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This study employed a two-phase methodology to assess the environmental impacts from offset lithographic printing on color-box packaging. The Analytic Hierarchy Process (AHP) was used to prioritize improvement options and the life-cycle assessment (LCA) approach was used to assess environmental impacts quantitatively. This study quantified the total amount of energy consumption and CO2 emissions caused by the printing processes of color-box packaging and showed that the total reduction of GHG emissions of the system that omitted the laminating and varnishing process was approximately 239 kg. Moreover, incineration contributes 2905–3004 kg of CO2 to potential global warming in the case of color-box packaging. The study demonstrated the viability of the AHP for evaluating environmental impacts of printing processes, ranking them in order of pollution potential, and subsequently identifying those critical for reducing environmental pollution on the printing operation. This study also showed how the LCA approach may be used together with expert opinion to identify opportunity to alter printing processes in order to address environmental impacts and improve the environmental profile of offset lithographic printing.

The purpose of this study was to examine the association between psychoactive drug use and motor vehicle crash (MVC) injuries requiring hospitalization in southern Taiwan. A case–control study was conducted in southern Taiwan from January 2009 to December 2009. The cases included car or van drivers who were involved in MVCs and required hospitalization. Demographic and trauma-related data were collected from questionnaires and hospital and ambulance records. Urine and/or blood samples were collected on admission. The controls consisted of drivers who were randomly recruited while driving on public roads. Study subjects were interviewed and asked to provide urine samples. All blood and urine samples were tested for alcohol and a number of other legal and illegal drugs. Only those subjects who provided urine and/or blood specimens were included in the study. During the study period, 254 case patients and 254 control drivers were enrolled. The analysis showed an odds ratio (OR) of 3.41 (95% confidence intervals (95% CI), 1.76–6.70; p < 0.001) for persons taking benzodiazepines, and an OR of 3.50 (95% CI, 1.81–6.85; p < 0.001) for those taking alcohol (blood alcohol concentrations (BAC) ≥ 0.8 g/l) with regard to hospitalizations due to MVCs. For persons taking combinations of benzodiazepines and alcohol, the OR increased to 5.12 (95% CI: 1.77–15.91, p < 0.001). This study concluded that drug use among motor vehicle drivers increases the risk of MVCs that require hospitalization. From a public health perspective, the high risk ratios are concerning, and preventive measures are warranted.

Background Measles remains a leading vaccine-preventable cause of child mortality worldwide. The impact of vaccination programs can be seen in the increasingly low incidence of measles. However, cases of measles continue to occur in low numbers every year in Taiwan. We assessed the epidemiology of measles in Taiwan from 1999 to 2008 with a focus on domestic versus imported cases. Methods We analyzed the data reported to surveillance systems at the Taiwan Center for Disease Control, where viral isolation was performed. Results A total of 84 measles cases were reported from 1999 to 2008 in Taiwan with the incidence of measles varying from 0 to 1.5 per 1,000,000 people per year, peaking in 2002 and again in 2008. The incidence decreased with increasing age in both males and females. Among the 84 reported measles cases, 39 (46%) originated internationally, 8 (10%) were epidemiologically linked to imported cases and the source was unknown in 37 (44%) of the cases. The unknown-source cases were analyzed for potential evidence of endemic measles transmission. Most of the measles cases that occurred in Taiwan from 1999 to 2008 were associated with imported cases. No endemic transmission of measles in Taiwan was identified. Conclusions This study suggests that maintaining the high rate of vaccination coverage is needed to prevent future outbreak and sustain the elimination of measles in Taiwan.

