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Yu Zhou,1 Jiao Lu,2 Lin Liu,2 Hao-Wei Wang2 1School of Sports Sciences, Nanjing Normal University, Nanjing, Jiangsu, People’s Republic of China; 2School of Sport and Health, Nanjing Sport Institute, Nanjing, Jiangsu, People’s Republic of ChinaCorrespondence: Lin Liu, School of Exercise and Health, Nanjing Sport Institute, Linggusi Road No. 8, Nanjing, 210014, People’s Republic of China, Tel +86 18817873543, Email liulinst1989@126.comPurpose: To systematically evaluate the effect of exercise rehabilitation as an adjuvant to clinical treatment for myofascial trigger points (MTrPs).Patients and Methods: ESBCO, PubMed, Science Direct, Web of Science, China Knowledge Network (CNKI), and Wanfang databases were comprehensively searched from database inception date through July 2022. Randomized controlled trials comparing MTrPs treatments that included exercise rehabilitation with a single clinical treatment. Two researchers independently screened articles using inclusion/exclusion criteria, scored methodologic quality, and extracted data including patient demographics, interventions, and outcomes.Results: We included 14 RCTs (N = 734). Results showed short-term (mean difference [MD], − 2.25; 95% confidence interval [CI], − 4.08 to − 0.41; Z = 2.40; P = 0.02) and long-term (MD = − 0.47; 95% CI: − 0.80 to − 0.17; Z = 3.05; P = 0.02) adjuvant exercise rehabilitation treatments were superior in reducing musculoskeletal pain intensity to single clinical treatment in controls, but long-term versus short-term effectiveness was not significantly different. The exercise rehabilitation group more effectively increased the range of motion (ROM) (standardized mean difference [SMD], 1.04; 95% CI: 0.32 to 1.77; Z = 2.84; P = 0.005) and decreased dysfunction (SMD = − 0.93; 95% CI: − 1.82 to − 0.05; Z = 2.06; P = 0.04) than controls; no significant difference was observed in the pressure pain threshold (PPT) between two groups.Conclusion: Exercise rehabilitation as an adjuvant to clinical treatment for MTrPs was moderately effective in relieving pain intensity, increasing ROM, and improving dysfunction versus single clinical intervention. These findings must be validated by larger, higher-quality studies.Keywords: trigger points, exercise, rehabilitation, meta-analysis, randomized controlled trial

Po-Ching Huang,1 Ching-Hsia Hung,1,2 Guan-Wei Chen,3 Ciaran Cashin,3 Mark D Griffiths,4 Wen-Chi Yang5,6 *, Hsiao-Wen Wang3 *, Chung-Ying Lin1,7– 9*, Nai-Ying Ko10 1Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 2Department of Physical Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 3Department of Hydraulic and Ocean Engineering, College of Engineering, National Cheng Kung University, Tainan, Taiwan; 4International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 5Division of Hematology and Medical Oncology, Department of Internal Medicine, E-DA Hospital, Kaohsiung, Taiwan; 6Faculty of School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan; 7Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 8Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 9Department of Public Health, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 10Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan*These authors contributed equally to this workCorrespondence: Chung-Ying Lin, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 701, Taiwan, Tel +886 6-2353535 ext. 5106, Fax +886 6-2367981, Email cylin36933@gmail.comPurpose: The duties related to COVID-19 control and prevention may have caused psychological stress for the individuals in charge (eg, frontline government workers) and have reportedly led to mental health issues, such as insomnia and post-traumatic stress disorder (PTSD). However, the prevalence of these COVID-19-related disorders and their associated factors remain unclear. Therefore, the purpose of the present study was to investigate the prevalence rates of insomnia, PTSD, COVID-19-related self-stigma, and smartphone addiction, along with the identification of risk factors and protective factors for Taiwan frontline government workers with COVID-19 pandemic control duties.Methods: The survey was carried out with 151 participants between September and October 2021. All participants completed the Fear of COVID-19 Scale (assessing fear of COVID-19), Self-Stigma Scale (assessing self-stigma during the COVID-19 pandemic), Smartphone Application-Based Addiction Scale (assessing the risk of smartphone addiction), Insomnia Severity Index (assessing insomnia), Impacts of Event Scale-6 (assessing PTSD), and a self-designed set of questions assessing trait resilience.Results: The results showed that the prevalence rate was 31.1% for insomnia and 33.8% for PTSD. Furthermore, service duration (adjusted odds ratio [AOR] = 0.93; 95% confidence interval [CI] = 0.86, 0.999) and trait resilience (AOR = 0.19; 95% CI = 0.08, 0.46) were protective factors and fear of COVID-19 (AOR = 1.91; 95% CI = 1.02, 3.57) was a risk factor for insomnia. Fear of COVID-19 (AOR = 2.63; 95% CI = 1.35, 5.14), self-stigma (AOR = 3.62; 95% CI = 1.19, 11.02), and smartphone addiction (AOR = 1.09, 95% CI = 1.001, 1.19) were risk factors, and trait resilience was a protective factor (AOR = 0.58; 95% CI = 0.29, 1.17) for PTSD.Conclusion: The findings demonstrated a high prevalence of insomnia and PTSD. Risk-reducing strategies and protective factor promotion strategies are recommended to help reduce the symptoms of insomnia and PTSD among Taiwan frontline government workers.Keywords: mental health, insomnia, post-traumatic stress disorder, smartphone addiction, village officer

