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Background: Lytic Epstein-Barr virus (EBV) infection plays a major role in the pathogenesis of nasopharyngeal carcinoma (NPC). For patients with recurrent or metastatic NPC and resistant to conventional therapies, adoptive cell therapy using EBV-specific cytotoxic T cells (EBV-CTLs) is a promising option. However, the long production period (around 3 to 4 weeks) and low EBV-CTL purity (approximately 40% of total CD8 T cells) in the cell product limits the application of EBV-CTLs in clinics. Thus, this study aimed to establish a protocol for the rapid production of EBV-CTLs., Methods: By culturing peripheral blood mononuclear cells (PBMCs) from EBV-seropositive donors with EBV-specific peptides and interleukin (IL)-2, IL-15, and interferon α (IFN-α) for 9 days, we identified that IL-15 can enhance IL-2-mediated CTL activation and significantly increase the yield of CTLs., Results: When IFN-α was used in IL-2/IL-15-mediated CTL production from days 0 to 6, the productivity of EBV-CTLs and EBV-specific cytotoxicity significantly were reinforced relative to EBV-CTLs from IL-2/IL-15 treatment. Additionally, IFN-α-induced production improvement of virus-specific CTLs was not only the case for EBV-CTLs but also for cytomegalovirus-specific CTLs., Conclusion: We established a novel protocol to rapidly expand highly pure EBV-CTLs from PBMCs, which can produce EBV-CTLs in 9 days and does not require feeder cells during cultivation., (© 2024. The Author(s).)

Objective: To review the effectiveness of different physical therapies for acute and sub-acute low back pain supported by evidence, and create clinical recommendations and expert consensus for physiotherapists on clinical prescriptions., Data Sources: A systematic search was conducted in PubMed and the Cochrane Library for studies published within the previous 15 years., Review Methods: Systematic review and meta-analysis, randomized controlled trials assessing patients with acute and sub-acute low back pain were included. Two reviewers independently screened relevant studies using the same inclusion criteria. The Physiotherapy Evidence Database and the Assessment of Multiple Systematic Reviews tool were used to grade the quality assessment of randomized controlled trials and systematic reviews, respectively. The final recommendation grades were based on the consensus discussion results of the Delphi of 22 international experts., Results: Twenty-one systematic reviews and 21 randomized controlled trials were included. Spinal manipulative therapy and low-level laser therapy are recommended for acute low back pain. Core stability exercise/motor control, spinal manipulative therapy, and massage can be used to treat sub-acute low back pain., Conclusions: The consensus statements provided medical staff with appliable recommendations of physical therapy for acute and sub-acute low back pain. This consensus statement will require regular updates after 5-10 years., Competing Interests: Declaration of conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: The primary objective of this meta-analysis was to determine whether high-intensity laser therapy (HILT) was effective in improving pain intensity, cervical range of motion (ROM), functional activity, and quality of life (QOL) in individuals with neck pain., Data Sources: PubMed, PEDro, Embase, Cochrane Library, Web of Science, and ClinicalTrials.gov were searched from inception to March 26, 2022., Study Selection: Randomized controlled trials (RCTs) involving HILT for neck pain were selected., Data Extraction and Data Synthesis: Two raters were independent in data extraction. The methodological quality was evaluated using the PEDro scale, and the level of evidence was assessed using the GRADE system. RevMan5.4 was used for meta-analysis., Results: Eight RCTs were included and their PEDro scores were moderate to high. Compared with placebo, HILT was effective in improving pain intensity (SMD 2.12, 95%CI 1.24 to 3.00; moderate quality evidence), cervical flexion (SMD 1.31, 95%CI 0.27 to 2.35; moderate quality evidence), extension (SMD 1.43, 95%CI 0.24 to 2.63; moderate quality evidence), right lateral flexion (SMD 1.36, 95%CI 0.15 to 2.56; low-quality evidence). There was a trend of better outcome in functional activity after HILT (SMD 1.73, 95%CI -0.05 to 3.54; low quality evidence)., Limitations: There was limited information available on QOL., Conclusion: HILT may be considered as an adjunctive treatment modality for neck pain. There was moderate quality evidence that HILT may improve pain intensity and cervical ROM in individuals with neck pain, but there was low quality evidence that HILT was not effective in improving functional activity., Systematic Review Registration Number: PROSPERO CRD42021254078 CONTRIBUTION OF THE PAPER., Competing Interests: Conflicts of interest All authors have no conflicts of interest to declare., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objective: To determine the reliability of shear-wave elastography (SWE)in assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles in neutral head posture (NHP) or forward head posture (FHP)., Methods: Sixteen healthy adults (mean age: 21.69 ± 1.01years, 9 females) were included. SWE mode was chosen to measure the nuchal fascia shear modulus and muscle thickness was measured in B-mode. Measurements were collected by two independent investigators on two different days. The intraclass correlation coefficient (ICC) was used to measure the relative reliability, and the standard error of measurement (SEM) were used to measure the absolute reliability., Results: Intra‑rater (ICC = 0.63-0.89) and inter-rater (ICC = 00.54-0.82) reliability for the nuchal fascia shear modulus were moderate to excellent. Intra‑rater (ICC = 00.64-0.96) and inter-rater (ICC = 00.48-0.86) reliability for upper cervical muscles thickness were moderate to excellent. The SEM percentage oscillated from 3.27% to 13.55%. There were significant differences(P < 0.05) between NHP and FHP on nuchal fascia shear modulus, right side splenius capitis muscle thickness and left side semispinalis capitis muscle thickness, but no significant differences(P > 0.05) were observed between the right and left sides. The upper cervical muscles thickness of males was significantly thicker(P < 0.01) than females while no significant differences were observed (P > 0.05) on the nuchal fascia shear modulus., Conclusions: Ultrasound-based SWE may be a reliable tool for assessing the stiffness of the nuchal fascia and the thickness of upper cervical muscles in clinical practice., Registration Number: ChiCTR2200055736., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023. Published by Elsevier Ltd.)

Background: Spasticity is a common motor disorder resulting from upper motor neuron lesions. It has a serious influence on an individual's motor function and daily activity. Repetitive peripheral magnetic stimulation (rPMS) is a non-invasive and painless approach developed for therapeutic intervention in clinical rehabilitation. However, the effectiveness of this intervention on spasticity in patients with spastic paralysis remains uncertain., Objective: This study aimed to investigate the effectiveness of rPMS on spasticity, motor function, and activities of daily living in individuals with spastic paralysis., Methods: PubMed, PEDro, Embase, Cochrane Library, and Web of Science were searched for eligible papers with date up to March 31, 2022. Two independent researchers conducted study screening, data extraction, and methodological quality assessment. RCTs that explored the effects of rPMS on spasticity, motor function, and activities of daily living in patients with spastic paralysis were included for review. The Cochrane collaboration tool was used to assess methodological quality. The cumulative effects of available data were processed for a meta-analysis using Reedman software., Results: Eight studies with 297 participants were included. Most of the studies presented low to moderate risk of bias. Compared with the control group, the results showed that rPMS had a significant effect on spasticity (all spasticity outcomes: standardized mean difference [SMD] = -0.55, 95% confidence interval [CI]: -0.94 to -0.16, I 2 = 40%, and P = 0.006, Modified Ashworth Scale: mean difference [MD] = -0.48, 95% CI: -0.82 to -0.14, I 2 = 0%, and P = 0.006), motor function (Fugl-Meyer Assessment: MD = 4.17, 95% CI: 0.89 to 7.46, I 2 = 28%, and P = 0.01), and activities of daily living (Barthel Index: MD = 5.12, 95% CI: 2.58 to 7.67, I 2 = 0%, and P < 0.0001). No side effect was reported., Conclusion: The meta-analysis demonstrated that the evidence supported rPMS in improving spasticity especially for passive muscle properties evaluated with Modified Ashworth Scale/Ashworth Scale, as well as motor function and daily activity of living in individuals with spastic paralysis., Study Registration: The reviewed protocol of this study is registered in the international prospective register of systematic reviews (PROSPERO) (CRD42022322395)., Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/#recordDetails, identifier CRD42022322395., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Pan, Diao, Peng, Wang, Liao, Wang, Wen, Jia and Liu.)

