Search

Wei-Ching Hsu,1,2 Chun-Hsiang Wang,3 Kang-Ming Chang,4– 6 Li-Wei Chou2,7,8 1Department of Bioinformatics and Medical Engineering, Asia University, Taichung, Taiwan; 2Department of Physical Medicine and Rehabilitation, Asia University Hospital, Asia University, Taichung, Taiwan; 3Fire Bureau of Taichung City Government, Taichung, Taiwan; 4Department of Computer Science and Information Engineering, Asia University, Taichung, Taiwan; 5Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan; 6Department of Digital Media Design, Asia University, Taichung, Taiwan; 7Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 8Department of Physical Therapy and Graduate Institute of Rehabilitation Science, China Medical University, Taichung, TaiwanCorrespondence: Kang-Ming ChangDepartment of Computer Science and Information Engineering, Asia University, 500, Lioufeng Road, Wufeng, Taichung, 41354, TaiwanTel +886-4-23323456Fax +886-4-23316699Email changkm@asia.edu.twLi-Wei ChouDepartment of Physical Medicine and Rehabilitation, China Medical University Hospital, No. 91, Hsueh-Shih Road, Taichung, 40402, TaiwanTel +886-4-22053366Fax +886-4-23316699Email chouliwe@gmail.comIntroduction: Taiwan’s firefighters use a shift rotation system with 2 days of work and 1 day of rest. Numerous papers have already explored the risks of shift work to the body. However, little data concern the impact of shift work on health as reflected in medical visits. This study used individuals’ medical visit record in Taiwan’s health insurance system. The locally called “health bank” contains individuals’ medical visit record, health insurance payment points and the medicine used.Methods: Consent was obtained from 150 firefighters who were serving under the shift rotation system to obtain their 2015 individual “My Health Bank” medical data. Comparisons were made between national health insurance data norm.Results: Firefighters make significantly more visits for Western medicine than the annual average (firefighters 6.27 vs norm 5.24, P = 0.04142), more total number of medical visits (9.57 vs 7.75, P = 0.0102), more annual average payment points for Western medicine (4079 vs 2741, P = 0.003151), and a greater average number of total annual medical visit points (7003 vs 4940, p = 0.0003157). Firefighters had significantly higher incidents of respiratory diseases, urogenital diseases, skin and subcutaneous tissue diseases, musculoskeletal system and connective tissue diseases, injuries, and illness from poisoning than did the norm (P< 0.05).Conclusion: A persuasive health-survey-based method for workers in high occupational hazard industries was proposed in this study, and the result was highly correlated with risk factors of fireworkers. The proposed study method is potential to investigate risk factors of other working.Keywords: firefighters, shift worker, health insurance record

Huei-Ling Huang,1,2 Yea-Ing L Shyu,1,3–5 Wen-Chuin Hsu6 1Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan; 2Nursing Department, Taoyuan Chang Gung Memorial Hospital, Taoyuan, Taiwan; 3School of Nursing, College of Medicine & Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; 4Department of Orthopedic Surgery, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 5Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; 6Chang Gung Dementia Center, Department of Neurology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan Background/aims: Limited research has been conducted on agitated behavior in Taiwan and dementia among community-dwelling elderly. Therefore, this study focused on community elderly with dementia and a factor analysis of an inventory of their agitated behaviors was conducted.Patients and methods: Participants (N=221) completed the Chinese Cohen-Mansfield Agitation Inventory, community form. Item analysis and exploratory factor analysis assessed reliability, validity, and the underlying factor structure.Results: Five factors were extracted and accounted for 44.53% of the total variance. This study classified agitated behaviors into 5 main subtypes: physically agitated behaviors, destructive behaviors, verbally agitated behaviors, handling things behavior, and aggressive behaviors.Conclusion: The results indicate that differences in the agitated behavior of elderly with dementia exist with respect to cultural background and setting. This novel research and its findings serve as a reference for assessing the agitated behaviors of elderly with dementia living in their homes. Applications may exist for other countries with Chinese/Taiwanese populations. Keywords: agitation, aggressive behavior, behavioral problem, caregiver, factor analysis, dementia

Huei-Ling Huang,1 Yea-Ing L Shyu,2,3 Min-Chi Chen,4 Chin-Chang Huang,5,6 Hung-Chou Kuo,5,6 Sien-Tsong Chen,5,6 Wen-Chuin Hsu6,71Department of Gerontological Care and Management, Chang Gung University of Science and Technology, Taoyuan, Taiwan; 2School of Nursing, College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; 4Department of Public Health and Biostatistics Consulting Center, Chang Gung University, Taoyuan, Taiwan; 5Department of Neurology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 6School of Medicine, Chang Gung University, Taoyuan, Taiwan; 7Chang Gung Dementia Center, Taoyuan, TaiwanPurpose: The purpose of this study was to explore family caregivers’ role-implementation experiences at different stages of dementia.Patients and methods: For this cross-sectional, exploratory study, 176 dyads of family caregivers and their community-dwelling elderly relatives with dementia were recruited from the neurological clinics of a medical center in Taiwan. The Family Caregiving Inventory was used to assess family caregivers for caregiving activities, role strain, role preparation, and help from others at different stages of care receivers’ dementia.Results: Family caregivers’ caregiving activities were related to patients’ stages of dementia. For patients with mild dementia, caregivers provided more assistance in transportation and housekeeping. In addition to these two activities, family caregivers of patients with moderate dementia provided more assistance with mobility and protection. For patients with severe dementia, family caregivers provided more assistance with personal care, mobility and protection, transportation, and housekeeping. Overall, family caregivers reported having some preparation to provide care; the most difficult caregiving activity was identified as managing behavioral problems.Conclusion: This study’s results provide a knowledge base for designing dementia stage-specific interventions in clinical practice and developing community-based, long-term care systems for families of patients with dementia.Keywords: behavioral problem, illness trajectory, role strain, caregiving activity, prepar­edness

Sea surface temperature (SST) patterns both local to and remote from tropical cyclone (TC) development regions are important drivers of the variability of TC activity. Therefore, reliable simulations and predictions of TC activity depend on a realistic representation of tropical SST. Nevertheless, severe SST biases are common to the current generation of global climate models, especially in the tropical Pacific and Atlantic. These biases are strongly positive in the southeastern tropical basins, and negative, but weaker, in the northwestern tropical basins. To investigate the impact of the tropical SST biases on simulated TC activity, an atmospheric-only tropical channel model was used to conduct several sets of ensemble simulations. The simulations suggest an underrepresentation in Atlantic TC activity caused by the Atlantic cold bias alone, and an overrepresentation in Eastern North Pacific (ENP) TC activity due to the Atlantic cold bias and Pacific warm bias jointly. While the local impact of SST biases on TC activity is generally induced by the local anomalous SST and the associated changes in atmospheric conditions, the remote impact of the Atlantic bias on the ENP TCs is strongly driven by the change in topographically forced regional circulation. Moreover, an eastward shift in Western North Pacific TCs was generated by the Pacific SST biases, even though basin-wide TC activity indicators change insignificantly. The results indicate the importance of considering SST bias effects on simulated TC activity in climate model studies and highlight key regions where reducing SST biases could potentially improve TC representation in climate models.