Daniel Kwasi Ahorsu,1,&ast; Iqbal Pramukti,2,&ast; Carol Strong,3 Hsiao-Wen Wang,4 Mark D Griffiths,5 Chung-Ying Lin,3,6– 8 Nai-Ying Ko9 1Department of Rehabilitation Sciences, Faculty of Health & Social Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong; 2Faculty of Nursing, Universitas Padjadjaran, West Java, Indonesia; 3Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 4Department of Hydraulic and Ocean Engineering, National Cheng Kung University, Tainan, 701, Taiwan; 5International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK; 6Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 7Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 8Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; 9Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan&ast;These authors contributed equally to this workCorrespondence: Chung-Ying LinInstitute of Allied Health Sciences and Departments of Occupational Therapy and Public Health, Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, TaiwanTel +886-6-2353535-5106Fax +886-6-2367981Email cylin36933@gmail.comCorrespondence: Nai-Ying KoDepartment of Nursing, College of Medicine, National Cheng Kung University, 1 University Road, Tainan, 701, TaiwanTel +886-6-2353535-5838Fax +886-6-2377550Email nyko@mail.ncku.edu.twPurpose: The present study examined the differences between international and local university students in Taiwan regarding COVID-19-related variables, anxiety, and suicidal ideation.Participants and Methods: An online cross-sectional survey (sent via an online link in an email) was carried out comprising university students (n=529). The students were assessed on measures (including validated psychometric instruments) of perceived susceptibility to COVID-19, perceived sufficiency of resources, sources of COVID-19 information, perceived satisfaction with support, anxiety and suicidal ideation.Results: Local students had higher susceptibility to COVID-19 (p< 0.001) but decreased sufficiency with resources (p< 0.001) and anxiety (p< 0.001) compared with international students. Staying with family members, satisfaction with support, and information seeking were the factors that predicted anxiety among international students (all p-values< 0.05), while information seeking predicted local students’ anxiety (p< 0.001). Furthermore, staying with family members, susceptibility to COVID-19, and sufficiency with resources were the factors that predicted suicidal ideation among international students (all p-values< 0.05), while being a male and satisfaction with support predicted suicidal ideation among local students (all p-values< 0.05).Conclusion: International students displayed different COVID-19-related challenges compared with local students. More specifically, international students as compared with local students had lower susceptibility to COVID-19 and higher anxiety. Therefore, healthcare providers should pay more attention to international students’ psychological health and awareness regarding impacts of COVID-19 on health.Keywords: anxiety, COVID-19, university students, suicidal ideation, Taiwan

Hong-Wu Wang,1,* Yi-Jin Hu,1,* Guo-Lin Wang2 1Department of Anesthesiology, TEDA International Cardiovascular Hospital of Tianjin Medical University, Tianjin, 300052, People’s Republic of China; 2Department of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin, 300074, People’s Republic of China*These authors contributed equally to this workCorrespondence: Guo-Lin WangDepartment of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin, 300074, People’s Republic of ChinaTel/Fax +86 15822855566Email wanggl698521@163.comBackground: Protamine is a polycationic, and a strong basic peptide isolated from Clupeidae or Salmonidae fishes’ sperm, which is rich in arginine and highly alkaline.Objective: To explore the effect of lidocaine pre-treatment on protamine-induced pulmonary vascular reaction during the repair of congenital heart disease.Methods: Eighty patients undergoing repair of congenital heart disease were randomly divided into four groups: A1 (non-pulmonary hypertension + lidocaine pre-treatment) group, A2 (non-pulmonary hypertension + normal saline) group, B1 (pulmonary hypertension + lidocaine pre-treatment) group, and B2 (pulmonary hypertension + normal saline) group. Hemodynamic parameters, pulmonary inflammation, and pulmonary function were assessed at six intraoperative time points, two intraoperative time points and three intraoperative time points, respectively. P-value < 0.05 was considered statistically significant.Results: A2 group exhibited increased PAP, Paw, RI and A-aDO2. B2 group exhibited increased Paw, RI and A-aDO2 and decreased Cydn and OI after protamine administration. These changes were not observed in A1 and B1 group. Compared with A1 and B1 groups, plasma TXB2 level in A2 and B2 group was higher, but 6-keto-PGF1a in A2 and B2 groups was lower. Incidence of protamine adverse reactions in A1 and B1 group was lower than that in A2 and B2 group.Conclusion: Precondition of lidocaine before neutralization of heparin may be effective for protamine-induced pulmonary vascular reaction during CHD repair.Keywords: congenital heart disease, protamine, adverse reactions, extracorporeal circulation, pulmonary hypertension

