Risk of serious infection and infection mortality in patients with psoriasis: A nationwide cohort study using the Taiwan National Health Insurance claims database.

BACKGROUND: The risks of serious infections that lead to hospitalization and mortality in patients with psoriasis in Asia have not been comprehensively studied. OBJECTIVES: We examined the incidence of serious infection and infection mortality in patients with psoriasis. METHODS: This population-based retrospective cohort study used the Taiwan National Health Insurance claims database from 2000 to 2017. Adult patients with psoriasis were identified by a relevant International Classification of Diseases (ICD) code and matched to six comparators without psoriasis on age and sex. Psoriasis patients were categorized as having moderate-to-severe disease once exposed to systemic therapies, phototherapy or biologic therapies. The incidence of serious infection and infection mortality were identified by ICD codes from inpatient hospitalization and death registration. Cox proportional hazard models were used to compare the risk, and the results were adjusted for covariates and presented as adjusted hazard ratios (aHR) and 95% confidence interval (95% CI). RESULTS: Overall, 185,434 psoriasis patients and 1,112,581 comparators were included. A higher rate of serious infection (aHR: 1.21, 95% CI: 1.19-1.22) was found in patients with psoriasis compared to matched comparators without psoriasis, and the risk was enhanced when patients had moderate-to-severe psoriasis (aHR: 1.30, 95% CI: 1.27-1.34). Specifically, there was an increased risk of serious infection due to respiratory infections (aHR: 1.11, 95% CI: 1.09-1.13), skin/soft-tissue infections (aHR: 1.57, 95% CI: 1.52-1.62), sepsis (aHR: 1.23, 95% CI: 1.19-1.27), urinary tract infections (aHR: 1.11, 95% CI: 1.08-1.14), hepatitis B (aHR: 1.18, 95% CI: 1.06-1.30) and hepatitis C (aHR: 1.49, 95% CI: 1.32-1.69). Furthermore, psoriasis patients were associated with a higher risk of infection-related mortality (aHR: 1.15, 95% CI: 1.11-1.18) compared to matched comparators. CONCLUSION: Patients with psoriasis had a higher risk of serious infection and infection mortality, which was enhanced by moderate-to-severe psoriasis. Practitioners should be aware of the increased risk in patients with psoriasis, but it should not be a barrier to offering effective treatment.

Longitudinal Trajectory of Opioid Prescribing and its Associated Serious Adverse Events: A Population-Wide Cohort Study in Taiwan.

Chronic opioid prescribing (COP) for noncancer pain is highly restricted in Taiwan, but tramadol is not listed in the regulation on chronic prescribing. This study investigated the trajectories of COP in noncancer pain when considering tramadol in Taiwan and identified the risk of serious adverse events. This population-wide longitudinal cohort study used the Taiwan National Health Insurance claims records from 2001 to 2016. Adults prescribed opioids (including tramadol) and without cancer were selected. Patients who received COP (opioid supply days for 28 days or continuous opioid supply for 14 days) in the first patient quarter were included, and serious adverse events were identified. Group-based trajectory models were applied to identify patients with a similar trajectory of quarterly COP. The Cox proportional hazard model was applied to assess the association between adverse events and patients' trajectories. Of the 2,360,358 noncancer opioid users, 476,934 (20.2%) received COP in the first quarter. Four groups of COP trajectory were identified, and 59,310 (12.8%) patients received COP quarterly over 2 years. Patients categorized into the trajectory of long-term COP had a significantly higher crude incidence rate of cardiovascular death, seizure, and hypoglycemia. Still, there is no newly developed opioid use disorder. There was a substantial underestimate in COP in Taiwan when tramadol was not considered. Notably, 10% of them could receive COP for over 2 years. The result raises concern about unmet pain management needs and the limited accessibility of alternative treatments for noncancer pain.

Partial Convolution for Padding, Inpainting, and Image Synthesis.

