Urinary catheter placement and adverse urinary outcomes with a focus on elevated risk in men with indwelling Foley catheters.

BACKGROUND: Prior studies indicated a link between urinary catheter use and urinary complications, highlighting the need for comprehensive, gender-specific investigations. This study explored the association through a national retrospective cohort, emphasizing gender disparities and long-term outcomes. METHODS: Our study utilized data from the entire population covered by Taiwan's National Health Insurance Research Database from 2000 to 2017. We included 148,304 patients who had undergone Foley catheter placement and their propensity-scores matched controls in the study. We evaluated urinary complications, which encompassed urinary tract cancer, urolithiasis, urethral stricture, obstructive uropathy, reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, urinary tract rupture, and urinary tract infection. These were assessed using the Fine and Gray sub-distribution proportional hazards model to compare between the Foley and non-Foley groups. Sensitivity analyses were conducted with different matching ratios. RESULTS: In the study, the non-Foley group presented a marginally higher mean age (75.24 ± 10.47 years) than the Foley group (74.09 ± 10.47 years). The mean duration of Foley catheterization was 6.1 ± 4.19 years. Men with Foley catheterization exhibited the highest adjusted sub-distribution hazard ratios for urinary tract cancer (6.57, 95% CI: 5.85-7.37), followed by women with Foley catheterization (4.48, 95% CI: 3.98-5.05), and men without catheterization (1.58, 95% CI: 1.39-1.8) in comparison with women without the procedure. Furthermore, men with Foley catheterization were found to be at the greatest risk for complications such as urolithiasis, urethral stricture, obstructive and reflux uropathy, fistula, diverticulum, caruncle, false passage, prolapsed urethral mucosa, and urinary tract rupture. Conversely, women with urinary catheterization were most susceptible to urinary tract infections. CONCLUSIONS: The evidence confirms that urinary catheterization significantly increases urinary complications, particularly among men. Our study underscores the crucial need for healthcare providers to carefully evaluate the necessity of catheterization, aim to shorten its duration whenever feasible, and strictly adhere to established protocols to minimize complications.

Daily supplement of sesame oil prevents postmenopausal osteoporosis via maintaining serum estrogen and aromatase levels in rats.

Estrogen deficiency is one of the main causes of postmenopausal osteoporosis in elderly women. Hormone replacement therapy has been employed to manage postmenopausal osteoporosis; however, it has raised concerns related to heart attacks and breast cancer. Sesame oil has been reported to affect sex hormone status. The aim of the present study is to evaluate the effect of sesame oil supplement on postmenopausal osteoporosis in rats. We used female Sprague Dawley rats that underwent bilaterally ovariectomy (OVX) as an experimental postmenopausal osteoporosis animal model. These rats were orally administrated sesame oil (0.25 or 0.5 mL/kg/day) for four months as the therapeutic group. We assessed bone mineral density (BMD) and the levels of osteocalcin, procollagen-I C-terminal propeptide (PICP), collagen cross-linked N-telopeptide (NTx), estradiol, and aromatase in the sera. The daily supplementation of sesame oil significantly increased BMD, serum osteocalcin levels, and trabecular areas in the OVX-treated rats. Sesame oil also elevated serum PICP levels and decreased NTx levels in these rats. Furthermore, sesame oil effectively maintained serum estradiol and aromatase levels in the OVX-induced osteoporosis rats. In conclusion, daily supplementation of sesame oil prevents postmenopausal osteoporosis by maintaining serum estrogen and aromatase levels, while also modulating the imbalance between bone formation and resorption in osteoporosis rats.

Advanced Sampling Technique in Radiology Free-Text Data for Efficiently Building Text Mining Models by Deep Learning in Vertebral Fracture.

