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Abstract Background Patellar tendinopathy, also known as jumper’s knee, can significantly impact the quality of daily life for patients due to the associated pain. A randomized controlled trial was investigated the clinical, sonographic, and serum cytokine markers in patellar tendinopathy of athletes following platelet-rich plasma (PRP) or PRP with extracorporeal shockwave therapy (ESWT) treatments. Our aims to investigate and compare therapeutic effects of PRP versus a combination of PRP with ESWT for treating patellar tendinopathy. Methods A total of 33 athletes with patellar tendinopathy were randomized into two groups. PRP + Sham (PS) group received intraarticular injection of autologous PRP (5 mL) once and sham ESWT. PRP + ESWT (PE) group received intraarticular injection of autologous PRP once and after 1 week ESWT (0.2 mJ/mm2 energy flux density, 1350 impulses, 4 Hz) once. All patients were followed up for 1 year. Results Autologous PRP injection and its combination with ESWT are both effective treatments for chronic patellar tendinopathy in athletes. PRP combined with ESWT resulted in faster reduction of knee pain than PRP alone at the 1-month follow-up. Serum IL-33 showed no significant difference at the 12-month follow-up. Levels of interleukin (IL)-6, IL-15, and IL-17 increased at the 12-month follow-up, potentially due to the additional training. However, the athletes did not report any discomfort or injuries, and no abnormalities were detected by ultrasonography after study. We demonstrated improvements in pain and functional scores, as well as knee injury protection in athletes, following 12 months of PRP and PRP with ESWT treatments. Conclusions The study analyzed the therapeutic effect of PRP injection alone and combining PRP injection with ESWT for chronic patellar tendinopathy. Our results showed that combined treatment can facilitate the pain relief early than PRP alone and is a safety treatment modality. No adverse effect was noted in our study. Trial registration Research registry and the registration number is researchregistry9518. Registered 14 September 2023. https://www.researchregistry.com/browse-the-registry#home/registrationdetails/650263e4f549fd00282a338c/ . The level of evidence is level II.

Aims: To explore the efficacy of extracorporeal shockwave therapy (ESWT) in the treatment of osteochondral defect (OCD), and its effects on the levels of transforming growth factor (TGF)-β, bone morphogenetic protein (BMP)-2, -3, -4, -5, and -7 in terms of cartilage and bone regeneration. Methods: The OCD lesion was created on the trochlear groove of left articular cartilage of femur per rat (40 rats in total). The experimental groups were Sham, OCD, and ESWT (0.25 mJ/mm2, 800 impulses, 4 Hz). The animals were euthanized at 2, 4, 8, and 12 weeks post-treatment, and histopathological analysis, micro-CT scanning, and immunohistochemical staining were performed for the specimens. Results: In the histopathological analysis, the macro-morphological grading scale showed a significant increase, while the histological score and cartilage repair scale of ESWT exhibited a significant decrease compared to OCD at the 8- and 12-week timepoints. At the 12-week follow-up, ESWT exhibited a significant improvement in the volume of damaged bone compared to OCD. Furthermore, immunohistochemistry analysis revealed a significant decrease in type I collagen and a significant increase in type II collagen within the newly formed hyaline cartilage following ESWT, compared to OCD. Finally, SRY-box transcription factor 9 (SOX9), aggrecan, and TGF-β, BMP-2, -3, -4, -5, and -7 were significantly higher in ESWT than in OCD at 12 weeks. Conclusion: ESWT promoted the effect of TGF-β/BMPs, thereby modulating the production of extracellular matrix proteins and transcription factor involved in the regeneration of articular cartilage and subchondral bone in an OCD rat model. Cite this article: Bone Joint Res 2024;13(7):342–352.

Background: Osteoporosis (OP) is a chronic inflammatory bone disease characterized by reduced bone structure and strength, leading to increased fracture risk. Effective therapies targeting both bone and cartilage are limited. This study compared the therapeutic effects of extracorporeal shockwave therapy (ESWT), bisphosphonate (Aclasta), and human Wharton jelly-derived mesenchymal stem cells (WJMSCs) in a rat model of OP. Methods: Female rats were assigned to four groups: Sham (no surgery or treatment), OP (bilateral ovariectomy, OVX), ESWT (OVX + ESWT on both tibias at 0.25 mJ/mm2, 1500 impulses per tibia), Aclasta (OVX + zoledronic acid 0.1 mg/kg via tail vein injection), and WJMSC (OVX + 2 × 10⁶ WJMSCs). Pathological changes, bone microarchitecture (by micro-CT), serum cytokines (by ELISA), and tissue-specific molecular markers (by immunohistochemistry) were evaluated. Results: All treatments improved bone density, preserved cartilage, and modulated cytokines (IL31, IL33, VEGF, and BMP2), with Aclasta showing the greatest improvements in bone parameters and cartilage preservation. ESWT and WJMSC also demonstrated significant effects, with ESWT highlighting non-invasive chondroprotective potential. Conclusions: Aclasta provided the best overall therapeutic response, particularly in bone regeneration. However, ESWT and WJMSC also showed comparable chondroprotective effects. ESWT emerges as a promising non-invasive alternative for OP management when pharmacological or cell-based therapies are not feasible.

