Sepsis-induced acute kidney injury (AKI) is a common complication in patients with severe illness and leads to increased risks of mortality and chronic kidney disease. We investigated the association between monocyte distribution width (MDW), red-blood-cell volume distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), sepsis-related organ-failure assessment (SOFA) score, mean arterial pressure (MAP), and other risk factors and sepsis-induced AKI in patients presenting to the emergency department (ED). This retrospective study, spanning 1 January 2020, to 30 November 2020, was conducted at a university-affiliated teaching hospital. Patients meeting the Sepsis-2 consensus criteria upon presentation to our ED were categorized into sepsis-induced AKI and non-AKI groups. Clinical parameters (i.e., initial SOFA score and MAP) and laboratory markers (i.e., MDW, RDW, and NLR) were measured upon ED admission. A logistic regression model was developed, with sepsis-induced AKI as the dependent variable and laboratory parameters as independent variables. Three multivariable logistic regression models were constructed. In Model 1, MDW, initial SOFA score, and MAP exhibited significant associations with sepsis-induced AKI (area under the curve [AUC]: 0.728, 95% confidence interval [CI]: 0.668–0.789). In Model 2, RDW, initial SOFA score, and MAP were significantly correlated with sepsis-induced AKI (AUC: 0.712, 95% CI: 0.651–0.774). In Model 3, NLR, initial SOFA score, and MAP were significantly correlated with sepsis-induced AKI (AUC: 0.719, 95% CI: 0.658–0.780). Our novel models, integrating MDW, RDW, and NLR with initial SOFA score and MAP, can assist with the identification of sepsis-induced AKI among patients with sepsis presenting to the ED.

Background: Unscheduled return visits (URVs) to the emergency department (ED) constitute a crucial indicator of patient care quality. Objective: We aimed to analyze the clinical characteristics of patients who visited the ED with abdominal pain and to identify the risk of URVs with admission (URVAs) from URVs without admission (URVNAs). Methods: This retrospective study included adult patients who visited the ED of Taipei Medical University Hospital because of abdominal pain and revisited in 72 h over a 5-year period (January 1, 2014, to December 31, 2018). Multivariable logistic regression analysis was employed to identify risk factors for URVAs and receiver operating characteristic (ROC) curve analysis was performed to determine the efficacy of variables predicting URVAs and the optimal cut-off points for the variables. In addition, a classification and regression tree (CART)-based scoring system was used for predicting risk of URVA. Results: Of 702 eligible patients with URVs related to abdominal pain, 249 had URVAs (35.5%). In multivariable analysis, risk factors for URVAs during the index visit included execution of laboratory tests (yes vs no: adjusted odds ratio [AOR], 4.32; 95% CI 2.99–6.23), older age (≥ 40 vs < 40 years: AOR, 2.10; 95% CI 1.10–1.34), Level 1–2 triage scores (Levels 1–2 vs Levels 3–5: AOR, 2.30; 95% CI 1.26–4.19), and use of ≥ 2 analgesics (≥ 2 vs < 2: AOR, 2.90; 95% CI 1.58–5.30). ROC curve analysis results revealed the combination of these 4 above variables resulted in acceptable performance (area under curve: 0.716). The above 4 variables were used in the CART model to evaluate URVA propensity. Conclusions: Elder patients with abdominal pain who needed laboratory workup, had Level 1–2 triage scores, and received ≥ 2 doses of analgesics during their index visits to the ED had higher risk of URVAs.

We have successfully fabricated a low-reflection organic light-emitting diode (LR-OLED) by replacing the highly reflective Al cathode of a conventional OLED with a Fabry–Pérot (FP) cavity cathode, which is simultaneously responsible for absorption, plasmonic absorption and destructive interference. The FP cavity cathode consisted of a front semi-transparent double thin metal layer (Al/Ag), an inserted organometallic black layer (BL) in the middle and a highly reflective Al mirror. The organometallic BL contained a high-mobility electron transport and broadband absorptive organic matrix, N,N′-bis(2,6-diisopropylphenyl)-1,7-bis(4-methoxy-phenyl)perylene-3,4,9,10-tetracarboxydiimide (MPPDI), and Ag-nanoparticle (NP) dopants which contributed not only to the plasmonic absorption but also to the metallic conductivity. By adjusting the thickness and Ag-NP concentration of the organometallic BL, one can optimize the destructive interference cavity effect. LR-OLEDs fabricated using the aforementioned characteristics of the Ag-NP yielded superior electrical performance and low reflection across almost the entire visible spectrum. With the exemption of surface reflection (air/glass ∼4%), a lowest reflection of 0% near 750 nm and an average reflection of 1.39% for the entire visible spectrum were obtained for a LR-OLED with a 65 nm organometallic BL (mixing ratio of MPPDI : Ag = 10 : 1). With the additional structural cavity cathode, the LR-OLEDs nonetheless exhibited similar electrical performances and continuous operational lifetimes to those of control devices with a traditional highly reflective Al cathode.