Partial convolution weights convolutions with binary masks and renormalizes on valid pixels. It was originally proposed for image inpainting task because a corrupted image processed by a standard convolutional often leads to artifacts. Therefore, binary masks are constructed that define the valid and corrupted pixels, so that partial convolution results are only calculated based on valid pixels. It has been also used for conditional image synthesis task, so that when a scene is generated, convolution results of an instance depend only on the feature values that belong to the same instance. One of the unexplored applications for partial convolution is padding which is a critical component of modern convolutional networks. Common padding schemes make strong assumptions about how the padded data should be extrapolated. We show that these padding schemes impair model accuracy, whereas partial convolution based padding provides consistent improvements across a range of tasks. In this article, we review partial convolution applications under one framework. We conduct a comprehensive study of the partial convolution based padding on a variety of computer vision tasks, including image classification, 3D-convolution-based action recognition, and semantic segmentation. Our results suggest that partial convolution-based padding shows promising improvements over strong baselines.

Incidence, Prevalence, and Mortality of People with Psoriasis and Psoriatic Arthritis in Taiwan: A Nationwide Cohort Study.

There is a recognized need to better understand changes in the epidemiology of psoriasis and psoriatic arthritis (PsA) over time in Asia. Using the Taiwan National Health Insurance claim records this population-based study examined changes in the prevalence, incidence, and mortality rates in patients with psoriasis or psoriatic arthritis in Taiwan over 12 years. Patients with ≥1 diagnosis code for psoriasis or psoriatic arthritis, recorded either by dermatologists or rheumatologists, were identified. Annual age- and sex-standardized prevalence and incidence rates were calculated using the Taiwan general population as reference. To investigate mortality, each patient in the incident cohort was matched to 10 comparators from the general population by sex and age (at diagnosis). The risk of mortality between study cohorts and comparators was analysed by Cox proportional hazard regression. The prevalence of psoriasis (0.18-0.86%) and psoriatic arthritis (0.01-0.08%) increased steadily between 2006 and 2017. The incidence rates, however, remained stable (psoriasis: 62-65 per 100,000 person-years; psoriatic arthritis: 6-5 per 100,000 person-years). The risk of all-cause mortality for patients with psoriasis (hazard ratio 1.16; 95% confidence interval: 1.13-1.19) was higher than the general population, despite a decreasing trend over time in the all-cause mortality rates for both groups. The steady increase in the prevalence of psoriasis despite stable incidence rates suggests that improvements in life expectancy may be the key determinant of this increase.

Domain Stylization: A Fast Covariance Matching Framework Towards Domain Adaptation.

Generating computer graphics (CG) rendered synthetic images has been widely used to create simulation environments for robotics/autonomous driving and generate labeled data. Yet, the problem of training models purely with synthetic data remains challenging due to the considerable domain gaps caused by current limitations on rendering. In this paper, we propose a simple yet effective domain adaptation framework towards closing such gap at image level. Unlike many GAN-based approaches, our method aims to match the covariance of the universal feature embeddings across domains, making the adaptation a fast, convenient step and avoiding the need for potentially difficult GAN training. To align domains more precisely, we further propose a conditional covariance matching framework which iteratively estimates semantic segmentation regions and conditionally matches the class-wise feature covariance given the segmentation regions. We demonstrate that both tasks can mutually refine and considerably improve each other, leading to state-of-the-art domain adaptation results. Extensive experiments under multiple synthetic-to-real settings show that our approach exceeds the performance of latest domain adaptation approaches. In addition, we offer a quantitative analysis where our framework shows considerable reduction in Frechet Inception distance between source and target domains, demonstrating the effectiveness of this work in bridging the synthetic-to-real domain gap.

Increasing tramadol utilisation under strict regulatory control of opioid prescribing - A cross-sectional study in Taiwan from 2002 through 2016.

