Taiwan ocular inflammation society consensus recommendations for the management of juvenile idiopathic arthritis-associated uveitis

We presented the development of a consensus guideline for managing juvenile idiopathic arthritis-associated uveitis (JIAU) in Taiwan, considering regional differences in manifestation and epidemiology. The Taiwan Ocular Inflammation Society (TOIS) committee formulated this guideline using a modified Delphi approach with two panel meetings. Recommendations were based on a comprehensive evidence-based literature review and expert clinical experiences, and were graded according to the Oxford Centre for Evidence-Based Medicine's "Levels of Evidence" guideline (March 2009). The TOIS consensus guideline consists of 10 recommendations in four categories: screening and diagnosis, treatment, complications, and monitoring, covering a total of 27 items. These recommendations received over 75% agreement from the panelists. Early diagnosis and a coordinated referral system between ophthalmologists and pediatric rheumatologists are crucial to prevent irreversible visual impairment in children with JIAU. However, achieving a balance between disease activity and medication use remains a key challenge in JIAU management, necessitating further clinical studies.

Epidemiology, Treatment, and Outcomes of Juvenile Idiopathic Arthritis-Associated Uveitis: A Multi-Institutional Study in Taiwan

PURPOSE

To assess the epidemiology, treatment, and outcomes of juvenile idiopathic arthritis (JIA)-associated uveitis (JIA-U) in Taiwan.

METHODS

Retrospective, multicenter database.

RESULTS

Totally, 44 (6.1%) of the 722 JIA patients had uveitis. The mean ages of JIA and JIA-U diagnosis were 10.7 and 11.1 years, respectively. JIA-U patients had more antinuclear antibody presence. Among JIA-U patients, 25 (56.8%) were male, 11 (25.0%) experienced any ocular complication, and 8 (18.2%) received ocular surgery. Inactivity lasting ≥6 months was achieved in 17 (38.6%) patients; however, 11 (25.0%) of those experienced reactivation with a mean of 624.7 days after achieving inactivity. Female had more ocular complications and surgeries.

CONCLUSION

Late age at JIA-U diagnosis and male predominance were distinctive in Taiwan. For patients with inactivity lasting ≥ 6 months was achieved, they still required close follow-up due to the high reactivation rate within 2 years. Female had poorer ocular outcomes.

Neoantigen Cancer Vaccine for Immunologically Cold Microsatellite-stable Colorectal Cancer

PURPOSE/OBJECTIVE(S)

Immunotherapies, such as immune checkpoint inhibitors (ICIs), have revolutionized management of some cancers but have little benefit for microsatellite-stable colorectal cancer patients (MSS-CRC). This is, in part, due to the low mutations and neoantigen expression in this immunogenically "cold" MSS-CRC. Therefore, we aim to develop novel shared neoantigen-based therapeutic cancer vaccine to reinvigorate antitumor immunity and enhance the therapeutic benefit of radiotherapy in MSS-CRC.

MATERIALS/METHODS

To identify novel highly expressed and shared neoantigens, we collected 40 match-paired adjacent normal and tumor tissues from MSS-CRC patients for WES-seq, RNA-seq, and liquid chromatography-MS/MS (LC-MS/MS). By incorporating these databases, we established Neoantigen Discovery and Validation (NeoDiva) system to identify a cluster of highly expressed and shared neoantigens derived from non-coding regions and evaluate its immunogenicity by HLA-A*11 transgenic mice. We then develop a neoantigen-based therapeutic cancer vaccine by an engineered adenovirus-associated virus (AAV) to evaluate its therapeutic efficacy in combination with radiotherapy in MSS-CRC animal model.

RESULTS

We identified a cluster of highly expressed and shared neoantigens (HLA-A*11-restricted) derived from non-coding regions. The immunogenicity of these novel neoantigens was demonstrated by HLA-A*11 transgenic mice and ex vivo stimulation. Moreover, the engineered AAV-based neoantigen cancer vaccine significantly eradicates cancer cells, prevents distant metastasis, prolong survival period in combination with radiotherapy. By flow cytometry, ELISPOT and MHC-I-tetramer assay, we demonstrated the recruitment of tumor-infiltrating lymphocytes was remarkably increased and neoantigen-specific T cell response was enhanced. Moreover, these isolated neoantigen-specific T cells can recognize cancer cells and produce IFNg to kill cancer cells.

CONCLUSION

Neoantigens identified by our NeoDiVa platform, via the combination of radiotherapy and a novel AAV vaccine delivery system, boosted antigen-specific T-cell function and improve tumor control of limnologically "cold" MSS colorectal cancer in vivo. We are in the process of obtaining an IND and initiating Phase I/II clinical trial to validate safety and efficacy of these exciting findings.

[The characteristics and correlations of vaginal flora in women with cervical lesions]

Objective: To explore the characteristics and correlations of vaginal flora in women with cervical lesions. Methods: A total of 132 women, including 41 women diagnosed with normal cervical (NC), 39 patients with low-grade cervical intraepithelial neoplasia (CIN 1), 37 patients with high-grade cervical intraepithelial neoplasia (CIN 2/3) and 15 patients with cervical squamous cell carcinoma (SCC), who came from the gynecological clinic of Second Hospital of Shanxi Medical University during January 2018 to June 2018, were enrolled in this study according to the inclusive and exclusive criteria strictly. The vaginal flora was detected by 16S rDNA sequencing technology. Co-occurrence network analysis was used to investigate the Spearman correlations between different genera of bacteria. Results: The dominant bacteria in NC, CIN 1 and CIN 2/3 groups were Lactobacillus [constituent ratios 79.4% (1 869 598/2 354 098), 63.6% (1 536 466/2 415 100) and 58.3% (1 342 896/2 301 536), respectively], while Peptophilus [20.4% (246 072/1 205 154) ] was the dominant bacteria in SCC group. With the aggravation of cervical lesions, the diversity of vaginal flora gradually increased (Shannon index: F=6.39, P=0.001; Simpson index: F=3.95, P=0.012). During the cervical lesion progress, the ratio of Lactobacillus gradually decreased, the ratio of other anaerobes such as Peptophilus, Sneathia, Prevotella and etc. gradually increased, and the differential bacteria (LDA score >3.5) gradually evolved from Lactobacillus to other anaerobes. The top 10 relative abundance bacteria, spearman correlation coefficient>0.4 and P<0.05 were selected. Co-occurrence network analysis showed that Prevotella, Peptophilus, Porphyrinomonas, Anaerococcus, Sneathia, Atopobium, Gardnerella and Streptococcus were positively correlated in different stages of cervical lesions, while Lactobacillus was negatively correlated with the above anaerobes. It was found that the relationship between vaginal floras in CIN 1 group was the most complex and only Peptophilus was significantly negatively correlated with Lactobacillus in SCC group. Conclusions: The increased diversity and changed correlations between vaginal floras are closely related to cervical lesions. Peptophilus is of great significance in the diagnosis, prediction and early warning of cervical carcinogenesis.

[Minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure: a series of 60 cases]

Objective: To examine the short-term curative effect with minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure. Methods: The clinical data of 60 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure from August 2021 to August 2022 at Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital were retrospectively analyzed. There were 31 males and 29 females, with the age (M (IQR)) of 54.0(22.3) years (range: 15 to 71 years). The echocardiography confirmed the diagnosis of moderate mitral regurgitation in 30 patients, and severe mitral regurgitation in 13 patients. Systolic anterior motion (SAM) was present preoperatively in 54 patients. All 60 patients underwent transaortic modified Morrow procedure through a right infra-axillary thoracotomy using femorofemoral cardiopulmonary bypass. Surgical procedures mainly included transverse aortic incision, exposure of left ventricular outflow tract (LVOT), septal myectomy, and correction of the abnormal mitral valve and subvalvular structures. Results: All 60 patients underwent the programmatic procedures successfully without conversion to full sternotomy. The cardiopulmonary bypass time was (142.0±32.1) minutes (range: 89 to 240 minutes), while the cross-clamp time was (95.0±23.5) minutes (range: 50 to 162 minutes). The patients had a postoperative peak LVOT gradient of 7.0 (5.0) mmHg (range: 0 to 38 mmHg) (1 mmHg=0.133 kPa). A total of 57 patients were extubated on the operating table. The drainage volume in the first 24 h was (175.9±57.0) ml (range: 60 to 327 ml). The length of intensive care unit stay was 21.0 (5.8)h (range: 8 to 120 h) and postoperative hospital stay was 8 (5) days (range: 5 to 19 days). The postoperative septal thickness was 11 (2) mm (range: 8 to 14 mm). All patients had no iatrogenic ventricular septal perforation or postoperative residual SAM. The patients were followed up for 4 (9) months (range: 1 to 15 months), and none of them needed cardiac surgery again due to valve dysfunction or increased peak LVOT gradient during follow-up. Conclusion: Using a video-assisted thoracoscopic transaortic modified Morrow procedure through a right infra-axillary minithoracotomy can provide good visualization of the LVOT and hypertrophic ventricular septum, ensure optimal exposure of the mitral valve in the presence of complex mitral subvalvular structures, so that allows satisfactory short-term surgical results.

An autonomous, multi-agent, IoT-empowered space logistics system for mission-critical inventory packing

In recent aerospace missions, space logistics have proven essential in storing, delivering and returning crew and materials between terrestrial facilities and space stations. Unlike classical commercial logistics, space logistics operations are cost-prohibitive and mission-driven, and its replenishment cycle for essential materials is relatively long. Therefore, the complete utilisation of spacecraft payload is of utmost importance. The theory of the inventory packing problem is extended in this study to build autonomous agents that interact with one another within a space logistics decision support system to reinforce the replenishment decision, chunk loading optimisation, and quality inspection. With the long replenishment cycle time, an agent embedded with interval type-2 fuzzy logic is explored to support chaotic time-series demand forecasting to derive re-order quantities in the desired period. Afterwards, the second agent solves the space chunk loading problem using the differential evolution algorithm to utilise payloads and capacities, particularly cylindrical chunks fully. The third agent measures actual item dimensions and quality to deploy the three-dimensional object scanning devices. Feedback is provided to the second agent to derive optimal chunk-loading instructions. Thanks to the autonomous interactions among the above agents, mission-critical decisions for space logistics are supported to achieve operational excellence.

Optical coherence tomography and imaging biomarkers as outcome predictors in diabetic macular edema treated with dexamethasone implant

In this retrospective, multicenter study, we determined the predictive value of imaging biomarkers in diabetic macular edema (DME) outcomes following dexamethasone (DEX) implant(s). Sixty-seven eyes of 47 patients' best-corrected visual acuity (BCVA) and central foveal thickness (CFT) on optical coherence tomography (OCT) before and after intravitreal DEX implants were evaluated. Baseline imaging biomarkers were graded using fundus photography and OCT, and the predictive value of biomarkers for significant treatment effects at six months was analyzed. Six months after 2.0 ± 0.8 (mean ± SD) DEX implants, 35 (52%) and 16 (24%) eyes had CFT reduction ≥ 10% from baseline and decreased to < 300 µm, respectively. BCVA improved ≥ 3 lines in 15 (22%) and remained stable in 38 (57%) eyes. At six months, eyes with severe intraretinal cyst (IRC), abundant hyperreflective dots (HRD), and moderate or severe hard exudate had a significantly higher chance of CFT reduction ≥ 10%. Eyes with abundant HRD at baseline and those underwent three DEX implants were more likely to achieve CFT < 300 µm. Eyes with DME and severe IRC, abundant HRD, or moderate-to-severe hard exudate at baseline were more likely to show a significant reduction in CFT six months after DEX implant.

Treatment responses for branch retinal vein occlusion predicted by semi-automated fluorescein angiography quantification

Backgrounds

Branch retinal vein occlusion (BRVO) is one of the most important causes of visual loss in retinal vascular diseases. The aim of this study is to predict the treatment response of anti-vascular endothelial growth factor (anti-VEGF) therapy in BRVO using semi-automated quantified fluorescein angiography (FA) features.

Methods

This retrospective case-control study enrolled patients with BRVO who are receiving anti-VEGF therapy and have been followed up for > 1 year. Those receiving < 5 anti-VEGF injections in the first year were classified as the responsive group, while those receiving ≥5 injections were the refractory group. The FA images were subjected to semi-automated pre-processing. Fluorescein leakages at the 5-min image were represented by mean gray value over parafoveal and perifoveal regions. FA leakages and central retinal thickness (CRT) on optical coherence tomography (OCT) were used for predicting the treatment response and compared using area under receiver operating characteristic curve (AUC).

Results

Eighty-nine patients (56 males, 33 females, mean age 62.5 ± 10.9 years) with BRVO were enrolled. Of the 89 eyes, 47 (53%) were in the responsive group and 42 (47%) were in the refractory group. The refractory group had a significantly higher number of anti-VEGF injections in the first year (5.9 ± 1.6 versus 2.4 ± 1.2, p < 0.001) when compared with that of the responsive group. It had thicker pre-treatment CRT (p = 0.011), post-treatment best CRT (p < 0.001) and CRT at 1-year (p < 0.001). It also had a higher mean gray value over the parafoveal (p < 0.001) and the perifoveal (p < 0.001) regions. The mean gray value over perifoveal (AUC 0.846) and parafovel (AUC 0.818) had significantly larger AUC than that of the pre-treatment OCT (AUC 0.653; p = 0.005 and p = 0.016, respectively) when predicting treatment response.

Conclusion

The refractory group had a more severe fluorescein leakage over the parafoveal and the perifoveal regions than the responsive group had. Semi-automated quantified FA leakage can be used as a biomarker for the prediction of anti-VEGF treatment response in macular edema due to BRVO.

Immersive Learning Design for Technology Education: A Soft Systems Methodology

Science, technology, engineering and mathematics (STEM) education is a globalized trend of equipping students to facilitate technological and scientific developments. Among STEM education, technology education (TE) plays a significant role in teaching applied knowledge and skills to create and add value to systems and products. In higher education, the learning effectiveness of the TE assisted by the immersive technologies is an active research area to enhance the teaching quality and learning performance. In this study, a taught subject of radio frequency identification (RFID) assisted by using mixed reality technologies in a higher education institution was examined, while the soft systems methodology (SSM) was incorporated to evaluate the changes in learning performance. Under the framework of SSM, stakeholders’ perceptions toward immersive learning and RFID education are structured. Thus, a rich picture for teaching activities is established for subject control, monitoring, and evaluation. Subsequently, the design of TE does not only satisfy the students’ needs but also requirements from teachers, industries, and market trends. Finally, it is found that SSM is an effective approach in designing courses regarding hands-on technologies, and the use of immersive technologies improves the learning performance for acquiring fundamental knowledge and application know-how.