Abstract Electrical neural recordings measured using direct electrical interfaces with neural tissue suffer from a short lifespan because the signal strength decreases over time. The inflammatory response to the inserted microprobe can create insulating tissue over the electrical interfaces, reducing the recorded signal below noise levels. One of the factors contributing to this inflammatory response is the tissue damage caused during probe insertion. Here, we explore the use of ultrasonic actuation of the neural probe during insertion to minimize tissue damage in mice. Silicon neural microprobes were designed and fabricated with integrated electrical recording sites and piezoelectric transducers. The microprobes were actuated at ultrasonic frequencies using integrated piezoelectric transducers. The microprobes were inserted into mouse brains under a glass window over the brain surface to image the tissue surrounding the probe using two-photon microscopy. The mechanical force required to penetrate the tissue was reduced by a factor of 2–3 when the microprobe was driven at ultrasonic frequencies. Tissue histology at the probe insertion site showed a reduced area of damage and decreased microglia counts with increasing ultrasonic actuation of the probes. Two-photon imaging of the microprobe over weeks demonstrated stabilization of the inflammatory response. Recording of electrical signals from neurons over time suggests that microprobes inserted using ultrasound have a higher signal-to-noise ratio over an extended time period.

Objective: Peripartum cardiomyopathy (PPCM) developed from late pregnancy to five months after delivery. Women with PPCM have the risk of mortality or non-recovered cardiac function. We aimed to investigate women with PPCM in Taiwan. Materials and methods: The retrospective study recruited patients with PPCM from January 2002 to October 2018 in a tertiary center. We evaluated the presentations, onset, associated conditions, maternal and fetal outcomes, follow-up cardiac function, and subsequent pregnancies. The clinical data were compared between antepartum and postpartum-onset of PPCM. Results: Thirty women were identified and seventeen (56.6%) patients were antepartum-onset. The delivery time, ranged from 26 to 40 weeks, was mostly at 35 weeks. Twenty-one patients had cardiac function follow-up and seven (33.3%) were non-recovered in six months. The associated conditions of PPCM included age >30, primiparity, preeclampsia or hypertension, obesity, twin pregnancy, and tocolysis. The maternal characteristics and associated conditions were not significant different, but early preterm (32.8 ± 3.6 vs. 35.5 ± 2.4 weeks, p = 0.042) and lower Apgar scores in one (7 vs. 9, p = 0.002) and 5 min (9 vs. 10, p = 0.005) were observed in the antepartum-onset group. Conclusion: In conclusion, PPCM commonly occurred around 35 weeks of gestation, ranged from 26 to 40 weeks. Additionally, there were risks of early preterm and low Apgar scores in women with antepartum-onset of PPCM.

IntroductionPost-stroke depression (PSD) is a serious mental disorder after ischemic stroke. Early detection is important for clinical practice. This research aims to develop machine learning models to predict new-onset PSD using real-world data.MethodsWe collected data for ischemic stroke patients from multiple medical institutions in Taiwan between 2001 and 2019. We developed models from 61,460 patients and used 15,366 independent patients to test the models’ performance by evaluating their specificities and sensitivities. The predicted targets were whether PSD occurred at 30, 90, 180, and 365 days post-stroke. We ranked the important clinical features in these models.ResultsIn the study’s database sample, 1.3% of patients were diagnosed with PSD. The average specificity and sensitivity of these four models were 0.83–0.91 and 0.30–0.48, respectively. Ten features were listed as important features related to PSD at different time points, namely old age, high height, low weight post-stroke, higher diastolic blood pressure after stroke, no pre-stroke hypertension but post-stroke hypertension (new-onset hypertension), post-stroke sleep-wake disorders, post-stroke anxiety disorders, post-stroke hemiplegia, and lower blood urea nitrogen during stroke.DiscussionMachine learning models can provide as potential predictive tools for PSD and important factors are identified to alert clinicians for early detection of depression in high-risk stroke patients.

Abstract Background The coronavirus disease 2019 pandemic significantly affected emergency department (ED) visits and urgent psychiatric consultation (UPC) seeking behavior in EDs. Our study explored the changes in UPCs during and after the pandemic peak. Methods This retrospective observational study evaluated UPCs in the ED of a referral medical center in Taiwan, where treated both physical and psychiatric complaints. We defined the COVID-19 pandemic peak period as calendar week 4–18, 2020. The corresponding baseline as calendar week 4–18, 2019, and the slack period as week 4–18, 2021. The total number of UPCs, patient demographic data such as sex and age of the patients seen, the referral system (whether police or emergency medical service [EMS] or other sources), and the chief complaint (self-harm or violence) were recorded. Results Compared with the baseline period, a significant decline in UPCs was observed in the pandemic peak period, and a rebound was observed in the slack period, with the median [IQR] Q1, Q3 values of 22 [18, 26], 12 [10, 17]), and 16 [15, 23], respectively. We observed significantly few men (34.9% vs 45.2%) and less violence (10.2% vs 17.6%) in the peak period compared with in the baseline period, but no significant difference was found compared with the slack period. Throughout the pandemic, younger patients (41.8 ± 17.4 in 2019, 39.2 ± 18.5 [p = 0.121] in 2020, and 35.6 ± 17.2 [p

