Visual-motor integration in children with unilateral cerebral palsy: application of the computer-aided measure of visual-motor integration.

BACKGROUND: Children with unilateral cerebral palsy (UCP) are encouraged to participate in the regular school curriculum. However, even when using the less-affected hand for handwriting, children with UCP still experience handwriting difficulties. Visual-motor integration (VMI) is a predictor of handwriting quality. Investigating VMI in children with UCP is important but still lacking. Conventional paper-based VMI assessments is subjective and use all-or-nothing scoring procedures, which may compromise the fidelity of VMI assessments. Moreover, identifying important shapes that are predictive of VMI performance might benefit clinical decision-making because different geometric shapes represent different developmental stepping stones of VMI. Therefore, a new computer-aided measure of VMI (the CAM-VMI) was developed to investigate VMI performance in children with UCP and to identify shapes important for predicting their VMI performance. METHODS: Twenty-eight children with UCP and 28 typically-developing (TD) children were recruited. All participants were instructed to complete the CAM-VMI and Beery-Buktenica Developmental Test of Visual-Motor Integration (Beery-VMI). The test items of the CAM-VMI consisted of nine simple geometric shapes related to writing readiness. Two scores of the CAM-VMI, namely, Error and Effort, were obtained by image registration technique. The performances on the Beery-VMI and the CAM-VMI of children with UCP and TD children were compared by independent t-test. A series of stepwise regression analyses were used to identify shapes important for predicting VMI performance in children with UCP. RESULTS: Significant group differences were found in both the CAM-VMI and the Beery-VMI results. Furthermore, Error was identified as a significant aspect for predicting VMI performance in children with UCP. Specifically, the square item was the only significant predictor of VMI performance in children with UCP. CONCLUSIONS: This study was a large-scale study that provided direct evidence of impaired VMI in school-aged children with UCP. Even when using the less-affected hand, children with UCP could not copy the geometric shapes as well as TD children did. The copied products of children with UCP demonstrated poor constructional accuracy and inappropriate alignment. Furthermore, the predictive model suggested that the constructional accuracy of a copied square is an important predictor of VMI performance in children with UCP.

Indispensable Nafion Ionomer for High-Efficiency and Stable Oxygen Evolution Reaction in Alkaline Media.

Addressing the challenge of sluggish kinetics and limited stability in alkaline oxygen evolution reactions, recent exploration of novel electrochemical catalysts offers improved prospects. To expedite the assessment of these catalysts, a half-cell rotating disk electrode is often favored for its simplicity. However, the actual catalyst performance strongly depends on the fabricated catalyst layers, which encounter mass transport overpotentials. We systematically investigate the role and sequence of electrode drop-casting methods onto a glassy carbon electrode regarding the efficiency of the oxygen evolution reaction. The catalyst layer without Nafion experiences nearly 50% activity loss post stability test, while those with Nafion exhibit less than 5% activity loss. Additionally, the sequence of application of the catalyst and Nafion also shows a significant effect on catalyst stability. The catalyst activity increases by roughly 20% after the stability test when the catalyst layer is coated first with an ionomer layer, followed by drop-casting the catalysts. Based on the half-cell results, the Nafion ionomer not only acts as a binder in the catalyst layer but also enhances the interfacial interaction between the catalyst and electrolyte, promoting performance and stability. This study provides new insights into the efficient and accurate evaluation of electrocatalyst performance and stability as well as the role of Nafion ionomer in the catalyst layer.

Clinical Trial and Real-World Outcomes of Patients With Metastatic NSCLC in the Post-Platinum-Based Chemotherapy Failure Setting.

Introduction: A literature review was undertaken to identify clinical trials and real-world studies of patients with stage IV NSCLC who had progressed on or after treatment with platinum-based chemotherapy. Methods: The EMBASE and MEDLINE databases were used to search for English-language studies published between September 28, 2017, and September 28, 2021. Studies were included in the review if they (1) were clinical trials or real-world analyses of one or more treatment regimens for patients with stage IV NSCLC who had progressed on or after treatment with platinum-based chemotherapy, (2) contained an end point including efficacy, effectiveness, or safety, and (3) included 45 or more patients. Results: In total, there were 15 publications (nine unique trials and three real-world studies) included. Sample size ranged from 49 to 1253 patients. At least one treatment arm in eight of the nine clinical trials reported an overall response rate of ≥15%. Median progression-free survival (PFS) and overall survival ranged from 1.9 to 5.2 months and 5.4 to 15.4 months in clinical trials and 4.4 to 6.8 months and 8.3 to 18.0 months in real-world studies, respectively. Within studies reporting median PFS, a median PFS of more than or equal to 3 months was reported in eight of 11 clinical trials and both real-world studies. Discontinuation due to adverse events ranged from 1.9% to 18% across all included studies. Conclusions: Patients with stage IV NSCLC had limited response and a high burden of adverse events during treatment after progression on platinum-containing chemotherapy. There remains a pressing unmet need for additional, effective, and tolerable treatment options in this setting.

