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An AI-assisted algorithm has been developed to improve the detection of significant coronary artery disease (CAD) in high-risk individuals who have normal electrocardiograms (ECGs). This retrospective study analyzed ECGs from patients aged ≥ 18 years who were undergoing coronary angiography to obtain a clinical diagnosis at Chang Gung Memorial Hospital in Taiwan. Utilizing 12-lead ECG datasets, the algorithm integrated features like time intervals, amplitudes, and slope between peaks, a total of 561 features, with the XGBoost model yielding the best performance. The AI-enhanced ECG algorithm demonstrated high sensitivity (0.82–0.84) when detecting CAD in patients with normal ECGs and gave remarkably high prediction rates among those with abnormal ECGs, both with and without ischemia (92 %-95 % and 80 %-83 %, respectively). Notably, the algorithm's top features, mostly related to slope and amplitude differences, are challenging for clinicians to discern manually. Additionally, the study highlights significant sex differences regarding feature prediction and ranking. Comparatively, the AI-enhanced ECG's detection capability matched that of myocardial perfusion scintigraphy, which is a costly nuclear medicine test, and offers a more accessible alternative for identifying significant CAD, especially among patients with atypical ECG readings.

Background/purpose: In Taiwan, there are very few dental radiology curricula in medical radiation education system. This study assessed the participants’ learning outcomes after finishing the dental radiology course for the continuing education of medical radiation technologists in Taiwan. Materials and methods: This study used the questionnaire survey to evaluate the participants’ learning outcomes after finishing the dental radiology course for the continuing education of medical radiation technologists in Taiwan. Results: In this study, 85 participants filled out the questionnaires completely after finishing the dental radiology course. The majority of participants agreed that dental radiology courses were rare in the medical radiation school curricula and the continuing education courses of medical radiation technologists. Moreover, most of participants found this course to be helpful in raising their basic knowledge about the dental radiology, their attitude towards the dental radiology, and their interest in further learning of the dental radiology. They were satisfied with the courses. The degree of agreement for each question was high with all the mean scores for each question being between 3.87 and 4.61. The numbers (rates) of respondents who answered as agree were between 58 (68.24%) and 84 (98.82%). Conclusion: The dental radiology course for the continuing education of medical radiation technologists is found to increase the participants’ basic knowledge about the dental radiology, and their awareness and understanding of the radiation protection in dental radiography. Thus, this model can be further used for the dental radiology course for the continuing education of medical radiation technologists in Taiwan.

Background and Objectives: Intoxicated patients with acute kidney injury (AKI) experience high morbidity and mortality. While prior studies suggest that toxicology care settings improve outcomes, the impact of care settings on patients with AKI remains unclear. This study aimed to compare the outcomes of intoxicated patients with AKI managed in toxicology versus non-toxicology care settings. Materials and Methods: This retrospective cohort study included intoxicated patients admitted to a tertiary hospital between January 2022 and December 2023. Patients were categorized into toxicology and non-toxicology care settings. Demographic characteristics, clinical outcomes focusing on mortality and length of hospital stay, and evaluation scores were compared. Results: A total of 31 intoxicated patients with AKI were included in the study. There were no significant differences in mortality or hospital length of stay between toxicology and non-toxicology care settings. However, the mortality rate in the AKI group was significantly higher (16%) compared to intoxicated patients without AKI (1.9%). Additionally, hospital stays were consistently longer in the AKI group than in the non-AKI group across all age groups. Conclusions: Hospital length of stay and mortality did not differ significantly between toxicology and non-toxicology care settings for intoxicated patients with AKI. However, both hospital length of stay and mortality were notably higher in patients with AKI compared to those without AKI.

Abstract This study investigates the effect of the consumption of caffeinated chewing gum on the performance of Romanian deadlift on the flywheel training device. A total of 19 participants completed a randomized, cross-over, single-blind experiment with food-grade caffeinated chewing gum trial (CAF) or placebo trail (PL). Gum were chewed for 10 min and rest for 15 min prior to the Romanian deadlift test using the inertial resistance training machine. 5 sets of 6 Romanian deadlifts were performed, with a 3-min rest between sets, followed by a 7-day washout period before the next set of trials. The average power, average force, total peak power, peak concentric power, peak eccentric power, heart rate, and rating of perceived exertion (RPE) for each trials were analyzed using paired-T test. Compared to placebo, caffeinated chewing gum trial enhanced peak concentric power (P = 0.016, Cohen's d = 0.44), peak eccentric power (P = 0.005, Cohen's d = 0.55), average power (P = 0.013, Cohen's d = 0.43), and total work (P = 0.026, Cohen's d = 0.28). However, in average force (P = 0.063, Cohen's d = 0.50), RPE (P = 0.266), and heart rate (P = 0.143), were no significant differences between trials. Caffeinated chewing gum with a dose of caffeine of 200 mg for 10 min may acutely enhance Romanian deadlift performance on the flywheel machine.

