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This study aimed to determine whether sleep disturbance, defined as the wakeup frequency at night, is associated with atherogenic dyslipidemia and to explore possible sex differences.A total of 1,368 adults aged 19-70 years were included in the study of lifestyles and atherogenic dyslipidemia at the National Taiwan University Hospital in the period of 2008-2012. They completed a questionnaire regarding lifestyle information and sleep quality, including sleep hour duration, use of sleeping pills, and wakeup frequency during nighttime sleep. The measured lipid profiles included total cholesterol, triglycerides, low- and high-density lipoprotein cholesterol (LDL-C and HDL-C, respectively), non-HDL-C, and small dense LDL-C (sdLDL-C). Multivariate logistic regression was performed to determine habitual interrupted sleep and the odds ratio of atherogenic dyslipidemia following adjustment for conventional risk factors and for sex-based subgroup analysis.A wakeup frequency ≥ 3 times per night was independently associated with an increased risk [odds ratio (95% confidence interval)] of dyslipidemia was 1.96 (1.17-3.28), and non-HDL-C ≥ 160 mg/dL was 1.78 (1.09-2.89). A higher wakeup frequency was associated with increased atherogenic dyslipidemia in women than in men. The multivariate adjusted relative risks for non-HDL ≥ 160 mg/dL and cholesterol ≥ 200 mg/dL were 3.05 (1.27-7.34) and 4.01(1.29-12.45) for female individuals with insomnia and those with a wakeup frequency ≥ 2 times per night, respectively.A higher wakeup frequency was associated with atherogenic dyslipidemia in Taiwanese adults, particularly in women. This study also provided another evidence of increasing cardiovascular diseases in subjects with habitual interrupted sleep.

Weight reduction decreases gastroesophageal reflux disease (GERD), but laparoscopic sleeve gastrectomy (LSG) that damages the structure of the stomach may worsen GERD. We aimed to elucidate the factors associated with increased severity of erosive esophagitis (EE) at 1 year after LSG.Data on patients who underwent LSG between February 2007 and March 2016 were reviewed. Endoscopic findings and anthropometric data before and after surgery were recorded. The severity of EE was assessed according to the Los Angeles classification; severe EE was defined as grade C or D esophagitis.Totally, 316 patients were enrolled. Before LSG, 96 patients (30.4%) had grade A or B EE. One year after LSG, 215 patients (68%) had EE, including 136 (43%) with grade A, 62 (19.6%) with grade B, and 17 (5.4%) with grade C or D EE. One-hundred and twenty-seven of 220 patients (57.7%) without EE before LSG developed de novo EE following LSG. The incidence of severe EE after LSG in patients without pre-operative EE, grade A EE, or grade B EE at baseline was 3.2%, 6.8%, and 50%, respectively. Independent factors for an increased severity of EE after LSG were male gender (OR = 2.55, 95% CI = 1.52-4.28) and post-operative hiatal hernia (OR = 3.17, 95% CI = 1.66-6.06).The prevalence and severity of EE increased after LSG. Male gender and post-operative hiatal hernia are independent factors for an increased severity of EE after LSG. The incidence of severe EE after LSG is low for patients without pre-operative EE or grade A EE at baseline.

Surgery for acute mesenteric infarction (AMI) is associated with high mortality. This study aimed to generate a mortality prediction model to predict the 30-day mortality of surgery for AMI. We included patients ≥18 years who received bowel resection in treating AMI and randomly divided into the derivation and validation groups. After multivariable analysis, the ‘Surgery for acute mesenteric infarction mortality score’ (SAMIMS) system was generated and was including age >62-year-old (3 points), hemodialysis (2 points), congestive heart failure (1 point), peptic ulcer disease (1 point), diabetes (1 point), cerebrovascular disease (1 point), and severe liver disease (4 points). The 30-day-mortality rates in the derivation group were 4.4%, 13.4%, 24.5%, and 32.5% among very low (0 point), low (1–3 point(s)), intermediate (4–6 points), and high (7–13 points)-risk patients. Compared to the very-low-risk group, the low-risk (OR = 3.332), intermediate-risk (OR = 7.004), and high-risk groups (OR = 10.410, p < 0.001) exhibited higher odds of 30-day mortality. We identified similar results in the validation group. The areas under the ROC curve were 0.677 and 0.696 in the derivation and validation groups. Our prediction model, SAMIMS, allowed for the stratification of the patients’ 30-day-mortality risk of surgery for acute mesenteric infarction.

The major treatment for perforated peptic ulcers (PPU) is surgery, and several scoring systems have been reported to predict morbidity and mortality after surgery. However, it remains unclear which patient should receive nonoperative management instead of surgery. This study aimed to generate a scoring system for surgeons to identify patients with PPU who may be too weak to undergo surgery and without any survival benefit. We extracted the admission data of adult (≥ 18 years) patients with PPU disease from the NHIRD database. They were randomly divided into an 80% model derivation cohort and a 20% validation cohort. Multivariate analysis with a logistic regression model was applied to generate the scoring system, PPUMS. The scoring system was then applied to the validation group. The PPUMS score ranged from 0 to 8 points, composite with age ( 80: 3 points), and five comorbidities (congestive heart failure, severe liver disease, renal disease, history of malignancy, and obesity: 1 point each). In the derivation group, patients with PPUMS > 4 had a 45.9% in-hospital mortality rate and similar in-hospital mortality risk in the operation group [traditional laparotomy: odds ratio (OR) = 0.729, p = 0.320, laparoscopy: OR = 0.772, p = 0.697] and the non-operation group. In the validation group, patients with PPUMS > 4 points had a 36.9% mortality rate and similar mortality risk in the operation group (traditional laparotomy: OR = 0.353, p = 0.093, laparoscopy: no applicable) and non-operation group. PPUMS is a good predictor of mortality risk in patients with PPU and with various underlying diseases or comorbidities. Surgical management is suggested for patients with PPU with PPUMS ≤ 4 points because of lower mortality risk. However, in patients with PPUMS > 4 points, surgery may have limited benefit due to the high mortality rate compared to nonoperative treatment.

