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AbstractObjective: Gastric cancer with peritoneal metastasis is considered to be final stage gastric cancer. One current treatment approach for this condition is combined cytoreductive surgery with hyperthermic intraperitoneal chemotherapy (HIPEC). However, the therapeutic mechanisms of HIPEC remain largely undescribed. Method: In order to assess the cellular effects of HIPEC in vitro, we treated AGS human gastric adenocarcinoma cells with or without 5-fluorouracil (5-Fu) at 37 °C or at 43 °C (hyperthermic temperature) for 1 h followed by incubation at 37 °C for 23 h. The impacts of hyperthermia/5-Fu on apoptosis, cell survival signals, oxidative stress, chemoresistance-related proteins and programmed death-ligand 1 (PD-L1) expression were measured. Results: Our results showed that hyperthermia potentiates 5-Fu-mediated cytotoxicity in AGS cells. Furthermore, the combination of 5-Fu and hyperthermia reduces levels of both phosphorylated STAT3 and STAT3, while increasing the levels of phosphorylated Akt and ERK. In addition, 5-Fu/hyperthermia enhances reactive oxygen species and suppresses superoxide dismutase 1. Chemoresistance-related proteins, such as multidrug resistance 1 and thymidylate synthase, are also suppressed by 5-Fu/hyperthermia. Interestingly, hyperthermia enhances 5-Fu-mediated induction of glycosylated PD-L1, but 5-Fu-mediated upregulation of PD-L1 surface expression is prevented by hyperthermia. Conclusion: Taken together, our findings provide insights that may aid in the development of novel therapeutic strategies and enhanced therapeutic efficacy of HIPEC.

New product development (NPD) is crucial for helping companies to maintain competitive advantages. In this study, a methodological framework is presented combining a novel Kano model and fuzzy axiomatic design (FAD) for improving the product development capability in the whole NPD process. In the Kano model, a novel mixed-class classification method is presented to classify each evaluation indicator agreed on by the majority, and to calculate the affiliation value based on category strength (CS) to display the degree to which the indicator belongs to a certain attribute. A new importance ratio is also proposed to adjust the importance of each indicator attribute. This helps to achieve higher customer satisfaction and improve the attractiveness of the product or service. FAD is then used to measure the gap between customer satisfaction and the company’s expected levels of satisfaction in terms of product functions. This enables the company to obtain more comprehensive information for decision-making. A case study is provided to verify the practicability of the proposed method. Sensitivity analysis proves the robustness of the results based on the number of respondents. Finally, comparative analysis with existing approaches demonstrates the strengths of the proposed method.

Evaluating the performance of city construction not only helps optimize city functions and improve city quality, but it also contributes to the development of sustainable cities. However, most of the scoring rules for evaluating the performance of city construction are overly cumbersome and demand very high data integrity. Moreover, the properties, change scale, and scope of different evaluation indicators of city construction often lead to uncertain and ambiguous results. In this study, a hybrid fuzzy method is proposed to conduct the performance evaluation of city construction in two phases. Firstly, a city performance index (CPI) was developed by combining the means and standard deviations of indicators of city construction to address the volatility of historical statistical data as well as different types of data. Considering the sampling errors in data analysis, the parameter estimation method was used to derive the 100% × (1 − α) confidence interval of the CPI. Buckley’s fuzzy approach was then adopted to extend the statistical estimators from the CPI into fuzzy estimators, after which a fuzzy CPI was proposed. To identify the specific improvement directions for city construction, the fuzzy axiom design (fuzzy AD) method was applied to explore the relationship between the targets set by city managers and actual performance. Finally, an example of six cities in China is provided to illustrate the effectiveness and practicality of the proposed method. The results show that the performance of Chongqing on several evaluation indicators is lower than that of other cities. The proposed method takes into account the issues of uniformity and diversity in the performance evaluation of city construction. It can enable a quantitative assessment of the city construction level in all cities and provide theoretical support and a decision-making basis for relevant government departments to optimize city construction planning and scientifically formulate city construction policies.

