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Data on predictors and time to relapse in patients with psoriasis who discontinue therapy in a real-world setting are scarce.To investigate predictors of relapse after withdrawal of ustekinumab in patients with psoriasis.This study screened 500 patients with psoriasis who received ustekinumab (669 treatment episodes) between 2011 and 2018. Overall, 202 patients (accounting for 304 treatment episodes) who had responded to therapy and were withdrawn from ustekinumab treatment were included.The cumulative probabilities of being relapse-free at 6, 12, 18, 24, and 36 months after withdrawal from ustekinumab treatment were 49.3%, 12.6%, 5.3%, 4.7%, and 1.6%, respectively. Multivariate regression analyses with a generalized estimating equation showed that after adjustments, biologic-naive status, maximum improvement in Psoriasis Area and Severity Index during ustekinumab treatment, time to achieve a 50% improvement in baseline Psoriasis Area and Severity Index score after initiation of ustekinumab, family history of psoriasis, chronic kidney disease, and immunosuppressant use while not taking ustekinumab were significant predictors of time to relapse following discontinuation of ustekinumab.Nonrandomized allocation of duration of treatment and follow-up.Given the high rates of relapse, withdrawal of ustekinumab from patients with well-controlled psoriasis cannot be recommended.

Ion beam-induced luminescence (IBIL) spectroscopy based on the stark level characteristics of trivalent neodymium (Nd3+): 4F3/2 → 4I9/2 emissions is a powerful tool for characterizing material molecules and crystal structures and quantifying radiation damage. Its spectral parameters are considered to characterize the molecular and crystal structure environment and to track the degree of short-range order disturbance of cationic sites. However, IBIL-based related technologies have rarely been reported. In this article, the IBIL of Nd3+ in yttria-stabilized zirconia (YSZs) was studied in the near-infrared region, especially the Nd3+: 4F3/2 → 4I9/2 emission at room temperature with 2 MeV H+. The results show that 1) a single IBIL spectrum carries as much information about the structure of a substance as the PL spectrum. 2) The surrounding crystal environments of Nd3+ cations in the three samples are consistent. 3) H+ does little damage to the sample in the course of analysis.

The increasing use of biologics is accompanied by a risk of hepatitis B (HBV) and C virus (HCV) reactivation.To determine the predictors of HBV and HCV reactivation in patients with psoriasis receiving biologics.This study screened 2060 patients with psoriasis (3562 treatment episodes) who were taking biologics from 2009 to 2018. There were 359 patients with psoriasis with HBV (561 treatment episodes) and 61 with HCV infection (112 treatment episodes).During 8809 and 1522 person-months of follow-up, 88 treatment episodes for HBV involved HBV reactivation, and 14 episodes of HCV involved reactivation. The reactivation rate was significantly higher in treatment episodes of chronic HBV infection than in that of occult HBV (34.3% vs 3.2%, P = .001) and resolved HBV (34.3% vs 5.0%, P .001). The multivariate analysis revealed that being hepatitis B surface antigen seropositive, being hepatitis B e-antigen seropositive, and tumor necrosis factor-α-inhibitor therapy were risk factors for HBV reactivation, whereas antiviral prophylaxis was effective in reducing the risk of HBV reactivation. No predictors were significantly associated with HCV reactivation.Observational design and a lack of a comparison group.Patients with psoriasis on biologics have a risk of HBV and HCV reactivations, particularly those who are seropositive for hepatitis B surface antigen and hepatitis B e-antigen and undergoing tumor necrosis factor-α-inhibitor therapy.

In Taiwan, the incidence and prevalence of psoriatic arthritis (PsA) have risen significantly in recent years. Moreover, data from the Taiwan National Health Insurance Research Database (NHIRD) show that more than 85% of PsA patients are treated with just non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional synthetic disease-modifying anti-rheumatic drugs (csDMARDs). Taiwanese clinicians have also expressed concerns regarding uncertainties in the diagnosis of PsA and the delayed, interrupted, and/or tapered use of biologics, as well as differences in therapeutic preferences between and within dermatologists and rheumatologists. To address these issues, the Taiwan Rheumatology Association and the Taiwanese Association for Psoriasis and Skin Immunology jointly convened a committee of 28 clinicians from the fields of rheumatology, dermatology, orthopedics, and rehabilitation, to develop evidence-based consensus recommendations for the practical management of PsA in Taiwan. A total of six overarching principles and 13 recommendations were developed and approved, as well as a treatment algorithm with four separate tracks for axial PsA, peripheral PsA, enthesitis, and dactylitis. Psoriasis (PsO) management was not discussed here, as the Taiwanese Dermatological Association has recently published a comprehensive consensus statement on the management of PsO. Together, these recommendations provide an up-to-date, evidence-based framework for PsA care in Taiwan.

