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This study delves into the critical realm of natural hazard preparedness by examining building vibrations after Taiwan's Chi-Chi earthquake (1999). By meticulously analyzing the monitored displacement of a building pre- and post-catastrophe, we unveil a notable correlation between the building's proximity to the hypocenter and subsequent changes in period and damping as earthquake magnitudes escalate. Based on these insights, we have devised a robust regression model to accurately estimate optimal periods using peak ground acceleration values. Our research provides a pragmatic assessment of a building's innate vibration characteristics, crucial for long-term seismic monitoring, with a focus on an attic-basement system. The findings offer a fresh perspective on how buildings respond to catastrophic earthquakes, shedding light on their resilience. Moreover, this study demonstrates the feasibility and practicality of evaluating a building's vibration evolution through comprehensive historical strong motion data. Our work provides valuable insights for future maintenance and safety considerations, ensuring steadfast structural integrity in the face of natural hazards. [ABSTRACT FROM AUTHOR]

Objective: With global aging, the occurrence of stroke and associated outcomes like dementia are on the rise. Seizures and epilepsy are common poststroke complications and have a strong connection to subsequent dementia. This study examines the relationship between poststroke seizures (PSS) or poststroke epilepsy (PSE) and dementia using a national health care database. Methods: We conducted a retrospective study using data from the Taiwan National Health Insurance Research Database from 2009 to 2020. We identified acute stroke patients from 2010 to 2015, excluding those with pre‐existing neurological conditions. Based on age, sex, stroke severity level, and the year of index stroke, patients with PSS or PSE were matched to those without. The main outcome was incident dementia. Results: This study included 62 968 patients with an average age of 63 years, with males accounting for 62.9%. Of them, 60.3% had ischemic strokes, and 39.7% had hemorrhagic strokes. After an average follow‐up period of 5.2 years, dementia developed in 15.9% of patients who had PSS or PSE, as opposed to 8.4% of those without these conditions. A time‐dependent Fine and Gray competing risk analysis showed that PSS and PSE were significantly associated with dementia across all stroke types. Subgroup analyses revealed significantly increased risk of dementia across all age groups (<50, 50–64, and ≥65 years), sexes, and various stroke severity levels. The link between PSS or PSE and dementia was particularly pronounced in men, with a less distinct correlation in women. Significance: The risk of incident dementia was higher in patients with PSS or PSE. The potential for therapeutic interventions for seizures and epilepsy to reduce poststroke dementia underscores the importance of seizure screening and treatment in stroke survivors. [ABSTRACT FROM AUTHOR]

Observational studies suggest a potential correlation between antidepressants and increased lung cancer risks. However, existing studies are limited to small sample sizes, unadjusted covariates especially smoking status, and unclear exposure duration. We performed a large-scale retrospective cohort study to re-examine the association. We analyzed non-smokers and smokers separately to eliminate the confounding effect of smoking status. We found patients with long-term antidepressant use were at a lower risk of lung cancer in both smokers and non-smokers (odds ratio (OR), 0.61; 95% CI: 0.46–0.80, OR: 0.75; 95% CI: 0.65–0.86). None of the antidepressants was associated with an increased lung cancer risk. [ABSTRACT FROM AUTHOR]

This article studies China's cross‐border impact on the legal profession, and develops the concept of the Sinophone lawyer to capture the inter‐jurisdictional transformation. Using Hong Kong as a case study, the article identifies a process of 'Sinophonication' brought about by Chinese capital; that is, lawyers and law firms have critically changed the language in which they practise. The fact that the Chinese language is multilingual and polyphonic further assigns different values to different aspects of linguistic proficiency and different levels of the legal profession. For law firm partners, the ability to speak Mandarin and Mandarin cultural literacy are now indispensable. For associates, the ability to read and write simplified Chinese is essential. A lower level of paralegals has been created, attracting native speakers from Mandarin‐speaking jurisdictions to serve as associates at a lower salary and with less career security. The article draws on qualitative interviews with solicitors, barristers, and foreign lawyers in Hong Kong, and quantitative data from Hong Kong Lawyer (1996–2016) and the annual reports of the Law Society of Hong Kong (1994–2016). [ABSTRACT FROM AUTHOR]

The reliability of medical equipment is paramount for surgical success. Manufacturers are continuously exploring risk assessment and improvement strategies to prevent equipment malfunctions during surgery. Failure mode and effects analysis (FMEA) can primarily be divided into two types: DFMEA (Design FMEA) and PFMEA (Process FMEA). Traditional FMEA serves as a practical tool for identifying and prioritizing key failure modes (FMs). However, past FMEA research has overlooked the interdependencies among FMs, treating them as independent entities, which does not align with real-world operations. This paper introduces a groundbreaking risk dependency assessment model aimed at addressing the influential relationships among FMs. The modified technique for defining the influential relationship of failure modes (modified TEDIR-FMs) is developed to compute the relative risk scores of different FMs accurately. At its core, this paper integrates concepts from multiple criteria decision-making (MCDM) techniques into FMEA, with a particular focus on the interdependencies of failure modes in the manufacturing and design manufacturing processes of medical equipment. The model's application is demonstrated through a case study on a medical device for hernia surgery. The introduction of modified TEDIR-FMs not only enhances the accuracy of risk assessments but also offers a fresh perspective on risk management within the design and manufacturing processes. The research results indicate that the three failure modes with the highest risk are "adhesive does not deploy or only partially deploys from the dispenser," "the mesh does not adhere to the adhesive," and "the adhesive drips from the tip." In the manufacturing and design processes of this device, greater attention should be given to improving the adhesive components. [ABSTRACT FROM AUTHOR]

Background: Recent studies propose 40 Hz neural activity induction as a promising approach for managing Alzheimer's dementia (AD). However, traditional flickering light is suboptimal in addressing cognitive and neuropsychiatric symptoms (NPS) of AD. This study aims to investigate the clinical efficacy of a novel multi-luminaire lighting technology, with reduced perceptible flickering, for treating AD NPS. Methods: This study is a prospective, convenient sampling, non-randomized case–control investigation involving seventy-eight clinically diagnosed AD patients from 7 daycare centers. Thirty-five were exposed to 40 Hz light through Delta M + BrainCare Light (M +), 4 h daily, 5 days/week, for 12 weeks. The other 43 patients served as controls. Sum of boxes of the Clinical Dementia Rating (CDR-SB) scale, Neuropsychiatric Inventory (NPI), and Zarit Burden Interview (ZBI) were assessed at baseline and the 13th week. Results: At baseline, the cases had worse cognitive function, lower cognitive score (Mini-Mental State Examination, p = 0.04; Cognitive Abilities Screening Instrument, p = 0.04), and advanced caregiver burden with higher ZBI scores (p < 0.01) than the controls. After the intervention, the cases had significant improvements in NPS as assessed using the NPI (p = 0.02), especially depression and euphoria symptoms (p = 0.04 and < 0.01, respectively) and less caregiver burden (ZBI score, p < 0.01). In global function, the control group showed a significant decline in CDR-SB score (p < 0.01), while the cases did not. Conclusions: Results suggest M + may slow global function decline, preserve cognitive function, improve NPS, and reduce caregiver burden in AD patients. Larger studies with biomarkers are needed to explore underlying mechanisms. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Alzheimer's disease (AD), the most prevalent neurodegenerative disorder globally, has emerged as a significant health concern. Recently it has been revealed that extracellular vesicles (EVs) play a critical role in AD pathogenesis and progression. Their stability and presence in various biofluids, such as blood, offer a minimally invasive window for monitoring AD‐related changes. METHODS: We analyzed plasma EV‐derived messenger RNA (mRNA) from 82 human subjects, including individuals with AD, mild cognitive impairment (MCI), and healthy controls. With next‐generation sequencing, we profiled differentially expressed genes (DEGs), identifying those associated with AD. RESULTS: Based on DEGs identified in both the MCI and AD groups, a diagnostic model was established based on machine learning, demonstrating an average diagnostic accuracy of over 98% and showed a strong correlation with different AD stages. DISCUSSION: mRNA derived from plasma EVs shows significant promise as a non‐invasive biomarker for the early detection and continuous monitoring of AD. Highlights: The study conducted next‐generation sequencing (NGS) of mRNA derived from human plasma extracellular vesicles (EVs) to assess Alzheimer's disease (AD).Profiling of plasma EV‐derived mRNA shows a significantly enriched AD pathway, indicating its potential for AD‐related studies.The AD‐prediction model achieved a receiver‐operating characteristic area under the curve (ROC‐AUC) of more than 0.98, with strong correlation to the established Clinical Dementia Rating (CDR). [ABSTRACT FROM AUTHOR]

