Impact of Pelvic Fracture on Patients with Blunt Bowel Mesenteric Injury: Is Immediate Laparotomy Warranted?

The management of blunt abdominopelvic trauma with combined hemoperitoneum and pelvic fractures is challenging for trauma surgeons. Although angioembolization can achieve hemostasis in most visceral organ injuries and pelvic fractures after blunt abdominal trauma, it cannot effectively control hemorrhage in patients with blunt bowel mesenteric injury (BBMI). This study aimed to determine the risk factors associated with hemodynamically unstable patients with BBMI and to test the hypothesis that pelvic fracture is an independent risk factor for patients with unstable BBMI and concomitant pelvic fracture to guide the therapeutic sequence for difficult-to-manage patients. This retrospective study reviewed the data of hospitalized patients with trauma between 2009 and 2021 and included 158 adult patients with surgically proven BBMI. The patients were divided on the basis of the presence of a shock episode before emergency laparotomy. The shock group included 44.3% of all patients in the study (n = 70). Clinical injury severity and prognosis for patients in the shock group were poorer than those for patients in the non-shock group, and more invasive treatments and transfusions were performed for patients in the shock group than for those in the non-shock group. Pelvic fractures were more frequently associated with the shock group than with the non-shock group (21.4% vs. 5.7%; p = 0.003). In multivariate analysis, the presence of intracerebral hemorrhage (odds ratio [OR] = 10.87, 95% confidence intervals [CIs]: 1.70-69.75) and rib fracture (OR = 5.94, 95% CIs = 1.06-33.45) was identified as an independent predictor of shock, whereas the effect of pelvic fracture did not achieve statistical significance (OR = 2.94, 95% CIs = 0.66-13.13) after adjusting for confounding factors. For patients with BBMI, outcomes need to be improved during early diagnosis, and treatments should be expeditiously performed on the basis of the rapid identification of unstable hemodynamic status. Our results support the recommendation of emergency laparotomy in unstable patients with concomitant pelvic fractures, followed by damage control TAE if needed.

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.

High-mobility and low subthreshold swing amorphous InGaZnO thin-film transistors byin situH2plasma and neutral oxygen beam irradiation treatment

In this work, staggered bottom-gate structure amorphous In-Ga-Zn-O (a-IGZO) thin film transistors (TFTs) with high-k ZrO₂gate dielectric were fabricated using low-cost atmospheric pressure-plasma enhanced chemical vapor deposition (AP-PECVD) within situhydrogenation to modulate the carrier concentration and improve interface quality. Subsequently, a neutral oxygen beam irradiation (NOBI) technique is applied, demonstrating that a suitable NOBI treatment could successfully enhance electrical characteristics by reducing native defect states and minimize the trap density in the back channel. A reverse retrograde channel (RRGC) with ultra-high/low carrier concentration is also formed to prevent undesired off-state leakage current and achieve a very low subthreshold swing. The resulting a-IGZO TFTs exhibit excellent electrical characteristics, including a low subthreshold swing of 72 mV dec^-1and high field-effect mobility of 35 cm²V^-1s^-1, due to conduction path passivation and stronger carrier confinement in the RRGC. The UV-vis spectroscopy shows optical transmittance above 90% in the visible range of the electromagnetic spectrum. The study confirms the H₂plasma with NOBI-treated a-IGZO/ZrO₂TFT is a promising candidate for transparent electronic device applications.

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.

Artificial-intelligence robot umpires in sailing race

Today, many maritime nations have been promoting boat sports proactively, including sailing races. As sailing races are large-scale regattas that require massive workforces to monitor the game fairly; however, with limited match budgets and labors, Internet of Things (IoT) technology supports monitoring games has become a trend. This article proposes a robot umpire system in sailing races based on Artificial Intelligence (AI) techniques, using drones and AIoT technology to monitor sailing matches. When a large number of sailboats are in a match, and each sail along different routes, drones can monitor the entire game simultaneously. The features of this proposed approach are (1) The system recognizes images by Faster R-CNN, judging whether a sailboat uses a motor to accelerate; (2) The system detects conditions by edge computing; when cheating behaviors happen, it can notify the event holder immediately; (3) Advanced drone route plans can avoid collision incidents; (4) Improve the system recognition by federated learning. This study has implemented an experiment with real drones and installed IoT equipment on the drones for taking videos and recognizing. The experimental result has shown that the proposed approach is feasible and benefits the match's fairness. Additionally, umpires can review the violation details from the videos taken by the drones, supporting evidence for judging.

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.

Effects of Microwave and Furnace Annealing for P-Type SnO Thin Film Material in Oxygen Ambient

Transparent conductive oxide (TCO) semiconductors are attracted considerable attention due to a wide range of applications, such as flat panel display (FPD), touch panels, solar cells, and other optoelectronic devices. Owing to the different carrier conduction paths between n-type and P-type TCOs, the n-type TCO used in TFTs usually have high I_on/I_off current ratio (>10⁷) and high electron mobility (>10 cm²/V·s), P-type TCO TFTs are both lower than that of n-type one. For complementary circuits design and applications, however, both P-type and n-type semiconductor materials are equally important. For SnO thin films, it is important to adjust the ratio of Sn²⁺ (SnO P-type) and Sn⁴⁺ (SnO₂ n-type) in order to modulate the electrical characteristics. In this investigation of post treatment for SnO thin films, both microwave annealing (MWA) and furnace annealing process with 0₂ ambient are studied. The results show that SnO thin films are optimized at 300 °C, 30 minutes furnace annealing, the P-type SnO/SnO₂ thin film shows surface mean roughness 0.168 nm, [Sn²⁺]/[Sn⁴⁺] ratio as 0.838, at least 80% transmittance between 380 nm-700 nm visible light. Withthe results, SnO can be even used to fabricate high performance P-type thin film transistors (TFTs) device for future applications.

