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This study examined the pattern of medical utilization and the distribution of comorbidities shortly before death among adolescents who died from suicide and compared these data with those of living controls.
Methods
From Taiwan's National Health Insurance Research Database, this study identified adolescents aged 10–19 years who died from suicide (n = 935) between 1 January 2000, and 31 December 2016, by linking each patient with the national mortality database. The researchers conducted a nested case–control study through risk set sampling, and for each case, 20 age- and sex-matched controls (n = 18 700) were selected from the general population. The researchers applied conditional logistic regression to investigate differences in medical utilization and physical and psychiatric comorbidities between cases and controls.
Results
Cases had a higher proportion of contact with the psychiatric department but a similar proportion of contact with any non-psychiatric medical department within 1 year before suicide compared with controls. There were 18.6% of adolescent suicide victims who only had contacted with a psychiatric department 3 months before suicide. Moreover, cases had a higher proportion of contact with non-psychiatric services within 3 months before suicide, particularly with emergency, surgery, and internal medicine departments. Cases had higher risks of several psychiatric disorders and physical illnesses, including heart diseases, pneumonia, and ulcer disease, than did controls.
Conclusions
The findings of increased medical utilization and higher risks of physical and psychiatric comorbidities in adolescent suicide victims are crucial for developing specific interventions to prevent suicide in this population.
Cognitive impairment is common in late-life depression, which may increase Alzheimer disease (AD) risk. Therefore, we aimed to investigate whether late-life major depressive disorder (MDD) has worse cognition and increases the characteristic AD neuropathology. Furthermore, we carried out a comparison between treatment-resistant depression (TRD) and non-TRD. We hypothesized that patients with late-life depression and TRD may have increased β-amyloid (Aβ) deposits in brain regions responsible for global cognition.
Methods
We recruited 81 subjects, including 54 MDD patients (27 TRD and 27 non-TRD) and 27 matched healthy controls (HCs). Neurocognitive tasks were examined, including Mini-Mental State Examination and Montreal Cognitive Assessment to detect global cognitive functions. PET with Pittsburgh compound-B and fluorodeoxyglucose were used to capture brain Aβ pathology and glucose use, respectively, in some patients.
Results
MDD patients performed worse in Montreal Cognitive Assessment (p = 0.003) and had more Aβ deposits than HCs across the brain (family-wise error-corrected p < 0.001), with the most significant finding in the left middle frontal gyrus. Significant negative correlations between global cognition and prefrontal Aβ deposits existed in MDD patients, whereas positive correlations were noted in HCs. TRD patients had significantly more deposits in the left-sided brain regions (corrected p < 0.001). The findings were not explained by APOE genotypes. No between-group fluorodeoxyglucose difference was detected.
Conclusions
Late-life depression, particularly TRD, had increased brain Aβ deposits and showed vulnerability to Aβ deposits. A detrimental role of Aβ deposits in global cognition in patients with late-onset or non-late-onset MDD supported the theory that late-life MDD could be a risk factor for AD.
Despite the fact that social deficits among individuals with autism spectrum disorder (ASD) are lifelong and impact many aspects of personal functioning, evidence-based programs for social skills training were not available until recently. The Program for the Education and Enrichment of Relational Skills (PEERS®) has been shown to effectively improve social skills for adolescents on the spectrum across different social cultures. However, the effectiveness for young adults beyond North America has yet to be examined. This study aimed to investigate the effectiveness of the PEERS intervention in Taiwanese young adults with ASD, and examine its durability and clinical correlates.
Methods
We recruited 82 cognitively-able young adults with ASD, randomized to the PEERS treatment or treatment-as-usual.
Results
Following treatment, significant improvement was found in aspects of social deficits, autism severity, social interaction anxiety, empathy, and social skills knowledge either by self-report or coach-report. Additionally, communicative behaviors rated by observers improved throughout the sessions, showing a trend toward more appropriate eye contact, gestures, facial expression during conversation, and appropriate maintenance of conversation and reciprocity. Most effects maintained at 3-month and 6-month follow-ups. The improvement of social deficits was positively correlated with baseline severity, while gains in social skills knowledge were positively correlated with IQ. The improvement of social deficits, autism severity, and empathy were positively correlated with each other.
Conclusion
Overall, the PEERS intervention appears to effectively improve social functioning in Taiwanese young adults with ASD. Improvement of social response and knowledge may be predicted by baseline severity and intelligence respectively.
