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Background: Sleep health and obesity may affect the risk of female infertility. However, few studies focused on the interaction of obesity and sleep health on the female infertility risk. This study aimed to evaluate the combined impact of trouble sleeping / sleep duration and overweight/obesity/ abdominal obesity on the risk of female infertility. Methods: The data for this cross-sectional study was obtained from National Health and Nutritional Examination Survey, which provided information on trouble sleeping, sleep duration, overweight/obesity, abdominal obesity, and confounding factors. Adopted weighted univariate and multivariate logistic regression models to explore the relationship between trouble sleeping, sleep duration, overweight/obesity, abdominal obesity, and the risk of infertility, respectively, and the combined effect of trouble sleeping and overweight/obesity, trouble sleeping and abdominal obesity, sleep duration and overweight/obesity, sleep duration and abdominal obesity, on the female infertility risk. Results: This study included a total of 1,577 women, and 191 were diagnosed with infertility. Women with infertility had a higher proportion of people with overweight/obesity, abdominal obesity, sleep duration ≤ 7 h and trouble sleeping than those with non-infertility. The result indicated that trouble sleeping [odds ratio (OR) = 2.25, 95% confidence intervals (CI): 1.49–3.39], sleep duration ≤ 7 h (OR = 1.59, 95% CI: 1.03–2.48), and the combined impact of abdominal obesity and trouble sleeping (OR = 2.18, 95% CI: 1.28–3.72), abdominal obesity and sleep duration ≤ 7 h (OR = 2.00, 95% CI: 1.17–3.40), overweight/obesity and trouble sleeping (OR = 2.29, 95% CI: 1.24–4.26), and overweight/obesity and sleep duration ≤ 7 h (OR = 1.88, 95% CI: 1.01–3.49) were associated with increased odds of infertility, respectively. Conclusion: There was combined effects of trouble sleeping/sleep duration ≤ 7 h and overweight/obesity/ abdominal obesity on increased odds of female infertility. [ABSTRACT FROM AUTHOR]

This study presents a novel label-free approach for characterizing cell death states, eliminating the need for complex molecular labeling that may yield artificial or ambiguous results due to technical limitations in microscope resolution. The proposed holographic tomography technique offers a label-free avenue for capturing precise three-dimensional (3D) refractive index morphologies of cells and directly analyzing cellular parameters like area, height, volume, and nucleus/cytoplasm ratio within the 3D cellular model. We showcase holographic tomography results illustrating various cell death types and elucidate distinctive refractive index correlations with specific cell morphologies complemented by biochemical assays to verify cell death states. These findings hold promise for advancing in situ single cell state identification and diagnosis applications. [ABSTRACT FROM AUTHOR]

This study aimed to investigate whether baroreflex sensitivity (BRS) could serve as a reliable metric for assessing cardiovascular autonomic neuropathy (CAN) and concurrently act as a surrogate biomarker for evaluating the severity of arterial stiffness and CAN in individuals diagnosed with type 2 diabetes mellitus (T2DM). Participants underwent brachial–ankle pulse wave velocity (baPWV) as well as autonomic function evaluations encompassing the Sudoscan-based modified composite autonomic scoring scale (CASS), baroreflex sensitivity, and heart rate variability in time domains and frequency domains. Linear regression analysis was performed to evaluate the influence of independent variables on baPWV and modified CASS. Participants with higher baPWV values were older, with longer diabetes duration, lower body weight, body mass index, waist circumference, elevated systolic and diastolic blood pressure, and mean arterial blood pressure. They also exhibited a higher prevalence of retinopathy as the underlying disease and reduced estimated glomerular filtration rate. Multiple linear regression analysis revealed that age and BRS were significantly associated with baPWV while diabetes duration, UACR, and BRS were significantly associated with modified CASS. Our study confirms the significant association of BRS with baPWV and modified CASS in T2DM, highlighting its pivotal role in linking microvascular and macrovascular complications. This supports BRS as a surrogate marker for assessing both the severity of arterial stiffness and cardiovascular autonomic neuropathy in T2DM, enabling the early identification of complications. [ABSTRACT FROM AUTHOR]

Double-diffusive convection under an external magnetic field has several industrial applications, and how the magnetic field affects flow and heat and mass transfer is a research focus. This paper studies the dynamical behavior of two-dimensional double-diffusive convection in a uniform magnetic field is investigated using a high-accuracy numerical method. The effects of the magnetic field strength on the flow and on the heat and mass transfer are analyzed, and the process of flow transition in the presence of a magnetic field is studied. The results show that, as the strength of the magnetic field increases, the flow is gradually inhibited, and most of the heat transfer occurs through conduction. For a fixed magnetic field strength, the temperature-dominated flow changes from periodic to chaotic, and finally back to periodic, as the orientation of the magnetic field increases. Two types of periodic flow occur in the transition route, namely, a simple periodic flow with an integer multiple of the fundamental frequency and a complex periodic flow with multiple lower-frequency subharmonic waves. In the presence of a strong magnetic field, the effect of the magnetic field orientation on the flow is significant. At high Rayleigh numbers and a fixed magnetic field strength, the heat transfer efficiency of a vertical magnetic field surpasses that of a horizontal magnetic field by approximately 50% when temperature is dominant, achieving a mass transfer efficiency of about 100%. In cases when concentration is dominant, the heat transfer efficiency of a vertical magnetic field is 20% higher than that of a horizontal magnetic field, and the mass transfer efficiency is approximately 60% higher for the vertical magnetic field compared to the horizontal magnetic field. The flow transitions from chaotic or periodic to steady as the Prandtl number increases. The solution branch bifurcates at certain Prandtl numbers, and hysteresis appears when Prandtl number is equal to 0.023. For low Rayleigh numbers, the heat and mass transfer efficiencies increase monotonically with increasing Prandtl number under a weak magnetic field but remain constant for various Prandtl numbers under a strong magnetic field. [ABSTRACT FROM AUTHOR]

We aimed to investigate the effect of altered metabolic syndrome (MetS) status on cancer risk. From 2002 through 2008 of the Taiwan MJ cohort, there were 111,616 adults who had repeated MetS measurements performed 3.3 years apart and were followed up for cancer incidence over 11.8 years. Cancer was confirmed based on histopathological reports. Participants were categorized as MetS-free (n = 80,409; no MetS at the first or last health screening), MetS-developed (n = 9833; MetS absence at the first screening and presence at the last screening), MetS-recovered (n = 8958; MetS presence at the first screening and absence at the last screening), and MetS-persisted (n = 12,416; MetS presence at the first and last screenings). We used the Fine-Gray sub-distribution method, with death as competing risk, to determine the association between MetS changes and incident cancer risk. During 1320,796 person-years of follow-up, 5862 individuals developed cancer. The incidence rate of cancer per 1000 person-years was 3.89 in the MetS-free, 5.26 in MetS-developed, 4.61 in MetS-recovered, and 7.33 in MetS-persisted groups (P <.001). Compared with the MetS-free group, MetS-persisted individuals had a higher risk of incident cancer. Persistent MetS was found to be associated with a high risk of incident cancer. • The effect of altered metabolic syndrome (MetS) on cancer risk is unknown. • The authors recruited 111,616 adults who had repeated MetS measurements. • All participants were followed up for cancer incidence over 11.8 years. • MetS-persisted individuals had a higher risk of incident cancer. • Individuals with MetS should seek treatment to reduce cancer risk. [ABSTRACT FROM AUTHOR]

The article discusses the Singapore Clinical Practice Guidelines (CPG) for Autism in Children and Adolescents. The CPG emphasizes the importance of early detection and intervention for children with autism spectrum disorder (ASD) and provides evidence-based recommendations for screening, treatment, and support. It also addresses the use of complementary and alternative medications (CAM) and highlights the need for professionals to guide parents in making informed decisions. The CPG recognizes the lifelong needs of individuals with ASD and emphasizes the importance of transition planning and holistic support. The article acknowledges the ongoing efforts to improve services and care for individuals with ASD in Singapore. [Extracted from the article]

This study focuses on the measurement and analysis of the complex permittivities of polymer blends using the field enhancement method (FEM). The blends, consisting of air-powder or solvent–solute mixtures, are placed in a Teflon holder and inserted into the FEM cavity to determine the complex permittivity. The resonant frequency and quality factor of the FEM cavity coupled with the samples provide information on the blends' dielectric constant and loss tangents. To extract the complex permittivities of three specific samples of DC-840, MCL-805, and MCL-Siloxane, we employ effective medium theories and the high-frequency structure simulator (HFSS) together with the measured data. The results reveal that when the volume fraction of the DC-840 solute in the xylene solvent surpasses a specific threshold, the dielectric constants and the loss tangents experience a notable increase. This phenomenon, known as percolation, strongly correlates with the viscosity of polymer blends. The observed percolation effect on the dielectric behavior is further elucidated using the generalized dielectric constant and the Debye model. By employing these models, the percolation effect and its impact on the dielectric properties of the blends can be explained. [ABSTRACT FROM AUTHOR]

