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Based on the lumped parameter method and the equal power division pressure ratio method, the unsteady heat transfer model of the quasi-one-dimensional engine is derived, and the one-dimensional engine transition state performance calculation model considering the heat transfer between the airflow and the solids of the components is established. The numerical simulation of the Bodie acceleration process of a triple-spool turboprop engine is carried out. The results show that the effect of heat transfer on the performance of the whole machine is mainly reflected by the response delay of each component. Bodie accelerates the process and the heat transfer effect has a significant impact on compressor performance.

Based on the component maps based high speed turbine engine simulation model, the influence of design point parameters of the rotational speed of the fan, the corrected rotational speed of the fan, and the throat area of nozzle on engine’s performance and control law is studied. With thrust, specific thrust and specific fuel consumption as performance parameters, the engine with different control laws is compared and evaluated, which provides a reference for the selection of high-speed turbofan engine design point parameters. The results show that: increase the value of the corrected rotational speed of the fan to use at design point, the engine velocity characteristic becomes better, the specific fuel consumption increases, and the engine size increases. Under the same value of corrected rotational speed of the fan to use at design point, the value of the rotational speed of the fan to use at design point increases, the engine velocity characteristic becomes better, the specific fuel consumption increases, and the engine size increases. Adjusting the throat area of nozzle keeps the rotational speed of the fan at the maximum in the wide Mach number range, while keeping the turbine inlet temperature and the rotational speed of the fan at the maximum, increasing the engine’s thrust at high Mach numbers.

This article takes the hydrogen-fueled scramjet as the research object, considering the mixing and combustion of the hydrogen fuel with the airflow, to propose a variable specific heat calculation method which considering the chemical equilibrium of the hydrogen-fueled combustion products. And then, propose a one-dimensional lumped parameter calculation model based on integral form for the geometry configuration design and performance simulation of hydrogen-fueled scramjet. On the basis of this calculation model, the constant static temperature heating method is used to simulate the combustion heating process of the combustion chamber, and the geometry configuration of the combustion chamber is designed. Using this profile as the final geometry configuration of the combustion chamber, conduct engine characteristics research and the results were analyzed. At the same time, the specific thrust Fs and specific impulse I SP are selected as the overall performance parameters, in the flight range of Ma710, the constant static temperature design of the combustion chamber is respectively performed to obtain the engine performance parameters, and the performance comparison with the corresponding engine reference configuration is completed. The comparison results show that the constant static temperature heating method can obtain better performance, and the Fs and I SP are about 35% higher than the engine reference configuration.

In this article, based on the component method, the engine steady state performance calculation model is established. Based on the model, the performance of the take-off and the high altitude climb of the civil turbofan engine is studied. The influence of the single control law and the combined control law on the engine characteristics is analyzed. Based on the thrust demand of the aircraft at cruise and take-off, the maximum state control law of the engine and the corresponding thrust control law are designed.

Background: Acromegaly is so rare that its natural history, including incidence, risk of cancers, and mortality rates, remains elusive. This natural study utilized a nationwide database to provide a better understanding of acromegaly’s disease course. Methods: A cohort of 1,195 acromegaly patients were identified and followed-up from 1997 to 2013. Incidence, operation, and re-operation rates were calculated. Excessive mortality and cancer risk related to acromegaly were estimated by standardized mortality ratio (SMR) and standardized incidence ratio (SIR). Results: The incidence was 2.78 per million-person-years, with little gender predominance (female vs. male, 49.5 vs. 50.5%, respectively). There was female predominance only among 50 and 60 year-olds (incidence rate ratio: 1.37 and 1.43, p < 0.001 and p = 0.002). Among them, 673 (56.3%) had hypophysectomy surgery, and the young-onset (p = 0.01). The overall mortality rate was 22.3 per 1,000 person-years, with a median survival of 4.67 years (with no gender differences, p = 0.38). The overall SMR of acromegaly patients was 1.41, and the onset-age-specific SMRs of the early- and middle-onset patients were higher than for those with late-onset. There were 87 newly diagnosed cancers in the cohort, with an incidence rate of 10.6 per 1,000 person-years (median 5.4 years). The overall SIR of cancers was 1.91, and there were no differences among gender, onset-age, and disease duration (all SIR >1, approximately 2). Conclusion: Acromegaly is associated with an excessive risk of mortality and two-fold higher risk of cancers. Patients with acromegaly should be managed appropriately after the diagnosis.

