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Abstract The associations between people with severe mental illnesses (SMI) and the risks of stroke, suicide, and death remain unclear. We examined healthcare service usage among adults with and without SMI and explored the risk of stroke, suicide, and death. We divided 18–80-year-old adults with SMI into catastrophic and non-catastrophic illness groups. These groups were subjected to a 1:5:5 propensity score matching with people without SMI. Data on demographic characteristics, economic factors, environmental factors, comorbid conditions, self-injury behavior, the number of outpatients and ED visits, and hospitalization were collected. The primary outcomes were risks of stroke, suicide, and death. We included 19,570 people with catastrophic SMI, 97,850 with non-catastrophic SMI, and 97,850 controls. Patients with SMI, especially those with catastrophic illnesses, had higher stroke risk, suicide, and death than those without SMI. People with SMI used health services more frequently than those without SMI. Patients with a history of hospitalization or ED access had a higher risk of stroke, suicide, and death. Our data indicate that special attention should be given to patients with SMI, particularly those with a history of healthcare service utilization, such as through more extended hospital stays with high-intensity interventions.

Objective: Lower serum low-density lipoprotein cholesterol (LDL-C) levels are associated with increased intracerebral hemorrhage (ICH) risk. However, reverse causality and residual confounding has not attracted public attention. Therefore, we assessed whether people with LDL-C have increased risk of mortality adjusting for potential confounders using two large Taiwan cohorts.Methods: The Mei-Jhao (MJ) cohort has 414,372 adults participating in a medical screening program with 378 ICH deaths within 15 years of follow-up (1994–2008). Cox proportional hazards regressions estimated hazard death ratios according to LDL-C levels. We identified 4,606 ICH patients from the Taiwan Stroke Registry (TSR) and analyzed the impact of LDL-C on 3-month mortality.Results: Low cholesterol (LDL-C

Abstract Cyclophilin A (CypA), secreted from vascular smooth muscle cells and inflammatory cells in response to oxidative stress, promotes vascular atherosclerosis and development of carotid stenosis. Increased concentration of plasma CypA in acute cerebral infarction was demonstrated clinically. The primary aim of this study was to investigate the prognostic impact between CypA level and outcome in patients with acute ischemic stroke. Admission serum CypA concentrations were detected in 66 acute cerebral infarction patients and in 52 healthy individuals. Inflammatory biomarkers, including high‐sensitivity C‐reactive protein, adhesion molecules, interleukins, and matrix‐metalloproteases, were also assessed. We also examined the relationship between plasma biomarkers, blood pressure (BP), pulse pressure, the carotid artery velocity, the prognostic assessment with modified Rankin scale, and stroke recurrence. Plasma CypA concentration was higher on the first day of hospitalization in the high BP stroke group than in normal BP stroke group, which was statistically significant, which was observed even in the third month and sixth month follow‐up outpatient periods. For stroke recurrence prediction, there was an important association between the higher (>60) pulse pressure on the seventh day of hospitalization and CypA level on the third month and sixth month follow‐up outpatient periods. Our study revealed higher circulating serum levels of CypA in the hypertensive stroke group than in the non‐hypertensive stroke group. We expect that elevated plasma CypA level and raised pulse pressure during hospitalization to become valuable biomarkers in predicting stroke recurrence in the sixth month assessment of acute cerebral infarction.

Objective: To compare the clinical effect of 3S-type and P-loops digestive reconstruction after total gastrectomy for gastric cancer., Methods: From February 2005 to February 2009, 85 cases underwent total gastrectomy in The First Affiliated Hospital of Henan University of Science and Technology. Two types of digestive reconstruction were performed with 3S-type jejunum(n=46) and P-loops Roux-en-Y esophagojejunostomy(n=39). The postoperative complications, nutrition index and the quality of life at half a year after surgery were comparatively analyzed., Results: Two types of digestive reconstruction had no statistical differences in operative time, postoperative complications and mortality(P>0.05). Compared with P-loops Roux-en-Y esophagojejunostomy at 6 months after operation, 3S-type jejunum had a lower incidence in dumping syndrome[4.3% (2/46) vs. 10.3% (4/39), P<0.05] and reflux esophagitis [10.8% (5/46) vs. 33.3% (13/39), P<0.05]. 3S-type jejunum was superior to P-loops Roux-en-Y esophagojejunostomy in serum total protein(55.7±3.1 g/L vs 50.3±5.1 g/L, P<0.05), albumin(36.5±3.6 g/L vs. 31.6±4.4 g/L, P<0.05), hemoglobin(120.2±13.4 g/L vs. 110.4±23.0 g/L, P<0.05), and nutritional assessment index(73.2±4.8 vs. 56.0±6.3, P<0.05)., Conclusion: Reconstruction of stomach with 3S-type jejunum may be an effective way to prevent reflux esophagitis and dumping syndrome, and to improve the nutritional status and the quality of life.

