Tactile processing in mouse cortex depends on action context

The brain receives constant tactile input, but only a subset guides ongoing behavior. Actions associated with tactile stimuli thus endow them with behavioral relevance. It remains unclear how the relevance of tactile stimuli affects processing in the somatosensory (S1) cortex. We developed a cross-modal selection task in which head-fixed mice switched between responding to tactile stimuli in the presence of visual distractors or to visual stimuli in the presence of tactile distractors using licking movements to the left or right side in different blocks of trials. S1 spiking encoded tactile stimuli, licking actions, and direction of licking in response to tactile but not visual stimuli. Bidirectional optogenetic manipulations showed that sensory-motor activity in S1 guided behavior when touch but not vision was relevant. Our results show that S1 activity and its impact on behavior depend on the actions associated with a tactile stimulus.

Erector spinae plane block reduces opioid consumption and improves incentive spirometry volume after cardiac surgery: A retrospective cohort study

BACKGROUND

Effective postoperative pain management is vital in cardiac surgery to prevent opioid dependency and respiratory complications. Previous studies on the erector spinae plane (ESP) block have focused on single-shot applications or immediate postoperative outcomes. This study evaluates the efficacy of continuous ESP block versus conventional care in reducing opioid consumption and enhancing respiratory function recovery post-cardiac surgery over 72 hours.

METHODS

A retrospective study at a tertiary hospital (Jan 2021 - Jul 2022) included 262 elective cardiac surgery patients. Fifty-three received a preoperative ESP block, matched 1:1 with a control group (n=53). The ESP group received 0.5% ropivacaine intraoperatively and 0.16% ropivacaine every 4 hours postoperatively. Outcomes measured were cumulative oral morphine equivalent (OME) dose within 72 hours postextubation, daily maximum numerical rating scale (NRS) ≥3, incentive spirometry volume, and %baseline performance, stratified by surgery type (sternotomy or thoracotomy).

RESULTS

Significant OME reduction was observed in the ESP group (sternotomy: median decrease of 113 mg, 95%CI 60-157.5mg, p < 0.001; thoracotomy: 172.5mg, 95%CI 45-285mg, p = 0.010). The ESP group also had a lower risk of daily maximum NRS ≥3 (adjusted OR sternotomy: 0.22, p < 0.001; thoracotomy: 0.07, p < 0.001), an higher incentive spirometry volumes (sternotomy: mean increase of 149mL, p = 0.019; thoracotomy: 521mL, p = 0.017), and enhanced spirometry %baseline (sternotomy: mean increase of 11.5%, p = 0.014; thoracotomy: 26.5%, p < 0.001).

CONCLUSION

Continuous ESP block was associated with a reduction of postoperative opioid requirements, lower instances of pain scores ≥3, and improve incentive spirometry performance following cardiac surgery. These benefits appear particularly prominent in thoracotomy patients. Further prospective studies with larger sample size are required to validate these findings.

Rule-based modulation of a sensorimotor transformation across cortical areas

Flexible responses to sensory stimuli based on changing rules are critical for adapting to a dynamic environment. However, it remains unclear how the brain encodes rule information and uses this information to guide behavioral responses to sensory stimuli. Here, we made single-unit recordings while head-fixed mice performed a cross-modal sensory selection task in which they switched between two rules in different blocks of trials: licking in response to tactile stimuli applied to a whisker while rejecting visual stimuli, or licking to visual stimuli while rejecting the tactile stimuli. Along a cortical sensorimotor processing stream including the primary (S1) and secondary (S2) somatosensory areas, and the medial (MM) and anterolateral (ALM) motor areas, the single-trial activity of individual neurons distinguished between the two rules both prior to and in response to the tactile stimulus. Variable rule-dependent responses to identical stimuli could in principle occur via appropriate configuration of pre-stimulus preparatory states of a neural population, which would shape the subsequent response. We hypothesized that neural populations in S1, S2, MM and ALM would show preparatory activity states that were set in a rule-dependent manner to cause processing of sensory information according to the current rule. This hypothesis was supported for the motor cortical areas by findings that (1) the current task rule could be decoded from pre-stimulus population activity in ALM and MM; (2) neural subspaces containing the population activity differed between the two rules; and (3) optogenetic disruption of pre-stimulus states within ALM and MM impaired task performance. Our findings indicate that flexible selection of an appropriate action in response to a sensory input can occur via configuration of preparatory states in the motor cortex.

Case report: Malignant transformation of ovarian endometrioma during long term use of dienogest in a young lady

Endometriosis is a benign disease, which is also regarded as a precursor to ovarian malignancy. Dienogest is a progestin treatment for endometriosis with efficacy and tolerability. A 35-year-old Taiwanese lady with ovarian endometrioma had taken dienogest for the last 5 years. During sonographic follow-up, surgery was suggested owing to suspicious of malignant transformation of ovarian endometrioma. While she hesitated and turned to receive two cycles of oocyte retrieval because of nulliparity. Meanwhile, more papillary growth in the ovarian endometrioma with intratumor flow was found during follow-up. Laparoscopic enucleation was performed later, and pathology revealed clear cell carcinoma with peritoneal involvement, at least FIGO stage IIB. She then underwent debulking surgery to grossly no residual tumor and received adjuvant chemotherapy with no tumor recurrence in post-operative 17-months follow-up. Considering fertility preservation, conservative treatment of ovarian endometrioma is typically indicated for those women who have not yet completed childbearing. However, malignant transformation may still occur despite long-term progestin treatment. Therefore, careful image follow-up is still indispensable.

The Effectiveness of Parenting Programs in Preventing Abusive Head Trauma: A Systematic Review and Meta-Analysis

Parenting programs are the most common intervention for preventing the lethal form of child maltreatment, abusive head trauma (AHT). However, certain results of the effects of these programs have not yet been compared across studies. A systematic review with meta-analysis is warranted to quantitively synthesize the available evidence to identify effective elements and strategies of the programs for preventing AHT. This review aims to estimate AHT preventive parenting programs' pooled effect on the reduction of AHT incidence, the improvement of parental knowledge, and the increased use of safe strategies in response to infants' inconsolable crying. Studies published in English and Mandarin were searched and retained if they were randomized control trials (RCTs) or with a quasi-experimental design, included an AHT preventive parenting program, and provided data that quantified targeted outcomes. Eighteen studies were included in this review. AHT preventive parenting programs had a pooled effect on improving parents' knowledge and increasing the use of safe coping strategies in response to inconsolable crying but not on the incidence of AHT and parents' emotional self-regulation. Subgroup analyses showed that the intervention effects were mostly present across study designs or measurements and emerged in the reduction of AHT incidence compared with historical controls. The findings suggest that AHT preventive parenting programs enhance parenting knowledge and skills to provide safe care for infants. Further efforts to evaluate AHT parenting programs on the reduction of AHT incidence are necessary for decision-making on allocating and disseminating interventions.

Cotadutide promotes glycogenolysis in people with overweight or obesity diagnosed with type 2 diabetes

Cotadutide is a dual glucagon-like peptide 1 and glucagon receptor agonist under development for the treatment of non-alcoholic steatohepatitis and type 2 diabetes mellitus (T2DM) and chronic kidney disease. Non-alcoholic steatohepatitis is a complex disease with no approved pharmacotherapies, arising from an underlying state of systemic metabolic dysfunction in association with T2DM and obesity. Cotadutide has been shown to improve glycaemic control, body weight, lipids, liver fat, inflammation and fibrosis. We conducted a two-part, randomized phase 2a trial in men and women with overweight or obesity diagnosed with T2DM to evaluate the efficacy and safety of cotadutide compared with placebo and liraglutide. The primary endpoints were change from baseline to day 28 of treatment in postprandial hepatic glycogen (part A) and to day 35 of treatment in fasting hepatic glycogen (part B) with cotadutide versus placebo. Secondary endpoints in part B were changes in fasting hepatic glycogen with cotadutide versus the mono glucagon-like peptide 1 receptor agonist, liraglutide, and change in hepatic fat fraction. The trial met its primary endpoint. We showed that cotadutide promotes greater reductions in liver glycogen and fat compared with placebo and liraglutide. Safety and tolerability findings with cotadutide were comparable to those of previous reports. Thus, this work provides evidence of additional benefits of cotadutide that could be attributed to glucagon receptor engagement. Our results suggest that cotadutide acts on the glucagon receptor in the human liver to promote glycogenolysis and improve the metabolic health of the liver. ClinicalTrials.gov registration: NCT03555994 .