[The effect of red blood cell folate on the prognosis of high-risk human papillomavirus infection: a community-based cohort study]

Objective: To investigate the effect of red blood cell folate on the prognosis of high-risk human papillomavirus (HR-HPV) infection. Methods: A total of 564 participants with low-grade cervical intraepithelial neoplasias (CINⅠ) were selected from the community-based married women cohort established in 2014. The general baseline information and factors related to HPV infection were collected. Meanwhile, HPV genotyping and levels of folate were measured. The subjects were divided into different levels of exposure group according to the folate levels and followed up for 24 months to observe the changes of HR-HPV infection status. There were four changes, including persistent infection, infection turned negative, from negative to positive and constant negative by comparing HR-HPV infection status at baseline and follow-up to 24 months. Results: 483 participators completed 24 months of follow-up observation, with a follow-up rate of 85.64% (483/564). The rates of persistent infection, infection turned negative, from negative to positive, and the constant negative were 52.45% (75/143), 47.55% (68/143), 19.71% (67/340), 80.29% (273/340), respectively. Our results demonstrated that the risk of persistent infection (aRR=2.50, 95%CI: 1.55-4.02) and from negative to positive (aRR=4.55, 95%CI: 2.52-8.23) in the low level of folate were significantly higher than that in the high level of folate, especially the risk of homotype persistent infection (aRR=2.72, 95%CI: 1.51-4.90). The risk of persistent infection (trend χ²=20.62, P<0.001), from negative to positive (trend χ²=31.76, P<0.001), persistent homotypic infection (trend χ²=20.09, P<0.001) increased with the decrease of red blood cell folate level. On the contrary, no similar results were found in persistent heterotypic infection. Conclusions: A low level of red blood cell folate could increase the risk of HR-HPV persistent infection and from negative to positive. In women with HR-HPV infection, the risk of persistent homotypic infection is higher.

[Effects of polycyclic aromatic hydrocarbons exposure on prognosis of high risk human papillomavirus infection: a prospective cohort study]

Objective: To investigate the effects of polycyclic aromatic hydrocarbons (PAHs) exposure on the prognosis of high risk human papillomavirus (HR-HPV) infection. Methods: In this prospective study, 564 patients with low-grade cervical intraepithelial neoplasia confirmed by pathology were selected from the natural cohort population established by our research group in Shanxi province in 2014. Based on the baseline data of demographic characteristics and factors related to HPV infection, the concentrations of 1-hydroxypyrene in urine samples of the patients were determined by high performance liquid chromatography to define the exposure level of PAHs. At baseline survey and follow-up after 24 months, flow-through hybridization was used to detect HPV infection types, and to evaluate the prognosis of HR-HPV (persistent infection, negative conversion, positive conversion and persistent negative status). Results: Of the 564 subjects, 483 completed the follow-up, with a follow-up rate of 85.6% (483/564). Among them, the persistent infection rate was 52.4% (75/143), the persistent homotype infection rate was 35.7% (51/143), the negative conversion rate was 47.6% (68/143), the positive conversion rate was 19.7% (67/340), and the persistent negative rate was 80.3% (273/340). The follow-up results showed that the persistent infection rate (aRR=3.22, 95%CI: 1.85-5.62) and positive conversion rate (aRR=2.84, 95%CI: 1.64-4.94) of HR-HPV in high PAHs exposure group were higher than those in low PAHs exposure group, while the persistent negative rate (aRR=0.55, 95% CI: 0.43-0.70) of HR-HPV in high PAHs exposure group were lower than those in low PAHs exposure group. Based on restrictive cubic spline analysis, the results showed that the effects of PAHs exposure on persistent HR-HPV infection and persistent homotype infection showed an ascending linear dose-response relationship, while on HR-HPV positive conversion and persistent negative status showed an ascending and declining nonlinear dose-response relationship respectively (P<0.01). Conclusions: High PAHs exposure could promote persistent HR-HPV infection and persistent homotypic infection. Reducing PAHs exposure might conducive to HR-HPV continuous negative maintenance. Active prevention and control of PAHs exposure is of great significance to prevent HR-HPV infection and persistent infection.

Mineralization of sulfonamides from wastewater using ozone-based systems

Ozone, UV/ozone, ozone/persulfate (PS) and UV/ozone/PS systems were used to mineralize sulfonamides. Sulfadiazine (SDZ), sulfamerazine (SMR) and sulfamethazine (SMZ) were the target compounds. The novel contribution of this study is its determination of the effects of PS addition, sulfonamide structure, pH and salinity on sulfonamide mineralization in ozone-based systems. The mineralization rate of sulfonamides satisfied pseudo-first-order kinetics. The SMZ mineralization rate constant in ozone, UV/ozone, ozone/PS and UV/ozone/PS systems at pH 5 were 0.0058; 0.0101; 0.0069 and 0.0802 min^-1, respectively, and those at pH 7 were 0.0075; 0.0116; 0.0083 and 0.0873 min^-1, respectively. The increase in the number of methyl substituents in the heterocyclic group of SMZ and the corresponding increase in the steric hindrance of radical addition, reduced mineralization rates below those of SMR and SDZ. The addition of PS promoted sulfonamide mineralization in the ozone-based systems; conversely, salinity inhibited sulfonamide mineralization.

Foveal Microvascular Integrity Association With Anti-VEGF Treatment Response for Diabetic Macular Edema

Purpose

To investigate the association between foveal microvascular integrity and anti-vascular endothelial growth factor (VEGF) treatment response for diabetic macular edema (DME).

Methods

This retrospective study enrolled 58 eyes (from 45 patients) with DME. Treatment strategy was three to five monthly anti-VEGF injections followed by a PRN protocol. Treatment with an intravitreal corticosteroid would be considered for persistent DME after five consecutive anti-VEGF injections. Eyes achieving a treatment-free interval ≥ four months within two years were classified into the good clinical course group (group 1). Eyes with frequent recurrent edema (treatment-free interval < four months) or requiring an intravitreal corticosteroid within two years were classified into the suboptimal clinical course group (group 2). Foveal microvascular integrity was evaluated by two continuous variables, that is, vessel density (%) within a width of 300 µm around the foveal avascular zone (FD-300) on optical coherence tomography angiography (OCTA) and perifoveal leakage (area %) on fluorescein angiography (FA).

Results

There were 37 eyes in group 1 and 21 eyes in group 2. FD-300 (odds ratio 0.733, 95% CI 0.620–0.867, P < 0.001) and perifoveal leakage (odds ratio 1.064, 95% CI 1.007–1.124, P = 0.027) were significantly associated with suboptimal clinical course. Area under curve (AUC) was 0.820 for FD-300 and 0.723 for perifoveal leakage in predicting clinical course. FD-300 was negatively correlated with perifoveal leakage (coefficient = −0.325, P = 0.014).

Conclusions

Compromised foveal microvascular integrity, represented by lower FD-300 and more severe perifoveal fluorescein leakage, was associated with suboptimal clinical course in anti-VEGF treatment for DME. A negative correlation between FD-300 and perifoveal leakage existed.

Comparative analysis of Student's live online learning readiness during the coronavirus (COVID-19) pandemic in the higher education sector

Amid the coronavirus outbreak, many countries are facing a dramatic situation in terms of the global economy and human social activities, including education. The shutdown of schools is affecting many students around the world, with face-to-face classes suspended. Many countries facing the disastrous situation imposed class suspension at an early stage of the coronavirus outbreak, and Asia was one of the earliest regions to implement live online learning. Despite previous research on online teaching and learning, students' readiness to participate in the real-time online learning implemented during the coronavirus outbreak is not yet well understood. This study explored several key factors in the research framework related to learning motivation, learning readiness and student's self-efficacy in participating in live online learning during the coronavirus outbreak, taking into account gender differences and differences among sub-degree (SD), undergraduate (UG) and postgraduate (PG) students. Technology readiness was used instead of conventional online/internet self-efficacy to determine students' live online learning readiness. The hypothetical model was validated using confirmatory factor analysis (CFA). The results revealed no statistically significant differences between males and females. On the other hand, the mean scores for PG students were higher than for UG and SD students based on the post hoc test. We argue that during the coronavirus outbreak, gender differences were reduced because students are forced to learn more initiatively. We also suggest that students studying at a higher education degree level may have higher expectations of their academic achievement and were significantly different in their online learning readiness. This study has important implications for educators in implementing live online learning, particularly for the design of teaching contexts for students from different educational levels. More virtual activities should be considered to enhance the motivation for students undertaking lower-level degrees, and encouragement of student-to-student interactions can be considered.

