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Background : Triple-negative breast cancer (TNBC) is a subtype of invasive cancer in breast with the symptoms of unfavourable prognosis and limited targeted treatment options. Evidence of changes in the metabolic status of TNBC, characterised by increased glycolysis, mitochondrial oxidative phosphorylation, as well as production and utilization of tricarboxylic acid cycle intermediates. Objective: Investigate the proteins altered in cryptotanshinone treated MDA-MB-231 cells and explore the key pathways and specific molecular markers involved in cryptotanshinone treatment. Method: We use unlabeled quantitative proteomics to gain insight into the anticancer mechanism of cryptotanshinone on MDA-MB231 triple negative breast cancer cells. And flow cytometry was used to detect apoptosis and changes in cell mitochondrial membrane potential. Results: We show that inhibiting the expression of electron transport chain complex proteins, also inhibits mitochondrial oxidative phosphorylation. Additionally, down-regulation of the ribosime biogenesis pathway was found to inhibit cell metabolism. Conclusion: In summary, results show that cryptotanshinone can trigger rapid and irreversible apoptosis in MDA-MB-231 cells through effectively inhibiting cell metabolism.

Purpose: To compare the amount of bone expansion, bone density change, and implant primary stability with an osseodensification technique to a conventional drilling protocol. Materials and methods: Twenty-four bovine rib segments (20 × 25 × 4 mm) with a 1-mm outer layer of cortical bone were randomly divided into two groups: an osseodensification group and a conventional drilling group. Each bone sample received one 4.1 × 10-mm implant. The density of the peri-implant bone before and after osteotomy was measured. After implant placement, primary stability was assessed. A laser surface scanner was used before and after implant placement to compare the dimension of crestal bone width and volumetric expansion. Histomorphometric analysis was performed to compare the bone-to-implant contact percentage (BIC%) of the two groups. Results: The peripheral and apical bone mineral density around the implants was significantly increased, and a statistically significantly higher peripheral BIC% was found in the osseodensification group. A significant increase in volume and bone width after implant placement was found in both groups. However, there were no significant differences in volume and bone width change at all three locations and in implant stability between the osseodensification and conventional drilling protocols. Conclusion: Within the limitations of this study, the osseodensification protocol increased the bone mineral density and primary bone-to-implant contact. Also, this study suggests that implant placement by osseodensification or conventional drilling can increase ridge dimensions in narrow alveolar ridges.

There is a gap between medical resources and patient needs, Managers need to obtain productivity information to optimize resources allocation. The value of this research is that the information provided by the dashboard allows hospital managers problems respond to it quickly. We recommend the research could integrate more data (such as temperature data, national death population data record), so as to be closed to hospital operating cost control and to estimate patients' needs.

There is a gap between medical resources and patient needs, Managers need to obtain productivity information to optimize resources allocation. The value of this research is that the information provided by the dashboard allows hospital managers problems respond to it quickly. We recommend the research could integrate more data (such as temperature data, national death population data record), so as to be closed to hospital operating cost control and to estimate patients’ needs.

Introduction Guided tissue regeneration (GTR) has been well documented with combination of bone graft substitutes and biologic modifiers to improve the outcomes of periodontal regenerative procedures. Amnion-chorion allograft membrane (ACM) is a placenta-derived resorbable allograft membrane which contains growth factors found in the placenta. The primary purpose of the barrier membranes for GTR was to exclude the epithelial down-growth along with the root surface, however, the ACM can be used as an additional biologic modifier because of the release of growth factors from the ACM after placement. The aim of this case report is to evaluate the efficacy and the application of ACM on the previously diseased root surface to treat periodontal intrabony defect. Case presentation A 60-year-old Caucasian male with deep and wide intrabony defect on mesial #19 was treated with a regenerative procedure with combination of application of ACM on the root surface and filling the intrabony defect with the corticocancellous freeze-dried bone allograft. The bone substitute was covered with another layer of ACM and primary closure was achieved. Wound healing process was uneventful, and the clinical and radiographic outcomes were favorable up to 18 months after the surgical procedure. Conclusion This case report demonstrated that the application of ACM on the root surface with a combination of bone substitute might enhance to the radiographic bone fill and the clinical attachment level gain and minimize the risk of post-operative gingival recession.