Abstract Background Acromioclavicular joint (ACJ) dislocation is a common shoulder injury. In treating acute unstable ACJ dislocation, a hook plate (HP) is a straightforward and popular option for ensuring proper reduction and rigid fixation while promoting AC and coracoclavicular (CC) ligament healing. Surgeons typically remove the HP to prevent subacromial impingement and acromial osteolysis; however, concerns about redislocation after implant removal remain. Therefore, additional CC augmentation may be helpful in combination with HP fixation. The aim of this meta-analysis is to compare the outcomes and complications of HP fixation with or without additional CC augmentation for acute unstable ACJ dislocation. Methods We searched the PubMed, EMBASE, and Web of Science databases for relevant case–control studies. The primary outcomes were patient-reported outcome measures; the secondary outcomes were pain measured using a visual analog scale (VAS), CC distance (CCD), and complications. Continuous data were assessed using weighted standardized mean differences (SMDs) with 95% confidence intervals (CIs), and dichotomous data were evaluated with Mantel–Haenszel odds ratio (ORs) with 95% CIs. Results We analyzed one randomized control trial and four case–control studies comparing HP fixation with or without CC augmentation. A total of 474 patients with Rockwood type III or V ACJ dislocation were included. We found no differences in Constant–Murley score (SMD, − 0.58, 95% CI − 1.41 to 0.26; P = 0.18), American Shoulder and Elbow Surgeons score (SMD, 0.21, 95% CI − 0.10 to 0.52; P = 0.19), University of California at Los Angeles shoulder rating scale score (SMD, − 0.02, 95% CI − 1.27 to 1.23; P = 0.97), or VAS pain score (SMD, 0.36, 95% CI − 0.16 to 0.88; P = 0.17) between groups. The CC augmentation group had lower odds of osteolysis (OR, 0.27, 95% CI 0.10 to 0.74; P = 0.01) and a shorter CCD (SMD, − 0.29, 95% CI − 0.57 to − 0.01; P = 0.04). Conclusion HP fixation with CC augmentation is preferable for acute unstable ACJ dislocations. Although CC augmentation did not provide additional benefits related to functional outcomes or pain, it resulted in greater reduction maintenance after implant removal and a 73% lower risk of acromial osteolysis. Trial registration PROSPERO ( CRD42021271118 ).

Purpose This study aimed to compare the ability of B-mode ultrasonography and magnetic resonance imaging (MRI) to predict the repairability of large-to-massive rotator cuff tears (RCTs). Methods This cross-sectional study included participants with large-to-massive RCTs who underwent arthroscopic repair. B-mode ultrasonography and MRI were conducted prior to arthroscopic repair. B-mode ultrasonography was used to evaluate the echogenicity of the rotator cuff muscle using the Heckmatt scale. Intra-rater and inter-rater reliabilities were examined for two independent physicians. MRI was used to evaluate the degrees of tendon retraction, fatty infiltration of rotator cuff muscles, and muscle atrophy. Finally, two experienced orthopedic surgeons performed surgery and decided whether the torn stump could be completely repaired intraoperatively. Results Fifty participants were included, and 32 complete repairs and 18 partial repairs were performed. B-mode ultrasonography showed good intra-rater reliability and inter-rater reliability for assessment of the muscle echogenicity of the supraspinatus and infraspinatus muscles. The correlation coefficients between B-mode ultrasound findings and MRI findings showed medium to large effect sizes (r=0.4-0.8). The Goutallier classification of the infraspinatus muscles was the MRI predictor with the best discriminative power for surgical reparability (area under the curve [AUC], 0.89; 95% confidence interval [CI], 0.81 to 0.98), while the Heckmatt scale for infraspinatus muscles was the most accurate ultrasound predictor (AUC, 0.85; 95% CI, 0.74 to 0.96). No significant differences in AUCs among the MRI and ultrasound predictors were found. Conclusion B-mode ultrasonography was a reliable examination tool and had a similar ability to predict surgical reparability to that of MRI among patients with large-to-massive RCTs.

Abstract Erectile dysfunction (ED) is mostly due to the lack of blood flow into the penis. In the past 20 years, near-infrared spectroscopy (NIRS) was used in measuring the concentrations and temporal dynamics of different hemoglobin types. However, the dynamics of the light absorption (photoplethysmography; PPG) have not been applied to survey penile hemodynamics and erection quality. This paper compared the use of photoplethysmography (PPG) to study vascular ED with standard penile Doppler ultrasonography. Men diagnosed with vascular ED for at least 6 months and nominated for penile ultrasonography were included. PPG signals were collected during the ultrasound examination. All beat-to-beat PPG waveforms were aligned with the peak and averaged to one representative template waveform for feature analysis, including amplitude differences (APD) index, reflection time index (RTI), augmentation index (AI), and perfusion index (PI). An inverse correlation was found between end-erection amplitude and both erection hardness score (EHS) and resistive index (RI). APD index and EHS as well as the international index of erectile function-5 (IIEF) and RI were positively correlated. RTI and AI were inversely correlated to IIEF and RI. PI was positively correlated to RI. PPG may therefore be useful as a noninvasive, convenient, technique for sexual function evaluation.