Pore-Scale Modeling of Microporous Layer for Proton Exchange Membrane Fuel Cell: Effective Transport Properties.

A microporous layer (MPL) is a transition layer with a porous material structure, located between the gas diffusion layer (GDL) and catalyst layer (CL) in a proton exchange membrane fuel cell (PEMFC). It not only significantly improves electron transfer and heat conduction in membrane electrode assembly, but also effectively manages liquid water transport to enhance the fuel cell performance. The MPL is usually coated on one side of the GDL. The fragile nature of MPL makes it challenging to characterize the effective transport properties using experimental methods. In this study, a stochastic numerical method is implemented to reconstruct the three-dimensional microstructure of an MPL consisting of carbon particles and PTFE. The reliability of the MPL reconstructed model is validated using experimental data. The relationship between the effective transport properties and the compression strain is obtained using the Pore Scale Model (PSM), while the relationship between the liquid water saturation and capillary pressure is solved by Lattice Boltzmann Method (LBM). The effective transport properties in the MPL are then imported into the two-phase flow fuel cell model. It is found that the effective transport parameters in MPL obtained by PSM and LBM can improve the accuracy of the model calculation. This study provides an effective method to reconstruct the microstructure of MPL that can generate precise MPL transport parameters for utilization in various PEMFC performance prediction models.

Development and Psychometric Evaluation of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) for School-Age Children.

IMPORTANCE: Handwriting legibility is the main criterion for determining whether a child has handwriting difficulties. A comprehensive assessment of handwriting legibility with sound psychometrics is essential to timely identification of handwriting difficulties and outcome measurement after handwriting interventions. OBJECTIVE: To evaluate the psychometrics of the Computer-Aided Measure of Chinese Handwriting Legibility (CAM-CHL) and to investigate Chinese handwriting legibility in school-age children using the CAM-CHL. DESIGN: Cross-sectional, repeated observation, test-retest. SETTING: Elementary schools in Taiwan. PARTICIPANTS: We recruited 25 lower-grade children for the examination of test-retest reliability, 75 children from all grade levels, and 10 senior schoolteachers for the examination of the CAM-CHL's convergent validity and the investigation of handwriting legibility. OUTCOMES AND MEASURES: Children were asked to copy a set of Chinese characters as legibly as possible. We used the CAM-CHL to assess handwriting legibility in four domains: Size, Orientation, Position, and Deformation. The schoolteachers were asked to subjectively assess the handwriting legibility using a 3-point Likert-type scale. RESULTS: The CAM-CHL demonstrated good to excellent test-retest reliability and acceptable random measurement error in all legibility domains. The CAM-CHL had fair to moderate convergent validity with schoolteachers' perceptions. Additionally, upper-grade children had better handwriting legibility in the Size and Position domains than lower-grade children. CONCLUSIONS AND RELEVANCE: The CAM-CHL, a comprehensive and objective method of assessing Chinese handwriting legibility, has sound reliability and acceptable validity, suggesting its potential as an outcome measure for school-age children. What This Article Adds: The CAM-CHL can be used in comprehensive evaluations of Chinese handwriting legibility in school-age children. The CAM-CHL has acceptable psychometrics for use as an outcome measure.

A flexible liposomal polymer complex as a platform of specific and regulable immune regulation for individual cancer immunotherapy.

