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Purpose This study examined the efficacy of prescribing antibiotics, specifically a single dose of vancomycin, in reducing the incidence of culture-positive and culture-negative sepsis prior to the removal of peripherally inserted central catheters (PICCs). Materials and methods We retrospectively reviewed charts of infants who had PICCs in a tertiary level hospital during the period from 2010 to 2019. The incidence of post-catheter removal clinical sepsis between the groups with or without antibiotics was compared. The antibiotic group was defined by receiving a single dose of vancomycin or any other antibiotic prior to line removal. Results We enrolled 585 PICC removal episodes in 546 infants for analysis. Antibiotics were given prior to removal in 257 cases (43.9%) and not given prior to removal in 328 cases (56.1%). There were 13 episodes of post-catheter removal clinical sepsis detected within 72 h (2.2%), 2 of which were culture-positive (0.3%). A 9.3-fold decrease in the odds for clinical sepsis was observed in the antibiotic group (p = 0.01). The incidence of post-catheter removal sepsis was decreased by a single prophylactic dose of vancomycin (p = 0.02), whereas the use of other antibiotics showed no effect (p = 0.35). Logistic regression analysis demonstrated that comorbidities with gastrointestinal diseases (p = 0.01), PICC insertion sites in the scalp and neck (p = 0.04), and no vancomycin administration prior to line removal (p = 0.02) were independent risk factors for subsequent clinical sepsis. Conclusion A single prophylactic dose of vancomycin prior to PICC line removal might reduce clinical sepsis events in infants.

Introduction: Palpitation is a common complaint among patients presenting to emergency departments or cardiologists. Palpitation caused by organic heart diseases, such as coronary atherosclerotic heart disease and hypertensive heart disease, may be a sign of a life-threatening condition. In such cases, treatment with western medicines or surgeries is warranted. However, for patients with palpitation caused by non-cardiac factors, western medicine treatment is often ineffective, and traditional Chinese medicine has comparatively superior advantage. With the change in people's lifestyle and habits in the past decades, the time spent sitting and that with a forward head posture is increasing, which has accelerated the process of spinal aging and increased the incidence rate of spinal diseases. Case presentation: A 54-year-old female presented with paroxysmal palpitations, chest depression, and neck pain that had lasted for more than 2 months. Western medicine diagnosis was palpitations due to spinal disorders, while the traditional Chinese medicine diagnosis was palpitation (heart and spleen deficiency). The patient was treated with traditional Chinese massage, 30 min sessions, 5 times a week, 3 weeks totally. Subsequently, the patient's neck pain and numbness disappeared and the palpitations, chest tightness, and dizziness ameliorated. The patient resumed regular appetite, experienced better sleep, and had further improvement of spirit, enabling her to lead a normal life. Conclusions: Traditional Chinese massage therapy can relieve muscle spasm, regulate cervical facet joint disorder and dislocation, release adhesion, relieve synovial incarceration, restore the dynamic and static balance of the cervical spine, improve blood circulation of the cervical spine, increase the nutritional supply of the cervical spine and surrounding soft tissue, and promote metabolism and tissue repair. All these advantages make it a good complementary and alternative therapy for palpitation caused by spine disorders.

Purpose This study aimed to compare the safety and efficacy of clarithromycin-naproxen-oseltamivir combination therapy to that of oseltamivir therapy alone in hospitalized pediatric influenza patients. Methods This prospective, single-blind study included children aged 1–18 years hospitalized with influenza, in MacKay Children’s Hospital, Taiwan, between December 2017 and December 2019. The primary outcomes were the time to defervescence and decrease of the Pediatric Respiratory Severity Score (PRESS) during hospitalization. The secondary outcomes were serial changes in virus titers, measured using real-time polymerase chain reaction. Results Fifty-four patients were enrolled (28 in the control group and 26 in the combination group) in total. There were no differences in the patients’ baseline characteristics between the groups. The time to defervescence was significantly shorter in the combination group than the oseltamivir group (13.2 hours vs. 32.1 hours, p=0.002). The decrease in the virus titer from days 1 to 3 (log Δ13) was more pronounced in the combination group than the oseltamivir group. (39% vs. 19%, p=0.001). There were no differences in adverse effects such as vomiting, diarrhea, and abdominal pain during the study or within 30 days after antiviral therapy. Conclusion The clarithromycin-naproxen-oseltamivir combination group experienced a more rapid defervescence and a more rapid decline of influenza virus titer than the group treated with oseltamivir alone. Further consideration should be given to whether the overall benefits of combination therapy in hospitalized pediatric influenza patients outweigh the risks.

To evaluate the intraocular pressure (IOP)-reducing efficacy and safety of Rho-kinase inhibitor (RKI). Published studies in PubMed and EMBASE were searched on March 20, 2021. Study selection and data extraction were performed according to PRISMA. Meta-analysis of the IOP-lowering effect was performed with the bivariate random-effects model, with studies categorized into 2 classes: RKI versus placebo and RKI versus another medication. The main outcome was the difference in IOP reduction between RKI and non-RKI groups. Subgroup analysis of adjunctive RKI efficacy and additional review of its major ocular adverse events (AE) were also performed. Ten (2.6%) out of 391 studies were retrieved. In the RKI versus placebo class, RKI showed greater IOP reduction after 4–8 weeks (mean difference = − 1.69 mmHg [− 2.22, − 1.16], P

Introduction Coronavirus disease 2019 (COVID-19) has had an enormous impact worldwide, and vaccination is believed to be the method that will control the pandemic. Several types of vaccines developed using different platforms have been authorized, but the immunogenicity and reactogenicity of heterologous prime–boost vaccination with different vaccines remain largely unclear. Areas covered Electronic databases including PubMed, Embase, medRxiv, Research Square, and SSRN were searched to investigate the immunogenicity and reactogenicity associated with heterologous vaccination. As of 30 June 2021, four trials including 1,862 participants were identified. Heterologous administration of BNT162b2 (BNT) in ChAdOx1 (ChAd)-primed participants (ChAd/BNT) showed noninferior immunogenicity to homologous BNT administration (both prime and booster were BNT vaccines, BNT/BNT) with tolerable reactogenicity and higher T cell responses. Compared with homologous ChAdOX1 vaccination (ChAd/ChAd), heterologous ChAd/BNT was found to elicit higher immunogenicity (ChAd/BNT vs. ChAd/ChAd, antibody titer ratio: 9.2). Expert opinion Our systematic review found robust immunogenicity and tolerable reactogenicity of heterologous administration of a BNT162b2 boost in ChAdOx1-primed participants. An additional benefit of stronger T cellular immunity was also observed. Heterologous vaccination is a reasonable and feasible strategy to combat COVID-19. Further studies are warranted to confirm the benefits and identify the optimal combinations, doses, and intervals.