This study involves the design, fabrication and characterization of a biocompatible silicon micropump. Three experiments were conducted to study the performance of this pump in clinical environments. They were a blood compatibility test, and in vitro and ex vivo studies. Whole blood is an intrinsically complex material and difficult to manipulate using a microsystem device. In the blood compatibility experiments, two materials N-(triethosilylpropyl)-O-polyethylene oxide urethane (PEOU) and polyethylene glycol (PEG) were employed to form a self-assembled monolayer (SAM) on a chip surface. According to the platelet remaining test and a 30-min blood transportation test, PEOU protected the micropump from thrombus. In the second experiment, the micropump handled several liquids, including DI water and whole blood. When the pump was operated at a voltage of 140 Vpp, the flow rates of the DI water and whole blood were 121.6 μl/min at 500 Hz and 50.2 μl/min at 450 Hz, respectively. The maximum back pressure of the water and the blood in the micropump were 3.2 and 1.8 kPa, respectively. Finally, the micropump injected phosphated buffered saline (PBS) and whole blood into the veins of rats. The pump was characterized ex vivo and discussed. The third experiment reveals that the micropump fulfilled the dosing condition for clinical medicine and did not affect the physiological function of the rats. This pump is highly promising for biomedical applications, such as in drug delivery for patients, or in clinical care. Moreover, the pump has potentials to control precisely medication to improve conventional clinical treatments.

To determine whether treatment with corticosteroids decreases the incidence of postextubation airway obstruction in an adult intensive care unit.Clinical experiment.Adult medical and surgical intensive care unit of a teaching hospital.One hundred twenty-eight patients who were intubated for24 hrs with a cuff leak volume24% of tidal volume and met weaning criteria.: Patients were randomized into a placebo group (control, n = 43) receiving four injections of normal saline every 6 hrs, a 4INJ group (n = 42) receiving four injections of methylprednisolone sodium succinate, or a 1INJ group (n = 42) receiving one injection of the corticosteroid followed by three injections of normal saline. Cuff volume was assessed 1 hr after each injection, and extubation was performed 1 hr after the last injection. Postextubation stridor was confirmed by examination using bronchoscopy or laryngoscopy.The incidences of postextubation stridor were lower both in the 1INJ and the 4INJ groups than in the control group (11.6% and 7.1% vs. 30.2%, both p.05), whereas there was no difference between the two treated groups (p = .46). The cuff leak volume increased after the second and fourth injection in the 4INJ group and after a second injection in the 1INJ group compared with the control group (both p.05).A reduced cuff leak volume is a reliable indicator to identify patients at high risk to develop stridor. Treatment with a single or multiple injections of methylprednisolone can effectively reduce the occurrence of postextubation stridor.

Dextromethorphan (DM) has been shown to protect against endotoxic shock in mice. Heatstroke resembles sepsis in many respects. The objective of this study was to examine the heat-induced acute lung inflammation and injury in rats with or without DM, and for comparison with those of the rats with MK-801 (an N-methyl-D-aspartate receptor antagonist), SA4503 (a sigma-1 receptor agonist), or fluoxetine (a serotonin reuptake inhibitor). Heatstroke was induced by exposing the anesthetized rats to heat stress (43°C for 68 min). At 68 minutes after start of heat stress, animals treated with vehicle medium, DM (10-30 mg/kg of body weight, intramuscular), MK-801 (1 mg/kg of body weight, intraperitoneal), SA4503 (1 mg/kg of body weight, intraperitoneal), or fluoxetine (5 mg/kg of body weight, intraperitoneal) were allowed to recover at room temperature (26°C). As compared with vehicle-treated heatstroke rats (25-31 min; n = 8), DM (30 mg/kg)-treated heatstroke rats and MK-801 (1 mg/kg)-treated heatstroke rats had significantly greater survival time (193-209 min [n = 7] and 121-133 min [n = 8], respectively). However, the survival times for the SA4503-treated heatstroke rats (28-34 min; n = 8) or the fluoxetine-treated heatstroke rats (20-26 min; n = 8) were not significantly different from the vehicle-treated heatstroke rats. DM treatment significantly: (1) reduced acute lung injury, including edema, neutrophils infiltration, and hemorrhage scores; (2) decreased acute pleurisy; and (3) decreased bronchoalveolar fluid levels of the proinflammatory cytokines, and ischemia and oxidative damage markers during heatstroke. Our results indicate that DM therapy may improve outcomes of heatstroke in rats by antagonizing the N-methyl-D-aspartate receptors.

