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Background: Gastroesophageal reflux disease (GERD) may cause airway symptoms and some airway diseases exacerbate GERD symptoms. Asthma and allergic rhinitis (AR) have been identified as united airway disease because of their similar epidemiology and pathophysiology. Asthma has been considered a risk factor to develop GERD. However, the association between AR and GERD is not clear. We tried to investigate whether AR could increase the development of GERD. Methods: Children diagnosed as AR without a prior history of GERD were conducted from the National Health Insurance Research Database between 2000 and 2005. After propensity score matching, we enrolled 36,588 children with AR and 36,588 non-AR children as the controls. Cox regression models were adopted to calculate the hazard ratio (HR) of GERD. Results: AR children had a significantly increased risk of GERD than non-AR children (adjusted HR 1.91, 95% CI = 1.73–2.11, p

OBJECTIVES The purpose of this study was to investigate the value of high-frequency ultrasound and shear wave elastography (SWE) in quantitative differential diagnosis of high-risk and low-risk basal cell carcinomas (BCCs). METHODS A total of 52 BCCs confirmed by surgical pathology were studied. Taking pathologic subtypes as reference, all the cases were classified as high-risk BCCs or low-risk BCCs. High-frequency ultrasound parameters and SWE parameters recorded preoperatively were retrospectively analyzed. The differences of two groups were compared. RESULTS There were 12 high-risk BCCs and 40 low-risk BCCs. The maximum infiltration depth (MID) and average Young's modulus (Eave ) of high-risk BCCs were 5.76 ± 2.56 mm and 31.61 ± 12.36 kPa, whereas of low-risk BCCs were 4.29 ± 1.77 mm and 20.04 ± 4.74 kPa, respectively, P .05. Taking 5.5 mm of MID and 24.45 kPa of Eave as the threshold for the diagnosis of high-risk BCCs, the sensitivity, specificity, and accuracy were 58.3%, 82.5%, 76.9% and 75.0%, 82.5%, 80.8%, P > .05. CONCLUSIONS The MID and Eave of the lesion can be used to determine the recurrence risk of BCCs and provide a reference for the development of individualized treatment plans.

The Clinical and Laboratory Standards Institute (CLSI) revised the fluoroquinolone MIC breakpoints for Enterobacterales in 2019, based on pharmacokinetic/pharmacodynamic analyses. However, clinical evidence supporting these breakpoint revisions is limited. A retrospective study was conducted at 3 hospitals in Taiwan between January 2017 and March 2019. Patients treated with levofloxacin for bacteremia caused by members of the Enterobacterales with high MICs (1 or 2 μg/ml; levofloxacin susceptible by pre-2019 CLSI breakpoints) were compared with those with low-MIC bacteremia (≤0.5 μg/ml; levofloxacin susceptible by 2019 CLSI breakpoints) to assess therapeutic effectiveness by multivariable logistic regression. The primary outcome was 30-day mortality, and the secondary outcome was the emergence of levofloxacin-resistant isolates within 90 days after levofloxacin initiation. A total of 308 patients were eligible for the study. Kaplan-Meier analysis showed that patients infected with high-MIC isolates (n = 63) had a significantly lower survival rate than those infected with low-MIC isolates (n = 245) (P = 0.001). Multivariable logistic regression revealed that high levofloxacin MIC was a predictor of 30-day mortality (odds ratio [OR], 6.05; 95% confidence interval [CI], 1.51 to 24.18; P = 0.011). We consistently found similar results in a propensity score-matched cohort (OR, 5.38; 95% CI, 1.06 to 27.39; P = 0.043). The emergence of levofloxacin-resistant isolates was more common in the high-MIC group than the low-MIC group (25.0% versus 7.5%; P = 0.065). An estimated area under the concentration-time curve/MIC ratio of ≥87 was significantly associated with better survival (P = 0.002). In conclusion, patients infected with isolates with levofloxacin MICs within the pre-2019 CLSI susceptible range of 1 or 2 μg/ml exhibited higher mortality than those infected with isolates with MICs of ≤0.5 μg/ml.

Ambient temperature change is one of the risk factors of human health. Moreover, links between white blood cell counts (WBC) and diseases have been revealed in the literature. Still, we do not know of any association between ambient temperature change and WBC counts. The aim of our study is to investigate the relationship between ambient temperature change and WBC counts. We conducted this two-year population-based observational study in Kaohsiung city, recruiting voluntary community participants. Total WBC and differential counts, demographic data and health hazard habits were collected and matched with the meteorological data of air-quality monitoring stations with participants’ study dates and addresses. Generalized additive models (GAM) with penalized smoothing spline functions were performed for the trend of temperature changes and WBC counts. There were 9278 participants (45.3% male, aged 54.3 ± 5.9 years-old) included in analysis. Compared with stable weather conditions, the WBC counts were statistically higher when the one-day lag temperature changed over 2 degrees Celsius, regardless of whether colder or hotter. We found a V-shaped pattern association between WBC counts and temperature changes in GAM. The ambient temperature change was associated with WBC counts, and might imply an impact on systematic inflammation response.

This study developed a novel chair-side tongue pressure (TP) measuring instrument with a disposable positioning mouthpiece controlled using a smartphone application (APP), denoted as the TP wireless application (TPWA). The mouthpiece was designed with a palate-shaped air balloon containing a tongue contact bump and a plastic bite positioning tube. Fatigue load testing was performed to evaluate mouthpiece durability by applying 700 displacement cycles (50 times a day for one week during training, with twice the safety factor) on the air balloon. The main component used in developing this instrument was a silicon pressure sensor equipped with wireless Bluetooth connection. Young (52 adults, mean age = 20.23 ± 2.17) and elderly (40 adults, mean age = 72.60 ± 7.03) individuals participated in the test with the new instrument, with the results compared to those of a commercial device. The TPWA mouthpiece fatigue test showed that mean response pressures were maintained at 12 kPa. No significant (p &gt, 0.05) differences were found during testing repetitions 0–10 and 701–710. There were no significant differences in the maximum TP values presented between the test sequences using different instruments for young and elderly participants. The TPWA results showed that TP values gradually decreased with increasing age (40.77 kPa for young and 16.55 kPa for elderly participants). The maximum TP for males (43.51 kPa) was significantly larger than that for females (35.14 kPa) in the young group, but an opposite trend was seen in the elderly group (12.97 for males and 17.59 for females). Thus, this study developed a novel chair-side TP measurement instrument with Bluetooth wireless mobile application control. A durable positioning oral mouthpiece was approved for measuring pressure sufficiently, reliably, and precisely for TP screening.