This groundbreaking study introduces a scientifically robust method for assessing internal heat generation in shallow, unsaturated aquifers, highlighting the intricate interplay between internal heat, thermal diffusivity, and hydraulic flux. The research pioneers a novel approach employing time‐frequency spectral analysis to address challenges posed by conventional methods that rely solely on prescribed thermal diffusivity and hydraulic flux for evaluating internal heat over time. Rooted in a solid theoretical framework supported by meticulous temperature and heat flux observations, the method adeptly incorporates the concept of an unknown internal heat. The study systematically explores three distinct boundary conditions, showcasing versatility: one with fixed temperatures at the inlet and outlet, another with known temperature at the inlet and no heat flux at the outlet, and a third with a prescribed inlet temperature and constrained outlet heat flux. The estimation of internal heat, coupled with prescribed thermal diffusivity and hydraulic flux, harnesses in‐situ temperature and heat flux spectra through an innovative inverse stochastic spectral approach. A notable feature of this research lies in its ability to strategically handle various parameters, including prescribed thermal diffusivity, hydraulic flux, variations in target depth, significant frequency components, and boundary conditions. The variation assessment findings emphasize the diverse range when predicting internal heat generation based on prescribed thermal diffusivity and hydraulic flux. This study facilitates the determination of potential internal heat magnitudes at different depths and provides profound insights into in‐situ conditions within the vadose zone. [ABSTRACT FROM AUTHOR]

This article develops a framework to understand the legal profession's participation in providing services to indigent clients. Our theory is based on two factors: whether lawyers have successful practices, and whether the legal aid delivered to indigent clients is free or below market price. Pro bono signals moral high ground in the profession. Conversely, a regime in which legal assistance is provided at a discounted market price ("low bono"), an under‐explored area in the literature, attracts less competitive attorneys, and doing legal aid cases is perceived as signifying incompetence in one's professional capacity. Using a unique, comprehensive data set on all legal aid lawyers in Taiwan (nearly 4000), two nationwide attorney surveys, and 143 in‐depth interviews with practicing lawyers across the country, we offer the first comprehensive empirical analysis of legal aid lawyers and explain that the design of a legal aid regime attracts lawyers of different hemispheres into the endeavor. [ABSTRACT FROM AUTHOR]

A compact tapered antenna with a meandered strip line for implanted biomedical applications is proposed. The proposed antenna can be operated at a medical device radio communication service (MedRadio) band, a long-term evolution (LTE) band 8, an LTE band 11, and an industrial, scientific, and medical (ISM) band. A linear tapered structure is introduced to improve antenna gain, and simultaneously, a meander line is adopted to lower the resonant frequency to the MedRadio band and reduce the size of the proposed antenna. The proposed compact tapered implanted antenna is fabricated and measured using a skin-mimicking gel. The measured results are in good agreement with the simulated ones. The proposed antenna has gain values of -15.55 and -8.37 dBi in MedRadio and ISM bands, respectively. Furthermore, the salient features of the proposed antenna make it a candidate for wireless biotelemetric applications. [ABSTRACT FROM AUTHOR]

Purpose: Nasopharyngeal carcinoma (NPC) patients may experience symptom distress and depression during and after radiation therapy, which negatively impacts quality of life (QOL). We sought to identify trajectories of symptom distress, depression, social support, and QOL in patients with NPC receiving intensity-modulated radiation therapy (IMRT) vs intensity-modulated proton therapy (IMPT). Methods: A multicenter prospective longitudinal study recruited NPC patients from two leading medical centers in Taiwan. The 121 NPC patients were followed from before RT (T0), at 4 weeks after beginning RT (T1), at 6 weeks of RT or the end of treatment (T2), and at 4 weeks post-RT (T3). Generalized estimating equation analysis was used to identify the factors related to QOL. Results: Patients’ symptom distress and depression increased from T0, peaked at T2, and decreased at T3. Physical-QOL and psychosocial-QOL decreased from T0 to T2, then increased by T3. Patients who had early-stage cancer, received a lower RT dose, had less symptom distress, and had less depression were more likely to have better QOL. Greater physical-QOL was associated with IMPT receipt, higher education level, early cancer stage, lower radiation dose, less symptom distress, and less depression. Patients who had good physical performance, received a lower radiation dose, had less symptom distress, and had less depression were more likely to have better psychosocial-QOL. Conclusion: Radiation dose, symptom distress, and depression were the most important factors affecting QOL in patients with NPC. Understanding the factors associated with the trajectory of QOL can guide care during radiation treatment. [ABSTRACT FROM AUTHOR]

This study delves into the interplay of Rayleigh wave‐groundwater‐aquifer dynamics, utilizing seismic data from designated stations, particularly the magnitude 9 event on March 11, 2011 (02:46:23 PM epicenter), Tohoku earthquake, Japan. Auto spectra uncover significant peaks, linking groundwater level with the vertical motion of Rayleigh waves. High coherence between groundwater levels and seismogram vertical displacements confirms this connection. Coherence analysis validates it at the significant frequency bands. Groundwater storage coefficient estimation aligns with typical values of confined aquifers, ranging from 1.0E‐05 to 1.0E‐03. This consistency applies across different methods and other earthquake events, highlighting seismic impact. The findings enhance understanding of aquifer behavior during seismic events, aiding groundwater management and earthquake readiness in susceptible regions. Further research should expand datasets for coefficient accuracy. Insights advance aquifer behavior comprehension during seismic events, guiding groundwater management and earthquake readiness in prone areas. [ABSTRACT FROM AUTHOR]

