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Objective: Pharmacotherapy including mood stabilizers and antipsychotics are frequently used in bipolar disorder (BD); however, the lack of consensus regarding the definition of polypharmacy hinders conducting comparative studies across different settings and countries. Research on Asian Prescription Pattern (REAP) is the largest and the longest lasting international collaborative research in psychiatry in Asia. The objective of REAP BD was to investigate the prescription patterns of psychotropic medications across Asian countries. The rates of polypharmacy and psychotropic drug load were also analyzed. Methods: The data collection was web-based. Prescription patterns were categorized as (1) mood stabilizer monotherapy: one mood stabilizer; (2) antipsychotic monotherapy: one antipsychotic; (3) simple polypharmacy: one mood stabilizer and one antipsychotic; and (4) complex polypharmacy: ≤ 2 mood stabilizers or/and antipsychotics. The psychotropic drug load in each patient was calculated using the defined daily dose method. Results: Among 2003 patients with BD (52.1% female, 42.4 years) from 12 countries, 1,619 (80.8%) patients received mood stabilizers, 1,644 (82.14%) received antipsychotics, and 424 (21.2%) received antidepressants, with 14.7% mood stabilizer monotherapy, 13.4% antipsychotic monotherapy, 48.9% simple polypharmacy, 20.3% complex polypharmacy, and 2.6% other therapy. The average psychotropic drug load was 2.05 ± 1.40. Results varied widely between countries. Conclusion: Over 70% of psychotropic regimens involved polypharmacy, which accords with the high prevalence of polypharmacy in BD under a permissive criterion (2 or more core psychotropic drugs) worldwide. Notably, ≤ 80% of our sample received antipsychotics, which may indicate an increasing trend in antipsychotic use for BD treatment. [ABSTRACT FROM AUTHOR]

Objective To investigate the effects of alprostadil combined with lipoic acid on clinical efficacy, hemodynamics, fibronectin and plasma D-dimer in elderly patients with type 2 diabetic foot. Methods Ninety-six elderly patients with type 2 diabetic foot hospitalized in Department of Endocrinology, Xining First People's Hospital from January 2017 to June 2019 were selected as the study subjects. They were divided into control group (48 cases) and case group (48 cases) by random number table method. The control group was treated with lipoic acid, and the case group was treated with Alprostadil for injection on the basis of the control group. The clinical efficacy, clinical symptom score, ulcer healing, hemodynamics of dorsal artery of foot, fibronectin and plasma D- two dimer in two groups were observed. Results The total effective rate of the case group was 95.83%, which was significantly higher than that of the control group (83.33%).The difference was statistically significant (P<0.05). After treatment, the pain, swelling, claudication, numbness score, ulcer area, wound PH value, plasma D-dimer level of the two groups were lower than those before treatment, and the oxygen partial pressure, blood flow velocity, vascular diameter, Resistance index (RI), pulsation index (PI) and fibronectin levels of the two groups were higher than those before treatment, the difference was statistically significant (P<0.05). The improvement of clinical efficacy, ulcer healing, dorsal pedal artery hemodynamics, fibronectin and plasma D-dimer levels in the case group were significantly better than those in the control group (P<0.05). There was no significant difference in the incidence of adverse reactions between the two groups (P>0.05). Conclusions Alprostadil combined with lipoic acid has significant clinical effect on elderly patients with type 2 diabetic foot. It can correct the abnormal hemodynamics of dorsal pedal artery, promote the healing of foot ulcer, increase the content of fibronectin ulcer tissue, reduce the level of plasma D-dimer and improve the high coagulation state. It has high efficiency and safety. It is worthy of clinical application. Further promotion. [ABSTRACT FROM AUTHOR]

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The corrosion properties of γ'-strengthened CoxNi-Al-W-Cr (where x = 15, 20, 25, and 30 at.%) superalloys were investigated in the mixture of 75 wt.% Na2SO4 + 25 wt.% NaCl at 900°C. The results showed that the corrosion behavior is associated with both sulfuration and oxidation processes. It was demonstrated that increasing the addition of Ni effectively promoted the formation of continuous Al2O3 scales, so that the hot corrosion resistance could be improved. When Ni content is more than 20 at.%, a large amount of Ni3S2 precipitates during the corrosion process. Sulfuration can destroy the integrity of the corrosion layer and increase the activity of oxygen. In this way, the internal oxidation of the alloys becomes more serious. Therefore, it is recommended that the optimum Ni addition is about 20 at.% for new type Co-Ni-Al-W-Cr superalloys. [ABSTRACT FROM AUTHOR]