Supplemental Digital Content is available in the text., Background: This phase 2 observer-blind, randomized, multicenter, dose-ranging study evaluated immunogenicity and safety of different formulations of an AS03-adjuvanted H5N1 influenza vaccine in children 6–35 months of age. Methods: One hundred eighty-five children randomized into 5 groups [1.9 µg hemagglutinin (HA)/AS03B, 0.9 µg HA/AS03C, 1.9 µg HA/AS03C, 3.75 µg HA/AS03C or 3.75 µg HA/AS03D] were to receive 2 doses administered 21 days apart (primary vaccination). AS03 was classified by amount of DL-α-tocopherol, with AS03B the highest amount. One year later, all subjects were to receive unadjuvanted 3.75 µg HA as antigen challenge. Immunogenicity was assessed 21 days after primary vaccination (day 42) and 7 days after antigen challenge (day 392). Immunogenicity-fever index, based on hemagglutination inhibition and microneutralization antibody titers at day 42 and fever 7 days after each vaccination, was used to guide the selection of an acceptable formulation. Results: After primary vaccination, formulations elicited strong homologous immune responses with all subjects’ hemagglutination inhibition titers ≥1:40 post-vaccination. Immunogenicity-fever index based on hemagglutination inhibition and microneutralization assays showed that 1.9 µg HA/AS03B ranked the highest. Antibody levels persisted >4 times above baseline 12 months after primary vaccination with all formulations (day 385). Antibodies increased >4-fold after antigen challenge (day 392/day 385) with 1.9 µg HA/AS03B, 0.9 µg HA/AS03C and 1.9 µg HA/AS03C formulations. Overall per subject, the incidence of fever ranged from 28.6% (3.75 µg HA/AS03D) to 60.5% (1.9 µg HA/AS03B). Conclusions: All formulations were highly immunogenic and demonstrated acceptable safety profiles, with the 1.9 µg HA/AS03B providing the most favorable balance of immunogenicity versus reactogenicity for use in children 6–35 months of age.

Diabetes mellitus (DM) is a common comorbidity and risk factor for postoperative complications in head and neck (H&N) microsurgical reconstructions. Our study focused on the association between DM and individual complications regarding both surgical and medical aspects. A meta-analysis of English-language articles comparing a series of complications between DM and non-DM H&N free-flap recipients was performed by comprehensive meta-analysis (CMA). Twenty-seven articles presented 14,233 H&N free-flap reconstructions, and a subset of 2329 analyses including diabetic cases was included for final analysis. Total postoperative (RR = 1.194, p p = 0.030) and surgical (RR = 1.550, p = 0.001; OR = 3.362, p p = 0.001; OR = 1.999, p = 0.001) and surgical site infections (OR = 2.414, p

Background Despite the increasingly recognized impact of novel coronavirus disease (COVID-19), caused by severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), on many aspects of health in adults and children, its effects on neonates born to infected mothers remain unclear. We conducted this study to investigate the outcomes of neonates born to mothers with COVID-19. Methods We searched the medical databases from inception to March 31, 2020 to perform a systematic review of outcomes in neonates born to mothers with COVID-19. Data were pooled using a random effects regression model. Primary and secondary outcomes were neonatal clinical outcomes and infectious status, respectively. Results Fourteen studies involving 105 neonates fulfilling the study criteria were identified. The rates of preterm neonates and those small for gestational age (SGA) were 25 (23.8%) and 10 (11.2%), respectively. Among 91 neonates who were tested, 8 (8.8%) were positive for nucleic acids or antibodies for SARS-CoV-2. Additionally, 28 (26.7%) of the neonates were symptomatic and two test-negative neonates died, including one stillbirth. Between test-positive and test-negative groups, the rates of SGA, preterm delivery, duration between maternal symptom onset and delivery, and perinatal complication were not significantly different; but the rate of symptomatic after birth reached significant difference (62.5% vs 20.5%, p = 0.008). Conclusions Most neonates born to infected mothers had favorable outcomes. Although direct evidences of intrauterine infection were scarce, the risk of intrauterine infection should be considered based on a positive test in 8.8% of the neonates. Symptomatic neonates born to infected mothers should receive tests for SARS-CoV-2 to initiate appropriate treatment and quarantine. Further studies are warranted to assess the outcomes of COVID-19 in neonates.

Background: Vagus nerve stimulation (VNS) is used as an add-on treatment for epilepsy. This study aimed to use Taiwanese nationwide registry data to analyze the therapeutic effects of VNS in children with refractory epilepsy (RE) and try to explore predictive factors of VNS treatment effectiveness. Methods: This retrospective study collected data from December 2007 to December 2014. Patient variables included gender, age, VNS implantation date, epilepsy duration, seizure frequency, seizure type, etiology, and antiepileptic drug (AED) history. We divided patients into three groups: Group I as seizure frequency >80 times per month, Group II as seizure frequency 24–80 times per month, and Group III as seizure frequency

Background Porcine circovirus type 1 (PCV-1) material was detected in the human rotavirus vaccine (HRV) in 2010. In this study we compared immunogenicity and safety of the PCV-free HRV vaccine (PCV-free HRV) with HRV. PCV-free HRV is an HRV with no detectable PCV-1 and PCV-2 according to the limit of detection of the tests used. Methods Healthy infants 6–12 weeks of age were randomized (1:1:1:1) to receive 2 doses of 1 of the 3 lots of PCV-free HRV or HRV. The study objectives were to demonstrate lot-to-lot consistency of the PCV-free HRV and noninferiority of PCV-free HRV as compared to HRV in terms of immunogenicity, 1–2 months post dose 2. Reactogenicity and safety were also assessed. Results Overall, 1612 infants were enrolled and 1545 completed the study. Study objectives were demonstrated because the predefined criteria were met. Among participants receiving PCV-free HRV and HRV, 79.27% and 81.76% seroconverted and geometric mean concentrations were 159.5 and 152.8 U/mL, respectively. The incidences of adverse events and serious adverse events were similar between the pooled PCV-free HRV and HRV groups. Conclusions The 3 PCV-free HRV lots demonstrated consistency and PCV-free HRV was noninferior compared to HRV in terms of immunogenicity. Clinical trials registration NCT02914184.

Background Japanese encephalitis (JE) is a significant public health concern in the Asia-Pacific region, with a case-fatality rate of around 20% for those who develop encephalitis. Mouse-brain derived vaccines against JE have been used in the publicly funded national immunization program (NIP) in Taiwan since 1968. They were replaced with a live-attenuated recombinant vaccine (JE-CV, IMOJEV®) in May 2017. We assessed reports of adverse events (AE) following the introduction of JE-CV into the Taiwan NIP to characterize its post-licensure safety profile. Methods AEs reported between 1 May 2017 and 31 December 2018 post vaccination with JE-CV were extracted from the National Adverse Drug Reactions (ADR) Reporting System, a passive surveillance system run by the Taiwan Food and Drug Administration. The report rates were calculated based on the number of doses distributed by the manufacturer during the assessment period. Results There were 51 AEs reported among 30 subjects (12 girls and 18 boys; mean age 25 months), with a reporting rate of 4.7 AEs per 100,000 doses distributed. The AEs occurred after a median of. 1-day post vaccination. Eight subjects had received concomitant vaccination with another vaccines. There were four serious AEs reported: febrile seizure, acute renal failure, viral respiratory tract infection, and injection site cellulitis. None of these serious AEs were classified as being causally related to JE-CV vaccination. Conclusion These post-licensure AE surveillance data confirm the favorable safety profile of JE-CV.