Background: Dactylitis is a characteristic feature of psoriatic arthritis (PsA). However, early diagnosis of mild dactylitis is challenging and image examination, such as ultrasonography (US), can be helpful. Objectives: We aimed to compare the clinical diagnosis of dactylitis made by the dermatologist and ultrasonographic diagnosis by the rheumatologist. Methods: Consecutive patients diagnosed with peripheral PsA seen in the dermatologic clinics were referred to the same dermatologist for evaluation of dactylitis. Consecutive patients with and without clinical dactylitis were diagnosed in 19 and 19 patients, respectively, by the referred dermatologist. All patients were then referred to an experienced rheumatologist unaware of the clinical diagnosis for sonographic examination of all 20 digits. Dactylitis under US was diagnosed when both proximal and distal parts of a digit were at least 0.25 mm larger than the contralateral digit. Results: For the clinical dactylitis group, 7 (36.8%) patients had more dactylitis diagnosed by US than clinically, and 2 (10.5%) patients had no dactylitis diagnosed by US. For the clinically no dactylitis group, 4 (21.1%) patients had no diagnosis of dactylitis by US, and most of these patients (78.9%) were diagnosed with dactylitis under US by the rheumatologist. More digits affected by dactylitis were found for both groups, although no statistically significant differences were found, probably due to the small sample size. Conclusion: The results revealed concordance between the dermatologist and rheumatologist for clinical dactylitis but not for patients without dactylitis. For PsA patients, US is more sensitive and useful for early dactylitis diagnosis in a dermatologic clinic.

The effects of annealing at 473 K and 800 K and of 2 MeV H+ irradiation on the behaviour of defects in ZnO crystals were studied via ionoluminescence (IL) and photoluminescence (PL). The PL spectra of samples annealed in vacuum at 473 K and 800 K showed stronger visible emission and weaker UV emission than virgin samples. The stronger visible emission corresponded to an increase in the concentration of point defects in the samples. The PL spectra of the sample annealed in vacuum at 473 K revealed stronger visible emission than that of the sample annealed in vacuum at 800 K; hence, the concentration of point defects in the sample annealed at 473 K was higher. The IL spectrum of ZnO annealed in vacuum at 473 K showed a weaker intensity than the spectrum of the sample annealed at 800 K, which seemed inconsistent with the PL spectra results. This inconsistency was attributed to different mechanism of PL and IL. IL and PL in some way link the ZnO DBE to different point defect related electronic transfer processes. The PL spectra of samples showed that deep band emission (DBE) is a superposition of 2.1 eV band emission and 2.4 eV band emission and that near band emission (NBE) is a superposition of 3.1 eV band emission and 3.3 eV band emission. However, the DBE of IL is a superposition of 1.8 eV band emission and 2.1 eV band emission, and the NBE exhibited overall weak intensity caused by an increase in the number of defects induced during irradiation. Comparing the effects of annealing in an oxygen atmosphere and in vacuum, the enhanced peak area ratio of 2.1 eV band emission to 2.4 eV band emission in the PL spectra and the enhanced peak area ratio of 2.1 eV band emission to 1.8 eV band emission in the IL spectra of the sample annealed in an oxygen atmosphere demonstrate a correspondence between the ~1.8 eV band and Zn interstitials (Zni), between the ~2.1 eV band and O interstitials (Oi) and between the ~2.4 eV band and O vacancies (VO). The increase in the UV emission of the sample annealed in an oxygen atmosphere suggested that the NBE is a superposition of 3.1 eV band emission and 3.3 eV band emission, which are associated with Zn vacancies (VZn) and self-trapped excitons, respectively.

Aim: No guidelines exist for biologic switch in psoriasis after treatment failure. Although, switching between TNF-α antagonists has been reviewed, switching information about newer biologics is limited. Materials & methods: We did a thorough systematic review from ‘PubMed’ and ‘Embase’, which includes new biologics such as IL-12/IL-23 antagonists, IL-17A antagonists and IL-23 antagonists. Results & conclusion: New biologics such as IL-17 antagonist or IL-23 antagonist show greater responses in bio-experienced patients and could even be used for patients in whom previous treatments failed.

The effect of temperature (300-100 K) on the luminescence behavior of ZnO crystals irradiated with 2 MeV H+ were reported by ion-beam-induced luminescence (IBIL). Compared with constant-temperature IBIL spectra, the fluence mainly affects the luminous intensity, and the peak position shift is mainly affected by the temperature. For deep-band emissions (DBEs) at temperature ranges of 300–200 K, three emission bands exist in the red, orange-red, and green regions. These three emission bands illustrate different temperature dependencies with decreasing temperature: red and orange-red emission bands are not sensitive to temperature and redshift to green emission bands. The origins of three emission bands are the radiative recombination of deeply trapped holes with shallowly trapped electrons at the O i , transition from the Z n i to O i level and transition related to oxygen vacancy levels. For DBE of 200–100 K, the orange-red emission band is not sensitive to temperature and has the same origin as the high-temperature section. The temperature dependence of UV band emission associated with recombination of excitons is caused by the temperature-induced band-gap shrinkage. The abnormal movement with temperature of violet emission band associated with Z n i results from competition between localization effect at Z n i and the band-gap shrinkage.