In the context of the heterogeneity in the unsaturated or vadose zone, accurately representing the analytical mechanisms and in‐situ water content within the soil layer poses a significant challenge. Particularly in shallow layers, thermal conditions exhibit rapid changes in response to evolving surface temperatures. This study proposes a hypothesis suggesting that the in situ heat mechanism may notably impact the soil water layer. The research introduces an innovative approach to theoretically uncover thermal conditions, including soil temperature, soil temperature gradients, and heat flux, within the shallow Quaternary gravel layer at various depths through spectral analysis of temporal observations. The study presents a stochastic inverse solution to estimate thermal conductivity by leveraging spectral analysis of soil heat flux and temperature gradients. The findings reveal that thermal conditions exhibit the most prominent periodic fluctuations during the diurnal process over a 24‐hour cycle. The soil temperature gradients and heat flux measurements at depths of 0.1, 0.3, 0.6, and 1.2 m demonstrate their ability to capture changes in soil temperature and air temperature to a certain extent within the frequency domain. Furthermore, the analysis highlights the intrinsic uncertainty and sensitivity of estimating thermal conductivity in heterogeneous soil environments. The wide variability observed in thermal conductivity values, coupled with their dependence on soil type and environmental conditions, underscores the need for careful consideration of these factors in future studies and modeling efforts. Applying the derived inverse spectral solution allows for determining thermal conductivity throughout the soil‐water system across depths ranging from 0.1 to 1.2 m. As a result, this research demonstrates the feasibility and practicality of assessing the thermal conductivity of the soil layer in conjunction with heat flux and temperature gradients through spectral analysis. [ABSTRACT FROM AUTHOR]

Quality care in healthcare is a multifaceted concept that encompasses the execution of effective medical treatments and the patient's overall experience. It involves a multitude of factors, including effectiveness, safety, timeliness, equity, and patient centeredness, which are important in shaping the healthcare landscape. This cross-sectional study used the data from the Health Information National Trends Survey 6 (HINTS 6), which collects data on various aspects of health communication and information-seeking behaviors, to investigate the factors associated with quality care among White and Hispanic populations. All adults who participated in HINTS 6 and visited healthcare service at least once in the past 12 months were included in this study. Multivariable logistic regression was used to determine the association between quality care and delay or discriminated care with the adjustment of all other sociodemographic variables. We analyzed a total of 3611 participants. Poor social determinants of health (SDOHs) (OR 0.61, CI 0.43–0.88, p = 0.008), delayed needed medical care (OR 0.34, CI 0.26–0.43, p < 0.001), and discriminated care (OR 0.29, CI 0.15–0.54, p < 0.001) were all negatively associated with optimal quality care. Negative SDOHs could also be positively associated with delayed care and discriminated care. [ABSTRACT FROM AUTHOR]

Background: Neuropsychiatric symptoms (NPS) are distressing for patients with dementia, often accelerating functional decline and nursing home placement. Medications such as quetiapine are used to alleviate NPS, but their side effects require cautious use. Liquid formulations such as quetiapine oral suspension suit specific populations; however, real-world data on their use in patients with dementia are limited. Objective: The purpose of this retrospective, naturalistic study was to provide preliminary data on the effects of treatment with quetiapine oral suspension on behavioral and psychiatric disturbances in Alzheimer's disease (AD) outpatients in Taiwan. Methods: Between January 2022 and June 2023, data were collected from outpatients with a diagnosis of probable AD who received treatment with Qting® (quetiapine oral solution 25 mg/ml). Primary outcome measures were changes in Neuropsychiatric Inventory (NPI) total score and its sub-items from baseline to the endpoint. Results: We recruited 66 AD patients with a mean age of 72.1±7.6 years, most of whom were female (69.7%). Twenty-three patients had data on neuropsychological test and NPI scores before and after quetiapine treatment. There was no significant change in global cognitive function from baseline to the endpoint. A significant reduction in NPI total score after quetiapine treatment was noted, while the effect on NPI sub-items was limited. The average maintenance dose was 1.5±0.6 ml. Conclusions: We demonstrated our clinical experience of the use of quetiapine oral solution in AD patients with NPS. Our results showed that quetiapine oral solution treatment significantly improved these symptoms at a relatively low dose. [ABSTRACT FROM AUTHOR]

Coenzyme Q (CoQ) is essential for mitochondrial respiration and required for thermogenic activity in brown adipose tissues (BAT). CoQ deficiency leads to a wide range of pathological manifestations, but mechanistic consequences of CoQ deficiency in specific tissues, such as BAT, remain poorly understood. Here, we show that pharmacological or genetic CoQ deficiency in BAT leads to stress signals causing accumulation of cytosolic mitochondrial RNAs and activation of the eIF2α kinase PKR, resulting in activation of the integrated stress response (ISR) with suppression of UCP1 but induction of FGF21 expression. Strikingly, despite diminished UCP1 levels, BAT CoQ deficiency displays increased whole-body metabolic rates at room temperature and thermoneutrality resulting in decreased weight gain on high-fat diets (HFD). In line with enhanced metabolic rates, BAT and inguinal white adipose tissue (iWAT) interorgan crosstalk caused increased browning of iWAT in BAT-specific CoQ deficient animals. This mitohormesis-like effect depends on the ATF4-FGF21 axis and BAT-secreted FGF21, revealing an unexpected role for CoQ in the modulation of whole-body energy expenditure with wide-ranging implications for primary and secondary CoQ deficiencies. [ABSTRACT FROM AUTHOR]

Background and purpose: Seizures commonly occur in patients with intracerebral hemorrhage (ICH). Anticonvulsants are commonly used for preventing seizures in patients with ICH. Thus, patients with ICH at high risk of seizures must be identified. The study aims to elucidate whether double the score of cortex involvement in ICH patients can increase accuracy of CAVE score for predicting late seizures. Method: This retrospective analysis of the medical records of surviving patients admitted between June 1, 2013, and December 31, 2019. Validated the CAVE score and modified it (CAVE2). The main outcome of patients with ICH was seizures. The first seizures occurring within 7 days after a stroke were defined as early seizures. Seizures occurring after 1 week of stroke onset, including patients who had experienced early seizures or patients who had not, were defined as late seizures. CAVE and CAVE2 scores were validated using the cohort. The accuracy and discrimination of those two scores were accessed by the area under the operating characteristic curve. Akaike information criterion, integrated discrimination improvement, and continuous net reclassification improvement were used to assess the performance of the CAVE and CAVE2 scores. Results: In the cohort showed that late seizures occurred in 12.7% (52/408) of patients with ICH. Male sex, age > 65 years, cortex involvement, and early seizures were associated with the occurrence of late seizures, with odds ratios of 2.09, 2.04, 4.12, and 3.78, respectively. The risk rate of late seizures was 6.66% (17/255), 14.8% (17/115), and 47.4% (18/38) for CAVE scores ≤ 1, 2, and ≥ 3, and 4.6% (12/258), 18.3% (13/71), and 54.4 (20/37) for CAVE2 scores ≤ 1, 2, and ≥ 3 respectively. The C-statistics for the CAVE and CAVE2 scores were 0.73 and 0.74 respectively. Conclusion: The CAVE score can identify patients with ICH and high risk for late seizures. The CAVE can be modified by changing the score of cortex involvement to 2 points to improve accuracy in predicting late seizures in patients with ICH. [ABSTRACT FROM AUTHOR]

Pain is strongly associated with neuro-immune activation. Thus, the emerging role of the endocannabinoid system in neuro-inflammation is important. Acupuncture has been used for over 2500 years and is widely accepted for the management of pain. Our study aimed to investigate the effects of electroacupuncture on the regulation of cannabinoid receptor type 1 within the peripheral nervous system. Inflammatory pain was induced by injecting Complete Freund's adjuvant to induce mechanical and thermal hyperalgesia. Electroacupuncture significantly attenuated the mechanical and thermal sensitivities, and AM251, a cannabinoid receptor type 1 antagonist, eliminated these effects. Dual immunofluorescence staining demonstrated that electroacupuncture elevated expression of cannabinoid receptor type 1, co-localized with Nav 1.8. Furthermore, electroacupuncture significantly reduced levels of Nav 1.8 and COX-2 by western blot analysis, but not vice versa as AM251 treatment. Our data indicate that electroacupuncture mediates antinociceptive effects through peripheral endocannabinoid system signaling pathway and provide evidence that electroacupuncture is beneficial for pain treatment. [ABSTRACT FROM AUTHOR]