Background/purpose The prevalence of developmental disabilities in Taiwan remains unclear, especially in young children under the age 3. We aimed to study the prevalence of developmental disabilities and verify a useful developmental screening tool in a community setting in Taiwan. Methods We conducted a prospective cross-sectional study in northeastern Taiwan from July 2008 to December 2009 in children aged 4 months to 6 years old from well-child visits. We devised a screening program using Taipei City Developmental Screening Checklist for Preschoolers, 2nd Version (Taipei-II), a validated parent-report milestone checklist tailored to the Taiwanese culture and language to assess the prevalence of developmental disabilities in Taiwan. Information about the children's medical conditions and their family were recorded. Results A total of 3214 children were recruited, of whom 365 had developmental disabilities, with an overall prevalence of 11.36%. Speech and language delay/disorders were the most common developmental problems followed by motor delays, with prevalence rates of 4.79% and 2.33%, respectively. Low economic status, prematurity and/or small for gestational age and a history of perinatal hypoxia or underlying medical disorders were the main risk factors correlated with developmental delays. However, foreign-born mother and aboriginal families were not important factors for poor developmental outcomes. Conclusion The prevalence rate of developmental disabilities in northeastern Taiwan was 11.36%. Low economic status, prematurity and/or small for gestational age and a history of underlying medical disorders were the main risk factors correlated with developmental disabilities. Taipei II is an easy-to-use and effective developmental surveillance tool for Taiwanese children.

BACKGROUND Malassezia pachydermatis is a rare cause of systemic infection in infants. METHODS A total of 4 cases of M. pachydermatis fungemia that occurred in our neonatal intensive care unit over a 21-month period were reviewed, as well as 27 cases reported in the literature since 1988. RESULTS The patients were preterm with multiple complications and had birth weights ranging from 490 to 810 g and gestational age between 23 and 26 weeks. All patients had received prophylactic fluconazole, broad-spectrum antibiotics and parenteral lipid supplements before fungemia onset, which occurred between the age of 7 and 28 days. Symptoms were nonspecific and thrombocytopenia was the primary laboratory finding. All patients received intravenous antifungal treatment and recovered from their infection. The 27 cases from review of the literature also indicated that the infected infants were extremely low birth weight (77.8%), with multiple underlying diseases (94.7%), receiving lipid-supplementation (100%) from a central vascular catheter. Most infants received antifungal treatment (73.1%) and catheter removal (73.1%) as the management. CONCLUSIONS M. pachydermatis is a pathogenic agent that causes late onset sepsis in critically ill low birth weight infants with generally good outcomes. Targeted antifungal treatment as well as catheter removal appear to be key factors for infection management.

Background: Children with tracheostomy are at increased risk for respiratory tract infections, yet the risk involved in tracheostomy related infections is unclear. Methods: We conducted a retrospective review of the medical records of children who underwent tracheostomy between January 2002 and December 2016 at a teaching hospital in Taipei. Demographics, underlying disease, indication for tracheostomy, laboratory data and management, and long-term outcome data were collected. Infection episodes were grouped into definite, possible, non-bacterial pneumonia, and local infection groups. Results: Ninety patients were enrolled. Forty-two (46.7%) patients had infections that required hospitalization. Definite bacterial pneumonia accounted for 12 (8.5%) episodes, 113 episodes (80.1%) were possible bacterial pneumonia, 12 (8.5%) were non-bacterial pneumonia, and 4 (2.8%) were local infections. Patients with definite and possible bacterial pneumonia were found to have a longer hospital duration than patients with non-bacterial pneumonia (p=0.024), with mean hospitalization stays of 8.83±5.59 days and 5.67±2.55 days, respectively. The median duration from tracheostomy to bacterial pneumonia was 1.78 years (range, 0.04- 11.38) whereas for the non-bacterial pneumonia group it was 0.57 years (range, 0.04-6.61). Cerebral palsy (CP) (adjusted odds ratio [AOR] 3.65; 95% confidence interval [CI]: 1.11-11.99; p=0.033) and gastroesophageal reflux disease (GERD) (AOR 2.84; 95% CI: 1.09-7.38; p=0.033) were independently associated with respiratory tract infections in these children. Conclusion: In this study, CP and GERD were associated with infections in children with tracheostomy. Bacterial and non-bacterial pneumonia are difficult to differentiate clinically which may lead to unnecessary antibiotics use. Keywords: Children, Respiratory tract infections, Tracheostomy

Background: Mycoplasma pneumoniae is a common pathogen of respiratory tract infections in pediatric patients. Serological studies are traditional methods for the diagnosis. However, early diagnosis of M. pneumoniae infections remains problematic. We investigate the value of early serum immunoglobulin A (IgA), in addition to immunoglobulin G (IgG), and immunoglobulin M (IgM) levels, in children infected with M. pneumoniae. Methods: From August 2016 to February 2017, we enrolled pediatric patients based on both clinical symptoms and chest x-ray, and confirmed by positive throat culture for M. pneumoniae. Serum titers of M. pneumoniae IgM, IgG, and IgA during the acute phase were checked. All respiratory samples were further analyzed by polymerase chain reaction (PCR). Diagnostic values of different tests were evaluated. Results: Fifty-six patients fulfilled the diagnostic criteria, with a median age of 4.84 years. Most of them (89.3%) were enrolled within 7 days of disease onset. PCR was positive in 71.4% of the study population. Early IgG samples were of limited value in diagnosing M. pneumoniae infection, of which 89.3% showed a negative result. Positive rates of early serum IgA and IgM were 48.2% and 46.4%, respectively. In combination with IgA and/or IgM, the sensitivity increased to 71.4% during their early clinical course. Conclusions: In the pediatric population, combined serological tests of M. pneumoniae IgA and IgM, offer an accurate method of early diagnosis comparable to that of PCR, and can be an alternative choice for prompt detection of mycoplasma infections when PCR and culture are not available. Keywords: Mycoplasma pneumoniae, Children, Diagnosis, Culture, Serology

Japanese encephalitis (JE) is a mosquito-borne viral infection which is prevalent in Taiwan. The virus circulates in an enzootic cycle in pigs which serve as amplifying hosts. Outbreaks typically occur during summer. A universal vaccination program using 4-shot mouse brain-derived inactivated vaccine has successfully controlled JE epidemics in Taiwan since 1968. More than 90% of JE cases in recent years were older than 20 years in Taiwan. Because of several drawbacks, mouse brain-derived vaccine has been replaced by newer generation JE vaccines, including inactivated Vero cell-derived vaccine and live chimeric vaccine. The present article describes the recommendations in Taiwan for the use of new JE vaccines and the schedules for shifting between different JE vaccines. Key Words: epidemiology, immunization schedule, Japanese encephalitis, vaccination

Background: Influenza is a major cause of acute respiratory infection burden worldwide, leading to many hospitalizations. An annual influenza vaccine is believed to be the best way to prevent influenza-related illnesses. We focused on the efficacies of other possible preventive measures such as increasing sun exposure time and dietary supplements to prevent these illnesses. Methods: We conducted a matched-pair case–control study along with the Taiwan Pediatric Infectious Disease Alliance. We included influenza-related hospitalized patients with age ranging from 6 months to 5 years during the 2012–2013, 2013–2014, 2014–2015, and 2015–2016 influenza seasons. The controls were comparable to cases in age, sex, and residential area and had no influenza-related hospitalization records in the same season. We extracted data from vaccination histories and got the patients’ guardians to complete questionnaires. Data were analyzed using conditional logistic regression. Results: We enrolled 1514 children (421 influenza-infected cases and 1093 controls) in the study. We found seasonal influenza vaccination to be an independent protective factor against hospitalizations owing to influenza [p 7 h/week had a significantly lower risk of influenza-related hospitalizations than those with the mean sun exposure time of ≤7 h/week (p 7 h of sun exposure/week may also be associated with lower risk of influenza-related hospitalizations in children. Keywords: Influenza, Vaccine effectiveness, Hospitalization, Sun exposure time