The aberrant expression of retinoic acid receptor‑α (RARα) has been reported in various types of cancer. However, its association with the prognosis and development of laryngeal squamous cell carcinoma (LSCC) has not yet been determined. Therefore, the present study aimed to examine the expression and function of RARα in patients with LSCC. The expression of RARα in LSCC tissues was investigated using immunostaining. An MTT assay and flow cytometry analysis were also performed to investigate the function of RARα in the proliferation and cell cycle of LSCC cells. The expression of RARα was significantly elevated in LSCC tissues compared with adjacent noncancerous tissues (78.1 vs. 6.3%, P<0.05). The overexpression of RARα was associated with poorly differentiated features of LSCC (P<0.05). Furthermore, the downregulation of RARα inhibited the proliferation of LSCC cells, and arrested the cell cycle at the G1 phase via upregulation of cyclin dependent kinase inhibitor 1A, which may be associated with inhibition of the protein kinase B signaling pathway. Therefore, the overexpression of RARα may contribute to the development of LSCC through the regulation of the cell cycle. The results of the present study provide evidence that RARα serves an important function in LSCC development and may be a potential therapeutic target or prognostic predictor for LSCC. [ABSTRACT FROM AUTHOR]

Objective: To investigate the national prevalence of potentially inappropriate medications (PIMs) prescribed in ambulatory care clinics in Taiwan according to three different sets of regional criteria and the correlates of PIM use. Design: Cross-sectional study. Setting: This analysis included older patients who visited ambulatory care clinics in 2009 and represented half of the older population included on the Taiwanese National Health Insurance Research Database. Participants: We identified 1 164 701 subjects who visited ambulatory care clinics and were over 65 years old in 2009. Primary and secondary outcome measures: PIM prevalence according to the 2012 Beers criteria, the PIM-Taiwan criteria and the PRISCUS criteria was estimated separately, and characteristics of PIM users were explored. Multivariate logistic regression analysis was used to determine patient factors associated with the use of at least one PIM. Leading PIMs for each set of criteria were also listed. Results: The prevalence of having at least one PIM at the patient level was highest with the Beers criteria (86.2%), followed by the PIM-Taiwan criteria (73.3%) and the PRISCUS criteria (66.9%). Polypharmacy and younger age were associated with PIM use for all three sets of criteria. The leading PIMs detected by the PIM-Taiwan and PRISCUS criteria were all included in the 2012 Beers criteria. Non-COXselective non-steroidal anti-inflammatory drugs in the Beers criteria and benzodiazepines in the PIM-Taiwan and PRISCUS criteria accounted for most leading PIMs. Conclusions: The prevalence of PIMs was high among older Taiwanese patients receiving ambulatory care visits. The prevalence of PIM and its associated factors varied according to three sets of criteria at the population level. [ABSTRACT FROM AUTHOR]

Background Cancer is a serious public health problem worldwide, and its relationship with affective disorders is not clear. Aims To investigate alcohol- and tobacco-related cancer risk among patients with affective disorders in a large Taiwanese cohort. M eth od Records of newly admitted patients with affective disorders from January 1997 through December 2002 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan. Cancers were stratified by site and grouped into tobacco- or alcohol-related cancers. Standardised incidence ratios (SIRs) were calculated to compare the risk of cancer between those with affective disorders and the general population. Results Some 10207 patients with bipolar disorder and 9826 with major depression were included. The risk of cancer was higher in patients with major depression (SIR=2.01, 95% Cl 1.85-2.19) than in those with bipolar disorder (SIR 1.39, 95% Cl 1.26-1.53). The elevated cancer risk among Individuals ever admitted to hospital for affective disorders was more pronounced in tobacco- and/or alcohol-related cancers. Conclusions Elevated cancer risk was found in patients who had received in-patient care for affective disorders. They require holistic approaches to lifestyle behaviours and associated cancer risks. Declaration of interest None. [ABSTRACT FROM AUTHOR]

Objective: Psychotropic polypharmacy in the treatment of bipolar disorder has proliferated. Yet evidence about the prevalence and predictors of different combinations of polypharmacy in inpatient settings is scarce. Methods: The Nationwide Psychiatric Inpatient Medical Claims (2000-2007) in Taiwan were used to examine prescriptions for mood stabilizers, antipsychotics, and antidepressants among recently discharged patients with bipolar disorder (N=5,449; 51% women, mean±SD age=36.8± 12.4). Results: A total of 71% of prescriptions involved between-class polypharmacy, and 17% involved within-class polypharmacy. Patients older than 50 and patients at medical centers (>500 beds) were less likely to receive polypharmacy. Lower prescribed doses predicted polypharmacy. Receiving polypharmacy was not associated with a higher rate of readmission within one year. Conclusions: There was substantial use of various forms of polypharmacy in die treatment of inpatients with bipolar disorder. Randomized studies should be used to compare die cost-effectiveness of common psychotropic combinations and monotherapy to treat bipolar disorder. [ABSTRACT FROM AUTHOR]