Li-Hua Deng,1,2 Hai Jiang,1 Fu-Lin Lu,1 Han-Wei Wang,1 Yu Pu,1 Chang-Qiang Wu,1 Hong-Jie Tang,3 Ye Xu,4 Tian-Wu Chen,1 Jiang Zhu,1 Cheng-Yi Shen,1 Xiao-Ming Zhang1 1Medical Imaging Key Laboratory of Sichuan Province and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, Nanchong, 637000, People’s Republic of China; 2Department of Radiology, First People’s Hospital of Neijiang, Neijiang 641000, People’s Republic of China; 3Department of Radiology, Nanchong Hospital of Traditional Chinese Medicine, Nanchong 637000, People’s Republic of China; 4Department of Radiology, Children’s Hospital of Chongqing Medical University, Chongqing 401122, People’s Republic of ChinaCorrespondence: Chang-Qiang Wu; Xiaoming ZhangSichuan Key Laboratory of Medical Imaging and School of Medical Imaging, Affiliated Hospital of North Sichuan Medical College, 234th Fujiang Road, Nanchong 637000, People’s Republic of ChinaTel +86-13990723836Email wucq1984@163.com; zhangxm@nsmc.edu.cnObjective: PEGylated superparamagnetic iron oxide (SPIO) is the most promising alternatives to gadolinium-based contrast agents (GBCAs) in MRI. This paper is to explore the imaging effects of PEGylated SPIO, which is influenced by particle sizes and surface polyethylene glycol (PEG) coating, using as MRI contrast agents at different magnetic field intensities.Methods: Firstly, nine PEGylated monocrystalline SPIO nanoparticles with different nanocrystal sizes and different molecular weights PEG coating were prepared, and then physical and biological properties were analyzed. Finally, MRI imaging in vivo was performed to observe the imaging performance.Results: Nine PEGylated monocrystalline SPIO nanoparticles have good relaxivities, serum stability, and biosecurity. At the same time, they show different imaging characteristics at different magnetic field intensities. Eight-nanometer SPIO@PEG5k is an effective T2 contrast agent at 3.0 T (r2/r1 = 14.0), is an ideal T1-T2 dual-mode contrast agent at 1.5 T (r2/r1 = 6.52), and is also an effective T1 contrast agent at 0.5 T (r2/r1 = 2.49), while 4-nm SPIO@PEG5k is a T1-T2 dual-mode contrast agent at 3.0 T (r2/r1 = 5.24), and is a useful T1 contrast agent at 0.5 T (r2/r1 = 1.74) and 1.5 T (r2/r1 = 2.85). MRI studies in vivo at 3.0 T further confirm that 4-nm SPIO@PEG5k displays excellent T1-T2 dual-mode contrast enhancement, whereas 8-nm SPIO@PEG5k only displays T2 contrast enhancement.Conclusion: PEGylated SPIOs with different nanocrystal sizes and PEG coating can be used as T1, T2, or T1-T2 dual-mode contrast agents to meet the clinical demands of MRI at specific magnetic fields.Keywords: magnetic resonance imaging, contrast agents, superparamagnetic iron oxide, polyethylene glycol