Biological nitrogen (N) fixation and organic N degradation are the main sources of soil available N, while microorganisms driving such processes play an important role in soil N supply and the maintenance of soil fertility. In this study, real-time quantitative PCR and amplicon sequencing technology were used to examine the effects of restoration types on the community structure of N 2 -fixing and chitin-degrading bacteria harboring nifH and chiA genes, respectively, and the gene abundance under four meadows (undisturbed, grazing, fencing, and fencing + reseeding mea-dows) in Qinghai-Tibet Plateau. The results showed that the abundance of nifH and chiA in the four meadows followed the order of undisturbed meadow > grazed meadow > fencing meadow > fencing + reseeding meadow. The abundance of nifH and chiA in the undisturbed meadow was 3.4-6.3 times and 3.3-8.3 times of that in the other three meadows. The α diversity of N 2 -fixing bacteria in gra-zing, fencing, and fencing + reseeding meadows was significantly higher than that in the undisturbed meadow, while the α diversity of chitin-degrading bacteria was higher in the undisturbed and grazing meadows. Grazing significantly increased the relative abundance of Proteobacteria, but decreased the relative abundance of Cyanobacteria and Actinobacteria. The abundance of nifH and chiA was significantly affected by soil moisture, nutrients, and vegetation characteristics, while the community structure of nifH and chiA was affected by soil moisture, soil organic carbon content, and soil pH. Compared with undisturbed meadow, grazing reduced the potential of N fixation and organic N degradation.The improvement of 10 years grazing prohibition with fencing and reseeding measures on the function of N fixation and organic N degradation was not obvious. The characteristics of functional microbes and their influencing factors should be comprehensively considered during meadow restoration, which might take longer time or take reasonable management measures to restore grazing meadow to undisturbed level.

Background: Neuropathic pain (NP), a severe and disruptive symptom following many diseases, normally restricts patients' physical functions and leads to anxiety and depression. As an economical and effective therapy, exercise may be helpful in NP management. However, few guidelines and reviews focused on exercise therapy for NP associated with specific diseases. The study aimed to summarize the effectiveness and efficacy of exercise for various diseases with NP supported by evidence, describe expert recommendations for NP from different causes, and inform policymakers of the guidelines. Design: A systematic review and expert consensus. Methods: A systematic search was conducted in PubMed. We included systematic review and meta-analysis, randomized controlled trials (RCTs), which assessed patients with NP. Studies involved exercise intervention and outcome included pain intensity at least. Physiotherapy Evidence Database and the Assessment of Multiple Systematic reviews tool were used to grade the quality assessment of the included RCTs and systematic reviews, respectively. The final grades of recommendation were based on strength of evidence and a consensus discussion of results of Delphi rounds by the Delphi consensus panel including 21 experts from the Chinese Association of Rehabilitation Medicine. Results: Eight systematic reviews and 21 RCTs fulfilled all of the inclusion criteria and were included, which were used to create the 10 evidence-based consensus statements. The 10 expert recommendations regarding exercise for NP symptoms were relevant to the following 10 different diseases: spinal cord injury, stroke, multiple sclerosis, Parkinson's disease, cervical radiculopathy, sciatica, diabetic neuropathy, chemotherapy-induced peripheral neuropathy, HIV/AIDS, and surgery, respectively. The exercise recommended in the expert consensus involved but was not limited to muscle stretching, strengthening/resistance exercise, aerobic exercise, motor control/stabilization training and mind-body exercise (Tai Chi and yoga). Conclusions: Based on the available evidence, exercise is helpful to alleviate NP intensity. Therefore, these expert consensuses recommend that proper exercise programs can be considered as an effective alternative treatment or complementary therapy for most patients with NP. The expert consensus provided medical staff and policymakers with applicable recommendations for the formulation of exercise prescription for NP. This consensus statement will require regular updates after five-ten years., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Zhang, Hu, Xiong, Peng, Hu, Kong, Wang, Guo, Bi, Li, Ao, Wang, Bai, Fang, Ma, Liao, Liu, Zhu, Zhang, Liu, Fang and Wang.)

Background: Neck pain is common and can have a significant impact on patients' physical functionality, mobility, and quality of life (QOL). In clinical practice, traditional Chinese mind and body exercise (TCMBE) is a combination of different types of exercise based on traditional Chinese medicine, including qigong, tai chi, the 12-words-for-life-nurturing exercise, and so on, and many studies have found that it is safe and effective at helping patients with neck pain., Objective: The aim of this study was to investigate the effectiveness of TCMBE on pain intensity, functional mobility, and QOL in individuals with neck pain., Methods: The PubMed, MEDLINE, PEDro, and Embase databases were systematically searched for relevant studies. Randomized controlled trials reporting the effects of TCMBE on pain intensity, functional mobility, and QOL in individuals with neck pain were included. Screening, data extraction, and literature quality assessments were performed independently by two reviewers. RevMan5.4 software was used for data analysis., Results: Six studies with 716 participants met the inclusion criteria. Compared with the control groups, TCMBE had no therapeutic advantage in improving pain intensity (visual analogue scale: mean difference (MD) = 1.8, 95% confidence interval (CI): -7.70 to 11.46, and P  = 0.70); functional mobility (neck disability index: MD = 0.15, 95% CI: -6.37 to 6.66, and P  = 0.96; neck pain and disability scale: MD = 1.31, 95% CI: -4.10 to 6.71, and P  = 0.64); or 36-item short-form health survey (SF-36) scores for physical function (MD = 5.58, 95% CI: -8.03 to 19.18, and P  = 0.42), general health (MD = 1.87, 95% CI: -4.99 to 8.72, and P  = 0.59), body pain (MD = 2.26, 95% CI: -3.80 to 8.32, and P  = 0.46), vitality (MD = 6.24, 95% CI: -1.49 to 13.98, and P  = 0.11), social function (MD = 8.06, 95% CI: -4.85 to 20.98, and P  = 0.22), role physical (MD = -1.46, 95% CI: -8.54 to 5.62, and P  = 0.69), or role emotional (MD = 6.5, 95% CI: -3.45 to 16.45, and P  = 0.2). However, TCMBE was less effective at improving mental health results based on the SF-36 survey (MD = 3.37, 95% CI: 0.5 to 6.24, and P  = 0.02)., Conclusions: Based on the meta-analysis, there is insufficient evidence to support the clinical use of TCMBE in improving pain intensity and enhancing functional mobility and QOL in individuals with neck pain., Competing Interests: The authors declare that there are no conflicts of interest., (Copyright © 2021 Yu-Hua Xie et al.)