© 2015 by the American Diabetes Association.According to the U.S. Census Bureau, an Asian is a person with origins fromthe Far East (China, Japan, Korea, and Mongolia), Southeast Asia (Cambodia, Malaysia, the Philippine Islands, Thailand, Vietnam, Indonesi

Motivation: This study tests if the 'oscillating spring' analogy for the radial vibration of the arterial wall can help to describe the relationship between the heart rate (HR), the blood pressure (BP), and properties of the arterial wall when different types of stimulation are applied on the cardiovascular system. It may help to suggest a possible role for arterial radial vibration in the association between the arterial stiffening and hypertension.Methods: Either mechanical stimulation was applied (0.5-mmHg pressure variation) to Wistar rats by at near-HR frequency (group A) or administered Propranolol (2mg/kg i.p.; group B), and measured HR and BP simultaneously.Results: In both groups, HR and BP were noted to change in the same direction (r2 = 0.72 and 0.62, respectively; p both < 0.05 by F-test). ANCOVA was performed on these two regression lines, and it was found that there was no significant difference between them (p > 0.3).Conclusion: In both groups, changes in haemodynamic parameters can be explained by the 'oscillating spring' analogy for the radial vibration of the arterial wall. This illustrates that, when facing various stimulations, it may be an important regulatory mechanism for the heart and the arteries to restore their frequency-matching condition in order to improve the arterial transmission efficiency. Paying more attention to the radial movement of the wall may therefore help to suggest a novel explanation of the mechanism that underlies the bidirectional relation between hypertension and arterial stiffening. [ABSTRACT FROM AUTHOR]

Background: Inflammatory events may contribute to the pathogenesis of dementia and interleukin-1 (IL-1) may exert both neurotoxic and neuroprotective effects. We investigated whether IL-1alpha -889 C/T and IL-1beta -511 C/T promoter polymorphisms are associated with the risk of Alzheimer's disease (AD) and vascular dementia (VaD). Methods: AD patients (n = 219) and VaD patients (n = 82), who fulfilled the criteria of the NINCDS-ADRDA and NINDS-AIREN, and ethnic-matched and nondemented controls (n = 209) were analyzed by means of genotype association method. Results: No significant difference in the genotype distribution of the analyzed single nucleotide polymorphisms was found between AD or VaD cases and controls. However, the frequency of the IL-1alpha -889 CT genotype was notably lower in VaD patients aged over 70 years than the age-matched controls (9.1 vs. 22.9%, p = 0.036) andtheIL-1alpha -889 CT genotype demonstrated a trend toward decrease in risk of developing VaD (odds ratio: 0.34; 95% confidence interval: 0.12-0.83, p = 0.026). Multivariate analysis revealed that the IL-1beta -511T-carrying genotype slightly strengthens the negative association of the IL-1alpha -889 CT genotype with VaD (odds ratio: 0.26; 95% confidence interval: 0.08-0.79, p = 0.024). Conclusion: Our data suggest a protective role of the IL-1alpha -889 CT genotype in VaD susceptibility among Taiwanese aged over 70 years. Copyright (c) 2007 S. Karger AG, Basel. [ABSTRACT FROM AUTHOR]

Background: Blood glucose monitoring is an important component of diabetes self-management for individuals with insulin-treated diabetes. Although patient-maintained logbooks are routinely used, glucose values may be inaccurately recorded or not recorded at all. Electronic logbooks may help overcome such problems. We conducted a randomized, controlled trial (RCT) to compare glycemic control in insulin-treated participants using integrated glucose meters and electronic logbooks (Electronic Group) with participants using conventional meters and paper logbooks (Paper Group), and to determine persistence of glycemic improvements during long-term observational follow-up. Methods: After a 4-week run-in, adult and pediatric participants (n = 205) with stable hemoglobin A(1C) (A1C) >/=8.0% were randomized, and their logbook data and A1C were monitored every 4 weeks for 16 weeks. After the RCT, patients selected their monitoring systems and resumed usual care. The four resulting subgroups, defined by whether patients continued or changed monitoring systems, were reassessed after 26-65 weeks. Results: During the RCT, mean A1C decreased -0.27% in the Paper Group and -0.35% in the Electronic Group. Repeated-measures analysis revealed that the mean decrease was significantly greater in the Electronic than the Paper Group (P = 0.022). From randomization through observational follow-up, participants consistently using integrated meters/logbooks had an A1C decrease of -0.36% (P = 0.008), whereas participants using conventional meters/logbooks throughout or switching meters returned to pre-enrollment A1C levels. Conclusions: Compared to conventional monitoring systems, use of an integrated meter and electronic logbook resulted in modest, but significant and sustained, improvement in A1C in insulin-treated patients with suboptimal glycemic control during an RCT and observational follow-up. [ABSTRACT FROM AUTHOR]

Biodegradable metals offer significant advantages by reducing the need for additional surgeries following bone fixation. These materials, with their optimal mechanical and degradable properties, also mitigate stress-shielding effects while promoting biological processes essential for healing. This study investigated the in vitro and in vivo biocompatibility of ZK60 magnesium alloy coated with a micro-arc oxidative layer incorporated with cerium oxide nanoparticles in orthopedic implants. The results demonstrated that the magnesium substrate undergoes gradual degradation, effectively eliminating long-term inflammation during bone formation. The micro-arc oxidative coating forms a dense ceramic layer, acting as a protective barrier that reduces corrosion rates and enhances the biocompatibility of the magnesium substrate. The incorporation of cerium oxide nanoparticles improves the tribological properties of the coating, refining degradation patterns and improving osteogenic characteristics. Furthermore, cerium oxide nanoparticles enhance bone reconstruction by facilitating appropriate interconnections between newly formed bone and native bone tissue. Consequently, cerium oxide nanoparticles contribute to favorable biosafety outcomes and exceptional bone remodeling capabilities by supporting bone healing and sustaining a prolonged degradation process, ultimately achieving dynamic equilibrium in bone formation. STATEMENT OF SIGNIFICANCE: This study comprehensively examined the incorporation of cerium oxide nanoparticles into biodegradable magnesium through a micro-arc oxidative process for use in orthopedic implants. This study conducted a comprehensive analysis involving material characterization, biodegradability testing, in vitro osteogenesis assays, and in vivo implantation, highlighting the potential benefits of the distinctive properties of cerium oxide nanoparticles. This research emphasizes the ability of cerium oxide nanoparticles to enhance the biodegradability of magnesium and facilitate remarkable bone regeneration, suggesting promising advantages for additive materials in orthopedic implants., Competing Interests: Declaration of interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: Intracavernous (IC) injections of stem cells has been shown to ameliorate cavernous nerve (CN)-induced erectile dysfunction (ED). However, the regenerative effects underlying the recovery of erectile function (EF) in human amniotic fluid-derived stem cells (hAFSCs) remain unclear. In the bilateral cavernous nerve crushing (BCNC) injury rat paradigm, we sought to ascertain the effects of hAFSC treatment on EF recovery during the incipient phase., Methods: Three groups of 45 male rats were used in this study: sham (Group 1), saline IC injection after BCNC (Group 2), and hAFSC intracavernous injection (ICI) after BCNC (Group 3). hAFSCs from the fourth passage showed potential to differentiate into trilineage cells. All animals were subjected to EF analysis on the 28th day post-injection and tissues were retrieved for histopathological and immunohistochemical analyses., Results: IC injections of hAFSC significantly improved EF parameters in BCNC-ED rats at 28 days post-injury. AFSC treatment enhanced the smooth muscle condition and increased the smooth muscle/collagen ratio, as evidenced by histological analysis. Immunohistology revealed increased expression of 𝛼-SMA andvWf in the corpus cavernosum and enhanced expression of nNOS in the dorsal penile nerve in BCNC-ED rats (p < 0.05). Western blotting showed that hAFSC treatment significantly increased α-SMA expression in the hAFSC group compared with that in the BCNC group. Electron microscopy revealed significantly elevated myelination in the CN (p < 0.05), maintenance of smooth muscle structures, and restoration of EF in BCNC-ED rats treated with hAFSC., Discussion and Conclusions: hAFSC treatment increased EF in BCNC-ED rats at a single dose. As BCNC-ED resembles ED caused by radical prostatectomy (RP), this therapy has high potential for ED patients after RP surgery., (© 2024. The Author(s).)

