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In this article, we searched the research literatures related to clinical investigation of non-invasive positive pressure ventilation (NPPV) in acute respiratory failure(ARF)/chronic respiratory failure(CRF) between 1本文通过Medline检索2021-10-01至2022-09-30期间无创正压通气（NPPV）用于治疗呼吸衰竭患者的相关临床研究文献并进行综述。在NPPV和高流量鼻导管氧疗（HFNC）治疗新型冠状病毒肺炎相关急性呼吸衰竭（ARF）中有3个大型随机对照试验，结果显示，NPPV（包括单水平持续气道正压通气和双水平气道内正压）可以降低气管插管率，HFNC的效果存在争论。此外，在NPPV治疗ARF的结局预测模型、NPPV相关的心搏骤停事件和人机界面对NPPV治疗效果的影响等方面也取得了一定进展。NPPV在气管插管前预氧合和辅助撤机拔管的研究中显示，NPPV可以减少气管插管过程中严重低氧血症的发生；有助于减少拔管后再次气管插管的风险。在长期家庭应用NPPV方面，提出成功启动的5个指标，但临床实践中符合5个指标的比例低，以及心理干预对长期NPPV依从性的影响等，这些研究结果有助于临床上合理选择和优化应用NPPV。.

Metabolic syndrome (MS) was conceptualized to identify people at risk for cardiovascular disease and type 2 diabetes; however, the epidemiology of MS and its combinations of components in older adults remains unclear. Data from the Senior Health Examination Program of the New Taipei City Government in Taiwan in 2014 were obtained for this study. All participants aged 65 years or older and those with a prior history of cardiovascular disease, cerebrovascular disease, or diabetes mellitus were excluded. 29,164 senior citizens were retrieved for this study, and 12,331 (41.28%) of the participants were male. Female participants were more likely to have MS (42.7% vs.31.3%, p

Background: Although the Decipher genomic classifier has been validated as a prognostic tool for several prostate cancer endpoints, little is known about its role in assessing risks of biopsy reclassification among patients on active surveillance, a key event that often triggers treatment. Objective: To evaluate the association between Decipher genomic classifier and biopsy Gleason upgrade among patients on active surveillance. Design, Setting, and Participants: Retrospective cohort study among patients with low- and favorable-intermediate-risk prostate cancer on active surveillance who underwent biopsy-based Decipher testing as part of clinical care. Outcomes measures and statistical analysis: Any increase in biopsy Gleason grade group (GG). We evaluated the association between Decipher score using univariable and multivariable logistic regression. We compared area under the receiver operating characteristic curve (AUC) of models comprised of baseline clinical variables with or without Decipher score. Results and limitations: We identified 133 patients of median age 67.7 years and median PSA 5.6 ng/mL. At enrollment 75.9% were GG1 and 24.1 GG2. Forty-three patients experienced biopsy upgrade. On multivariable logistic regression, Decipher score was significantly associated with biopsy upgrade (OR 1.37 per 0.10 unit increase, 95% CI 1.05-1.79 p=0.02). Decipher score was associated with upgrade among patients with biopsy Grade group 1, but not Grade Group 2 disease. The discriminative ability of a clinical model (AUC 0.63, 95% CI 0.51-0.74) was improved with the integration of Decipher score (AUC 0.69, 95% CI 0.58-0.80). Conclusions: The Decipher genomic classifier was associated with short-term biopsy Gleason upgrading among patients on active surveillance. Patient summary: The results from this study indicate that among patients with prostate cancer undergoing active surveillance, those with higher Decipher scores were more likely to have higher-grade disease found over time. These findings indicate that the Decipher test might be useful for guiding the intensity of monitoring during active surveillance.

《ERS/ATS重症哮喘管理指南（2020年修订版）》在2014版的基础上修订，维持重症哮喘定义和评估方法不变，针对6个热点进行文献综述，给出建议如下：针对未控制的重症嗜酸粒细胞表型，建议有条件使用抗IL-5和抗IL-4/13药物。建议在全身性糖皮质激素依赖性重症哮喘患者中使用抗IL-4/13药物，无论嗜酸粒细胞状态如何。推荐采用外周血嗜酸粒细胞≥260/μl和FeNO≥19.5 ppb来筛选对抗IL-5或抗IgE治疗疗效更显著的患者。建议在GINA第4~5级或NAEPP第5级疗法未控制时添加吸入噻托溴铵或大环内酯类长期治疗。.