A variety of process capability indices are applied to the quantitative measurement of the potential and performance of processes in manufacturing. As it is easy to understand the formulae of these indices, this method is easy to apply. Furthermore, a process capability index is frequently utilized by a manufacturer to gauge the quality of a process. This index can be utilized by not only an internal process engineer to assess the quality of the process but also as a communication tool for an external sales department. When the manufacturing process deviates from the target value T, the process capability index CPMK can be quickly detected, which is conducive to the promotion of smart manufacturing. Therefore, this study applied the index CPMK as an evaluation tool for process quality. As noted by some studies, process capability indices have unknown parameters and therefore must be estimated from sample data. Additionally, numerous studies have addressed that it is essential for companies to establish a rapid response mechanism, as they wish to make decisions quickly when using a small sample size. Considering the small sample size, this study proposed a 100 (1 − α)% confidence interval for the process capability index CPMK based on suggestions from previous studies. Subsequently, this study built a fuzzy testing model on the 100 (1 − α)% confidence interval for the process capability index CPMK. This fuzzy testing model can help enterprises make decisions rapidly with a small sample size, meeting their expectation of having a rapid response mechanism.

Climate change threatens human survival and development. Cities, as the main gathering places for human production and life, serve as the focal points for the implementation of the policies related to energy efficiency, energy transition, and environmental protection. This study constructs an index system for the evaluation of carbon-neutral cities from the perspectives of carbon sources and carbon sinks. The system includes thirteen indicators under six dimensions. It combines objective and subjective data (i.e., statistical data and expert evaluations) by integrating two approaches: the fuzzy analytic hierarchy process (fuzzy AHP) and vise kriterijumska optimizacija i kompromisno resenje with hesitant fuzzy sets (HFS-VIKOR). We verify the efficacy of the proposed approach through a case study of thirteen low-carbon pilot cities in China. The results indicate that among these cities, Shenzhen performs the best, followed by Guangzhou and Hangzhou, while Kunming, Baoding, and Tianjin show poor performance in terms of carbon neutrality. Kunming and Baoding exhibit shortcomings mainly in carbon sources, while Tianjin faces deficiencies in both carbon sources and carbon sinks. Sensitivity analysis and comparative analysis show the availability and effectiveness of the proposed method. The proposed radar chart further highlights the improvement directions for each city to achieve carbon neutrality.

Shoes designed for the elderly can reduce the risk of injury associated with falling. Pinpointing the specific needs of users and directions for product improvement allows companies to maximize the allocation of limited resources. However, user evaluation of important criteria is often ambiguous and uncertain. This paper contributes to solving this issue through the development of a two-stage user-satisfaction framework with a fuzzy-Six Sigma index and fuzzy axiomatic design (FAD). In the proposed method, we consider sampling uncertainty, analyze the vagueness of natural-language evaluations, and explore the match between company capabilities and user satisfaction. This framework highlights both the advantages and disadvantages of current shoe designs for the elderly, and a case study illustrates the applicability of the framework. Additionally, result comparison and sensitivity analysis are conducted to verify the reliability and effectiveness of the proposed method. Finally, the managerial implications, conclusions and limitations of the study are discussed.

In facing the many negative impacts of global warming on the earth’s environment, the machining industry must reduce the rates of product rework and scrap in the manufacturing process by enhancing the process quality of the processed product. According to the concept of the Taguchi loss function, the closer the measured value of the processed product is to the target value T, then the longer the mean time between failures (MTBF) of the product. Clearly, raising the process quality of the processed product can effect energy saving and waste reduction during production and sales, which can help enterprises fulfill their corporate social responsibilities. On the basis of the Taguchi loss function, this study used the process expected loss to evaluate the process loss. Next, the process expected loss was used as an evaluation index, in which the accuracy index and the precision index can help the machining industry find the direction for improvement. Additionally, this study first derived a confidence interval of the process expected loss. Then, it was built on the confidence interval, and a confidence interval-based fuzzy test was developed for the process expected loss. Finally, an empirical example was adopted to explain the application of the fuzzy evaluation model of the machining process proposed in this paper.

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

For autonomous legged robots to be deployed in practical scenarios, they need to perform perception, motion planning, and locomotion control. Since robots have limited computing capabilities, it is important to realize locomotion control with simple controllers that have modest calculations. The goal of this paper is to create computational simple controllers for locomotion control that can free up computational resources for more demanding computational tasks, such as perception and motion planning. The controller consists of a leg scheduler for sequencing a trot gait with a fixed step time; a reference trajectory generator for the feet in the Cartesian space, which is then mapped to the joint space using an analytical inverse; and a joint controller using a combination of feedforward torques based on static equilibrium and feedback torque. The resulting controller enables velocity command following in the forward, sideways, and turning directions. With these three velocity command following-modes, a waypoint tracking controller is developed that can track a curve in global coordinates using feedback linearization. The command following and waypoint tracking controllers are demonstrated in simulation and on hardware.