Psoriasis is a common, chronic immune-mediated disorder that occurs worldwide. The prevalence of psoriasis in Taiwan is lower than that in Caucasian countries. Nevertheless, an increasing trend in the prevalence of psoriasis and psoriatic arthritis has been observed in Taiwan over the past decade. Accumulating studies have also suggested that psoriasis is not a disease limited to the skin and joints but has far-reaching systemic effects, associated with a higher prevalence of comorbid diseases, such as cardiovascular diseases, diabetes mellitus, metabolic syndrome, depression, and chronic kidney disease, than in the normal population. To date, our understanding of the mechanisms linking psoriasis and comorbidities remains far from complete. Psoriasis and its comorbid diseases confer substantial disease and health care burdens and have a significant negative impact on the quality of life of affected patients. The discovery of new, promising drugs has revolutionized psoriasis treatment, but patients still have unmet needs that require further investigation. Studies specifically on the Taiwanese population with psoriasis remain scarce. Herein, we review the medical literature, with a focus on studies examining the Taiwanese population, with regard to epidemiology, comorbidities, and effects of antipsoriatic agents on comorbidities, as well as the efficacy and safety of novel antipsoriatic treatments for patients with psoriasis. Keywords: Psoriasis, Epidemiology, Comorbidity, Biologics, Interleukin-17a inhibitor, Interleukin-23 inhibitor

Safety data for secukinumab in patients with psoriasis and viral hepatitis are lacking. The aim of this study is to investigate the risk of reactivation of hepatitis B virus (HBV)/hepatitis C virus (HCV) in patients with psoriasis who are receiving secukinumab therapy. This multicentre study screened 284 patients with psoriasis with available HBV and HCV serological data and 63 patients with concurrent HBV/HCV infection were enrolled. In the absence of antiviral prophylaxis, 7 of 46 (15.2%) patients with HBV exhibited HBV reactivation during secukinumab therapy. The risk of reactivation was significantly higher in HBsAg-positive patients, compared with HBsAg-negative/HBcAb-positive patients (24.0% vs. 4.17%, p = 0.047). One of 14 (7.1%) HCV patients showed enhanced replication of HCV with hepatitis. No virus reactivation occurred in patients receiving antiviral prophylaxis. HBsAg-positive and HBsAg-negative/HBcAb-positive psoriasis patients can develop virus reactivation during secukinumab therapy, thus necessitating close monitoring of viral load and considering an antiviral prophylaxis for all HBsAg-positive patients with psoriasis.

In this paper, ion-beam-induced luminescence (IBIL) spectra of raw ZrO2 irradiated with 2 MeV H+ ions and photoluminescence (PL) spectra of annealed (200, 500 and 800 °C in air, nitrogen or oxygen) ZrO2 were investigated. The luminescence intensity decreased with increasing fluence, which indicated that the concentration of luminescence centers decreased during irradiation. The PL spectral results show that, with increasing partial pressure of oxygen during annealing, the intensity of luminescence decreases due to the decrease in oxygen vacancies. First-principles calculations were used to study the formation energy and transition level for oxygen vacancies (Vo), Ti-substituted Zr (Ti) and Ti adjacent to the nearest Vo (Ti-Vo) complex. The binding energies of Ti3+ and Vo + are 2.10 eV, which indicates that oxygen vacancies benefit the formation of Ti3+. The calculated configuration coordinate diagram and IBIL results indicated that Vo is not the luminescence origin. A new light-emitting structure of the Ti-Vo complex (FA center) structure was proposed based on our calculations and previous studies. The calculated results of the luminescence model match the PL and IBIL spectra remarkably. The emission band of ZrO2 at approximately 500 nm was assigned to the FA center or Ti3+ (the eg to t2g transition) adjacent to Vo+.

Psoriatic arthritis is a heterogeneous disease that has been difficult to manage until the recent advent of biologics. However, there are still unmet medical needs for newer agents. Tofacitinib is a Janus family of kinases inhibitor approved for treating rheumatoid arthritis in many countries and psoriasis in Russia. We reviewed the evidences of tofacitinib in psoriatic arthritis treatment. The efficacy and safety profiles result from Phase III clinical trials (OPAL BROADEN and OPAL BEYOND) and one open-label extension study (OPAL BALANCE). Both tofacitinib 5 or 10 mg twice a day were superior to placebo for American College of Rheumatology 20% improvement criteria response at 3 months and showed significant improvement of skin, enthesitis and dactylitis. Tofacitinib is a promising treatment option for psoriatic arthritis.

Scalp psoriasis is commonly the initial presentation of psoriasis, and almost 80 % of patients with psoriasis will eventually experience it. Although several systematic reviews and guidelines exist, an up-to-date evidence-based review including more recent progress on the use of biologics and new oral small molecules was timely. Of the 475 studies initially retrieved from PubMed and the 845 from Embase (up to May 2016), this review includes 27 clinical trials, four papers reporting pooled analyses of other clinical trials, ten open-label trials, one case series, and two case reports after excluding non-English literature. To our knowledge, few randomized controlled trials (RCTs) are conducted specifically in scalp psoriasis. Topical corticosteroids provide good effects and are usually recommended as first-line treatment. Calcipotriol–betamethasone dipropionate is well tolerated and more effective than either of its individual components. Localized phototherapy is better than generalized phototherapy on hair-bearing areas. Methotrexate, cyclosporine, fumaric acid esters, and acitretin are well-recognized agents in the treatment of psoriasis, but we found no published RCTs evaluating these agents specifically in scalp psoriasis. Biologics and new small-molecule agents show excellent effects on scalp psoriasis, but the high cost of these treatments mean they may be limited to use in extensive scalp psoriasis. More controlled studies are needed for an evidence-based approach to scalp psoriasis.