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.

Long-Term Trends and Predictors of Medical Resource Utilization and Medical Outcomes in Inguinal Hernia Repair: A Nationwide Cohort Study

BACKGROUND

Few studies have comprehensively and systematically analyzed nationwide samples. This study purposed to explore temporal trends and predictors of medical resource utilization and medical outcomes in these patients to obtain data that can be used to improve healthcare policies and to support clinical and administrative decision-making.

METHODS

This study used nationwide population data contained in the Longitudinal Health Insurance Database of Taiwan. The 14,970 inguinal hernia repair patients were enrolled in this study (age range, 18-100 years) from 1997 to 2013 in Taiwan. After temporal trends analysis of demographic characteristics, clinical characteristics, and institutional characteristics, predictors of postoperative medical resource utilization and medical outcomes were evaluated through multiple linear regression analysis and Cox regression analysis.

RESULTS

The prevalence of inguinal hernia repair per 100,000 population significantly decreased from 195.38 in 1997 to 39.66 in 2013 (p < 0.05). Demographic characteristics, clinical characteristics, and institutional characteristics were significantly associated with postoperative medical resource utilization and medical outcomes (p < 0.05). Of these characteristics, both surgeon volume and hospital volume had the strongest association.

CONCLUSIONS

The inguinal hernia repair prevalence rate gradually decreased during the study period. Demographic characteristics, clinical characteristics, and institutional characteristics had strong associations with postoperative medical resource utilization and medical outcomes. Furthermore, hospital volume and surgeon volume had the strongest associations with postoperative medical resource utilization and medical outcomes. Additionally, providing the education needed to make the most advantageous medical decisions would be a great service not only to patients and their families, but also to the general population.

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.

Does inappropriate initial antibiotic therapy affect in-hospital mortality of patients in the emergency department with Escherichia coli and Klebsiella pneumoniae bloodstream infections?

Extended-spectrum β-lactamase (ESBL)-positive bloodstream infection (BSI) is on the rise worldwide. The purpose of this study is to evaluate the impact of inappropriate initial antibiotic therapy (IIAT) on in-hospital mortality of patients in the emergency department (ED) with Escherichia coli and Klebsiella pneumoniae BSIs. This retrospective single-center cohort study included all adult patients with E. coli and K. pneumoniae BSIs between January 2007 and December 2013, who had undergone a blood culture test and initiation of antibiotics within 6 h of ED registration time. Multiple logistic regression was used to adjust for bacterial species, IIAT, time to antibiotics, age, sex, quick Sepsis Related Organ Failure Assessment (qSOFA) score ⩾ 2, and comorbidities. A total of 3533 patients were enrolled (2967 alive and 566 deceased, in-hospital mortality rate 16%). The patients with K. pneumoniae ESBL-positive BSI had the highest mortality rate. Non-survivors had qSOFA scores ⩾ 2 (33.6% vs 9.5%, P < 0.001), more IIAT (15.0% vs 10.7%, P = 0.004), but shorter mean time to antibiotics (1.70 vs 1.84 h, P < 0.001). A qSOFA score ⩾ 2 is the most significant predictor for in-hospital mortality; however, IIAT and time to antibiotics were not significant predictors in multiple logistic regression analysis. In subgroup analysis divided by qSOFA scores, IIAT was still not a significant predictor. Severity of the disease (qSOFA score ⩾ 2) is the key factor influencing in-hospital mortality of patients with E. coli and K. pneumoniae BSIs. The time to antibiotics and IIAT were not significant predictors because they in turn were affected by disease severity.

Using Long Short-Term Memory for Building Outdoor Agricultural Machinery

Today, climate change has caused a decrease in agricultural output or overall yields that are not as expected; however, with the ongoing population explosion, many undeveloped countries have transformed into emerging countries and have transformed farmland to be used in other types of applications. The resulting decline in agricultural output further increases the severity of the food crisis. In this context, this study proposes an outdoor agricultural robot that uses Long Short-Term Memory (LSTM). The key features of this innovation include: (1) the robot is portable, and it uses green power to reduce installation cost, (2) the system combines the current environment with weather forecasts through LSTM to predict the correct timing for watering, (3) detecting the environment and utilizing information from weather forecasts can help the system to ensure that growing conditions are suitable for the crops, and (4) the robot is mainly for outdoor applications because such farms lack sufficient electricity and water resources, which makes the robot critical for environmental control and resource allocation. The experimental results indicate that the robot developed in this study can detect the environment effectively to control electricity and water resources. Additionally, because the system is planned to increase agricultural output significantly, the study predicts the variables through multivariate LSTM, which controls the power supply from the solar power system.

