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Intracerebral hemorrhage (ICH) induces a complex sequence of apoptotic cascades and inflammatory responses, leading to neurological impairment. Transient receptor potential vanilloid 1 (TRPV1), a nonselective cation channel with high calcium permeability, has been implicated in neuronal apoptosis and inflammatory responses. This study used a mouse ICH model and neuronal cultures to examine whether TRPV1 activation exacerbates brain damage and neurological deficits by promoting neuronal apoptosis and neuroinflammation. ICH was induced by injecting collagenase in both wild‐type (WT) C57BL/6 mice and TRPV1−/− mice. Capsaicin (CAP; a TRPV1 agonist) or capsazepine (a TRPV1 antagonist) was administered by intracerebroventricular injection 30 min before ICH induction in WT mice. The effects of genetic deletion or pharmacological inhibition of TRPV1 using CAP or capsazepine on motor deficits, histological damage, apoptotic responses, blood–brain barrier (BBB) permeability, and neuroinflammatory reactions were explored. The antiapoptotic mechanisms and calcium influx induced by TRPV1 inactivation were investigated in cultured hemin‐stimulated neurons. TRPV1 expression was upregulated in the hemorrhagic brain, and TRPV1 was expressed in neurons, microglia, and astrocytes after ICH. Genetic deletion of TRPV1 significantly attenuated motor deficits and brain atrophy for up to 28 days. Deletion of TRPV1 also reduced brain damage, neurodegeneration, microglial activation, cytokine expression, and cell apoptosis at 1 day post‐ICH. Similarly, the administration of CAP ameliorated brain damage, neurodegeneration, brain edema, BBB permeability, and cytokine expression at 1 day post‐ICH. In primary neuronal cultures, pharmacological inactivation of TRPV1 by CAP attenuated neuronal vulnerability to hemin‐induced injury, suppressed apoptosis, and preserved mitochondrial integrity in vitro. Mechanistically, CAP reduced hemin‐stimulated calcium influx and prevented the phosphorylation of CaMKII in cultured neurons, which was associated with reduced activation of P38 and c‐Jun NH2‐terminal kinase mitogen‐activated protein kinase signaling. Our results suggest that TRPV1 inhibition may be a potential therapy for ICH by suppressing mitochondria‐related neuronal apoptosis. [ABSTRACT FROM AUTHOR]

Objectives: Empty nose syndrome (ENS) is an underdiagnosed but burdensome clinical condition. Studies that have addressed the impact of remnant inferior turbinate volume (ITV) on ENS are scarce. We aimed to evaluate the impact of ITV and phenotyping on the severity and presentation of ENS. Methods: All the enrolled patients underwent the following subjective assessments: the ENS 6‐Item Questionnaire (ENS6Q), Sino‐Nasal Outcome Test‐25 (SNOT‐25), Beck Depression Inventory‐II (BDI‐II) and Beck Anxiety Inventory (BAI). The ITV was obtained from finely cut (1‐mm‐thick slices) sino‐nasal computed tomography scan images and analyzed using ImageJ. The correlation between ITV, subjective measurements, and morphology of inferior turbinates was evaluated. ENS was categorized as torpedo type (balanced tissue volume) or pistol type (posterior dominance) based on the morphology. Results: Overall, 54 patients met the inclusion criteria. The ITV was positively correlated with the ENS6Q score and domain of ENS symptoms in SNOT‐25. Neither BDI‐II nor BAI scores had a significant correlation with ITV. Based on their morphological classification, the torpedo type exhibited diverse manifestations in the SNOT‐25 analysis in response to changes in ITV, while the pistol type demonstrated an elevated rhinologic symptom burden and ENS‐specific symptoms as their ITV increased. Nasal resistance did not correlate with the ITV in either type of ENS. Conclusions: Symptoms were paradoxically worse in ENS patients with greater remnant ITV, and distinct morphological phenotypes in the nasal cavities may result in different presentations. Further investigation into the correlation between remnant inferior turbinates and nerve function is warranted. Level of Evidence: 3 Laryngoscope, 134:3060–3066, 2024 [ABSTRACT FROM AUTHOR]

Constraining strain localization and the growth of shear fabrics within brittle fault zones at sub‐seismic slip rates is important for understanding fault strength and frictional stability. We conducted direct shear experiments on simulated sandstone‐derived fault gouges at an effective normal stress of 40 MPa, a pore pressure of 15 MPa, and a temperature of 100°C. Using a passive strain marker and X‐ray Computed Tomography, we analyzed the spatial distribution of deformation in gouges deformed in the strain‐hardening, subsequent strain‐softening, and then steady‐state regimes at displacement rates of 1, 30, and 1,000 µm/s. We developed a machine‐learning‐based automatic boundary detection method to recognize the shear fabrics and quantify displacement partitioning between each fabric element. Our results show fabrics oriented along R1 and Y (including boundary) shears are the two major fabric elements. At rates of 1 and 30 µm/s, the relative amount of displacement on R1 shears is displacement dependent, increasing to ∼20% of the total displacement up to the strain‐softening stage, then decreasing to ∼10%–18% at the steady state. This trend is absent at the high rate where ∼18% of the displacement occurs on R1 shears throughout all investigated stages. At all rates, the relative amount of displacement on Y shears increases linearly with displacement to a total of larger than 50% at the steady state. Our study provides constraints on the development of the active slip zone, which is an important factor controlling heating and weakening associated with small‐magnitude earthquakes with limited displacement (mm‐dm), such as induced seismicity. Plain Language Summary: In the past few decades, several studies have focused on the mechanical behavior of simulated fault zones to understand earthquake nucleation. However, minor attention has been paid to the microstructural characterization of fault‐zone gouges due to the difficulties in quantifying deformation. An understanding of brittle fault‐zone fabrics and their development provides crucial constraints on the mechanical strength and stability of faults. We conducted laboratory experiments on simulated sandstone‐derived fault gouges with a passive strain marker under the conditions relevant to earthquake nucleation to explore the development and evolution of shear zone fabrics and their relations to fault strength. We combined X‐ray Computed Tomography (XCT) and a custom‐designed machine‐learning‐based automatic boundary detection method to analyze the spatial distribution of gouge deformation and to quantify displacement partitioning between deformation features. The results show that our samples have similar evolution of the shear fabrics, partitioning of displacement, and mechanical response with increasing shear strain at all tested nucleation velocities. The evolution of the mechanical behavior from strain‐hardening, to softening, to steady‐state stages is related to the transformation of R1 to shear‐parallel shear bands. Up to 50% of the total displacement can be accommodated within shear‐parallel shear bands, facilitating strain weakening of the materials. Key Points: We performed 3‐D analyses on the evolution of shear zone fabrics within sandstone‐derived fault gouges utilizing the X‐ray CT techniqueOur samples show similar evolution of shear fabrics, slip partitioning, and mechanical response with shear strain at all tested velocitiesUp to 50% of the total imposed displacement can be accommodated within shear‐parallel shear bands during earthquake nucleation [ABSTRACT FROM AUTHOR]

Objective: Artificial intelligence (AI) prediction is increasingly used for decision making in health care, but its application for adverse outcomes in emergency department (ED) patients with acute pancreatitis (AP) is not well understood. This study aimed to clarify this aspect. Methods: Data from 8274 ED patients with AP in three hospitals from 2009 to 2018 were analyzed. Demographic data, comorbidities, laboratory results, and adverse outcomes were included. Six algorithms were evaluated, and the one with the highest area under the curve (AUC) was implemented into the hospital information system (HIS) for real‐time prediction. Predictive accuracy was compared between the AI model and Bedside Index for Severity in Acute Pancreatitis (BISAP). Results: The mean ± SD age was 56.1 ± 16.7 years, with 67.7% being male. The AI model was successfully implemented in the HIS, with Light Gradient Boosting Machine (LightGBM) showing the highest AUC for sepsis (AUC 0.961) and intensive care unit (ICU) admission (AUC 0.973), and eXtreme Gradient Boosting (XGBoost) showing the highest AUC for mortality (AUC 0.975). Compared to BISAP, the AI model had superior AUC for sepsis (BISAP 0.785), ICU admission (BISAP 0.778), and mortality (BISAP 0.817). Conclusions: The first real‐time AI prediction model implemented in the HIS for predicting adverse outcomes in ED patients with AP shows favorable initial results. However, further external validation is needed to ensure its reliability and accuracy. [ABSTRACT FROM AUTHOR]

The severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus emerged in late 2019 leading to the COVID‐19 disease pandemic that triggered socioeconomic turmoil worldwide. A precise, prompt, and affordable diagnostic assay is essential for the detection of SARS‐CoV‐2 as well as its variants. Antibody against SARS‐CoV‐2 spike (S) protein was reported as a suitable strategy for therapy and diagnosis of COVID‐19. We, therefore, developed a quick and precise phase‐sensitive surface plasmon resonance (PS‐SPR) biosensor integrated with a novel generated anti‐S monoclonal antibody (S‐mAb). Our results indicated that the newly generated S‐mAb could detect the original SARS‐CoV‐2 strain along with its variants. In addition, a SARS‐CoV‐2 pseudovirus, which could be processed in BSL‐2 facility was generated for evaluation of sensitivity and specificity of the assays including PS‐SPR, homemade target‐captured ELISA, spike rapid antigen test (SRAT), and quantitative reverse transcription polymerase chain reaction (qRT‐PCR). Experimentally, PS‐SPR exerted high sensitivity to detect SARS‐CoV‐2 pseudovirus at 589 copies/ml, with 7‐fold and 70‐fold increase in sensitivity when compared with the two conventional immunoassays, including homemade target‐captured ELISA (4 × 103 copies/ml) and SRAT (4 × 104 copies/ml), using the identical antibody. Moreover, the PS‐SPR was applied in the measurement of mimic clinical samples containing the SARS‐CoV‐2 pseudovirus mixed with nasal mucosa. The detection limit of PS‐SPR is calculated to be 1725 copies/ml, which has higher accuracy than homemade target‐captured ELISA (4 × 104 copies/ml) and SRAT (4 × 105 copies/ml) and is comparable with qRT‐PCR (1250 copies/ml). Finally, the ability of PS‐SPR to detect SARS‐CoV‐2 in real clinical specimens was further demonstrated, and the assay time was less than 10 min. Taken together, our results indicate that this novel S‐mAb integrated into PS‐SPR biosensor demonstrates high sensitivity and is time‐saving in SARS‐CoV‐2 virus detection. This study suggests that incorporation of a high specific recognizer in SPR biosensor is an alternative strategy that could be applied in developing other emerging or re‐emerging pathogenic detection platforms. [ABSTRACT FROM AUTHOR]

Hepatic angiosarcoma (HAS) is an aggressive mesenchymal malignancy that remains underexplored with respect to its etiology and mutational landscapes. To clarify the association between HAS and end‐stage renal disease (ESRD), we used nationwide data of the National Health Insurance Research Database (NHIRD) in Taiwan, covering ~99% of the population, from 2001 to 2016. To investigate molecular signatures, we performed whole‐exome sequencing (WES) in 27 surgical specimens, including nine ESRD‐associated cases. The NHIRD analysis demonstrated that HAS ranked second among all angiosarcomas in Taiwan, with the incidence rates of HAS being 0.08, 2.49, and 5.71 per 100,000 person‐years in the general population, chronic kidney disease (CKD), and ESRD patients, respectively. The standardized incidence ratios of HAS in CKD and ESRD patients were 29.99 and 68.77, respectively. In comparison with nonhepatic angiosarcoma, the multivariate regression analysis of our institutional cohort confirmed CKD/ESRD as an independent risk factor for HAS (odds ratio: 9.521, 95% confidence interval: 2.995–30.261, p < 0.001). WES identified a high tumor mutation burden (TMB; median: 8.66 variants per megabase) and dominant A:T‐to‐T:A transversion in HAS with frequent TP53 (81%) and ATRX (41%) mutations, KDR amplifications/gains (56%), and CDKN2A/B deletions (48%). Notably, ESRD‐associated HAS had a significantly higher TMB (17.62 variants per megabase, p = 0.01) and enriched mutational signatures of aristolochic acid exposure (COSMIC SBS22, p < 0.001). In summary, a significant proportion of HAS in Taiwan is associated with ESRD and harbors a distinctive mutational signature, which concomitantly links nephrotoxicity and mutagenesis resulting from exposure to aristolochic acid or related compounds. A high TMB may support the eligibility for immunotherapy in treating ESRD‐associated HAS. © 2023 The Pathological Society of Great Britain and Ireland. [ABSTRACT FROM AUTHOR]

Background: Factors of metabolic syndrome such as obesity are well‐known risk factors for gallstone disease (GSD). There are different indicators of obesity, including weight, body mass index, waist circumference, and waist‐to‐height ratio. The predictive ability of different obesity indicators for GSD remains unclear. Objective: To explore the most efficient predictor of GSD among the different anthropometric indicators of obesity. Methods: This population‐based cross‐sectional study included 2263 participants who completed a questionnaire detailing their demographics, medical history, and lifestyle between 2014 and 2017 in Taiwan. Blood samples were collected and physical examinations, including anthropometric measurements, were performed. Gallstone disease was ascertained using ultrasonography. Multivariate analyses were performed to identify independent risk factors for GSD. Results: The overall prevalence of GSD was 8.8%. According to the multivariate analysis, individuals with a waist‐to‐height ratio ≥0.5 (odds ratio|odds ratios (OR) = 1.65, 95% confidence interval (CI) = 1.10−2.48, p = 0.017) had an increased risk of GSD. Diabetes was the main risk factor for GSD in men (OR = 2.06, 95% CI = 1.17−3.65, p = 0.013). Among women, waist‐to‐height ratio >0.5 (OR = 1.76, 95% CI = 1.03−3.02, p = 0.040) and current hormone drug use (OR = 2.73, 95% CI = 1.09−6.84, p = 0.033) were significant risk factors for gallstones. Conclusion: GSD was independently associated with central obesity and exogenous hormone intake in women. Among the anthropometric indicators used to assess central obesity, waist‐to‐height ratio was the most accurate predictor of GSD. [ABSTRACT FROM AUTHOR]

This study aimed to develop and validate the psychometric properties of a novel instrument that measures Indoor Air Pollution Health Literacy (IAPHL). The qualitative phase was conducted to design questions based on the conceptual model of the European Health Literacy Survey Questionnaire. We developed a 38‐item instrument covering 12 constructs, that is, four information competencies within three health domains to assess IAPHL. A cross‐sectional online video survey of 647 adults aged 20 years and above in Taiwan was conducted. Various measures of validity and reliability coefficients were assessed to indicate the psychometric properties of the IAPHL instrument. The content validity indices for relevance, importance, and clarity of the 38 questions were 0.97, 0.96, and 0.89, respectively. The model fit indices obtained from the confirmatory factor analysis supported the acceptable structures of the theoretically hypothetical 12‐factor model (standardized root mean square residual = 0.055; root mean square error of approximation = 0.065). Internal consistency for the instrument showed a Cronbach's alpha of 0.96. The IAPHL instrument developed in this study showed satisfactory validity and reliability and can be used in future fieldwork. [ABSTRACT FROM AUTHOR]

The 2008 Mw 7.9 Wenchuan earthquake generated ∼270 and ∼80 km long surface ruptures along the Longmenshan fault belt, namely the Yingxiu‐Beichuan fault (YBF) and the Guanxian‐Anxian faults (GAF), respectively. So far, most of the frictional investigations were performed on the YBF gouge materials. Here, we present the results of rotary shear friction experiments performed on the GAF gouges recovered from the depth of ∼1.25 km of the Wenchuan Earthquake Fault Scientific Drilling project‐3 along the GAF. The fault gouges, mainly composed of quartz, illite, chlorite, and kaolinite, were sheared at slip velocities V ranging from 10−5 to 2 m/s and normal stresses from 8.5 to 10 MPa under both room humidity and wet conditions. At any imposed slip velocity, the wet gouges have an apparent friction coefficient lower than the room humidity one. In addition, enhanced velocity‐strengthening behavior at intermediate velocities (10−2 m/s < V ≤ 10−1 m/s) was recognized. We characterized the products using field‐emission scanning electron microscopy combined with synchrotron X‐ray diffraction analysis. These microanalytical investigations evidence the formation of size‐reduced particles (without mineral phase changes) and R‐ and Y‐shears in the principal slip zone (PSZ). Regardless of the ambient conditions, the width of PSZ was proportional to the input frictional work density (the product of shear stress times displacement). Our results support the hypothesis that the GAF preferentially ruptures through wet fault gouges; however, the enhanced velocity‐strengthening regime at intermediate velocities may act as a barrier to slip acceleration during fault rupture propagation. Plain Language Summary: During the 2008 Mw 7.9 Wenchuan earthquake, two surface ruptures were generated, namely the ∼270 km long Yingxiu‐Beichuan fault (YBF) and the ∼80 km long Guanxian‐Anxian faults (GAF), respectively. This earthquake triggers mechanisms that weaken fault‐zone rocks, allowing the rupture to propagate. While the frictional behavior of the YBF fault gouges and the possible mechanisms were investigated in detail, the GAF materials have not been studied yet. Here, we shear fault gouges of the GAF from low to high velocities and characterize the products. Results show that at any imposed slip velocity, the wet gouges are weaker than the room humidity ones. In addition, GAF fault gouges show high frictional resistance at intermediate velocities (10−2 m/s < V ≤ 10−1 m/s). The microanalytical investigations evidence the similarity between the experimentally formed principal slip zone and the reported natural observation of GAF fault gouges. Our results support the hypothesis that the GAF preferentially ruptures through wet fault gouges; however, the high frictional resistance at intermediate velocities may act as a barrier to slip acceleration during the 2008 Wenchuan Mw 7.9 earthquake. Key Points: Fault gouges of Wenchuan Earthquake Fault Scientific Drilling‐3 show three velocity friction regimes from low to high velocitiesAt any imposed slip velocity, the wet gouges have an apparent friction coefficient lower than the room humidity oneHigh frictional resistance at intermediate velocities may act as a barrier to slip acceleration during the 2008 Wenchuan Mw 7.9 earthquake [ABSTRACT FROM AUTHOR]