This study aims to establish advanced sampling methods in free-text data for efficiently building semantic text mining models using deep learning, such as identifying vertebral compression fracture (VCF) in radiology reports. We enrolled a total of 27,401 radiology free-text reports of X-ray examinations of the spine. The predictive effects were compared between text mining models built using supervised long short-term memory networks, independently derived by four sampling methods: vector sum minimization, vector sum maximization, stratified, and simple random sampling, using four fixed percentages. The drawn samples were applied to the training set, and the remaining samples were used to validate each group using different sampling methods and ratios. The predictive accuracy was measured using the area under the receiver operating characteristics (AUROC) to identify VCF. At the sampling ratios of 1/10, 1/20, 1/30, and 1/40, the highest AUROC was revealed in the sampling methods of vector sum minimization as confidence intervals of 0.981 (95%CIs: 0.980-0.983)/0.963 (95%CIs: 0.961-0.965)/0.907 (95%CIs: 0.904-0.911)/0.895 (95%CIs: 0.891-0.899), respectively. The lowest AUROC was demonstrated in the vector sum maximization. This study proposes an advanced sampling method, vector sum minimization, in free-text data that can be efficiently applied to build the text mining models by smartly drawing a small amount of critical representative samples.

Deleterious genetic changes in AGTPBP1 result in teratozoospermia with sperm head and flagella defects.

Approximately 10%-15% of couples worldwide are infertile, and male factors account for approximately half of these cases. Teratozoospermia is a major cause of male infertility. Although various mutations have been identified in teratozoospermia, these can vary among ethnic groups. In this study, we performed whole-exome sequencing to identify genetic changes potentially causative of teratozoospermia. Out of seven genes identified, one, ATP/GTP Binding Protein 1 (AGTPBP1), was characterized, and three missense changes were identified in two patients (Affected A: p.Glu423Asp and p.Pro631Leu; Affected B: p.Arg811His). In those two cases, severe sperm head and tail defects were observed. Moreover, AGTPBP1 localization showed a fragmented pattern compared to control participants, with specific localization in the neck and annulus regions. Using murine models, we found that AGTPBP1 is localized in the manchette structure, which is essential for sperm structure formation. Additionally, in Agtpbp1-null mice, we observed sperm head and tail defects similar to those in sperm from AGTPBP1-mutated cases, along with abnormal polyglutamylation tubulin and decreasing △-2 tubulin levels. In this study, we established a link between genetic changes in AGTPBP1 and human teratozoospermia for the first time and identified the role of AGTPBP1 in deglutamination, which is crucial for sperm formation.

Is moderate resistance training adequate for older adults with sarcopenia? A systematic review and network meta-analysis of RCTs.

BACKGROUND: Resistance training (RT) and nutritional supplementation are recommended for the management of sarcopenia in older adults. However, optimal RT intensity for the treatment of sarcopenia has not been well investigated. METHODS: This network meta-analysis aims to determine the comparative effectiveness of interventions for sarcopenia, taking RT intensity into consideration. RT intensity was classified into light-to-moderate intensity RT(LMRT), moderate intensity RT(MRT), and moderate-to-vigorous intensity RT(MVRT) based on percentage of one repetition maximum (%1RM) and/or rating of perceived exertion. RESULTS: A total of 50 RCTs (N = 4,085) were included after screening 3,485 articles. The results confirmed that RT with or without nutrition was positively associated with improved measures of muscle strength and physical performance. Regarding RT intensity, LMRT only demonstrated positive effects on hand grip (aerobic training + LMRT + nutrition: mean difference [MD] = 2.88; 95% credential intervals [CrI] = 0.43,5.32). MRT provided benefits on improvement in the 30-s chair stand test (repetitions) (MRT: MD = 2.98, 95% CrI = 0.35,5.59), timed up and go test (MRT: MD = -1.74, 95% CrI: = -3.34,-0.56), hand grip (MRT: MD = 2.44; 95% CrI = 0.03,5.70), and leg press (MRT: MD = 8.36; 95% CrI = 1.87,13.4). MVRT also improved chair stand test repetitions (MVRT: MD = 5.64, 95% CrI = 0.14,11.4), gait speed (MVRT + nutrition: MD = 0.21, 95% CrI = 0.003,0.48), appendicular skeletal muscle index (MVRT + nutrition: MD = 0.25, 95% CrI = 0.01,0.5), and leg press (MVRT: MD = 14.7, 95% CrI: 5.96,22.4; MVRT + nutrition: MD = 17.8, 95% CrI: 7.55,28.6). CONCLUSION: MVRT had greater benefits on muscle mass, lower extremity strength, and physical performance compared to MRT. Increasing RT intensity may be recommended for sarcopenic older adults.

