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INTRODUCTION: One session of high energy extracorporeal shockwave therapy (ESWT) was found to improve the healing of anterior cruciate ligament (ACL) after reconstruction in animal and human studies. This study investigated the effects of three and six sessions of low energy ESWT on graft incorporation and knee functions post ACL reconstruction in humans. MATERIALS AND METHODS: Thirty participants with ACL injuries were recruited and assigned equally into three groups with 10 participants per group (n=10). Participants in the control group received physiotherapy alone without low energy ESWT. Participants in the 3ESWT group underwent three sessions of low energy ESWT (one session per week) combined with physiotherapy, and participants in the 6ESWT group received six sessions of low energy ESWT (one session per week) combined with physiotherapy. However, five participants were lost to follow-up. Evaluations of graft incorporation of the tibial tunnel using magnetic resonance (MRI) and Lysholm score were carried out before ACL reconstruction and after six months post ACL reconstruction. RESULTS: The number of grafts with partial incorporation in the tibia tunnel in 6ESWT was significantly higher compared with the number of grafts with non-incorporation at six months post-operatively, X2 (1, N=9) =5.44, p =0.02. However, there was no significant difference between frequencies of graft incorporation in tibia tunnel in the control and 3ESWT groups, X2 (1, N=7) =3.57, p =0.06 and X2 (1, N=9) =2.78, p =0.10, respectively at 6 months post- operatively. Lysholm scores were significantly higher at 6 months post ACL reconstruction compared to the baseline value for each group (p

Chin-Kuo Chen,1,2 Shih Chieh Shen,1– 3 Li-Ang Lee,1,2 Ming-Hui Sun,2,4 Ning-Hung Chen,2,5 Li-Pang Chuang,2,5 Hsueh-Yu Li1,2 1Department of Otolaryngology-Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital (Linkou), Taoyuan City, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan City, Taiwan; 3Department of Otolaryngology-Head and Neck Surgery, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan; 4Department of Ophthalmology, Chang Gung Memorial Hospital (Linkou), Taoyuan City, Taiwan; 5Department of Pulmonary and Critical Care Medicine, Sleep Center, Chang Gung Memorial Hospital (Linkou), Taoyuan City, TaiwanCorrespondence: Hsueh-Yu Li; Shih Chieh ShenDepartment of Otolaryngology-Head and Neck Surgery, Sleep Center, Chang Gung Memorial Hospital (Linkou), 33, No. 5, Fushing Street, Gueishan Shiang, Taoyuan City, TaiwanTel +886-3-3281200 ext.3966Fax +886-3-3979361Email hyli38@cgmh.org.tw; b9102083@cgmh.org.twPurpose: Obstructive sleep apnea (OSA) is characterized by recurring hypoxic-apneic events during sleep, and labyrinthine vascular compromise is a pathophysiologic hallmark of idiopathic sudden sensorineural hearing loss (ISSNHL). Some reports have discussed the relationship between OSA and hearing impairment; however, few have examined hearing prognosis in OSA and patients without OSA with ISSNHL. We aimed to investigate clinical manifestations of ISSNHL in patients with OSA, including severity of hearing loss and response to treatment.Patients and Methods: A case-control study was conducted by extracting data from the sleep center and cochlea center databases of the Chang Gung Memorial Hospital. A retrospective chart review was performed to include confirmed adult OSA patients diagnosed with unilateral ISSNHL. Age and sex-matched patients without OSA with ISSNHL were enrolled as controls. Pure-tone average (PTA) thresholds were measured at specific frequencies. Changes in PTA before and after standard treatment with oral prednisolone (1mg/kg/day for 5 days, then tapered) and between participants with OSA and without OSA were compared. Standard treatment was given to all ISSNHL patients.Results: Twenty-eight out of 8500 (0.33%) OSA patients experienced subsequent ISSNHL in 9 years. Patients with OSA (n=28) had poorer high-frequency perception in the unaffected ear than the patients without OSA (n=120), although the difference was not significant. Hearing in the affected ear among patients with OSA was comparable to that patients without OSA at individual frequencies and average, suggesting no difference in hearing loss in the affected ear between the two groups. In terms of high-frequencies (4000 and 8000 Hz) perception, patients with OSA had significantly poorer responses to steroid treatment than patients without OSA.Conclusion: ISSNHL may be one of the auditory complications associated with OSA. Patients with OSA had poorer prednisolone related hearing improvement in high frequencies than patients without OSA. Despite study limitations, OSA-related hypoxia and snoring noise is hazardous to hearing and standard treatments with CPAP is suggested in OSA patients for both holistic and auditory health.Keywords: obstructive sleep apnea, idiopathic sudden sensorineural hearing loss, high-frequency, hypoxemia, pure-tone average, frequencies