Aerobic exercise, in relation to physical activity, has been shown to have beneficial effects on anxiety. However, the underlyig neural mechanism remains elusive. Using a within-subject crossover design, this fMRI study examined how exercise (12-min treadmill running versus walking) mediated amygdala reactivity to explicit and implicit (backward masked) perception of emotional faces in young adults (N = 40). Results showed that acute exercise-induced differences of state anxiety (STAI-S) varied as a function of individual’s habitual physical activity (IPAQ). Subjects with high IPAQ levels showed significant STAI-S reduction (P

A 38-GHz-band transformer based high linear power amplifier with analog pre-distortion for wideband modulated signal in 65-nm GP CMOS process is presented in this paper. The output power is based on the two-way transformer current combining structure. The driver amplifier which is biased in deep class-AB acts as an AM-AM pre-distorter to produce better OP1dB and improve the third order intermodulation distortion (IMD3). Also a PMOS capacitor is used to compensate the AM-PM distortion of the input capacitor at the driver stage. In the continuous-wave measurement, this power amplifier achieves 14.4-dB small-signal power gain, 20.7-dBm PSAT, 35% PAEMAX, 20.2-dBm OP1dB, and 32.8% PAE1dB at 39 GHz. In the modulated signal measurement, this power amplifier achieves 13.2-dBm output power, 7.1% PAE, and EVM < -25 dBc at 1600-MHz channel bandwidth of 64-QAM OFDM with 38-GHz carrier frequency. The highest transmission data rate of the proposed power amplifier reaches up to 6.98 Gb/s.

Cervical spondylotic myelopathy (CSM) has become a prevalent cause of spinal cord dysfunction among the aging population worldwide. Although great strides have been made in spine surgery in past decades, the optimal timing and surgical strategy to treat CSM have remained controversial. In this article the authors aimed to analyze the current trends in studies of CSM and to summarize the recent advances of surgical techniques in its treatment.The PubMed database was searched using the keywords pertaining to CSM in human studies that were published between 1975 and 2018. Analyses of both the bibliometrics and contents, including the types of papers, authors, affiliations and countries, number of patients, and the surgical approaches were conducted. A systematic review of the literature was also performed with emphasis on the diagnosis and treatment of mild CSM.A total of 1008 papers published during the span of 44 years were analyzed. These CSM studies mainly focused on the natural history, diagnosis, and treatment, and only a few prospective randomized trials were reported. For the authors and affiliations, there was a shift of clustering of papers toward Asian countries in the past decades. Regarding the treatment for CSM, there was an exponential growth of surgical series published, and there was a trend toward slightly more anterior than posterior approaches through the past decade. Patients with CSM had increased risks of neurological deterioration or spinal cord injury with nonoperative management. Because surgery might reduce the risks, and early surgery was likely to be correlated with better outcomes, there was a trend toward attention to mildly symptomatic CSM.There is emerging enthusiasm for research on CSM worldwide, with more publications originating in Asian countries over the past few decades. The surgical management of CSM is evolving continuously toward early and anterior approaches. More prospective investigations on the optimal timing and choices of surgery are therefore needed.

Degenerative spinal deformity (DSD) has become a prevalent cause of disability and pain among the aging population worldwide. Though surgery has emerged as a promising option for DSD, the natural course, outcomes, and effects of surgery on DSD have remained elusive. This cohort study used a national database to comprehensively follow up patients of DSD for all-cause mortality, respiratory problems, and hip fracture-related hospitalizations. All patients were grouped into an operation or a non-operation group for comparison. An adjustment of demographics, comorbidities, and propensity-score matching was conducted to ameliorate confounders. A Cox regression hazard ratio (HR) model and Kaplan-Meier analysis were also applied. The study comprised 21,810 DSD patients, including 12,544 of the operation group and 9266 of the non-operation group. During the 14 years (total 109,591.2 person-years) of follow-up, the operation group had lower mortality (crude hazard ratio = 0.40), lower respiratory problems (cHR = 0.45), and lower hip fractures (cHR = 0.63) than the non-operation group (all p &lt, 0.001). After adjustment, the risks for mortality and respiratory problems remained lower (adjusted HR = 0.60 and 0.65, both p &lt, 0.001) in the operation than the non-operation group, while hip fractures were indifferent (aHR = 1.08, p &gt, 0.05). Therefore, surgery for DSD is invaluable since it could reduce the risks of mortality and of hospitalization for respiratory problems.

