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A 75-year-old female patient presented with signs and symptoms of a right hemispheric syndrome. A CT scan of the brain with angiogram showed an acute infarct in the right middle cerebral artery (MCA) territory secondary to thromb-occlusion of the M1 segment of the right MCA. A follow-up CT scan 2 weeks later showed a large hyperdense region in the infarcted area. With the aid of a dual-energy CT scan, this was eventually shown to be due to contrast staining from an earlier administration of iodinated contrast on the same day, rather than frank haemorrhagic conversion of the recent right MCA infarct.

Certain immune cells and inflammatory cytokines are essential components in the tumor microenvironment to promote breast cancer progression. To identify key immune players in the tumor microenvironment, we applied highly invasive MDA-MB-231 breast cancer cell lines to co-culture with human monocyte THP-1 cells and identified CXCL7 by cytokine array as one of the increasingly secreted cytokines by THP-1 cells. Further investigations indicated that upon co-culturing, breast cancer cells secreted CSF1 to induce expression and release of CXCL7 from monocytes, which in turn acted on cancer cells to promote FAK activation, MMP13 expression, migration, and invasion. In a xenograft mouse model, administration of CXCL7 antibodies significantly reduced abundance of M2 macrophages in tumor microenvironment, as well as decreased tumor growth and distant metastasis. Clinical investigation further suggested that high CXCL7 expression is correlated with breast cancer progression and poor overall survival of patients. Overall, our study unveils an important immune cytokine, CXCL7, which is secreted by tumor infiltrating monocytes, to stimulate cancer cell migration, invasion, and metastasis, contributing to the promotion of breast cancer progression.

Capillary blood pressure (CBP) is the primary driving force for fluid exchange across microvessels. Subclinical systemic venous congestion prior to overt peripheral edema can directly result in elevated peripheral CBP. Therefore, CBP measurements can enable timely edema control in a variety of clinical cases including venous insufficiency, heart failure and so on. However, currently CBP measurements can be only done invasively and with a complicated experimental setup. In this work, we proposed an opto-mechanical system to achieve non-invasive and automatic CBP measurements through modifying the widely implemented oscillometric technique in home-use arterial blood pressure monitors. The proposed CBP system is featured with a blue light photoplethysmography sensor embedded in finger/toe cuffs to probe skin capillary pulsations. The experimental results demonstrated the proposed CBP system can track local CBP changes induced by different levels of venous congestion. Leveraging the decision tree technique, we demonstrate the use of a multi-site CBP measurement at fingertips and toes to classify four categories of subjects (total N = 40) including patients with peripheral arterial disease, varicose veins and heart failure. Our work demonstrates the promising non-invasive CBP measurement as well as its great potential in realizing point-of-care systems for the management of cardiovascular diseases.

With the development of medical artificial intelligence, automatic magnetic resonance image (MRI) segmentation method is quite desirable. Inspired by the power of deep neural networks, a novel deep adversarial network, dilated block adversarial network (DBAN), is proposed to perform left ventricle, right ventricle, and myocardium segmentation in short-axis cardiac MRI. DBAN contains a segmentor along with a discriminator. In the segmentor, the dilated block (DB) is proposed to capture, and aggregate multi-scale features. The segmentor can produce segmentation probability maps while the discriminator can differentiate the segmentation probability map, and the ground truth at the pixel level. In addition, confidence probability maps generated by the discriminator can guide the segmentor to modify segmentation probability maps. Extensive experiments demonstrate that DBAN has achieved the state-of-the-art performance on the ACDC dataset. Quantitative analyses indicate that cardiac function indices from DBAN are similar to those from clinical experts. Therefore, DBAN can be a potential candidate for short-axis cardiac MRI segmentation in clinical applications.

Phthalates are a group of industrial chemicals widely used in everyday products including cosmetics, food packaging and containers, plastics, and building materials. Previous studies have indicated that urinary phthalate metabolites are associated with metabolic effects including those on lipid metabolism, but the results are mixed. Furthermore, whether thyroid function mediates the association between phthalate exposure and lipid metabolism remains unclear. In the present study, we explored whether changes in thyroid function markers mediate the associations between phthalate exposure and lipid metabolism indicators in Taiwanese adults. The cross-sectional data were obtained from the Taiwan Environmental Survey for Toxicants conducted in 2013. Levels of 11 urinary phthalate metabolites, levels of 5 thyroid hormones, and 8 indicators of lipid metabolism were assessed in 222 Taiwanese adults. The relationships of urinary phthalate metabolite levels with serum thyroid hormone levels and lipid metabolism indicators were explored using multiple regression models. Mediation analysis was conducted to evaluate the role of thyroid function in the association between phthalate exposure and lipid metabolism. The metabolite of di(− 2-ethylhexyl) phthalate (∑DEHPm) exhibited a significant positive association with the lipid metabolite indicator of high-density lipoprotein cholesterol (HDL-C; β = 0.059, 95% confidence interval [CI] = 0.009, 0.109) in adults, and the thyroid function indicator thyroxine (T4) had a significant negative association with the metabolite ∑DEHPm (β = − 0.059, 95% CI = − 0.101, − 0.016) and a significant negative association with HDL-C (β = − 0.284, 95% CI = − 0.440, − 0.128). The T4 indirect effect was 0.015 (95% CI = − 0.0087, 0.05), and the mediation effect was 32.2%. Our results support the assumption that exposure to phthalates influences the homeostasis of lipid metabolism by interfering with thyroid function.

To explore the metabolically healthy (MH) to metabolically unhealthy (MU) transition and its association with body size change patterns according to age.In total, 12,910 MH subjects were evaluated in 2013 and reevaluated in 2020. A MH state was defined as a score ≤ 1, and a MU state was defined as a score 1 on the National Cholesterol Education Program-Adult Treatment Panel III criteria.Approximately 27.0% of MH individuals converted to MU status over the follow-up. Compared with young adults, middle adulthood individuals had a 1.33-fold (95% CI: 1.21-1.46) and late adulthood individuals had a 1.55-fold (95% CI: 1.41-1.70) risk of transition. The body mass index (BMI)/waist circumference (WC)-value change was positively associated with metabolic deterioration; the association weakened with age. With stable normal body size (defined by BMI) as a reference, changing phenotype categories of maximum overweight [hazard ratio (HR): 1.75; 95% CI: 1.56-1.95], non-obesity to general obesity (HR: 2.96; 95% CI: 2.47-3.54) and stable general obesity (HR: 2.44; 95% CI: 1.92-3.10) conferred a higher risk of metabolic deterioration.MH status is a transient state, especially in late and middle adulthood. Individuals transitioning to an obese phenotype should receive attention for concomitant metabolic deterioration.

This study was designed to reveal structural abnormalities in singleton and twin pregnancies in the Chinese population.This retrospective study spanned 8 years and included 1228 singleton pregnancies (112,919 examinees) and 49 twin pregnancies (1865 examinees) with structural anomalies diagnosed by ultrasound. Detailed descriptions of anomalies, gestational weeks at diagnosis, and maternal age were recorded. The odds ratio was evaluated in twin pregnancies with detectable structural anomalies.The annual average "ultrasound prevalence of fetal anomalies" among singleton and twin pregnancies were 1.09 and 3.06%, respectively. Mothers with twin anomalies were older (P .001), and twin pregnancies were diagnosed with anomalies in earlier gestational weeks than singleton (P = .011). No differences were found in the types of anomalies between singleton and twin pregnancies. Central nervous system anomaly was the most common type in singleton and twin pregnancies. Twin pregnancies had higher rates of major anomalies than singleton (total OR 2.45), especially cardiovascular, central nervous, and gastrointestinal systems and ear/eye/face/neck disorders.Compared with singleton, twin pregnancies had higher odds of detectable structural anomalies. Twin pregnancies with structural anomalies were diagnosed at earlier gestational age and associated with older maternal age. Central nervous system anomaly was the most common type in singleton and twin pregnancies.

