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本文由林維祥醫師領導與執行，使用中華民國心臟學會心衰竭資料庫分析臺灣老年人收縮性心衰竭死亡風險的性別差異，再進一步分析在臺灣老年人急性心衰竭中存在之生理性別(sex)與社會性別(gender)的差異。本研究發現心衰竭病人的生理性別與社會性別相互交織會影響病程發展與醫師診斷，因此提供醫療照護時，應看見病人生理性別與社會性別交織的影響，而非以男女的生理性別為基礎進行診治。本研究為本土的性別醫學新知識，若能在各專科醫學課程增列類似的本土研究案例，必能提高醫師與醫學生的性別敏感度，增強性別醫學知識，提升醫療照護品質。 This study was conducted under the leadership of Dr. Wei-Shiang Lin. The heart failure database of the Taiwan Society of Cardiology provided the source data for the analysis of sex differences in the risk of dying from systolic heart failure in Taiwanese older adults, and the findings were used to further determine the sex and gender differences in Taiwanese older adults that developed acute heart failure. This study noted that the intertwining sex and gender concepts of patients with heart failure affected their disease development and diagnoses. Therefore, the provision of medical care should be based on the effect of a patient’s intertwining sex and gender concepts rather than the patient’s sex. This study has enriched the field of gender medicine in Taiwan. The addition of similar studies on local cases to the curricula of medical schools will improve the gender sensitivity of physicians and medical students, expand their knowledge in gender medicine, and enhance the quality of medical care. &nbsp

Background: Healthcare professionals follow codes of ethics, making them responsible for providing holistic care to all disaster victims. However, this often results in ethical dilemmas due to the need to provide rapid critical care while simultaneously attending to a complex spectrum of patient needs. These dilemmas can cause negative emotions to accumulate over time and impact physiological and psychological health, which can also threaten nurse–patient relationships. Aim: This study aimed to understand the experience of nurses who cared for burn victims of the color-dust explosion and the meaning of ethical relationships between nurse and patient. Research design: A qualitative descriptive study using a phenomenological approach. Participants and research context: Clinical nurses who provided care to the patients of the Formosa color-dust explosion of 2015 were selected by purposive sampling (N = 12) from a medical center in Taiwan. Data were collected using individual in-depth semi-structured interviews. Audiotaped interviews were transcribed and analyzed using Colaizzi’s method. Ethical considerations: This study was approved by the institutional review board of the study hospital. All participants provided written informed consent. Findings Three main themes described the essence of the ethical dilemmas experienced by nurses who cared for the burn-injured patients: (1) the calling must be answered, (2) the calling provoked my feelings, and (3) the calling called out my strengths. Conclusions: Healthcare providers should recognize that nurses believed they had an ethical responsibility to care for color-dust explosion burn victims. Understanding the feelings of nurses during the care of patients and encouraging them to differentiate between the self and the other by fostering patient–nurse relationships based on intersubjectivity could help nurses increase self-care and improve patient caregiving.

Hepatocellular carcinoma (HCC) located in the caudate lobe (caudate HCC) is rare; however, patients with this type of tumour have poorer prognoses than those with HCC in other segments. Despite many published reports on the clinical usefulness of proton beam therapy (PBT) for HCC, data on the clinical outcomes of patients undergoing PBT for caudate HCC remain scarce. Therefore, the present study aimed to investigate the outcomes of this group of patients. Thirty patients with caudate HCC who underwent definitive PBT between February 2002 and February 2014 were retrospectively analysed. The total irradiation doses ranged from 55 to 77 (median 72.6) Gy relative biological dose. The median follow-up period was 37.5 (range, 3.0–152.0) months. The overall survival (OS) rates at one, three and five years were 86.6%, 62.8% and 46.1%, respectively. According to univariate and multivariate analyses, Child-Pugh A (P

Unirradiated liver volume (ULV) preservation rate is an important factor associated with radiation-induced liverdisease (RILD) in patients with hepatocellular carcinoma (HCC) undergoing proton beam therapy (PBT). The purpose of this study is to identify the predictors for ULV preservation and quantify the capacity of proton beamsin normal liver sparing during PBT. We reviewed planning data of 92 patients with single intrahepatic HCC tumors undergoing PBT. The potential clinical and planning factors that may affect ULV preservation were involved in multiple linear regression forULVpreservation rate.The significant factorswere determined to be predictors and their influences were quantified. The median ULV preservation rate was 62.08%. All the assessed clinical factors showed significant effects on ULV preservation rate: clinical target volume (CTV), P