Children are the sensitive population to fine particulate matter (PM2.5) exposure and spend most of their time in bedroom. Infiltration factor (Finf) can be used to calculate the fraction of total indoor PM2.5 with outdoor origin to increase the accuracy of exposure assessment. However, studies have ignored the diurnal variations of PM2.5Finf values, and a few studies have estimated Finf values for heavy metals in PM2.5 in children's bedrooms. To calculate the PM2.5Finf, real‐time indoor and outdoor PM2.5 concentrations and occupants' activities were collected in 56 study bedrooms. At 22 of the 56 study bedrooms, PM2.5 samples were also collected for heavy metals analysis. We noted the PM2.5Finf was higher during the daytime (0.70 ± 0.23) than nighttime (0.54 ± 0.27) during the hot season, and the time of air conditioner use was longer at nighttime. The largest Finf value of heavy metal was V (0.88 ± 0.25), followed by Pb (0.85 ± 0.28), Mn (0.72 ± 0.26), Cr (0.69 ± 0.35), and Zn (0.61 ± 0.32), with a larger variation. Our findings suggest that the estimations of diurnal PM2.5 and heavy metals Finf values are necessary to increase the accuracy of exposure assessment. [ABSTRACT FROM AUTHOR]

Background: Artificial intelligence of things (AIoT) may be a solution for predicting adverse outcomes in emergency department (ED) patients with pneumonia; however, this issue remains unclear. Therefore, we conducted this study to clarify it. Methods: We identified 52,626 adult ED patients with pneumonia from three hospitals between 2010 and 2019 for this study. Thirty‐three feature variables from electronic medical records were used to construct an artificial intelligence (AI) model to predict sepsis or septic shock, respiratory failure, and mortality. After comparisons of the predictive accuracies among logistic regression, random forest, support‐vector machine (SVM), light gradient boosting machine (LightGBM), multilayer perceptron (MLP), and eXtreme Gradient Boosting (XGBoost), we selected the best one to build the model. We further combined the AI model with the Internet of things as AIoT, added an interactive mode, and implemented it in the hospital information system to assist clinicians with decision making in real time. We also compared the AIoT‐based model with the confusion‐urea‐respiratory rate‐blood pressure‐65 (CURB‐65) and pneumonia severity index (PSI) for predicting mortality. Results: The best AI algorithms were random forest for sepsis or septic shock (area under the curve [AUC] = 0.781), LightGBM for respiratory failure (AUC = 0.847), and mortality (AUC = 0.835). The AIoT‐based model represented better performance than CURB‐65 and PSI indicators for predicting mortality (0.835 vs. 0.681 and 0.835 vs. 0.728). Conclusions: A real‐time interactive AIoT‐based model might be a better tool for predicting adverse outcomes in ED patients with pneumonia. Further validation in other populations is warranted. [ABSTRACT FROM AUTHOR]

Intrauterine growth restriction (IUGR) is a leading cause of perinatal mortality and morbidity, and IUGR survivors are at increased risk of neurodevelopmental deficits. No effective interventions are currently available to improve the structure and function of the IUGR brain before birth. This study investigated the protective effects of low‐intensity pulsed ultrasound (LIPUS) on postnatal neurodevelopmental outcomes and brain injury using a rat model of IUGR induced by maternal exposure to dexamethasone (DEX). Pregnant rats were treated with DEX (200 μg/kg, s.c.) and LIPUS daily from gestational day (GD) 14 to 19. Behavioral assessments were performed on the IUGR offspring to examine neurological function. Neuropathology, levels of neurotrophic factors, and CaMKII‐Akt‐related molecules were assessed in the IUGR brain, and expression of glucose and amino acid transporters and neurotrophic factors were examined in the placenta. Maternal LIPUS treatment increased fetal weight, fetal liver weight, and placental weight following IUGR. LIPUS treatment also increased neuronal number and myelin protein expression in the IUGR brain, and attenuated neurodevelopmental deficits at postnatal day (PND) 18. However, the number of oligodendrocytes or microglia was not affected. These changes were associated with the upregulation of brain‐derived neurotrophic factor (BDNF) and placental growth factor (PlGF) protein expression, and enhancement of neuronal CaMKII and Akt activation in the IUGR brain at PND 1. Additionally, LIPUS treatment promoted glucose transporter (GLUT) 1 production and BDNF expression in the placenta, but had no effects on GLUT3 or amino acid transporter expression. Our findings suggest that antenatal LIPUS treatment may reduce IUGR‐induced brain injury via enhancing cerebral BDNF/CaMKII/Akt signaling. These data provide new evidence that LIPUS stimulation could be considered for antenatal neuroprotective therapy in IUGR. [ABSTRACT FROM AUTHOR]

Differentiated cells across multiple species and organs can re‐enter the cell cycle to aid in injury‐induced tissue regeneration by a cellular program called paligenosis. Here, we show that activating transcription factor 3 (ATF3) is induced early during paligenosis in multiple cellular contexts, transcriptionally activating the lysosomal trafficking gene Rab7b. ATF3 and RAB7B are upregulated in gastric and pancreatic digestive‐enzyme‐secreting cells at the onset of paligenosis Stage 1, when cells massively induce autophagic and lysosomal machinery to dismantle differentiated cell morphological features. Their expression later ebbs before cells enter mitosis during Stage 3. Atf3–/– mice fail to induce RAB7‐positive autophagic and lysosomal vesicles, eventually causing increased death of cells en route to Stage 3. Finally, we observe that ATF3 is expressed in human gastric metaplasia and during paligenotic injury across multiple other organs and species. Thus, our findings indicate ATF3 is an evolutionarily conserved gene orchestrating the early paligenotic autodegradative events that must occur before cells are poised to proliferate and contribute to tissue repair. Synopsis: Pancreatic and gastric exocrine cells regenerate after injury through a process called paligenosis. Injury‐induced ATF3 promotes cell autodegradation via transcriptional activation of Rab7b, a regulator of late endosomal and lysosomal trafficking. Atf3 upregulation in injury across diverse organs and species suggests a conserved role in governing the cell plasticity program of paligenosis. ATF3 transcriptionally activates Rab7b during paligenotic autodegradation of exocrine cells of the stomach and pancreas.Atf3 is required for lysosome and autophagy induction in paligenosis.Atf3 loss leads to increased cell death during paligenosis and decreased tissue repair following injury. [ABSTRACT FROM AUTHOR]

Aluminum (Al) was successfully bonded with alumina (Al2O3) using Ni films of different thicknesses (3, 6, 12 μm) through electroplating and electroless plating processes after annealing at the relatively low melting point of Al. The microstructure, bonding area percentage, shear strength, and thermal conductivity of Al/Al2O3 joints were evaluated using scanning electron microscopy, scanning acoustic tomography (SAT), the ISO 13124 test, and the laser flash method respectively. No reaction layer was found at the interface of the Al/Al2O3 joint, and the Ni film diffused completely into Al to form an intermetallic compound, Al3Ni, in the Al foil. The amount and size of the Al3Ni phase in the Al foil increased gradually with the thickness of the Ni film. The samples with Ni deposited via electroplating had a higher shear stress and bonding area than the samples with Ni deposited via electroless plating. The Al/Al2O3 specimen with a 3‐μm‐thick Ni film interlayer deposited using electroplating had the highest shear strength (50.6 MPa), thermal conductivity (39.45 W/mK), and bonding area percentage (~99.97%); therefore, specimens produced under these conditions were considered suitable for use as a substrate in high‐power devices. [ABSTRACT FROM AUTHOR]