The present study aimed to investigate bariatric surgery’s effects on pregnancy in obese women. The source of the data was the Taiwan National Health Insurance Research Database. We extracted female patients aged 18 to 45 years who had been diagnosed with obesity from 2005 to 2010. Two groups were formed based on bariatric surgery, according to the medical procedure codes of ICD-9-2001. The propensity score match of 1:1 was coordinated, based on the age, previous delivery, and the existence of comorbidities in patients. The primary endpoint was regarded as a pregnancy, including abortion, ectopic pregnancy, and delivery. The follow-up was performed until the end of 2013, or death. There were 689 patients placed in each group, with a median of 64.8 follow-up months. Following multivariate analysis of the data, bariatric surgery resulted in significantly higher chances for pregnancy (aHR 2.886, p

This study aims to determine whether bariatric surgery (BS) decreases the risk of respiratory tract infections (RTIs) in obese patients. This retrospective, population-based, matched cohort study utilized data from the Taiwan National Health Insurance Research Database. All patients 18 to 55 years of age with obesity diagnosed between 2005 and 2010 were enrolled. Patients were separated into two groups based on whether they underwent BS. Two groups were selected using 1:1 propensity score matching according to age, sex, and comorbidities. The general population was also enrolled for comparison. The primary endpoint was the incidence of RTIs, including pneumonia, influenza, and bronchitis. All patients were followed up until the end of 2013, the primary endpoint, or death. Compared to the non-surgery group, the BS group was at significantly lower risk for RTIs (aHR 0.432, 95% CI 0.340–0.549, p

Low-density lipoprotein cholesterol (LDL-C) and total to high-density lipoprotein cholesterol (TC/HDL-C) ratio are both common risk factors for atherosclerotic cardiovascular diseases (ASCVDs). However, whether high-sensitivity C-reactive protein (hsCRP) has synergistic or attenuated effects on atherogenic dyslipidemia remains unclear. We investigated subclinical carotid atherosclerosis in patients with familial hypercholesterolemia (FH) and their family members. A total of 100 families with 761 participants were prospectively studied. Participants were categorized into four groups according to atherogenic dyslipidemia and inflammatory biomarkers. The group with LDL-C ≥ 160 mg/dL (or TC/HDL-C ratio ≥ 5) combined with hsCRP ≥ 2 mg/L have a thicker carotid intima-media thickness (CIMT) in different common carotid artery (CCA) areas and a higher percentage of high plaque scores compared with other subgroups. Multivariate logistic regression analysis revealed a significantly higher adjusted odds ratio (aOR) for thicker CIMT of 3.56 (95% CI: 1.56–8.16) was noted in those with concurrent LDL-C ≥ 160 mg/dL and hsCRP ≥ 2 mg/L compared with the group with concurrent LDL-C < 160 mg/dL and hsCRP < 2 mg/L. Our results demonstrated that systemic inflammation, in terms of higher hsCRP levels ≥ 2 mg/L, synergistically contributed to atherogenic dyslipidemia of higher LDL-C or a higher TC/HDL-C ratio on subclinical atherosclerosis.

Consumption of certain berries appears to slow postprandial glucose absorption, attributable to polyphenols, which may benefit exercise and cognition, reduce appetite and/or oxidative stress. This randomised, crossover, placebo-controlled study determined whether polyphenol-rich fruits added to carbohydrate-based foods produce a dose-dependent moderation of postprandial glycaemic, glucoregulatory hormone, appetite andex vivooxidative stress responses. Twenty participants (eighteen males/two females; 24 (sd5) years; BMI: 27 (sd3) kg/m2) consumed one of five cereal bars (approximately 88 % carbohydrate) containing no fruit ingredients (reference), freeze-dried black raspberries (10 or 20 % total weight; LOW-Rasp and HIGH-Rasp, respectively) and cranberry extract (0·5 or 1 % total weight; LOW-Cran and HIGH-Cran), on trials separated by ≥5 d. Postprandial peak/nadir from baseline (Δmax) and incremental postprandial AUC over 60 and 180 min for glucose and other biochemistries were measured to examine the dose-dependent effects. Glucose AUC0–180 mintrended towards being higher (43 %) after HIGH-Raspv.LOW-Rasp (P=0·06), with no glucose differences between the raspberry and reference bars. Relative to reference, HIGH-Rasp resulted in a 17 % lower Δmaxinsulin, 3 % lower C-peptide (AUC0–60 minand 3 % lower glucose-dependent insulinotropic polypeptide (AUC0–180 min)Pex vivooxidation, appetite-mediating hormones or appetite. Fortification with freeze-dried black raspberries (approximately 25 g, containing 1·2 g of polyphenols) seems to slightly improve the glucoregulatory hormone and glycaemic responses to a high-carbohydrate food item in young adults but did not affect appetite or oxidative stress responses at doses or with methods studied herein.

BACKGROUND The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health. OBJECTIVE This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic. METHODS We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper. RESULTS Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of CONCLUSIONS The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies.