Objective: This study aimed to examine the use of high doses of antipsychotic medications (≥ 600 mg/day chlorpromazine equivalent) in older Asian patients with schizophrenia and its demographic and clinical correlates. Method: Information on hospitalized patients with schizophrenia aged ≥ 50 years was extracted from the database of the Research on Asian Psychotropic Prescription Patterns study (2001-2009).Data on 2203 patients in six Asian countries and territories, including China, Hong Kong, Japan, Korea, Singapore and Taiwan, were analyzed. Socio-demographic and clinical characteristics and antipsychotic prescriptions were recorded. Results: The frequency for high-dose antipsychotic medications was 36.0% overall, with 38.4% in 2001, 33.3% in 2004 and 36.0% in 2009. Multiple logistic regression analysis of the whole sample showed that compared to patients receiving low-medium antipsychotic doses, those on high doses had a longer illness duration (odds ratio (OR): 2.0, 95% confidence interval (CI):1.2-3.3, p = 0.008), were more likely in the 50-59-year group (OR: 0.95, 95% CI: 0.94-0.97, p<0.001), more often had current positive (OR: 1.5, 95% CI: 1.2-1.8, p<0.001) or negative symptoms (OR: 1.3, 95% CI: 1.03-1.6, p = 0.03), and more commonly received antipsychotic polypharmacy (OR: 5.3, 95% CI: 4.1-6.7, p<0.001). Extrapyramidal symptoms (p = 0.25) and tardive dyskinesia (p = 0.92) were not more frequent in the high-dose group. Conclusions: High doses of antipsychotic medications were used in more than one third of older Asian patients with schizophrenia. The reasons for the frequent use of high antipsychotic doses in older Asian patients warrant further investigation. [ABSTRACT FROM AUTHOR]

Efficient syntheses of four aminocyclitols are reported. Each synthesis is accomplished in eight steps starting from D-(-)-quinic acid. The key step involves a highly regioselective ring opening of epoxides by sodium azide. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to investigate the sex differences in prescribing patterns of psychotropic drugs and drug-induced side effects in schizophrenia patients in Asia using the data of the Research on Asian Psychotropic Prescription Pattern (REAP) surveys. Method: The prescription patterns of 6,441 schizophrenia inpatients in six Asian countries and regions were investigated during the 2001--2009 period. The patients' socio-demographic and clinical characteristics and their prescriptions for psychotropic drugs were recorded using a standardized protocol and data collection procedure. Results: Univariate analyses found the following factors to be significantly associated with the male sex: a younger age, higher doses of antipsychotics, less prominent delusions and hallucinations, more prominent negative symptoms, less likelihood of a prescription for second-generation antipsychotics (SGAs), greater use of antipsychotic polypharmacy, mood stabilizers and depot antipsychotics, more frequent tardive dyskinesia (TD), and less weight gain. In multivariate analyses, fewer prescriptions for SGAs, greater use of mood stabilizers, anticholinergics, antipsychotic polypharmacy and depot antipsychotics, extrapyramidal side effects (EPS) and TD, and less weight gain were independently associated with the male sex. Conclusions: Sex is one of the independent contributors to psychotropic prescription and side effects in Asian schizophrenia patients. Psychopharmacological treatment guidelines for schizophrenia should consider the sexes separately. [ABSTRACT FROM AUTHOR]