Simple Summary Glossina morsitans is a species of tsetse flies and a vector for Human African Trypanosomiasis, which is a severe parasitic infectious illness that can lead to death unless treated. At present, the G. morsitans are mainly found in sub-Saharan Africa. But modifications of its distribution undergoing as a result of climate change is still unknown. In order to provide scientific basis for effective monitoring and G. morsitans control, this study aimed to collect the distribution and to explore the potentially suitable habitat for G. morsitans under various scenarios. We downloaded the major data of G. morsitans occurrence from the Global Biodiversity Information Facility. Maxent software and R language were employed to analyze the relationship between occurrence records and climatic variables and project the potentially suitable habitat for G. morsitans in historical and future periods. The results showed that Isothermality contributed most to the distribution of G. morsitans. The predicted potentially suitable areas for G. morsitans under historical climate conditions include a large area of Africa near and below the equator, small equatorial regions of southern Asia, America, and Oceania. Under the future climate conditions, the potentially suitable areas would decline about −5.38 ± 1.00% as a whole under all SSPs compared with 1970–2000. Abstract Glossina morsitans is a vector for Human African Trypanosomiasis (HAT), which is mainly distributed in sub-Saharan Africa at present. Our objective was to project the historical and future potentially suitable areas globally and explore the influence of climatic factors. The maximum entropy model (MaxEnt) was utilized to evaluate the contribution rates of bio-climatic factors and to project suitable habitats for G. morsitans. We found that Isothermality and Precipitation of Wettest Quarter contributed most to the distribution of G. morsitans. The predicted potentially suitable areas for G. morsitans under historical climate conditions would be 14.5 million km2, including a large area of Africa which is near and below the equator, small equatorial regions of southern Asia, America, and Oceania. Under future climate conditions, the potentially suitable areas are expected to decline by about −5.38 ± 1.00% overall, under all shared socioeconomic pathways, compared with 1970–2000. The potentially suitable habitats of G. morsitans may not be limited to Africa. Necessary surveillance and preventive measures should be taken in high-risk regions.

Simple Summary Climate change has a significant impact on the quantity and distribution of vectors and may thus threaten the health of the population. We used the maximum entropy model to predict the near-current distribution of potentially suitable areas for Anopheles philippinensis and Anopheles nivipes in the world, as well as the distribution of potentially suitable areas in China under future climate scenarios. We also constructed a vector risk assessment system to assess the possibility of the two mosquito species invading China. Among the meteorological factors, the precipitation in September makes the greatest contribution to the distribution of areas suitable for the two mosquito species, which have a moderate risk of invading China. The relevant management departments should formulate scientific prevention and control measures for the two mosquitoes according to meteorological factors and the risk level of invasion. Abstract Background: Anopheles philippinensis and Anopheles nivipes are morphologically similar and are considered to be effective vectors of malaria transmission in northeastern India. Environmental factors such as temperature and rainfall have a significant impact on the temporal and spatial distribution of disease vectors driven by future climate change. Methods: In this study, we used the maximum entropy model to predict the potential global distribution of the two mosquito species in the near future and the trend of future distribution in China. Based on the contribution rate of environmental factors, we analyzed the main environmental factors affecting the distribution of the two mosquito species. We also constructed a disease vector risk assessment index system to calculate the comprehensive risk value of the invasive species. Results: Precipitation has a significant effect on the distribution of potentially suitable areas for Anopheles philippinensis and Anopheles nivipes. The two mosquito species may spread in the suitable areas of China in the future. The results of the risk assessment index system showed that the two mosquito species belong to the moderate invasion risk level for China. Conclusions: China should improve the mosquito vector monitoring system, formulate scientific prevention and control strategies and strictly prevent foreign imports.

Background:Precisely predicting coronary artery aneurysms (CAAs) remains a clinical challenge. We aimed to investigate whether coronary dimensions adjusted for body surface area (Z scores) on baseline echocardiography and clinical variables before primary treatment could predict the presence of late CAAs.Methods:We conducted a retrospective study including children hospitalized for Kawasaki disease and received intravenous immunoglobulin within 10 days of illness. We defined late CAAs as a maximum Z score (Zmax) ≥2.5 of the left main, right, or left anterior descending coronary artery at 11–60 days of illness. Associations between late CAAs and clinical parameters and baseline maximum Z scores were analyzed.Results:Among the 314 included children, 31 (9.9%) had late CAAs. Male, higher C-reactive protein, and higher baseline Zmax were risk factors of late CAAs. Late CAAs were significantly associated with baseline Zmax ≥2.0 vs. P< 0.001). The odds ratio for late CAAs among the patients with baseline Zmax ≥2.0 vs. P< 0.001). The sensitivity, specificity, positive predictive value, and negative predictive value of baseline Zmax ≥2.0 for the presence of later CAAs were 80.6, 81.6, 32.5, and 97.5%, respectively.Conclusions:Findings from this study suggest that Zmax ≥2.0 of coronary arteries on baseline echocardiography may be used to predict children at a high risk of late CAAs and allow for targeted early intensification therapy.

Background A feasible and accurate risk prediction systems for emergency department (ED) patients is urgently required. The Modified Early Warning Score (MEWS) is a wide-used tool to predict clinical outcomes in ED. Literatures showed that machine learning (ML) had better predictability in specific patient population than traditional scoring system. By analyzing a large multicenter dataset, we aim to develop a ML model to predict in-hospital morality of the adult non traumatic ED patients for different time stages, and comparing performance with other ML models and MEWS. Methods A retrospective observational cohort study was conducted in five Taiwan EDs including two tertiary medical centers and three regional hospitals. All consecutively adult (>17 years old) non-traumatic patients admit to ED during a 9-year period (January first, 2008 to December 31th, 2016) were included. Exclusion criteria including patients with (1) out-of-hospital cardiac arrest and (2) discharge against medical advice and transferred to other hospital (3) missing collect variables. The primary outcome was in-hospital mortality and were categorized into 6, 24, 72, 168 hours mortality. MEWS was calculated by systolic blood pressure, pulse rate, respiratory rate, body temperature, and level of consciousness. An ensemble supervised stacking ML model was developed and compared to sensitive and unsensitive Xgboost, Random Forest, and Adaboost. We conducted a performance test and examine both the area under the receiver operating characteristic (AUROC) and the area under the precision and recall curve (AUPRC) as the comparative measures. Result After excluding 182,001 visits (7.46%), study group was consisted of 24,37,326 ED visits. The dataset was split into 67% training data and 33% test data for ML model development. There was no statistically difference found in the characteristics between two groups. For the prediction of 6, 24, 72, 168 hours in-hospital mortality, the AUROC of MEW and ML mode was 0.897, 0.865, 0.841, 0.816 and 0.939, 0.928, 0.913, 0.902 respectively. The stacking ML model outperform other ML model as well. For the prediction of in-hospital mortality over 48-hours, AUPRC performance of MEWS drop below 0.1, while the AUPRC of ML mode was 0.317 in 6 hours and 0.2150 in 168 hours. For each time frame, ML model achieved statistically significant higher AUROC and AUPRC than MEWS (all P P 3, >4, and >5) were determined as baselines for comparison, ML mode consistently showed improved or equally performance in sensitivity, PPV, NPV, but not in specific. Conclusion Stacking ML methods improve predicted in-hospital mortality than MEWS in adult non-traumatic ED patients, especially in the prediction of delayed mortality.