Background Breast cancer is one of the most prevalent gynecologic malignancies worldwide. Despite the high sensitivity in response to chemotherapy, drug resistance occurred frequently in clinical treatment. Cryptotanshinone (CTS) is a herbal medicine and has been identified as an anti-inflammatory and anti-oxidative drug. Methods In vitro assays, including the cell proliferation assay, colony formation assay, Western blot analysis, transwell migration/invasion assays, and cell scratch assay were used to explore the biological activities and working mechanism of CTS. Breast cancer cells were also transfected with PKM2 expressing vectors to define the molecular mechanisms involved in CTS-mediated anti-tumor activity. Results We found that CTS shows anti-proliferative effects and decreases the clonogenic ability of breast cancer cells. We also found that CTS inhibited the migration and invasion activity of MCF-7 and MDA-MB-231 cells by different analyzed methods. CTS also downregulated the levels of glycolysis-related proteins, such as PKM2, LDHA, and HK2. In addition, overexpression of PKM2 recovered CTS-mediated suppression of cell proliferation, colony formation, and cell mobility of breast cancer cells. We also found PKM2 was significantly overexpressed in tumor tissues and invasive ductal breast carcinoma compared to normal tissues and patients with high PKM2 expression had worse overall survival and metastasis-free survival outcomes. Conclusion CTS inhibited the proliferation, migration, and invasion of breast cancer cells. The involved mechanism may refer to the downregulation of the PKM2/β-catenin axis.

Background: The fractionated picosecond laser produces microscopic lesions in the epidermis and dermis, which are known as laser-induced optical breakdown (LIOB) and intra-dermal laser-induced cavitation (LIC). There have been multiple histological reports on these phenomena, although some have been challenged on the grounds of similarity to artifacts. Asian skins, with a higher melanin content, may react differently to this treatment, and present literature is also lacking in this area.Purpose: To observe and report the histological effect of different energy levels and parameters of the fractional 532 nm/1064 nm picosecond laser on Asian skin ex vivo.Methods: Six skin samples were taken from clinically normal-looking perilesional areas and treated with different energy levels and parameters of the fractional 532 nm/1064 nm picosecond laser. The specimens were then sent to the lab for HE deep, intra-dermal LICs were seen in skin treated at lower energies. Lesion sizes and depths were consistent with previously reported values on Caucasian skins, and lesions were spaced in 600-μm intervals or its multiple.Conclusions: The histological findings are consistent with results from other ethnicities, and the spacing of lesions is a strong indication of their validity as LIOBs or LICs.

Acute kidney disease (AKD) comprises acute kidney injury (AKI). However, whether the AKD staging system has prognostic values among AKI patients with different baseline estimated glomerular filtration (eGFR) remains a controversial issue. Algorithm-based approach was applied to identify AKI occurrence and to define different AKD stages. Risk ratio for major adverse kidney events (MAKE), including (1) eGFR decline > 35% from baseline, (2) initiation of dialysis, (3) in-hospital mortality of different AKD subgroups were identified by multivariable logistic regression. Among the 4741 AKI patients identified from January 2015 to December 2018, AKD stages 1–3 after AKI was common (53% in the lower baseline eGFR group and 51% in the higher baseline eGFR group). In the logistic regression model adjusted for demographics and comorbidities at 1-year follow-up, AKD stages 1/2/3 (AKD stage 0 as reference group) were associated with higher risks of MAKE (AKD stage: odds ratio, 95% confidence interval [95% CI], AKD 1: 1.85, 1.56–2.19; AKD 2: 3.43, 2.85–4.12; AKD 3: 10.41, 8.68–12.49). Regardless of baseline eGFR, staging criteria for AKD identified AKI patients who were at higher risk of kidney function decline, dialysis and mortality. Post-AKI AKD patients with severer stage need intensified care and timely intervention.