The ability to expertly control different fingers contributes to hand dexterity during object manipulation in daily life activities. The macroscopic spatial patterns of muscle activations during finger movements using global surface electromyography (sEMG) have been widely researched. However, the spatial activation patterns of microscopic motor units (MUs) under different finger movements have not been well investigated. The present work aims to quantify MU spatial activation patterns during movement of distinct fingers (index, middle, ring and little finger). Specifically, we focused on extensor muscles during extension contractions. Motor unit action potentials (MUAPs) during movement of each finger were obtained through decomposition of high-density sEMG (HD-sEMG). First, we quantified the spatial activation patterns of MUs for each finger based on 2-dimension (2-D) root-mean-square (RMS) maps of MUAP grids after spike-triggered averaging. We found that these activation patterns under different finger movements are distinct along the distal-proximal direction, but with partial overlap. Second, to further evaluate MU separability, we classified the spatial activation pattern of each individual MU under distinct finger movement and associated each MU with its corresponding finger with Regularized Uncorrelated Multilinear Discriminant Analysis (RUMLDA). A high accuracy of MU-finger classification tested on 12 subjects with a mean of 88.98% was achieved. The quantification of MU spatial activation patterns could be beneficial to studies of neural mechanisms of the hand. To the best of our knowledge, this is the first work which manages to quantify MU behaviors under different finger movements.

Vitiligo is an acquired chronic depigmentation disorder that can have a negative impact on the quality of life (QoL). This is especially true for patients with non-white skin. Only few studies have investigated the QoL of Asian patients with vitiligo. We aimed to investigate the QoL in Taiwanese vitiligo patients and identify the factors that influence their QoL. The cross-sectional study recruited 100 vitiligo patients and 100 controls with general skin diseases in the Department of Dermatology of Changhua Christian Hospital. Data were obtained using a structured questionnaire for demographic information and modified Skindex-21 instruments. The QoL was not significantly different between vitiligo patients and controls. Among the vitiligo patients, adults exhibited deteriorated emotional levels and total QoL as compared with non-adults. Married females reported greater levels of emotional disturbance than the unmarried ones. A higher educational level and shorter history of disease were associated with greater emotional impacts. The patients with a generalized type of vitiligo suffered more in total QoL. After multivariate adjustment, the young adult patients aged 20–39 were associated with poorer total QoL. It is suggested that vitiligo patients who are aged between 20 and 39, are married females, are highly educated, have a shorter disease history, and suffer from the generalized type of this disease demonstrate more deterioration in their life quality compared with other vitiligo patients. Care providers should tailor the psychological counseling and treatment accordingly.

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic with serious clinical manifestations including death. A pandemic at the large-scale like COVID-19 places extraordinary demands on the world's health systems, dramatically devastates vulnerable populations, and critically threatens the global communities in an unprecedented way. While tremendous efforts at the frontline are placed on detecting the virus, providing treatments and developing vaccines, it is also critically important to examine the technologies and systems for tackling disease emergence, arresting its spread and especially the strategy for diseases prevention. The objective of this article is to review enabling technologies and systems with various application scenarios for handling the COVID-19 crisis. The article will focus specifically on 1) wearable devices suitable for monitoring the populations at risk and those in quarantine, both for evaluating the health status of caregivers and management personnel, and for facilitating triage processes for admission to hospitals; 2) unobtrusive sensing systems for detecting the disease and for monitoring patients with relatively mild symptoms whose clinical situation could suddenly worsen in improvised hospitals; and 3) telehealth technologies for the remote monitoring and diagnosis of COVID-19 and related diseases. Finally, further challenges and opportunities for future directions of development are highlighted.

circRNAs have been considered as a rising factor in cancers. However, the roles and mechanisms of circ-sirt1 in gastric cancer (GC) remain largely unknown. In this study, we found that the expressions of sirt1 and circ-sirt1 are decreased in tissues or serums of GC patients by real-time quantitative PCR (RT-qPCR). The expressions of miR-132-3p/miR-212-3p showed an opposite tendency in these samples. The co-transfection of miR-132-3p/miR-212-3p mimics counteracted the enhancement of sirt1 expression induced by circ-sirt1. The results of cell colony-formation assay and transwell assays demonstrated that the proliferation, migration, and invasion activities of BGC-823 cells were inhibited by circ-sirt1 overexpression or miR-132-3p/miR-212-3p knockdown, respectively. The xenograft tumor model result indicated that the circ-sirt1 overexpression suppressed the tumor growth of BGC-823 cells. The regulation of miR-132-3p/miR-212-3p between circ-sirt1 and sirt1 was verified in the mice tumor tissues. Thus, circ-sirt1 inhibited tumor growth and invasion probably by sponging miR-132-3p/miR-212-3p and upregulating sirt1 expression in GC. These findings may provide a theoretical basis for the classification of GC and a novel therapeutic target for GC patients.

Background Phenotypic switching of vascular smooth muscle cells (VSMCs) plays a key role in atherosclerosis. Long noncoding RNA ANRIL (lncRNA-ANRIL) is critical in vascular homeostasis. Metformin produces multiple beneficial effects in atherosclerosis. However, the underlying mechanisms need to be elucidated. Methods and results Metformin increased lncRNA-ANRIL expression and AMPK activity in cultured VSMCs, and inhibited the phenotypic switching of VSMCs to the synthetic phenotype induced by platelet-derived growth factor (PDGF). Overexpression of lncRNA-ANRIL inhibited phenotypic switching and reversed the reduction of AMPK activity in PDGF-treated VSMCs. While, gene knockdown of lncRNA-ANRIL by adenovirus or silence of AMPKγ through siRNA abolished AMPK activation induced by metformin in VSMCs. RNA-immunoprecipitation analysis indicated that the affinity of lncRNA-ANRIL to AMPKγ subunit was increased by metformin. In vivo, administration of metformin increased the levels of lncRNA-ANRIL, suppressed VSMC phenotypic switching, and prevented the development of atherosclerotic plaque in Apoe-/- mice fed with western diet. These protective effects of metformin were abolished by infecting Apoe-/- mice with adenovirus expressing lncRNA-ANRIL shRNA. The levels of AMPK phosphorylation, AMPK activity, and lncRNA-ANRIL expression were decreased in human atherosclerotic lesions. Conclusion Metformin activates AMPK to suppress the formation of atherosclerotic plaque through upregulation of lncRNA-ANRIL.

Objective This study aimed to examine the health service use and healthcare costs of adults with anorexia nervosa (AN) and bulimia nervosa (BN) in Taiwan. Method AN and BN cases between 2002-2013 were extracted from a national health insurance database. For each AN and BN case, we randomly selected 10 controls with no eating disorder, matched for sex, age, urbanization of residence, and year of medical visit. The percentage and frequency of health services use and costs in the year preceding and after the diagnosis of AN/BN were compared between groups. We used generalized linear models with gamma distribution and log link function to determine the effects of age, sex, and psychiatric comorbidities on the total cost adjusting for physical comorbidities and to calculate the mean cost difference between groups by using marginal and incremental effects. Results Both individuals with AN and BN had significantly elevated healthcare utilization and costs compared to controls during the baseline and one-year period after diagnosis. Patients with AN had more than three times higher total costs (US $792) and patients with BN had two times higher total costs (US $320) than individuals without eating disorders. Comorbidity of depressive disorder and older age significantly increased healthcare costs among both individuals with AN and BN. Discussion There are high medical and economic burdens of care for individuals with AN and BN. Early diagnosis and integrated care for eating disorders are important tasks to reduce disease burden in Taiwan.

