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Background: Hepatitis C virus (HCV) infection is a global problem, and older patients are more likely to develop advanced liver disease. Direct-acting antiviral treatments (DAA) have revolutionized the paradigm of HCV treatment and made its elimination possible. However, hematological and biochemical changes have rarely been discussed. Methods: This was a retrospective observational study of enrolled patients who received DAA for chronic HCV between Aug 2018 and Mar 2020. Patients were divided into two groups: younger < 65 years and older 65 years. The HCV genotype, changes in biochemistry and hematologic data before and after treatment, and sustained virologic response at 12 weeks after cessation of drug administration were recorded. Results: Of the 226 enrolled patients, 130 (57.5%) belonged to the younger group and 96 (42.5%) to the older group. Most patients had HCV genotype 2 infections (54.4%), and older patients tended to have genotype 2 infections (70.7% vs. 42.3%). The older patients had significantly lower hemoglobin, platelet, albumin, and BUN levels initially. After treatment, the platelet count and BUN levels significantly improved in older patients. Older patients had higher fibrosis-4 (FIB-4) scores than younger patients before and after treatment. After treatment, the FIB-4 score in the older group showed a significant change (3.90 vs. 2.67; p = 0.001), but the younger group did not (1.97 vs. 1.75; p = 0.05). Conclusion: Older patients tended to have genotype 2 infections. After DAA treatment, the improvements in platelet count and albumin level were better in older patients than in younger patients. Improvement in FIB-4 was also significant in the older population. [ABSTRACT FROM AUTHOR]

Mesothelioma is a rare malignancy often observed in the pleura of patients exposed to asbestos. Peritoneal mesothelioma is a rare malignancy accounting for less than 20% of all mesothelioma cases. Many older adults might have been exposed to asbestos in the past; therefore, they could still develop mesothelioma later. Due to its rarity and nonspecific presentation, peritoneal mesothelioma is often overlooked. We present the case of a 64-year-old man who had been exposed to asbestos for two year 40 years ago because he lived in an asbestos factory. He visited our emergency room because of acute abdominal pain for one day. Abdominal computed tomography showed many ascites with an irregularly thickened peritoneum, and ascites without portal hypertension were suspected. Esophagogastroduodenoscopy, small-bowel capsule endoscopy, and colonoscopy revealed no organic lesions. Diagnostic laparotomy revealed uniform epithelioid tumor cells with eosinophilic cytoplasm and a predominant tubular pattern infiltrating the peritoneal stroma. Therefore, peritoneal mesothelioma was diagnosed, and the patient received cytoreduction plus hyperthermic intraperitoneal chemotherapy (HIPEC) with a stable condition. [ABSTRACT FROM AUTHOR]

Background: Pharmacotherapy of insomnia is prescribed often but may be complicated by drug dependence. Cognitivebehavioral therapy for insomnia is effective, but requires time to take effect. Repetitive transcranial magnetic stimulation (rTMS) is effective for depression but of uncertain benefit for insomnia. We studied low-frequency rTMS of the left dorsal medial prefrontal cortex (DMPFC) as an adjunctive therapy of insomnia. Methods: We recruited 60 patients with insomnia, of whom 49 completed the study. We applied 1 Hz rTMS to the DMPFC in the experimental group (n = 36) and sham coil for the placebo group (n = 13). Outcome measures included objective polysomnography (PSG) and subjective Pittsburgh Sleep Quality Index (PSQI). All participants were requested to continue prescribed pharmacotherapy. Results: After 10 sessions of low-frequency DMPFC-rTMS, the experimental group demonstrated a reduction of duration of wake after sleep onset (WASO) from 75.4 (±53.3) to 51.2 (±75.1) min (p = 0.011). Sleep efficiency (SE) increased from 74.6% (±15.6) to 80.8% (±13.8) (p = 0.004). The sham group experienced improved SE from 79.4% (±30.7) to 88.9% (±5.6) (p = 0.039). After controlling for baseline PSG parameters and hypnotic dosage, the sham group exhibited better effects of sleep onset latency and SE than the rTMS group but no difference on PSQI. Conclusion: Although the effects of rTMS and sham coil on insomnia were similar (which implied significant placebo effect), low-frequency DMPFC-rTMS might offer a safe, non-invasive, and useful adjunctive therapy of insomnia by reducing WASO. The DMPFC may represent a new target for future rTMS insomnia studies. [ABSTRACT FROM AUTHOR]