Chip resistors are a type of resistor among passive components; they are mainly used to regulate the voltage and current in electronic products. A single electronic product may be embedded with dozens of or even more than a thousand thin-film chip resistors varying in resistance. Thin-film chip resistors have low temperature coefficients, which makes them stable and reliable. They have five primary nominal-the-best (NTB) quality characteristics: length, width, height, upper width, and lower width. To increase the quality of thin-film chip resistors and prevent losses from customers returning low-quality or defected products, this study proposes a quality capability assessment method. The proposed method takes sampling errors into account and includes acceptance criteria for individual quality characteristics and the total quality capability. If either of the criteria is not fulfilled, then the manufacturer must improve quality capabilities. A case study of a manufacturer in central Taiwan is presented to illustrate the feasibility of the proposed method. Finally, conclusions and recommendations for future work are presented.

It is important to estimate the sample data when inspecting the quality of products. Therefore, sampling error and uncertainty in the measurement are inevitable, which may lead to misjudgment in product performance evaluation. Since the important quality characteristics of gasoline belong to one-sided specifications, a one-sided specification capability index was proposed to evaluate whether the process capabilities of various quality characteristics of gasoline reach the required quality levels. The 100(1−α)% upper confidence limits of the index were obtained to ensure low producer’s risk and reduce sampling errors. To deal with fuzzy data and limited sample sizes, a fuzzy testing model based on the 100(1−α)% upper confidence limits of the index was developed. A practice example of 95 unleaded gasoline was used to illustrate the effectiveness and usefulness of the proposed method. The result shows that two quality characteristics—Reid vapor pressure and oxygen content—of the nine quality characteristics of the 95 unleaded gasoline should be considered for improvements. This study provided an evaluation procedure to facilitate quality managers to take the opportunity to improve product quality, promoting the improvement of air quality, and the sustainability of industrial processes or products.

Global economic integration drives the development of dynamic competition. In a dynamic competitive environment, the ever-changing customer demands and technology directly affect the leadership of the core competence of enterprises. Therefore, assessing the performance of enterprises in a timely manner is necessary to adjust business activities and completely adapt to new changes. Enterprise diagnosis is a scientific tool for judging the development status of enterprises, and building a scientific and rational index system is the key to enterprise diagnosis. Considering the large number of enterprise diagnostic indicators and the high similarity among indicators, this study proposes a selection method for enterprise diagnostic indicators based on interval-valued hesitant fuzzy clustering by comparing the existing indicator systems. First, enterprise organizations are considered as the starting point. Through the key analysis of relevant indicators of domestic and foreign enterprise diagnosis, enterprise diagnosis candidate indicators are constructed from three aspects, namely enterprise performance, employee health, and social benefit. In view of the ambiguity and inconsistency of expert judgment, this study proposes an interval-valued hesitant fuzzy set based on the characteristics of hesitant fuzzy sets and interval-valued evaluation. For improving the interval-valued hesitant fuzzy entropy function, an interval-valued hesitant fuzzy similarity measurement formula considering information features is designed to avoid the problem of data length and improve the degree of identification among indicators. Then, the similarity, equivalence, and truncation matrices are constructed, and the interval-valued hesitant fuzzy clustering method is used to eliminate redundant indicators with repeated information. The availability of the proposed method is illustrated via an example, and the key indicators in the enterprise diagnostic index system are found. Finally, the advantages of the proposed method are discussed using comparative analysis with existing methods. A rational and comprehensive enterprise diagnostic index system was constructed. The system can be used as a scientific basis for diagnosing the development of enterprises and providing an objective and effective reference.

Lipoteichoic acid (LTA) is a key cell wall component and virulence factor of Gram-positive bacteria. LTA contributes a major role in infection and it mediates inflammatory responses in the host. Rutaecarpine, an indolopyridoquinazolinone alkaloid isolated from Evodia rutaecarpa, has shown a variety of fascinating biological properties such as anti-thrombotic, anticancer, anti-obesity and thermoregulatory, vasorelaxing activity. It has also potent effects on the cardiovascular and endocrine systems. Herein, we investigated rutaecarpine’s (Rut) anti-inflammatory effects in LTA-stimulated RAW macrophage cells. The Western blot and spectrophotometric results revealed that Rut inhibited the production of nitric oxide (NO) and the expression of inducible nitric oxide synthase (iNOS), cyclooxygenase-2 (COX-2), and interleukin (IL)-1β in the LTA-induced macrophage cells. Successively, our mechanistic studies publicized that Rut inhibited LTA-induced phosphorylation of mitogen-activated protein kinase (MAPK) including the extracellular signal-regulated kinase (ERK), and p38, but not c-Jun NH2-terminal kinase (JNK). In addition, the respective Western blot and confocal image analyses exhibited that Rut reserved nuclear transcription factor kappa-B (NF-κB) by hindering inhibitor of nuclear factor κB-α (IκBα) and NF-κB p65 phosphorylation and p65 nuclear translocation. These results indicate that Rut exhibits its anti-inflammatory effects mainly through attenuating NF-κB and ERK/p38 signaling pathways. Overall, this result suggests that Rut could be a potential therapeutic agent for the treatment of Gram-positive bacteria induced inflammatory diseases.