Nasopharyngeal carcinoma (NPC) has a distinctive geographical distribution in China, especially southern China. There are several risk factors for NPC, such as Epstein-Barr virus, genetics, and environmental exposures. Although the incidence of eye metastasis (EM) is lower than metastasis in other body parts, it often indicates poor prognosis. We assessed several serum biomarkers for their ability to predict EM in NPC. Patients with NPC were selected (n = 963), and were separated into two groups, EM and no eye metastasis. Ten factors were analyzed in both groups including triglyceride (TG), high-density lipoprotein, low-density lipoprotein, alkaline phosphatase, alpha fetoprotein, carbohydrate antigen-199, cancer antigen-153, apolipoproteins AI, apolipoprotein B, and cytokeratin fragment 19 (CYFRA21-1). Independent t tests, binary logistic regression, and receiver operating characteristic curves were used to assess the data. The EM group had significantly higher CYFRA21-1 and lower TG compared with the no eye metastasis group. Areas under the curve for CYFRA21-1, TG and CYFRA21-1/TG were 0.966, 0.771, and 0.976, respectively. The corresponding cut-off values were 12.12 ng/ml, 0.41 mmol/L, and 13.5. The sensitivity and specificity of CYFRA21-1/TG were 100% and 92.2%, respectively. The increased ratio of CYFRA21-1 to TG can be an accurate method to detect EM in patients with NPC.

Coronavirus disease 2019 (COVID-19), the current uncontrolled outbreak of infectious disease, has caused significant challenges throughout the world. A reliable rapid diagnostic test for COVID-19 is demanded worldwide. The real-time reverse transcriptase polymerase chain was one of the most quickly established methods in the novel viral pandemic and was considered as the gold standard for the detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). In this report, we illustrate our experience of applying a protocol from the Taiwan CDC and achieving assay optimization in the immediate circumstances to meet the urgent medical and public health needs.

No abstract available Keywords: Big data integration and analytics; COVID-19; Prevention strategies.

Rationale: Peripheral artery disease, common in metabolic syndrome and diabetes mellitus, responds poorly to medical interventions and is characterized by chronic vessel immaturity leading to lower extremity amputations. Objective: To define the role of reversible palmitoylation at the endothelium in the maintenance of vascular maturity. Methods and Results: Endothelial knockout of the depalmitoylation enzyme APT-1 (acyl-protein thioesterase 1) in mice impaired recovery from chronic hindlimb ischemia, a model of peripheral artery disease. Endothelial APT-1 deficiency decreased fibronectin processing, disrupted adherens junctions, and inhibited in vitro lumen formation. In an unbiased palmitoylation proteomic screen of endothelial cells from genetically modified mice, R-Ras, known to promote vessel maturation, was preferentially affected by APT-1 deficiency. R-Ras was validated as an APT-1 substrate, and click chemistry analyses demonstrated increased R-Ras palmitoylation in cells with APT-1 deficiency. APT-1 enzyme activity was decreased in endothelial cells from db/db mice. Hyperglycemia decreased APT-1 activity in human umbilical vein endothelial cells, due, in part, to altered acetylation of the APT-1 protein. Click chemistry analyses demonstrated increased R-Ras palmitoylation in the setting of hyperglycemia. Altered R-Ras trafficking, increased R-Ras palmitoylation, and fibronectin retention were found in diabetes mellitus models. Loss of R-Ras depalmitoylation caused by APT-1 deficiency constrained R-Ras membrane trafficking, as shown by total internal reflection fluorescence imaging. To rescue cellular phenotypes, we generated an R-Ras molecule with an inserted hydrophilic domain to circumvent membrane rigidity caused by defective palmitoylation turnover. This modification corrected R-Ras membrane trafficking, restored fibronectin processing, increased adherens junctions, and rescued defective lumen formation induced by APT-1 deficiency. Conclusions: These results suggest that endothelial depalmitoylation is regulated by the metabolic milieu and controls plasma membrane partitioning to maintain vascular homeostasis.

We tested the hypothesis that allogenic adipose-derived mesenchymal stem cells (ADMSCs) alleviated brain death (BD)-induced remote organ damage and events of post heart-transplant acute rejection. To determine the impact of BD on remote organ damage, adult-male F344 rats (n=24) were categorized sham-control (SC), BD and BDMSC (allogenic ADMSC/1.2 × 106 cells/derived from F344 by intravenous transfusion 3 h after BD procedure). To determine the protective effect of allogenic ADMSCs, animals (n=8/each group in F344/Lewis) were categorized into groups BD-T(F344 heart transplanted into Lewis by 6h after BD), BD-TMSC(D1/3) (BD induction for 6h then heart transplantation, and allogenic ADMSCs transfusion at days 1 and 5 after heart transplantation), BD-TMSC(3h) (BD + ADMSC/1.2 × 106 cells at 3h and heart transplantation at 6h after BD) and BD-TMSC(3h, D1/3) [BD + ADMSC/1.2 × 106 cells at 3h and heart transplantation at 6h after BD, then ADMSC therapy by days 1/3]. At day 5 post procedure, liver, kidney and heart specimens showed higher molecular-cellular levels of inflammation, immune reaction, apoptosis and fibrosis in BD than in SC that were reversed in BDMSC (all P < 0.0001). These molecular-cellular expressions and circulating/splenic levels of innate/adoptive immune cells were higher in BD-T, lowest in BD-TMSC(3h, D1/3) and higher BD-TMSC(3h) in than BD-TMSC(D1/3), whereas heart function showed an opposite pattern among the four groups (all P < 0.001). In conclusion, ADMSCs suppressed BD-caused remote organ damage and heart-transplant rejection.

Commercial double Perovskite Sr 2 Fe 1.5 Mo 0.5 O 6-δ (SFM), a high performance and redox stable electrode material for solid oxide fuel cell (SOFC), has been used for the electrolyte (layer) -free fuel cell (EFFC) and also as the cathode for the electrolyte based SOFC in a comprehensive study. The EFFC with a homogeneous mixture of Ce 0.8 Sm 0.2 O 2-δ (SDC) and SFM achieved a higher power density (841 mW cm −2 ) at 550 °C, while the SDC electrolyte based SOFC, using the SDC-SFM composite as cathode, just reached 326 mW cm −2 at the same temperature. The crystal structure and the morphology of the SFM-SDC composite were characterized by X-ray diffraction analysis (XRD), and scanning electron microscope (SEM), respectively. The electrochemical impedance spectroscopy (EIS) results showed that the charge transfer resistance of EFFCs were much lower than that of the electrolyte-based SOFC. To illustrate the operating principle of EFFC, we also conducted the rectification characteristics test, which confirms the existence of a Schottky junction structure to avoid the internal electron short circuiting. This work demonstrated advantages of the semiconductor-ionic SDC-SFM material for advanced EFFCs.