Yi-Chia Wei,1– 4 Li-Yuan Huang,1,2,5 Chemin Lin,1,2,6 Yu-Chiau Shyu,1,7 Chih-Ken Chen1,2,6 1Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan; 2College of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Department of Neurology, Chang Gung Memorial Hospital, Keelung, Taiwan; 4Institute of Neuroscience, National Yang-Ming University, Taipei, Taiwan; 5Department of Nursing, Chang Gung Memorial Hospital, Keelung, Taiwan; 6Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; 7Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, TaiwanCorrespondence: Chih-Ken ChenDepartment of Psychiatry, Chang Gung Memorial Hospital at Keelung, No. 200 Lane 208, Jijin 1st Road, Anle District, Keelung City, 204, TaiwanTel +886-2-24329292-2725Fax +886-2-24315931Email kenchen@cgmh.org.twBackground: Major depressive disorder (MDD) presents with emotional and somatic symptoms and sometimes subjective cognitive complaints (SCCs). This study developed a collaborative method to integrate SCC assessment for evaluating late-life MDD.Methods: Residents aged > 50 years in the Community Medicine Research Center of Keelung Chang Gung Memorial Hospital in Taiwan during 2017– 2018 were prospectively recruited in this study. The participants were asked to report their depressive tendency and SCCs using the Taiwanese Depression Questionnaire (TDQ) and the AD8, respectively, and were administered psychiatric evaluation through the Mini–International Neuropsychiatric Interview (MINI). The participants were divided into elderly (age≥ 65 years) and older adult (age 50– 65) groups. The MDD predictive powers were assessed using logistic regression and receiver operating characteristic (ROC) curve analyses.Results: Of the 118 enrolled participants (mean age: 64.81± 4.99, female-to-male ratio: 1.62), 9, 21, and 88 were categorized as those with current MDD, past MDD, and non-MDD on the basis of the MINI results, respectively. After adjustments for age, sex, and sleep quality, the TDQ score (odds ratio: 1.152, p=0.003) and AD8 score (odds ratio: 1.710, p=0.020) were used individually to predict current MDD. Overall, the TDQ individually predicted current MDD well with area under the ROC curve (AUC) of 0.835 (p=0.001). However, in the elderly group (N=63), the TDQ score did not identify current MDD well (AUC: 0.780, p=0.063). After co-considering SCCs, the linear combination of the sum of the TDQ score and four folds of the AD8 score could effectively distinguished elderly people with current MDD from those without it (AUC: 0.875, p=0.013)—with the cutoff of the aforementioned combined score being ≥ 32.Conclusion: The self-reported response to the TDQ is a feasible approach of identifying MDD in community-dwelling people. Combining TDQ and AD8 scores further improved depression detection in elderly people.Keywords: geriatric depression, major depressive disorder, Taiwanese Depression Questionnaires, subjective cognitive complaint, AD8

Chan-Lin Chu,1,2 Yueh-Peng Chen,3 Carl CP Chen,3,4 Chih-Kuang Chen,3,4 Hsiang-Ning Chang,4 Chien-Hung Chang,1,2,5,* Yu-Cheng Pei3,4,6,7,* 1Department of Neurology, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 2School of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Center for Artificial Intelligence in Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 4Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; 5Department of Electrical Engineering, College of Engineering, Chang Gung University, Taoyuan, Taiwan; 6Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan; 7Center of Vascularized Tissue Allograft, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan*These authors contributed equally to this workCorrespondence: Yu-Cheng Pei; Chien-Hung Chang Email yspeii@gmail.com; cva9514@gmail.comBackground: Tailored rehabilitation programs for stroke patients cannot be made without knowledge of their recovery potential. The aim of this study is to characterize the functional recovery patterns of ischemic stroke (IS) and intracerebral hemorrhage (ICH) patients under post-acute care stroke rehabilitation.Methods: This retrospective study analyzed the data of patients enrolled in the Post-Acute Care-Cerebrovascular Disease (PAC-CVD) rehabilitation program, which provides an individualized 1- to 3-hour intensive physical, occupational, and speech and language therapy for post-acute stroke patients in Taoyuan Chang Gung Memorial hospital in Taiwan. Our primary endpoint measure was Barthel Index (BI), and secondary endpoint measures included other 12 functional measures.Results: A total of 489 patients were included for analysis. Patients with stroke history had less BI improvement than those who suffered their first-ever stroke. In first-ever stroke patients who had completed 6 to 12 weeks of PAC-CVD program, subcortical ICH patients had greater BI, quality of life, sensation, and balance improvements, and had greater late-phase recovery than their IS counterparts. In IS patients, those with age > 75 had less BI improvement; those with National Institute of Health Stroke Scale (NIHSS) score 1– 5 had greater Motor Activity Log quality of use (MAL-quality) improvement than those with NIHSS score > 5; those with Mini-Mental State Examination (MMSE) score ≥ 24 had greater BI and instrumental activities of daily living (IADL) improvement. Using the general linear model, previous stroke (ß: − 6.148, p=0.01) and subcortical ICH (ß: 5.04, p=0.03) were factors associated with BI improvement.Conclusion: Subcortical ICH patients have greater functional improvement and greater late-phase recovery than their IS counterparts following PAC rehabilitation. More studies are needed to validate our findings and unravel the underlying mechanisms of stroke recovery to optimize the treatment strategy following a stroke.Keywords: activities of daily living, functional recovery, hemorrhagic stroke, ischemic stroke, post-acute care, rehabilitation