Reliability of Atmosphere Pressure-Plasma Enhanced Chemical Vapor Deposition Deposited Indium Gallium Zinc Oxide Resistive Random Access Memory Device with Microwave Annealing

Recently resistive random access memory (RRAM) is considered to be the most promising one to become the next generation memory since its simple Metal/Insulator/Metal (MIM) structure, lower power consumption and fabrication cost (Meena, J.S., et al., 2014. Overview of emerging nonvolatile memory technologies. Nanoscale Research Letters, 9(1), p.526). Due to some bottlenecks for current flash memory, such as high operation voltage, low operation speed, poor retention time and endurance, RRAM device is regarded as an alternative solution (Fuh, C.S., et al., 2011. Role of environmental and annealing conditions on the passivation-free In-Ga-Zn-O TFT. Thin Solid Films, 520, pp.1489-1494). In this investigation, the memory layer of RRAM device is IGZO, and it is deposited with AP-PECVD technique which can operate under atmosphere, reduce cost of the process. Microwave annealing (MWA) is used to enhance the RRAM device reliability (Fuh, C.S., et al., 2011. Role of environmental and annealing conditions on the passivation-free In-Ga-Zn-O TFT. Thin Solid Films, 520, pp.1489-1494). Experiment shows that with appropriate MWA treatment, the IGZO RRAM device exhibits better electrical characteristics, reliability issues such as numbers of switching cycle and data retention time are also improved (Teng, L.F., et al., 2012. Effects of microwave annealing on electrical enhancement of amorphous oxide semiconductor thin film transistor. Applied Physics Letters, 101, p.132901).

Effects of P-Type SnOx Thin-Film Transistors with N₂ and O₂ Ambient Furnace Annealing

Recently oxide-based thin-film transistors (TFTs) are investigated for emerging applications of the next generation display devices and other electronic circuits (Fortunato, E., et al., 2012. Oxide semiconductor thin-film transistors: A review of recent advances. Advanced Materials, 24, pp.2945-2986). Despite of the great success in n-type oxide semiconductors with high transparency and high field-effect mobility, high performance P-type oxide TFTs are so highly desired that complementary circuits can be realized with low power and high performance (Ou, W.C., et al., 2008. Anomalous P-channel amorphous oxide transistors based on tin oxide and their complementary circuits. Applied Physics Letters, 92, p.122113). There are some oxides such as SnO, CuO, Cu₂O and NiO are regarded as promising P-type semiconductor materials. In this investigation, tin oxide SnO_x is fabricated to be active layer for TFTs device, and furnace annealing with several combinations of nitrogen and oxygen ambient is compared to enhance the electrical characteristics of P-type SnO_x TFTs (Park, K.S., et al., 2009. High performance solution-processed and lithographically patterned zinc-tin oxide thin-film transistors with good operational stability. Electrochemical and Solid-State Lett., 12, pp.H256-H258). The results show that with N₂+O₂ ambient, 30 minutes furnace annealing, the P-type SnO_x TFTs device shows better performance with mobility (μ_FE) 0.883 cm²/V · S, threshold voltage (V_T) -4.63 V, subthreshold swing (SS) 1.15 V/decade, and I_on/I_off ratio 1.01×10₃.

Study of Atmospheric-Pressure Plasma Enhanced Chemical Vapor Deposition Fabricated Indium Gallium Zinc Oxide Thin Film Transistors with In-Situ Hydrogen Plasma Treatment

Amorphous InGaZnO (a-IGZO) Thin Film Transistors (TFTs) has been studied extensively for their perspective applications in next generation active-matrix displays such as liquid crystal displays and flat-panel displays, due to its better field-effect mobility (>10 cm²/V · S), larger I_on/I_off ratio (>10₆), and better stability electrical. Hydrogen is known as shallow donors for n-type (channel) oxide semiconductors (Dong, J.J., et al. 2010. Effects of hydrogen plasma treatment on the electrical and optical properties of Zno films: Identification of hydrogen donors in ZnO. ACS Appl. Mater. Interfaces, 2, pp.1780-1784), and it is also effective passivator for traps (Tsao, S.W., et al., 2010. Hydrogen-induced improvements in electrical characteristics of a-IGZO thin-film transistors. Solid-State Electron, 54, pp.1497-1499). In this study, In-Situ hydrogen plasma is applied to deposit IGZO channel. With atmospheric-pressure PECVD (AP-PECVD), IGZO thin film can be deposited without vacuum system, large area manufacturing, and cost reducing (Chang, K.M., et al., 2011. Transparent conductive indium-doped zinc oxide films prepared by atmospheric pressure plasma jet. Thin Solid Films, 519, pp.5114-5117). The results show that with appropriate flow ratio of Ar/H₂ plasma treatment, the a-IGZO TFT device exhibits better performance with mobility (μ_FE) 19.7 cm²/V · S, threshold voltage (V_T) 1.18 V, subthreshold swing (SS) 81 mV/decade, and I_on/I_off ratio 5.35×10₇.