Esthetic crown lengthening is a periodontal surgical procedure to correct excess gingival display (ie, "gummy smile"). The procedure may require soft-tissue excision only, osseous resection, or a combination of both. However, the long-term healing responses, such as soft-tissue relapse or recession and hard-tissue regrowth and resorption, have not been fully reported in the literature. This case report describes the management of a patient with esthetic concerns about a gummy smile. The patient stated that the maxillary anterior area had been previously treated with periodontal surgery 7 years earlier but the condition had slowly recurred over time. The authors highlight the possible reasons for the recurrence and the keys to successfully managing the case.

Intussusception in relation to appendicitis is an uncommon occurrence and is rarely described in the literature. We describe a case of diagnostic uncertainty and finding of ileocolic intussusception associated with appendicitis in a 22-year-old male. The patient presented with a history of acute right-sided abdominal pain. He underwent a computed tomography scan showing ileocolic intussusception following an operation with the finding of an inflamed appendix, which was likely to have served as a mechanical lead point of the intussusception. Due to the presence of ischaemia of the right colon, he underwent a right hemicolectomy.

Sophisticated dissection into the interiors of the three different birefringent types of poly(l-lactic acid) (PLLA) spherulites via delicate fracturing across the thickness sections, coupled with proper etching techniques, was adopted to reveal the correlations between the diversified birefringence patterns and interior lamellae assembly. The three types of spherulites are circularly ringed spherulite (type 1), hexagon-shaped axialite (type 2), and circularly core–stripe dendrites (type 3). Such morphological diversification originates from different nuclei geometries. For all three different types (circularly ringed, hexagonal, and core–stripe) of PLLA aggregation into spherulites or dendrites/axialites, the dissected inner lamellar arrangement shares universal commonality of intersecting at a 60° angle in the intersection between different lamellar species, with distinct discontinuity in the grating structures being characteristic of all three types of aggregated PLLA spherulites. This kind of grating a...

Background Masseteric hypertrophy is a benign condition characterized by the enlargement of the masseter muscles. A square-shaped jawline due to masseter muscle prominence or hypertrophy is one of the general characteristics of the Asian face, making it a frequent target for esthetic treatment requests. While the application of botulinum toxin on the masseter muscle is an off-label use, it is very popular in Asian countries. However, comprehensive reviews of the complications associated with this procedure remain limited in scope. Objectives The goal of this study is to help physicians achieve a comprehensive understanding of the complications associated with neuromodulator injection over the masseter muscle via a thorough literature review. Methods A literature search was performed on the PubMed/MEDLINE, Google Scholar, and Science Direct databases using the search terms botulinum toxin, masseter hypertrophy, masseteric hypertrophy, and/or masseter hyperplasia. Literature from January 1994 to February 2018 was deemed to be allegeable for inclusion and analysis. All available prospective and retrospective studies, case series, case reports, and expert reviews were included, with an emphasis on types of complications, incidence rate, onset time, recovery time, and product used. Articles that do not mention side effects, complications, or adverse events were excluded. Results Thirty-six articles were found, covering type, incidence rate, and clinical course of the complications. These studies were summarized into tabular form for easy reference and comparison. Conclusion Botulinum toxin masseter injections are commonly performed procedures with good results and safety profiles. The majority of complications appeared within 2-4 weeks of injection and disappeared within 12 weeks. Despite the temporary nature of these complications, they often decrease patient satisfaction and confidence, so physicians should familiarize themselves with the regional anatomy and injection safety zones.

Nature tends to assemble hierarchical structures in similar ways to achieve compactness and functions. This work probes the interior lamellae assembly of crystalline spherulites of poly(ethylene adipate) (PEA) with striking birefringence patterns versus some known biological structures for optical color diffraction. Three-dimensional dissecting onto interior lamellar structures of spherulites in poly(ethylene adipate) (PEA) in bulk forms crystallized at 28 ± 3 °C were studied in correlation with thin-film forms. Interior morphology in bulk PEA samples revealed periodic hemisphere or arc-shaped layers resembling corrugate boards with liner-flute medium alteration. Interior spherulites clearly expose that the lamellae within the intralayer are kebabs (plates) in the radial direction while the interlayer region are thin sheaths (fibrils) composed of cilia-like lamellae in the tangential direction. The interior repetitive lamellar assembly of PEA banded spherulites in displaying periodic optical birefringence...