Sb2Te3 is an important thermoelectric material. Co is a potential diffusion barrier. This study examined the electroplated Co/Sb2Te3 interfacial reactions at 300 °C, 400 °C and 500 °C. To provide fundamental information and for better understanding the reaction paths, the Co-Sb-Te phase equilibria isothermal sections at these three temperatures are proposed. No ternary compound is found. The 400 °C isothermal section contains (Co), (Sb), (Te), β-CoSb, β-Co1−xTe, CoSb3, δ-(Sb2Te), γ-(SbTe), Sb2Te3 and a continuous solid solution γ-Co(Sb,Te)2. At 500 °C, except for Te being molten, the phase relationships are similar to those at 400 °C. At 300 °C, although γ-CoSb2 and γ-CoTe2 have very significant mutual solubilities, they are two separate phases and do not form a continuous solid solution. In the Co/Sb2Te3 couple reacted at 300 °C, only one reaction phase, γ-CoTe2 with Sb solubility, is formed. Similar results are found in the Co/Sb2Te3 couple reacted 400 °C, and the reaction phase is the continuous solid solution γ-Co(Sb,Te)2. Two reaction phases, β-Co1-xTe and γ-Co(Sb,Te)2, are found in the couple reacted at 500 °C. The compositional ratio of Sb/Te in the reaction phase remained at 2/3 indicates that Co is the dominating diffusion species. The reaction phases are formed rapidly by Co penetration into the Sb2Te3 substrate. A peculiar phenomenon was found with the reaction layer that formed on the side of Co that was not in direct contact with the Sb2Te3 substrate which will be further investigated. [ABSTRACT FROM AUTHOR]

Evidence supports the view that postural sway in a quiet stance increases with clinical disease severity and dopaminergic therapy in idiopathic Parkinson's disease (PD), which, in turn, increases the risk of falling. This study evaluated the feasibility of combining disease-specific and balance-related measures as risk predictors for future falls in patients with PD. The patients with PD underwent postural sway measurements (area, length, and velocity traveled by the excursion of the center of pressure) and clinical functional scores (Parkinson's Disease Rating Scale [UPDRS] and Tinetti balance and gait score assessment) in both the on- and off-states of dopaminergic therapy. The outcome was defined as the development of a new fall. The sway area, velocity, and length increased after the medication administration. The Cox proportional hazards model showed that only previous fall history, Tinetti balance and gait score (on-state), and levodopa equivalent daily dose (LEDD) were associated with the development of future falls. The cumulative risk of fall development showed that the sway length and velocity were associated with future falls after more than six months. The combined LEDD, Tinetti balance and gait score (on-state), and velocity and length of postural sway (on-state) had the highest diagnostic accuracy (area under the curve = 0.9, p < 0.0001). Dopaminergic therapy can improve clinical functional scores but worsen balance-related measures. Increased sway length and velocity during the medication state are hallmarks of future falls, particularly in advanced PD. Combining disease-specific and balance-related measures can serve as an auxiliary diagnosis as risk predictors for future falls. [ABSTRACT FROM AUTHOR]

Euryhaline teleosts exhibit varying acclimability to survive in environments that alternate between being hypotonic and hypertonic. Such ability is conferred by ion channels expressed by ionocytes, the ion-regulating cells in the gills or skin. However, switching between environments is physiologically challenging, because most channels can only perform unidirectional ion transportation. Coordination between acute responses, such as gene expression, and long-term responses, such as cell differentiation, is believed to strongly facilitate adaptability. Moreover, the pre-acclimation to half seawater salinity can improve the survivability of Japanese medaka (Oryzias latipes) during direct transfer to seawater; here, the ionocytes preserve hypertonic acclimability while performing hypotonic functions. Whether acclimability can be similarly induced in a closed species and their corresponding responses in terms of ion channel expression remain unclear. In the present study, Japanese medaka pre-acclimated in brackish water were noted to have higher survival rates while retaining higher expression of the three ion channel genes ATP1a1a.1, ATP1b1b, and SLC12a2a. This retention was maintained up to 2 weeks after the fish were transferred back into freshwater. Notably, this induced acclimability was not found in its close kin, Indian medaka (Oryzias dancena), the natural habitat of which is brackish water. In conclusion, Japanese medaka surpassed Indian medaka in seawater acclimability after experiencing exposure to brackish water, and this ability coincided with seawater-retention gene expression. [ABSTRACT FROM AUTHOR]

The objective of this study was to develop artificial intelligence-based deep learning models and assess their potential utility and accuracy in diagnosing and predicting the future occurrence of diabetic distal sensorimotor polyneuropathy (DSPN) among individuals with type 2 diabetes mellitus (T2DM) and prediabetes. In 394 patients (T2DM=300, Prediabetes=94), we developed a DSPN diagnostic and predictive model using Random Forest (RF)-based variable selection techniques, specifically incorporating the combined capabilities of the Clinical Toronto Neuropathy Score (TCNS) and nerve conduction study (NCS) to identify relevant variables. These important variables were then integrated into a deep learning framework comprising Convolutional Neural Networks (CNNs) and Long Short-Term Memory (LSTM) networks. To evaluate temporal predictive efficacy, patients were assessed at enrollment and one-year follow-up. RF-based variable selection identified key factors for diagnosing DSPN. Numbness scores, sensory test results (vibration), reflexes (knee, ankle), sural nerve attributes (sensory nerve action potential [SNAP] amplitude, nerve conduction velocity [NCV], latency), and peroneal/tibial motor NCV were candidate variables at baseline and over one year. Tibial compound motor action potential amplitudes were used for initial diagnosis, and ulnar SNAP amplitude for subsequent diagnoses. CNNs and LSTMs achieved impressive AUC values of 0.98 for DSPN diagnosis prediction, and 0.93 and 0.89 respectively for predicting the future occurrence of DSPN. RF techniques combined with two deep learning algorithms exhibited outstanding performance in diagnosing and predicting the future occurrence of DSPN. These algorithms have the potential to serve as surrogate measures, aiding clinicians in accurate diagnosis and future prediction of DSPN. [ABSTRACT FROM AUTHOR]

The study aimed to explore risk stratification approaches for cardiovascular autonomic neuropathy (CAN) in individuals with prediabetes and type 2 diabetes (T2DM) over a three-year follow-up period. Participants underwent evaluations of autonomic function encompassing cardiovascular autonomic reflex tests (CARTs), baroreflex sensitivity (BRS), heart rate variability (HRV) in time domains (standard deviation of all normal RR intervals (SDNN)) and frequency domains (high frequency/low frequency ratio), and electrochemical skin conductance (ESC). The diagnosis of CAN relied on abnormal CART results. Subjects were categorized into 4 groups, based on their assessment of cardiac autonomic function at 3-year follow-up, relative to the presence or absence of CAN at baseline assessment: Persistent absence of CAN; Resolution of CAN; Progression to CAN; and Persistent CAN. Participants with T2DM/prediabetes (n = 91/7) were categorized as: Persistent absence of CAN (n = 25), Resolution of CAN (n = 10), Progression to CAN (n = 18), and Persistent CAN (n = 45) groups. The Persistent absence of CAN group showed significant associations with SDNN. The Resolution of CAN group exhibited notable associations with mean HbA1C (follow-up), while the Progression to CAN group displayed a significant link with baseline estimated glomerular filtration rate. The Persistent CAN group demonstrated significant associations with SDNN and Sudoscan CAN risk score. Screening recommendations involve biennial to annual assessments based on risk levels, aiding in CAN detection and subsequent comprehensive and time-intensive autonomic function tests for confirmation. The study's findings offer improved risk categorization approaches for detecting CAN, which has relevance for shaping public health strategies. [ABSTRACT FROM AUTHOR]

Studies to examine the impact of end-of-life (EOL) discussions on the utilization of life-sustaining treatments near death are limited and have inconsistent findings. This nationwide population-based cohort study determined the impact of EOL discussions on the utilization of life-sustaining treatments in the last three months of life in Taiwanese cancer patients. From 2012 to 2018, this cohort study included adult cancer patients, which were confirmed by pathohistological reports. Life-sustaining treatments during the last three months of life included cardiopulmonary resuscitation, intubation, and defibrillation. EOL discussions in cancer patients were confirmed by their medical records. Association of EOL discussions with utilization of life-sustaining treatments were assessed using multiple logistic regression. Of 381,207 patients, the mean age was 70.5 years and 19.4% of the subjects received life-sustaining treatments during the last three months of life. After adjusting for other covariates, those who underwent EOL discussions were less likely to receive life-sustaining treatments during the last three months of life compared to those who did not (Adjusted odds ratio [AOR] 0.87; 95% confidence interval [CI] 0.85–0.89). Considering the type of treatments, EOL discussions correlated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR = 0.45, 95% CI 0.43–0.47), endotracheal intubation (AOR = 0.92, 95%CI 0.90–0.95), and defibrillation (AOR = 0.54, 95%CI 0.49–0.59). Since EOL discussions are associated with less aggressive care, our study supports the importance of providing these discussions to cancer patients during the EOL treatment. [ABSTRACT FROM AUTHOR]