BackgroundCardiac rehabilitation (CR) is recommended for patients with acute heart failure (HF). However, the results of outcome studies and meta-analyses on CR in post-acute care are varied. We aimed to assess the medium- to long-term impact of CR and ascertain the predictors of successful CR.MethodsIn this propensity score-matched retrospective cohort study, records of consecutive patients who survived acute HF (left ventricular ejection fraction

Lower urinary tract symptoms (LUTS), such as urgency, urinary incontinence, and/or difficulty voiding, hamper the quality of life (QoL) of patients with spinal cord injury (SCI). If not managed adequately, urological complications, such as urinary tract infection or renal function deterioration, may further deteriorate the patient’s QoL. Botulinum toxin A (BoNT-A) injection within the detrusor muscle or urethral sphincter yields satisfactory therapeutic effects for treating urinary incontinence or facilitating efficient voiding; however, adverse effects inevitably follow its therapeutic efficacy. It is important to weigh the merits and demerits of BoNT-A injection for LUTS and provide an optimal management strategy for SCI patients. This paper summarizes different aspects of the application of BoNT-A injection for lower urinary tract dysfunctions in SCI patients and provides an overview of the benefits and drawbacks of this treatment.

Background: Allergic diseases are frequently observed in children with Kawasaki disease (KD). However, the evidence supporting the association between KD and allergies has been conflicting. The objective of the current study is to examine the association between KD and allergic diseases.Methods: We conducted an electronic search using PubMed, Embase, and the Cochrane through 24 July 2021. The inclusion criteria consisted of studies that examined the prevalence of allergic diseases in children with a previous diagnosis of KD and in a comparison group. We pooled studies by using a random effects model. The effects of KD on the subsequent risk of allergic diseases were expressed as odds ratio (OR) with 95% confidence intervals (CI).Results: We included a total of four studies that assessed the effect of KD on asthma, allergic rhinitis, and atopic dermatitis vs. non-KD children (KD individuals for asthma, four studies, n = 8,474; allergic rhinitis, four studies, n = 8,474; atopic dermatitis, three studies, n = 8,330). The overall prevalence of asthma, allergic rhinitis, and atopic dermatitis was 9.12, 27.63, and 6.55% among patients with previous KD. The meta-analysis showed a significantly increased risk of asthma (OR:1.437, CI: 1.067–1.937) and allergic rhinitis (OR: 1.726, CI: 1.291–2.307) in patients with KD, compared with the control groups. However, patients with KD did not have a significantly different level of risk of atopic dermatitis (OR: 1.243, 95% CI: 0.857–1.802).Conclusion: This meta-analysis supports that individuals with KD are more likely to have asthma and allergic rhinitis compared to controls.

The use of the flexible ureteroscope for treating renal and ureteral calculi has rapidly increased in the last decade. Although the use of the flexible ureteroscope by experienced surgeons has excellent outcomes and safety profiles, several studies have reported many surgical complications with its use. We conducted a narrative review of the published literature sourced from PubMed. We used a combination of three keywords: “ureteroscope,” “morbidity,” and “urolithiasis,” with or without the additional keywords of “infection,” “mortality,” “hematoma,” and “ureteral injury.” Infection, bleeding, and ureteral injury are the main complications. We analyzed the possible causes of morbidity and death after the use of a flexible ureteroscope. Finally, we propose recommendations to prevent these complications.

Blue swimmer crabs (Portunus pelagicus) primarily inhabit the coastal regions of Southeast Asia. This study aimed to examine their population genetic structure, phylogeography, and historical demography by applying partial sequences to the control region in the mitochondrial DNA. The analysis focused on 6 populations comprising 166 individual samples collected from Taiwan (Kezailiao Kaohsiung (KK) and Penghu (PH)), mainland China (Xiamen (XM) and Hong Kong (HK)), Vietnam (Hanoi (VN)), and Singapore (SGP). The estimated nucleotide diversity (π) for all of the samples was 0.062, with values ranging between 0.018 (PH) and 0.045 (HK). Our study collected 116 haplotypes and classified them into lineages A and B. The XM, HK, VN, and SGP populations made up lineage A, and the PH and KK populations comprised lineage B. For each lineage, the results highlighted indications of demographic expansion. Lineage A can be traced back to the second-to-last interglacial period, while lineage B possibly originated in the last glacial period. There were significant differences in the FST values among the six populations, except for the pairs HK–XM and PH–KK. In conclusion, the phylogeography and genetic structure of P. pelagicus in Southeast Asia were potentially affected by the Pleistocene glacial cycles and human introduction. These findings further highlight the possible dispersal routes of P. pelagicus throughout Southeast Asia.