Made available in DSpace on 2021-06-25T10:21:50Z (GMT). No. of bitstreams: 0 Previous issue date: 2021-02-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) Considering the importance and lack of data of toxicogenomic approaches on occupational exposure to anesthetics, we evaluated possible associations between waste anesthetic gases (WAGs) exposure and biological effects including oxidative stress, DNA damage, inflammation, and transcriptional modulation. The exposed group was constituted by anesthesia providers who were mainly exposed to the anesthetics sevoflurane and isoflurane (10 ppm) and to a lesser degree to nitrous oxide (150 ppm), and the control group was constituted by physicians who had no exposure to WAGs. The oxidative stress markers included oxidized DNA bases (comet assay), malondialdehyde (high-performance liquid chromatography [HPLC]), nitric oxide metabolites (ozone-chemiluminescence), and antioxidative markers, including individual antioxidants (HPLC) and antioxidant defense marker (ferric reducing antioxidant power by spectrophotometry). The inflammatory markers included high-sensitivity C-reactive protein (chemiluminescent immunoassay) and the proinflammatory interleukins IL-6, IL-8 and IL-17A (flow cytometry). Telomere length and gene expression related to DNA repair (hOGG1 and XRCC1), antioxidant defense (NRF2) and inflammation (IL6, IL8 and IL17A) were evaluated by real-time quantitative polymerase chain reaction. No significant differences (p >.0025) between the groups were observed for any parameter evaluated. Thus, under the conditions of the study, the findings suggest that occupational exposure to WAGs is not associated with oxidative stress or inflammation when evaluated in serum/plasma, with DNA damage evaluated in lymphocytes and leucocytes or with molecular modulation assessed in peripheral blood cells in university anesthesia providers. However, it is prudent to reduce WAGs exposure and to increase biomonitoring of all occupationally exposed professionals. Medical School São Paulo State University (UNESP) Department of Epidemiology Harvard T.H. Chan School of Public Health Channing Division of Network Medicine Department of Medicine Brigham and Women's Hospital and Harvard Medical School Antioxidants Research Laboratory Jean Mayer Human Nutrition Research Center on Aging (HNRCA) Tufts University UNIPEX Medical School São Paulo State University (UNESP) Institute of Biosciences São Paulo State University (UNESP) Medical School São Paulo State University (UNESP) UNIPEX Medical School São Paulo State University (UNESP) Institute of Biosciences São Paulo State University (UNESP) CNPq: 147505/2018-6 CNPq: 149888/2019-8 FAPESP: 2016/155559-1 FAPESP: 2016/23902-8 FAPESP: 2017/18045-1 CNPq: 304107/2018-2

This study evaluated the differences in long-term cardiovascular events between obese patients who received bariatric surgery (BS), those who did not, and the general population (GP). Between 2003 and 2008, patients with severe obesity, aged 18–55 years, were divided into the non-surgical (NS) and BS groups and were included in this retrospective study. We also extracted data of healthy civilians defined as the GP. The incidence of cardiovascular events, including myocardial infarction, intracranial hemorrhage, epidural hemorrhage, ischemic stroke, and transient ischemic attack, was defined as the primary end point. Patients were followed up either until the end of 2013, upon reaching the primary end point, or death. After propensity score matching, 1436 patients were included in both the BS and NS groups, and 4829 subjects were enrolled as the GP. Of these, 57 (3.9%), 10 (0.6%), and 30 (0.62%) subjects in the NS, BS, and GP, respectively, experienced cardiovascular events. Multivariate analysis revealed that patients with BS had a significantly lower risk of cardiovascular events (HR = 0.168; 95% CI 0.085–0.328; p

Made available in DSpace on 2020-12-12T01:55:06Z (GMT). No. of bitstreams: 0 Previous issue date: 2020-05-01 Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq) Agricultural Research Service Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) This cross-sectional study analyzed the impact of occupational waste anesthetic gases on genetic material, oxidative stress, and inflammation status in young physicians exposed to inhalational anesthetics at the end of their medical residency. Concentrations of waste anesthetic gases were measured in the operating rooms to assess anesthetic pollution. The exposed group comprised individuals occupationally exposed to inhalational anesthetics, while the control group comprised individuals without anesthetic exposure. We quantified DNA damage; genetic instability (micronucleus-MN); protein, lipid, and DNA oxidation; antioxidant activities; and proinflammatory cytokine levels. Trace concentrations of anesthetics (isoflurane: 5.3 ± 2.5 ppm, sevoflurane: 9.7 ± 5.9 ppm, and nitrous oxide: 180 ± 150 ppm) were above international recommended thresholds. Basal DNA damage and IL-17A were significantly higher in the exposed group [27 ± 20 a.u. and 20.7(19.1;31.8) pg/mL, respectively] compared to the control group [17 ± 11 a.u. and 19.0(18.9;19.5) pg/mL, respectively], and MN frequency was slightly increased in the exposed physicians (2.3-fold). No significant difference was observed regarding oxidative stress biomarkers. The findings highlight the genetic and inflammatory risks in young physicians exposed to inhalational agents in operating rooms lacking adequate scavenging systems. This potential health hazard can accompany these subjects throughout their professional lives and reinforces the need to reduce ambient air pollution and consequently, occupational exposure. GENOTOX Laboratory - UNIPEX Department of Anesthesiology Medical School São Paulo State University - UNESP Antioxidants Research Laboratory Jean Mayer USDA Human Nutrition Research Center on Aging Tufts University Department of Bioestatistics Institute of Biosciences São Paulo State University - UNESP Department of Pathology Medical School São Paulo State University - UNESP GENOTOX Laboratory - UNIPEX Department of Anesthesiology Medical School São Paulo State University - UNESP Department of Bioestatistics Institute of Biosciences São Paulo State University - UNESP Department of Pathology Medical School São Paulo State University - UNESP CAPES: 14527-13-8 CNPq: 164242/2014-7 Agricultural Research Service: 1950-51000-087 FAPESP: 2013/12120-0 FAPESP: 2013/18075-7 FAPESP: 2013/21130-0 FAPESP: 2014/08661-9 FAPESP: 2015/06420-7 CNPq: 472453/2013-0