Chih-Kuang Chen,1 Ping-Kuan Huang,2 Wing-Cheung Law,3 Chia-Hui Chu,4 Nai-Tzu Chen,5 Leu-Wei Lo4 1Department of Materials and Optoelectronic Science, National Sun Yat-Sen University, Kaohsiung 80424, Taiwan; 2Department of Fiber and Composite Materials, Feng Chia University, Taichung 40724, Taiwan; 3Department of Industrial and Systems Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, People’s Republic of China; 4Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan 35053, Taiwan; 5Institute of New Drug Development, China Medical University, Taichung 40402, TaiwanCorrespondence: Chih-Kuang ChenDepartment of Materials and Optoelectronic Science, National Sun Yat-Sen University, Kaohsiung 80424, TaiwanTel +886-7-5252000 ext. 4060Fax +886-7-5254099Email chihkuan@mail.nsysu.edu.twLeu-Wei LoInstitute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan 35053, TaiwanTel +886-37-246166 ext. 37115Email lwlo@nhri.org.twAbstract: Gene-based therapies have emerged as a new modality for combating a myriad of currently incurable diseases. However, the fragile nature of gene therapeutics has significantly hampered their biomedical applications. Correspondingly, the development of gene-delivery vectors is of critical importance for gene-based therapies. To date, a variety of gene-delivery vectors have been created and utilized for gene delivery. In general, they can be categorized into viral- and non-viral vectors. Due to safety issues associated with viral vectors, non-viral vectors have recently attracted much more research focus. Of these non-viral vectors, polymeric vectors, which have been preferred due to their low immunogenicity, ease of production, controlled chemical composition and high chemical versatility, have constituted an ideal alternative to viral vectors. In particular, biodegradable polymers, which possess advantageous biocompatibility and biosafety, have been considered to have great potential in clinical applications. In this context, the aim of this review is to introduce the recent development and progress of biodegradable polymers for gene delivery applications, especially for their chemical structure design, gene delivery capacity and additional biological functions. Accordingly, we first define and categorize biodegradable polymers, followed by describing their corresponding degradation mechanisms. Various types of biodegradable polymers resulting from natural and synthetic polymers will be introduced and their applications in gene delivery will be examined. Finally, a future perspective regarding the development of biodegradable polymer vectors will be given.Keywords: gene therapy, gene delivery, non-viral vectors, polymeric vectors, biodegradable polymers

Yi-Hsun Yu,1,2 Demei Lee,2 Yung-Heng Hsu,1,2 Ying-Chao Chou,1,2 Steve WN Ueng,1 Che-Kang Chen,2 Shih-Jung Liu1,2 1Department of Orthopedic Surgery, Musculoskeletal Research Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan; 2Department of Mechanical Engineering, Chang Gung University, Taoyuan, TaiwanCorrespondence: Shih-Jung LiuBiomaterials Lab, Department of Mechanical Engineering, Chang Gung University, No. 259 Wen-Hwa 1st Road, Guishan District, Taoyuan 333, TaiwanTel +886 3 211 8166Fax +886 3 211 8558Email shihjung@mail.cgu.edu.twIntroduction: Masquelet proposed a new solution for the healing of segmental bone defects, thus minimizing the disadvantages associated with traditional bone grafting. However, a major factor leading to the failure of this technique pertains to be the residual infection. Accordingly, we developed an antibiotic- and osteo-inductive agent-loaded composite scaffold to solve this problem.Methods: A mesh-like polycaprolactone scaffold was prepared using a lab-exploited solution-type three-dimensional printer, and hybrid sheath-core structured poly(lactic-co-glycolic-acid) nanofibers were fabricated using co-axial electrospinning technology. Vancomycin, ceftazidime, and bone morphological protein (BMP)-2 were employed. The in vitro and in vivo (rabbit fracture model) release patterns of applied agents from the composite scaffold were investigated.Results: The results revealed that the drug-eluting composite scaffold enabled the sustainable release of the medications for at least 30 days in vitro. Animal tests demonstrated that a high concentration of medications was maintained. Abundant growth factors were induced within the bioactive membrane stimulated by the applied scaffold. Finally, satisfactory bone healing potential was observed on radiological examination and biomechanical evaluation.Discussion: The developed composite scaffold may facilitate bone healing by inducing bioactive membrane formation and yielding high concentrations of antibiotics and BMP-2 during the Masquelet procedure.Keywords: Masquelet procedure, composite scaffold, three-dimensional printing, co-axial electrospinning

Sabri Sudirman, Chun-Kai Chen, Bing-Ting Long, Heng-Wei Chang, David Tsou, Zwe-Ling Kong Department of Food Science, National Taiwan Ocean University, Keelung City 20224, TaiwanCorrespondence: Zwe-Ling KongDepartment of Food Science, National Taiwan Ocean University, Keelung City 20224, TaiwanTel/Fax +886 2 24622192 Ext. 5130Email kongzl@mail.ntou.edu.twPurpose: To investigate the ameliorative effects of Vitellaria paradoxa (VP) nut extract for an anterior cruciate ligament transection with medial meniscectomy (ACLT+MMx)-induced osteoarthritis (OA) in high-fat diet (HFD)-induced obese rats.Methods: The rats were fed by HFD for 5 weeks before surgery-induced OA. Rats were treated orally with three different doses of VP nut extract (111.6, 223.2, and 446.4 mg/kg) for 8 weeks.Results: The VP nut triterpene-rich extract decreased the level of triglycerides and increased high-density lipoprotein-cholesterol. The level of nitric oxide, interleukin (IL)-1β, IL-6, and tumor necrosis factor-α decreased after treatment with VP nut triterpene-rich extract, especially in high-doses. The VP nut triterpene-rich extracts also alleviated swelling in the knee OA, weight-bearing difference, and suppressed cartilage degradation.Conclusion: The Vitellaria paradoxa nut triterpene-rich extract suppressed proinflammatory mediators and attenuated the cartilage degradation and pain in osteoarthritis with an obesity rat model. As such, Vitellaria paradoxa nut triterpene-rich extract can be used as an alternative for osteoarthritis treatment.Keywords: medial meniscectomy, obesity, osteoarthritis, triterpene, Vitellaria paradoxa