• Cardiovascular autonomic dysfunction after CCRT is a progressive process. • Cardiovagal impairment occurs in the early phase and persists in decline. • Adrenergic dysfunction only showed significance after a nine-year follow-up. • Both afferent and efferent baroreflex pathways can be involved after CCRT. Concurrent chemoradiation therapy (CCRT) is the mainstay treatment for patients with nasopharyngeal carcinoma (NPC). Baroreflex impairment can be a late sequela in patients after neck radiotherapy. We hypothesized that cardiovascular autonomic dysfunction is a progressive process that can begin after CCRT and persists for a longer period. Cardiovascular autonomic function was assessed in 29 newly diagnosed patients with NPC using standardized measures including heart rate response to deep breathing (HRDB), Valsalva ratio (VR), baroreflex sensitivity (BRS), and analyses of heart rate variability (HRV), biomarkers of oxidative stress, and inflammation at three different time points (baseline, immediately after CCRT, and 9 years after enrollment). A healthy control group was recruited for the comparison. Although there was an aging effect on autonomic parameters in both groups during the 9 years of follow-up, the between-group comparison showed that there was a significant decrease in HRDB, VR, and HRV at the 9th year of follow-up in the NPC group. Repeated measures ANOVA after controlling for age and sex showed that both HRDB and triangle index of HRV had statistically significant differences between the two groups. Based on our results, cardiovascular autonomic dysfunction after CCRT is a progressive and dynamic process. Cardiovagal impairment occurs in the early phase and persists in decline, while adrenergic dysfunction is significant only after a 9-year follow-up. In contrast to the current opinion, our study showed that both afferent and efferent baroreflex pathways can be involved after CCRT. [ABSTRACT FROM AUTHOR]

Thermal convection of binary fluid mixtures with negative separation ratios in a tilted rectangular cavity heated from below is numerically investigated using a high-accuracy finite-difference method. The fluids under consideration are Newtonian fluids with the Prandtl number (Pr) and Lewis number (Le) in the ranges of 0.01 ≤ Pr ≤ 10 and 0.001 ≤ Le ≤ 1 , respectively. Extensive direct numerical simulations are conducted to explore the dynamics of the system by varying the control parameters, namely, the relative Rayleigh number (r) and the inclination angle of the cavity (β) together with the separation ratio (ψ) in the ranges of 1.0 ≤ r ≤ 2.0 , 0 ° ≤ β ≤ 90 ° , and − 0.6 ≤ ψ ≤ 0. It is found that the inclination angle leads to a distinct trend for heat and mass transfer: the Nusselt number first decreases for small β , then gradually increases for moderate β , and finally decreases again for large β when r varies from 1.4 to 2.0. The optimal inclination angle lies in the range of 54 ° ≤ β ∗ ≤ 64 ° , where the heat transport peaks. The Sherwood number initially decreases for small β , then increases with increasing β , and finally remains constant for large β. We present the bifurcation diagram of the solutions for different separation ratios, focusing on the distinct variation trends of the inclination angle. The corresponding heat- and mass-transfer properties of the flow on different branches of the bifurcation diagram are investigated. Furthermore, we explore the effect of the relative Rayleigh number, Prandtl number and Lewis number as well as the separation ratio on heat and mass transfer for various inclination angles, and obtain the Nusselt number as a function of the separation ratio and inclination angle. [ABSTRACT FROM AUTHOR]

Introduction: The sural sensory nerve action potential (SNAP) amplitude is a measure of the number of axons. We tested the hypothesis that sural SNAP amplitude can be used as a marker in screening, severity evaluation, and follow-up of diabetic distal symmetrical polyneuropathy (DSPN).Methods: Patients with type 2 diabetes underwent nerve conduction studies and were followed for 6 years. Composite amplitude scores (CASs) were determined to evaluate DSPN severity.Results: Sural SNAP amplitudes were negatively correlated with CAS (r = -.790, P < .0001), and changes in sural SNAP amplitudes were negatively correlated with those of CAS after controlling for follow-up duration (r = -.531, P = .028).Discussion: When a patient's baseline sural SNAP amplitude is above zero, it can be used as one measure of DSPN in screening, severity evaluation, and follow-up. However, if the patient's sural SNAP value is zero, CAS can be used as a follow-up measure. [ABSTRACT FROM AUTHOR]

Aims/Introduction: Clinical studies show that either heart rate variability (HRV) or electrochemical skin conductance (ESC) alone can serve as a simple and objective method for screening cardiovascular autonomic neuropathy (CAN). We tested the hypothesis that combining these two quantitative approaches can not only reinforce accuracy in CAN screening but also provide a better estimate of CAN severity in patients with type 2 diabetes (T2DM) who had already had CAN in outpatient clinics. Materials and Methods: Each patient received a complete battery of cardiovascular autonomic reflex tests (CARTs), with ESC measured by SUDOSCAN, time domain of HRV measured by standard deviation of all normal RR intervals (SDNN) and frequency domain of HRV (low frequency [LF], high frequency [HF], and LF/HF ratio), and peripheral blood studies for vascular risk factors. Severity of CAN was measured by CAN score. Results: The 90 T2DM patients included 50 males and 40 females. Those with more severe CAN had lower values in feet ESC (P = 0.023) and SDNN (P < 0.0001). Multiple linear regression analysis also showed that feet ESC and SDNN value (P = 0.003 and P < 0.0001) were significantly associated with CAN score. Combining SDNN and feet ESC also can increase the diagnostic accuracy of CAN with respective to sensitivity and specificity by using receiver operating characteristic analysis. Conclusions: Combining the results of SDNN and feet ESC can not only assess, but also quantitatively reflect the progress or improvement of autonomic nerve function (including sympathetic and parasympathetic activity) in patients with T2DM. [ABSTRACT FROM AUTHOR]

The integration of high strength and toughness concurrently is a vital requirement for elastomers from the perspective of long-term durability and reliability. Unfortunately, these properties are generally conflicting in artificial materials. In the present work, we propose a facile strategy to simultaneously toughen and strengthen elastomers by constructing 3D segregated filler network via a simple latex mixing method. The as-fabricated elastomers are featured by a microscopic 3D interconnected segregated network of rigid graphene oxide (GO) nanosheets and a continuous soft matrix of sulfur vulcanized natural rubber (NR). We demonstrate that the interconnected segregated filler network ruptures preferentially upon deformation, and thus is more efficient in energy dissipation than the dispersed filler network. Therefore, the segregated filler network exhibits better reinforcing effects for the rubber matrix. Moreover, the excellent energy dissipating ability also contributes to the outstanding crack growth resistance through the release of concentrated stress at the crack tip. As a result, the strength, toughness and fatigue resistance of the nanocomposites are concurrently enhanced. The methodology in this work is facile and universally applicable, which may provide new insights into the design of elastomers with both extraordinary static and dynamic mechanical performance for practical applications. [ABSTRACT FROM AUTHOR]

Context: The impact of hospice care services on the utilization of life-sustaining treatments during end-of-life care in terminally ill patients has not been extensively studied.Objectives: To determine the impact of hospice care services on the utilization of life-sustaining treatments during the last three months of life among patients with cancer.Methods: This nationwide population-based cohort study identified adults with cancer diagnosis from the Taiwan Registry for Catastrophic Illness, 2006-2016. Life-sustaining treatments included cardiopulmonary resuscitation, intubation, mechanical ventilation support, nasogastric tube feeding, and total parenteral nutrition. Hospice care services consisted of hospice inpatient care, hospice-shared care, and hospice home care. The association of hospice care services with the utilization of life-sustaining treatments was determined using multiple logistic regression.Results: Of 516,409 patients with cancer, 310,722 (60.2%) patients used life-sustaining treatments during the last three months of life. After adjusting for covariates, patients with hospice care services were less likely to receive life-sustaining treatments during the last three months of life than those without the services (adjusted odds ratio [AOR]: 0.70; 95% CI: 0.69-0.71). While type of life-sustaining treatments were considered, hospice care services were associated with a lower likelihood of receiving cardiopulmonary resuscitation (AOR: 0.125; 95% CI: 0.118-0.131), endotracheal intubation (AOR: 0.204; 95% CI: 0.199-0.210), mechanical ventilation support (AOR: 0.265; 95% CI: 0.260-0.270), nasogastric tube feeding (AOR: 0.736; 95% CI: 0.727-0.744), and total parenteral nutrition (AOR: 0.86; 95% CI: 0.84-0.88).Conclusion: Hospice care services were associated with a lower likelihood of receiving life-sustaining treatments during the last three months of life in patients with cancer. [ABSTRACT FROM AUTHOR]