This study aims to determine the trigger conditions behind trade wars and explore the prerequisites required to institute trade subsidies. Additionally, it investigates the potential effectiveness of both a trade war and a trade subsidy within an economic framework shaped by the international division of labor, particularly focusing on intermediate goods production. The study formulates a theoretical model for trade wars and derives three crucial findings. Firstly, it establishes that a critical condition for triggering a trade war hinges on maintaining a balanced self-price coefficient of demand, neither excessively large nor small relative to the cross-price coefficient of demand. Secondly, failure to meet this condition would preclude the occurrence of a trade war; instead, it would prompt the emergence of trade subsidies and reciprocal actions between the two countries involved. Lastly, the scale of the trade war or a trade subsidy in this study is not influential in the countries of trade war. Therefore, this study recommends that changing the current market structure of the international division of labor would be necessary to make the trade war or trade subsidies effective.

The current study aimed to determine the safety profile of intra-articular-injected allogeneic adipose-derived mesenchymal stem cells (ADSCs) GXCPC1 in subjects with knee osteoarthritis (OA) and its preliminary efficacy outcome. The 3 + 3 phase I study was designed with two dose-escalation cohorts: low dose (6.7 × 10 6 GXCPC1, N = 5) and high dose (4 × 10 7 GXCPC1, N = 6). The primary endpoint was safety, which was evaluated by recording adverse events throughout the trial; the secondary endpoints included total, pain, stiffness, and function subscales of the Western Ontario and McMaster Universities Arthritis Index (WOMAC), Visual Analogue Scale (VAS) for pain, and 12-Item Short Form (SF-12) health survey questionnaire. The GXCPC1 treatment was found to be safe after 1 year of follow-up with no treatment-related severe adverse events observed. When compared to baseline, subjects in both the low- and high-dose cohorts demonstrated improving trends in pain and knee function after receiving GXCPC1 treatment. Generally, the net change in pain (95% confidence interval (CI) = −7.773 to −2.561t at 12 weeks compared to baseline) and knee function (95% CI = −24.297 to −10.036t at 12 weeks compared to baseline) was better in subjects receiving high-dose GXCPC1. Although this study included a limited number of subjects without a placebo arm, it showed that the intra-articular injection of ADSCs was safe and well-tolerated in subjects with therapeutic alternatives to treat knee OA. However, a larger scale study with an appropriate control would be necessary for clinical efficacy in the following study.

In this study, we consider the problem of node ranking in a random network. A Markov chain is defined for the network, and its transition probability matrix is unknown but can be learned by sampling random interactions among nodes. Our objective is to decompose the Markov chain into several ergodic classes and select the best node in each ergodic class. We propose a dynamic sampling procedure, which gives a probability guarantee on correct decomposition and maximizes a weighted probability of correct selection of the best node in each ergodic class. Numerical experiment results demonstrate the efficiency of the proposed sampling procedure.

BackgroundShift work may disrupt the sleep and wake cycles and negatively affect physical and mental health. Dementia is a neurodegenerative disorder with progressively declining cognition that is receiving increasing attention. Studies on the association between shift work and dementia are rare. Herein, we conducted a meta-analysis to investigate the association between shift work and dementia.Materials and methodsThis study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched the PubMed, Embase, and Web of Science databases using a related set of keywords. The inclusion criteria were as follows: (1) adult employees working in a factory, company, or organization; (2) exposure to shift work/non-shift work; and (3) outcome of dementia based on examination or assessment. A meta-analysis using a fixed-effects model was performed. The hazard ratio of dementia was compared between shift workers and non-shift workers.ResultsFive studies were included in the quantitative synthesis, and two were selected for further meta-analysis. A random-effects model showed a modest association between shift work and an increase in dementia cases (pooled hazard ratio = 1.13; 95% confidence interval: 1.04–1.23; p = 0.04). This association also occurred in night workers for more than 1 year.ConclusionShift work and long-term night work were modestly associated with a higher risk of developing dementia. Avoiding long-term night shifts may be effective in reducing dementia risk. Further studies are required to confirm this hypothesis.