BackgroundIt has been seemed that the gut microbiome alterations might be proposed as the metabolic disorder. However, the relationship between the microbiome and AMI has not been well validated. Methods The feces of the 44 subjects (AMI: 19; control: 25) were collected for fecal genomic DNAs extraction. The variable region V3–V4 of the 16S rRNA gene was sequencing by the platform of Illumina Miseq. The abundances of metabolites were analyzed by the Kyoto Encyclopedia of Genes and Genomes (KEGG) metabolic pathways. ResultsThe abundance of bacteria was more enriched in the AMI group both in the observed operational taxonomic units (OTUs) and faith phylogenetic diversity (PD) (p-value=0.01 and Selenomonadales was less enriched in the AMI group at the Family, Genus, and Species levels [all linear discriminant analysis (LDA) scores >2]. The seleno-compound was more abundant in the AMI group at the Family, Genus, and Species levels (all LDA scores >2).Conclusions This is the first study to demonstrate Selenomonadales and seleno-compound to be associated with the occurrence of AMI. Our findings provide an opportunity for a novel prevention and treatment of AMI.

Background: Left atrial (LA) size represents atrial fibrillation (AF) burden and has been shown to be a predictor for AF stroke. The CHA2DS2-VASc score is also a well-established predictor of AF stroke. It is unknown to cardiologists whether these two risk scores are correlated, whether both are independent prognostic predictors and complimentary to each other, or whether one of them is a major determinant of stroke risk for AF patients.Method: A total of 708 patients from the National Taiwan University Atrial Fibrillation Registry were longitudinally followed up for more than 15 years. Left atrial size was measured by M mode of echocardiography. Adverse thromboembolic endpoints during follow-up were defined as ischemic stroke or transient ischemic attack.Results: The mean age was 72.1 ± 12.9 years, with 53% men. Both LA size and CHA2DS2-VASc score were associated with the risk of stroke in univariate analyses. There was a weak but significant positive correlation between LA size and CHA2DS2-VASc score (r = 0.17, P < 0.0001). Patients with higher CHA2DS2-VASc scores had a higher mean LA size (P < 0.01 for trend). When combining LA size and CHA2DS2-VASc score in the multivariable Cox model, only CHA2DS2-VASc score remained statistically significant [HR 1.39 (1.20–1.63); P < 0.001].Conclusion: LA size is not an independent predictor of AF stroke, and calculation of CHA2DS2-VASc score may be an alternative to measurement of echocardiographic LA size when evaluating the risk of stroke for AF patients.

Background & Aims Sofosbuvir is approved for chronic hepatitis C (CHC) patients with severe chronic kidney disease (CKD). The impact of sofosbuvir-based therapy on renal function augmentation on a real-world nationwide basis is elusive. Methods The 12,995 CHC patients treated with sofosbuvir-based (n = 6802) or non–sofosbuvir-based (n = 6193) regimens were retrieved from the Taiwan nationwide real-world HCV Registry Program. Serial estimated glomerular filtration rate (eGFR) levels were measured at baseline, end of treatment (EOT), and end of follow-up (EOF) (3 months after EOT). Results The eGFR decreased from baseline (91.4 mL/min/1.73 m2) to EOT (88.4 mL/min/1.73 m2; P 90 mL/min/1.73 m2 was the only factor independently associated with significant slope coefficient differences of eGFR (–1.98 mL/min/1.73 m2; 95% confidence interval, –2.24 to –1.72; P Conclusions Both sofosbuvir and non–sofosbuvir-based regimens restored renal function in CHC patients with CKD, especially in those with significant renal function impairment.

Background: Little is known regarding the impact of socioeconomic factors on the use of evidence-based therapies and outcomes in patients with heart failure with reduced ejection fraction across Asia. Methods: We investigated the association of both patient-level (household income, education levels) and country-level (regional income level by World Bank classification, income disparity by Gini index) socioeconomic indicators on use of guideline-directed therapy and clinical outcomes (composite of 1-year mortality or HF hospitalization, quality of life) in the prospective multinational ASIAN-HF study (Asian Sudden Cardiac Death in Heart Failure). Results: Among 4540 patients (mean age: 60±13 years, 23% women) with heart failure with reduced ejection fraction, 39% lived in low-income regions; 34% in regions with high-income disparity (Gini ≥42.8%); 64.4% had low monthly household income (P interaction Conclusions: These findings highlight the importance of socioeconomic determinants among patients with heart failure in Asia and suggest that attention should be paid to address disparities in access to care among the poor and less educated, including those from wealthy regions. Registration: URL: https://clinicaltrials.gov ; Unique Identifier: NCT01633398.

Background: Campylobacter and Non-typhoidal Salmonella (NTS) are the two most common bacterial pathogens associated with acute gastroenteritis in children. This study aims to elucidate the epidemiology of Campylobacter and NTS gastroenteritis and develop a scoring system to differentiate them. Materials and methods: This retrospective study enrolled 886 children ≤18 years of age, hospitalized due to acute gastroenteritis with stool culture-proven Campylobacter or NTS infection from July 2012 to December 2015. Pearson's chi-square test and multivariate logistic regression were used to compare clinical manifestations and laboratory data. Receiver operating characteristic curves were plotted to evaluate the scoring system. Results: Seasonality was found in NTS gastroenteritis from May to September, but no seasonality in Campylobacter gastroenteritis. Campylobacter jejuni and Salmonella serogroup B were the most common pathogens. The median ages were 68.2 and 18.5 months and the incidence rates of bacteremia were 0.6% and 7.1% in the Campylobacter and NTS groups, respectively. Salmonella serogroup C2 infection had the highest risk of bacteremia (OR: 5.9, 95% CI: 2.8–12.7, p

To evaluate the clinical manifestations, management, and outcomes of Mycobacterium bovis Bacillus Calmette-Guérin (BCG) osteitis/osteomyelitis.We reviewed 71 cases of BCG osteitis/osteomyelitis registered in Taiwan's vaccine injury compensation program (VICP) in 1998-2014. Demographic, clinical, laboratory, treatment, and outcome data were compared according to site(s) of infection.Involvement of a long bone of the lower extremity was present in 36.6% of the children, followed by foot bone (23.9%), rib or sternum (15.5%), upper extremity long bone (9.9%), hand bone (7%), multiple bones (4.2%), and vertebrae (2.8%). Children with lower extremity long bone involvement had a longer interval from receipt of BCG vaccine to presentation (median, 16.0 months; P = .02), and those with foot bone infection had higher rates of swelling (94.1%; P = .02) and local tenderness (76.5%; P = .004). Surgical intervention was performed in 70 children, with no significant difference in the number of procedures by site (median, 1.0 procedure per patient). Among the 70 children who received antimicrobial therapy, those with vertebral and multifocal infections had a longer duration of treatment (P .001) and/or second-line antituberculosis medications (P = .002). Three children with vertebral and multifocal infections had major sequelae with kyphosis or leg length discrepancy. Outcomes were good for children with involvement of the ribs, sternum, and peripheral bones without multifocal involvement. The average time for functional recovery was 6.2 ± 3.9 months.Children with BCG osteitis/osteomyelitis in different bones had distinct presentations and outcomes. Pediatricians should consider BCG bone infection in young vaccinated children with insidious onset of signs and symptoms, and consider affected site(s) in the management plan.