Jian-Hong Chen,1,2,* Po-Hsin Tsai,1,2,* Yin-Chou Lin,2,3 Chih-Ken Chen,1,2 Ching-Yen Chen1,2 1Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan, Republic of China; 2School of Medicine, Chang Gung University, Taoyuan, Taiwan, Republic of China; 3Department of Rehabilitation, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, Republic of China *These authors contributed equally to this work Objective: To examine the effect of mindfulness-based training on performance and mental health among a group of elite athletes. Methods: This study aimed to evaluate the effect of mindful sport performance enhancement (MSPE) on mental health, flow state, and competitive state anxiety using a 4-week workshop. We recruited an amateur baseball team (N=21) in Taiwan, and collected information by self-reported questionnaires administered before, immediately after, and at a 4-week follow-up. The primary outcome was to evaluate sports performance by flow state and competitive state anxiety, which included self-confidence, somatic anxiety, and cognitive anxiety. The secondary outcome was to explore whether MSPE intervention can improve anxiety, depression, sleep disturbance, and eating disorders.Result: After the workshop and follow-up 1 month later, we found improvements in flow state (P=0.001; P=0.045), cognitive anxiety in competitive anxiety (P=0.056; P=0.008), global eating disorder (P=0.009; P

Ching-Yen Chen,1,2 Tze-Chun Tang,3 Tzu-Ting Chen,4 Ya Mei Bai,5,6 Huei-Huang Tsai,7 Hou-Liang Chen,7 Chun-Jen Huang,8,9 Chih-Ken Chen,1,2 Chun-Chih Chen,10 Mei-Chun Hsiao,11 Chia-Yih Liu,2,12 Hong-Shiow Yeh,13 Nan-Ying Chiu,10 Cheng-Chen Hsiao,14 Cheng-Sheng Chen,8,9 Tung-Ping Su5,15,16 1Department of Psychiatry, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; 2School of Medicine, Chang Gung University, Taoyuan, Taiwan; 3Dr Tang’s Psychiatric Clinic, Kaohsiung, Taiwan; 4Department of Psychiatry, National Taiwan University Hospital, Yunlin Branch Hospital, Yunlin, Taiwan; 5Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan; 6Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan; 7Tsao Tun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan; 8Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; 9Department of Psychiatry, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; 10Department of Psychiatry, Changhua Christian Hospital Lukang Branch Hospital, Changhua, Taiwan; 11Yong Mei Psychiatric Clinic, Taoyuan City, Taiwan; 12Department of Psychiatry, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; 13Department of Psychiatry, Mackay Memorial Hospital, Taipei, Taiwan; 14Cheng Chen Hsiao Clinic, Chiayi, Taiwan; 15Division of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan; 16Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan Purpose: Paliperidone extended release (ER) is an oral psychotropic treatment formulated to release paliperidone at a controlled, gradually ascending rate. We evaluated the efficacy and safety of switching to paliperidone ER in Taiwanese patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy.Patients and methods: This was a 24-week, open-label, single-arm, multicenter, Phase IV trial. Based on consulting psychiatrists’ judgment, patients were deemed eligible for the switch to paliperidone ER; the switch was achieved by cross-tapering, using a recommended starting dose of 6 mg. Eligibility considerations included lack of efficacy, tolerability, and/or adherence to previous oral antipsychotic medication. Results: Of the 297 enrolled patients, 178 (59.5%) completed the study. The main reasons for discontinuation included insufficient efficacy (8.7%), patient decision (8.4%), and adverse events (AEs; 6.4%). Improvements in the: Positive and Negative Syndrome Scale total score and Clinical Global Impression-Severity score were observed only in patients treated at medical centers and not in those treated at psychiatric hospitals. The most common AEs were insomnia, headache, constipation, and extrapyramidal syndrome. One or more serious AEs were reported in 11 (3.7%) patients; none resulted in death. No significant changes in body weight, plasma glucose, or lipid levels were observed.Conclusion: Switching to paliperidone ER was effective and well tolerated for up to 24 weeks in patients with schizophrenia who were unresponsive or intolerant to previous antipsychotic therapy. The observed differences in treatment between psychiatric hospitals and medical centers with regard to dosage and titration of paliperidone ER warrant further investigation. Keywords: prospective, switch study, open-label, paliperidone extended release, schizophrenia, settings