Objective: To summarize the clinical pathological characteristics and treatment patterns of breast cancer in elderly women., Methods: A total of 87 patients (≥ 60 years) admitted to our hospital between January and December 2007 were included in this retrospective study. The patients were divided into 60-69-year group and ≥ 70-year group, and their clinical pathological data and treatment modes were summarized and compared., Results: The tumor size (T2-T3), number of involved axillary lymph nodes,and positive rates of estrogen/progesterone receptors,over-expression of epidermal growth factor receptor 2, and ≥ 2 complication were not significantly different between two groups (P > 0.05). The ≥ 70-year group tended to have similar p53 gene mutation and Ki-67 labeling index with the 60-69-year group, although the P values were close to 0.05 (P = 0.09, P = 0.08,respectively). In the ≥ 70-year group, 33.3% of patients underwent extended resection,while in the 60-69-year group, all patients received modified radical treatment (P < 0.005). The percentages of adjuvant chemotherapy were 25% and 56.9% in the ≥ 70-year group and the 60-69-year group (0.005). The percentages of adjuvant endocrine therapy applied after surgery were similar in 2 groups (77.8% and 68.6% separately, P=0.347). Binary logistic regression showed that age,number of involved axillary lymph nodes,and estrogen receptor-positive rate were independently associated with adjuvant chemotherapy,while the pathological tumor size and complication were irrelevant. The 2-year disease-free survival rates of 2 groups were not significantly different., Conclusions: The clinical pathological characteristics of breast cancer were similar in elderly patients who are 60-69 years old or ≥ 70 years. In the treatment pattern,patients who are ≥ 70 years tend to receive endocrine therapy rather than adjuvant chemotherapy.

Objective: To explore the efficacy, time to disease progression (TTP), overall survival (OS) and toxicity of paclitaxel liposome versus paclitaxel combined with 5-fluorouracil (5-Fu) for patients with advanced gastric cancer., Methods: The therapeutic efficacy of chemotherapy with either of the two regimens for 67 cases of naïve advanced gastric cancer was analyzed. Among them, 31 patients in the paclitaxel liposome-5-Fu group received paclitaxel liposome 175 mg/m(2) d1, CF 200 mg/m(2) d1, 5-Fu 2.6 g/m(2) civ. 46 hours, 21 days as one cycle, and 34 patients in the paclitaxel-5-Fu group received paclitaxel 175 mg/m(2) d1, CF 200 mg/m(2) d1, 5-Fu 2.6 g/m(2) civ. 46 hours, 21 days as one cycle., Results: The objective response rate was 54.8% in the paclitaxel liposome group and 44.1% in the paclitaxel group (P = 0.388). The median time to progression was 5.10 months vs. 5.20 months (P = 0.266) and the median survival time was 10.07 months vs. 8.97 months (P = 0.186). The most frequent side-effects were nausea, vomit and hematological toxicities. The rates of grade III-IV nausea and vomit were 16.1% and 50.0% (P = 0.038), muscle and joint pain were 9.7% and 29.4% (P = 0.047)., Conclusion: Both regimens are effective in the treatment of advanced gastric cancer. However, less adverse effects occur in the paclitaxel liposome group.