We investigated the effects of grazing exclusion on the abundance of functional genes (nifH, amoA-AOA, amoA-AOB, narG, nirK, nirS, and nosZ) involved in soil nitrogen cycling in soil profiles (0-10, 10-20, 20-40 and 40-60 cm) from a chronosequence of grazing exclusion (0, 7, 18, 27 and 35 years) in the semiarid grasslands of the Loess Plateau. The relationship between abundance of functional genes and soil nitrogen storage was evaluated. The results showed that 35 years exclusion increased the abundance of nifH and amoA-AOB genes by 67.8% and 17.6% compared with the grazed grassland, respectively, and decreased that of nirK genes. The abundance of nifH, narG, and nirS genes in surface soil (0-10 cm) were significantly higher than that in deep soil (20-40 and 40-60 cm), indicating that those genes had surface accumulation effects. Grazing exclusion increased soil nitrogen storage. Soil nitrogen storage in 0-60 cm layer was the highest at 27 years (20.96 mg·hm -2 ), indicating that 27 years might be the optimum for grazing exclusion. The abundance of nifH, amoA-AOA and amoA-AOB had a significant linear relationship with nitrogen storage, suggesting that microbes harboring these genes played an important role in soil nitrogen accumulation. Total nitrogen, bulk density, and available phosphorus content were the dominant factors affecting the abundance of functional genes involved in soil nitrogen cycling. Our results provided a scientific reference for understanding soil nitrogen cycling and restoration of degraded grassland.

Objective: To investigate whether a comprehensive exercise program was effective in improving physical function among institutionalized older adults and whether adding whole-body vibration to the program conferred additional therapeutic benefits., Design: A single-blinded randomized controlled trial was conducted., Setting: This study was carried out in residential care units., Participants: In total, 73 older adults (40 women, mean age: 82.3 ± 7.3 years) were enrolled into this study., Interventions: Participants were randomly allocated to one of the three groups: strength and balance program combined with whole-body vibration, strength and balance program without whole-body vibration, and social and recreational activities consisting of upper limb exercises only. All participants completed three training sessions per week for eight weeks., Outcome Measures: Assessment of mobility, balance, lower limb strength, walking endurance, and self-perceived balance confidence were conducted at baseline and immediately after the eight-week intervention. Incidences of falls requiring medical attention were recorded for one year after the end of the training period., Results: A significant time × group interaction was found for lower limb strength (five-times-sit-to-stand test; P = 0.048), with the exercise-only group showing improvement (pretest: 35.8 ± 16.1 seconds; posttest: 29.0 ± 9.8 seconds), compared with a decline in strength among controls (pretest: 27.1 ± 10.4 seconds; posttest: 28.7 ± 12.3 seconds; P = 0.030). The exercise with whole-body vibration group had a significantly better outcome in balance confidence (pretest: 39.2 ± 29.0; posttest: 48.4 ± 30.6) than the exercise-only group (pretest: 35.9 ± 24.8; posttest: 38.2 ± 26.5; P = 0.033)., Conclusion: The exercise program was effective in improving lower limb strength among institutionalized older adults but adding whole-body vibration did not enhance its effect. Whole-body vibration may improve balance confidence without enhancing actual balance performance.

Objective: To evaluate the effects of whole-body vibration (WBV) added to a routine activity program on lower limb strength, balance, and mobility among community-dwelling individuals with mild or moderate dementia, compared with the routine program alone., Methods: Fifty-four older adults (40 women; mean (SD) age: 79.8 (6.1) years) with mild or moderate dementia were recruited from two daycare centers. The participants were randomly allocated to undergo a routine day activity program combined with WBV training (WBV at 30 Hz, 2-mm peak-to-peak amplitude) or the routine program only without WBV for 9 weeks (18 sessions). The primary outcome was functional mobility, measured using the timed up-and-go test. The following secondary outcomes were evaluated: Berg Balance Scale, Tinetti balance assessment, time to complete 5 repetitions of sit-to-stand, Quality of Life in Alzheimer's disease questionnaire, and Activities-specific Balance Confidence scale. The attendance rate and incidence of adverse events were also recorded., Results: The attendance rate for the training was high (86.0%). The incidence of adverse events was low, with only two of the 27 participants in the WBV group reporting mild knee pain. While significant improvement in timed up-and-go, Berg Balance Scale, and Tinetti balance score was found in both groups, none of the outcomes demonstrated a significant group by time interaction., Conclusions: WBV training is feasible and safe to use with people with mild or moderate dementia. However, it did not lead to further improvement in physical function and quality of life than the usual activity program provided at the daycare centers. Copyright © 2017 John Wiley & Sons, Ltd., (Copyright © 2017 John Wiley & Sons, Ltd.)

Question: Does physical exercise training improve physical function and quality of life in people with cognitive impairment and dementia? Which training protocols improve physical function and quality of life? How do cognitive impairment and other patient characteristics influence the outcomes of exercise training?, Design: Systematic review with meta-analysis of randomised trials., Participants: People with mild cognitive impairment or dementia as the primary diagnosis., Intervention: Physical exercise., Outcome Measures: Strength, flexibility, gait, balance, mobility, walking endurance, dual-task ability, activities of daily living, quality of life, and falls., Results: Forty-three clinical trials (n=3988) were included. According to the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system, the meta-analyses revealed strong evidence in support of using supervised exercise training to improve the results of 30-second sit-to-stand test (MD 2.1 repetitions, 95% CI 0.3 to 3.9), step length (MD 5cm, 95% CI 2 to 8), Berg Balance Scale (MD 3.6 points, 95% CI 0.3 to 7.0), functional reach (3.9cm, 95% CI 2.2 to 5.5), Timed Up and Go test (-1second, 95% CI -2 to 0), walking speed (0.13m/s, 95% CI 0.03 to 0.24), and 6-minute walk test (50m, 95% CI 18 to 81) in individuals with mild cognitive impairment or dementia. Weak evidence supported the use of exercise in improving flexibility and Barthel Index performance. Weak evidence suggested that non-specific exercise did not improve dual-tasking ability or activity level. Strong evidence indicated that exercise did not improve quality of life in this population. The effect of exercise on falls remained inconclusive. Poorer physical function was a determinant of better response to exercise training, but cognitive performance did not have an impact., Conclusion: People with various levels of cognitive impairment can benefit from supervised multi-modal exercise for about 60minutes a day, 2 to 3days a week to improve physical function. [Lam FMH , Huang MZ, Liao LR, Chung RCK, Kwok TCY, Pang MYC (2018) Physical exercise improves strength, balance, mobility, and endurance in people with cognitive impairment and dementia: a systematic review. Journal of Physiotherapy 64: 4-15]., (Copyright © 2017 Australian Physiotherapy Association. Published by Elsevier B.V. All rights reserved.)