BACKGROUND Missed appointments mean appointments neither attended nor canceled by patients. Missed appointments belong to one of the important subjects of hospital management because they would incur the inactivity of medical professionals and devices, occupy the health resources for other patients, and thus impair the quality of healthcare services. The aim of this study was to explore the factors of missed appointments at the outpatient department of an academic medical center in Taiwan. METHODS This was a cross-sectional study based on registration records of an academic medical center in Northern Taiwan in 2015. Fifteen variables of patients, appointments, and weathers were taken into analysis. Logistic regression was used to calculate the adjusted odds ratio of each variable. For nonfirst visits, we further built a logistic regression model with the five most influential variables and the personal attendance pattern of the previous three appointments. RESULTS Of 2 132 577 eligible appointments in 2015, the overall no-show rate was 16.9%. The influential factors included the following: (1) patient characteristics: younger than 40 years, ≤6 visits, and a no-show rate between 50% and 75% in the previous year; (2) appointment characteristics: Saturdays, evenings, on the last third of the waiting list, only one appointment on the same day, online appointments, appointment-to-visit intervals (wait time) in 7 to 14 days, appointments to obstetrics/gynecology or pediatrics, first-time appointments, and the interval between the appointed visit and the previous visit in

Percutaneous lung biopsy is a technique used for sampling peripherally located lung masses and has been gaining in popularity. However, its exact utilization is unknown, and its safety has not been well studied. The current study aimed to assess the trend of utilization and study the safety of this procedure. Using the National Health Insurance Research Database, we retrospectively determined the total number of procedures that were performed on subjects older than 20 years between 2001 and 2010. We also estimated the rates of major complications, such as pneumothorax, requiring intercostal drainage. A total of 630 percutaneous biopsies were performed in 2001, while 3814 were performed in 2010, representing a 6.1-fold increase. The compound annual growth rate was 22.1%. The number of hospitals that performed the procedure increased from 55 to 99. Pneumothorax requiring drainage occurred in 1.5% of the procedures. The factors associated with a higher complication rate included male gender, chronic obstructive pulmonary disease, rural hospital, and low-volume hospital. Percutaneous lung biopsies are a relatively safe procedure, and their performance has been rapidly increasing. The number of procedures performed by a hospital was associated with the complication rate.

In the present study, we found that our isolate Shewanella decolorationis NTOU1 is able to degrade acetate under anaerobic condition with concomitant implementation of extracellular electron transfer (EET). With +0.63 V (vs. SHE) poised on the anode, in a 72-h experiment digesting acetate, only 2 mM acetate was consumed, which provides 6% of the electron equivalents derived from the initial substrate mass to support biomass (5%) and current generation (1%). To clarify the effects on EET of the addition of electron-shuttles, riboflavin, anthraquinone-2,6-disulfonate (AQDS), hexaammineruthenium, and hexacyanoferrate were selected to be spiked into the electrochemical cell in four individual experiments. It was found that the mediators with proton-associated characteristics (i.e., riboflavin and AQDS) would not enhance current generation, but the metal-complex mediators (i.e., hexaammineruthenium, and hexacyanoferrate) significantly enhanced current generation as the concentration increased. According to the results of electrochemical analyses, the i-V graphs represent that the catalytic current induced by the primitive electron shuttles started at the onset potential of -0.27 V and continued increasing until +0.73 V. In the riboflavin-addition experiment, the catalytic current initiated at the same potential but rapid saturated beyond -0.07 V; this indicated that the addition of riboflavin affects mediator secretion by S. decolorationis NTOU1. It was also found that the current was eliminated after adding 48 mM N-acetyl-L-methionine (i.e., the cytochrome inhibitor) when using acetate as a substrate, indicating the importance of outer-membrane cytochrome.

Anterior cervical discectomy and fusion (ACDF) is the standard surgical management for disc herniation and spondylosis worldwide and reportedly performed with short hospitalization and early discharge (ED). However, it is unknown if ED improves the outcomes of ACDF including among older adults. This cohort study included patients who underwent ACDF surgery in Taiwan over two years analyzed in two groups: the ED group (discharged within 48 hours), and the comparison group (hospitalized for more than 48 h). Both groups were followed-up for at least 180 days. Pre- and post-operative comorbidities, re-admissions and re-operations were analyzed using a multivariate cox-regression model, with bootstrapping, and Kaplan&ndash, Meier analysis. Among 5565 ACDF patients, the ED group (n = 405) had a higher chance (crude and adjusted hazard ratio = 2.33 and 2.39, both p &lt, 0.001) of re-admission than the comparison group (n = 5160). The ED group had an insignificant trend toward more re-admissions for spinal problems and re-operations within 180 days. In the ED group, older age (&ge, 60) and hypertension were predictive of re-admission. For ACDF surgery, the ED group had higher rates of re-admission within 180 days of post-op, suggesting that the current approach to ED requires modification or more cautious selection criteria be adopted, particularly for older adults.