Classical congenital adrenal hyperplasia (CAH) is characterized by the defects in cortisol and aldosterone secretion, and accompanied with adrenal hyperandrogenism. It is likely that the impaired adrenocortical function and intermittent treatment-related hypercortisolism may predispose patients to the development of metabolic syndrome in adulthood. Our aim was to assess the impact of hyperandrogenism on metabolic profiles in CAH women without glucocorticosteroid treatment. We evaluated the clinical characteristics and metabolic profiles in 30 untreated Chinese female adults with simple virilizing congenital adrenal hyperplasia (SV-CAH). Mutation analysis was performed by sequencing the entire 21-hydroxylase gene ( CYP21A2). As compared with the controls, CAH patients had higher BMI (BMI, 21.5 ± 2.1 vs. 20.0 ± 1.8 kg/m, P < 0.05), higher 2 h post-load plasma glucose levels (6. 35 ± 1.74 vs. 5. 35 ± 1.17 mmol/l, P < 0.05), higher serum triglycerides (TG) (1.12 ± 0.64 vs. 0.63 ± 0.15 mmol/l, P < 0.01), and lower high-density lipoprotein cholesterol (HDL-c) (1.30 ± 0.39 vs. 1.67 ± 0.29 mmol/l, P < 0.01). Moreover, CAH patients had higher fasting insulin and homeostasis model assessment of insulin resistance (HOMA-IR) (1.81 ± 0.99 vs. 1.24 ± 0.50, P < 0.05), while ΔIns30/ΔGlu30 showed no statistically significant difference in two groups. In addition, a marked reduction of serum adiponectin levels were observed in CAH patients (7.0 ± 3.3 vs. 13.2 ± 4.8 μg/ml, P < 0.001), however, serum CRP levels were not different between patients and the controls. Further regression analysis showed that higher serum testosterone concentrations were associated with metabolic disorder indexes and reduction of serum adiponectin. Our study demonstrates that untreated CAH patients are prone to have metabolic disorders in association with elevated serum testosterone levels and reduced insulin insensitivity. [ABSTRACT FROM AUTHOR]

Purpose: We sought to explore the correlations of incontinence-related quality of life (QoL) measures with the symptom severity and pathophysiological factors for female stress urinary incontinence (SUI). Methods: We retrospectively reviewed the records of 707 women who had primary SUI. Clinical data for analysis included Ingelman-Sundberg scales, 1-h pad tests, incontinence-related QoL questionnaires comprising short forms of the Urogenital Distress Inventory (UDI-6) and Incontinence Impact Questionnaire (IIQ-7), ultrasound assessment of urethral support and urethral sphincter function determined by maximum urethral closure pressure and Valsalva leak point pressure. The correlations of incontinence-related QoL, measured by UDI-6 and IIQ-7 questionnaires, with the independent variables such as Ingelman-Sundberg scales, 1-h pad tests, urethral support and urethral sphincter function were investigated. Results: The scores of item 3 of UDI-6 as well as the sum scores of UDI-6 and IIQ-7 had significant correlation with incontinence severity assessed by Ingelman-Sundberg scales and 1-h pad tests. However, only the scores of item 3 of UDI-6 were significantly correlated with the presence of bladder neck funneling on ultrasound and maximum urethral closure pressure. No correlations exist between sum scores of UDI-6 or IIQ-7 and the pathophysiological factors of SUI. Conclusions: Urogenital Distress Inventory-6 and IIQ-7 play important and complementary roles in comprehensive assessment for SUI, but are not identical to the pathophysiological factors. [ABSTRACT FROM AUTHOR]

The pathophysiology of stress urinary incontinence (SUI) is multifactorial. The aim of this study was to explore the factor determining the symptom severity of SUI. One hundred twenty-four women with SUI were retrospectively investigated. Clinical data for analyses included demographics, pelvic organ prolapse quantification, SUI severity using a 4-point Likert scale, ultrasound, 1-h pad tests, and urodynamic studies. Data were analyzed using the Spearman's rho test and Kruskal–Wallis test. The symptom severity was not correlated with risk factors of SUI or the morphologic manifestations representing urethral support defect, but was significantly correlated with urine loss on 1-h pad test, Valsalva leak point pressure (VLPP) grading, and maximum urethral closure pressure (MUCP). Women with higher SUI severity had greater urine loss on 1-h pad tests, worse VLPP grading, and lower MUCP. Urethral sphincter function appears to be an important determinant for the symptom severity of SUI. [ABSTRACT FROM AUTHOR]