Investigation of Microwave Annealing on Resistive Random Access Memory Device with Atmospheric Pressure Plasma Enhanced Chemical Vapor Deposition Deposited IGZO Layer

Non-volatile memory (NVM) is essential in almost every consumer electronic products. The most prevalent NVM used nowadays is flash memory (Meena, J.S., et al., 2014. Overview of emerging nonvolatile memory technologies. Nanoscale Res. Letters, 9(1), p.526). However, some bottlenecks of flash memory have been identified, such as high operation voltage, low operation speed, and poor retention time. Resistive random access memory (RRAM) is considered to be the most promising one to become the next generation NVM device since its simple structure, fast program/erase speed, and low power consumption. In this experiment, the RRAM device is fabricated, and its IGZO (memory) layer is deposited with AP-PECVD technique which can reduce cost of the process. Microwave annealing (MWA) is used to enhance electrical characteristics of the RRAM device (Fuh, C.S., et al., 2011. Role of environmental and annealing conditions on the passivation-free In-Ga- Zn-O TFT. Thin Solid Films, 520, pp.1489-1494). Experiment results show that with appropriate MWA treatment, the IGZO RRAM device exhibits better electrical characteristics under bipolar operation, all forming/set/reset voltage for RRAM device is simultaneously lowered.

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.

Investigation of Electrical Characteristics on AP-PECVD Fabricated Amorphous IGZO TFTs with Hydrogen Plasma Treatment

TFT panel production process can be divided into three kinds of technology. There have amorphous silicon (a-Si), low-temperature polysilicon (LTPS) and amorphous IGZO (a-IGZO) oxide. Traditional amorphous silicon (a-Si) silicon has a lot of advantages such as good productivity, short process and low-cost. It also has a lot of shortcomings on these applications on TFTs such as photosensitivity, light degradation, and opacity, etc. The dispute of the material based on a-Si:H as an active layer in TFT is low field effect mobility (~1 cm²/V·S) (M. Shur and M. Hack, J. Appl. Phys. 55, 3831 (1984)), photo sensitivity (low band gap about 1.7 V) and high deposition temperature (~400 °C) (M. Shur, et al., J. Appl. Phys. 66, 3371 (1989); K. khakzar and E. H. Lueder, IEEE Trans. Electron Devices 39, 1438 (1992)). Amorphous In-Ga-Zn-O (IGZO) had attracted attention that compared with the conventional a-Si:H, in the past three years, a-IGZO thin film transistors is more popular which compared with the other oxide semiconductors, because of its larger I_on/I_off ratio (>10⁶, smaller subthreshold swing (SS), better field-effect mobility and better stability against electrical stress. Hydrogen plasma treatment is applied in improving a-IGZO TFTs active layer, which is fabricated by atmospheric pressure-plasma enhanced chemical vapor deposition (AP-PECVD), the electrical characteristics of a-IGZO TFTs is investigated.

The Effect of Microwave Annealing of Reliability Characteristics on Amorphous IGZO Thin Film Transistors

Amorphous oxide semiconductors (AOSs) are attracted much attention due to high mobility, low temperature deposition, flexible, transmission, and uniformity. The thin film transistors (TFTs) with a-IGZO thin film as active layer perform higher field-effect mobility (>10 cm²/V·S), larger I_on/I_off ratio (10⁶), smaller subthreshold swing and better stability against electrical stress. LaAlO₃/ZrO₂ is employed as gate electrode and gate dielectric layer for a-IGZO TFTs, under the premise that performance of a-IGZO TFTs without decreasing. Due to the good selectivity of energy transformation and rapid heating rate, microwave annealing is applied to improve the device reliability in the investigation. With adjusting the parameter of microwave annealing, the effect on reliability characteristics of a-IGZO TFTs is studied.

Study of In-Situ Hydrogen Plasma Treatment on InGaZnO with Atmospheric Pressure-Plasma Enhanced Chemical Vapor Deposition

In the past few years, thin film transistors have a wide range of applications on display technology, material selection and quality for its active layer is critical for device performance. Traditional amorphous silicon (a-Si) silicon has a lot of advantages such as good productivity, short process and low-cost. It also has a lot of shortcomings on these applications on TFTs such as photosensitivity, light degradation, and opacity, etc. The dispute of the material based on a-Si:H as an active layer in TFT is low field effect mobility (~1 cm²/V·S) (M. Shur and M. Hack, J. Appl. Phys. 55, 3831 (1984)), photo sensitivity (low band gap about 1.7 V) and high deposition temperature (~400 °C) (M. Shur, et al., J. Appl. Phys. 66, 3371 (1989); K. Khakzar and E. H. Lueder, IEEE Trans. Electron Devices 39, 1438 (1992)). Amorphous In-Ga-Zn-O (IGZO) had attracted attention that compared with the conventional a-Si:H, due to its good properties of simultaneously high/low conductivity with high visual transparency via doping level. Oxide-based semiconductors, such as ZnO (G. Adamopoulos, et al., Appl. Phys. Lett. 95, 133507-3 (2009); H.-C. Cheng, et al., Appl. Phys. Lett. 90, 012113-3 (2007)) and IGZO (C. J. Chiu, et al., Electron Device Letters, IEEE 31, 1245 (2010); L. Linfeng and P. Junbiao, IEEE Transactions on Electron Devices 58, 1452 (2011)) have been reported for the active channel layer. These oxide-based materials offer good electrical properties and high transparency for thin film transistors, its high transmittance can be applied to fabricate the full transparent TFT on flexible substrate. With In-Situ hydrogen plasma treatment on a-IGZO produced by atmospheric pressure-plasma enhanced chemical vapor deposition (AP-PECVD), the material characteristics of a-IGZO is studied.