A Multimodal Imaging-Based Deep Learning Model for Detecting Treatment-Requiring Retinal Vascular Diseases: Model Development and Validation Study

BACKGROUND

Retinal vascular diseases, including diabetic macular edema (DME), neovascular age-related macular degeneration (nAMD), myopic choroidal neovascularization (mCNV), and branch and central retinal vein occlusion (BRVO/CRVO), are considered vision-threatening eye diseases. However, accurate diagnosis depends on multimodal imaging and the expertise of retinal ophthalmologists.

OBJECTIVE

The aim of this study was to develop a deep learning model to detect treatment-requiring retinal vascular diseases using multimodal imaging.

METHODS

This retrospective study enrolled participants with multimodal ophthalmic imaging data from 3 hospitals in Taiwan from 2013 to 2019. Eye-related images were used, including those obtained through retinal fundus photography, optical coherence tomography (OCT), and fluorescein angiography with or without indocyanine green angiography (FA/ICGA). A deep learning model was constructed for detecting DME, nAMD, mCNV, BRVO, and CRVO and identifying treatment-requiring diseases. Model performance was evaluated and is presented as the area under the curve (AUC) for each receiver operating characteristic curve.

RESULTS

A total of 2992 eyes of 2185 patients were studied, with 239, 1209, 1008, 211, 189, and 136 eyes in the control, DME, nAMD, mCNV, BRVO, and CRVO groups, respectively. Among them, 1898 eyes required treatment. The eyes were divided into training, validation, and testing groups in a 5:1:1 ratio. In total, 5117 retinal fundus photos, 9316 OCT images, and 20,922 FA/ICGA images were used. The AUCs for detecting mCNV, DME, nAMD, BRVO, and CRVO were 0.996, 0.995, 0.990, 0.959, and 0.988, respectively. The AUC for detecting treatment-requiring diseases was 0.969. From the heat maps, we observed that the model could identify retinal vascular diseases.

CONCLUSIONS

Our study developed a deep learning model to detect retinal diseases using multimodal ophthalmic imaging. Furthermore, the model demonstrated good performance in detecting treatment-requiring retinal diseases.

Removal of sulfamethizole from aqueous solution using advanced oxidation processes: effects of pH and salinity

This study investigates the removal of sulfamethizole (SFZ) in ozone (O₃), O₃/Na₂S₂O₈ (sodium persulfate), UV/Na₂S₂O₈, UV/O₃, and UV/O₃/Na₂S₂O₈ systems. The effects of pH and salinity on SFZ mineralization were evaluated. The mineralization of SFZ followed pseudo-first-order kinetics. At pH 5, the rate constants of SFZ mineralization in O₃, O₃/Na₂S₂O₈, UV/Na₂S₂O₈, UV/O₃, and UV/O₃/Na₂S₂O₈ systems were 0.576, 0.924, 0.702, 1.26, and 5.21 h^-1, respectively. The SFZ mineralization rate followed the order pH 5 > pH 7 > pH 9 in all tested advanced oxidation processes. Salinity increased the rate of SFZ mineralization in O₃ and O₃/Na₂S₂O₈ systems and decelerated it in UV/Na₂S₂O₈, UV/O₃, and UV/O₃/Na₂S₂O₈ systems. UV/O₃/Na₂S₂O₈ was the best system for mineralizing SFZ, and sulfate radicals were the predominant species in UV/O₃/Na₂S₂O₈.

Development of a new dynamic foveated imager on wide-angle infra-red thermography system to improve local spatial resolution in EAST

A new dynamic foveated imager has been developed and commissioned on the wide-angle infra-red thermography system in the Experimental Advanced Superconducting Tokamak. This technique improves the local spatial resolution by a factor of 2 while maintaining the wide-angle view to ensure safety operation. Taking advantage of the new foveated imager, heat flux splitting under the application of resonant magnetic perturbation (RMP) coils has been clearly observed. The results indicate that the toroidal asymmetric power load pattern is closely related to the perturbation field induced by the RMP coils.

[Clinical characteristics and outcome of 64 patients with severe COVID-19]

Objective: To investigate the causes of death in patients with severe COVID-19. Methods: A retrospective analysis was performed on 64 patients with severe COVID-19 admitted to Wuhan Pulmonary Hospital from January 12, 2020 to February 28, 2020. There were 36 males and 28 females, aging from 44 to 85 years[median 68 (62, 72)]. Fifty-two patients (81%) had underlying comorbidities. The patients were divided into the death group (n=40) and the survival group (n=24) according to the treatment outcomes. In the death group, 24 were male, and 16 were female, aging from 49 to 85 years [median 69 (62, 72)], with 31 cases (78%) complicated with underlying diseases. In the survival group, there were 12 males and 12 females, aging from 44 to 82 years[median 66 (61,73)], with 21 cases (88%) with comorbidities. Clinical data of the two groups were collected and compared, including general information, laboratory examinations, imaging features and treatments. For normally distributed data, independent group t test was used; otherwise, Mann Whitney test was used to compare the variables. χ(2) test and Fisher exact test was used when analyzing categorical variables. Results: The median of creatine kinase isozyme (CK-MB) in the death group was 19.0 (17.0,23.0) U/L, which was higher than that in the survival group 16.5 (13.5,19.6) U/L. The median level of cTnI in the death group was 0.03 (0.03, 0.07) μg/L, which was significantly higher than that in the survival group (0.02, 0.03) μg/L, with a statistically significant difference between the two groups (P=0.007). The concentration of myoglobin in the death group was 79.5 (28.7, 189.0) μg/L, which was higher than 33.1 (25.7, 54.5) μg/L in the survival group. The level of D-dimer in the death group was 2.0 (0.6, 5.2) mg/L, which was higher than 0.7 (0.4, 2.0) mg/L in the survival group. The LDH level of the death group was 465.0 (337.5,606.5) U/L, which was higher than that of the survibal group, 341.0 (284.0,430.0) U/L, the difference being statistically significant (P=0.006). The concentration of alanine aminotransferase in the death group was 40.0 (30.0, 48.0) U/L, which was higher than 32.5 (24.0, 40.8) U/L in the survival group, and the difference was statistically significant (P=0.047).Abnormal ECG was found in 16 cases (62%) in the death group, which was significantly higher than that in the survival group (29%), the difference being statistically significant (P=0.024) .The main causes of death were severe pneumonia with acute respiratory distress syndrome (ARDS, n=20), acute heart failure(n=9), atrial fibrillation(n=3) and multiple organ dysfunction syndrome (MODS, n=3). Conclusions: ARDS caused by severe pneumonia and acute heart failure and atrial fibrillation caused by acute viral myocarditis were the main causes of death in severe COVID-19 patients. Early prevention of myocardial injury and treatment of acute viral myocarditis complicated with disease progression may provide insights into treatment and reduction of mortality in patients with severe COVID-19.