Study design Clinical case series. Objective The aim of this study was to propose a novel posterior ligament-bone injury classification and severity (PLICS) score system that can be used to reflect the severity of subaxial cervical fracture dislocations (SCFDs) and predict the failure of anterior-only surgery; and to measure the intraobserver and interobserver reliability of this system. Summary of background data The approach selection for SCFDs is controversial. Although the anterior approach is familiar for most surgeons, postoperative hardware failure and/or delayed cervical deformity is a nonnegligible complication. Methods Ten patients were randomly selected for intraobserver reliability evaluation on two separate occasions, one month apart. Another 30 patients were randomly selected, and the interobserver reliability was measured by comparing results of each case between each reviewer and averaging. To analyze the difference in the PLICS score, 354 patients fulfilled the follow-up were divided into stable and unstable groups according to whether radiologically stable was observed during follow-up. Results For the intraobserver reliability, the mean intraclass correlation coefficient for the 10 reviewers was 0.931. For the interobserver reliability, the mean interobserver correlation coefficient for the three elements was 0.863. Among 16 patients with PLICS score ≥7, two patients in the stable group manifested with severe injury of the posterior ligamentous complex (PLC); extremely unstable lateral mass fractures with or without severe injury of PLC were detected in the 14 patients of the unstable group. Conclusion The proposed PLICS score system showed excellent intraobserver and interobserver reliability. When a PLICS score is >7 or 7 accompanied by extremely unstable lateral mass fractures, the risk of postoperative failure after an anterior-only reconstruction is high and supplemental posterior strengthening can be considered.Level of Evidence: 4.

BACKGROUND: Population-wide screening for prostate cancer remains a controversial topic, given the need for an individualized approach to patients regarding the risks and benefits of prostate-specific antigen testing and digital rectal examination. OBJECTIVE: The aim of this study was to investigate the prevalence of, and factors associated with, prostate examination among men aged 45 or older. DESIGN AND SETTING: Cross-sectional population-based study developed in the city of Rio Grande (RS), Brazil. METHODS: The outcome of interest was a history of prostate examination (prostate-specific antigen testing or digital rectal examination). The following independent variables were analyzed: age group, skin color, marital status, schooling, economic level, leisure-time physical activity, smoking habits, excessive alcohol consumption, overweight, health insurance, visits to the doctor during the preceding year, hypertension and diabetes. After a two-stage sampling process, the final sample consisted of 281 male individuals. RESULTS: The prevalence of a history of prostate-specific antigen testing or digital rectal examination was 68.3% (95% confidence interval (CI): 62.2 to 74.5). The highest prevalence rates were observed among men aged 70 years or older (88%) and the lowest among smokers (36%). The following characteristics were found to be associated with the outcome: advanced age; marital status other than single; more schooling and higher economic status; practicing physical activity; non-smoking habits; overweight; having health insurance; and having visited a doctor during the preceding year. CONCLUSION: Approximately two thirds of the study population had been screened for prostate examination, mostly older individuals, with higher socioeconomic status and a healthier lifestyle.

Objective This study aimed to examine the characteristics of psychiatrists and the hospital settings in relation to the first-time diagnoses of anorexia nervosa (AN) and bulimia nervosa (BN) and depict medical utilization and the detection rate before diagnosis of patients with AN and BN. Method We extracted data of individuals with AN or BN, as defined by the International Classification of Diseases, Ninth Revision, Clinical Modification, from a national health insurance database. Individuals with AN (n = 1,893) or BN (n = 10,542) who were first-time diagnosed by psychiatrists from 2002 to 2013 were included. Individuals with schizophrenia were selected as control groups that were matched with the incident AN and BN cases for sex, age stratum, and year of diagnosis. Results AN was more likely to be diagnosed by female psychiatrists. Patients with AN were more frequently diagnosed in medical centers while patients with BN were mostly diagnosed in primary care clinics. Nearly all patients with AN and BN had sought treatment for physical problems but less than half had sought help for mental health problems in the year preceding the diagnosis. Individuals with AN, BN, and schizophrenia were all under-detected by nonpsychiatric medical professionals. Notably, BN was least likely to be recognized by both psychiatrists and other medical professionals. Discussion Our findings underscore the importance of educational programs that are designed to improve the detection and management of eating disorders by medical professionals in Taiwan. Advanced educational programs that target differential diagnosis and the tailored management of different eating disorders should be highlighted among psychiatrists.

Sichuan pickle is one of popular traditional fermented foods in China. However, the contamination of heavy metals in Sichuan pickle, particularly home-made Sichuan pickle and aged pickle brine, is little known. Therefore, the content of trace (Cr, Cu, and Zn) and toxic elements (As, Pb, and Cd) in Sichuan industrial pickle (SIP), Sichuan home-made pickle (SHP), and aged pickle brine collected from local markets and families in Sichuan province, respectively, was detected by inductively coupled plasma-tandem mass spectrometry (ICP-MS/MS) and the health risk was assessed by target hazard quotients including target hazard quotient (THQ) and total target hazard quotient (TTHQ). Consequently, the mean concentrations of Cr, Cu, Zn, As, Pb, and Cd were 0.122, 0.540, 2.516, 0.023, 0.015, and 0.106 mg/kg in SIP and 0.071, 0.364, 2.698, 0.014, 0.015, and 0.289 mg/kg in SHP, respectively, lower than the maximum allowable concentrations set by Chinese regulations, except for Cr and Cd in few samples. Principal component analysis of the heavy metal content could obviously distinguish between SIP and SHP. The content of As, Pb, and Cd in leaf pickles was significantly higher than that in pickles fermented with other types of vegetables. A significant enrichment of heavy metals in aged pickle brine over 10 years was observed, but pickle jars had no significant effect on heavy metal content in aged pickle brine. The intake of heavy metals through daily consumption of SIP and SHP was at a safe level, whereas the TTHQ of leaf pickle was 1.006, indicating a potential health risk. In conclusion, this study provided fundamental data for food safety assurance of Sichuan pickle. PRACTICAL APPLICATION: Sichuan pickle is one of popular traditional fermented foods in China. In the present study, we investigated the contamination of heavy metals in Sichuan pickles by detecting the content of Cr, Cu, Zn, As, Cd, and Pb in Sichuan industrial pickle, Sichuan home-made pickle, and aged pickle brine, and estimated the health risk to local residents. This study can provide a reference for the safety risk of Sichuan industrial and home-made pickle in terms of heavy metal contamination, and enhance the food safety in the processing, production, and consumption of Sichuan pickle in local families and pickle industry.

Purpose To investigate whether a cocktail therapy of dexamethasone, ropivacaine, dexmedetomidine, and vitamin B12 can achieve satisfactory pain relief and promote early functional recovery after PPECD. Methods Eighty single-level patients with CDH who received PPECD were retrospectively divided into two groups: the cocktail and control groups. Clinical data were recorded and evaluated by a dedicated physician who was not involved in the patient’s treatment. The primary clinical outcomes included visual analog scores (VASs) for upper limber pain and neck disability index (NDI) scores. The follow-up time points were preoperatively and postoperative 1 week, 1 month, 3 months, 6 months, and 12 months. The modified MacNab criteria was used to evaluate the surgical effect of the last follow-up. Results The follow-up data of 74 cases were complete, except 6 cases lost to follow-up. There was no significant difference between the two groups in demographics, duration of symptoms, operation stage (p > 0.05), and operation time (80.5 ± 5.5 vs. 81.5 ± 3.5 min). The VAS in the upper limbs pain was significantly higher postoperatively than preoperatively in both groups (p p p > 0.05). In the control group, two cases with foraminal stenosis were found to have unrelieved pain in the early postoperative period, but the pain was relieved at the final follow-up and did not convert to open decompression surgery. Conclusions Cocktail treatment, in which a drug sustained-release material made of gelatin sponge was impregnated with dexamethasone, ropivacaine, dexmedetomidine and vitamin B12, facilitates pain relief and early postoperative recovery after PPECD.