A Gram-reaction-negative, heterotrophic, marine bacterium, designated strain SPT1T, was isolated from an aged seawater sample which was collected from the shallow coastal region of Nanya, Keelung, Taiwan and stored at room temperature for more than 7 years. Strain SPT1T was a motile rod which exhibited monotrichous flagellation. It required NaCl for growth and exhibited optimal growth at 30-35 °C, 1-3 % NaCl and pH 7-8. The strain was a strictly aerobic bacterium, incapable of anaerobic growth by nitrate reduction or denitrification, or by fermenting glucose or other carbohydrates. Cellular fatty acids were dominated by C16 : 1ω7c and/or C16 : 1ω6c (23.4 %), C17 : 1ω8c (18.1 %), C16 : 0 (8.5 %), C18 : 1ω7c (8.4 %) and C10 : 0 3-OH (6.3 %). The predominant isoprenoid quinone was Q-8. Polar lipids consisted of phosphatidylethanolamine, phosphatidylglycerol and phosphatidic acid. The DNA G+C content was 57.9 mol%. Phylogeny based on 16S rRNA gene sequences showed that strain SPT1T formed a distinct species-level lineage within the genus Spongiibacter of the class Gammaproteobacteria and shared sequence similarities of 94.4-96.2 % with Spongiibacter marinusand Spongiibacter tropicus, the only two species of the genus Spongiibacterwith validly published names. The 16S rRNA gene sequence similarities between strain SPT1T and other species were less than 93.1 %. Polyphasic taxonomic data obtained in this study indicated that strain SPT1T could be classified as a novel species of the genus Spongiibacter, for which the name Spongiibacter taiwanensis sp. nov. is proposed. The type strain is SPT1T (=JCM 31012T=BCRC 80916T).

The elderly are high risk for chronic diseases and multiple drug use - two problems that make geriatric medication use more complex; as a result, the possibility of duplicate prescriptions and drug interactions increase, affecting patient safety. The objective of this study was to develop an Intelligent Prescription System Combined with a National PharmaCloud for Geriatrics Care (IPSPcG) that can reduce the occurrence of duplicate prescriptions.The system was implemented in a teaching hospital in Taiwan. The IPSPcG consists of two major components: (1) the collection module and (2) Intelligent Knowledge-base Module. Data on medication prescription behaviors and medication-blocking rates were gathered from January 2015 to December 2017.Overall, during the study period, the IPSPcG system included 39,678 prescriptions. Antihypertensive medications were included at the highest proportion (8962, 22.6%). The system changed physician's prescription behavior (p .001) and decreased potential duplicate prescription times (14%).The results of this study show that integrating appropriate recommendations from drug messages can reduce repeated drug prescriptions. Due to the diversity of diseases, the diversity and accuracy of medical advice must improve. The results of the 'Comprehensive Prescription Information' provided by this system can serve as a reference for future research.

BACKGROUND Outbreaks of several serious infectious diseases have occurred in recent years. In response, to mitigate public health risks, countries worldwide have dedicated efforts to establish an information system for effective disease monitoring, risk assessment, and early warning management for international disease outbreaks. A cloud computing framework can effectively provide the required hardware resources and information access and exchange to conveniently connect information related to infectious diseases and develop a cross-system surveillance and control system for infectious diseases. OBJECTIVE The objective of our study was to develop a Hospital Automated Laboratory Reporting (HALR) system based on such a framework and evaluate its effectiveness. METHODS We collected data for 6 months and analyzed the cases reported within this period by the HALR and the Web-based Notifiable Disease Reporting (WebNDR) systems. Furthermore, system evaluation indicators were gathered, including those evaluating sensitivity and specificity. RESULTS The HALR system reported 15 pathogens and 5174 cases, and the WebNDR system reported 34 cases. In a comparison of the two systems, sensitivity was 100% and specificity varied according to the reported pathogens. In particular, the specificity for Streptococcus pneumoniae, Mycobacterium tuberculosis complex, and hepatitis C virus were 99.8%, 96.6%, and 97.4%, respectively. However, the specificity for influenza virus and hepatitis B virus were only 79.9% and 47.1%, respectively. After the reported data were integrated with patients’ diagnostic results in their electronic medical records (EMRs), the specificity for influenza virus and hepatitis B virus increased to 89.2% and 99.1%, respectively. CONCLUSIONS The HALR system can provide early reporting of specified pathogens according to test results, allowing for early detection of outbreaks and providing trends in infectious disease data. The results of this study show that the sensitivity and specificity of early disease detection can be increased by integrating the reported data in the HALR system with the cases’ clinical information (eg, diagnostic results) in EMRs, thereby enhancing the control and prevention of infectious diseases.