BACKGROUND: The applicability and therapeutic efficacy of specific personalized immunotherapy for cancer patients is limited by the genetic diversity of the host or the tumor. Side-effects such as immune-related adverse events (IRAEs) derived from the administration of immunotherapy have also been observed. Therefore, regulatory immunotherapy is required for cancer patients and should be developed. METHODS: The cationic lipo-PEG-PEI complex (LPPC) can stably and irreplaceably adsorb various proteins on its surface without covalent linkage, and the bound proteins maintain their original functions. In this study, LPPC was developed as an immunoregulatory platform for personalized immunotherapy for tumors to address the barriers related to the heterogenetic characteristics of MHC molecules or tumor associated antigens (TAAs) in the patient population. Here, the immune-suppressive and highly metastatic melanoma, B16F10 cells were used to examine the effects of this platform. Adsorption of anti-CD3 antibodies, HLA-A2/peptide, or dendritic cells' membrane proteins (MP) could flexibly provide pan-T-cell responses, specific Th1 responses, or specific Th1 and Th2 responses, depending on the host needs. Furthermore, with regulatory antibodies, the immuno-LPPC complex properly mediated immune responses by adsorbing positive or negative antibodies, such as anti-CD28 or anti-CTLA4 antibodies. RESULTS: The results clearly showed that treatment with LPPC/MP/CD28 complexes activated specific Th1 and Th2 responses, including cytokine release, CTL and prevented T-cell apoptosis. Moreover, LPPC/MP/CD28 complexes could eliminate metastatic B16F10 melanoma cells in the lung more efficiently than LPPC/MP. Interestingly, the melanoma resistance of mice treated with LPPC/MP/CD28 complexes would be reversed to susceptible after administration with LPPC/MP/CTLA4 complexes. NGS data revealed that LPPC/MP/CD28 complexes could enhance the gene expression of cytokine and chemokine pathways to strengthen immune activation than LPPC/MP, and that LPPC/MP/CTLA4 could abolish the LPPC/MP complex-mediated gene expression back to un-treatment. CONCLUSIONS: Overall, we proved a convenient and flexible immunotherapy platform for developing personalized cancer therapy.

Transdermal nanolipoplex simultaneously inhibits subcutaneous melanoma growth and suppresses systemically metastatic melanoma by activating host immunity.

Benefit for clinical melanoma treatments, the transdermal neoadjuvant therapy could reduce surgery region and increase immunotherapy efficacy. Using lipoplex (Lipo-PEG-PEI-complex, LPPC) encapsulated doxorubicin (DOX) and carrying CpG oligodeoxynucleotide; the transdermally administered nano-liposomal drug complex (LPPC-DOX-CpG) would have high cytotoxicity and immunostimulatory activity to suppress systemic metastasis of melanoma. LPPC-DOX-CpG dramatically suppressed subcutaneous melanoma growth by inducing tumor cell apoptosis and recruiting immune cells into the tumor area. Animal studies further showed that the colonization and growth of spontaneously metastatic melanoma cells in the liver and lung were suppressed by transdermal LPPC-DOX-CpG. Furthermore, NGS analysis revealed IFN-γ and NF-κB pathways were triggered to recruit and activate the antigen-presenting-cells and effecter cells, which could activate the anti-tumor responses as the major mechanism responsible for the therapeutic effect of LPPC-DOX-CpG. Finally, we have successfully proved transdermal LPPC-DOX-CpG as a promising penetrative carrier to activate systemic anti-tumor immunity against subcutaneous and metastatic tumor.

Patient Characteristics, Treatment Patterns, Healthcare Resource Utilization, and Costs of Targeted Therapy-Eligible Atopic Dermatitis Patients in Taiwan-A Real-World Study.

INTRODUCTION: The objective of this study was to conduct a retrospective analysis to understand the patient profile, treatment patterns, healthcare resource utilization, and cost of atopic dermatitis (AD) of patients eligible for targeted therapy in Taiwan. METHODS: A retrospective, claims-based analysis was undertaken using Taiwan's National Health Insurance Research Database from 01 January 2014 to 31 December 2017. Patients aged ≥ 2 years and with at least one diagnosis code for AD during 2015 were identified. Patients with comorbid autoimmune diseases were excluded. Enrolled AD patients were categorized using claims-based treatment algorithms by disease severity and their eligibility for targeted therapy treatment. A cohort of targeted therapy-eligible patients was formed, and a matched cohort using patients not eligible for targeted therapy was derived using propensity score matching based on age, gender, and the Charlson Comorbidity Index (CCI). Treatment patterns, resource utilization, and costs were measured during a 1-year follow-up period. RESULTS: A total of 377,423 patients with AD were identified for this study. Most patients had mild AD (84.5%; n = 318,830) with 11.9% (n = 45,035) having moderate AD, and 3.6% (n = 13,558) having severe AD. Within the 58,593 moderate-to-severe AD patients, 1.5% (n = 897) were included in the targeted therapy-eligible cohort. The matched cohort consisted of 3558 patients. During the 1-year follow-up period, targeted therapy-eligible patients utilized antihistamines (85.5%), topical treatments (80.8%), and systemic anti-inflammatories (91.6%) including systemic corticosteroids (51.4%) and azathioprine (59.1%). During the first year of follow-up, targeted therapy-eligible patients (70.5%; 7.01 [SD = 8.84] visits) had higher resource utilization rates and frequency of AD-related outpatient visits compared with the matched cohort (40.80%; 1.85 [SD = 4.71] visits). Average all-cause direct costs during 1-year follow-up were $2850 (SD = 3629) and $1841 (SD = 6434) for the eligible targeted therapy and matched cohorts, respectively. AD-related costs were 17.7% ($506) of total costs for the targeted therapy eligible cohort and 2.2% ($41) for the matched cohort. CONCLUSIONS: AD patients eligible for targeted therapy in Taiwan experienced high resource and economic burden compared with their non-targeted-therapy-eligible counterparts.