Examining Health Literacy in Taiwanese Smoking Cessation Populations: A Multidimensional Evaluation of Sociodemographic Factors and Domain-Specific Competencies.

BACKGROUND: Cigarette smoking is a serious global health issue. Limited studies previously analyzed health literacy components in patients undergoing smoking cessation interventions. This study focuses on individuals enrolled in smoking cessation services and investigates the distribution of health literacy in three domains (health care, disease prevention, and health promotion) and four abilities (access, understand, appraise, and apply health information). The study also explores the correlation between background factors (age, BMI, etc.) and health literacy, as well as the differences in health literacy levels among different background variables (gender, etc.). METHODS: 228 individuals completed the health literacy questionnaire. Descriptive statistical analysis, Pearson Correlation, and a Chi-Squared Test were employed to investigate the various health literacy levels and background variables. RESULTS: 68% had excellent or sufficient health literacy. A total of 32% were considered problematic or to have inadequate health literacy. Of the three domains of health literacy, participants performed better in the healthcare domain. More than one-third were problematic in accessing and appraising information. CONCLUSIONS: this paper, being the pilot study in providing an analysis of health literacy components in individuals undergoing smoking cessation, could serve as a useful reference for devising interventions for different population groups in trying to maximize successful cessation rates.

Effects of parents' voice on reducing heel puncture pain in high-risk newborns: A randomized controlled trial.

BACKGROUND: High-risk newborns, such as premature or severely ill infants, often experience painful treatments and separation from their parents. While previous studies have focused on the positive impacts of a mother's voice on newborns' physiology and pain response, research on the father's voice and vocal acoustics in high-risk newborns is limited. AIM: To examine whether parents' voices reduce heel puncture pain in high-risk newborns and the relationship between parents' vocal acoustics, physiological parameters and pain response. STUDY DESIGN: A randomized controlled clinical trial was conducted with 105 high-risk newborn-parent dyads. Participants were randomly assigned to three groups: recorded mother's voice, recorded father's voice or control group without any recorded voice. Outcome measures included heart rate, respiratory rate, oxygen saturation and pain response assessed using the Neonatal Infant Pain Scale. Data analysis utilized generalized estimation equations, and parents' vocal acoustics were analysed using Praat voice credit software. RESULTS: The mother's voice group exhibited significantly lower heart rates at 1, 5 and 10 min after the procedure, along with lower respiratory rates and pain levels at 5 and 10 min after the procedure compared with the control group. Similarly, the father's voice group demonstrated significantly lower heart rates at 1 and 5 min after the procedure, decreased respiratory rates at 5 and 10 min after the procedure and reduced pain levels at 1 and 5 to 10 min after the procedure compared with the control group. Higher minimum and mean pitches in parents' voices correlated with slower heart rates, while slower parental speech was associated with reduced newborn pain. CONCLUSION: Both maternal and paternal vocal interventions alleviated pain during heel puncture procedures among high-risk newborns. RELEVANCE TO CLINICAL PRACTICE: The noninvasive intervention serves as a reference for parental participation in care. Nurses can help parents to intervene with the acoustic characteristics that alleviate pain among high-risk newborns.

Atrial Fibrillation After mRNA-1273 SARS-CoV-2 Vaccination: Case Report with Literature Review.