Background: Little epidemiological research has investigated the associations of air pollutant exposure over various time windows with older adults' symptoms of depression. This study aimed to analyze the relationships of long- and short-term ambient air pollution exposure (to coarse particulate matter, O3, SO2, CO, and NOx) with depressive symptoms in a sample of community-dwelling older adults.Methods: A sample of older adults (n = 1,956) was recruited from a nationally representative multiple-wave study (Taiwan Longitudinal Study on Aging). Between 1996 and 2007, four waves of surveys investigated depressive symptoms by using the 10-item Center for Epidemiologic Studies Depression questionnaire. We approximated air pollutant concentrations from 1995 to 2007 by using daily concentration data for five air pollutants at air quality monitoring stations in the administrative zone of participants' residences. after adjusting for covariates, we applied generalized linear mixed models to analyze associations for different exposure windows (7-, 14-, 21-, 30-, 60-, 90-, and 180-day and 1-year moving averages).Results: In a one-pollutant model, long- and short-term exposure to CO and NOx was associated with heightened risks of depressive symptoms; the odds ratio and corresponding 95% confidence interval for each interquartile range (IQR) increment in CO at 7-, 14-, 21-, 30-, 60-, 90-, and 180-day and 1-year moving averages were 1.232 (1.116, 1.361), 1.237 (1.136, 1.348), 1.216 (1.128, 1.311), 1.231 (1.133, 1.338), 1.224 (1.124, 1.332), 1.192 (1.106, 1.285), 1.228 (1.122, 1.344), and 1.180 (1.102, 1.265), respectively. Those for each IQR increment in NOx were 1.312 (1.158, 1.488), 1.274 (1.162, 1.398), 1.295 (1.178, 1.432), 1.310 (1.186, 1.447), 1.345 (1.209, 1.496), 1.348 (1.210, 1.501), 1.324 (1.192, 1.471), and 1.219 (1.130, 1.314), respectively. The exposure to PM10, O3, and SO2 over various windows were not significant. In the two-pollutant model, only the associations of NOx exposure with depressive symptoms remained robust after adjustment for any other pollutant.Conclusions: Exposure to traffic-associated air pollutants could increase depression risks among older adults.

Objective Diabetes-related cerebral microangiopathy can manifest as cerebral small vessel disease (CSVD) and exhibit cognitive decline. To find the early change of function in advance, this study examined the spatiotemporal dynamics of cerebral permeability (Ktrans) in the progression of diabetes-related CSVD. Methods Cerebral vascular permeability was crossectional measured in diabetic patients with or without CSVD, and non-diabetic patients with or without CSVD by using dynamic contrast-enhanced MRI (DCE-MRI). Results In all diabetic patients, the Ktrans of white matter (WM) was increased. However, the Ktrans of gray matter (GM) was only increased in those with CSVD. This suggested the earlier involvement of WM than GM and indicated the development of diabetes-related cerebral microangiopathy was prior to it could be visualized as features of CSVD on MRI. To broaden the application of cerebral permeability and overcome the limitations of DCE-MRI, the commonly available CSVD items of MRI were used to indicate the increase in Ktrans. Among all CSVD items, the presence of microbleeds was most correlated with the increased permeability in all patients. In contrast to non-diabetic patients, increased Ktrans in diabetes was more associated with moderate WM hyperintensity but less with the presence of lacunae or multiple perivascular spaces. The differential correlation suggested distinct mechanisms underlying diabetes-related CSVD and other CSVDs. Conclusions This study highlights the early development of cerebral microangiopathy in diabetes and broadens the applicability of cerebral permeability. The results may increase the proactivity of clinicians in recognizing the subsequent neurological comorbidities.

ObjectivesEvidence on the associations between short-term and long-term air temperature exposure and cognitive function in older adults, particularly those in Asia, is limited. We explored the relationships of short-term and long-term air temperature exposure with cognitive function in Taiwanese older adults through a repeated measures survey.Design and settingWe used data the ongoing Taiwan Longitudinal Study on Aging, a multiple-wave nationwide survey.ParticipantsWe identified 1956, 1700, 1248 and 876 older adults in 1996, 1999, 2003 and 2007, respectively.Primary and secondary outcome measuresParticipants’ cognitive function assessment was based on the Short Portable Mental Status Questionnaire. We calculated the temperature moving average (TMA) for temperature exposure windows between 1993 and 2007 using data from air quality monitoring stations, depending on the administrative zone of each participant’s residence. Generalised linear mixed models were used to examine the effects of short-term and long-term temperature changes on cognitive function.ResultsShort-term and long-term temperature exposure was significantly and positively associated with moderate-to-severe cognitive impairment, with the greatest increase in ORs found for 3-year TMAs (OR 1.247; 95% CI 1.107 to 1.404). The higher the quintiles of temperature exposure were, the higher were the ORs. The strongest association found was in long-term TMA exposure (OR 3.674; 95% CI 2.103 to 6.417) after covariates were controlled for.ConclusionsThe risk of mild cognitive impairment increased with ambient temperature in community-dwelling older adults in Taiwan.

The purpose of this pictorial essay is to review the imaging appearances of the spectrum of thrombophlebitis of abdominal veins on computed tomography (CT) scans. Thrombophlebitis of abdominal veins is rare but mimics other more common conditions presenting with acute abdomen. Due to non-specific presenting symptoms, signs and laboratory findings, diagnosis is largely reliant on imaging, particularly CT which is readily available in the emergency setting.

Background Vitiligo is an acquired disease that involves low pigment variation in the skin. The use of cultured melanocytes for treatment of recalcitrant vitiligo has become a well-established treatment modality. In vitro cultured melanocytes present an effective autologous transplantation treatment modality for vitiligo. The present study investigated the in vitro culture of epidermal melanocytes sampled from multiple body parts, as well as the differences in total propagation time. Methods Skin specimens were collected from 30 participants (14 males and 16 females) who supplied normal colored skin sections from various regions of their body, including the face, chest, abdomen, buttock, and extremities. Subsequently, all of these specimens were treated with an identical melanocyte purification and culturing process. Results Melanocytes from the face demonstrated the most rapid growth and longest total propagation time. Melanocytes from the buttock, abdomen, and extremities displayed similar results to one another, and melanocytes from the chest and back had the slowest growth and shortest total propagation time. Conclusion Selecting the most favorable site to obtain epidermal melanocytes will reduce the required quantity of skin and culturing time, and maximize the growth and total propagation time of melanocytes. Therefore, care should be exercised when selecting the region of skin when culturing epidermal melanocytes.