Ultrasound Elastography in Musculoskeletal Radiology: Past, Present, and Future

Ultrasound elastography (USE) is becoming an important adjunct tool in the evaluation of various musculoskeletal (MSK) traumatic conditions and diseases, with an increasing number of applications and publications in recent years. This rapidly evolving technique enhances the conventional ultrasound (US) examination by providing information on the elastic properties of tissue alongside the morphological and vascular information obtained from B-mode US and Doppler imaging. Those performing USE must have basic knowledge of its proper imaging techniques and limitations. In this review article, we place the USE in historical perspective and discuss basic techniques and current applications of USE in the evaluation of various traumatic and pathologic conditions of fasciae, nerves, muscles, tendons, ligaments, and MSK soft tissue masses.

Inhibition of tetrachloroethene and trichloroethene on methanogenesis in anaerobic sludges from various origins

Nine anaerobic sludges were screened to obtain the most effective methanogenic inoculum for the anaerobic treatment of groundwater that is contaminated with tetrachloroethene (PCE) or trichloroethene (TCE). The selection was based on the toxicity of PCE or TCE to acetoclastic methanogens in different sludges. The effects of two biological factors, sludge origin and specific acetoclastic methanogenic activity, and a physical factor, specific surface area of sludge, on the degree of inhibition were examined and compared. The fifty percent inhibition concentrations (IC₅₀) of PCE and TCE that were obtained from 30 °C batch inhibition tests ranged from 0.18 to 0.41 and 1.71 to 3.31 mM, respectively, for the examined sludges. The toxicity of the contaminants to anaerobic sludges did not depend on the two biological factors but was closely correlated with the specific surface area of sludge. Suspended sludges, which have higher specific surface areas than granular sludges, suffered much greater inhibition. This paper suggests the use of anaerobic granular sludges as inocula in bioreactors for treating PCE- and TCE-contaminated groundwater to reduce the effect of their inhibition.

Removal of sulfonamides from wastewater in the UV/TiO2 system: effects of pH and salinity on photodegradation and mineralization

The effects of salinity on the photodegradation and mineralization of sulfonamides in the UV/TiO₂ system were investigated. The goals of this study were to analyze the effects of pH and salinity on the sulfonamide concentration and total organic carbon (TOC) during the removal of sulfonamides in a UV/TiO₂ system. Four sulfonamides - sulfadiazine (SDZ), sulfamethizole (SFZ), sulfamethoxazole (SMX) and sulfathiazole (STZ) - were selected as parent compounds. The photodegradation and mineralization rates of sulfonamides in the UV/TiO₂ system satisfy pseudo-first-order kinetics. Direct photolysis degraded sulfonamides but sulfonamides cannot be mineralized. The photodegradation and mineralization rate constants in all experiments followed the order pH 5 > pH 7 > pH 9. At pH 5, the mineralization rate constants of SMX, SFZ, SDZ and STZ were 0.015, 0.009, 0.012 and 0.011 min^-1, respectively. The addition of NaCl inhibited the mineralization of the four tested sulfonamides more than it inhibited their photodegradation. The inhibitory effect of chloride ions on the removal of sulfonamides in the UV/TiO₂ system was attributed to the scavenging by chloride ions of hydroxyl radicals (HO•) and holes and the much lower reactivity of chlorine radicals thus formed, even though the chlorine radicals were more abundant than HO•.

Effect of Selenization Processes on CIGS Solar Cell Performance

Cu(In, Ga)Se2 (CIGS) films were fabricated by a two-step process method using sputtering from Cu0.7Ga0.3 and In targets. The metallic precursor structures of In/CuGa/In were prepared, and CuGa film was adjusted to the thicknesses of 150, 200, 250 and 300 nm, in order to optimize the CIGS film. After selenization, three independent CIGS (112), CIGS (220/204) and CIGS (312/116) began to crystallize at ~280 °C and phase peaks continued growing until 560 °C. Experimental results showed that with a single stage selenization method, the excessive stoichiometry of the CIGS films was obtained. Using three sequential stages for the selenization process, with a annealing time of 20 min, the stoichiometry of the CIGS absorbers with the Cu/(In + Ga) and Ga/(In + Ga) showed atomic ratios of 0.94 and 0.34, respectively. The intensity of the (112) XRD diffraction peak became stronger, indicating an improvement in the crystallinity. Raman spectra of CIGS absorbers showed a main peak (174 cm-1) and two weak signals (212 and 231 cm-1). TEM image for electron diffraction pattern showed that the grains were randomly oriented. CIGS solar cell device prepared with a proper selenization, a maximum efficiency of 12.45% was obtained.

High-free androgen index is associated with increased risk of non-alcoholic fatty liver disease in women with polycystic ovary syndrome, independent of obesity and insulin resistance

BACKGROUND/OBJECTIVE

Central obesity and insulin resistance (IR) are common conditions in women with polycystic ovary syndrome (PCOS) and in subjects with non-alcoholic fatty liver disease (NAFLD). However, few studies have addressed the association between hyperandrogenism (HA) and NAFLD. We aimed to determine whether variations in the free androgen index (FAI) might be associated with NAFLD prevalence.

SUBJECTS/METHODS

A cross-sectional study was performed including 400 Chinese women with PCOS and 100 age, and body mass index (BMI)-matched women. The anthropometric and serum biochemical parameters related to sex steroids, glucose and lipid profiles were examined. Liver fat content (LFC) was measured by quantitative ultrasound.

RESULTS

The prevalence of NAFLD was 56.23% in PCOS patients and 38% in controls (P=0.001), and this prevalence increased with FAI quartile independently of obesity and homeostasis model assessment of insulin resistance (HOMA-IR). The FAI level increased from non-NAFLD group to NAFLD group. The FAI was positively associated with the metabolic parameters LFC, BMI, waist circumference, alanine aminotransferases, aspartate, triglyceride, total cholesterol and low-density lipoprotein cholesterol, and was negatively associated with high-density lipoprotein. Moreover, in multivariate logistic regression analysis BMI, high-sensitivity C-reactive protein (hsCRP), FAI, LFC and HOMA-IR were significantly associated with NAFLD. The cut-off values of FAI, LFC, BMI and hsCRP to predict NAFLD were 9.86%, 17.19%, 24.38% and 0.72%, respectively. The area under the curve for predicting NAFLD in PCOS patients showed comparable sensitivity and specificity between BMI and a new index combining FAI with hsCRP.

CONCLUSIONS

A higher FAI level is associated with increased LFC and NAFLD prevalence independent of obesity and IR.

Surgical outcome of deep anterior lamellar keratoplasty with air-assisted manual dissection for corneas with previous inflammation or fibrosis

PURPOSE:

To report our experience in air-assisted manual dissection deep anterior lamellar keratoplasty (DALK) for the treatment of corneal scar with previous inflammation and fibrosis.

MATERIALS AND METHODS:

We retrospectively reviewed the medical history of 21 patients (male:female = 13:8 mean age 41.9 years old) with corneal pathology from previous infection and inflammation. Trephination diameter ranged from 7.0 to 8.0 mm, and the graft was oversized by 0.25–0.50 mm. Debulking technique was performed to expose Descemet's membrane after filling stroma with air. Starting from postoperative 3 months, selective suture removal was performed to reduce corneal astigmatism.

RESULTS:

The mean follow-up period was 59.9 ± 19.8 (20–96) months. Intraoperative microperforation occurred in 2 eyes (9.5%); however, there was no shift to penetrating keratoplasty. Air-bubble tamponade was performed in 7 eyes (33.3%) for postoperative gapping of the graft. There were 2 failed grafts (9.5%) due to corneal ulcer while all the other grafts remained clear throughout follow-up. The mean preoperative best-corrected visual acuity (BCVA) was 1.84 ± 0.66 logMAR, which improved to 0.74 ± 0.63 (P < 0.01). The average sphere power was − 0.88 ± 3.88 diopter (D), average cylinder power 3.03 ± 1.46D, and average endothelial count 1877 ± 375 cells/mm².