Lamellar assembly with fractal-patterned growth into dendritic and ringed spherulites of crystallized poly(l-lactic acid) (PLLA), of two molecular weight (MW) grades and crystallized at (temperature of crystallization) Tc = 120 and 130 °C, respectively, are evaluated using optical and atomic-force microscopies. The results of surface-relief patterns in correlation with interior microscopy analyses in this work strongly indicate that the observed birefringence changes in PLLA polymer dendritic or ringed spherulites (from blue to orange, or to optical extinction) need not be definitely associated with the continuous helix twisting of lamellae; they can be caused by sudden and discontinuous lamellae branching at intersected angles with respect to the original main lamellae, as proven in the case of dendritic and zig-zag rough-ringed spherulites. Intersection angles between the main stalks and branches tend to be governed by polymer crystal lattices; for PLLA, the orthorhombic lattice (α-form) usually gives a 60° angle of branching and hexagonal growth. The branching lamellae then further bend to convex or concave shapes and finally make a 60–90° angle with respect to the main stalks. Such mechanisms are proven to exist in the straight dendritic/striped high-molecular weight (HMW)-PLLA spherulites (Tc = 120 °C); similar mechanisms also work in circularly ringed (Tc = 130 °C) HMW-PLLA spherulites.

Equally partitioned data are essential for prediction. However, in some important cases, the data distribution is severely unbalanced. In this study, several algorithms are utilized to maximize the learning accuracy when dealing with a highly unbalanced dataset. A linguistic algorithm is applied to evaluate the input and output relationship, namely Fuzzy c-Means (FCM), which is applied as a clustering algorithm for the majority class to balance the minority class data from about 3 million cases. Each cluster is used to train several artificial neural network (ANN) models. Different techniques are applied to generate an ensemble genetic fuzzy neuro model (EGFNM) in order to select the models. The first ensemble technique, the intra-cluster EGFNM, works by evaluating the best combination from all the models generated by each cluster. Another ensemble technique is the inter-cluster model EGFNM, which is based on selecting the best model from each cluster. The accuracy of these techniques is evaluated using the receiver operating characteristic (ROC) via its area under the curve (AUC). Results show that the AUC of the unbalanced data is 0.67974. The random cluster and best ANN single model have AUCs of 0.7177 and 0.72806, respectively. For the ensemble evaluations, the intra-cluster and the inter-cluster EGFNMs produce 0.7293 and 0.73038, respectively. In conclusion, this study achieved improved results by performing the EGFNM method compared with the unbalanced training. This study concludes that selecting several best models will produce a better result compared with all models combined.

The purpose of this study is to build a practical, highly efficient management information system (MIS) for elderly day care (EDC) centers to improve elders' lives. Based on system requirements and the management operation guidelines for EDC, we have developed an MIS. The introduction of the system will help EDC management to be more accurate, comprehensive, and efficient.

a b s t r a c t A niobium oxide (NbOx) layer is firstly investigated as a pH sensing membrane in single-layer light- addressable potentiometric sensor (LAPS) in this study. To confirm basic sensing performances, NbOx layer directly deposited on silicon substrate was prepared by reactive rf sputtering and following with post-deposition rapid thermal anneal (RTA) for electrolyte insulator semiconductor (EIS) structure first. RTA processed at 500 to 700

A deformed open stub and its non-coplanar complementary slot line are employed to implement a dispersive delay line (DDL) with all-pass response and excessive group delay. The maximum group delay occurring in the deformed stub-line/slot-line configuration is 0.8 ns at 2.5 GHz which is 60% more than the maximum group delay obtained in the conventional open-stub/slot-line configuration. Measured and simulation results of group delay are presented to show the versatility of the novel dispersive structure.