This study investigated the coexistence of public and private companies using a complementary model to explore mixed oligopoly strategies. Compared to the traditional theory of mixed oligopoly, the main difference of this study is that it revealed that the products produced by both companies are completely complementary. The five findings of the study were as follows: First, under the premise of having one firm classified as a public firm, although it can reach the equilibrium of the maximum solution for social welfare, this causes a loss. Second, more seriously, the private firm would view this as a huge incentive and aggressively pursue to be the price leader, which may result in a greater loss for the public firm. Third, the asymmetry of the model of the complementary mixed oligopoly is of note; that is, when the private firm is in aggressive pursuit to be the price leader, it can elevate its profit margin, but when the public firm is aggressively pursuing be the price leader, this would not result in better profits. Fourth, if the public firm is under budgetary constraints, then the private firm would have no incentive to aggressively pursue being the price leader. Fifth, if the price of the product between the public firm and the private firm is a “strategic substitute,” the coexistence of the public firm and the private firm will be better than total privatization.

The global population of individuals afflicted with diabetes mellitus has been increasing year by year, and this disease poses a serious threat to human health as well as the economies worldwide. Pancreatic or islet transplantations provide one of the most effective and long-term therapies available to treat diabetes, but the scarcity and quality of pancreatic islets limit their use in treatments. Here, we report the development of a one-step, monolayer culture, and chemical-based protocol that efficiently mediates the differentiation of human adipose-derived stem cells (hADSCs) into insulin-producing cells (IPCs). Our data indicate that hADSCs in monolayer culture that are allowed to differentiate into IPCs are superior to those in suspension cultures with respect to insulin secretion capacity (213-fold increase), cell viability (93.5 ± 3.27% vs. 41.67 ± 13.17%), and response to glucose stimulation. Moreover, the expression of genes associated with pancreatic lineage specification, such as PDX1 , ISL1 , and INS (encoding insulin), were expressed at significantly higher levels during our differentiation protocol (6-fold for PDX1 and ISL1 , 11.5-fold for INS ). Importantly, in vivo studies demonstrated that transplantation with IPCs significantly mitigated hyperglycemia in streptozotocin-induced diabetic rats. Our results indicate that this one-step, rapid protocol increases the efficiency of IPC generation and that the chemical-based approach for IPC induction may reduce safety concerns associated with the use of IPCs for clinical applications, thereby providing a safe and effective cell-based treatment for diabetes.

Objective: Lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with increased intracerebral hemorrhage (ICH) risk. However, reverse causality and residual confounding has not attracted public attention. Therefore, we assessed whether people with LDL-C have increased risk of mortality adjusting for potential confounders using two large Taiwan cohorts.Methods: The Mei-Jhao (MJ) cohort has 414,372 adults participating in a medical screening program with 378 ICH deaths within 15 years of follow-up (1994–2008). Cox proportional hazards regressions estimated hazard death ratios according to LDL-C levels. We identified 4,606 ICH patients from the Taiwan Stroke Registry (TSR) and analyzed the impact of LDL-C on 3-month mortality.Results: Low cholesterol (LDL-C

Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.

Habits such as smoking and alcohol drinking and existing esophageal malfunction are considered the main risk factors for esophageal carcinogenesis. Caustic ingestion of acidic or alkaline agents or strong irritants can induce severe esophageal corrosive injury and increase esophageal cancer risk. We studied the relationship between esophageal carcinoma and acute detergent or pesticide poisoning by using nationwide health insurance data. Methodology/Principle findings: We compared a pesticide/detergent intoxication cohort (N = 21,840) and an age- and gender-matched control cohort (N = 21,840) identified from the National Health Insurance Research Database between 2000 and 2011. We used the multivariable Cox proportional model to determine esophageal carcinoma risk. The overall incidence density of esophageal cancer was 1.66 per 10,000 person-years in the comparison cohort and 4.36 per 10,000 person-years in the pesticide/detergent intoxication cohort. The corresponding adjusted hazard ratio (HR) for esophageal cancer was 2.33 (95% confidence interval [CI] = 1.41-3.86) in the pesticide/detergent intoxication cohort compared with the control cohort. Patients with corrosive and detergent intoxication did not have a higher risk of esophageal cancer (adjusted HR = 0.98, 95% CI = 0.29-3.33) than those without pesticide/detergent intoxication. However, patients with pesticide intoxication had a significantly higher risk of esophageal cancer (adjusted HR = 2.52, 95% CI = 1.52-4.18) than those without pesticide/detergent intoxication. Conclusion: In the present study, after adjusting for conventional risk factors, we observed that pesticide intoxication could exert substantial effects through increased esophageal cancer risk. However, patients with detergent intoxication may not have an increased risk of esophageal cancer.