Gut microbiota of Pacific white shrimp (Litopenaeus vannamei) exhibits distinct responses to pathogenic and non-pathogenic Vibrio parahaemolyticus

Acute hepatopancreatic necrosis disease (AHPND), a high-mortality-rate shrimp disease, is caused by specific Vibrio parahaemolyticus (Vp) strains with a plasmid encoding the PirABVp toxins. As a bacterial pathogen, the invasion of AHPND-causing Vp might impose pressure on commensal microbiota in the shrimp gut, while the relationship between the pathogenesis of AHPND and the dysbiosis of gut bacterial communities remains unclear. Here we explored the temporal changes of shrimp gut microbiota in response to AHPND-causing and non-AHPND-causing Vp strains, with the non-infected controls as a baseline of the shrimp gut microbiota. The diversity and composition of bacterial communities from 168 gut samples (covering three treatments at seven time points with eight individuals per set) were investigated using 16S rRNA gene metabarcoding with high-throughput sequencing. The results showed that (i) species diversity of gut bacterial communities declined in Vp-infected shrimp, independent of the strain pathogenicity; (ii) taxonomic compositions of gut bacterial communities were significantly different between shrimp infected by AHPND-causing and non-AHPND-causing Vp strains; (iii) short-term (within 6 hours) compositional shifts in the gut microbiota were found only in AHPND-causing Vp-infected shrimp; (iv) the gut microbiota of AHPND-causing Vp-infected shrimp was enriched with genera Photobacterium and Vibrio, with a decline in Candidatus Bacilliplasma; and (v) functional predictions suggested the loss of normal metabolism due to compositional shifts in the gut microbiota. Our work reveals distinct features of community dynamics in shrimp gut microbiota, associated with pathogenic versus non-pathogenic Vibrio infections, providing a new perspective of the pathogenesis of AHPND. IMPORTANCE Shrimp production is continually threatened by newly emerging diseases, such as AHPND, which is caused by specific Vp strains. Previous studies on the pathogenesis of AHPND have mainly focused on the histopathology and immune responses of the host. However, more attention needs to be paid to the gut microbiota, which acts as the first barrier to pathogen colonization. In this study, we revealed that shrimp gut microbiota responded differently to pathogenic and non-pathogenic Vp strains, with bacterial genera Photobacterium and Vibrio enriched in pathogenic Vp-infected shrimp, and Candidatus Bacilliplasma enriched in non-pathogenic Vp-infected shrimp. Moreover, functional predictions suggested that changes in taxonomic compositions would further affect normal metabolic functions, emphasizing the importance of sustaining an equilibrium in the gut microbiota. Several biomarkers associated with specific microbial taxa and functional pathways were identified in our data sets, which help predict the incidence of disease outcomes.

Kernel-wise difference minimization for convolutional neural network compression in metaverse

Convolutional neural networks have achieved remarkable success in computer vision research. However, to further improve their performance, network models have become increasingly complex and require more memory and computational resources. As a result, model compression has become an essential area of research in recent years. In this study, we focus on the best-case scenario for Huffman coding, which involves data with lower entropy. Building on this concept, we formulate a compression with a filter-wise difference minimization problem and propose a novel algorithm to solve it. Our approach involves filter-level pruning, followed by minimizing the difference between filters. Additionally, we perform filter permutation to further enhance compression. Our proposed algorithm achieves a compression rate of 94× on Lenet-5 and 50× on VGG16. The results demonstrate the effectiveness of our method in significantly reducing the size of deep neural networks while maintaining a high level of accuracy. We believe that our approach holds great promise in advancing the field of model compression and can benefit various applications that require efficient neural network models. Overall, this study provides important insights and contributions toward addressing the challenges of model compression in deep neural networks.

Update on Regulation of Regenerative Medicine in Taiwan

Due to rapid development of biotechnology in recent years, the field of regenerative medicine has attracted considerable attention. Regenerative medicine-related regulations have been established in several countries to ensure the quality, safety, and efficacy of innovative treatments. Considering the diversity of regenerative medicine, the regulatory framework in Taiwan has been adjusted in response to global trend and local demand. Before 2010, cell and gene therapies were regarded as "new medical practice" under the "Medical Care Act." Along with the establishment of Taiwan Food and Drug Administration (TFDA) in 2010, regenerative medicine was regulated as "medicinal products" under the "Pharmaceutical Affairs Act." Then, the Ministry of Health and Welfare (MOHW) established a new dual-track regulatory pathway for regenerative medicine in 2016. The dual-track pathway divided regenerative medicine into medical practices and medicinal products, aiming to improve the accessibility of new treatments to patients and maintain the flexibility for clinical operations. In order to refine the regulation, the MOHW proposed two draft Acts for regenerative medicine in 2022. The two draft Acts are currently under legislative process. It is expected that the research and development of regenerative medicine can be further accelerated, thus providing early access to innovative therapies for patients in the future.

Workplace Deceptions During the Pandemic: Differences in Conspiracy Beliefs, Psychological Functioning, and Covid-19 Experiences

The global pandemic has disrupted virtually all countries on health, psychological functioning, and economies, to name a few. Accurate information has also fallen victim to the pandemic, which has been rife with misinformation and conspiracy theories. The current study investigated Covid-19 deceptions related to employment. With complete anonymity via MTurk, 389 participants from the United States rated their likelihood of deception regarding hypothetical four workplace scenarios. The first set of analyses examined differences between high and low risk of deceptions for each scenario based on participants' self-appraisals. The largest differences were found for general conspiracy beliefs and affective disorders, specifically major depression and generalized anxiety. The second set of analyses focused across the workplace scenarios on two operationalized groups with Likely-Deceptive (n = 189) vastly outnumbering Likely-Genuine (n = 55). Personal experiences with Covid-19 dramatically increased deceptions. Testing positive for Covid-19 increased the odds of being in the Likely-Deceptive by twelve-fold. Two discriminant models examined cognitive misbeliefs and psychological functioning. When both were combined, depression and Covid-19 misinformation produced the strongest structure coefficients followed closely by general conspiracy beliefs and generalized anxiety. The far-ranging implications of these findings are discussed.

The role of vein grafts in reconstructive head and neck microsurgery

OBJECTIVE

Free tissue transfer is widely used for head and neck reconstruction. In certain circumstances, vein grafting is required to elongate free flap pedicles to connect them to appropriate recipient vessels. Because of controversy regarding the use of interposition vein grafts in free tissue reconstruction, this paper reports vein graft indications, techniques, safety, and outcomes for head and neck microvascular surgery.

METHODS

Twenty-six patients (23 men and 3 women) who underwent interposition vein grafting concurrent with free tissue transfer were included in this study. The most common reason for head and neck reconstruction with vein graft was tumor recurrence, followed by flap salvage. The interposition vein grafts were applied in two manners as temporary arteriovenous (A-V) loop and conduit to extend the length of the free flap for venous drainage.

RESULTS

The most common reconstructions were anterolateral thigh flaps (15 cases), followed by vastus lateralis myocutaneous (3 cases) and radial forearm (2 cases) flaps. The common recipient vessels were superior thyroid artery, superficial temporal artery and external jugular vein. The free flap loss rate was 7.7% with vein grafts and 4.9 without vein grafts (p = 0.380). The free flap complication rate was 50.0% and 16.8% in patients with and without vein grafts, respectively (p < 0.001). Radiation therapy, chemotherapy, prior neck dissection, and prior free flap transfer were more common in the vein graft group (all p < 0.001). The hospital stay was significantly longer for the vein graft group than for the non-vein graft group (29.5 vs. 19.0 days; p = 0.001).