Importance: COVID-19 vaccination has been associated with various adverse outcomes. Although studies have reported cases of arrhythmia after COVID-19 vaccination, the precise underlying mechanism remains to be elucidated. Objective: Here, we report the case of a patient who developed atrial fibrillation after receiving the mRNA-1273 vaccine and describe our findings in light of relevant cases in the literature. Design Setting and Participants: This is a case report and a review of the relevant literature. A 55-year-old woman presented to our clinic with a history of paroxysmal atrial fibrillation, hypertension, and mild mitral valve prolapse. The patient developed atrial fibrillation 3 days after receiving a COVID-19 vaccine. She was diagnosed with moderate-to-severe tricuspid regurgitation and severe mitral regurgitation, and underwent valve repair surgery. To obtain relevant articles (December 2020 through August 2022), we searched the following key words on PubMed: atrial fibrillation and COVID-19 vaccination. Results: A total of 5 relevant case reports were identified. COVID-19 vaccination led to arrhythmia, including atrial fibrillation, within 14 days. Conclusions and Relevance: Cases of patients developing arrhythmia after COVID-19 vaccination have been increasingly reported. Although the underlying mechanism remains unclear, we hypothesize that mRNA vaccination may lead to arrhythmia and associated valve diseases. Thus, before administering mRNA-1273 vaccines to patients with a history of valvular heart disease or atrial fibrillation, the patients' cardiologists must be consulted.

All-Cause Standardized Mortality Ratio in Hemodialysis and Peritoneal Dialysis Patients: A Nationwide Population-Based Cohort Study.

Patients with end-stage renal disease (ESRD) are at a higher mortality risk compared with the general population. Previous studies have described a relationship between mortality and patients with ESRD, but the data on standardized mortality ratio (SMR) corresponding to different causes of death in patients undergoing hemodialysis (HD) and peritoneal dialysis (PD) are limited. This study was designed as a nationwide population-based retrospective cohort study. Incident dialysis patients between January 2000 and December 2015 in Taiwan were included. Using data acquired from the Taiwan Death Registry, SMR values were calculated and compared with the overall survival. The results showed there were a total of 128,966 patients enrolled, including 117,376 incident HD patients and 11,590 incident PD patients. It was found that 75,297 patients (58.4%) died during the period of 2000-2017. The overall SMR was 5.21. The neoplasms SMR was 2.11; the endocrine, nutritional, metabolic, and immunity disorders SMR was 13.53; the circulatory system SMR was 4.31; the respiratory system SMR was 2.59; the digestive system SMR was 6.1; and the genitourinary system SMR was 27.22. Therefore, more attention should be paid to these diseases in clinical care.

Highly Efficient Ternary Near-Infrared Organic Photodetectors for Biometric Monitoring.

Near-infrared (NIR) small-molecule acceptors that absorb at wavelengths of up to 1000 nm are attractive for applications in organic photodetectors (OPDs) and biometrics. In this study, we incorporated IEICO-4F as the third component for PffBT4T-2OD:PC71BM-based OPDs to provide an efficient NIR response while greatly suppressing the leakage current at reverse bias. By varying the blend ratio and thickness (250-600 nm), we obtained an NIR OPD displaying an ultralow dark-current density (JD = 2.62 nA cm-2), ultrahigh detectivity [D* = 7.2 × 1012 Jones (850 nm)], high sensitivity, and photoresponsivity covering the region from the ultraviolet to the NIR. We used tapping-mode atomic force microscopy, optical microscopy, grazing-incidence wide-angle X-ray scattering, and contact angle measurements to investigate the effect of IEICO-4F on the performance of the ternary OPDs. The low compatibility of PffBT4T-2OD and IEICO-4F, originating from weak intermolecular interactions, allowed us to manipulate the degree of phase separation between the donor and acceptor in the ternary blends, leading to an optimized blend morphology featuring efficient charge separation, transport, and collection. To demonstrate its applicability, we integrated our OPD with two light-emitting diodes and used the system for precisely calculated transmissive pulse oximetry.

Chronic intermittent hypoxia worsens brain damage and sensorimotor behavioral abnormalities after ischemic stroke: Effect on autonomic nervous activity and sleep patterns.