Various proportions of ZrO2/CaTiO3 powders were mixed and hot pressed at 1500°C/30 min for Ti casting. The hot‐pressed ZrO2/CaTiO3 composites were reacted with pure Ti at 1700°C/10 min in Ar. The interfacial reaction between Ti and ZrO2/CaTiO3 composites was investigated through X‐ray diffraction, scanning electron microscopy, transmission electron microscopy, and energy‐dispersive X‐ray spectroscopy. The ZrO2/CaTiO3 composites with less than 10 vol.%, CaTiO3, and a minor amount of residual TiO2 were found. When the content of ZrO2 was increased to larger than 10 vol.%, two Ca2Zr5Ti2O16 and CaZrTi2O7 phases appeared in the composites. The amount of CaTiO3 and CaZrTi2O7 in the composites gradually decreased as the amount of ZrO2 increased. When Ti came in contact with ZrO2/CaTiO3 composites with less than 10 vol.% ZrO2, the resulting eutectic reaction produced a liquid phase and induced melting. When ZrO2 was increased to more than 30 vol.% in the composites, Ca2Zr5Ti2O16 and CaZrTi2O7 changed completely to CaZrO3, Ti2O, CaO, and ZrO2. With more than 30 vol.% ZrO2, no other reaction phases occurred in the Ti side after contact with the ZrO2/CaTiO3 composites, which is conducive for producing ceramic composites for Ti casting applications. [ABSTRACT FROM AUTHOR]

Background. Out-of-hospital cardiac arrest (OHCA) remains a big issue of critical care. It is well known that bystander cardiopulmonary resuscitation (CPR) with an automated external defibrillator (AED) used did improve the survival rate. Therefore, CPR education including basic life support (BLS) and AED has been advocated for years. It showed significant improvement of knowledge and willingness to perform CPR through adolescents after the course. However, little is known regarding the ability and learning effectiveness of school students who attend such courses. Therefore, this study aimed to evaluate the CPR effectiveness of both adolescents (12 years old) and adults who undergo the same course of BLS and AED. Methods. This is a retrospective study. Sixth-grade elementary school students in Northern Taiwan were selected to compare with the adult group. Both took 90 minutes of the BLS and AED course by the doctor with BLS instructor qualification. The primary outcomes were CPR quality and passing or failing the skill examination parameters. The secondary outcome was the posttraining written test and questionnaire of CPR willingness. Results. In the written test, there was a statistical difference in the pretest score except AED knowledge, but no difference was revealed in the posttest score. No statistical difference in CPR quality was noted. In the skill examination, only checking breathing status had statistical difference (elementary group (71%) vs. adult group (86%) (p = 0.003)). Conclusion. We revealed that sixth-grade elementary students' performance in CPR and AED was similar to that of adults after completing the current 90-minute course. Therefore, we strongly advocate offering CPR and AED courses to 12-year-old children, and these courses should emphasize checking the victim's breathing status. [ABSTRACT FROM AUTHOR]

Background. The prevalence of geriatric syndromes and the need for hospice care in the emergency department (ED) in Asian populations remain unclear. This study was conducted to fill the data gap. Methods. Using a newly developed emergency geriatric assessment (EGA), we investigated the prevalence of geriatric syndromes and the need for hospice care in older ED patients of a tertiary medical center between September 1, 2016, and January 31, 2017. Results. We recruited a total of 693 patients with a mean age of 78.0 years (standard deviation 8.2 years), comprising 46.6% of females. According to age subgroups, 37.4% of patients were aged 65–74 years, 37.4% were aged 75–84 years, and 25.2% were aged ≥85 years. The prevalence rates of geriatric syndromes were as follows: delirium (11.4%), depression (23.4%), dementia (43.1%), deterioration of activities of daily living (ADL) for <1 year (29.4%), vision impairment (22.2%), hearing impairment (23.8%), sleep disturbance (13.1%), any fall in <1 year (21.8%), polypharmacy (28.7%), pain (35.1%), pressure ulcer (5.6%), incontinence or retention (29.6%), indwelling device or physical restrain (21.6%), nutrition problem (35.7%), frequent use of medical resources (50.1%), lack of advance care planning (84.0%), caregiver problem (4.6%), socioeconomic problem (5.5%), and need for family meeting (6.2%). The need for hospice care was 11.9%. Most geriatric syndromes increased with advancing age except depression, sleep disturbance, polypharmacy, pain, nutrition problem, lack of advance care planning, caregiver problem, and socioeconomic problem. Conclusion. Geriatric syndromes and the need for hospice care were common in the older ED patients. Further studies about subsequent intervention for improving geriatric care are needed. [ABSTRACT FROM AUTHOR]

Directed bonding with Al and Al2O3 was achieved using a transient liquid phase (TLP) method after annealing at the low melting point of Al, which deposited Ni, Cu, Ge, and Si on the Al2O3 substrate. Al/Al2O3 microstructures were evaluated using a scanning electron microscopy and transmission electron microscopy. A reaction layer was absent at the Al/Al2O3 interface, and all deposited metal films dissolved into the Al foil and reacted with Al to form an eutectic liquid phase near the interface to wet and join with the Al2O3. Al9Fe2 and Al3Fe intermetallic compounds were formed in the Al substrate because of Fe precipitation, which is an impurity of Al foil, and the reaction with Al at the grain boundaries of Al. The bonding area percentage, shear strength, and thermal conductivity for Al and Al2O3 were assessed using scanning acoustic tomography (SAT), the ISO 13 124 shear strength test, and the laser flash method, respectively. The Al/Al2O3 specimen deposited with the Ni film had the highest shear strength (33.74 MPa), thermal conductivity (42.3 W/mK), and bonding area percentage (96.78%). The Al/Al2O3 specimens deposited with Ge and Si exhibited relatively poor bonding because of the oxidation of Ge and Si at the surface of Al2O3 before bonding with Al. [ABSTRACT FROM AUTHOR]

In titanium casting, the interfacial reactions between selected Y2O3/Ca4Ti3O10 composites in contact with titanium at 1600°C for 30 minutes in an argon environment were characterized using X‐ray diffraction, scanning electron microscopy, and analytical transmission electron microscopy. Before contact with titanium, reaction phases of the Y2O3/Ca4Ti3O10 composites formed through hot pressing at 1500°C or annealing at 1600°C. These phases were identified as Ca4Ti3O10, Y2O3, and minor amounts of CaO. The amount of Ca4Ti3O10 in the composites gradually decreased as the amount of Y2O3 increased. When the Y2O3/Ca4Ti3O10 composites were in contact with titanium, a reaction layer of α‐Ti and Y2O3 was formed near the interface of the composite side. Large amounts of calcium and oxygen were expelled toward the composite side from Ca4Ti3O10 near the interface to form CaO, which precipitated in the Ca4Ti3O10 and Y2O3 phases. Furthermore, no reaction phases were detected in titanium. Ca4Ti3O10 and Y2O3 can function as diffusion barrier layers to effectively suppress the diffusion of oxygen into titanium. [ABSTRACT FROM AUTHOR]

The bis‐N‐heterocyclic carbene‐catalyzed (bis‐NHC‐catalyzed) oxidative transformation of aldehydes was successfully studied in water under air. The reaction rate increased through the use of Pd(OAc)2 as an additive. Notably, the catalytic system exhibited good tolerance toward aliphatic and aromatic aldehydes bearing halide and alkyl functional groups. In addition, gram‐scale reaction was also tested in this study. The use of water and operational simplicity make this methodology environmentally benign and cost‐effective. [ABSTRACT FROM AUTHOR]