This study aims to evaluate the feasibility of substituting electrochemical skin conductance measurement using SUDOSCAN for sudomotor function testing in the Composite Autonomic Scoring Scale (CASS) and to correlate the results with the Composite Autonomic Symptom Scale 31 (COMPASS 31) among patients with type 2 diabetes mellitus (T2DM). Fifty patients with T2DM underwent cardiovascular autonomic function testing and the SUDOSCAN test and completed the COMPASS 31 questionnaire. We developed a SUDOSCAN-based sudomotor subscore as a substitute for the original sudomotor subscore (based on the quantitative sudomotor axon reflex test [QSART]). The modified CASS score (SUDOSCAN-based sudomotor subscore combined with the adrenergic and cardiovagal subscores) and the original CASS score without suomotor assessment (sum of the adrenergic and cardiovagal subscores) were obtained according to the results of the cardiovascular autonomic function and SUDOSCAN tests. The total COMPASS 31 score was significantly correlated with the modified CASS score (p = 0.019 and 0.037 for the raw and weighted scores, respectively) but not with the CASS score without sudomotor assessment. After adding the SUDOSCAN-based sudomotor subscore, the number of patients identified as having diabetic autonomic neuropathy (DAN) increased from 24 (48 %, based on the CASS score without sudomotor assessment) to 35 (70 %, based on the modified CASS score). The modified CASS score enhances the accuracy of assessing autonomic function and improves the diagnosis of diabetic autonomic neuropathy (DAN) among patients with T2DM. In medical settings where QSART is not accessible, SUDOSCAN testing offers a practical and efficient alternative. [ABSTRACT FROM AUTHOR]

Background: Evidences support the view that central obesity is an independently cardiovascular risk. It is thought that leptin contributes to autonomic dysfunction and cardiovascular risks in type 1 and type 2 diabetes mellitus (T1DM and T2DM). This raises the possibility that leptin might mediate the relationship between central obesity and the severity of cardiovascular autonomic neuropathy (CAN) in patients with well-controlled T2DM and prediabetes.Methods: The complete cardiovascular reflex tests and biomarkers were assessed for each patient. The severity of CAN was assessed using composite autonomic scoring scale (CASS). A single-level three-variable mediation model was used to investigate the possible relationships among central obesity [as indicated by waist circumference (WC)], leptin level, and severity of CAN (as indicated by CASS value).Results: A total of 107 patients were included in this study: 90 with diabetes and 17 with prediabetes. The results demonstrate that increased WC is associated with increased severity of CAN (r = 0.242, P = 0.017). We further discovered that leptin level is positively correlated with WC (r = 0.504, P < 0.0001) and the CASS value (r = 0.36, P < 0.0001). Further mediation analysis shows that leptin level serves as mediators between higher WC and higher CASS.Conclusions: Our results highlighted the relationship among leptin, central obesity, and severity of CAN. As the leptin level serves as mediator between central obesity and severity of CAN, a longitudinal study is needed to confirm that control of WC can decrease leptin levels and can be effective in reducing CAN progression. [ABSTRACT FROM AUTHOR]

Purpose. The iStent provides a direct pathway for aqueous outflow from the anterior chamber to Schlemm's canal in patients with open-angle glaucoma (OAG). We performed a meta-analysis to evaluate the effectiveness of iStent as a standalone operation in patients with OAG in reducing the intraocular pressure (IOP) and the number of topical glaucoma medications. Methods. We searched various databases between January 1, 2000, and September 30, 2019, and included only peer-reviewed, prospective, or retrospective clinical studies in our analyses. Details regarding the IOP and the number of medications at baseline and end point were recorded from each study. Standardized mean differences (SMDs) of IOP and medication numbers were calculated. Furthermore, the success rate (the proportion of IOP ≤18 mmHg and IOP reduction ≥20% at end point) and the complication rate were also summarized. Finally, a subgroup analysis was done based on the iStent generation (first and second), follow-up duration (≤6, 6–18, 18–36, and >36 months), and iStent number (one, two, and three). The outcome measures were aggregated SMDs computed from each study. Results. A total of 17 studies with 978 eyes were included in this analysis. All studies demonstrated a reduction in IOP after iStent implantation. Aggregated SMDs of IOP revealed a significant reduction (SMD = −2.64, 95% confidence interval (CI): −3.21 to −2.07). The success rate was significantly good, and most of the complication rates were low. The number of medications was also significantly reduced (SMD = −1.71, 95% CI: −2.18 to −1.24). The subgroup analysis revealed a reduction in IOP and medication burden in each category of iStent generation, follow-up duration of up to 42 months, and iStent numbers. Conclusion. Use of iStent as a standalone procedure does reduce the IOP and the number of glaucoma medications. The benefit of iStent lasts for at least 42 months. [ABSTRACT FROM AUTHOR]

Background Human life expectancy has increased rapidly in recent decades. Regular exercise can promote health, but the effect of exercise on mortality is not yet well understood. Objective To investigate the association of exercise with mortality in the older people. Methods We used data from annual health check-ups of the older citizens of Taipei in 2006. Participants were interviewed by trained nurses using a structured questionnaire to collect data on demographics and lifestyle behaviours. Overnight fasting blood was collected for measuring blood glucose, liver and renal function and lipid profiles. Exercise frequency was categorised into no exercise, 1–2 times in a week and more than 3–5 times in a week. All-cause mortality was ascertained from the National Registration of Death. All participants were followed up until death or December 312012, whichever came first. Kaplan–Meier curves and Cox proportional hazard analysis were used to investigate the association between exercise and all-cause mortality. Results In total, 42,047 older people were analysed; 22,838 (54.32%) were male and with a mean (SD) age of 74.58 (6.32) years. Kaplan–Meier curves of all-cause mortality stratified by exercise frequency demonstrated significant findings (Log-rank P  < 0.01). Multivariate Cox regression analysis showed that older people with higher exercise levels had a significantly decreased risk of mortality (moderate exercise HR = 0.74, 95% CI: 0.68–0.81, high exercise HR = 0.65, 95% CI: 0.59–0.70) after adjusting for potential confounders, with a significant trend (P for trend<0.01). Conclusions Older people with increased exercise levels had a significantly decreased risk of all-cause mortality. [ABSTRACT FROM AUTHOR]

Background: Pregnant women have high serum concentrations of sex steroid hormones, which are major regulators of paracrine and autocrine responses for many maternal and placental functions. The main purpose of this study was to compare patients with preeclampsia and patients with uncomplicated pregnancies in terms of serum steroid hormones (estradiol [E2], progesterone [P4], dehydroepiandrosterone sulfate [DHEAS], and testosterone [T]) throughout pregnancy and the levels of cord blood and placental steroid receptors during the third trimester. Methods: Quantitative real-time reverse transcription PCR, western blotting, and immunohistochemistry were used to determine the levels of steroid hormones in the serum and cord blood and the placental levels of estrogen receptor-α (ERα), ERβ, androgen receptor (AR), and progesterone receptor (PR). Results: There were 45 women in the uncomplicated pregnancy group and 30 women in the preeclampsia group. Serum levels of T were greater and serum levels of E2 were reduced in the preeclampsia group, but the two groups had similar levels of P4 and DHEAS during the third trimester. Cord blood had a decreased level of DHEAS in the preeclampsia group, but the two groups had similar levels of P4, E2, and T. The two groups had similar placental mRNA levels of ERα, ERβ, AR, and PR, but the preeclampsia group had a higher level of ERβ protein and a lower level of ERα protein. Immunohistochemistry indicated that the preeclampsia group had a greater level of ERβ in the nucleus and cytoplasm of syncytiotrophoblasts and stromal cells. Conclusions: Women with preeclampsia had lower levels of steroid hormones, estrogen, and ERα but higher levels of T and ERβ. These molecules may have roles in the pathogenesis of preeclampsia. [ABSTRACT FROM AUTHOR]

Background. Glycemic variability is associated with higher risk of microvascular complications in patients with type 2 diabetes. Aim. To test the hypothesis that glycemic variability can contribute to progression to macroalbuminuria in normal or microalbuminuria in patients with type 2 diabetes. Design. This prospective study enrolled 193 patients with type 2 diabetes at a tertiary medical center. Methods. For each patient, the intrapersonal glycemic variability (mean, SD, and coefficient of variation of HbA1c) was calculated using all measurements obtained three years before the study. Patients were divided into four groups stratified by both urine albumin/creatinine ratio and HbA1c-SD. The presence of macroalbuminuria was assessed with Kaplan–Meier plots and compared by log-rank test. Results. Of the 193 patients, 83 patients were in the macroalbuminuria state. Patients in the initial macroalbuminuria group after enrollment had the highest diabetes duration, mean, CV-HbA1c and HbA1c-SD, and uric acid level, and the lowest estimate glomerular filtration rate, followed by subsequent macroalbuminuria and without macroalbuminuria groups. Patients with microalbuminuria and high HbA1c-SD showed the highest progression rate to macroalbuminuria, after a six-year follow-up study by Kaplan–Meier Plots and compared by log-rank test. Conclusions. Higher HbA1C variability is more likely to progress to macroalbuminuria in those patients who are already in a microalbuminuria state. We recommend that clinicians should aggressively control blood glucose to an acceptable range and avoid blood glucose fluctuations by individualized treatment to prevent renal status progression. [ABSTRACT FROM AUTHOR]