第五代移动通信技术（5G）具有时延低、速度快、流量大的特点，2019年正式进入临床医疗领域。5G技术构建了万物互联的基础，目前在远程会诊、远程手术和远程检查操作等临床应用场景进行了初步探索，带来了全新的体验。相信未来5G结合大数据、互联网等与临床医学的深度融合，势必带来革命性的改变，催生出新的行业标准、新的业态。.

慢性阻塞性肺疾病（慢阻肺）的健康损害和疾病负担严重，其个体化防治研究越来越受到重视。2018年以来的慢阻肺研究，增加了室内外空气污染促进慢阻肺发病的知识，发现了电子烟的危害。嗜酸粒细胞、气道葡萄糖、免疫调节介质等生物标志物被发现参与慢阻肺发病机制、有助于开发新的防治靶点。研究者提出了早期慢阻肺的概念和频繁急性加重表型的新定义，利用微生物组学研究探讨了急性加重表型的稳定性。几项大型药物临床试验的结果对三联吸入疗法、双支气管舒张剂和吸入性糖皮质激素的适用人群、疗效及安全性等贡献了新的认识，有利于慢阻肺个体化治疗的发展。.

近年来支气管扩张逐渐受到国内外学者的重视，该病的循证医学证据在不断积累。2018年英国胸科协会首次更新了成人支气管扩张指南，对于疾病的诊断、病因学、严重程度分级、分级管理方案、物理治疗及疾病恶化时的处理策略都给出了较为明确的推荐意见。本文将从上述几个方面重点介绍该版指南的更新要点，并简要介绍我国学者对于指南的贡献，期望能够促进国内支气管扩张诊治和研究水平的提高。.

本文通过Medline检索2017年5月至2018年5月无创正压通气（noninvasive ventilation，NIV）相关的论著，对2017—2018年度发表的NIV相关临床研究进展进行综述。结果显示，在NIV的应用时机、预测NIV治疗失败、选择不同模式和连接方法等方面有一些新的研究报道。.

Background Androgen deprivation therapy (ADT) in localized prostate cancer improves overall survival and is recommended by National Comprehensive Cancer Network guidelines in certain situations. However, ADT is without benefit in other situations and can actually cause harm. This study examines recent trends in the ADT use and quantifies the cost of guideline-discordant ADT. Patients and methods Patients, aged 66-80 years, in the Surveillance Epidemiology and End Results-Medicare database with non-metastatic prostate cancer diagnosed between 2004 and 2007 were included for analysis. Prostate-specific antigen, Gleason score, and stage were used to define D'Amico risk categories. Logistic regression was used to examine factors associated with guideline-discordant ADT. Annual direct cost was estimated using 2011 Medicare reimbursement for ADT. Results Of 28 654 men included, 12.4% received guideline-discordant ADT. In low-risk patients, 14.9% received discordant ADT, mostly due to simultaneous ADT with radiation. Discordant use was seen in 7.3% of intermediate and 14.9% of high-risk patients, mostly from ADT as primary therapy. The odds of receiving guideline-discordant ADT decreased over time (2007 versus 2004; OR 0.69; 95% CI 0.62-0.76). The estimated annual direct cost from discordant ADT is $42 000 000. Conclusion Approximately one in eight patients received ADT discordant with published guidelines. Elimination of discordant use would result in substantial savings.

Dynamic programming equations are derived which characterize the optimal value functions for a partially observed constrained Markov decision process problem with both total cost and probabilistic criteria. More specifically, the goal is to minimize an expected total cost subject to a constraint on the probability that another total cost exceeds a prescribed threshold. The Markov decision process is partially observed, but it is assumed that the constraint costs are available to the controller, i.e., they are fully observed. The problem is motivated by an adaptive sequential detection application. The application of the dynamic programming results to optimal adaptive truncated sequential detection is demonstrated using an example involving the optimization of a radar detection process.