Background: Concerns about non-typeable Haemophilus influenzae (NTHi) in otitis media (OM) have grown after the introduction of pneumococcal conjugate vaccine (PCV). We aim to better understand the clinical role of NTHi in pediatric OM. Methods: Middle ear fluid samples from children

Inhalation is the most important route of entry for aerosol particles. Deposition in the respiratory tract is affected by many factors, such as particle size, shape, charge, density, breathing pattern and physical tract structure. However, most of the currently available lung deposition data are on Caucasians, with very limited data on Taiwanese. Therefore, it is essential to clarify whether there is a significant difference in respiratory tract deposition between Caucasian and Taiwanese individuals. This work is thus aimed at characterizing regional lung deposition in Taiwanese. A rapid method of measuring regional lung deposition was employed in the present study. The experimental system consisted of an aerosol chamber, a mouthpiece, a pneumotachograph flow meter, and a particle counter. A cylinder-piston type breathing machine was used to generate a series of “standard” breathing patterns for subjects to follow. In addition to oral breathing, nasal breathing was also conducted. A special respirator was employed to facilitate measurements of the nasal route deposition. The regional lung deposition data obtained in this work showed good agreement with previous studies based on the bolus technique, indicating that the difference in lung deposition between Taiwanese and Caucasian individuals is negligible. The local deposition efficiency increased with the penetration volume. This increased trend was particularly prominent in the deep lungs, which was likely due to the dilution effect caused by the relatively clean air in the functional residual capacity. When a fixed fraction of the forced vital capacity was used to replace the fixed tidal volume, the total lung deposition became less dependent on the tidal volume. Primarily due to nostril hairs and the complex configuration of the nasal turbinate, the local deposition efficiency of the nasal route was higher than that of the oral route but only in the early stage of penetration (200 mL).

Trapped temporal horn of lateral ventricle (TTHLV) is a rare condition of isolated focal hydrocephalus. We report two cases with different presentations, etiologies, and surgical managements. The first case involved an extremely preterm male baby with a history of ventriculitis and intraventricular hemorrhage; he received external ventricle drainage twice due to obstructive hydrocephalus. TTHLV was detected by sonography. He received a ventriculoperitoneal shunt involving two catheters to bypass the adhesion site. There was no ventricular dilatation during 2 years of follow-up. The second case involved a term baby with an enlarged head; brain sonography revealed left focal hydrocephalus with TTHLV and mild midline shift. Neuroendoscopic cystoventriculostomy with fenestration from the left trigone to the frontal horn was performed and serial follow-up brain sonography for 3 months showed decreased ventricle size. The suitable surgical techniques for the management of TTHLV should be adjusted according to the patients' condition to obtain more favorable outcomes. Brain sonography can be a useful tool for the diagnosis and for following up the surgical outcomes in infants with TTHLV.

This study used photoplethysmography signals to classify hypertensive into no hypertension, prehypertension, stage I hypertension, and stage II hypertension. There are four deep learning models are compared in the study. The difficulties in the study are how to find the optimal parameters such as kernel, kernel size, and layers in less photoplethysmographyt (PPG) training data condition. PPG signals were used to train deep residual network convolutional neural network (ResNetCNN) and bidirectional long short-term memory (BILSTM) to determine the optimal operating parameters when each dataset consisted of 2100 data points. During the experiment, the proportion of training and testing datasets was 8:2. The model demonstrated an optimal classification accuracy of 76% when the testing dataset was used.

Since December 2019, the outbreak of coronavirus disease 2019 (COVID-19) has spread rapidly around the world. The severity of COVID-19 ranges from asymptomatic carriers to severe acute respiratory distress syndrome (ARDS). Accumulating evidence has shown that COVID-19 may be associated with multiple organ complications including cardiac injury, viral myositis and neurological deficits. Numerous laboratory biomarkers including lymphocytes, platelets, lactate dehydrogenase and creatine kinase (CK) have been associated with the prognostic outcomes of patients with COVID-19. However, dynamic correlations between levels of biomarkers and clinical course have not been studied. Herein, we report a 74-year-old female patient with severe COVID-19 which progressed to ARDS requiring intubation and mechanical ventilation. The laboratory findings showed lymphopenia, hypogammaglobulinemia, and elevated inflammatory biomarkers and CK. She received intensive therapy with hydroxychloroquine, lopinavir/ritonavir, and azithromycin with limited effects. Immunomodulatory treatments with high dose intravenous immunoglobulin and baricitinib were prescribed with satisfactory biochemical, radiographic and clinical recovery. We found an interesting correlation between serum CK elevation and inflammatory biomarkers, which reflected clinical improvement. This case demonstrates that inflammatory biomarkers, cytokines, and CK level correlated with disease severity and treatment response, and combined use of intravenous immunoglobulin and baricitinib is a potential treatment in patients with severe COVID-19.

Background: There is an increasing interest about the mechanisms of acute myocardial infarction (AMI). To investigate the influence of the gut microbiota and the metabolic pathway in associated with AMI, we conduct this case-control study. Methods: We explore 44 subjects with/without AMI (AMI: 19 vs control: 25) and feces are collected from each subject. The fecal microbial genomic DNA is extracted and the variable region, V3–V4, of the 16S rRNA gene is sequencing by the platform of Illumina Miseq. The number of observed operational taxonomic units (OTUs) at 97% similarity level is classified. A histogram of linear discriminant analysis (LDA) distribution is also implemented by the LDA effect size analysis (LEfSe) to find bacteria with significant differences in relative abundance between two groups. The abundances of metabolites are analyzed by the KEGG metabolic pathways. Findings: The abundance of bacteria is more enriched in the AMI group both in the observed OTUs and faith phylogenetic diversity (PD) ( p -value= 0.01 and 2). There is also a difference of the seleno-compound distribution between the groups. The seleno-compound is more abundant in the AMI group at the Family, Genus, and Species levels (all LDA scores >2). Interpretation: This is the first study to demonstrate Selenomonadales and seleno-compound to be associated with the occurrence of AMI. Our findings provided an opportunity for the novel therapeutic strategies for prevention and treatment of AMI. Funding Statement: None. Declaration of Interests: All authors disclose no financial and personal relationships with other people or organisations that could inappropriately influence (bias) their work. Ethics Approval Statement: This study is approved by the Institutional Review Board committee on human research of the medical research department, National Taiwan University Hospital Taiwan.

For the "COVID-19" pandemic spreading around the globe, the successful development of nucleic acid testing reagents is critical to disease prevention and control. It has also made governments and institutions aware of the importance of original innovation for disruptive technology. Based on the literature review, this paper discusses the concepts of disruptive technology and original innovation. It then extracts the core elements for original innovation by analyzing two cases of the fundamental research teams of Tsinghua University. Finally, it puts forward a model on achieving original innovation for disruptive technology to a project or team.

Most enterprises want to increase their competitiveness through the implementation of disruptive technology, but not all enterprises have achieved their initial expectations after adopting disruptive technologies. One of the most important reasons is that the enterprise itself is not well prepared for a disruptive technology in all aspects, which leads to many problems and risks in the implementation process. As the successful implementation of disruptive technology depends on enterprises’ innovativeness. The extant research focuses on its predictive identification, technical characteristics, and application directions. However, there is a lack of research on organizational preparation for implementing disruptive technologies to promote their success. Based on the technology-organization-environment (TOE) framework, this study reviews the literature to explore the readiness of enterprises adopting and implementing disruptive technologies. It extracts the factors that affect technological readiness, organizational readiness and environmental readiness respectively. Affecting an organization’s choice of adopting disruptive technologies, these three aspects of readiness ultimately determine their success.