• Patients with DSPN had longer blink R1, R2, and contralateral R2 latencies. • Blink R1 latency is valuable in auxiliary diagnosis in DSPN. • Blink R1 latency was independently associated with CAS. Studies showed a relatively prolonged blink R1 latency in patients with diabetic distal symmetrical polyneuropathy (DSPN) compared to that without DSPN. We tested the hypothesis that blink R1 latency would provide a diagnostic alternative to nerve conduction studies (NCS) in DSPN and act as a marker of the severity of NCS abnormalities in DSPN. A total of 109 patients with type 2 diabetes underwent blink reflex studies and NCS. We used the composite amplitude scores of nerve conductions (CAS), which consisted of motor (tibial, peroneal and ulnar) and sensory (sural and ulnar) amplitudes for estimating the severity of NCS. Patients with DSPN had longer blink R1, R2, and contralateral R2 latencies (P < 0.0001, P = 0.001, and P = 0.031, respectively) and higher CAS (P < 0.0001). Area under curve on receiver operating characteristic curve analysis in diagnosing occurrence of DSPN in blink R1 latency was 0.772 (P < 0.0001). Multiple linear regression analysis showed that blink R1 latency was independently associated with CAS. Blink R1 latency may be valuable in auxiliary diagnosis and in determining the severity of NCS abnormalities in DSPN. Blink R1 latency can be added as a supplemental marker of severity of NCS in DSPN, especially if the patient's sural amplitudes has a floor effect. [ABSTRACT FROM AUTHOR]

• Sural SNAP was positively correlated with parameters of HR_DB and Valsalva ratio. • A longer duration of diabetes had both higher severity and a higher percentage of CAN and DSPN. • Multiple linear regression show sural SNAPs were independently associated with HR_DB. Both diabetic distal symmetrical polyneuropathy (DSPN) and cardiac autonomic neuropathy (CAN) indicate the length-dependent pattern of disease. Decreased parasympathetic activity has been found in the early phase of CAN and sural sensory nerve action potential (SNAP) imply axonal loss in DSPN. All patients with type 2 diabetes underwent cardiovascular autonomic function and nerve conduction studies (NCS). We constructed modified composite autonomic scoring scale (CASS) and composite score of NCS to measure the severity of CAN and DSPN, respectively. Patients with a longer duration of diabetes had a lower heart rate response to deep breathing (HR_DB), Valsalva ratio (VR), and baroreflex sensitivity (BRS), higher CASS, a higher percentage of CAN, lower sural SNAP, higher composite score of NCS, and a higher percentage of DSPN. Multiple linear regression analysis showed that only sural SNAPs were independently associated with mean HR_DB. Sural SNAP was closely correlated with parameters of cardiovagal functions in patients with different durations of diabetes. The percentage and severity of CAN and DSPN increase with longer duration of diabetes. The independent association of sural sensory nerve action potential amplitude and heart rate response to deep breathing with type 2 diabetes is important because combined testing increases diagnostic sensitivity and specificity. [ABSTRACT FROM AUTHOR]

Background. α-1-Acid glycoprotein (AGP) is an acute-phase protein that plays a role in first-line defense against infection and is therefore elevated in sepsis. We tested the hypothesis that AGP levels increase initially in sepsis and decrease after antimicrobial therapy and that these levels may predict treatment outcomes. Methods. AGP, biomarkers widely used in clinical practice, and maximum 24-h acute physiology and chronic health evaluation (APACHE)-II scores upon emergency department (ED) admission were prospectively evaluated and compared. We further examined changes in AGP concentrations 1, 4, and 7 days after admission and determined the value of AGP that may be used to accurately and reliably predict the prognosis in patients with sepsis. Results. Mechanical ventilation, white blood cell (WBC) counts, C-reactive protein (CRP) and lactate levels, maximum 24-h APACHE-II scores, and AGP concentrations were significantly higher upon admission in patients with sepsis who died. AGP and lactate concentrations were also significantly higher in non-survivors than in survivors on days 1, 4, and 7. As indicated by the stepwise logistic regression model analysis and area under the curve analysis, AGP was the best prognostic indicator, and the cut-off value for predicting fatality was 1307 μg/mL, and any increase 1-ng/mL in AGP concentration would increase the fatality rate by 0.5%. Conclusion. Based on our observations, AGP may be a good prognostic predictor in patients with sepsis. In addition, serial AGP levels meet the requirements for predicting outcomes in patients with sepsis. [ABSTRACT FROM AUTHOR]

The peripheral immune system plays a critical role in aging and in the response to brain injury. Emerging data suggest inflammatory responses are exacerbated in older animals following ischemic stroke; however, our understanding of these age-related changes is poor. In this work, we demonstrate marked differences in the composition of circulating and infiltrating leukocytes recruited to the ischemic brain of old male mice after stroke compared to young male mice. Blood neutrophilia and neutrophil invasion into the brain were increased in aged animals. Relative to infiltrating monocyte populations, brain-invading neutrophils had reduced phagocytic potential, and produced higher levels of reactive oxygen species and extracellular matrix-degrading enzymes (i.e., MMP-9), which were further exacerbated with age. Hemorrhagic transformation was more pronounced in aged versus young mice relative to infarct size. High numbers of myeloperoxidase-positive neutrophils were found in postmortem human brain samples of old (> 71 years) acute ischemic stroke subjects compared to non-ischemic controls. Many of these neutrophils were found in the brain parenchyma. A large proportion of these neutrophils expressed MMP-9 and positively correlated with hemorrhage and hyperemia. MMP-9 expression and hemorrhagic transformation after stroke increased with age. These changes in the myeloid response to stroke with age led us to hypothesize that the bone marrow response to stroke is altered with age, which could be important for the development of effective therapies targeting the immune response. We generated heterochronic bone marrow chimeras as a tool to determine the contribution of peripheral immune senescence to age- and stroke-induced inflammation. Old hosts that received young bone marrow (i.e., Young → Old) had attenuation of age-related reductions in bFGF and VEGF and showed improved locomotor activity and gait dynamics compared to isochronic (Old → Old) controls. Microglia in young heterochronic mice (Old → Young) developed a senescent-like phenotype. After stroke, aged animals reconstituted with young marrow had reduced behavioral deficits compared to isochronic controls, and had significantly fewer brain-infiltrating neutrophils. Increased rates of hemorrhagic transformation were seen in young mice reconstituted with aged bone marrow. This work suggests that age alters the immunological response to stroke, and that this can be reversed by manipulation of the peripheral immune cells in the bone marrow. [ABSTRACT FROM AUTHOR]

In situ stabilization of trace elements by adding cheap amendments is an emerging technology for large-scale soil remediation. Various amendments have been examined well in the literature, but related have focused predominantly on short-term laboratory scale incubation or pot experiments. This study applied dolomitic lime at 40 ton ha −1 , oyster shell (OS) at 80 ton ha −1 , and sugarcane bagasse compost (SC) at 60 ton ha −1 to a paddy field in Taiwan for two rice ( Oryza sativa L.) cropping seasons. The aims of study were to gain an understanding of the bioavailable concentrations of Cr, Ni, Cu, and Zn in the amended soil and the metal uptake of rice for practical amendment use in field-scale remediation of contaminated soils. The treatments of lime and OS significantly ( p  < 0.05) decreased the 0.1 N HCl–extractable metals in the soil. The increase in soil pH was the key factor in decreasing the bioavailable pool of metals in the soil by using lime and OS. The concentrations of Cu, Zn, and Ni in the brown rice were substantially reduced only through the addition of OS, and thus OS met the requirement of being a cheap, locally available, and environmentally compatible amendment for field-scale soil remediation. The translocation of Cr in rice plants is heavily restricted, and thus no significant differences in Cr uptake by rice grain were observed between the different amendment treatments. However, SC is not recommended as an immobilization agent because it caused a pH decrease in the amended soil. [ABSTRACT FROM AUTHOR]

Isoliquiritigenin is a natural chalcone derived from Glycyrrhiza , which has been reported to have anti-tumor activity in recent years. Here, we investigate the anticancer efficacy and associated mechanisms of isoliquiritigenin in human prostate cancer PC-3 and 22RV1 cells. Isoliquiritigenin (25–50 μM) inhibited cell proliferation, induced cell apoptosis, and caused G2/M cell cycle arrest in vitro. This agent also repressed the growth of PC-3 xenograft tumors in vivo with the results of hematoxylin/eosin staining and immunohistochemistry staining showing differences between isoliquiritigenin-treated groups and control group. Next, we used microarray transcriptional profiling to identify isoliquiritigenin-regulated genes on PC-3 prostate cancer cells. Multiple genes involved in cell cycle, DNA damage, and apoptosis signaling pathways were changed remarkably with the treatment of isoliquiritigenin. Molecular studies revealed that G2/M arrest was associated with a decrease in cyclin B1, cyclin-dependent kinase 1 (CDK1), and phosphorylated CDK1 (Thr14, Tyr15, and Thr161), whereas the expression of 14-3-3σ and growth arrest and DNA damage-inducible 45 alpha (GADD45A) was increased. The complexes of cyclin B1–CDK1 were also examined to show a decrease in the binding of CDK1 with cyclin B1. In addition, treatment with relatively high concentrations of isoliquiritigenin induced apoptosis, mainly associated with enhancing apoptosis regulator (Bax/Bcl-2) ratio. Collectively, these findings indicate that isoliquiritigenin modulates cyclin B1–CDK1 for G2/M arrest, together with an alteration of cell cycle regulators and apoptotic factors in human prostate cancer cells. However, we observed pleiotropic effects for isoliquiritigenin in microarray results, suggesting that other biological mechanisms also contribute to its efficacy, which could be of interest for future investigations. [ABSTRACT FROM AUTHOR]

