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The incidence of Mycobacterium marinum infection is on the rise; however, the existing drug treatment cycle is lengthy and often requires multi-drug combination. Therefore, there is a need to develop new and effective anti-M. marinum drugs. Cochliomycin A, a 14-membered resorcylic acid lactone with an acetonide group at C-5′ and C-6′, exhibits a wide range of antimicrobial, antimalarial, and antifouling activities. To further explore the effect of this structural change at C-5′ and C-6′ on this compound's activity, we synthesized a series of compounds with a structure similar to that of cochliomycin A, bearing ketal groups at C-5′ and C-6′. The R/S configuration of the diastereoisomer at C-13′ was further determined through an NOE correlation analysis of CH3 or CH2 at the derivative C-13′ position and the H-5′ and H-6′ by means of a 1D NOE experiment. Further comparative 1H NMR analysis of diastereoisomers showed the difference in the chemical shift (δ) value of the diastereoisomers. The synthetic compounds were screened for their anti-microbial activities in vitro. Compounds 15–24 and 28–35 demonstrated promising activity against M. marinum, with MIC90 values ranging from 70 to 90 μM, closely approaching the MIC90 of isoniazid. The preliminary structure–activity relationships showed that the ketal groups with aromatic rings at C-5′ and C-6′ could enhance the inhibition of M. marinum. Further study demonstrated that compounds 23, 24, 29, and 30 had significant inhibitory effects on M. marinum and addictive effects with isoniazid and rifampicin. Its effective properties make it an important clue for future drug development toward combatting M. marinum resistance. [ABSTRACT FROM AUTHOR]

In this paper, multifunctional, multilevel phase plates of quartz substrate were efficiently prepared by using a newly developed polygon scanner-based femtosecond laser photolithography system combined with inductively coupled discharge plasma reactive-ion etching (ICP-RIE) technology. The femtosecond laser photolithography system can achieve a scanning speed of 5 m/s and a preparation efficiency of 15 cm2/h while ensuring an overlay alignment accuracy of less than 100 nm and a writing resolution of 500 nm. The ICP-RIE technology can control the etching depth error within ±5 nm and the mask-to-mask edge error is less than 1 μm. An 8-level Fresnel lens phase plate with a focal length of 20 mm and an 8-level Fresnel axicon phase plate with a cone angle of 5° were demonstrated. The diffraction efficiency was greater than 93%, and their performance was tested for focusing and glass cutting, respectively. Combined with the high-speed femtosecond laser photolithography system's infinite field-of-view (IFOV) processing capability, the one-time direct writing preparation of phase plate masks of different sizes was realized on a 6-inch wafer. This is expected to reduce the production cost of quartz substrate diffractive optical elements and promote their customized mass production. [ABSTRACT FROM AUTHOR]

Background and Objectives: The Connexin43 (Cx43) gene is a suspected tumor suppressor gene, as re-expressed wild-type Cx43 genes reduce the malignancy potential of tumor cells. However, the role of Cx43 gene expression in human lung tumorigenesis remains unclear. Materials and Methods: Tumor tissues from 165 primary lung cancer patients were collected to study Cx43 protein expression and gene mutations using immunohistochemistry and direct DNA sequencing. In addition, Cx43 genes with or without mutations were transfected to CL-3 human lung cancer cells to confirm the function of these mutant forms of the Cx43 gene. Results: Aberrant localization of Cx43 protein in the nucleus and cytoplasm of tumor cells was detected in 14 out of 165 non-small cell lung cancer (NSCLC) patients. Mutations in the Cx43 gene were also found in patients with aberrant Cx43 localization, and transfection of these mutant genes into lung cancer cells enhanced their proliferation. Conclusions: To our knowledge, this is the first study to demonstrate Cx43 gene mutations in human lung neoplasm, supporting the hypothesis that Cx43 may function as a tumor suppressor in some lung cancer patients. Additionally, the findings suggest an association between aberrant localization of Cx43 protein expression and tumor progression. [ABSTRACT FROM AUTHOR]

Thin film lithium niobate (TFLN) has become a promising material platform for large scale photonic integrated circuits (PICs). As an indispensable component in PICs, on-chip electrically tunable narrow-linewidth lasers have attracted widespread attention in recent years due to their significant applications in high-speed optical communication, coherent detection, precision metrology, laser cooling, coherent transmission systems, light detection and ranging (LiDAR). However, research on electrically driven, high-power, and narrow-linewidth laser sources on TFLN platforms is still in its infancy. This review summarizes the recent progress on the narrow-linewidth compact laser sources boosted by hybrid TFLN/III-V semiconductor integration techniques, which will offer an alternative solution for on-chip high performance lasers for the future TFLN PIC industry and cutting-edge sciences. The review begins with a brief introduction of the current status of compact external cavity semiconductor lasers (ECSLs) and recently developed TFLN photonics. The following section presents various ECSLs based on TFLN photonic chips with different photonic structures to construct external cavity for on-chip optical feedback. Some conclusions and future perspectives are provided. [ABSTRACT FROM AUTHOR]

We demonstrate high-extraction-rate Ta2O5-core/SiO2-clad photonic waveguides on silicon fabricated by the photolithography-assisted chemo-mechanical etching technique. Low-confinement waveguides of larger than 70% coupling efficiency with optical fibers and medium propagation loss around 1 dB/cm are investigated in the experiment. Monolithic microring resonators based on Ta2O5 waveguides have shown the quality factors to be above 105 near 1550 nm. The demonstrated Ta2O5 waveguides and their fabrication method hold great promise in various cost-effective applications, such as optical interconnecting and switching. [ABSTRACT FROM AUTHOR]

Background: Hepatocellular carcinoma (HCC) remains a significant concern for patients with chronic hepatitis C (HCV), even after achieving a sustained virological response (SVR) with direct-acting antivirals (DAAs) or interferon (IFN)-based therapies. This study compared the risk of HCC in patients with HCV who achieved SVR through the DAA versus IFN regimens. Methods: A retrospective analysis was conducted on 4806 HCV patients, without coinfection nor prior HCC history, treated at the Chang Gung Memorial Hospital, Taiwan (DAA: 2825, IFN: 1981). Kaplan–Meier and Cox regression analyses with propensity score matching (PSM) were used to adjust for baseline differences. Results: DAA-treated patients exhibited a higher incidence of HCC than IFN-treated patients before and after PSM (after PSM: annual: 1% vs. 0.5%; 6-year: 6% vs. 3%, p = 0.01). Both DAA and IFN patients had a decreased HCC incidence during follow-up (>3 vs. <3 years from the end of treatment: DAA: 1.43% vs. 1.00% per year; IFN: 0.47% vs. 0.36% per year, both p < 0.05). HCC incidence was higher in the first three years post-SVR in DAA-treated ACLD patients and then decreased (3.26% vs. 1.39% per year, p < 0.01). In contrast, HCC incidence remained constant in the non-ACLD and IFN-treated groups. Multivariate Cox regression identified age ≥ 60, male sex, BMI, AFP ≥ 6 ng/mL, FIB-4, and ACLD status as independent risk factors for HCC, but antiviral regimens were not an independent factor for HCC. Conclusion: DAA treatment significantly affects HCC risk primarily within three years post-treatment, especially in younger HCV patients with ACLD. HCC incidence was reduced after three years in ACLD patients treated by DAA, but continued surveillance was still necessary. However, patients under 60 without advanced liver disease may require less intensive follow-up. [ABSTRACT FROM AUTHOR]