Cheng Chen,1,2,* Yan Wu,2 Bao Ling Liu,2 Hong Wei Wang,2 Jian Hua Ma,2,* Ju Ying Zhou1,* 1Department of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China; 2Department of Radiotherapy, The Second People’s Hospital of Lianyungang, Lianyungang, Jiangsu Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Ju Ying ZhouDepartment of Radiotherapy, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215006, People’s Republic of ChinaTel +86 512 67780008Fax +86 512 65228072Email zhoujuyingsy@163.comJian Hua MaDepartment of Radiotherapy, The Second People’s Hospital of Lianyungang, NO. 161 Xingfu Road, Lianyungang, Jiangsu Province 222023, People’s Republic of ChinaTel +86 518 8577511Fax +86 518 85214221Email jianhuamama@126.comObjective: To observe whether whole-brain radiotherapy (WBRT) can bring survival benefits to patients with multiple brain metastases (BM) from non-small cell lung cancer (NSCLC) treated by epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) and determine the best time for WBRT intervention.Methods: A retrospective analysis was performed on 148 patients diagnosed with EGFR gene-mutated NSCLC. All patients had multiple BM and received EGFR-TKI targeted therapy, which was performed to observe whether WBRT can bring survival benefits, and whether the choice of WBRT timing affects the survival of patients.Results: Among the 148 patients with NSCLC treated with EGFR-TKI, 76 received WBRT; 72 were without WBRT. WBRT can reduce the intracranial progression rate in the patients (19.7% vs 33.3%, P=0.040), thus improving the intracranial progression-free survival (iPFS) (median iPFS: 11.9 months versus 10.2 months, P=0.039) and overall survival (OS) (median OS: 21.0 months versus 16.7 months, P=0.043). Multivariate analysis showed that WBRT (HR=0.606; 95% CI: 0.403– 0.912, P=0.016) and the low Eastern Cooperative Oncology Group performance status (HR=1.884; 95% CI: 1.120– 3.170, P=0.017) are independent prognostic factors in all patients. Further subgroup analysis showed that the choice of WBRT time had no effect on patient survival.Conclusion: WBRT can improve the survival of patients with multiple BM from NSCLC receiving EGFR-TKI targeted therapy and is an independent prognostic factor. The choice of RT time has no effect on patient survival.Keywords: epidermal growth factor receptor-tyrosine kinase inhibitors, whole-brain radiotherapy, non-small cell lung cancer, multiple brain metastases

Jing-Jin Weng,* Jia-Zhang Wei,* Min Li, Shao-Jie Zhang, Yun-Zhong Wei, Han-Wei Wang, Dan-Xue Qin, Jin-Long Lu, He Jiang, Shen-Hong Qu Department of Otolaryngology & Head and Neck, The People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, People’s Republic of China*These authors contributed equally to this work.Correspondence: Shen-Hong QuDepartment of Otolaryngology & Head and Neck, The People’s Hospital of Guangxi Zhuang Autonomous Region, No. 6 Taoyuan Road, Nanning 530021, People’s Republic of ChinaTel +86-771-2186580Fax +86-771-2186317Email qshdoctor@163.comObjective: The efficacy of surgery as the primary treatment modality for nasopharyngeal carcinoma (NPC) is yet to be clarified. Therefore, we aimed to explore the short- and long-term efficacy of surgery for early-stage NPC.Methods: We retrospectively evaluated 341 patients diagnosed with early-stage NPC between September 2010 and December 2015. Among them, 58 patients underwent endoscopic nasopharyngectomy combined with chemoradiotherapy, whereas 283 patients underwent conventional chemoradiotherapy. The patients who underwent concurrent chemoradiotherapy or radiotherapy alone were matched to patients who underwent surgery in a 1:2 ratio using propensity score matching to analyze the clinical efficacy of each therapeutic modality. The primary endpoint was survival, and the secondary endpoints were tumor regression rate and reduction in Epstein–Barr virus (EBV)-DNA levels.Results: After matching, 156 patients were enrolled (58 patients in the surgery group; 98 patients in the non-surgery group). The baseline data of the matched patients had good inter-group comparability (All P> 0.05). The surgery group had significantly higher 5-year overall survival (98.30% vs. 91.70%), disease-free survival (98.30% vs. 81.40%), and recurrence-free survival (100.00% vs. 90.10%) rates than did the non-surgery group (All P< 0.05). In total, 0 and 14 patients in the surgery and non-surgery groups, respectively, had residual cancer at the end of treatment (P=0.001). All patients in the surgery group tested negative for EBV-DNA, whereas two patients in the non-surgery group tested positive. The incidence of hematologic toxicity during treatment was similar between the two groups (All P> 0.05). Still, the incidence of severe oral mucositis was lower in the surgery group than in the non-surgery group (37.9% vs. 54.08%, P=0.051).Conclusion: Surgery can improve the clearance rate of EB virus and reduce tumor residue. Surgery may be a safe and effective treatment for early NPC.Keywords: nasopharyngeal carcinoma, endoscopic surgery, radiotherapy, prognosis