Background/purpose The evidence provided by syntheses of the preventative effects of gabexate mesilate against pancreatitis among patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) is limited and highly heterogeneous. To enhance the understanding of this topic, this study aimed to provide overview of gabexate mesilate on preventing post ERCP pancreatitis (PEP) by synthesizing all relevant randomized controlled trials (RCTs). Methods: We searched three databases for relevant RCTs. Two authors independently extracted data of pancreatitis incidence after ERCP, abdominal pain within 48 hours, and hyperamylasemia for quality assessment and meta-analysis. Results: Thirteen RCTs with 3718 patients undergoing ERCP met the eligibility criteria and were included. The results revealed that the use of gabexate mesilate led to lower PEP (Peto odds ratio: 0.66, 95% confidence interval [CI]: 0.49 to 0.89), especially in the subgroup of gabexate mesilate infusion starting more than 30 min (Risk ratio: 0.45, 95% CI: 0.29 to 0.72). Conclusion: The present synthesis found that gabexate mesilate could be an option of prophylactic treatment of pancreatitis for patients undergoing ERCP, and reveals that it is favorable to administer it starting 30 min before the ERCP. This evidence may improve the clinical prevention of PEP.

Atrial fibrillation (AF) is the most common arrhythmia. The most common diagnostic method, 12-lead electrocardiogram (ECG), can record episodes of arrhythmia from which the type and severity can be determined. The Heart Spectrum Blood Pressure Monitor (P2; OSTAR Meditech Corp., New Taipei City, Taiwan) is used to measure cardiovascular pressure change with fast Fourier transform (FFT) analysis to obtain heart rate frequency variability and accurate blood pressure data. We compared the diagnostic efficacy of the Heart Spectrum Blood Pressure Monitor to a 12-lead ECG (gold standard) for patients with AF. Three measurement methods were used in this study to analyze the heart index and compare the results with simultaneous 12-lead ECG: blood pressure; mean arterial pressure, which was calculated from individual blood pressure as a constant pressure; and a constant pressure of 60 mmHg. The physician used a 12-lead ECG and the Heart Spectrum Blood Pressure Monitor simultaneously. The Heart Spectrum Blood Pressure Monitor used FFT analysis to diagnose AF, and the findings were compared to the 12-lead ECG readings. This unblinded clinical trial was conducted in the emergency department of Taipei Medical University Hospital. Twenty-nine subjects with AF and 33 without AF aged 25 to 97 y (mean, 63.5 y) were included. Subjects who were exposed to high-frequency surgical equipment during testing, those with cardiac pacemakers or implantable defibrillators, and pregnant women were excluded. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 97%, 97%, 97%, and 97%, respectively, for method 1; 90%, 100%, 100%, and 91%, respectively, for method 2; and 100%, 94%, 94%, and 100%, respectively, for method 3. The sensitivity, specificity, PPV, and NPV for both methods ranged between 90% and 100%, indicating that the Heart Spectrum Blood Pressure Monitor can be effectively applied for AF detection.

The submodeling technique is a powerful analysis tool. The method promotes more accurate analysis and also helps enhance productivity. It has been shown that by using displacement-force cut boundary condition method, it can be made even more versatile. The local stress phenomena of the solder microbump have been solved with this approach to demonstrate the concept. From the simulation model, it is known that the ENIG pad thickness has an effect on the aluminium pad stress in the silicon chip. This is important as the shear stress will damage the pad and circuitry on the chip. Previously this is not reported in other literatures as there is no strain gage available that can measure such a small dimension.