Background: Acupuncture is frequently used to manage pediatric cerebral palsy (CP), yet updated evidence is needed to guide future research and clinical practice. Methods: Seven databases were searched from 1994 to 26 June 2023. Randomized controlled trials (RCTs) involving body, scalp, or ear acupuncture for managing CP, excluding acupoint injection, catgut embedding, electro-acupuncture, or laser acupuncture, were included. Results: Twenty RCTs with 1797 participants were analyzed. Acupuncture groups had better improvements in gross motor function measure (GMFM) scores by 5% (mean difference: 5.93, 95% CI: 3.67–8.19, p < 0.001, I2 = 57%); a 16% higher probability to yield prominent improvement in effectiveness rate (ER) (risk ratio: 1.16, 95% CI: 1.08–1.25, p < 0.001, I2 = 0%); and better outcomes in the Modified Ashworth Scale (MAS) (standardized mean difference [SMD]: 0.3, 95%, CI: 0.11–0.49, p < 0.001, I2 = 0%), the Berg Balance Scale (BBS) (SMD: 2.48; 95% CI: 2.00–2.97, p < 0.001, I2 = 72%) and ADL (SMD: 1.66; 95% CI: 1.23–2.08, p < 0.001, I2 = 91%). Studies with eight core acupoints identified from all ninety-five acupoints had better ER. Conclusions: Acupuncture, especially using core acupoints, may be effective for managing symptoms in children with CP. [ABSTRACT FROM AUTHOR]

Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global health crisis, exacerbating issues like malnutrition due to increased metabolic demands and reduced intake during illness. Malnutrition, a significant risk factor, is linked to worse outcomes in patients with COVID-19, such as increased mortality and extended hospital stays. This retrospective cohort study investigated the relationship between malnutrition and clinical outcomes within 90–180 days using data obtained from the TriNetX database. Patients aged >18 years diagnosed with COVID-19 between 1 January 2022, and 31 March 2024 were enrolled in the study. The propensity score-matching (PSM) method was used to match patients with malnutrition (malnutrition group) and those without malnutrition (control group). The primary composite outcome was the cumulative hazard ratio (HR) for post-COVID-19 condition, all-cause hospitalization, and all-cause mortality between 90 days and 180 days after COVID-19 diagnosis. The secondary outcomes were the individual components of the primary outcomes. Two cohorts, each consisting of 15,004 patients with balanced baseline characteristics, were identified using PSM. During the 90–180-day follow-up period, the malnutrition group exhibited a higher incidence of all-cause hospitalization, mortality, or post-COVID-19 condition (HR = 2.315, 95% confidence interval: 2.170–2.471, p < 0.0001). Compared with patients with COVID-19 without malnutrition, those with malnutrition may be associated with a higher risk of adverse clinical outcomes. [ABSTRACT FROM AUTHOR]

With the rapid development of new energy vehicles and energy storage industries, the demand for lithium-ion batteries has surged, and the number of spent LIBs has also increased. Therefore, a new method for lithium selective extraction from spent lithium-ion battery cathode materials is proposed, aiming at more efficient recovery of valuable metals. The acid + oxidant leaching system was proposed for spent ternary positive electrode materials, which can achieve the selective and efficient extraction of lithium. In this study, 0.1 mol L−1 H2SO4 and 0.2 mol L−1 (NH4)2S2O8 were used as leaching acid and oxidant. The leaching efficiencies of Li, Ni, Co, and Mn were 98.7, 30, 3.5, and 0.1%, respectively. The lithium solution was obtained by adjusting the pH of the solution. Thermodynamic and kinetic studies of the lithium leaching process revealed that the apparent activation energy of the lithium leaching process is 46 kJ mol−1 and the rate step is the chemical reaction process. The leaching residue can be used as a ternary precursor to prepare regenerated positive electrode materials by solid-phase sintering. Electrochemical tests of the regenerated material proved that the material has good electrochemical properties. The highest discharge capacity exceeds 150 mAh g−1 at 0.2 C, and the capacity retention rate after 100 cycles exceeds 90%. The proposed new method can extract lithium from the ternary material with high selectivity and high efficiency, reducing its loss in the lengthy process. Lithium replenishment of the delithiation material can also restore its activity and realize the comprehensive utilization of elements such as nickel, cobalt, and manganese. The method combines the lithium recovery process and the material preparation process, simplifying the process and saving costs, thus providing new ideas for future method development. [ABSTRACT FROM AUTHOR]

Gray mold, caused by Botrytis cinerea, poses significant threats to various crops, while it can be remarkably inhibited by ε-poly-L-lysine (ε-PL). A previous study found that B. cinerea extracts could stimulate the ε-PL biosynthesis of Streptomyces albulus, while it is unclear whether the impact of the B. cinerea signal on ε-PL biosynthesis is direct or indirect. This study evaluated the role of elevated reactive oxygen species (ROS) in efficient ε-PL biosynthesis after B. cinerea induction, and its underlying mechanism was disclosed with a transcriptome analysis. The microbial call from B. cinerea could arouse ROS elevation in cells, which fall in a proper level that positively influenced the ε-PL biosynthesis. A systematic transcriptional analysis revealed that this proper dose of intracellular ROS could induce a global transcriptional promotion on key pathways in ε-PL biosynthesis, including the embden-meyerhof-parnas pathway, the pentose phosphate pathway, the tricarboxylic acid cycle, the diaminopimelic acid pathway, ε-PL accumulation, cell respiration, and energy synthesis, in which sigma factor HrdD and the transcriptional regulators of TcrA, TetR, FurA, and MerR might be involved. In addition, the intracellular ROS elevation also resulted in a global modification of secondary metabolite biosynthesis, highlighting the secondary signaling role of intracellular ROS in ε-PL production. This work disclosed the transcriptional mechanism of efficient ε-PL production that resulted from an intracellular ROS elevation after B. cinerea elicitors' induction, which was of great significance in industrial ε-PL production as well as the biocontrol of gray mold disease. [ABSTRACT FROM AUTHOR]