Lei Shi,1 Xiuli Wang,1 Feng Zhao,2 Hansen Luan,2 Qingfeng Tu,1 Zheng Huang,3 Hao Wang,2 Hongwei Wang1,41Shanghai Skin Disease Hospital, Shanghai, People's Republic of China; 2National Pharmaceutical Engineering Research Center, China State Institute of Pharmaceutical Industry, Shanghai, People's Republic of China; 3Ministry of Education (MOE) Key Laboratory of OptoElectronic Science and Technology for Medicine, Fujian Normal University, Fuzhou, People's Republic of China; 4Huadong Hospital, Fudan University, Shanghai, People's Republic of ChinaBackground: 5-Aminolevulinic acid (ALA) is a prodrug for topical photodynamic therapy. The effectiveness of topical ALA can be limited by its bioavailability. The aim of this study was to develop a novel ALA delivery approach using poly(lactic-co-glycolic acid) (PLGA) nanoparticles (NPs).Methods: A modified double emulsion solvent evaporation method was used to prepare ALA loaded PLGA NPs (ALA PLGA NPs). The characteristics, uptake, protoporphyrin IX fluorescence kinetics, and cytotoxicity of ALA PLGA NPs toward a human skin squamous cell carcinoma cell line were examined.Results: The mean particle size of spherical ALA PLGA NPs was 65.6 nm ± 26 nm with a polydispersity index of 0.62. The encapsulation efficiency was 65.8% ± 7.2% and ALA loading capacity was 0.62% ± 0.27%. When ALA was dispersed in PLGA NPs, it turned into an amorphous phase. ALA PLGA NPs could be taken up by squamous cell carcinoma cells and localized in the cytoplasm. The protoporphyrin IX fluorescence kinetics and 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide assay showed that ALA PLGA NPs were more effective than free ALA of the same concentration.Conclusion: PLGA NPs provide a promising ALA delivery strategy for topical ALA-photodynamic therapy of skin squamous cell carcinoma.Keywords: 5-Aminolevulinic acid (ALA), nanoparticles, poly(lactic-co-glycolic acid) (PLGA), skin squamous cell carcinoma, photodynamic therapy (PDT)

Hsiao-Wei Wang1, Chung-Wei Cheng2, Ching-Wen Li3, Han-Wei Chang4, Ping-Han Wu2, Gou-Jen Wang 1Graduate Institute of Biomedical Engineering, National Chung Hsing University, Taichung, Taiwan, 2Laser Application Technology Center, Industrial Technology Research Institute, Tainan County, Taiwan, 3Department of Mechanical Engineering, 4Department of Chemical Engineering, National Chung Hsing University, Taichung, Taiwan, People’s Republic of ChinaAbstract: One of the persistent challenges confronting tissue engineering is the lack of intrinsic microvessels for the transportation of nutrients and metabolites. An artificial microvascular system could be a feasible solution to this problem. In this study, the femtosecond laser ablation technique was implemented for the fabrication of pillared microvessel scaffolds of polylactic-co-glycolic acid (PLGA). This novel scaffold facilitates implementation of the conventional cell seeding process. The progress of cell growth can be observed in vitro by optical microscopy. The problems of becoming milky or completely opaque with the conventional PLGA scaffold after cell seeding can be resolved. In this study, PLGA microvessel scaffolds consisting of 47 µm × 80 µm pillared branches were produced. Results of cell culturing of bovine endothelial cells demonstrate that the cells adhere well and grow to surround each branch of the proposed pillared microvessel networks.Keywords: femtosecond laser ablation, pillared microvessel scaffold, polylactic-co-glycolic acid, bovine endothelial cells

Boehmite (γ-AlOOH) and gibbsite (α-Al(OH)3) are important archetype (oxy)hydroxides of aluminum in nature that also play diverse roles across a plethora of industrial applications. Developing the ability to understand and predict the properties and characteristics of these materials, on the basis of their natural growth or synthesis pathways, is an important fundamental science enterprise with wide-ranging impacts. The present study describes bulk and surface characteristics of these novel materials in comprehensive detail, using a collectively sophisticated set of experimental capabilities, including a range of conventional laboratory solids analyses and national user facility analyses such as synchrotron X-ray absorption and scattering spectroscopies as well as small-angle neutron scattering. Their thermal stability is investigated using in situ temperature-dependent Raman spectroscopy. These pure and effectively defect-free materials are ideal for synthesis of advanced alumina products. ©

The magnetic structure of two natural samples of goethite (α-FeOOH) with varying crystallinity was analyzed at 15 and 300 K by neutron diffraction. The well crystallized sample has the Pb′nm color space group and remained antiferromagnetic up to 300 K, with spins aligned parallel to the c axis. The purely magnetic 100 peak, identifying this color space group, was clearly resolved. The nanocrystalline sample shows a phase transition to the paramagnetic state at a temperature below 300 K. This lowering of the Néel temperature may be explained by the interaction of magnetic clusters within particles. The nuclear structure, refined with the Rietveld and pair distribution function methods, is consistent with reports in the literature.