Multivessel versus Culprit-Only Revascularization Strategies in Cardiac Arrest Survivors.

Background: Whether multivessel revascularization or culprit-only revascularization is more beneficial in cardiac arrest survivors with multivessel coronary artery disease remains unclear. We aimed to retrospectively evaluate whether multivessel or culprit-only revascularization following cardiac arrest was associated with a reduced incidence of in-hospital mortality. Methods: A total of 273 adult nontraumatic cardiac arrest survivors (aged ≥ 18 years) who underwent emergent coronary angiography (CAG) within 24 h following cardiac arrest were retrospectively recruited from three hospitals. Patients without definite coronary artery stenosis (n = 72), one-vessel stenosis (n = 74), or failed percutaneous coronary intervention (PCI; n = 37) were excluded. A total of 90 patients were enrolled for the final analysis and classified into multivessel (revascularization of more than one major vessel during the index CAG; n = 45) and culprit-only (revascularization of the infarct-related artery alone; n = 45) groups. Results: Twenty-five patients (55.6%) in the culprit-only group and 17 patients (37.8%) in the multivessel group failed to survive to discharge [adjusted hazard ratio (HR) = 0.47, 95% confidence interval (CI) = 0.24-0.95, p = 0.035]. The benefit of multivessel revascularization on survival was obvious among those with a prolonged cardiopulmonary resuscitation duration (> 10 min) (47.82% vs. 76.92%, adjusted HR = 0.27, 95% CI = 0.08-0.93, p = 0.03). No difference in neurological outcomes (favorable = cerebral performance category scores 1-2; poor = 3-5) between groups was observed (60.0% vs. 55.6%, adjusted OR = 1.22, 95% CI = 0.35-4.26, p = 0.753). Conclusions: Compared with culprit-only revascularization, multivessel revascularization was associated with lower in-hospital mortality among cardiac arrest survivors with multivessel lesions. Owing to the retrospective design and small sample size, the current study should be interpreted as observational and exploratory.

Impact of protocolized postarrest care with targeted temperature management on the outcomes of cardiac arrest survivors without temperature management.

INTRODUCTION: Protocolized postarrest care that includes targeted temperature management (TTM) improves survival and neurological outcomes in cardiac arrest survivors. Whether the accumulated experience regarding the use of the protocolized approach also benefits patients who did not undergo TTM has yet to be investigated. METHODS: Adults (≥18 years old) with nontraumatic cardiac arrest and who survived to intensive care unit (ICU) admission were retrospectively recruited from a single tertiary medical centre from 2006 to 2009 and 2011 to 2017. Patients were excluded if they had traumatic injuries, were pregnant, did not survive to ICU admission, regained clear consciousness within 3 h after the return of spontaneous circulation, or underwent TTM. The sum of TTM cases since 2006 and before the cardiac arrest of each enrolled patient was used as a substitute index for the amount of experience accumulated from the use of protocolized TTM care. RESULTS: In total, 802 non-TTM patients were enrolled in the final analysis. The rate of survival to hospital discharge increased from 25.9% in 2006 to 33.3% in 2017. Regarding neurological recovery at hospital discharge, the incidence of favourable neurological function (cerebral performance category: 1 or 2) increased from 10.3% in 2006 to 23.5% in 2017. A multiple logistic regression indicated a significant association between the cumulative TTM case numbers and neurological outcomes in patients who did not receive TTM. CONCLUSIONS: The improvement of neurological outcomes in adult nontraumatic cardiac arrest survivors who did not receive TTM was associated with the cumulative number of cases receiving protocolized TTM care. In the era of TTM, the use of only historical control data might lead to bias, which is caused by overlooking the influence of a more refined protocolized postarrest care that includes TTM.KEY MESSAGEThe cumulative number of cases receiving protocolized TTM care, which we used as a substitute index for the amount of experience accumulated from the use of protocolized postarrest care that includes TTM, was associated with the improvement of neurological outcomes in adult nontraumatic cardiac arrest survivors who did not receive TTM.