During seismic slip, the elastic strain energy released by the wall rocks drives grain fragmentation and flash heating in the slipping zone, resulting in formation of (nano)powders and melt droplets, which lower the fault resistance. With progressive seismic slip, the frictional melt covers the slip surface and behaves as a lubricant reducing the coseismic fault strength. However, the processes associated to the transition from grain fragmentation to bulk frictional melting remain poorly understood. Here we discuss in situ microanalytical investigations performed on experimentally produced solidified frictional melts from the transition regime between grain fragmentation and frictional melting. The experiments were performed on granitic gneiss at seismic slip rates (1.3 and 5 m/s), normal stresses ranging from 3 to 30 MPa. At normal stresses <12 MPa, the apparent friction coefficient μapp (shear stress versus normal stress) evolves in a complex manner with slip: μapp decreases because of flash weakening, increases up to a peak value μp1 ~0.6–1.0, slightly decreases and increases again to a second peak value μp2 ~0.44–0.83, and eventually decreases with displacement to a steady‐state value μss ~0.3–0.45. In situ synchrotron observations of the solidified frictional melt show abundance of ultrafine quartz grains before μp2 and enrichment in SiO2 at μp2. Because partial melting occurs on the ultrafine quartz grains and, as a consequence, it suggested that the second re‐strengthening (μp2) is induced by the higher viscosity of the melt due to its enrichment in Si from melting of the ultrafine quartz grains derived from grain fragmentation. Key Points: Granitic rocks sheared at seismic slip velocities and low normal stress show double‐strengthening friction evolution before final weakeningParticle size distribution constrained by in situ synchrotron analysis shows the presence of additive ultrafine quartz grainsThe re‐strengthening was due to viscous frictional melts by quasi‐equilibrium melting and the Gibbs‐Thomson effect on quartz grains [ABSTRACT FROM AUTHOR]

OBJECTIVES: Whether early medication reconciliation and integration can reduce polypharmacy and potentially inappropriate medication (PIM) in the emergency department (ED) remains unclear. Polypharmacy and PIM have been recognized as significant causes of adverse drug events in older adults. Therefore, this pilot study was conducted to delineate this issue. DESIGN: An interventional study. SETTING: A medical center in Taiwan. PARTICIPANTS: Older ED patients (aged ≥65 years) awaiting hospitalization between December 1, 2017, and October 31, 2018 were recruited in this study. A multidisciplinary team and a computer‐based and pharmacist‐assisted medication reconciliation and integration system were implemented. MEASUREMENTS: The reduced proportions of major polypharmacy (≥10 medications) and PIM at hospital discharge were compared with those on admission to the ED between pre‐ and post‐intervention periods. RESULTS: A total of 911 patients (pre‐intervention = 243 vs post‐intervention = 668) were recruited. The proportions of major polypharmacy and PIM were lower in the post‐intervention than in the pre‐intervention period (−79.4% vs −65.3%; P < .001, and − 67.5% vs −49.1%; P < .001, respectively). The number of medications was reduced from 12.5 ± 2.7 to 6.9 ± 3.0 in the post‐intervention period in patients with major polypharmacy (P < .001). CONCLUSION: Early initiation of computer‐based and pharmacist‐assisted intervention in the ED for reducing major polypharmacy and PIM is a promising method for improving geriatric care and reducing medical expenditures. J Am Geriatr Soc 67:2298–2304, 2019 [ABSTRACT FROM AUTHOR]

Non‐small‐cell lung cancer (NSCLC) accounts for the majority of the lung cancer cases that have become a leading cause of cancer deaths worldwide. Overexpression of transcription factor forkhead box M1 (FOXM1) is involved in the inauspicious development of several types of cancer, including lung tumor aggressiveness. Our laboratory has previously found that MED28, a Mediator subunit for transcriptional activation, modulates cell growth, epithelial‐mesenchymal transition, migration, and invasion in human breast cancer cells. The objective of the current study is to investigate the potential role of MED28 and FOXM1 in NSCLC. In addition to A549 and PC9 cells, we also used a doxycycline‐inducible system to generate FOXM1‐overexpressed A549‐DN cells, and we explored the connection of MED28 with FOXM1 and their effect on migration. Herein, we report that the increased expression levels of both MED28 and FOXM1 elevated the expression of matrix metalloproteinase 2 (MMP2), a metastasis marker, which enhanced cell migration and matrigel invasion of NSCLC cells. Furthermore, MED28 interacted with FOXM1, and both exhibited a mutual effect on the expression and subcellular localization. Moreover, MED28 small interfering RNA‐mediated MMP2 gene suppression could be attenuated by inducible expression of a constitutively active form of FOXM1, which consequently restored the migration and invasion ability of NSCLC cells. Our data indicate that MED28 interacts with FOXM1, and each affects the expression and localization of the other, and, more importantly, both regulate MMP2‐dependent migration and invasion in human lung cancer cells. The authors reported a mutual effect of MED28, a Mediator subunit, and forkhead box M1 (FOXM1), a transcription factor, in matrix metalloproteinase 2 (MMP2)‐dependent migration and invasion in human non‐small‐cell lung cancer (NSCLC) cells. These findings highlight the significance of MED28 in human lung cancer cells in addition to the previous publications in human breast cancer cells. [ABSTRACT FROM AUTHOR]

In the conventional designs of orthogonal graph filter bank, both eigenvalues and eigenvectors of Laplacian matrix are assumed to be unknown such that graph filter bank can be efficiently implemented by using polynomial graph filters; that is, the output signal at each vertex is computed only from the signal at that vertex and its K ‐hop neighbourhoods. However, the disadvantage of these methods is that the designed orthogonal filter bank does not have the exact perfect reconstruction (PR). In this study, the authors first assume that the eigenvalues of Laplacian matrix are known but eigenvectors are still unknown. Then, the orthogonal graph filter bank is designed by solving the simultaneous equation or Lagrange multiplier method such that the PR condition at all eigenvalues can be achieved for a given graph structure. Although the proposed filter bank is a graph‐structure‐dependent design, it can be efficiently implemented by using polynomial graph filters. Finally, experimental results are shown to demonstrate the effectiveness of the proposed design method. [ABSTRACT FROM AUTHOR]

Summary: Diabetes mellitus may be a risk factor of HCC development in chronic hepatitis B infected patients and affect the all‐cause mortality. This study aimed to examine whether DM was associated with the development of HCC with CHB and affected the all‐cause mortality. A total of 2966 CHB patients newly diagnosed with DM in 2000 were retrieved from the Longitudinal Cohort of Diabetes Patients database and used propensity scores matching based on age, sex‐gender, alcohol‐related liver disease and baseline liver cirrhosis to compare with the non‐DM patients from the Taiwanese National Health Insurance Research Database. The CHB patients with DM compared to the non‐DM had significantly increased (3.3%) risk for HCC development and significantly increased (2.8%) risk of HCC‐related mortality. Interestingly, the all‐cause mortality was significantly higher in the DM cohort (16.9%) compared to the non‐DM cohort (8.2%). In a multivariable transition‐specific Cox model to investigate the adjusted hazard ratio of CHB patients with DM or non‐DM during the transitions from start to HCC was 1.35; 95% CI (1.16‐1.57) and from HCC to death was 1.31; 95% CI (1.06‐1.62). All‐cause mortality between CHB patients with DM or non‐DM during the transitions from start to death was 2.32; 95% CI (1.84‐2.92). Taken together, DM is an independent risk factor associated with increasing disease development of HCC, HCC‐related mortality and all‐cause mortality in CHB patients. This study may provide a clinical strategy for strict DM control in order to reduce the risk of disease development in CHB patients. [ABSTRACT FROM AUTHOR]

Stress interviews can help interviewers effectively measure and evaluate job applicants' emotion regulation in highly stressful settings. This research uses 90 applicants and 62 interviewers as a sample in real interview settings. Results show that there was a positive relationship between interviewers' use of stress interviews and the interviewers' accuracy in assessing applicants' emotion‐regulation abilities, but that there was a negative relationship between interviewers' use of stress interviews and applicants' perceptions of interviewer friendliness and organizational attraction. Implications of this study's findings, contributions, and limitations, as well as future research directions, are discussed. Key points: Researchers seldom examine whether stress interviews can help measure applicants' stress resistance. Stress interviews enhance the accuracy of interviewers' assessments of applicants' emotion‐regulation ability. The use of stress interviews decreases applicants' perceptions of interviewer friendliness and organizational attraction. [ABSTRACT FROM AUTHOR]

