized a one-way ANOVA, Pearson correlation analysis, and simple regression analysis, all of which demonstrated significant correlations among these tools. These findings can serve as a reference for other partner countries, accelerating the global industry's transition toward green operations. [ABSTRACT FROM AUTHOR]

(1) Background: An asthma exacerbation that is not relieved with medication typically requires an emergency room visit (ERV). The coronavirus disease 2019 (COVID-19) pandemic began in Taiwan in January of 2020. The influence of the COVID-19 pandemic on pediatric ERVs in Taiwan was limited. Our aim was to survey pediatric asthma ERVs in the COVID-19 era; (2) Methods: Data were collected from the health quality database of the Taiwanese National Health Insurance Administration from 2019 to 2021. Air pollution and climatic factors in Taipei were used to evaluate these relationships. Changes in the rates of pediatric asthma ERVs were assessed using logistic regression analysis. Poisson regression was used to evaluate the impact of air pollution and climate change; (3) Results: The rate of pediatric asthma ERVs declined in different areas and at different hospital levels including medical centers, regional and local hospitals. Some air pollutants (particulate matter ≤ 2.5 µm, particulate matter ≤ 10 µm, nitrogen dioxide, and carbon monoxide) reduced during the COVID-19 lockdown. Ozone increased the relative risk (RR) of pediatric asthma ERVs during the COVID-19 period by 1.094 (95% CI: 1.095–1.12) per 1 ppb increase; (4) Conclusions: The rate of pediatric asthma ERVs declined during the COVID-19 pandemic and ozone has harmful effects. Based on these results, the government could reduce the number of pediatric asthma ERVs through healthcare programs, thereby promoting children's health. [ABSTRACT FROM AUTHOR]

Background: The assessment of future risk of cardiovascular diseases (CVD) is strongly recommended for all asymptomatic adults without CVD history. Carotid atherosclerosis (CA) is a preclinical phenotype of CVDs. However, data on estimated future CVD risks with respect to preclinical atherosclerosis are limited. This community-based study aimed to assess the relationships between predicted CVD risks and CA. Methods: We enrolled 3908 subjects aged 40–74 years without CVD history and calculated their 10-year CVD risks using the Framingham Risk Score (FRS) and the Pooled Cohort Equations (PCE). Carotid plaque (CP) at the extracranial carotid arteries was determined by high-resolution B-mode ultrasonography and further classified into mild or advanced CA. Results: The means of FRS for CP-negative and mild and advanced CA were 9.0%, 14.4%, and 22.1%, respectively (p-value < 0.0001). The corresponding values for PCE score were 4.8%, 8.8%, and 15.0%, respectively (p-value < 0.0001). The odds ratios (ORs) of having CP per 5.0% increase in FRS and PCE score were 1.23 (95% CI, 1.19–1.28) and 1.36 (95% CI, 1.28–1.44), respectively. The corresponding values of having advanced CA were 1.24 (95% CI, 1.19–1.29) and 1.38 (95% CI, 1.30–1.48), respectively. Among the models of FRS or PCE plus other conventional CVD risk factors, the FRS + age model had the highest discrimination for the presence of CP (AUROC, 0.7533; 95% CI, 0.7375–0.7691) as well as for the presence of advanced CA (AUROC, 0.8034; 95% CI, 0.7835–0.8232). The calibration of the FRS + age models for the presences of CP and advanced CA was excellent (χ2 = 8.45 [p = 0.49] and 10.49 [p = 0.31], respectively). Conclusions: Estimated future CVD risks were significantly correlated with risks of having CA. Both FRS and PCE had good discrimination for the presences of CP and advanced CA. [ABSTRACT FROM AUTHOR]

Background: Cardiovascular magnetic resonance (CMR) has emerged as the most accurate, non-invasive method to support the diagnosis of clinically suspected myocarditis and as a risk-stratification tool in patients with cardiomyopathies. We aim to assess the diagnostic and prognostic role of CMR at diagnosis in patients with myocarditis. Methods: We enrolled consecutive single-center patients with 2013 ESC consensus-based endomyocardial biopsy (EMB)-proven or clinically suspected myocarditis undergoing CMR at diagnosis. The pre-specified outcome was defined as NYHA class > I and echocardiographic left ventricular ejection fraction (LVEF) < 50% at follow-up. Results: We included 207 patients (74% male, median age 36 years; 25% EMB-proven). CMR showed the highest sensitivity in myocarditis with infarct-like presentation. Patients with EMB-proven myocarditis were more likely to have diffuse LGE and right ventricular LGE (p < 0.001), which was also more common among patients with arrhythmic presentation (p = 0.001). The outcome was met in 17 patients at any follow-up time point, more commonly in those with larger biventricular volumes (p < 0.001), CMR-based diagnosis of dilated cardiomyopathy (p < 0.001), and ischemic LGE (p = 0.005). Higher biventricular systolic function (p < 0.001) and greater LGE extent (p = 0.033) at diagnosis had a protective effect. Conclusions: In our single-center cohort of rigorously defined myocarditis patients, higher biventricular systolic function and greater LGE extent on CMR at diagnosis identified patients with better functional class and higher left ventricular ejection fraction at follow-up. Conversely, larger biventricular volumes, CMR-based DCM features, and the presence of an ischemic LGE pattern at diagnosis were predictors of worse functional class and LV systolic dysfunction at follow-up. Larger prospective studies are warranted to extend our findings to multi-center cohorts. [ABSTRACT FROM AUTHOR]

Blood oxygen saturation (SpO2) is an essential physiological parameter for evaluating a person's health. While conventional SpO2 measurement devices like pulse oximeters require skin contact, advanced computer vision technology can enable remote SpO2 monitoring through a regular camera without skin contact. In this paper, we propose novel deep learning models to measure SpO2 remotely from facial videos and evaluate them using a public benchmark database, VIPL-HR. We utilize a spatial–temporal representation to encode SpO2 information recorded by conventional RGB cameras and directly pass it into selected convolutional neural networks to predict SpO2. The best deep learning model achieves 1.274% in mean absolute error and 1.71% in root mean squared error, which exceed the international standard of 4% for an approved pulse oximeter. Our results significantly outperform the conventional analytical Ratio of Ratios model for contactless SpO2 measurement. Results of sensitivity analyses of the influence of spatial–temporal representation color spaces, subject scenarios, acquisition devices, and SpO2 ranges on the model performance are reported with explainability analyses to provide more insights for this emerging research field. [ABSTRACT FROM AUTHOR]