Currently, the only effective therapy for cirrhosis of the liver is liver transplantation. However, finding a compatible liver is difficult due to the low supply of healthy livers and the ever-increasing demand. However, stem-cell therapy may offer a solution for liver cirrhosis; for example, GXHPC1 therapy preparation contains adipose-derived mesenchymal stem cells (AD-MSCs) and was developed for the treatment of liver cirrhosis. In our previous report, animal studies suggested that treatment of a diseased liver via GXHPC1 transplantation can abrogate liver fibrosis and facilitate recovery of liver function. In our current human trial, patients with liver cirrhosis were included. Their adipose tissue was harvested from the subcutaneous fat of the abdominal wall during surgery. AD-MSCs were cultured and suspended at a concentration of 100 million cells in 1 ml of physiological saline (i.e., GXHPC1). This human study passed the Taiwan Food and Drug Administration IND inspection and received Phase I clinical trial permission. The trial was conducted with six patients with liver cirrhosis to demonstrate the safety and efficacy of administering GXHPC1. Intrahepatic injection of GXHPC1 did not cause any safety issues in the analysis of adverse drug reactions and suspected unexpected serious adverse reactions, and showed a tendency for improvement of liver function, METAVIR score, Child–Pugh score, MELD score, and quality of life for patients with liver cirrhosis.

This study aims to explore the prediction of S&P 500 stock price movement and conduct an analysis of its investment performance. Based on the S&P 500 index, the study compares three machine learning models: ANN, SVM, and Random Forest. With a performance evaluation of S&P 500 index historical data spanning from 2014 to 2018, we find: (1) By overall performance measures, machine learning models outperform benchmark market index. (2) By risk-adjusted measures, the empirical results suggest that Random Forest generates the best performance, followed by SVM and ANN. Keywords: ANN, SVM, Random Forest, Machine Learning, Investment Performance JEL Classifications: C11; C15; C53; G17 DOI: https://doi.org/10.32479/ijefi.8925

Left ventricular hypertrophy (LVH) in hypertension has prognostic significance on cardiovascular mortality and morbidity. Recently, we have shown that n-butylidenephthalide (BP) improves human adipose-derived stem cell (hADSC) engraftment via attenuated reactive oxygen species (ROS) production. This prompted us to investigate whether remote transplantation of BP-pretreated hADSCs confers attenuated LVH at an established phase of hypertension. Male spontaneously hypertensive rats (SHRs) aged 12 weeks were randomly allocated to receive right hamstring injection of vehicle, clinical-grade hADSCs, and BP-preconditioned hADSCs for 8 weeks. As compared with untreated SHRs, naïve hADSCs decreased the ratio of LV weight to tibia, cardiomyocyte cell size, and collagen deposition independent of hemodynamic changes. These changes were accompanied by attenuated myocardial ROS production and increased p-STAT3 levels. Compared with naïve hADSCs, BP-preconditioned hADSCs provided a further decrease of ROS and LVH and an increase of local hADSC engraftment, STAT3 phosphorylation, STAT3 activity, STAT3 nuclear translocation, myocardial IL-10 levels, and the percentage of M2 macrophage infiltration. SIN-1 or S3I-201 reversed the effects of BP-preconditioned ADSCs increase on myocardial IL-10 levels. Furthermore, SIN-1 abolished the phosphorylation of STAT3, whereas superoxide levels were not affected following the inhibition of STAT3. Our results highlighted the feasibility of remote transplantation of hADSCs can be considered as an alternative procedure to reverse cardiac hypertrophy even at an established phase of hypertension. BP-pretreated hADSCs polarize macrophages into M2 immunoregulatory cells more efficiently than naïve hADSCs via ROS/STAT3 pathway. Keywords: Adipose-derived stem cell, Butylidenephthalide, Left ventricular hypertrophy, M2 macrophage, Signal transducer and activator of transcription 3, Spontaneously hypertensive rats