Liao, L-R, and Pang, MYC. Effect of whole-body vibration on neuromuscular activation of leg muscles during dynamic exercises in individuals with stroke. J Strength Cond Res 31(7): 1954-1962, 2017-This study examined the leg muscle activity during exposure to different whole-body vibration (WBV) intensities while performing various dynamic exercises in patients with chronic stroke. Thirty patients with chronic stroke performed a series of dynamic exercises under 3 conditions: (a) low-intensity WBV (peak acceleration: 0.96 units of gravity of Earth [g]), (b) high-intensity WBV (1.61 g), and (c) no WBV. Neuromuscular activation was recorded with surface electromyography (EMG) on bilateral biceps femoris (BF), vastus lateralis, tibialis anterior (TA), and gastrocnemius (GS) in both legs and was reported as EMGrms (root mean square) normalized to % maximal voluntary contraction. The EMG amplitude of all tested muscles was significantly increased by adding WBV during dynamic exercise (p ≤ 0.05). The EMG amplitude of BF, TA, and GS during exposure to high-intensity WBV was significantly greater than low-intensity WBV (p ≤ 0.05). The increase in EMG amplitude caused by WBV was exercise dependent in GS and TA (p ≤ 0.05). The EMG response to WBV in GS and BF in the affected leg was significantly greater than the corresponding muscles in the unaffected leg (p ≤ 0.05). The extent of WBV-induced muscle activity was dependent on the dynamic exercise, WBV intensity, and muscle trained among patients with chronic stroke.

Background: The ability of performing a balance or walking task in conjunction with a secondary cognitive or motor task, referred to as dual-task (DT) ability, is essential in daily living. While there is some evidence that DT performance is impaired in individuals with neurological conditions, using reliable and valid tools to measure DT performance is essential. This systematic review aimed to evaluate the psychometric properties of DT balance and walking assessments in individuals with different neurological conditions., Methods: A systematic literature search was conducted using PubMed, CINAHL, MEDLINE, PsycINFO, SCOPUS, Web of Science, and Cochrane Library (last search done in April 2016). The methodological quality was rated using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist., Results: Twenty-three articles involving individuals with stroke, Parkinson's disease, mild cognitive impairment, dementia, Alzheimer's disease, and multiple sclerosis were included. Outcomes derived from the walking tasks under DT condition generally demonstrated good reliability (correlation coefficient ≥0.75) across different neurological disorders, but their usefulness in distinguishing fallers from non-fallers was inconclusive. The reliability of outcomes derived from the cognitive/motor tasks and from the dual-task effect (DTE) (i.e., DT performance minus single-task performance) seemed to be lower but was understudied. The reliability of static or dynamic sitting/standing balance outcomes in DT condition was not assessed in any of the selected studies., Conclusions: The reliability of the outcomes derived from walking tasks was good. The psychometric properties of other DT outcomes need to be further investigated., (Copyright © 2016 Elsevier B.V. All rights reserved.)

Objectives: To examine the effects of whole-body vibration on spasticity among people with central nervous system disorders., Methods: Electronic searches were conducted using CINAHL, Cochrane Library, MEDLINE, Physiotherapy Evidence Database, PubMed, PsycINFO, SPORTDiscus and Scopus to identify randomized controlled trials that investigated the effect of whole-body vibration on spasticity among people with central nervous system disorders (last search in August 2015). The methodological quality and level of evidence were rated using the PEDro scale and guidelines set by the Oxford Centre for Evidence-Based Medicine., Results: Nine trials with totally 266 subjects (three in cerebral palsy, one in multiple sclerosis, one in spinocerebellar ataxia, and four in stroke) fulfilled all selection criteria. One study was level 1b (PEDro⩾6 and sample size>50) and eight were level 2b (PEDro<6 or sample size ⩽50). All three cerebral palsy trials (level 2b) reported some beneficial effects of whole-body vibration on reducing leg muscle spasticity. Otherwise, the results revealed no consistent benefits on spasticity in other neurological conditions studied. There is little evidence that change in spasticity was related to change in functional performance. The optimal protocol could not be identified. Many reviewed studies were limited by weak methodological and reporting quality. Adverse events were minor and rare., Conclusion: Whole-body vibration may be useful in reducing leg muscle spasticity in cerebral palsy but this needs to be verified by future high quality trials. There is insufficient evidence to support or refute the notion that whole-body vibration can reduce spasticity in stroke, spinocerebellar ataxia or multiple sclerosis.

Background: Burn injury may be associated with long-term rehabilitation and disability, while research studies on the functional performance after injuries, quality of life (QOL), and abilities to return to work of burn patients are limited. These outcomes are related not just to the degree and nature of injuries, but also to the socio-economical background of the society. This study aimed to identify the factors which might affect burn patients' abilities to reintegrate back to the society based on a sample in mainland China., Methods: A retrospective study was conducted to collect data of demographic characteristics, medical data about burn injuries, physical and psychological status, and self-perceived QOL at the initial phase and upon discharge from a rehabilitation hospital, timing of rehabilitation, and duration of rehabilitation intervention. Four hundred fifteen patients with burn injuries were recruited in the study. Multiple linear regression and logistic regression were used to obtain a model to predict the functional abilities and the perceived QOL at discharge and their changes during rehabilitation, as well as the post-injury work status within 6 months after discharge., Results: The functional performance at discharge and its change were significantly predicted by the functional abilities and QOL at the admission, duration of treatment, timing of rehabilitation, payer source, and total body surface area burned. The perceived QOL at discharge and its change were significantly predicted by the baseline QOL at admission and duration of treatment. The significant predictors of work status within 6 months post-discharge included age, education, payer source, total body surface area burned, perceived QOL, and bodily pain at admission., Conclusions: The present study identified a number of factors affecting the rehabilitation outcomes of people with burn injuries. Identification of these predictors may help clinicians assess the rehabilitation potential of burn survivors and assist in resource allocation. Policy makers should ensure that resources are adequate to improve the outcomes based on these factors.

Purpose: A single-blinded randomized controlled study was conducted to investigate the effects of different whole-body vibration (WBV) intensities on body functions/structures, activity, and participation in individuals with stroke., Methods: Eighty-four individuals with chronic stroke (mean age = 61.2 yr, SD = 9.2) with mild to moderate motor impairment (Chedoke-McMaster Stroke Assessment lower limb motor score: median = 9 out of 14, interquartile range = 7-11.8) were randomly assigned to a low-intensity WBV, high-intensity WBV, or control group. The former two groups performed various leg exercises while receiving low-intensity and high-intensity WBV, respectively. Controls performed the same exercises without WBV. All individuals received 30 training sessions over an average period of 75.5 d (SD = 5.2). Outcome measurements included knee muscle strength (isokinetic dynamometry), knee and ankle joint spasticity (Modified Ashworth Scale), balance (Mini Balance Evaluation Systems Test), mobility (Timed-Up-and-Go test), walking endurance (6-Minute Walk Test), balance self-efficacy (Activities-specific Balance Confidence scale), participation in daily activities (Frenchay Activity Index), perceived environmental barriers to societal participation (Craig Hospital Inventory of Environmental Factors), and quality of life (Short-Form 12 Health Survey). Assessments were performed at baseline and postintervention., Results: Intention-to-treat analysis revealed a significant time effect for muscle strength, Timed-Up-and-Go distance, and oxygen consumption rate achieved during the 6-Minute Walk Test, the Mini Balance Evaluation Systems Test, the Activities-specific Balance Confidence scale, and the Short-Form 12 Health Survey physical composite score domain (P < 0.05). However, the time-group interaction was not significant for any of the outcome measures (P > 0.05)., Conclusion: The addition of the 30-session WBV paradigm to the leg exercise protocol was no more effective in enhancing body functions/structures, activity, and participation than leg exercises alone in chronic stroke patients with mild to moderate motor impairments.

