Artificial intelligence-assisted remote detection of ST-elevation myocardial infarction using a mini-12-lead electrocardiogram device in prehospital ambulance care

ObjectiveTo implement an all-day online artificial intelligence (AI)-assisted detection of ST-elevation myocardial infarction (STEMI) by prehospital 12-lead electrocardiograms (ECGs) to facilitate patient triage for timely reperfusion therapy.MethodsThe proposed AI model combines a convolutional neural network and long short-term memory (CNN-LSTM) to predict STEMI on prehospital 12-lead ECGs obtained from mini-12-lead ECG devices equipped in ambulance vehicles in Central Taiwan. Emergency medical technicians (EMTs) from the 14 AI-implemented fire stations performed the on-site 12-lead ECG examinations using the mini portable device. The 12-lead ECG signals were transmitted to the AI center of China Medical University Hospital to classify the recordings as “STEMI” or “Not STEMI”. In 11 non-AI fire stations, the ECG data were transmitted to a secure network and read by available on-line emergency physicians. The response time was defined as the time interval between the ECG transmission and ECG interpretation feedback.ResultsBetween July 17, 2021, and March 26, 2022, the AI model classified 362 prehospital 12-lead ECGs obtained from 275 consecutive patients who had called the 119 dispatch centers of fire stations in Central Taiwan for symptoms of chest pain or shortness of breath. The AI's response time to the EMTs in ambulance vehicles was 37.2 ± 11.3 s, which was shorter than the online physicians' response time from 11 other fire stations with no AI implementation (113.2 ± 369.4 s, P < 0.001) after analyzing another set of 335 prehospital 12-lead ECGs. The evaluation metrics including accuracy, precision, specificity, recall, area under the receiver operating characteristic curve, and F1 score to assess the overall AI performance in the remote detection of STEMI were 0.992, 0.889, 0.994, 0.941, 0.997, and 0.914, respectively. During the study period, the AI model promptly identified 10 STEMI patients who underwent primary percutaneous coronary intervention (PPCI) with a median contact-to-door time of 18.5 (IQR: 16–20.8) minutes.ConclusionImplementation of an all-day real-time AI-assisted remote detection of STEMI on prehospital 12-lead ECGs in the field is feasible with a high diagnostic accuracy rate. This approach may help minimize preventable delays in contact-to-treatment times for STEMI patients who require PPCI

Thermal Convection Using Carbon Nanotube Forest Device

自奈米碳管被發現以來，一直是備受矚目的研究對象，其優秀的機械性質使得大眾對於其應用方面備感興趣，而本研究也是其一。 本研究先探討填鐵奈米碳管於純鋁基材上之生長參數，成長出不同高度以及結構之填鐵奈米碳管叢，再以實驗法來探討填鐵奈米碳管叢對於表面自然對流的影響，藉由量測填鐵奈米碳管叢表面散熱情形，比較在相同環境下、無奈米碳管叢之試片量測數據，探討填鐵奈米碳管的散熱能力與特性，並研究不同高度與結構的填鐵奈米碳管叢對表面熱對流之影響。 本研究發現成長填鐵奈米碳管叢在材料表面時，可以增加近30至50%之自然對流熱交換率，且和環境溫差成正相關，亦即試片和環境之溫差愈大，對流效應導致散熱供率增加之效果愈好。而研究也發現，填鐵奈米碳管對於表面熱對流之增幅效應，並不會隨著高度變化而有所改變，將之做為鰭片狀之形貌也無助於增加散熱效率，說明了填鐵奈米碳管對表面對流之增益乃源自其優異的軸向熱傳導特性。The research of carbon nanotubes (CNTs) has been remarkable since it was discovered. The excellent promising mechanical properties of CNTs are the most interesting reasons to research. So does the motivation of this thesis. This thesis discusses the growth procedure of the iron-filled CNTs which is synthesized on aluminum substrate. After synthesizing the different heights and structures of iron-filled CNTs, the effect of the natural convection for iron-filled CNTs by experiment processing are also be mentioned. In the same environment, it compares the ability of heat dissipation efficiency which caused by natural convection between the sample of iron-filled CNTs and the other without. After that, there is an analysis of heat dissipation efficiency for the iron-filled CNTs in different heights and structures. In this research, the material surface with iron-filled CNTs improves heat convection efficiency from 30% to 50%, which is proportional to the temperature difference between the specimen and environment. The effect on the higher iron-filled CNTs is similar, and even the one in fin-like still not able to perform better heat dissipation efficiency. Therefore, we can conclude that the gain of the convection by iron-filled CNTs is due to the outstanding axial thermal conductivity