Objective: Systemic hypoperfusion is intricately involved in neurohormone secretion, vascular calcification (VC) related impaired vasodilation, and luminal stenosis. We aimed to conduct a joint evaluation of vasopressin-neurophysin II-copeptin peptide (VP) and advanced aortic arch calcification (AAC) on all-cause and cardiovascular (CV) mortality in maintenance hemodialysis (MHD) patients.Methods: Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed for different groups of VP and AAC in 167 MHD patients. The modification effect between higher VP and advanced AAC on mortality risk was examined using an interaction product term.Results: Interactions between VP and AAC with respect to all-cause and CV mortality were statistically significant. In multivariable analysis, higher VP predicted all-cause and CV mortality [aHR: 2.2 (95% confidence interval (CI): 1.1–4.5)] and 2.6 (95% CI: 1.1–4.6), respectively. Advanced AAC was associated with incremental risks of all-cause and CV mortality [aHR: 2.1 (95% CI: 1.1–4.0)and 2.5 (95% CI: 1.0–4.3), respectively]. Patients with combined higher VP (>101.5 ng/mL) and advanced AAC were at the greatest risk of all-cause and CV mortality [aHR: 4.7 (95% CI: 1.2–16.2)and 4.9 (95% CI: 1.1–18.9), respectively].Conclusion: Combined VP and advanced AAC predict not only all-cause but also CV death in MHD patients, and a joint evaluation is more comprehensive than single marker. In light of hypoperfusion and ischemic events in vital organs, VP and AAC could act as more robust dual marker for prognostic assessment.

The three-spot swimming crab (Portunus sanguinolentus) is mainly distributed in South East Asia. An analysis of mitochondrial control region partial sequences allows us to determine the population genetic structure, phylogeography and historical demography of this species in East Asia. The seven populations, which included 110 individuals, were collected from mainland China (Shanghai, SH, Xiamen, XM and Hong Kong, HK), Taiwan (Yilan, YL, Taichung, TC, Donggang, DG) and Singapore (Singapore, SGP). The nucleotide diversity (π) of all individuals was 0.01149, with values ranging from 0.00372 (SGP) to 0.01345 (YL). In total, 90 haplotypes have been identified, which can be divided into two major lineages: lineage A consists of specimens from SH, YL, XM, TC and DG, and lineage B corresponds to specimen from SGP. From the second to the most recent interglacial period, population expansion was observed in each lineage. However, a low level of genetic differentiation was also observed in the three-spotted swimming crab, P. sanguinolentus, according to FST values. Our results suggest that several past and present habitat configurations have shaped the genetic patterns of P. sanguinolentus until now. During Pleistocene glaciations, when sea levels were low, this species may have moved along the coast from Southeast Asia to China. It first colonized the Hong Kong area during this era. After sea levels rose and shorelines receded, it subsequently spread to the coast of mainland China.

Objective: To compare the outcomes of ultrasound-guided vs direct approach corticosteroid injection in patients with idiopathic carpal tunnel syndrome. Methods: A double-blind randomized controlled study. Wrists affected by carpal tunnel syndrome were randomized to the ultrasound-guided (n = 22 wrists) or direct approach injection group (n = 17 wrists) before receiving 1 ml Betamethasone. Outcome measures were physical findings and electrodiagnostic parameters assessed at 1, 3 and 6 months after injection. Complications were also recorded. Results: Both groups showed improvement through-out the follow-up period after injections, in physical findings and in most electrodiagnostic parameters (all p

For machining parts with complex shapes, consisting of computer numerical control (CNC) machine tools, different CNC machine tools will be used according to the machining method. If the workpiece is removed for off-machine measurement after machining, when the size is incorrect, it will need to be returned to the CNC machine tool for secondary machining. In this case, the workpiece surface quality and machining accuracy will be affected, which is very time-consuming. On-machine measurement and complex machine center is a key to solve this problem. In the recent researches that the touch probe was integrated on three or five axis machine for error compensation and shape construction based on on-machine measurement, but turning-milling machine was rare. In addition, the most types of parts were thin-walled parts or thin web parts. In this study, a contact measurement system is integrated into a CNC combined turning-milling machine for on-machine measuring. Macro-programming is used to design the machining path of A6061-T6 aluminum alloy hexagonal punch, and the action of probe measurement is added to the machining path. As the measured data exceed the tolerance range, the calculated data are fed back to the controller for machining improvement by compensation. The finished hexagonal punch is measured in a 3D coordinate measuring machine and the error is compared. The experimental results show that the contact probe needs to be corrected before machining, and the size of the corrected workpiece can reach the tolerance range of ±0.01 mm. The size error of rough machining is larger than that of fined machining, and the size error of rough machining will increase with the length of the workpiece.

Objectives: We studied patients who underwent extracorporeal shock wave lithotripsy (SWL) to investigate the factors influencing the outcome, and built a logistic regression model to estimate the stone-free rate (SFR) after SWL. Material and methods: From January 2013 to December 2013, we retrospectively reviewed the clinical status of 641 patients with a solitary urinary calculus who underwent SWL in our hospital. Univariate logistic regression was used to identify the factors leading to a high SFR, and significant factors were further analyzed by multivariate logistic regression. After the optimal model had been developed, we placed it on the website so others could calculate the SFR at their institutions. Results: The overall SFR for all patients, patients with ureteral stones, and patients with renal stones were 54.8%, 67.8%, and 46.7%, respectively. Multivariate logistic regression showed that body mass index (BMI), stone length, stone width, and stone location were the independent factors that affected the overall successful rate. Stone length was the only significant factor to predict SFR for ureteral stones. BMI, stone length, and stone width were significant SFR predictors for renal stones. A logistic regression model was designed to estimate SFR, which has a sensitivity of 77.8% and specificity of 75.5%. Conclusion: BMI, stone length, stone width, and kidney and ureteral stones were all prognostic factors influencing the outcome of SWL. We built a logistic regression formula to predict the SFR, which helps urologists to select patients for SWL.

