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Yuan-Kai Fu,1 Chi-chin Sun,2,3 Kuan-Jen Chen,1,3 Yu-Jr Lin,4 Chee-Jen Chang,4– 6 Shu-Chen Chang,4 Ming-Hui Sun1,3 1Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 2Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 3College of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan; 5Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan; 6Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, TaiwanCorrespondence: Ming-Hui Sun, Department of Ophthalmology, Linkou Chang Gung Memorial Hospital, No. 5, Fuxing Street, Guishan District, Taoyuan, 333, Taiwan, Tel +886-3-3281200 ext 8666, Fax +886-3-3287798, Email minghui0215@gmail.comStudy Objectives: To evaluate the association between obstructive sleep apnea (OSA) and dry eye disease (DED) and analyze the impact of Continuous Positive Airway Pressure (CPAP) on DED.Methods: This is a retrospective population-based case-control study. Patients who underwent polysomnography in Taiwan from March 1, 2009, to March 1, 2020, were identified from the database of a sleep center. Patients who were diagnosed with keratoconjunctivitis sicca or tear film insufficiency were included. Patients without data from Schirmer’s test, lacking tear break-up time values, or with a history of refractive surgery, Sjögren’s syndrome, ocular injuries, or a disability in eyelid closure were excluded. All patients with DED enrolled had DED in both eyes. OSA severity between patients with and without DED was compared.Results: In total, 86 patients with DED and 86 age-matched patients without DED were enrolled. Significant differences in apnea-hypopnea index values (patients with DED: 29.1 ± 23.4, patients without DED: 17.9 ± 20.2, P < 0.001), OSA severity (P < 0.001), and lowest oxygen saturation (P = 0.040) between patients with and without DED were observed. A multivariate logistic regression model indicated that the use of CPAP was independently associated with DED after adjustments for OSA severity. Patients undergoing CPAP were at greater risk of developing DED than those not undergoing CPAP (Odds ratio: 3.93, 95% confidence interval: 1.47– 10.49, P = 0.006).Conclusion: OSA severity is associated with DED and might be attributed to the use of CPAP.Keywords: dry eye disease, obstructive sleep apnea, continuous positive airway pressure

Guo-lan Cao,1 Ke-jian Chen2 1Ophthalmic Clinic, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of China; 2Internal Medicine Clinic, The First Affiliated Hospital of Soochow University, Suzhou, 215006, People’s Republic of ChinaCorrespondence: Ke-jian Chen, Internal Medicine Clinic, The First Affiliated Hospital of Soochow University, No. 188, Shizi Street, Gusu District, Suzhou, 215006, People’s Republic of China, Email jiangde1817720@163.comObjective: This study was performed to evaluate the effectiveness of social platform-based continuity of care in improving cognitive and prognostic effects of young age diabetic patients without diabetic retinopathy (DR).Methods: A total of 88 young age diabetic patients admitted to the outpatient clinic of First Affiliated Hospital of Soochow University (Endocrine and Ophthalmology Outpatient) from January 2021 to May 2022 were recruited and assigned via random number table method to receive either routine follow-up care (routine group) or social platform-based continuity of care (WeChat group), with 44 patients in each group. Treatment compliance, cognitive-behavioral ability, self-care ability (self-care responsibility, self-care skills, self-status, knowledge of diabetic retinopathy), quality of life (physical function, psychosocial, symptom and visual function, social activity), and prognosis of the patients were analyzed to investigate the effectiveness of WeChat social platform-based continuity of care. All patients were followed up for one year.Results: Patients receiving WeChat social platform-based continuity of care exhibited obviously higher treatment compliance and better cognitive-behavioral ability, self-care responsibility, self-care skills, self-state, and diabetic retinopathy knowledge follow-up than those with routine care (P< 0.05). Patients in the WeChat group had significantly better physical function, mental psychology, symptoms and visual function, and social activity levels than those in the routine group (P< 0.05). WeChat-based continuity of care resulted in a significantly lower incidence of visual acuity loss and diabetic retinopathy during follow-up than routine care (P< 0.05).Conclusion: WeChat social platform-based continuity of care effectively improves treatment compliance and diabetic retinopathy awareness, and enhances self-care ability of young patients with diabetes mellitus. The life quality of these patients is improved and the risk of poor prognosis has been reduced.Keywords: social platform-based continuity of care, young patients, diabetic retinopathy, cognitive and prognostic