Background: Medical residency is a time of high stress and long working hours, which increase the risk of cardiovascular disease. This study aimed to investigate the autonomic modulation of resident physicians throughout the on-call duty cycle. Methods: Spectral analysis of heart rate variability (HRV) was used to compute cardiac parasympathetic modulation (high-frequency power, HF) and cardiac sympathetic modulation (normalized low-frequency power, LF%, and the ratio of LF and HF, LF/HF) of 18 residents for a consecutive 4-day cycle. Results: Male residents show reduced cardiac sympathetic modulation (i.e., higher LF/HF and LF%) than the female interns. Medical residents&rsquo, cardiac parasympathetic modulation (i.e., HF) significantly increased on the first and the second post-call day compared with the pre-call day. In contrast, LF% was significantly decreased on the first and the second post-call day compared with the pre-call day. Similarly, LF/HF was significantly decreased on the second post-call day compared with the pre-call day. LF/HF significantly decreased on the first post-call day and on the second post-call day from on-call duty. Conclusion: The guideline that limits workweeks to 80 h and shifts to 28 h resulted in reduced sympathetic modulation and increased parasympathetic modulation during the two days following on-call duty.

Little is known about the effects of desflurane associated or not with nitrous oxide (N2O) on oxidative stress and patient genetic material. The aim of this study was to compare the effects of anesthesia maintained with desflurane associated or not with N2O on DNA damage (as a primary outcome) and oxidative stress (as a secondary outcome) in patients who underwent an elective minimally invasive surgery.This prospective randomized clinical trial analyzed 40 patients of both sexes with an American Society of Anesthesiologists physical status I who were 18-50 years of age and scheduled for septoplasty. The patients were randomly allocated into 2 groups according to anesthesia maintenance as follows: desflurane (n = 20) or desflurane/N2O (n = 20). Blood samples were collected before anesthesia (T1 = baseline), 1.5 hours after anesthesia induction (T2), and on the morning of the postoperative first day (T3). Basal and oxidative DNA damage (determined using formamidopyrimidine DNA glycosylase to detect oxidized purines and endonuclease III to detect oxidized pyrimidines) were evaluated using the comet assay. Oxidative stress markers were evaluated based on lipid peroxidation (by assessing 4-hydroxynonenal and 8-iso-prostaglandin F2α [8-isoprostane] using enzyme linked immunosorbent immunoassay), protein carbonyls (assessed by enzyme linked immunosorbent immunoassay), and antioxidant defense (ferric-reducing antioxidant power by spectrophotometry). The effect size was expressed as the mean differences between groups and the corresponding 95% confidence interval (CI).There was no significant mean difference between groups in relation to DNA damage (-1.7 [95% CI, -7.0 to 3.5]), oxidized DNA pyrimidines (-1.8 [95% CI, -12.5 to 8.9]) and purines (-1.9 [95% CI, -13.9 to 10.1]), 4-hydroxynonenal (-0.2 [95% CI, -2.8 to 2.4]), 8-isoprostane (549 [95% CI, -2378 to 3476]), protein carbonyls (0.2 [95% CI, -2.1 to 2.3]), or ferric-reducing antioxidant power (24 [95% CI, -52.0 to 117.2]).The coadministration of 60% N2O with desflurane did not seem to impair the effects on DNA or the redox status compared with desflurane anesthesia, suggesting that both studied anesthetic techniques can be suitable options for healthy individuals who undergo minimally invasive surgery lasting at least 1.5 hours. However, due to the low power of the study, more research is necessary to confirm our findings.

Grape pomace (GP) is rich in polymeric polyphenolics and glycosides which have lower bioefficacy than monomeric and aglycone counterparts. The aim of this study was to determine whether tannin acyl hydrolase [tannase (TNS)] can improve the antioxidant and anti-inflammatory actions of GP in Caco-2 cells treated with IL-1β. TNS increased quercetin content by 45% and decreased quercetin-3-O-rutinoside by 71% as compared to untreated GP. Further, TNS increased total phenols and DPPH, ORAC, and FRAP values by 39, 57, 215, and 12%, respectively. However, GP and GPTNS at 100 and 200 μg/mL (dry extract wt/v) displayed comparable efficacy in the reduction of ROS in Caco-2 cells. After 24 h pre-treatment, GPTNS (200 μg/mL) decreased IL-1β-induced PGE2 and IL-8 secretion by 107 and 83% respectively, and down-regulated NF-κB activation by 63%. Thus, TNS appears to enhance antioxidant and anti-inflammatory activities of GP polyphenolics and suggests their use as a value-added agroindustrial residue.