Introduction: However, the reference ranges for echocardiography might be varying due to ethnicity, gender and age. Therefore, the normal reference ranges obtained from the healthy Asians are important for clinical utility of echocardiography in Asia. Methods: Population-based echocardiography dataset from 6,023 healthy ethnic Asians (47.1±10.9 years, 61.3% men) were divided into 6 age decades: ≤29, 30-39, 40-49, 50-59, 60-69 and ≥70 years. We explored age- and sex-related structural/functional alterations according to 2016 American Society of Echocardiography (ASE) diastolic dysfunction (DD) criteria and their correlates with clinical N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off for heart failure (HF). Racial comparisons were made using data from London Life Sciences Prospective Population (LOLIPOP) study. Results: Age- and sex-based normative reference ranges (including mean, median, 10% and 90% lower and upper reference values) were extracted from our large healthy population. In fully adjusted models, advanced age (treated as linear) was independently associated with cardiac structural remodeling and worsened diastolic parameters: larger indexed LA volume (LAVi), lower e’, higher E/e’, and higher TR velocity; all p interaction : Conclusions: This is to date the largest cohort exploring the normative reference values using guideline-centered diastolic parameters from healthy Asians, with senescence process played as central role in diastolic dysfunction. Observed sex and ethnic differences in defining healthy diastolic cut-offs likely impact future clinical definition for DD.

Introduction: Exosomes were found to be involved in the pathophysiological process of coronary artery disease (CAD). The study investigated the relationship of the exosome amounts and imaging markers of myocardial perfusion in patients with CAD. Methods: Peripheral blood was collected from patients who had more than 70% luminal stenosis of coronary arteries on coronary angiography. Plasma exosomes were extracted by chemical precipitation and flow cytometry (CytoFLEX BB10068). Further confirmation of exosome surface markers was performed by Western blot. The myocardial perfusion imaging (MPI) of single photon emission computed tomography performed less than 6 months before coronary angiography were retrospectively reviewed. Perfusion deficits of MPI were scored visually by a nuclear medicine physician. Functional parameters of MPI were generated from gated images by QPS/QGS software (Cedars-Sinai), including ejection fraction (EF), diastolic function, shape index of heart, etc. The amounts of exosomes were correlated with the perfusion deficits and functional parameters of MPI using Spearman’s correlation. Comparison of the exosome amounts between patients with normal or abnormal functional parameters was performed by Mann-Whitney U test. Results: Exosome amounts and MPI images from 40 patients with CAD were analyzed. Exosome amounts have poor correlation with perfusion and functional parameters of MPI (all R value Conclusions: CAD patients with abnormal systolic function have increasing amounts of exosomes. Exosomes may participate in the dysfunction process of ischemic heart disease. The exact casual relationship and mechanism needs further investigation.

Background Ischemia/reperfusion of the intestine often leads to distant organ injury, but the mechanism of intestinal ischemia/reperfusion-induced renal dysfunction is still not clear. The present study aimed to investigate the mechanisms of acute renal damage after intestinal ischemia/reperfusion challenge and explore the role of released high-mobility group box-1 in this process. Methods Intestinal ischemia/reperfusion was induced in male Sprague-Dawley rats by clamping the superior mesenteric artery for 1.5 hours. At different reperfusion time points, anti−high-mobility group box-1 neutralizing antibodies or ethyl pyruvate were administered to neutralize or inhibit circulating high-mobility group box-1, respectively. Results Significant kidney injury was observed after 6 hours of intestinal reperfusion, as indicated by increased serum levels of urea nitrogen and creatinine, increased expression of neutrophil gelatinase-associated lipocalin, interleukin-6, and MIP-2, and enhanced cell apoptosis, as indicated by cleaved caspase 3 levels in renal tissues. The levels of phosphorylated eIF2ɑ, activating transcription factor 4, and C/EBP-homologous protein (CHOP) were markedly elevated, indicating the activation of endoplasmic reticulum stress in the impaired kidney. High-mobility group box-1 translocated to cytoplasm in the intestine and serum concentrations of high-mobility group box-1 increased notably during the reperfusion phase. Both anti−high-mobility group box-1 antibodies and ethyl pyruvate treatment significantly reduced serum high-mobility group box-1 concentrations, attenuated endoplasmic reticulum stress in renal tissue and inhibited the development of renal damage. Moreover, the elevated expression of receptor for advanced glycation end products in the kidneys after intestinal ischemia/reperfusion was abrogated after high-mobility group box-1 inhibition. Conclusion These results suggested that high-mobility group box-1 signaling regulated endoplasmic reticulum stress and promoted intestinal ischemia/reperfusion-induced acute kidney injury. High-mobility group box-1 neutralization/inhibition might serve as a pharmacological intervention strategy for these pathophysiological processes.

Coronavirus disease 2019 (COVID-19) patients exhibited protean clinical manifestations. Olfactory and gustatory abnormalities (anosmia and ageusia) were observed in COVID-19 patients, but the reported prevalence varied. In this systematic review, the prevalence of olfactory and gustatory abnormalities (OGA) was evaluated in laboratory-confirmed COVID-19 patients. On 8 May 2020, 14,506 articles were screened, while 12 of them were enrolled. A total of 1739 COVID-19 patients were analyzed, with a wide range of prevalence observed (5.6–94%). The pooled prevalence was 48.5% with high heterogeneity (I2, 98.8%; p < 0.0001). In total, 15.5% had OGA as their first symptom (I2, 22.6%; p = 0.27) among the patients analyzed. Contradictory to COVID-19 negative controls, patients with COVID-19 had a higher risk of OGA (odds ratio, 5.3; I2, 66.5%; p = 0.03). In conclusion, approximately half of COVID-19 patients had OGA, and one-seventh of them had OGA as their initial symptoms. OGA were cardinal symptoms of COVID-19, which may serve as clues for early diagnosis. Diagnostic testing for SARS-CoV-2 was suggested in patients with OGA during the COVID-19 pandemic to ensure timely diagnosis and appropriate quarantine.

Background: Diastolic dysfunction (DD) has shown to be a hallmark pathological intermediate in the development of heart failure with preserved ejection fraction (HFpEF). We aim to establish age- and sex-stratified normal reference values of diastolic indices and to explore racial-differences. Methods: We explored age- and sex-related structural/functional alterations from 6023 healthy ethnic Asians (47.1 ± 10.9 years, 61.3% men) according to 2016 American Society of Echocardiography (ASE) diastolic dysfunction (DD) criteria. Racial comparisons were made using data from London Life Sciences Prospective Population (LOLIPOP) study. Results: Age- and sex-based normative ranges (including mean, median, 10% and 90% lower and upper reference values) were extracted from our large healthy population. In fully adjusted models, advanced age was independently associated with cardiac structural remodeling and worsened diastolic parameters including larger indexed LA volume (LAVi), lower e’, higher E/e’, and higher TR velocity; all p

This paper reports a novel investigation of the voltage modulation efficiency (VME) in scanning capacitance microscopy (SCM). A signal intensity model was used to define the VME, which is dependent on the impedance components in an SCM setup. In SCM, the VME was found to play a key mediating role in the close relationship between the signal intensity and the modulation voltage, providing an indicator for the surface treatment and the back-contact process of an SCM specimen. We observed that, for silicon-based specimens, ultraviolet-assisted oxidation and microwave annealing improved the specimen surface and the back-contact, respectively, which increased the VME. It was also found that a high modulation voltage and a large back-contact area may induce a significant stray capacitance around the conductive tip and, hence, lower the VME. The VME degradation not only decreased the SCM signal intensity but also reduced the image contrast in the regions with high carrier concentrations. In addition, our experimental results further revealed that the signal intensity model also provided a promising opportunity to establish a precise and quantitative method for measuring the thickness of insulating layers.