Abstract GaN-based materials are widely used for light emission devices, but the intrinsic property of wide bandgap makes it improper for photovoltaic applications. Recently, manganese was doped into GaN for absorption of visible light, and the conversion efficiency of GaN-based solar cells has been greatly improved. We conducted transient optical measurements to study the carrier dynamics of Mn-doped GaN. The lifetime of carriers in the Mn-related intermediate bands (at 1.5 eV above the valence band edge) is around 1.7 ns. The carrier relaxation within the Mn-induced bandtail states was on the order of a few hundred picoseconds. The relaxation times of different states are important parameters for optimization of conversion efficiency for intermediate-band solar cells.

Background: Parkinson’s disease (PD) is a neurodegenerative disease manifested by both motor and non-motor dysfunctions and co-existence of cognitive impairment and physical frailty is common. Given that research in this area is limited, a better understanding of associated factors with physical frailty could provide a focused screening method and facilitate early intervention in PD.Methods: Seventy-six patients with idiopathic PD were recruited and Fried’s criteria of physical frailty were used to group all participants. Comprehensive cognitive tests and clinical characteristics were measured, and univariate and multivariate analysis was performed to explore the relationship between clinical factors or neuropsychological functions.Results: Twenty-nine patients with PD (38%) exhibited physical frailty. Compared to PD patients without frailty, PD patients with frailty were older in age and demonstrated worse disease severity and poorer cognitive functions, including attention, executive function, memory, speech and language, and visuospatial function (p < 0.05). Further, stepwise logistic regression analysis revealed that disease severity by the Unified Parkinson’s Disease Rating Scale (UPDRS) total score (OR: 1.065; 95% CI: 1.033–1.099) and executive function (OR: 0.724; 95% CI: 0.581–0.877) were independent risk factors for predicting physical frailty (p = 0.003 and 0.002). The best cut-off points are 46 in UPDRS (sensitivity: 62.1%; specificity: 91.5%).Conclusions: Executive function impairment is an independent risk factor for the development of physical frailty with disease progression. Awareness of such comorbidity might provide a screening tool to facilitate investigation in their underlying etiology and early intervention for frailty prevention.

Background: The risk of skeletal events is rising in parallel with the burden of chronic kidney disease and mineral bone disorder (CKD-MBD), whilst the role of the fat-bone axis in CKD-MBD remains elusive. Adiponectin derived from adipocytes has emerged as a valid biomarker of low bone mineral density and increased marrow adiposity. We aimed to explore the association between adiponectin and bone fracture (BF) risks in patients with maintenance hemodialysis (MHD). Methods: Serum concentrations of adiponectin and bio-clinical data were determined at study entry. The Cox proportional hazard regression analyses were used to assess unadjusted and adjusted hazard ratios (aHRs) of adiponectin and various clinical predictors for BF risks. The predictive accuracy of adiponectin for BF events was evaluated by receiver operating characteristic (ROC) curve analysis. Results: Age and serum concentrations of adiponectin, phosphate, and intact parathyroid hormone were significantly associated with higher risks of BF. With respect to the risk of BF events, the cumulative event-free survival curves differed significantly between the high and low concentration groups of adiponectin (p = 0.02). In multivariable analysis, higher adiponectin levels were associated with an incremental risk of BF (adjusted hazard ratios (aHRs): 1.08 (95% confidence interval (CI): 1.01–1.15, p < 0.05). The ROC analysis of adiponectin cutoff point concentration (18.15 ug/mL) for prediction of BF showed 0.66 (95% CI = 0.49 to 0.84). Conclusion: Adiponectin was associated with an incremental risk of BF that could serve as a potential predictor of BF in MHD patients. In the high-risk population with hyperphosphatemia, an elevated adiponectin level could alert clinicians to the urgent need to correct mineral dysregulation and undertake further bone survey.

Background: The risk of cardiovascular (CV) and fatal events remains extremely high in patients with maintenance hemodialysis (MHD), and the growth differentiation factor 15 (GDF15) has emerged as a valid risk stratification biomarker. We aimed to develop a GDF15-based risk score as a death prediction model for MHD patients. Methods: Age, biomarker levels, and clinical parameters were evaluated at study entry. One hundred and seventy patients with complete information were finally included for data analysis. We performed the Cox regression analysis of various prognostic factors for mortality. Then, age, GDF15, and robust clinical predictors were included as a risk score model to assess the predictive accuracy for all-cause and CV death in the receiver operating characteristic (ROC) curve analysis. Results: Age, GDF15, and albumin were significantly associated with higher all-cause and CV mortality risk that were combined as a risk score model. The highest tertile of GDF-15 (>1707.1 pg/mL) was associated with all-cause mortality (adjusted hazard ratios (aHRs): 3.06 (95% confidence interval (CI): 1.20–7.82), p < 0.05) and CV mortality (aHRs: 3.11 (95% CI: 1.02–9.50), p < 0.05). The ROC analysis of GDF-15 tertiles for all-cause and CV mortality showed 0.68 (95% CI = 0.59 to 0.77) and 0.68 (95% CI = 0.58 to 0.79), respectively. By contrast, the GDF15-based prediction model for all-cause and CV mortality showed 0.75 (95% CI: 0.67–0.82) and 0.72 (95% CI: 0.63–0.81), respectively. Conclusion: Age, GDF15, and hypoalbuminemia predict all-cause and CV death in MHD patients, yet a combination scoring system provides more robust predictive powers. An elevated GDF15-based risk score warns clinicians to determine an appropriate intervention in advance. In light of this, the GDF15-based death prediction model could be developed in the artificial intelligence-based precision medicine.