Unirradiated liver volume (ULV) preservation rate is an important factor associated with radiation-induced liver disease (RILD) in patients with hepatocellular carcinoma (HCC) undergoing proton beam therapy (PBT). The purpose of this study is to identify the predictors for ULV preservation and quantify the capacity of proton beams in normal liver sparing during PBT. We reviewed planning data of 92 patients with single intrahepatic HCC tumors undergoing PBT. The potential clinical and planning factors that may affect ULV preservation were involved in multiple linear regression for ULV preservation rate. The significant factors were determined to be predictors and their influences were quantified. The median ULV preservation rate was 62.08%. All the assessed clinical factors showed significant effects on ULV preservation rate: clinical target volume (CTV), P

Cervical cancer patients may sometimes experience subserosal tandem insertions during brachytherapy, which can lead to increased but unnoticed irradiations to the small bowel (SB). In this study, we aimed to quantify and further predict individual SB dose increase and to increase focus on the SB in subserosal tandem insertions. Images and dosimetry data of cervical cancer brachytherapy with subserosal insertion (SI) were reviewed. The percentage increases in the SB dose compared with intracavitary insertion (II) at 8 points of D(x)cc with 10 cc intervals were assessed. SI was classified into anterior and posterior SI according to the insertion site. The differences in minimum distance from the tandem tip to the SB on the axial view between these 2 insertions were tested using the Mann-Whitney test. The distance and D(x)cc were involved in the individual dose increase model by linear regression as prediction factors. A total of 27 insertions were evaluated, including 8 insertions with SI and 19 insertions with II. The median percentage increases in the normalized SB dose for all SI showed a logarithmic trend with a 55.4% increase at the hotspot. In contrast to posterior SI, anterior SI demonstrated a more significantly logarithmic trend, which featured highly increased doses at the hotspot (79.1% for the absolute SB dose and 137.8% for the normalized SB dose). The prediction models can predict the percentage dose increases in SI: Increased D(x)cc [%] = 31.370 – 7.865 ln (distance) – 3.949 ln (x) (absolute SB dose), and Increased D(x)cc [%] = 55.618 – 18.591 ln (distance) – 7.232 ln (x) (normalized SB dose). We developed prediction models for individual SB dose increase in SI in our study. SB hotspots in anterior SI require greater attention during cervical cancer brachytherapy. The models are new ones and are given for the first time.

Purpose The purpose of this study is to introduce half‐beam volumetric‐modulated arc therapy (HVMAT), an innovative treatment planning technique from our work, for reducing dose to the organs at risk (OAR) during adjuvant radiotherapy for gynecological cancers. Methods and materials Seventy‐two treatment plans of 36 patients with gynecological cancers receiving adjuvant radiotherapy were assessed. Among them, 36 plans were designed using HVMAT and paired with the other 36 traditional volumetric‐modulated arc therapy (VMAT) plans for each patient. The main uniqueness of the HVMAT designs was that it consisted of two opposite‐shielded half‐beam fields rotated inversely in two coplanar arcs, collocating with the specially‐devised avoidance structures to enhance the control of the OAR doses. The dose distributions in HVMAT and VMAT were evaluated and compared using the random effects model. Results The ratios of OAR doses in HVMAT compared with VMAT showed a comprehensive OAR dose reduction when using HVMAT (V 20Gy: bladder, 0.92; rectum, 0.95; V 30Gy: bowel, 0.91; femoral heads, 0.66), except for the ilium (V 30Gy: 1.12). The overall mean difference for each OAR across V 40Gy, V 30Gy, V 20Gy, and bowel V 15Gy was statistically significant (almost all p

The objective of this study is to elucidate the relationship between obstructive sleep apnea (OSA) and the risk of work-related injuries (WRIs), synthesize the latest clinical evidence and conduct a systematic review and meta-analysis adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (PRISMA 2020). Observational studies published before April 2020 in PubMed, Cochrane library, PsycINFO, Scopus, Google Scholar and Web of Science were included. Random-effects Mantel-Haenszel meta-analysis was performed. A total of 15 studies with 21,507 participants were included. Prespecified subgroup analyses based on study design and the characteristics of the enrollees were conducted. Overall, workers with OSA had 1.64-fold increased odds of being involved in WRIs compared to their counterparts (OR = 1.64, 95% CI = 1.24-2.16, p = 0.0005). In addition to the professional drivers that have been studied in the past, such a trend also existed in the general working population (OR = 1.68, 95% CI = 1.14-2.49, p = 0.01). We also found that workers with excessive daytime sleepiness (Epworth Sleepiness Scale score >10) had a 1.68-fold increased risk of WRIs compared to those with lower ESS scores (OR = 1.68, 95% CI = 1.22-2.30, p = 0.002). This study verified that OSA workers had a higher risk of WRIs, and such correlations do not show obvious differences in subgroups with different sample sizes, OSA diagnosis methods, job types or definitions of WRI. Based on the association between OSA and WRIs identified in our study, further studies investigating the protective effects of early identification and management of OSA on WRIs are warranted.