To understand the evolution of defects in SiC during irradiation and the influence of temperature, in situ luminescence measurements of 6H-SiC crystal samples were carried out by ion beam induced luminescence (IBIL) measurement under 2 MeV H+ at 100 K, 150 K, 200 K, 250 K, and 300 K. A wide band (400–1000 nm) was found in the spectra at all temperatures, and the intensity of the IBIL spectra was highest at 150 K among the five temperatures. A small peak from 400 nm to 500 nm was only observed at 100 K, related with the D1 defect as a donor–acceptor pair (D–A) recombination. For further understanding the luminescent centers and their evolution, the orange band (1.79 eV) and the green band (2.14 eV) in the energy spectrum were analyzed by Gaussian decomposition, maybe due to the donor–deep defect/conduction band–deep defect transitions and Ti related bound excition, respectively. Finally, a single exponential fit showed that when the temperature exceeded 150 K, the two luminescence centers’ resistance to radiation was reduced.

To contrast the generation and their evolution behaviors of irradiation damage in lithium fluoride under various ion, in situ luminescence measurements from lithium fluoride are carried out under 100 keV H+, He+ and O+ on the ion beam induced luminescence(IBIL) experimental setup on BNU400 ion implanter. Combined with Stopping and Range of Ions in Matter (SRIM) calculation of 100 keV H+, He+ and O+ stopping power in lithium fluoride, the emission intensity under He+ is the strongest,due to the higher excitation density of electron-hole pairs than them under H+ and the rising non-radiative recombination ratio under heavy ion O+. With the mass number increase of the incident ion, the nuclear stopping power would be increased, resulting in the faster rate of both formation and annihilation of point defects、the lower fluence for F-type centers reaching the highest intensity and the weaker luminescence intensity at the state of equilibrium. The irradiation resistance of \begin{document}$ \rm F_3^{-}/F_2^+ $\end{document} centers at 880 nm are better than the F2 centers at 670 nm, shown not only in the slower formation and annihilation rates of \begin{document}$ \rm F_3^{-}/F_2^+ $\end{document} centers but also the higher luminescence intensity of \begin{document}$ \rm F_3^{-}/F_2^+ $\end{document} centers under heavy ion O+.

The optical and electrical properties of ZnO related on the type and the concentration of defects in ZnO crystal. Ion implantation and annealing can change the type and the concentration of defects in ZnO. To understand the variation of defects in ZnO during ion implantation and after different temperature annealing, in situ luminescence measurements of ZnO crystal samples were carried out by ion beam induced luminescence (IBIL) during ion implantation of 2 MeV H+ and then after annealing at 473 K and 800 K in vacuum on the GIC4117 tandem accelerator in Beijing Normal University.IBIL spectra of ZnO showtwo emission peaks: UV emission, which is called near band emission (NBE), and visible emission, which is called deep band emission (DBE).The high-intensity of DBE and weak NBE of IBIL spectra of ZnOmay be due to the NBE is intrinsic to ZnO samples and therefore is just visibly observed from samples that are virtually defect-free. With the ion implantation, the destruction of the crystal structure and the arising of a mass of defects, inducing the weak intensity NBE and intense DBE.In addition, the overall IBIL spectra of ZnOreveal decrease intensity with the ion fluence,which indicates that the concentration of luminescence centersdecreases duringion implantation.With the H+ fluence, the concentration of the point defects increases. The point defects migrate and subsequently agglomerate into larger defect clusters. These defect clusters serve as traps for catching electrons and holes, which result in the quenching of luminescence centres. Annealing can help todecompose the defect clusters and repair the defects of crystal. However, amounts of defects and clusters still remain in the irradiated sample annealed at 473 K in vacuum, which acted as nonradiative center and suppress the luminescence induced weak intensity of IBIL. Annealing the sample at 800 K in vacuum may facilitate the decomposition of defect clusters during ion irradiation to point defects and the point defect return to the lattice position that can reduce the nonequilibrium defects inside the crystal and improve the crystallinity of the crystal, which increase the intensity of its IBIL.

Although anti-drug antibodies against biologics have been associated with decreased clinical efficacy, the immunogenicity of biologics seems to vary between drugs, diseases and ethnicities. This study aims to investigate the predictors for the formation of anti-adalimumab antibodies (AAA) and the clinical consequences of AAA formation. In 53 Chinese psoriatic patients treated with adalimumab, AAA was detected in 50.9%. Differences in Psoriasis Area and Severity Index 75 (PASI75) response rates among patients with and without AAA were significant (44.4% vs. 88.5%; p = 0.001). Patients with AAA had significantly lower trough concentrations of adalimumab than those without AAA. Risk factor analysis showed that treatment interruption, low trough adalimumab concentration, absence of concomitant methotrexate use and biologics switching were associated with a higher AAA titre. The treatment pattern of biologics influences the risk of AAA formation, thereby leading to reduced efficacy of adalimumab.