Objective: To investigate the long-term effects of androgen combined with low dose all-trans-retinoic acid on myelodysplastic syndrome (MDS)., Methods: Sixty-two MDS patients, 48 with RA, 2 of RAS, 9 with RA with excess of blasts (RAEB), 2 with RAEB-transformation (RAEB-t ), and 1 with chronic myelogenous-monocytic leukemia (CMML) according to the FAB subtype standard, received stanazolol (6 mg/d) or danazol (600 mg/d) and low dose all-trans-retinoic acid (ATRA 10 mg/d). Three months later the treatment was discontinued on 22 patients that showed ineffective and 2 more patients withdrew from the treatment due to exacerbation. The remaining 36 patients were treated according to the original protocol, and the doses of these 2 drugs were reduced by half until the condition was exacerbated. Follow-up was conducted for 47 (34-78) months., Results: After 6 months of treatment, complete remission (CR) was seen in 1 patient, partial remission (PR) in 6 patients, and hematologic Improvement (HI) in 19 of the 60 patients evaluated with a response rate of 43.3% (26/60) in all patients, 50% (24/48) in RA/RAS group, and 16.7% (2/12) in RAEB/RAEB-t/CMML group. There were not significant differences in cellularity, dysplastic hematopoiesis, and myeloblast before and after treatment among the RA/RAS patients. After 12 months of treatment, CR was seen in 1 patient, PR in 7, and HI in 9, with a response rate of 28.3% (17/60) in all patients, 35.4% (17/48) in the RA/RAS group, and 0% (0/12) in the RAEB/RAEB-t/CMML group. Adverse effects were mild and did not require discontinuance of the therapy. The survival time of the 19 patients in the RA group that responded well to treatment was 54 months (41, 66), significantly longer than that of the 20 patients without good outcomes [23 months (13,32), chi2=4.72, P=0.025]., Conclusion: Effective, economic, and safe, stanozolol or danazol with low-dose all-trans-retinoic acid improves the life quality and prolongs the survival time of the MDS patients who respond well.

Objective: To evaluate the toxicity and efficacy of combination regimen with oxaliplatin plus fluorouracil and leucovorin(FOLFOX) as post-operative adjuvant chemotherapy in local advanced gastric cancer., Methods: Twenty-five gastric cancer patients, 2 at the stage II, 17 at the stage III, and 6 at the stage IV received the FOLFOX regimen after surgery: intravenous infusion of oxaliplatin 85 mg/m2 for 2 h on day 1, intravenous infusion of leucovorin 200 mg/m2 for 2 h on days 1-2, and intravenous bolus injection of 5-fluorouracil (5-FU) 400 mg/m2 on days 1-2, and continuous infusion of 5-FU 600 mg/m2 for 22 h on days 1-2; and this regimen was repeated every 2 weeks. The effect and adverse reactions were recorded., Results: The median disease free survival time and overall survival time were 26.0 months and 38.0 months respectively. The frequent grade 3/4 toxicity of the FOLFOX regimen included: neutropenia (12.4%), thrombocytopenia (8.2%), and nausea (7.5%)., Conclusion: The post-operative adjuvant chemotherapy of FOLFOX regimen has expectable efficacy in treatment of gastric cancer with light and well tolerable toxicity.

Objective: To investigate the clinical and pathological features, optimal treatment and prognostic factor in primary mediastinal germ cell tumors (PMGCT)., Methods: The clinical presentation, pathological features and therapeutic results of 29 patients with PMGCT were retrospectively analyzed., Results: All the 29 patients were male with a mean age of 26.1 +/- 9.6 years at diagnosis. All tumors were originated from the anterior mediastinum with a mean diameter of 16.0 +/- 5.2 cm. There were 5 (17.2%) primary mediastinal seminomas (PMSGCT) and 24 (82.8%) primary mediastinal nonseminomas (PMNSGCT) in this series. Dyspnea, cough and chest pain were the most common symptoms. Multimodality treatment consisting of cisplatin-based chemotherapy, surgery and radiotherapy was the principal therapy for PMGCT patients. The median survival of the 24 PMNSGCT patients was 19.0 months with 1-, 2-year survival rate of 65.3% and 28.1%, respectively; whereas the median survival of the 5 PMSGCT patients has not reached but longer with significant differences (P = 0.008). Cox multivariate analysis indicated that limited mediastinal disease at diagnosis (P = 0.004) and the use of cisplatin-based combined chemotherapy (P = 0.005) were independent good prognostic factors of PMNSGCT., Conclusion: Primary mediastinal nonseminoma constitutes the most of primary mediastinal germ cell tumors. Cisplatin-based combined chemotherapy may be the most effective for the treatment of primary mediastinal germ cell tumors. The prognosis of primary mediastinal nonseminomas is significantly worse than that of primary mediastinal seminomas, and correlated with the extent of disease and chemotherapy.