Purpose. Liver metastasis is the final stage of cancer progression and is associated with poor prognosis. Although numerous indicators have been identified as having prognostic value for lung cancer and liver metastasis, liver metastases are still not diagnosed by imaging in many patients. To provide a more accurate method for clinical prediction of liver metastasis, we analyzed multiple factors to identify potential predictive factors for liver metastasis of lung cancer. Methods. Patients first diagnosed with lung cancer between 2002 and 2016 ( n = 1746 ) were divided into two groups, with and without liver metastasis. Serum concentrations of calcium, carcinoembryonic antigen (CEA), cancer antigen-125 (CA125), cancer antigen-153 (CA153), carbohydrate antigen-199 (CA199), cytokeratin fraction 21-1 (CYFRA21-1), total prostate-specific antigen (TPSA), and neuron-specific enolase (NSE) were analyzed in both patient groups. Results. There was no significant difference in age or sex between the two groups. CA125 and NSE were significantly associated with liver metastasis. Compared with CA125, NSE was more specific, while it was less sensitive ( P < 0.001 ). Further analysis of NSE concentrations was conducted in patients with non-small-cell lung cancer and indicated that NSE concentration differed significantly between those with and without liver metastasis ( P = 0.023 ). We conducted analysis with NSE and CA125 combined, resulting in acceptable sensitivity (51.2%), specificity (72.6%), and area under the curve (0.64) values; sensitivity and area under the curve values were higher than those for individual factors, while specificity was higher than that for CA125. Conclusions. The combination of CA125 and NSE can assist prediction of liver metastasis of lung cancer, providing improved diagnostic accuracy.

Feature subset selection has been an important problem in machine learning research. Recently, new appeared data with high dimensionality, such as microarray gene expression data and text classification data, drive feature subset selection techniques advance speedily. DOCTOR OF PHILOSOPHY (EEE)

This study tested the therapeutic impact of double-loading dose (i.e., 600 mg) versus standard-loading dose (i.e., 300 mg) of clopidogrel on ST-segment-elevation-myocardial-infarction (STEMI) patients undergoing primary-coronary-intervention (PCI).Between January 2005 and December 2013, a total of 1461 STEMI patients undergoing PCI were consecutively enrolled into the study and categorized into group 1 (600 mg/clopidogrel; n = 508) and group 2 (300 mg/clopidogrel; n = 953). We assessed angiographic thrombolysis-in-myocardial-infarction (TIMI) flow in the infarct-related-artery, 30-day mortality and upper-gastrointestinal-bleeding (UGIB) within 30 days as primary-endpoints and later incidents of UGIB as secondary-endpoints.The results showed that the incidences of advanced Killip score (defined as ≥ score 3) upon presentation (23.8% versus 24.6%) and advanced heart failure (defined as ≥ NYHAFc-3) (10.2% versus 10.4%) did not differ between groups 1 and 2 (all P > 0.4). Primary-endpoints, which were final TIM-3 flow (91.3% versus 91.7%) in the infarct-related-artery, incidences of 30-day mortality (5.8% vs. 7.1%), and UGIB ≤ 30 day (7.8% versus 8.9%) did not differ between group 1 and group 2 (all P > 0.33). The secondary-endpoints which were incidences of ≥ 30-day one-year (8.9% versus 10.1%) UGIB did not differ between groups 1 and 2 (all P > 0.45). One-year mortality did not differ between two groups (10.74% versus 12.9%) (P > 0.25). Multiple-stepwise-logistic-regression analysis showed that age and advanced-Killip score were independently predictive of 30-day mortality (all P < 0.001).Double-loading dose of clopidogrel did not confer an additional benefit to the final angiograph results, 30-day/one-year clinical outcomes; and age and advanced Killip-score were powerful predictors of 30-day mortality.

The mixture of ionic electrolyte Ce0.8Sm0.05Ca0.15O2−δ (SCDC) and semiconductor Ni0.8Co0.15Al0.05LiO2−δ (NCAL) layers was used for low temperature solid oxide fuel cell (LT-SOFC) applications. Using the as-prepared SCDC-NCAL semiconductor-ionic layer to replace the ionic SCDC electrolyte, following results have been obtained: the SCDC electrolyte fuel cell reached a lower voltage, 1.05 V, and lower power output, 415 mW cm−2, compared to that using the semiconductor-ionic layer, 1.06 V and 617 mW cm−2 at 550 °C. The electrochemical impedance spectroscopy (EIS) was applied to investigate the electrochemical processes of the device; X-ray diffraction (XRD) and field emission scanning electron microscope (FE-SEM) for the microstructure and morphology of the as-prepared materials. The results have illuminated that the introduction of semiconductor into ionic electrolyte could make extended triple phase boundary (TPB) area, which can provide more active sites to accelerate the fuel cell reactions and enhance the cell performance. Furthermore, we also discovered that the ionic SCDC and electronic NCAL should be in an appropriate composition to achieve a balanced ionic and electronic conductivity, which is the key issue for high performance semiconductor-ionic fuel cells.

// Kuan-Hung Chen 1,8,* , Chih-Hung Chen 2,* , Christopher Glenn Wallace 3 , Chun-Man Yuen 4 , Gour-Shenq Kao 5 , Yi-Ling Chen 5 , Pei-Lin Shao 6 , Yung-Lung Chen 5 , Han-Tan Chai 5 , Kun-Chen Lin 1 , Chu-Feng Liu 7 , Hsueh-Wen Chang 8 , Mel S. Lee 9 and Hon-Kan Yip 5,6,10,11,12 1 Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 2 Department of Internal Medicine, Division of General Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 3 Department of Plastic Surgery, University Hospital of South Manchester, Manchester, UK 4 Department of Surgery, Division of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 5 Department of Internal Medicine, Division of Cardiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 6 Department of Nursing, Asia University, Taichung, Taiwan 7 Department of Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 8 Department of Biological Sciences, National Sun Yat-Sen University, Kaohsiung, Taiwan 9 Department of Orthopedics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 10 Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 11 Center for Shockwave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan 12 Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan * These authors have contributed equally to this work Correspondence to: Hon-Kan Yip, email: // Keywords : xenogenic adipose-derived mesenchymal stem cell, exosomes, ischemic stroke, brain infarct size, neurological function, Pathology Section Received : August 15, 2016 Accepted : October 14, 2016 Published : October 25, 2016 Abstract We tested the hypothesis that combined xenogenic (from mini-pig) adipose-derived mesenchymal stem cell (ADMSC) and ADMSC-derived exosome therapy could reduce brain-infarct zone (BIZ) and enhance neurological recovery in rat after acute ischemic stroke (AIS) induced by 50-min left middle cerebral artery occlusion. Adult-male Sprague-Dawley rats ( n = 60) were divided equally into group 1 (sham-control), group 2 (AIS), group 3 [AIS-ADMSC ( 1 . 2 × 10 6 cells)], group 4 [AIS-exosome ( 100 &#x 3 bc;g)], and group 5 (AIS-exosome-ADMSC). All therapies were provided intravenously at 3h after AIS procedure. BIZ determined by histopathology (by day-60) and brain MRI (by day-28) were highest in group 2, lowest in group 1, higher in groups 3 and 4 than in group 5, but they showed no difference between groups 3 and 4 (all p < 0.0001). By day-28, sensorimotor functional results exhibited an opposite pattern to BIZ among the five groups ( p < 0.005). Protein expressions of inflammatory (inducible nitric oxide synthase/tumor necrosis factor-α/nuclear factor-κB/interleukin-1β/matrix metalloproteinase-9/plasminogen activator inhibitor-1/RANTES), oxidative-stress (NOX-1/NOX-2/oxidized protein), apoptotic (caspase-3/ Poly-ADP-ribose polymerase), and fibrotic (Smad3/transforming growth factor-β) biomarkers, and cellular expressions of brain-damaged (γ-H2AX+/ XRCC1-CD90+/p53BP1-CD90+), inflammatory (CD11+/CD68+/glial fibrillary acid protein+) and brain-edema (aquaporin-4+) markers showed a similar pattern of BIZ among the groups (all n < 0.0001). In conclusion, xenogenic ADMSC/ADMSC-derived exosome therapy was safe and offered the additional benefit of reducing BIZ and improving neurological function in rat AIS.