Investigation of Electrical Characteristics on LaAlO₃/ZrO₂/IGZO TFTs with Microwave Annealing

Conventional thin film transistor suffered from high threshold voltage, poor subthreshold swing, and high operation voltage. These shortcomings make the traditional thin film transistor does not meet the needs with the high-performance, high-resolution, low temperature and energy conservation nowadays. Due to the good selectivity of energy transformation and rapid heating rate, microwave annealing is promising to replace conventional furnace annealing and applied in the investigation. LaAlO₃/ZrO₂ is employed as gate electrode and gate dielectric layer for a-IGZO TFTs, under the premise that performance of a-IGZO TFTs without decreasing. With adjusting the power/time of microwave annealing, the effect on electrical characteristics of a-IGZO TFTs is investigated.

The Ottawa subarachnoid hemorrhage clinical decision rule for classifying emergency department headache patients

BACKGROUND

Subarachnoid hemorrhage (SAH) is a serious cause of headaches. The Ottawa subarachnoid hemorrhage (OSAH) rule helps identify SAH in patients with acute nontraumatic headache with high sensitivity, but provides limited information for identifying other intracranial pathology (ICP).

OBJECTIVES

To assess the performance of the OSAH rule in emergency department (ED) headache patients and evaluate its impact on the diagnosis of intracranial hemorrhage (ICH) and other ICP.

METHOD

We conducted a retrospective cohort study from January 2016 to March 2017. Patients with acute headache with onset within 14 days of the ED visit, were included. We excluded patients with head trauma that occurred in the previous 7 days, new onset of abnormal neurologic findings, or consciousness disturbance. According to the OSAH rule, patients with any included predictors required further investigation.

RESULTS

Of 913 patients were included, 15 of them were diagnosed with SAH. The OSAH rule had 100% (95% CI, 78.2%-100%) sensitivity and 37.0% (95% CI, 33.8-40.2%) specificity for identifying SAH. Twenty-two cases were identified as SAH or ICH with 100% sensitivity (95% CI, 84.6%-100%) and 37.3% (95% CI, 34.1%-40.5%) specificity. As for non-hemorrhagic ICP, both the sensitivity and negative predictive values (NPV) decreased to 75.0% (95% CI, 53.3%-90.2%) and 98.2% (95% CI, 96.1%-99.3%), respectively.

CONCLUSIONS

The OSAH rule had 100% sensitivity and NPV for diagnosing SAH and ICH with acute headache. The sensitivity and specificity were lower for non-hemorrhagic ICP. The OSAH rule may be an effective tool to exclude acute ICH and SAH in our setting.

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•.

The effect of peer influence on the use of CT by emergency physicians for patients with headaches

BACKGROUND

It is challenging for emergency physicians (EPs) to distinguish between patients with life-threatening and benign headaches. We examined the effect of peer influence on computed tomography use by EPs for patients with headache and evaluated the peer influence effect in EPs with different levels of risk tolerance.

METHODS

We conducted a before- and after-retrospective case review, and administered the Risk-Taking subscale of the Jackson Personality Index to attending physicians. Each EP computed tomography (CT) use rate, patient number, and CT use, were e-mailed every two months to enhance EP team norm and establish a trend in behavior.

RESULTS

Of the 665 (before intervention) and 669 (after intervention) patients with headache, 206 (31%) and 171 (25.6%) underwent brain CT scans, respectively. Decreased use of CT examination was found in the post-intervention group (OR = 0.758, 95% CI: 0.593-0.967), especially for most risk-tolerant physicians (OR = 0.530, 95% CI: 0.311-0.889). There was prolonged ED length of stay (LOS) in the pre-intervention group (OR = 51.52, 95% CI: 26.998-76.050).

CONCLUSIONS

We observed that peer influence is an effective way to improve CT use rate and emergency department LOS for patients with isolated headache, especially for most risk-tolerant physicians. These findings could enhance the development of appropriate guidelines to assist ED physicians' CT use.

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.

Using KrF ELA to Improve Gate-Stacked LaAlO₃/ZrO₂ Indium Gallium Zinc Oxide Thin-Film Transistors with Novel Atmospheric Pressure Plasma-Enhanced Chemical Vapor Deposition Technique

Atmospheric pressure plasma-enhanced chemical vapor deposition (AP-PECVD) technique and KrF excimer laser annealing (ELA) were employed for the fabrication of indium gallium zinc oxide thin-film transistors (IGZO-TFTs). Device with a 150 mJ/cm2 laser annealing densities demonstrated excellent electrical characteristics with improved on/off current ratio of 4.7×107, high channel mobility of 10 cm2/V-s, and low subthreshold swing of 0.15 V/dec. The improvements are attributed to the adjustment of oxygen vacancies in the IGZO channel to an appropriate range of around 28.3% and the reduction of traps at the high-k/IGZO interface.