OBJECTIVE: Sleep apnea (SA) is characterized by intermittent hypoxia (IH), which increases sympathetic activity and sleep fragmentation, thus increasing the risk of stroke. SA is a highly prevalent disease and can worsen prognosis in patients with stroke. However, the correlation of changes in the cardiac autonomic nervous system and sleep patterns under IH with sensorimotor behavior and cerebral infarction after stroke remains unclear. We hypothesized that dysregulated autonomic activity and unstable sleep patterns induced by IH and correlated with cerebral infarction and abnormal sensorimotor behavior after middle cerebral artery occlusion (MCAO). METHODS: Wistar-Kyoto rats (WKY) were divided into IH (hypoxia: 5 % O2, 8 h/day) and RA group (room air) for 2 weeks and both groups were subjected to MCAO. After MCAO, the IH group was continuously exposed to IH for 1 week. The 24-h physiological signals, blood pressure, and sensorimotor behavior were recorded at baseline (Bas), the first and second weeks during IH (RA/IH1W and RA/IH2W, respectively), and poststroke. RESULTS: Before MCAO, IH caused sympathetic activity during sleep and parasympathetic activity of active waking (AW) to increase. Moreover, IH reduced the accumulated time and duration of paradoxical sleep (PS) and increased the interruption during sleep. After MCAO, IH increased blood pressure, more severe brain damage, and poor sensorimotor performance. Moreover, IH reduced autonomic activity after MCAO and decreased sympathetic activity was associated with poor sensorimotor performance. CONCLUSION: Autonomic activity and sleep patterns affected by IH were correlated with increased cerebral infarction and poor sensorimotor behavior after MCAO.

Long-term mortality rates of young stroke in Taiwan: A decade-long epidemiology population-based study.

Introduction: Stroke remains a leading cause of death worldwide. Stroke in young adults is an important issue, gaining extra attention in recent years. This study aims to investigate the mortality after stroke in young adults in Taiwan. Patients and methods: This is a registry- and population-based study in Taiwan of patients aged 20-50 years with first-ever stroke between 1999 and 2012, with follow-up until January 1, 2022. Patients and mortalities were identified through Taiwan National Health Insurance database. Results: The study population included 65,097 patients with stroke (mean age, 42.6 ± 6.6 years; 30.5% woman). There were 23,481 (36.1%) intracranial hemorrhage, 37,522 (57.6%) ischemic stroke, and 4094 (6.3%) stroke not otherwise specified. At the end of follow-up, a total of 18,248 deaths (28.0%) occurred during a median follow-up of 9.8 years (interquartile range, 6.4-13.7 years). Conclusion: Taiwan young adults who were 30-day survivors of first-ever stroke have significantly higher long-term mortality rates when compared to other population-based studies.

The Risk Factors for Radiolucent Nephrolithiasis among Workers in High-Temperature Workplaces in the Steel Industry.

Workers in high-temperature workplaces with inadequate water supply may exhibit symptoms of chronic dehydration and have increased risk of nephrolithiasis. The aim of this study was to investigate the risk of radiolucent stone formation among workers in a high-temperature workplace and the related risk factors associated with the condition. We collected data from 1681 workers in a steel factory in Southern Taiwan who underwent regular health examinations. Radiolucent stones were defined as positive findings on ultrasound with negative radiographic images. The prevalences of nephrolithiasis and radiolucent stones in this study were 12.0% and 5.1%, respectively. Heat exposure and age were two major risk factors influencing the probability of radiolucent stones. We combined the age and heat exposure into four groups (over and under 35 years of age with and without heat exposure) in a logistic regression. For workers younger than 35 years, the odds ratio of radiolucent stones was 2.695 (95% confidence interval: 1.201-6.049) in workers with heat exposure compared to workers without. Our investigation further demonstrated that heat exposure was a main risk factor for radiolucent stone formation. In conclusion, our identification of heat exposure as an independent factor for radiolucent stone development in steel workers highlights the need for attention to be paid to those working in similar environments.