Background Although the incidence of second surgery for adjacent segment disease (ASD) after anterior cervical discectomy and fusion (ACDF) has been reported, its risk factors remain elusive. Few studies have had a sufficiently large number of patients, long follow-up time, and high follow-up rate for investigation. To identify non-surgical risk factors of second surgery for ASD following ACDF, the study used a national cohort with comprehensive follow-up. Materials and methods All second ACDF surgery after one year from the first ACDF were identified as a consequence of ASD that required another surgery. A multivariate competing risk survival model, Kaplan-Meier survivorship, and average time to events were calculated. Results Among 38,149 patients who had the first ACDF, 1,092 (2.9%) later (mean 4.66 years) received a second ACDF surgery, during the nearly-perfect follow-up of 16 years. Young age and psychiatric disorders were independent risk factors. Patients who were aged under 40, 50, 60 and 70 years were, respectively, 4.56, 4.09, 3.09 and 2.17 times more likely than those older than 70 years. Also, patients with depression or psychoses were, respectively, 1.42 and 1.45 times more likely to have second surgery for ASD. (all p Conclusion Young age and psychiatric disorders are independent risk factors of second ACDF surgery for ASD. Personalized strategies to ameliorate or postpone the development of ASD are therefore warranted for patients who need ACDF surgery.

Hemodialysis (HD) is the most common renal replacement therapy for patients with end-stage renal disease in Taiwan. The use of HD in hospice care and its impact on terminal cancer patients remains unclear.Using claim data from the Taiwan National Health Insurance Research Database, all patients who died from cancer and claim data of their terminal admissions in hospice from 2007 to 2010. Those with a comorbid diagnosis of renal failure or who had health insurance claims data for HD were enrolled.A total of 5482 subjects were identified, of whom 4484 received HD and 998 did not. The HD group was significantly correlated with a younger age and high costs of terminal hospice admission. After adjusting for age and gender, the HD group was positively associated with a long hospice stay, in-hospice death, bone/connective tissue/breast cancers, and secondary/metastatic cancers, but negatively associated with genitourinary cancer. Compared with Department of Health/municipal hospitals, patients at both national and private university-affiliated hospitals were less likely to undergo HD.For terminal cancer patients under hospice care, HD was associated with a younger age, long terminal hospice stay, and high medical costs. Some types of cancers were associated with HD. University-affiliated hospitals played significant roles in non-HD renal supportive care. In-hospice HD is still common in Taiwan. Dialysis withdrawal and alternative care have space to promoting in hospice care.

In this paper, based on the scramjet, by the mode of characteristic calculation of one-dimensional scramjet engine, the effect of three and four-section combustion chamber geometry, fuel distribution ratio on scramjet performance is studied. The results of the comparison and evaluation of engine performance provide a certain reference for the geometric configuration of the combustion chamber and fuel injection parameters of the design point. It is mainly to determine the appropriate combustion chamber geometry and fuel injection method to obtain better combustion chamber performance and overall engine performance. The results show that increasing the thermal throat area of the combustion chamber can effectively increase the thrust of the aircraft during low-speed flight condition, and increase the fuel distribution ratio and the length of the expansion section in the front section of the combustion chamber without thermal choke and without affecting the inlet start, can improve the specific impulse of the engine at high speed.

Cartilage can redistribute human body’s daily loads and decrease the friction force in the diarthrodial joints. However, it may be injured due to trauma, sports injury, biomechanical imbalance, and genetic disease. Microfracture (MF), osteochondral autograft transplantation (OAT), and autologous chondrocyte implantation (ACI) are the most common treatment procedures in the hospital. Recently, the concept of tissue engineering involving the combination of cells, scaffolds, and bioactive signals has inspired researchers. Our team of researchers synthesized a tri-copolymer from biological polymer by using gelatin, chondroitin-6-sulfate, and hyaluronic acid through cross-linking reaction. Lacuna formation could be seen in the tri-copolymer surrounding the chondrocytes, and some newly formed glycosaminoglycan was found in the engineered cartilage. Considering the dedifferentiation possibility of chondrocyte, bone marrow mesenchymal stem cells (BMSCs) become an ideal cell source for cartilage tissue regeneration, since they can be easily harvested from adult tissue, and be expanded in vitro. In an in-vivo porcine pilot study, the results showed that the defect site could be regenerated by BMSCs/collagen gel, and is formed with fibro/hyaline mixed cartilage tissue after implantation for six months. Several clinical studies using BMSCs for cartilage defect treatment were also conducted recently; clinical outcomes such as IKDC, Lysholm, and Tegner scores improved when the cartilage defects were repaired by several millions of mesenchymal stem cells, and there is no tumor formation after being treated with BMSCs during the 10-year follow-up. Moreover, recently a commercial BMSCs/collagen gel composite for cartilage repair was developed in Taiwan and clinical trial was conducted in 2008; the results showed that there is an improvement in IKDC and MRI scores during the nine-year follow-up. It seems that using an engineered cartilage made from BMSCs/collagen gel for cartilage defect treatment is a promising method.