Family caregivers of persons with mild cognitive impairment attempt to understand the behavioural and functional changes exhibited by their relative. However, how caregivers respond to initial changes and changes over time has not been explored. The purpose of this qualitative study was to explore the experience of family caregivers responding to changes in their relative's memory, behaviours, and physical functions over 2 years. Eleven family caregivers of a relative with mild cognitive impairment were purposively recruited from neurological clinics in Taiwan. Face-to-face semi-structured interviews were conducted within 6-months of referral; three follow-ups were conducted at 6-month intervals. Content analysis of 41 transcribed audio-recorded interviews revealed the longitudinal changes in their relative with cognitive impairment was made caregiving challenging. Three themes described the challenges: (1) Changes related to their relative's cognitive impairment, which included increases in mood fluctuations, erratic behaviours, and reductions in physical abilities; (2) changes in their relative's comorbidities, which included adapting to new symptoms and treatments for a chronic disease, monitoring medication adherence and drug interactions; and (3) changes in caregiver burden, which increased levels of stress, uncertainty, and anxiety resulting in greater role strain. Caregiving became more challenging with time, especially caregivers whose relative developed dementia during the study period. These findings offer insight into the trajectory of the experience of family caregivers attempting to understand changes in cognition, behaviours, and physical functions for their relative with mild cognitive impairment over 2 years, which could help mental healthcare providers develop support services to reduce caregiver role strain., (© 2024 John Wiley & Sons Australia, Ltd.)

Objectives: This study aims to assess the impact of Traditional Chinese Medicine (TCM) on dementia patients, utilizing real-world data. Specifically, it seeks to evaluate how TCM influences clinical outcomes by examining changes in the Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) scores, as well as its effect on medical expenses over a two-year period. Data from a multi-center research database spanning from 2004 to 2021 will be used to achieve these objectives, addressing the current gap in empirical data concerning intuitive outcomes and cognitive function assessments., Methods: Propensity score matching was adopted to improve comparability among the intervention and control groups. Due to repeated dependent variable measurements, the generalized estimating equation was used to control for socio-demographic characteristics, regional characteristics, and Western medicine treatments for dementia., Results: After propensity score matching, a total of 441 research subjects were included: 90 in the TCM intervention group and 351 in the non-TCM intervention group. The results of multivariate regression analysis showed that compared with the non-TCM intervention group, the MMSE scores in the TCM intervention group increased by 0.608 points each year. The annual change in CDR scores in the TCM intervention group was 0.702 times that of the non-TCM utilization group. After TCM intervention, annual outpatient expenses increased by US$492.2, hospitalization expenses increased by US$324.3, and total medical expenses increased by US$815.9, compared with the non-intervention group., Conclusions: TCM interventions significantly decelerate cognitive decline in dementia patients, evidenced by slower reductions in MMSE scores and mitigated increases in CDR scores. However, these benefits are accompanied by increased medical expenses, particularly for outpatient care. Future healthcare strategies should balance the cognitive benefits of TCM with its economic impact, advocating for its inclusion in dementia care protocols., (© 2024. The Author(s).)

Cyberchondria is a hybrid term signifying a state in which individuals compulsively search for health-related information online because of health distress or anxiety, further aggravating their worries. This study develops a Cyberchondria Severity Scale (CSS) to assess the current situation of university students. Exploratory factor analysis (EFA) was conducted using 145 valid questionnaires. Subsequently, a nationwide survey was conducted at various universities in Taiwan, and 802 questionnaires were used for confirmatory factor analysis (CFA). The EFA led to the development of a CSS for college students with four constructs: increased anxiety (α = 0.91), obsessive-compulsive hypochondria (α = 0.87), perceived controllability (α = 0.88), and online physician-patient interaction (α = 0.86), with a Cronbach's alpha of 0.92 and variance of 66.81%. The CFA indicated that item reliability ranged from 0.50 to 0.86, factor loadings ranged from 0.71 to 0.93, and the composite reliability for latent variables ranged from 0.83 to 0.90 (p < .001). The extracted average variance ranged from 0.46 to 0.60. There were significant differences in various dimensions: perceived controllability had the highest score and obsessive-compulsive hypochondria had the lowest (F 3,2403 =256.26, p < .001). Therefore, CSS has emerged as a reliable and valid measure. Future studies should explore the factors that influence cyberchondria, promote online health information searches, and enhance reading comprehension skills., (© 2024. The Author(s).)

Objectives: According to most guidelines, dietary interventions are essential in the management of diabetes. Fasting has emerged as potential therapeutic regimes for diabetes. The proof-of-concept study and the fasting in diabetes treatment trial are the first to explore the clinical impact of the Fasting Mimicking Diet (FMD) in patients with type 2 diabetes mellitus. Their results showed that FMD cycles improve glycemic management and can be integrated into usual care complementary to current guidelines. This economic evaluation aims to assess the 10-year quality-of-life effects, cost implications, and cost-effectiveness of adding a 3-year FMD program to diabetes standard care in diabetic population on dual or triple medications at baseline from the perspective of the US payer., Methods: We constructed a microsimulation model in TreeAge using a published US-specific diabetes model. The model was populated using FMD effectiveness outcomes and publicly available clinical and economic data associated with diabetes complications, use of diabetes medications, hypoglycemia incidence, direct medical costs in 2021 USD, quality of life, and mortality. All benefits were discounted by 3%., Results: This cost-utility analysis showed that the FMD program was associated with 11.4% less diabetes complications, 67.2% less overall diabetes medication use, and 45.0% less hypoglycemia events over the 10-year simulation period. The program generated an additional effectiveness benefit of 0.211 quality-adjusted life year and net monetary benefit of 41 613 USD per simulated patient. Thus, the FMD program is cost saving., Conclusions: These results indicate that the FMD program is a beneficial first-line strategy in T2DM management., Competing Interests: Author Disclosures Author disclosure forms can be accessed below in the Supplemental Material section., (Copyright © 2024. Published by Elsevier Inc.)

Background and Objectives: This study aimed to confirm the effectiveness of the virtual passport for dementia care., Research Design and Methods: The virtual passport is an application (app) tool connecting healthcare professionals, dementia care sites, and people living with dementia (PLWD) and their family caregivers. This tool assists case managers in hospitals by providing individualized care plans and health education to PLWD and their caregivers. The dementia quality indicator achievement rates, care needs investigation and fulfillment, severity of behavioral and psychological symptoms of dementia (BPSD), and changes in caregiver burden and depression are measured at the initial interview and 6 and 12 months after the intervention., Results: We enrolled 57 and 54 patients and their caregivers in the virtual passport and routine care groups, respectively. Compared to the control group, six quality indicators in the passport group showed significantly higher achievement at 6 months after using the virtual passport. Case managers addressed more care needs at 6 months (1.37 vs 0, p < 0.001) and 12 months (1.32 vs 0, p < 0.001). Improvement in severity of neuropsychiatric symptoms (neuropsychiatric inventory (NPI) irritability/lability difference: -0.58 vs 0.22, p = 0.044; NPI agitation/aggression difference =-0.78 vs 0.00, p = 0.042) were also observed. No obvious influence was found in caregiver burden and depression after using the virtual passport., Discussion and Implications: The virtual passport is an effective information technology tool in improving the quality of dementia care, assisting case management in identifying more care needs, and reducing the severity of BPSD., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hong, Wang, Yang, Tung, Dai, Hsu, Huang and Jhang.)