Background There is increasing concern about the risk of latent tuberculosis infection (LTBI) reactivation during the use of biologics for psoriasis. Although ustekinumab had been documented with low risk of tuberculosis, the long-term follow-up of LTBI as determined by QuantiFERON-TB Gold (QFT-G) testing in patients treated with ustekinumab is limited. Objectives This study aims to use serial QFT-G testing as a screening method for detecting LTBI in patients with psoriasis from an intermediate tuberculosis burden country. Methods This retrospective review investigated 134 psoriatic patients in whom ustekinumab was prescribed for at least one year between 2010 and 2016 in National Taiwan University Hospital. All patients underwent annular QFT-G testing during ustekinumab therapy. Results Among the 134 enrolled patients, baseline LTBI rate was 13.4% (18/134). Indeterminate QFT-G result was noted in 5.2% (7/134) of patients and 71.4% (5/7) of them turn to be QFT-G negative during the next testing. 81.3% (109/134) of patients had a negative QFT-G at baseline and the seroconversion rate was 7.3% (8/109) in the serial QFT-G. All the patients in the conversion group were referred to a pulmonologist for evaluation and 81.5% (22/27) of them underwent chemoprophylactic therapy while on ustekinumab. No active TB infection was noted during further follow-up with or without chemoprophylaxis. Conclusions This study revealed that psoriatic patients receiving long-term ustekinumab therapy had a low QFT-G conversion rate (7.3%). The clinical significance of QFT-G conversion remains controversial and needs larger scale trials to investigate.

Summary Background Ustekinumab, an interleukin-12/23 inhibitor, is effective in the treatment of psoriasis. A recent Italian study showed more favourable response to ustekinumab in patients with positive human leucocyte antigen (HLA)-Cw6. Nonetheless, there are differences in genetic susceptibility to psoriasis between races, and no studies have specifically assessed the candidate genetic markers in predicting therapy outcome in Chinese patients with psoriasis treated with ustekinumab. Objectives To determine whether HLA gene polymorphisms can predict the response to ustekinumab in Chinese patients with psoriasis. Methods Sixty-six patients with psoriasis treated with ustekinumab were included in the study, and the effectiveness of ustekinumab therapy was evaluated at weeks 0, 16 and 28 by Psoriasis Area and Severity Index (PASI). Results More HLA-Cw6-positive patients achieved a PASI 75 response at week 4 compared with HLA-Cw6-negative patients (38% vs. 9%, P = 0·019). Similarly, at week 16, patients carrying the HLA-Cw6 allele showed a higher likelihood of achieving PASI 50, 75 and 90 than Cw6-negative patients, although this was not statistically significant. At week 28, a significantly higher percentage of HLA-Cw6-positive patients maintained PASI 90 response compared with Cw6-negative patients (63% vs. 26%, P = 0·035). Further analysis of other HLA allele polymorphisms did not show significant associations with therapeutic response to ustekinumab. Conclusions This pharmacogenetic study provides preliminary data indicating that positive HLA-Cw6 is associated with a good response to ustekinumab treatment in Chinese patients with psoriasis.

Background Few studies exist that evaluate the therapeutic response among switchers of tumor necrosis antagonists in patients with psoriasis, especially Asian patients. Objective This study aimed to evaluate the safety and effectiveness of adalimumab in patients with moderate-to-severe psoriasis who had inadequate therapeutic response to prior etanercept. Methods This is a single-center, open-labeled, retrospective study on the effects of adalimumab in patients with moderate-to-severe psoriasis who had inadequate therapeutic responses to prior etanercept. We included 13 patients who had received etanercept for at least 3s months but showed inadequate therapeutic response, as defined by less than 50% improvement in psoriasis area and severity index (PASI) 50, compared to baseline after 6 months or less than PASI25 improvement after 3 months in our hospital during 2006–2012. Adalimumab 40 mg was given every other week with a loading dose of 80 mg. Patients were evaluated monthly for safety and effectiveness. PASI, physician global assessment, and scores of scalp lesions were calculated at Weeks 12 and 24. Scalp lesions were assessed separately. Results At Week 12, one patient (7%) had at least PASI90, two (15%) had at least PASI75, four (31%) had at least PASI50, and eight (61.5%) had at least PASI25 response. At Week 24, two patients (15%) had at least PASI90, three (23%) had at least PASI75, six (46%) had at least PASI50, and nine (69%) had at least PASI25 response. No severe adverse events were recorded in our series. For scalp lesion, adalimumab showed similar efficacy to etanercept nonresponders. Conclusion Safety profiles of adalimumab were similar to those of etanercept, and PASI50 was achieved in 46% of patients, who failed prior etanercept therapy, after 24 weeks of adalimumab treatment.