Liang-Jen Wang,1 Pao-Yen Lin,2,3 Yu Lee,2 Yu-Chi Huang,2 Su-Ting Hsu,4 Chi-Fa Hung,2 Chih-Ken Chen,5,6 Yi-Chih Chen,5,6 Ya-Ling Wang,2 Ming-Che Tsai2 1Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 2Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 3Institute for Translational Research in Biomedical Sciences, Kaohsiung Chang Gung Memorial Hospital, 4Department of Community Psychiatry, Kaohsiung Municipal Kai-Syuan Psychiatric Hospital, Kaohsiung, 5Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, 6Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China Objective: A test battery that measures cognitive function impairment in patients with schizophrenia, the Brief Assessment of Cognition in Schizophrenia (BACS), has been translated into various languages and validated. This study aimed to test the reliability and validity of the Chinese version of the BACS in a Chinese-speaking population. Methods: All participants in this study (66 patients with schizophrenia [mean age: 41.2 years, 57.6% male] and 66 age- and sex-matched healthy controls) were from Taiwan and assessed using the BACS and the University of California, San Diego (UCSD) Performance-Based Skills Assessment, Brief Version (UPSA-B). Thirty-eight of the 66 patients with schizophrenia received a reassessment using the BACS. Results: The BACS had good test–retest reliability, and all BACS subtests had statistically insignificant practice effects. Principal components analysis demonstrated that a one-factor solution best fits our dataset (60.9% of the variance). In both patients and controls, the BACS composite scores were positively correlated with all BACS subscales (P

Liang-Jen Wang,1,* Chih-Ken Chen,2,3,* Heng-Jung Hsu,3,4 I-Wen Wu,3,4 Chiao-Yin Sun,3,4 Chin-Chan Lee3,41Department of Child and Adolescent Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; 2Department of Psychiatry, Chang Gung Memorial Hospital, Keelung, Taiwan; 3Chang Gung University School of Medicine, Taoyuan, Taiwan; 4Department of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan *LJW and CKC are joint first authors and contributed equally to this manuscriptObjective: Depression is the most prevalent comorbid psychiatric disease among hemodialysis patients with end-stage renal disease. This cross-sectional study investigated whether depression in hemodialysis patients is associated with the polymorphism of the 5' flanking transcriptional region (5-HTTLPR) of the serotonin transporter gene, the valine (Val)-to-methionine (Met) substitution at codon 66 (Val66Met) polymorphism of the brain-derived neurotrophic factor (BDNF) gene, or plasma BDNF levels.Methods: A total of 188 participants (mean age: 58.5±14.0 years; 89 men and 99 women) receiving hemodialysis at the Chang Gung Memorial Hospital were recruited. The diagnosis of major depressive disorder (MDD) was confirmed using the Chinese version of the Mini International Neuropsychiatric Interview. The genotypes of 5-HTTLPR and BDNF Val66Met were conducted using polymerase chain reactions plus restriction fragment length polymorphism analysis. The plasma BDNF levels were measured using an enzyme-linked immunosorbent assay kit.Results: Forty-five (23.9%) patients fulfilled the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV-TR) criteria for a MDD. There were no significant effects of the 5-HTTLPR or BDNF Val66Met gene polymorphism on MDD among the hemodialysis patients. The plasma BDNF levels correlated significantly with age (P=0.003) and sex (P=0.047) but not with depression, the genotypes of 5-HTTLPR and BDNF Val66Met, the current antidepressant treatment, or the duration under hemodialysis.Conclusion: Our results did not support the hypothesis of an involvement of the 5HTTLPR and BDNF Val66Met genotypes, or plasma BDNF levels in the pathogenesis of depression, in patients receiving hemodialysis. A study with a large sample size and homogenous patient group is warranted to confirm these findings.Keywords: mood disorder, BDNF, serotonin, gene, hemodialysis, medical disease

Background: Percutaneous cholecystostomy is an alternative treatment for acute cholecystitis patients with high surgical risk.Methods: One hundred and sixty-six patients consecutively treated by percutaneous cholecystostomy for acute cholecystitis in a single medical center were retrospectively reviewed.Results: The cohort included 121 males and 45 females with mean age of 75.9 years. The overall inhospital mortality rate was 15.1 % (n = 25). Elevated serum creatinine level at diagnosis [odds ratio (OR) 1.497; p = 0.020], septic shock (OR 11.755; p = 0.001), and development of cholecystitis during admission (OR 7.256; p = 0.007) were predictive of inhospital mortality. Of 126 patients who recovered from calculous cholecystitis, 11 experienced recurrent cholecystitis within 2 months. Serum C-reactive protein (CRP) level >15 mg dl(-1) at diagnosis [hazard ratio (HR) 10.141; p = 0.027] and drainage duration of cholecystostomy longer than 2 weeks (HR 3.638; p = 0.039) were independent risk factors of early recurrence. The 53 patients who underwent cholecystectomy had an 18.9 % perioperative complication rate and no operation-related mortality.Conclusions: In-patients or those with septic shock or renal insufficiency have worse outcome. Prolonged drainage duration and high CRP level predict early recurrence. Removal of the drainage tube is recommended after resolution of the acute illness. [ABSTRACT FROM AUTHOR]