Seismic signals near rivers are partially composed of the elastic waves generated by bedload particles impacting the river bed. In this study, we explore the relationship between this seismic signal and river bedload transport by analyzing high-frequency broadband seismic data from multiple stations along the Chijiawan River in northern Taiwan following the removal of a 13 m check dam. This dam removal provides a natural experiment in which rapid and predictable changes in the river's profile occur, which in turn enables independent constraints on spatial and temporal variation in bedload sediment transport. We compare floods of similar magnitudes with and without bedload transport, and find that the amplitude of seismic shaking produced at a given river stage changes over the course of a single storm when bedload transport is active. Hysteresis in the relationship between bedload transport and river stage is a well-documented phenomenon with multiple known causes. Consequently, previous studies have suggested that hysteresis observed in the seismic amplitude-stage response is the signature of bedload transport. Field evidence and stream profile evolution in this study corroborate that interpretation. We develop a metric ( Ψ) for the normalized magnitude of seismic hysteresis during individual floods. This metric appears to scale qualitatively with total bedload transport at each seismic station, indicating a dominance of transport on the rising limbs of both storms. We speculate that hysteresis at this site arises from time-dependent evolution of the bed, for example due to grain packing, mobile armoring, or the temporal lag between stage and bedform growth. Ψ reveals along-stream variations in hysteresis for each storm, with a peak in hysteresis further downstream for the second event. The pattern is consistent with a migrating sediment pulse that is a predicted consequence of the dam removal. Our results indicate that hysteresis in the relationship between seismic wave amplitude and river stage may track sediment transport. © 2014 The Authors.

Objectives: Patients undergoing hemodialysis using a catheter are at significant risk of developing central venous catheter–related bloodstream infections (CRBSIs), especially with methicillin-resistant Staphylococcus aureus (MRSA), resulting in increased morbidity, mortality, and cost. In our 1,000-bed regional hospital, the average CRBSI (any bacteria) rate in patients dialyzing via dialysis catheters was 1.44 per 1,000 catheter days, and the average CRBSI (MRSA) rate was 0.56 per 1,000 catheter days. A quality improvement project was initiated to reduce the overall dialysis CRBSI and CRBSI-MRSA by 50%. Methods: Following the formation of a multidisciplinary team, the catheter-insertion protocols and catheter-care protocols were standardized throughout the hospital. We adopted a well-established scientific quality improvement method, plan–do–study–act (PDSA) cycle model for all interventions that were implemented. The patients and general ward nursing staff were provided education and training in dialysis catheter care. Results: The project was initiated in January 2016, and the initial improvement was seen from July 2017 onward. Analysis of the data since 2016 showed a steady improvement in the overall CRBSI rates, as well as CRBSI-MRSA rates. The average CRBSI rate improved to 0.76 per 1,000 catheter days, and the average CRBSI-MRSA rates improved to 0.15 per 100 catheter days in the calendar year 2021. Conclusions: Because the causes of these infections are multifactorial, emphasis should be placed on improving care processes from the patient preparation phase prior to catheter insertion to regular catheter care in the inpatient wards and dialysis units. We attribute the success of our project to involving all stakeholders and obtaining constant feedback from the staff. We successfully applied PDSA cycles to make relevant incremental changes.

Recent research works in the area of experimental and computational analyses of microscale mechanisms of strength, damage and degradation of glass fiber polymer composites for wind energy applications, which were carried out in the framework of a series of Sino–Danish collaborative research projects, are summarized in this article. In a series of scanning electron microscopy in situ experimental studies of composite degradation under off-axis tensile, compressive and cyclic loadings as well as three-dimensional computational experiments based on micromechanics of composites and damage mechanics, typical damage mechanisms of wind turbine blade composites were clarified. It was demonstrated that the damage mechanisms in the composites strongly depend on the orientation angle of the applied loading with the fiber direction. The matrix cracking was observed to be the main damage mechanism for tensile axial (or slightly off-axis axial) loading; for all other cases (off-axis tensile, compressive and cyclic tensile loadings), the interface debonding and shear control the damage mechanisms. [ABSTRACT FROM AUTHOR]

Using the evanescent-wave saturation effect of hydrogen-free low-temperature synthesized few-layer graphene covered on the cladding region of a side-polished single-mode fiber, a blue pump/infrared probe-based all-optical switch is demonstrated with specific wavelength-dependent probe modulation efficiency. Under the illumination of a blue laser diode at 405 nm, the few-layer graphene exhibits cross-gain modulation at different wavelengths covering the C- and L-bands. At a probe power of 0.5 mW, the L-band switching throughput power variant of 16 μW results in a probe modulation depth of 3.2%. Blue shifting the probe wavelength from 1580 to 1520 nm further enlarges the switching throughput power variant to 24 mW and enhances the probe modulation depth to 5%. Enlarging the probe power from 0.5 to 1 mW further enlarges the switching throughput power variant from 25 to 58 μW to promote its probe modulation depth of up to 5.8% at 1520 nm. In contrast, the probe modulation depth degrades from 5.1% to 1.2% as the pumping power reduces from 85 to 24 mW, which is attributed to the saturable absorption of the few-layer graphene-based evanescent-wave absorber. The modulation depth at wavelength of 1550 nm under a probe power of 1 mW increases from 1.2% to 5.1%, as more carriers can be excited when increasing the blue laser power from 24 to 85 mW, whereas it decreases from 5.1% to 3.3% by increasing the input probe power from 1 to 2 mW to show an easier saturated condition at longer wavelength.

