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Background: Caregiver burden is an important issue that needs to be addressed when developing management programs for persons with chronic mental illnesses, but there is, as yet, no reliable way for assessing this in China., Aim: Assess the validity and reliability of a brief adapted Chinese version of the Family Experience Interview Schedule (FEIS) among caregivers of inpatients with mental disorders in China., Methods: We first translated and back-translated the original 114-item FEIS and administered it to 606 primary caregivers of psychiatric inpatients. After excluding 9 items about sociodemographic variables and 9 items that over 15% of respondents were unable to answer, we conducted an exploratory factor analysis using a random half of the sample on the remaining 96 items and, based on the results of the factor analysis, selected the items to be included in the final shortened scale. Correlation analysis, confirmatory factor analysis, and internal consistency measures were used to assess the reliability and validity of the final scale using data from the second half of the sample., Results: The final scale included 28 items that loaded on five dimensions: (a) patients' violent behavior; (b) patients' suicidal tendency; (c) caregivers' depression and anxiety; (d) disruption of caregivers' daily routines; and (e) caregivers' satisfaction with health services. These five dimensions explained 50.5% of the total variance. Confirmatory factor analysis found reasonable fit of this 5-factor model (χ (2) /df=2.94, p<0.001, goodness-of-fit index [GFI]=0.85, comparative fit index [CFI]=0.85, root-mean-square error of approximation [RMSEA]=0.08). The correlation coefficients between each item and the corresponding factor were all above 0.5. The Cronbach α coefficient of the entire scale was 0.76 and that for the five dimensions varied between 0.71 and 0.84., Conclusion: The five dimensions of family burden assessed by the 28-item brief Chinese version of FEIS have good internal consistency and, thus, appear to assess valid dimensions of family burden in Chinese caregivers of persons with serious mental illnesses. Further work is needed to assess the test-retest reliability of this scale and its sensitivity to change over time.

Objective: Lack of insight into illness has long been recognized as a central characteristic of schizophrenia. Although recent theories have emphasized neurocognitive dysfunction as a central impairment in schizophrenia it remains unclear whether the lack of insight in schizophrenia is more strongly associated with measures of symptom severity or neuropsychological dysfunction., Methods: Seventy-four consecutive inpatients with chronic schizophrenia were enrolled in a cross-sectional study. All subjects were assessed with the Positive and Negative Syndrome Scale (PANSS, five-factor model), the Insight and Treatment Attitudes Questionnaire (ITAQ), and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus Cognitive Battery (MCCB). Bivariate association and multiple linear regression analyses were used to investigate the relationship between insight and both symptoms and neurocognition., Results: On bivariate correlation, the positive, negative, disorganized and excited factors of the PANSS showed a negative correlation with insight but there was no significant association between the MCCB total score or any component subscale and insight. Multiple regression analysis showed that positive symptoms, disorganized/concrete symptoms and excited symptoms contributed to awareness of mental illness; positive and disorganized/concrete symptoms were significant contributors to awareness of the need for treatment; but there were no significant associations with the MCCB., Conclusions: Insight in this sample of patients with chronic schizophrenia is significantly associated with clinical symptoms but not with neuropsychological functioning., (Copyright © 2014 Elsevier B.V. All rights reserved.)