Background: Patients with frog-leg squatting have restricted internal rotation and adduction of the affected hips during sitting or squatting. In the surgical literature, the cause generally has been presumed to arise from and be pathognomonic for gluteal muscle contracture. However, we have encountered patients with frog-leg squatting but without gluteal muscle contracture.Questions/purposes: We therefore raised the following questions: What are the imaging features of patients with frog-leg squatting? Do conditions other than gluteal muscle contracture manifest frog-leg squatting?Patients and Methods: We retrospectively reviewed the MR images of 67 patients presenting with frog-leg squatting from April 1998 to July 2010. There were four females and 63 males; their mean age was 22.2 years (range, 4-50 years). During MRI readout, we observed aberrant axes of some femoral necks and obtained additional CT to measure femoral torsion angles in 59 of the 67 patients.Results: MR images of 27 (40%) patients had signs of gluteal muscle contracture. Twenty-two (33%) patients (40 femora) had aberrant femoral torsion, including diminished anteversion (range, 6°-0°; average, 3.9°) in 11 femora of eight patients and femoral retroversion (range, < 0° to -31°, average, -7.5°) in 29 femora of 17 patients. The remaining 18 (27%) patients did not have gluteal muscle contracture or aberrant femoral torsion. The observation of aberrant femoral torsion was not anticipated before imaging studies.Conclusions: In addition to gluteal muscle contracture, aberrant femoral torsion can be a cause of frog-leg squatting.Level Of Evidence: Level II, diagnostic study. See the guidelines for Authors for a complete description of levels of evidence. [ABSTRACT FROM AUTHOR]

Objective: There are reports in China about males suffering from anorexia nervosa and bulimia nervosa, but hitherto no report of binge eating disorder (BED). Method: This case report describes the history, symptom progression and treatment of a male suffering from BED. Results: Many Chinese people who come from rural areas try to integrate in the urban life. Regardless of their level of education many suffer various difficulties, which can trigger psychological disorders. [ABSTRACT FROM AUTHOR]

Assisted living facilities have become increasingly popular for older adults needing assistance. They are intended to enable privacy and provide support, but the extent to which they do so, and the degree to which these relate to residents' needs, are unknown. This observational study of 1,830 residents in 182 facilities indicates that, during the mid-afternoon, the majority of residents are awake (79%), and one-half (49%) are awake and in public spaces. Residents who are cognitively and functionally impaired are more likely to be in public spaces, but less likely to be engaged. Residents who are awake and alone in private spaces are less likely to be impaired, but more likely to have medical conditions. Thus, residents needing more oversight seem to be positioned to obtain that oversight. [ABSTRACT FROM AUTHOR]

We explore the association between family caregiver depression and the quality of staff-family relationships, and we test burden as a mediator of this relationship. Using structural equation modeling, we used data from a representative sample of 932 family members from 20 nursing homes in Central New York to examine the association between staff-family relationship quality and family caregiver depression. We then tested family caregiver burden as a mediator of the relationship between staff-family relationship quality and family caregiver depression. Staff-family relationship quality, specifically perceived conflict with staff, is significantly associated with family caregiver depression. Further, caregiver burden mediates this relationship. Interventions to improve staff-family relationships may impact family caregiver depression by reducing the stress that family caregivers experience. [ABSTRACT FROM AUTHOR]

OBJECTIVES: The objective of this work was to determine 1-year medical outcomes, nursing home transfer, and functional change of assisted living (AL) residents and their relationship to care. METHODS: On-site interviews and observations regarding the status and care of 2,078 residents in 193 facilities across four states were conducted; follow-up was by telephone interview with care providers. RESULTS: Annual mortality and transfer rates were 14.4 and 21.3 per 100 residents. The probability of hospitalization and new/worsening morbidities over a standardized quarter per 100 residents was 12.7 and 22.7. Standardized change in function was notable among those who were transferred or died and small among others. Facility characteristics did not generally relate to medical outcomes and transfer, and those that related to functional change were small and occurred across multiple functions. Facilities that are affiliated with another level of care were more likely to transfer; nurse staffing was favorable for hospitalization but not transfer; and aide turnover was protective for mortality. DISCUSSION: No single component defines 'good' AL care. Predictors and outcomes are inconsistent, and effect sizes are small. Therefore, practice and policy should not focus narrowly on any one area or restrict the type of care-this being welcome news that supports diversity to accommodate individual preferences. [ABSTRACT FROM AUTHOR]

Background and Objective: Correlations between the image analysis of CT scan, lung function and quality of life in patients with idiopathic pulmonary fibrosis (IPF) remain unclear. This study aimed to investigate the impacts of pulmonary blood-vessel distribution and the extent of fibrosis on the lung function and quality of life of patients with IPF., Methods: Patients were enrolled in an IPF registry and had completed pulmonary function tests, chest HRCT, St. George Respiratory Questionnaire (SGRQ) and echocardiography. Pulmonary blood-vessel distribution, specific image-derived airway volume (siVaw) and fibrosis extent (siVfib) were quantitatively calculated by functional respiratory imaging on HRCT., Results: The study subjects were categorized into DLco <40% pred. (n = 40) and DLco ≥40% pred. (n = 19) groups. Patients with DLco <40% pred. had significantly higher scores of SGRQ, composite physiologic index (CPI), exercise oxygen desaturation (∆SpO 2 ), siVaw, lower FVC% pred. and 6-minute walking distance% pred. The proportion of small blood vessels in the upper lobes (BV5PR-UL) was significantly correlated with CPI, DLco % Pred., FVC% pred., SGRQ and ∆SpO 2 . Only BV5PR-UL had a significant impact on all indices but not BV5PR in the lower lobes (BV5PR-LL). siVfib was significantly negatively correlated with BV5PR-UL, DLco% pred. and FVC% pred., as well as positively correlated with CPI, ∆SpO 2 and siVaw., Conclusion: BV5PR-UL and siVfib had significant correlations with lung function and may become important indicators to assess the severity of IPF and the impact on quality of life., (© 2024 The Author(s). Respirology published by John Wiley & Sons Australia, Ltd on behalf of Asian Pacific Society of Respirology.)