CONCLUSION

Overall free flap survival rates of 92.3% and 95.1% in the vein and non-vein graft groups, respectively - indicating the reliability of the vein grafts in challenging head and neck reconstructions, particularly in salvage cases and patients with multiple reconstructions.

LEVEL OF EVIDENCE

Level 3.

Randomized, Placebo-Controlled Phase 2b Study to Evaluate the Safety and Efficacy of Recombinant Human Lecithin Cholesterol Acyltransferase in Acute ST-Segment-Elevation Myocardial Infarction: Results of REAL-TIMI 63B

BACKGROUND

High-density lipoprotein plays a key role in reverse cholesterol transport. In addition, high-density lipoprotein particles may be cardioprotective and reduce infarct size in the setting of myocardial injury. Lecithin-cholesterol acyltransferase is a rate-limiting enzyme in reverse cholesterol transport. MEDI6012 is a recombinant human lecithin-cholesterol acyltransferase that increases high-density lipoprotein cholesterol. Administration of lecithin-cholesterol acyltransferase has the potential to reduce infarct size and regress coronary plaque in acute ST-segment-elevation myocardial infarction.

METHODS

REAL-TIMI 63B (A Randomized, Placebo‑controlled Phase 2b Study to Evaluate the Safety and Efficacy of MEDI6012 in Acute ST Elevation Myocardial Infarction) was a phase 2B multinational, placebo-controlled, randomized trial. Patients with ST-segment-elevation myocardial infarction within 6 hours of symptom onset and planned for percutaneous intervention were randomly assigned 2:1 to MEDI6012 (2- or 6-dose regimen) or placebo and followed for 12 weeks. The primary outcome was infarct size as a percentage of left ventricular mass by cardiac MRI at 10 to 12 weeks, with the primary analysis in patients with TIMI Flow Grade 0 to 1 before percutaneous intervention who received at least 2 doses of MEDI6012. The secondary outcome was change in noncalcified plaque volume on coronary computed tomographic angiography from baseline to 10 to 12 weeks with the primary analysis in patients who received all 6 doses of MEDI6012.

RESULTS

A total of 593 patients were randomly assigned. Patients were a median of 62 years old, 77.9% male, and 95.8% statin naive. Median time from symptom onset to randomization was 146 (interquartile range [IQR], 103-221) minutes and from hospitalization to randomization was 12.7 (IQR, 6.6-24.0) minutes, and the first dose of drug was administered a median of 8 (IQR, 3-13) minutes before percutaneous intervention. The index myocardial infarction was anterior in 69.6% and TIMI Flow Grade 0 to 1 in 65.1% of patients. At 12 weeks, infarct size did not differ between treatment groups (MEDI6012: 9.71%, IQR 4.79-16.38; placebo: 10.48%, [IQR, 4.92-16.61], 1-sided P=0.79. There was also no difference in noncalcified plaque volume (geometric mean ratio, 0.96 [95% CI, NA-1.10], 1-sided P=0.30). There was no significant difference in treatment emergent serious adverse events.

CONCLUSIONS

Administration of MEDI6012 in patients with acute ST-segment-elevation myocardial infarction did not result in a significant reduction in infarct size or noncalcified plaque volume at 12 weeks. MEDI6012 was well tolerated with no excess in overall serious adverse events.

REGISTRATION

URL: https://www.

CLINICALTRIALS

gov; Unique identifier: NCT03578809.

Effect of Total Intravenous Anesthesia on Postoperative Pulmonary Complications in Patients Undergoing Microvascular Reconstruction for Head and Neck Cancer: A Randomized Clinical Trial

Importance

Free flap surgery is a lengthy procedure with massive tissue destruction and reconstruction, which makes postoperative pulmonary complications (PPCs) a noticeable issue among patients with head and neck cancer. Propofol-based total intravenous anesthesia (TIVA) has better survival outcomes than inhalational anesthesia (INH) in several types of cancer surgery. A previous retrospective study found that patients in the TIVA group had a lower PPC rate, which may be correlated with a lower intraoperative fluid requirement. We hypothesize that the protective effect remains among patients undergoing free flap surgery for head and neck cancer in a prospective and goal-directed fluid therapy setting.

Objective

To assess the effect of TIVA vs INH on PPCs in patients undergoing microvascular reconstruction for head and neck cancer.

Design, Setting, and Participants

This prospective, 2-arm, randomized clinical trial was conducted at a tertiary hospital in Taiwan; a total of 78 patients 18 years and older with American Society of Anesthesiologists physical status classification 1 to 3 who were scheduled for elective free flap surgery under general anesthesia were included. The trial started in October 2017, completed in October 2019, and finished analysis in January 2022.

Interventions

Patients were enrolled and randomized to the TIVA or INH group. All patients received goal-directed fluid therapy and hemodynamic management if they had a mean arterial pressure (MAP) below 75 mm Hg or a reduction of 10% from baseline MAP.

Main Outcomes and Measures

The primary outcome was a composite of PPCs. The secondary outcomes were the differences in intraoperative hemodynamic values (mean arterial pressure, MAP; cardiac index, CI; systemic vascular resistance index, SVRI; and stroke volume variation, SVV).

Results

A total of 70 patients (65 men [93%]; 5 women [7%]) completed the trial; median (IQR) age was 52.0 (48-59) years in the TIVA group and 57.0 (46-64) years in the INH group. The demographic characteristics were similar between the 2 groups, except that patients in the TIVA group had a slightly lower body mass index. Patients in the TIVA group had a lower risk of developing PPCs (unadjusted odds ratio, 0.25; 95% CI, 0.08-0.80). The TIVA group had significantly higher MAP, lower CI, and higher SVRI than the INH group after the third hour of monitoring. The TIVA group showed a relatively stable hourly MAP, CI, SVRI, and SVV across time points, while the INH group showed a more varying pattern. The generalized estimating equation showed no clinical differences in the trend of hemodynamic parameters across time between groups.

Conclusions and Relevance

In this randomized clinical trial, using propofol-based TIVA reduced the incidence of PPCs in free flap surgery. This finding may be related to more stable hemodynamic manifestations and a lower total balance of fluid throughout the surgery.

Trial Registration

ClinicalTrials.gov Identifier: NCT03263078.

Health services utilization and cost of abusive head trauma in Taiwan: A population-based retrospective matched cohort study

BACKGROUND

Abusive head trauma (AHT) is a serious health problem that results the highest mortality among children who are maltreated. Many AHT survivors suffer from long-term sequelae and require medical treatment. However, the knowledge of AHT-attributable health services utilization and costs at national level are limited.

OBJECTIVE

To estimate health services utilization and costs attributable to AHT among children aged 0-4 years in Taiwan.

PARTICIPANTS AND SETTING

Sixty-three fatal and 664 survival AHT cases were identified using Taiwan national population database between 2003 and 2015. A total of 2656 non-AHT children were exactly 4:1 matched to the survival cases based on their birth year, gender, the calendar year of the index date, insured location, and health insurance premium (social economic status indicator).

METHODS

Health services utilization and costs were calculated on an annual basis for 3 years after the index date. AHT-attributable health services utilization and costs during 3-year follow-up period was evaluated by regression models.

RESULTS

AHT diagnosis was positively associated with inpatient admissions, length of stay, emergency room (ER) visits, and outpatient visits. AHT-attributable medical costs were 1.64-17.27 times, 1.25-5.22 times, and 1.77-2.36 times greater for inpatient, ER, and outpatient during 3-year period than matched controls, respectively. Fatal AHT cases had higher inpatient utilization and greater medical costs than AHT survivors.

CONCLUSIONS

Children with AHT had greater health services utilization and higher costs for years. Strategies to reduce the burden of AHT on health care system are imperative.