Background: Case managers for persons with dementia not only coordinate patient care but also provide family caregivers with educational material and available support services. Taiwan uses a government-based information system for monitoring the provision of health care services. Unfortunately, scheduling patient care and providing information to family caregivers continues to be paper-based, which results in a duplication of patient assessments, complicates scheduling of follow-ups, and hinders communication with caregivers, which limits the ability of case managers to provide cohesive, quality care., Objective: This multiphase study aimed to develop an electronic information system for dementia care case managers based on their perceived case management needs and what they would like included in an electronic health care app., Methods: Case managers were recruited to participate (N=63) by purposive sampling from 28 facilities representing two types of community-based dementia care centers in Taiwan. A dementia case management information system (DCMIS) app was developed in four phases. Phase 1 assessed what should be included in the app by analyzing qualitative face-to-face or internet-based interviews with 33 case managers. Phase 2 formulated a framework for the app to support case managers based on key categories identified in phase 1. During phase 3, a multidisciplinary team of information technology engineers and dementia care experts developed the DCMIS app: hardware and software components were selected, including platforms for messaging, data management, and security. The app was designed to eventually interface with a family caregiver app. Phase 4 involved pilot-testing the DCMIS app with a second group of managers (n=30); feedback was provided via face-to-face interviews about their user experience., Results: Findings from interviews in phase 1 indicated the DCMIS framework should include unified databases for patient reminder follow-up scheduling, support services, a health education module, and shared recordkeeping to facilitate teamwork, networking, and communication. The DCMIS app was built on the LINE (LY Corporation) messaging platform, which is the mobile app most widely used in Taiwan. An open-source database management system allows secure entry and storage of user information and patient data. Case managers had easy access to educational materials on dementia and caregiving for persons living with dementia that could be provided to caregivers. Interviews with case managers following pilot testing indicated that the DCMIS app facilitated the completion of tasks and management responsibilities. Some case managers thought it would be helpful to have a DCMIS desktop computer system rather than a mobile app., Conclusions: Based on pilot testing, the DCMIS app could reduce the growing challenges of high caseloads faced by case managers of persons with dementia, which could improve continuity of care. These findings will serve as a reference when the system is fully developed and integrated with the electronic health care system in Taiwan., (©Huei-Ling Huang, Yi-Ping Chao, Chun-Yu Kuo, Ya-Li Sung, Yea-Ing L Shyu, Wen-Chuin Hsu. Originally published in JMIR Aging (https://aging.jmir.org), 23.09.2024.)

Background: Evaluating outcome reliability is critical in real-world evidence studies. Overall survival is a common outcome in these studies; however, its capture in real-world data (RWD) sources is often incomplete and supplemented with linked mortality information from external sources. Conflicting recommendations exist for censoring overall survival in real-world evidence studies. This simulation study aimed to understand the impact of different censoring methods on estimating median survival and log hazard ratios when external mortality information is partially captured., Methods: We used Monte Carlo simulation to emulate a non-randomized comparative effectiveness study of two treatments with RWD from electronic health records and linked external mortality data. We simulated the time to death, the time to last database activity, and the time to data cutoff. Death events after the last database activity were attributed to linked external mortality data and randomly set to missing to reflect the sensitivity of contemporary real-world data sources. Two censoring schemes were evaluated: (1) censoring at the last activity date and (2) censoring at the end of data availability (data cutoff) without an observed death. We assessed the performance of each method in estimating median survival and log hazard ratios using bias, coverage, variance, and rejection rate under varying amounts of incomplete mortality information and varying treatment effects, length of follow-up, and sample size., Results: When mortality information was fully captured, median survival estimates were unbiased when censoring at data cutoff and underestimated when censoring at the last activity. When linked mortality information was missing, censoring at the last activity date underestimated the median survival, while censoring at the data cutoff overestimated it. As missing linked mortality information increased, bias decreased when censoring at the last activity date and increased when censoring at data cutoff., Conclusions: Researchers should consider the completeness of linked external mortality information when choosing how to censor the analysis of overall survival using RWD. Substantial bias in median survival estimates can occur if an inappropriate censoring scheme is selected. We advocate for RWD providers to perform validation studies of their mortality data and publish their findings to inform methodological decisions better., (© 2024. The Author(s).)

Objective: First branchial cleft anomalies are rare congenital head and neck lesions. Literature pertaining to classification, work up and surgical treatment of these lesions is limited and, in some instances, contradictory. The goal of this work is to provide refinement of the classification system of these lesions and to provide guidance for clinicians to aid in the comprehensive management of children with first branchial cleft anomalies., Materials and Methods: Delphi method survey of expert opinion under the direction of the International Pediatric Otolaryngology Group (IPOG) was conducted to generate recommendations for the definition and management of first branchial cleft anomalies. The recommendations are the result of expert consensus and critical review of the literature., Results: Consensus recommendations include evaluation and diagnostic considerations for children with first branchial cleft anomalies as well as recommendations for surgical management. The current Work classification system was reviewed, and modifications were made to it to provide a more cogent categorization of these lesions., Conclusion: The mission of the International Pediatric Otolaryngology Group (IPOG) is to develop expertise-based recommendations based on review of the literature for the management of pediatric otolaryngologic disorders. These consensus recommendations are aimed at improving care of children presenting with first branchial cleft anomalies. Here we present a revised classification system based on parotid gland involvement, with a focus on avoiding stratification based on germ layer, in addition to guidelines for management., Competing Interests: Declaration of competing interest Below we have listed any relevant disclosures or conflicts of interest among the authors of our manuscript, “Comprehensive management and classification of first branchial cleft anomalies: An International Pediatric Otolaryngology Group (IPOG) consensus statement.” Daniel Chelius, MD: Leadership role and stipend as AAO-HNSF Annual Meeting Coordinator, 2021–2024. Steven Goudy, MD, MBA: Founder and Chief Medical Officer of Dr. Noze Best. Kris Jatana, MD, FACS, FAAP: Royalties (Marpac Inc.), Shareholder (Tivic Health Systems), Officer/Shareholder (Zotarix LLC, in collaboration with Grace Medical). For all remaining authors of this work, there are no conflicts of interest or financial disclosures to report., (Copyright © 2024. Published by Elsevier B.V.)