Health-Related Quality of Life for Patients Receiving Tumor Treating Fields for Glioblastoma.

BACKGROUND: To date, there has been no large-scale, real-world study of the health-related quality of life outcomes for patients using tumor treating fields (TTFields) therapy for glioblastoma (GBM) treatment. METHODS: A survey was mailed to 2,815 patients actively using TTFields for treatment of GBM in the USA (n = 2,182) and Europe (n = 633). The survey included patient-reported demographic and clinical information, as well as EuroQol's EQ-5D-5L and visual analogue scale (EQ-VAS) overall health score. RESULTS: A total of 1,106 applicable patients responded to the survey (USA = 782 and Europe = 324), with a mean age of 58.6 years (SD = 12.3). The average time since diagnosis and time using TTFields were 21.5 months (SD = 25.1) and 13.5 months (SD = 13.2), respectively. Over 61% of patients had been diagnosed at least 1 year prior and 28.4% at least 2 years prior; 45 patients (4.2%) had been diagnosed at least 5 years prior. Progressed disease was reported in 307 patients, while 690 reported non-progressed disease. Regression analyses showed that GBM disease progression and older age had predictable negative associations (p < 0.001) with most EQ-5D-5L dimensions and the EQ-VAS. However, longer time since diagnosis was associated with improved self-care (p < 0.05), usual activities (p < 0.01), and EQ-VAS (p < 0.05) overall and in patients with progressed disease (p < 0.01, p < 0.05, and p < 0.01, respectively). Additionally, longer time using TTFields was associated with improved mobility (p < 0.05), self-care (p < 0.001), usual activities (p < 0.01), and EQ-VAS (p < 0.01) overall; with improved EQ-VAS in progression-free patients (p < 0.05); and with improved mobility (p < 0.05), self-care (p < 0.01), usual activities (p < 0.05), and EQ-VAS (p < 0.05) in patients with progressed disease. CONCLUSION: This is the largest real-world study of patient-reported quality of life in GBM and TTFields treatment to date. It shows unsurprising negative associations between quality of life and disease progression and older age, as well as more novel, positive associations between quality of life and longer time since diagnosis and time using TTFields therapy.

A nationwide study of the risk of all-cause, sudden death, and cardiovascular mortality among antipsychotic-treated patients with schizophrenia in Taiwan.

INTRODUCTION: Studies have reported higher risks of mortality for patients with schizophrenia, compared to the general population. This study aimed to evaluate the risk of all-cause, sudden death, and cardiovascular mortality among patients with schizophrenia in terms of types of antipsychotics. METHODS: A retrospective cohort study assessed the risk of mortality among antipsychotic-treated patients with schizophrenia. The study linked the Taiwan National Health Insurance (NHI) claims and National Register of Death databases from 2001 to 2015. Patients were hierarchically assigned to the following index antipsychotic treatment groups: atypical long acting injection (LAI), typical LAI, atypical oral, and typical oral. RESULTS: A total of 68,159 antipsychotic-treated patients with schizophrenia were analyzed. Under the hierarchical grouping, the largest percentages of patients were on atypical oral antipsychotic regimens (65.51%), followed by typical oral (14.00%), typical LAI (12.84%), and atypical LAI (7.65%). Typical oral patients had the highest incidence of all-cause mortality of 27.48 per 1000 patient-years and the atypical LAI group had the lowest incidence (13.95 per 1000 patient-years). Compared to typical oral users, there were lower risks of all-cause mortality for users of atypical LAI (aHR = 0.62, 95% CI: 0.47-0.81), typical LAI (aHR = 0.65, 95% CI: 0.55-0.78), and atypical orals (aHR = 0.55, 95% CI: 0.49-0.62). CONCLUSION: Compared to typical oral users, we found a lower risk of all-cause mortality, sudden death, and cardiovascular mortality among schizophrenia users of LAIs and oral atypicals. Further research is warranted to characterize the risk of mortality among users of more recently available LAIs in the Asia Pacific region and elsewhere.

Alkaline earth atom doping-induced changes in the electronic and magnetic properties of graphene: a density functional theory study.