Background Recent global data show an increasing prevalence of psoriasis and psoriatic arthritis in western countries. Objective The current study analyzed the trend of prevalence rates of psoriasis and psoriatic arthritis in Taiwan and examined biologic prescription patterns by different specialties. Methods Data were accessed from the national payer National Health Insurance Research Database in Taiwan. This study protocol was approved by Joint Institutional Review Board established by Medical Research Ethics Foundation (No 13-S-001). Results Between 2003 and 2013, the prevalence of psoriasis and psoriatic arthritis increased by 41% (from 15.54 to 21.90 per 10,000 population) and 191% (from 0.45 to 1.31 per 10,000 population), respectively, while the prevalence of psoriatic arthritis among patients with psoriatic disease increased from 6.3% to 12.7%. Dermatologists are the main caregivers for patients with psoriasis and psoriatic arthritis; however, data suggest a decreasing trend in the proportion of dermatologists for psoriasis patients from 24.7% between 2003 and 2008 to 10.74% between 2008 and 2013, with a corresponding decrease in dermatologists for psoriatic arthritis patients from 62.30% to 44.65% during the same periods, respectively. In 2013, of the 51,191 patients with psoriasis, only 596 (1.16%) received biologics (73.3% by dermatologists and 25.8% by rheumatologists), while 1120 of the 7470 (14.99%) psoriatic arthritis patients received biologics (72.8% by rheumatologists and 22.3% by dermatologists). The proportion of biologics use was 1.12% and 7.75% among all patients with only psoriasis and 8.01% and 26.70% among all patients with psoriatic arthritis seen by dermatologists and rheumatologists, respectively. Conclusion The prevalence of psoriasis and psoriatic arthritis is increasing in Taiwan. The use of biologics in patients with psoriatic arthritis was comparable to that reported in previous studies in the United States and Europe; however, the use of biologics remained low in patients with psoriasis in Taiwan.

BACKGROUND:The increased rates of cardiovascular morbidity and mortality in patients with psoriasis are not adequately explained by traditional risk factors. Whether concomitant sleep disorders (SDs) modify the risk of cardiovascular disease (CVD) in patients with psoriasis remains unknown. METHODS:Using the Taiwan National Health Insurance Research Database (NHIRD), we conducted a cohort study to investigate the association between concomitant SDs and CVD risk in patients with psoriasis. Data from 99,628 adults who received a psoriasis diagnosis during the period from 2004 to 2010 were analyzed. Cox proportional hazards regression analysis models were used to compare the risks of ischemic heart disease (IHD) and stroke between patients with and without SDs. RESULTS:Psoriasis patients with a concomitant SD had significantly higher risks of IHD (adjusted hazard ratio [aHR], 1.25; 95% confidence interval [CI], 1.22-1.28) and stroke (aHR, 1.24; 95% CI, 1.16-1.33) as compared with psoriasis patients without SDs. All psoriasis patient subgroups, including those with mild and severe psoriasis and those with and without arthritis, had increased HRs for IHD and stroke. The increases in IHD and stroke risks conferred by SDs were proportional to the dose of hypnotics used. The effect of SDs on the risks of IHD and stroke was greater in young adults than in middle-aged and older adults. CONCLUSIONS:The risks of IHD and stroke were higher for psoriasis patients with SDs than for those without SDs. Clinicians should carefully evaluate CVD risk, particularly in young patients with psoriasis.

Localized resistant plaques of psoriasis often remain despite highly effective anti-psoriasis treatment. Intralesional therapy is often used to treat various malignant, infectious or inflammatory cutaneous diseases, including psoriasis. Despite the presence of many review articles on the treatment of psoriasis, no articles exist which review the use of intralesional therapy for psoriasis. In this article, we review the published literatures of intralesional therapy for psoriasis. Corticosteroids, methotrexate, cyclosporin, biologics, botulinum toxin type-A, 15-hydroxyeicosatetraenoic acid, and chemotherapy agents such as 5-fluorouracil are discussed. Also, agents which may be used intralesionally and have the potential to treat psoriasis will also be reviewed such as bleomycin, vincristine or vinblastine, mitomycin-C, aminophylline, 5-aminolevulinic acid, rituximab, bevacizumab and pentoxifylline are included.

Background The reported efficacy and safety of some biologic agents for psoriasis vary between Caucasians and Asians. Few reports of etanercept exist in psoriasis patients within the Asia-Pacific region. Objectives The study aims to report our clinical experience of etanercept in the treatment of patients with moderate-to-severe psoriasis in Taiwan. Methods A retrospective analysis of 59 patients with moderate-to-severe psoriasis who received etanercept was conducted in a tertiary referral center. Results Etanercept therapy resulted in a reduction of mean Psoriasis Area and Severity Index (PASI) of 47% at week 12 and 61% at week 24. After 12 weeks of treatment, 48%, 26%, and 3.4% of the patients achieved at least PASI50, 75 and 90 response, respectively. At week 24, the proportion of patients achieving at least PASI50, 75 and 90 response was 59%, 37%, and 14%, respectively. Etanercept efficacy in achieving PASI75 improvement was, however, lower than that reported in previous pivotal placebo-controlled trials. No cases of active tuberculosis, viral hepatitis or malignancies were observed during the observation period. Conclusion Our case series demonstrated the efficacy and safety of etanercept for the management of moderate-to-severe psoriasis in Taiwan.