It may be possible to enhance adults' cognitive health and promote healthy aging through processing speed training using the Useful Field of View (UFOV) related activities and software. This study investigated the impact of utilizing UFOV on processing speed improvement in older adults in response to the growing global attention on cognitive health and aging issues. In this quasi-experimental study, 22 individuals (mean age ± SD = 71.9 ± 4.8) participated in the experimental group, and 20 community-based participants (mean age ± SD = 67.1 ± 4.8) were in the control group. The intervention involved ten sessions of UFOV training, each lasting 60 min, conducted twice a week for the experimental group while the control group engaged in volunteer service activities. Measurements of Counting Back, Fabrica, Double-Decision, and Hawkeye were administered to all participants before and after the intervention. The results showed significant improvements in the experimental group for the four measurements (p ≤ 0.01, 0.05, 0.001, 0.001) and non-significant gains in the control group (p ≥ 0.05) for all. Furthermore, mixed repeated-measures ANOVA analysis, with time 1 pre-test measures as the covariate, revealed significant interaction effects between time and group for all measurement indicators (p = 0.05, 0.01, 0.05) except for Fabrica (p > 0.05). In conclusion, these findings support the effectiveness of UFOV cognitive training interventions in enhancing specific cognitive abilities. [ABSTRACT FROM AUTHOR]

Background: In situ simulation is the practice of using simulated scenarios to improve skill implementation, train critical thinking and problem-solving abilities, and enhance self-efficacy. This study aimed to enhance nursing knowledge, skills, and attitudes toward clinical work by applying in situ simulation training to improve the healthcare of critically ill patients. Methods: This study was conducted from a medical center in northern Taiwan and included 86 trainees who received intensive care training courses from 1 June 2017 to 31 May 2019. The self-report knowledge assessment, empathetic self-efficacy scale, skill assessment, and attitudes of instructors before and after training were collected. The statistical analysis used the Wilcoxon test for knowledge and attitudes, and chi-square tests were used for skills to evaluate the learning effect. Results: The results showed a statistically significant improvement in knowledge, skills, attitudes, and empathy in nursing care. Conclusions: In situ simulation learning can be an accepted method for nursing skills in the intensive care unit. Through this study, we understood that the in situ simulation method was beneficial to nurses' care and care thinking processes. It is worth developing and evaluating integrated simulation education to enhance learning, change behavior, and promote holistic care in the nursing field. [ABSTRACT FROM AUTHOR]

Background and Objectives: Hearing loss after septicemia has been found in mice; the long-term risk increased 50-fold in young adults in a previous study. Hearing loss after septicemia has not received much attention. The aim of this study was to assess the relationship between septicemia and subsequent hearing loss. Materials and Methods: Inpatient data were obtained from the Taiwan Insurance Database. We defined patients with sensorineural hearing loss and excluded patients under 18 years of age. Patients without hearing loss were selected as controls at a frequency of 1:5. The date of admission was defined as the date of diagnosis. Comorbidities in the 3 years preceding the date of diagnosis were retrieved retrospectively. Associations with hearing loss were established by multiple logistic regression and forward stepwise selection. Results: The odds ratio (OR) for the association between sepsis and hearing loss was 3.052 (95% CI: 1.583–5.884). Autoimmune disease (OR: 5.828 (95% CI: 1.906–17.816)), brain injury (OR: 2.264 (95% CI: 1.212–4.229)) and ischemic stroke (OR: 1.47 (95% CI: 1.087–1.988)) were associated with hearing loss. Conclusions: Our study shows that hearing loss occurred after septicemia. Apoptosis caused by sepsis and ischemia can lead to hair cell damage, leading to hearing loss. Clinicians should be aware of possible subsequent complications of septicemia and provide appropriate treatment and prevention strategies for complications. [ABSTRACT FROM AUTHOR]

Simple Summary: Hypoxia-inducible factor 1α (HIF-1α) is a driver of tumor cell metastasis through epithelial–mesenchymal transition (EMT) in solid tumors, while autophagy increases invasiveness and drug resistance in the hypoxic environment of breast cancer. Our study demonstrates that inducing miR-622 inhibits HIF-1α, subsequently activating miR-30a expression. This orchestrated modulation resulted in a significant reduction in the invasive and migratory capabilities of MDA-MB-231 breast cancer cells, making them more responsive to docetaxel treatment. These findings underscore the therapeutic potential of miR-622-induced miR-30a in disrupting HIF-1α-mediated EMT and autophagy, offering innovative approaches to the treatment of aggressive breast cancer. Hypoxia-inducible factor 1α (HIF-1α) plays a pivotal role in the survival, metastasis, and response to treatment of solid tumors. Autophagy serves as a mechanism for tumor cells to eliminate misfolded proteins and damaged organelles, thus promoting invasiveness, metastasis, and resistance to treatment under hypoxic conditions. MicroRNA (miRNA) research underscores the significance of these non-coding molecules in regulating cancer-related protein synthesis across diverse contexts. However, there is limited reporting on miRNA-mediated gene expression studies, especially with respect to epithelial–mesenchymal transition (EMT) and autophagy in the context of hypoxic breast cancer. Our study reveals decreased levels of miRNA-622 (miR-622) and miRNA-30a (miR-30a) in invasive breast cancer cells compared to their non-invasive counterparts. Inducing miR-622 suppresses HIF-1α protein expression, subsequently activating miR-30a transcription. This cascade results in reduced invasiveness and migration of breast cancer cells by inhibiting EMT markers, such as Snail, Slug, and vimentin. Furthermore, miR-30a negatively regulates beclin 1, ATG5, and LC3-II and inhibits Akt protein phosphorylation. Consequently, this improves the sensitivity of invasive MDA-MB-231 cells to docetaxel treatment. In conclusion, our study highlights the therapeutic potential of inducing miR-622 to promote miR-30a expression and thus disrupt HIF-1α-associated EMT and autophagy pathways. This innovative strategy presents a promising approach to the treatment of aggressive breast cancer. [ABSTRACT FROM AUTHOR]