Background The relationship between maternal chronic diseases and congenital anomalies of the kidneys and urinary tract (CAKUT) in offspring still needs elucidation. This study aimed to comprehensively evaluate the associations between maternal chronic disease and CAKUT in their offspring. Methods Data of mothers and children were extracted from the Taiwan Maternal and Child Health Database and National Health Insurance Research Database. The concept of developmental origins of health and disease (DOHaD) was used to select maternal chronic diseases. Results The study cohort included 1 196 175 mothers and 1 628 706 offspring. Analysis showed that maternal chronic diseases, especially type 1 diabetes, type 2 diabetes, gestational diabetes, connective tissue disorders and CAKUT were highly associated with CAKUT in the offspring. Higher maternal age, abnormal birthweight (>3500 g or <2500 g), gestational age <36 weeks and birth order <2 were all associated with a higher risk of CAKUT. Maternal chronic hypertension and taking angiotensin-related drugs increased the odds ratios of obstructive kidney disease in the offspring. Offspring tended to have the same type of CAKUT as their mothers. Conclusion Maternal chronic diseases, older maternal age and abnormal birthweight are risk factors for CAKUT. Also, a percentage of patients with CAKUT were not full-term newborns. Results support prenatal counselling and health management of pregnant women with chronic diseases and extra care for infants with a high risk of anomalies. It is strongly recommended that prevention of CAKUT in offspring should start with care of the mothers' prenatal chronic diseases. [ABSTRACT FROM AUTHOR]

Purpose: Malignant head and neck squamous cell carcinoma (HNSCC) is characterized by a poor prognosis and resistance to conventional radiotherapy. Infiltrating myeloid-derived suppressive cells (MDSCs) is prominent in HNSCC and is linked to immune suppression and tumor aggressiveness. This study aimed to investigate the impact of boron neutron capture therapy (BNCT) on the MDSCs in the tumor microenvironment and peripheral blood and to explore the potential for MDSCs depletion combined with BNCT to reactivate antitumor immunity. Methods and materials: Carcinogen, 4-NQO, -induced oral tumors were irradiated with a total physical dose of 2 Gy BNCT in Tsing Hua Open Reactor (THOR). Flow cytometry and immunohistochemistry accessed the dynamics of peripheral MDSCs and infiltrated MDSCs within the tumor microenvironment. Mice were injected with an inhibitor of CSF-1 receptor (CSF-1R), PLX3397, to determine whether modulating M-MDSCs could affect mice survival after BNCT. Results: Peripheral CD11b+Ly6ChighLy6G- monocytic-MDSCs (M-MDSCs), but not CD11b+Ly6CloLy6Ghigh polymorphonuclear-MDSCs (PMN-MDSCs), increased as tumor progression. After BNCT treatment, there were temporarily decreased and persistent increases of M-MDSCs thereafter, either in peripheral blood or in tumors. The administration of PLX-3397 hindered BNCT-caused MMDSCs infiltration, prolonged mice survival, and activated tumor immunity by decreasing tumor-associated macrophages (TAMs) and increasing CD8+ T cells. Conclusion: M-MDSCs were recruited into 4-NQO-induced tumors after BNCT, and their number was also increased in peripheral blood. Assessment of MMDSCs levels in peripheral blood could be an index to determine the optimal intervention window. Their temporal alteration suggests an association with tumor recurrence after BNCT, making M-MDSCs a potential intervention target. Our preliminary results showed that PLX-3397 had strong M-MDSCs, TAMs, and TIL (tumor-infiltrating lymphocyte) modulating effects that could synergize tumor control when combined with BNCT. [ABSTRACT FROM AUTHOR]

Objectives: Behavioral and psychological symptoms of dementia (BPSD) are highly prevalent in patients with Alzheimer's disease (AD), causing burdens on caregivers. Behavioral and psychological symptoms of dementia and subclinical epileptiform discharge (SED) increased with the disease course of AD. However, the interaction between them was still unknown. The present study aimed to evaluate the associations between SED and BPSD. Methods/Design: Patients with AD from Kaohsiung Municipal Ta‐tung Hospital were included in this study. International 10–20 system scalp electroencephalography (EEG) for 13 min was performed to detect SED. Behavioral and psychological symptoms of dementia was assessed by neuropsychiatric inventory (NPI) questionnaires. The occurrence of BPSD subsyndromes was compared between patients with and without SED. Results: Two hundred sixty‐three adult patients qualified for the inclusion criteria and were enrolled in this study. The mean age of patients was 80.2 years, and approximately 62% were women. 17.1% of patients showed SED on EEG. Apathy was the most commonly reported BPSD subsyndrome in this cohort. There was no significant difference in the prevalence of BPSD between patients with and without SED. (75.6% vs. 67.4%, p = 0.2806). However, the NPI score of irritability subsyndrome was significantly higher in the SED (+) group (2.6 ± 3.7 vs. 1.2 ± 2.7, p = 0.0028). In addition, subclinical epileptiform discharge in the frontal lobe was associated with a considerably higher occurrence of hyperactivity subsyndrome, including irritability. Conclusions: SED may not be a direct cause of BPSD, but the presence of SED may affect the manifestation of BPSD. Key points: Behavioral and psychological symptoms of dementia (BPSD) and subclinical epileptiform discharge (SED) increase with the progression of Alzheimer's disease.In the present study, we aimed to evaluate the associations between SED and BPSD.Apathy was the most commonly reported subsyndrome in our cohort, followed by nighttime behavior and irritability.There was no significant difference in the prevalence of BPSD between patients with and without SED. However, the NPI score for irritability subsyndromes was significantly higher in the SED (+) group.SED may not be a direct cause of BPSD, but its presence may affect the manifestation of BPSD. [ABSTRACT FROM AUTHOR]

Several studies have demonstrated accelerated brain aging in Alzheimer's dementia (AD). Previous studies have also reported that facial asymmetry increases with age. Because obtaining facial images is much easier than obtaining brain images, the aim of this work was to investigate whether AD exhibits accelerated aging patterns in facial asymmetry. We developed new facial asymmetry measures to compare Alzheimer's patients with healthy controls. A three-dimensional camera was used to capture facial images, and 68 facial landmarks were identified using an open-source machine-learning algorithm called OpenFace. A standard image registration method was used to align the three-dimensional original and mirrored facial images. This study used the registration error, representing landmark superimposition asymmetry distances, to examine 29 pairs of landmarks to characterize facial asymmetry. After comparing the facial images of 150 patients with AD with those of 150 age- and sex-matched non-demented controls, we found that the asymmetry of 20 landmarks was significantly different in AD than in the controls (p < 0.05). The AD-linked asymmetry was concentrated in the face edge, eyebrows, eyes, nostrils, and mouth. Facial asymmetry evaluation may thus serve as a tool for the detection of AD. [ABSTRACT FROM AUTHOR]