Background: The application of positron emission tomography/computed tomography (PET/CT) helps provide accurate clinical staging for lung cancer patients. However, the effects and trends in early-stage lung cancer remain unclear. The aim of this study was to compare differences between clinical stage I lung cancer patients who received PET/CT for staging and those who did not. Methods: Data were obtained from the Taiwan Society of Cancer Registry. There were 6587 clinical stage I lung cancer patients between 2009 and 2014 analyzed in this study. We compared the characteristics of the PET/CT and no PET/CT groups. After propensity score matching, it resulted in both groups having 2649 patients. We measured the overall survival rates of all clinical stage I lung cancer patients and the overall survival rates of patients with PET/CT and without PET/CT. Results: The 1-, 3-, and 5-year survival rates of all clinical stage I lung cancer patients were 97.2%, 88.2%, and 79.0%, respectively. Patients with a larger tumor size tended to receive PET/CT for staging (stage Ib: 38.25% vs. 27.82%, p < 0.0001) and a larger resection (lobectomy: 74.62% vs. 66.61%, p < 0.0001). The 5-year survival rates were 79.8% in the PET/CT group and 78.2% in the no PET/CT group after propensity score matching (p = 0.6528). Conclusions: For clinical stage I lung cancer in Taiwan, patients with larger tumor sizes tend to have PET/CT for staging. Although PET/CT provided more precise clinical staging, these patients still received larger resections and had more pathological migration. However, there was no overall survival rate benefit after PET/CT. [ABSTRACT FROM AUTHOR]

Tissue inhibitor of metalloproteinases-3 (TIMP3) is vital in regulating several biological processes. TIMP3 exerts antitumour effects via matrix metalloproteinase (MMP)-dependent and MMP-independent pathways. Due to promoter methylation and miRNA binding, TIMP3 expression has been observed to decrease in various cancers. Consequently, the migration and invasion of cancer cells increases. Conflicting results have reported that expression levels of TIMP3 in primary and advanced cancers are higher than those in healthy tissues. Therefore, the role of TIMP3 in cancer biology and progression needs to be elucidated. This review provides an overview of TIMP3, from its biological function to its effects on various cancers. Moreover, gynaecological cancers are discussed in detail. TIMP3 has been associated with cervical adenocarcinoma as well as cancer development in serous ovarian cancer and breast cancer metastasis. However, the relationship between TIMP3 and endometrial cancers remains unclear. TIMP3 may be a useful biomarker for gynaecological cancers and is a potential target for future cancer therapy. [ABSTRACT FROM AUTHOR]

With the emergence of drug-resistant strains, the treatment of tuberculosis (TB) is becoming more difficult and there is an urgent need to find new anti-TB drugs. Mycobacterium marinum, as a model organism of Mycobacterium tuberculosis, can be used for the rapid and efficient screening of bioactive compounds. The 14-membered resorcylic acid lactones (RALs) have a wide range of bioactivities such as antibacterial, antifouling and antimalarial activity. In order to further study their bioactivities, we initially constructed a 14-membered RALs library, which contains 16 new derivatives. The anti-M. marinum activity was evaluated in vitro. Derivatives 12, 19, 20 and 22 exhibited promising activity with MIC90 values of 80, 90, 80 and 80 μM, respectively. The preliminary structure–activity relationships showed that the presence of a chlorine atom at C-5 was a key factor to improve activity. Further studies showed that 12 markedly inhibited the survival of M. marinum and significantly reduced the dosage of positive drugs isoniazid and rifampicin when combined with them. These results suggest that 12 is a bioactive compound capable of enhancing the potency of existing positive drugs, and its effective properties make it a very useful leads for future drug development in combating TB resistance. [ABSTRACT FROM AUTHOR]

Raman microlasers form on-chip versatile light sources by optical pumping, enabling numerical applications ranging from telecommunications to biological detection. Stimulated Raman scattering (SRS) lasing has been demonstrated in optical microresonators, leveraging high Q factors and small mode volume to generate downconverted photons based on the interaction of light with the Stokes vibrational mode. Unlike redshifted SRS, stimulated anti-Stokes Raman scattering (SARS) further involves the interplay between the pump photon and the SRS photon to generate an upconverted photon, depending on a highly efficient SRS signal as an essential prerequisite. Therefore, achieving SARS in microresonators is challenging due to the low lasing efficiencies of integrated Raman lasers caused by intrinsically low Raman gain. In this work, high-Q whispering gallery microresonators were fabricated by femtosecond laser photolithography assisted chemo-mechanical etching on thin-film lithium niobate (TFLN), which is a strong Raman-gain photonic platform. The high Q factor reached 4.42 × 106, which dramatically increased the circulating light intensity within a small volume. And a strong Stokes vibrational frequency of 264 cm−1 of lithium niobate was selectively excited, leading to a highly efficient SRS lasing signal with a conversion efficiency of 40.6%. And the threshold for SRS was only 0.33 mW, which is about half the best record previously reported on a TFLN platform. The combination of high Q factors, a small cavity size of 120 μm, and the excitation of a strong Raman mode allowed the formation of SARS lasing with only a 0.46 mW pump threshold. [ABSTRACT FROM AUTHOR]

Endothelial cells (ECs) respond to concurrent stimulation by biochemical factors and wall shear stress (SS) exerted by blood flow. Disruptions in flow-induced responses can result in remodeling issues and cardiovascular diseases, but the detailed mechanisms linking flow-mechanical cues and biochemical signaling remain unclear. Activin receptor-like kinase 1 (ALK1) integrates SS and ALK1-ligand cues in ECs; ALK1 mutations cause hereditary hemorrhagic telangiectasia (HHT), marked by arteriovenous malformation (AVM) development. However, the mechanistic underpinnings of ALK1 signaling modulation by fluid flow and the link to AVMs remain uncertain. We recorded EC responses under varying SS magnitudes and ALK1 ligand concentrations by assaying pSMAD1/5/9 nuclear localization using a custom multi-SS microfluidic device and a custom image analysis pipeline. We extended the previously reported synergy between SS and BMP9 to include BMP10 and BMP9/10. Moreover, we demonstrated that this synergy is effective even at extremely low SS magnitudes (0.4 dyn/cm2) and ALK1 ligand range (femtogram/mL). The synergistic response to ALK1 ligands and SS requires the kinase activity of ALK1. Moreover, ALK1's basal activity and response to minimal ligand levels depend on endocytosis, distinct from cell–cell junctions, cytoskeleton-mediated mechanosensing, or cholesterol-enriched microdomains. However, an in-depth analysis of ALK1 receptor trafficking's molecular mechanisms requires further investigation. [ABSTRACT FROM AUTHOR]