This study adopted a cost efficiency model to assess the operational efficiency of the banking industry in Taiwan. Empirical results show that the Bank of Taiwan, Taiwan Cooperative Bank, and First Commercial Bank have higher operational efficiency than the other banks. Banks with relatively low operational efficiency include Taipei Star Bank, the Enterprise Bank of Hualien, which was merged into the CTBC Bank, and the ABN AMRO-acquired Taitung Business Bank, which together with ABN AMRO’s other business in Taiwan, was later acquired by the Australia and New Zealand Banking Group (ANZ) and renamed ANZ Bank (Taiwan). These findings show that banks with low operational efficiency are unable to maintain sustainable operations.Keywords: Operational efficiency, cost efficiency, data envelopment analysisJEL Classifications: C1, G1, J3

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 > 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.

The paper introduces a computational model of airspace conflict risk in the hierarchy of performance-based navigation (PBN) airspace operation and combines it with air traffic controller (ATC) workload to propose a method for safety assessment of PBN airspace operational planning. Capacity probability distribution is employed to depict airspace capacity in uncertain weather, errors of deviating from nominal PBN track are taken into consideration, and the stochastic process based on Gaussian distribution is used to depict random aircraft motion according to airspace PBN specification, so as to build an airspace conflict risk computational model in corresponding capacity scenario. Guangzhou No. 15 sector is chosen for simulation validation. The analysis results suggest that 60% of ATC workload is corresponding to sector traffic flow of 31 aircraft/h and airspace risk of 0.018 conflict/h, while 70% of ATC workload is corresponding to sector traffic flow of 35 aircraft/h and airspace risk of 0.03 conflict/h. As air traffic flow increases, both airspace conflict risk value and ATC workload will increase, resulting in reduction of airspace safety, though their increasing magnitudes differ with different capacity scenarios. The safety assessment method enables effective quantization of safety with regard to airspace operational planning strategy, and benefits the development of optimal operational scheme that balances risk with capacity demand.

Human adipose-derived stem cells (hADSCs) are a promising source of autologous stem cells for personalized cell-based therapies. Culture expansion of ADSCs provides an attractive opportunity for liver cirrhosis patients. However, safety and stability issues can pose big challenges for personalized autologous stem cell products. In the present study, we addressed whether the commercial production program could provide a consistent product for liver cirrhosis therapy. We collected adipose tissue from three human donors by lipoaspirate and isolated ADSCs, which were expanded in culture to reach 1 × 10 8 cells (an approximately 1,000-fold expansion) within four passages. We then examined their morphology, chromosome stability, surface markers, and differentiation ability after culture. Next, we explored their therapeutic potential using a rat model of thioacetamide-induced liver cirrhosis. Culture-expanded ADSCs were injected intrahepatically, and their biodistribution was tracked by immunohistochemistry using an antibody against human mitochondria. Finally, we tested for tumor development by subcutaneously injecting a 100-fold dose range of cultured ADSCs into immunocompromised mice. Taken together, we find that culture expansion of autologous ADSCs is a potentially suitable stem cell product for personalized cell-based therapy for patients with liver cirrhosis.

This study describes the development of an information technology (IT)-mediated home-based healthcare model designed to improve the effectiveness of caring for stroke patients who require chronic, home care. This model was evaluated at Kaohsiung Medical Hospital in Taiwan between 2005 and 2008; 84 newly diagnosed stroke patients diagnosed as the chronic covalence stage were enrolled for preliminary testing of this model. These patients required 24-hour in-home monitoring of their health status and emergency call service. Over the course of the study, 15 emergency transfers were carried out, and the acute stroke patients were sent to the emergency care within 26 minutes, on average. This system helped physicians, patients, and their families to more efficiently detect the occurrence of recurrent stroke. In addition, we found a statistically significant finding (p