Introduction: The Apolipoprotein E (APOE) epsilon (+) 4 allele is a well-established risk factor for late-onset Alzheimer's disease (AD). Reports on white ancestry populations have showed that age, sex, and ethnicity have different effects on the association between APOE genotype and AD. However, studies on Asian populations such as Taiwan Chinese populations are limited. This study aimed to evaluate the association between APOE genotype and AD in a Taiwan Chinese population, and to explore if the association varies by age and sex. Methods: We conducted a case-control study in 725 patients with AD and 1,067 age- and sex- matched controls without dementia from a Taiwan Chinese population. Logistic regression models were used to test the association between AD and APOE genotypes. Secondary analyses considered age (<75 or ≥75 years old), and sex stratified models. Results: The risk of AD was significantly increased for people with at least one copy of APOE ε4 (OR = 2.52, 95% CI = 2.01--3.17, p < 0.001) and in a dose-dependent manner. Our results did not show an statistically significance different in AD risk when women and men carrying APOEε4 were compared. Despite not reaching statistical significance, the risk of APOE ε4 for AD was higher among younger participants (OR = 3.21, 95% CI = 2.26-4.56, p < 0.001) compared to older ones (OR = 2.13, 95% CI = 1.53-2.97, p < 0.001). When considering both sex and age, the risk of AD was higher among older men carrying APOE ε4 (OR = 2.64, 95% CI = 1.51-4.60 in men; OR = 1.90, 95% CI = 1.26-2.86 in women), while women carrying APOE ε4 appeared to have an increased risk at a younger age (OR = 3.29, 95% CI = 2.20-4.93 in women; OR = 2.91, 95% CI = 1.40-6.05 in men). Discussion: The APOE ε4 allele represents a major risk factor for AD in the Taiwanese population. The effect of APOE ε4 allele on AD risk appeared to be stronger among men aged 75 years or more and among younger women. [ABSTRACT FROM AUTHOR]

Despite the abundance of research on the risk factors for mortality following hip fracture surgery, there has been a dearth of studies on prediction models in this population. The objective of this research was to explore the influencing factors and construct a clinical nomogram to predict one-year postoperative mortality in patients with hip fracture surgeries. Using the Ditmanson Research Database (DRD), we included 2333 subjects, aged ≥ 50 years who underwent hip fracture surgery between October, 2008 and August, 2021. The endpoint was all-cause mortality. A least absolute shrinkage and selection operator (LASSO) derived Cox regression was performed to select the independent predictors of one-year postoperative mortality. A nomogram was built for predicting one-year postoperative mortality. The prognostic performance of nomogram was evaluated. On the basis of tertiary points in a nomogram, the patients were divided into low, middle and high risk groups, and compared by the Kaplan–Meier analysis. Within 1 year after hip fracture surgery, 274 patients (11.74%) died. Variables retained in the final model comprised age, sex, length of stay, RBC transfusions, hemoglobin, platelet, and eGFR. The AUC for one-year mortality predictions were 0.717 (95% CI = 0.685–0.749). The Kaplan–Meier curves were significantly different among the three risk groups (p < 0.001). The nomogram showed good calibration. In summary, we explored the one-year postoperative mortality risk in geriatric patients with a hip fracture and developed a prediction model that could help clinicians identify patients at high risk of postoperative mortality. [ABSTRACT FROM AUTHOR]

The purpose of this research was to investigate the immediate and 3-week short-term effects of kinesio taping (KT) on balance and walking ability in patients with stroke during post-acute care (PAC). A randomized controlled trial was designed to compare the outcome. Twenty stroke patients were randomly allocated into the KT or control group. After the KT intervention, there was no significant improvements in KT group in either balance or walking ability. After 3-week physical therapy, there were significant improvements in berg balance scale (BBS), 10 meter test (10MWT) and 6-minute walk test (6MWT) in both groups ( p<0.05). However, no significant differences in BBS, 10MWT, 6MWT and functional ambulation category scale between groups was found ( p>0.05). The results of this research demonstrated that KT seems to have no immediate and short-term effects on balance, walking speed, cardiopulmonary endurance and walking ability of PAC stroke patients. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the feasibility of textile sludge as a raw material for sintering lightweight aggregates (LWAs) and its application in concrete. Three samples of different components were taken from the textile sludge, which came from different textile factories in Taiwan. The analysis of the chemical composition of the sludge shows that the total content of SiO2, Al2O3, and Fe2O3 in the textile sludge was far lower than the recommended value in the literature, and that glassy melt could not be produced and sintered into LWAs alone. Therefore, the water purification sludge obtained from a water purification plant owned by the Taiwan Water Supply Company was used as the main raw material, and the textile sludge was used as the auxiliary raw material in addition amounts of 7.5%, 15.0%, and 22.5%. The test results showed that the LWAs sintered by adding textile sludge to water purification sludge could reach the particle density that is generally required for LWAs (between 0.2 and 1.8 g/cm3). The 14-day compressive strength of the lightweight aggregate concrete made from textile-sludge-based LWAs was between 20 and 25 MPa. This means that textile-sludge-based LWAs can be used in secondary structural concrete. [ABSTRACT FROM AUTHOR]

How do Taiwanese judges acquire autonomy in decision-making, free from intervention from the judicial administration? Using diverse archival data and in-depth interviews with 31 incumbent judges, this article makes three statements. First, the judiciary has multiple and inter-connected mechanisms to secure autonomy in decision making. The establishment of judicial independence is a dynamic and interactive process. Second, a distinctive "sandwich mobilization model" can be observed in the emergence and sustaining of internal mechanisms. Both the bottom-up mobilization by ordinary judges and the top-down policy reform by the judicial administration are critical driving forces for the establishment of judicial autonomy. Third, as Taiwan's judiciary normalized, the institutional tension inherent in the continental judicial system emerged. That is, the individual space for judicial decision-making stands in contrast to the bureaucratic monitoring of individual judges' performance. Particularly, untenured junior judges are under critical impact. [ABSTRACT FROM AUTHOR]

Airway management is a common and critical procedure in acute settings, such as the Emergency Department (ED) or Intensive Care Unit (ICU) of hospitals. Many of the traditional physical examination methods have limitations in airway assessment. Point-of-care ultrasound (POCUS) has emerged as a promising tool for airway management due to its familiarity, accessibility, safety, and non-invasive nature. It can assist physicians in identifying relevant anatomy of the upper airway with objective measurements of airway parameters, and it can guide airway interventions with dynamic real-time images. To date, ultrasound has been considered highly accurate for assessment of the difficult airway, confirmation of proper endotracheal intubation, prediction of post-extubation laryngeal edema, and preparation for cricothyrotomy by identifying the cricothyroid membrane. This review aims to provide a comprehensive overview of the key evidence on the use of ultrasound in airway management. Databases including PubMed and Embase were systematically searched. A search strategy using a combination of the term "ultrasound" combined with several search terms, i.e., "probe", "anatomy", "difficult airway", "endotracheal intubation", "laryngeal edema", and "cricothyrotomy" was performed. In conclusion, POCUS is a valuable tool with multiple applications ranging from pre- and post-intubation management. Clinicians should consider using POCUS in conjunction with traditional exam techniques to manage the airway more efficiently in the acute setting. [ABSTRACT FROM AUTHOR]