The global hotel and tourism business has been significantly affected by the COVID-19 pandemic, prompting governments and researchers to explore ways for mitigation. Within this particular setting, this study investigation centers on Taiwan at a crucial phase of the pandemic. It utilizes the uncertainty avoidance theory and the protection motive theory to analyze the impact of perceived risk associated with COVID-19, perceptions of travel risk, and hotel hygiene and safety practices on the intention to stay in those hotels. A total of 500 valid survey responses were obtained from travelers in Taiwan during the nationwide level 3 alert for COVID-19 in 2021, via the cluster sampling technique. Using SPSS 25.0 and AMOS 22.0, the reliability and validity test as well as structure equation analysis were used to examine the proposed model. Analytical results indicate that perceived risk of COVID-19 positively affects travel risk perceptions, which in turn negatively affects hotel staying intention. Moreover, travel risk perceptions mediate the relationship between perceived risk of COVID-19 and hotel staying intention. The findings of this study indicate that there is a strong moderating effect of hotel hygiene and safety practices on the link between travel risk perceptions and hotel staying intention, highlighting the importance of these practices in influencing individuals' decisions to remain at a hotel. The results of this study provide valuable insights into the management of tourism crises, specifically emphasizing the need for prioritizing safety and hygiene measures throughout the post-COVID era. These findings underline the importance of effectively managing perceptions of travel risks and maintaining high standards of hotel hygiene in order to enhance the likelihood of tourists' intent to stay at a hotel. Furthermore, this study presents an in-depth strategy for hoteliers and practitioners to navigate the road to recovery, consequently facilitating the revitalization of the sector and offering valuable perspectives for future research investigations. [ABSTRACT FROM AUTHOR]

Simple Summary: We aimed to investigate if VDT could be applied as a predictor of clinical outcome in segmentectomy and wedge resection. We retrospectively studied 96 NSCLC patients post sublobar resection from 2012 to 2018, collecting two chest CT scans preoperatively of each case and calculating VDT. The receiver operating characteristic curve was constructed to identify the optimal cut-off point of VDTs as 133 days. We divided patients into two groups: VDT < 133 days (n = 22) and VDT ≥ 133 days (n = 74). Univariable and multivariable analyses were performed for comparative purposes. Our study demonstrated that the five year OS rates of patients with VDTs ≧ 133 days and VDTs < 133 days, respectively, were 89.9% and 71.9% (p = 0.003), and the five year DFS rates were 95.9% and 61.5% (p = 0.002). Thus, we concluded that VDT can be a powerful prognostic predictor and provides an essential role in planning surgical procedures. Background: Volume doubling time (VDT) has been proven to be a powerful predictor of lung cancer progression. In non-small cell lung cancer patients receiving sublobar resection, the discussion of correlation between VDT and surgery was absent. We proposed to investigate the surgical outcomes according to VDT. Methods: We retrospectively studied 96 cases post sublobar resection from 2012 to 2018, collecting two chest CT scans preoperatively of each case and calculating the VDT. The receiver operating characteristic curve was constructed to identify the optimal cut-off point of VDTs as 133 days. We divided patients into two groups: VDT < 133 days and VDT ≥ 133 days. Univariable and multivariable analyses were performed for comparative purposes. Results: Univariable and multivariable analyses revealed that the consolidation and tumor diameter ratio was the factor of overall survival (OS), and VDT was the only factor of disease-free survival (DFS). The five year OS rates of patients with VDTs ≥ 133 days and VDTs < 133 days, respectively, were 89.9% and 71.9%, and the five year DFS rates were 95.9% and 61.5%. Conclusion: As VDT serves as a powerful prognostic predictor and provides an essential role in planning surgical procedures, the evaluation of VDT preoperatively is highly suggested. [ABSTRACT FROM AUTHOR]

We demonstrate a narrow linewidth 980 nm laser by self-injection locking of an electrically pumped distributed-feedback (DFB) laser diode to a high quality (Q) factor (>105) lithium niobate (LN) microring resonator. The lithium niobate microring resonator is fabricated by photolithography-assisted chemo-mechanical etching (PLACE) technique, and the Q factor of lithium niobate microring is measured as high as 6.91 × 105. The linewidth of the multimode 980 nm laser diode, which is ~2 nm measured from its output end, is narrowed down to 35 pm with a single-mode characteristic after coupling with the high-Q LN microring resonator. The output power of the narrow-linewidth microlaser is about 4.27 mW, and the wavelength tuning range reaches 2.57 nm. This work explores a hybrid integrated narrow linewidth 980 nm laser that has potential applications in high-efficient pump laser, optical tweezers, quantum information, as well as chip-based precision spectroscopy and metrology. [ABSTRACT FROM AUTHOR]

Many countries worldwide have adopted a sustainable development model to strike a balance between economic progress, environmental preservation, and social protection, and one of the most effective solutions for promoting sustainable development has been the circular economy (CE). Given each country's resource restrictions, businesses must implement green manufacturing practices to establish a circular economy. Therefore, this study intends to assess the role of green logistics (GL) and green human capital (GHC) in promoting a circular economy. Additionally, the mediating role of sustainable production (SP) in the interplays between the constructs was examined. Data for this research was collected from 211 garment manufacturing firms in Bangladesh, using a standardized questionnaire. The partial least square structural equation modeling (PLS-SEM) technique was employed for inferential statistical analysis. The findings revealed that GL and GHC are significant drivers of CE. Additionally, GL and GHC were observed to have a positive linkage with the SP of firms. The findings uncovered that SP positively impacts circular economy implementation. Furthermore, SP was found to significantly mediate the linkages between GL and CE, as well as between GHC and CE. Ours is one of a limited number of research projects that address the role of GL and GHC in implementing CE through SP. Hence, this study added critical insights to the extant theory and practice while reporting several theoretical and managerial implications. [ABSTRACT FROM AUTHOR]

We numerically investigate a second harmonic generation (SHG) in a z-cut lithium niobate on insulator (LNOI) waveguide based on type-I mode phase matching (MPM) between two fundamental modes. A mode overlap factor that is close to unity is achieved and the normalized SHG efficiency reaches up to 72.1% W−1cm−2 at the telecommunication band, together with a large spectral tunability of 2.5 nm/K. Moreover, a bandwidth of about 100 nm for the broad SHG in a 5 mm-long LNOI ridge waveguide is demonstrated with this scheme. This stratagem will inspire new integrated nonlinear frequency conversion methods for versatile applications. [ABSTRACT FROM AUTHOR]

Exceeding the permitted manganese (Mn2+) and ammonium (NH4+-N) levels is a frequent seasonal occurrence in a water treatment plant in south China. An iron Fe–Mn complex oxide film was found capable of removing more than 95% of Mn2+ and NH4+-N at a water temperature of 20 °C and an alkalinity level of 30 mg/L. It could remove up to 5.5 mg/L of Mn2+ and up to 3.5 mg/L of NH4+-N in a stable manner. Alkalinity is a crucial factor in the removal process. The morphology, elemental composition, and micro-structure of the oxide film were investigated using a scanning electron microscope, an energy-dispersive spectrometer, a Brunauer–Emmett–Teller specific surface-area analyzer, an X-ray diffractometer, and a Fourier-transform infrared spectrometer. The capacity of the Fe–Mn complex oxide film on the surface of the filter medium increased appreciably as its content and specific surface area increased. This research, which provides a theoretical basis for simultaneous manganese and NH4+-N removal by catalytic oxidation, demonstrates an engineering reference value. [ABSTRACT FROM AUTHOR]