Attention-deficit/hyperactivity disorder (ADHD) is associated with a higher risk of burn injury than in the normal population. Nevertheless, the influence of methylphenidate (MPH) on the risk of burn injury remains unclear. This retrospective cohort study analysed the effect of MPH on the risk of burn injury in children with ADHD.
Method
Data were from Taiwan's National Health Insurance Research Database (NHIRD). The sample comprised individuals younger than 18 years with a diagnosis of ADHD (n = 90 634) in Taiwan's NHIRD between January 1996 and December 2013. We examined the cumulative effect of MPH on burn injury risk using Cox proportional hazards models. We conducted a sensitivity analysis for immortal time bias using a time-dependent Cox model and within-patient comparisons using the self-controlled case series model.
Results
Children with ADHD taking MPH had a reduced risk of burn injury, with a cumulative duration of treatment dose-related effect, compared with those not taking MPH. Compared with children with ADHD not taking MPH, the adjusted hazard ratio for burn injury was 0.70 in children taking MPH for <90 days (95% confidence interval (CI) 0.64–0.77) and 0.43 in children taking MPH for ≥90 days (95% CI 0.40–0.47), with a 50.8% preventable fraction. The negative association of MPH was replicated in age-stratified analysis using time-dependent Cox regression and self-controlled case series models.
Conclusion
This study showed that MPH treatment was associated with a lower risk of burn injury in a cumulative duration of treatment dose-related effect manner.
Research suggests an association between metabolic disorders, such as type 2 diabetes mellitus (T2DM), and schizophrenia. However, the risk of metabolic disorders in the unaffected siblings of patients with schizophrenia remains unclear.
Methods
Using the Taiwan National Health Insurance Research Database, 3135 unaffected siblings of schizophrenia probands and 12,540 age-/sex-matched control subjects were included and followed up to the end of 2011. Individuals who developed metabolic disorders during the follow-up period were identified.
Results
The unaffected siblings of schizophrenia probands had a higher prevalence of T2DM (3.4% vs. 2.6%, p = 0.010) than the controls. Logistic regression analyses with the adjustment of demographic data revealed that the unaffected siblings of patients with schizophrenia were more likely to develop T2DM (odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.10–1.75) later in life compared with the control group. Moreover, only female siblings of schizophrenia probands had an increased risk of hypertension (OR: 1.47, 95% CI: 1.07–2.01) during the follow-up compared with the controls.
Discussion
The unaffected siblings, especially sisters, of schizophrenia probands had a higher prevalence of T2DM and hypertension compared with the controls. Our study revealed a familial link between schizophrenia and T2DM in a large sample. Additional studies are required to investigate the shared pathophysiology of schizophrenia and T2DM.
Systemic lupus erythematosus (SLE) is an autoimmune disease that is characterised by a dysregulation of the immune system, which causes inflammation responses, excessive oxidative stress and a reduction in the number of cluster of differentiation (CD)4+CD25+forkhead box P3 (FoxP3)+ T cells. Supplementation with certain Lactobacillus strains has been suggested to be beneficial in the comprehensive treatment of SLE. However, little is known about the effect and mechanism of certain Lactobacillus strains on SLE. To investigate the effects of Lactobacillus on SLE, NZB/W F1 mice were orally gavaged with Lactobacillus paracasei GMNL-32 (GMNL-32), Lactobacillus reuteri GMNL-89 (GMNL-89) and L. reuteri GMNL-263 (GMNL-263). Supplementation with GMNL-32, GMNL-89 and GMNL-263 significantly increased antioxidant activity, reduced IL-6 and TNF-α levels and significantly decreased the toll-like receptors/myeloid differentiation primary response gene 88 signalling in NZB/W F1 mice. Notably, supplementation with GMNL-263, but not GMNL-32 and GMNL-89, in NZB/W F1 mice significantly increased the differentiation of CD4+CD25+FoxP3+ T cells. These findings reveal beneficial effects of GMNL-32, GMNL-89 and GMNL-263 on NZB/W F1 mice and suggest that these specific Lactobacillus strains can be used as part of a comprehensive treatment of SLE patients.