Qian Ye, Ke-Jun Chen, Meng Jia, Sheng Fang Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, People’s Republic of ChinaCorrespondence: Sheng FangDepartment of Dermatology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People’s Republic of ChinaEmail fangshengderm@163.comObjective: The aim of this study was to describe the clinical and histopathological characteristics of seborrheic keratosis (SK) with secondary tumor and identify associated factors.Methods: This study was a monocentric retrospective case-control study describing the factors associated with the development of tumors in SK. A total of 1365 patients with SK were admitted to our department between 2018 and 2021. All of the histopathological specimens and medical records of these patients were reviewed. We compared the data of 36 patients with tumors arising in SK with those of the remaining 1329 patients with only SK, which were designated the control group.Results: The incidence of tumors arising in SK that were biopsied was 2.6%. The tumor types included squamous cell carcinoma (SCC), basal cell carcinoma (BCC) and keratoacanthoma (KA). Compared with other patients with SK, elderly patients with immunosuppression, patients presenting surrounding erythema or ulceration, and those with SK in exposed areas had an increased possibility of developing a secondary tumor. Tumors arising within SK have the histopathological features of ulceration, cytologic atypia, mitosis, “malignant horn”, trabecular cell cords, solar elastosis and severe inflammatory infiltration in the dermis.Conclusion: SK can show malignant progression in a small fraction of SK cases that are biopsied. This study is the first report on the clinical and histopathological characteristics of tumors arising in SK and identifies relevant factors in an Asian population.Keywords: seborrheic keratosis, tumor, clinical, histopathological

Meng Jia, Feng-Zeng Li, Qian Ye, Ke-Jun Chen, Sheng Fang Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of ChinaCorrespondence: Sheng FangDepartment of Dermatology, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuzhong District, Chongqing, 400016, People’s Republic of ChinaEmail fangshengderm@163.comBackground: Heat shock proteins (HSPs), a group of heat stress proteins, are characterized by highly conserved properties. Malignant transformation is a cellular stress, and the expression of HSPs may be affected during this process. Heat shock protein 105 (HSP105) is a protective protein that has long been observed in many cancer types, but little attention has been given to cutaneous squamous cell carcinoma (CSCC). As such, the objectives of this study were to observe the expression of HSP105 on CSCC and evaluate its correlation with clinicopathological characteristics.Methods: This retrospective study enrolled 60 patients with CSCC. The patients’ clinical data, including sex, age, tumor location, tumor type, and degree of pathological differentiation, were collected. The expression of HSP105 was measured by Western blot and immunohistochemical staining.Results: HSP105 expression was decreased in CSCC (HSCORE=0.65 (0.30, 1.98)) compared with normal skin (HSCORE=2.20 (1.50, 2.80)) (P< 0.001). These results were consistent with the Western blot analysis. HSP105 immunostaining of Bowen disease (HSCORE=1.28 (1.08, 2.40)) revealed higher expression than in verrucous carcinoma (HSCORE=0.30 (0.23, 0.85)), keratoacanthoma (HSCORE=0.53 (0.29, 0.93)) and acantholytic squamous cell carcinoma (HSCORE=0.53 (0.41, 0.68) (P< 0.01)). Poorly differentiated CSCC showed significantly higher expression of HSP105.Conclusion: Our study reveals for the first time that the expression of HSP105 is decreased in CSCC. We suggest that the molecular mechanisms underlying the differential expression of HSP deserve a more rigorous future study, the results of which might explain its role in carcinogenesis and its potential as a target for selective tumor therapy.Keywords: heat shock protein 105, cutaneous, squamous cell carcinoma, expression

Liang-Jian Hong, Ai-Jun Chen, Feng-Zeng Li, Ke-Jun Chen, Sheng Fang Department of Dermatology, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400016, People’s Republic of ChinaCorrespondence: Sheng FangDepartment of Dermatology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, People’s Republic of ChinaEmail fangshengderm@163.comObjective: To explore the molecular mechanism of 17-AAG in the treatment of systemic lupus erythematosus (SLE), and the effects of the heat shock protein 90 (HSP90) inhibitor 17-AAG on the activation and proliferation of lymphocytes and the AKT/GSK3β signaling pathway in MRL/lpr mice were detected.Methods: MRL/lpr mice were randomly divided into the control group and the experimental group. The experimental group was injected intraperitoneally with 17-AAG, and T lymphocytes were separated by magnetic beads. Lymphocyte proliferation was detected by MTT and flow cytometry (FCM), and the expression of the HSP90 protein and PI3K/AKT signaling pathway-related proteins was detected by Western blotting. Renal histopathology and immune complex deposition were also observed in both groups.Results: Immune complex deposition and inflammation decreased in kidneys from MRL/lpr mice in the experimental group. HSP90 protein expression, T lymphocyte proliferation and phosphorylated AKT and GSK3β levels also decreased in the experimental group.Conclusion: 17-AAG can inhibit the activation and proliferation of T lymphocytes and downregulate the AKT/GSK3β signaling pathway, which may be relevant for the treatment of SLE.Keywords: 17-AAG, HSP90, AKT, lupus, activation