Background: Patients with a traumatic injury often require intensive care for life-saving treatments. Physical suffering and emotional stress during critical care can be alleviated by ethical caring provided by nurses. The relationship between body and self are fundamentally inseparable. Nurses need to understand the impacts of traumatic injury on a patient’s body and self. Aim: To understand the meaning of traumatic injury for body and self for patients receiving intensive care. Research design: A qualitative descriptive study using Giorgi’s phenomenological approach. Participants and research context: Patients receiving intensive care for physical trauma were selected by purposive sampling (N = 15) from a medical center in Taiwan. Individual in-depth, face-to-face audiotaped interviews, guided by semi-structured questions, were used to collect data. Each interview lasted 30–60 min. Audiotaped interviews were transcribed and analyzed. Ethical considerations: This study was approved by the Institutional Review Board of the medical center. Findings: The impact of the experience of traumatic injury on participants’ body and self was described by three main themes: (1) Searching for the meaning of the injured body, (2) Feeling trapped in the bed, and (3) The carer and the cared-for. Discussion and conclusion: The implications of the three themes described in the findings are as follows: Trauma as a source of meaning; Body and self are mutually limiting or mutually enabling; and Ethical relationships. The experience of needing intensive care following a traumatic injury on the body and self was dynamic and mutual. The experience of the injury changed the relationship between body and self, and gave new meaning to life. Nurses play a crucial role in continuity of care by understanding the meaning of a traumatic injury for patient’s body and self that facilitates ethical care and recovery from injury.

Background and Aims Nitrate can stimulate seed germination of many plant species in the absence of light; however, the molecular mechanism of nitrate-promoted seed germination in the dark remains largely unclear and no component of this pathway has been identified yet. Here, we show that a plastid J-domain protein, DJC75/CRRJ, in arabidopsis (Arabidopsis thaliana) is important for nitrate-promoted seed germination in the dark. Methods The expression of DJC75 during imbibition in the dark was investigated. The seed germination rate of mutants defective in DJC75 was determined in the presence of nitrate when light cues for seed germination were eliminated by the treatment of imbibed seeds with a pulse of far-red light to inactivate phytochrome B (phyB), or by assaying germination in the dark with seeds harbouring the phyB mutation. The germination rates of mutants defective in CRRL, a J-like protein related to DJC75, and in two chloroplast Hsp70s were also measured in the presence of nitrate in darkness. Key Results DJC75 was expressed during seed imbibition in the absence of light. Mutants defective in DJC75 showed seed germination defects in the presence of nitrate when light cues for seed germination were eliminated. Mutants defective in CRRL and in two chloroplast Hsp70s also exhibited similar seed germination defects. Upregulation of gibberellin biosynthetic gene GA3ox1 expression by nitrate in imbibed phyB mutant seeds was diminished when DJC75 was knocked out. Conclusions Our data suggest that plastid J-domain protein DJC75 regulates nitrate-promoted seed germination in the dark by upregulation of expression of the gibberellin biosynthetic gene GA3ox1 through an unknown mechanism and that DJC75 may work in concert with chloroplast Hsp70s to regulate nitrate-promoted seed germination. DJC75 is the first pathway component identified for nitrate-promoted seed germination in the dark.

Purpose To introduce the benefits of tangent-based volumetric modulated arc therapy (TVMAT), an innovative radiotherapy planning technique, compared with traditional volumetric modulated arc therapy (VMAT) for advanced left breast cancer needing nodal irradiation. Materials and methods Twenty-three patients with advanced left breast cancer who had received modified radical mastectomy (MRM) and needed adjuvant radiotherapy including nodal irradiation were assessed. Among 23 radiotherapy treatment plans, 17 plans were designed by using TVMAT technique and 6 plans were designed by using traditional VMAT. The main difference of TVMAT from VMAT was that the area of avoidance sector within specific degrees of angle that had no monitor unit (MU) delivery was used in the arc planning, including a total of 5 sectors in 5 partial arcs. The dosimetries of planning target volume (PTV), right breast, bilateral lungs, and heart between TVMAT and VMAT were compared. Results The conformity index (CI) and homogeneity index (HI) of PTV between two groups were statistically equivalent (CI: 0.98 ± 0.02 and 0.98 ± 0.03, P = 0.431; HI: 0.12 ± 0.03 and 0.11 ± 0.05, P = 0.177), which indicated that the treatment efficacy of the plans regarding TVMAT was compatible with VMAT. However, all neighboring organs at risk (OAR) showed a great percentage of reduction in mean doses (right breast: 53.1%, right lung: 37.7%, left lung: 8.8%, heart: 21.2%) and low dose parameters (V10: right breast: 72.3%, right lung: 86.1%, left lung: 12.5%, heart: 25.1%; V5: right breast: 56.5%, right lung: 28.3%, left lung: 12.7%, heart: 18.2%) by using TVMAT. Conclusion TVMAT greatly decreases the radiation doses delivered to the OAR with maintained therapeutic efficacy. It is highly recommended for treating breast cancer, especially for difficult cases with left side disease needing nodal irradiation.