Investigation of Gate-Stacked In-Ga-Zn-O TFTs with Ga-Zn-O Source/Drain Electrodes by Atmospheric Pressure Plasma-Enhanced Chemical Vapor Deposition

Atmospheric pressure plasma-enhanced chemical vapor deposition (AP-PECVD) was employed for the fabrication of indium gallium zinc oxide thin-film transistors (IGZO TFTs) with high transparent gallium zinc oxide (GZO) source/drain electrodes. The influence of post-deposition annealing (PDA) temperature on GZO source/drain and device performance was studied. Device with a 300 °C annealing demonstrated excellent electrical characteristics with on/off current ratio of 2.13 × 108, saturation mobility of 10 cm2/V-s, and low subthreshold swing of 0.2 V/dec. The gate stacked LaAlO3/ZrO2 of AP-IGZO TFTs with highly transparent and conductive AP-GZO source/drain electrode show excellent gate control ability at a low operating voltage.

A 12-year analysis of closed medical malpractice claims of the Taiwan civil court: A retrospective study

Malpractices lawsuits cause increased physician stress and decreased career satisfaction, which might result in defensive medicine for avoiding litigation. It is, consequently, important to learn experiences from previous malpractice claims. The aim of this study was to examine the epidemiologic factors related to medical malpractice claims, identify specialties at high risk of such claims, and determine clinical which errors tend to lead to medical malpractice lawsuits, by analyzing closed malpractice claims in the civil courts of Taiwan.The current analysis reviewed the verdicts of the Taiwan judicial system from a retrospective study using the population-based databank, focusing on 946 closed medical claims between 2002 and 2013.Among these medical malpractice claims, only 14.1% of the verdicts were against clinicians, with a mean indemnity payment of $83,350. The most common single specialty involved was obstetrics (10.7%), while the surgery group accounted for approximately 40% of the cases. In total, 46.3% of the patients named in the claims had either died or been gravely injured. Compared to the $75,632 indemnity for deceased patients, the mean indemnity payment for plaintiffs with grave outcomes was approximately 4.5 times higher. The diagnosis groups at high risk of malpractice litigation were infectious diseases (7.3%), malignancies (7.2%), and limb fractures (4.9%). A relatively low success rate was found in claims concerning undiagnosed congenital anomalies (4.5%) and infectious diseases (5.8%) group. A surgery dispute was the most frequent argument in civil malpractice claims (38.8%), followed by diagnosis error (19.3%).Clinicians represent 85.9% of the defendants who won their cases, but they spent an average of 4.7 years to reach final adjudication. Increased public education to prevent unrealistic expectations among patients is recommended to decrease frivolous lawsuits. Further investigation to improve the lengthy judicial process is also necessary to relieve the stress of medical malpractice claims on clinicians and practitioners, as well as on the judicial system and rightful claimants.

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.

An analysis of causative factors in closed criminal medical malpractice cases of the Taiwan Supreme Court: 2000-2014

Most medical malpractice in Taiwan leads to criminal prosecution. This study examined the epidemiologic factors and clinical errors that led to medical malpractice convictions in Taiwanese criminal prosecutions. A retrospective, 15-year population-based review of criminal Supreme Court judgments pertaining to medical malpractice against physicians and nurses was conducted. Eighty-four cases were reviewed, yielding data that included the number and specialty involved, accused hospitals, the diagnosis, the time interval between incidents to closure, result of adjudication, the origin of cases (private vs. public prosecution), the result of medical appraisal, and the primary error. Overall, the cases averaged 7.6years to achieve final adjudication. Seventy-five percent were settled in favor of the clinician; twenty-three physicians and three nurses were found guilty, but all of these avoided imprisonment via probation or replacement with forfeit. The single most risky specialty was emergency medicine (22.6% of the cases), with 36.8% of those resulting in guilty verdicts. The most common diagnosis groups were infectious diseases (23.8%), intracranial hemorrhages (10.7%), and acute coronary syndrome (9.5%). Public prosecutions had a 41.2% conviction rate; no guilty verdicts resulted from private prosecution. Nineteen (22.6%) cases were commuted, and 73.7% of those had a controversial appraisal result. The characteristics of criminal malpractice prosecution in Taiwan that could be improved to relieve the stress of frivolous lawsuits on the judicial process include lengthy jurisdiction process; low public-prosecution conviction rate; frequent commuted jurisdiction related to a controversial appraisal; and zero imprisonment rate for clinicians.