Background The World Health Organization has recognized the importance of assessing population-level mental health during the COVID-19 pandemic. During a global crisis such as the COVID-19 pandemic, a timely surveillance method is urgently needed to track the impact on public mental health. Objective This brief systematic review focused on the efficiency and quality of data collection of studies conducted during the COVID-19 pandemic. Methods We searched the PubMed database using the following search strings: ((COVID-19) OR (SARS-CoV-2)) AND ((Mental health) OR (psychological) OR (psychiatry)). We screened the titles, abstracts, and texts of the published papers to exclude irrelevant studies. We used the Newcastle-Ottawa Scale to evaluate the quality of each research paper. Results Our search yielded 37 relevant mental health surveys of the general public that were conducted during the COVID-19 pandemic, as of July 10, 2020. All these public mental health surveys were cross-sectional in design, and the journals efficiently made these articles available online in an average of 18.7 (range 1-64) days from the date they were received. The average duration of recruitment periods was 9.2 (range 2-35) days, and the average sample size was 5137 (range 100-56,679). However, 73% (27/37) of the selected studies had Newcastle-Ottawa Scale scores of Conclusions The studies examined in this systematic review used an efficient data collection method, but there was a high risk of bias, in general, among the existing public mental health surveys. Therefore, following recommendations to avoid selection bias, or employing novel methodologies considering both a longitudinal design and high temporal resolution, would help provide a strong basis for the formation of national mental health policies.

Taiwan, as one of the jurisdictions comprising the so-called “fourth wave of democratization,” fundamentally altered its criminal justice system over the course of just decades. This was particularly true with respect to the rule of law and the procedural law around the exclusion of evidence. For example, although illegally obtained, or “tainted” evidence may be crucial in the search for the truth, it is to be excluded if it was obtained under certain circumstances, including torture or coercion. The legal theory behind this area of Taiwanese law is grounded in the common law criminal justice system, although Taiwan has developed its own procedures and remedies. How illegally obtained evidence is excluded in Taiwanese criminal procedure is discussed, as is the melding of the Thai approach with its theoretical basis in Anglo-US criminal procedure. Both practical and theoretical perspectives are explored and the gaps between the formation of legislation and its enactment into judicial practice are addressed.

Introduction Size-selective aerosol samplers are used to assess the health effect, because the retention of deposited particles in the respiratory tract is strongly size dependent. The main objective of this work is to examine the particle loading effects on PM2.5 cyclone samplers. Methods In this work, five PM2.5 cyclones of different body diameters (9.3–35.6 mm), derived from the BGI VSCC, were designed and fabricated to investigate the effects of particle loading. An ultrasonic atomizing nozzle was used to generate micro-meter-sized potassium sodium tartrate (PST) particles and Sodium chloride (NaCl) particles as solid challenge aerosols, and di-ethyl-hexyl-sebacate (DEHS) particles as liquid challenge particles. Aerosol number size distributions and concentrations, both upstream and downstream of the cyclones, were measured using an aerodynamic particle sizer. In addition to the cyclone body diameter, other parameters investigated in this work included: challenge aerosol size distribution, chamber humidity, and the material of the cyclone. Results The PM2.5 cyclones could be used to sample liquid particles without any bias, because the deposited liquid aerosols dripped down and did not accumulate on the inner wall of the cyclone. However, when challenged with solid particles, the deposited and accumulated aerosols on the wall reduced the aerosol penetration, and changed the curve to be less sharp. The extent of underestimation was affected by many parameters, such as challenge aerosol size distribution, humidity, test agent, and the elastic properties of the cyclone and the test agent. On average, there was an underestimation of 20% of 2.5 µm aerosol penetration when challenged with PST particles, regardless of cyclone body size. This suggested that cyclones might not be ideal for sampling solid particles. Discussion Cyclone samplers currently used for size-selective sampling are likely subject to aerosol loading effect, and resulted in underestimation of the PM2.5 measurements. The use of virtual cyclone or wet cyclone might solve parts of the problem.

Introduction Fit testing should be performed before the use of tight-fitting respirators. However, it may not always be conducted for various reasons, mostly time consuming and costly. This study aimed to shorten the fit testing procedures by improving the instrumental settings, sampling system design, and data analysis protocols. Methods Experiments of fit factor measurements were divided into two parts: constant flow and cyclic flow using a breathing simulator. To simulate leakage, capillaries (10 mm in length, diameter 1.0–1.5 mm) were used to insert on N95 and N100 filtering facepieces. The ratio of total to leak flow was considered the ‘true fit factor, FFt’. Flow rates ranging from 5–50 L/min were employed to study the flow dependency. The measured fit factors were determined by concurrent particle concentration measured by a Portacount and a OPS 3330. The default 1.7 m sampling tube was used to connect filtering facepiece to the aerosol instruments. In addition, the effects of breathing pattern (tidal volume: 0.5–1 L, frequency: 5–20 times/min) and lung deposition (with/without HEPA filter behind the respirator) on in-mask particle concentration during fit testing were analysed, to explore the minimal sampling time that approximated the FFt. Results The particle measurement response times for Portacount and OPS were approximately 5 and 2 s, respectively. For P100 respirators, most measured fit factors were close to the FFt. Whereas, there was an underestimation while using N95 respirator due to filter penetration. Therefore, N95-companion was necessary while testing N95 respirator. For the cyclic flow tests, the fit factor was overestimated because the sampling tube was connected onto the facepiece where filtered air was partly sampled. The higher the breathing flow rate, the more the fit factor was overestimated. On the other hand, the measured fit factor would be close to the FFt when using the highest concentration during a breathing cycle (FFmin). In theory, it could be decided in only one breathing cycle. Conclusion With improved design in instrumental setting and operating procedures, a fit test for an individual exercise would take approximately only 12 s. Therefore, the whole fit testing process could be shortened from 7.5 to about 3 min.