BACKGROUND/PURPOSE: Prescribing of opioids to patients with non-cancer pain is strictly regulated in Taiwan, but tramadol is not included in the regulation on chronic opioid prescribing. This study aims to identify the utilization trend of prescribing tramadol and other opioid analgesics and investigate the influence of government regulation on opioid prescribing in Taiwan. METHODS: This cross-sectional study used the Taiwan National Health Insurance claims database and the cancer registry from 2001 through 2016. The annual number of adult opioid users, opioid utilization (Defined Daily Doses [DDDs]/1000 registrants) and the number of supply days were enumerated for each calendar year and stratified by cancer or non-cancer patients. Descriptive statistics were used to report the trends in utilization for each calendar year. RESULTS: The regulation strictly limited persistent use of opioids for patients with non-cancer pain, of which only a small proportion of fentanyl (20%) and morphine (<2%) users were prescribed with an annual number of supply days greater than 28 days. The annual utilization of morphine (6.4-53.5 vs. 1.1 to 9.6 DDD/1000 registrants) and fentanyl (8.3-37.0 vs. 0.16 to 1.8 DDD/1000 registrants) to patients with cancer was consistently higher than patients without cancer. In contrast to morphine and fentanyl, the utilization of tramadol prescribed to patients without cancer increased 92.2-fold (3.7-341.2 DDD/1000 registrants) from 2002 to 2016. CONCLUSION: The regulation in Taiwan limited the prescribing of selective opioids for patients with non-cancer pain and the substitution of tramadol for other opioids may have safety implications.

SVBRDF-Invariant Shape and Reflectance Estimation from a Light-Field Camera.

Light-field cameras have recently emerged as a powerful tool for one-shot passive 3D shape capture. However, obtaining the shape of glossy objects like metals or plastics remains challenging, since standard Lambertian cues like photo-consistency cannot be easily applied. In this paper, we derive a spatially-varying (SV)BRDF-invariant theory for recovering 3D shape and reflectance from light-field cameras. Our key theoretical insight is a novel analysis of diffuse plus single-lobe SVBRDFs under a light-field setup. We show that, although direct shape recovery is not possible, an equation relating depths and normals can still be derived. Using this equation, we then propose using a polynomial (quadratic) shape prior to resolve the shape ambiguity. Once shape is estimated, we also recover the reflectance. We present extensive synthetic data on the entire MERL BRDF dataset, as well as a number of real examples to validate the theory, where we simultaneously recover shape and BRDFs from a single image taken with a Lytro Illum camera.

Enhanced Performance of GaN-based Ultraviolet Light Emitting Diodes by Photon Recycling Using Graphene Quantum Dots.

Graphene quantum dots (GQDs) with an average diameter of 3.5 nm were prepared via pulsed laser ablation. The synthesized GQDs can improve the optical and electrical properties of InGaN/InAlGaN UV light emitting diodes (LEDs) remarkably. An enhancement of electroluminescence and a decrease of series resistance of LEDs were observed after incorporation of GQDs on the LED surface. As the GQD concentration is increased, the emitted light (series resistance) in the LED increases (decreases) accordingly. The light output power achieved a maximum increase as high as 71% after introducing GQDs with the concentration of 0.9 mg/ml. The improved performance of LEDs after the introduction of GQDs is explained by the photon recycling through the light extraction from the waveguide mode and the carrier transfer from GQDs to the active layer.

Radiometric Compensation of Images Projected on Non-White Surfaces by Exploiting Chromatic Adaptation and Perceptual Anchoring.

Flat surfaces in our living environment to be used as replacements of a projection screen are not necessarily white. We propose a perceptual radiometric compensation method to counteract the effect of color projection surfaces on image appearance. It reduces color clipping while preserving the hue and brightness of images based on the anchoring property of human visual system. In addition, it considers the effect of chromatic adaptation on perceptual image quality and fixes the color distortion caused by non-white projection surfaces by properly shifting the color of the image pixels toward the complementary color of the projection surface. User ratings show that our method outperforms the existing methods in 974 out of 1020 subjective tests.

Depth Estimation with Occlusion Modeling Using Light-Field Cameras.