The National Health Insurance Administration (NHIA) has adopted smart cards (or NHI-IC cards) as health cards to carry patients’ medication histories across hospitals in Taiwan. The aims of this study are to enhance a computerized physician order entry system to support drug-drug interaction (DDI) checking based on a patient’s medication history stored in his/her NHI-IC card. For performance evaluation, we developed a transaction tracking log to keep track of every operation on NHI-IC cards. Based on analysis of the transaction tracking log from 1 August to 31 October 2007, physicians read patients’ NHI-IC cards in 71.01% (8,246) of patient visits, 33.02% (2,723) of the card reads showed at least one medicine currently being taken by the patient, 82.94% of which were prescribed during the last visit. Among 10,036 issued prescriptions, seven prescriptions (0.09%) contained at least one drug item that might interact with the currently-taken medicines stored in NHI-IC cards and triggered pop-up alerts. This study showed that the capacity of an NHI-IC card is adequate to support DDI checking across hospitals. Thus, the enhanced computerized physician order entry (CPOE) system can support better DDI checking when physicians are making prescriptions and provide safer medication care, particularly for patients who receive medication care from different hospitals.

A microgrid including distributed generation sources (DGSs) is generally connected to a bulk power system to provide power to its local loads. The point of common coupling between the bulk power system and microgrid should meet relevant standards. The microgrid becomes a weak system with unbalanced and distorted voltages after it is disconnected from the bulk power system. A synchronisation controller for the DGS considering imbalanced three-phase voltages and harmonic voltages is presented. The proposed method can be implemented without altering the traditional phase-locked loop circuit. No filters and compensators are needed in the proposed method. Simulation results reveal that the proposed method is applicable.

This study discusses the application of microwave-based heating for the pretreatment of biomass material, with Pennisetum purpureum selected for pretreatment. The Taguchi method was used to plan optimization experiments for the pretreatment parameter levels, and to measure the dynamic responses. With a low number of experiments, this study analyzed and determined a parameter combination in which Pennisetum purpureum can be rapidly heated to 190 °C. The experimental results suggested that the optimal parameter combination is: vessel capacity of 150 mL (level 2), heating power of 0.5 kW (level 1), and mass of Pennisetum purpureum of 5 g (level 1). The mass of Pennisetum purpureum is a key factor affecting system performance. An eight-order ARX model (Auto-Regressive eXogeneous) was representative of the actual system performance, and the fit was 99.13%. The results proved that microwave-based heating, with the assistance of the Taguchi method for pretreatment of the biomass material, can reduce the parameter combination variations.

The advent of total mesorectal excision (TME) together with minimally invasive techniques such as laparoscopic colorectal surgery and robotic surgery has improved surgical results. However, the incidence of bladder and sexual dysfunction remains high. This may be particularly distressing for the patient and troublesome to manage for the surgeon when it does occur. The increased use of neoadjuvant and adjuvant radiotherapy is also associated with poorer functional outcomes. In this review, we evaluate current understanding of the anatomy of pelvic nerves which are divided into the areas of the inferior mesenteric artery pedicle, the lateral pelvic wall and dissection around the urogenital organs. Surgical techniques in these areas are discussed. We also discuss the results in functional outcomes of the various techniques including open, laparoscopic and robotic over the last 30 years.

This study discussed the application of microwave-based heating for the pretreatment of biomass material, and selected Pennisetum purpureum for pretreatment. The Taguchi method was used to plan optimization experiments for pretreatment parameter levels, and measured the dynamic responses. With lower frequency of experiments, this study analyzed and determined a parameter combination in which Pennisetum purpureum can be rapidly heated to 190°C. The experimental results indicate an eight-order ARX model (Auto-Regressive eXogeneous) was representative of actual system performance, and the fit was 99.13%.