To study the effects of condensate in the piezometric tube on patient ventilator interaction during noninvasive positive pressure ventilation.Eleven healthy adults volunteered to receive noninvasive positive pressure ventilation. Different capacity of physiological saline was injected gradually into the piezometric tube until the volunteers could not trigger the ventilator or the total volume of the water reached 1.5 ml. The dynamic changes of the pressure of mask(Pmask), piezometric tube near mask (Ppro), piezometric tube near breathing machine(Pdis), and the flow were observed.With increasing volume of saline injected, the trigger time TItri(Pmask) increased from 0.09(0.07-0.11) to 0.31(0.22-0.39)s, the trigger pressure TPtri(Pmask) increased from 0.26(0.15-0.33) to 2.29(1.76-3.09)cmH2O, and the pressure-time product PTP (Pmask) increased from 0.02(0.01-0.03) to 0.55(0.41-0.68) cmH2O·s. Ineffective triggering rate increased from 0 up to 9 times/min, and spurious triggering rate increased from 0 up to 33 times/min. The plateau pressure of Pmask and Ppro exceeded the preset parameters, increased significantly as compared with 0 ml, from (9.74±0.34)to (15.79±3.10) cmH2O and from(9.80±0.31) to(15.44±3.47) cmH2O. The change of plateau pressure of Pdis was not significant [from (9.85±0.29)to (12.58±2.64)cmH2O]. The baseline pressure of Pmask, Ppro and Pdis changed from (3.67±0.36) to (8.40±3.22) cmH2O, from (3.71±0.32) to (8.13±3.55) cmH2O and from( 3.77±0.32) to (5.36±1.25) cmH2O, respectively. The pressure fluctuation of platform of Pmask increased significantly compare with 0 ml, from 0.60(0.48-0.71) to 7.94(7.11-8.63)cmH2O. The frequency of fluctuation of platform increased as many as 7 times during a single respiratory period. The time when the pressure of the Pdis began to change was delayed to Pmask and Ppro, 0.11(0.08-0.12)s compared with 0 ml.Condensate in the piezometric tube during noninvasive positive pressure ventilation could influence patient-ventilator synchrony. To improve patient ventilator interaction in noninvasive positive pressure ventilation, condensate in the piezometric tube should be avoided.

To study the risk factors for acute pulmonary embolism (PE) in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD).From November of 2009 to May of 2014, 522 admitted patients [aged 42-93 years, mean(72±9)] with AECOPD received CT pulmonary angiography(CTPA) in the First Affiliated Hospital of Guangzhou Medical University. The patients were classified as PE positive (positive result on CTPA) or PE negative (negative results on CTPA), and related risk factors for PE were analyzed.The frequency of PE was 10.3% in this series of 522 patients with AECOPD. Single factor analysis showed that the following factors were significantly different (χ(2)=4.32-57.06, mean P0.05)between PE positive and PE negative groups: age≥70 years, immobilization≥3 days, deep vein thrombosis(DVT) and a history of venous thromboembolism(VTE), cor pulmonale caused by COPD, pneumonia, stroke, artery embolization, atrial fibrillation, lower extremity edema, the levels of N-terminal pro-brain natriuretic peptide(NT-proBNP) and D-dimmer. Multiple regression analysis showed that immobilization ≥3 days(OR=25.36, 95%CI: 7.42-86.69, P0.001), lower extremity edema(OR=7.34, 95%CI: 3.43-15.71, P0.001) and D-dimmer≥2 000 μg/L(OR=10.10, 95%CI: 2.25-45.42, P=0.003) were the risk factors. The ratio for purulent sputum was 48.1%(26/54) in the PE positive group, and 42.6% (23/54) of the patients showed concurrent purulent sputum and increase of blood markers of infection. The frequency of purulent sputum between PE positive and PE negative groups was not different.Patients with AECOPD admitted to hospital should be considered for the presence of PE if they had the risk factors of immobilization≥3 days, lower extremity edema and D-dimmer ≥2 000 μg/L.