We propose a hybrid laser microfabrication approach for the manufacture of three-dimensional (3D) optofluidic spot-size converters in fused silica glass by a combination of femtosecond (fs) laser microfabrication and carbon dioxide laser irradiation. Spatially shaped fs laser-assisted chemical etching was first performed to form 3D hollow microchannels in glass, which were composed of embedded straight channels, tapered channels, and vertical channels connected to the glass surface. Then, carbon dioxide laser-induced thermal reflow was carried out for the internal polishing of the whole microchannels and sealing parts of the vertical channels. Finally, 3D optofluidic spot-size converters (SSC) were formed by filling a liquid-core waveguide solution into laser-polished microchannels. With a fabricated SSC structure, the mode spot size of the optofluidic waveguide was expanded from ~8 μm to ~23 μm with a conversion efficiency of ~84.1%. Further measurement of the waveguide-to-waveguide coupling devices in the glass showed that the total insertion loss of two symmetric SSC structures through two ~50 μm-diameter coupling ports was ~6.73 dB at 1310 nm, which was only about half that of non-SSC structures with diameters of ~9 μm at the same coupling distance. The proposed approach holds great potential for developing novel 3D fluid-based photonic devices for mode conversion, optical manipulation, and lab-on-a-chip sensing. [ABSTRACT FROM AUTHOR]

Glucagon, a 29-amino acid polypeptide hormone, is an essential therapeutic agent used in the emergency treatment of hypoglycemia. However, glucagon is inherently unstable in aqueous solution. While glucagon equilibrates between unordered and the secondary α-helix state in solution, it can quickly transform into a different secondary β-sheet-rich amyloid-like fibril/oligomer structure under various conditions. Since changes in the secondary structure of glucagon can cause significant impacts, structure analysis is necessary and essential to assess the safety of the product. This study analyzed the secondary structure of glucagon products at the release and at the expiry using circular dichroism spectroscopy (CD) and 2D Nuclear Overhauser effect spectroscopy (2D NOESY). In order to also determine if structural differences exist between glucagon produced through different manufacturing processes, synthetic and recombinant glucagon products were used and compared. The CD results indicated that for all release and expired glucagon products, the structure compositions were 14 to 16% α-helix, 17 to 19% β-strand, 14 to 15% Turn, and 53 to 54% Unordered. This was consistent with the 2D NOESY analysis which showed that both products had an approximate α-helix composition of 14 to 17%. Overall, there were no significant differences in terms of the secondary structure between synthetic and recombinant glucagon products both at the release and at the expiry. [ABSTRACT FROM AUTHOR]

Porous silicon-based anode materials have gained much interest because the porous structure can effectively accommodate volume changes and release mechanical stress, leading to improved cycling performance. Magnesiothermic reduction has emerged as an effective way to convert silica into porous silicon with a good electrochemical performance. However, corrosive HF etching is normally a mandatory step to improve the electrochemical performance of the as-synthesized silicon, which significantly increases the safety risk. This has become one of the major issues that impedes practical application of the magnesiothermic reduction synthesis of the porous silicon anode. Here, a facile HF-free method is reported to synthesize macro-/mesoporous silicon with good cyclic and rate performance by simply increasing the reduction temperature from 700 °C to 800 °C and 900 °C. The mechanism for the structure change resulting from the increased temperature is elaborated. A finite element simulation indicated that the 3D continuous structure formed by the magnesiothermic reduction at 800 °C and 900 °C could undertake the mechanical stress effectively and was responsible for an improved cyclic stability compared to the silicon synthesized at 700 °C. [ABSTRACT FROM AUTHOR]

Background: The objective of our study was to assess if 3D reconstructed images could be extrapolated to reflect pathologies, as evaluated by early-stage lung adenocarcinoma tumor size and simulated segmentectomy resection margin. Methods: Retrospectively selected patients (n = 18) who underwent segmentectomy at Changhua Christian Hospital between 2012 and 2018 and then had pulmonary 3D reconstruction using Ziostation2 were included in our study. Tumor size and simulated segmentectomy resection distance on a 3D model were measure and compared to pathology. Results: Both tumor size and segmentectomy resection margin showed positive correlations between 3D image measurements and pathological measurements. The resection margin showed a stronger correlation and was beneficial in pre-operative planning. Conclusions: A 3D reconstructed model aided understanding of pulmonary anatomy, prompting confidence in surgical approaches and ensured segmentectomy outcome success. Regardless of age and pulmonary function, 3D simulation can accurately mimic segmentectomy, making it a simple, effective and feasible pre-operative planning tool. [ABSTRACT FROM AUTHOR]

Mediastinal lymph dissection in esophagectomy for patients with esophageal cancer is important. The dissection of recurrent laryngeal nerve (RLN) lymph nodes could cause RLN injury, vocal cord palsy, pneumonia, and respiratory failure. This retrospective study aimed to evaluate the effects of intraoperative RLN monitoring in esophagectomy and mediastinal lymph node dissection in preventing RLN injury and vocal cord palsy. This study included 75 patients who underwent minimally invasive esophagectomy and mediastinal lymph node dissection for esophageal cancer with (38 patients) and without (37 patients) IONM at Changhua Christian Hospital from 2015 to 2020. The surgical and clinical outcomes were reviewed. Patients in the IONM group had more advanced clinical T status, shorter operation time (570 vs. 633 min, p = 0.007), and less blood loss (100 mL vs. 150 mL, p = 0.019). The IONM group had significantly less postoperative vocal palsy (10.5% vs. 37.8%, p = 0.006) and pneumonia (13.2% vs. 37.8%, p = 0.014) than that in the non-IONM group. IONM was an independent factor for less postoperative vocal cord palsy that was related to postoperative 2-year survival. This study demonstrated that IONM could reduce the incidence of postoperative vocal cord palsy and pneumonia. [ABSTRACT FROM AUTHOR]