CONCLUSION:

In severe ocular surface diseases, big-bubble technique frequently failed to separate predescemtic plane; however, it effectively created air-filled stroma which was easier to remove. Although BCVA was suboptimal due to ocular surface disorders, graft survival and clarity rate is high, justifying the application of DALK in these cases.

Isolation and characterization of microsatellite markers for Eucommia ulmoides (Eucommiaceae), an endangered tree, using next-generation sequencing

Eucommia ulmoides Oliver, a single extant species of Eucommiaceae, is an endemic dioecious tree in China. The natural resources of E. ulmoides have rapidly declined in recent years because of the over-collection of its cortex. To design a suitable protection strategy, it is necessary to develop a set of molecular markers to investigate genetic diversity and population structure of E. ulmoides. Pyrosequencing of an enriched microsatellite library by Roche 454 FLX+ platform was used to isolate simple sequence repeats (SSRs) for E. ulmoides. A total of 1568 SSRs that contained enough flanking sequences for primer pair design were identified from 45,236 raw sequence reads. One hundred SSRs were randomly selected to design primer pairs and polymerase chain reaction was performed. Among these 100 tested primer pairs, 16 were polymorphic across 18 individuals from three E. ulmoides populations. The number of alleles ranged from 3 to 8, with an average of 5.1. The expected heterozygosity ranged from 0.110 to 0.830, with an average of 0.648, and the observed heterozygosity ranged from 0.111 to 0.833, with an average of 0.524. The inbreeding coefficient ranged from -0.349 to 0.547. This set of microsatellite markers could be valuable for landscape genetic structure assessment and molecular marker-assisted breeding in E. ulmoides.

[A biomechanical evaluation of odontoid screw plate fixation system]

OBJECTIVE

To evaluate the biomechanical stability of anterior odontoid screw plate (AOSP).

METHODS

Eight fresh-frozen cadaveric cervical spine specimens were subjected to stepwise destabilization of the C1-C3 complex, simulating a type Ⅰ Hangman fracture, type Ⅱ odontoid fracture, and the C2-3 disc injury. Intact specimens, fractured specimens, and fractured specimens with posterior, anterior fixation techniques were divided into six groups: control group (intact), injury group of type Ⅱ odontoid fracture and type Ⅰ Hangman fracture combined with C2-3 disk injury, after anterior cervical plate+ odontoid screw+ cage (ACP+ OS+ cage) group, after anterior odontoid screw plate (AOSP) fixation system group, after affixing rods from pedicle screws in C2 to lateral mass screws in C3+ odontoid screw (C2PS+ C3LMS+ OS) group, after affixing rods from pedicle screws in C1 to pedicle screws in C2 and lateral mass screws in C3 (C1PS+ C2PS+ C3LMS) group. The range of motion (ROM) and neutral zone of C1-C2 and C2-C3 segment was tested.

RESULTS

There was statistically significant difference between the C1PS+ C2PS+ C3LMS fixation group and the AOSP fixation group of ROMC1-C2(P<0.05). During all loading modes, AOSP+ Bone graft fixation significantly outperformed the ACP+ OS+ cage fixation in limiting ROMC2-C3. During flexion and extension, AOSP fixation significantly outperformed the C1PS+ C2PS+ C3LMS fixation and C2PS+ C3LMS+ OS fixation in limiting ROMC2-C3.

CONCLUSION

The AOSP fixation system has excellent biomechanical performance when dealing with type Ⅰ Hangman fracture, type Ⅱ odontoid fracture, and the C2-3 disc injury, and appear to be a safe and effective technique for dealing with the combined injury.

Chemical derivatization for forensic drug analysis by GC- and LC-MS

Utilizing chemical derivatization (CD) to improve gas chromatographic (GC) and GC-mass spectrometric (MS) analysis of drugs has been abundantly studied and widely practiced, while in liquid chromatography (LC) and LC-MS, application of CD approaches is still at an early stage. Silylation, acylation, and alkylation are common CD reactions, long adopted by GC and GC-MS (including GC-MS/MS) methodologies, to improve analytes' stability and/or to optimize their extraction/separation and detection efficiencies. Highly polar and nonvolatile analytes are not amenable to GC-MS analysis without the CD step; however, CD can improve LC-MS analysis of highly polar analytes, especially those with low molecular weights. Many CD reagents developed for GC and GC-MS applications are also effective in LC-MS. Other CD reagents are developed for LC-MS to enhance analytes' performance under electrospray and atmospheric pressure ionization sources. Certain CD reagents are designed to facilitate analytes' fragmentation (upon collision-induced dissociation) in generating intense product ions for sensitive MS/MS detection. In this review, various CD reagents, reaction types, and application examples are presented and discussed, with emphases on GC-MS and LC-MS analysis of drugs of abuse.

Mineralization of sulfamethizole in photo-Fenton and photo-Fenton-like systems

In this investigation, UV/H2O2, UV/H2O2/Fe(2+) (photo-Fenton) and UV/H2O2/Fe(3+) (photo-Fenton-like) systems were used to mineralize sulfamethizole (SFZ). The optimal doses of H2O2 (1-20 mM) in UV/H2O2 and iron (0.1-1 mM) in photo-Fenton and photo-Fenton-like systems were determined. Direct photolysis by UV irradiation and direct oxidation by added H2O2, Fe(2+) and Fe(3+) did not mineralize SFZ. The optimal dose of H2O2 was 10 mM in UV/H2O2 and that of iron (Fe(2+) or Fe(3+)) was 0.2 mM in both UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems. Under the best experimental conditions and after 60 min of reaction, the SFZ mineralization percentages in UV/H2O2, UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems were 16, 90 and 88%, respectively. The UV/H2O2/Fe(2+) and UV/H2O2/Fe(3+) systems effectively mineralized SFZ.

Additional chromosomal abnormalities in core-binding factor acute myeloid leukemia

Despite sharing a similar genetic abnormality, patients with core binding factor acute myeloid leukemia (CBF-AML), which is characterized by the presence of t(8;21) or inv(16)/t(16;16), show heterogeneous survival. Other molecular or cytogenetic factors are supposed to have an impact on the prognosis. We enrolled 24 CBF-AML patients to determine the impact of cytogenetic abnormality, and c-KIT, FLT3, NPM1, and CEBPA mutations on the prognosis. Only three patients had the c-KIT mutation (3/24, 12.5%) and one had the FLT3 mutation. However, over half of the patients (14/24) harbored additional cytogenetic changes, including ten with loss of sexual chromosomes (LOS) [all in the t(8;21) group], and six had additional abnormalities (two cases had both LOS and additional abnormalities). From this small-number study, no association was found between c-KIT mutation and survival and relapse rate. However, additional chromosome abnormalities had a significant association with relapse of the disease (P = 0.027). Stem cell transplant had a trend of benefitting patients after relapse (P = 0.065). This implies that chromosome abnormalities occur in CBF-AML and might take part in the heterogeneous nature of CBF-AML.

EURO-MUSCULUS/USPRM. Basic scanning protocols for knee

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned knee structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM. Basic scanning protocols for hip

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned hip structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM. Basic Scanning Protocols for Ankle and foot

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned ankle/foot structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM Basic Scanning Protocols for elbow

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned elbow structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM Basic Scanning Protocols for wrist and hand

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned wrist/hand structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

EURO-MUSCULUS/USPRM Basic Scanning Protocols for shoulder

In this protocol, the patient/probe positionings, anatomical drawings and ultrasound images of commonly scanned shoulder structures are described. This practical guide is prepared (with an international consensus of several expert physiatrists) to serve as a uniform/standard approach especially for beginner sonographers.