Adolescent idiopathic scoliosis (AIS) is a three-dimensional spinal deformity that is associated with low bone mineral density (BMD). Vitamin D (Vit-D) supplementation has been suggested to improve BMD in AIS, and its outcomes may be related to genetic factors. The present study aimed to (a) investigate the synergistic effect between a low BMD-related gene (wingless-related integration site 16, WNT16) and two important Vit-D pathway genes (Vit-D receptor, VDR, and Vit-D binding protein, VDBP) on serum Vit-D and bone qualities in Chinese AIS patients and healthy adolescents, and (b) to further investigate the effect of ablating Wnt16 on the cortical bone quality and whether diets with different dosages of Vit-D would further influence bone quality during the rapid growth phase in mice in the absence of Wnt16. A total of 519 girls (318 AIS vs. 201 controls) were recruited, and three selected single-nucleotide polymorphisms (SNPs) (WNT16 rs3801387, VDBP rs2282679, and VDR rs2228570) were genotyped. The serum 25(OH)Vit-D level was significantly associated with VDBP rs2282679 alleles (OR = −4.844; 95% CI, −7.521 to −2.167, p < 0.001). Significant multi-locus models were identified by generalized multifactor dimensionality reduction (GMDR) analyses on the serum 25(OH)Vit-D level (p = 0.006) and trabecular area (p = 0.044). In the gene-edited animal study, Wnt16 global knockout (KO) and wildtype (WT) male mice were provided with different Vit-D diets (control chow (1000 IU/Kg) vs. Vit-D-deficient chow (Nil in Vit-D) vs. high-dose Vit-D chow (20,000 IU/Kg)) from 4 weeks to 10 weeks old. Wnt16 global KO mice had significantly lower serum 25(OH)Vit-D levels and higher liver Vdbp mRNA expression levels than WT mice. In addition, Wnt16 global KO mice showed a decrease in bone density, cortical thickness and cortical area compared with WT mice. Interestingly, high-dose Vit-D chow led to lower bone density, cortical thickness, and cortical area in WT mice, which were less obvious in Wnt16 global KO mice. In conclusion, WNT16 may regulate the serum 25(OH)Vit-D level and bone qualities, which might be associated with VDBP expression. Further investigations with a larger sample size and wider spectrum of scoliosis severity are required to validate our findings regarding the interaction between WNT16 and Vit-D status in patients with AIS. [ABSTRACT FROM AUTHOR]

Hereditary sensory and autonomic neuropathy type 4 (HSAN4), also known as congenital insensitivity to pain with anhidrosis (CIPA), is a rare genetic disorder caused by NTRK1 gene mutations, affecting nerve growth factor signaling. This study investigates the central nervous system's (CNS) involvement and its relation to pain insensitivity in HSAN4. We present a 15-year-old girl with HSAN4, displaying clinical signs suggestive of CNS impact, including spasticity and a positive Babinski's sign. Using Technetium-99m ethyl cysteinate dimer single-photon emission computed tomography (Tc−99m ECD SPECT) imaging, we discovered perfusion deficits in key brain regions, notably the cerebellum, thalamus, and postcentral gyrus. These regions process pain signals, providing insights into HSAN4's pain insensitivity. This study represents the first visualization of CNS perfusion abnormality in an HSAN4 patient. It highlights the intricate relationship between the peripheral and central nervous systems in HSAN4. The complexity of HSAN4 diagnosis, involving potential unidentified genes, underscores the need for continued research to refine diagnostic approaches and develop comprehensive treatments. [ABSTRACT FROM AUTHOR]

(1) Background: Patients who are critically ill or undergo major surgery are admitted to intensive care units (ICUs). Prolonged immobilization is the most likely cause of pressure injuries (PrIs) in the ICU. Previous studies of Western populations found that effective protocols could reduce the incidence of PrIs, and the efficacy of systemic targeted intervention protocols in preventing PrIs in the Chinese population needs to be surveyed. (2) Methods: We reviewed cases of PrIs in the ICUs of Taipei Veterans General Hospital from 2014 to 2019. The ICU nurses at the hospital began to implement targeted interventions in January 2017. The incidence density of PrIs was calculated by dividing the number of PrIs by person days of hospitalizations in the pre-bundle (2014–2016) and post-bundle (2017–2019) stages. Poisson regression was performed to compare the trend of incidence densities. (3) Results: The incidence density of PrIs was 9.37/1000 person days during the pre-bundle stage and 1.85/1000 person days during the post-bundle stage (p < 0.001). The relative risk (RR) was 0.197 (95% confidence interval: 0.149–0.26). The incidence densities of iatrogenic PrIs and non-iatrogenic PrIs decreased as the RRs decreased. (4) Conclusions: Targeted interventions could significantly reduce the incidence of PrIs. Healthcare providers must follow the bundle care protocol for PrI prevention to improve the quality of healthcare and promote patient health. [ABSTRACT FROM AUTHOR]

The traditional light source of projection lamps adopts a halogen lamp, which has the advantages of high brightness, but its luminous efficiency is not good and consumes energy. A light-emitting diode (LED) has the characteristics of high luminous efficiency and energy savings and can be used as a new light source for projection lamps. The conventional two-stage electronic lighting driver circuit for supplying an LED projection lamp is composed of an AC-DC converter with power factor correction (PFC) as the first stage and a DC-DC converter for providing rated lamp voltage and current as the second stage. The conventional LED projection lamp driver circuit has more circuit components, a higher cost and limited efficiency. Therefore, this paper proposes a novel electronic lighting driver circuit for supplying an LED projection lamp with PFC function, which integrates a modified stacked dual boost converter and a half-bridge LLC resonant converter into a single-stage power-conversion circuit. The inductor inside the modified stacked boost converter is designed to operate at discontinuous conduction mode (DCM) for the driver circuit achieving PFC. Wide bandgap semiconductor devices silicon carbide (SiC)-based Schottky diodes are utilized to reduce power diode losses, and soft switching is implemented in the proposed LED projector lamp driver circuit to reduce the switching losses of the power switches and thus improve circuit efficiency. This paper has completed a single-stage prototype driver circuit for an LED projection lamp with PFC function, and the prototype circuit has a high power factor (PF > 0.98), low input current total-harmonic-distortion (THD < 6%) and high efficiency (>89%) in the case of an AC input power supply with an RMS value of 110 volts, and both power switches have the characteristics of soft switching. [ABSTRACT FROM AUTHOR]

The transform domain provides a useful tool in the field of confidential data hiding and protection. In order to protect and transmit patients' information and competence, this study develops an amplitude quantization system in a transform domain by hiding patients' information in an electrocardiogram (ECG). In this system, we first consider a non-linear model with a hiding state switch to enhance the quality of the hidden ECG signals. Next, we utilize particle swarm optimization (PSO) to solve the non-linear model so as to have a good signal-to-noise ratio (SNR), root mean square error (RMSE), and relative root mean square error (rRMSE). Accordingly, the distortion of the shape in each ECG signal is tiny, while the hidden information can fulfill the needs of physiological diagnostics. The extraction of hidden information is reversely similar to a hiding procedure without primary ECG signals. Preliminary outcomes confirm the effectiveness of our proposed method, especially an Amplitude Similarity of almost 1, an Interval RMSE of almost 0, and SNRs all above 30. [ABSTRACT FROM AUTHOR]

