Taiwan cobra (Naja atra) bites account for approximately 20% of all venomous snakebites in Taiwan. In Taiwan, the rates of wound necrosis and secondary infection from Taiwan cobra bites are higher than those associated with other venomous snakebites. Clinical tools to evaluate the infection risk after Taiwan cobra bites are lacking. Therefore, in this study, we developed a useful clinical tool to evaluate the infection risk after Taiwan cobra bites. Moreover, we investigated wound infection bacteriology. We analyzed the data of patients bitten by N. atra who had undergone freeze-dried neurotoxic antivenin treatment in emergency rooms of the Chang Gung Memorial Hospital network, which comprises seven hospitals and the largest medical system in Taiwan, from January 2001 to May 2017. Because patients with wound necrosis required antibiotics for infection treatment, we included only patients with wound infection but without tissue necrosis in the development of our Cobra Bacteriology of Infections in Taiwanese snake Envenomation (Cobra BITE) score by using univariate and multiple logistic regression. In total, 8,295,497 emergency department visits occurred from January 2001 to May 2017, and 195 patients were diagnosed has having cobra bites. Among them, 23 and 30 patients had wound necrosis and wound infection, respectively. The wound infection rate was 27.2% (53/195). Regardless of whether the patients had necrosis, Enterococcus faecalis and Morganella morganii were the main bacteria identified in the culture report. Gentamicin, ceftriaxone, ciprofloxacin, and levofloxacin are the ideal first-line antibiotics for treating N. atra bite wounds in Taiwan. As per our Cobra BITE score, the three factors predicting secondary wound infection after cobra bites are hospital admission, a white blood cell count (in 103/µL) × by neutrophil–lymphocyte ratio value of ≥114.23, and the use of antivenin medication. The area under the receiver operating characteristic curve for the Cobra BITE score system was 0.88. The ideal sensitivity and specificity were 0.89 and 0.76, respectively, and the optimal cutoff point for Cobra BITE score was 7. The Hosmer–Lemeshow p value was 0.4. In conclusion, our Cobra BITE study established a new practical clinical tool for clinicians to evaluate infection risk after N. atra bites. This score system enables the assessment of wound infections after N. atra bites, and it could be modified and improved in future for other Naja spp. bites.

In the realm of smart manufacturing, equipment plays a pivotal role, impacting the efficiency and quality of production. Ensuring equipment availability and optimal performance is crucial, necessitating effective maintenance strategies. This paper addresses the complexities of smart device maintenance, which often involves collaboration between multiple entities like device owners, manufacturers, suppliers, and external maintenance services. To enhance this cooperative maintenance, we propose a novel maintenance system based on permissioned blockchain technology, offering superior security and reliability compared to conventional cloud-based platforms. Our contributions include developing an integrated maintenance system framework for smart manufacturing, which facilitates interactions among diverse stakeholders. Additionally, we have developed a prototype of this maintenance system, serving as a practical model for real-world application. Our research primarily demonstrates the practicality and advantages of using permissioned blockchain for maintenance systems in the manufacturing sector, paving the way for more secure, efficient, and collaborative maintenance practices.

The chromatographic conditions were optimized using headspace gas chromatography, and a simple and rapid method was established for the simultaneous determination of five residual solvents in ursodeoxycholic acid raw materials. The corresponding quality standards were revised. The results showed that the concentration of methanol ranged from 0.06mg/ml to 0.3mg/ml, and the concentrations of acetone, tert butanol, ethyl acetate, and triethylamine showed a good linear relationship with the peak area within the range of 0.1mg/ml to 0.5mg/ml (r=0.999); The quantitation limits for methanol, acetone, tert-butanol, ethyl acetate, and triethylamine were 4.2, 0.9, 1.5, 1, and 0.1 μg/ml, respectively, with detection limits of 1.2, 0.25, 0.025, 0.3, and 0.025 μg/ml, respectively. The recovery rates of each solvent ranged from 92.9% to 106.0%, with RSD% (n=9) less than 3.8%; The method exhibited good repeatability, with RSD% (n=6) less than 2.5%. Furthermore, the durability is good. The established method is simple, accurate, specific, and highly sensitive, and can be used for the simultaneous and rapid determination of five residual solvents in ursodeoxycholic acid raw materials.

Background: Many randomized controlled trials (RCTs) and systematic reviews (SRs) on acupuncture treatment for post-acute stroke dysphagia have been published. Due to conflicting results an overview of SRs to summarize and assess the quality of this evidence to determine whether acupuncture is effective for this disease was conducted. Methods: Seven databases were searched for SRs and/or Meta-analysis of RCTs and quasi-RCTs on acupuncture for post-acute stroke dysphagia. Two authors independently identified SRs and meta-analyses, collected data to assess the quality of included SRs and meta analyses according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) and the revised Assessment of Multiple Systematic Reviews (AMSTAR 2). Results: 31 SRs were identified. Quality of 22 SRs was critically low, 5 SRs were low, and 4 Cochrane SRs were moderate when evaluated by AMSTAR2. 17 SRs reported 85.2-96.3% items of PRISMA. Five SRs included explanatory RCTs, 16 SRs included pragmatic RCTs, and 10 SRs included both. Conclusion: Currently evidence on the effectiveness of acupuncture on post-acute stroke dysphagia is low quality. Type of study appeared to have no direct influence on the result, but the primary outcome measures showed a relationship with the quality of SRs. High quality trials with large sample sizes should be the focus of future research. PROSPERO REGISTRATION NUMBER: CRD42019134163

Biogeography research is flawed by the poor understanding of microbial distributions due to the lack of a systematic research framework, especially regarding appropriate study units. By combining pure culture and molecular methods, we studied the biogeographic patterns of nematode-trapping fungi by collecting and analysing 2,250 specimens from 228 sites in Yunnan Province, China. We found typical watershed patterns at the species and genetic levels of nematode-trapping fungi. The results showed that microbial biogeography could be better understood by 1) using watersheds as research units, 2) removing the coverup of widespread species, and 3) applying good sampling efforts and strategies. We suggest that watersheds could help unify the understanding of the biogeographic patterns of animals, plants, and microbes and may also help account for the historical and contemporary factors driving species distributions.