Objective: Most neurological diseases are usually accompanied by changes in the oculomotor nerve. Analysis of different types of eye movements will help provide important information in ophthalmology, neurology, and psychology. At present, many scholars use optokinetic nystagmus (OKN) to study the physiological phenomenon of eye movement. OKN is an involuntary eye movement induced by a large moving surrounding visual field. It consists of a slow pursuing eye movement, called "slow phase" (SP), and a fast re-fixating saccade eye movement, called "fast phase" (FP). Non-invasive video-oculography has been used increasingly in eye movement research. However, research-grade eye trackers are often expensive and less accessible to most researchers. Using a low-cost eye tracker to quantitatively measure OKN eye movement will facilitate the general application of eye movement research. Methods & Results: We design an analytical algorithm to quantitatively measure OKN eye movements on a low-cost eye tracker. Using simple conditional filtering, accurate FP positions can be obtained quickly. The high-precision FP recognition rate is of great help for the subsequent calculation of eye movement analysis parameters, such as mean slow phase velocity (MSPV), which is beneficial as a reference index for patients with strabismus and other eye diseases. Conclusions: Experimental results indicate that the proposed method achieves faster and better results than other approaches, and can provide an effective algorithm to calculate and analyze the FP position of OKN waveforms. [ABSTRACT FROM AUTHOR]

Glucagon is a polypeptide hormone that serves as an essential therapeutic agent in the emergency treatment of hypoglycemia. Recently, the first generic glucagon for injection was approved. However, unlike its brand name counterpart, which is produced via recombinant DNA, the generic glucagon is produced using a chemical synthesis method. Regardless of its origin, impurities may occur in both glucagon drug products. While these impurities may greatly compromise the safety and efficacy of the glucagon drug products, studies accessing the impurities of glucagon for injection are limited. This manuscript analyzed the stability and impurities of a generic and brand glucagon for injection, including desamido and non-desamido impurities, under various storage and temperature conditions using an ultra-performance liquid chromatography method. The glucagon products were analyzed after 6 and 24 months of storage under room temperatures (20–25 °C). In addition, the products were also assessed after 6 months of storage under high temperatures (40 °C). Under each stability storage condition, three lots of the synthetic glucagon were evaluated by UPLC with at least one lot of the recombinant glucagon for comparison. A total of 37 peaks were identified (except for the solvent peaks, which appeared at retention times less than 1.5 min) from the synthetic and recombinant glucagon lots. It was found that the number of impurities observed in the synthetic glucagon were lower than the referenced recombinant glucagon across all stability conditions. Throughout all tested conditions, the synthetic glucagon for injection had an averaged purity of 92.8–99.3%, while the referenced recombinant drug had an averaged purity of 70.3–91.7%. Based on the study results, it can be concluded that the impurity profile for the synthetic glucagon for injection has a comparable and even lower level of impurities than the recombinant version under all stability conditions. [ABSTRACT FROM AUTHOR]

We report the fabrication and optical characterization of Yb3+-doped waveguide amplifiers (YDWA) on the thin film lithium niobate fabricated by photolithography assisted chemo-mechanical etching. The fabricated Yb3+-doped lithium niobate waveguides demonstrates low propagation loss of 0.13 dB/cm at 1030 nm and 0.1 dB/cm at 1060 nm. The internal net gain of 5 dB at 1030 nm and 8 dB at 1060 nm are measured on a 4.0 cm long waveguide pumped by 976 nm laser diodes, indicating the gain per unit length of 1.25 dB/cm at 1030 nm and 2 dB/cm at 1060 nm, respectively. The integrated Yb3+-doped lithium niobate waveguide amplifiers will benefit the development of a powerful gain platform and are expected to contribute to the high-density integration of thin film lithium niobate based photonic chip. [ABSTRACT FROM AUTHOR]

Background: Empyema is known as a serious infection, and outcomes of empyema cases remain poor. Pleural fluid culture and blood culture have been reported to give unsatisfactory results. We introduce a novel pleural peels tissue culture during surgery and aim to improve the culture results of empyema. Methods: This was a retrospective study and was obtained from our institute. Patients with stage II or III empyema undergoing video-assisted thoracic surgery decortication from January 2019 to June 2021 were included in the study. Results: There were 239 patients that received a pleural peels tissue culture, a pleural fluid culture, and a blood culture concurrently during the perioperative period. Of these, 153 patients had at least one positive culture and 86 patients showed triple negative culture results. The positive culture rates were 46.9% for pleural peels tissue cultures, 46.0% for pleural fluid cultures, and 10% for blood cultures. The combination of pleural peels tissue culture and pleural fluid culture increased the positive rate to 62.7%. Streptococcus species and Staphylococcus species were the most common pathogens. Conclusion: The combination of pleural peels tissue culture and pleural fluid culture is an effective method to improve the positive culture rate in empyema. [ABSTRACT FROM AUTHOR]

We demonstrate a hybrid laser microfabrication approach, which combines the technical merits of ultrafast laser-assisted chemical etching and carbon dioxide laser-induced in situ melting for centimeter-scale and bonding-free fabrication of 3D complex hollow microstructures in fused silica glass. With the developed approach, large-scale fused silica microfluidic chips with integrated 3D cascaded micromixing units can be reliably manufactured. High-performance on-chip mixing and continuous-flow photochemical synthesis under UV irradiation at ~280 nm were demonstrated using the manufactured chip, indicating a powerful capability for versatile fabrication of highly transparent all-glass microfluidic reactors for on-chip photochemical synthesis. [ABSTRACT FROM AUTHOR]

Introduction: High sustained virological response (SVR) rate (>95%) and liver stiffness regression can be achieved with direct acting antivirals treatment (DAA) in patients with chronic hepatitis C virus (CHC) infection. Reactivation of hepatitis B virus (HBV) was reported during DAA treatment in patients co-infected with HBV, although its impact on liver stiffness remains unknown. This study aims to investigate whether the liver stiffness (LSM) regression is different between HBV/HCV co-infected and mono-HCV-infected patients. Materials and Methods: CHC patients with/without HBV co-infection who received DAA treatment and achieved SVR12 between March 2015 and December 2019 in Chang Gung Memorial Hospital, Linkou branch were prospectively enrolled. LSM was assessed by transient elastography (TE, Fibroscan) at baseline and after SVR. Propensity score matching (PSM) at 3:1 ratio, adjusted for age, gender, pre-DAA alanine aminotransferase (ALT), platelet count, and LSM, between CHC with and without HBV co-infection, was performed before further analysis. Results: Among 906 CHC patients enrolled, 52 (5.7%) patients had HBV/HCV co-infection. Patients with HBV/HCV co-infection were of younger age (61.8 vs. 63.2, p = 0.31), with a higher proportion of males (53.8% vs. 38.9%, p = 0.03), and lower pretreatment LSM level (8.15 vs. 10.2 kPa, p = 0.09), while other features were comparable. After PSM, patients with HBV/HCV co-infection had insignificantly lower LSM regression compared to mono-HCV-infected patients (−0.85 kPa vs. −1.65 kPa, p = 0.250). Conclusions: The co-infection of HBV among CHC patients has limited impact on liver stiffness regression after successful DAA treatment. [ABSTRACT FROM AUTHOR]