Measurement of the strain induced by compression can be useful in the diagnosis of breast tumors. Microcalcification (MC) detected by mammography could be the only symptom of early breast cancers. The purpose of this study was to develop a quantitative method for a differential diagnosis of MC lesions based on the strain ratio (SR) obtained by applying different breast compression pressure during mammography. Methods: This prospective study was conducted with institutional review board approval and the written informed consent was obtained. Twenty-five mastectomy specimens (24 for treatment of breast cancer and 1 from contralateral prophylactic mastectomy) with MCs were examined by digital mammography. There were 24 malignant MCs (mean size of 18.8 mm) detected in the 24 separate specimens, including 14 lesions of invasive carcinoma and 10 lesions of carcinoma in situ. Five benign MCs (mean size of 21.6 mm) were detected, including four lesions which coexisted with malignant MCs in the four separate specimens, and one was discovered in the prophylactic mastectomy specimen. Each specimen experienced four different magnitudes of compression force and the corresponding images were acquired for further analysis. Images in Digital Imaging and Communications in Medicine format (DICOM) were exported into custom software, written in Matlab, to contour the region of interest. Stress was defined as the force divided by the whole specimen area, and the square root of MC area was calculated to represent strain deformation. The SR was the slope of the best-fit line through the four points of each lesion. Histology of the MC was correlated with SR. Receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic performance of SR for discrimination between benign and malignant MC. Results: The SRs were higher in the malignant MC group (139.10 a.u.) than in the benign MC group (34.09 a.u.; p = 0.024). The SR between invasive carcinoma and carcinoma in situ showed no statistic significance (127.03 a.u. vs. 156.00 a.u.; p = 0.642). The area under the ROC curve for the diagnosis of benign and malignant MC was 0.825 (95% CI, 0.667 to 0.982). Conclusion: This study demonstrated that the SR detected by mammography showed potential for distinguishing benign from malignant MCs. Further in vivo investigations of larger cohorts are necessary to validate these results. Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P5-08-01.

Background and context: Cervical cancer has been one of the most important cancers over the last 3 decades in Taiwan, and it still is among the top 10 cause of death for women. Aim: The aim of the policy was to achieving the following KPIs: HPV vaccine inoculation rate to 60%; 30-69 year Papanicolaou test screening rate ≥ 70%; and cervical cancer mortality dropped to 3.3/105 (baseline 1995 = 11/105). Strategy/Tactics: We provided annual Pap test for all women aged 30 years or more since 1995 and encourage women to screen at least every 3 years. We will introduce national HPV vaccination program for girls aged 13 years later this year. Program/Policy Process: We used a coordinated multichannel delivery system including clinical and community approaches that empower people to access services. The cost of treatment was covered by the universal health insurance. Our vaccination program started from whom are likely to have less access to screening later in life since 2011, and some cities/counties initiated their own vaccination program. Our national HPV vaccination aims to increase the inoculation rate to 60%. Outcomes: The standardized cervical cancer incidence rate decreased by 66%, from 25 per 100,000 in 1995 to 8.5 per 100,000 in 2014. The standardized mortality rate fell by 70% between 1995 and 2016, from 11 to 3.3 people per 100,000. In 2015, the total inoculation rate was about 38%. According to the Vaccine Adverse Effect Reporting System, the HPV vaccine is very safe. Among almost 820,000 doses inoculated from 2010 to 2016, the number of adverse effect was 2107 (0.25%). What was learned: The policy combined HPV vaccination and national Papanicolaou test screening strategies are successful. The implementation of the act, funding allocation, information system, health education to target population and medical staff as well as media advocacy, were keys to success.

Background and context: Cancer has been the leading cause of death since 1982 in Taiwan. Taiwan cancer case management program started from major 4 cancers (breast cancer, liver cancer, colorectal cancer, oral cancer) since 2004. However, only 82% of patients with a confirmed cancer diagnosis received their first cancer treatment within 3 months in 2012. Aim: To increase the navigation coverage for all cancer patients, Health Promotion Administration (HPA) sets the goal that 91% of patients with a confirmed cancer diagnosis should receive their first cancer treatment within 3 months in 2018. Strategy/Tactics: (1) Subsidize cancer hospitals (2) Accreditation for oncology case management (3) Pay for performance (P4P) Program/Policy process: We subsidized hospitals to establish oncology case manager since 2004. Gradually, hospitals in Taiwan accept this new nursing role and recognize its positive impacts on cancer care. Moreover, Taiwan Accreditation Program of Cancer Care mandated all cancer care institutes to establish the program for oncology case management since 2010. However, there were only 4-6 major cancer patients got the case management service. Thus HPA launched P4P Cancer Patient Navigation Program in 2014 and established reporting system. Outcomes: 95% of newly cancer diagnosis patients (including 92 hospitals) in Taiwan receive the service and 96% of patients with a confirmed cancer diagnosis receive their first cancer treatment within 3 months in 2017. Through the implementation of subsidy, accreditation and P4P, the relative survival rate showed significant improved. The 5-year relative survival rate for all cancers increases from 49% during 2003-2007% to 55.8% during 2011-2015. What was learned: A successful program might start small from few trial sites, should be fully supported and well established the systems by government and will move fast by all healthcare professionals.