Background/aims: Crohn's Disease (CD) can affect the entire gastrointestinal tract, including the upper sections (UGI), which is often overlooked, especially in Asian populations. There's a notable gap in research regarding the impact of UGI involvement on the intricate landscape of ensuing complications. This study aims to address this gap., Methods: Conducting a retrospective study at Chang Gung Memorial Hospital from January 2001 to September 2023, we compared CD patients with UGI (Montreal L4) involvement against non-L4 counterparts, focusing on baseline characteristics, post-diagnosis complications, and overall outcomes. Routine UGI endoscopy was performed around the time of diagnosis in all patients followed in our inflammatory bowel disease (IBD) center, and all CD patients with adequate follow-up were included in this study., Results: The study included 212 CD patients, 111 in the L4 group and 101 in the non-L4 group, with an average follow-up of 40.8 ± 15.1 months. At baseline, individuals in the L4 category demonstrated elevated smoking rates, increased Crohn's Disease Activity Index scores, a higher prevalence of strictures, and a more prevalent usage of biologics and proton pump inhibitors. Moreover, this group was characterized by reduced albumin levels. Upon concluding the follow-up, those with L4 involvement continued to show escalated CDAI scores and hospitalization frequencies, alongside heightened C-reactive protein levels and diminished albumin concentrations. Additionally, the occurrence of UGI involvement, stricturing disease at the time of diagnosis, and a younger age at the onset of CD were pinpointed as independent predictors for the development of new-onset strictures., Conclusions: CD patients with UGI involvement exhibit elevated disease activity and serve as independent predictors for the development of intestinal strictures. Thorough UGI evaluations at the time of diagnosis, coupled with assertive treatment strategies, are essential for managing these patients effectively., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background: Family caregivers of persons with dementia are faced with complex caregiving management needs. This study had two aims: (1) to identify caregiving management needs of family caregivers of persons with dementia and (2) identify any variables that might influence these needs., Methods: This cross-sectional study recruited family caregivers of persons with dementia (N = 250) through referrals from clinicians at a dementia outpatient clinic in Northern Taiwan. Data were collected with a 32-item researcher-developed instrument, the Caregiving Management Needs Scale (CMNS), to identify management needs specific to family caregivers of persons with dementia. The CMNS was comprised of questions about the types of assistance or support family caregivers would like to receive to facilitate caregiving., Results: CMNS scores indicated caregivers had moderate management needs. Caregivers of relatives with a moderate severity of dementia had significantly higher scores on the CMNS compared with caregivers of persons with very mild dementia (p < 0.01). Linear regression analysis indicated significant predictors of high caregiving management needs were caregivers who were female (p < 0.01), and persons with dementia with behavioral problems (p < 0.01), low scores for Activities of Daily Living (p < 0.01), regular medication adherence (p < 0.01), and use of long-term care services (p < 0.001) were significant (F[13, 236] = 7.12; p < 0.001; R 2  = 28.2%)., Conclusions: Understanding variables and predictors of caregiving management needs for family caregivers could reduce the complexity of caregiving., Trial Registration: ClinicalTrials.gov NCT05151185., (© 2024. The Author(s).)

The impact of global population aging on older adults' health and emotional well-being is examined in this study, emphasizing innovative technological solutions to address their diverse needs. Changes in physical and mental functions due to aging, along with emotional challenges that necessitate attention, are highlighted. Gaze estimation and interactive art are utilized to develop an interactive system tailored for elderly users, where interaction is simplified through eye movements to reduce technological barriers and provide a soothing art experience. By employing multi-sensory stimulation, the system aims to evoke positive emotions and facilitate meaningful activities, promoting active aging. Named "Natural Rhythm through Eyes", it allows for users to interact with nature-themed environments via eye movements. User feedback via questionnaires and expert interviews was collected during public demonstrations in elderly settings to validate the system's effectiveness in providing usability, pleasure, and interactive experience for the elderly. Key findings include the following: (1) Enhanced usability of the gaze estimation interface for elderly users. (2) Increased enjoyment and engagement through nature-themed interactive art. (3) Positive influence on active aging through the integration of gaze estimation and interactive art. These findings underscore technology's potential to enhance well-being and quality of life for older adults navigating aging challenges., Competing Interests: The authors declare no conflicts of interest.

Nosema ceranae is a microsporidian parasite that threatens current apiculture. N. ceranae-infected honey bees (Apis mellifera) exhibit morbid physiological impairments and reduced honey production, malnutrition, shorter life span, and higher mortality than healthy honey bees. In this study, we found that dimethyl sulfoxide (DMSO) could enhance the survival rate of N. ceranae-infected honey bees. Therefore, we investigated the effect of DMSO on N. ceranae-infected honey bees using comparative RNA sequencing analysis. Our results revealed that DMSO was able to affect several biochemical pathways, especially the metabolic-related pathways in N. ceranae-infected honey bees. Based on these findings, we conclude that DMSO may be a useful alternative for treating N. ceranae infection in apiculture., (© 2024 Wiley Periodicals LLC.)

Background and Objectives : Frailty in older adults is associated with adverse health outcomes. This study aimed to analyze the frailty status of community-dwelling older adults in Taiwan using the Kihon Checklist (KCL) and explore associations with demographic, physiological, and functional factors. Materials and Methods : In this cross-sectional study, 278 community-dwelling older adults were classified as robust, prefrail, or frail based on their KCL scores. Participants underwent physical fitness assessments including muscle strength and endurance tests, walking speed tests, and flexibility tests. One-way ANOVA and logistic regression analyses were used to examine differences and associations between frailty status and physical fitness indicators. Results : 36% of participants were robust, 47.1% prefrail, and 16.9% frail. The robust group significantly outperformed the prefrail and frail groups in the 30 s sit-to-stand test, 2.44 m sit-to-walk test, and walking speed ( p < 0.001). The 2.44 m sit-to-walk test was a significant predictor of prefrailty (OR = 1.18, 95% CI = 1.02-1.36) after adjusting for other physical fitness indicators. Conclusions : Lower limb functional capacity, particularly in the 2.44 m sit-to-walk test, was significantly associated with pre-frailty among community-dwelling older adults in Taiwan. Early screening, the classification of frailty by the Kihon Checklist, and targeted interventions focusing on lower limb strength, endurance, and mobility are crucial for preventing and delaying frailty progression in older populations.

Background: Human flourishing is an emerging concept, extending beyond the conventional boundaries of subjective well-being and evolving into a comprehensive capture of the diverse dimensions of human life within complex societal structures. Therefore, moving away from traditional approaches centered on the single latent construct, this study aims to explore the multiple aspects of human flourishing and the intricate interplay of their contributing factors., Methods: Data were collected from the Health and Living Environments Survey of Taiwanese Retirees during 2023 (valid sample n = 1,111). Human flourishing was measured using the Secure Flourish Index developed by Harvard University, which includes 12 indicators: (1) life satisfaction, (2) happiness, (3) mental health, (4) physical health, (5) meaning in life, (6) sense of purpose, (7) promoting good, (8) delaying gratification, (9) content relationships, (10) satisfying relationships, (11) financial stability, and (12) material stability. A mixed graphical network analysis was employed to analyze the related determinants, divided into four groups: (a) sociodemographic factors, (b) physical functions and health status, (c) social and family engagement, and (d) community environmental characteristics as nodes., Results: We analyzed 31 variables and identified 133 nonzero edges out of 465 potential connections in the comprehensive network. Results showed that happiness and promoting good were the two most critical indicators influencing retirees' overall flourishing. Different flourishing indicators were also associated with various influential factors. For instance, personal characteristics, especially gender and education, emerged as central factors. Family caregiving negatively affected happiness and financial stability, whereas social engagement was positively associated with life satisfaction and meaning in life. Employment status had mixed effects, negatively associated with life satisfaction but positively associated with mental health. Community environments, such as a sense of community and neighborhood safety, generally enhanced flourishing. However, the accessibility of neighborhood resources was paradoxically associated with material stability, pointing to the complexity of environmental factors in human flourishing., Conclusion: This study provides a comprehensive network analysis that reveals intricate connections between personal, behavioral, and environmental factors, offering profound insights for targeted interventions to foster human flourishing., (© 2024. The Author(s).)