Effect of health literacy and shared decision-making on choice of weight-loss plan among overweight or obese participants receiving a prototype artificial intelligence robot intervention facilitating weight-loss management decisions.

Implementation of artificial intelligence (AI) in medical decision-making is still in early development. We developed an AI robot intervention prototype with a health literacy-friendly interface that uses interactive voice response (IVR) surveying to assist in decision-making for weight loss. The weight-specific health literacy instrument (WSHLI) and Shared Decision-Making Questionnaire (SDMQ) were used to measure factors influencing weight-loss decisions. Factors associated with participants choosing to lose weight were analyzed using logistic regression, and factors influencing the selection of specific weight-loss plans were examined with one-way analysis of variance. Our study recruited 144 overweight or obese adults (69.4% women, 58.3% with body mass index (BMI) ≥ 24). After interacting with the AI robot, 78% of the study population made the decision to lose weight. SDMQ score was a significant factor positively influencing the decision for weight-loss (odds ratio [OR]: 2.16, 95% confidence interval [CI]: 1.09-4.29, p = 0.027). Individuals who selected self-monitored lifestyle modification (mean ± SD: 11.52 ± 1.95) had significantly higher health literacy than those who selected dietician-assisted plan (9.92 ± 2.30) and physician-guided treatment (9.60 ± 1.52) (both p = 0.001). The study results demonstrated that our prototype AI robot can effectively encourage individuals to make decisions regarding weight management and that both WSHLI and SDMQ scores affect the choice of weight-loss plans.

Dual-Functional Enantiomeric Compounds as Hole-Transporting Materials and Interfacial Layers in Perovskite Solar Cells.

In this paper, we describe the application of the enantiomeric compounds YLC-1-YLC-4, each featuring a bulky spiro[fluorene-9,9'-phenanthren]-10'-one moiety, as both hole-transporting materials (HTMs) and interfacial layers in both n-i-p and p-i-n perovskite solar cells (PSCs). These HTMs contain an enantiomeric mixture and a variety of core units linked to triarylamine donors to extend the degree of π-conjugation. The n-i-p PSCs incorporating YLC-1(a) exhibited a power conversion efficiency (PCE) of 19.15% under AM 1.5G conditions (100 mW cm-2); this value was comparable with that obtained using spiro-OMeTAD as the HTM (18.25%). We obtained efficient and stable p-i-n PSCs having the dopant-free structure indium tin oxide (ITO)/NiOx/interfacial layer (YLC)/perovskite/PC61BM/BCP/Ag. The presence of the spiro-based compounds YLC-1 and YLC-2 efficiently passivated the interfacial and grain boundary defects of the perovskite and enhanced the sizes of its grains, more so than did YLC-3 and YLC-4. These spiro-based YLC derivatives packed densely and functioned as Lewis bases to coordinate Pb and Ni ions in the perovskite and NiOx layers, respectively. Together, the effects of smaller grain boundaries and defect passivation of the perovskite enhanced the optoelectronic properties of the PSCs. The photoinduced charge carrier extraction in the linearly increasing voltage (photo-CELIV) curves of NiOx/YLC-1(a) showed the faster carrier transport 3.3 × 10-3 cm2 V-1 s-1, which improved the carrier mobility, supporting the notion of defect passivation of the perovskite. The best-performing NiOx/YLC-1(a) device provided a short-circuit current density (JSC) of 22.88 mA cm-2, an open-circuit voltage (VOC) of 1.10 V, and a fill factor (FF) of 80.93%, corresponding to an overall PCE of 20.37%. In addition, the PCEs of the NiOx/YLC-1(a) and NiOx/YLC-4(b) PSC devices underwent decays of only 98.1 and 97.0% of their original values after 41 days under an Ar atmosphere. Thus, these YLC derivatives passivated the NiOx surface and optimized the film quality of perovskites, thereby leading to superior PCEs of their respective PSCs.