The sonic band-gap structures of 12-fold symmetry quasicrystals consisting of rigid cylinders in air are investigated by using the multiple scattering method. Large full gaps are found in this system owing to its high symmetry. At filling fractions between 0.2 and 0.4, this 12-fold square–triangle tiling is much better for the realization of sonic band gaps than the square or triangular lattice. This makes the 12-fold quasicrystal a promising structure for acoustic-wave band-gap materials. © 2002 American Institute of Physics. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic autoimmune disease. Its pathological features are synovial inflammation, bone erosion, and joint structural damages. Our previous studies have shown that kefir peptides (KPs) can reduce cardiovascular disease, osteoporosis and renal inflammation. In this study, we further evaluate the efficacy of KPs on adjuvant-induced arthritis (AIA) in a rat model. After the 14th day of adjuvant induction, rats were subsequently orally administered KPs (83 or 166 mg/day/kg) or tofacitinib (6.2 mg/day/kg) for 14 days. On the 28th day, the rats were anesthetized with isoflurane for ultrasonic, in vivo imaging system (IVIS), and radiographic imaging and then sacrificed for ankle tissues collection and analysis. In vitro , IL-1β-treated human synovial cells (SW982) were subjected to anti-arthritis mechanism study in the presence of KPs. The results of ultrasonography, radiograph, histology, the expression of matrix metalloproteinases (MMPs), inflammatory cytokines and RANKL/OPG ratio demonstrated decreasing severity of synovitis and bone erosion in the ankle joints after KPs treatment. Activation of the NF-κB and MAPK pathways was significantly reduced in KPs treated AIA group. Furthermore, KPs attenuated IL-1β-induced inflammatory cytokine production and the expression of MMPs in a human synovial cell line SW982. These results demonstrated that KPs alleviated adjuvant-induced arthritis in rats by inhibiting IL-1β-related inflammation and MMPs production. We concluded that KPs can exhibit anti-inflammatory effects by reducing the levels of macrophage-related inflammatory cytokines and MMPs, thus alleviating bone erosion in the ankle joint and constituting a potential therapeutic strategy for rheumatoid arthritis. [ABSTRACT FROM AUTHOR]

Background: The association between body mass index and mortality in patients with tuberculosis has not been extensively studied, and the existing evidence is inconsistent. This study aimed to investigate the impact of body mass index on timing of death in patients with tuberculosis. Methods: All Taiwanese adults with tuberculosis in Taipei, Taiwan, were included in a retrospective cohort study in 2011–2012. Multinomial logistic regression was used to evaluate the association between body mass index and timing of death in patients with tuberculosis. Results: Among 1557 eligible patients, 84.1% (1310), 8.2% (128), and 7.6% (119) underwent successful treatment, early death, and late death, respectively. The mean age of the patients with tuberculosis was 64.2 years old, and 67.7% were male. After controlling for potential confounding variables, underweight with body mass index less than 18.5 kg/ m2 was significantly associated with elevated risk of all-cause mortality [Adjusted odds ratio (AOR), 1.64; 95% confidence interval (CI), 1.17–2.30]. Considering timing of death, underweight with body mass index less than 18.5 was significantly associated only with elevated risk of early mortality within the first 8 weeks of treatment onset (AOR, 2.22; 95% CI, 1.45–3.40) Conclusions: For patients with tuberculosis infection, underweight with body mass index less than 18.5 kg/ m2 is an independent predictor for early mortality within the first 8 weeks of treatment. [ABSTRACT FROM AUTHOR]

Human epidermal growth factor receptor 2 (HER2)-overexpressed breast cancer is known to be more aggressive and resistant to medicinal treatment and therefore to whom an alternative therapeutics is needed. Indocyanine green (ICG) has been widely exploited in breast cancer phototherapy. However, drawbacks of accelerated degradation and short half-life (2–4 min) in blood seriously hamper its use in the clinic. To overcome these challenges, an anti-HER2 ICG-encapsulated polyethylene glycol-coated poly(lactic-co-glycolic acid) nanoparticles (HIPPNPs) were developed in this study. Through the analyses of degradation rate coefficients of ICG with and without polymeric encapsulation, the photostability of HIPPNP-entrapped ICG significantly enhanced 4 folds (P < 0.05) while its thermal stabilities at 4 and 37°C significantly enhanced 5 and 3 (P < 0.05 for each) folds, respectively, under equal lighting and/or heating treatment for 48 h. The target specificity of HIPPNPs to HER2-positive cells was demonstrated based on a 6-fold (P < 0.05) enhancement of uptake efficiency of HIPPNPs in MDA-MB-453/HER2(+) cells within 4 h as compared with that in MCF7/HER2(-) cells. Moreover, the HIPPNPs with ≤ 25 μM ICG equivalent were nontoxic to cells in the absence of light illumination, and enabled to generate similar amount of singlet oxygen and hyperthermia effect as compared with that used by free ICG upon NIR irradiation. After 808 nm-laser irradiation with intensity of 6 W/cm2 for 5 min, the viability of MDA-MB-453 cells pre-treated by HIPPNPs with ≥ 5 μM ICG equivalent for 4 h significantly reduced as compared with that treated by equal concentration of free ICG (P < 0.05) and > 90% of the cells were eradicated while the dose of HIPPNPs was increased to 25 μM ICG equivalent. In summary, the developed HIPPNPs are anticipated as a feasible tool for use in phototherapy of breast cancer cells with HER2 expression. [ABSTRACT FROM AUTHOR]

Since the work of Taft and Forster (), a growing literature has examined how English compound words are recognized and organized in the mental lexicon. Much of this research has focused on whether compound words are decomposed during recognition by manipulating the word frequencies of their lexemes. However, many variables may impact morphological processing, including relational semantic variables such as semantic transparency, as well as additional form-related and semantic variables. In the present study, ratings were collected on 629 English compound words for six variables [familiarity, age of acquisition (AoA), semantic transparency, lexeme meaning dominance (LMD), imageability, and sensory experience ratings (SER)]. All of the compound words selected for this study are contained within the English Lexicon Project (Balota et al., ), which made it possible to use a regression approach to examine the predictive power of these variables for lexical decision and word naming performance. Analyses indicated that familiarity, AoA, imageability, and SER were all significant predictors of both lexical decision and word naming performance when they were added separately to a model containing the length and frequency of the compounds, as well as the lexeme frequencies. In addition, rated semantic transparency also predicted lexical decision performance. The database of English compound words should be beneficial to word recognition researchers who are interested in selecting items for experiments on compound words, and it will also allow researchers to conduct further analyses using the available data combined with word recognition times included in the English Lexicon Project. [ABSTRACT FROM AUTHOR]

Background: Understanding the risk factors of metabolic syndrome (MetS) is important to public health, since individuals with MetS have an increased risk of health problems. This study examined the associations of exercise, sedentary time and insomnia with incident MetS among older adults 1 year later.Method: A total of 1,359 older adults receiving hospital health examinations in 2012 were studied, and 779 subjects had a follow-up after 1 year. The components of MetS (waist, blood pressure, high-density lipoprotein cholesterol, fasting glucose and triglyceride) were defined by the Program’s Adult Treatment Panel III report. Exercise, sedentary time and insomnia data were obtained through self-report questionnaires. Physical fitness (body fatness, balance and hand grip strength) was measured. Two logistic regressions were computed to examine the associations of exercise/physical fitness, sedentary time and insomnia at baseline with incident MetS 1 year later. The first regression included age, sex, smoking and alcohol as covariates. The second regression was further adjusted with the components of MetS.Results: Sex, exercise/balance, sedentary time and insomnia were significant predictors of MetS. The risk of MetS incidence was 3.36 (95% CI 1.96–5.77) for women, 1.92 (95% CI 1.01–3.63) for those who did not exercise, 2.52 (95% CI 1.37–4.63) for those who sat more than 5 h/day, and 2.17 (95% CI 1.13–4.15) for those with insomnia. Poor balance was significantly associated with greater risk of MetS (AOR = 1.07, 95% CI 1.02–1.12). Sex, sedentary time, insomnia and balance remained significant after adjusting with the components of MetS.Conclusions: Cultivating exercise habits, reducing sedentary time and improving sleep quality may be important strategies for MetS prevention among older adults. [ABSTRACT FROM AUTHOR]