Background: A phenomenon of 'masking' or 'cloaking' in pharmacovigilance data mining has been described, which can potentially cause signals of disproportionate reporting (SDRs) to be missed, particularly in pharmaceutical company databases. Masking has been predicted theoretically, observed anecdotally or studied to a limited extent in both pharmaceutical company and health authority databases, but no previous publication systematically assesses its occurrence in a large health authority database.Objective: To explore the nature, extent and possible consequences of masking in the US FDA Adverse Event Reporting System (AERS) database by applying various experimental unmasking protocols to a set of drugs and events representing realistic pharmacovigilance analysis conditions.Methods: This study employed AERS data from 2001 through 2005. For a set of 63 Medical Dictionary for Regulatory Activities (MedDRA®) Preferred Terms (PTs), disproportionality analysis was carried out with respect to all drugs included in the AERS database, using a previously described urn-model-based algorithm. We specifically sought masking in which drug removal induced an increase in the statistical representation of a drug-event combination (DEC) that resulted in the emergence of a new SDR. We performed a series of unmasking experiments selecting drugs for removal using rational statistical decision rules based on the requirement of a reporting ratio (RR) >1, top-ranked statistical unexpectedness (SU) and relatedness as reflected in the WHO Anatomical Therapeutic Chemical level 4 (ATC4) grouping. In order to assess the possible extent of residual masking we performed two supplemental purely empirical analyses on a limited subset of data. This entailed testing every drug and drug group to determine which was most influential in uncovering masked SDRs. We assessed the strength of external evidence for a causal association for a small number of masked SDRs involving a subset of 29 drugs for which level of evidence adjudication was available from a previous study.Results: The original disproportionality analysis identified 8719 SDRs for the 63 PTs. The SU-based unmasking protocols generated variable numbers of masked SDRs ranging from 38 to 156, representing a 0.43-1.8% increase over the number of baseline SDRs. A significant number of baseline SDRs were also lost in the course of our experiments. The trend in the number of gained SDRs per report removed was inversely related to the number of lost SDRs per protocol. Both the number and nature of the reports removed influenced the number of gained SDRs observed. The purely empirical protocols unmasked up to ten times as many SDRs. None of the masked SDRs had strong external evidence supporting a causal association. Most involved associations for which there was no external supporting evidence or were in the original product label. For two masked SDRs, there was external evidence of a possible causal association.Conclusions: We documented masking in the FDA AERS database. Attempts at unmasking SDRs using practically implementable protocols produced only small changes in the output of SDRs in our analysis. This is undoubtedly related to the large size and diversity of the database, but the complex interdependencies between drugs and events in authentic spontaneous reporting system (SRS) databases, and the impact of measures of statistical variability that are typically used in real-world disproportionality analysis, may be additional factors that constrain the discovery of masked SDRs and which may also operate in pharmaceutical company databases. Empirical determination of the most influential drugs may uncover significantly more SDRs than protocols based on predetermined statistical selection rules but are impractical except possibly for evaluating specific events. Routine global exercises to elicit masking, especially in large health authority databases are not justified based on results available to date. Exercises to elicit unmasking should be driven by prior knowledge or obvious data imbalances. [ABSTRACT FROM AUTHOR]