Newly Diagnosed Type 2 Diabetes Care between Family Physicians, Endocrinologists, and Other Internists in Taiwan: A Retrospective Population-Based Cohort Study.

(1) Background: We aimed to determine whether physicians of different specialties perform differently in the monitoring, cost control, and prevention of acute outcomes in diabetes care. (2) Methods: Using data from the Health and Welfare Data Science Center, participants with newly diagnosed type 2 diabetes (n = 206,819) were classified into three cohorts based on their primary care physician during the first year of diagnosis: family medicine (FM), endocrinologist, and other internal medicine (IM). The three cohorts were matched in a pairwise manner (FM (n = 28,269) vs. IM (n = 28,269); FM (n = 23,407) vs. endocrinologist (n = 23,407); IM (n = 43,693) vs. endocrinologist (n = 43,693)) and evaluated for process indicators, expenditure on diabetes care, and incidence of acute complications (using subdistribution hazard ratio; sHR). (3) Results: Compared to the FM cohort, both the IM (sHR, 1.26; 95% CI, 1.08 to 1.47) and endocrinologist cohorts (sHR, 1.57; 95% CI, 1.38−1.78) had higher incidences of acute complications. The FM cohort incurred lower costs than the IM cohort (USD 487.41 vs. USD 507.67, p = 0.01) and expended less than half of the diabetes-related costs of the endocrinology cohort (USD 484.39 vs. USD 927.85, p < 0.001). (4) Conclusion: Family physicians may provide better care at a lower cost to newly diagnosed type 2 diabetes patients. Relatively higher costs incurred by other internists and endocrinologists in the process of diabetes care may be explained by the more frequent ordering of specialized tests.

An FGM decomposition-based fuzzy MCDM method for selecting smart technology applications to support mobile health care during and after the COVID-19 pandemic.

In a fuzzy multicriteria decision-making (MCDM) problem, a decision maker may have differing viewpoints on the relative priorities of criteria. However, traditional methods merge these viewpoints into a single one, which leads to an unrepresentative decision-making result. Several recent methods identify the multiple viewpoints of a decision maker by decomposing the decision maker's fuzzy judgment matrix into several symmetric fuzzy subjudgment matrices, which is an inflexible strategy. To enhance flexibility, this study proposed a fuzzy geometric mean (FGM) decomposition-based fuzzy MCDM method in which FGM is applied to decompose a fuzzy judgment matrix into several fuzzy subjudgment matrices that can be asymmetric. These fuzzy subjudgment matrices are diverse and more consistent than the original fuzzy judgment matrix. The proposed methodology was applied to select the best choice from a group of smart technology applications for supporting mobile health care during and after the COVID-19 pandemic. According to the experimental results, the proposed methodology provided a novel approach to decomposing fuzzy judgment matrices and produced more diverse fuzzy subjudgment matrices.

Evaluation of the 10 Years' Association Between DXA Screening and Mortality in Patients Who Received Vertebroplasty in the Taiwan Population.

BACKGROUND: Osteoporotic fractures are a significant cause of morbidity and mortality affecting population worldwide. All guidelines recommended vertebral fracture assessment by dual-energy X-ray absorptiometry (DXA). This study aimed at evaluation of any associated benefits of screening with DXA in patients who had received vertebroplasty in Taiwan. METHODS: Data were obtained from the National Health Insurance Research Database (NHIRD) in Taiwan. We retrospectively compared the data of patients, who were admitted for vertebroplasty, whether they received DXA screening or not. The outcomes of interest were recurrence of spinal fracture and mortality during a follow-up period of 10 years. RESULTS: From this Taiwan national database, the screening rate of osteoporosis in patient who received vertebroplasty was 11.7%. The mean age in the non-DXA screened cohort (n=32,986) was 74.03±12.21 years (71.98% female). In the DXA screened cohort (n=4361), the mean age was 76.43±9.19 years (79.91% female). During the 10-year follow-up period, after matching, non-DXA patients had significantly higher mortality rates than their DXA counterparts, which were 42.37% and 37.73% (p-value < 0.0001), respectively. The re-fracture rates between non-DXA and DXA patients were not significantly different at 17.26% and 16.89% (p-value = 0.1766), respectively. CONCLUSION: The rate of DXA screening before patients receiving vertebroplasty was extremely low, at 11.7%. Our results showed that DXA screening before vertebroplasty in spinal fractures patients had lower mortality. From this national retrospective cohort study, routine screening of osteoporosis in spinal fracture patients can lead to reduction in mortality.