Background Recent findings in psoriasis research have shown that psoriasis is frequently associated with systemic comorbidities. Objectives This study aims to describe the epidemiology of psoriasis and the prevalence of comorbidities in patients with psoriasis in Taiwan. Methods Patients who had at least one outpatient visit or admission with ICD-9-CM diagnosis code 696.0-1 in the Taiwan National Health Insurance (NHI) claims database during 2006 were identified as psoriasis cases. The cases were further classified into moderate to severe psoriasis (sPsO) for those who had previously received systemic therapy during the study period and mild psoriasis (mPsO) for those who had not. The cases were matched in a 1:4 ratio with controls from a sample cohort of 997,771 enrolees representative of the Taiwan population. Matching variables included age, gender and residential area. Prevalence of comorbidities was assessed using prevalence relative risk (RR) based upon a Cox proportional regression model. Results 51,800 psoriasis cases were identified (prevalence = 0.235%; mean age = 46.4 ± 18.6; male:female = 1.6:1) and 17.5% of cases were sPsO type. Psoriasis was associated with a significantly increased prevalence ratio (RR; [95% confidence interval]) for hypertension (1.51; [1.47, 1.56]), diabetes (1.64; [1.58, 1.70]), hyperglyceridaemia (1.61; [1.54, 1.68]), heart disease (1.32; [1.26, 1.37]), hepatitis B viral infection (1.73; [1.47, 2.04]), hepatitis C viral infection (2.02; [1.67, 2.44]), rheumatoid arthritis (3.02; [2.68, 3.41]), systemic lupus erythematosus (6.16; [4.70, 8.09]), vitiligo (5.94; [3.79, 9.31]), pemphigoid (14.75; [5.00, 43.50]), pemphigus (41.81; [12.41, 140.90]), alopecia areata (4.71; [2.98, 7.45]), lip, oral cavity and pharynx cancer (1.49; [1.22, 1.80]), digestive organs and peritoneum cancer (1.57; [1.41, 1.74]), depression (1.50; [1.39, 1.61]), fatty liver (2.27; [1.90, 2.71]), chronic airways obstruction (1.47; [1.34, 1.61]), sleep disorder (3.89; [2.26, 6.71]), asthma (1.29; [1.18, 1.40]), and allergic rhinitis (1.25; [1.18, 1.33]). Conversely, psoriasis was not associated with an increased risk of Crohn's disease. Conclusions Psoriasis was associated with a significantly increased risk of comorbidities, especially for those patients with moderate to severe disease. These health associations should be taken into consideration when evaluating the burdens of psoriasis and designing effective treatment plans.

Different studies have reported various values for the percentage of patients with IL36RN mutations, and it has also been reported that the sites of these mutations differ among different ethnicities. The current study was a cross-sectional study conducted to investigate the risk factors predicting IL36RN mutation in Chinese patients with different clinical features of pustular psoriasis. 57 Han Chinese patients, including 32 with generalized pustular psoriasis, 14 with palmoplantar pustulosis, 9 with plaque-type psoriasis with pustules, and 2 with erythrodermic psoriasis, were enrolled between March 2013 and July 2014. Blood samples were collected, genomic DNA was extracted from leukocytes, and polymerase chain reaction (PCR)-based Sanger sequencing was used to analyze the coding exons and flanking introns of the IL36RN gene. The patients with generalized pustular psoriasis exhibited the highest IL36RN mutation rate (75 %) among the aforementioned patient types, with the subgroup consisting of those patients who had features of acrodermatitis continua of Hallopeau exhibiting the highest c.115+6T>C mutation rate (93.8 %). In addition, early onset, ever generalized pustular psoriasis (more than two attacks), ever acrodermatitis continua of Hallopeau, inverse psoriasis, and a family history of pustular psoriasis were associated with IL36RN mutation. The c.115+6T>C mutation was the most common and the most important variant in all subtypes of pustular psoriasis with IL36RN mutations among our sample of Chinese patients.

An engineering analysis for determining the strain energy release rate of symmetrically loaded double beam-plates with repairing or reinforcing elements in the transverse direction which are densely distributed across the width in the disbond regions is presented. The concept of strain energy release rate evaluated by computing the rate of energy released from the disbond front has been verified to be exactly the same and simpler to use than the most referenced work of Kanninen by differentiation of the total strain energy of the entire system with respect to the disbond length. Due to the simplicity of the new concept for determining the strain energy release rate, it allows one to derive the exact analytical solutions for double beam-plates containing repair or reinforce elements and satisfying continuity at the delamination front as well as boundary conditions at both ends of the system. Some comparisons of the strain energy release rate for double beam-plates without repair elements to other approximations are also made. Each side of a double beam-plate system in the perfect segment is modeled as a beam-plate on an elastic foundation, while disbond segments are treated as beam-plates under transverse loading and constrained by repairing or reinforcing elements as axially loaded members at discrete points. Some numerical results for a double cantilever beam-plate with one and two rows of reinforcing elements under end loads are presented for illustrating the procedure as well as for future reference. The general concept and analysis procedure should be applicable to other structural systems and for mixed-mode delaminations.