Background: Many studies have shown that more severe symptoms and poorer insight are associated with poor treatment compliance in schizophrenia while severe symptoms may result in higher medication dosages. Since pharmacologic side effects may accompany greater medication compliance and higher medication dosage, the relationship between symptoms, insight and side effects deserves study., Methods: In this study, 174 inpatients diagnosed with schizophrenia were assessed during the week before hospital discharge from a large psychiatric hospital in Guangzhou, China. Symptoms were measured by the Positive and Negative Syndrome Scale for Schizophrenia (PANSS). Insight was assessed by the Insight and Treatment Attitudes Questionnaire (ITAQ). Pharmacologic side effects were assessed by the Treatment Emergent Symptoms Scale (TESS). Bivariate and multivariate regression models were used to examine the relationship of symptoms, insight and the interaction between the two, to the severity of side effects., Results: As expected, the PANSS total score was significantly associated with poorer ITAQ scores and with more severe side effects, and on multivariate analysis both higher PANSS and lower ITAQ scores were associated with more severe side effects. Stepwise multiple linear regression analysis showed that the model with the PANSS total score alone explained 3.4% of the variance in side-effect scores, while adding the ITAQ increased the explained variance to 11.8%. Analysis of the interaction of symptoms and insight showed that patients with both more severe symptoms and high insight had the most severe side effects (B=.006, p=.008, R(2)=15.4%)., Conclusion: More severe symptoms and greater insight among schizophrenic inpatients were both significantly if modestly associated with more severe pharmacologic side effects, the former presumably because of the need for higher doses of medication and the latter because of greater medication compliance. In addition, patients with both more severe symptoms and greater insight were even more prone to pharmacologic side effects than others presumably reflecting higher doses and higher compliance. Clinicians treating highly symptomatic but insightful patients, i.e. those most likely to need and to adhere to prescribed medications, may need to be especially vigilant about side effects., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Liver cancer is one of the leading causes of cancer death worldwide. A very high incidence of new liver cancer cases is diagnosed every year, and metastasis has been found to correlate to poor prognoses in humans. Better treatments for liver cancer are thus clearly needed. Sinigrin is one of the major ingredients present in Brassica nigra, which has been used in combination with other herbs for treatment of various diseases. The anti-proliferative activities of sinigrin were studied in a model of carcinogen-induced hepatotoxicity in rats. Rats were orally administered with sinigrin on a daily basis for three months before sacrifice. Sinigrin was found to significantly inhibit the proliferation of liver tumor cells; the number of surface tumors in the rat liver was dramatically reduced. Sinigrin induced apoptosis of liver cancer cells through up-regulation of p53 and down-regulation of Bcl-2 family members and caspases. Our findings indicated that the liver functions were gradually restored after treatment with sinigrin and that the agent did not cause liver toxicity. Cell cycle analysis indicated that sinigrin caused cell cycle arrest in G0/G1 phase. The results suggest that sinigrin exerts important anti-proliferative activities in carcinogen-induced hepatocarcinogenesis in rats, and highlight the potential of sinigrin as an anti-cancer agent for liver cancer.

Introduction: For many patients with psychiatric disorders, the course of illness is characterized by frequent relapses, resulting to re-hospitalization and high costs. While the correlates of readmission have been extensively studied in developed countries, few studies have examined readmission in low- and middle-income countries where bed supply is limited., Methods: Using administrative data from the Guangzhou Psychiatric Hospital (GPH), we used Cox regression models to evaluate the relationship among age, gender, index length of stay (LOS), and the number of previous admissions to post-discharge readmission risk. Linear regression is used to evaluate predictors of total hospital days during the year after the index discharge., Results: Between April 1, 2010 and March 31, 2011, 2,525 patients were discharged with International Classification of Diseases, 10th Revision psychiatric diagnoses from GPH, with an average LOS of 64.2 (SD = 69.0), and 317 (12.4%) were readmitted in the following year. Survival analysis showed older age (P < 0.05), and the number of previous hospitalizations (P < 0.01) were significant predictors of the risk of readmission but not diagnosis or LOS. The number of previous admissions was the only predictor of total bed days of psychiatric care at GPH in the year following the initial discharge., Discussion: Shortened LOS was not associated with increased readmission risk or post-discharge hospital days. Rather, the number of past hospitalizations was the major predictor of both readmission risk and post-discharge hospital days of psychiatric care, and such patients deserve special attention. Lowering LOS may be justified, allowing funds to be redeployed to outpatient or community-based care., (© 2013 Wiley Publishing Asia Pty Ltd.)