Objective: This study aimed to investigate how whole-body vibration (WBV) and exercise and their interactions influenced leg muscle activity in elderly adults., Study Design: An experimental study with repeated measures design that involved a group of ambulatory, community-dwelling elderly adults (n=30; 23 women; mean age=61.4±5.3years)., Main Outcome Measures: Muscle activity of the vastus lateralis (VL), biceps femoris (BF), tibialis anterior (TA), and gastrocnemius (GS) was measured by surface electromyography (EMG), while participants were performing seven different exercises during 4 WBV conditions (condition 1: frequency=30Hz, amplitude=0.6mm, intensity=2.25 units of Earth's gravity (g); condition 2: 30Hz, 0.9mm, 3.40g; condition 3: 40Hz, 0.6mm, 3.65g; condition 4: 40Hz, 0.9mm, 5.50g) and a no-WBV condition in a single experimental session., Results: Significantly greater muscle activity was recorded in VL (3%-148%), BF (16%-202%), and GS (19% -164%) when WBV was added to the exercises, compared with the same exercises without WBV (p≤0.015). The effect of vibration intensity on EMG amplitude was exercise-dependent in VL (p=0.002), and this effect was marginally significant in GS (p=0.052). The EMG activity induced by the four WBV intensities was largely similar, and was the most pronounced during static erect standing and static single-leg standing., Conclusions: The EMG amplitude of majority of leg muscles tested was significantly greater during WBV exposure compared with the no-WBV condition. Low-intensity WBV can induce muscle activity as effectively as higher-intensity protocols, and may be the preferred choice for frail elderly adults., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Whole-body vibration (WBV) has increasingly been used as an adjunct treatment in neurological rehabilitation. However, how muscle activation level changes during exposure to different WBV protocols in individuals after stroke remains understudied., Objective: The purpose of this study was to examine the influence of WBV intensity on the magnitude of biceps femoris (BF) and tibialis anterior (TA) muscle activity and its interaction with exercise and with severity of motor impairment and spasticity among individuals with chronic stroke., Methods: Each of the 36 individuals with chronic stroke (mean age=57.3 years, SD=10.7) performed 8 different static exercises under 3 WBV conditions: (1) no WBV, (2) low-intensity WBV (frequency=20 Hz, amplitude=0.60 mm, peak acceleration=0.96g), and (3) high-intensity WBV (30 Hz, 0.44 mm, 1.61g). The levels of bilateral TA and BF muscle activity were recorded using surface electromyography (EMG)., Results: The main effect of intensity was significant. Exposure to the low-intensity and high-intensity protocols led to a significantly greater increase in normalized BF and TA muscle electromyographic magnitude in both legs compared with no WBV. The intensity × exercise interaction also was significant, suggesting that the WBV-induced increase in EMG activity was exercise dependent. The EMG responses to WBV were similar between the paretic and nonparetic legs and were not associated with level of lower extremity motor impairment and spasticity., Limitations: Leg muscle activity was measured during static exercises only., Conclusions: Adding WBV during exercise significantly increased EMG activity in the TA and BF muscles. The EMG responses to WBV in the paretic and nonparetic legs were similar and were not related to degree of motor impairment and spasticity. The findings are useful for guiding the design of WBV training protocols for people with stroke., (© 2015 American Physical Therapy Association.)

Background/purpose: Monocytes play important roles in inflammatory responses and vascular remodeling after vascular stenting. This research focused on impacts of nickel (Ni) ions released from a corroded cardiovascular stent on cytotoxicity and monocyte activation., Methods: A human promonocytic (macrophage-like) cell line (U937) was exposed to graduated concentrations of Ni(2+)in vitro. Cells were observed and harvested at indicated times to determine the effects using histological and biochemical methods., Results: Ni caused U937 cell death in dose- and time-dependent manners. In vitro, high concentrations of Ni(2+) (>240 μM) significantly induced cell apoptosis and increased terminal deoxynucleotidyl transferase (TdT) dUTP nick end labeling (TUNEL)-positive cells according to flow cytometric surveillance and triggered apoptotic cell death. Although no significant changes in Bcl-2 or Bax expressions were detected after 24 hours of Ni(2+) treatment, increasing cleavage of caspase-3 and -8 was present. Results showed that cleavage of caspase-8 was inhibited by the presence of the inhibitor, Z-IETD-FMK, and this suggested the presence of Ni(2+)-induced U937 cell death through a death receptor-mediated pathway. Simultaneously, when treated with a high concentration of Ni(2+) ions, expressions of the vascular remodeling factors, matrix metalloproteinases (MMP)-9 and -2, were activated in dose- and time-dependent manners. Secretion of the proliferative factor, monocyte chemoattractant protein (MCP)-1, significantly increased during the first 6 hours of incubation with 480 μM Ni(2+)-treated medium., Conclusion: Our results demonstrated that a high concentration of Ni ions causes apoptotic cell death of circulating monocytes. They may also play different roles in vascular remodeling during the corrosion process following implantation of Ni alloy-containing devices., (Copyright © 2014. Published by Elsevier B.V.)

Background: Although whole-body vibration (WBV) has sparked tremendous research interest in neurorehabilitation, the cardiovascular responses to WBV in people with stroke remain unknown., Objective: The aim of this study was to determine the acute effects of different WBV protocols on oxygen consumption (V̇o2), heart rate (HR), rate of perceived exertion (RPE), blood pressure (BP), and rate-pressure product (RPP) during the performance of 6 different exercises among people with chronic stroke (time since onset ≥6 months)., Design: A repeated-measures design was used., Methods: Each of the 48 participants experienced all 3 WBV protocols in separate sessions: (1) no WBV, (2) low-intensity WBV (peak acceleration=0.96 unit of gravity of Earth [g]), and (3) high-intensity WBV (1.61g). The order in which they encountered the WBV protocols was randomized, as was the order of exercises performed during each session. Oxygen consumption, HR, and RPE were measured throughout the study. Blood pressure and RPP were measured before and after each session., Results: Low-intensity and high-intensity WBV induced significantly higher V̇o2 by an average of 0.69 and 0.79 mL/kg/min, respectively, compared with the control condition. These protocols also increased HR by an average of 4 bpm. The 2 WBV protocols induced higher RPE than the control condition during static standing exercise only. Although the diastolic and systolic BP and RPP were increased at the end of each exercise session, the addition of WBV had no significant effect on these variables., Limitations: The results are generalizable only to ambulatory and community-dwelling people with chronic stroke., Conclusions: Addition of high- and low-intensity WBV significantly increased the V̇o2 and HR, but the increase was modest. Thus, WBV should not pose any substantial cardiovascular hazard in people with chronic stroke., (© 2015 American Physical Therapy Association.)