Pei-Lun Chung,1 Chien-Wei Huang,2 Min-Jing Lee,1,3 Yao-Hsu Yang,4,5 Ko-Jung Chen,4 Mong-Liang Lu,6 Jun-Cheng Weng,1,7 Vincent Chin-Hung Chen1,3 1Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; 2Division of Nephrology, Department of Medicine, School of Medicine, Kaohsiung Veterans General Hospital, and National Yang-Ming University, Taiwan; 3School of Medicine, Chang Gung University, Taoyuan, Taiwan; 4Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; 5Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; 6Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; 7Department of Medical Imaging and Radiological Sciences, Chang Gung University, Taoyuan, TaiwanCorrespondence: Vincent Chin-Hung ChenDepartment of Psychiatry, Chang Gung Memorial Hospital, Chiayi, TaiwanEmail cch1966@gmail.comPurpose: This study explored and compared the effects of depression and antidepressants on sexual dysfunction in men with diabetes mellitus (DM).Patients and Methods: Patients older than 18 years who had been newly diagnosed with DM (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 250) between 1999 and 2010 were identified from Taiwan’s National Health Insurance Research Database and were followed up until 2013. Patients with preexisting depression or sexual dysfunction were excluded. A total of 636,210 patients with DM were enrolled. These patients were divided into two groups: DM with comorbid depression and a matched cohort without depression. The groups were followed up until the end of 2010 for the first diagnosis of sexual dysfunction (ICD-9-CM codes 302.70, 302.71, 302.72, 302.74, 302.75, 302.76, 302.79, 607.84, and V417). A Cox proportional hazard model and a Cox regression model with time-dependent covariates were applied.Results: Patients with DM and depression had a higher risk of sexual dysfunction than those with DM without depression (hazard ratio [HR] =  1.44; 95% confidence interval [CI], 1.33– 1.55). The risk of sexual dysfunction was lower in the subgroup who used antidepressants (per 28 cumulative defined daily doses [cDDDs]), HR = 0.96; 95% CI, 0.94– 0.97). A significantly lower incidence of sexual dysfunction was also associated with the use of selective serotonin reuptake inhibitors (SSRIs, per 28 cDDD). The adjusted HR was 0.95 (95% CI, 0.93– 0.97). Subgroup analysis indicated that SSRI use was significantly associated with an amelioration of erectile dysfunction (per 28 cDDD), with an HR of 0.95 (95% CI, 0.92– 0.97).Conclusion: Male patients with DM and depression are at increased risk of sexual dysfunction. Antidepressant use had a small inverse association with the risk of sexual dysfunction in men with DM and depression. Antidepressants, in particular SSRIs, did not increase the risk of sexual dysfunction in this population.Keywords: selective serotonin reuptake inhibitor, SSRI, sexual functioning, diabetes mellitus, depression

Kitty Jieyi Chen, Sherry Shiqian Gao, Duangporn Duangthip, Edward Chin Man Lo, Chun Hung Chu Faculty of Dentistry, The University of Hong Kong, Sai Ying Pun, Hong Kong Abstract: Surveys have shown that the prevalence of early childhood caries (ECC) among 5-year-old children decreased from 63% in 1993 to 55% in 2017. Caries experience was unevenly distributed; 81% of the caries lesions were found in 26% of the children. Risk factors, including oral hygiene practice behaviors, sugar consumption, parental oral health-related knowledge, and sociodemographic backgrounds, were significantly related to ECC. Oral health promotion aimed at managing the burden of ECC has been implemented. Water fluoridation was launched in 1961, and the fluoride concentration has been adjusted to 0.5 ppm since 1988. It is considered an important dental public health measure in Hong Kong. The Department of Health set up the Oral Health Education Unit in 1989 to deliver oral health education to further improve the oral health of preschool children. Other nongovernmental organizations also launched short-term oral health promotion programs for preschool children. However, no significant change in the prevalence of ECC has been observed in the recent two decades. There is a necessity to revisit dental public health policies and develop effective evidence-based strategies to encourage changes in oral health-related behaviors to forestall the impending epidemic of ECC in Hong Kong. Keywords: caries, oral health, children, Hong Kong