Circular bars under distributed torque are formulated based on the linear theory of elasticity, and analysis is presented for bars under a single Fourier term of distributed torque. As the motivation of the study is to examine the extent of adequacy of the conventional technical torsion theory to bars under distributed torques, stress distribution in solid bars is first investigated. Stress distribution for hollow bars under three different loading conditions is then analyzed. Results indicate that the conventional theory is adequate when the region of distributed torque is large. In small regions, the conventional theory may substantially be in error resulting in underestimating the maximum shear stress and misidentifying the location of maximum shearing stress.

The paper, summarizing studies presented in seven journal papers using the method of continuous analysis, is written to honor Professor Y.H. Pao of the Institute of Applied Mechanics at the National Taiwan University on his seventieth birthday for his many significant contributions and leadership in the field of mechanics. These seven papers contain investigations concerning stress, buckling, and vibration analyses of beams and plates having disbonds. The authors feel privileged to have this opportunity to join with Professor Pao's many friends, colleagues and students to participate in this joyous occasion. Being able to appear in this prestigious special issue of the Chinese Journal of Mechanics, the authors believe that the spread of each of the seven papers in the structural mechanics community must at least be increased by ten fold. Hence, the numbering of the reference papers is amplified by a factor of ten which amounts to a total number of seventy as being used in the listing of papers under References. We use this number of seventy to wish Professor Y.H. Pao to have many happy returns on his seventieth birthday.

Some aspects of pin loaded laminates, including basic kinematics related to the contact angle and moving boundary, validity and applicability of cosine distribution of contact stress, effects of stiffness ratios as well as clearance and friction are presented. Numerical results on the basis of a previously developed direct boundary element procedure, with a refined and improved computational algorithm with additional capabilities are given and used for discussing various aspects of pin-loaded orthotropic laminates. Empirical formulas based on generated computer results are suggested.

A previously developed direct boundary element method for analyzing stresses around pin-loaded holes of compositelaminates hasbeen extended witha ree ned and improved computationalalgorithm. Themethod,procedure, and computer program are verie ed by elasticity solutions in polar coordinates for eyebars and plates having an open, as well as loaded, hole. In turn, boundary tractions generated by the direct boundary element method allowing direct application of elasticity solutions are presented. Such a scheme, which couples the boundary element and analytical methods, appears to be plausible, accurate, and efe cient for practical applications.

A methodology for alleviating the deformation of cylindrical shells has been developed. The basic idea is to use piezoelectric ring stiffeners bonded to the surface of the shell to stiffen and counteract the deformation caused by external loads such as gravity, internal pressure and temperature change. The function of the piezoelectric ring stiffeners may be realized by their stiffening effects and, more importantly, through their electrically induced strains causing pressure on the surface of the shell. These strains can, at desirable locations, produce adjustable deformations in the opposite direction of the deformations caused by external loading. Conventional differential equations governing displacements of linearly elastic cylindrical shells are used. For computer simulations, a simply supported thin cylindrical shell having 18 piezoelectric ring stiffeners bonded to its outer surface along the length of the shell is considered. Deformations along two generatrices of the shell are computed to demonstrate the effect of alleviation. Since the deformation produced by an individual ring stiffener depends on the magnitude and polarity of the applied voltage, it is possible to counteract deformations caused by any other type of loading. The simulated results for illustration show that the deformation of cylindrical shells can be effectively alleviated.

An analysis procedure for determining the buckling load of beam-plates having multiple single delaminations is presented. Free and constrained models based on the usual beam-column theory are used for perfect and separated parts of delaminated segments. Successive corrections of buckled delaminated segments are made by inserting constrained models in the portions where overlapping of the upper and lower parts occurred in the segments of assumed free mode deformations. It appears to be the first time such analysis leading to buckling load with physically realistic mode of deformation has been considered. Recurrence equations relating integration constants of adjacent segments are established which lead to a 2 by 2 buckling determinant and allow direct determination of buckling mode along the entire beam-plate. Some numerical examples are presented for illustrative purposes. The procedure established appears to be simple, systematic and effective which should be useful for engineering applications.

The paper presents a method of continuous analysis for predicting the local delamination buckling load of the face sheet of sandwich beams. The discontinuous system of a face sheet delaminated from the elastic core is treated as a continuous system of the face sheet without debond but subjected to an added force system that causes the net interfacial tractions at the separated region to vanish. The effect of transverse normal and shear resistance from the core is accounted for. The procedure allowing direct determination of the buckling load by considering the entire region without separating it into regions with and without delaminations is effective for this class of problems. Fourier series in conjunction with the Stokes transformation is used which provides a unified solution for problems with different end conditions. The concept of analysis can foreseeably be extended to two-dimensional plate problems with delamination regions of arbitrary shapes. Some numerical results are presented to illustrate the applicability of the analysis procedure and effects of various parameters to the buckling load.