The Effect of Color and Fractal Dimension on natural Landscape Preference

本研究之主要目的為利用客觀的測量工具，評估景觀色彩中明度、色相、彩度及色彩變異量等色彩屬性之變化與組合，以及畫面構成之複雜度等因子對人們自然景觀偏好之影響。在景觀色彩屬性方面，本研究利用Lab色彩空間作為表色方法將色彩量化，在景觀複雜度方面則以碎形維度作為複雜度的預測指標。本研究先從資料庫中選取大量自然景觀照片，利用軟體進行色彩屬性及碎形維度之數值分析，並根據分析結果，選出共210張包含各種不同色彩屬性及碎形維度變化之景觀照片作為刺激物。其中10張作為基準，將其餘200張分成兩組後，進行景觀偏好問卷調查，請受測者觀看照片後，根據其偏好以1~10分之等距尺度針對每張照片進行評分，並利用基準將偏好評值進行標準化處理，以消除因不同受測者個人評量尺度不同所造成之誤差。最後將所獲得之資料進行統計分析及假設之驗證，並建立綜合偏好預測迴歸模型。分析結果顯示在色彩屬性方面，景觀偏好與Lab色彩空間中之L值成負相關、與a值、a值之標準差、b平方值及彩度值成正相關；在碎形維度方面，景觀偏好與碎形維度值兩者之間為一倒U字形二次曲線關係，當碎形維度值為1.333時，景觀偏好值最高；在景觀偏好預測模型中，a值、b平方值、碎形維度值及其平方等4個變項皆可顯著解釋景觀偏好，迴歸模型之解釋力為20.4%。根據本研究之研究結果，人們在色彩方面偏好明度較低、色相偏紅、偏黃或偏藍且紅－綠變化多、色彩鮮豔或對比強烈之景觀；在複雜度方面則以複雜度中間偏低之景觀最受偏好。本研究證實Lab色彩空間可以有效將景觀照片中各項色彩屬性量化，且碎形維度可以作為景觀複雜度的預測指標，研究結果可以作為未來景觀偏好領域研究之參考。The main purpose of this study is to evaluate the effect of different color qualities and complexity on people’s preferences for natural landscape. In this study, Lab color space is used to quantify color qualities, and Fractal Dimension is applied as the index of landscape complexity. In the beginning, large amount of landscape pictures were collected from the database built earlier. Then researcher used software to analyze each picture, calculating fractal dimension and the color qualities in Lab color space, including Brightness, Hue, Chroma and the variance of color. The final samples contained 210 pictures with varying color qualities and fractal dimension, including 10 Baseline pictures and two groups of 100 pictures each. Second, people’s landscape preferences of each picture were collected through a 10-point-scale questionnaire. Finally, the quantified data was analyzed to vertify the hypotheses. The result shows that people’s landscape preference is negative correlated to L, but positive correlated to a, aS.D., b2, and Chroma in Lab color space. An inverted U-shape curve was found between fractal dimension and landscape preference, 1.333 is the most preferred Db value. The regression model shows that a, b2, Db, Db2 can explain 20.4% of landscape preference. According to the results, people tend to prefer natural landscape which is darker in Brightness, more red, yellow or blue in Hue, more colorful in Saturation and more red-green variances in color, and lower-middle landscape complexity is preferred more. This study proves that Lab color space is an effective tool to quantify color qualities, and Fractal Dimension is a predictive index of landscape complexity. The results can contribute to future studies in the field of landscape preference

Mortality Risk and Decompensation in Hospitalized Patients with Non-Alcoholic Liver Cirrhosis: Implications for Disease Management

Here we aimed to assess the mortality risk and distribution of deaths from different complications and etiologies for non-alcoholic liver cirrhosis (NALC) adult inpatients and compare them with that of the general hospitalized adult population. Hospitalized patients with a primary diagnosis of NALC and aged between 30 and 80 years of age from 1999 to 2010 were identified using a population-based administrative claims database in Taiwan. They were matched with a general, non-NALC population of hospitalized patients. Causes of death considered were variceal hemorrhage, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatocellular carcinoma, jaundice, and hepatorenal syndrome. A total of 109,128 NALC inpatients were included and then matched with 109,128 inpatients without NALC. Overall mortality rates were 21.2 (95% CI: 21.0–21.4) and 6.27 (95% CI: 6.17–6.37) per 100 person-years, respectively. Among complications that caused death in NALC patients, variceal hemorrhage was the most common (23.7%, 11.9 per 100 person-years), followed by ascites (20.9%, 10.4 per 100 person-years) and encephalopathy (18.4%, 9.21 per 100 person-years). Among all etiologies, mortality rates were highest for NALC patients with HBV infection (43.7%, 21.8 per 100 person-years), followed by HBV-HCV coinfection (41.8%, 20.9 per 100 person-years), HCV infection (41.2%, 20.6 per 100 person-years), and NAFLD (35.9%, 17.9 per 100 person-years). In this study, we demonstrated that mortality risks in NALC patients may differ with their etiology and their subsequent complications. Patients’ care plans, thus, should be formulated accordingly

Migraine and risk of narcolepsy in children: A nationwide longitudinal study.