In order to study whether erythroleukemia was really a subtype of acute leukemia, the clinical laboratory characteristics and development of disease in 21 cases of erythroleukemia were analyzed. The results indicated that the percentage of patients with leucocytopenia, anemia and thrombocytopenia were 42.9%, 81% and 81% respectively at the time of diagnosis. These were 85.7% of patients with myelocytes and premonocyte, 52.4% of patients with erythroblast in their blood smear respectively. All of the bone marrow showed active or significantly active proliferation. The median percentage of erythro-lineage, myeloblast of NEC and displasia were (58.3 +/- 8.0)%, (58.0 +/- 18.4)% and 66.7% respectively, that is different from typical AML. 52.4% of M(6) patients transferred to RAEB/RAEB-T and AML-M(2) subtype in the disease progression. 11/19 cases (57.4%) achieved remission (CR 10; PR 1) after chemotherapy. The median remission length were 6 months for CR patients and 2 months for PR patients, but most of CR patients displayed obvious displasia of bone marrow and cytopenia of blood in the period of CR. The median survival length of M(6) and MDS-->M(6) from time of diagnosis were 13.0 +/- 13.2 and 2.3 +/- 1.3 months respectively. It is concluded that there are differences between M(6) and typical AML. Most of M(6) patients would rather be classified MDS RAEB and RAEB-t with over-hyperplasia of erythron lineage than a subtype of AML.

Objective: To evaluate the efficacy of cyclosporin A (CsA) in treatment of myelodysplastic syndromes (MDS)., Methods: Thirty-three patients with MDS, including refractory anemia (RA, n = 24), refractory anemia with ringed sideroblasts (RAS, n = 2), and refractory anemia with excess blasts (RAEB, n = 7), 23 males and 10 females, aged 46 (6 approximately 71), hospitalized in 4 CsA, grade 3 hospitals in Beijing who failed to respond to folic acid and vitamin B12, received CsA 3 approximately 5 mg x kg(-1)x d(-1), 2 times per days, taken orally in 2 separate doses for at least 3 months (2 approximately 27 months). During the course of treatment the dosage was adjusted according to the CsA blood concentration and curative effect. Follow-up was conducted for 14 months on average. The curative effect of those who took CSA for more than 2 months underwent statistical analysis, and for those who took CSA for less than 2 months only the side effects underwent statistical analysis., Results: After 3 months of the treatment, the hematological improvement (HI) was observed in 18 of the 32 evaluative patients (56.3%) by the criteria of the International Working Group (IWG). At the end of the follow-up 4 patients showed alteration of disease progression, including 1 case of complete remission (CR) and 3 cases of partial remission (PR), and 16 patients showed homological improvement, responders numbering 20 totally, with a response rate of 62.5% (20/32). One of the 20 patients respondent to CsA died and 7 of the 12 patients who failed to respond to CsA died., Conclusion: Improving the clinical manifestations and lengthening the survival time, CsA therapy is effective in the patients with RA or RAEB, and both hypoplastic bone marrow and hyperplastic bone marrows respond to the therapy. CsA therapy is potentially the most effective therapy for MDS.

Objective: To investigate the clinical and pathological features, optimal treatment and prognostic factors in primary intestinal non-Hodgkin's lymphoma., Methods: The clinical presentations, pathological features and therapeutic results of 32 primary intestinal non-Hodgkin's lymphoma were retrospectively analyzed. Statistical analyses were performed with SSPS 10.0 software., Results: The most frequently site of the lesions in the 32 patients was the large intestine (n = 16, 50.0%), followed by small intestine (n = 8, 25.0%), ileocaecal region (n = 6, 18.8%) and multiple intestinal sites (n = 2, 6.2%). Clinical presentations were as follows: abdominal pain and/or distention (n = 26, 81.2%); abdominal mass (n = 14, 43.8%); diarrhea (n = 12, 37.5%); melena (n = 10, 31.3%); weight loss (n = 10, 31.3%) and fever (n = 8, 25.0%). Twenty-one patients (65.6%) were diagnosed as B-cell lymphoma, 15 (46.9%) were diffuse large B-cell lymphoma. Ten patients (31.2%) were diagnosed as T-cell lymphoma and one (3.1%) as histiocytic lymphoma. Twenty-nine patients were treated initially by surgery with or without chemotherapy, 19 of them (59.4%) achieved complete response. Based on Cox multivariate analysis, stage III - IV, B symptoms and T cell phenotype of the disease were the independent adverse prognostic factors (P < 0.05)., Conclusion: The clinical presentation of primary intestinal non-Hodgkin's lymphoma are not specific clinically. Most of the histological types are diffuse large B-cell type lymphoma. Complete resection combined with chemotherapy may be the best effective approach for treatment of this disease. The prognosis of this disease are correlated with the stage, B symptoms and T cell phenotype.