Density functional theory was used to investigate the effects of doping alkaline earth metal atoms (beryllium, magnesium, calcium and strontium) on graphene. Electron transfer from the dopant atom to the graphene substrate was observed and was further probed by a combined electron localization function/non-covalent interaction (ELF/NCI) approach. This approach demonstrates that predominantly ionic bonding occurs between the alkaline earth dopants and the substrate, with beryllium doping having a variant characteristic as a consequence of electronegativity equalization attributed to its lower atomic number relative to carbon. The ionic bonding induces spin-polarized electronic structures and lower workfunctions for Mg-, Ca-, and Sr-doped graphene systems as compared to the pristine graphene. However, due to its variant bonding characteristic, Be-doped graphene exhibits non-spin-polarized p-type semiconductor behavior, which is consistent with previous works, and an increase in workfunction relative to pristine graphene. Dirac half-metal-like behavior was predicted for magnesium doped graphene while calcium doped and strontium doped graphene were predicted to have bipolar magnetic semiconductor behavior. These changes in the electronic and magnetic properties of alkaline earth doped graphene may be of importance for spintronic and other electronic device applications.

Additive Effects of Arsenic and Aristolochic Acid in Chemical Carcinogenesis of Upper Urinary Tract Urothelium.

BACKGROUND: Aristolochic acids (AA) and arsenic are chemical carcinogens associated with urothelial carcinogenesis. Here we investigate the combined effects of AA and arsenic toward the risk of developing upper tract urothelial carcinoma (UTUC). METHODS: Hospital-based (n = 89) and population-based (2,921 cases and 11,684 controls) Taiwanese UTUC cohorts were used to investigate the association between exposure to AA and/or arsenic and the risk of developing UTUC. In the hospital cohort, AA exposure was evaluated by measuring aristolactam-DNA adducts in the renal cortex and by identifying A>T TP53 mutations in tumors. In the population cohort, AA exposure was determined from prescription health insurance records. Arsenic levels were graded from 0 to 3 based on concentrations in well water and the presence of arseniasis-related diseases. RESULTS: In the hospital cohort, 43, 26, and 20 patients resided in grade 0, 1+2, and 3 arseniasis-endemic areas, respectively. Aristolactam-DNA adducts were present in >90% of these patients, indicating widespread AA exposure. A>T mutations in TP53 were detected in 28%, 44%, and 22% of patients residing in grade 0, 1+2, and 3 arseniasis-endemic areas, respectively. Population studies revealed that individuals who consumed more AA-containing herbs had a higher risk of developing UTUC in both arseniasis-endemic and nonendemic areas. Logistic regression showed an additive effect of AA and arsenic exposure on the risk of developing UTUC. CONCLUSIONS: Exposure to both AA and arsenic acts additively to increase the UTUC risk in Taiwan. IMPACT: This is the first study to investigate the combined effect of AA and arsenic exposure on UTUC.

Prognosis Value of Gray-White-Matter Ratios in Comatose Survivors After In-Hospital Cardiac Arrest.

BACKGROUND: The gray-white-matter ratio (GWR) measured on cerebral non-contrasted computed tomography (NCCT) has been reported to help the prognostication of mortality or comatose status of out-of-hospital cardiac arrest (OHCA) victims. Since the etiologies and resuscitative process differ significantly between patients with OHCA and in-hospital cardiac arrest (IHCA), the predictive ability of GWR in IHCA survivors remains unclear. METHODS: This retrospective observational study conducted in a single tertiary medical center in Taiwan enrolled all the non-traumatic IHCA adults with sustained return of spontaneous circulation (ROSC) and had received cerebral NCCT examination within 24 hours following cardiac arrest. The GWR of survivor and non-survivor as well as good and poor neurological outcome were analyzed. RESULTS: A total of 79 IHCA patients with 68.4% in male gender and mean age of 66-year-old were enrolled in the current study. 34 patients (43.0%) survived to hospital discharge and 20 patients (25.3%) were discharged with good neurological outcome. The median GWR of patients with good and poor outcomes in either aspect of survival or neurological function did not show significant difference. The area under the plotted receiver of characteristic curves of each GWR also did not show satisfactory predictive performance. CONCLUSIONS: The use of GWR for outcome prognosis of patients in emergency department whom progressed to circulatory failure did not show promising result.

Targeted temperature management and emergent coronary angiography are associated with improved outcomes in patients with prehospital return of spontaneous circulation.