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • High-dose antipsychotic use in schizophrenia has been a topic of continuous debate since the introduction of the first antipsychotic in the 1950s. • There are reasons arguing for (such as pharmacokinetic reasons for the possible use of high antipsychotic doses in those with genetic polymorphisms associated with unusually high metabolic rates and the presence of inducers such as co-prescriptions of other medications and smoking) and against high-dose antipsychotic use (such as the pharmacokinetic understanding that Asians may need lower antipsychotic doses, the association of high antipsychotic doses with more frequent adverse effects, and receptor occupancy data from neuroimaging studies). • There is increasing awareness of the need for more practice-based research in order to highlight discrepancies between the empirical data and clinical practice. WHAT THIS STUDY ADDS • There was an overall significant decrease in the frequency of high-dose antipsychotic use from 17.9% in 2001 to 6.5% in 2004 within East Asia. • The association of high antipsychotic doses with demographic, psychopathological and treatment variables identified the clinical profile of schizophrenia patients who are at risk of receiving high antipsychotic doses. • These findings provide information and impetus for clinicians to constantly monitor the drug regimes and to foster rational, evidence-based prescribing practices. AIMS We aimed to examine the frequency of high-dose (defined as mean chlorpromazine mg equivalent doses above 1000) antipsychotic prescriptions in schizophrenia and their clinical correlates in the context of a comparison between studies in 2001 and 2004 within six East Asian countries and territories. METHODS Prescriptions of high-dose antipsychotic for a sample of 2136 patients with schizophrenia from six countries and territories (mainland China, Hong Kong, Korea, Japan, Taiwan and Singapore) were evaluated in 2004 and compared with data obtained for 2399 patients in 2001. RESULTS Overall, the comparison between 2001 and 2004 showed a significant decrease in high-dose antipsychotic use from 17.9 to 6.5% [odds ratio (OR) 0.32, 95% confidence interval (CI) 0.26, 0.39, P < 0.001]. Patients who received high-dose antipsychotics were significantly more likely to have multiple admissions (OR 1.96, 95% CI 1.16, 3.33, P = 0.009), more positive psychotic symptoms such as delusions (OR 2.05, 95% CI 1.38, 3.05, P < 0.001) and hallucinations (OR 1.85, 95% CI 1.30, 2.64, P = 0.001), but less likely to have negative symptoms (OR 0.58, 95% CI 0.40, 0.82, P = 0.002). Multivariate regression analyses revealed that prescription of high-dose antipsychotics was also predicted by younger age ( P < 0.001), time period of study (2001; P < 0.001), use of first-generation antipsychotic ( P < 0.001) and depot antipsychotics ( P < 0.001) as well as antipsychotic polytherapy ( P < 0.001). CONCLUSIONS We identified the clinical profile and treatment characteristics of patients who are at risk of receiving high antipsychotic doses. These findings should provide impetus for clinicians to constantly monitor the drug regimes and to foster rational, evidence-based prescribing practices. [ABSTRACT FROM AUTHOR]

Aims Antidepressant use in East Asia is poorly documented. We compared patients given newer and older antidepressants to test the hypothesis, suggested in the literature, that use of newer antidepressants is associated with treatment settings rather than specific diagnostic categories. Methods We compared rates of use of older (pre1990) vs. newer antidepressants among 1898 patients identified as antidepressant treated at 21 centres in five East Asian countries (China, Japan, Korea, Singapore, Taiwan) in 2003. Demographics, treatment setting and clinical factors associated with preferential use of newer drugs were tested in univariate and multivariate analyses. Results Newer antidepressants were included in the treatment regimens of 67.5% ( N = 1282/1898) of study subjects. Prescription for newer antidepressants was significantly associated with younger age (z = −4.55, d.f. = 1888, P < 0.001), hospitalization [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.07, 1.64, P < 0.01] and treatment within psychiatric hospitals (OR 1.59, 95% CI 1.27, 2.00, P < 0.001). On multivariate analyses, treatment with newer antidepressants was independently associated with younger age ( P < 0.001), country ( P < 0.001) and treatment within private hospitals ( P < 0.001), but not with sex or diagnosis of affective or anxiety disorders (all P > 0.1). Conclusion Demographic factors and treatment settings appear to influence antidepressant choice more than clinical factors such as diagnosis. [ABSTRACT FROM AUTHOR]

Aims Few studies have examined the use of depot antipsychotics in East Asian patients with schizophrenia. This study examined the prevalence of depot antipsychotic use and its clinical correlates. Methods Across six East Asian countries and territories, 2399 patients with schizophrenia were surveyed using a standardized protocol. Results Depot antipsychotic medications were prescribed in 15.3% (n =368) of the patients, being the most common in Singapore, followed by Taiwan, Japan and China. Being on depot antipsychotic drugs was significantly associated with male gender (particularly in Taiwan and Japan), delusions in Japan, aggression, higher daily CPZ equivalent dose and co-prescription of anticholinergic drugs but less likely with disorganized speech (particularly in China) and negative symptoms (particularly in Japan and Singapore). On multivariate analysis, the significant associated factors were treatment setting, younger age, longer duration of illness, aggression and the lack of use of an oral, atypical antipsychotic. Conclusion There was a wide variation in the prevalence of depot antipsychotic prescription, suggesting that it may not be guided by any recognizable principles and is more likely determined by local traditions and prescription culture. There is a need to re-examine the risk–benefit profile of each patient before deciding on the initiation or continuation of depot antipsychotic medication. Copyright © 2004 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]