Primary cilia are nearly ubiquitous organelles that transduce molecular and mechanical signals. Although the basic structure of the cilium and the cadre of genes that contribute to ciliary formation and function (the ciliome) are believed to be evolutionarily conserved, the presentation of ciliopathies with narrow, tissue-specific phenotypes and distinct molecular readouts suggests that an unappreciated heterogeneity exists within this organelle. Here, we provide a searchable transcriptomic resource for a curated primary ciliome, detailing various subgroups of differentially expressed genes within the ciliome that display tissue and temporal specificity. Genes within the differentially expressed ciliome exhibited a lower level of functional constraint across species, suggesting organism and cellspecific function adaptation. The biological relevance of ciliary heterogeneity was functionally validated by using Cas9 geneediting to disrupt ciliary genes that displayed dynamic gene expression profiles during osteogenic differentiation of multipotent neural crest cells. Collectively, this novel primary cilia-focused resource will allow researchers to explore longstanding questions related to how tissue and cell-type specific functions and ciliary heterogeneity may contribute to the range of phenotypes associated with ciliopathies. [ABSTRACT FROM AUTHOR]

Aim: Alzheimer's dementia (AD) is a slowly progressing neurodegenerative disease, characterized by beta‐amyloid deposition and neurofibrillary tangles. Peripheral atherosclerosis may deteriorate these processes via endothelial cell dysfunction and microvascular impairment. Cilostazol – a phosphodiesterase 3 inhibitor – is a standard treatment for peripheral arterial occlusive disease and a potential treatment for preserving cognitive function in AD patients. We aimed to determine whether cilostazol is beneficial in AD patients with peripheral arterial occlusive disease by evaluating Cognitive Abilities Screening Instrument (CASI) domains. Methods: We conducted a retrospective case–control study of 62 AD patients in Taiwan. Thirty‐one patients had peripheral arterial occlusive disease and were receiving cilostazol plus acetylcholinesterase inhibitors (AchEIs) or N‐methyl d‐aspartate antagonists, whereas 31 others were receiving AchEIs. Therapeutic responses were measured using neuropsychological assessments. The CASI was administered at baseline and 12 months later; different domains were analyzed between the groups using univariate and multivariate analyses. Results: Age, sex, education duration, ApoE ε4 gene status, and initial Mini‐Mental State Examination scores were not different between the two groups. Except for fluency, no CASI domains showed a statistical difference between the groups. A significant difference was observed in category fluency (P = 0.010). In the logistic regression analysis, after adjusting for covariate effects, category fluency still showed a significant difference between the groups (P = 0.013). Conclusions: In AD patients with peripheral arterial occlusive disease who have received Food and Drug Administration‐approved pharmacotherapy, cilostazol, as an antiplatelet, may help to preserve general cognitive function, with significant preservation in category fluency. Geriatr Gerontol Int 2023; 23: 194–199. [ABSTRACT FROM AUTHOR]

The Minbaklu Bridge, an essential segment of the southern cross-island expressway in Taiwan, was destroyed owing to debris flow in the Yusui Stream. To elucidate the development of debris flow in the Yusui Stream and the bridge collapse event, this study proposed a hybrid model of the discrete element method and depth-averaged model to simulate the event through three stages: formation of the natural dam, debris flow triggered by dam braking, and bridge collapse owing to the debris flow. The simulation results obtained indicate that the proposed model can provide reasonable simulations of the formation of natural dam in both time line and spatial distribution. Further, it indicated that the erosion developed at the river bed of the flow region, and illustrated the failure process of the Minbaklu Bridge, which revealed that it was uplifted before being pushed away. Furthermore, the final deposition of the alluvial fan deposition was demonstrated as well. Overall, the proposed hybrid model provides a useful tool for investigating debris flow and interaction with engineering structures. [ABSTRACT FROM AUTHOR]

Background: We established 1-h and 1-day survival models after terminal extubation to optimize ventilator use and achieve a balance between critical care for COVID-19 and hospice medicine. Methods: Data were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between APACHE II scores and parameters with survival time were analyzed. Parameters with a p-value ≤ 0.2 in univariate analysis were included in multivariate models. Cox proportional hazards regression analysis was used for the multivariate analysis of survival time at 1 h and 1 day. Results: Of the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time. Conclusion: An APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of palliative care in the era of COVID-19. Trial registration They study was retrospectively registered. IRB No.: 202101929B0. [ABSTRACT FROM AUTHOR]

Coenzyme Q (CoQ, aka ubiquinone) is a key component of the mitochondrial electron transport chain (ETC) and membrane-incorporated antioxidant. CoQ10 deficiencies encompass a heterogeneous spectrum of clinical phenotypes and can be caused by hereditary mutations in the biosynthesis pathway or result from pharmacological interventions such as HMG-CoA Reductase inhibitors, and statins, which are widely used to treat hypercholesterolemia and prevent cardiovascular disease. How CoQ deficiency affects individual tissues and cell types, particularly mitochondrial-rich ones such as brown adipose tissue (BAT), has remained poorly understood. Here we show that pharmacological and genetic models of BAT CoQ deficiency show altered respiration that can only in part be explained by classical roles of CoQ in the respiration chain. Instead, we found that CoQ strongly impacts brown and beige adipocyte respiration via the regulation of uncoupling protein 1 (UCP1) expression. CoQ deficiency in BAT robustly decreases UCP1 protein levels and uncoupled respiration unexpectedly, resulting in increased inner mitochondrial membrane potential and decreased ADP/ATP ratios. Suppressed UCP1 expression was also observed in a BAT-specific in vivo model of CoQ deficiency and resulted in enhanced cold sensitivity. These findings demonstrate an as yet unappreciated role of CoQ in the transcriptional regulation of key thermogenic genes and functions. [ABSTRACT FROM AUTHOR]

Patients with Alzheimer's disease typically have initial deficits in memory. Memory testing can be categorized as verbal or nonverbal by the modality of the stimuli used. We compared the discriminative validity of selected verbal and nonverbal memory tests between non-dementia and Alzheimer's disease in Taiwan. Ninety-eight patients with mild Alzheimer's disease and 269 non-dementia individuals underwent story recall test (immediate and delayed recall), and constructional praxis test (copy and delayed recall). The receiver-operating characteristic curve and area under the curve were evaluated to compare between tests. Patients with Alzheimer's disease performed poorly across all memory tests, and the receiver-operating characteristic curve analysis indicated that story recall immediate and relayed recall, and constructional praxis delayed recall had good classification accuracy with area under the curve of.90,.87 and.87 respectively. These results provide support that both verbal and nonverbal memory tests are reliable measure for screening patients with Alzheimer's disease. [ABSTRACT FROM AUTHOR]

Neuropsychiatric symptoms (NPSs) are known to be frequent in Parkinson's disease (PD) with great impacts on the quality of life, but reports about the prevalence in institutions are few. Our aim was to investigate the prevalence of and risk factors for NPSs in institutionalized patients with PD in Taiwan. The National Health Research Institute executed a cross-sectional, community-based, observational study on residential long-term care service institutions. The diagnosis of PD was determined by physicians with the estimated Hoehn and Yahr stage of PD according to the EQ-5D-5L questionnaire. A total of 370 patients with PD (80.1 ± 9.94 years old, 55.1% females) were included, and 139 (37.6%) had more than one NPS in the prior 3 months. The top three NPSs were nighttime behavior (65 (17.6%)), depression (53 (14.3%)), and fear/anxiety (49 (13.2%)). There were no differences between those with NPS and those without NPS in terms of age, gender, education, Mini-Mental State Examination, or Hoehn and Yahr stage. However, multivariate logistic regression analysis showed that genitourinary disease (odds ratio (OR) = 3.13; 95% confidence interval (95%CI) = 1.77–5.51) and psychiatric disorders (OR = 5.18; 95%CI = 3.09–8.69) may be associated with increased risk of NPSs. Increased physical restraint was observed in residents with advanced PD. Genitourinary disease and psychiatric disorders appear to increase the risk of NPSs in institutionalized residents with PD. [ABSTRACT FROM AUTHOR]