Background: Effectively predicting and reducing readmission in long-term home care (LTHC) is challenging. We proposed, validated, and evaluated a risk management tool that stratifies LTHC patients by LACE predictive score for readmission risk, which can further help home care providers intervene with individualized preventive plans. Method: A before-and-after study was conducted by a LTHC unit in Taiwan. Patients with acute hospitalization within 30 days after discharge in the unit were enrolled as two cohorts (Pre-Implement cohort in 2017 and Post-Implement cohort in 2019). LACE score performance was evaluated by calibration and discrimination (AUC, area under receiver operator characteristic (ROC) curve). The clinical utility was evaluated by negative predictive value (NPV). Results: There were 48 patients with 87 acute hospitalizations in Pre-Implement cohort, and 132 patients with 179 hospitalizations in Post-Implement cohort. These LTHC patients were of older age, mostly intubated, and had more comorbidities. There was a significant reduction in readmission rate by 44.7% (readmission rate 25.3% vs. 14.0% in both cohorts). Although LACE score predictive model still has room for improvement (AUC = 0.598), it showed the potential as a useful screening tool (NPV, 87.9%, 95% C.I., 74.2&ndash, 94.8). The reduction effect is more pronounced in infection-related readmission. Conclusion: As real-world evidence, LACE score-based risk management tool significantly reduced readmission by 44.7% in this LTHC unit. Larger scale studies involving multiple homecare units are needed to assess the generalizability of this study.

The focus of research and development on electric motorcycle range extender are system integration and energy regulation and management but the present fuel cell stack range extender still has defects, such as large volume, heavy weight and high cost. Its volume and weight will have a strong impact on the endurance of electric motorcycle. The bipolar plate takes most volume and weight of a proton exchange membrane fuel cell (PEMFC) stack and it is the key component influencing the overall power density and cost. Therefore, how to thin and lighten the bipolar plate and to enhance the performance and life of PEMFC stack is an urgent research subject to be solved for the moment and will be the key to whether the PEMFC stack range extender can be put in the electric motorcycle or not. In addition, the internal temperature, humidity, flow, voltage and current in the operation of PEMFC stack will influence its performance and life and the overall performance and life of fuel cell stack will be directly influenced by different external operating conditions. As nonuniform distribution of temperature, humidity, flow, voltage and current will occur in various regions inside the fuel cell stack, this study will use micro-electro-mechanical systems (MEMS) technology to develop a flexible five-in-one microsensor, which is embedded in the PEMFC stack range extender for real-time wireless microscopic diagnosis and the reliability test is performed, so that the actual operating condition inside the fuel cell stack range extender can be mastered instantly and correctly and the internal information is fed back instantly, the fuel cell stack range extender control system can be modified to the optimum operating parameters immediately, so as to enhance the performance and prolong the lifetime effectively.

This study utilized a radar echo extrapolation system, a high-resolution numerical model with radar data assimilation, and three blending schemes including a new empirical one, called the extrapolation adjusted by model prediction (ExAMP), to carry out 150 min reflectivity nowcasting experiments for various heavy rainfall events in Taiwan in 2019. ExAMP features full trust in the pattern of the extrapolated reflectivity with intensity adjustable by numerical model prediction. The spatial performance for two contrasting events shows that the ExAMP scheme outperforms the others for the more accurate prediction of both strengthening and weakening processes. The statistical skill for all the sampled events shows that the nowcasts by ExAMP and the extrapolation system obtain the lowest and second lowest root mean square errors at all the lead time, respectively. In terms of threat scores and bias scores above certain reflectivity thresholds, the ExAMP nowcast may have more grid points of misses for high reflectivity in comparison to extrapolation, but serious overestimation among the points of hits and false alarms is the least likely to happen with the new scheme. Moreover, the event type does not change the performance ranking of the five methods, all of which have the highest predictability for a typhoon event and the lowest for local thunderstorm events.