In this study, short-term accelerated creep tests were conducted using the stepped isostress method (SSM) to investigate the impact of hydrothermal treatment on the long-term creep behaviour of Japanese cedar wood and to determine optimal hydrothermal treatment conditions. The results showed that SSM can effectively predict the creep behaviour of hydrothermally treated wood. Among the treatment conditions tested, Japanese cedar wood treated hydrothermally at 180 °C for 4 h exhibited higher flexural strength retention (91%) and moisture excluding efficiency (MEE) (44%) and demonstrated superior creep resistance compared to untreated wood. When subjected to a 30% average breaking load (ABL) over 20 years, the specimen's creep compliance, instantaneous creep compliance, b value, activation volume, and improvement in creep resistance (ICR) were 0.17 GPa−1, 0.139 GPa−1, 0.15, 1.619 nm3, and 4%, respectively. The results indicate that subjecting Japanese cedar wood to hydrothermal treatment at 180 °C for 4 h has a negligible effect on its flexural properties but results in significant improvements in both dimensional stability and creep resistance. [ABSTRACT FROM AUTHOR]

Piezoelectric ceramic actuators utilize an inverse piezoelectric effect to generate high-frequency vibration energy and are widely used in ultrasonic energy conversion circuits. This paper presents a novel drive circuit with input-current shaping (ICS) and soft-switching features which consists of a front AC-DC full-wave bridge rectifier and a rear DC-AC circuit combining a stacked boost converter and a half-bridge resonant inverter for driving a piezoelectric ceramic actuator. To enable ICS functionality in the proposed drive circuit, the inductor of the stacked boost converter sub-circuit is designed to operate in boundary-conduction mode (BCM). In order to allow the two power switches in the proposed drive circuit to achieve zero-voltage switching (ZVS) characteristics, the resonant circuit of the half-bridge resonant inverter sub-circuit is designed as an inductive load. In this paper, a prototype drive circuit for providing piezoelectric ceramic actuators was successfully implemented. Experimental results tested at 110 V input utility voltage show that high power factor (PF > 0.97), low input current total harmonic distortion (THD < 16%), and ZVS characteristics of the power switch were achieved in the prototype drive circuit. [ABSTRACT FROM AUTHOR]

(1) Background: Intravenous thrombolysis following acute ischemic stroke (AIS) can reduce disability and increase the survival rate. We designed a functional recovery analysis by using semantic visualization to predict the recovery probability in AIS patients receiving intravenous thrombolysis; (2) Methods: We enrolled 131 AIS patients undergoing intravenous thrombolysis from 2011 to 2015 at the Medical Center in northern Taiwan. An additional 54 AIS patients were enrolled from another community hospital. A modified Rankin Score ≤2 after 3 months of follow-up was defined as favorable recovery. We used multivariable logistic regression with forward selection to construct a nomogram; (3) Results: The model included age and the National Institutes of Health Stroke Scale (NIHSS) score as immediate pretreatment parameters. A 5.23% increase in the functional recovery probability occurred for every 1-year reduction in age, and a 13.57% increase in the functional recovery probability occurred for every NIHSS score reduction. The sensitivity, specificity, and accuracy of the model in the validation dataset were 71.79%, 86.67%, and 75.93%, respectively, and the area under the receiver operating characteristic curve (AUC) was 0.867; (4) Conclusions: Semantic visualization-based functional recovery prediction models may help physicians assess the recovery probability before patients undergo emergency intravenous thrombolysis. [ABSTRACT FROM AUTHOR]

(1) Background: The acute effects of ozone, cold temperature and particulate matter less than 2.5 μm (PM2.5) in size related to asthma attacks are well known worldwide. The adverse effects of ozone and cold temperature on asthma morbidity in Taiwan are still inconclusive. (2) Methods: This retrospective study included patients who had asthma emergency room visits (ERVs) from 1 January 2016 to 31 December 2019 in a regional hospital in Taiwan. The short-term negative effects were estimated using Distributed Lag Non-Linear Models (DLNMs) for the relative risks (RRs) of asthma ERVs associated with PM2.5, ozone and cold temperature exposures within 5 days. (3) Results: There was a significant association between a 10 ppm increase in PM2.5 exposure and asthma ERVs at a 2-day lag (RR 1.166, 95% confidence interval (C.I.): 1.051–1.294). There was a significant association between ozone and asthma ERVs at a 1-day lag (RR 1.179, 95% C.I.: 1.034–1.345). The ambient temperature in cold weather compared with the temperature of minimum asthma ERV showed an RR of 1.214, 95% C.I.: 1.009–1.252 at a 1-day lag. (4) Conclusions: This study provides evidence that short-term exposure to fine suspended particulates, ozone and inverse temperature is associated with asthma exacerbation. [ABSTRACT FROM AUTHOR]

In this work, a series of clinoptilolite composites decorated with carbon quantum dots (CQDs/clinoptilolite) with hierarchical pore structures was demonstrated that exhibits good photocatalytic performance for the removal of xylene. The technique for the attachment of carbon quantum dots to clinoptilolite was prepared by a hydrothermal method in this study. The structural features were confirmed by SEM, TEM, EDS, XRD, BET, XPS, and solid diffuse reflection measurements, while the degradation mechanism was investigated by adding a trapping agent into the nanocomposites. The introduction of CQDs promoted the separation of photogenerated electrons and holes as well as the generation of reactive radicals, which effectively improved the light utilization and even increased the degradation rate of xylene by 73% at the optimal state. The photocatalytic test was conducted under a different dwell time, catalyst dosage, initial concentration, and illumination intensity. The results showed that the degradation rate of xylene by the CQDs/clinoptilolite catalyst reached 97.4% under the optimal reaction conditions (the catalyst was Catalyst No. 2, the residence time was 90 s, the initial concentration was 2.5 g/m3, the light intensity was three lamps for irradiation, and the catalyst dosage was 0.05 g). In addition, the degradation efficiency of the CQDs/clinoptilolite photocatalyst still reached 78% after eight consecutive catalytic regeneration cycles. This work sheds new light on the degradation of xylene. [ABSTRACT FROM AUTHOR]