This study investigates river dust episodes along the Choshui and Kaoping Rivers in Taiwan, focusing on their spatiotemporal distribution and correlation with hydrometeorological factors (temperature, precipitation, relative humidity, and wind speed). Using the Improved Complete Ensemble Empirical Mode Decomposition with Adaptive Noise (ICEEMDAN) algorithm and time-dependent intrinsic correlation (TDIC) analysis, we identified significant annual and diurnal correlations between PM10 concentrations and these factors. The analysis revealed that wind speed at Lunbei station had a positive annual correlation with PM10, while other factors exhibited significant negative correlations. Seasonal variations in PM10 correlations with temperature, relative humidity, and wind speed were observed, aligning with the prevailing seasons of river dust episodes. Wind motion analysis highlighted diurnal associations with land-sea breezes and annual correlations with the winter monsoon. Specifically, the Choshui River's dust events coincided with the northeast monsoon, whereas the Kaoping River's events occurred during the northwest and southwest monsoons. The study also uncovered that downstream stations (Lunbei and Daliao) were more prone to severe dust events than upstream stations (Douliu and Pingtung). These findings enhance our understanding of the dynamics and environmental impacts of river dust episodes, providing valuable insights for air quality management and health risk mitigation., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Background: As individuals age, the incidence and mortality rates of cerebrovascular accidents significantly rise, leading to fine motor impairments and cognitive deficits that impact daily life. In modern occupational therapy, assessing manual dexterity and cognitive functions typically involves observation of patients interacting with physical objects. However, this pen-and-paper method is not only time-consuming, relying heavily on therapist involvement, but also often inaccurate. Digital assessment methods, therefore, have the potential to increase the accuracy of diagnosis, as well as decrease the workload of health care professionals., Objective: This study examined the feasibility of an interactive electronic pegboard for the assessment and rehabilitation of patients with stroke., Methods: We explored the pegboard's clinical applicability by examining the relationship among stages, timing, and difficulty settings, as well as their alignment with patient capabilities. In total, 10 participants used a prototype of the pegboard for functional and task assessments; questionnaire interviews were conducted simultaneously to collect user feedback., Results: Patients with stroke consistently required more time to complete tasks than expected, significantly deviating from the initial time frames. Additionally, the participants exhibited a slight reduction in performance levels in both manual dexterity and cognitive abilities. Insights from questionnaire responses revealed that the majority of participants found the prototype interface easy and enjoyable to use, with good functionality., Conclusions: This preliminary investigation supports the efficacy of interactive electronic pegboards for the rehabilitation of the hand functions of patients with stroke, as well as training their attentional and cognitive abilities. This digital technology could potentially alleviate the burden of health care workers, positioning it as a valuable and intelligent precision health care tool., (©Shih-Ying Chien, Ching-Yi Wu, Alice May-Kuen Wong, Chih-Kuang Chen, Sara L Beckman. Originally published in JMIR Formative Research (https://formative.jmir.org), 24.10.2024.)

Background: Tug-of-War (TOW) games involve repetitive hand movements and vigorous force, raising the risk of peripheral neuropathy in the upper extremities. The prevalence of carpal tunnel syndrome (CTS) in TOW athletes remains unclear. We hypothesize that elite female TOW athletes have a higher prevalence of CTS than the general population. Methods: Twenty-nine female TOW athletes were recruited from a national team and participated in the study. CTS was clinically diagnosed by history taking and physical examination. Nerve conduction studies (NCS) were additionally performed to confirm CTS. Results: Twelve athletes were clinically diagnosed with CTS; however, only nine were confirmed by NCS. Ten athletes were diagnosed with subclinical CTS by NCS, while seven were classified as truly-non-CTS by both clinical assessment and NCS. The prevalence of CTS and subclinical CTS among the athletes was found to be 33.3% and 37.0%, respectively, significantly higher than 2.7% in the general population by electrodiagnosis. The body weight ( p = 0.025) of the athletes with CTS and subclinical CTS was significantly different from those of the athletes without CTS. Conclusions: Our observations revealed a higher prevalence of CTS among elite female TOW athletes, with body weight being a risk factor. The forceful grasping and pulling of the rope may contribute to the development of CTS.