Assessment of Malingering among Servicemembers with a Focused Examination of Explanatory Models

Umbrasas briefly mentioned established models of malingering that sought to understand the driving motivations for feigning mental disorders. He used these models as a point of departure to consider the unique experiences and enduring challenges of active and retired servicemembers. For military malingering, he identified acute distress malingering and disability malingering with the former occurring within the first five years and the latter after a military career had been established. To provide a strong foundation, this commentary revisits three explanatory models of malingering (i.e., pathogenic, criminological, and adaptational) that have been empirically tested. Of these, the adaptational model appears the best suited in the military context to explain nongenuine responding because most mandatory evaluations carry highly negative consequences, such as seriously damaging future careers in the armed forces. Most examinees would be seen as denying and defensive, however, the polar opposite of malingering. When symptoms are eventually reported, Umbrasas acknowledges the temptation to consider this atypical presentation as possible evidence of malingering. We concur with Umbrasas's conclusion that such an extrapolation would be generally unwarranted. In summary, the overriding goal of this commentary is to understand Umbrasas's thought-provoking contributions to military malingering in the larger landscape of explanatory models of malingering.

Association between sodium-glucose co-transporter 2 inhibitors and risk of bullous pemphigoid in patients with type 2 diabetes: A nationwide population-based cohort study

BACKGROUND

Certain anti-diabetic agents have been linked to the development of bullous pemphigoid (BP). However, the relationship between BP and sodium-glucose co-transporter 2 inhibitors (SGLT2is) remains inconclusive.

OBJECTIVE

To investigate the association between SGLT2i usage and BP.

METHODS

Participants were recruited from the Taiwan National Health Insurance Database between 2007 and 2018. A total of 149,060 patients with diabetes receiving SGLT2i were matched 1:2 with diabetic patients without SGLT2i usage. Factors such as age, sex, duration of diabetes condition, DPP4i usage, insulin usage, and selected comorbidities were included in the multivariate analysis.

RESULTS

Compared with the control, the 2-year-cumulative incidence was significantly low in patients using SGLT2i after adjustment for competing mortality. Patients with diabetes receiving SGLT2i had a low risk (adjusted hazard ratio [HR] 0·56, 95% confidence interval [CI], 0·33-0·96) for BP after adjustment for potential confounders. Age (HR, 1·06), renal disease (HR, 1·79), cerebrovascular disease (HR, 3·23), epilepsy (HR, 3·07), DPP4i users (HR: 2·55), and insulin users (HR: 2·56) were significant risk factors for BP.

CONCLUSIONS

The risk of BP did not increase in patients receiving SGLT2i. Thus, SGLT2i could be a safe choice for patients with diabetes having additional risk factors or a history of BP.

Recipient vessel selection for multiple free flap transfers in head and neck reconstruction at different periods

BACKGROUND

Treatment decisions can be challenging in patients undergoing multiple oropharyngeal microsurgical reconstructions at different periods by various causes. We, retrospectively, reviewed patients with at least three consecutive free flap reconstructions to determine the optimal strategy for selecting recipient vessels.

METHODS

Then, 36 patients (33 men and 3 women) who underwent at least 3 microsurgical reconstructions with a total of 51 free flap transfers for head and neck defects were included in this report. The most common reason for multiple microsurgical reconstructions was recurrent disease. For reconstructions, recipient vessel candidates on the same side of the head and neck were prioritized; if ipsilateral vessels were unavailable, contralateral recipient vessels, which might necessitate vein grafts, were used.

RESULTS

The most common reconstructions were anterolateral thigh flaps (19 cases). The most commonly used contralateral recipient vessels were the superior thyroid artery, facial artery, and external jugular vein. All vessel anastomoses were performed using the end-to-end method. Postoperative complications occurred at the sites of 26 free flap reconstructions. The overall flap reconstruction success rate in patients with at least three surgeries was 90.2%. The median follow-up duration was 25.8 months. During follow-up, 26 patients survived until the end of follow-up.

CONCLUSIONS

In patients undergoing multiple free flap reconstructions, recipient vessels on the ipsilateral side that have not been subjected to radiation should be selected first. Recipient vessels contralateral to the reconstruction side can then be selected; however, they may require vein grafts. Finally, distant healthy recipient vessels can be selected through vein grafting.

A psychometric analysis of a short form of the Chinese version of the ISPCAN child abuse screening tools - Children's home version (SC-ICAST-CH) using multidimensional item response theory

BACKGROUND

The development of measures of child maltreatment for the Chinese population were limited until the Chinese version of the ISPCAN Child Abuse Screening Tools - Children's Home version (ICAST-CH-C) was proposed. Although the ICAST-CH-C was found to be effective in assessing the scope and prevalence of child maltreatment, it has several potential drawbacks. The time that is required to complete the ICAST-CH-C scale is longer than usual for a 36-item scale, because many of its items have one or more follow-up questions. Moreover, each item requires child victims to recall unpleasant experiences. Both phenomena can cause increases in invalid responses and in turn damage the data quality.

OBJECTIVE

The goal of this study was to propose a short form of the ICAST-CH-C (called the SC-ICAST-CH) to reduce the test length and response time in order to improve the measurement quality.

PARTICIPANTS AND SETTING

A dataset from a national survey of 5236 adolescents in Taiwan was used.

METHODS

A multidimensional version of the rating scale model (MRSM) was fitted to the data. The model parameters were estimated with the ConQuest software.

RESULTS

The results indicated the reliability of the SC-ICAST-CH was fairly good, with only 61 % of the original test length. Disordered thresholds were found in all five subscales; the underlying reasons for this phenomenon need further investigation. Specific cultural differences related to item retention/removal decisions were also discussed.

CONCLUSION

The efficient, shorter SC-ICAST-CH was shown to be a valid and reliable instrument for assessing the prevalence of child maltreatment.

Incidence and characteristics of paediatric abusive head trauma in Taiwan, 2006-2015: a nationwide population-based study

OBJECTIVES

To examine the incidence rate and characteristics of paediatric abusive head trauma (PAHT) among children under age 5 years in Taiwan.

METHODS

The International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) was used to identify broad and narrow definitions of children aged under 5 years with PAHT from 2006 to 2015 in Taiwan using a representative national insurance research database. Medical resource utilisation was also analysed. Incidence rates per 100 000 person-years were calculated and presented with 95% CI. Joinpoint regression analysis was used to detect the changes in trends and calculate the annual percentage change in PAHT incidence over time.

RESULTS

From 2006 to 2015, 479 (narrow definition) and 538 (broad definition) PAHT cases were identified. Incidence rates of PAHT by narrow and broad definitions among children under 1 year of age (18.7/100 000 and 20.0/100 000) were nearly 10-fold or 20-fold higher than for children aged 1-2 (1.7/100 000 and 2.1/100 000) and 3-5 (0.9/100 000 and 1.2/100 000) years. The PAHT incidence significantly increased since 2012, with trends varying by age and gender. Our results suggest that over 40% of the children with PAHT experienced serious injury and nearly 13% were fatal cases. For 87% (n=57) of fatal cases, this was their first ever hospitalisation. The number of fatal cases among infants was fourfold higher than that of children aged 1-5 years.

CONCLUSIONS

This study provides a robust national estimate of PAHT and identifies infants as the most vulnerable group for PAHT in Taiwan. Education to enhance healthcare profession's sensitivity and competence for the early identification and diagnosis of PAHT is critical.

Effects of academic performance on the relationship between child maltreatment and deviant behavior: A national study in Taiwan

BACKGROUND

Child maltreatment has been found to significantly increase the risk of deviant behavior. Academic performance has been shown to have an indirect effect on the relationship between child maltreatment and deviant behavior. However, not all adolescents who have been maltreated engage in deviant behavior, so the relationship between child maltreatment and deviant behavior has remained unclear.

OBJECTIVE

The aim of this research was to examine the potential mediating and/or moderating effects of academic performance on the relationship between child maltreatment and deviant behavior.

PARTICIPANTS AND SETTING

The data in this study were from a nationwide study examining the consequences of childhood maltreatment in Taiwan. The database consisted of data from 2321 adolescents.

METHODS

A secondary data analysis was conducted. Self-report data were obtained on childhood maltreatment experiences, academic performance, and deviant behaviors. Path analyses and a generalized linear model were used to examine the effects of academic performance on the relationship between child maltreatment and deviant behavior.

