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Dental plaque is the main cause leading to the dental caries and periodontal diseases. The main purpose of this study was to test the efficacy of oral spray containing the antimicrobial peptide P-113 on the reduction of oral bacteria number and dental plaque formation in a randomized clinical assessment. This study was divided into two parts. In Part A, we investigated the user experiences with the P-113 containing oral spray. In part B, 14 subjects in the experimental group used the P-113-containing oral spray, while 14 subjects in the control group used a placebo without the P-113 in a 4-week clinical trial. Participants were asked to use the P-113-containing oral spray or placebo 3 times per day and 5 times per use. Moreover, 3 check-ups and 2 washouts were carried out to evaluate the DMFT score, dental plaque weight, dental plaque index, and gingival index. In part A, up to 91.8% of the subjects in the experimental group were satisfied with the use of the P-113-containing oral spray. In part B, based on our PacBio SMRT sequencing platform and DADA2 analysis, the numbers of Streptococcus and Porphyromonas in the experimental group were lower than those in the control group. In addition, decreased dental plaque weight, dental plaque index, and gingival index were all observed in the experimental group. The P-113-containing oral spray has the potential to reduce the dental caries and periodontal disease-related bacteria and to control the dental plaque formation. [ABSTRACT FROM AUTHOR]

Purpose: The purpose of this study is to evaluate the association between lipid‐lowering agent use and the risks of diagnosed dry eye disease (DED). Methods: This retrospective, case–control study included 780 786 patients who received lipid‐lowering agents in 2002–2016, of which 17 409 were newly diagnosed with DED during a ≥2‐year follow‐up period. These patients were matched 1:4 with control participants for age, sex, and comorbidities. Separate odds ratios (OR) were calculated for DED and each of statin and fibrate use. Results: Statin users had significantly higher odds of DED (adjusted OR = 1.12; 95% confidence interval (CI) = 1.08–1.16, p < 0.0001) than nonusers. Fibrate users did not show higher odds of DED than nonusers (adjusted OR = 1.04; 95% CI = 0.99–1.10, p = 0.125). The lipophilic statin users did not show higher odds of DED compared with the hydrophilic statin users (adjusted OR = 0.99, 95% CI = 0.93–1.06, p = 0.729). Among statin users, the odds of DED did not differ significantly between patients receiving statin therapy for >180 days vs. ≤90 days or patients receiving statin therapy for 91–180 days vs. ≤90 days (adjusted OR = 1.00, p = 0.922; adjusted OR = 0.94, p = 0.541, respectively). The odds of DED were not statistically different among patients receiving low‐intensity, moderate‐intensity, and high‐intensity of statin therapy. Conclusions: Patients receiving statin therapy had a higher DED risk than patients not receiving statin therapy. The type of statin, the duration, and the intensity of statin use were not significantly associated with DED risks. Further studies are required to identify the relevant factors related to DED risks with statin. [ABSTRACT FROM AUTHOR]

Objective: To investigate natural‐ and unnatural‐cause mortality at different follow‐up time points in Taiwanese patients with anorexia nervosa (AN) and bulimia nervosa (BN). Method: In this longitudinal cohort study, 330,393 patients, including 2143 patients with AN, 13,590 with BN, and 20 times as many respective non‐AN and non‐BN patients, were followed up for 16 years. We performed conditional Cox regression survival analysis to examine the risk of mortality in the AN and BN groups relative to the comparison group. Results: A total of 1242 patients died, including 101 and 343 patients with AN and BN, respectively. Mortality rates for AN and BN were 5.42 and 2.90 deaths per 1000 person‐years, respectively. Compared with the non‐AN group, the AN group had a significantly higher risk of both natural‐ and unnatural‐cause mortality, and the BN group had a significantly higher risk of unnatural‐cause mortality. Suicide was the most common cause of death, and suicide risk was significantly higher in both the AN and BN groups. All‐cause mortality risk was the highest at the beginning of follow‐up and markedly declined in the AN group. In the BN group, all‐cause mortality risk was lower but stable at follow‐up. The risk of unnatural‐cause mortality remained high throughout the follow‐up period for both the groups. Conclusions: Early detection and treatment for associated physical problems in patients with AN are crucial. Regular monitoring for unnatural‐cause mortality events (mainly suicide) in AN and BN over time is also crucial. Public Significance: AN had a significantly higher risk of both natural‐ and unnatural‐cause mortality and BN had a significantly higher risk of death from unnatural causes. All‐cause mortality risk was highest at the beginning of follow‐up in AN, but unnatural‐cause mortality risk remained high throughout the follow‐up period for both groups. Our findings imply that early detection and treatment in AN and regular monitoring for unnatural‐cause mortality events in AN and BN are crucial. [ABSTRACT FROM AUTHOR]