Background: Atrial fibrillation (AF) is associated with an increased risk of dementia. However, limited data are available on the predictors of dementia in patients with AF. This study aimed to evaluate whether the CHADS2 score could be a useful tool for risk stratification with regard to dementia occurrence among patients with AF. Methods: AF patients were identified from the National Health Insurance sampling database, which has accumulated a total of 1,000,000 participants since 2000. After excluding patients diagnosed with dementia prior to the index day of enrollment, CHADS2 score was measured to investigate its association with the occurrence of dementia, including vascular dementia and Alzheimer's disease. Results: During the mean follow-up period of 3.71 ± 2.78 years, 1135 dementia cases (7.36%) were identified, including 241 cases of vascular dementia and 894 cases of Alzheimer's disease. In multivariate analysis, an increase of 1 point in the CHADS2 score was independently associated with a 54% increase in the risk of vascular dementia (hazard ratio = 1.54; 95% confidence interval, 1.41–1.69; p

Cancer is the leading cause of human death worldwide. Although many scientists work to fight this disease, multiple drug resistance is a predominant obstacle for effective cancer therapy. In drug-resistant MCF-7/ADR cells, the acidic organelles with lower pH value than normal one can cause the protonation of anthracycline drugs, inducing drug accumulation in these organelles. In this study, single-walled carbon nanotubes with polyethylene glycol phospholipids surface modification (PEGylated SWNTs) were utilized as near infrared-activated drug carriers for doxorubicin (DOX) delivery against MCF-7/ADR cells. Our results showed that a concentration-dependent temperature increase was observed in a solution of PEGylated SWNTs with 808 nm laser irradiation, whereas a water solution showed no significant changes in temperature under a thermal camera using the same irradiation dose. Interestingly, PEGylated DOX-SWNTs enhanced the nuclear accumulation of DOX with 808 nm irradiation whereas free DOX or PEGylated DOX-SWNTs revealed discrete red spots in MCF-7/ADR cells by confocal microscopic observation. Cell viability of PEGylated DOX-SWNTs-treated cells was also significantly decreased after 808 nm laser irradiation. Thus, photothermally activated PEGylated SWNTs can be a potential nanocarrier to deliver DOX into cancer cells and successfully overcome drug-resistant behavior in MCF-7/ADR breast cancer cells.

Objective To evaluate whether the addition of porogens to polymethyl methacrylate (PMMA) enhances the antibiotic elution rate from antibiotic-loaded bone cement. Methods Two porogens, gelatin sponge (Spongostan, Ferrosan Medical Devices) and ceramic granules (Bicera, Wiltrom), were added to liquid gentamicin-loaded PMMA at increasing concentrations. Porosity was analyzed using Fourier transform infrared (FTIR) spectroscopy and scanning electron microscopy. Young's modulus and drug elution were also measured. The gentamicin content of the eluents was evaluated by o-phthaldialdehyde (OPA) assay on days 1, 2, 5, 7, 10, and 14. Results After day 5, the drug-releasing rate of Spongostan was significantly higher than that of Bicera in the order G3 > G2 > T3 > G1 > T2 > T1 > bone cement, where G represents the concentration of Spongostan and T represents the concentration of Bicera. The addition of Bicera and Spongostan increased the drug-releasing efficiency of PMMA by 3.75-fold and 5.65-fold, respectively. Spongostan also resulted in larger pores (ie, 70 to approximately 200 μm) compared with Bicera (5 to 10 μm) but reduced biomechanical strength. Conclusion Both gelatin sponge and ceramic granules improved the local antibiotic elution rate, although the drug-releasing rate of Spongostan was significantly higher than that of Bicera.

We unambiguously discovered the existence of room-temperature ferromagnetic-like behavior (RTFM) in pure ZnO pellets, which are made from the nanoparticles showing only paramagnetism and diamagnetism. In contrast to previous reports, our systematic work shows that thermal annealing of ZnO at different temperatures can either enhance or reduce ferromagnetic-like ordering regardless of post-treatment in argon and oxygen. After post-annealing under different conditions, the treated pellets show significant and complicated variation in surface configurations, including for example different levels of surface dehydrogenation, carbon adsorption, grain size and Zn/O ratio. The quantitative analysis indicates that the RTFM of ZnO is affected mainly by surface oxygen vacancies and hydrogenation. The observed dependence of intrinsic RTFM on the energy position of the Zn 3d photoemission peak suggests the presence of unpaired electrons leading to vacancy-mediated ferromagnetism. On the other hand, we also found that the RTFM of ZnO can be easily modified by adsorbed species, which give rise to charge-transfer at the surface. Based on this result, we further identified that surface carbon contamination is a potential source for the reported controversies, related to poor reproducibility of experimental results in the area of so-called d0 ferromagnetism.