Background: Oral cancer is a major public health burden in Taiwan. Studies have suggested that habits of betel quid chewing, tobacco smoking and alcohol drinking as well as their interaction effects are important risk factors for oral cancer and oral potentially malignant disorders (OPMD). A population-based oral cancer screening program has been implemented by Health Promotion Administration, Ministry of Health and Welfare, Taiwan. People with betel quid chewing and/or cigarette smoking habits are recommended for biennially screening. Previous studies found that majority of betel quid chewers were in labor intensive occupations. Given the fact that high risk groups of oral cancer are often reluctant to attend screening, targeted approach should be applied to improve the effectiveness of screening program. Aim: The aims of this study are to identify occupations with high prevalence of betel-quid chewing and also to investigate changing trends using the National Health Interview Survey (NHIS) database. Methods: The NHIS database of 2009 and 2013 were used to conduct this study. We identified current users of betel quid and/or cigarette from adults with aged 20-64 years old and working on jobs. Occupations were classified using the International Standard Classification of Occupations (ISCO-88). Statistical analyses included indirect standardized rate ratios and cluster analysis of chewing/smoking habits. Results: From the total survey participants (2009: 19,201, 2013: 17,249), we extracted 11,507 and 10,760 persons for the study. In the year of 2013, using the 2-digit code of ISCO-88, drivers and mobile-plant operators (code 83 in ISCO-88) had the highest prevalence of betel quid chewing habit (30.9%), followed by extraction and building trades workers (code 71 in ISCO-88, 29.6%). These two groups also had the 2 highest smoking prevalence (61.2% and 62.2%). The betel quid chewing prevalence decreased from 2009 to 2013 slightly (32.3%-30.9%). However, the prevalence of smoking increased (60.0%-62.2%). Among the betel quid chewers of the two focused occupations, the corresponding rates of receiving oral cancer screening were rather low (35.47% and 21.52%). The indirect standardized ratios using the total sample as the reference showed 6 occupations (2 digit of ISCO-88) with significantly higher ratios (larger than 2). Cluster analysis demonstrated that the group with high prevalence of betel quid chewing also had high prevalence of cigarette smoking habit. Conclusion: The betel quid chewing prevalence has been decreased in all occupations. While at the same time, prevalence of cigarette smoking did not largely decrease. We analyzed the NHIS databases and found that workers in some occupations tend to have higher prevalence in both betel quid chewing and smoking. The oral cancer screening and cancer awareness need be targeted on certain occupations.

Background: Betel quid (BQ) and cigarette smoking (CS) are oral cancer risk factors. It has been estimated that hundreds of million people mainly in the Asia-Pacific region were consume certain variety of BQ. BQ is the fourth most commonly used psychoactive substance in the world and require assist the chewers to withdraw it. In Taiwan, Health Promotion Administration (HPA) has initiated a hospital-based in-reach screening services for oral cancer to chewers and smokers since 2010 and proposed a financial incentive BQ cessation program designed based on Transtheoretical Model (TTM) to BQ chewers within entrusted “Cancer Control Advanced Program” hospitals in 2017. Aim: This study aims to examine whether this strategy can assist BQ chewers to diminish or quit chewing BQ. Methods: This study was a longitudinal study design used an administration database. BQ chewers were interviewed with 3 times within 1 year follow by a uniform TTM-based BQ cessation intervention by HPA-trained health educators. A face-to-face questionnaire interview were conducted to obtain baseline information, 3 interventions' behavior change stages as well as final BQ chewing status. Generalized linear mixed model was used to determine the association between TTM changing process and effectiveness of BQ chewing behavior changes. Results: A total of 5476 BQ chewers completed 3 times interventions and classified into high-reduction group (N = 2698), middle-reduction group (N = 1978), and low-reduction group (N = 800) after 1-year follow-up. We found BQ chewers were primarily men and aged 40 to 60 years. Over half participants chewed BQ ≤10 BQ per day. Most of them were higher percentage on cigarette smoking and alcohol drinking. Almost 45% BQ chewers did not have regular oral mucosa screening. The stages of change were shift from precontemplation and contemplation stage to action and maintenance stage during 3 interventions. After adjusting for covariates, participants in preparation stage compared with those in precontemplation stage were associated with an increasing odds ratio in middle-reduction BQ (odds ratio = 2.79, 95% confidence interval = 2.27-3.44) and in high-reduction BQ (odds ratio = 3.75, 95% confidence interval = 3.02-4.66). Moreover, BQ chews who chewed BQ ≤10 BQ per day and did not a cigarette smoking had higher chance to had high-reduction of BQ. Conclusion: This modified TTM BQ cessation provides according to behavior change 5 stages could benefit from hospital-based health education to lower BQ, however, future relapse rate should be concerned.