The most commonly used oscillometric upper-arm (UA) blood pressure (BP) monitors are not convenient enough for ambulatory BP monitoring, given the large size of the arm cuff and the compression of UA during the measurement. Finger-worn oscillometric BP devices featuring miniaturized finger cuff have been developed and researched as an alternative solution to the UA-based measurement, yet the reliability of the finger-based measurement is still questioned. To investigate the feasibility of oscillometric BP measurements at the finger position, we performed model-based analysis and experimental validation to explore the underlying issues associated with extending the cuff-based oscillometric approach from UA to other alternative sites. The simulation results revealed that a larger bone-to-tissue volume ratio produced a lower pressure transmission efficiency, which can account for the inter-site measurement discrepancies of mean blood pressure (MBP). We also experimentally compared the oscillometric MBP measurements at UA, middle forearm, wrist, finger proximal phalanx, and finger distal phalanx (FD) of 20 young adults, and each position was matched with a cuff of appropriate size and kept at the same height with the heart. The experimental results demonstrated that FD could be a superior alternative position for oscillometric BP measurement, as it requires the smallest cuff size while providing the most consistent MBP with the UA. Our analysis also suggested that further study is demanded to identify the appropriate oscillometric algorithm for reliable systolic blood pressure and diastolic blood pressure measurements at FD.

Powered by the technologies that have originated from manufacturing, the fourth revolution of healthcare technologies is happening (Healthcare 4.0). As an example of such revolution, new generation homecare robotic systems (HRS) based on the cyber-physical systems (CPS) with higher speed and more intelligent execution are emerging. In this article, the new visions and features of the CPS-based HRS are proposed. The latest progress in related enabling technologies is reviewed, including artificial intelligence, sensing fundamentals, materials and machines, cloud computing and communication, as well as motion capture and mapping. Finally, the future perspectives of the CPS-based HRS and the technical challenges faced in each technical area are discussed.

For many cerebrovascular diseases both blood pressure (BP) and hemodynamic changes are important clinical variables. In this paper, we describe the development of a novel approach to noninvasively and simultaneously monitor cerebral hemodynamics, BP, and other important parameters at high temporal resolution (250 Hz sampling rate). In this approach, cerebral hemodynamics are acquired using near infrared spectroscopy based sensors and algorithms, whereas continuous BP is acquired by superficial temporal artery tonometry with pulse transit time based drift correction. The sensors, monitoring system, and data analysis algorithms used in the prototype for this approach are reported in detail in this paper. Preliminary performance tests demonstrated that we were able to simultaneously and noninvasively record and reveal cerebral hemodynamics and BP during people’s daily activity. As examples, we report dynamic cerebral hemodynamic and BP fluctuations during postural changes and micturition. These preliminary results demonstrate the feasibility of our approach, and its unique power in catching hemodynamics and BP fluctuations during transient symptoms (such as syncope) and revealing the dynamic features of related events.

Cerebral venous thrombosis (CVT) occasionally presents with acute focal neurologic signs, mimicking arterial stroke syndrome. Diagnosing CVT in the setting of thrombolysis eligibility evaluation is challenging. We reported this case to discuss the promptly recognizing CVT in the setting of thrombolysis eligibility evaluation, and review the literature of thrombolytic therapy in CVT patients.A 57-year-old man presented with acute-onset right upper extremity monoparesis, right facial palsy, and aphasia. He underwent emergent thrombolysis with recombinant tissue plasminogen activator according to American Stroke Association guidelines. Subsequently, CVT was identified on multiphase computed tomography (CT) angiography. His symptoms initially improved but subsequently deteriorated because of intracranial hemorrhage. Cryoprecipitate and tranexamic acid were immediately administered. Anticoagulation was started 24 hours after the onset of hemorrhage. His modified Rankin Scale score was 4 at 120 days after the hemorrhage.Patients with CVT have a higher risk of thrombolysis-related intracranial hemorrhage than other stroke mimics. A greater focus on noncontrast brain CT and the venous phase of CT angiography help identifying this stroke mimic before thrombolysis.

Picrasidine I is a dimeric alkaloid derived from a Southern Asian plant Picrasma quassioides and demonstrated to possess pharmacological activities, such as anti-inflammatory and anti-osteoclastogenic effects. However, its potential anticancer effect remains unclear. In the present study, anticancer activity of picrasidine I was assessed by treating oral squamous cell carcinoma cells with different concentrations of picrasidine I (20, 30, and 40 μM) for 24, 48, and 72 h. The findings revealed that picrasidine I reduced the cell viability in a dose-dependent manner. Picrasidine I exerted its cytotoxic effect through arresting cell cycle at G2/M phase by downregulating cyclin A, cyclin B, CDK4, and CDK6, and inducing apoptosis in oral cancer cells. The induction of apoptosis was evidenced by increasing expression of death receptors, disruption of mitochondrial membrane potential, increased activation of PARP and caspases 3, 8, and 9, enhanced expression of proapoptotic mediators (Bak and Bim L/S), and reduced expression of antiapoptotic mediators (Bcl-2 and Bcl-xL). Moreover, analysis of MAPK signaling pathway revealed that picrasidine I-mediated proapoptotic activities by downregulating JNK phosphorylation. Taken together, the study identifies picrasidine I as a potent anticancer agent that can be used as a therapeutic intervention against oral squamous cell carcinoma.

Few studies have investigated food security, dietary quality, or unfavorable food intake through self-reports among children and adolescents in Asia. This study assessed the association of perceived food insecurity with dietary quality and unfavorable food intake among 1111 children and 538 adolescents from economically disadvantaged families in Taiwan. Food security status was collected by a validated questionnaire. Dietary quality was examined using a dietary diversity score (DDS). Unfavorable food intake was defined as fried food, bread/cake/pastries, sugar-sweetened beverages, and biscuits/chips. Food-insecure participants had lower DDS, whole grains and protein-rich food intake than food-secure participants. Furthermore, food-insecure children had a higher frequency of unfavorable food consumption. The level of children’s food insecurity was inversely associated with DDS (β: −0.047, 95% CI: −0.085 to −0.009) but positively with bread/pastry (β: 0.103, 95% CI: 0.022–0.184) and sugar-sweetened beverages (β: 0.117, 95% CI: 0.018–0.215) intake. Adolescents who reported food insecurity and not enough money for household expenses had an odds ratio of 2.85 (95% CI: 1.15–7.10) for poor DDS relative to their food-secure and financially able counterparts. We recommended that health policy needs to include diversifying food and nutrition education for vulnerable children and adolescents to improve dietary quality.

Different from the traditional methods of assessing the cardiac activities through heart rhythm statistics or P-QRS-T complexes separately, this study demonstrates their interactive effects on the power density spectrum (PDS) of ECG signal with applications for the diagnosis of ST-segment elevation myocardial infarction (STEMI) diseases. Firstly, a mathematical model of the PDS of ECG signal with a random pacing pulse train (PPT) mimicking S-A node firings was derived. Secondly, an experimental PDS analysis was performed on clinical ECG signals from 49 STEMI patients and 42 healthy subjects in PTB Diagnostic Database. It was found that besides the interactive effects which are consistent between theoretical and experimental results, the ECG PDSs of STEMI patients exhibited consistently significant power shift towards lower frequency range in ST-elevated leads in comparison with those of reference leads and leads of health subjects with the highest median frequency shift ratios at 51.39 ± 12.94% found in anterior MI. Thirdly, the results of ECG simulation with systematic changes in PPT firing statistics over various lengths of ECG data ranging from 10 s to 60 mins revealed that the mean and median frequency parameters were less affected by the heart rhythm statistics and the data length but more depended on the alterations of P-QRS-T complexes, which were further confirmed on 33 more STEMI patients in European ST-T Database, demonstrating that the frequency indexes could be potentially used as alternative indicators for STEMI diagnosis even with ultra-short-term ECG recordings suitable for wearable and mobile health applications in living-free environments.