Numerous studies have pointed out that the issue of global warming is getting increasingly more serious. Therefore, the concepts of circular economy (CE) and sharing economy have been more and more valued by enterprises and governments. With the gradual popularization and maturity of the Internet of Things (IoT), various smart APP platforms have sprung up rapidly. For example, the fuzzy evaluation model of bank APP performance was proposed in such an environment, aiming to improve the APP service performance by means of evaluating, analyzing, improving, and enhancing customers’ satisfaction with their use of APPs, and increasing the number of users of APPs. Since the follow-up of the article did not mention the improved testing model used to verify the improvement effect, this paper then proposed a fuzzy two-tailed testing model with two indices before and after the improvement based on the confidence interval to verify whether the improvement has had a significant effect. This complete bank APP fuzzy performance evaluation, analysis, and improvement model measured the bank APP operation performance using customer time intervals, so the data collection time was short. Not only can it meet enterprises’ need for rapid response and grasp the opportunity for improvement to achieve the effect of energy-saving and carbon reduction, but it also can satisfy enterprises’ requirement to pursue fast and accurate decision-making. Furthermore, the fuzzy two-tailed test proposed by this paper was based on the confidence interval, which can reduce the risk of misjudgment caused by sampling error. Plenty of studies have indicated that the designs based on confidence intervals can integrate expert experience and past data so that the accuracy of testing can be maintained in the case of small-sized samples.

Hydrogen evolution reaction (HER) has a dominant function in energy conversion and storage because it supplies a most effective way for converting electricity into sustainable high-purity hydrogen. Layered double hydroxides (LDHs) have shown promising performance in the process of electrochemical water oxidation (a half-reaction for water splitting). Nevertheless, HER properties have not been well released due to the structural characteristics of related materials. Herein, a simple and scalable tactics is developed to synthesize chromium-doped CoFe LDH (CoFeCr LDH). Thanks to oxygen vacancy, optimized electronic structure and interconnected array hierarchical structure, our developed ternary CoFeCr-based layered double hydroxide catalysts can provide 10 mA cm−2 current density at −0.201 V vs. RHE with superior long-term stability in alkaline electrolyte. We anticipate that the simple but feasible polymetallic electronic modulation strategy can strengthen the electrocatalytic property of the layered double hydroxides established in the present study, based on a carbon neutral and hydrogen economy.

As the environment of the Internet of Things (IoT) gradually becomes common and mature, various smart application (APP) platforms have sprung up, making what we are doing more convenient, more economical and more efficient. Then, this paper used a bank APP as the research background to discuss issues related to smart APPs. Obviously, through the bank APPs, customers can complete their transfer and payment for various expenses at home, eliminating the inconvenience of going out, which not only can alleviate traffic congestion as well as reduce carbon emissions but also can save the manpower expenditure costs for banks. Consequently, improving APP performance and increasing the number of users of an APP is a very important issue. Therefore, this paper proposed an APP performance index to evaluate the performance of a bank APP. This APP performance index is to evaluate the performance of the APP through the time interval of customers’ access to the APP. The shorter the time interval is, the greater the number of users within a unit time is. In addition, based on cost considerations and effectiveness, the sample size n is usually not too large in practice, in order to make decisions quickly and accurately in a short time. Since the fuzzy testing model based on the confidence interval can be integrated with the past accumulated experience of data experts, the testing accuracy can be leveled up under the condition of small-sized samples. Accordingly, a fuzzy evaluation model was proposed to evaluate whether the performance of the bank APP can reach the required level, and this model was also regarded as a basis for decision-making to determine whether to improve the bank APP. At the same time, we can grasp the opportunities for improvement, achieve the effect of cost reduction, energy saving and carbon reduction, and further move towards the goal of innovative and intelligent management.