Introduction This study described the trends and compensation patterns of fatal occupational injuries and occupational diseases in Taiwan and examined the similarities and differences with that of selected countries. Methods Numbers, occurrence rates and compensation benefits of fatal occupational injuries and occupational diseases in Taiwan were obtained from official statistics for the period from 1998 to 2016. Also obtained were official statistics on the numbers and major types of compensated occupational diseases from Japan, South Korea and selected European countries. Results From 1998 to 2016, the coverage of the workers’ compensation insurance program expanded from 79.6% to 86.7%, and occupational fatality had declined substantially but was still higher as compared to other developed countries. Analyses of the levels of claimants’ compensation benefits showed that the average amount of benefits for fatal cases had been reduced steadily. Despite of recent efforts by the government in improving the recognition of occupational disease, the compensation rates of occupational diseases remained low (8.18 per 1 00 000 insured). Musculoskeletal disorders were the most dominant type of occupational disease in Taiwan, accounting for up to 66% in 2016, following by respiratory diseases (17%) and stress-related cerebrovascular and cardiovascular diseases (10%). Discussion The observed improvement in occupational fatality had been accompanied by a downward trend in average compensation benefits, suggesting a shift of occupational fatalities toward low-wage groups. On one hand, under-recognition and under-compensation of occupational diseases were severe, that may due to multiple institutional and administrative barriers as well as lower social awareness on the work-relatedness of disease causality. On the other hand, the high visibility of cerebrovascular and cardiovascular events suggested the social concerns over long working hours and heavy workloads might have played a significant role in the recognition of overwork-related occupational diseases.

Introduction Motorcyclists could be exposed to high PM2.5 up to 460 μg/m3. The aim of this work was to develop a full faced helmet (FFH) that provides clean air and cool temperature inside the helmet to reduce particulate exposure and increase comfort for motorcyclists. Methods A commercial FFH was modified to generate cool and clean air in a way similar to the powered-air-purified-respirator, commonly used in industrial settings. Three different clean air supply locations (A: upper rear of the head, B: zygomatic side, and C: lower chin) were applied to investigate the location effect. A small wind tunnel was used to simulate the turbulence that motorcyclists might encounter while riding on the road. The operating parameters included: the supply air flow rate to the helmet (Qs), the velocity in the wind tunnel (U0) and breathing flow rate which is a combination of tidal volume and breathing frequency. To minimise infiltration of aerosol outside the helmet into the breathing zone, the FFH was tightly surrounded with a neckerchief made of different materials. The stiffness of the neckerchief was measured by using a 45° angled Cantilever. A condensation particle counter was used to measure particle number concentrations both inside and outside the FFH, to calculate the protection factor, PF. Results The PF of the FFH increased with increasing Qs, but decreased with increasing wind speed and breathing flow rate. At breathing flow rate of 7.5 L/min with the FFH sealed using neckerchief, PF increased from 1 to 900 as Qs increased from 0 to 50 L/min under calm air condition, with air supply through location A. Meanwhile, the PF decreased from 900 to 3 when wind velocity increased from calm air to 10 m/s. The PF increased significantly when the FFH was sealed with a neckerchief made of soft shell (stiffness 19.2 mm, 28 cm long). In addition, the temperature on the top of head decreased with increasing supply air flow. Discussion Applying a higher Qs up to 100 L/min is necessary, not only to maintain a positive pressure inside the helmet but also to decrease the concentration of carbon dioxide exhaled by the wearer. The use of the soft shell neckerchief is also critical to reduce the infiltration due to external turbulence.

Laparoscopic gastric bypass is a commonly performed bariatric surgery for the treatment of morbid obesity. Revision surgery for patients who have gastric bypass complications is a challenge for bariatric surgeon. Our aim is to present the early results of the conversions of gastric bypass complications to sleeve gastrectomies. From January 2001 to April 2015, 49 of 2382 gastric bypasses underwent revisional surgery to convert gastric bypasses to sleeve gastrectomies. The demographic data, surgical parameters, and outcomes were studied. The mean age of the study group was 35.0 years (range 20 to 55), and the average body mass index (BMI) prior to the reoperation was 25.3 kg/m2. Seven patients had previous laparoscopic Roux-en-Y gastric bypasses (LRYGBs), and 42 had laparoscopic single anastomosis (mini-) gastric bypasses (LSAGBs). The main reasons for the revisions were malnutrition (58 %), weight regain (10 %), intolerance (18 %), and others (14 %). The revisional surgeries had longer operative times, greater blood loss, and longer flatus passage times than the primary gastric bypass surgeries. Four patients (8.1 %) developed major complications during revisional surgery, including three (6.1 %) cases of leakage and one (2.0 %) case of internal bleeding. No mortality was noted. After conversion to sleeve gastrectomy, the body weights of the patients remained stable, and all patients improved in terms of malnutrition, including anemia, hypoalbuminemia, and secondary hyperparathyroidism. Conversion to sleeve gastrectomy is an effective and safe option for patients with gastric bypass complications. The conversions to sleeve gastrectomy resulted in significant improvements in malnutrition and maintained weight loss at the early follow-ups.

As visible light communication (VLC) can be one of the promising wireless communication technologies in the future, improving the transmission security in VLC is highly desirable. We propose and demonstrate a secure VLC system using data superposition of different light emitting diodes (LEDs). The eavesdroppers can receive similar illumination but cannot obtain enough signal-to-noise ratio (SNR) for communication. The channel model and simulation parameters are presented. Analysis of the secure VLC zone forming using practical in-home scenarios is also discussed, showing the flexibly control the size and shift of secure VLC zone. A proof-of-concept experiment is performed, and there is a good match in trend between the experimental and simulation results.