The association between migraine and narcolepsy remains controversial. We aim to investigate whether migraine is associated with an increased risk of developing narcolepsy in children.In this longitudinal study, nationwide medical-claims data of pediatric patients (0-17y) with migraine are identified using the National Health Insurance Research Database (NHIRD) between 1997 and 2010 in Taiwan. Two cohorts are selected: migraine cases (n = 8,923) and propensity score-matched non-migraine controls (n = 35,692). Children with previous history of narcolepsy or headache before the index date are excluded. Cohorts are followed until the end of 2012, their withdrawal from the NHI program, or incidence of narcolepsy (ICD-9-CM: 347). Cox proportional hazards regression models are used to estimate hazard ratios (HRs) and 95% confidence intervals of developing narcolepsy in children with migraine compared to their non-migraine controls.A total of 13 incident cases with narcolepsy are observed during follow-up, with incidence rates of 0.1915 and 0.0278 per 1,000 person-years in migraine and non-migraine children, respectively. After a mean follow-up period of 4.68 and 5.04 years in the case and control cohort, respectively, the former exhibited a greater risk of developing narcolepsy compared to the latter (adjusted hazard ratio (aHR) = 5.30, 95% confidence interval (CI): 1.61, 17.4; p = 0.006). This finding persisted after controlling for potential confounders like baseline comorbidities and concurrent medication uptake, and in our analyses with migraine subtypes.Migraine is an independent risk factor for narcolepsy development in children. Further studies are needed to validate our findings and to explore the exact pathophysiological mechanisms linking migraine and narcolepsy

Oleic Acid-Based Self Micro-Emulsifying Delivery System for Enhancing Antifungal Activities of Clotrimazole

Due to the increasing rate of drug resistance in Candida spp., higher doses of antifungal agents are being used resulting in toxicity. Drug delivery systems have been shown to provide an effective approach to enhance the efficacy and reduce the toxicity of antifungal agents. Oleic acid was revealed to effectively inhibit biofilm formation, hence reducing the virulence of Candida albicans. In this study, oleic acid-based self micro-emulsifying delivery systems (OA-SMEDDS) were developed for delivering clotrimazole (CLT). Based on the pseudo-ternary phase diagram and loading capacity test, the optimal ratio of OA-SMEDDS with CLT was selected. CLT-loaded OA-SMEDDS not only bears a higher drug loading capacity but also maintains good storage stability. The minimum inhibitory concentration (MIC50) of CLT-loaded OA-SMEDDS (0.01 μg/mL) in Candida albicans was significantly lower than that of CLT dissolved in DMSO (0.04 μg/mL). Moreover, we showed CLT-loaded OA-SMEDDS could effectively prevent biofilm formation and destroy the intact biofilm structure of Candida albicans. Furthermore, a CLT-loaded OA-SMEDDS gel was developed and evaluated for its antifungal properties. Disk diffusion assay indicated that both CLT-loaded OA-SMEDDS and CLT-loaded OA-SMEDDS gels were more effective than commercially available products in inhibiting the wild-type and drug-resistant species of Candida

The Role of Organelle Stresses in Diabetes Mellitus and Obesity: Implication for Treatment

The type 2 diabetes pandemic in recent decades is a huge global health threat. This pandemic is primarily attributed to the surplus of nutrients and the increased prevalence of obesity worldwide. In contrast, calorie restriction and weight reduction can drastically prevent type 2 diabetes, indicating a central role of nutrient excess in the development of diabetes. Recently, the molecular links between excessive nutrients, organelle stress, and development of metabolic disease have been extensively studied. Specifically, excessive nutrients trigger endoplasmic reticulum stress and increase the production of mitochondrial reactive oxygen species, leading to activation of stress signaling pathway, inflammatory response, lipogenesis, and pancreatic beta-cell death. Autophagy is required for clearance of hepatic lipid clearance, alleviation of pancreatic beta-cell stress, and white adipocyte differentiation. ROS scavengers, chemical chaperones, and autophagy activators have demonstrated promising effects for the treatment of insulin resistance and diabetes in preclinical models. Further results from clinical trials are eagerly awaited