Background: The ability to maintain balance while simultaneously performing a cognitive task is essential for daily living and has been implicated as a risk factor of falls in older adults., Aims: To evaluate the evidence related to the psychometric properties of dual-task balance assessments in older adults., Methods: An extensive literature search of electronic databases was conducted. Articles were included if they evaluated the psychometric properties of dual-task balance assessment tools in older adults. The data were extracted by two independent researchers and confirmed with the principal investigator. The methodology quality of each study was rated by using the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) checklist., Results: Twenty-six articles were included in this systematic review. For dual-task static standing balance assessments, the center of pressure-related parameters (displacement, velocity) and reaction time measurements were reliable but not useful for prediction of falls. For walking balance assessments, the gait outcomes derived generally demonstrated good to excellent reliability (intraclass correlation coefficient >0.75), but their ability to predict falls varied. Outcomes derived from the cognitive tasks and the dual-task cost (dual-task performance minus single-task performance) mostly demonstrated low to fair reliability. The methodological quality of majority of studies was poor to fair, mainly due to small sample size., Conclusions: Among the dual-task balance assessments examined, the reliability and validity varied. The findings of this review should be useful in guiding the selection of dual-task balance measures in future research., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

We aimed to investigate the associations between three smoking-related constructs (pros and cons of smoking, temptation to smoke, and self-efficacy of resisting smoking) and stage of change (precontemplation, contemplation, preparation, and action) based on the transtheoretical model among smokers attending a community-based screening program. We also assessed their effects on long-term all-cause mortality. A prospective cohort study, with an average of 7 years of follow-up, was conducted by enrolling 454 male smoking screenees. The comparisons of the mean score of each variable pertaining to three smoking-related constructs across four stages of smoking cessation were assessed by analysis of variance. The impacts of both smoking-related constructs and smoking cessation stage measured at baseline on 7-year mortality were assessed by using proportional hazards regression model. The differences in the mean scores of pros and cons of smoking, temptation to smoke, and self-efficacy of resisting smoking across four stages of smoking cessation were statistically significant (P < 0.01). The precontemplation group and the contemplation group as opposed to the action group increased the risk for all-cause mortality, but the size of effect was not statistically significant (P = 0.39) when age, duration of smoking, and three smoking- related constructs were controlled. Those with a lower social aspect of self-efficacy were approximately threefold [adjusted hazard ratio = 3.22 (95 % CI 1.26-8.21)] risk for all-cause death compared with those with a higher one. Three smoking-related constructs were highly associated with smoking cessation stage, and low self-efficacy was independently predictive of long-term mortality among male smokers attending a community-based screening program.

Background: Whole-body vibration (WBV) has gained increasing popularity in rehabilitation. Recent studies have investigated the application of WBV in individuals with chronic illnesses, including stroke., Purpose: The purpose of this study was to compare WBV exercise with the same exercise condition without WBV and with other types of physical exercise in enhancing body functions and structures, activity, and participation in individuals with stroke and examine its safety., Data Source: Electronic searches were conducted on MEDLINE, CINAHL, PEDro, PubMed, PsycINFO, and Science Citation Index., Study Selection: Randomized controlled trials (RCTs) that investigated the effects of WBV among individuals with stroke were identified by 2 independent researchers. Ten articles (9 studies, totaling 333 study participants) satisfied the selection criteria and were included in this review., Data Extraction: The methodological quality was rated using the PEDro scale. The results were extracted by 2 independent researchers and confirmed with the principal investigator., Data Synthesis: Only 2 RCTs were considered as demonstrating level 1 evidence (PEDro score ≥6 and sample size >50). Two RCTs examined the effects of a single WBV session, and 7 RCTs examined the effects of WBV programs spanning 3 to 12 weeks. No consistent benefits on bone turnover, leg motor function, balance, mobility, sensation, fall rate, activities of daily living, or societal participation were found, regardless of the nature of the comparison group. Adverse events were minor., Limitations: A broad approach was used, with stroke as an inclusion criterion for review. No solid evidence was found concerning the effects of WBV on subgroups of people with specific stroke-related deficits due to the heterogeneity of patient groups., Conclusions: Based on the review, there is insufficient evidence to support clinical use of WBV in enhancing body functions and structures, activity, and participation after stroke., (© 2014 American Physical Therapy Association.)

Purpose: It has been previously shown that whole-body vibration (WBV) can augment muscle activity in young healthy adults. However, the EMG response of leg muscles during WBV in individuals with stroke is unknown. The objective of this study was to determine the influence of WBV on the activity of the vastus lateralis (VL) and gastrocnemius (GS) muscles during the performance of different exercises in chronic stroke patients., Methods: Forty-five chronic stroke patients were studied. Each subject was exposed to three WBV conditions of 1) no WBV, 2) low-intensity WBV protocol (peak acceleration: 0.96 unit of gravitational constant [g]), and 3) high-intensity WBV protocol (peak acceleration: 1.61g) while performing eight different static exercises involving upright standing, semisquat, deep squat, weight shifted forward, weight shifted backward, weight shifted to the side, forward lunge, and single-leg standing. Bilateral VL and GS muscle activity was recorded with surface EMG and expressed as a percentage of the EMG amplitude recorded during a maximal voluntary contraction of the respective muscles., Results: Two-way repeated-measures ANOVA revealed that exposure to WBV (low- and high-intensity protocols) significantly increased VL and GS EMG amplitude (large effect size, partial η = 0.135-0.643, P < 0.001) on both the paretic and nonparetic sides in different exercise conditions compared with no WBV. No significant difference in EMG magnitude was found between the high- and the low-intensity WBV protocols (P > 0.05). With a few exceptions, WBV enhanced EMG activity in the paretic and nonparetic leg muscles to a similar extent in different exercise conditions., Conclusions: Leg muscle activity was increased significantly with the addition of WBV. Further clinical trials are needed to determine the effectiveness of different WBV protocols for strengthening leg muscles in chronic stroke patients.

Aims: To identify an easily obtainable non-neoplastic tissue that can be used as control material for monitoring optimal Ki-67 immunohistochemical staining., Methods and Results: Various tissues, including tonsil (60), uterine cervix (31), breast skin (26), oesophagus (15), stomach (15), small intestine (15) and colon (16), were studied in the search for ideal control tissue. Tonsil surface epithelium is superior to other tissues because it displayed an easily recognized Ki-67 staining pattern including high positive (parabasal layer), low positive (intermediate layer) and negative (basal and superficial layers) zones. Moderate to weak staining of the majority of the intermediate cells could serve as a threshold for positive staining. Of the variables potentially affecting staining results that were tested, the pretreatment solution for antigen retrieval had the greatest impact, of which pH 9 EDTA was far better than pH 6 citrate solution., Conclusions: Tonsil surface epithelium is a useful control for monitoring Ki-67 staining. Achieving optimal staining results could minimize variations in Ki-67 index due to differences in the staining methods used by different laboratories., (© 2013 John Wiley & Sons Ltd.)