The causative/regulatory connections between changes in tissue redox state and fever induction were investigated herein. Wherefore, LPS, the primary element of bacterial cell wall, in addition to inducing pro-inflammatory cytokines, activated macrophages and other leukocytes to secrete hydroxyl radical (OH), nitric oxide metabolites (NO(x)(-)), superoxide (O(2)) and other reactive oxygen/nitrogen species. Furthermore, inflammation response-associated hypoxia stimulated glutamate release, which caused excitotoxicity of cells by increasing extracellular Ca(2+). Cytokines and glutamate in turn also triggered the release of large amounts of NO(x)(-), OH, O(2), and other radicals. Those reactive nitrogen species in turn caused cellular injury via the peroxidation of membrane lipids and oxidative damage of proteins and DNA. Glutamate, NO(x)(-), OH and antioxidants participated in the pathogenesis and regulation of LPS- or cytokines-induced fever. In particular, to highlight the role of glutamate, prostaglandin E(2), NO(x)(-) and OH generated in the hypothalamus during pyrogenic fever was attempted hereby. To find the link among the signaling with the glutamate, NO(x)(-) and OH/prostaglandin E(2) in the hypothalamus during pyrogenic fever will be challenging and could now clinically suppress pyrogenic fever.

Objectives: To investigate the clinical features, especially cancer-related complications, and short-term outcome of critically ill patients with head and neck cancer (HNC) in the medical intensive care unit. Methods: We reviewed 57 patients with a diagnosis of HNC in the medical intensive care unit (≥24 hours) of a tertiary-care medical center between January 1999 and December 2005. Results: Thirty-two (56.1%) patients had advanced cancers (stage III/IV), and 21 (36.8%) remained uncontrolled (ie, relapsed or progressive). Twenty-five (43.9%) patients had cancer-related complications, including airway obstruction, tumor bleeding, or wound infection. Among 47 (82.4%) patients with acute respiratory failure, 25.5% of them were caused by cancer-related life-threatening airway complications. After excluding 5 already tracheos-tomized acute respiratory failure patients, difficult intubation was encountered in 26.2% (11/42); and 72.7% (8/11) of them required emergency tracheostomy. The 30-day mortality was 38.6%. Uncontrolled HNC (adjusted odds ratio [OR], 4.13; 95% confidence interval, 1.14-14.92) and Acute Physiology and Chronic Health Evaluation II score (adjusted OR 1.13; 95% confidence interval, 1.04-1.22) were found as the risk factors for 30-day mortality in multivariate analysis. Conclusions: Although critically ill patients with HNC usually had advanced cancers and carried a high rate of cancer-related life-threatening airway complications, their 30-day mortality was favorable and only independently associated with cancer status and Acute Physiology and Chronic Health Evaluation II score.

To investigate the characteristics and outcomes of surgical patients who were readmitted to the intensive care unit (ICU).The data were collected for all readmissions to the surgical ICUs in a tertiary hospital in the year 2003.Of all the 945 ICU discharges, 110 patients (11.6%) were readmitted. They had a longer initial ICU stay (8.05 +/- 7.17 vs 5.22 +/- 4.95, P0.001) and were older and in a more severe condition than those not readmitted, but with a longer hospital stay and higher mortality rate (40% vs 3.6%, P0.001). A total of 26.4% of the readmission patients had an early readmission (48 h), with a lower mortality rate than those with a late readmission (24.1% vs 45.7%, P = 0.049). A total of 46.4% of the patients were readmitted with the same diagnosis while the rest were readmitted with a new complication. Respiratory disease was the most common diagnosis for patients readmitted with a new complication (66.1%). The nonsurvivors had a significantly higher second Acute Physiology and Chronic Health Evaluation (APACHE II) score (22.1 +/- 8.8 vs.14.6 +/- 7.4, P0.001) and second Therapeutic Intervention Scoring System (TISS) score (30.1 +/- 8.7 vs 24.7 +/- 7.6, P = 0.001) and a longer stay in the first ICU admission (10.4 +/- 9 days vs 6.4 +/- 5 days, P = 0.010). A multivariate analysis showed that the first ICU length of stay and the APACHE II score at the time of readmission were the two risk factors for mortality.The mortality of surgical patients with ICU readmission was high with respiratory complications being the most important issue.