The outbreak of COVID-19 in 2020 resulted in notable disruptions to global shipping and the global economy. As a key indicator influenced by supply and demand conditions in the shipping industry, the Baltic Dry Index (BDI) serves as an early economic indicator for global economic production. Contrary to expectations of decline, the BDI has exhibited a substantial increase. This research paper aims to investigate the impact of the COVID-19 pandemic on global shipping through a comprehensive analysis of the BDI. The study incorporates data spanning from 2019 to 2021, encompassing the pre- and post-pandemic periods. It examines 13 independent variables, including raw material prices (such as iron ore prices), international scrap steel prices, energy prices, stock market indexes, international commodity price volatility (as represented by the Commodity Research Bureau Index), global port calls, and confirmed COVID-19 cases. The primary objective is to explore the factors influencing the BDI and how they were affected by the pandemic. The study employs stepwise regression to select variables and build models before and after the pandemic. The findings of this study elucidate the prominent factors that influence the BDI in different temporal contexts. Before the outbreak, the BDI was notably impacted by variables, including the US Dollar Index (positive relationship), Brent, Port Calls, and CRB Index. However, a discernible shift in the relative significance of these factors has been observed in the post-pandemic period. Specifically, the US Dollar Index now exhibits a negative relationship with the BDI, whereas variables such as Port Calls, Iron Price, Steel Scrap Price, and confirmed COVID-19 cases had attained heightened prominence in shaping the dynamics of the freight index. These findings underscored the dynamic nature of the factors influencing the BDI, particularly in light of the unique circumstances brought about by the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

With the global advocacy of green lighting and the urgent need for energy saving and carbon reduction, more and more street lighting applications have entered the era of being replaced by light-emitting diode (LED) lighting sources. This paper presents a new LED streetlight driving circuit applied to a direct current (DC)-input voltage source, which consists of a buck converter combined with a flyback converter to reduce the number of circuit components required and to recover the leakage energy of the transformer to improve energy conversion efficiency. In addition, this study also completed the analysis of the operational principle of the new LED streetlight driving circuit, and developed a prototype LED streetlight driver with DC-input voltage of 48V and output power of 72 W (36 V/2 A). Finally, the measurement results of the prototype circuit show that the output voltage ripple rate was less than 15%, the output current ripple rate was less than 6%, and the circuit efficiency was as high as 91%. [ABSTRACT FROM AUTHOR]

The genus Flavivirus is a group of arthropod-borne single-stranded RNA viruses, which includes important human and animal pathogens such as Japanese encephalitis virus (JEV), Zika virus (ZIKV), Dengue virus (DENV), yellow fever virus (YFV), West Nile virus (WNV), and Tick-borne encephalitis virus (TBEV). Reverse genetics has been a useful tool for understanding biological properties and the pathogenesis of flaviviruses. However, the conventional construction of full-length infectious clones for flavivirus is time-consuming and difficult due to the toxicity of the flavivirus genome to E. coli. Herein, we applied a simple, rapid, and bacterium-free circular polymerase extension reaction (CPER) method to synthesize recombinant flaviviruses in vertebrate cells as well as insect cells. We started with the de novo synthesis of the JEV vaccine strain SA-14-14-2 in Vero cells using CPER, and then modified the CPER method to recover insect-specific flaviviruses (ISFs) in mosquito C6/36 cells. Chimeric Zika virus (ChinZIKV) based on the Chaoyang virus (CYV) backbone and the Culex flavivirus reporter virus expressing green fluorescent protein (CxFV-GFP) were subsequently rescued in C6/36 cells. CPER is a simple method for the rapid generation of flaviviruses and other potential RNA viruses. A CPER-based recovery system for flaviviruses of different host ranges was established, which would facilitate the development of countermeasures against flavivirus outbreaks in the future. [ABSTRACT FROM AUTHOR]

The use of light-emitting diodes (LEDs) in street lighting applications has been greatly welcomed with the current trends of energy saving, environmental protection, carbon reduction, and sustainable development. This paper presents a novel AC-DC LED integrated streetlight driver that combines an interleaved buck converter with a coupled inductor and a half-bridge series resonant converter with a full-bridge rectifier into a single-stage power conversion topology with power factor correction (PFC) and soft switching capabilities. The PFC is achieved by designing the coupling inductor in the interleaved buck converter sub-circuit in discontinuous conduction mode. In addition, the resonant tank in the half-bridge series resonant converter sub-circuit is designed to be similar to an inductive load, thus giving the power switch a zero-voltage switching (ZVS) function, decreasing switching losses and increasing the overall efficiency of the proposed circuit. A prototype circuit of the proposed LED integrated streetlight driver with a power rating of 165 W (235 V/0.7 A) and 110 V input utility voltage has been developed and tested. According to the measurement results, a power factor greater than 0.98, a total harmonic distortion coefficient of the input current less than 3%, and an efficiency greater than 89% were obtained in the AC-DC LED integrated streetlight driver. Therefore, the experimental results are satisfactory and demonstrate the functionality of the proposed AC-DC LED integrated streetlight driver. [ABSTRACT FROM AUTHOR]

Background and Objectives: Sepsis increases cardiovascular disease and causes death. Ischemic heart disease (IHD) without acute myocardial infarction has been discussed less, and the relationship between risk factors and IHD in septicemia survivors within six months is worthy of in-depth study. Our study demonstrated the incidence of IHD and the possible risk factors for IHD in septicemia patients within six months. Materials and Methods: An inpatient dataset of the Taiwanese Longitudinal Health Insurance Database between 2001 and 2003 was used. The events were defined as rehospitalization of stroke and IHD after discharge or death within six months after the first septicemia hospitalization. The relative factors of major adverse cardiovascular events (MACEs) and IHD were identified by multivariate Cox proportional regression. Results: There were 4323 septicemia survivors and 404 (9.3%) IHD. New-onset atrial fibrillation had a hazard ratio (HR) of 1.705 (95% confidence interval (C.I.): 1.156–2.516) for MACEs and carried a 184% risk with HR 2.836 (95% C.I.: 1.725–4.665) for IHD by adjusted area and other risk factors. Conclusions: This study explored advanced-aged patients who experienced more severe septicemia with new-onset atrial fibrillation, which increases the incidence of IHD in MACEs within six months of septicemia. Therefore, healthcare providers must identify patients with a higher IHD risk and modify risk factors beforehand. [ABSTRACT FROM AUTHOR]