Integrated thin-film lithium niobate (LN) electro-optic (EO) modulators of broad bandwidth, low insertion loss, low cost and high production rate are essential elements in contemporary interconnection industries and disruptive applications. Here, we demonstrated the design and fabrication of a high performance thin-film LN EO modulator using photolithography assisted chemo-mechanical etching (PLACE) technology. Our device shows a 3-dB bandwidth over 50 GHz, along with a comparable low half wave voltage-length product of 2.16 Vcm and a fiber-to-fiber insertion loss of 2.6 dB. The PLACE technology supports large footprint, high fabrication uniformity, competitive production rate and extreme low device optical loss simultaneously, our result shows promising potential for developing high-performance large-scale low-loss photonic integrated devices. [ABSTRACT FROM AUTHOR]

In this study, the effects of different fruit parts and extraction conditions on the antioxidant properties of jujube (Ziziphus jujuba Mill.) fruit were investigated. Five in vitro antioxidant models and statistical analyses were performed. The results revealed that jujube peel with pulp (peel pulp) exhibited better antioxidant capacity than did seeds. Overall, jujube peel pulp extracted using 50% ethanol at 60 °C exhibited the best antioxidant capacity in terms of 2,2-diphenyl-1-picrylhydrazyl radical scavenging activity (0.3 ± 0 mg/mL), 2,2-azino-bis-(3-ethylbenzothiazoline-6-sulfonic acid) radical scavenging activity (0.5 ± 0 mg/mL), total phenolic content (38.3 ± 0.4 mg gallic acid equivalent per gram dry weight), total flavonoid content (43.8 ± 0.2 mg quercetin equivalent per gram dry weight), and reducing power (41.9 ± 2.2 mg ascorbic acid equivalent per gram dry weight). The results indicated that jujube peel pulp is a more potential natural antioxidant than seeds. [ABSTRACT FROM AUTHOR]

Micro free-flow electrophoresis (μFFE) provides a rapid and straightforward route for the high-performance online separation and purification of targeted liquid samples in a mild manner. However, the facile fabrication of a μFFE device with high throughput and high stability remains a challenge due to the technical barriers of electrode integration and structural design for the removal of bubbles for conventional methods. To address this, the design and fabrication of a high-throughput μFFE chip are proposed using laser-assisted chemical etching of glass followed by electrode integration and subsequent low-temperature bonding. The careful design of the height ratio of the separation chamber and electrode channels combined with a high flow rate of buffer solution allows the efficient removal of electrolysis-generated bubbles along the deep electrode channels during continuous-flow separation. The introduction of microchannel arrays further enhances the stability of on-chip high-throughput separation. As a proof-of-concept, high-performance purification of fluorescein sodium solution with a separation purity of ~97.9% at a voltage of 250 V from the mixture sample solution of fluorescein sodium and rhodamine 6G solution is demonstrated. [ABSTRACT FROM AUTHOR]

Background: Although several studies suggest the benefit of a low-protein diet supplemented with amino acids and keto acids (sLPD) in delaying the initiation of hemodialysis, evidence on whether these nutritional approaches could delay the timing of preemptive transplantation is lacking. Methods: Retrospective nationwide cohort study, from Taiwan's National Health Insurance Research Database. Patients having undergone a first preemptive kidney transplantation between 2001 and 2017 were identified and divided into two groups according to the presence of sLPD treatment or not. The primary outcome was the time between the diagnosis of advanced CKD and transplantation. Secondary outcomes were post-transplantation adverse events. Results: A total of 245 patients who received their first preemptive kidney transplantation were identified from the nationwide database; 63 of them had been on an sLPD prior to transplantation (sLPD group). The duration between the day of advanced CKD diagnosis and the day of transplantation was significantly longer in the sLPD group compared with the non-sLPD group (median duration: 345 vs. 220 days, p = 0.001). The risk of post-transplantation adverse events did not differ between the two groups. Conclusions: Within the limits of its observational, retrospective design, this is the first study to suggest that nutritional management with sLPDs can safely delay the timing of preemptive kidney transplantation. [ABSTRACT FROM AUTHOR]

Background: Patients undergoing hemodialysis are prone to cardiac arrests. Methods: This study aimed to develop a risk score to predict in-hospital cardiac arrest (IHCA) in emergency department (ED) patients undergoing emergency hemodialysis. Patients were included if they received urgent hemodialysis within 24 h after ED arrival. The primary outcome was IHCA within three days. Predictors included three domains: comorbidity, triage information (vital signs), and initial biochemical results. The final model was generated from data collected between 2015 and 2018 and validated using data from 2019. Results: A total of 257 patients, including 52 with IHCA, were analyzed. Statistical analysis selected significant variables with higher sensitivity cutoff, and scores were assigned based on relative beta coefficient ratio: K > 5.5 mmol/L (score 1), pH < 7.35 (score 1), oxygen saturation < 85% (score 1), and mean arterial pressure < 80 mmHg (score 2). The final scoring system had an area under the curve of 0.78 (p < 0.001) in the primary group and 0.75 (p = 0.023) in the validation group. The high-risk group (defined as sum scores ≥ 3) had an IHCA risk of 47.2% and 41.7%, while the low-risk group (sum scores < 3) had 18.3% and 7%, in the primary and validation databases, respectively. Conclusions: This predictive score model for IHCA in emergent hemodialysis patients could help healthcare providers to take necessary precautions and allocate resources. [ABSTRACT FROM AUTHOR]

Background: Taiwan implemented the post-graduate year (PGY) training to reform the medical education system to provide holistic medical care after severe acute respiratory syndrome in 2003. In late 2019, COVID-19 quickly spread across the globe and became a pandemic crisis. This study aimed to investigate whether the establishment of the PGY training had positive effects on the self-efficacy and emotional traits of medical workers. Methods: One hundred and ten physicians, including PGY, residents, and visiting staff, were investigated using the General Self-Efficacy Scale (GSES) and Emotional Trait and State Scale (ETSS), and their feedback and suggestions were collected. An exploratory factor analysis was done to reduce the factor dimensions using the varimax rotation method, which was reduced to four factors: "the ability to cope with ease", "proactive ability", "negative emotion", and "positive emotion". A comparison with and without PGY training when facing the COVID-19 pandemic was conducted. Results: Those who had received PGY training (n = 77) were younger, had a lower grade of seniority, and had less practical experience than those who had not received PGY (n = 33). Those who had received PGY training had significantly higher scores for the factors "ability to cope with ease", "proactive ability", and "positive emotion" than those who had not received PGY training. Conclusion: The study revealed that PGY training may have had positive effects on the personal self-efficacy and emotional traits of physicians coping with the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Among hemodialysis patients aged more than 40 years old, previous large-scale studies showed statin treatment had no effect on reducing cardiovascular adverse events. However, young-adult-onset end-stage renal disease (ESRD) patients have different physicosocial factors compared to older ESRD patients. The benefit of statins in such a specific group has not been well evaluated. Through the use of Taiwan's National Health Insurance Research Database (NHIRD), young adult patients aged 20–40 with incident ESRD requiring permanent dialysis between 1 January 2003 and 31 December 2015 were identified. The enrollees were further divided into two groups depending on whether they received statin therapy for more than 90 days (statin group) or never received any statin (nonstatin group) in the first year after initiation of dialysis. Propensity score weighting (PSW) was used to balance the baseline characteristics between the two groups. After PSW, the statin group (n = 771) exhibited a higher rate of major adverse cardiac and cerebrovascular events (MACCEs) (2.65% vs. 1.44%, hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.43–2.45), and acute myocardial infarction (1.51% vs. 0.30%, HR: 5.34, 95% CI: 3.40–8.39) compared to the nonstatin group (n = 1709). The risk of all-cause mortality, cardiovascular (CV) death. and stroke did not significantly differ between the two groups. Similar to older patients, this study demonstrated that statin therapy cannot offer any protective effects in reducing CV outcomes among young adult ESRD patients undergoing dialysis. [ABSTRACT FROM AUTHOR]