Purpose The purpose of this study was to observe the clinical efficacy and toxicity of cisplatin in combination with gemcitabine or Abraxane as first-line chemotherapy for stage III/IV non-small-cell lung cancer (NSCLC). Patients and methods A total of 200 patients with advanced NSCLC, which was confirmed by pathology or cytology, were enrolled into our research by reviewing previous complete and retrievable medical records data of our hospital. A total of 100 patients were treated with gemcitabine (1,000 mg/m2, day 1 and day 8) in combination with cisplatin (75 mg/m2, days 1–3; GP group) and another 100 patients were treated with Abraxane (260 mg/m2, day 1) in combination with cisplatin (75 mg/m2, days 1–3; TP group). Twenty-one days were required to complete one cycle; at least two cycles were completed by each group. Results For the 100 patients in the GP group, the effective response rate (RR) was 27%, the disease control rate (DCR) was 63%, and the median progression-free survival (PFS) time was 8 months. For the 100 patients in the TP group, the RR was 52%, the DCR was 75%, and the median PFS was 20 months. There was significant difference in RR (P0.05). Common treatment-related adverse events were hematologic toxicity and gastrointestinal reaction. Hematologic toxicity mainly included decreased white blood cells and platelets. The differences between the two groups were statistically significant (P0.05). For the 115 patients with adenocarcinoma in the TP group, the RR was 47%, the DCR was 73%, and the median PFS was 8 months. For the 115 patients with adenocarcinoma in the GP group, the RR was 20%, the DCR was 64%, and the median PFS was 20.5 months. There was significant difference in RR (P=0.003), but no significant difference in DCR and PFS (P>0.05). Conclusion The efficacy of cisplatin in combination with Abraxane is better than that with gemcitabine in the treatment of NSCLC, and the treatment has less risk of hematologic toxicity.

We hypothesized that combined treatment with autologous adipose-derived mesenchymal stem cell (ADMSC) and ciprofloxacin is superior to ciprofloxacin only in reducing sepsis-induced urogenital organ damage and mortality in rat sepsis syndrome (SS) caused by intrapelvic injection of cecal bacteria (1.0 × 104 cells per milliliter; total, 5.0 ml). Male Sprague-Dawley rats (n = 60) equally divided into group 1 (sham-control), group 2 (SS), group 3 (SS-ADMSC [5.0 × 105 intravenously at 0.5, 6, and 18 hours after sepsis induction]), group 4 (SS-ciprofloxacin [3.0 mg/kg, b.i.d.] for 5 days), and group 5 (SS-ADMSC-ciprofloxacin) were sacrificed by day 5. Mortality rate and creatinine level were highest in group 2 and lowest in group 1 and significantly higher in groups 3 and 4 than those in group 5, but there was no difference between groups 3 and 4 (all p < .005). The kidney injury score, inflammatory biomarker expressions at protein (tumor necrosis factor-1α, nuclear factor-κB, matrix metallopeptidase-9, regulated on activation, normal T-cell expressed and secreted, interleukin-1β) and cellular (CD14+, migratory inhibitor factor positive, CD68+) levels in kidneys and urinary bladder were lowest in group 1 and highest in group 2, higher in group 4 than in groups 3 and 5, and higher in group 3 than in group 5 (all p < .001). Protein expressions of apoptosis (Bax, cleaved caspase 3 and poly[ADP-ribose] polymerase 1, p21 protein [Cdc42/Rac]-activated kinase 2) and oxidative stress (oxidized protein, NADPH oxidase (NOX)-1, NOX-2) in these organs showed an identical pattern compared with that of inflammation in all groups (all p < .001). In conclusion, ADMSC-assisted ciprofloxacin therapy offered an additional benefit by reducing acute urogenital organ damage in rat. Significance Autologous adipose-derived mesenchymal stem cell-assisted ciprofloxacin therapy offered an additional benefit by reducing acute urogenital organ damage in rats.

Semiconductor nanowires (NWs) have been extensively investigated and discussed in various fields due to their unique physical properties. In this paper, we successfully produce SiGe NWs biosensor by VLSI technology. We propose the dual plasma technology with CF4 plasma pre-treatment and N2 plasma post-treatment for repairs of defects as well as optimization of SiGe NWs biosensor. The results indicate that sensitivity (S) of the biosensor with dual plasma technology has significantly improved at least 32.8%, suitable for producing industrial SiGe NWs biosensor in the future.

IntroductionThe present study aims to clarify the advantages and disadvantages of elite biopsy, to provide a reference for selecting the puncture method.Material and methodsA total of 802 patients with a BI-RADS grade ≥ 4, as evaluated by the molybdenum target, and measurable lesions revealed by colour Doppler ultrasound, who were admitted at our department from January 2017 to January 2018, were enrolled in the present study. These patients were randomly divided into three groups: elite, Mammotome and core needle biopsy groups. The pathological underestimation rate, diagnostic accordance rate, haematoma incidence rate, and costs of these three biopsy methods were compared.ResultsThe difference in diagnostic accordance rates between the elite biopsy group and core needle biopsy group was statistically significant (98.9% vs. 94.7%, p = 0.003), as well as between the Mammotome biopsy group and core needle biopsy group (99.6% vs. 94.7%, p < 0.001). The difference in pathological underestimation rates between the elite biopsy group and core needle biopsy group was statistically significant (7.2% vs. 37.3%, p < 0.001), as well as between the Mammotome biopsy group and core needle biopsy group (1.6% vs. 7.2%, p < 0.001). The difference between the Mammotome biopsy group and elite biopsy group was not statistically significant. The incidence of haematoma in the Mommotome, elite, and core needle groups was 15.9%, 13%, and 21.7%, respectively (13% vs. 21.7%, p = 0.021).ConclusionsElite biopsy has a low rate of pathological underestimation and low incidence of haematoma, can improve the breast conserving rate, and has an affordable cost. As a biopsy method with high accuracy, safety, and economy, elite biopsy can be widely used in clinics.