A novel class of compounds bearing indole and benzimidazole rings was designed and easily synthesized from 2‐indolecarboxylic acid and o‐phenylenediamine. The catalytic system derived from a 2‐indolylbenzimidazole‐based ligand and Pd(OAc)2 in situ could lead to complete conversion of aryl bromides at 0.5 mol% Pd loading under mild reaction conditions. In the presence of a catalyst, sterically hindered biaryls were selectively generated in excellent yields by adjusting reaction parameters through the coupling of arylboronic acids with aryl halides. The efficiency of this reaction was demonstrated by its compatibility with various functional groups. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: Fluid resuscitation is the mainstay treatment to reconstitute intravascular volume and maintain end‐organ perfusion in patients with severe burns. The use of a hyperosmotic or isoosmotic solution in fluid resuscitation to manage myocardial depression and increased capillary permeability during burn shock has been debated. We conducted a systematic review and meta‐analysis to compare the efficacies of hyperosmotic and isoosmotic solutions in restoring hemodynamic stability after burn injuries. Methods: PubMed, Embase, Cochrane Library, Scopus, and ClinicalTrials.gov registry were searched. Randomized control trials evaluating the efficacy and safety of hyperosmotic and isoosmotic fluid resuscitation in patients with burn injuries were selected. Eligible trials were abstracted and assessed for the risk of bias by two reviewers and results of hemodynamic indicators in the included trials were analyzed. Results: Ten trials including 502 participants were published between 1983 and 2013. Compared with isoosmotic group, the hyperosmotic group exhibited a significant decrease in the fluid load (vol/% total body surface area [TBSA]/weight) at 24 hours postinjury, with a mean difference of −0.54 (95% confidence interval = −0.92 to −0.17). No differences were observed in the urine output, creatinine level, and mortality at 24 hours postinjury between groups. Conclusions: Hyperosmotic fluid resuscitation appears to be an attractive choice for severe burns in terms of TBSA or burn depth. Further investigation is recommended before conclusive recommendation. [ABSTRACT FROM AUTHOR]

Background: The prognosis of out-of-hospital cardiac arrest is generally poor. It is known that the survival of out-of-hospital cardiac arrest patients depends on treatments delivered in a very short time frame. Identifying outcome-associated factors may provide valuable information for decision-making in clinical practices. Aim: The objective of the present study was to assess the associations between various factors (e.g. serum biomarker levels and prehospital factors) and outcomes in adult, non-traumatic out-of-hospital cardiac arrest patients. Methods: Data from 386 consecutive out-of-hospital cardiac arrest patients treated from January 2012 to December 2015 at Taoyuan Chang Gung Memorial Hospital (Taiwan, ROC) were collected. While performing cardiopulmonary resuscitation in the emergency room, the levels of creatinine, aspartate aminotransferase, sodium, potassium, troponin-I, hydrogen bicarbonate and haemoglobin were determined, blood pH and pCO2 were measured and the white blood cell count was calculated. The response time and scene time interval were also recorded. Results: Here we found that out-of-hospital cardiac arrest patients with blood pH values of <7.34 had a lower chance of survival to 24 h (Odds Ratio (OR) = 2.77), survival to discharge (OR = 7.06) and a good neurological outcome (OR = 64.59). Moreover, patients without an automated external defibrillator shock had a lower chance of being discharged (OR = 4.27) and enjoying good neurological outcomes (OR = 25.09). Conclusion: Our data suggest that the blood pH and an automated external defibrillator shockable rhythm are two easily measurable factors strongly associated with the outcomes of out-of-hospital cardiac arrest patients. [ABSTRACT FROM AUTHOR]

Bis-benzimidazolium salts were prepared successfully from commercially available and inexpensive o-phenylenediamine through a series of simple reactions. The bis-NHC-Pd complexes prepared in situ can catalyze Suzuki-Miyaura cross-coupling reaction under very mild conditions in aqueous media with excellent yields. The efficiency of this reaction is demonstrated by its compatibility with a range of functional groups. Di- ortho-substituted biaryls could be accomplished in 89-99% yields. Moreover, the rigorous exclusion of air or moisture is not required in these transformations. [ABSTRACT FROM AUTHOR]

The role of glutathione reductase (GR; EC 1.6.4.2) in the tolerance of Chlamydomonas reinhardtii P.A. Dangeard to high‐intensity light stress (HL, 1400 μmol m−2 s−1) was examined. Cells survived under high light (HL) stress, although their growth was inhibited after long‐term treatment (9‐24 h). GR activity increased 1 h after HL treatment. The contents of total glutathione, reduced glutathione (GSH) and glutathione disulfide (GSSG) increased 1‐3 h after HL treatment and then decreased after 24 h, while the GSH:GSSG ratio (glutathione redox potential) decreased after 3–9 h and recovered after 24 h. The transcript abundance of GR, CrGR1 (Cre06.g262100) and CrGR2 (Cre09.g396252) as well as glutathione synthesis‐related genes, CrGSH1 (Cre02g077100.t1.1) and CrGSH2 (Cre17.g70800.t1.1), increased with a peak near 1 h after HL treatment. Except for enhanced glutathione synthesis, the GR‐mediated glutathione redox machinery is also critical for the tolerance of C. reinhardtii cells to HL stress. Therefore, GR was downregulated or upregulated to investigate the importance of GR in HL tolerance. The CrGR1 knockdown amiRNA line exhibited low GR transcript abundance, GR activity and GSH:GSSG ratio and could not survive under HL conditions. Over‐expression of CrGR1 or CrGR2 driven by a HSP70A:RBCS2 fusion promoter resulted in a higher GR transcript abundance, GR activity and GSH:GSSG ratio and led to cell survival when exposed to high‐intensity illumination, i.e. 1800 μmol m−2 s−1. In conclusion, GR‐mediated modulation of the glutathione redox potential plays a role in the tolerance of Chlamydomonas cells to photo‐oxidative stress. [ABSTRACT FROM AUTHOR]

Recent studies using microarray-based approaches have demonstrated that micro RNAs (mi RNAs) are involved in pain processing pathways. However, a significant proportion of computational predictions of mi RNA targets are false-positive interactions. To increase the chance of identifying biologically relevant targets, we performed an integrated analysis of both mi RNA and mRNA expression profiles in the rat spinal cord during complete Freund's adjuvant ( CFA)-induced inflammatory pain. We generated mi RNA and mRNA arrays from the same corresponding samples on days 5 and 14 after CFA injection. Five mi RNAs and 1096 mRNAs in the CFA 5d group and 16 mi RNAs and 647 mRNAs in the CFA 14d group were differentially expressed based on a filter of at least a 1.5-fold change in either direction. An integrated analysis revealed 54 mRNA targets with an inverse correlation to the expression patterns of three mi RNAs in the CFA 5d group. Seventy-five targets were inversely correlated to six mi RNAs in the CFA 14d group. The mi RNA- mRNA interaction networks revealed significant changes in miR-124, miR-149, miR-3584 and their target genes, IL-6R, ADAM19, LAMC1 and CERS2, in the CFA 5d group. In the CFA 14d group, significant changes were noted in miR-124, miR-29, miR-34, miR-30, miR-338 and their target genes, TIMP2, CREB5 and EFNB1. We also investigated an interaction pair, miR-124-3p and IL-6R, and the results showed that miR-124-3p could attenuate inflammatory pain and decrease IL-6R expression in the spinal cord. These specific mi RNAs and their target genes provide possible avenues for the diagnosis and treatment of inflammatory pain. [ABSTRACT FROM AUTHOR]

Background. Posttraumatic psychiatric disorders (PTPDs) are common in disaster workers; however, their incidence and resilience in healthcare providers (HCPs) following a disastrous earthquake are still unclear. Therefore, we conducted an interventional study to clarify this issue. Methods. After a medical response to the scene of a collapsed huge building, we conducted an assessment of the HCPs using an immediate self-administered questionnaire and a follow-up questionnaire 1 month later. Psychological support after the operation was implemented. We performed analysis of the risk for PTPDs and comparison between immediate and follow-up questionnaires. Results. The mean age (standard deviation) of the HCPs was 32.7 (5.2) years, with 33.5 (5.8) years for nurses and 32.4 (4.4) years for physicians. The proportion of females among the nurses and physicians was 94.3% and 12.5%, respectively. In total, 16.4% (11/67) of HCPs fit the criteria of PTPDs. Nurses had a trend of higher incidence than physicians. Female HCPs had a trend of higher incidence than male HCPs. After intervention, none of the HCPs reported PTPDs in the follow-up questionnaire (p<0.05). Conclusion. This study delineated that PTPDs were common in HCPs following medical response to an earthquake; however, the resilience was good after the early intervention. [ABSTRACT FROM AUTHOR]

Study Objectives. Differences between returning and non-returning minor head injury (MHI) emergency department (ED) patients, between the characteristics of the first visit and revisit, and between admitted and nonadmitted returning patients were investigated. Methods. This was a retrospective study. All discharged ED patients with ICD-9 codes 850.0 to 850.9, 920, and 959.01 in 2013 were enrolled. Patients’ demographic data, vital signs, Glasgow Coma Scale, ED diagnosis, length of stay, triage levels, ED examinations performed, and comorbidities were recorded for analysis. Results. A total of 2,815 patients were enrolled. Of 57 (2%) patients who revisited the ED, 47 (82%) were discharged from the ED and ten (18%) were admitted to the hospital. Patients who returned to the ED were older, and they exhibited more comorbidities. Those who presented with vomiting, triage level of 1 or 2, and GCS score of <15 and who received more blood tests during their first visit were more likely to be admitted when they returned to the ED. Conclusions. Discharging MHI patients who are older or exhibit comorbidities only when symptoms and concerns are relieved completely, providing clear discharge instructions, and arranging timely clinical follow-ups may help reduce such patients’ return rate. [ABSTRACT FROM AUTHOR]