Background Vertebral augmentation (VA) techniques are used to treat acute osteoporotic vertebral compression fractures (OVCFs). However, the incidence of recurrent vertebral fractures after VA is controversial. Various factors have been discussed in the literature, but no convincing study on the quality of paraspinal muscles has been reported. The purposes of this study were to evaluate the changes in paraspinal muscles and discuss the relationship between paraspinal muscle degeneration and vertebral refractures after percutaneous kyphoplasty (PKP). Methods This retrospective study was conducted in patients who underwent PKP for an initial OVCF between July 2017 and August 2018. Patients were followed up and categorized in the refractured or non-refractured group. A final magnetic resonance imaging (MRI) scan and a preoperative MRI scan were used to determine the measurements. The paraspinal muscles at the mid-height level of the initial fractured vertebral body were measured using regions of interest (ROIs), including the cross-sectional area (CSA) and signal intensity (SI). The changes in the observed data were compared between the groups using rank-sum tests. Results Overall, 92 patients were enrolled in the study; 33 of them sustained vertebral refractures during the follow-up and the other 59 patients did not. There were no significant differences in terms of sex, age, preoperative bone mineral density, and body mass index between the groups (all, P > 0.05). The refractured group had a significantly higher decrease in the ROI-CSA and CSA/SI, and a higher increase in ROI-SI, compared with the preoperative data (all, P < 0.05). Conclusions The quality of paraspinal muscles significantly decreased in patients with new OVCFs after PKP. This brings a new perspective to the study of postoperative recurrent fractures; patients and physicians need to pay more attention to the efficacy of bed rest and bracing.

We investigated factors associated with vulnerability to the psychological impact of celebrity suicide news reporting after the suicide of an emerging Taiwanese novelist, Ms Yi-Han Lin.We conducted a cross-sectional online survey. Participants completed a questionnaire which asked whether they were affected by the media coverage of Lin's suicide and whether they would seek help if affected. Logistic regression was used to identify factors associated with being affected by the celebrity suicide media reporting and, among those affected, factors associated with feeling suicidal or not seeking help.A total of 1258 respondents (81% females) completed the survey. Affected individuals (n=907; 70%) were more likely to be females, younger (age40 years), have past psychiatric treatment, and show increased interest in the incident (e.g., spending more time on reading the celebrity suicide news) than non-affected individuals. Among those affected, negative views of the media reporting impact, pessimistic attitude toward both depression treatment and suicide prevention, and having a history of past psychiatric treatment were associated with feeling suicidal, while low education attainment, increased interest in the celebrity suicide, and permissive attitude toward inappropriate media reporting were additionally associated with not seeking help.Selection bias of participants through internet-based surveying should be considered.Individuals affected by the media coverage of celebrity suicide showed similar demographic and mental health characteristics as those of the deceased celebrity. Poor mental health and suicide prevention literacy may increase the risk of psychological impact and not seeking help. Future interventions could target at enhancing mental health literacy and help seeking intention in vulnerable individuals.

Epidemiological studies concerning whether oxidative stress mediates phthalate exposure-insulin resistance (IR) associations in young adults are limited. Therefore, we investigated this potential mediation by using a cumulative risk approach involving daily intake (DI) and a hazard index (HIThe participants were 391 Taiwanese military personnel. This study measured their IR (as homeostatic model assessment of estimated IR [HOMA-IR]), levels of oxidative stress biomarkers (8-hydroxy-2-deoxyguanosine, 8-nitroguanine, 8-iso-prostaglandin F2α, and N-acetyl-S-[tetrahydro-5-hydroxy-2-pentyl-3-furanyl]-L-cysteine [HNE-MA]), the sum of these four biomarkers (ΣOS), and urinary phthalate metabolite concentrations. The HIWe discovered positive associations between high DI of DBP, BBzP, and DEHP; high HIOxidative stress may partially mediate the phthalate-IR relationship in young adults.

Background: Percutaneous kyphoplasty (PKP) has been reported to provide a favorable analgesic effect for pain caused by osteoporotic vertebral compression fractures (OVCFs). However, a systematic review demonstrated that pain relief was only reported for approximately 86% of kyphoplasty treatments. Objectives: To explore whether an additional facet joint block (FJB) can minimize pain and improve the clinical outcome of PKP in patients with acute OVCFs. Study Design: Prospective study. Setting: All data were from Honghui Hospital in Xi’an. Methods: According to the inclusion and exclusion criteria, 194 patients were eventually included in our study; they were randomly divided into 2 groups of 97 patients each and treated with either PKP + FJB or PKP alone. Follow-up consultations were scheduled 1 day, 3 days, 1 week, 1 month, 3 months, and 1 year postoperatively; the demographic characteristics, related surgical information, and complications observed within both groups were recorded. The clinical evaluation parameters included the intraoperative satisfaction score, the Visual Analog Scale (VAS) score, and the Oswestry Disability Index (ODI). Results: A total of 171 patients (61 men and 110 women; age range: 62–85 years) completed the full postoperative follow-up schedule, with 83 patients in the PKP + FJB group and 88 in the PKP group. No significant differences were observed in the genders, ages, preoperative bone mineral density, surgical levels, or volume of cement injected between the 2 groups (P > 0.05, respectively). The average duration of the surgeries in the PKP + FJB group was slightly longer than that in the PKP group (35.5 ± 4.8 min vs. 31.8 ± 4.3 min; P = 0.038), and in terms of the clinical outcomes, the average intraoperative satisfaction score was significantly higher in the PKP + FJB group (8.6 ± 1.1 vs. 6.3 ± 1.3; P < 0.001). Compared with the preoperative data, significant improvements in the VAS scores of back pain and ODI were observed at each follow-up interval (P < 0.05, respectively). These scores were significantly higher in the PKP + FJB group than in the PKP group; however, this was only observed within the first month after the procedure. Limitations: A single-center noncontrol study. Conclusions: The addition of an FJB (which in our study involved a unique combination of ropivacaine, prednisolone, and vitamin B12) improved the short-term clinical outcome of PKP for acute OVCFs. The local anti-inflammatory and analgesic effects on the facet joints resulted in higher intraoperative satisfaction and lower VAS and ODI scores for the first postoperative month when compared with the PKP group. Key words: Osteoporotic vertebral compression fracture, pain, posterior elements, percutaneous kyphoplasty, facet joint block, medial branch

Background: Resection of the ossification of the thoracic ligamentum flavum (OTLF) with a high-speed burr may cause a high rate of perioperative complications, such as dural laceration and/or iatrogenic spinal cord injury. Objectives: The aim of this study was to investigate the safety and feasibility of the endoscopicmatched ultrasonic osteotome in full-endoscopic spinal surgery for direct removal of OTLF. Study Design: Retrospective study. Setting: All data were from Honghui Hospital in Xi’an. Methods: This study conducted between December 2017 and December 2018, included 27 consecutive patients who met the study criteria, had single-level OTLF, and underwent fullendoscopic decompression under local anesthesia. The postoperative follow-up was scheduled at 1, 3, 6, and 12 months postoperatively. Outcomes evaluations included the Visual Analog Scale (VAS) score for lower extremity pain and the modified Japanese Orthopaedic Association (mJOA) score and improvement rate for the assessment of thoracic myelopathy. Removal of OTLF was measured by comparing the pre- and postoperative computed tomography (CT) and magnetic resonance imaging (MRI) scans. Results: The operation was completed in all patients without conversion to open surgery. The operation time ranged from 65 to 125 minutes (average, 83.7 ± 12.3 minutes). All patients were followed up for 12 to 18 months, with an average follow-up of 14.3 ± 1.3 months. Satisfactory neurologic decompression was confirmed by postoperative CT and MRI, and no revision surgery was required. The VAS and mJOA scores showed statistically higher improvement at the 1-month follow-up and the last follow-up compared with the preoperative assessment (P < 0.05). According to the improvement rate at the final follow-up, 20 cases were classified as good, 6 cases were fair, and 1 case remained unchanged. Limitations: A single-center, noncontrol study. Conclusions: The endoscopic-matched ultrasonic osteotome can be considered quite safe and feasible for direct removal of OTLF during full-endoscopic spinal surgery in strictly selected patients, as this allows for effective direct decompression of OTLF while minimizing trauma and instability. In addition, because of the design characteristics of the ultrasonic osteotome, surgical complications, especially dural tears and spinal cord injury, can also be effectively controlled. Key words: Percutaneous endoscopic spinal surgery, ultrasonic osteotome, ossification of thoracic ligamentum flavum, microsurgery, thoracic myelopathy, minimally invasive procedures