When all of the one-sided specification indices of each quality characteristic reach the requirements of the process quality level, they can ensure that the process capability of the product meets the requirements of the process quality level. This study constructs a fuzzy membership function based on the upper confidence limit of the index, derives the fuzzy critical value, and then labels the fuzzy critical value on the axis of the visualized radar chart as well as connects adjacent critical points to shape a regular polygonal critical region. Next, this study calculates the observed value of the index to estimate and mark it on the axis for forming a visualized fuzzy radar evaluation chart. Obviously, this fuzzy evaluation model not only reduces the testing cost but also makes the quality level quickly meet the requirements of the specifications. Further, the radar chart can reduce the risk of misjudgment attributable to sampling errors and help improve the accuracy of evaluation by a confidence-upper-limit-based fuzzy evaluation model. Therefore, this easy-to-use visualized fuzzy radar evaluation chart is used as an evaluation interface, which has good and convenient management performance to identify and improve critical-to-quality quickly. Improving the quality of the process before the product is completed will also have the advantage of reducing social losses and environmental damage costs.

In order to take into account cost and timeliness and enhance accuracy testing, this study developed the fuzzy number and membership function, using the confidence interval of ratio operating performance index. Subsequently, according to the statistical test rules and the application of the fuzzy number and membership function, a fuzzy evaluation decision model for the operating performance index is proposed, to evaluate if the business performance reaches the needed level. Based on the abovementioned, the evaluation model in this study took into account not only timeliness but also accuracy, so that it could grasp the opportunity of improvement for operating organizations with poor operating performance after being evaluated. This fuzzy evaluation decision model for the operating performance index constructs a fuzzy membership function retrieved from an index’s confidence interval, reducing the chance of miscalculation due to sampling mistakes and improving the efficiency of evaluation. Finally, in order to facilitate the application of readers and the industry, this paper uses cases to explain the proposed fuzzy verification method. On the whole, the model proposed in this paper is a data-based auxiliary tool for the service operating performance improvement strategy.

The growth periods (GPs, from planting/emergence to reproductive stage 8 (R8) of soybean cultivars vary in different ecological regions, especially in China with a very complex soybean cropping system. In this study, a 3-yr experimental study was undertaken in three geographical locations of China from 2008 to 2010, including the Northeast (40.66–45.85°N), Huang-Huai (34.75–38.04°N) and southern (22.82–30.60°N) eco-regions with about 250 accessions in each region to clarify the classification of maturity group (MG) and identify the cultivars with stable GP to increase the knowledge about the GP distribution of soybean cultivars in China. GPs of soybean cultivars in different eco-regions were significant different with a gradual decrease from 115–125 d in the Northeast part to the 85–100 d in the southern part of China. The geographical location was the major factor for GP of cultivars from the Northeast, while the year of planting was the major factor affecting the stability of GPs in Huang-Huai summer and southern summer soybean. AMMI2 (additive main effects and multiplicative interaction)-Biplot analysis showed that the GPs of soybean cultivars from the Northeast eco-region have a comparatively satisfactory environmental stability. Moreover, soybean cultivars with moderate GP/MG and stable environment adaptability in different eco-regions were identified based on the linear regression and AMMI analysis, which was important for the accurate classification of soybean MGs in future. Taken together, our results reflected the genetic diversity, geographical distribution and environmental stability of the Chinese soybean GP trait. Soybean cultivars with stable GP for various Chinese eco-regions would be beneficial for Chinese soybean genetic improvement, varietal introduction, exchange, and soybean breeding program for wide adaptability.

The impact of leukoaraiosis on the risk of symptomatic intracerebral hemorrhage (SICH) after stroke thrombolysis is conflicting, and the data on Asian populations are lacking. Therefore, in this study, we assessed the association between leukoaraiosis and SICH, and the association between leukoaraiosis and the 90-day functional outcome in the Asian population.Data were collected from a two-center prospective registry of acute ischemic stroke patients given intravenous tissue plasminogen activator between 2006 and 2014. A total of 614 pretreatment brain CT and 455 posttreatment MRI were retrospectively assessed using two different rating scales for the presence of leukoaraiosis. Outcome measures were the occurrence of SICH with three definitions and any hemorrhage after thrombolysis and functional outcome at 3 months.Of the 614 patients assessed, 30.3% showed severe leukoaraiosis on the baseline brain CT. The SICH rate was 4.6% - 7.2% based on different definitions, and overall, 24.9% of patients showed any post-tPA hemorrhage. No association was observed between the severity of leukoaraiosis and SICH, regardless of having used different leukoaraiosis rating scales or as assessment using different imaging modalities. However, severe leukoaraiosis was independently associated with poor functional outcome at 3 months (OR 1.96, 95% C1 1.24-3.11, P = 0.004) after adjustment for confounders.Our results showed no association between leukoaraiosis and the risk of SICH. Although the presence of severe leukoaraiosis predicted a poor functional outcome after stroke, IV thrombolysis might not be withheld in acute ischemic stroke patients solely based on the presence of severe leukoaraiosis on pre-thrombolytic CT scans.