Objective: The purpose of this study was to assess endometriomas and follicular cysts using a new quantitative method provided by the picture archiving and communication system. Materials and Methods: We reviewed our computer ultrasound database of endometriomas and follicular cysts between November 2003 and July 2007. A total of 123 consecutive women diagnosed with an endometrioma or follicular cyst on two-dimensional sonography were re-evaluated using new parameters with the picture archiving and communication system. We chose quantitative tumor density and standard deviation on sonographic images as the new diagnostic parameters. Analysis of variance and Scheffé post hoc test were analyzed to compare the mean tumor density of the endometriomas and follicular cysts. The receiver operating characteristic curve was plotted to choose the cutoff value of the endometrioma tumor density with the best sensitivity and specificity. Results: There was a significant difference when the tumor density of the follicular cyst and endometrioma groups was compared using the vaginal, abdominal or endovaginal approach (p < 0.001). Based on the results of the receiver operating characteristic curve, endovaginal ultrasonography is an excellent diagnostic tool with which to evaluate endometriomas. With endovaginal ultrasonography examination, the best cutoff value of tumor density is 28 and the sensitivity and specificity are 64% and 100%, respectively. Conclusion: The use of quantitative tumor density and standard deviation on sonographic images is a potential new diagnostic tool in the assessment of endometriomas and follicular cysts.

Objective: To determine the prevalence and age of patients with cervical carcinoma missed by a loop electrosurgical excision procedure. Materials and Methods: A total of 253 women with cervical dysplasia who underwent conization and 248 women who later underwent hysterectomy were retrospectively reviewed. The age and prevalence of those with cervical carcinoma diagnosed and missed by conization were determined. Results: Of the 248 patients, 11 cases (4.4%) of cervical carcinoma were missed by cervical conization. The age of those with cervical carcinoma missed by conization was significantly greater than those whose diagnosis was not missed (p < 0.05). Conclusion: Women with severe cervical dysplasia who no longer wish to preserve fertility should be advised to undergo hysterectomy if the conization margins are not free of disease. Older women with incomplete resection margins tend to have undiagnosed hidden cervical carcinoma after cervical conization.

In the era of thrombolytic therapy for hyperacute ischemic stroke, most investigators have focused their attention on the factors influencing mortality and functional outcomes in patients treated with thrombolysis, but very few have focused on these factors among patients not receiving thrombolysis. The aim of this study was to investigate the prognostic factors for mortality in all hyperacute stroke patients with or without thrombolysis. In 2005, we enrolled 101 ischemic stroke patients (43 females, 58 males; mean age, 68 years) who were transported to the emergency department (ED) within 4 hours of symptom onset. The overall in-hospital mortality rate was 17.8% (18/101). According to t test analysis, age (p = 0.034), time interval from neurologist consultation (p < 0.0001) and ED to ward admission (p = 0.001), Glasgow coma scale (GCS) (p = 0.001), National Institutes of Health Stroke Scale (NIHSS) (p < 0.0001) and the sum of major risk factors of cerebrovascular disease (CVD) (p < 0.0001) were significantly different between mortality and survivor groups. Further χ2 test analysis revealed significant differences in the presenting consciousness disturbance (p = 0.001), place of attack (p = 0.04), and referral transportation (p = 0.008) between these groups. In conclusion, old age, delay between neurologist consultation and ward admission, severity of stroke, and multiple risk factors of CVD are significant risk factors for in-hospital mortality. Conversely, being free of initial consciousness disturbance, living in an urban area, and having direct transportation to a stroke center are protective factors in survivors. The concept of “brain attack” should be re-emphasized among ED physicians. The interconnection between stroke centers and emergency medical systems (EMS) should be more tightly built to promote timely management for hyperacute stroke care.

The biggest hurdle for early hospital presentation is the narrow therapeutic window after stroke. The aims of our study were to investigate the time lags and the factors causing pre‐hospital and emergency department (ED) delay during acute ischemic stroke attack. Between June 2004 and October 2005, we prospectively studied 129 acute ischemic stroke patients who presented to the ED of the study hospital within 4 hours after symptom onset. Chi‐square testing for trend, uni‐variate and multiple logistic regression analyses was performed to evaluate the factors influencing delays in the ED presentation of acute ischemic stroke patients. The median time from symptom onset to ED arrival was 71 (mean ± SD, 82.7 ± 57.7) minutes. The median times from ED arrival to neurologic consultation, computed tomography scan, electrocardiogram, and laboratory data completion were 10 (11.3±9.9) minutes, 17 (9.6±11.3) minutes, 14 (23.3±55) minutes, and 39 (44.4±24.5) minutes, respectively. Univariate and multiple logistic regression models revealed that age < 65 years, illiteracy and awakening with symptoms were the most significant factors related to a delay in ED presentation. This study indicates that 2 hours of pre‐hospital delay is the cutoff point for thrombolytic therapy. Organization of a stroke team and standardized stroke pathways may help to shorten in‐hospital time consumption. Educational efforts should not only focus on the public, but also on the training of ED physicians and other medical personnel.