Because of the rapid and serious nature of acute cardiovascular disease (CVD) especially ST segment elevation myocardial infarction (STEMI), a leading cause of death worldwide, prompt diagnosis and treatment is of crucial importance to reduce both mortality and morbidity. During a pandemic such as coronavirus disease-2019 (COVID-19), it is critical to balance cardiovascular emergencies with infectious risk. In this work, we recommend using wearable device based mobile health (mHealth) as an early screening and real-time monitoring tool to address this balance and facilitate remote monitoring to tackle this unprecedented challenge. This recommendation may help to improve the efficiency and effectiveness of acute CVD patient management while reducing infection risk.

Hyaluronic acid (HA) is a glycosaminoglycan that was first isolated and identified from the vitreous body of a bull’s eye. HA is ubiquitous in the soft connective tissues of animals and therefore has high tissue compatibility for use in medication. Because of HA’s biological safety and water retention properties, it has many ophthalmology-related applications, such as in intravitreal injection, dry eye treatment, and contact lenses. Due to its broad range of applications, the identification and quantification of HA is a critical topic. This review article discusses current methods for analyzing HA. Contact lenses have become a widely used medical device, with HA commonly used as an additive to their production material, surface coating, and multipurpose solution. HA molecules on contact lenses retain moisture and increase the wearer’s comfort. HA absorbed by contact lenses can also gradually release to the anterior segment of the eyes to treat dry eye. This review discusses applications of HA in ophthalmology.

Oxidative stress plays a crucial role in the development of diseases induced by welding fumes. To our knowledge, little information is available on the relationship between multiple heavy metal exposure and oxidative stress in welders. We assessed the relationship between multiple heavy metal exposure and oxidative damage by analyzing 174 nonsmoking male welders in a shipyard. Urinary metals were used as the internal dose of exposure to metals in welding fumes, and urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG) was used as an oxidative DNA damage marker. The relationship between workers' metal levels and 8-OHdG was estimated using a multiple linear regression model. The geometric mean levels of urinary chromium (Cr), nickel (Ni), cadmium (Cd), and lead (Pb) were considerably higher in welders than in controls. Urinary Cr and Ni were determined as effective predictors of urinary 8-OHdG levels after adjusting for covariates. Oxidative DNA damage was associated with both Cr and Ni of welding fume exposure in shipyard welders (Ln Cr: β = 0.33, 95%C.I. = 0.16-0.49; Ln Ni: β = 0.27, 95%C.I. = 0.12-0.43). In this study, we investigated the significantly positive relationship between urinary metals (especially Cr and Ni) and 8-OHdG in nonsmoking shipyard welders. Moreover, the use of particulate respirators did not reduce metal exposure and oxidative damage. Therefore, we infer that hazard identification for welders should be conducted.

Background Information on the relationships between phthalate exposure, insulin resistance, and metabolic syndrome (MetS) in younger adults is limited. It is still unclear whether changes in insulin resistance represent an intermediate biological mechanism linking phthalate exposure and MetS. Objective To investigate the associations between cumulative risk of phthalates (such as daily intake [DI] and hazard index [HI]), insulin resistance, and MetS in younger adults and to examine the mediating role of insulin resistance in the associations between phthalate exposure and MetS. Methods Urinary phthalate metabolite levels, insulin resistance (by using the Homeostatic Model Assessment of estimated Insulin Resistance [HOMA-IR]), and MetS status were determined in 435 military personnel in Taiwan. We estimated the DI of five phthalates: dimethyl phthalate (DMP), diethyl phthalate, dibutyl phthalate, benzyl butyl phthalate (BBzP), and di (2-ethylhexyl) phthalate and the HI based on urinary phthalate metabolite levels. Cross-sectional associations between DI and HI, HOMA-IR, and the indicators of MetS were explored using logistic regression models. Mediation analysis was conducted to assess the role of insulin resistance in the associations between phthalate exposure and MetS. Results Higher DIDMP was associated with an increased odds of high HOMA-IR and MetS (odds ratio [OR], 1.686; 95% confidence interval [CI], 1.079–2.634 for high HOMA-IR; OR, 2.329; 95% CI, 1.263–4.295 for MetS). The mediation analysis indicated that 43% of the association between higher DIDMP and MetS was mediated by HOMA-IR. Higher DIBBzP and HI were associated with an increased odds of abdominal obesity (OR, 1.816; 95% CI, 1.180–2.797 for the high DIBBzP group; OR, 1.700, 95% CI, 1.105–2.614 for the high HI groups). Conclusions Exposure to environmental phthalates may be positively associated with insulin resistance and MetS. Insulin resistance may mediate these associations between exposure to certain phthalates and MetS.

Objective: To fight the “silent killer” hypertension, continuous blood pressure (BP) monitoring has been one of the most desired functions in wearable electronics. However, current BP measuring principles and protocols either involve a vessel occlusion process with a cuff or require multiple sensing nodes on the body, which makes it difficult to implement them in compact wearable electronics like smartwatches and wristbands with long-term wearability. Methods: In this work, we proposed a highly compact multi-wavelength photoplethysmography (MWPPG) module and a depth-resolved MWPPG approach for continuous monitoring of BP and systemic vascular resistance (SVR). By associating the wavelength-dependent light penetration depth in the skin with skin vasculatures, our method exploited the pulse transit time (PTT) on skin arterioles for tracking SVR ( n = 20). Then, we developed an arteriolar PTT-based method for beat-to-beat BP measurement. The BP estimation accuracy of the proposed arteriolar PTT method was validated against Finometer ( n = 20) and the arterial line ( n = 4). Results: The correlation between arteriolar PTT and SVR was theoretically deduced and experimentally validated on 20 human subjects performing various maneuvers. The proposed arteriolar PTT-based method outperformed the traditional arterial PTT-based method with better BP estimation accuracy and simpler measurement setup, i.e., with a single sensing node. Conclusion: The proposed depth-resolved MWPPG method can provide accurate measurements of SVR and BP, which are traditionally difficult to measure in a noninvasive or continuous fashion. Significance: This MWPPG work provides the wearable healthcare electronics of compact size with a low-cost and physiology-based solution for continuous measurement of BP and SVR.

Background Multiple acyl-CoA dehydrogenase deficiency (MADD) is a treatable lipid metabolism disorder that presents as myopathy and episodic metabolic crisis. The metabolic crisis is typically associated with prolonged fasting or physical stress; however, the mechanism of metabolic crisis is not yet fully understood. Case presentation A 28-year-old Taiwanese woman presented with dyspnoea, poor appetite, and muscle weakness after using antiobesity drugs, including metformin, triiodothyronine, and topiramate. MADD was diagnosed, and her symptoms rapidly improved after treatment with riboflavin, carnitine, and ubiquinone. To date, antiobesity drugs have not been reported to be a provoking factor in fatty acid oxidation disorder. Conclusions The increase of β-oxidation activity due to antiobesity drugs supports the hypothetical substrate competition model for MADD metabolic crisis. Because the drugs our patient used are commonly prescribed, we report this case to increase the vigilance and proactivity of clinicians in recognising this treatable adult-onset myopathy.