Objective: To prospectively evaluate the feasibility, safety and efficacy of the percutaneous pedicle screw fixation through the pedicle of fractured vertebra in the treatment of type A thoracolumbar fractures using Sextant system in the retrospective non-randomized case-control study.Methods: A total of 38 consecutive non-randomized patients with type A thoracolumbar fractures, which had been stabilized posteriorly from December 2006 to March 2009, were examined retrospectively more than 9 months after surgery. Twenty-one patients had been treated conventionally with open pedicle screw fixation (OPSF) and 17 patients received minimally invasive treatment with Sextant percutaneous pedicle screw fixation (SPPSF). As a method of evaluation, the incision size, the intraoperation and postoperative volume of blood loss, operation time, postoperative hospital stay, blood transfusion, the radiological assessment of the sagittal Cobb;s angle, vertebral body angle and vertebral body height were recorded and compared.Results: All patients were followed up for 8-24 months (average 11.6 months). There were significant differences in the incision size, surgical blood loss, surgical draining loss, operation time, hospital stay after operation, blood transfusion, the proportion of antalgic supplement and postoperative incisional VAS between the two groups (P less than 0.05). Mean preoperative kyphotic deformity was 16.0 degree and improved by 9.3 degree after surgery in OPSF group, but 15.2 degree and 10.3 degree respectively in SPPSF group. Mean preoperative angle of the fractured vertebral body was 15.9 degree and improved by 7.9 degree after surgery in OPSF group, but 14.9 degree and 6.6 degree respectively in SPPSF group. Mean anterior vertebral body height (% of normal) was 67.3% before surgery and 95.8% after surgery, but 69.1% and 90.1% respectively in SPPSF group. Mean posterior vertebral body height (% of normal) was 93.3% before surgery and 99.5% after surgery, but 88.9% and 93.3% respectively in SPPSF group. Among the patients whose 9-month follow-up films were available, 3.0 degree of kyphosis correction was lost in OPSF group, but 3.2 degree in SPPSF group. And 1.0 degree of the angle of the fractured vertebral body correction was lost in OPSF group, but 1.5 degree in SPPSF group. Then 3.0% of the anterior vertebral body height correction was lost in OPSF group, but 2.2% in SPPSF group. And 3.0% of the posterior vertebral body height correction was lost in OPSF group, but 2.5% in SPPSF group. The sagittal Cobb's angle, vertebral body angle and anterior height of the fractured vertebra were all significantly different in each group before and after operation (P less than 0.05). There were no significant differences in the postoperative sagittal Cobb's angle, vertebral body angle and the improvement of the vertebral body height and the kyphotic deformity correction between OPSF and SPPSF groups (P larger than 0.05), but there was significant difference in the postoperative anterior height of the fractured vertebra between the two groups (P less than 0.05).Conclusion: The percutaneous pedicle screw fixation through the pedicle of fractured vertebra using Sextant system is a good minimally-invasive surgical therapeutic choice for patients with type A thoracolumbar fracture except for that the SPPSF has a little insufficiency in resuming the anterior height of the fractured vertebra compared with OPSF. [ABSTRACT FROM AUTHOR]

Objective: In recent years, oxidative stress has been implicated in a variety of degenerative process and diseases, including acute and chronic inflammatory conditions such as wound healing. Green tea polyphenols have shown anti-oxidant property. The present study discussed the application of chitosan green tea polyphenol complex on the wound healing.Methods: The wound healing effect of chitosan green tea polyphenol complex was studied in ten-week-old healthy male Sherman rats weighing 150-180 g by two wound models. The rats were randomly chosen and divided into four groups (n=5), administered with distilled water in Group A as control group, epigallocatechin-3-gallate (EGCG) in Group B, chitosan-EGCG complex in Group C and chitosan-green tea polyphenols complex in Group D, respectively. In rats'incision wound model, two straight paravertebral incisions were made and skin tensile strength was measured using continuous water flow technology on the 10th day. In rats'excision wound model, wound contraction and period of epithelization were measured. The polyphenols release from the complex was continuously monitored by an elution technique in aqueous solution at different pH values (pH=4, 5, 6, 7).Results: The treatment groups showed significantly enhanced the breaking strength in incision wound (328+/-14.5) g and (421+/-18.5) g compared with control (264+/-16.7) g. In the excision wound model, the wound contraction percentage in treatment groups was relatively increased during the recovery period. Respectively, the percentage of wound contraction ranged from 47.60%+/-2.15% on day 4 to 107.98% +/-1.26% on day 16 compared with control group (8.46%+/-5.42% to 59.80%+/-4.47%). The complex demonstrated a gradual increase in the release rate from the initial stage and slow increase at different pH values. The release rate approximated 0.6-0.7 in the complex and remained stable 6 hours after injury, which may be the end of the release process.Conclusions: In our study, chitosan polyphenol complex has enhanced the healing of incision wounds by increasing the breaking strength of the wounds. In excision wound model, the complex hastens the period of epithelialization. The study on the optimal release of complex among various pH values could be applied in the wound test, which can lead to a gradually active substance(polyphenols) release and efficient coverage of epithelial layers found in the healing of incision and excision wound. [ABSTRACT FROM AUTHOR]

Epilepsy is one of the most common neurological disorders, which is characterized by unpredictable brain seizure. About 30% of the patients are not even aware that they have epilepsy and many have to undergo surgeries to relieve the pain. Therefore, developing a robust brain-computer interface for seizure prediction can help epileptic patients significantly. In this paper, we propose a hybrid CNN-SVM model for better epileptic seizure prediction. A convolutional neural network (CNN) consists of a multilayer structure, which can be adapted and modified according to the requirement of different applications. A support vector machine is a discriminative classifier which can be described by a separating optimal hyperplane used for categorizing new samples. The combination of CNN and SVM is found to provide an effective way for epileptic prediction. Furthermore, the resulting model is made autonomous using edge computing services and is shown to be a viable seizure prediction method. The results can be beneficial in real-life support of epilepsy patients.