This study's aims are to examine the effects of aromatherapy massage on women's stress and immune function during pregnancy.This longitudinal, prospective, randomized controlled trial recruited 52 healthy pregnant women from a prenatal clinic in Taipei using convenience sampling. The participants were randomly assigned to the intervention (n = 24) or control (n = 28) group using Clinstat block randomization. The intervention group received 70 min of aromatherapy massage with 2% lavender essential oil every other week (10 times in total) for 20 weeks; the control group received only routine prenatal care. In both groups, participants' salivary cortisol and immunoglobulin A (IgA) levels were collected before and after the intervention group received aromatherapy massage (every month from 16 to 36 weeks gestation) and were analyzed using enzyme-linked immunosorbent assay.The pregnant women in the intervention group had lower salivary cortisol (p 0.001) and higher IgA (p 0.001) levels immediately after aromatherapy massage than those in the control group, which did not receive massage treatment. Comparing the long-term effects of aromatherapy massage on salivary IgA levels between groups at different times, the study found that the pretest salivary IgA levels at 32 (p = 0.002) and 36 (p 0.001) weeks gestational age (GA) were significantly higher than the pretest IgA at 16 weeks GA (baseline).This study presented evidence that aromatherapy massage could significantly decrease stress and enhance immune function in pregnant women. The findings can guide clinicians or midwives in providing aromatherapy massage to women throughout the pregnancy.

A three-year-old female intact albino ferret was presented with clinical signs of panting, hyperpnea, weakness in all four limbs, loss of the swallowing reflex, lockjaw and sudden paleness of the oral mucosa and extremities. An abdominal mass was discovered during palpation. The patient died suddenly after clinical signs were observed. At necropsy, hemoperitoneum was noted in the abdominal cavity and a [Formula: see text][Formula: see text]cm dark red moruloid mass was found in the mesentery of the ileum. Histopathological examination of the mass revealed multiple cavernous structures with significant blood accumulation. Oval to polygonal neoplastic cells with frequent mitotic figures were also noted. Furthermore, neoplastic cells were positively stained with antibodies of CD34 and Factor VIII, and had metastasized to the mesentery lymph nodes. The definitive diagnosis was visceral hemangiosarcoma in a ferret.

A young female Reeves’s muntjac (Muntiacus reevesi) was presented with signs of weakness and inability to stand. Radiographic examination revealed a healed bone fracture in the right radius and ulna. The animal failed to respond to therapy and died two days later. At necropsy, serous atrophy was mainly present in the subcutis of the skull and ventral cervical skin. Muscular atrophy was also evident, especially around the right femur. Multiple bone calluses with newly developed bone fractures were distributed on both sides of the ribs. Microscopically, decreased and irregularly thin bony trabeculae and widened trabeculae with excess unmineralized osteoid were observed in both femurs. Multiple sarcocysts were incidentally noted in the right femoral and longissimus dorsi muscles. It was concluded that M. reevesi in the present case appeared to have suffered from osteoporosis and osteomalacia with multiple bone fractures.