Background and Objective: Therapeutic responses of lung adenocarcinoma patients to tyrosine kinase inhibitors (TKIs) of epidermal growth factor receptor (EGFR) are closely associated with activating mutations within the EGFR tyrosine kinase domain. Screening activating EGFR mutations prior to selection for therapeutic strategy has been considered extremely valuable for clinical management of lung adenocarcinoma patients in Asian countries including Taiwan, where the EGFR mutation rate is higher than in the rest of the world. Currently there is no consensus on the method of choice to assess EGFR mutations in tumour tissue., Methods: We enrolled 445 lung adenocarcinoma patients for analysis of tumour EGFR mutations using polymerase chain reaction (PCR)-direct sequencing, scorpion/amplified refractory mutation system (ARMS) technology and immunohistochemistry with mutation-specific antibodies., Results: Two hundred forty-five patients (245/445; 55%) were found to harbour activating EGFR mutations using PCR-direct sequencing method, with a majority of patients (233/245; 95%) carrying exon 19 deletion or p.L858R point mutations. One hundred three of 200 patients were negative for EGFR mutations from PCR-direct sequencing were further analysed using Scorpion/ARMS technology. Up to 30% of the PCR-direct sequencing negative patients turned out to be positive in the Scorpion/ARMS EGFR mutation tests. For immunohistochemistry analysis of EGFR mutations, the p.E746&#95;A750del specific antibody showed a sensitivity of 57% and a specificity of 100% for exon 19 deletions while the p.L858R point mutation specific antibody showed a sensitivity of 68% and a specificity of 95%., Conclusions: Based on this study, we proposed an algorithm for comprehensive and efficient testing of EGFR mutations on lung adenocarcinoma patients in Asia., (© 2013 The Authors. Respirology © 2013 Asian Pacific Society of Respirology.)

Background: The Mini-Balance Evaluation Systems Test (Mini-BESTest) is a new balance assessment, but its psychometric properties have not been specifically tested in individuals with stroke., Objectives: The purpose of this study was to examine the reliability and validity of the Mini-BESTest and its accuracy in categorizing people with stroke based on fall history., Design: An observational measurement study with a test-retest design was conducted., Methods: One hundred six people with chronic stroke were recruited. Intrarater reliability was evaluated by repeating the Mini-BESTest within 10 days by the same rater. The Mini-BESTest was administered by 2 independent raters to establish interrater reliability. Validity was assessed by correlating Mini-BESTest scores with scores of other balance measures (Berg Balance Scale, one-leg-standing, Functional Reach Test, and Timed "Up & Go" Test) in the stroke group and by comparing Mini-BESTest scores between the stroke group and 48 control participants, and between fallers (≥1 falls in the previous 12 months, n=25) and nonfallers (n=81) in the stroke group., Results: The Mini-BESTest had excellent internal consistency (Cronbach alpha=.89-.94), intrarater reliability (intraclass correlation coefficient [3,1]=.97), and interrater reliability (intraclass correlation coefficient [2,1]=.96). The minimal detectable change at 95% confidence interval was 3.0 points. The Mini-BESTest was strongly correlated with other balance measures. Significant differences in Mini-BESTest total scores were found between the stroke and control groups and between fallers and nonfallers in the stroke group. In terms of floor and ceiling effects, the Mini-BESTest was significantly less skewed than other balance measures, except for one-leg-standing on the nonparetic side. The Berg Balance Scale showed significantly better ability to identify fallers (positive likelihood ratio=2.6) than the Mini-BESTest (positive likelihood ratio=1.8)., Limitations: The results are generalizable only to people with mild to moderate chronic stroke., Conclusions: The Mini-BESTest is a reliable and valid tool for evaluating balance in people with chronic stroke.

Objective: To develop and validate a Chinese version of the Craig Hospital Inventory of Environmental Factors., Design: Descriptive case-series., Subjects: A total of 107 individuals with chronic stroke and 56 age-matched healthy subjects., Methods: The English version of the 25-item Craig Hospital Inventory of Environmental Factors was translated into Chinese using standardized procedures, and then administered to both the stroke and control groups. The same questionnaire was administered again to the stroke group 1-2 weeks after the first session., Results: The Craig Hospital Inventory of Environmental Factors had good internal consistency (Cronbach's alpha = 0.916) and test-retest reliability (intra-class correlation coefficient = 0.845). It also had significant association with Personal Wellbeing Index (r(s) = -0.379, p = 0.001) but not with Fugl-Meyer Assessment upper limb (r(s) = -0.107, p = 0.320) and lower limb motor scores (r(s) = -0.032, p = 0.768) among stroke subjects, thus demonstrating convergent and discriminant validity, respectively. The mean Craig Hospital Inventory of Environmental Factors score in the stroke group was also significantly higher than that in controls (p = 0.020), thus showing good known-groups validity., Conclusion: The Chinese version of the Craig Hospital Inventory of Environmental Factors is a reliable and valid tool for evaluating the perceived environmental barriers experienced by people with chronic stroke.

Objective: A systematic review and meta-analysis of randomized controlled trials was undertaken to determine whether whole body vibration improves bone mineral density and leg muscle strength in older adults., Data Sources: Sources included MEDLINE, CINAHL, EMBASE, PEDro, PubMed, Science Citation Index and the reference list of each eligible article., Review Methods: Article search and selection was performed independently by two researchers. The methodological quality of each selected article was rated by the PEDro scale., Results: Thirteen randomized trials (18 articles) totalling 896 subjects fulfilled the selection criteria. Four were considered to have good or excellent methodological quality and the rest were rated as fair. Meta-analyses revealed that whole body vibration has no significant effect on hip or lumbar spine bone mineral density in older women when compared with no intervention or active exercise (P > 0.05). Whole body vibration, however, had a significant treatment effect on knee extension dynamic strength (standardized mean difference = 0.63, P = 0.006), leg extension isometric strength (standardized mean difference = 0.57, P = 0.003), and functional measures of leg muscle strength such as jumping height (standardized mean difference = 0.51, P = 0.010) and performance in sit-to-stand (standardized mean difference = 0.72, P < 0.001) among older adults compared with no intervention., Conclusion: Whole body vibration is beneficial for enhancing leg muscle strength among older adults. However, the review suggests that whole body vibration has no overall treatment effect on bone mineral density in older women. No randomized trial has examined the effects of whole body vibration on bone mineral density in older men.

Background: Little is known about outcomes after self-harm in East Asia., Aims: To investigate mortality after self-harm in a Taiwanese population., Method: Between 2000 and 2003, 1083 individuals who self-harmed were identified through a population self-harm register in Nantou County, Taiwan, and followed until 2007 for date and cause of death on a national mortality database., Results: In total, 145 individuals died, 48 through suicide. The risks of all-cause and suicide mortality in the first year were 4.7% and 2.1% respectively, representing 8- and 131-fold age- and gender-standardised increases. Male gender and older age were independent risk factors for both suicide and non-suicide mortality. Use of more lethal methods in the index episode was associated with higher mortality but this was accounted for by gender., Conclusions: Results in this sample support the recommendation that people with a history of recent self-harm should be a major target for suicide prevention programmes.

Background: Repeated self-harm is relatively common and is linked with an elevated risk of eventual suicide. There has been no study of this involving a large sample from the Far East., Aims: To estimate the risk over the medium term of non-fatal repetition of self-harm and identify predictive factors in those carrying out self-harm., Method: A total of 970 individuals who had self-harmed were recruited from a community-based suicide behaviour register system in Nantou, Taiwan from July 2000 to February 2003. Information regarding demography and suicide methods was collected. Individuals were followed-up until December 2005 to examine the risk of repeated self-harm and independent predictive factors., Results: Ninety cohort members had repeated self-harm during the follow-up period (accounting for 131 repeated self-harm episodes in all). The cumulative risks were 5.7% for the first year, 7.8% for the second year and 9.5% for the fourth year. The risk was highest within the first year after the self-harm event. Independent risk factors included female gender and self-cutting as well as self-poisoning with drugs. Effect of younger age was mediated through the choice of methods., Conclusions: Individuals with self-harm have a high risk of repetition, especially within the first year. Suicide prevention strategies need to focus on intervening with this population to reduce their repetition.