BackgroundRespiratory diseases, including pneumoconiosis, asthma, chronic obstructive pulmonary disease (COPD) and respiratory malignancies, are featured by their multi-etiological nature and long latency periods, adding to the difficulties in recognizing their work-relatedness. Due to their heavy overall disease burdens and high healthcare spending, examining the fraction of respiratory diseases attributable to occupational factors is helpful in understanding the magnitude of under-estimation of occupational injuries and diseases.MethodsPrevalence rates of various occupational exposures were assessed retrospectively with self-reported surveys or job-exposure matrices. Relative risks of theses exposures were drawn from international epidemiological literatures. The above two parameters were used to calculate population attributable risk percentages (PAR%), and with that the numbers of visiting and amounts of payment attributable to occupational factors were estimated based on the claim data of the National Health Insurance (NHI). The estimates were compared with the data of actual payment by the Workers’ Compensation Insurance (WCI).ResultsWe estimated that around 15 000 patients visited medical facilities for occupational respiratory diseases in 2015, costing a total of 10 million USD. In contrast, less than 200 cases were approved by WCI in the same year. A 100-fold gap between the estimated and actual payment was also noted. Estimation analyses further indicated that 9.6% of cases and 48.1% of healthcare costs were asbestos-related.ConclusionFor occupational respiratory diseases with long latency periods and great causal complexity, the scope of under-estimation was substantial, and their medical expenses had been largely paid by NHI rather than WCI. To increase the visibility of occupational respiratory diseases, workplace exposure assessment and disease surveillance should be improved and public awareness of occupational diseases should be raised.

Based on the rolling shutter effect of the complementary metal-oxide-semiconductor (CMOS) image sensor, bright and dark fringes can be observed in each received frame. By demodulating the bright and dark fringes, the visible light communication (VLC) data logic can be retrieved. However, demodulating the bright and dark fringes is challenging as there is a high data fluctuation and large extinction ratio (ER) variation in each frame due. Hence proper thresholding scheme is needed. In this work, we propose and compare experimentally three thresholding schemes; including third-order polynomial curve fitting, iterative scheme and quick adaptive scheme. The evaluation of these three thresholding schemes is performed.

Almond skin polyphenolics (ASP) and vitamin C (VC) or E (VE) inhibit the Cu(2+)-induced generation of conjugated dienes in human low-density lipoprotein (LDL) in a synergistic manner. However, the mechanism(s) by which this synergy occurs is unknown. As modification of apolipoprotein (apo) B-100 is an early, critical step in LDL oxidation, we examined the effects of combining ASP or quercetin and antioxidant vitamins on the oxidation of this moiety as well as on the alteration of LDL conformation and electronegativity (LDL-). In a dose-dependent manner, ASP (0.12-2.0 micromol/L gallic acid equivalents) decreased tryptophan (Trp) oxidation by 6.7-75.7%, increased the generalized polarity (Gp) of LDL by 21.0-81.5% at 90 min and reduced the ratio of LDL- to total LDL (tLDL) by 38.2-83.8% at 5 h. The actions of ASP on these parameters were generally additive to those of VC and VE. However, a 10-25% synergy of ASP plus VC in protecting apo B-100 Trp against oxidation may result from their synergistic interaction in prolonging the lag time to oxidation. ASP and VE acted in synergy to reduce LDL-/tLDL by 24-43%. Quercetin's actions were similar to ASP, though more effective at inhibiting Trp oxidation. Thus, ASP and quercetin reduce the oxidative modification of apo B-100 and stabilize LDL conformation in a dose-dependent manner, acting in an additive or synergistic fashion with VC and VE.

The antioxidant activities of fruits (n = 21), vegetables (n = 67) and legumes (n = 7) commonly consumed in Korea were determined by both the lipophilic antioxidant performance assay (LAP) and the hydrophilic oxygen radical absorbance capacity assay (ORAC). The LAP assay used the lipophilic radical initiator MeO-AMVN [2,2′-azobis(4-methoxy-2,4-dimethylvaleronitrile)] and the lipophilic probe BODIPY 581/591 [4,4-difluoro-5-(4-phenyl-1,3-butadienyl)-4-bora-3a, 4a-diaza-s-indacene-3-undecanoic acid]. The ORAC assay used the hydrophilic radical initiator AAPH [2,2′-azobis(2-amidinopropane) dihydrochloride] and the hydrophilic probe fluorescein. In addition, the lipid-soluble phytonutrients, carotenoids and tocopherols were determined by a reverse-phase HPLC system using a C30 column with a UV detector. The water-soluble phytonutrient, ascorbic acid, was analyzed using an HPLC system with an electrochemical detector. Total phenols were determined by UV spectrophotometry. Tocopherols (r = 0.774, p < 0.0001) and carotenoids (r = 0.569, p < 0.0001) were significantly correlated with LAP in total samples (n = 95). ORAC was significantly correlated with total phenols (r = 0.893, p < 0.0001), but not with ascorbic acid (r = 0.009, p = 0.929) in total samples (n = 95). These data indicate that carotenoids and tocopherols and total phenols are the major contributors to the lipophilic and hydrophilic antioxidant capacities, respectively. Therefore, the contribution of both the hydrophilic and lipophilic components of fruits and vegetables should be considered when determining the actual ‘total’ antioxidant activity of fruits and vegetables. Copyright © 2007 Society of Chemical Industry

We demonstrate using solar cell as optical receiver (Rx) for visible light communication (VLC). The solar cell is low cost and can convert the VLC optical signal into electrical signal without external power supply. As the response of the solar cell is very limited; we also propose and demonstrate using pre-distortion to significantly enhance the response of the solar cell Rx. A VLC capacity of 0.4 Mbit/s at bit-error-rate (BER) of 10−9 under wireless transmission distance of 75 cm; and a capacity of 0.3 Mbit/s at BER of 10−9 under wireless transmission distance of 125 cm can be achieved.