A Nanoscale-Localized Ion Damage Josephson Junction Using Focused Ion Beam and Ion Implanter

High-T(c) Josephson junctions were fabricated by nanolithography using focused ion beam (FIB) milling and ion implantation. The junctions were formed in a YBa2Cu3O7-x, thin film in regions defined using a gold-film mask with 50-nm-wide (top) slits, engraved by FIB. The focused ion beam system parameters for dwell time and passes were set to remove gold up to a precise depth. 150 keV oxygen ions were implanted at a nominal dose of up to 5 x 10(13) ions/cm2 into YBa2Cu3O7-x microbridges through the nanoscale slits. The current-voltage curves of the ion implantation junctions exhibit resistive-shunted-junction-like behavior at 77 K. The junction had an approximately linear temperature dependence of critical current. Shapiro steps were observed under microwave irradiation. A 50-nm-wide slit and 0-20-nm-thick buffer layers were chosen in order to make Josephson junctions due to the V-shape of the FIB-milled trench.

Photodegradation of sulfonamide antimicrobial compounds (sulfadiazine, sulfamethizole, sulfamethoxazole and sulfathiazole) in various UV/oxidant systems

This study used Na₂S₂O₈, NaBrO8 and H₂O₂to degrade sulfadiazine (SDZ), sulfamethizole (SFZ), sulfamethoxazole (SMX) and sulfathiazole (STZ) under ultraviolet (UV) irradiation. The initial concentration of sulfonamide and oxidant in all experiments was 20 mg/L and 5 mM, respectively. The degradation rate for sulfonamides satisfies pseudo-first-order kinetics in all UV/oxidant systems. The highest degradation rate for SDZ, SFZ, SMX and STZ was in the UV/Na₂S₂O₈, UV/NaBrO₃, UV/Na₂S₂O₈ and UV/H₂O₂ system, respectively. In the UV/Na₂S₂O₈ system, the photodegradation rate of SDZ, SFZ, SMX and STZ was 0.0245 min⁻¹, 0.0096 min⁻¹, 0.0283 min⁻¹ and 0.0141 min⁻¹, respectively; moreover, for the total organic carbon removal rate for SDZ, SFZ, SMX and STZ it was 0.0057 min⁻¹, 0.0081 min⁻¹, 0.0130 min⁻¹ and 0.0106 min⁻¹, respectively. Experimental results indicate that the ability of oxidants to degrade sulfonamide varied with pollutant type. Moreover, UV/Na₂S₂O₈ had the highest mineralization rate for all tested sulfonamides.

Using bio-functionalized magnetic nanoparticles and dynamic nuclear magnetic resonance to characterize the time-dependent spin-spin relaxation time for sensitive bio-detection

In this work, we report the use of bio-functionalized magnetic nanoparticles (BMNs) and dynamic magnetic resonance (DMR) to characterize the time-dependent spin-spin relaxation time for sensitive bio-detection. The biomarkers are the human C-reactive protein (CRP) while the BMNs are the anti-CRP bound onto dextran-coated Fe₃O₄ particles labeled as Fe₃O₄-antiCRP. It was found the time-dependent spin-spin relaxation time, T₂, of protons decreases as time evolves. Additionally, the ΔT₂ of of protons in BMNs increases as the concentration of CRP increases. We attribute these to the formation of the magnetic clusters that deteriorate the field homogeneity of nearby protons. A sensitivity better than 0.1 μg/mL for assaying CRP is achieved, which is much higher than that required by the clinical criteria (0.5 mg/dL). The present MR-detection platform shows promise for further use in detecting tumors, viruses, and proteins.

Outcomes after surgery in patients with previous stroke

BACKGROUND

Limited information is available on the association between a medical history of stroke and postoperative outcomes. This study investigated the outcomes following non-neurological surgery in patients with previous stroke.

METHODS

Using Taiwan's National Health Insurance Research Database, a nationwide cohort study was conducted of patients who underwent non-neurological surgery between 2008 and 2010 with a medical history of stroke in the 24-month period before operation. Patients who had non-neurological surgeries without previous stroke were selected as controls by the propensity score-matched pair method. Thirty-day postoperative complications and in-hospital mortality were compared between the two groups.

RESULTS

Some 1 426 795 adults underwent major inpatient non-neurological surgery, of whom 45 420 had a medical history of previous stroke. Patients with previous stroke who underwent surgery had an increased risk of postoperative pneumonia, septicaemia, acute renal failure, acute myocardial infarction, pulmonary embolism and 30-day in-hospital mortality (adjusted rate ratio (RR) 1·79, 95 per cent c.i. 1·61 to 1·99). Compared with controls, patients with previous stroke due to intracerebral haemorrhage (RR 3·41, 2·97 to 3·91), and those who were treated in intensive care (RR 2·55, 2·24 to 2·90) or underwent neurosurgery (RR 2·49, 2·12 to 2·92), had an increased 30-day in-hospital mortality rate. Postoperative mortality also increased with stroke-related co-morbidities, and with stroke 1-6 months before surgery (RR 3·31, 2·91 to 3·75).

CONCLUSION

Patients with previous stroke had a higher risk of adverse postoperative outcomes; their 30-day in-hospital mortality rate was nearly twice that of patients without previous stroke.

Deferoxamine retinopathy: spectral domain-optical coherence tomography findings

BACKGROUND

To describe the spectral domain optical coherence tomography (SD-OCT) findings of a patient who developed pigmentary retinopathy following high-dose deferoxamine administration.

CASE PRESENTATION

A 34-year-old man with thalassemia major complained of nyctalopia and decreased vision following high-dose intravenous deferoxamine to treat systemic iron overload. Fundus examination revealed multiple discrete hypo-pigmented lesions at the posterior pole and mid-peripheral retina. Recovery was partial following cessation of desferrioxamine six weeks later. A follow-up SD-OCT showed multiple accumulated hyper-reflective deposits primarily in the choroid, retina pigment epithelium (RPE), and inner segment and outer segment (IS/OS) junction.

CONCLUSION

Deferoxamine retinopathy primarily targets the RPE-Bruch membrane-photoreceptor complex, extending from the peri-fovea to the peripheral retina with foveola sparing. An SD-OCT examination can serve as a simple, noninvasive tool for early detection and long-term follow-up.

Biological treatment of pharmaceutical wastewater from the antibiotics industry

Pharmaceutical wastewater generated by an antibiotics (penicillin) company was treated by aerobic membrane bioreactors (MBRs) and sequencing batch reactors (SBRs). At a low organic loading rate of 0.22 kg-COD m(-3)d(-1), both types of reactors were capable of treating the wastewater such that the treated effluent met the discharge regulation except for the total dissolved solids. However, when the loading rate was increased to 2.92 kg-COD m(-3)d(-1), foaming issues resulted in unstable performance. Overall, the MBRs achieved better solid removal but the SBRs performed better in regards to the degradation of aromatic compounds, as determined by UV absorbance (UVA). Finally, ozonation was applied on two different streams and showed promise on the strong stream - that corresponds to the formulation effluent and contains most of the biorefractory compounds. Ozonation successfully reduced the UVA, lowered the pH and increased the biochemical oxygen demand : chemical oxygen demand (BOD5 : COD) ratio of the strong stream. However, it was less efficient on the effluent having undergone pre-treatment by a biofilter due to a lack of selectivity towards refractory compounds.