Objective: To investigate the incidence and risk of renal‐related complications in a nationwide cohort of Taiwanese patients with anorexia nervosa (AN). Method: This longitudinal cohort study analyzed the data of 43,951 individuals—comprising 2091 patients with AN and their controls matched (1:20) using propensity scores according to sex, age, degree of urbanization of residence, socioeconomic status, and year of diagnosis—from a population‐based health insurance database; the study lasted 16 years. We used Kaplan–Meier curves to estimate the cumulative incidence of renal events. We also performed Cox proportional regression and constructed a risk model with death as a competing event (both adjusted for basic characteristics, renal diseases, and psychiatric comorbidities) to examine the risk of dialysis and renal outcomes in the AN group relative to the control group. Results: In total, 204 and 10 patients with AN had renal‐related outcomes and end‐stage renal disease (ESRD), respectively. The cumulative incidence rates of all renal outcomes and ESRD in the AN group were 10.72% and.64%, respectively, at 10‐year follow‐up. Compared with the control group, the AN group had a significantly higher risk of acute dialysis (adjusted hazard ratio 2.10 [95% confidence interval 1.19–3.68]), hypokalemia, hypovolemia, nephritis, acute renal failure, and chronic renal failure. The AN group did not have a significantly higher risk of ESRD. Discussion: The elevated risks of acute dialysis and some renal outcomes in AN highlight the importance of monitoring electrolyte imbalance and renal malfunctioning. Public Significance: Malnutrition and purging behaviors may cause renal complications in patients with AN. In this longitudinal cohort study, we found that the 10‐year cumulative incidence of all renal outcomes in AN was 10.72%, and that patients with AN had a two‐fold higher risk of overall renal outcomes compared with those without AN. Our findings imply that weight restoration and ceasing purging behaviors are crucial for recovery from AN. [ABSTRACT FROM AUTHOR]

Objectives: This study assessed risk adjustment performance of six comorbidity indices in two categories of comorbidity measures: diagnosis-based comorbidity indices and medication-based ones in patients with chronic obstructive pulmonary disease (COPD). Methods: This was a population–based retrospective cohort study. Data used in this study were sourced from the Taiwan National Health Insurance Research Database. The study population comprised all patients who were hospitalized due to COPD for the first time in the target year of 2012. Each qualified patient was individually followed for one year starting from the index date to assess two outcomes of interest, medical expenditures within one year after discharge and in-hospital mortality of patients. To assess how well the added comorbidity measures would improve the fitted model, we calculated the log-likelihood ratio statistic G2. Subsequently, we compared risk adjustment performance of the comorbidity indices by using the Harrell c-statistic measure derived from multiple logistic regression models. Results: Analytical results demonstrated that that comorbidity measures were significant predictors of medical expenditures and mortality of COPD patients. Specifically, in the category of diagnosis-based comorbidity indices the Elixhauser index was superior to other indices, while the RxRisk-V index was a stronger predictor in the framework of medication-based codes, for gauging both medical expenditures and in-hospital mortality by utilizing information from the index hospitalization only as well as the index and prior hospitalizations. Conclusions: In conclusion, this work has ascertained that comorbidity indices are significant predictors of medical expenditures and mortality of COPD patients. Based on the study findings, we propose that when designing the payment schemes for patients with chronic diseases, the health authority should make adjustments in accordance with the burden of health care caused by comorbid conditions. [ABSTRACT FROM AUTHOR]

This paper proposes a bridgeless-type ac-side continuous-conduction-mode (CCM) current-source (CS) charge-pump (CP) power-factor-correction (PFC) electronic ballast. The drawbacks of conventional dc-side discontinuous-conduction-mode (DCM) electronic ballasts include high di/dt, high current stress, and high switching losses. As a result, conventional dc-side DCM CS-CP-PFC electronic ballasts have low efficiency, due to the DCM operation, and the ballasts require a large input electromagnetic interference filter. Conventional dc-side CCM CS-CP-PFC electronic ballasts are able to solve these problems, but still require a higher component count. To efficiently reduce the cost of electronic components, a bridgeless-type ac-side CCM CS-CP-PFC electronic ballast is proposed. A 32-W rated power electronic ballast prototype circuit is designed and implemented. Experimental results verify that the input-current harmonics meet the IEC 61000-3-2 Class-C Standard, and the CP capacitor helps the PFC inductor current to achieve CCM and high power factor. Index Terms--Charge-pump (CP), continuous-conduction-mode (CCM), current-source (CS), discontinuous-conduction-mode (DCM), electromagnetic interference (EMI), power-factor-correction (PFC).