Background The increased incidence of pyogenic liver abscess caused by Klebsiella pneumoniae (K.pneumoniae) was reported in the recent literature. This study was conducted retrospectively to investigate the clinical characteristics and outcomes of these patients. Methods Microbiological and medical databases of a medical center were searched from January 2000 to June 2003. Eighty-four patients with liver abscess caused by K.pneumoniae were analyzed. Results In the 84 patients, 52 men and 32 women aged (58.2 +/- 13.3) years on average, 64.4% had concomitant diabetes mellitus and 23.8% had biliary disease. The most common clinical symptoms were fever (98.8%), chills (69.0%) and abdominal pain (58.3%). 85.7% of the 84 patients received catheter drainage for the abscess. The length of hospital stay was (17.4 +/- 8.7) days. The mortality rate was 7.1%. Older age and presence of biliary disease were associated with mortality. Conclusions The low mortality of our patients was probably related to the high proportion of patients who received catheter drainage. Older age and presence of biliary disease were associated with the mortality.

Despite significant efforts to develop micropumps, cumbersome driving equipment means that the design of portable micropumps remains a challenge. This study presents a stand-alone micropump system, which includes a peristaltic micropump based on piezoelectric actuation and a driving circuit. This battery-based driving circuit comprises a 12 V battery, an ATmega 8535 microprocessor, a 12 V-to-180 V DC to DC converter using transformerless technology, three differential amplifiers, an IC 7805, a phase controller, an A/D converter, a keyboard and an LCD module. The system can produce step-function signals with voltages of up to 228 V(pp) and frequencies ranging from 10 Hz to 100 kHz, as the inputs for the pump. It is portable and programmable with the package size of 22 x 12.8 x 9 cm. Additionally, this proposed system is used to design the driving signals of the pump which are 3-, 4, and 6-phase actuation sequences. This work performs the circuit testing and fluid pumping, and demonstrates the effects of actuation sequences on pump performance in terms of the dynamic behavior of the diaphragm, flow rates, back pressure and power consumption of the system. The experimental results show that the pump excited by the 6-phase sequence results in better performance compared with the 3- and 4-phase sequences, and produces a maximum flow rate of 36.8 microl/min and a maximum back pressure of 520 Pa with deionized water at 100 V (pp) and 700 Hz.

To evaluate the therapeutic effects of activated protein C in an animal model of heat stroke.Laboratory investigation.Chi-Mei Medical Center research laboratory.Male Sprague-Dawley rats weighing 252-304 g.Anesthetized animals were subjected to heat stress (40 degrees C) to induce heat stroke. A bolus injection of normal saline or recombinant human activated protein C (drotrecogin alfa, activated) was conducted via femoral catheters immediately after the onset of heat stroke. Blood sampling was done before initiation of heat stress and 0 and 40 mins after the onset of heat stroke.When the vehicle-treated rats underwent heat exposure, their survival time values were found to be 56-64 mins (n = 16). Resuscitation with activated protein C significantly and dose-dependently improved survival during heat stroke (108-246 mins for doses of 0.5-20 mg of activated protein C per kilogram of body weight) (n = 32). All heat-stressed animals displayed systemic inflammation and activated coagulation, evidenced by increased tumor necrosis factor-alpha, prothrombin time, activated partial thromboplastin time, and D-dimer and decreased platelet count and protein C. Biochemical markers evidenced by cellular ischemia and injury/dysfunction included increased plasma levels of blood urea nitrogen, creatinine, glutamic oxaloacetic transaminase, glutamic pyruvic transaminase, and alkaline phosphatase; increased striatal levels of glutamate, glycerol, and lactate/pyruvate ratio; and decreased striatal levels of partial pressure of oxygen and local cerebral blood flow, which were all observed during heat stroke. These heat stroke reactions were all significantly suppressed by resuscitation with activated protein C but not vehicle solution.The results indicate that systemic delivery of human recombinant activated protein C at the time point of onset of heat stroke may improve survival by ameliorating systemic inflammation, hypercoagulable state, and tissue ischemia and injury in multiple organs.