Background and aims: Colorectal cancer (CRC) is a leading cause of cancer deaths worldwide, and fecal immunochemical testing (FIT) is most widely used for population-based screening. Reduced long-term CRC mortality has been reported only scarcely in response to early detection with FIT screening. We aimed to elucidate whether and how FIT screening led to overall and site-specific reduction of advanced stage CRC incidence and mortality after the first decade of Taiwan's screening program, which offers biennial FIT screening for people aged 50-69 years. Method: The study cohort comprised eligible subjects who did (screened group) and did not (unscreened group) participate in FIT screening during the inaugural 5 years (2004-2009) with follow up until 2014. FIT-positive subjects were offered colonoscopy as a confirmatory exam. The primary outcome was incidence of advanced stage CRC and CRC mortality. Results: Among 5,417,699 eligible subjects, 3,072,164 (56.6%) had at least once FIT screening, and 1,605,200 (52.3%) received 2 or more screenings during the study period. During mean follow-up of 9.78 years, 5716 screened and 20,962 unscreened subjects developed incident advanced stage cancers [adjusted relative risk (aRR) = 0.76; 95% CI, 0.72-0.79] after controlling for self-selection to attend screening and increasing CRC incidence. CRC deaths during follow-up included 3077 screened and 15,550 unscreened subjects (aRR = 0.56, 95% CI, 0.53-0.59). Effectiveness was greater for distal cancers (advanced cancer incidence aRR = 0.68, 95% CI, 0.65-0.71); mortality aRR = 0.52 95% CI, 0.49-0.55) than for proximal cancers (advanced cancer incidence aRR = 0.99 95% CI, 0.92-1.07; mortality aRR = 0.69 95% CI, 0.63-0.75). Conclusion: FIT screening effectively reduces risk of advanced stage CRC and CRC mortality, with effectiveness consistently stronger for distal CRC than proximal CRC.

Background Several studies have demonstrated the inhibitory effect of propofol on diaphragmatic contractility in laboratory animals, but there have been few studies in humans. We have investigated the effect of a single bolus injection of propofol on twitch diaphragmatic pressure (TwPdi) evoked by cervical supramaximal magnetic stimulation, and its impact on diaphragmatic contractility. Methods In 16 patients scheduled for elective operation, TwPdi was evoked bilaterally at the cervical phrenic nerves with supramaximal magnetic stimulations using a 140 mm diameter magnetic coil. Changes of TwPdi were monitored dynamically before and during general anaesthesia induced by single bolus of propofol 2 mg kg −1 . During the study, all patients breathed 100% oxygen by a face mask, maintaining S p o 2 ≥99% and P e′ co 2 4.6–5.2 kPa. Results TwPdi declined after administration of propofol with gradual recovery. Compared with baseline [20.6 (6.0) cm H 2 O], TwPdi decreased by 23.3% ( P 2 O]. When the patients regained awareness, TwPdi returned to [19.1 (6.1) cm H 2 O], close to baseline ( P =0.063). The time from starting the propofol infusion to the lowest TwPdi was [240 (86) s]. Total time course of stimulation lasted [363 (89) s]. Conclusions A single bolus propofol depressed TwPdi evoked by cervical magnetic stimulation, demonstrating inhibitory effects of propofol on diaphragmatic contractility in patients during general anaesthesia.