Correlation Between Malpractice Litigation and Legislation Reform in Taiwan Over a 30-Year Period.

BACKGROUND: The annual medical litigation rate has increased yearly since 1987 in Taiwan. Policy makers keep going medical legislation reforms. The effectiveness of legislation reforms to reduce malpractice litigation risk is uncertain. OBJECTIVE: To determine whether medical legislation reform helps reduce the risk of medical litigation. DESIGN SETTING AND PARTICIPANTS: This retrospective study used national data obtained from Ministry of Health and Welfare in Taiwan. The period analyzed was from 1987 to 2018. The annual medical litigation rate was determined, types of medical negligence litigation were compared, medical appraisal results were summarized, and the importance of medical legislation was identified. INTERVENTIONS: After legislation reform vs before legislation reform. MEASUREMENTS: The main outcome showed trends in medical dispute assessments over time by adjusting for the general population (per 1, 000, 000 people). We established 2004 and 2012 as the 2 cut-points for further analysis of medical appraisal results due to legislation reform. RESULTS: With legislation reforms, the annual medical litigation rate decreased from 26.68 cases per million people in 2012 to 16.41 cases per million people in 2018. The annual medical litigation rate declined by approximately 38% from 2012 to 2018. Medical appraisal results were malpractice cases in 22.1% before Medical Care Act (2004 Reform) compared with 18.8% from 2004 to 2012 (odds ratio [OR], 0.82; 95% CI, 0.727-0.924; p=0.001), and 6.4% after mediation system introduced in 2012 (odds ratio [OR], 0.243; 95% CI, 0.205-0.288; p<0.001). CONCLUSION: Medical legislation reform has reduced the risk of malpractice litigation over time.

Mucous membrane pemphigoid in a patient with chronic hepatitis B virus infection: A case report.

RATIONALE: Mucous membrane pemphigoid (MMP) is a rare, autoimmune bullous disease that affects mucosal surfaces and skin. Early and aggressive treatment initiation may be warranted due to the risks of serious complications. However, it can be challenging to make an initial diagnosis. Viral infection such as hepatitis B virus (HBV) infection has been found to be associated with the formation of autoimmune bullous diseases. PATIENT CONCERNS: The patient was a 43-year-old male with gingivitis and recurrent swelling over the neck, cheeks, lips, and eyelids. The patient presented at oral medicine, otolaryngology, plastic surgery, and ophthalmology sequentially, and was later referred to the rheumatology, dermatology, and family medicine departments. Recurrent hemorrhagic bullae on oral mucosa and skin scarring occurred 2 years after the onset of the initial symptoms. DIAGNOSIS: Skin biopsy with direct immunofluorescence was performed under the suspicion of MMP. Lesional hematoxylin and eosin stain and perilesional direct immunofluorescence were consistent with MMP. INTERVENTIONS: Systemic Prednisolone and topical corticosteroid were used to control the disease. OUTCOMES: A flare-up of hepatitis B developed as a result of systemic prednisolone use. The disease went through relapses and remissions. The patient is on low-dose prednisolone (5 mg/day) with a monthly outpatient visit in the family medicine department. LESSONS: It would be useful for medical practitioners in different specialties to be alert of the heterogeneous presentations of MMP. Chronic HBV infection might be a risk factor for MMP. In patients with chronic HBV infection, treatment of MMP must be closely monitored for the risk of reactivation of HBV.