Pyogenic liver abscess (PLA) is a potentially life-threatening disease, and early diagnosis may be difficult. In order to provide diagnostic clues and to enhance the prompt management of such cases, we retrospectively investigated the clinical characteristics of PLA during a 3-year period in a tertiary-care hospital. The crude incidence rate of PLA in our study was 446.1 per 100,000 hospital admissions. Male predominance and a mean age of 57.6 +/- 14.4 years were observed. Diabetes mellitus was the most common concomitant disease, and biliary pathologies were the most common predisposing cause of this type of abscess. The most common clinical features were fever, chills, and abdominal pain. Leukocytosis was found in 67.3% of the patients, and the observed C-reactive protein (CRP) values were high. The most common pathogen was Klebsiella pneumoniae. The mortality rate was 6.5%. A complete history, physical examination, evaluation of the white blood cell count and CRP, and the prompt arrangement of imaging studies may lead to an earlier diagnosis. The aggressive performance of image-guided catheter drainage and the appropriate administration of antibiotics may reduce the mortality rate of PLA.

As a part of our program aimed at exploring the biological activity of symmetrical substitution of side chains into the anthracene-9,10-dione chromophore, we have synthesized a series of 1,5-bisthioanthraquinones 2 and 1,5-bisacyloxyanthraquinones 3 that are related to the antitumor agent mitoxantrone. Since the telomerase enzyme is a novel target for potential anticancer therapy and stem cell expansion, we explore the biological effects of these compounds by evaluating their effects on telomerase activity and telomerase expression. Telomerase is required for telomere maintenance and is active in most human cancers and in germinal cells but not in most of the normal human somatic tissues. We found that most of the 1,5-disubstituted anthraquinones did not exhibit inhibitory activity at the concentration ranging from 20 to 30 microM. To facilitate the analysis of the expression of telomerase, we used cancer and normal cell lines that carry secreted alkaline phosphatase (SEAP) gene under the control of human telomerase reverse transcriptase (hTERT). The effects of these compounds on the expression of telomerease were analyzed using the cell-based reporter systems. While most of these compounds did not appear to selectively repress the expression of hTERT in cancer cells, compounds 3a, 3d, and 3i activated hTERT expression in normal cells. The effects of these three compounds on hTERT expression appear to be specific because they did not increase the expression of a CMV promoter-driven SEAP. Thus, in addition to anticancer functions, our finding raises the possibility that these compounds might also have a role in cell immortalization. The application of these anthraquinone derivatives in stem cell research and tissue engineering is also discussed.

Human infections caused by Vibrio fluvialis are rarely reported. The most common clinical presentation of V. fluvialis infection is acute gastroenteritis with diarrhea. Reported extra-intestinal infections caused by V. fluvialis have included bacteremia, hemorrhagic cellulitis and cerebritis. Peritonitis is an uncommon clinical presentation of Vibrio infections, and most cases have occurred in patients receiving peritoneal dialysis or those with liver cirrhosis. Herein, we report the first case of acute appendicitis with V. fluvialis peritonitis.