Dysphagia may result in poor outcomes in stroke patients due to aspiration pneumonia and malnutrition.The aim of the study was to investigate aspiration pneumonia and the mortality rate in stroke patients with dysphagia in Taiwan.We selected 1220 stroke patients, divided them into dysphagia and nondysphagia groups, and matched them according to age; covariates and comediations from 2000 to 2005 were identified from the NHIRD 2000 database. The date of the diagnosed stroke for each patient was defined as the index date. All patients were tracked for 5 years following their index visit to evaluate mortality and the risk of aspiration pneumonia. We estimated the adjusted hazard ratio using Cox proportional hazard regression.Within 1 year, the dysphagia group was 4.69 times more likely to develop aspiration pneumonia than the nondysphagia group (adjusted hazard ratio [aHR], 4.69; 95% confidence interval [CI] 2.83-7.77; P.001). The highest significant risk of aspiration pneumonia was in the cerebral hemorrhage patients within 3 years of the index visit (aHR, 5.04; 95% CI 1.45-17.49; P = .011). The 5-year mortality rate in the dysphagia group was significantly higher than that in the nondysphagia group (aHR, 1.84; 95% CI 1.57-2.16; P.001).Dysphagia is a critical factor in aspiration pneumonia and mortality in stroke patients. Early detection and intervention of dysphagia in stroke patients may reduce the possibility of aspiration pneumonia.

To analyze and compare prospectively the curative effects between mammotome-assisted minimally invasive resection (MAMIR) and traditional open surgery (TOS) for gynecomastia in Chinese male patients, a total of 60 patients suffering from grade I and II gynecomastia, evaluated by automated whole-breast ultrasound (AWBU), were recruited and randomly divided into TOS and MAMIR groups (each n = 30). The postoperative scar size, healing time, patient hospital stay, postoperative satisfaction, postoperative pain, and complications including edema and bruising were analyzed. The participants were followed up for 1 week, 1 month, 6 months, and 1 year after surgery. Compared with patients who received TOS, patients in the MAMIR group had significantly smaller scar sizes (0.40 ± 0.08 cm vs 5.34 ± 0.38 cm, P < 0.01), shorter healing times (3.67 ± 0.71 days vs 7.90 ± 0.92 days, P < 0.01), and hospitalization (2.60 ± 0.62 vs 7.17 ± 0.83 days, P < 0.01), as well as higher postoperative satisfaction (4.70 ± 0.60 vs 3.20 ± 0.55 scores, P < 0.01), respectively. Patients in the MAMIR group experienced postoperative mild pain significantly more often than those in the TOS group (6.70 ± 1.06 vs 4.13 ± 0.78 scores, P < 0.01, respectively), but with significantly less postoperative severe pain (53.33% vs 0.00%, P < 0.000). While the incidence rate of edema and bruises was significantly higher in the MAMIR group compared with the TOS group (47% vs 17%, P = 0.013 and 54% vs 20%, P = 0.007, respectively). MAMIR had advantages for curative effects compared with traditional open surgery. However, the recurrence rate in patients needs to be further studied.

A novel composite was synthesized by mixing La0.1Sr0.9MnO3&minus, &delta, (LSM) with Ce0.8Sm0.2O2&minus, (SDC) for the functional layer of low temperature solid oxide fuel cell (LT-SOFC). Though LSM, a highly electronic conducting semiconductor, was used in the functional layer, the fuel cell device could reach OCVs higher than 1.0 V without short-circuit problem. A typical diode or rectification effect was observed when an external electric force was supplied on the device under fuel cell atmosphere, which indicated the existence of a junction that prevented the device from short-circuit problem. The optimum ratio of LSM:SDC = 1:2 was found for the LT-SOFC to reach the highest power density of 742 mW&middot, cm&minus, 2 under 550 &deg, C The electrochemical impedance spectroscopy data highlighted that introducing LSM into SDC electrolyte layer not only decreased charge-transfer resistances from 0.66 &Omega, &middot, cm2 for SDC to 0.47&ndash, 0.49 &Omega, cm2 for LSM-SDC composite, but also decreased the activation energy of ionic conduction from 0.55 to 0.20 eV.

Circulating tumor cells are low-frequency cells that are shed into the peripheral bloodstream from a primary solid tumor and/or metastasis. Although these cells were recognized initially in 1869, it is only in the past 2 decades that they have been isolated for use as a surrogate biomarker to monitor response to therapy, evaluate prognosis, detect tumor mutations, assist in selecting personalized medicine, and enable earlier cancer diagnosis.

In this letter, a new ultrahigh-density memory constructed with a contact resistive random access memory (RRAM) is proposed. This slot contact RRAM (SCRRAM) with transition metal oxide from contact liner layers has been successfully demonstrated by a standard 16-nm FinFET process without extra mask or processing step. The new FinFET RRAM features low-power forming and reset operation, stable Low Resistance State (LRS)/High Resistance State (HRS), and compact cell size. As a logic nonvolatile memory (NVM) solution, SCRRAM exhibits high endurance, stable data retention, read and program disturb immunity, which further support this new 1T1R cell as one of the promising embedded NVM solutions in FinFET CMOS generations.

This paper reports a novel full logic compatible 4T2R non-volatile static random access memory (nv-SRAM) featuring its self-inhibit data storing mechanism for in low-power/high-speed SRAM application. With compact cell area and full logic compatibility, this new nv-SRAM incorporates two STI-ReRAMs embedded inside the 4T SRAM. Data can be read/write through a cross-couple volatile structure for maintaining fast accessing speed. Data can be non-volatilely stored in new SRAM cell through a unique self-inhibit operation onto the resistive random access memory (RRAM) load, achieving zero static power during data hold.

Image-guided radiotherapy (IGRT) provides precise positioning for the tumor target, but it may bring extra irradiation dose in the target positioning with a cone beam CT (CBCT) which has been increasingly used in IGRT. In this work, we focused on biological effects of the low-dose irradiation in IGRT, which have not been considered so far. Primary human fibroblasts cells from the lung and MRC-5 were irradiated by a CBCT. DNA double-strand breaks (γ-H2AX foci) and micronucleus frequency of the irradiated samples were analyzed. Compared to the control, the γ-H2AX foci yields of the samples irradiated to 16 mGy increased significantly, and the micronuclei rate of the samples irradiated for 3 days increased notably. The dose by imaging guidance device can be genotoxic to normal tissue cells, suggesting a potential risk of a secondary cancer. The effects, if confirmed by clinical studies, should be considered prudentially in designing IGRT treatment plans for the radiosensitive population, especially for children.

The improvements to electrical properties of SiGe nanowires by surface plasma treatment were investigated. Various durations of pre-oxidation with fluorine; ambients for post-nitridation plasma treatment, and annealing temperature after plasma treatment, 800–950 °C, were applied. Pre-oxidation treatment using fluorine plasma; improved the conductance of SiGe nanowires because the Si–F binding energy created a more stable interface state than bare nanowire on the surface of SiGe. N 2 plasma incorporated more N than does in NH 3 plasma, and NH 3 has the drawback of introducing electron traps, causing Si–H bonds to break in the subsequent annealing process. Since the reparation of surface defects by plasma treatment is valid, the high post-annealing temperature to reduce defect by re-crystallizing can be reduced. Hence, Ge diffusion at low post-annealing temperature did not reduce the high concentration of Ge at the SiGe nanowire surfaces.