Light-field cameras have become widely available in both consumer and industrial applications. However, most previous approaches do not model occlusions explicitly, and therefore fail to capture sharp object boundaries. A common assumption is that for a Lambertian scene, a pixel will exhibit photo-consistency, which means all viewpoints converge to a single point when focused to its depth. However, in the presence of occlusions this assumption fails to hold, making most current approaches unreliable precisely where accurate depth information is most important - at depth discontinuities. In this paper, an occlusion-aware depth estimation algorithm is developed; the method also enables identification of occlusion edges, which may be useful in other applications. It can be shown that although photo-consistency is not preserved for pixels at occlusions, it still holds in approximately half the viewpoints. Moreover, the line separating the two view regions (occluded object versus occluder) has the same orientation as that of the occlusion edge in the spatial domain. By ensuring photo-consistency in only the occluded view region, depth estimation can be improved. Occlusion predictions can also be computed and used for regularization. Experimental results show that our method outperforms current state-of-the-art light-field depth estimation algorithms, especially near occlusion boundaries.

Depth Estimation and Specular Removal for Glossy Surfaces Using Point and Line Consistency with Light-Field Cameras.

Light-field cameras have now become available in both consumer and industrial applications, and recent papers have demonstrated practical algorithms for depth recovery from a passive single-shot capture. However, current light-field depth estimation methods are designed for Lambertian objects and fail or degrade for glossy or specular surfaces. The standard Lambertian photoconsistency measure considers the variance of different views, effectively enforcing point-consistency, i.e., that all views map to the same point in RGB space. This variance or point-consistency condition is a poor metric for glossy surfaces. In this paper, we present a novel theory of the relationship between light-field data and reflectance from the dichromatic model. We present a physically-based and practical method to estimate the light source color and separate specularity. We present a new photo consistency metric, line-consistency, which represents how viewpoint changes affect specular points. We then show how the new metric can be used in combination with the standard Lambertian variance or point-consistency measure to give us results that are robust against scenes with glossy surfaces. With our analysis, we can also robustly estimate multiple light source colors and remove the specular component from glossy objects. We show that our method outperforms current state-of-the-art specular removal and depth estimation algorithms in multiple real world scenarios using the consumer Lytro and Lytro Illum light field cameras.

Trans-foramen ovale biopsy of a parasellar lesion guided by intraoperative CT neuronavigation with MRI fusion: a case report.

A 23-year-old male presented with a parasellar lesion which was suspected as disseminated intracranial germ cell tumour. The diagnosis of germinoma was made using immunohistochemistry from percutaneous trans-foramen ovale biopsy. This report describes the role of neuronavigation-guided biopsy through the foramen ovale for lesions in the parasellar region.

[Effects of total flavonoids in Drynaria fortunei on osteoblasts differentiation and the expression of ERK1/2 and p38 MAPK after treatment by high glucose in vitro].

OBJECTIVE: To observe the effects of Total Flavonoids in Drynaria fortunei (TFDF) on osteoblasts differentiation activity after treatment by high glucose and observe the effects on p38MAPK and ERK1/2 signaling protein in osteoblasts. METHODS: Primary osteoblasts of newborn SD rats was extracted and cultured and its biological characteristics was observed. MTT method was used to observe osteoblasts' cytotoxicity,and to choose a suitable concentration of TFDF in the culture medium. pNPP,ELISA,Alizarin dyeing were used to test ALP,Type I collagen,osteocalcin and mineralization of osteoblasts after treatment by different concentration of glucose respectively and after treatment by TFDF and high glucose. Western-blot was used to detect p38MAPK and ERK1/2 protein phosphorylation after treatment by TFDF and high glucose. RESULTS: Primary osteoblasts of newborn SD rats could be used well in this experiment. According to the toxicity of TFDF on OB, 25, 50, 100 mg/L of TFDF were selected for the experimental concentration gradient. ALP, Type I collagen,osteocalcin and mineralization of osteoblasts after treatment with glucose (25, 50 mmol/L) were less than those of control group respectively. TFDF could increase ALP, Type I collagen, osteocalcin activity and mineralization of osteoblasts in a dose-dependent manner after treatment by high glucose (25 mmol/L). TFDF(50 mg/L) could increase protein phosphorylation of p38MAPK and ERK1/2 of osteoblasts after treatment by high glucose (25 mmol/L). CONCLUSION: High glucose can decrease differentiation and mineralization of osteoblasts. TFDF can increase differentiation and mineralization of osteoblasts in a dose-dependent manner after treatment by high glucose. The role of TFDF in the promotion of osteoblasts differentiation is related to protein phosphorylation of p38MAPK and ERK1/2.