BACKGROUND/PURPOSE: Whether targeted temperature management (TTM) and emergent coronary angiography (CAG) remain associated with better outcomes in patients with prehospital return of spontaneous circulation (ROSC) was unknown. METHODS: This retrospective cohort study enrolled 81 adult, nontraumatic out-of-hospital cardiac arrest patients who had good pre-arrest neurological function and achieved prehospital ROSC during 2012 to August 2017. The outcomes were survival-to-discharge and neurological recovery at discharge. RESULTS: Fifty-five patients (67.9%) survived to hospital discharge (the survivor group) and twenty-six (32.1%) failed (the non-survivor group). A total of 47 patients (58.0%) presented favorable neurological outcomes [Cerebral Performance Category (CPC) score = 1-2, the favorable group], and 34 patients (42.0%) presented unfavorable neurological outcomes (CPC score = 3-5, the poor group). The survivor group had more patients with TTM (45.5% vs. 19.2%, p = 0.023) and emergent CAG (76.4% vs. 19.2%, p < 0.001) than the non-survivor group, and similar findings were noted in the neurological outcomes (TTM: 44.7% vs. 26.5%, p = 0.094; CAG: 80.9% vs. 26.5%, p < 0.001). TTM remained associated with increased survival-to-discharge [odds ratio (OR) = 14.635, 95% confidence interval (CI) = 1.296-165.305, p = 0.030] and a trend toward good neurological recovery (OR = 4.551, 95%CI = 0.963-21.517, p = 0.056). After excluding patients with rapid neurological recovery after ROSC (n = 70), TTM was associated with good neurological outcomes (OR = 4.534, 95% CI = 1.075-19.127, p = 0.040). Emergent CAG had the trend associated with survival-to-discharge (OR = 9.599, 95%CI = 0.764-120.634, p = 0.080) and was significantly associated with good neurological outcomes (OR = 21.785, 95%CI = 2.004-236.836, p = 0.011). CONCLUSION: In patients with prehospital ROSC, both TTM and emergent CAG were associated to improved survival and neurological outcomes.

Electrolyte-Dependent Oxygen Evolution Reactions in Alkaline Media: Electrical Double Layer and Interfacial Interactions.

Traditional understanding of electrocatalytic reactions generally focuses on either covalent interactions between adsorbates and the reaction interface (i.e., electrical double layer, EDL) or electrostatic interactions between electrolyte ions. Here, our work provides valuable insights into interfacial structure and ionic interactions during alkaline oxygen evolution reaction (OER). The importance of inner-sphere OH- adsorption is demonstrated as the IrOx activity in 4.0 M KOH is 6.5 times higher than that in 0.1 M KOH. Adding NaNO3 as a supporting electrolyte, which is found to be inert for long-term stability, complicates the electrocatalytic reaction in a half cell. The nonspecially adsorbed Na+ in the outer compact interfacial layer is suggested to form a stronger noncovalent interaction with OH- through hydrogen bond than adsorbed K+, leading to the decrease of interfacial OH- mobility. This hypothesis highlights the importance of outer-sphere adsorption for the OER, which is generally recognized as a pure inner-sphere process. Meanwhile, based on our experimental observations, the pseudocapacitive behavior of solid-state redox might be more reliable in quantifying active sites for OER than that measured from the conventional EDL charging capacitive process. The interfacial oxygen transport is observed to improve with increasing electrolyte conductivity, ascribing to the increased accessible active sites. The durability results in a liquid alkaline electrolyzer which shows that adding NaNO3 into KOH solution leads to additional degradation of OER activity and long-term stability. These findings provide an improved understanding of the mechanistic details and structural motifs required for efficient and robust electrocatalysis.

Stenosis and revascularization of the coronary artery are associated with outcomes in presumed cardiogenic arrest survivors: A multi-center retrospective cohort study.