New and efficacious medical therapies have become available that have greatly enhanced clinicians' ability to manage inflammatory bowel diseases (IBDs). IBD activity should be assessed regularly in scheduled examinations as the part of a treat-to-target strategy for IBD care. The gold-standard approach to investigating IBD is colonoscopy, but this is an invasive procedure. Intestinal ultrasound (IUS) has played a crucial role in recent years regarding the assessment of IBD activity because it is noninvasive, safe, reproducible, and inexpensive. IUS findings could inform changes in therapeutic interventions for IBDs; this would necessitate fewer endoscopies and enable faster decision-making processes. Furthermore, patients are accepting and tolerant of IUS examinations. This review outlines the current evidence and gives indication regarding the use of IUS in the management of IBDs. [ABSTRACT FROM AUTHOR]

Objectives: Osteocalcin, a protein from osteoblasts, affects bone mineralization and turnover. This study evaluates the association between fasting serum osteocalcin and bone mineral density (BMD) in renal transplant recipients. Materials and Methods: This study recruited 66 renal transplant recipients. We analyzed blood biochemistry studies from fasting blood samples. The serum osteocalcin levels were measured using a commercial enzyme immunoassay kit. We measure BMD by dual-energy X-ray absorptiometry in lumbar vertebrae (L2–L4). By the World Health Organization classification, we group recipients into three groups: normal, osteopenia, and osteoporosis. Results: Of the renal transplant recipients, 8 patients (12.1%) were osteoporosis, and 28 patients (42.4%) were osteopenia. From normal to osteoporosis groups, the osteoporosis group has highest serum osteocalcin (P < 0.001), alkaline phosphatase (P = 0.005), lowest body mass index (P = 0.015), and body weight (P = 0.008). Females had lower lumbar BMD than males among recruited renal transplant recipients (P = 0.023). In the multivariate forward stepwise linear regression analysis, body weight (adjusted R2 change = 0.138; P = 0.010), and logarithmically transformed osteocalcin (log-osteocalcin; adjusted R2 change = 0.131; P = 0.012) can predict lumbar BMD in the renal transplant recipients. Conclusion: Our study showed that fasting serum osteocalcin concentration was negatively correlated with the lumbar BMD in renal transplant recipients. [ABSTRACT FROM AUTHOR]

Background: The acute onset of insomnia following surgical operations has long been neglected, and long-term outcomes are not clear. Our aims were (1) to evaluate the risk of postoperative insomnia, (2) to identify which surgeries are related, and (3) to follow patients with postoperative insomnia for the development of major mental and physical disorders. Methods: We conducted a case-crossover study comprising 9898 participants with new-onset insomnia from the Taiwan National Health Insurance Research Database between 1997 and 2011. We determined the odds of having surgery in the case period (30 days) before the onset of insomnia by logistic regression analysis. Types of surgery that postoperative insomniacs had undergone were compared with age-/gender-/timing-matched controls. Longitudinal follow-up of postoperative and non-postoperative insomniacs was performed. Results: The odds ratio of surgical exposure vs. nonexposure within 30 days was 12.05 (p < 0.001) before new-onset insomnia. Surgery of musculoskeletal and nervous systems predisposed to insomnia. The duration of hypnotic drug use (0.83 years) was shorter and with a nearly 2-fold faster remission rate in postoperative than in non-postoperative insomniacs (1.45 years). Approximately 25% of each insomnia group developed persistent sleep disturbance. Conclusion: Surgery is associated with subsequent insomnia, which has a shorter duration and a faster remission than nonpostoperative insomnia. Our data provide a reference for postoperative care, and warrant future studies. [ABSTRACT FROM AUTHOR]

Ulcerative colitis (UC) is a common cause of chronic gastrointestinal disease in the developed world, which has a bimodal age distribution, with 10-30% of the affected population older than 60 years. Elderly patients with UC will be seen more frequently with the aging of the population and increasing incidence of UC. The management of UC in the elderly population is more complex due to comorbidities and polypharmacy. This review article provides a brief up-to-date comprehensive summary of the epidemiology, diagnosis, and management of UC, with a focus on the special caring for elderly patients. Clinical challenges in the diagnosis of elderly patients with UC and the adverse effects or benefits of treatment options have been described. [ABSTRACT FROM AUTHOR]

Spinal dura arteriovenous fistula (SDAVF) is not an uncommon vascular malformation but is rare at craniocervical junction. The initial presentation is usually subarachnoid hemorrhage or cervical myelopathy caused by venous hypertension of the drainage vein. We report a male patient who has sudden onset of paraplegia, anesthesia of bilateral lower limbs, and urine retention. Cervical spinal cord edema and engorgement of posterior and anterior spinal veins were noted on magnetic resonance image study. Angiogram disclosed a SDAVF feeding by meningeal branch of the left vertebral artery and drainage inferiorly through posterior and anterior spinal vein. Complete obliteration of the fistula was achieved by transarterial embolization with n-butyl cyanoacrylate. The muscle power of lower limbs improved after the embolization. In previous studies, functional outcome is most correlated with pretreatment condition. Early diagnosis and treatment of the lesion will prevent permanent neurological deficit. [ABSTRACT FROM AUTHOR]