Background Tangent-based intensity modulated radiation therapy (TIMRT) is a common adjuvant radiotherapy strategy for breast cancer patients. This study compared the dosimetric characteristics of tangent-based volumetric modulated arc therapy (TVMAT) and TIMRT for left breast cancer patients during deep inspiration breath-hold (DIBH) and free breathing (FB) techniques. Methods Fourteen patients with left breast cancer after breast-conserving surgery were included. The first arc started at 331.8–353.6 degrees and stopped at 281.8–315.0 degrees. The third arc started at 123.2–149.1 degrees and stopped at 88.0–96.0 degrees. The second and fourth arcs were reverse arcs of first and third arcs. DIBH-TIMRT inversing plans were generated using opposing tangential fields. Wilcoxon signed rank test and Spearman correlation were used to examine the significance of dose difference. Results Compared with FB-TVMAT, the mean heart dose of DIBH-TVMAT plans was reduced from 7.9 Gy to 3.2 Gy (p

Cervical cancer patients may sometimes experience different types of uterine perforation by a tandem during brachytherapy. The purpose of this study was to address possibly different management strategies regarding different tandem positions from a dosimetry aspect by evaluating radiation doses delivered to organs-at-risk (OAR) in order to help medical professionals handle different types of uterine perforation. Images and dosimetry data in cervical cancer brachytherapy with uterine perforation were reviewed. Uterine perforation was classified into anterior and posterior perforation according to their tandem positions. Radiation doses received by OAR, including D2cc and D1cc of the bladder, rectum, and sigmoid colon, were statistically compared with nonperforation. The doses of high-risk clinical target volume (HR-CTV) of cervical tumor and bilateral point A were also compared in order to assure that the plans had not compromised the treatment efficacy. A total of 21 applications were assessed, including 5 with anterior perforation, 4 with posterior perforation, and 12 without perforation. In anterior perforation, the bladder was the only organ that received a significantly increased dose about 30% at D2cc and D1cc. However, in posterior perforation, multiple OAR received significantly excessive doses: approximately 30% for the bladder, 37% for the rectum, and 100% for the sigmoid colon. The OAR dose assessment was based on a statistically equivalent cervical tumor dose. Different management strategies are possible for anterior vs posterior perforation during brachytherapy due to different detrimental extents on OAR dosimetry. The bladder warrants more attention in anterior perforation, without compromising target coverage in treatment planning. On the other hand, repositioning may be considered in posterior perforation due to relatively massive OAR detriments. This concept is a new one and is given for the first time.

Background To analyze the respiratory-induced motion of each liver segment using helical computed tomography (helical CT) and 4-dimensional computed tomography (4DCT), and to establish the individual segment expansion margin of internal target volume (ITV) to facilitate target delineation of tumors in different liver segments. Methods Twenty patients who received radiotherapy with CT-simulation scanning of the whole liver in both helical CT and 10-phase-gated 4DCT were investigated, including 2 patients with esophagus cancer, 4 with lung cancer, 10 with breast cancer, 2 with liver cancer, 1 with thymoma, and 1 with gastric diffuse large B-cell lymphoma (DLBCL). For each patient, 9 representative points were drawn on the helical CT images of liver segments 1, 2, 3, 4a, 4b, 5, 6, 7, and 8, respectively, and adaptively deformed to 2 phases of the 4DCT images at the end of inspiration (phase 0 CT) and expiration (phase 50 CT) in the treatment planning system. Using the amplitude of each point between phase 0 CT and phase 50 CT, we established quantitative data for the respiration-induced motion of each liver segment in 3-dimensional directions. Moreover, using the amplitude between the original helical CT and both 4DCT images, we rendered the individual segment expansion margin of ITV for hepatic target delineation to cover more than 95% of each tumor. Results The average amplitude (mean ± standard deviation) was 0.6 ± 3.0 mm in the left-right (LR) direction, 2.3 ± 2.4 mm in the anterior-posterior (AP) direction, and 5.7 ± 3.4 mm in the superior-inferior (SI) direction, respectively. All of the segments moved posteriorly and superiorly during expiration. Segment 7 had the largest amplitude in the SI direction, at 8.6 ± 3.4 mm. Otherwise, the segments over the lateral side, including segments 2, 3, 6, and 7, had greater excursion in the SI direction compared to the medial segments. To cover more than 95% of each tumor, the required expansion margin of ITV in the LR, AP, and SI directions were at least 2.5 mm, 2.5 mm, and 5.0 mm on average, respectively, with variations between different segments. Conclusions The greatest excursion occurred in liver segment 7, followed by the segments over the lateral side in the SI direction. The individual segment expansion margin of ITV is required to delineate targets for each segment and direction.

The study purpose was to examine the validities and reliabilities of the Chinese-versions Frommelt Attitudes Toward Care of the Dying Scale (Attitudes Scale) and Caregiving Behaviors Scale for End-of-Life Patients and Families (Behaviors Scale). The scales were tested in a convenience sample of 318 nurses with ≥6 months work experience at three hospitals. Cronbach’s alphas of the Attitudes and Behaviors Scales were .90 and .96, respectively. Each scale had Kaiser–Meyer–Olkin index >.85 and Bartlett’s test of sphericity >4000 ( p < .001). Attitudes Scale loaded on three factors: respecting and caring for dying patients and families, avoiding care of the dying, and involving patients and families in end-of-life care. The Behaviors Scale loaded on two factors: supporting dying patients and families, and helping families cope with grief. Factor loadings for both scales were ≥.49. Both Attitudes and Behaviors Scales are reliable and valid for evaluating nurses’ attitudes and caregiving behaviors for the dying.