Objective: Few studies have focused on factors influencing outcomes of patients with in-hospital cardiac arrest (IHCA) in general wards. The goal of this study was to report the outcomes of adult patients with IHCA in the general wards and identified the prognostic factors. Methods: Adult patients with IHCA having received cardiopulmonary resuscitation in general wards from January 2008 to December 2011 were retrospectively reviewed from our registry system. The primary outcome was survival to hospital discharge, while the secondary outcome was sustained return of spontaneous circulation (ROSC). Results: A total of 544 general ward patients were analyzed for event variables and resuscitation results. The rate of establishing a ROSC was 40.1% and the rate of survival to discharge was 5.1%. Ventricular tachycardia/ventricular fibrillation (VT/VF) was the initial rhythm in 3.9% of patients. Pre-arrest factors including a high Charlson comorbidity index (CCI) ≥ 9 (OR 0.251, 95% CI 0.098 - 0.646), cardiac comorbidity (OR 0.612, 95% CI 0.401 - 0.933), and arrest time on the midnight shift (OR 0.403, 95% CI 0.252 - 0.642) were independently associated with a low possibility of ROSC. The initial VT/VF presenting rhythms (OR 0.135, 95% CI 0.030 - 0.601) were independently associated with a high survival rate, whereas patients with deteriorated disease course were independently associated with a decreased hospital survival (OR 3.902, 95% CI 1.619 - 9.403). Conclusions: We demonstrated that pre-arrest factors can predict patient outcome after IHCA in general wards, including the association of a CCI ≥ 9 and cardiac comorbidity with poor ROSC, and deteriorated disease course as an independent predictor of a low survival rate.

With the aid of vector network analyzer (VNA), a relatively simple polarization scattering matrix (PSM) measurement system is constructed in an anechoic chamber. Four antennas with different polarization are connected for dual-channel measurement, then the PSM parameters and the frequency-amplitude characteristic can be obtained, finally the calibration is completed with three known model, with the help of metal disc, a vertical dihedral and a dihedral rotated at 22.5°, a polarization scattering matrix of a ball is measured in the experiment, The results show that polarization purity of the system reaches 25 dB without calibration, and can be better than 40 dB after that. Moreover, the system is easy to achieve.

Because earthquakes may cause severe damage to buried pipelines, it is important to study dynamic response of buried pipelines. For dynamic response problem of buried pipelines, variational method is the suitable method. In the paper, Gurtin-type quasi-variational principle of buried pipelines dynamics is established by convolutional variational integral method, which is theoretical foundation of finite element method for solving buried pipelines dynamics problems.

Background Most studies have investigated the diagnostic accuracy of 64-slice multi-detector computed tomography (MDCT) to detect coronary artery stent patency by using conventional coronary angiography (CCA) as the reference standard. In this study, we compared the diagnostic accuracy of MDCT and CCA by using intravascular ultrasonography (IVUS) as the reference standard. Methods Forty-six patients with previously implanted coronary artery stents (n=87) underwent MDCT followed by CCA and IVUS within 24h. Sensitivities, specificities, positive predictive values (PPV) and negative predictive values (NPV) of MDCT and CCA for detecting or excluding in-stent diameter restenosis (ISDR) by using in-stent area restenosis (ISAR) and minimal luminal area (MLA) ≤4.0mm 2 of IVUS as the reference standard were determined. Results Eight stents (9%) were judged non-evaluable using MDCT for the detection of ISDR. ISDR was detected in 28% (22/79) of the evaluable stents using CCA. When ISAR was detected using IVUS, the sensitivity, specificity, PPV, and NPV for ISDR detection by using MDCT were 71%, 96%, 91% and 86%, and the corresponding values for CCA were 64%, 96%, 90% and 83%. When MLA ≤4.0mm 2 was detected using IVUS, the sensitivity, specificity, PPV, and NPV for ISDR detection by using MDCT were 87%, 96%, 91% and 95%, and for CCA were 78%, 96%, 90% and 92%. Conclusions When ISAR with MLA ≤4.0mm 2 was detected on IVUS, CCA and MDCT had similar diagnostic accuracies for ISDR detection. High specificity and NPV make 64-slice MDCT a reliable non-invasive method for excluding ISDR.

The oxidation of an SiGe-on-Insulator (SGOI) that is caused by Ge condensation increases the fraction of Ge therein and significantly increases the hole mobility. This effect can be exploited to improve the sensitivity of SGOI nano-wires. However, previous investigations by the authors have revealed that the sensitivity of SGOI nano-wires is reduced when the Ge fraction increase over 20%, because a high Ge fraction destabilizes the surface state of SiGe. In this work, a top surface passivation PECVD SiO2 layer that was deposited on a Si0.8Ge0.2 nano-wire improved its sensitivity to approximately 1.3 times that of a nano-wire sample without a top passivation layer.

Background. This study evaluated the impact on clinical outcomes using a cloud computing system to reduce percutaneous coronary intervention hospital door-to-balloon (DTB) time for ST segment elevation myocardial infarction (STEMI). Methods. A total of 369 patients before and after implementation of the transfer protocol were enrolled. Of these patients, 262 were transferred through protocol while the other 107 patients were transferred through the traditional referral process. Results. There were no significant differences in DTB time, pain to door of STEMI receiving center arrival time, and pain to balloon time between the two groups. Pain to electrocardiography time in patients with Killip I/II and catheterization laboratory to balloon time in patients with Killip III/IV were significantly reduced in transferred through protocol group compared to in traditional referral process group (both p<0.05). There were also no remarkable differences in the complication rate and 30-day mortality between two groups. The multivariate analysis revealed that the independent predictors of 30-day mortality were elderly patients, advanced Killip score, and higher level of troponin-I. Conclusions. This study showed that patients transferred through our present protocol could reduce pain to electrocardiography and catheterization laboratory to balloon time in Killip I/II and III/IV patients separately. However, this study showed that using a cloud computing system in our present protocol did not reduce DTB time.

This paper proposes a novel synchronous wideband frequency domain method for measuring time domain response of long- distance channel. Its core consists of: (1) baseband signal generators at the transmission terminal and the reception terminal respectively are used to generate the wideband signal of the same frequency; (2) the two GPS clock frequency reference sources locked on the same satellite are used to yield the high-stability 10MHz signal as the external reference source of the baseband signal generator so that the initial phases of the wideband signals are basically the same; (3) the pulse per second (PPS) signal generated by the GPS clock frequency reference source is used as trigger signal to ensure that the baseband signal generator and the vector network analyzer (VNA) can transmit and receive signals synchronously; (4) the time domain response of the channel is indirectly obtained through the inverse Fourier transform of amplitude and phase of the frequency domain response. To verify the measurement method, experiments were performed, in which the sea surface evaporation waveguide which is tens of kilometers apart from each other was selected as the channel. The experimental results, given in Figs. 4 and 5, and their analysis show that the measurement method can obtain amplitude and phase of the signal whose band is hundreds of MHz and whose equivalent pulse width reaches 5ns. The measurement method is used to obtain the time domain response of the long-distance channel, verifying that the measurement method is efiective.