RESULTS

Most participants were male (61.4%), with a mean age of 15.9 years. The mean scores of self-rated academic performance and deviant behavior were 2.86 and 8.2, respectively. A total of 83% participants reported having experienced childhood maltreatment. In this study, academic performance was found to have a moderating rather than a mediating effect on the relationship between child maltreatment and deviant behavior. Among adolescents who had been maltreated during childhood, those who self-rated poorer academic performance were more likely to have a higher deviant behavior score than those who self-rated better academic performance.

CONCLUSIONS

Good academic performance can be a buffer that reduces the risk of deviant behavior among individuals with a history of childhood maltreatment. Healthcare professionals and educators can tailor early prevention and intervention educational programs targeted toward adolescents with experience of childhood abuse or poor academic performance to prevent the incidence of deviant behavior and thus break the cycle of violence.

The first harmonic of radial pulse wave predicts major adverse cardiovascular and microvascular events in patients with type 2 diabetes

This brief report take a further look on the first harmonic of radial pulse wave (C1) after the 1.8 ± 0.5 years follow-up and demonstrated that the quartile level of C1 independently predicts the risk of cardiovascular death, major adverse cardiovascular events, and microvascular outcomes in 2324 patients with type 2 diabetes.

A potential probiotic Chromobacterium aquaticum with bacteriocin-like activity enhances the expression of indicator genes associated with nutrient metabolism, growth performance and innate immunity against pathogen infections in zebrafish (Danio rerio)

The use of probiotics as alternatives to antibiotics for disease control is a relatively eco-friendly approach in aquaculture; hence, studies isolating and assessing the benefit of potential probiotics to fish farming are common. The zebrafish is an excellent model system for validating beneficial functions of potential probiotics before their practical application in aquaculture. Here, a potentially probiotic Chromobacterium aquaticum was isolated from lake water samples and characterized by biochemical analysis and 16S rDNA sequencing. The probiotic produced extracellular enzymes (protease and xylanase) and a bacteriocin-like substance, which exhibited tolerance to extreme pH and high-temperature conditions and broad-spectrum bactericidal activity against diverse pathogens, including aquatic, foodborne, clinical and plant pathogens. The effects of C. aquaticum on zebrafish nutrient metabolism, growth performance and innate immunity were evaluated by measuring the expression of indicator genes after C. aquaticum feeding for 8 weeks. Fish administered the probiotic exhibited significantly increased hepatic mRNA expression of carbohydrate metabolism-related genes, including glucokinase (GK), hexokinase (HK), glucose-6-phosphatase (G6Pase), and pyruvate kinase (PK-L), and growth-related genes, including the growth hormone receptor (GHR) and insulin-like growth factor-1 (IGF-1). Innate immune-related genes (IL-1β, IL-6, TNF-α, IL-10, IL-21, NF-κb, lysozyme and complement C3b) were induced in fish with probiotic supplementation. Probiotic-treated fish exhibited a higher survival rate than control fish after challenge with Aeromonas hydrophila and Streptococcus iniae. Together, these data suggest that C. aquaticum, as a probiotic feed supplement, could enhance nutrient metabolism and growth performance and could modulate innate immunity against A. hydrophila and S. iniae in zebrafish.

Abstract 444: The Phase of Third Harmonic of Radial Pulse Predicts Cardiac Risk in Asymptomatic Patients With Type 2 Diabetes

Patients with type 2 diabetes (T2DM) have a significantly increased risk of heart disease and adverse cardiac events(ACE). Many of asymptomatic patients with T2DM have myocardial perfusion defects or coronary artery disease and are not recognized by traditional risk factors. The third harmonic of radial pulse has been proved a risk factor for myocardial ischemia. We sought to further investigate if the third harmonic phase of the radial pulse(P3) could be an independent predictor of ACE and cardiac dysfunction in asymptomatic T2DM patients. The study consisted of 1968 asymptomatic T2DM patients who had no history of angina and cardiovascular disease. We conducted the pulse wave measurement at baseline and dived the enrolled patients into quartile groups based on P3 value(>3.2, 3.0 to 3.2, 2.7 to 3.0, and <2.7). Participated patients received an average of 1.8 years of follow-up. To assess the risk of ACE , the primary outcomes were the composite of myocardial infarction, heart failure, and cardiovascular death. To measure the risk of cardiac dysfunction, the secondary outcomes were composed of newly discovered single or multi coronary stenosis, myocardial ischemia, and left ventricular dysfunciton. Cox proportional hazards model were used. Reference to patients with P3>3.2, the hazard ratios(HR) of patients with P3<2.7 were as follows: (1) myocardial infarction(HR, 1.98; 95% CI, 1.32-2.98), heart failure(HR, 1.64; 95% CI, 0.88-3.06), and cardiovascular death(HR, 3.51; 95% CI, 0.73-16.9); (2) Single coronary stenosis(HR, 10.1; 95% CI, 1.29-78.7), multi coronary stenosis(HR, 9.06; 95% CI, 1.15-71.5), myocardial ischemia(HR, 3.05; 95% CI, 1.37-6.80), and low left ventricular ejection fraction(HR, 2.09; 95% CI, 1.13-38.7). The trend analysis further demonstrated that the reducing P3 leads to higher incidence of both primary and secondary composite outcomes(P<0.001). After adjusting for age, gender, smoking, systolic blood pressure, dyslipidemia, duration of diabetes, and Hba1c, P3 was still an independent predictor of ACE and cardiac dysfunction (P trend <0.005). Conclusively, this report suggested that P3 provides independent predictive value for risk assessment of ACE and cardiac dysfunction in asymptomatic patients with T2DM.

Abstract 176: The Effects of Age, Menopause, and Body Mass Index on Blood Pressure and Radial Pulse Wave in Women

Age, gender, and body mass index (BMI) play an important roles in cardiovascular risk. However, the independent effects of menopause on the ventricular-arterial system in female individuals have not been fully investigated. Thus, this study aimed to assess the effect of age, menopause and body mass index on different hemodynamic parameters including systolic blood pressure (SBP), diastolic blood pressure (DBP) and harmonics of radial pulse wave. This study enrolled 327 female subjects(230 pre-menopausal and 97 post-menopausal), aged 20-87 and without cardiovascular history. SBP and DBP were evaluated by an automatic blood pressure monitor. A 12-second continuous radial pulse data was recorded using medical grade pulse measuring instrument and standard protocol. Spectrum analysis of radial pressure wave was calculated and transformed into first five harmonic amplitudes(C1~C5). We further performed multivariable linear regression models to assess the independent effects of age, menopause, and body mass index on SBP, DBP, and C1 to C5 respectively. The mean age, BMI, SBP, and DBP in enrolled subjects were 43±13 yeas, 23±4 kg/m 2 , 116±16 mmHg, and 69±11 mmHg. Regression analysis demonstrated that age was positively correlated with SBP(P<0.001), whereas effect of age exerted no significant influence on DBP. BMI had positive associations with SBP and DBP(P<0.001), while menopause had no significant effect on neither SBP nor DBP. Multivariable linear regression showed that menopause had significant effects on C1 (P<0.05) and C3 (P<0.05). C1 is associated with atherosclerosis and is an independent risk predictor for adverse cardiac events. We proposed that an increase in cardiovascular risk during menopause may be due to hormonal changes exacerbating the progression of atherosclerosis and reflected in the radial pulse spectrum. Conclusively, this study demonstrates that age and BMI have an independent effect on SBP, whereas menopause has no significant independent effect on SBP. The effects of menopause on C1 and C3, independent of age and BMI, may partially explain the reasons of dramatically increased cardiovascular risk during menopause and provide clues to the underlying mechanisms of the change in cardiovascular system.

Fourth harmonic of radial pulse wave predicts adverse cardiac events in asymptomatic patients with type 2 diabetes

AIMS

Studies have shown that the fourth harmonic of the radial pulse wave (C4) is associated with atherosclerotic processes and myocardial ischemia. We sought to investigate whether C4 is an independent predictor of adverse cardiac events (ACE).

METHODS

The baseline C4 is calculated using the Fourier series method. 1968 asymptomatic patients with type 2 diabetes were followed up for 1.8 ± 0.4 years and survival analysis were performed using Cox proportional hazard model.