Preparation of immobilized Cu2O using microwave irradiation and its catalytic activity for bisphenol A: comparisons of Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems

This study produced immobilized Cu2O via microwave irradiation. The surface properties of Cu2O were assessed by X-ray diffraction, scanning electron microscopy, and UV-vis spectroscopy. The catalytic activity of the generated Cu2O was examined for bisphenol (BPA) degradation in Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems under various H2O2 concentrations. Cu2O can decompose H2O2 to generate radicals, similar to the Fenton-like process. The BPA degradation rate followed pseudo-first-order kinetics. The optimal H2O2 concentration was 30 mM and the BPA degradation rate under 30 mM H2O2 in the Cu2O/H2O2 and visible-light/Cu2O/H2O2 systems was 1.43 and 2.69 h(-1), respectively. The original Cu2O partly oxidized into CuO in the visible-light/Cu2O/H2O2 system and the BPA degradation percentage declined to 51% from 100% after the fifth cycle.

Portal serum constituents possible determinants for anatomical localization ofSchistosoma mansoni during maturation and reproduction

Coupled adult pairs ofSchistosoma mansoni were incubated in medium containing either peripheral or portal serum from rat, rabbit, hamster, or man, and egg production was measured daily. In all cases egg production was significantly increased for pairs in the presence of portal sera compared with that in the presence of peripheral sera. Fractionation of rabbit portal serum according to molecular weight demonstrated that the most active component(s) were in the range of 2000 to 50,000. Similarly, a rat portal serum fraction in the range of 2000 to 30,000 molecular weight was most stimulatory. These fractions were as effective in stimulating oviposition as whole portal serum.

CONCLUSIONS

(1) portal serum factor(s) exist that stimulateS. mansoni oviposition in vitro; (2) they are present in susceptible and nonsusceptible hosts; and (3) the molecular weight range for the active components is larger than would be expected for simple carbohydrates, amino acids, or free fatty acids absorbed from the gastrointestinal tract.

Oral carcinoma with perineural invasion has higher nerve growth factor expression and worse prognosis

BACKGROUND

This study elucidated the association between histopathological factors and the prognosis of oral carcinoma. As the histopathological factors were determined from the surgical specimen and this can only be used for the choices of postoperative regimens, this study also investigated the linkage between prognostic factors and the expression of key molecules to examine the feasibility of markers as predictors.

METHODS

Clinicopathological factors of 101 oral carcinomas were cross-analyzed with disease-free survival. The expression of nerve growth factor (NGF) and its receptor, tyrosine kinase A receptor, was assayed with immunohistochemistry.

RESULTS

Nodal metastasis was the most crucial clinical predictor for disease-free survival. Perineural invasion (PNI) was an independent histopathological predictor for both nodal metastasis (P = 0.004) and disease-free survival (P = 0.019). Patients with advanced tumor and PNI exhibited the high hazard for tumor progression and poor disease-free survival. NGF immunoreactivity in tumors was correlated with PNI (P = 0.005) and neck lymph node metastasis (P = 0.036).

CONCLUSION

Perineural invasion is the indicator of worst prognosis. As NGF immunoreactivity was found to be associated with PNI and nodal metastasis, the NGF immunoreactivity of oral carcinoma revealed by diagnostic biopsy suggests that alternative therapeutic approaches might be appropriate.

Adverse postoperative outcomes in surgical patients with immune thrombocytopenia

Background

Patients with immune thrombocytopenia (ITP) are likely to have various medical co-morbidities, yet their global features regarding adverse postoperative outcomes and use of medical resources when undergoing major surgery are unknown. The objective of this study was to validate whether ITP is an independent risk factor for adverse postoperative outcomes, and to explore the potential clinical predictors of outcomes after major surgery among patients with ITP.

Methods

A retrospective population-based cohort study was conducted using Taiwan's National Health Insurance Research Database, controlling for preoperative co-morbidities by means of multiple logistic regression. Major postoperative complication and mortality rates, and in-hospital medical costs were analysed.

Results

The study included 11 085 surgical patients with ITP and 44 340 controls without ITP matched for sex, age, and type of surgery and anaesthesia. Surgical patients with ITP had a higher risk of postoperative death (odds ratio (OR) 1·89, 95 per cent confidence interval 1·57 to 2·27), and overall postoperative complications (OR 1·47, 1·39 to 1·56), and increased hospital stay (OR 1·90, 1·80 to 2·01), admission to the intensive care unit (OR 1·73, 1·63 to 1·83) and medical costs (OR 1·89, 1·79 to 1·99). Amount of preoperative platelet and/or red blood cell transfusion, emergency visits and admission to hospital for ITP care were identified as risk factors for adverse postoperative outcomes.

Conclusion

Patients with ITP undergoing surgery are at increased risk of adverse perioperative events, particularly if blood or blood product transfusion are required preoperatively, or the procedure is done as an emergency.

Optical coupling from InGaAs subcell to InGaP subcell in InGaP/InGaAs/Ge multi-junction solar cells

Spatially-resolved electroluminescence (EL) images in the triple-junction InGaP/InGaAs/Ge solar cell have been investigated to demonstrate the subcell coupling effect. Upon irradiating the infrared light with an energy below bandgap of the active layer in the top subcell, but above that in the middle subcell, the EL of the top subcell quenches. By analysis of EL intensity as a function of irradiation level, it is found that the coupled p-n junction structure and the photovoltaic effect are responsible for the observed EL quenching. With optical coupling and photoswitching effects in the multi-junction diode, a concept of infrared image sensors is proposed.

The effect of soy isoflavone on bone mineral density in postmenopausal Taiwanese women with bone loss: a 2-year randomized double-blind placebo-controlled study

The treatment of 300-mg/day isoflavones (aglycone equivalents) (172.5 mg genistein + 127.5 mg daidzein) for 2 years failed to prevent lumbar spine and total proximal femur bone mineral density (BMD) from declining as compared with the placebo group in a randomized, double-blind, two-arm designed study enrolling 431 postmenopausal women 45-65 years old.

INTRODUCTION

This study evaluated the effects of soy isoflavones on bone metabolism in postmenopausal women.

METHODS

Four hundred and thirty-one women, aged 45-65 years, orally consumed 300-mg/day isoflavones (aglycone equivalents) or a placebo for 2 years in a parallel group, randomized, double-blind, two-arm study. Each participant also ingested 600 mg of calcium and 125 IU of vitamin D(3) per day. The BMD of the lumbar spine and total proximal femur were measured using dual-energy X-ray absorptiometry at baseline and every half-year thereafter. Serum bone-specific alkaline phosphatase, urinary N-telopeptide of type 1 collagen/creatinine, and other safety assessments were examined regularly.

RESULTS

Two hundred out of 217 subjects in the isoflavone group and 199 out of 214 cases in placebo group completed the treatment. Serum concentrations of isoflavone metabolites, genistein and daidzein, of the intervention group were remarkably elevated following intake of isoflavones (p < 0.001). However, differences in the mean percentage changes of BMD throughout the treatment period were not statistically significant (lumbar spine, p = 0.42; total femur, p = 0.39) between the isoflavone and placebo groups, according to the generalized estimating equation (GEE) method. A significant time trend of bone loss was observed at both sites as assessed by the GEE method following repeated measurement of BMD (p < 0.001). Differences in bone marker levels were not significant between the two treatment groups.

CONCLUSION

Treatment with 300-mg/day isoflavones (aglycone equivalents) failed to prevent a decline in BMD in the lumbar spine or total femur compared with the placebo group.