Aims: To investigate the interaction effects of diabetes and hypertension on stroke, and also investigate the independent and interaction effects of parental history and environmental factors on diabetes and hypertension in a cross-sectional elderly population. Methods: The Shih-Pai Community Medical Service Program was a community-based, fixed cohort study conducted between June 1999 and November 2002. Socio-demographic and clinical data of subjects aged 65 years and older were collected by well-trained interviewers during home visits. Interaction effects were analyzed using Rothman’s synergy index (SI). Results: In total, 4,124 subjects were included in the study, with 2,284 males and 1,840 females. The synergistic interaction of diabetes and hypertension on stroke was statistically significant in women (SI = 3.16, 95% CI: 1.35–7.39). The synergistic interaction of parental diabetes and being overweight on diabetes was only statistically significant in men, and not in women (SI = 3.30, 95% CI: 1.00–10.83 in men, and SI = 1.15, 95% CI: 0.30–4.39 in women). Conclusions: A synergistic interaction was found for diabetes and hypertension in both sexes when parental history and being overweight were combined. Furthermore, combining diabetes and hypertension in elderly women was significant in terms of the risk of stroke. Strategies to control risk factors in individuals at additional high risk are urgently needed. [ABSTRACT FROM AUTHOR]

Background Diabetic patients have an increased risk of lower extremity amputations ( LEAs). In the present study we analyzed the incidence of LEA in patients with type 2 diabetes mellitus ( T2DM) in Taiwan from 2001 to 2010, and determined risk factors for LEA. Methods Data from the Taiwan National Health Insurance Research Database collected between 1 January 2001 and 31 December 2010 were analyzed. First, the incidence of LEA in the diabetic population was calculated. Subsequently, patients with new-onset T2DM during the study period were selected, and Cox's proportional hazards model was used to identify factors associated with LEA. The characteristics of patients who underwent major and multiple amputations were also analyzed. Results From 2001 to 2010, 1588 non-traumatic LEAs were performed among the study subjects; 776 (48.9%) were minor and 812 (51.1%) were major LEAs. Over the period in question, the incidence of LEAs decreased from 3.08 to 1.65 per 1000 person-years. Factors associated with LEA included peripheral arterial occlusive disease (hazard ratio [ HR] 4.134; 95% confidence interval [ CI] 2.72-6.29), diabetic neuropathy ( HR 2.34; 95% CI 1.62-3.38), diabetic retinopathy ( HR 2.07; 95% CI 1.12-3.82), heart failure ( HR 2.13; 95% CI 1.45-3.15), male gender ( HR 1.64; 95% CI 1.24-2.18), and adult onset diabetes ( HR 1.02; 95% CI 1.01-1.04). Patients with a history of stroke were more likely to undergo major and multiple amputations ( P < 0.001 and P < 0.01, respectively). Conclusions The incidence of LEA in the Taiwan diabetic population decreased over the study period. The results indicate that efforts to improve diabetic care should be supported and sustainable, especially for those at high risk. [ABSTRACT FROM AUTHOR]

Background and objectives School immunization requirements have ensured high vaccination rates and have helped to control vaccine-preventable diseases. However, vaccine exemptions have increased in the last decade. This study compared New York State private versus public schools with respect to medical and religious exemption rates. Methods This retrospective study utilizes New York State Department of Health Immunization Survey data from the 2003 through 2012 academic years. Schools were categorized as private or public, the former further categorized by religious affiliation. Rates of medical and religious vaccine exemptions were compared by school category. Results From 2003 to 2012, religious exemptions increased in private and public schools from 0.63% to 1.35% and 0.17% to 0.29% (Spearman's R : 0.89 and 0.81), respectively. Among private schools, increases in religious exemption rates during the study period were observed in Catholic/Eastern Orthodox, Protestant/Other Christian, Jewish, and secular schools (Spearman's R = 0.66, 0.99, 0.89, and 0.93), respectively. Exemption rate ratios in private schools compared to public schools were 1.39 (95% CI 1.15–1.68) for medical and 3.94 (95% CI: 3.20–4.86) for religious exemptions. Among private school students, all school types except for Catholic/Eastern Orthodox and Episcopal affiliates were more likely to report religious exemptions compared to children in public schools. Conclusions Medical and religious exemption rates increased over time and higher rates were observed among New York State private schools compared to public schools. Low exemption rates are critical to minimize disease outbreaks in the schools and their community. [ABSTRACT FROM AUTHOR]

We report both experimentally and numerically that a low-frequency acoustic absorber is realized by double split-ring resonators backed with a rigid wall. This absorber leverages the impedance matching and dissipation effect, which arises due to the thermal-viscous loss within the dual channels. As a result, this absorber achieves near-perfect sound absorption (the absorption coefficient α = 0.99) at a subwavelength thickness of around λ/23. By assembling six unit cells with distinct structure parameters to form a supercell, the fractional bandwidth (the ratio of the bandwidth to the center frequency) is increased to 40% with an average α of 0.86. Acoustic experiment results validate this exceptional performance, which is also in agreement with the simulation results. Moreover, by employing the supercell, we create an anechoic room demonstrating broadband sound absorption in a wide range of incident angles while occupying significantly less space than traditional sound-absorbing porous materials. Our double split-ring composite design paves the way for broadband acoustic absorbers at the deep subwavelength scale [ABSTRACT FROM AUTHOR]

The Composite Autonomic Scoring Scale (CASS) is a quantitative scoring system that integrates the sudomotor, the cardiovagal, and the adrenergic subscores, and the Composite Autonomic Symptom Scale 31 (COMPASS 31) is based on a well-established comprehensive questionnaire designed to assess the autonomic symptoms across multiple domains. We tested the hypothesis that electrochemical skin conductance (Sudoscan) can be a substitute for the quantitative sudomotor axon reflex test (QSART) in the sudomotor domain and assessed its correlation with COMPASS 31 in patients with Parkinson's disease (PD). Fifty-five patients with PD underwent clinical assessment and cardiovascular autonomic function tests and completed the COMPASS 31 questionnaire. We compared the modified CASS (integrating the Sudoscan-based sudomotor, adrenergic, and cardiovagal subscores) and CASS subscores (the sum of the adrenergic and cardiovagal subscores). The total weighted score of COMPASS 31 was significantly correlated with both the modified CASS and the CASS subscore (p = 0.007 and p = 0.019). The correlation of the total weighted score of COMPASS 31 increased from 0.316 (CASS subscores) to 0.361 (modified CASS). When we added the Sudoscan-based sudomotor subscore, the case numbers for autonomic neuropathy (AN) increased from 22 (40%, CASS subscores) to 40 (72.7%, modified CASS). The modified CASS not only better reflects the exact autonomic function, but also improves the characterization and quantification of AN in patients with PD. In areas in which a QSART facility is not easily available, Sudoscan could be a time-saving substitution. [ABSTRACT FROM AUTHOR]

Simple Summary: Radiotherapy has become a common treatment modality for nasopharyngeal carcinoma, and concurrent chemoradiation therapy prolongs the survival of patients. Radiotherapy leads to the increased generation of reactive oxygen species and free radicals to destroy abnormal cell growths within normal cell environmental conditions. However, the late effects on "bystander" organs (e.g., extracranial arteries) among survivors after radiotherapy have become increasingly prevalent. This study showed radiation-related extracranial vasculopathy is a progressive process that begins immediately after radiotherapy with significantly increased carotid IMT compared to the control group during the 9-year follow-up. Chronic inflammation and oxidative stress might serve to drive the process and also contribute to increased platelet activation. Radiation-related extracranial vasculopathy is a common late effect after radiation in patients with nasopharyngeal carcinoma (NPC). We proposed the hypothesis that radiation-related extracranial vasculopathy is a progressive process that can begin immediately after radiotherapy and persist for a longer period, and inflammation and oxidative stress may play a pivotal role in this process. Thirty-six newly diagnosed NPC patients were assessed with B-mode ultrasound for the common carotid artery (CCA) intima media thickness (IMT) measurement as well as surrogate markers at three different stages (baseline, immediately after concurrent chemoradiation therapy (CCRT), and 9 years after enrollment). A healthy control group was also recruited for comparison. Surrogate markers including a lipid profile, HbA1c, inflammation, oxidative stress, and platelet activation markers were assessed. The mean CCA IMT in the NPC group were increased immediately after CCRT (p = 0.043). The mean CCA IMT value after a 9-year follow-up also showed a significant increase in NPC and control group, respectively (p < 0.0001 and p < 0.0001, paired t test). The annual increase mean CCA IMT (mm) was 0.053 ± 0.025 and 0.014 ± 0.013 in NPC and control group, respectively (p < 0.0001). The baseline high sensitivity CRP (hs-CRP), thiol, TBARS, and CD63 level were significantly higher in the NPC group (hs-CRP, p = 0.001, thiol, p < 0.0001, TBARS, p = 0.05, and CD63 level, p = 0.04). The thiol and TBARS levels were significantly lower in NPC patients immediately after CCRT (thiol, p < 0.0001, and TBARS, p = 0.043). The CD62P level was significantly higher while the thiol level was significantly lower in the NPC group after a 9-year follow-up (CD62P level, p = 0.007; and thiol level, p = 0.004). Radiation-related extracranial vasculopathy is a progressive process that begins immediately after radiotherapy with significantly increased carotid IMT compared to the control group during the 9-year follow-up. Chronic inflammation and oxidative stress might serve to drive the process and also contribute to increased platelet activation. [ABSTRACT FROM AUTHOR]