This 2-year longitudinal study sought to identify a developmental pattern of Chinese and English reading skills in children with and without dyslexia from 6 to 8years of age. Three groups of 15 children each-those with dyslexia, age-matched (AM) controls, and reading-matched (RM) controls-participated. Dyslexia was diagnosed at 8years of age. All children were tested on phonological awareness, rapid automatized naming (RAN), morphological awareness, word reading, and vocabulary knowledge in both Chinese and English and also speed of processing skill. AM controls outperformed the group with dyslexia on all measures except for phonological awareness, English word reading, and vocabulary. However, those with dyslexia and AM controls developed at a similar rate across all reading-related skills from 6 to 8years of age. Compared with the RM controls, the group with dyslexia scored higher in phonological awareness, morphological awareness, and vocabulary knowledge in both Chinese and English and also in English word reading but scored similarly in RAN. Children with dyslexia, thus, manifested clear difficulties in Chinese vocabulary knowledge, morphological awareness, and RAN as well as general speed of processing, representing a developmental lag in cognitive skills. Among these, RAN deficits are likely to be the most severe deficits in Chinese children with dyslexia., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Background: Most psychiatric inpatients in China are involuntarily admitted by their families, resulting in relatively long admissions and relatively low readmission rates. However, this pattern may change after implementation of China's new national mental health law (promulgated in 2013), which restricts involuntary psychiatric admissions to the small proportion of mentally ill individuals who are a danger to self or others., Aim: Assess the factors associated with readmission rates of psychiatric inpatients in Guangzhou, China., Methods: A retrospective analysis of data from the Guangzhou Psychiatric Hospital, one of the largest psychiatric hospitals in China, used Cox regression models to evaluate the relationship between age, gender, diagnosis, marital status, employment status, relationship with the primary caregiver, type of medical insurance, length of stay of the index admission, and the number of previous admissions to estimate the risk of readmission over the year following discharge. Multivariate regression is used to assess factors associated with the total time of readmission during the year of follow-up., Results: Among 3455 patients admitted from 1 January 2011 to 31 December 2012 who had a mean (sd) length of stay of 65.7 (66.3) days, 476 (13.8%) were readmitted one or more times within one year of discharge. After considering all potential predictors of readmission in a multivariate survival analysis, the number of previous hospitalizations prior to the index admission was the only statistically significant predictor of readmission. The only factor that was significantly related to the total time of readmission was the duration of the index admission., Conclusion: Shorter length of stay was not associated with increased readmission rates in patients admitted to a large public psychiatric hospital in southern China. This suggests that the expected decrease in the length of psychiatric inpatient admissions that is likely to occur when, based on China's new regulations, most patients are admitted voluntarily may not lead to increased rates of readmission. Prospective studies with a more comprehensive set of outcome measures (including patient functioning, medication adherence, and family burden) are needed to monitor the effect of the law on patients and on the distribution of mental health services.

Background: Economic reform in China 30 years ago virtually eliminated all public health insurance. In the last 10 years, diverse government insurance programs have been implemented, now covering 95% of the population, primarily for inpatient care. While the development of health care in China is an incomplete work in progress and highly variable, it is unclear whether the depth of insurance coverage affects the accessibility, length of stay (LOS) of inpatient mental health services or not., Aim of the Study: This study aims to examine the relationship between variation in insurance coverage, accessibility to inpatient mental health care and intensity of care as measured by length of stay (LOS)., Methods: Using administrative data from the Guangzhou Psychiatric Hospital (GPH), we used regression models to determine the relationship between the depth of insurance coverage and the likelihood of hospital utilization and LOS net of sociodemographic characteristics and diagnosis., Results: Between April 1, 2010 and March 31, 2013, 8,478 patients were discharged with ICD-10 psychiatric diagnoses with an average LOS of 75.1 (sd=244.3) days, among which 4,727 (55.8%) patients were first admissions. Logistic regression analysis showed that insurance plans with lower co-payments were significant predictors of multiple psychiatric admissions and longer LOS., Implications for Health Policy: These data point to significant variability in the health insurance coverage in China and indicate a clear need for greater equalization in future years. Although the Chinese government has provided at least shallow coverage to virtually all of its citizens at this stage, further efforts are needed to expand and equalize coverage as economic development proceeds, especially in rural areas., Implications for Further Research: Although variation in health insurance plans in China are extensive and impact the accessibility and duration of psychiatric hospital care, their impact on outcomes and use of post-discharge outpatient care is unknown and requires further study.