ObjectiveTo assess the clinical characteristics, prognostic factors, and treatment outcomes of primary testicular lymphoma (PTL).Materials and MethodsWe reviewed the medical records of PTL patients diagnosed between January 2000 and May 2012 at four hospitals in Taiwan. The following data were collected and analyzed: patient age at diagnosis, B symptoms (fever, night sweats, and/or weight loss), tumor localization (diffuse or testis alone), tumor site (left, right, or bilateral), stage of disease, histological pattern, International Prognostic Index, treatment method and outcome, relapse, and survival time. Kaplan–Meier curves were constructed to assess the effects of various factors on patient survival.ResultsThirty patients with PTL were included in this study. The median age at diagnosis was 62.5 years (range: 19–89 years) and median overall survival (OS) was 44 months. The majority of the patients had unilateral lymphoma, stage I/II disease, and diffuse large B-cell lymphoma. An absence of B symptoms, limited disease stage, lymphoma localized to testis only, and orchidectomy were considered to be significantly favorable prognostic factors of OS (p

The activated cannabinoid receptor 1 (CB1R) is exclusively responsible for food intake and weight gain and regulates several pathological features associated with obesity in mammals. However, the precise role of CB1R in non-mammalian model systems is poorly understood. To investigate the functions of CB1R in zebrafish liver, we conditionally expressed CB1R proteins using a liver-specific Tet(off) transgenic system. In this study, we found hepatic lipid accumulation in CB1R transgenic zebrafish (CB) without doxycycline treatment (-Dox) and a suppression of CB1R expression, resulting in the loss of lipid accumulation in the livers of CB fish that received doxycycline treatment (+Dox). Oil Red O (ORO)-stained hepatocytes were predominant in the liver buds of CB-Dox larvae, indicating that CB1R functionally promotes lipid accumulation during CB hepatogenesis. More than 73 % of CB-Dox adults showed increased lipid content, which leads, in turn, to steatosis. Liver histology and ORO staining of CB-Dox hepatocytes also indicated the accumulation of fatty droplets in the CB liver samples, consistent with the specific pathological features of liver steatosis or steatohepatitis. We also found that hepatic CB1R overexpression accompanies the stimulation of the lipogenic transcription factor SREBP-1c and its target enzymes, acetyl coenzyme-A carboxylase-1 (ACC1) and fatty acid synthase (FAS), and increases de novo fatty acid synthesis. This study is the first to report CB1R as a potential hepatic stimulator for zebrafish liver steatosis.

Ketamine is an addictive drug that has been shown to inflict considerable physical and mental damage on users. Due in part to its low cost, ketamine has become one of the most popular club drugs among young adults and teenagers in Southeast Asia. This paper proposes a phone-based support system (KeDiary) with Bluetooth-enabled device for the screening of saliva, as a means of assisting ketamine-dependent patients to self-monitor their ketamine use following acute withdrawal treatment. We also conducted a practical experiment to evaluate the feasibility of the proposed system, wherein three ketamine-dependent patients self-administered tests at least once per day over a period of three weeks. Follow-up interviews with the same users helped in the further refinement of the proposed self-monitoring system.

A multi-user multiple-input multiple-output (MU-MIMO) downlink system with zero-forcing beamforming and semi-orthogonal user selection (SUS) scheduling algorithm is considered in this paper. It is well known that in practical implementation of MU-MIMO, the channel state information (CSI) feedback overhead becomes a limiting factor as the number of users to be supported increases. A novel scheme to reduce the feedback load, in the event of large number of users, by using a threshold-based feedback strategy is proposed and studied in this paper. The key feature of the proposed approach uses the concept of order statistics to construct multiple thresholds on the CSI. This paper also proposes a new modified formulation of the expected signal to interference plus noise ratio (SINR) to address the mismatch of analytical sum rate and simulation results. Simulation results show a significant reduction of feedback load when the scheme is used, while the sum rate performance is not compromised.