It remains unknown as to whether the use of new-generation drug-eluting stent (NG-DES) in patients with ST-elevation myocardial infarction (STEMI) who receive an undefined duration of dual antiplatelet therapy (DAPT) reduces the risk of hospitalization for heart failure (HHF). In this population-based retrospective cohort study, we applied propensity score matching to select 6831 pairs of patients with STEMI who had similar baseline characteristics and received either NG-DES or bare-metal stent (BMS) implantation between 1 January 2007 and 31 December 2016. The risk of stent-associated HHF was evaluated, wherein death was considered a competing risk. Rates of cumulative incidence competing risk for HHF at the 1, 2, 3, 4, and 5 year follow-up were lower in the NG-DES group (3.79%, 5.21%, 6.15%, 7.01%, and 8.29%, respectively) than in the BMS group (4.51%, 6.21%, 7.32%, 8.33%, and 9.83%, respectively). NG-DES implantation was associated with a lower risk of HHF than BMS implantation after 5 years, with an adjusted subdistribution hazard ratio of 0.82 (95% confidence interval 0.72–0.92, p = 0.001). These results accord with those of patients who received DAPT for >6 months. Our findings highlight that NG-DESs may reduce HHF risk in patients with STEMI receiving an undefined duration of DAPT. [ABSTRACT FROM AUTHOR]

Multidrug resistance (MDR) resulting from the overexpression of drug transporters such as P-glycoprotein (Pgp) increases the efflux of drugs and thereby limits the effectiveness of chemotherapy. To address this issue, this work develops an injectable hollow microsphere (HM) system that carries the anticancer agent irinotecan (CPT-11) and a NO-releasing donor (NONOate). Upon injection of this system into acidic tumor tissue, environmental protons infiltrate the shell of the HMs and react with their encapsulated NONOate to form NO bubbles that trigger localized drug release and serve as a Pgp-mediated MDR reversal agent. The site-specific drug release and the NO-reduced Pgp-mediated transport can cause the intracellular accumulation of the drug at a concentration that exceeds the cell-killing threshold, eventually inducing its antitumor activity. These results reveal that this pH-responsive HM carrier system provides a potentially effective method for treating cancers that develop MDR. [ABSTRACT FROM AUTHOR]

New-onset atrial fibrillation (NOAF) is associated with adverse outcomes in patients with coronary artery disease (CAD). Although newer generation drug-eluting stents (NG-DESs) are more beneficial than bare-metal stents (BMSs) in reducing the risk of in-stent restenosis and revascularization, whether NG-DES implantation in patients with stable CAD reduces NOAF risk compared with BMS implantation remains unknown. This population-based cohort study was conducted using data from Taiwan's National Health Insurance Research Database. Propensity score matching was used to select 18,423 pairs of patients with stable CAD receiving NG-DES implantation and BMS implantation with similar baseline characteristics for evaluation. A competing risk model was used to evaluate the risk of NOAF between the NG-DES and BMS groups in which death was considered a competing risk. After adjustment for patients' clinical variables, the use of NG-DESs was associated with a decreased risk of NOAF at 1-year follow-up (adjusted subdistribution hazard ratio [SHR] = 0.79, 95% confidence interval [CI] = 0.68–0.93, P = 0.005) compared with the use of BMSs. Similar results indicated that NG-DESs were beneficial for reducing the risk of NOAF (adjusted SHR = 0.81, 95% CI = 0.67–0.97, P = 0.020) in patients with a CHA 2 DS 2 -VASc score of ≥2. These findings were also consistent with those for patients who received dual antiplatelet therapy for an undefined duration of >1 month following stent implantation. Our findings suggest that NG-DESs might reduce the risk of NOAF in patients with stable CAD. • The strategies to prevent NOAF in patients with stable CAD remain still unclear. • The use of NG-DESs is beneficial to prevent NOAF in patients with stable CAD. • CHA 2 DS 2 -VASc score assists to identify patients who can benefit from NG-DESs implantation. [ABSTRACT FROM AUTHOR]

Abstract: Using a murine hypodermic air pouch infection model designed to mimic the release of bacterial products at physiological levels, 3-hydroxy fatty acid (3-OH FA) and endotoxin unit levels from Burkholderia cenocepacia isolates were assessed. The B. cenocepacia environmental isolates (n=35) survived in the hypodermic air pouch but did not invade across the peritoneal epithelial layer during a 72-h infection. For all 35 strains, when the molar ratio of C14:0 3-OH FA to C16:0 3-OH FA in the air pouch fluid wash samples was between 1.4 and 2.5, the concentrations of C14:0 3-OH FA were correlated with the endotoxin unit levels. However, both surrogate markers exhibited different correlations to the inflammatory response. The linear regression coefficient was 0.4234 for C14:0 3-OH FA concentrations vs. NO productions, 0.223 for endotoxin unit levels vs. NO productions, 0.5008 for C14:0 3-OH FA concentrations vs. TNF-alpha productions and 0.2869 for endotoxin unit levels vs. TNF-alpha productions. Therefore, C14:0 3-OH FA concentrations, rather than endotoxin unit levels, acted as an immunostimulatory indicator for LPS in the B. cenocepacia isolates. [Copyright &y& Elsevier]