Objective: Gastric bypass is a surgical procedure that is popularly used to treat morbid obesity. Herein, we report a woman who had a rare gastrointestinal complication during the subsequent antepartum period following a gastric bypass surgery. Case Report: After a Roux-en-Y gastric bypass surgery, a 32-year-old woman had unrelenting epigastria for one week at 36 weeks' gestation. An emergency cesarean delivery, followed by laparotomy, was performed. A female neonate was delivered with Apgar scores of 8 and 9 at 1 and 5 minutes, respectively. Strangulation and gangrene of the upper jejunum caused by a fibrous band at the site of the Roux anastomosis were revealed. Segmental resection of the nonviable bowel was performed. The patient experienced a smooth postoperative course. Conclusion: The awareness of internal hernias and small bowel strangulation should be addressed when unrelenting epigastric pain is present in women after Roux-en-Y gastric bypass surgery, during their first subsequent pregnancy.

Cerebral venous thrombosis (CVT) is not uncommon, but CVT associated with bilateral internal jugular vein stenosis (BIJVS) is rare. Bilateral internal jugular vein stenting is also a rare procedure. We report on a patient with CVT associated with BIJVS, who was treated successfully using direct thrombolysis and bilateral internal jugular vein stenting.

Objective: To evaluate the status of human papillomavirus (HPV) following radiotherapy, and its prognostic significance in cervical cancer. Materials and Methods: Multiple tissue sections obtained from 58 patients with cervical cancer before and after radiotherapy were analyzed for the presence of HPV types 16 and 18 DNA by using the polymerase chain reaction. Results: The overall frequencies of HPV-16/18 infection among cervical cancer patients were 93.1% (54/58) and 56.9% (33/58) before and after radiotherapy, respectively. Patients with HPV-16 DNA-containing tumors were significantly associated with a favorable tumor response following radiotherapy compared with patients who had HPV-18-positive tumors (92.9% vs 50%, p = 0.002). After a median follow-up of 5.1 years (range, 3.2–6.5 years), patients with HPV-18-positive tumors were found to have a significantly higher relapse rate than HPV-16-positive patients (50.0% vs 14.3%, p = 0.02). Conclusion: The results suggest that cervical cancer patients with HPV-18 DNA in their tumors have a significantly poorer response to radiotherapy. This implies that the identification of HPV genotypes in cervical carcinoma may play a valuable role in predicting tumor response to radiotherapy.

Alzheimer's disease (AD) has increased in its prevalence due to the increasing aged population. Currently there is no updated data on the prevalence of dementia including its very mild stage in Taiwan. Under the extensive coverage of Mentality Protection Center (MPC), Fo Guang Shan, Taiwan, the volunteers of MPC have conducted the medicine-related services and the screening of dementia by AD8 (ascertainment of dementia 8) that can screen the dementia even at its very mild stage in general population in all Taiwan. From 2011 to 2013, in total, 2,171 participants, 368 in the northern, 549 in the central, 877 in the southern, and 377 in the eastern part, were recruited with the mean age being 66.9 ± 10.2 years old. The ratio of suspected dementia patients, AD8 score greater than or equal to 2, was 13.6% of all recruited participants with their mean AD8 score being 2.9±1.3, mean age being 69.4±10.8 years old, and female predominance being 73.0%. Although this is a screening study, it has extensive coverage of all Taiwan and the use of AD8 is capable of screening very mild dementia. A further study with a randomized sampling to examine the prevalence and incidence of dementia including its very mild stage is encouraged.

A 3-D numerical model has been developed to investigate the transient thermal, electrical, and optical output performance of a single-chip light-emitting diode (LED) with an interdigitated mesa geometry under dc operation and a multimicrochip LED under either dc or full-wave operation. These two LED chips are fabricated on the same sapphire wafer. The junction temperature, the light output power, and the electroluminescence intensity of both LEDs are measured under dc to prove the results of the numerical simulations. The numerical simulation results are in good agreement with the experimental ones. The numerical results indicate that the multimicrochip LED under dc operation will demonstrate the best thermal and light output performance. Utilizing the input power considered in the present computation, the light output power for the multimicrochip LED, under either dc or full-wave operation, is raised continuously. On the other hand, the saturation of the light output is observed for the single-chip LED with interdigitated mesa geometry.