This paper is concerned with the coordination of setup times in a two-stage production system. The problem is derived from a furniture plant, where there are two consecutive departments including cutting and painting departments. Items with the same levels of both attributes are grouped into a single batch in advance. A sequence-dependent setup time is required in a stage when a new batch has a different level of attribute from the previous one. The objective is to minimize the total setup time. In this paper, we first propose a simple dispatching rule called the Least Flexibility with Setups (LFS) rule. The LFS rule can yield a solution better than an existing genetic algorithm while using much less computation time. Using the LFS rule as both the initial solution method and the heuristic desirability, an Ant Colony Optimization (ACO) algorithm is developed to further improve the solution. Computational experiments show that the proposed ACO algorithm is quite effective in finding the near-optimal solution.

Purpose This study was to quantify the correlation of the infrared reflecting marker movement and deep inspiration breath-hold (DIBH) lung expansions by setting the infrared reflecting marker below the xiphoid process on the abdominal wall. Methods Ten patients with left breast cancer post operation underwent free-breathing (FB) and DIBH computed tomography (CT) using infrared reflecting marker on the abdominal wall. Therapists coached patient breathing maneuvers before CT scans. The breath-hold level (BHL) was recorded by infrared reflecting marker in the anteroposterior (AP) direction by Real-time Position Management system (RPM) system during CT procedure. Lung diameter in AP direction on both free-breathing (FB) and DIBH images were measured at 4 levels: half upper, upper border of heart, half lower and diaphragm levels of lung. The first CT slice with visible lung tissue and diaphragm level were identified for lung diameter in superioinferior (SI) direction corresponding Z values (slice position). Pearson correlation test was used to examine the correlation significance among BHL, lung AP diameter, lung SI diameter, heart dose, and left lung dose. Results The BHL had strongly positive correlation with lung expansion in SI direction (Pearson correlation r = 0.770). When BHL increased 1.0 cm, the lung expansion in SI direction increased 2.6 cm. Also, moderately positive correlation was revealed between BHL and total lung volume (Pearson correlation r = 0.596). When BHL increased 1.0 cm, the total lung volume increased 414.1c.c. Heart mean dose and maximum dose were strongly negative correlated to BHL according to inverse square law. Weak or no correlation was noted between BHL and lung expansion in AP direction at 4 levels (Pearson correlation r = 0.318, 0.009, −0.105 and −0.238). DIBH plans had lower heart dose (2.64 vs. 1.32 Gy; P = 0.005) and ipsilateral lung V20 (%) relative volume (13.6 vs. 10.9 %; P = 0.007) than FB plans as previous studies. Conclusions Setting infrared reflecting marker below the xiphoid process on the abdominal wall is sufficient for DIBH technique to detect lung expansion in SI direction and decrease the heart dose significantly. Patient couching before CT scans is recommended.

Background: Adjuvant radiotherapy reduces local recurrence and improves overall survival of breast cancer. But adjuvant radiotherapy also leads to excess mortality caused by heart and lung disease. Deep inspiration breath hold (DIBH) technique has been proven to reduce radiation exposure to heart and lung. However, effectiveness of DIBH variates from each patient. This study collected one institutional data and further analyzed associated physical factors. Methods: Left breast cancer patients received left partial mastectomy followed by adjuvant radiotherapy with DIBH technique between Sep 1, 2013 and Sep 1, 2014 were included. Treatment plans based on both free breathing (FB) and DIBH computed tomography scan image for each patient were constructed. Physical factors including chest wall expansion at different levels were measured. Dose of ipsilateral, contralateral, and total lung, and heart were compared between FB and DIBH. Correlation between normal organ irradiated dose and physical factors change were calculated by Pearson correlation test. Results: Anterior-to-posterior diameter (APd) increase of lung at half upper chest wall level, upper heart border level, and half lower chest wall level, and extra lung length of DIBH had positive correlation with the reduction of irradiated lung dose. The increase of APd of lung at upper heart border level, half lower chest wall level, and right-to-left diameter (RLd) at diaphragm level also had positive correlation with the reduction of Dmax of heart (Pearson correlation r=0.795, 0.835, 0.655; P=0.006, 0.003, and 0.04, respectively) and Dmax of left anterior descending artery (LAD) (r=0.788, 0.795, 0.673; P=0.007, 0.006, and 0.033, respectively). Increase of free-contour heart height had negative correlation with V30, Dmax of heart, and Dmax of LAD. Conclusions: DIBH can reduce dose to critical organs. One-point chest wall motion monitored by Realtime Position Management TM (RPM) system can only represent the change of APd at diaphragm level and part of the change of half of lower chest wall level. Respiration is a complicated motion and multiple level monitoring system was suggested. Patient education to explain the idealist chest wall expansion condition with DIBH is important. Our CT-based instruction model provides a clearer instruction. This study suggested a new direction to evaluate and enhance DIBH performance.