12th WINFOCUS world congress on ultrasound in emergency and critical care

TABLE OF CONTENTS

A1 Point-of-care ultrasound examination of cervical spine in emergency departmentYahya Acar, Onur Tezel, Necati SalmanA2 A new technique in verifying the placement of a nasogastric tube: obtaining the longitudinal view of nasogastric tube in addition to transverse view with ultrasoundYahya Acar, Necati Salman, Onur Tezel, Erdem CevikA3 Pseudoaneurysm of the femoral artery after cannulation of a central venous line. Should we always use ultrasound in these procedures?Margarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA4 Ultrasound-guided supraclavicular subclavian vein catheterization. A novel approach in emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA5 Clinical ultrasound in a septic and jaundice patient in the emergency departmentMargarita Algaba-Montes, Alberto Oviedo-García, Mayra Patricio-BordomásA6 Characterization of the eyes in preoperative cataract Saudi patients by using medical diagnostic ultrasoundMustafa Z. Mahmoud, Abdelmoneim SuliemanA7 High-frequency ultrasound in determining the causes of acute shoulder joint painMustafa Z. MahmoudA8 Teaching WINFOCUS Ultrasound Life Support Basic Level 1 for Providers in resource-limited countriesAbbas Ali, Alrayah Mustafa, Ihab Abdelrahman, Mustafa Bahar, Osama Ali, H. Lester Kirchner, Gregor ProsenA9 Changes of arterial stiffness and endothelial function during uncomplicated pregnancyAjda Anzic, Paul LeesonA10 Cardiovascular haemodynamic properties before, during and after pregnancyAjda Anzic, Paul LeesonA11 An old man with generalized weaknessMaryam Bahreini, Fatemeh RasooliA12 Ultrasonography for non-specific presentations of abdominal painMaryam Bahreini, Houman HosseinnejadA13 Introduction of a new imaging guideline for suspected renal colic in the emergency department: effect on CT Urogram utilisationGabriel Blecher, Robert Meek, Diana Egerton-WarburtonA14 Transabdominal ultrasound screening for pancreatic cancer in Croatian military veterans: a retrospective analysis from the first Croatian veteran's hospitalEdina Ćatić Ćuti, Stanko Belina, Tihomir Vančina, Idriz KovačevićA15 The challenge of AAA: unusual case of obstructive jaundiceEdina Ćatić Ćuti, Nadan RustemovićA16 Educational effectiveness of easy-made new simulator model for ultrasound-guided procedures in pediatric patients: vascular access and foreign body managementIkwan Chang, Jin Hee Lee, Young Ho Kwak, Do Kyun KimA17 Detection of uterine rupture by point-of-care ultrasound at emergency department: a case reportChi-Yung Cheng, Hsiu-Yung Pan, Chia-Te KungA18 Abdominal probe in the hands of interns as a relevant diagnostic tool in revealing the cause of heart failureEla Ćurčić, Ena Pritišanac, Ivo Planinc, Marijana Grgić Medić, Radovan RadonićA19 Needs assessment of the potential utility of point-of-care ultrasound within the Zanzibar health systemAbiola Fasina, Anthony J. Dean, Nova L. Panebianco, Patricia S. HenwoodA20 Ultrasonographic diagnosis of tracheal compressionOliviero Fochi, Moreno Favarato, Ezio BonanomiA21 The role of ultrasound in the detection of lung infiltrates in critically ill patients: a pilot studyMarijana Grgić Medić, Ivan Tomić, Radovan RadonićA22 The SAFER Lasso; a novel approach using point-of-care ultrasound to evaluate patients with abdominal complaints in the emergency departmentYoungrock Ha, Hongchuen TohA23 Awareness and use of clinician-performed ultrasound among clinical clerkship facultyElizabeth Harmon, Wilma Chan, Cameron Baston, Gail Morrison, Frances Shofer, Nova Panebianco, Anthony J. DeanA24 Clinical outcomes in the use of lung ultrasound for the diagnosis of pediatric pneumoniasAngela Hua, Sharon Kim, James TsungA25 Effectiveness of ultrasound in hypotensive patientsIsa Gunaydin, Zeynep Kekec, Mehmet Oguzhan AyA26 Moderate-to-severe left ventricular ejection fraction related to short-term mortality of patients with post-cardiac arrest syndrome after out-of-hospital cardiac arrestJinjoo Kim, Jinhyun Kim, Gyoosung Choi, Dowon ShimA27 Usefulness of abdominal ultrasound for acute pyelonephritis diagnosis after kidney transplantationJi-Han LeeA28 Lung ultrasound for assessing fluid tolerance in severe preeclampsiaJana Ambrozic, Katja Prokselj, Miha LucovnikA29 Optic nerve sheath ultrasound in severe preeclampsiaGabrijela Brzan Simenc, Jana Ambrozic, Miha LucovnikA30 Focused echocardiography monitoring in the postoperative period for non-cardiac patientsAsta Mačiulienė, Almantas Maleckas, Algimantas Kriščiukaitis, Vytautas Mačiulis, Andrius MacasA31 POCUS-guided paediatric upper limb fracture reduction: algorithm, tricks, and tipsSharad MohiteA32 Point-of-care lung ultrasound: a good diagnostic tool for pneumonia in a septic patientZoltan Narancsik, Hugon MožinaA33 A case of undergraduate POCUS (r)evolutionSara Nikolić, Jan Hansel, Rok Petrovčič, Una Mršić, Gregor ProsenA34 The Graz Summer School for ultrasound: from first contact to bedside application: three-and-a-half-day undergraduate ultrasound training: résumé after two years of continuous developmentSimon Orlob, Markus Lerchbaumer, Niklas Schönegger, Reinhard KaufmannA35 Usefulness of point-of-care ultrasound in the emergency room in a patient with acute abdominal painAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA36 Use of bedside ultrasound in a critically ill patient. A case reportAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA37 Diagnostic yield of clinical echocardiography for the emergency physicianAlberto Oviedo-García, Margarita Algaba-Montes, Mayra Patricio-BordomásA38 Focused cardiac ultrasound in early diagnosis of type A aortic dissection with atypical presentationChun-I Pan, Hsiu-Yung Pan, Chien-Hung WuA39 Detection of imperforated hymen by point-of-care ultrasoundHsiu-yung Pan, Chia-Te KungA40 Developing a point-of-care ultrasound curriculum for pediatric nurse practitioners practicing in the pediatric emergency departmentSarah Pasquale, Stephanie J. Doniger, Sharon Yellin, Gerardo ChiricoloA41 Use of transthoracic echocardiography in emergency setting: patient with mitral valve abscessMaja Potisek, Borut Drnovšek, Boštjan LeskovarA42 A young man with syncopeFatemeh Rasooli, Maryam BahreiniA43 Work-related repetitive use injuries in ultrasound fellowsKristine Robinson, Clara Kraft, Benjamin Moser, Stephen Davis, Shelley Layman, Yusef Sayeed, Joseph MinardiA44 Lung ultrasonography in the evaluation of pneumonia in childrenIrmina Sefic Pasic, Amra Dzananovic, Anes Pasic, Sandra Vegar ZubovicA45 Central venous catheter placement with the ultrasound aid: two years' experience of the Interventional unit, Division of Intensive Care Medicine, KBC ZagrebAna Godan Hauptman, Marijana Grgic Medic, Ivan Tomic, Ana Vujaklija Brajkovic, Jaksa Babel, Marina Peklic, Radovan RadonicA46 Duplicitas casui: two patients admitted due to acute liver failureVedran Radonic, Ivan Tomic, Luka Bielen, Marijana Grgic MedicA47 A pilot survey on an understanding of Bedside Point-of-Care Ultrasound (POCUS) among medical doctors in internal medicine: exposure, perceptions, interest, and barriers to trainingPeh Wee MingA48 Unusual case of defecation syncopeNur hafiza Yezid, Fatahul Laham MohammedA49 A case report of massive pulmonary embolism; a multidisciplinary approachZainal Abidin Huda, Wan Nasarudin Wan Ismail, W.Yus Haniff W.Isa, Hashairi Fauzi, Praveena Seeva, Mohd Zulfakar Mazlan.