We aim to establish a noninvasive diagnostic platform to capture early phenotypic transformation for metastasis using 18F-FDG PET and 1H-NMR-based serum metabolomics. Mice with implantation of NCI-H460 cells grew only primary lung tumors in the localized group and had both primary and metastatic lung tumors in the metastatic group. The serum metabolites were analyzed using 1H-NMR at the time of PET/CT scan. The glycolysis status and cell proliferation were validated by Western blotting and staining. A receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic accuracy of SUVmean and serum metabolites in metastasis. In the metastatic mice, the SUVmean of metastatic tumors was significantly higher than that of primary lung tumors in PET images, which was supported by elevated glycolytic protein expression of HK2 and PKM2. The serum pyruvate level in the metastatic group was significantly lower than that in the localized group, corresponding to increased pyruvate-catalyzed enzyme and proliferation rates in metastatic tumors. In diagnosing localized or metastatic tumors, the areas under the ROC curves of SUVmean and pyruvate were 0.92 and 0.91, respectively, with p < 0.05. In conclusion, the combination of 18F-FDG PET and 1H-NMR-based serum metabolomics demonstrated the feasibility of a glycolytic platform for diagnosing metastatic lung cancers. [ABSTRACT FROM AUTHOR]

Head and neck cancer (HNC) patients who are unable to return to work after completing treatment might face financial loss and reduced self-esteem. The aim of this study was to identify factors influencing a return to work in HNC cancer patients in the first 6 months after treatment. This cross-sectional study examined HNC patients who completed treatment from the outpatient radiation department of a single cancer center in northern Taiwan. Patients were assessed according to psychological distress, patient-perceived health status, barriers to returning to work, and facilitators of returning to work. Of the 106 HNC patients surveyed, 54.7% successfully returned to work. Barriers to returning to work included poor self-perception of health, greater psychological distress, and age ≥50 years. Patients who had higher psychological distress, returned to work after start of the pandemic, or received reconstruction surgery were less likely to experience a positive environment facilitating a return to work. [ABSTRACT FROM AUTHOR]

There is growing evidence that the coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is associated with increased risks of psychiatric sequelae. Depression, anxiety, cognitive impairments, sleep disturbance, and fatigue during and after the acute phase of COVID-19 are prevalent, long-lasting, and exerting negative consequences on well-being and imposing a huge burden on healthcare systems and society. This current review presented timely updates of clinical research findings, particularly focusing on the pathogenetic mechanisms underlying the neuropsychiatric sequelae, and identified potential key targets for developing effective treatment strategies for long COVID. In addition, we introduced the Formosa Long COVID Multicenter Study (FOCuS), which aims to apply the inflammation theory to the pathogenesis and the psychosocial and nutrition treatments of post-COVID depression and anxiety. [ABSTRACT FROM AUTHOR]

Objective: To explore the effectiveness of a nurse‐led mobile health (mHealth) intervention to prevent excessive gestational weight gain (GWG) in overweight and obese women. Methods: A randomized controlled trial with an experimental study design. Ninety‐two pregnant women with body mass index (BMI) ≥25 kg/m2 at less than 17 weeks gestation were recruited from two prenatal clinics in northern Taiwan from January to June 2020. The experimental group used the MyHealthyWeight (MHW) app and a wearable activity tracker (WAT), and the controls received standard antenatal treatments with no mHealth‐based elements. Two hospital follow‐up visits were scheduled at 24–26 weeks in the second trimester and 34–36 weeks in the third trimester. A generalized estimating equation (GEE) was used to examine the trajectories and the effectiveness of mHealth on GWG. Results: No difference in GWG was found between the intervention and control groups at baseline (p > 0.05). The GWG trajectory in the entire cohort of women with obesity exhibited a quadratic pattern (ß = 1.8, 95% confidence interval [CI] = 1.27–2.32), and intervention participants' weekly GWG was gained significantly lower than their controls in the second trimester (p < 0.05). Throughout the pregnancy, the mHealth intervention group had a significantly lower proportion of individuals who exceeded their GWG in both total (21.6% vs. 32.6%) and weekly weight gain (first trimester = 58.7% vs. 65.2%; second trimester = 45% vs. 67.4%; third trimester = 48.6% vs. 55.1%). In particular, among obese women in the third trimester, those in the intervention group gained less gestational weight than their controls. The adjusted body weight difference was 5.44 kg (p = 0.023), signifying the total GWG difference (3.30 vs. 8.74 kg) between the means of the two groups. The GEE model indicated that obese women who were aged 35 years, had prepregnancy exercise habits, perceived self‐efficacy of diet, and more physical activity tended to have low GWG (p < 0.05). Conclusions: The nurse‐led mHealth‐based intervention shows promising results in significantly preventing excessive GWG among high‐BMI women. More effectiveness was found among the obese subgroup. Clinical relevance: The mHealth‐based intervention would be successfully implemented by nurses to help high‐BMI women maintain their optimal body weight and promote healthy behavioral changes, particularly in diet and physical activity during pregnancy. [ABSTRACT FROM AUTHOR]

Background: In Taiwan, physical restraint is commonly used in institutions to protect residents from falling or injury. However, physical restraint should be used cautiously to avoid side effects, such as worse cognition, mobility, depression, and even death. Objectives: To identify the rate of physical restraint and the associated risk factors in institutionalized residents in Taiwan. Methods: A community-based epidemiological survey was conducted from July 2019 to February 2020 across 266 residential institutions. Among the estimated 6,549 residents being surveyed, a total of 5,752 finished the study. The questionnaires were completed by residents, his/her family or social workers. The cognition tests were conducted by specialists and a multilevel analysis approach was used to identify cognition/disability/medical history/special nursing care/BPSD risk factors for physical restraints. Results: Of the 5,752 included institutionalized residents, 30.2% (1,737) had been previously restrained. Older age, lower education level, lower cognitive function, higher dependence, residents with cerebrovascular disease, pulmonary disease, dementia, and intractable epilepsy, all contributed to a higher physical restraint rate, while orthopedic disease and spinal cord injury were associated with a lower physical restraint rate. Furthermore, residents with special nursing care had a higher restraint rate. Residents with most of the behavior and psychological symptoms were also associated with an increased restraint rate. Conclusions: We studied the rate of physical restraint and associated risk factors in institutionalized residents in Taiwan. The benefits and risks of physical restraint should be evaluated before application, and adjusted according to different clinical situations. [ABSTRACT FROM AUTHOR]