Background: Premenstrual syndrome (PMS) is a multifactorial disorder caused by hormone and autonomic imbalance. In our study, hyperglycemia-induced insulin secretion increased progesterone secretion and progressive autonomic imbalance. The young patients with diabetes mellitus (DM) revealed hypo-parasympathetic function and hypersympathetic function compared with nondiabetic controls. Young female patients with DM with higher blood sugar and autonomic malfunction may be associated with PMS. However, there is a lack of evidence about DM in females related to PMS. We evaluated female patients with DM who subsequently followed PMS in a retrospective cohort study. Methods: We retrieved data from the National Health Insurance Research Database in Taiwan. Female patients with DM between 20 and 50 years old were assessed by the International Classification of Disease, 9 Revision, Clinical Modification (ICD-9-CM) disease code of 250. Patients who were DM-free females were fourfold matched to the control group by age and disease index date. The ICD-9-CM disease code of 625.4 identified the incidence of PMS followed by the index date as events. The possible risk factors associated with PMS were detected with a Cox proportional regression. Results: DM was a significant risk factor for PMS incidence with an adjusted hazard ratio of 1.683 (95% confidence interval: 1.104–2.124, p < 0.001) in females after adjusting for age, other comorbidities, season, urbanization status of patients and the hospital status of visiting. Conclusions: This study noted an association between DM and PMS in female patients. Healthcare providers and female patients with DM must be aware of possible complications of PMS, aggressive glycemic control, decreased hyperglycemia and autonomic dysfunction to prevent this bothersome disorder. [ABSTRACT FROM AUTHOR]

(1) Background: Different distal radial fracture types have different prognosis after fixation. Our study aim is to evaluate the differences in radiographic parameters by using variable-angle volar locking plate (VAVLP) fixation according to extra-articular and intra-articular distal radial fracture. (2) Methods: There are two groups: extra-articular group (21) and intra-articular group (25). Forearm radiographs immediately after surgery and at 3 months after operation were reviewed for analyzing radial height (RH), ulnar variance (UV), radial inclination (RI), volar tilt (VT), tear drop angle (TDA), distal dorsal cortical distance (DDD), and Soong classification (SC). (3) Results: There were no significant differences in the above parameters between two groups at either immediately post-operative or at 3-month follow-up, except for TDA (p = 0.048). Most patients in both groups were at low risk of flexor tendon rupture, except for two cases. We observed a positive correlation between post-operative DDD and 3-month change in the intra-articular group, but not the extra-articular group. (4) Conclusions: Our study demonstrates that VAVLP fixation is effective in maintaining the stability of most radiographic parameters and reduces the risk of tendon rupture in both extra-articular and intra-articular distal radial fractures. Post-operative DDD can be used to predict the degree of subsequent displacement in patients with intra-articular fractures fixed with VAVLP. [ABSTRACT FROM AUTHOR]

In this work, we investigate the ferroelectricity of stacked zirconium oxide and hafnium oxide (stacked HfZrO) with different thickness ratios under metal gate stress and simultaneously evaluate the electrical reliability of stacked ferroelectric films. Based on experimental results, we find that the stacked HfZrO films not only exhibited excellent ferroelectricity but also demonstrated a high performance on reliability. The optimized condition of the 45% Zr proportion exhibited a robust ferroelectric polarization value of 32.57 μC/cm2, and a polarization current with a peak value of 159.98 μA. Besides this, the ferroelectric stacked HfZrO also demonstrated good reliability with a ten-year lifetime under >−2 V constant voltage stress. Therefore, the appropriate modulation of zirconium proportion in stacked HfZrO showed great promise for integrating in high-performance ferroelectric memory. [ABSTRACT FROM AUTHOR]

Purple sweet potato (PSP) powder with anthocyanins possesses the ability to reduce oxidative stress and inflammation. Studies have presumed a positive correlation between body fat and dry eye disease (DED) in adults. The regulation of oxidative stress and inflammation has been proposed as the mechanism underlying DED. This study developed an animal model of high fat diet (HFD)-induced DED. We added 5% PSP powder to the HFD to evaluate the effects and underlying mechanisms in mitigating HFD-induced DED. A statin drug, atorvastatin, was also added to the diet separately to assess its effect. The HFD altered the structure of lacrimal gland (LG) tissue, reduced LG secretory function, and eliminated the expression of proteins related to DED development, including α-smooth muscle actin and aquaporin-5. Although PSP treatment could not significantly reduce body weight or body fat, it ameliorated the effects of DED by preserving LG secretory function, preventing ocular surface erosion, and preserving LG structure. PSP treatment increased superoxide dismutase levels but reduced hypoxia-inducible factor 1-α levels, indicating that PSP treatment reduced oxidative stress. PSP treatment increased ATP-binding cassette transporter 1 and acetyl-CoA carboxylase 1 levels in LG tissue, signifying that PSP treatment regulated lipid homeostasis maintenance to reduce the effects of DED. In conclusion, PSP treatment ameliorated the effects of HFD-induced DED through the regulation of oxidative stress and lipid homeostasis in the LG. [ABSTRACT FROM AUTHOR]

In factories, energy conservation is a crucial issue. The co-fabrication space is a modern-day equivalent of a new factory type, and it makes use of Internet of Things (IoT) devices, such as sensors, software, and online connectivity, to keep track of various building features, analyze data, and produce reports on usage patterns and trends that can be used to improve building operations and the environment. The co-fabrication user requires dynamic and flexible space, which is different from the conventional user's usage. Because the user composition in a co-fabrication space is dynamic and unstable, we cannot use the conventional approach to assess their usage and rentals. Prototyping necessitates a specifically designed energy-saving strategy. The research uses a "seeing–moving–seeing" design thinking framework, which enables designers to more easily convey their ideas to others through direct observation of the outcomes of their intuitive designs and the representation of their works through design media. The three components of human behavior, physical manufacture, and digital interaction are primarily the focus of this work. The computing system that connects the physical machine is created through communication between the designer and the digital interface, giving the designer control over the physical machine. It is an interactive fabrication process formed by behavior. The Sensible Energy System+ is an interactive fabrication process of virtual and real coexistence created by combining the already-existing technology, the prototype fabrication machine, and SENS. This process analyzes each step of the fabrication process and energy, fits it into the computing system mode to control the prototype fabrication machine, and reduces the problem between virtual and physical fabrication and energy consumption. [ABSTRACT FROM AUTHOR]