Chlorogenic acid (3-O-caffeoylquinic acid, CA) is the active component in several botanical beverage, vegetables, fruits, and herbal drugs. The effect of water boiling on the bioactivity of CA was studied. CA could be isomerized to 4-O-caffeoylquinic acid (4-O-CA) and 5-O-caffeoylquinic acid (5-O-CA) in decoctive extraction, and each of the isomers occupied about one-third of the total caffeoylquinic acids. A novel method, using water elution of microsphere resin, was used to purify CA and its 2 isomers. The yield of CA, 4-O-CA, and 5-O-CA was 82%, 5.6%, and 50%, with the purity of 98%, 97%, and 99%, respectively. The DPPH radical scavenging assay showed that 4-O-CA, 5-O-CA, and CA exhibited similar activity. However, there was no significant difference between 4-O-CA and 5-O-CA when used against CCl₄-induced toxicity in hepG2 cells. Our studies show that isomerization is the main transformation of CA in boiling, and the decoction could not decrease the anti-oxidant activity of CA., (© 2014 Institute of Food Technologists®)

Liquiritin, isoliquiritin and isoliquirigenin are the active polyphenols present in Glycyrrhiza uralensis which has been used for the treatment of cancer and its complications. The present study was conducted to evaluate the cytotoxicity and antitumor activity of liquiritin, isoliquiritin and isoliquirigenin on human non-small lung cancer cells including apoptosis-induction, inhibition of apoptotic pathways and to explore the underlying mechanism. Lactate dehydrogenase assays, FITC Annexin V staining assay were performed to evaluate cellular cytotoxicity and apoptosis activity. The results showed that pretreatment with these polyphenols induced apoptosis in A549 cells. Liquiritin, isoliquiritin and isoliquirigenin significantly increased cytotoxicity of, and upregulated p53 and p21 and downregulated the apoptotic pathways. Furthermore, it inhibited cell cycle at the G2/M phase. Western blot analysis showed it significantly decreased the protein expression of PCNA, MDM2, p-GSK-3β, p-Akt, p-c-Raf, p-PTEN, caspase-3, pro-caspase-8, pro-caspase-9 and PARP, Bcl-2 in a concentration-dependent manner while the protein expression of p53, p21 and Bax was increased. In addition, Akt pathway was downregulated. These findings suggest that liquiritin, isoliquiritin and isoliquirigenin inhibited the p53-dependent pathway and showed crosstalk between Akt activities. These active polyphenols can be an alternative agent for the treatment of lung cancer.

Chlorogenic acid (1), salvianolic acid B (2), and tanshinone IIA (3) are commonly used as chemoprotective agents for chemotherapy in cancer patients. The present study deals with the effect of these three compounds on cytotoxicity of doxorubicin in HepG2 cells. The results showed that 1 and 2 reduced the cytotoxicity of doxorubicin through scavenging ROS generated by doxorubicin in HepG2 cells. The findings suggest that 1 and 2 could enhance the expression of SOD and decrease that of NADPH oxidase, which resulted in the elimination of ROS. On the contrary, 3 enhanced the cytotoxicity of doxorubicin in HepG2 cells. Furthermore, drug interactions between doxorubicin and 3 produce synergistic effects in HepG2 cells., (Georg Thieme Verlag KG Stuttgart · New York.)

Negative motor evoked potentials after cerebral infarction, indicative of poor recovery of limb motor function, tend to be accompanied by changes in fractional anisotropy values and the cerebral peduncle area on the affected side, but the characteristics of these changes have not been reported. This study included 57 cases of cerebral infarction whose motor evoked potentials were tested in the 24 hours after the first inspection for diffusion tensor imaging, in which 29 cases were in the negative group and 28 cases in the positive group. Twenty-nine patients with negative motor evoked potentials were divided into two groups according to fractional anisotropy on the affected side of the cerebral peduncle: a fractional anisotropy < 0.36 group and a fractional anisotropy ≥ 0.36 group. All patients underwent a regular magnetic resonance imaging and a diffusion tensor imaging examination at 1 week, 1, 3, 6 and 12 months after cerebral infarction. The Fugl-Meyer scores of their hemiplegic limbs were tested before the magnetic resonance and diffusion tensor imaging tions. In the negative motor evoked potential group, fractional anisotropy in the affected cerebral peduncle declined progressively, which was most obvious in the first 1-3 months after the onset of cerebral infarction. The areas and area asymmetries of the cerebral peduncle on the affected side were significantly decreased at 6 and 12 months after onset. At 12 months after onset, the area asymmetries of the cerebral peduncle on the affected side were lower than the normal lower limit value of 0.83. Fugl-Meyer scores in the fractional anisotropy ≥ 0.36 group were significantly higher than in the fractional anisotropy < 0.36 group at 3-12 months after onset. The fractional anisotropy of the cerebral peduncle in the positive motor evoked potential group decreased in the first 1 month after onset, and stayed unchanged from 3-12 months; there was no change in the area of the cerebral peduncle in the first 1-12 months after cerebral infarction. These findings confirmed that if the fractional anisotropy of the cerebral peduncle on the affected side is < 0.36 and the area asymmetries < 0.83 in patients with negative motor evoked potential after cerebral infarction, then poor hemiplegic limb motor function recovery may occur.