Background: Inhibiting the development and progression of diabetic kidney disease (DKD) is an important issue, but the renoprotective effect of metformin is still controversial., Aims: To assess the renoprotective effect of metformin in patients with type 2 diabetes., Methods: This retrospective observational multicenter cohort study included 316,693 patients with type 2 diabetes from seven hospital. After age, gender, medical year, baseline estimated glomerular filtration rate (eGFR), urine protein (dipstick), glycated hemoglobin (HbA1C) and propensity score matching; a total of 13,096 metformin and 13,096 non-metformin patients were included. The main results were doubling of serum creatinine, eGFR ≤ 15 mL/min/1.73 m2 and end stage kidney disease (ESKD)., Results: After conducting a multivariable logistic regression analysis on the variables, the metformin group was revealed to have better renal outcomes than non-metformin group, including a lower incidence of doubling of serum creatinine (hazard ratio [HR], 0.71; 95% CI, 0.65-0.77), eGFR ≤ 15 mL/min/1.73 m2 (HR 0.61; 95% CI 0.53-0.71), and ESKD (HR 0.55; 95% CI 0.47-0.66). The subgroup analyses revealed a consistent renoprotective effect across patients with various renal functions. Furthermore, when considering factors such as age, sex, comorbidities, and medications in subgroup analyses, it consistently showed that the metformin group experienced a slower deterioration in renal function across nearly all patient subgroups., Conclusions: Metformin decreased the risk of renal function deterioration., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com. See the journal About page for additional terms.)

Background: Circadian rhythm disruptions are a common concern for poststroke patients undergoing rehabilitation and might negatively impact their functional outcomes., Objective: Our research aimed to uncover unique patterns and disruptions specific to poststroke rehabilitation patients and identify potential differences in specific rest-activity rhythm indicators when compared to inpatient controls with non-brain-related lesions, such as patients with spinal cord injuries., Methods: We obtained a 7-day recording with a wearable actigraphy device from 25 poststroke patients (n=9, 36% women; median age 56, IQR 46-71) and 25 age- and gender-matched inpatient control participants (n=15, 60% women; median age 57, IQR 46.5-68.5). To assess circadian rhythm, we used a nonparametric method to calculate key rest-activity rhythm indicators-relative amplitude, interdaily stability, and intradaily variability. Relative amplitude, quantifying rest-activity rhythm amplitude while considering daily variations and unbalanced amplitudes, was calculated as the ratio of the difference between the most active 10 continuous hours and the least active 5 continuous hours to the sum of these 10 and 5 continuous hours. We also examined the clinical correlations between rest-activity rhythm indicators and delirium screening tools, such as the 4 A's Test and the Barthel Index, which assess delirium and activities of daily living., Results: Patients who had a stroke had higher least active 5-hour values compared to the control group (median 4.29, IQR 2.88-6.49 vs median 1.84, IQR 0.67-4.34; P=.008). The most active 10-hour values showed no significant differences between the groups (stroke group: median 38.92, IQR 14.60-40.87; control group: median 31.18, IQR 18.02-46.84; P=.93). The stroke group presented a lower relative amplitude compared to the control group (median 0.74, IQR 0.57-0.85 vs median 0.88, IQR 0.71-0.96; P=.009). Further analysis revealed no significant differences in other rest-activity rhythm metrics between the two groups. Among the patients who had a stroke, a negative correlation was observed between the 4 A's Test scores and relative amplitude (ρ=-0.41; P=.045). Across all participants, positive correlations emerged between the Barthel Index scores and both interdaily stability (ρ=0.34; P=.02) and the most active 10-hour value (ρ=0.42; P=.002)., Conclusions: This study highlights the relevance of circadian rhythm disruptions in poststroke rehabilitation and provides insights into potential diagnostic and prognostic implications for rest-activity rhythm indicators as digital biomarkers., (©Huey-Wen Liang, Chueh-Hung Wu, Chen Lin, Hsiang-Chih Chang, Yu-Hsuan Lin, Shao-Yu Chen, Wei-Chen Hsu. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 04.07.2024.)

Objectives: The purpose of this study was to examine the role of predictability in the relationship between caregiving demands and caregiving consequences., Design: This 2-year longitudinal survey study collected from self-report questionnaires. A convenience sample of family caregivers of older persons living with dementia were recruited from a neurology clinic., Results: A total of 200 family caregivers were recruited to participate. Analysis indicated predictability was a partial mediator between caregiving demand and caregiver consequences of role strain, depressive symptoms and both physical and mental components of health-related quality of life at the 2-year follow. Predictability accounted for 25 %, 28.8 %, 15.3 % and 46.5 % of the relationship between caregiving demand and caregiving consequences of role strain, depressive symptoms, physical- and mental-health related quality of life, respectively., Conclusions: The contributions of caregiving demand to outcomes of caregiver consequences were in part due family caregivers perceived predictability for caregiving., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Phosphatase and tensin homolog (PTEN) is vital for B cell development, acting as a key negative regulator in the PI3K signaling pathway. We used CD23-cre to generate PTEN-conditional knockout mice (CD23-cKO) to examine the impact of PTEN mutation on peripheral B cells. Unlike mb1-cre-mediated PTEN deletion in early B cells, CD23-cKO mutants exhibited systemic inflammation with increased IL-6 production in mature B cells upon CpG stimulation. Inflammatory B cells in CD23-cKO mice showed elevated phosphatidylinositol 3-phosphate [PI(3)P] levels and increased TLR9 endosomal localization. Pharmacological inhibition of PI(3)P synthesis markedly reduced TLR9-mediated IL-6. Single-cell RNA-sequencing (RNA-seq) revealed altered endocytosis, BANK1, and NF-κB1 expression in PTEN-deficient B cells. Ectopic B cell receptor (BCR) expression on non-inflammatory mb1-cKO B cells restored BANK1 and NF-κB1 expression, enhancing TLR9-mediated IL-6 production. Our study highlights PTEN as a crucial inflammatory checkpoint, regulating TLR9/IL-6 axis by fine-tuning PI(3)P homeostasis. Additionally, BCR downregulation prevents the differentiation of inflammatory B cells in PTEN deficiency., Competing Interests: The authors declare no competing interests., (© 2024 The Author(s).)

Purpose: This study assesses the effectiveness of a health education program on caregiving outcomes for people with dementia and their families., Methods: This quasi-experimental study involved 250 people with dementia and their family caregivers. Behavioral problems in people with dementia were assessed using the Chinese version of the Cohen-Mansfield Agitation Inventory-community form. Family caregiver outcomes were measured using the Agitation Management Self-Efficacy Scale, Caregiver Preparedness Scale, Competence Scale, and Community Resource Awareness and Utilization Assessment., Results: Following the intervention, the experimental group demonstrated significant improvements in terms of self-efficacy, preparedness, competence, and awareness and utilization of community resources among family caregivers. Additionally, the experimental group exhibited lower levels of behavioral problems among people with dementia., Conclusions: This study helped improve caregiving outcomes for people with dementia and their family caregivers. Therefore, outpatient healthcare providers can utilize these findings to enhance care for this population., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Adenotonsillectomy is one of the most common surgical procedures performed on children. Caregivers are often concerned about voice change after the procedure, and such concerns remain unsettled. This meta-analysis analyzed voice change in children after adenotonsillectomy., Data Sources: The PubMed, Medline, EMBASE, and Cochrane databases., Review Methods: The study protocol was registered on PROSPERO. Two authors independently searched for articles using keywords "adenoidectomy," "tonsillectomy, "voice," "nasalance,"and "speech." English articles specifying voice changes after adenotonsillectomy were pooled with standardized mean difference (SMD) using random-effects model. Evaluation methods were computerized acoustic voice analysis, aerodynamic analysis, nasometer, rhinomanometry, evaluations from a speech-language pathologist or otolaryngologist, and a caregiver assessment questionnaire., Results: Twenty-three studies with 2154 children were analyzed (mean age: 8.0 y; 58% boys; mean sample size: 94 children). Due to insufficient data for other outcome variables, this meta-analysis only summarized changes in the computerized acoustic voice analysis 1 month and 3 months after surgery. The computerized acoustic analysis revealed significant changes in jitter (SMD = -0.36; 95% confidence interval [CI]: -0.60 to -0.11), shimmer (SMD = -0.34; 95% CI: -0.57 to -0.11), and soft phonation index (SMD = -0.36; 95% CI: -0.57 to -0.15) at 1 month after surgery. Parameters including fundamental frequency, jitter, noise-to-harmonics ratio, and shimmer were not significantly changed at 3 months after surgery., Conclusions: This meta-analysis observed small improvements in jitter, shimmer, and soft phonation index 1 month after surgery. No significant effects were observed in voice outcomes 3 months after surgery. Laryngoscope, 134:2538-2550, 2024., (© 2023 The American Laryngological, Rhinological and Otological Society, Inc.)