Several studies have shown that liver resection (LR) confers better survival outcomes in intermediate- and advanced-stage hepatocellular carcinoma (HCC) patients. However, the postoperative recurrence rate is high, and little is known about the survival benefits of LR for recurrent HCC patients who have already received systemic treatment. This study aimed to evaluate the impact of LR on recurrent advanced-stage HCC patients who received sorafenib as a systemic treatment. In this study, 147 advanced HCC patients were enrolled between 1 January 2012 and 31 December 2019. Two study groups were classified, based on whether they underwent LR or not. To reduce the possible selection bias, a propensity score matching (PSM) analysis was performed. The primary study endpoint was set as overall survival (OS), and the secondary endpoint was set as progression-free survival (PFS). Our study results revealed that advanced HCC patients who received sorafenib with LR had a longer OS than did those without LR, whether before or after PSM (15.0 months vs. 6.0 months, HR 0.45, 95% CI 0.31–0.67, p < 0.001; 15.0 months vs. 5.0 months, HR 0.46, 95% CI 0.28–0.76, p = 0.001). Similar results were obtained in PFS, before or after PSM (4.14 months vs. 2.60 months, HR 0.60, 95% CI 0.40–0.89, p = 0.01; 4.57 months vs. 2.63 months, HR 0.58, 95% CI 0.34–0.97, p = 0.037). Multivariate analysis showed that the experience of LR was independent of other factors associated with better OS and PFS, whether before or after PSM (p < 0.05). Therefore, advanced HCC patients who have undergone liver resection should be encouraged to continue sorafenib treatment to improve prognosis. [ABSTRACT FROM AUTHOR]

Truffles are known worldwide for their peculiar taste, aroma, and nutritious properties, which increase their economic value. However, due to the challenges associated with the natural cultivation of truffles, including cost and time, submerged fermentation has turned out to be a potential alternative. Therefore, in the current study, the cultivation of Tuber borchii in submerged fermentation was executed to enhance the production of mycelial biomass, exopolysaccharides (EPSs), and intracellular polysaccharides (IPSs). The mycelial growth and EPS and IPS production was greatly impacted by the choice and concentration of the screened carbon and nitrogen sources. The results showed that sucrose (80 g/L) and yeast extract (20 g/L) yielded maximum mycelial biomass (5.38 ± 0.01 g/L), EPS (0.70 ± 0.02 g/L), and IPS (1.76 ± 0.01 g/L). The time course analysis of truffle growth revealed that the highest growth and EPS and IPS production was observed on the 28th day of the submerged fermentation. Molecular weight analysis performed by the gel permeation chromatography method revealed a high proportion of high-molecular-weight EPS when 20 g/L yeast extract was used as media and the NaOH extraction step was carried out. Moreover, structural analysis of the EPS using Fourier-transform infrared spectroscopy (FTIR) confirmed that the EPS was β-(1–3)-glucan, which is known for its biomedical properties, including anti-cancer and anti-microbial activities. To the best of our knowledge, this study represents the first FTIR analysis for the structural characterization of β-(1–3)-glucan (EPS) produced from Tuber borchii grown in submerged fermentation. [ABSTRACT FROM AUTHOR]

The clinical use of mifepristone for medical abortions has been established in 1987 in France and since 2000 in the United States. Mifepristone has a limited medical period that lasts <9 weeks of gestation, and the incidence of mifepristone treatment failure increases with gestation time. Mifepristone functions as an antagonist for progesterone and glucocorticoid receptors. Studies have confirmed that mifepristone treatments can directly contribute to endometrium disability by interfering with the endometrial receptivity of the embryo, thus causing decidual endometrial degeneration. However, whether mifepristone efficacy directly affects embryo survival and growth is still an open question. Some women choose to continue their pregnancy after mifepristone treatment fails, and some women express regret and seek medically unapproved mifepristone antagonization with high doses of progesterone. These unapproved treatments raise the potential risk of embryonic fatality and developmental anomalies. Accordingly, in the present study, we collected mouse blastocysts ex vivo and treated implanted blastocysts with mifepristone for 24 h. The embryos were further cultured to day 8 in vitro to finish their growth in the early somite stage, and the embryos were then collected for RNA sequencing (control n = 3, mifepristone n = 3). When we performed a gene set enrichment analysis, our data indicated that mifepristone treatment considerably altered the cellular pathways of embryos in terms of viability, proliferation, and development. The data indicated that mifepristone was involved in hallmark gene sets of protein secretion, mTORC1, fatty acid metabolism, IL-2-STAT5 signaling, adipogenesis, peroxisome, glycolysis, E2F targets, and heme metabolism. The data further revealed that mifepristone interfered with normal embryonic development. In sum, our data suggest that continuing a pregnancy after mifepristone treatment fails is inappropriate and infeasible. The results of our study reveal a high risk of fetus fatality and developmental problems when pregnancies are continued after mifepristone treatment fails. [ABSTRACT FROM AUTHOR]

The relation between antifungal susceptibility and treatment outcomes is not well-characterized. There is paucity of surveillance data for cerebrospinal fluid (CSF) isolates of cryptococcus investigated with YEASTONE colorimetric broth microdilution susceptibility testing. A retrospective study of laboratory-confirmed cryptococcus meningitis (CM) patients was conducted. The antifungal susceptibility of CSF isolates was determined using YEASTONE colorimetric broth microdilution. Clinical parameters, CSF laboratory indices, and antifungal susceptibility results were analyzed to identify risk factors for mortality. High rates of resistance to fluconazole and flucytosine were observed in this cohort. Voriconazole had the lowest MIC (0.06 µg/mL) and lowest rate of resistance (3.8%). In a univariate analysis, hematological malignancy, concurrent cryptococcemia, high Sequential Organ Failure Assessment (SOFA) score, low Glasgow coma scale (GCS) score, low CSF glucose level, high CSF cryptococcal antigen titer, and high serum cryptococcal antigen burden were associated with mortality. In a multivariate analysis, meningitis with concurrent cryptococcemia, GCS score, and high CSF cryptococcus burden, were independent predictors of poor prognosis. Both early and late mortality rates were not significantly different between CM wild type and non-wild type species. [ABSTRACT FROM AUTHOR]

While genetic analyses have revealed ~100 risk loci associated with osteoarthritis (OA), only eight have been linked to hand OA. Besides, these studies were performed in predominantly European and Caucasian ancestries. Here, we conducted a genome-wide association study in the Han Chinese population to identify genetic variations associated with the disease. We recruited a total of 1136 individuals (n = 420 hand OA-affected; n = 716 unaffected control subjects) of Han Chinese ancestry. We carried out genotyping using Axiom Asia Precisi on Medicine Research Array, and we employed the RegulomeDB database and RoadMap DNase I Hypersensitivity Sites annotations to further narrow down our potential candidate variants. Genetic variants identified were tested in the Geisinger's hand OA cohort selected from the Geisinger MyCode community health initiative (MyCode®). We also performed a luciferase reporter assay to confirm the potential impact of top candidate single-nucleotide polymorphisms (SNPs) on hand OA. We identified six associated SNPs (p-value = 6.76 × 10−7–7.31 × 10−6) clustered at 2p13.2 downstream of the CYP26B1 gene. The strongest association signal identified was rs883313 (p-value = 6.76 × 10−7, odds ratio (OR) = 1.76), followed by rs12713768 (p-value = 1.36 × 10−6, OR = 1.74), near or within the enhancer region closest to the CYP26B1 gene. Our findings showed that the major risk-conferring CC haplotype of SNPs rs12713768 and rs10208040 [strong linkage disequilibrium (LD); D' = 1, r2 = 0.651] drives 18.9% of enhancer expression activity. Our findings highlight that the SNP rs12713768 is associated with susceptibility to and severity of hand OA in the Han Chinese population and that the suggested retinoic acid signaling pathway may play an important role in its pathogenesis. [ABSTRACT FROM AUTHOR]