The aims of this study were to evaluate the duration of acetylcholinesterase inhibitors (AChEI) utilization as well as the patients' cognition maintenance. This study was using panel data from the Bureau of National Health Insurance (BNHI) of Taiwan from 2001 to 2004. Patients with mild or moderate AD were prescribed AChEI (donepezil, rivastigmine, or galantamine). By the regulation of BNHI, if the score of Mini-Mental Status Examination worsened by more than two points or clinical dementia rating (CDR) worsened by one or more grades in the follow-up every half year, the AChEI treatment would be terminated. Kaplan-Meier product-limit method was used to estimate duration of drug utilization. Regression model was performed to analyse the factors affecting the discontinuation of AChEI treatment. Our results showed female are more and younger than male in mild to moderate Alzheimer's dementia. The mean duration of use of AChEI was 432 days. Only 9.6% of patients maintained stable cognition tests results with continued drug refill for more than 3 years. Discontinuation rate in older patients (age > or =76 years) was higher than those in younger age (P = 0.0009). The average duration for AChEI therapy is around 14 months. The elderly are at high risk for treatment discontinuation.

In this paper, the application of the dynamic programming approach to constrained stochastic control problems with expected value constraints is demonstrated. Specifically, two such problems are analyzed using this approach. The problems analyzed are the problem of minimizing a discounted cost infinite horizon expectation objective subject to an identically structured constraint, and the problem of minimizing a discounted cost infinite horizon minimax objective subject to a discounted expectation constraint. Using the dynamic programming approach, optimality equations, which are the chief contribution of this paper, are obtained for these problems. In particular, the dynamic programming operators for problems with expectation constraints differ significantly from those of standard dynamic programming and problems with worst-case constraints. For the discounted cost infinite horizon cases, existence and uniqueness of solutions to the dynamic programming equations are explicitly shown by using the Banach fixed point theorem to show that the corresponding dynamic programming operators are contractions. The theory developed is illustrated by numerically solving the constrained stochastic control dynamic programming equations derived for simple example problems. The example problems are based on a two-state Markov model that represents an error prone system that is to be maintained.

A clinical mammography program is in progress at the medical beamline SYRMEP of the Italian synchrotron radiation laboratory ELETTRA in Trieste. A conventional screen-film system is utilized as detector for the examinations on patients. For the next experimental step a digital detector has been designed taking into account the essential requirements for mammography such as high spatial and contrast resolution, high efficiency for low dose examinations and high speed for short acquisition time. A double-layer prototype has already been tested in the frame of the PICASSO project. In addition, an analyzer crystal set-up for Diffraction Enhanced Imaging (DEI) has been available for many years at the SYRMEP beamline. Applying the DEI technique several successful experiments have been carried out in biomedical imaging and in particular in-vitro breast imaging utilizing commercially available detectors. Recently a system upgrade yielded a double-crystal analyzer set-up with improved stability and higher angular resolution. In this study the PICASSO detector has been utilized in combination with the new analyzer set-up for imaging in-vitro breast tissue samples. In order to test the potential of the combined system planar and tomographic images have been acquired and the first results are here presented.

Purpose: To analyze MR direct and indirect signs for knees with anterior cruciate ligament (ACL) partial or complete tear. Material and Methods: According to documented MR direct and indirect signs for ACL tear, we retrospectively reviewed the incidence of those signs in 15 partial ACL tear and 17 complete ACL tear patients. The findings were also compared with duration of injury (less or more than 6 weeks, as acute or chronic stages). Results: A residual straight and tight ACL fiber in at least one pulse sequence was more frequently detected in partial ACL tears. The empty notch sign, a wavy contour of ACL, bone contusion at lateral compartment and lateral meniscus posterior horn tear were significantly more frequently seen in complete tear cases. The posterior cruciate ligament angle in chronic complete ACL tear cases (109°±20°) had a tendency to be less than in chronic partial ACL tear cases (119±18°). Conclusion: The empty notch sign, a wavy ACL, bone contusion, and posterior horn of lateral meniscus tears are suggestive of a complete ACL tear. A residual straight and tight ACL fiber seen in at least one image section is a helpful sign to diagnosis of partial ACL tear. In the acute ACL injury stage, a focal increase of the ACL signal intensity is more suggestive of a partial ACL tear.