Objectives: Multilayer monolithic zirconia (M-Zr) crowns can be engineered to achieve gradational translucency and color intensity. However, this modification may compromise the mechanical strength, raising concerns regarding the ability of M-Zr crowns to withstand occlusal stresses. The effects of M-Zr crown thickness on translucency and ability to endure occlusal forces were investigated at different tooth positions (incisors, premolars, and molars). The objective was to determine the minimal thickness of M-Zr crowns used in tooth preparation to meet aesthetic and functional demands., Methods: M-Zr samples (Vita A1) with four thicknesses (0.5, 1.0, 1.5, and 2.0 mm) were prepared and subjected to translucency testing using a digital colorimeter by 3-third and 9-square division methods. Crown-shaped M-Zr samples with three thicknesses (1.0, 1.5, and 2.0 mm) and three tooth positions (incisor, premolar, and molar) were digitally designed, and 2.0 mm metal abutments were fabricated. The samples were bonded to the abutments; their fracture characteristics were evaluated using a universal testing machine, and their fracture surfaces examined using an optical microscope. Statistical analyses included the Shapiro-Wilk test, Pearson correlation, and one-way and two-way ANOVA with a post hoc Tukey HSD test (α = 0.05)., Results: Color analysis results revealed a significant negative correlation between thickness and translucency (r < -0.96, P < 0.01), with the highest values in the incisal region. Cross-sectional profiles confirmed the uniform thickness and morphology of the digitally designed M-Zr crowns. The results of fracture strength analysis showed position-dependent variability, a strong positive correlation with thickness (r > 0.96, P < 0.01), and fracture strengths consistently exceeding 1200 N across all tooth positions. Fracture patterns indicated that thinner crowns at the incisors and molars were more prone to cracking, whereas those at the premolars demonstrated significantly higher strength (4872.51 N, P < 0.05), only with crack or even no fracture occurring at 2.0 mm., Conclusions: Thickness significantly influenced both the translucency and fracture strength of M-Zr, with the tooth position playing an additional role, albeit to a lesser extent. Although thinner crowns exhibited lower strength at each tooth position, even at a thickness of 1.0 mm, fracture strength exceeding 1200 N was maintained, surpassing the typical occlusal forces. Thus, it can be asserted that M-Zr crowns with a minimum thickness of 1.0 mm can meet both aesthetic and functional requirements., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Study Objectives: The relationship between obstructive sleep apnea (OSA) and gastroesophageal reflux disease (GERD) is complex. We aimed to determine the association of self-reported and objective sleep parameters with diverse manifestations of the GERD spectrum., Methods: We prospectively recruited 561 individuals who underwent an electrocardiogram-based cardiopulmonary coupling for OSA screening during a health check-up. All participants received the Reflux Disease Questionnaire and an upper endoscopy to determine the presence of troublesome reflux symptoms and erosive esophagitis (EE). Sleep quality was evaluated by the Pittsburgh Sleep Quality Index and sleep dysfunction was defined as a Pittsburgh Sleep Quality Index score > 5. OSA was defined as a cardiopulmonary coupling-derived apnea-hypopnea index exceeding 15 events/h. Comparisons were made between participants on the GERD spectrum with respect to their various self-reported and objective sleep parameters., Results: Among the 277 patients with GERD (49.4%), 198 (35.3%) had EE. Patients with GERD had higher PSQI scores (6.99 ± 3.97 vs 6.07 ± 3.73, P = .005) and a higher prevalence of sleep dysfunction (60.6% vs 49.6%, P = .009). Patients with EE had a higher prevalence of OSA (42.9% vs 33.9%, P = .034). Along the GERD spectrum, symptomatic patients with EE had the highest PSQI scores and prevalence of sleep dysfunction (70.7%), while asymptomatic patients with EE had the highest prevalence of OSA (44%)., Conclusions: Our findings indicate a high prevalence of sleep dysfunction among individuals with GERD. Furthermore, patients on the GERD spectrum are prone to experiencing a range of self-reported and objective sleep disturbances., Citation: Hu K-Y, Tseng P-H, Hsu W-C, et al. Association of self-reported and objective sleep disturbance with the spectrum of gastroesophageal reflux disease. J Clin Sleep Med . 2024;20(6):911-920., (© 2024 American Academy of Sleep Medicine.)

Introduction: Multiple sclerosis (MS) is a complex neurodegenerative disorder that affects the brain and spinal cord. In this study, we applied a deep learning-based approach using the StyleGAN model to explore patterns related to MS and predict disease progression in magnetic resonance images (MRI)., Methods: We trained the StyleGAN model unsupervised using T 1 -weighted GRE MR images and diffusion-based ADC maps of MS patients and healthy controls. We then used the trained model to resample MR images from real input data and modified them by manipulations in the latent space to simulate MS progression. We analyzed the resulting simulation-related patterns mimicking disease progression by comparing the intensity profiles of the original and manipulated images and determined the brain parenchymal fraction (BPF)., Results: Our results show that MS progression can be simulated by manipulating MR images in the latent space, as evidenced by brain volume loss on both T 1 -weighted and ADC maps and increasing lesion extent on ADC maps., Conclusion: Overall, this study demonstrates the potential of the StyleGAN model in medical imaging to study image markers and to shed more light on the relationship between brain atrophy and MS progression through corresponding manipulations in the latent space., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier GmbH.. All rights reserved.)

Neurotrophic receptor tyrosine kinase 3 (NTRK3) has pleiotropic functions: it acts not only as an oncogene in breast and gastric cancers but also as a dependence receptor in tumor suppressor genes in colon cancer and neuroblastomas. However, the role of NTRK3 in upper tract urothelial carcinoma (UTUC) is not well documented. This study investigated the association between NTRK3 expression and outcomes in UTUC patients and validated the results in tests on UTUC cell lines. A total of 118 UTUC cancer tissue samples were examined to evaluate the expression of NTRK3. Survival curves were generated using Kaplan-Meier estimates, and Cox regression models were used for investigating survival outcomes. Higher NTRK3 expression was correlated with worse progression-free survival, cancer-specific survival, and overall survival. Moreover, the results of an Ingenuity Pathway Analysis suggested that NTRK3 may interact with the PI3K-AKT-mTOR signaling pathway to promote cancer. NTRK3 downregulation in BFTC909 cells through shRNA reduced cellular migration, invasion, and activity in the AKT-mTOR pathway. Furthermore, the overexpression of NTRK3 in UM-UC-14 cells promoted AKT-mTOR pathway activity, cellular migration, and cell invasion. From these observations, we concluded that NTRK3 may contribute to aggressive behaviors in UTUC by facilitating cell migration and invasion through its interaction with the AKT-mTOR pathway and the expression of NTRK3 is a potential predictor of clinical outcomes in cases of UTUC., (© 2024 The Authors. The Kaohsiung Journal of Medical Sciences published by John Wiley & Sons Australia, Ltd on behalf of Kaohsiung Medical University.)