This paper presents a robust intelligent tracking-control technique which is subsequently applied to single-phase SPWM inverters. The proposed technique mixes advanced sliding mode control (ASMC) with grey-Markov model (GMM). The advanced sliding mode control allows the system state to converge quickly to the origin in a limited amount of time. Unfortunately, a chattering problem frequently occurs when the inverter suffers drastically from highly nonlinear or internal parameters changes. The large power losses and high harmonic distortion emerge in the inverter output. The role that the grey-Markov model plays is to reduce the chattering of the ASMC during system uncertainty overestimation, or to reduce the steady-state error caused by underestimation of system uncertainty. In conjunction with the GMM and the ASMC, fast transient response, low distortion of the sinusoidal output-voltage and reduced chattering can be obtained. Simulation results of the proposed single-phase SPWM inverter are carried out in MATLAB/Simulink. The experimental results have been validated through digital signal processors, enabling the single-phase SPWM inverter output to effectively improve the transient tracking speed and steady-state performance. [ABSTRACT FROM AUTHOR]

The stemness and metastasis of cancer cells are crucial features in determining cancer progression. Argonaute-2 (AGO2) overexpression was reported to be associated with microRNA (miRNA) biogenesis, supporting the self-renewal and differentiation characteristics of cancer stem cells (CSCs). Ursolic acid (UA), a triterpene compound, has multiple biological functions, including anticancer activity. In this study, we find that UA inhibits the proliferation of MDA-MB-231 and MCF-7 breast cancer cell lines using the CCK-8 assay. UA induced a significant decrease in the fraction of CSC in which it was examined by changes in the expression of stemness biomarkers, including the Nanog and Oct4 genes. UA altered invasion and migration capacities by significant decreases in the levels of epithelial-to-mesenchymal transition (EMT) proteins of slug and vimentin. Furthermore, the co-reduction in oncogenic miRNA levels (miR-9 and miR-221) was a result of the down-modulation in AGO2 in breast cancer cells in vitro. Mechanically, UA increases PTEN expression to inactivate the FAK/PI3K/Akt/mTOR signaling pathway and the decreased level of c-Myc in quantitative RT-PCR and Western blot imaging analyses. Our current understanding of the anticancer potential of UA in interrupting between EMT programming and the state of CSC suggests that UA can contribute to improvements in the clinical practice of breast cancer. [ABSTRACT FROM AUTHOR]

In order to adapt to the launch velocity of modern artillery, it is necessary to study the fracture mechanism of the high-velocity penetration of penetrators. Therefore, the penetration fracture mode of tungsten-fiber-reinforced Zr-based bulk metallic glass matrix composite (WF/Zr-MG) rods at a high velocity is studied. An experiment on WF/Zr-MG rods penetrating into rolled homogeneous armor steel (RHA) was carried out at 1470~1650 m/s. The experimental results show that the higher penetration ability of WF/Zr-MG rods not only results from their "self-sharpening" feature, but also due to the fact they have a longer quasi-steady penetration phase than tungsten alloy (WHA) rods. Above 1500 m/s, the penetration fracture mode of the WF/Zr-MG rod is the bending and backflow of tungsten fibers. Our theoretical calculation shows that the deformation mode of the Zr-based bulk metallic glass matrix (Zr-MG) is an important factor affecting the penetration fracture mode of the WF/Zr-MG rod. When the impact velocity increases from 1000 m/s to 1500 m/s, the deformation mode of Zr-MG changes from shear localization to non-Newtonian flow, leading to a change in the penetration fracture mode of the WF/Zr-MG rod from shear fracture to the bending and backflow of tungsten fibers. [ABSTRACT FROM AUTHOR]

To develop composite materials of biochar micro-coated soil beneficial microorganisms, soil samples were collected from the saline-alkali land of the Penghu in Taiwan. After isolation, purification and identification, a total of one Bacillus amyloliquefaciens and two Bacillus megaterium were identified as the source of beneficial microorganisms. The agricultural waste is collected and initially crushed, and then made into biochar through a series of thermal cracking processes. The specific surface area of biochar is more than 100 m2/g, the fixed carbon is more than 80%, the proportion of medium and large pores is more than 30%, the pH after adjustment is 7.3 ± 0.2, and the pore size of beneficial microorganisms grows inward, which is one of the beneficial microorganisms. The biochar micro-coated soil-beneficial microorganism composite material developed in this experiment can indeed help crops to overcome the stress of salt damage to a certain extent, and Bacillus amyloliquefaciens can indeed promote plant growth and help crops effects of over-salting adversity. [ABSTRACT FROM AUTHOR]

Aims: The role of inflammation markers in myocarditis is unclear. We assessed the diagnostic and prognostic correlates of C-reactive protein (CRP) at diagnosis in patients with myocarditis. Methods and results: We retrospectively enrolled patients with clinically suspected (CS) or biopsy-proven (BP) myocarditis, with available CRP at diagnosis. Clinical, laboratory and imaging data were collected at diagnosis and at follow-up visits. To evaluate predictors of death/heart transplant (Htx), a machine-learning approach based on random forest for survival data was employed. We included 409 patients (74% males, aged 37 ± 15, median follow-up 2.9 years). Abnormal CRP was reported in 288 patients, mainly with CS myocarditis (p < 0.001), recent viral infection, shorter symptoms duration (p = 0.001), chest pain (p < 0.001), better functional class at diagnosis (p = 0.018) and higher troponin I values (p < 0.001). Death/Htx was reported in 13 patients, of whom 10 had BP myocarditis (overall 10-year survival 94%). Survival rates did not differ according to CRP levels (p = 0.23). The strongest survival predictor was LVEF, followed by anti-nuclear auto-antibodies (ANA) and BP status. Conclusions: Raised CRP at diagnosis identifies patients with CS myocarditis and less severe clinical features, but does not contribute to predicting survival. Main death/Htx predictors are reduced LVEF, BP diagnosis and positive ANA. [ABSTRACT FROM AUTHOR]