Objectives Doctor shopping (or hospital shopping), which means changing doctors (or hospitals) without professional referral for the same or similar illness conditions, is common in Hong Kong, Taiwan and Japan. Due to the lack of infrastructure for sharing health information and medication history among hospitals, doctor-shopping patients are more likely to receive duplicate medications and suffer adverse drug reactions. The Bureau of National Health Insurance (BNHI) adopted smart cards (or NHI-IC cards) as health cards in Taiwan. With their NHI-IC cards, patients can freely access different medical institutions. Because an NHI-IC card carries information about a patient's prescribed medications received from different hospitals nationwide, we used this system to address the problem of duplicate medications for outpatients visiting multiple hospitals. Methods A computerized physician order entry (CPOE) system was enhanced with the capability of accessing NHI-IC cards and providing alerts to physicians when the system detects potential duplicate medications at the time of prescribing. Physician responses to the alerts were also collected to analyze changes in physicians’ behavior. Chi-square tests and two-sided z -tests with Bonferroni adjustments for multiple comparisons were used to assess statistical significance of differences in actions taken by physicians over the three months. Results The enhanced CPOE system for outpatient services was implemented and installed at the Pediatric and Urology Departments of Taipei Medical University Wan-Fang Hospital in March 2007. The “Change Log” that recorded physician behavior was activated during a 3-month study period from April to June 2007. In 67.93% of patient visits, the physicians read patient NHI-IC cards, and in 16.76% of the reads, the NHI-IC card contained at least one prescribed medication that was taken by the patient. Among the prescriptions issued by physicians, on average, there were 2.36% prescriptions containing at least one medication that might be duplicative to the prior prescriptions stored in NHI-IC cards. The rate of potential duplicate medication alerts for the Pediatric Department was higher than that for the Urology Department (2.78% versus 1.67%). However, the rate of revisions to prescriptions was higher in the Urology Department than the Pediatric Department. Overall, the rate of physicians reviewing and revising their prescriptions was 29.25%; the rate of physicians reviewing without revising their prescriptions was 43.62%; the rate of physicians turning off the alert screens right after the screens popped up (overridden) was 27.13%. Thus, physicians accepted alerts to review their prescriptions with patients in most situations (72.87%). Moreover, over the study period, the rate of total revisions made to prescriptions increased and the “overridden” rate decreased. Conclusions Our approach enhances the capability of CPOE systems using NHI-IC cards as a nationwide infrastructure to provide more complete patient health information and medication history sharing among hospitals in Taiwan. Thus, our system can provide a better prescribing tool to help physicians detect potential duplicate medications for frequent doctor-shopping patients and hence enhance patient safety across hospital boundaries. However, the effectiveness of detecting duplicate medications with our approach is very much dependent on the completeness of NHI-IC cards, which in turn primarily depends on physician use of the cards when prescribing.

The stems of Cinnamomum reticulatum Hay (Lauraceae) were extracted with hexane and chloroform successively. A series of new esters, including a mixture of 4-hydroxy-3-methoxyphenethyl derivatives, along with two butanolides, isoobtusilactone A and obtusilactone A, two amides, N-trans-feruloylmethoxytyramine and N-cis-feruloyl-methoxytyramine, three benzenoids, p-hydroxybenzoic acid, syringic acid and vanillic acid, one lignan, (+)-syringaresinol and one steroid, beta-sitostenone, were isolated. The structures of the new esters were elucidated by chemical and physical evidence.

In this paper, the resistive switching characteristic of the SrZrO3(SZO)-based resistance random access memory (RRAM) composed of Pt/Ti/SZO/LaNiO3(LNO) are investigated. The electrical testing results show that the device has lower operation voltage, lower compliance current, long retention behavior, and stable resistance ratio over 104 s under 0.3 V reading voltage. It is demonstrated that the active metal Ti as an oxygen getter can modify the resistive switching property of the SZO based RRAM. After depositing all stack films, the post annealing (PA) treatment with various conditions was carried out to form the interfacial layer (TiOx) between Ti and SZO. By using X-ray Photoelectron Spectrometer (XPS) analysis, the Ti layer as an oxygen getter is confirmed. The better SZO based RRAM device can be made with the proper TiOx film formed by suitable annealing temperature and thickness of Ti layer.