Background: Sacubitril/valsartan, an angiotensin receptor-neprilysin inhibitor (ARNI), is an established treatment for heart failure (HF) with reduced left ventricular ejection fraction. It has not been rigorously compared with angiotensin-converting enzyme inhibitors in children. PANORAMA-HF (Prospective Trial to Assess the Angiotensin Receptor Blocker Neprilysin Inhibitor LCZ696 Versus Angiotensin-Converting Enzyme Inhibitor for the Medical Treatment of Pediatric HF) is a randomized, double-blind trial that evaluated the pharmacokinetics and pharmacodynamics (PK/PD), safety, and efficacy of sacubitril/valsartan versus enalapril in children 1 month to <18 years of age with HF attributable to systemic left ventricular systolic dysfunction (LVSD)., Methods: Children with HF attributable to LVSD were randomized to sacubitril/valsartan versus enalapril to assess the efficacy and safety of sacubitril/valsartan at 52 weeks of follow-up. The primary end point of the study was to determine whether sacubitril/valsartan was superior to enalapril for the treatment of pediatric patients with HF attributable to systemic LVSD, assessed using a primary global rank end point consisting of ranking patients from worst to best on the basis of clinical events such as death, listing for urgent heart transplant, mechanical life support requirement, worsening HF, New York Heart Association (NYHA)/Ross class, Patient Global Impression of Severity (PGIS), and Pediatric Quality of Life Inventory physical functioning domain. The change from baseline to 52 weeks in NT-proBNP (N-terminal pro-B-type natriuretic peptide) was an exploratory end point., Results: A total of 375 children (mean age, 8.1±5.6 years; 52% female) were randomized to sacubitril/valsartan (n=187) or enalapril (n=188). At week 52, no significant difference was observed between the 2 treatment arms in the global rank end point (Mann-Whitney probability, 0.52 [95% CI, 0.47-0.58]; Mann-Whitney odds, 0.91 [95% CI, 0.72-1.14]; P =0.42). At week 52, clinically meaningful reductions were observed in both treatment arms in NYHA/Ross, PGIS, Patient Global Impression of Change, and NT-proBNP, without significant differences between groups. Adverse events were similar between treatment arms (incidence: sacubitril/valsartan, 88.8%; enalapril, 87.8%), and the safety profile of sacubitril/valsartan was acceptable in children., Conclusions: In this study, sacubitril/valsartan did not show superiority over enalapril in the treatment of children with HF attributable to systemic LVSD using the prespecified global rank end point. However, both treatment arms showed clinically meaningful improvements over 52 weeks., Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02678312.

Titanium complexes bearing 2-(arylideneamino)phenolates and 2-((arylimino)methyl)phenolates were synthesized, and their catalytic activities in the polymerization of ε-caprolactone and L-lactide were studied. Among five-membered ring Ti complexes bearing 2-(arylideneamino)phenolates, FCl-Ti exhibited the highest level of catalytic activity ([CL] : [FCl-Ti] = 100 : 1, where [CL] = 2 M, and conv. = 86% at 60 °C after 9 h). For six-membered ring Ti complexes bearing 2-((arylimino)methyl)phenolates, SCl-Ti exhibited the highest level of catalytic activity ([CL] : [SCl-Ti] = 100 : 1, where [CL] = 2 M, and conv. = 88% at 60 °C after 118 h). The five-membered ring Ti complexes bearing 2-(arylideneamino)phenolates exhibited a higher level of catalytic activity (6.1-12.8 fold for the polymerization of ε-caprolactone and 6.2-23.0 fold for the polymerization of L-lactide) than the six-membered ring Ti complexes bearing 2-((arylimino)methyl)phenolates. The density functional theory (DFT) results revealed that the free energy of the first transition state FH-Ti-TS1 is 36.49 kcal mol -1 which is lower than that of SH-Ti-TS1 (46.58 kcal mol -1 ), which was ascribed to the fact that the Ti-N im bond (2.742 Å) of FH-Ti-TS1 is longer than that of SH-Ti-TS1 (2.229 Å) and reduces the repulsion between ligands.

Background: Vascular complications increase morbidity and mortality after transcatheter aortic valve replacements (TAVR), often related to failures in vascular closure devices (VCDs). We intended to compare the dual Perclose ProGlide (PP) strategy and the hybrid combination of PP and Angio-Seal (AS) for femoral access hemostasis after TAVR., Methods: A randomised controlled trial with 257 patients comparing dual PP with 1 PP and 1 AS (AS+PP) for vascular closure after transfemoral TAVR was conducted. The primary end point was the composite of TAVR access site-related vascular complications and life-threatening type 2/3 or 1 bleeding according to the Valve Academic Research Consortium 3. Secondary end points included additional VCD use and significant peripheral ischemia related to arteriotomy closure within 1 year. Modified VCD failure, defined as failure to achieve hemostasis within 5 minutes or requiring additional endovascular manoeuvres, was also recorded., Results: The AS+PP combination yielded lower rates of the primary end point (18.2% vs 29.8%; P = 0.0381), vascular complication (18.2% vs 29.8%; P = 0.0381), additional VCD use (0.8% vs 19.0%; P < 0.0001), and modified VCD failure (9.9% vs 33.1%; P < 0.0001) than the dual PP. Bleeding complication rates were similar between the 2 groups. Three-month follow-up vascular duplex tests showed similar common femoral artery (CFA) diameters and peak systolic velocities (PSVs) between the 2 groups, but those with additional intervention had higher PSVs and smaller CFA diameters than those without., Conclusions: Combined PP+AS for large-bore femoral access hemostasis after TAVR promises to be more effective and safer than dual PP in terms of vascular complications. Moreover, additional intervention for vascular complications resulted in smaller CFA diameters., Clinical Trial Registration: NCT05491070., (Copyright © 2024 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.)

Competing Interests: Dr. Milrod reports receiving book royalties from the Taylor & Francis Group. The other authors report no financial relationships with commercial interests.