Acute appendicitis is one of the most common pediatric abdominal emergencies. Early diagnosis is vital for a positive outcome. However, it may initially present with diarrhea and vomiting, mimicking acute gastroenteritis, thus delaying prompt surgery. Differentiating appendicitis from gastroenteritis in a timely manner poses a challenge. Therefore, we aim to investigate the predictors that help distinguish acute appendicitis from acute gastroenteritis. We conducted a retrospective case-control study, evaluating children admitted due to abdominal pain with diarrhea. Subjects were divided into two groups according to the final diagnoses: acute appendicitis and acute gastroenteritis. We adopted multiple logistic regression analysis and the area under the receiver operating characteristic curve to identify independent predictors of acute appendicitis and select the best model. A total of 32 patients diagnosed with appendicitis and 82 patients with gastroenteritis were enrolled. Five independent predictors of acute appendicitis included vomiting, right lower quadrant (RLQ) pain, stool occult blood (OB), white blood cell (WBC) count, and C-reactive protein (CRP). The revised combined model exhibited a higher degree of discrimination and outperformed the pediatric appendicitis score (PAS) model. In conclusion, our study was proved to be helpful for assessing cases with abdominal pain and diarrhea in order to more accurately distinguish appendicitis from gastroenteritis in children in a timely manner.

Botulinum toxin A (BTX-A) is a powerful neurotoxin with long-lasting activity that blocks muscle contractions. In addition to effects on neuromuscular junctions, BTX-A also plays a role in sensory feedback loops, suggesting the potentiality for pain relief. Although the only approved indications for BTX-A in the bladder are neurogenic detrusor overactivity and refractory overactive bladder, BTX-A injections to treat bladder pain refractory to conventional therapies are also recommended. The mechanism of BTX-A activity in bladder pain is complex, with several hypotheses proposed in recent studies. Here we comprehensively reviewed properties of BTX-A in peripheral afferent and efferent nerves, the inhibition of nociceptive neurotransmitter release, the reduction of stretch-related visceral pain, and its anti-inflammatory effects on the bladder urothelium. Studies have also revealed possible effects of BTX-A in the human brain. However, further basic and clinical studies are warranted to provide solid evidence-based support in using BTX-A to treat bladder pain.

Growing evidence points out that the capacity of organisms to acclimate or adapt to new habitat conditions basically depends on their phenomic plasticity attributes, of which their gut commensal microbiota might be an essential impact factor. Especially in aquatic organisms, which are in direct and continual contact with the aquatic environment, the complex and dynamic microbiota have significant effects on health and development. However, an understanding of the relative contribution of internal sorting (host genetic) and colonization (environmental) processes is still unclear. To understand how microbial communities differ in response to rapid environmental change, we surveyed and studied the environmental and gut microbiota of native and habitat-exchanged shrimp (Macrobrachium nipponense) using 16S rRNA amplicon sequencing on the Illumina MiSeq platform. Corresponding with microbial diversity of their living water areas, the divergence in gut microbes of lake-to-river shrimp (CK) increased, while that of river-to-lake shrimp (KC) decreased. Importantly, among the candidate environment specific gut microbes in habitat-exchanged shrimp, over half of reads were associated with the indigenous bacteria in native shrimp gut, yet more candidates presented in CK may reflect the complexity of new environment. Our results suggest that shrimp gut microbiota has high plasticity when its host faces environmental changes, even over short timescales. Further, the changes in external environment might influence the gut microbiome not just by providing environment-associated microbes directly, but also by interfering with the composition of indigenous gut bacteria indirectly.

The oriental river prawn (Macrobrachium nipponense) is mainly distributed in East Asia. The phylogeography, population genetic structure and historical demography of this species in the East Asia were examined by using partial sequences of the cytochrome oxidase subunit I (COI) and 16S rRNA in mitochondrial DNA. Ten populations that included 239 individuals were collected from Taiwan (Shihmen Reservoir, SMR, Mingte Reservoir, MTR and Chengching Lake Reservoir, CLR), mainland China (Taihu Lake, TLC, Min River, MRC, Jiulong River, JRC and Shenzhen Reservoir, SRC), Japan (Biwa Lake, BLJ and Kasumigaura Lake, KLJ) and Korea (Han River, HRK). The nucleotide diversity (π) of all individuals was 0.01134, with values ranging from 0.0089 (BLJ, Japan) to 0.01425 (MTR, Taiwan). A total of 83 haplotypes were obtained, and the haplotypes were divided into 2 main lineages: lineage A included the specimens from BLJ, KLJ, CLR, MTR, TLC, MRC and JRC, and lineage B comprised the ones from HRK, SRC, SMR, MTR, TLC, MRC and JRC. Lineage A could be further divided two sub-lineages (A1 and A2). Individuals of lineage A2 were only from TLC. Demographic expansion was observed in each lineage, starting within the second-to-latest interglacial period for lineage A and within the last glacial period for lineage B. All FST values among the ten populations were significantly different, except for the values between MRC and JRC, and SMR and SRC. The phylogeography and genetic structure of M. nipponense in East Asia might be influenced by Pleistocene glacial cycles, lake isolation and human introduction. The possible dispersal routes of M. nipponense in the East Asia were also discussed.