Background Significant differences exist between eastern and western diets, and the way in which Chinese dietary intake relates to specific cognitive domains remains unclear. We aimed to assess the association between dietary patterns ( DPs) and cognitive decline in Chinese elderly. Setting Participants were recruited from the elderly health checkup program of a teaching hospital in Taipei, Taiwan. Participants A total of 475 elders (age ≥65) were included in this prospective cohort study. Measurements The outcome comprised the decline of global and domain-specific cognition between baseline (2011-2013) and follow-up (2013-2015). Dietary data from the previous year were collected via a food frequency questionnaire at baseline, and a factor analysis was performed to identify DPs. Multivariable linear regression and logistic regression models were used to assess associations between Chinese DPs and cognitive decline over 2 years adjusting for selected covariates. Results Three DPs (vegetable, meat, and traditional) were identified. Moderate- or high-score 'vegetable' DP significantly protected against decline of logical memory (recall I: β = 0.16-0.18, odds ratio ( OR) = 0.42-0.48; recall II: β = 0.17-0.21); while high-score DP increased executive function decline (β = −0.22). A high-score 'meat' DP was related to decline of verbal fluency-total score (β = −0.19); while moderate- or high-score 'meat' DP protected against attention decline (β = 0.20-0.22). High-score 'traditional' DP protected against decline of logical memory-recall I (β = 0.18). No significant association was observed for global cognition. Conclusion These findings suggest that three DPs identified in Chinese elderly were associated with different cognitive domains. Further research is needed to explore the efficacy of dietary interventions in reducing cognitive decline in older adults. [ABSTRACT FROM AUTHOR]

Background: Neural crest stem cells (NCSCs) are a population of adult multipotent stem cells. We are interested in studying whether oxygen tensions affect the capability of NCSCs to self-renew and repair damaged tissues. NCSCs extracted from the hair follicle bulge region of the rat whisker pad were cultured in vitro under different oxygen tensions. Results: We found significantly increased and decreased rates of cell proliferation in rat NCSCs (rNCSCs) cultured, respectively, at 0.5% and 80% oxygen levels. At 0.5% oxygen, the expression of both hypoxia-inducible factor (HIF) 1α and CXCR4 was greatly enhanced in the rNCSC nuclei and was suppressed by incubation with the CXCR4-specific antagonist AMD3100. In addition, the rate of cell apoptosis in the rNCSCs cultured at 80% oxygen was dramatically increased, associated with increased nuclear expression of TP53, decreased cytoplasmic expression of TPM1 (tropomyosin-1), and increased nuclear-to-cytoplasmic translocation of S100A2. Incubation of rNCSCs with the antioxidant N-acetylcysteine (NAC) overcame the inhibitory effect of 80% oxygen on proliferation and survival of rNCSCs. Conclusions: Our results show for the first time that extreme oxygen tensions directly control NCSC proliferation differentially via distinct regulatory pathways of proteins, with hypoxia via the HIF1α-CXCR4 pathway and hyperoxia via the TP53-TPM1 pathway. Developmental Dynamics 246:162-185, 2017. © 2016 Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Background and Purpose RNA polymerase II promoters that drive the expression of rationally designed primary micro RNA-based sh RNA, for example, sh RNAmir, can produce more potent gene knockdown than RNA polymerase III promoters. Antagonists of peripheral N methyl-D-aspartate ( NMDA) receptors that do not interfere with central glutamate processing would prevent the development of adverse central nervous system effects. Thus, in this study, we examined the effects of gene silencing and antinociception on formalin- and Complete Freund's adjuvant ( CFA)-induced pain in rats by subcutaneously injecting a lentiviral vector encoding a sh RNAmir that targets the NR1 subunit of the NMDA receptor. Methods Rats received intradermal injections of different doses of NR1 sh RNAmir at different time points before injection of formalin. Pain behavior was assessed by monitoring the paw flinch response, paw withdrawal threshold, and thermal withdrawal latency. We then analyzed NR1 messenger RNA and protein expression in skin and the L5 dorsal root ganglion ( DRG). Results We found that intradermal injection of 1, 5, and 10 μg of sh RNAmir significantly inhibited flinch responses ( p < .05). Administration of 5 μg of sh RNAmir resulted in the attenuation of CFA-induced mechanical allodynia, but did not affect the time spent on the rotarod. Real-time polymerase chain reaction and western blotting revealed that NR1 mRNA and protein levels were significantly lower in all NR1 sh RNAmir1 groups than in controls ( p < .05). There was a significant reduction in the percentage of NR1- and pERK-positive neurons in the DRG ipsilateral to sh RNAmir treated paws ( p < .05). The effect of antinociception and inhibition of NR1 expression by NR1 sh RNAmir was evident on day 3 and persisted for 7 days after injection of 5 μg of vector. Conclusion Peripheral administration of the vector-encoded NR1 sh RNAmir is a promising therapy for persistent inflammatory pain. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of our study was to evaluate the relationship between spleen stiffness measured by transient elastography and the degree of thrombocytopenia in patients with liver cirrhosis. Methods: A total of 67 patients with liver cirrhosis were prospectively enrolled in the study. All patients underwent single‐day hematologic and biochemical tests, sonography, and transient elastography of the liver and spleen. Thrombocytopenia was categorized as mild (platelet count, 75,000–150,000/μL), moderate (50,000–75,000/μL), and severe (<50,000/μL). Results: The degree of thrombocytopenia was significantly correlated with spleen stiffness (P =.001) and spleen size (P =.002) but not with liver stiffness (P =.086). In patients without splenomegaly, spleen stiffness values were significantly higher in patients with thrombocytopenia than in those without thrombocytopenia (P =.035). In patients with splenomegaly, spleen stiffness values were significantly higher in patients with moderate to severe thrombocytopenia than in those with a normal platelet count or mild thrombocytopenia (P =.007). Compared to liver stiffness, spleen stiffness showed a better and statistically significant correlation with platelet count and spleen size in patients with cirrhosis. Conclusions: The degree of thrombocytopenia was directly correlated with spleen stiffness, irrespective of the presence of splenomegaly. The clinical phenomenon of unexpected thrombocytopenia may be explained by a subtle or irreversible change in spleen stiffness. [ABSTRACT FROM AUTHOR]

Backgrounds and Aim. Taiwan’s population is gradually aging; however, there are no comparative data on emergency medical services (EMS) use between the elderly and nonelderly. Methods. We analyzed the emergency calls dealt with between January 1 and April 4, 2014, by EMS in one city in Taiwan. All calls were divided into two groups: elderly (≥65 years) and nonelderly (<65 years). Nontransport and transport calls were compared between the groups for demographic characteristics, transport time, reasons for calling EMS, vital signs, and emergency management. Results. There were 1,001 EMS calls: 226 nontransport and 775 transport calls. The elderly accounted for significantly (P<0.05) fewer (28 (9.2%)) nontransport calls than did the nonelderly (136 (21.4%)). In the transport calls, 276 (35.6%) were the elderly. The elderly had a higher proportion of histories for cardiovascular disease, cerebrovascular disease, hypertension, diabetes, end-stage renal disease, cancer, Parkinson’s disease, and Alzheimer’s disease. In addition, the elderly had significantly longer total transport time, more nontrauma reasons, and poorer consciousness levels and lower oxygen saturation and needed more respiratory management and more frequent resuscitation during transport than did the nonelderly. Conclusion. The elderly have more specific needs than do the nonelderly. Adapting EMS training, operations, and government policies to aging societies is mandatory and should begin now. [ABSTRACT FROM AUTHOR]