Background Taiwan has the highest end-stage renal disease prevalence in the world, and the costs on the maintenance of dialysis imposes a great financial burden on National Health Insurance. Routine urinalysis provides an opportunity for the early detection of microalbuminuria. We evaluated the accuracy of semi-quantitative chemical methods from Siemens Novus Pro12 dipstick for albumin-creatinine ratio (ACR). Methods We collected 1029 random urine samples and performed urinary analytic tests by Siemens Novus with Pro12 dipsticks and also calculated the urinary ACR. The reference method was performed by Hitachi LST008, a quantitative assay. The percentage of exact agreement in ACR was 81.9% between Siemens Novus and Hitachi LST008. The percentage of agreement within 1 level between the 2 methods was 98.5%. When ACR > 30 mg/g was defined as the threshold for positive results, the sensitivity, specificity, positive, and negative predictive values for microalbuminuria were 87.2%, 91.6%, 91.5%, and 87.3%, respectively. There were 778 cases with negative results of urinary protein, analyzed by conventional dipsticks. 149 of 778 (19.2%) cases were positive, measured by Pro12 dipsticks, and 111 of 149 (74.5%) cases were confirmed positive ACR by Hitachi LST008. Conclusions Urinary ACR measured by Siemens Novus with Pro12 dipsticks was shown to be a reliable test for detection of microalbuminuria.

Background To analyze the findings of cranial ultrasonographic screening in asymptomatic neonates and to assess the association between abnormal results and neurodevelopment. Methods We retrospectively reviewed the cranial ultrasonographic screening results of healthy neonates born between 35 and 42 weeks gestation at our hospital from October 2011 to October 2018. Results In total, 11,681 neonates underwent cranial ultrasonographic screening during the study period, and 9666 (82.7%) had normal results. Of 2015 neonates with abnormal findings, 294 had more than two abnormalities. The most common minor findings were subependymal cysts (8.99%), choroid plexus cysts (2.43%), lenticulostriate vasculopathy (2.34%), frontal horn cysts (1.80%), and enlarged cisterna magna (1.04%). Then, 33 (0.28%) neonates had major abnormalities, including cerebral hemorrhage, periventricular heterotopia, focal cortical dysplasia, anomalies of the corpus callosum, and vascular malformation. Of 1334 neonates who underwent serial clinical evaluations, 76 (5.69%) had neurodevelopmental disorders, including developmental delay, attention-deficit/hyperactivity disorder, and autistic spectrum disorder. Conclusion The incidence rate of intracranial anomalies in healthy neonates was 17.3%, and about 5.69% had neurodevelopmental disorders. Cranial ultrasonographic screening has its own value in helping early detection of intracranial anomalies in healthy neonates, some of which have prognostic implications.

A strategy to covalently connect crystalline covalent organic frameworks (COFs) with semiconductors to create stable organic-inorganic Z-scheme heterojunctions for artificial photosynthesis is presented. A series of COF-semiconductor Z-scheme photocatalysts combining water-oxidation semiconductors (TiO2 , Bi2 WO6 , and α-Fe2 O3 ) with CO2 reduction COFs (COF-316/318) was synthesized and exhibited high photocatalytic CO2 -to-CO conversion efficiencies (up to 69.67 μmol g-1 h-1 ), with H2 O as the electron donor in the gas-solid CO2 reduction, without additional photosensitizers and sacrificial agents. This is the first report of covalently bonded COF/inorganic-semiconductor systems utilizing the Z-scheme applied for artificial photosynthesis. Experiments and calculations confirmed efficient semiconductor-to-COF electron transfer by covalent coupling, resulting in electron accumulation in the cyano/pyridine moieties of the COF for CO2 reduction and holes in the semiconductor for H2 O oxidation, thus mimicking natural photosynthesis.

Respiratory viruses are a common cause of respiratory tract infection (RTI), particularly in neonates and children. Rapid and accurate diagnosis of viral infections could improve clinical outcomes and reduce the use of antibiotics and treatment sessions. Advances in diagnostic technology contribute to the accurate detection of viruses. We performed a multiplex real-time polymerase chain reaction (PCR) to investigate the viral etiology in pediatric patients and compared the detection rates with those determined using traditional antigen tests and virus cultures. Fifteen respiratory viruses were included in our investigation: respiratory syncytial virus A/B (RSV), influenza virus A (FluA) and influenza virus B (FluB), human metapneumovirus (MPV), enterovirus (EV), human parainfluenza virus (PIV) types 1&ndash, 4, human rhinovirus (RV), human coronavirus OC43, NL63, and 229E, human adenovirus (ADV), and human bocavirus (Boca). In total, 474 specimens were collected and tested. Respiratory viruses were detected more frequently by PCR (357, 75.3%) than they were by traditional tests (229, 49.3%). The leading pathogens were RSV (113, 23.8%), RV (72, 15.2%), PIV3 (53, 11.2%), FluA (51, 10.8%), and ADV (48, 10.1%). For children younger than 5 years, RSV and RV were most prevalent, for children older than 5 years, FluA and ADV were the most frequently detected. Of the specimens, 25.8% (92/357) were coinfected with two or more viruses. RV, Boca, PIV2, FluB, and PIV4 had higher rates of coinfection, MPV and PIV1 had the lowest rates of coinfection (9.1% and 5.3%). To conclude, the detection power of PCR was better than that of traditional antigen tests and virus cultures when considering the detection of respiratory viruses. RSV and RV were the leading viral pathogens identified in the respiratory specimens. One-quarter of the positive specimens were coinfected with two or more viruses. In the future, further application of PCR may contribute to the rapid and accurate diagnosis of respiratory viruses and could improve patient outcomes.

Background Data comparing outcomes in heart failure ( HF ) across Asia are limited. We examined regional variation in mortality among patients with HF enrolled in the ASIAN ‐HF (Asian Sudden Cardiac Death in Heart Failure) registry with separate analyses for those with reduced ejection fraction ( EF ; Methods and Results The ASIAN ‐ HF registry is a prospective longitudinal study. Participants with symptomatic HF were recruited from 46 secondary care centers in 3 Asian regions: South Asia (India), Southeast Asia (Thailand, Malaysia, Philippines, Indonesia, Singapore), and Northeast Asia (South Korea, Japan, Taiwan, Hong Kong, China). Overall, 6480 patients aged >18 years with symptomatic HF were recruited (mean age: 61.6±13.3 years; 27% women; 81% with HF and reduced r EF ). The primary outcome was 1‐year all‐cause mortality. Striking regional variations in baseline characteristics and outcomes were observed. Regardless of HF type, Southeast Asians had the highest burden of comorbidities, particularly diabetes mellitus and chronic kidney disease, despite being younger than Northeast Asian participants. One‐year, crude, all‐cause mortality for the whole population was 9.6%, higher in patients with HF and reduced EF (10.6%) than in those with HF and preserved EF (5.4%). One‐year, all‐cause mortality was significantly higher in Southeast Asian patients (13.0%), compared with South Asian (7.5%) and Northeast Asian patients (7.4%; P Conclusions This first multinational prospective study shows that the outcomes in Asian patients with both HF and reduced or preserved EF are poor overall and worst in Southeast Asian patients. Region‐specific risk factors and gaps in guideline‐directed therapy should be addressed to potentially improve outcomes. Clinical Trial Registration URL : https://www.clinicaltrials.gov/ . Unique identifier: NCT 01633398.