Background Academic publications are important for developing a medical specialty or discipline and improvements of quality of care. As hospice palliative care medicine is a rapidly growing medical specialty in Taiwan, this study aimed to analyze the hospice palliative care-related publications from 1993 through 2013 both worldwide and in Taiwan, by using the Web of Science database. Methods Academic articles published with topics including “hospice”, “palliative care”, “end of life care”, and “terminal care” were retrieved and analyzed from the Web of Science database, which includes documents published in Science Citation Index-Expanded and Social Science Citation Indexed journals from 1993 to 2013. Compound annual growth rates (CAGRs) were calculated to evaluate the trends of publications. Results There were a total of 27,788 documents published worldwide during the years 1993 to 2013. The top five most prolific countries/areas with published documents were the United States (11,419 documents, 41.09%), England (3620 documents, 13.03%), Canada (2428 documents, 8.74%), Germany (1598 documents, 5.75%), and Australia (1580 documents, 5.69%). Three hundred and ten documents (1.12%) were published from Taiwan, which ranks second among Asian countries (after Japan, with 594 documents, 2.14%) and 16 th in the world. During this 21-year period, the number of hospice palliative care-related article publications increased rapidly. The worldwide CAGR for hospice palliative care publications during 1993 through 2013 was 12.9%. As for Taiwan, the CAGR for publications during 1999 through 2013 was 19.4%. The majority of these documents were submitted from universities or hospitals affiliated to universities. Conclusion The number of hospice palliative care-related publications increased rapidly from 1993 to 2013 in the world and in Taiwan; however, the number of publications from Taiwan is still far below those published in several other countries. Further research is needed to identify and try to reduce the barriers to hospice palliative care research and publication in Taiwan.

Calcitonin gene-related peptide (CGRP) and its receptors are widely distributed in the nervous and cardiovascular systems as a potent vasodilator; however, the underlying mechanisms of action of CGRP on cardiovascular regulation, such as cooling-elicited hemodynamic perturbation (CEHP), are still unclear. We used spectral and crossspectral analyses to explore such questions in this study. Conscious rats were pretreated with the CGRP antagonist CGRP_(8-37)-only, or following the removal of sympathetic influences using hexamethonium (HEX) or guanethidine (GUA) and then subjected the treated rats to a stressful cooling trial (CS). Cardiovascular indices were monitored via an implanted telemetric device throughout the experiment. The analyses included measurements of blood pressure (BP), heart rate (HR), cardiovascular variabilities (BPV, HRV), coherence linkage at very-low, low and high frequency regions (VLF: 0.02 to 0.2 Hz, LF: 0.2 to 0.6 Hz, and HF: 0.6 to 3.0 Hz), and dicrotic notch (Dn). Key findings of the hemodynamic indices and spectral changes in efferent sympathetic oscillations (LF) and myogenic oscillations (VLF) in comparison with the control vehicle were demonstrated: (I) under resting condition, CGRP_(8-37)- only increased the BP, HR and powers of VLF_(BPV), LF_(BPV). In contrast, the effects of CGRP_(8-37)-only were generally diminished or further reduced when the rats were pretreated with HEX or GUA. (II) Under CS condition, CGRP_(8-37)-only increased the HR but attenuated the power of LF_(BPV), converted the negative correlation (NC) into positive correlation (PC) for VLF_(HRV) with VLF_(BPV) (VLF pair) and LF_(HRV) with LF_(BPV) (LF pair). On the other hand, when pretreated with sympathetic removals, both HEX+CGRP_(8-37) and GUA+CGRP_(8-37) generally abolished the control coolinginduced pressor and tachycardia, attenuated or further reduced the effects of CGRP_(8-37)-only on VLF_(BPV), VLF_(HRV) and LF_(BPV). In addition, HEX+CGRP_(8-37) generally persisted the CGRP_(8-37)-only effect of PC for VLF and LF pairs, but GUA reversed the PC of VLF pair back to a NC tendency. Furthermore, cross-spectral analyses indicated that throughout the experiment, CGRP8-37-only enhanced the coherence linkage between BPV and HRV at the LF region but weakened that at the HF region. HEX+CGRP_(8-37) abolished the CGRP_(8-37)-only effect on the LF region but GUA+CGRP_(8-37) persisted the CGRP_(8-37)-only effects. Taken together, our results indicate that CGRP is dependent on the status of intrinsic sympathetic tonus to exert its function on cardiovascular regulation.