Objective: It was unclear whether older people without dementia who attempted suicide were at increased risk of subsequently developing dementia.Methods: Using the Taiwan National Health Insurance Research Database, 1,189 patients aged ≥ 65 years who attempted suicide and 4,756 age- and sex-matched control subjects were enrolled in our study and followed to the end of 2011. Those who developed dementia during the follow-up were identified.Results: Cox regression analysis, after adjusting for demographic data and medical comorbidities, found that geriatric suicide attempt was associated with an increased risk of subsequent dementia (HR: 7.40; 95% CI: 6.11-8.97; Wald χ2 = 414.87, df = 1, p < 0.001). Both patients aged between 65 and 79 years (HR: 7.74; 95% CI: 6.17-9.71; Wald χ2 = 312.62, df = 1, p < 0.001) and patients aged ≥ 80 years (HR: 6.94; 95% CI: 4.73-10.17; Wald χ2 = 97.78, df = 1, p < 0.001) who attempted suicide had an increased risk of developing dementia in later life.Conclusion: The elderly who attempted suicide were prone to developing dementia in later life, independent of depression and medical comorbidities. Further studies are necessary to clarify the underlying mechanisms between geriatric suicide and dementia and whether the prompt intervention for geriatric suicide may reduce this risk. [ABSTRACT FROM AUTHOR]

Carbon nanocapsule (CNC)@MnO2 core-shell particles are prepared with a reaction of KMnO4 with CNC at 90°C. Bimessite-type MnO2 nanoflakes are grown on CNC seeds, resulting in CNC@MnO2 panicles with a petal-like structure. The electrochemical characteristics of the prepared materials show that the highest specific capacitance (163 Fg-1 ) was obtained with a scan rate of 2 mVs-1 in 1 M Na2SO4. In addition, the synthesized material has superior cycling stability. The capacitance retains 97.8% of its initial value after 5000 cycles with a scan rate of 100 mVs-1 . [ABSTRACT FROM AUTHOR]

After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure- like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naeglefia fowlefi in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later. [ABSTRACT FROM AUTHOR]

Continuous ambulatory peritoneal dialysis (CAPD) is the most portable type of dialysis. Encapsulating peritoneal sclerosis (EPS) is a rare but devastating complication of CAPD. We report the case of a 65- year-old man with uremia who was under CAPD for a long time and presented with refractory abdominal pain. Abdominal X-ray showed several linear calcification in the bowel loop. Abdominal computer tomography showed coarse calcification in the peritoneum, omentum, and mesentery surrounding some small bowel loops. Based on the findings, EPS was diagnosed. After using tamoxifen and prednisolone, the patient was discharged with improved symptoms. [ABSTRACT FROM AUTHOR]

The purposes of this study are to explore the design of National Agricultural Library (NAL) of United States Department of Agriculture (USDA) and to evaluate the communication effectiveness of its web resources. This paper first discusses concepts of agricultural extension and information communication as well as agricultural web resource ape plication. It then analyzes the design of web resources on the NAL website. Finally, it concludes with the importance of constructing and adding values to digital library resources to expand the impacts of agricultural information on rural development. Also, some suggestions for researchers and practitioners in this field are proposed to help improve effectiveness of agricultural information communication in Taiwan. [ABSTRACT FROM AUTHOR]

Non-steroidal anti-inflammatory drugs (NSAIDs) can damage the gastrointestinal tract and cause severe complications, such as NSAID-induced enteropathy, which although reported previously, is easily ignored. NSAIDs are commonly used in the elderly owing to higher incidence of comorbidities. NSAIDinduced enteropathy is more important than the previously reported cases. We report a case of an 86-year-old woman who presented with persistent iron deficiency anemia with a positive fecal occult blood test. Initial esophagogastroduodenoscopy and colonoscopy showed no active bleeding. Although proton pump inhibitors were used, the anemia was refractory. Capsule enteroscopy revealed several circular and linear ulcers in the jejunum and ileum. NSAID-induced ulcers were considered. After discontinuing NSAIDs, the anemia improved gradually. In view of this case, we report our experience of typical NSAID-induced enteropathy with a successful clinical outcome. [ABSTRACT FROM AUTHOR]