RESULTS

The Cox regression analysis showed that the C4 value is independent and inversely related to ACE both before and after adjusting for age, sex, smoke, systolic blood pressure, dyslipidemia, and Hba1c. (P for trend < 0.001) CONCLUSIONS: Decreasing C4 is associated with an increased risk of ACE in asymptomatic patients with type 2 diabetes.

Impact of emotional and motivational regulation on putting performance: a frontal alpha asymmetry study

Background

The efficacy of emotional and motivational regulation can determine athletic performance. Giving the short duration and fast changing nature of emotions experienced by athletes in competition, it is important to examine the temporal dynamics of emotional and motivational regulation. The aim of this study was to investigate emotional and motivational regulation as measured by frontal alpha asymmetry in skilled golfers during putting performance after a performance failure.

Methods

Twenty skilled university golfers were recruited and requested to perform 40 putts at an individualized difficulty level of 40-60% successful putting rate. Trials immediately after a failed putt were selected for analysis. Successful performances were those trials where a hole was and unsuccessful performances were those that failed. The frontal alpha asymmetry index of LnF4-LnF3 was derived for statistical analysis.

Results

(1) Successful performance was preceded by a larger frontal alpha asymmetry index at T2 than that of T1, and (2) a larger frontal alpha asymmetry index was observed for unsuccessful performance than for successful performance at T1.

Discussion

The results suggest that successful emotional and motivational regulation was characterized by a progressive increase of frontal alpha asymmetry, which led to subsequent putting success when facing an emotionally provocative putting failure. These findings shed light on the application of frontal alpha asymmetry for the understanding and enhancement of emotional and motivational regulation during sport performance.

Approval of modified-release products by FDA without clinical efficacy/safety studies: A retrospective survey from 2008 to 2017

In principle, approval of a modified-release (MR) drug product is based on evidence from pharmacokinetic (PK) and/or pharmacodynamic studies and clinical efficacy/safety studies. The purpose of this survey is (i) to explore the number of new drug applications (NDAs) of MR drug products, approved by the FDA, employ the PK study as a bridge to already-approved immediate-release drug products without conducting their own clinical efficacy/safety studies; and (ii) to understand the type of PK studies are required for such NDAs. To this end, we surveyed the approved records of MR drug products from 2008 to 2017 from the Drug@FDA website, and filtered pertinent information from FDA's assessment reports. A total of five out of 79 products were found. A single dose PK study was conducted to investigate the underlying drug release mechanisms in four of these products. For these products, the applicants also performed multiple dose PK equivalence studies, but the PK parameters used to support the equivalence were different among studies. Information regarding the exposure-response relationship was available for all selected products, which is fundamental for such cases. Although the difference in PK curve shapes is recognized as being critical for the clinical effectiveness, this evaluation was not performed in all selected cases, as indicated in FDA's assessment reports.

The effect of radial pulse spectrum on the risk of major adverse cardiovascular events in patients with type 2 diabetes

Radial pulse spectrum has been shown to correlate with coronary stenosis in patients with type 2 diabetes mellitus (T2DM). In academia, it has not been demonstrated that the radial artery pulse spectrum is an independent risk factor for major adverse cardiovascular events (MACE), including myocardial infarction, stroke, and all-cause mortality. The primary objective of this study is to assess the risk of MACE, in patients with T2DM and to determine if an increase in MACE would be associated with a first harmonic (C1) increase in the radial artery pulse. 1972 consecutive patients with T2DM were enrolled. All subjects received measurements of radial pulse waves at baseline. Harmonic analysis of radial pressure wave was performed. The hazard ratios for MACE and its 95% confident interval were estimated using Cox proportional hazard model. The follow-up period lasted for one year. MACE was detected in 232 (11.8%) of those with T2DM. The log-rank test demonstrated that the cumulative incidence of patients with C1 above 0.96 was greater than those with C1 bellow 0.96. Comparing the patients with C1 smaller than first quartile to the patients with C1 greater than third quartile, higher C1 increased the cardiovascular risks as follows: MACE (Hazard ratio,1.93; 95% CI,1.31-2.86), stroke (Hazard ratio, 1.61; 95% CI, 0.90-2.90), myocardial infarction (Hazard ratio, 2.23; 95% CI, 1.33-3.74). The risk for the composite MACE increased continuously as C1 increased (P < 0.001 for trend). The hazard ratio and trend for all-cause mortality were not significant. Increased C1 resulted in increased risk for nonfatal stroke, and nonfatal myocardial infarction among patients with T2DM. Our results indicate that the degree of C1 is a risk factor for nonfatal MACE. Therefore, the radial pulse spectrum could identify patients with T2DM at high risk of nonfatal MACE.

Cancer is not a risk factor for bullous pemphigoid: 10-year population-based cohort study

BACKGROUND

Bullous pemphigoid (BP) is the most common autoimmune bullous disease. Whether there is an increased risk for subsequent BP among patients with cancer is still unclear.

OBJECTIVES

To evaluate the risk for subsequent BP in patients with cancer.

METHODS

This nationwide population-based cohort study was based on data obtained from the Taiwan National Health Insurance Database between 2000 and 2011. A total of 36 838 patients with cancer and 147 352 age-, sex- and index-date-matched controls were recruited. The hazard ratio (HR) of subsequent BP in the patients with cancer was analysed using a Fine-Gray competing risk regression model with mortality as the competing event.

RESULTS

The incidence of BP per 100 000 person-years was 17·2 in the patients with cancer and 19·8 in the controls; therefore, the crude incidence rate ratio was 0·87 [95% confidence interval (CI) 0·53-1·36]. The HR of subsequent BP in the patients with cancer was 0·47 (95% CI 0·23-0·94) using the Fine-Gray competing risk regression model. Age (HR 1·05, 95% CI 1·03-1·07), diabetes mellitus (HR 1·69, 95% CI 1·10-2·59) and cerebrovascular disease (HR 2·14, 95% CI 1·36-3·34) were independent risk factors for BP.

CONCLUSIONS

The incidence of BP in patients with cancer was not higher than in the control group. Cancer is not a risk factor for BP.

Measurement of the Dynamical Structure Factor of a 1D Interacting Fermi Gas

We present measurements of the dynamical structure factor S(q,ω) of an interacting one-dimensional Fermi gas for small excitation energies. We use the two lowest hyperfine levels of the ^{6}Li atom to form a pseudospin-1/2 system whose s-wave interactions are tunable via a Feshbach resonance. The atoms are confined to one dimension by a two-dimensional optical lattice. Bragg spectroscopy is used to measure a response of the gas to density ("charge") mode excitations at a momentum q and frequency ω, as a function of the interaction strength. The spectrum is obtained by varying ω, while the angle between two laser beams determines q, which is fixed to be less than the Fermi momentum k_{F}. The measurements agree well with Tomonaga-Luttinger theory.

Effects of a Fixed-Dose Co-Formulation of Daclatasvir, Asunaprevir, and Beclabuvir on the Pharmacokinetics of a Cocktail of Cytochrome P450 and Drug Transporter Substrates in Healthy Subjects

Background

A fixed-dose combination of daclatasvir (DCV; hepatitis C virus NS5A inhibitor), asunaprevir (ASV; non-structural protein 3 inhibitor), and beclabuvir (BCV; non-structural protein 5B inhibitor) is approved in Japan for hepatitis C virus genotype 1.

Objective

The objective of this study was to assess the combination’s drug–drug interaction potential in vivo using a validated cocktail of eight cytochrome P450 (CYP) and transporter probes.

Methods

We conducted an open-label single-sequence study in healthy adults (n = 20) given single-dose caffeine (CYP1A2 substrate), metoprolol (CYP2D6), flurbiprofen (CYP2C9), montelukast (CYP2C8), omeprazole (CYP2C19), midazolam (CYP3A4), digoxin (P-glycoprotein), and pravastatin (organic anion-transporting polypeptide), alone or with steady-state twice-daily DCV/ASV/BCV 30/200/75 mg (with or without additional BCV 75 mg to adjust for higher exposure in hepatitis C virus infection).