Allopurinol, a common drug for treating hyperuricemia, is associated with cutaneous adverse drug reactions ranging from mild maculopapular exanthema to life-threatening severe cutaneous adverse reactions, including drug reaction with eosinophilia and systemic symptoms, Stevens-Johnson syndrome, and toxic epidermal necrolysis. We have previously reported that HLA-B*58:01 is strongly associated with allopurinol-induced severe cutaneous adverse reactions in Han Chinese, but the associations of the HLA-B*58:01 genotype in an allopurinol-induced hypersensitivity phenotype remain unclear. To investigate the comprehensive associations of HLA-B*58:01 , we enrolled 146 patients with allopurinol-induced cutaneous adverse drug reactions (severe cutaneous adverse reactions, n = 106; maculopapular exanthema, n = 40) and 285 allopurinol-tolerant control subjects. Among these allopurinol-induced cutaneous adverse drug reactions, HLA-B*58:01 was strongly associated with severe cutaneous adverse reactions (odds ratio [OR] = 44.0; 95% confidence interval = 21.5–90.3; P = 2.6 × 10 -41 ), and the association was correlated with disease severity (OR = 44.0 for severe cutaneous adverse reactions, OR = 8.5 for maculopapular exanthema). The gene dosage effect of HLA-B*58:01 also influenced the development of allopurinol-induced cutaneous adverse drug reactions (OR = 15.25 for HLA-B*58:01 heterozygotes and OR = 72.45 for homozygotes). Furthermore, coexistence of HLA-B*58:01 and renal impairment increased the risk and predictive accuracy of allopurinol-induced cutaneous adverse drug reactions (heterozygous HLA-B*58:01 and normal renal function: OR = 15.25, specificity = 82%; homozygous HLA-B*58:01 and severe renal impairment: OR = 1269.45, specificity = 100%). This HLA-B*58:01 correlation study suggests that patients with coexisting HLA-B*58:01 and renal impairment (especially estimated glomerular filtration rate 2 ) should be cautious and avoid using allopurinol.

Summary Purpose To investigate the impacts of the first phase of Taiwan's Bureau of National Health Insurance (TBNHI) smart card project on existing hospital information systems. Setting TBNHI has launched a nationwide project for replacement of its paper-based health insurance cards by smart cards (or NHI-IC cards) since November 1999. The NHI-IC cards have been used since 1 July 2003, and they have fully replaced the paper-based cards since 1 January 2004. Hospitals must support the cards in order to provide medical services for insured patients. Methods We made a comprehensive study of the current phase of the NHI-IC card system, and conducted a questionnaire survey (from 1 October to 30 November, 2003) to investigate the impacts of NHI-IC cards on the existing hospital information systems. A questionnaire was distributed by mail to 479 hospitals, including 23 medical centers, 71 regional hospitals, and 355 district hospitals. The returned questionnaires were also collected by prepaid mail. Results The questionnaire return rates of the medical centers, regional hospitals and district hospitals were 39.1, 29.6 and 20.9%, respectively. In phase 1 of the project, the average number of card readers purchased per medical center, regional hospital, and district hospital were 202, 45 and 10, respectively. The average person-days for the enhancement of existing information systems of a medical center, regional hospital and district hospital were 175, 74 and 58, respectively. Three months after using the NHI-IC cards most hospitals (60.6%) experienced prolonged service time for their patients due to more interruptions caused mainly by: (1) impairment of the NHI-IC cards (31.2%), (2) failure in authentication of the SAMs (17.0%), (3) malfunction in card readers (15.3%) and (4) problems with interfaces between the card readers and hospital information systems (15.8%). The overall hospital satisfaction on the 5-point Likert scale was 2.86. Although most hospitals were OK with the project, there was about 22% dissatisfied and strongly dissatisfied, that is twice as many hospitals with satisfied (about 10%). Conclusions Our recommendations for those who are planning to implement similar projects are: (1) provide public-awareness programs or campaigns across the country for elucidating the smart card policy and educate the public on the proper usage and storage of the cards, (2) improve the quality of the NHI-IC cards, (3) conduct comprehensive tests in software and hardware components associated with NHI-IC cards before operating the systems and (4) perform further investigations in authentication approaches and develop tools that can quickly identify where and what the problems are.