BACKGROUND: The emergent coronary angiography (CAG) is associated with better outcomes in CA survivors. However, the impact of severity and revascularization of coronary artery stenosis on outcomes in cardiac arrest (CA) survivors remains unclear. METHODS: A total of 273 non-traumatic adult CA survivors who underwent emergent CAG from January 2011 to July 2017 were retrospectively recruited. The stenosis and non-revascularization of an individual coronary artery ≥70% were defined as significant in any of the major coronary arteries based on an operator visual estimate. RESULTS: There were 201 patients (73.63%) had ≧1 significant coronary artery stenosis and 58 patients (21.25%) with ≧1 non-revascularized coronary artery. The increased number of stenosed coronary artery was associated with an increased risk for in-hospital mortality [1-vessel: adjusted hazard ration (HR) 2.27, 95% confidence interval (CI) = 1.43-4.04, p = 0.021; 2-vessel: adjusted HR 5.49, 95% CI=2.17-13.89, p < 0.001; 3-vessel: adjusted HR 11.05, 95% CI=4.20-29.04, p < 0.001)] and poor neurological recovery (cerebral performance category = 3-5) [(1-vessel: adjusted odds ration (OR) 1.66, 95% CI 0.67-4.15, =0.275; 2-vessel: adjusted OR 1.81, 95% CI 1.05-3.97, p = 0.045; 3-vessel: adjusted OR 3.19, 95% CI 1.25-8.15, p = 0.001)], which was positively correlated with the number of vessels. The incomplete revascularization were also associated with increased in-hospital mortality and poor neurological function in patients with ≧1vessel stenosis. CONCLUSION: The severity and incomplete revascularization of coronary artery stenosis were associated with increased in-hospital mortality and poor neurological recovery in patients with presumed cardiogenic arrest.

Postarrest Steroid Use May Improve Outcomes of Cardiac Arrest Survivors.

OBJECTIVES: To evaluate the ramifications of steroid use during postarrest care. DESIGN: Retrospective observational population-based study enrolled patients during years 2004-2011 with 1-year follow-up. SETTING: Taiwan National Health Insurance Research Database. PATIENTS: Adult nontraumatic cardiac arrest patients in the emergency department, who survived to admission. INTERVENTIONS: These patients were classified into the steroid and nonsteroid groups based on whether steroid was used or not during hospitalization. A propensity score was used to match patient underlying characteristics, steroid use prior to cardiac arrest, the vasopressors, and shockable rhythm during cardiopulmonary resuscitation, hospital level, and socioeconomic status. MEASUREMENTS AND MAIN RESULTS: There were 5,445 patients in each group after propensity score matching. A total of 4,119 patients (75.65%) in the steroid group died during hospitalization, as compared with 4,403 patients (80.86%) in the nonsteroid group (adjusted hazard ratio, 0.74; 95% CI, 0.70-0.77; p < 0.0001). The mortality rate at 1 year was significantly lower in the steroid group than in the nonsteroid group (83.54% vs 87.77%; adjusted hazard ratio, 0.73; 95% CI, 0.70-0.76; p < 0.0001). Steroid use during hospitalization was associated with survival to discharge, regardless of age, gender, underlying diseases (diabetes mellitus, chronic obstructive pulmonary disease, asthma), shockable rhythm, and steroid use prior to cardiac arrest. CONCLUSIONS: In this retrospective observational study, postarrest steroid use was associated with better survival to hospital discharge and 1-year survival.

Effect of glucocorticoid use on survival in patients with stage I-III breast cancer.

PURPOSE: Glucocorticoids (GCs) are commonly used in breast cancer patients to ameliorate emesis induced by chemotherapy. Some preclinical studies have suggested that systemic GCs might promote survival of estrogen receptor (ER)-negative breast cancer cells. This study aims to clarify their clinical effect on patient survival. METHODS: A total of 18,596 women with newly diagnosed stage I-III breast cancer in 2002-2006 were identified from the Taiwan Cancer Database and drug treatment was examined from the Taiwan National Health Insurance Claims Database. Of these, 3989 who did not receive adjuvant chemotherapy (non-chemotherapy cohort) and 3237 patients who received six cycles of adjuvant anthracycline-based chemotherapy (anthracycline cohort) were included. The impact of GC use on survival was analyzed separately in these two cohorts using Cox proportional hazards models. RESULTS: In the non-chemotherapy cohort, GC use was associated with aggressive clinicopathological features of breast cancer. High-dose GC was associated with shorter overall survival in univariate analysis but not in multivariate analysis. In the anthracycline cohort, multivariate analysis showed that GC use at each dose level was significantly associated with longer breast cancer-specific survival (HR 0.65, 0.70, and 0.70 for low-dose, median-dose, and high-dose GC, respectively) and overall survival (HR 0.72, 0.76, and 0.73, respectively) when compared with those receiving no GC. The associations were significant in both ER-positive and ER-negative subgroups for breast cancer-specific survival, and in ER-negative subgroup for overall survival. CONCLUSION: Concomitant use of GC improved survival in patients receiving adjuvant anthracycline-based chemotherapy for stage I-III breast cancer.