With rapid industrialization, humans produce an increasing number of products. The composition of these products is usually decomposed. However, some substances are not easily broken down and gradually become environmental pollutants. In addition, these substances may cause bioaccumulation, since the substances can be fragmented into micro- and nanoparticles. These particles or their interactions with other toxic matter circulate in humans via the food chain or air. Whether these micro- and nanoparticles interfere with extracellular vesicles (EVs) due to their similar sizes is unclear. Micro- and nanoparticles (MSs and NSs) induce several cell responses and are engulfed by cells depending on their size, for example, particulate matter with a diameter ≤2.5 μm (PM2.5). Autophagy is a mechanism by which pathogens are destroyed in cells. Some artificial materials are not easily decomposed in organisms. How do these cells or tissues respond? In addition, autophagy operates through two pathways (increasing cell death or cell survival) in tumorigenesis. Many MSs and NSs have been found that induce autophagy in various cells and tissues. As a result, this review focuses on how these particles interfere with cells and tissues. Here, we review MSs, NSs, and PM2.5, which result in different autophagy-related responses in various tissues or cells. [ABSTRACT FROM AUTHOR]

We demonstrate the hybrid integration of a lithium niobate microring resonator with a silicon nitride waveguide in the vertical configuration to achieve efficient light coupling. The microring resonator is fabricated on a lithium niobate on insulator (LNOI) substrate using photolithography assisted chemo-mechanical etching (PLACE). A fused silica cladding layer is deposited on the LNOI ring resonator. The silicon nitride waveguide is further produced on the fused silica cladding layer by first fabricating a trench in the fused silica while using focused ion beam (FIB) etching for facilitating the evanescent coupling, followed by the formation of the silicon nitride waveguide on the bottom of the trench. The FIB etching ensures the required high positioning accuracy between the waveguide and ring resonator. We achieve Q-factors as high as 1.4 × 107 with the vertically integrated device. [ABSTRACT FROM AUTHOR]

Background: Non-dialysis-dependent chronic kidney disease (CKD-ND) patients are recommended to receive a one-dose influenza vaccination annually. However, studies investigating vaccine efficacy in the CKD-ND population are still lacking. In this study, we aimed to evaluate vaccine efficacy between the one-dose and two-dose regimen and among patients with different stages of CKD throughout a 20-week follow-up period. Methods: We conducted a single-center, non-randomized, open-label, controlled trial among patients with all stages of CKD-ND. Subjects were classified as unvaccinated, one-dose, and two-dose groups (4 weeks apart) after enrollment. Serial changes in immunological parameters (0, 4, 8, and 20 weeks after enrollment), including seroprotection, geometric mean titer (GMT), GMT fold-increase, seroconversion, and seroresponse, were applied to evaluate vaccine efficacy. Results: There were 43, 84, and 71 patients in the unvaccinated, one-dose, and two-dose vaccination groups, respectively. At 4–8 weeks after vaccination, seroprotection rates in the one- and two-dose group for H1N1, H3N2, and B ranged from 82.6–95.8%, 97.4–100%, and 73.9–100%, respectively. The concomitant seroconversion and GMT fold-increases nearly met the suggested criteria for vaccine efficacy for the elderly population. Although the seroprotection rates for all of the groups were adequate, the seroconversion and GMT fold-increase at 20 weeks after vaccination did not meet the criteria for vaccine efficacy. The two-dose regimen had a higher probability of achieving seroprotection for B strains (Odds ratio: 3.5, 95% confidence interval (1.30–9.40)). No significant differences in vaccine efficacy were found between early (stage 1–3) and late (stage 4–5) stage CKD. Conclusions: The standard one-dose vaccination can elicit sufficient protective antibodies. The two-dose regimen induced a better immune response when the baseline serum antibody titer was low. Monitoring change in antibody titers for a longer duration is warranted to further determine the current vaccine strategy in CKD-ND population. [ABSTRACT FROM AUTHOR]

Postoperative swallowing, affected by general anesthesia and intubation, plays an important part in airway and oral intake safety regarding effective oropharyngeal and esophageal emptying. However, objective evidence is limited. This study aimed to determine the time required from emergence to effective oropharyngeal and esophageal emptying in patients undergoing non-intubated (N) or tracheal-intubated (I) video-assisted thoracoscopic surgery (VATS). Hyoid bone displacement (HBD) by submental ultrasonography and high-resolution impedance manometry (HRIM) measurements were used to assess oropharyngeal and esophageal emptying. HRIM was performed every 10 min after emergence, up to 10 times. The primary outcome was to determine whether intubation affects the time required from effective oropharyngeal to esophageal emptying. The secondary outcome was to verify if HBD is comparable to preoperative data indicating effective oropharyngeal emptying. Thirty-two patients suitable for non-intubated VATS were recruited. Our results showed that comparable HBDs were achieved in all patients after emergence. Effective esophageal emptying was achieved at the first HRIM measurement in 11 N group patients and 2 I group patients (p = 0.002) and was achieved in all N (100%) and 13 I group patients (81%) within 100 min (p = 0.23). HBD and HRIM are warranted for detecting postoperative oropharyngeal and esophageal emptying. [ABSTRACT FROM AUTHOR]

We demonstrate a microfluidic mixer of high mixing efficiency in fused silica substrate using femtosecond laser-induced wet etching and hydroxide-catalysis bonding method. The micromixer has a three-dimensional geometry, enabling efficient mixing based on Baker's transformation principle. The cross-sectional area of the fabricated micromixer was 0.5 × 0.5 mm2, enabling significantly promotion of the throughput of the micromixer. The performance of the fabricated micromixers was evaluated by mixing up blue and yellow ink solutions with a flow rate as high as 6 mL/min. [ABSTRACT FROM AUTHOR]