Electroencephalography (EEG) can provide important and useful information in clinical diagnosis. The conventional EEG electrode with conductive gel (wet electrode) is most frequently used for measuring EEG. However, the wet electrode encounters the issue of dehydration for long-term measurement. Recently, different types of dry electrodes were proposed to overcome the above issue, but measuring EEG in a hairy site is still a challenge for these electrodes. In this paper, a novel noncontact dry electrode with adaptive mechanical design is proposed to measure EEG in a hairy site without conductive gel. The proposed noncontact dry electrode can measure EEG across the hair layer to reduce the influence of hair. By the adaptive mechanical design, the influence of motion artifact can also be effectively improved. From the experimental results, the proposed noncontact dry electrode can provide a good performance of measuring EEG in a hairy site and a good ability to avoid the influence of motion artifact.

Objectives: This study aimed to investigate the long-term risk of stroke in adult patients with spinal deformity. Specifically, the study addressed the possible protective effect of surgery for spinal deformity against stroke. Methods: Using the National Health Insurance Research Database (NHIRD), a monopolistic national database in Taiwan, this retrospective cohort study analyzed the incidence of stroke in patients with adult spinal deformity (ASD) in a 11-year period. A total of 13,503 patients, between 55 and 75 years old, were identified for the diagnosis of ASD. The patients were grouped into two: the surgical group (n = 10,439) who received spinal fusion surgery, and the control group (n = 2124) who received other medical treatment. The incidence rates of all subsequent cerebrovascular accidents, including ischemic and hemorrhagic strokes, were calculated. Hazard ratios for stroke were calculated use a full cohort and a propensity score matched cohort. Adjustments for co-morbidities that may predispose to stroke, including hypertension, diabetes mellitus, arrhythmia and coronary heart disease were conducted. Kaplan-Meier and Cox regression analyses were performed to compare the risk of stroke between the two groups. Results: During the total observation period of 50,450 person-years, the incidence rate of stroke in the surgical group (15.55 per 1000 person-years) was significantly lower than that of the control group (20.89 per 1000 person-years, p &lt, 0.001). Stroke was more likely to occur in the control group than in the surgical group (crude hazard ratio 1.34, p &lt, 0.001, adjusted HR 1.28, p &lt, 0.001, by a propensity score matched model). Conclusions: In this national cohort of more than 13,000 ASD patients covering 10 years, stroke was approximately 25% less likely to happen in patients who underwent spinal fusion surgery than those who received medical management. Therefore, spinal fusion surgery may provide a protective effect against stroke in adult patients with spinal deformity.

High-performance MnBi isotropic magnets have been prepared via spark-plasma-sintering, which achieves bulk magnets with high densification and little grain growth. The sintered magnets in this work show high saturation magnetization at high temperatures. Moreover, hard magnetic behavior is still present after heating beyond its phase transition temperature. The exceptional thermal stability could be due to the observed fine-grained microstructure. The analysis of temperature dependence of coercivity behavior demonstrates that the magnetization process can be explained by nucleation model.

In this study, we present that anisotropic MnBi bulk magnets can be obtained using spark-plasma-sintering technique (SPS). Grain misalignment was suppressed by either external field or addition of appropriate polymer binder. Various microstructures were effectively achieved during SPS processing, and lead to distinct magnetic performance. Microstructure analysis reveals that the coercive field of the SPS-compacted magnets declines strongly with increasing grain size. Bi-rich residue clearly plays a role in magnetic decoupling to enhance the coercive field, whereas the exchange coupling mediated by excess Mn reduces it dramatically. In addition, the amount and distribution of Mn and Bi residue has a profound influence on the thermal magnetic stability of sintered MnBi magnets. We suggest that fast consolidation methods like SPS technique enable to tailor the microstructure of bulk magnetic products to meet specific application requirements.

Viral glycoproteins are expressed by many viruses, and during infection they usually play very important roles, such as receptor attachment or membrane fusion. The mature virion of the white spot syndrome virus (WSSV) is unusual in that it contains no glycosylated proteins, and there are currently no reports of any glycosylation mechanisms in the pathogenesis of this virus. In this study, we cloned a glycosylase, mannosyl-glycoprotein endo-β-N-acetylglucosaminidase (ENGase, EC 3.2.1.96), from Penaeus monodon and found that it was significantly up-regulated in WSSV-infected shrimp. A yeast two-hybrid assay showed that PmENGase interacted with both structural and non-structural proteins, and GST-pull down and co-immunoprecipitation (Co-IP) assays confirmed its interaction with the envelope protein VP41B. In the WSSV challenge tests, the cumulative mortality and viral copy number were significantly decreased in the PmEngase-silenced shrimp, from which we conclude that shrimp glycosylase interacts with WSSV in a way that benefits the virus. Lastly, we speculate that the deglycosylation activity of PmENGase might account for the absence of glycosylated proteins in the WSSV virion.