Investigation on seroprevalence and risk factors of Toxoplasma gondii infections among indigenous and immigrant pregnant women in Mid-Taiwan showed that anti Taxoplasma-specific IgG antibody counts were significantly higher in indigenes (40.6%) than in immigrants (18.2%), with an odds ratio of OR=3.34 (95% CI: 1.93-4.80). The titre of Taxoplasma-specific IgG was also significantly higher in indigenes than in immigrants (P<0.001). Differences of living styles for Toxoplasma infection between the two groups were drinking untreated water (OR=2.34, 95% CI: 1.36-4.02), consumption of raw/undercooked meats (OR=10.11 95% CI: 4.92-20.78), especially raw/undercooked pork (P=0.000), or raw/undercooked viscera (OR=9.16, 95% CI: 2.97-27.94), contact with cats (OR=5.69, 95% CI: 2.83-11.47), or soil (OR=2.55 95% CI: 1.72-3.80). Differences of risk factors for Toxoplasma infection in terms of positive IgG in the two groups were consumption of raw/undercooked meats (P=0.005) especially raw/undercooked pork (P=0.004), and contact with cats (P=0.013) or soil (P=0.028). It is concluded that seroprevalence of Toxoplasma infection is higher in indigenous pregnant women and related to their living styles. To prevent congenital toxoplasmosis, health education seems required.

Unlabelled: This study is conducted to explore an effective culture method for supporting the embryo development. The cattle fetal ear fibroblasts and the goat fetal ear fibroblasts are transplanted into the enucleated cattle oocytes separately by oocyte intraplasmic nuclear injection method to construct bovine cloned embryos and goat-bovine cloned embryos. The embryos are first cultivated in modified charles rosenkrans 2 amino acid medium (mCR2aa) and modified synthetic oviduct fluid medium (mSOF) separately. Then BSA (8 mg/mL) or FBS (10%) can be added to mSOF according to the different culture period. The supplements and orders, added during the first three days and after three days are as follow: BSA and BSA, BSA and FBS, FBS and BSA, FBS and FBS. On the basis of the cleavage rate, 8/16-cell rate, blastocysts rate and total cell number of blastocysts, the best culture way can be screened out., Result: First, cleavage rate, 8/16-cell rate, blastocysts rate and total cell number of blastocysts, cultivated in mSOF solution are all higher than those cultivated in mCR2aa( P < 0.05). Second, the cleavage rate and 8/16-cell rate, adding BSA and FBS into mSOF, are in turn 79.8% +/- 7.1%, 49.7% +/- 3.5%, 21.5% +/- 1.8%, and 115.2 +/- 4.3 in bovine cloned embryo, and 40.1% +/- 6.3%, 29.2% +/- 2.0%, 13.4% +/- 2.1% and 100.1 +/- 3.0 in goat-bovine cloned embryo, which are significant higher than other culture groups (P < 0.05)., Conclusion: The goat-bovine cloned embryo can be cultivated by the optimized culture measure of bovine cloned embryo. The best culture ways of bovine cloned embryo and goat-bovine cloned embryo are all to use mSOF supplemented BSA in the first three days and then use mSOF supplemented FBS in the next five days.

Objective: Severe natural disasters can cause long-term psychological impact on the survivors. This study aimed to examine the prevalence and risk factors of posttraumatic stress symptoms and psychiatric morbidity among survivors of the severe earthquake that occurred in Chi-Chi, Taiwan, in September 21, 1999., Methods: A total of 6412 earthquake survivors whose houses were destroyed by earthquake were recruited about 2 years after the disaster. They completed a self-report questionnaire assessing posttraumatic stress symptoms, psychiatric morbidity, and information of demographics, trauma exposure, and current living status., Results: The estimated rates of posttraumatic stress disorder caseness and psychiatric morbidity were 20.9% and 39.8%, respectively. Psychiatric morbidity occurred mainly in survivors who were female, older, with low education level, and currently living in a prefabricated house. The risk factors for posttraumatic stress disorder caseness were female sex, currently living in a prefabricated house, low education level, and experienced complete destruction of property., Conclusion: These results showed that severe earthquake can cause long-term psychological impact in the survivors. The findings of risk factors suggest avenues for targeting postdisaster interventions.

Aims: To evaluate a modified radiofrequency-assisted approach to right hemihepatectomy., Methods: Following a bilateral subcostal incision and intraoperative ultrasonography, the liver was mobilized in the standard manner, and a cholecystectomy was performed. The portal vein was isolated, encircled, and ligated. After demarcating the liver parenchyma, coagulation necrosis was achieved using a radiofrequency-assisted device along the line demarcated for transecting the liver parenchyma. The actual transection of the liver parenchyma and the right portal vein was done using a surgical scalpel along the radiofrequency-coagulated line. The right hepatic vein was coagulated using the radiofrequency sealer or by stitching in the resection plane. The hepatic artery was not dissected and was sealed together with the bile ducts in the resection plane using the radiofrequency instrument. The hepatic vein was not divided., Results: Between July 2005 and July 2006, a total of 49 liver resections were performed in our unit. Of these, the radiofrequency-assisted technique was used in 33 cases with metastatic disease; 14 of these cases had right hemihepatectomies, including 2 repeat resections. The mean operation time was 180min (range, 120-240min), and the average blood transfusion was 0.14U (range, 0-2U). Postoperatively, there was no morbidity, such as bleeding, infection, or biliary fistula, related to the liver resection technique, and no patients died as a result of surgery. In 8 out of the 14 right hemihepatectomies, a right-sided pleural effusion was observed; 3 of them required evacuation., Conclusion: This paper describes a modified radiofrequency-assisted hemihepatectomy, which allows one to obtain control of the portal blood flow going into the resected part of liver. The modified approach appears to be simple and safe.

This study was a preliminary examination of the effect of low-intensity home-based physical therapy on the performance of activities of daily living (ADL) and motor function in patients more than 1 year after stroke. Twenty patients were recruited from a community stroke register in Nan-Tou County, Taiwan, to a randomized, crossover trial comparing intervention by a physical therapist immediately after entry into the trial (Group I) or after a delay of 10 weeks (Group II). The intervention consisted of home-based physical therapy once a week for 10 weeks. The Barthel Index (BI) and Stroke Rehabilitation Assessment of Movement (STREAM) were used as standard measures for ADL and motor function. At the first follow-up assessment at 11 weeks, Group I showed greater improvement in lower limb motor function than Group II. At the second follow-up assessment at 22 weeks, Group II showed improvement while Group I had declined. At 22 weeks, the motor function of upper limbs, mobility, and ADL performance in Group II had improved slightly more than in Group I, but the between-group differences were not significant. It appears that low-intensity home-based physical therapy can improve lower limb motor function in chronic stroke survivors. Further studies will be needed to confirm these findings.