Chen-Pang Hou,1 Chien-Lun Chen,1 Yu-Hsiang Lin,1 Yu-Lun Tsai,1 Phei-Lang Chang,1 Horng-Heng Juang,2 Ke-Hung Tsui11Department of Urology, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 2Department of Anatomy, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of ChinaPurpose: We investigated the association of the prostatic urethral angle (PUA) with peak urinary flow rate (Qmax) and the severity of lower urinary tract symptoms (LUTS) on the aging male. We also evaluated the effect of the PUA on the treatment efficacy of tamsulosin on men with LUTS.Materials and methods: The records were obtained from a prospective database for first-visit male patients with LUTS in the outpatient department of our institution. These patients underwent a detailed physical examination and taking of medical history. A transrectal ultrasound was performed on these patients. The prostate size, length of intravesical prostatic protrusion (IPP), PUA, and International Prostate Symptom Score (IPSS) of the patients were evaluated. Uroflowmetry and a bladder scan for residual urine were also performed on every patient. Tamsulosin 0.2 mg per day was prescribed. The IPSS and uroflowmetry were reevaluated after they had received treatment for 3 months.Results: A total of 178 patients were included, and 149 of them completed this cohort study. The mean PUA was 48.32°±13.74°. The mean prostate volume was 39.19±20.87 mL, and the mean IPP was 5.67±7.85 mm. On multivariate linear regression analysis, the PUA was independently associated with the IPSS (P

In a multiuser system, independent time-varying channels among different users can be exploited to provide multiuser diversity (MUD) gain and increase the system throughput. For the downlink channel, this requires the users to feedback their channel state information (CSI) to the base station (BS), which incurs a large aggregate feedback load, especially when the number of users is large. In this paper, we propose a novel scheme to reduce the feedback load in a downlink orthogonal space division multiple access (SDMA) system by allowing the users to dynamically determine the number of feedback bits to use according to multiple thresholds. These thresholds are derived from the statistics of the signal-to-interference-plus-noise ratio (SINR). Through simulation, we demonstrate that the proposed scheme is more efficient than the existing feedback methods, and it achieves the same sum rate growth as the full CSI feedback scheme. Furthermore, a fast bit allocation method is also proposed for the multi-threshold feedback scheme. Simulation results show that this method achieves almost the same sum rate as that achieved by the the optimal bit allocation algorithm.

Aim The aim of this study was to understand the early stage of illness recovery experiences and related needs of patients who underwent emergency cardiac surgery. Methods A qualitative approach was used. Patients who had been transferred from intensive care units to a general ward for least 6 days and were expecting to be discharged within one week were interviewed at a medical center in northern Taiwan. Results A total of 9 patients participated in this study. Two themes emerged from the analysis related to their illness experiences. Patients felt ‘shock’ when they were informed to have emergency surgery or when they woke up to know surgery had been done on them, including unbelieving and suspicious. They also described various degree of ‘psychiatric symptoms’, such as fragment of memory or memory loss related to the medical procedure, nightmares, insomnia,hallucinations, derealization, daze, sluggish response, and attention deficit. Three themes emerged from the analysis looking at their needs. Patients described the needs for ‘reassurances,’ ‘support,’ and ‘more information about subsequent treatment and care’ to rebuild their new life in the future. Conclusion This study has shown that these patients had many of symptoms related to acute stress and their related needs in the early recovery stage. The findings would enhance the health professions can design early interventions to treat acute stress symptoms in critical care units. It would help patients in the restore their social and occupational functions, and prevent the development of PTSD. It is suggested integrated interdisciplinary care and support are crucial helping patients recovery.

Introduction Alcohol is legally accessible and widely used in Taiwan, but few studies have addressed alcohol-drinking problems in hospital settings. Aims To explore (1) the prevalence and risk factors for hazardous alcohol-drinking problems and (2) previous assessments and interventions for alcohol-drinking problems among a general Chinese patient population. Methods Self-report data were collected from 484 patients at five randomly selected hospitals. Results The prevalence of hazardous alcohol-drinking problems was 19.2%. Logistic regression analysis revealed that risk factors for hazardous drinking problems were being male, smoking, and chewing betel quid. Only 29.1% of participants were assessed for drinking problems in the past year. Only 38.7% of participants with drinking problems had received a drinking intervention in the past year. Conclusions Alcohol problems in Taiwanese general hospitals are insufficiently assessed and targeted with interventions. Targeting high-risk groups and integrating psychiatric healthcare teams in general hospitals are important to prevent patients’ drinking problems.