Episode pattern mining is a very powerful technique to get high-valued information for people to solve real-life cross-disciplinary problems, such as for the analysis of manufacturing, stock markets, weather records and so on. As data grows, the mining process must be re-triggered again and again to obtain the most updated information. However, periodically re-mining the full dataset is not cost-effective, and thus a number of incremental mining approaches arise for the growing data. However, to our best knowledge, there exist few studies targeted on the problem of incremental episode mining. Moreover, streaming data of complex events is more and more popular because digital sensors always collect data around us in this big data age. Now the challenge is not only mining valuable episode patterns of incremental dataset, but also mining episode patterns over data streams of complex events. To address this research problem, we adopt the Lambda Architecture to design a scalable complex event analytical system that could be used to facilitate the incremental episode mining process over complex event sequences of data streams. Apache Spark and Apache Spark Streaming are applied as the development framework of the batch layer and the speed layer, respectively. To take both the efficiency and accuracy into consideration, we develop a series of modules and three algorithms, namely, batch episode mining, delta episode mining and pattern merging. Results from the experimental validation on a real dataset show that the proposed system carries high scalability and delivers excellent performance in terms of efficiency and accuracy.

This cross-sectional, descriptive, correlational study performed a structured questionnaire survey of a Taiwan population of male prison inmates to determine the prevalence of sexually transmitted infections (STIs), intravenous drug users (IDUs), and drug abuse and to assess their knowledge of HIV/AIDS. The objective was to obtain data needed to control the spread of HIV. Out of 1000 questionnaires distributed, 908 valid questionnaires were returned. Inmates were classified into three groups: IDUs with HIV (13.5%), IDUs without HIV (49.3%), and non-IDUs without HIV (37.2%). A total of 115 (12.7%) inmates had contracted STIs other than HIV. Compared with inmates without HIV, those with HIV were more likely to have a junior high school education level or lower and a history of the following: employment as a blue-collar laborer, STI, unprotected sexual activity, and needle sharing during intravenous drug use. The longer they have used intravenous drugs, the higher the probability that they shared needles, and the more likely they contracted with HIV. Taiwanese male inmates had a low level of knowledge about safe sex and HIV transmission routes, except for sharing needles. The three groups did not significantly differ in HIV-related knowledge. Given the high percentage of IDU and HIV infection in male prison inmates in Taiwan, interventions are needed to educate this population in the increased risk of contracting HIV/AIDS associated with unsafe sex and needle sharing during illicit drug use. Such interventions are crucial for limiting the spread of HIV as this population reintegrates with the community.

The post-adoption behaviors of online service users are critical performance factors for online service providers. To fill an academic gap that persists regarding bloggers' switching behavior across online service substitutes, this empirical study investigates which factors affect bloggers who switch social network sites, in an attempt to understand specifically how push, pull, and mooring factors shape their switching intentions. The data to test the hypotheses come from an online survey of 319 bloggers, analyzed using partial least squares techniques. The results confirm positive influences of push and pull effects, a negative influence of mooring effects, and an interactive effect of push and mooring on switching intentions. The push-pull-mooring framework thus is a useful tool for comprehending the competing forces that influence the use of online service substitutes. In particular, perceptions of weak connections and writing anxiety push bloggers away, whereas relative enjoyment and usefulness pull bloggers to social network sites; switching cost and past experience also inhibit a change. These findings offer key insights and implications for the competitive strategy choices of online service providers.

Background Melioidosis has emerged as a global problem; however, few studies have specifically described the clinical characteristics and outcomes when patients with melioidosis are treated at an emergency department (ED). Purpose The objective of this study was to examine the demographics and clinical characteristics of patients with melioidosis who visited an ED. Methods A retrospective analysis of patients treated for melioidosis at an ED. Results Of the 25 patients identified over 7 years, 22 patients had bacteremia, whereas diabetes mellitus was the most common underlying disease (17 patients). Acute respiratory failure requiring mechanical ventilation developed in 52% of the patients. The overall mortality rate was 40%, and death within 48 hours of presentation at the ED occurred in 24% of the patients. The most common infection site was the lungs (in 52% of patients), and 36% of the patients presented with community-acquired pneumonia (CAP) at the ED. A comparison of the CAP and non-CAP groups of patients revealed that the presence of shock upon arrival (56% vs. 0; p = 0.002), total mortality (78% vs. 19%; p = 0.009), and early mortality (56% vs. 6%; p = 0.012) were significantly more common among the individuals who comprised the CAP group. Early mortality accounted for 60% of total deaths, and all of these patients died before final microbiologic data were available. CAP presentation ( p = 0.012), the presence of band-form leukocytes ( p = 0.001), increased serum creatinine ( p = 0.037), and shock on arrival ( p = 0.005) were significantly more common among patients with early mortality. Conclusion Melioidosis is a devastating illness with a high rate of mortality occurring within 48 hours of presentation. Melioidosis that presents with CAP is the most severe form of the disease and is associated with greatly increased early mortality.

Background Mandated reporters inconsistently report child abuse cases. Ethical dilemmas and legal challenges to reporting arise creating barriers to assist abused children and their families. Purpose The purpose of this study was to describe professionals' ethical dilemmas and legal challenges to reporting child abuse. Method A qualitative study was conducted to explore the ethical and legal challenges of mandated reporters when reporting child abuse. Individual interviews between 60 and 100 min were conducted with a purposive sample of 18 mandated reporters including physicians, nurses, social workers, and teachers. Grounded theory methodology was used to develop categorical themes that reflected mandated reporters' experiences and challenges. Result Three themes emerged from the data: conflicts, time, and law as refuge. Professionals described challenges in balancing autonomy, beneficence, nonmaleficence, and justice. There was no best solution to do no harm. The associated stigma and pressure of cultural and secular norms of child abuse inhibit professionals' action based on legal and ethical requirements. The theme of time included limited time and an uncertain future. The law provides security and refuge for professionals to find a solution to the challenges of reporting child abuse. Conclusion The ethical and legal challenges of reporting child abuse create complex dilemmas for mandated reporters. Ethical principles are in constant opposition when negotiating rights of children and rights of parents. Supportive structures and education are needed to assist professionals in meeting their reporting obligation and solving their dilemmas.

AIM To evaluate the potential of the lipoprotein-associated phospholipase A(2) (Lp-PLA(2) level as a biomarker in the prediction of prognostic outcome in patients with acute ischemic stroke (IS). METHODS From October 2008 to March 2010, 130 patients with acute IS were prospectively enrolled in the study and their medical records were reviewed. A blood sample was collected from each patient 48 hours after acute IS, as well as from 20 healthy volunteers as controls. Messenger-RNA (mRNA) expression of Lp-PLA(2) of peripheral-blood mononuclear cells (PBMNCs) relative to that of β actin was measured using quantitative reverse transcription polymerase chain reaction (RT-PCR). RESULTS Patients with acute IS exhibited significantly higher Lp-PLA(2) mRNA expression of PBMNCs than the control group (p

Ge condensation has been reported to improve the hole mobility of the SiGe-on-insulator (SGOI). Our previous studies have shown that the higher Ge fraction of Si1-xGex nano-wire exhibits higher sensitivity. In this work, we investigated the effect of different oxidation recipe to provide information on the sensitivity of SiGe nano-wire. The 3-amino-propyltrime-thoxy-silane (APTMS) is used to modify the nano-wire's surface potential. Induced sensitivity characteristics of the samples were preformed to estimate the improvement effect. The mixed N2/O2 oxidation process with optimization ratio can be an effective technology to improve the sensitivity of SGOI nano-wires.