Objective:To investigate whether an after-school nutrition education (ASNE) programme can improve the nutrition knowledge and healthy eating behaviour of adolescents from economically disadvantaged families.Design:One-group pretest and posttest design. Nutrition knowledge and dietary intake were collected using a questionnaire, and anthropometric measurements were measured before and after the intervention. Nine components of healthy eating behaviour were assessed with reference to the Dietary Guideline of Taiwan. Pretest and posttest differences were analysed using generalised estimating equations.Setting:Three after-school programmes in central and southern Taiwan. The ASNE programme comprised three monthly 1-h sessions (20–30-min lecture and 30–40-min interaction).Participants:A total of 153 adolescents aged 10–15 years from economically disadvantaged families (seventy-eight elementary students and seventy-five junior high school students).Results:Elementary and junior high school students’ nutrition knowledge scores (range 0–6) increased by 0·28 (+ 5·7 %, P = 0·02) and 0·30 points (+ 6·18 %, P = 0·02), respectively, but their fruit intake decreased by 0·36 serving/d (–22·9 %, P = 0·02) and 0·29 serving/d (–18·9 %, P = 0·03), respectively. Junior high school students’ mean snacking frequency and fried food intake dropped to 0·75 d/week (–21·3 %, P = 0·008) and 0·10 serving/d (–28·8 %, P = 0·01), respectively.Conclusions:Short-term ASNE programmes can increase nutrition knowledge and reduce snacking frequency and fried food intake despite a decrease in fruit intake among adolescents from economically disadvantaged families.

Background: Dietary betaine intake was reported to associate with favorable profile of metabolic disorders. However, the role of circulating betaine in coronary artery disease (CAD) patients with dysglycemia is still unknown. The present study aimed to investigate the potential associations between plasma betaine levels and dysglycemia in CAD patients. Methods: Total 307 subjects were enrolled in the present study with 165 CAD patients (57 with dysglycemia and 108 with normal glycemia) and 142 age- and sex-matched controls (CON). Fasting plasma betaine was detected using liquid chromatography tandem mass spectrometry. Results: Plasma betaine was lower in normal glycemia CAD patients (28.29 (22.38–35.73) μM) compared with healthy controls (29.75 (25.32–39.15) μM), and was further decreased in CAD patients with dysglycemia (24.14 (20.84–30.76) μM, P Conclusion: Plasma betaine levels are independently and inversely associated with dysglycemia in CAD after adjustment for multiple factors, and may be useful for risk stratification of dysglycemia in CAD.

This study identified factors associated with interstitial lung disease (ILD) in patients with idiopathic inflammatory myopathy (IIM) based on the latest classification and recent advances in autoantibody serology. We retrospectively analyzed data of 173 patients who underwent complete myositis autoantibody serology examination in a medical center in Taiwan from July 2018 to February 2020. After exclusion of patients who did not receive a final diagnosis of IIM, clinical features, serology data, concomitant diseases, treatment, presence of respiratory failure, and mortality rate of the remaining 97 patients were analyzed. Of IIM patients in our cohort, 47.4% had ILD. ILD was significantly associated with subtypes of IIM, older age of onset, presence of mechanic’s hand, and presence of anti-Jo-1 and anti-Ro52 antibodies. Among five IIM subtypes, overlap myositis (OM) and dermatomyositis (DM) were significantly associated with a higher prevalence rate of ILD (67.5% in OM and 53.3% in DM). Among patients with OM, the presence of anti-Jo-1 (100%), anti-PL-7 (100%), and anti-EJ antibodies (77.8%) was most significantly associated with ILD. The latest classification of IIM, older age of onset, presence of mechanic’s hand, and presence of anti-Jo-1 and anti-Ro52 antibodies were significantly associated with ILD. Among five IIM subtypes, OM and DM had higher prevalence rate of ILD. Among OM patients, the presence of anti-Jo-1, anti-EJ, and anti-PL-7 antibodies was significantly associated with ILD. The study results may help physicians to timely screen and monitor pulmonary function in high-risk groups.

Choline is an important nutrient involved in multiple biosynthesis pathways. However, whether circulating choline levels are associated with the risk of hypertension (HTN) and artery stenosis in HTN remains unknown. We investigated the correlations of plasma choline with HTN and coronary artery injury and explored the utility of plasma choline as a diagnostic biomarker for HTN and artery stenosis. 193 HTN patients and 154 age- and sex-matched healthy controls (CON) were recruited in this study. Fasting plasma choline was detected using liquid chromatography tandem mass spectrometry. Choline levels were significantly higher in HTN without artery stenosis (HTN-AS) than CON (8.07 [7.19-9.24] μM vs 7.03 [6.21-8.13] μM, P < .01) group and were further upregulated in HTN with artery stenosis (HTN + AS) (8.63 [7.09-10.59] μM, P < .01) group. Patients with multivessel disease (MVD) also exhibited higher choline levels than those with single vessel disease (SVD) (8.64 [7.16-10.55] μM vs 8.04(6.74-9.38) μM, P < .01). Increased choline levels were independently associated with the risk of HTN (OR = 1.2, 95% CI: 1-1.45, P = .05), HTN + AS (OR = 1.27, 95% CI: 1.09-1.48, P < .01), and MVD (OR = 1.16, 95% CI: 1.02-1.31, P = .02) after adjustment for multiple risk factors. Receiver operating characteristic (ROC) analysis showed that choline had an area under curve (AUC) score of 0.69, 0.67, and 0.63 in determining HTN, HTN + AS, and MVD. In conclusion, higher choline levels were associated with increased risk of HTN and artery stenosis in hypertensive patients.

Background While the cities in China in which spinal cord injury (SCI) studies have been conducted previously are at the forefront of medical care, northwest China is relatively underdeveloped economically, and the epidemiological characteristics of SCI have rarely been reported in this region. Methods The SCI epidemiological survey software developed was used to analyze the data of patients treated with SCI from 2014 to 2018. The sociodemographic characteristics of patients, including name, age, sex, and occupation, were recorded. The following medical record data, obtained from physical and radiographic examinations, were included in the study: data on the cause of injury, fracture location, associated injuries, and level of injury. Neurological function was evaluated using the American Spinal Injury Association (ASIA) impairment scale. In addition, the treatment and complications during hospitalization were documented. Results A total of 3487 patients with SCI with a mean age of 39.5 ± 11.2 years were identified in this study, and the male to female ratio was 2.57:1. The primary cause of SCI was falls (low falls 47.75%, high falls 37.31%), followed by traffic accidents (8.98%), and impact with falling objects (4.39%). Of all patients, 1786 patients (51.22%) had complications and other injuries. According to the ASIA impairment scale, the numbers of grade A, B, C, and D injuries were 747 (21.42%), 688 (19.73%), 618 (17.72%), and 1434 (41.12%), respectively. During the hospitalization period, a total of 1341 patients experienced complications, with a percentage of 38.46%. Among all complications, pulmonary infection was the most common (437, 32.59%), followed by hyponatremia (326, 24.31%), bedsores (219, 16.33%), urinary tract infection (168, 12.53%), deep venous thrombosis (157, 11.71%), and others (34, 2.53%). Notably, among 3487 patients with SCI, only 528 patients (15.14%) received long-term rehabilitation treatment. Conclusion The incidence of SCI in northwest China was on the rise with higher proportion in males; fall and the MCVs were the primary causes of SCI. The occupations most threatened by SCI are farmers and workers. The investigation and analysis of the epidemiological characteristics of SCI in respiratory complications are important factors leading to death after SCI, especially when the SCI occurs in the cervical spinal cord. Finally, the significance of SCI rehabilitation should be addressed.