Objectives: Adolescents with a homicidal tendency is a growing concern in the United States. Studies in the past have showcased the relationship between homicidal ideation (HI) and psychiatric illnesses, but very limited information is available on the adolescent and inpatient population. We aim to evaluate the prevalence of demographic characteristics and psychiatric disorders in adolescents with and without HI. Materials and methods: Adolescent (age 12-17) population admitted to the hospital with the diagnosis of homicidal ideation was identified from the 2016-2018 National Inpatient Sample Dataset (NISD). Patients without HI were defined as the control group. The prevalence of psychiatric comorbidities between the groups was compared by applying the Rao-Scott adjusted chi-square test. We used multivariable logistic regression to generate odds ratio (OR) of homicidal ideation as an outcome; we adjusted age, sex, race, socioeconomic status, substance use disorders, alcohol use disorders, and psychiatric comorbidities. Results: A total of 18,935 patients (mean age: 14.5) with HI diagnosis were identified in this study. Majority of the patients were male subjects in the HI group compared to the control group (58.7 vs. 41.2%, p < 0.001). Racially, HI was more prevalent in white race (56.0 vs. 52.6%, p < 0.001) and black race (22.3 vs. 17.8%, p < 0.001), compared to Hispanic race (14.9 vs. 21.3%, p < 0.001). Major depression (Odds ratio [OR]: 2.66, p < 0.001), bipolar disorder (OR: 3.52, p < 0.001), anxiety disorder (OR: 1.85, p < 0.001), ADHD, and other conduct disorders (OR: 4.01, p < 0.001), schizophrenia (OR: 4.35, p < 0.001) are strong predictors of HI. Suicidality was prevalent in 66.9% of patients with HI. Conclusion: We found a higher prevalence of psychiatric illnesses such as depression, anxiety, and bipolar disorder in adolescents with homicidal ideation in the inpatient setting. White and black races were more prevalent in patients with homicidal ideation. Further large-scale longitudinal research studies are warranted to establish the correlation between psychiatric disorders and homicidal ideation among adolescents. [ABSTRACT FROM AUTHOR]

Background: The reactivation of herpes zoster (HZ) is associated with disease stress. However, the relationship between chondromalacia patella (CMP) and HZ remains poorly understood. This study investigated the relationship between CMP and the risk of developing HZ.Methods: Data were collected from the Taiwan's National Health Insurance Research Database. Patients with CMP diagnosed between 2000 and 2017 were assigned to the case group; patients without CMP were randomly selected from the same database and paired with controls matched by age and sex. The primary outcome was a diagnosis of HZ. All patients were followed until their diagnosis of HZ, their withdrawal from the NHI program, their death, or the end of 2017, whichever was earliest. The risk of developing HZ was compared between the case and control groups.Results: In total, 22,710 patients with CMP and 90,840 matched controls were enrolled. The overall incidence rates of HZ in the CMP and control cohorts were 7.94 and 7.35 per 1,000 person-years, respectively. After potential confounders were controlled for, the case group exhibited a higher risk of HZ than did the control group [adjusted hazard ratio (aHR) = 1.06, p < 0.05]. In a stratification analysis by age, patients over 65 years old in the CMP group exhibited a higher risk of HZ than did those in the control group (aHR = 1.22, p < 0.01). In a stratification analysis by sex, women with CMP were at greater risk of developing HZ than women without CMP (aHR = 1.18, p < 0.01).Conclusion: Patients with CMP, especially elder adults and women, exhibited a higher risk of HZ. The HZ risk of patients with CMP should thus be assessed, and the necessity of HZ vaccination should be informed. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's disease (AD) is the most common type of dementia. Aging is a risk factor for both AD and seizures. Subclinical epileptiform discharge (SED) has no evident clinical manifestation in patients with AD. Therefore, SED is liable to be overlooked in these patients since electroencephalography is not routinely performed in clinical settings. Previous studies about the association between SED and AD have yielded inconsistent results.Objective: The current study aimed to evaluate the prevalence of SED and its effect on AD severity and clinical outcomes.Methods: Patients with AD from Kaohsiung Municipal Ta-tung Hospital were included in this study. International 10-20 system scalp electroencephalography for 13 minutes was performed to detect SED. Clinical outcomes of patients with and without SED were assessed by neuropsychological tests [Cognitive Abilities Screening Instrument (CASI), Mini-Mental State Examination (MMSE), and Clinical Dementia Rating Scale Sum of Boxes (CDR-SOB)].Results: 288 patients (mean age 80.5 years, 60.4% female) were enrolled in this study. Fifty-seven (19.8%) out of 288 patients with AD had SED. The prevalence of SED increased with the severity of cognitive impairment. Compared with patients without SED, those with SED showed significantly greater decline in CASI (-9.32 versus -3.52 points, p = 0.0001) and MMSE (-2.52 versus -1.12 points, p = 0.0042) scores in one year.Conclusion: SED may play a significant role in AD progression and is a potential therapeutic target. [ABSTRACT FROM AUTHOR]

The risk factors for recurrence of hemorrhagic or ischemic stroke in patients with intracranial hemorrhage (ICH) are inconclusive. This study was designed to investigate the risk factors for stroke recurrence and the impact of antiplatelet on stroke recurrence in patients with ICH. This population-based case-cohort study analyzed the data obtained from a randomized sample of 2 million subjects in the Taiwan National Health Insurance Research Database. The survival of patients with hemorrhagic stroke from January 1, 2000, to December 31, 2013, was included in the study. During the 5-year follow-up period, the recurrence rate of stroke was 13.1% (7.01% hemorrhagic stroke, and 6.12% ischemic stroke). The recurrence rate of stroke was 13.3% in the without antiplatelet group and 12.6% in the antiplatelet group. The risk factor for hemorrhagic stroke was hypertension (OR 1.87). The risk factors for ischemic stroke were age (OR 2.99), diabetes mellitus (OR 1.28), hypertension (OR 2.68), atrial fibrillation (OR 1.97), cardiovascular disease (OR 1.42), and ischemic stroke history (OR 1.68). Antiplatelet may decrease risk of hemorrhagic stroke (OR 0.53). The risk of stroke recurrence is high in patients with ICH. Hypertension is a risk factor for ischemic and hemorrhagic stroke recurrence. Antiplatelet therapy does not decrease risk of ischemic stroke recurrence but may reduce recurrence of hemorrhagic stroke. [ABSTRACT FROM AUTHOR]

Background: Alzheimer's dementia (AD) is a degenerative disease that impairs cognitive function, initially, and then motor or other function, eventually. Motor coordination function impairment usually accompanies cognition impairment but it is seldom examined whether it can reflect the clinical outcomes of AD. Methods: 113 clinically diagnosed AD patients with a mean age of 78.9 ± 6.9 years underwent an annual neuropsychological assessment using the Mini-Mental State Examination (MMSE), the Cognitive Abilities Screening Instrument (CASI), the Sum of Boxes of Clinical Dementia Rating (CDR-SB), and the CDR. The cerebral coordination function was evaluated through correlations among 15 joints with a kinetic depth sensor annually. An intra-individual comparison of both cognitive and motor coordination functions was performed to examine their correlations. Results: The changes in coordination function in the lower limbs can significantly reflect the clinical outcomes, MMSE (p < 0.001), CASI (p = 0.006), CDR (p < 0.001), and CDR-SB (p < 0.001), but the changes in upper limbs can only reflect the clinical outcome in CDR (p < 0.001). Conclusions: The use of a kinetic depth sensor to determine the coordination between joints, especially in lower limbs, can significantly reflect the global functional and cognitive outcomes in AD. Such evaluations could be another biomarker used to evaluate non-cognitive outcomes in AD for clinical and research purposes. [ABSTRACT FROM AUTHOR]