Reducing the width of a nano-wire increases its surface to volume ratio, increasing the sensitivity of its conductivity to charges on its surface. Our previous studies have shown that increasing the Ge fraction in Si1-xGex nano-wires improves their sensitivity as bio-sensing. In this work, an α-Si/SiGe core/shell nano-wire is successfully fabricated using side-wall spacer method. The maximum sensitivity of a nano-wire bio-sensor with an optimizedα-Si/SiGe thickness ratio is investigated.

We investigated the impacts of introducing an expedited acid-fast bacilli (AFB) smear laboratory procedure and an automatic, real-time laboratory notification system by short message with mobile phones on delays in prompt isolation of patients with pulmonary tuberculosis (TB).We analyzed the data for all patients with active pulmonary tuberculosis at a hospital in Kaohsiung, Taiwan, a 1,600-bed medical center, during baseline (January 2004 to February 2005) and intervention (July 2005 to August 2006) phases.A total of 96 and 127 patients with AFB-positive TB was reported during the baseline and intervention phases, respectively. There were significant decreases in health care system delays (ie, laboratory delays: reception of sputum to reporting, P.001; response delays: reporting to patient isolation, P = .045; and interval from admission to patient isolation, P.001) during the intervention phase. Significantly fewer nurses were exposed to each patient with active pulmonary TB during the intervention phase (P = .039).Implementation of expedited AFB smear laboratory procedures and an automatic, real-time laboratory mobile notification system significantly decreased delays in the diagnosis and isolation of patients with active TB.

To investigate the optimal timing of radiotherapy with alternating/sequential radio-chemotherapy for limited-stage small cell lung cancer (LS-SCLC).91 patients with LS-SCLC were retrospectively analyzed and divided into two groups according to the number of chemotherapy cycles before radiotherapy. If the patient received radiotherapy after 3 cycles or fewer cycles of chemotherapy, classification was into the early group, if not, into the late group. All patients received 6 cycles of standard chemotherapy (EP/EC) and conventional radiotherapy (56 gy~ 60 gy/28 f ~30 f).The response rate (RR) of the early and late groups were 85.7% and 81.6%, respectively, with no significant difference (p0.05). In contrast, the progression-free survival (PFS) in the early group was better than that in the late group (11.8 months vs 9.86 months), and the difference was significant (p0.05). There was no significant difference between two groups in adverse reactions, which gastrointestinal irritation and bone marrow suppression being the most common (p0.05).Radiotherapy after 3 cycles or fewer cycles of chemotherapy does not bring significant benefits for RR of patients with LS-SCLC, but it could significantly prolong their PFS without increase in adverse reactions.

Background/Purpose Surgical site infection (SSI) after cardiac surgery leads to morbidity and mortality. Identifying SSI risk factors, which vary between populations, is important in preventing infection. Methods A retrospective chart review of adult cases receiving cardiac surgery in a Taiwan medical center in 2004 and 2005. Results Of the 260 cases included in the study, 169 (65.0%) received a coronary artery bypass graft, 65 (25.0%) cardiac valvular surgery and 26 (10.0%) aortic or septal defect operations. The SSI rate was 13.5%. Univariate analysis showed that chronic obstructive pulmonary disease (COPD) ( p = 0.008), congestive heart failure New York Heart Association class IV ( p = 0.048), longer preoperative hospital stay, preoperative nosocomial infection, higher volume of blood loss and larger packed red blood cell transfusions during the operation were significantly related to SSI. Logistic regression analysis further identified COPD, pre-operative nosocomial infection and emergency surgery as being independently associated with SSI (odds ratios of 4.96, 5.88 and 9.77, respectively). Obesity and diabetes mellitus were not associated with SSI. Conclusion COPD is an independent underlying illness associated with SSI after cardiac surgery. Minimizing preoperative hospitalization and nosocomial infection, and awareness of cases presenting with relevant risk factors, are useful in reducing SSI.

Background/Purpose The early diagnosis and appropriate management of spinal tuberculosis (TB) is challenging for clinicians. This study aimed to characterize the clinical features and factors affecting treatment outcomes. Methods A retrospective study of patients with spinal TB over a 7-year period at a medical center in southern Taiwan was conducted. Clinical features, underlying diseases, laboratory results, imaging findings, therapy, treatment duration and outcomes were analyzed. Results Forty-eight patients (24 men and 24 women) were diagnosed with spinal TB. Their mean age was 64.3 years. The most common presenting symptoms were backache, neurological deficits, and fever. The most common vertebral area involved was lumbar spine (41.7%). The mean number of vertebra involved was 2.46. Surgery was carried out on 30 patients (62.5%). Patients who had a longer duration of symptoms prior to diagnosis were more likely to have surgery ( p = 0.03), and patients who received surgery had a more favorable outcome ( p = 0.063). The mean treatment course was 11.4 ± 3.7 months. A long course treatment did not contribute to favorable outcomes. Twenty-six patients had a favorable outcome and 11 had an unfavorable outcome. Factors associated with an unfavorable outcome included older age, limb weakness, incontinence, spinal kyphotic deformity, and spinal cord compression. Conclusion For elderly patients with chronic back pain in Taiwan, the differential diagnosis of spinal TB should be considered. Image studies and computed tomography-guided aspiration are helpful for early detection. Combined surgical intervention tended to have a more favorable outcome and longer treatment periods had no additional benefit.

The stress, needs and quality of life (QoL) of family members of people living with HIV/AIDS (PLWHA) are critical to explore in Taiwan where home care projects are not available to help the PLWHA families. We examined the extent of stress, needs, QoL and its correlates that family caregivers of PLWHA experienced with structural questionnaires survey. A total of 50 family caregivers of PLWHA visiting a medical center in Taiwan participated in the study from October 2005 to August 2006. Family caregivers felt most stressful on disclosure and stigma issues, and most worried about patients' interpersonal relationships. The most important needs were care-related needs including knowledge of the disease progression, methods of examination and treatment, and the related side effects. The level of stress significantly positively correlated with needs, and negatively correlated with QoL. Availability of alternative manpower to care PLWHA and being PLWHA's parents were two significant factors affecting family caregivers' QoL. In conclusion, family members of PLWHA experienced high level of stress, enormous caring needs, and poor QoL. A family-centered care for PLWHA and their families in the community is crucial to improve quality of care and to prevent family's overload, particularly for families with no alternative manpower and for those being PLWHA's parents.