The electronics industry in Taiwan has achieved a complete information and communication technology chain with a firm position in the global electronics industry. The integrated-circuit (IC) packaging industry chain adopts a professional division of labor model, and each process (including wafer dicing, die bonding, wire bonding, molding, and other subsequent processes) must have enhanced process capabilities to ensure the quality of the final product. Increasing quality can also lower the chances of waste and rework, lengthen product lifespan, and reduce maintenance, which means fewer resources invested, less pollution and damage to the environment, and smaller social losses. This contributes to the creation of a green process. This paper developed a complete quality evaluation model for the IC packaging molding process from the perspective of a green economy. The Six Sigma quality index (SSQI), which can fully reflect process yield and quality levels, is selected as a primary evaluation tool in this study. Since this index contains unknown parameters, a confidence interval based fuzzy evaluation model is proposed to increase estimation accuracy and overcome the issue of uncertainties in measurement data. Finally, a numerical example is given to illustrate the applicability and effectiveness of the proposed method.

Background and objectivesTo determine the incidence rates and mortality of liver abscess in ESRD patients on dialysis.Design setting participants & measurementsUsing Taiwan's National Health Insurance Research Database, we collected data from all ESRD patients who initiated dialysis between 2000 and 2006. Patients were followed until death, end of dialysis, or December 31, 2008. Predictors of liver abscess and mortality were identified using Cox models.ResultsOf the 53,249 incident dialysis patients identified, 447 were diagnosed as having liver abscesses during the follow-up period (224/100,000 person-years). The cumulative incidence rate of liver abscess was 0.3%, 1.1%, and 1.5% at 1 year, 5 years, and 7 years, respectively. Elderly patients and patients on peritoneal dialysis had higher incidence rates. The baseline comorbidities of diabetes mellitus, polycystic kidney disease, malignancy, chronic liver disease, biliary tract disease, or alcoholism predicted development of liver abscess. Overall in-hospital mortality was 10.1%.ConclusionsThe incidence of liver abscess is high among ESRD dialysis patients. In addition to the well known risk factors of liver abscess, two other important risk factors, peritoneal dialysis and polycystic kidney disease, were found to predict liver abscess in ESRD dialysis patients.

Lower urinary tract symptoms (LUTS) have been reported to be associated with metabolic syndrome and may predispose subjects to cardiovascular disease. The magnitude of the impact on the medical care remains to be elucidated. Based on a population-based claims dataset in Taiwan, we explored the association between LUTS and the risk of subsequent hospitalization for acute cardiovascular events.Among a representative sample of one million subjects from nationwide health insurance enrollees, subjects with codes of LUTS in service claims and without previous cardiovascular diseases including stroke were compared with age- and sex-matched non-LUTS subjects in subsequent hospitalization for acute coronary syndrome or stroke from the recruited date (between 2001-2004) to 2009. The risk of outcomes was assessed with Kaplan-Meier curves and the impact of LUTS was estimated with Poison regression analysis and Cox proportional hazards models.We included 4,553 LUTS subjects and 22,765 matched non-LUTS subjects, with a mean age of 47 years and 43% of men. Hypertension, diabetes, and hyperlipidemia were more prevalent in the LUTS group. The incidence rate of the composite endpoint was significantly higher in the LUTS group than in the non-LUTS group (5.4/1000 vs. 4.0/1000 person-years). The difference mainly derived from stroke rather than acute coronary syndrome. After adjusting for age, sex, diabetes, hypertension, and hyperlipidemia in multivariable analysis, LUTS remained a significant predictor (hazard ratio, 1.29; 95% confidence incidence, 1.06-1.50).Subjects free of cardiovascular disease and presenting with LUTS are at risk of subsequent hospitalization for acute cardiovascular events, mainly stroke. The information might prompt practitioners encountering such patients to undergo appropriate diagnostic and preventive measures.