The shuffling gait with slowed speed and reduced stride length has been considered classic clinical features in idiopathic Parkinson's disease (PD), and the risk of falling increases as the disease progresses. This raises the possibility that clinical disease severity might mediate the relationship between stride length and speed and the risk of falling in patients with PD. Sixty-one patients with PD patients underwent the clinical scores as well as quantitative biomechanical measures during walking cycles before and after dopamine replacement therapy. Mediation analysis tests whether the direct effect of an independent variable (stride length and speed) on a dependent variable (three-step fall prediction model score) can be explained by the indirect influence of the mediating variable (Unified Parkinson's Disease Rating Scale (UPDRS) total scores). The results demonstrate that decreased stride length, straight walking speed, and turning speed is associated with increased three-step fall prediction model score (r = −0.583, p < 0.0001, r = −0.519, p < 0.0001, and r = −0.462, p < 0.0001, respectively). We further discovered that UPDRS total scores value is negatively correlated with stride length, straight walking, and turning speed (r = −0.651, p < 0.0001, r = −0.555, p < 0.0001, and r = −0.372, p = 0.005, respectively) but positively correlated with the fall prediction model score value (r = 0.527, p < 0.0001). Further mediation analysis shows that the UPDRS total score values serve as mediators between lower stride length, straight walking, and turning speed and higher fall prediction model score values. Our results highlighted the relationship among stride length and speed, clinical disease severity, and risk of falling. As decreased stride length and speed are hallmarks of falls, monitoring the changes of quantitative biomechanical measures along with the use of wearable technology in a longitudinal study can provide a scientific basis for pharmacology, rehabilitation programs, and selecting high-risk candidates for surgical treatment to reduce future fall risk. [ABSTRACT FROM AUTHOR]

Abstract: Objectives: The evidence concerning the relationship between nonapnea sleep disorders and the risk for type 2 diabetes mellitus (DM) is scant and elusive. Our study aimed to examine if nonapnea sleep disorders increase the risk for DM using a population-based retrospective cohort study from 1997 to 2010. Methods: In the Taiwan’s National Health Insurance Research Database (NHIRD), 45,602 patients with nonapnea sleep disorders were identified as the study cohort. The comparison cohort was formed by 91,204 age- and gender-matched controls. Cox proportional hazards regression model was used to estimate the risk for developing DM. Results: In 45,602 patients with nonapnea sleep disorders, 7241 new cases of DM were reported during the follow-up period. The mean follow-up time was 9.04 (standard deviation [SD], 3.33) and 8.96 (SD, 3.47) for the nonapnea sleep disorders cohort and the comparison cohort, respectively. The incidence rate of DM was higher in the nonapnea sleep disorder cohort than in the comparison cohort (17.6 vs 13.3 per 1000 individuals-years). Overall, patients with nonapnea sleep disorders had a higher risk for DM compared to patients without nonapnea sleep disorders (adjusted hazard ratio [HR], 1.05 [95% confidence interval {CI}, 1.02–1.08]). Men with nonapnea sleep disorders had a higher risk for DM than the men in the comparison group (adjusted HR, 1.08 [95% CI, 1.03–1.14]). Among subjects aged less than 40years, patients with nonapnea sleep disorders had a higher risk for DM than the comparison group (adjusted HR, 1.42 [95% CI, 1.27–1.59]). Compared with the comparison cohort, patients with sleep disturbance had an 11% higher risk for DM (adjusted HR, 1.11 [95% CI, 1.07–1.16]). Conclusion: Compared to patients without nonapnea sleep disorders, patients with nonapnea sleep disorders had a higher risk for developing DM, especially among those who were less than 40years of age and who had sleep disturbances. [Copyright &y& Elsevier]

• In this work,good quality free-standing C-doped semi-insulating GaN was successfully prepared. • The wafer has low dislocation density with high radius and good XRD data. The SIMS shows the carbon are successfully doped in and the wafer has high resistivity. • After laser cutting, grinding, lapping, and polishing, the wafer is enough to epitaxial growth. Four-inch semi-insulating free-standing gallium nitride (GaN) wafers grown by hydride vapor phase epitaxy (HVPE) with carbon doping were obtained by a self-separated process. The as-grown wafer thickness can reach 900 µm without cracks. The dopant gas was methane (CH 4) with concentration of 5% CH 4 in N 2. The FWHMs of (0 0 2) and (1 0 2) x-ray diffraction rocking curves were lower than 100 arcsec and typically were 40 – 60 arcsec. The resistivity was measured to be greater than 1010 Ω-cm. [ABSTRACT FROM AUTHOR]

SUMMARY Optimal design for tuned mass dampers (TMDs) with linear or nonlinear viscous damping is formulated in order for design practitioners to directly compute the optimal parameters of a TMD in a damped structure subjected to wind excitations. The optimal TMD tuning frequency ratio and damping coefficient for a viscous TMD system installed in a damped structure under 10 white noise excitations are determined by using the time-domain optimization procedure, which minimizes the structural response. By applying a sequence of curve-fitting schemes to the obtained optimal values, design formulas for optimal TMDs are then derived. These are expressed as a function of the mass ratio and damping power-law exponent of the TMD as well as the damping ratio of the structure. The feasibility of the proposed optimal design formulas is verified in terms of formulary accuracy and of comparisons with existing formulas from previous research works. In addition, one numerical example of the Taipei 101 building with a nonlinear TMD, which is redesigned according to the proposed optimal formulas, is illustrated in effort to describe the use of the formulas in the TMD design procedure and to investigate the effectiveness of the optimal TMD. The results indicate that the proposed optimal design formulas provide a convenient and effective approach for designing a viscous TMD installed in a wind-excited damped structure. Copyright © 2011 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Abstract: This study presents a novel hybrid technique for fabricating a multi-edged co-axial micro diamond wheel-tool array. The technique combines an electrochemical process with a RWEDM (Rotary Wire Electrical Discharge Machining) technique to precisely electroform a diamond wheel-blank and then produce a co-axial wheel-tool array. A duplex tank design, containing a mini-tank made of porous aluminium-dioxide material is developed for the electrochemical co-deposition of a nickel-based diamond matrix onto a cylindrical aluminium alloy substrate. Optimal conditions for the co-deposition are examined and tested in the production of the wheel-blank. A small RWEDM mechanism that uses permanent magnet tension braking to maintain wire tension and reduce wire vibration is also proposed. The RWEDM process is used for slicing, truing and dressing the grinding edges of the blank. Experimental findings and machining examples show that the proposed novel hybrid process can successfully fabricate a co-axial diamond wheel-tool with a grinding-edge array that has extremely thin high integrity cutting edges. [Copyright &y& Elsevier]

Abstract: Anthocyanin biosynthesis is often regulated by MYB transcription factors that are classified into AN2 and C1 subgroups. The AN2 subgroup regulates the late genes in the anthocyanin biosynthesis pathway of eudicots, whereas the C1 subgroup controls both early and late genes in monocots. Anthocyanin is a major pigment in Asiatic hybrid lilies (Lilium spp.), with LhMYB12 being the first AN2 subgroup in monocots. In this study, the accumulation of pigments and gene transcripts during flower bud development was evaluated to determine the genes regulated by LhMYB12. LhMYB12 and anthocyanin biosynthesis genes showed the same transcription profiles, with LhMYB12 directly activating the promoters of chalcone synthase and dihydroflavonol 4-reductase. This indicates that LhMYB12 regulates both early and late genes, despite belonging to the AN2 subgroup. The cultivar Landini accumulated anthocyanin and flavonol. The contents of these pigments increased during the late stages of flower bud development; this might result from the coordinated expression of early and late genes. During the early stages of flower bud development, the tepals contained no flavonoids but accumulated cinnamic acid derivatives. These results indicate that the profiles of pigment accumulation and gene transcription in lily tepals are unique among angiosperm flowers. [Copyright &y& Elsevier]

Abstract: This study presents a hybrid fabrication technique for developing a diamond-blade array used to directly generate a microgroove array onto NAK80 steel. The microgroove array on the NAK80 steel can be used as a biochip mold. The diamond-blade array is made by depositing a nickel-based diamond film onto a disk tool (substrate) through electrochemical co-deposition. The nickel–diamond wheel blank is then cut using RWEDM (Rotary Wire Electrical Discharge Machining) to produce a multi grinding-edge array from the blank. The developed diamond-blade array is then employed in machining a microgroove array on NAK80 steel to produce a biochip mold. The resultant dimensional accuracy, geometric accuracy, and surface finish of the grinding-edge and finished microgroove array are measured and evaluated. The factors influencing formability, thermal machinability, and mechanical properties of the diamond film are discussed in detail. Experimental results indicate that a lower current density and moderate diamond abrasive concentration create a diamond film of high-integrity. Increasing the thickness of the deposited film suppresses thermal fracturing and raises the rigidity of grinding-edges helping to keep the diamond cutting-edge accurate. Nano-metric scale grinding of microgrooves on the NAK80 steel is helpful in maintaining sharpness and slowing the wear rate of the diamond-film grinding-edges. [Copyright &y& Elsevier]