Limited information is available concerning the qualitative and quantitative composition of polyphenolic compounds, especially flavonoids, in almonds. We determined total phenols, flavonoids, and phenolic acids in California almond (Prunus dulcis) skins and kernels among the principal almond varieties (Butte, Carmel, Fritz, Mission, Monterey, Nonpareil, Padre, and Price) with high-performance liquid chromatography (HPLC)/electrochemical detection and UV detection. Liquid chromatography/tandem mass spectrometry under identical HPLC conditions was utilized to verify identities of the predominant flavonoids and phenolic acids. Total phenols ranged from 127 (Fritz) to 241 (Padre) mg gallic acid equivalents/100 g of fresh weight. The analyses were compiled to produce a data set of 18 flavonoids and three phenolic acids. The predominant flavonoids were isorhamnetin-3-O-rutinoside and isorhamnetin-3-O-glucoside (in combination), catechin, kaempferol-3-O-rutinoside, epicatechin, quercetin-3-O-galactoside, and isorhamnetin-3-O-galactoside at 16.81, 1.93, 1.17, 0.85, 0.83, and 0.50 mg/100 g of fresh weight almonds, respectively. Using the existing approach of calculating only the aglycone form of flavonoids for use in the U.S. Department of Agriculture nutrient database, whole almonds would provide the most prevalent aglycones of isorhamnetin at 11.70 (3.32), kaempferol at 0.60 (0.17), catechin at 1.93 (0.55), quercetin at 0.72 (0.20), and epicatechin at 0.85 (0.24) mg/100 g of fresh weight (mg/oz serving), respectively. These data can lead to a better understanding of the mechanisms of action underlying the relationship between almond consumption and health-related outcomes and provide values for whole and blanched almonds suitable for inclusion in nutrient databases.

Soy isoflavones are associated with low incidence of cardiovascular diseases (CVD) and hormone-dependent cancers, but no solid information is available on the relative deposition of isoflavones in the body as a function of age. One-year-old (adult) male Sprague-Dawley rats were fed control diet or one of three high-genistein isoflavone (HGI) diets at a dose of 62, 154, or 308 genistein mg/kg (ppm) diet for 5 weeks; 2-year-old (old) were fed a dose of 154 or 308 ppm. Steady-state genistein concentrations in plasma, liver, and gastrocnemius muscle of the adult rats after 12 h fast revealed a linear dose-dependent manner (P < or = 0.0001). However, there was no such relationship in the old rats. Nevertheless, old rats fed the 308 ppm genistein diet had significantly lower steady-state genistein concentrations in plasma and liver than the adult rats did (P < or = 0.05); but similar genistein concentration in muscle. The results of this study indicate that steady-state genistein concentrations in tissues of adult rats after 12 h fast exhibited a dose-dependent fashion and were diminished in specific tissues by age.

Almonds provide a nutrient-dense source of vitamin E, manganese, magnesium, copper, phosphorus, fibre, riboflavin, monounsaturated fatty acids and protein. Although almost 50% of almond weight is fat, incremental intakes of 7 g day−1 of this tree nut reduce low-density lipoprotein (LDL) cholesterol concentration by 1%, especially within the context of diets recommended by the National Cholesterol Education Program. Habitual almond consumption does not lead to weight gain, and their inclusion in low-calorie diets appears to promote more weight loss than a comparable carbohydrate-based low-calorie diet. Also, almonds have a low glycemic index and do not adversely impact insulin sensitivity. Almonds are an excellent source of bioavailable α-tocopherol, and increasing their intake enhances the resistance of LDL against oxidation. In addition, the polyphenolic constituents of almonds have been characterised recently and found to possess antioxidant actions. While benefits of almonds for cardiovascular health and obesity-related diseases appear promising, the potential allergenic reaction among susceptible individuals can present a risk. Further research is required to achieve a better understanding of the role that the bioavailability and bioaccessibility of almond constituents and the synergy between them play in their associated health outcomes. Copyright © 2006 Society of Chemical Industry

Consumption of tree nuts such as almonds has been associated with a reduced risk of coronary heart disease. Flavonoids, found predominantly in the skin of almonds, may contribute to their putative health benefit, but their bioactivity and bioavailability have not previously been studied. Almond skin flavonoids (ASF) were extracted with HCl:H2O:methanol (1:19:80) and their content of catechins and flavonols identified by HPLC with electrochemical detection. ASF bioactivity was assessed in vitro by their capacity to increase the resistance of human LDL to oxidation induced by 10 micromol/L Cu2+. ASF from 0.18 to 1.44 mumol gallic acid equivalent (GAE)/L increased the lag time to LDL oxidation in a dose-dependent manner (Por = 0.0001). Combining ASF with vitamin E or ascorbic acid extended the lag time200% of the expected additive value (Por = 0.05). The bioavailability and in vivo antioxidant activity of 40 micromol ASF were examined in BioF1B hamsters. Peak plasma concentrations of catechin, epicatechin, and flavonols (quercetin, kaempferol, and isorhamnetin) occurred at 60, 120, and 180 min, respectively. The concentration of isorhamnetin was significantly elevated in liver at 180 min. Absorbed ASF enhanced the ex vivo resistance of hamster LDL collected at 60 min to oxidation by 18.0% (P = 0.028), and the in vitro addition of 5.5 micromol/L vitamin E synergistically extended the lag time of the 60-min sample by 52.5% (Por = 0.05). Thus, ASF possess antioxidant capacity in vitro; they are bioavailable and act in synergy with vitamins C and E to protect LDL against oxidation in hamsters.