An automated gas chromatographic system aimed at performing unattended measurements of ambient volatile organic compounds was configured and tested. By exploiting various off-the-shelf components, the thermal desorption unit was easily assembled and can be connected with any existing commercial gas chromatograph in the laboratory to minimize cost. The performance of the complete thermal desorption gas chromatographic system was assessed by analyzing a standard mixture containing 56 target nonmethane hydrocarbons from C2-C12 at sub-ppb levels. Particular attention was given to the enrichment efficiency of the C2 compounds, such as ethane (b.p. = -88.6°C) and ethylene (b.p. = -104.2°C), due to their extremely high volatilities. Quality assurance was performed in terms of the linearity, precision and limits of detection of the target compounds. To further validate the system, field measurements of target compounds in ambient air were compared with those of a commercial total hydrocarbon analyzer and a carbon monoxide analyzer. Highly coherent results from the three instruments were observed during a two-month period of synchronized measurements. Moreover, the phenomenon of opposite diurnal variations between the biogenic isoprene and anthropogenic species was exploited to help support the field applicability of the thermal desorption gas chromatographic method. [ABSTRACT FROM AUTHOR]

Background and Aim: CO2 has been reported to be absorbed from the bowel more rapidly than air, resulting in a discomfort reduction after colonoscopy. Its role in deeply sedated patients is limited. This study was designed to investigate the efficacy and safety of CO2 insufflation during colonoscopy in patients deeply sedated with propofol. Methods: A total of 125 continuous patients were randomly assigned to receive either CO2 ( n = 63) or air ( n = 62) insufflation during propofol-sedated colonoscopy. Postcolonoscopy abdominal pain, distention, and satisfaction were assessed at 1, 3, and 24 h after the procedure, and the proportions of pain-free and distention-free patients were compared. Residual bowel gas in the colon and small bowel was evaluated at 1 h after colonoscopy. End-tidal CO2 and O2 saturation was measured for safety analysis. Results: There was a significant difference between the two groups regarding the postcolonoscopy abdominal pain, distention, and subjective satisfaction at 1 h ( P < 0.001) and 3 h ( P < 0.01) after the procedure. Patients' pain and distention at 1 and 3 h after the procedure were significantly lower in the CO2 group ( P < 0.01). Residual bowel gas in the colon and small bowel was significantly less in the CO2 group ( P < 0.001). There was no significant difference in end-tidal CO2 levels between two groups before, during, and after the procedure. Conclusions: Compared with air, CO2 insufflation during colonoscopy reduced postcolonoscopy abdominal discomfort and improved patients' satisfaction. It was safe to use CO2 insufflation in deeply sedated colonoscopy. [ABSTRACT FROM AUTHOR]

The geriatric population (aged ≥65 years) accounts for 12–24% of all emergency department (ED) visits. Of them, 10% have a fever, 70–90% will be admitted and 7–10% of will die within a month. Therefore, mortality prediction and appropriate disposition after ED treatment are of great concern for geriatric patients with fever. We tried to identify independent mortality predictors of geriatric patients with fever, and combine these predictors to predict their mortality. Methods: We enrolled consecutive geriatric patients visiting the ED between 1 June and 21 July 2010 with the following criteria of fever: a tympanic temperature ≥37.2°C or a baseline temperature elevated ≥1.3°C. We used 30-day mortality as the primary end-point. Results: A total of 330 patients were enrolled. Hypotension, bedridden, leukocytosis, thrombocytopenia and serum creatinine >2 mg/dL, but not age, were independently associated with 30-day mortality. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) ranged from 18.2% to 90.9%, 34.7% to 100%, 9.0% to 100% and 94.5% to 98.2%, respectively, depending on how many predictors there were. Conclusions: The 30-day mortality increased with the number of independent mortality predictors. With at least four predictors, 100% of the patients died within 30 days. With none of the predictors, just 1.8% died. These findings might help physicians make decisions about geriatric patients with fever. [ABSTRACT FROM AUTHOR]

Physicians in Taiwan have a heavy workload and a stressful workplace, both of which may contribute to cardiovascular disease. However, the risk of acute myocardial infarction (AMI) in physicians is not clear. This population-based cohort study used Taiwan’s National Health Insurance Research Database. We identified 28,062 physicians as the case group and randomly selected 84,186 nonmedical staff patients as the control group. We used a conditional logistic regression to compare the AMI risk between physicians and controls. Subgroup analyses of physician specialty, age, gender, comorbidities, area, and hospital level were also done. Physicians have a higher prevalence of HTN (23.59% versus 19.06%, P<0.0001) and hyperlipidemia (21.36% versus 12.93%, P<0.0001) but a lower risk of AMI than did the controls (adjusted odds ratio (AOR): 0.57; 95% confidence interval (CI): 0.46–0.72) after adjusting for DM, HTN, hyperlipidemia, and area. Between medical specialty, age, and area subgroups, differences in the risk for having an AMI were nonsignificant. Medical center physicians had a lower risk (AOR: 0.42; 95% CI: 0.20–0.85) than did local clinic physicians. Taiwan’s physicians had higher prevalences of HTN and hyperlipidemia, but a lower risk of AMI than did the general population. Medical center physicians had a lower risk than did local clinic physicians. Physicians are not necessary healthier than the general public, but physicians, especially in medical centers, have a greater awareness of disease and greater access to medical care, which permits timely treatment and may prevent critical conditions such as AMI induced by delayed treatment. [ABSTRACT FROM AUTHOR]

ABSTRACT 2-Aminobiphenyls (2-ABP) induces oxidative DNA damage and leads to apoptosis. The precise signaling pathways of inducing apoptosis in vitro are still unknown. This study provides insight into the relationship between 2-ABP-induced apoptosis and the activation of MAPK and downstream transcription factors using pharmacological inhibitors of ERK, p38, and JNK pathways. Results showed that 2-ABP induced the activation of ERK and JNK but not p38. The ERK/JNK pathways downstream transcription factors, c-Jun and ATF-2, were also activated by 2-ABP. The inhibitory effects of ERK inhibitor, U0126, on 2-ABP-induced caspase-3 activity were not detected. However, JNK inhibitor, SP600125, significantly attenuated the caspase-3 activity induced by 2-ABP. The expression of the transcription factors c-Jun and ATF-2 were decreased in 2-ABP treated cells in the presence of ERK/JNK inhibitors, suggesting that the expression of ERK/JNK pathways leads to the downstream activation of c-Jun and ATF-2. N-acetylcysteine, an ROS scavenger, inhibited 2-ABP-induced activation of ERK and JNK, the cell death and caspase-3 activity, which suggested that oxidative stress plays a crucial role in apoptosis through activation of caspase-3 in a ROS/JNK-dependent signaling cascade. © 2013 Wiley Periodicals, Inc. Environ Toxicol 30: 205-211, 2015. [ABSTRACT FROM AUTHOR]

Aims/Introduction Hyperglycemic crises without a history of diabetes have not been well studied. We compared the clinical characteristics of patients with and without a history of diabetes, and evaluated the glycated hemoglobin levels. Materials and Methods Consecutive adult patients (aged >18 years) visiting the emergency department ( ED) between January 2004 and December 2010 were enrolled if they met the criteria for a hyperglycemic crisis. Patients were separated into those without and those with a history of diabetes. The 30-day mortality was the primary end-point. Results We enrolled 295 patients who made 330 visits to the ED. Patients without a history of diabetes made up 24.5% (81/330) of the hyperglycemic crises. Patients without a history of diabetes were more prone than patients with a history of diabetes to be younger and male, and to have better consciousness and renal function, more significant diabetic signs and symptoms (e.g., thirst, polydipsia, polyuria and bodyweight loss), higher blood sugar, and less opportunity of infection and mortality. Most of the patients (93.8%, 76/81) had glycated hemoglobin of ≥6.5%. Conclusions The present study delineates the clinical characteristics of patients with hyperglycemic crises, but without a history of diabetes. Most patients had glycated hemoglobin ≥6.5%, which raises the argument of using this biomarker for routine screening of diabetes. [ABSTRACT FROM AUTHOR]

The main purpose of this study is to investigate whether applicants' impression management ( IM) tactics indirectly influence hiring recommendations through cognitive mechanisms (i.e. recruiters' perceptions of person-organisation [ P- O] fit, person-job [ P- J] fit, and person-recruiter [ P- R] fit) or affective mechanisms (i.e. recruiters' positive mood) during authentic employment interviews for actual job openings. Participants consisted of 221 applicant-recruiter dyads from 50 companies in Taiwan. The results demonstrated that applicants' self-focused IM tactics are positively related to recruiter perceptions of P- J fit, which in turn influence hiring recommendations. In addition, applicant other-focused IM tactics affect hiring recommendations through recruiters' perceptions of P- O fit. Moreover, applicants' non-verbal IM tactics were positively related to recruiters' positive mood, which in turn affected recruiters' perceptions of P- J fit and P- O fit, thereby affecting hiring recommendations. [ABSTRACT FROM AUTHOR]