[Effects of yigu capsule containing serum on the osteoblast differentiation and the expressions of osteoprotegerin and bone morphogenetic protein 2 after treatment by advanced glycation end products in vitro].

OBJECTIVE: To observe the effects of Yigu Capsule (YGC) containing serum on the differentiation and the expressions of osteoprotegerin (OPG) and bone morphogenetic protein 2 (BMP-2) in osteoblasts after treatment by advanced glycation end products (AGEs), and to explore the mechanisms of YGC for treating osteoporosis (OP). METHODS: Forty 10-month-old female Sprague Dawley (SD) rats were randomly divided into four groups equally, i.e., the low dose YGC group, the moderate dose YGC group, the high dose YGC group, and the blank control group. The YGC containing serum and the control serum were prepared with the method of gastric perfusion. Primary osteoblasts of newborn SD rats was extracted and cultured, then they were passaged and divided into five groups, i. e., the vehicle control group, the model group, the low dose YGC group, the moderate dose YGC group, and the high dose YGC group. The model group was treated by AGEs (400 mg/L), the three YGC groups were treated by AGEs (400 mg/L) and YGC containing serum at different concentrations. Alkaline phosphatase (ALP) activity, type I collagen (ColI), bone gla protein (BGP), and mineralization of osteoblasts were tested using pNPP, ELISA, and Alizarin dyeing. The mRNA and protein levels of BMP-2 and OPG were respectively determined using RT-PCR and ELISA. RESULTS: Primary osteoblasts from newborn SD rats could be used well in this experiment. Compared with the vehicle control group, the ALP, ColI, BGP, the mRNA and protein levels of BMP-2 and OPG of osteoblasts decreased in the model group, and the mineralized nodes were reduced, showing statistical difference (P<0.01). Compared with the model group, the ALP, ColI, BGP, the mRNA and protein levels of BMP-2 and OPG of osteoblasts increased in the three YGC groups, and the mineralized nodes increased in a dose-dependent manner, showing statistical difference (P<0.05, P<0.01). CONCLUSIONS: YGC containing serum could promote the differentiation and mineralization of osteoblasts, and improve the expressions of OPG and BMP-2 after treatment by AGEs. These might be one of YGC's mechanisms for treating OP.

[Effects of xinmaikang capsule on acute myocardial ischemia in coronary artery occlusion dogs].

OBJECTIVE: To observe the preventive effect of xinmaikang capsule against acute myocardial ischemia in coronary artery occlusion dogs. METHODS: 25 healthy hybrids dogs, male and female, were randomly divided into control group (physiological saline solution), 40 mg/kg Di'aoxinxuekang Group, xinmaikang low doses (1.55 g/kg), median doses (3.10 g/kg) and high doses (6.20 g/kg) group, 5 dogs a group. The left downwards coronary arteries of dogs were ligated to establish the acute myocardial ischemia model. The blood gas analysis, myocardial enzyme detection, blood pressure,heart rate and epicardial electrogram recorded were detected before and after the stomach lavage. 240 min later, the myocardial tissues were stained with NBT technology to examine the sizes of infarction areas. RESULTS: (1) Each dose of xinmaikang capsule could increase coronary artery blood flow (CBF) and reduce the coronary resistance (CVR) (P < 0.05 or P < 0.01). (2) The median and high doses of xinmaikang capsule could decrease myocardial oxygen consumption significantly (P < 0.05 or P < 0.01); (3) In the median and high doses of the xinmaikang capsule groups, the infarction areas decreased significantly (P < 0.01). (4) Serum lactate dehydrogenase (LDH) and Creatine phosphokinase (CPK) levels decreased significantly (P < 0.05 or P < 0.01) in all xinmaikang groups. CONCLUSION: Xinmaikang capsule has the effect of anti-myocardial ischemia and can protect myocardial cells, which is a potential drug and precaution treatment for myocardial ischemia.