Emphysematous prostatic abscess is a rare but relatively serious infectious disease, and its association with rectoprostatic fistula is extremely unusual. The reported risk factors for this condition include diabetes mellitus, immunosuppression, and prostate surgery. We report a rare case of emphysematous prostatic abscess successfully treated by transurethral drainage. Nonetheless, a rectoprostatic fistula was found postoperatively. The fistula healed spontaneously without fasting or fecal diversion after suprapubic cystostomy and placement of a urethral catheter. This case highlights the importance of surgical drainage for the treatment of an emphysematous prostatic abscess and that conservative treatment can be a safe and effective approach for an associated rectoprostatic fistula.

The oriental river prawn (Macrobrachium nipponense) is a non-obligatory amphidromous prawn, and it has a wide distribution covering almost the entire Taiwan. Mitochondrial DNA fragment sequences of the cytochrome oxidase subunit I (COI) and 16S rRNA were combined and used to elucidate the population structure and historical demography of oriental river prawn in Taiwan. A total of 202 individuals from six reservoirs and three estuaries were separately collected. Nucleotide diversity (π) of all populations was 0.01217, with values ranging from 0.00188 (Shihmen Reservoir, SMR, northern Taiwan) to 0.01425 (Mingte Reservoir, MTR, west-central Taiwan). All 76 haplotypes were divided into 2 lineages: lineage A included individuals from all sampling areas except SMR, and lineage B included specimens from all sampling locations except Chengching Lake Reservoir (CLR) and Liyu Lake Reservoir (LLR). All FST values among nine populations were significantly different except the one between Jhonggang River Estuary (JGE, west-central Taiwan) and Kaoping River Estuary (KPE, southern Taiwan). UPGMA tree of nine populations showed two main groups: the first group included the SMR and Tamsui River Estuary (TSE) (both located northern Taiwan), and the second one included the other seven populations (west-central, southern and eastern Taiwan). Demographic analyses implied a population expansion occurred during the recent history of the species. The dispersal route of this species might be from China to west-central and west-southern Taiwan, and then the part individuals belonging to lineage A and B dispersed southerly and northerly, respectively. And then part individuals in west-central Taiwan fell back to and stay at estuaries as the sea level rose about 18,000 years ago.

The gut microbial community is one of the richest and most complex ecosystems on earth, and the intestinal microbes play an important role in host development and health. Next generation sequencing approaches, which rapidly produce millions of short reads that enable the investigation on a culture independent basis, are now popular for exploring microbial community. Currently, the gut microbiome in fresh water shrimp is unexplored. To explore gut microbiomes of the oriental river prawn (Macrobrachium nipponense) and investigate the effects of host genetics and habitats on the microbial composition, 454 pyrosequencing based on the 16S rRNA gene were performed. We collected six groups of samples, including M. nipponense shrimp from two populations, rivers and lakes, and one sister species (M. asperulum) as an out group. We found that Proteobacteria is the major phylum in oriental river prawn, followed by Firmicutes and Actinobacteria. Compositional analysis showed microbial divergence between the two shrimp species is higher than that between the two populations of one shrimp species collected from river and lake. Hierarchical clustering also showed that host genetics had a greater impact on the divergence of gut microbiome than host habitats. This finding was also congruent with the functional prediction from the metagenomic data implying that the two shrimp species still shared the same type of biological functions, reflecting a similar metabolic profile in their gut environments. In conclusion, this study provides the first investigation of the gut microbiome of fresh water shrimp, and supports the hypothesis of host species-specific signatures of bacterial community composition.

Recently, the high incidence of construction firm bankruptcies has underlined the importance of forecasting defaults in the construction industry. Early warning systems need to be developed to prevent or avert contractor default; additionally, this evaluation result could facilitate the selection of firms as collaboration or investment partners. Financial statements are considered one of the key basic evaluation tools for demonstrating firm strength. This investigation provides a framework for assessing the probability of construction contractor default based on financial ratios by using the Logit model. A total of 21 ratios, gathered into five financial groups, are utilized to perform univariate logit analysis and multivariate logit analysis for assessing contractor default probability. The empirical results indicate that using multivariate analysis by adding market factor to the liquidity, leverage, activity and profitability factors can increase the accuracy of default prediction more than using only four financial factors. While considering the market factor in the multivariate Logit model, clear incremental prediction performance appears in 1-year evaluation. This study thus suggests that the market factor comprises important information to increase the prediction performance of the model when applied to construction contractors, particularly in short-term evaluation.

Due to the high attenuation in vitreous silica, acoustic attenuations in the THz regime are typically measured by incoherent techniques such as Raman, neutron, and X-ray scattering. Here, we utilized multiple-quantum-well structures to demonstrate acoustic spectroscopy of vitreous silica up to ∼740 THz. The acoustic properties of silica thin films prepared by physical and chemical deposition methods were characterized in the sub-THz regime. This technique can be useful in resolving debated issues relating to Boson peak around 1 THz.