Kuan-Chin Jean Chen,1 Michelle Klingel,2 Shelley McLeod,3 Sean Mindra,4 Victor K Ng5 1Department of Emergency Medicine, Faculty of Medicine, The Ottawa Hospital, University of Ottawa, Ottawa, 2Division of Respiratory Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, 3Department of Family and Community Medicine, University of Toronto, Schwartz/Reisman Emergency Medicine Institute, Mount Sinai Hospital, Toronto, 4Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, 5Division of Emergency Medicine, Faculty of Medicine, London Health Sciences Centre, Western University, London, ON, Canada Background: Necrotizing soft tissue infections (NSTIs) are aggressive infections associated with significant morbidity, including amputation and organ failure, and high mortality. The rapid progression and significant risk of morbidity and mortality associated with NSTIs makes quick diagnosis and treatment critical. The objective of this study was to determine the presentation of patients diagnosed with NSTIs and their in-hospital outcomes. Methods: This was a retrospective review of adult (>17 years) patients with a discharge diagnosis of necrotizing fasciitis at London Health Sciences Centre (annual census 125,000) over a 5-year period (April 2008–March 2013). Results: Sixty patients with confirmed NSTI were included in this study. Common comorbidities at presentation included immunocompromise (58.3%), diabetes mellitus (41.7%), vascular disease (45.0%), and obesity (24.6%). Initial presentations included swelling (91.7%), erythema (86.7%), bullae (28.3%), petechiae (8.3%), and bruising (45.0%). Fifty (83.3%) underwent surgery, with a median (interquartile range) time from initial emergency department presentation to surgery of 15.5 hours (7.8, 74.9). In-hospital mortality among those who had surgical intervention was 14.0%, compared to 60.0% for patients who did not have surgery (Δ46.0%; 95% CI: 14.8% to 70.2%). Conclusion: Diabetes mellitus, immune-compromise, vascular disease, and obesity are common comorbidities of NSTIs. Survival is higher among patients who receive surgical treatment. Patients presenting with this clinical picture warrant a high degree of suspicion. Keywords: clinical evaluation and treatment, skin diseases, infectious diseases of the skin

Chao-Chien Chang,1–3 Yueh-Chung Chen,4,5 Eng-Thiam Ong,1 Wei-Cheng Chen,1 Chia-Hsiu Chang,1 Kuan-Jen Chen,1 Cheng-Wen Chiang1 1Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan, ROC; 2Graduate Institute of Medical Sciences, Taipei Medical University, Taipei, Taiwan, ROC; 3Department of Pharmacology, Taipei Medical University, Taipei, Taiwan, ROC; 4Division of Cardiology, Department of Internal Medicine, Taipei City Hospital Ren-Ai branch, Taipai, Taiwan, ROC; 5Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan, ROC Background: Percutaneous coronary intervention (PCI) has been widely used to treat acute coronary syndrome but is only recommended as an additional treatment to medical therapy and risk modification in patients with refractory or progressing angina. The number of PCI in this patient population is still increasing. Post-PCI chest pain (PPCP) is one of the common problems of PCI. Its presentation and causes in patients with stable angina are poorly understood.Patients and methods: This study retrospectively collected clinical information of 167 patients who had stable angina and underwent elective PCI, including 70 patients with PPCP 24 hours after procedure and 97 patients without PPCP. The incidence and predictors of PPCP were analyzed.Results: The incidence of PPCP was 41.9% (70/167). Compared with non-PPCP patients, PPCP patients had more abnormal post-PCI electrocardiogram (ECG) changes (new Q-waves, ST-segment shifts, or T-waves inversion) and serum cardiac troponin I (cTnI) elevation, more PCI vessels, and stent placement (all P

Supramolecular nanosubstrate-mediated delivery (SNSMD) leverages the power of molecular self-assembly and a nanostructured substrate platform for the low toxicity, highly efficient co-delivery of biological factors encapsulated in a nanovector. Human fibroblasts are successfully reprogrammed into induced pluripotent stems and transdifferentiated into induced neuronal-like cells.

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In the past 50 years, integration of traditional Chinese medicine and Western medicine, known as the Chinese version of integrative medicine (IM), has achieved significant developments. In this article, the present situation and progress in IM development in China are summarized from the aspects of IM application, policy making, scientific research, education, academic exchanges, and its future development. With continuous support from the Chinese government and successful scientific achievements in the past 50 years, the authors believe that IM will be moving forwards to a full globalization. [ABSTRACT FROM AUTHOR]