Purpose: To compare i.v. contrast-enhanced sonography (CEUS), power Doppler sonography (PDUS) and i.a. carbon dioxide-enhanced sonography (CO 2 US) in assessing hepatocellular carcinoma (HCC) vascularities before and after treatment. Differences between PDUS and CEUS with the aid of CO 2 US were also observed. Material and Methods: In all, 43 patients with 67 histologically proved HCCs were examined with PDUS, CEUS, and CO 2 US. Among these tumors, 36 were HCCs before treatment and 31 were HCCs treated by transcatheter arterial chemoembolization or percutaneous ethanol injection or a combination of these two treatments. CO 2 US was used as the gold standard when comparing the PDUS and CEUS. Results: Of the 36 untreated HCC tumors, 20 (55.6%) were hypervascular compared with the liver parenchyma at PDUS, 28 (77. 8%) at CEUS, 31 (86.1%) at the early phase of CO 2 US and 32 (88.9%) at the late phase of CO 2 US. Of the 31 post-treatment HCCs, 11 (35.5%) showed hypervascularity at PDUS, 25 (80.6%) at CEUS, 25 (80.6%) at the early phase of CO 2 US and 26 (83.9%) at the late phase of CO 2 US. Conclusion: CO 2 US was superior to CEUS and CEUS was superior to PDUS for the detection of tumor vascularity in both untreated and treated HCCs. The duration of enhancement at CEUS was shorter than at CO 2 US. The ability of CO 2 US to detect additional small tumors was not possible with PDUS and CEUS.

The particle tracking flow visualization method (PTFV) and particle image velocimetry (PIV) are used to obtain a clear picture of vortex evolution on the suction surface of an impulsively started NACA 0012 wing. The experiments are conducted in a towing water tank. The formation, evolution, and shedding of the vortex system on the suction surface are observed and analysed by streak pictures of particle images. Five characteristic vortex evolution regimes are identified in the parameter domain of angle of attack and chord Reynolds number. The pathline patterns, instantaneous streamlines, and vorticity of various vortex evolution processes are presented. Stable vortex shedding in the wake is eventually established after the initial period of complex vortex evolution on the suction surface of the wing. Various types of instabilities in the wake, e.g. instability wave, surface vortex shedding, and bluff-body vortex shedding, are found to correspond to different evolution processes of the surface flow. The shedding frequency of the vortices is correlated and compared with several conventional results. Topological critical points, separatrices, and alleyways are identified and discussed to elucidate the unsteady structure of the instantaneous streamline patterns. The topological rule for the number of singular points is verified.

Computer Science Department

Metachronous primary malignant tumors of uterine papillary serous carcinoma (UPSC) and non-Hodgkin's lymphoma (NHL) are rare. UPSC is a clinically aggressive and morphologically distinctive variant of endometrial carcinoma. We describe the clinical features of a 63-year-old patient with UPSC that was found 2 years after chemotherapy for malignant lymphoma of neck, stage IV and 5 months after radiation therapy for recurrence. This patient had undergone staging surgery and postoperative radiation for UPSC. One month after completion of radiotherapy, the patient expired due to persistence of the disease. The association between host immunity and UPSC is rarely described in the literature. Immunological profiles of this patient, with compositional changes of natural killer, B, and T cell, dramatically altered the percentage of CD4(+) T cell, CD8(+) T cell, and CD4/CD8 ratio, signifying depressed host immunity. Immunological profile of this patient stressed the issue of depressed host immunity and associated malignancies.

Metachronous primary malignant tumors of uterine papillary serous carcinoma (UPSC) and non-Hodgkin's lymphoma (NHL) are rare. UPSC is a clinically aggressive and morphologically distinctive variant of endometrial carcinoma. We describe the clinical features of a 63-year-old patient with UPSC that was found 2 years after chemotherapy for malignant lymphoma of neck, stage IV and 5 months after radiation therapy for recurrence. This patient had undergone staging surgery and postoperative radiation for UPSC. One month after completion of radiotherapy, the patient expired due to persistence of the disease. The association between host immunity and UPSC is rarely described in the literature. Immunological profiles of this patient, with compositional changes of natural killer, B, and T cell, dramatically altered the percentage of CD4+ T cell, CD8+ T cell, and CD4/CD8 ratio, signifying depressed host immunity. Immunological profile of this patient stressed the issue of depressed host immunity and associated malignancies.