The Performance Improvement of N2 Plasma Treatment on ZrO2 Gate Dielectric Thin-Film Transistors with Atmospheric Pressure Plasma-Enhanced Chemical Vapor Deposition IGZO Channel

The aim of this paper is to illustrate the N2 plasma treatment for high-κ ZrO2 gate dielectric stack (30 nm) with indium-gallium-zinc-oxide (IGZO) thin-film transistors (TFTs). Experimental results reveal that a suitable incorporation of nitrogen atoms could enhance the device performance by eliminating the oxygen vacancies and provide an amorphous surface with better surface roughness. With N2 plasma treated ZrO2 gate, IGZO channel is fabricated by atmospheric pressure plasma-enhanced chemical vapor deposition (AP-PECVD) technique. The best performance of the AP-PECVD IGZO TFTs are obtained with 20 W-90 sec N2 plasma treatment with field-effect mobility (μ(FET)) of 22.5 cm2/V-s, subthreshold swing (SS) of 155 mV/dec, and on/off current ratio (I(on)/I(off)) of 1.49 x 10(7).

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.

Correlation between drug–drug interaction-induced Stevens–Johnson syndrome and related deaths in Taiwan

Concomitant use of some drugs can lead to interactions between them resulting in severe adverse effects. To date, there are few reports of incidences of Stevens-Johnson syndrome (SJS) associated with combination drug administration. Therefore, we studied the relationship between drug combinations and SJS-related mortality, with the hope that a retrospective study of this nature would provide information crucial for the prevention of future drug-drug interaction related deaths attributable to SJS. This retrospective longitudinal study used mortality cases from 1999 to 2008 that were diagnosed as erythema multiforme (International Classification of Diseases, Ninth Revision, Clinical Modification 695.1) from the National Health Insurance database in Taiwan. Statistical comparisons of the results were performed using analysis of variance (ANOVA), independent sample t-tests, and odds ratio (OR). In this way, the relationship between combinations of SJS-inducing drugs and mortality could be determined. A total of 111 patients who had died, including 63 males and 48 females (66.0 ± 20 and 70.0 ± 17.7 years, respectively), were suspected of having experienced drug-drug interaction-related adverse effects. The associated drug combinations included allopurinol and ampicillin (p = 0.049), carbamazepine and sulfamethoxazole/trimethoprim (TMP) (p < 0.0001), carbamazepine and phenytoin (p < 0.0001), sulfamethoxazole/TMP and phenytoin (p = 0.015), sulfadoxine and piroxicam (p = 0.045), phenobarbital and cephalexin (p < 0.0001), ampicillin and erythromycin (p < 0.0001), erythromycin and minocycline (p < 0.0001), and vancomycin and ethambutol (p < 0.0001) administered 1 month before the patients’ deaths. Caution should be exercised when administering any drugs that may possibly induce SJS. In addition, attention should be paid to ensure prompt identification of possible drug-drug interactions, and patients should be closely monitored. Furthermore, medications should be immediately discontinued at the first sign or symptom suggesting the occurrence of drug-related SJS, and then prompt, adequate supportive care should be provided.

[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.