Results

Daclatasvir/asunaprevir/beclabuvir did not affect CYP1A2, CYP2C8, or CYP2C9; the probe maximum observed concentration and area under the concentration–time curve extrapolated to infinite time geometric mean ratios and 90% confidence intervals were all within the 0.8–1.25 bioequivalence range. Beclabuvir showed moderate dose-dependent CYP2C19 induction; omeprazole maximum observed concentration and area under the concentration–time curve from 0 to the last quantifiable concentration were lower with additional BCV [geometric mean ratio 0.36 (90% confidence interval 0.23–0.55) and 0.34 (0.25–0.46), respectively] than without [0.57 (0.42–0.78), 0.48 (0.39–0.59)]. Weak-to-moderate CYP3A4 induction was observed, plus weak CYP2D6, P-glycoprotein, and organic anion-transporting polypeptide inhibition [maximum observed concentration and area under the concentration–time curve extrapolated to infinite time without additional BCV: midazolam 0.57 (0.50–0.65), 0.53 (0.47–0.60); metoprolol 1.40 (1.20–1.64), 1.71 (1.49–1.97); digoxin 1.23 (1.12–1.35), 1.23 (1.17–1.29); pravastatin 2.01 (1.63–2.47), 1.68 (1.43–1.97)].

Conclusions

No dose adjustments with DCV/ASV/BCV are indicated for CYP1A2, CYP2C8, CYP2C9, or P-glycoprotein substrates. CYP3A4, CYP2D6, and OATP substrates should be co-administered with caution. Co-administration with agents solely metabolized by CYP2C19 is not recommended.

Electronic supplementary material

The online version of this article (10.1007/s40268-017-0222-8) contains supplementary material, which is available to authorized users.

External light activates hair follicle stem cells through eyes via an ipRGC-SCN-sympathetic neural pathway

Changes in external light patterns can alter cell activities in peripheral tissues through slow entrainment of the central clock in suprachiasmatic nucleus (SCN). It remains unclear whether cells in otherwise photo-insensitive tissues can achieve rapid responses to changes in external light. Here we show that light stimulation of animals' eyes results in rapid activation of hair follicle stem cells with prominent hair regeneration. Mechanistically, light signals are interpreted by M1-type intrinsically photosensitive retinal ganglion cells (ipRGCs), which signal to the SCN via melanopsin. Subsequently, efferent sympathetic nerves are immediately activated. Increased norepinephrine release in skin promotes hedgehog signaling to activate hair follicle stem cells. Thus, external light can directly regulate tissue stem cells via an ipRGC-SCN autonomic nervous system circuit. Since activation of sympathetic nerves is not limited to skin, this circuit can also facilitate rapid adaptive responses to external light in other homeostatic tissues.

Interaction of poly-l-lysine coating and heparan sulfate proteoglycan on magnetic nanoparticle uptake by tumor cells

Background

Poly-l-lysine (PLL) enhances nanoparticle (NP) uptake, but the molecular mechanism remains unresolved. We asked whether PLL may interact with negatively charged glycoconjugates on the cell surface and facilitate uptake of magnetic NPs (MNPs) by tumor cells.

Methods

PLL-coated MNPs (PLL-MNPs) with positive and negative ζ-potential were prepared and characterized. Confocal and transmission electron microscopy was used to analyze cellular internalization of MNPs. A colorimetric iron assay was used to quantitate cell-associated MNPs (MNP_cell).

Results

Coadministration of PLL and dextran-coated MNPs in culture enhanced cellular internalization of MNPs, with increased vesicle size and numbers/cell. MNP_cell was increased by eight- to 12-fold in response to PLL in a concentration-dependent manner in human glioma and HeLa cells. However, the application of a magnetic field attenuated PLL-induced increase in MNP_cell. PLL-coating increased MNP_cell regardless of ζ-potential of PLL-MNPs, whereas magnetic force did not enhance MNP_cell. In contrast, epigallocatechin gallate and magnetic force synergistically enhanced PLL-MNP uptake. In addition, heparin, but not sialic acid, greatly reduced the enhancement effects of PLL; however, removal of heparan sulfate from heparan sulfate proteoglycans of the cell surface by heparinase III significantly reduced MNP_cell.

Conclusion

Our results suggest that PLL-heparan sulfate proteoglycan interaction may be the first step mediating PLL-MNP internalization by tumor cells. Given these results, PLL may facilitate NP interaction with tumor cells via a molecular mechanism shared by infection machinery of certain viruses.

REST reduction is essential for hypoxia-induced neuroendocrine differentiation of prostate cancer cells by activating autophagy signaling

Prostate cancer (PCa) with neuroendocrine differentiation (NED) is tightly associated with hormone refractory PCa (HRPC), an aggressive form of cancer that is nearly impossible to treat. Determining the mechanism of the development of NED may yield novel therapeutic strategies for HRPC. Here, we first demonstrate that repressor element-1 silencing transcription factor (REST), a transcriptional repressor of neuronal genes that has been implicated in androgen-deprivation and IL-6 induced NED, is essential for hypoxia-induced NED of PCa cells. Bioinformatics analysis of transcriptome profiles of REST knockdown during hypoxia treatment demonstrated that REST is a master regulator of hypoxia-induced genes. Gene set enrichment analysis (GSEA) of hypoxia and REST knockdown co-upregulated genes revealed their correlation with HRPC. Consistently, gene ontology (GO) analysis showed that REST reduction potential associated with hypoxia-induced tumorigenesis, NE development, and AMPK pathway activation. Emerging reports have revealed that AMPK activation is a potential mechanism for hypoxia-induced autophagy. In line with this, we demonstrate that REST knockdown alone is capable of activating AMPK and autophagy activation is essential for hypoxia-induced NED of PCa cells. Here, making using of in vitro cell-based assay for NED, we reveal a new role for the transcriptional repressor REST in hypoxia-induced NED and characterized a sequential molecular mechanism downstream of REST resulting in AMPK phosphorylation and autophagy activation, which may be a common signaling pathway leading to NED of PCa.

A pilot study on the Chinese Minnesota Multiphasic Personality Inventory-2 in detecting feigned mental disorders: Simulators classified by using the Structured Interview of Reported Symptoms

The Minnesota Multiphasic Personality Inventory-2 (MMPI-2) is often used in forensic psychological/psychiatric assessment. This was a pilot study on the utility of the Chinese MMPI-2 in detecting feigned mental disorders. The sample consisted of 194 university students who were either simulators (informed or uninformed) or controls. All the participants were administered the Chinese MMPI-2 and the Structured Interview of Reported Symptoms-2 (SIRS-2). The results of the SIRS-2 were utilized to classify the participants into the feigning or control groups. The effectiveness of eight detection indices was investigated by using item analysis, multivariate analysis of covariance (MANCOVA), and receiver operating characteristic (ROC) analysis. Results indicated that informed-simulating participants with prior knowledge of mental disorders did not perform better in avoiding feigning detection than uninformed-simulating participants. In addition, the eight detection indices of the Chinese MMPI-2 were effective in discriminating participants in the feigning and control groups, and the best cut-off scores of three of the indices were higher than those obtained from the studies using the English MMPI-2. Thus, in this sample of university students, the utility of the Chinese MMPI-2 in detecting feigned mental disorders was tentatively supported, and the Chinese Infrequency Scale (ICH), a scale developed specifically for the Chinese MMPI-2, was also supported as a valid scale for validity checking.

Assessing bioequivalence of generic modified-release antiepileptic drugs

OBJECTIVES

The purpose of this study was to determine how closely generic modified-release antiepileptic drugs (MR-AEDs) resemble reference (brand) formulations by comparing peak concentrations (Cmax), total absorption (area under the curve [AUC]), time to Cmax (Tmax), intersubject variability, and food effects between generic and reference products.

METHODS

We tabulated Cmax and AUC data from the bioequivalence (BE) studies used to support the approvals of generic Food and Drug Administration-approved MR-AEDs. We compared differences in 90% confidence intervals of the generic/reference AUC and Cmax geometric mean ratios, and intersubject variability, Tmax and delivery profiles and food effects.