This review summarizes the current evidence in systematic reviews, meta-analysis and randomized controlled trials regarding adenotonsillectomy outcomes in pediatric obstructive sleep apnea (OSA). Adenotonsillectomy is effective in treating OSA in children without co-morbidities, despite postoperative residual OSA remained in roughly half of these children. For children with comorbidities such as Down syndrome, Prader-Willi syndrome, sickle cell disease, or cerebral palsy, adenotonsillectomy is less effective and associated with more postoperative complications than that in children without comorbidities. For other OSA-related outcomes, evidence from meta-analyses and randomized controlled trials confirm adenotonsillectomy results in improvement of subjective OSA-related outcomes (e.g. symptoms, behaviors, and quality of life), but the results in objective OSA-related outcomes (e.g. cardiometabolic parameters or neurocognitive functions) are inconsistent. Future studies should focus on randomized controlled trials comparing objective OSA-related outcomes and the long-term effects of adenotonsillectomy in children with OSA., Competing Interests: Conflicts of interest The authors declare no conflicts of interest., (Copyright © 2023 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: Frailty is common among older adults, often associated with activity limitations during physical and walking tasks. The interactive boxing-cycling combination has the potential to be an innovative and efficient training method, and our hypothesis was that interactive boxing-cycling would be superior to stationary cycling in improving frailty and activity limitations in frail and prefrail older adults., Objective: To examine the impact of interactive boxing-cycling on frailty and activity limitations in frail and prefrail older adults compared to stationary cycling., Materials and Methods: A single-blinded randomized controlled trial. Forty-five participants who met at least one frailty phenotype criteria were randomly assigned to receive either interactive boxing-cycling (n = 23) or stationary-cycling (n = 22) for 36 sessions over 12 weeks. The interactive boxing-cycling was performed on a cycle boxer bike with an interactive boxing panel fixed in front of the bike. The primary outcomes were frailty status, including score and phenotypes. Secondary outcomes included activity limitations during physical and walking tasks. The pre- and post-intervention data of both groups were analyzed using a repeated measures two-way ANOVA., Results: Both types of cycling significantly improved frailty scores (p<0.001). Interactive boxing-cycling was more effective than stationary cycling in reversing the frailty phenotype of muscle weakness (p = 0.03, odds ratio 9.19) and demonstrated greater improvements than stationary cycling in arm curl (p = 0.002, η 2 =0.20), functional reach (p = 0.001, η 2 =0.22), and grip strength (p = 0.02, η 2 =0.12) tests. Additionally, interactive boxing-cycling exhibited a greater effect on gait speed (p = 0.02, η 2 =0.13) and gait variability (p = 0.01, η 2 =0.14) during dual-task walking., Conclusion: In frail and prefrail older adults, interactive boxing-cycling effectively improves frailty but is not superior to stationary cycling. However, it is more effective at improving certain activity limitations., Registration Number: TCTR20220328001., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Background: /Purpose: The Pediatric Eating Assessment Tool-10 (Pedi-EAT-10) is a caregiver-administrated subjective questionnaire for evaluating swallowing and feeding disorders among children. This study translated the Pedi-EAT-10 into Traditional Chinese and tested the translated version's reliability and validity., Methods: Pedi-EAT-10 was translated into Traditional Chinese by experts and finalized after discussion and testing. A total of 168 participants, consisting of 32 children with dysphagia from a tertiary medical center and 136 healthy controls from its Children Care Center for Employees, were recruited. All participants were assessed by an otolaryngologist and speech-language pathologist. The reliability, validity, and efficacy of the translated Pedi-EAT-10 were analyzed to ensure it could be used to identify pediatric dysphagia and feeding problems., Results: The Traditional Chinese version of the Pedi-EAT-10 had significant clinical discriminative validity between the dysphagia group and the control group (total score = 9.6 vs. 2.6, P < 0.001), acceptable test-retest reliability (intraclass correlation = 0.63), and excellent internal consistency (Cronbach's α = 0.91 for the entire cohort). The overall performance of the test for distinguishing children with dysphagia from normal controls was acceptable, and the area under the curve was 74.8% (sensitivity = 71.9%; specificity = 69.9%). The optimal cutoff score was ≥3 on the Youdex index., Conclusions: The Traditional Chinese version of the Pedi-EAT-10 has fair reliability and validity and can be quickly and easily completed by caregivers. The translated Ped-EAT-10 can be used as a first-line tool for assessing the need for further referral and instrumental examination., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Individuals in the early stages of dementia often endure elevated levels of stress and anxiety, which can hinder their ability to adapt to the progression of dementia. To mitigate the negative impacts of dementia more effectively, it is necessary to explore the trajectory of the adaptation process of persons living with dementia. This study aimed to construct a theoretical framework for the adaptation process of individuals in the early stages of dementia. Participants were dyads of persons diagnosed with mild dementia or mild cognitive impairment (≥ 60 years of age) and their primary family caregivers. This longitudinal study used a grounded theory approach to explore the adaptation trajectory changes in persons with mild dementia over a 3-year period. Data were collected from dyads with face-to-face interviews. Analysis of the interview data revealed the core category was 'Coexisting with anomie: Progressive disappointment and striving', which was comprised of three categories: awareness of alienation, unsettled feelings, and restorative avoidance coping. Categories changed depending on levels of cognition and constituted progressive and cyclical dynamic processes. Four contextual factors positively or negatively influenced adaptation: level of insight about dementia, personal traits, caregiving style of the caregiver, and level of social interactions. These findings provide a new perspective about the mental health of persons in early-stage dementia. Understanding coexisting with anomie and related influencing factors could facilitate the development of support interventions by mental health nursing staff, which could improve emotional safety, promote psychological well-being, and increase quality of life for persons living with dementia., (© 2023 John Wiley & Sons Australia, Ltd.)

In practice, individuals strive to develop highly original and valuable creative products within specific limitations. However, previous functional Magnetic Resonance Imaging (fMRI) studies focused on divergent-thinking tasks without considering the "valuableness" of an idea. Additionally, different types of creative tasks (e.g., the easier association vs. the harder association task) may engage distinct cognitive processes. This study aimed to investigate the underlying neural mechanisms associated with different types of creative thinking, specifically focusing on the generation of the most original and valuable creative product within an fMRI scanner. Twenty-one college students participated in a block design study. During each trial, participants were instructed to draw the most original and valuable product inspired by a given figure. The findings revealed that, in comparison to the harder association task, the easier association task led to broader activation across multiple brain regions. However, this broader activation resulted in inefficient thinking and poorer creative performance. Notably, the orbitofrontal cortex exhibited activation across various creativity tasks and displayed connectivity with several seed brain regions, highlighting the importance of decision-making when only one original and valuable product design is allowed. Furthermore, the complex functional connectivity observed between different brain networks reflects the intricate nature of creative thinking. To conclude, widespread activation of brain regions does not necessarily indicate superior creativity. Instead, optimal creative performance within constraints is achieved through an efficient utilization of association for generating innovative ideas, inhibition for suppressing unoriginal ideas, and decision-making to select the most creative idea., Competing Interests: There is no conflict of Interest and the study is in compliance with ethical standards, (© 2024 The Authors.)