Objective: To investigate the relationship between fractional anisotropy (FA) and somatosensory evoked potentials (SEP) in the postcentral gyrus subcortex in patients with acute infarction of the posterior limb of the internal capsule., Methods: Thirty-one patients with acute infarction of the posterior limb of the internal capsule underwent diffusion tensor imaging to obtain the FA values of the subcortical region of the postcentral gyrus with manual placement of the regions of interest (ROI). SEP and the sensory functions of the patients were examined and graded., Results: In each SEP grade group, the FA values of the subcortical region of the postcentral gyrus were significantly decreased on the diseased side compared to those of the normal side (P<0.05). The FA values of the diseased side differed significantly between patients with different SEP grades (P<0.05), and increased SEP abnormalities were associated with lowered FA values. The sensory function of the patients was positively correlated to the grade of SEP (r=0.520, P<0.05)., Conclusion: For patients with acute infarction of the posterior limb of the internal capsule, the changes of FA in the postcentral gyrus subcortex on the diseased side are correlated and complementary to SEP in evaluating the prognosis.

Does learning to read influence one's visual skill? In Study 1, kindergartners from Hong Kong, Korea, Israel, and Spain were tested on word reading and a task of visual spatial skill. Chinese and Korean kindergartners significantly outperformed Israeli and Spanish readers on the visual task. Moreover, in all cultures except Korea, good readers scored significantly higher on the visual task than did less good readers. In Study 2, we followed 215 Hong Kong Chinese kindergartners across 1year, with word reading and visual skills tested twice. In this study, word reading at Time 1 by itself predicted 13% of unique variance in visual skill at Time 2. Together, these results underscore the potential importance of the process of learning to read for shaping one's visual spatial skill development., (Copyright © 2010 Elsevier Inc. All rights reserved.)

Decellularized heart valve scaffolds possess many desirable properties in valvular tissue engineering. However, their current applications were limited by short durability, easily structural dysfunction and immunological competence. Although crosslinking with chemical reagents, such as glutaraldehyde (GA), will enhance the mechanical properties, the low long-term stability and cytotoxicity of the scaffolds remains potential problem. Nordihydroguaiaretic acid (NDGA) is a bioactive natural product which is able to crosslink collagen and was proven to be effective in preparation of scaffold for tendon tissue engineering. In this paper, NDGA crosslinked decellularized heart valve scaffolds demonstrated higher tensile strength, enzymatic hydrolysis resistance and store stability than the non-crosslinked ones. Its mechanical properties and cytocompability were superior to that of GA-crosslinked heart valve matrix. Below the concentration of 10 microg/ml, NDGA has no visible cytotoxic effect on both endothelial cells (EC) and valvular interstitial cells (VIC) and its cytotoxicity is much less than that of GA. The LC50 (50% lethal concentration) of NDGA on ECs and VICs are 32.6 microg/ml and 47.5 microg/ml, respectively, while those of GA are almost 30 times higher than NDGA (P < 0.05). ECs can attach to and maintain normal morphology on the surface of NDGA-crosslinked valvular scaffolds but not GA-crosslinked ones. This study demonstrated that NDGA-crosslinking of decellularized valvular matrix is a promising approach for preparation of heart valve tissue engineering scaffolds.