RESULTS

Forty-two MR-AED formulations were studied in 3,175 healthy participants without epilepsy in 97 BE studies. BE ratios for AUC and Cmax were similar between most generic and reference products: AUC ratios varied by >15% in 11.4% of BE studies; Cmax varied by >15% in 25.8% of studies. Tmax was more variable, with >30% difference in 13 studies (usually delayed in the fed compared to fasting BE studies). Generic and reference MR products had similar intersubject variability. Immediate-release AEDs showed less intersubject variability in AUC than did MR-AEDs.

CONCLUSIONS

Most generic and reference MR-AEDs have similar AUC and Cmax values. Ratios for some products, however, are near acceptance limits and Tmax values may vary. Food effects are common with MR-AED products. High variability in pharmacokinetic values for once-a-day MR-AEDs suggests their major advantage compared to immediate-release AED formulations may be the convenience of less frequent dosing to improve adherence.

Differences between Total Intravenous Anesthesia and Inhalation Anesthesia in Free Flap Surgery of Head and Neck Cancer

BACKGROUND

Many studies have evaluated risk factors associated with complications after free flap surgery, but these studies did not evaluate the impact of anesthesia management. The goal of the current study was to evaluate the differences between patients who received inhalation and total intravenous anesthesia (TIVA) in free flap surgery.

METHODS

One hundred and fifty-six patients who underwent free flap surgery for head and neck cancer were retrospectively divided into the TIVA (96 patients) and the inhalation group (87 patients). Perioperative hemodynamic data and postoperative medical complications were determined by documented medical records.

RESULTS

Ninety-six patients in the TIVA group were compared with 87 patients who received inhalation anesthesia. There were no differences in gender, age, classification of physical status based on American Society for Anesthesiologists (ASA) score, and cormobidities between the two groups. Patients in the TIVA group required less perioperative crystalloid (4172.46 ± 1534.95 vs. 5183.91 ± 1416.40 ml, p < 0.0001) and colloid (572.46 ± 335.14 vs. 994.25 ± 434.65 ml, p < 0.0001) to maintain hemodynamic stability. Although the mean anesthesia duration was shorter in the TIVA group (11.02 ± 2.84 vs. 11.70± 1.96 hours, p = 0.017), the blood loss was similar between groups (p = 0.71). There was no difference in surgical complication rate, but patients in the TIVA group developed fewer pulmonary complications (18 vs. 47, p = 0.0008). After multivariate regression, patients in the TIVA group had a significantly reduced risk of pulmonary complication compared with the inhalation group (Odds ratio 0.41, 95% CI 0.18-0.92).

CONCLUSIONS

Total intravenous anesthesia was associated with significantly fewer pulmonary complications in patients who received free flap reconstruction.

Hes1 Increases the Invasion Ability of Colorectal Cancer Cells via the STAT3-MMP14 Pathway

The Notch pathway contributes to self-renewal of tumor-initiating cell and inhibition of normal colonic epithelial cell differentiation. Deregulated expression of Notch1 and Jagged1 is observed in colorectal cancer. Hairy/enhancer of split (HES) family, the most characterized targets of Notch, involved in the development of many cancers. In this study, we explored the role of Hes1 in the tumorigenesis of colorectal cancer. Knocking down Hes1 induced CRC cell senescence and decreased the invasion ability, whereas over-expression of Hes1 increased STAT3 phosphorylation activity and up-regulated MMP14 protein level. We further explored the expression of Hes1 in human colorectal cancer and found high Hes1 mRNA expression is associated with poor prognosis in CRC patients. These findings suggest that Hes1 regulates the invasion ability through the STAT3-MMP14 pathway in CRC cells and high Hes1 expression is a predictor of poor prognosis of CRC.

Prevalence of different forms of child maltreatment among Taiwanese adolescents: a population-based study

Reported cases of child maltreatment are increasing in Taiwan. Yet, comprehensive epidemiological characteristics of adolescents' exposure over the wide spectrum of violence are still lacking. The purpose of this study was to estimate the prevalence and magnitude of child maltreatment among Taiwanese adolescents. A population-based study was conducted with 5,276 adolescents aged 12-18 from 35 schools in 17 cities and townships to determine the prevalence of five forms of child maltreatment in Taiwan. A total of 5,236 adolescents completed anonymous, self-report, structured questionnaires. Most adolescents (91%, n=4,788) experienced at least one form of maltreatment with 83% (n=4,347) exposed during the previous year. Violence exposure was the most common type of child maltreatment experienced, followed by psychological abuse, physical abuse, neglect, and sexual abuse. Adolescents reported an average of 7.4 (SD=5.87) victimizations over their lifetime and 4.8 (SD=4.82) victimizations during the past year. Females reported a higher rate of neglect, while males reported a higher rate of sexual abuse. Most of the sexual abuse perpetrators were known by their victims. Adolescents' victimization and polyvictimization from child maltreatment in Taiwan deserves a review and modification of national control and prevention policies.

Autophagy pathway is required for IL-6 induced neuroendocrine differentiation and chemoresistance of prostate cancer LNCaP cells

Prostate cancer (PCa) cells undergoing neuroendocrine differentiation (NED) are clinically relevant to the development of relapsed castration-resistant PCa. Increasing evidences show that autophagy involves in the development of neuroendocrine (NE) tumors, including PCa. To clarify the effect of autophagy on NED, androgen-sensitive PCa LNCaP cells were examined. Treatment of LNCaP cells with IL-6 resulted in an induction of autophagy. In the absence of androgen, IL-6 caused an even stronger activation of autophagy. Similar result was identified in NED induction. Inhibition of autophagy with chloroquine (CQ) markedly decreased NED. This observation was confirmed by beclin1 and Atg5 silencing experiments. Further supporting the role of autophagy in NED, we found that LC3 was up-regulated in PCa tissue that had relapsed after androgen-deprivation therapy when compared with their primary tumor counterpart. LC3 staining in relapsed PCa tissue showed punctate pattern similar to the staining of chromogranin A (CgA), a marker for NED cells. Moreover, autophagy inhibition induced the apoptosis of IL-6 induced NE differentiated PCa cells. Consistently, inhibition of autophagy by knockdown of beclin1 or Atg5 sensitized NE differentiated LNCaP cells to etoposide, a chemotherapy drug. To identify the mechanisms, phosphorylation of IL-6 downstream targets was analyzed. An increase in phospho-AMPK and a decrease in phospho-mTOR were found, which implies that IL-6 regulates autophagy through the AMPK/mTOR pathway. Most important to this study is the discovery of REST, a neuronal gene-specific transcriptional repressor that is involved in autophagy activation. REST was down-regulated in IL-6 treatment. Knockdown experiments suggest that REST is critical to NED and autophagy activation by IL-6. Together, our studies imply that autophagy is involved in PCa progression and plays a cytoprotective role when NED is induced in PCa cells by IL-6 treatment. These results reveal the potential of targeting autophagy as part of a combined therapeutic regime for NE tumors.

Associations of cyclooxygenase 2 polymorphic genotypes with bladder cancer risk in Taiwan

AIM

Bladder cancer is the sixth most common cancer worldwide and its incidence is particularly high in southwestern Taiwan. However, the genetic contribution to its etiology is not well-understood. The aim of this study is to evaluate the association of cyclooxygenase 2 (Cox-2) polymorphic genotypes with Taiwan bladder cancer patients.

MATERIALS AND METHODS

Six polymorphic variants of Cox-2 were analyzed regarding their association with bladder cancer risk, and three hundred and seventy-five patients with bladder cancer and same amount of age- and gender-matched healthy controls recruited were genotyped by the PCR-RFLP method.

RESULTS

Among the six polymorphic sites examined, only the Cox-2 promoter G-765C (rs20417) genotypes were positively associated with bladder cancer risk (p=0.0102). Individuals with the Cox-2 -765GC genotypes were associated with higher prostate cancer risk than those with -765GG.

CONCLUSION

Our findings provide evidence that the C allele of Cox-2 promoter G-765C may be associated with the overexpression of COX-2 during bladder cancer development and may be a useful marker for the early detection of bladder cancer.