Probiotics are known to regulate host immunity by interacting with systemic and mucosal immune cells as well as intestinal epithelial cells. Supplementation with certain probiotics has been reported to be effective against various disorders, including immune-related diseases. However, little is known about the effectiveness of Lactobacillus paracasei GMNL-32 (GMNL-32), Lactobacillus reuteri GMNL-89 (GMNL-89) and L. reuteri GMNL-263 (GMNL-263) in the management of autoimmune diseases, especially systemic lupus erythematosus (SLE). NZB/W F1 mice, which are a lupus-prone animal model, were orally gavaged with GMNL-32, GMNL-89 or GMNL-263 to investigate the effects of these Lactobacillus strains on liver injuries in NZB/W F1 mice. The results thus obtained reveal that supplementary GMNL-32, GMNL-89 or GMNL-263 in NZB/W F1 mice ameliorates hepatic apoptosis and inflammatory indicators, such as matrix metalloproteinase-9 activity and C-reactive protein and inducible nitric oxide synthase expressions. In addition, supplementation with GMNL-32, GMNL-89 or GMNL-263 in NZB/W F1 mice reduced the expressions of hepatic IL-1β, IL-6 and TNF-α proteins by suppressing the mitogen-activated protein kinase and NF-κB signalling pathways. These findings, presented here for the first time, reveal that GMNL-32, GMNL-89 and GMNL-263 mitigate hepatic inflammation and apoptosis in lupus-prone mice and may support an alternative remedy for liver disorders in cases of SLE.
This study examines the relationship between Islam and democracy with emphasis on the issue of whether and how Islam has bearings on democratic adjustment speed. Using comprehensive data on 17 Asian countries from 1996 to 2010, the study demonstrates that religion is a significant factor for determining democracy. Results indicate that the level of democracy in Islamic countries is generally lower than that in non-Islamic countries. However, the level of democracy in Islamic countries exhibits an upward trend, whereas that in non-Islamic countries displays a downward trend. Moreover, when benchmark variables are controlled, democratic adjustment in Islamic countries is faster than in non-Islamic countries. Hence, despite the current lower level of democracy in Islamic countries, the results of this study refute the conventional wisdom that Islam hinders democracy. Instead, Islamic countries are highly malleable and exhibit a potential for faster democratic development compared with non-Islamic countries. Results further suggest that Islamic countries can effectively promote democracy by improving education, minimizing the gender gap, controlling population growth, or becoming an oil exporter similar to non-Islamic countries. However, Islamic countries likely own an additional unique advantage in effectively improving democracy – that is, promoting urbanization. This aspect is in contrast to non-Islamic countries where urbanization plays no role in determining democracy.
This study presents a numerical solution to the three-dimensional solute transport in heterogeneous media by using a layer-integrated approach. Omitting vertical spatial variation of soil and hydraulic properties within each layer, a three-dimensional solute transport can be simplified as a quasi-three-dimensional solute transport which couples a horizontal two-dimensional simulation and a vertical one-dimensional computation. The finite analytic numerical method was used to discretize the derived two-dimensional governing equation. A quadratic function was used to approximate the vertical one-dimensional concentration distribution in the layer to ensure the continuity of concentration and flux at the interface between the adjacent layers. By integration over each layer, a set of system of equations can be generated for a single column of vertical cells and solved numerically to give the vertical solute concentration profile. The solute concentration field was then obtained by solving all columns of vertical cells to achieve convergence with the iterative solution procedure. The proposed model was verified through examples from the published literatures including four verifications in terms of analytical and experimental cases. Comparison of simulation results indicates that the proposed model satisfies the solute concentration profiles obtained from experiments in time and space.
We have developed a low cost and convenient approach to fabricate ITO-comparable transparent electrodes by using solution process of silver nanowires mixed with poly peroxotitanic acid (PPT) gel. The PPT gel is applied to connect the dispersed silver nanowires to preserve its high conductivity while remaining transparency and reducing surface roughness of the transparent electrode. The silver nanowires were synthesized via a modified polyol method, and the PPT gels were prepared by sol-gel method in appropriate concentrations. After applying the PPT gels, the sheet resistance of the transparent electrodes was improved from 192 Ω/□ to 44.7 Ω/□ with a transmittance of 81 %. And the roughness (RMS) was decreased from 106.3 nm to 48.1 nm. The PPT gel also improved the reliability of the proposed electrodes, which the conductivity was remained after general atmospheric storage of 6 months. We also demonstrate an Alq3 based OLED with the proposed transparent electrodes.
Impaired regulation of blood glucose levels in diabetes mellitus (DM) patients and the associated elevation of blood glucose levels are known to increase the risk of diabetic cardiomyopathy (DC). In the present study, a probiotic bacterium, Lactobacillus reuteri GMN-32, was evaluated for its potential to reduce blood glucose levels and to provide protection against DC risks in streptozotocin (STZ)-induced DM rats. The blood glucose levels of the STZ-induced DM rats when treated with L. reuteri GMN-32 decreased from 4480 to 3620 mg/l (with 107 colony-forming units (cfu)/d) and 3040 mg/l (with 109 cfu/d). Probiotic treatment also reduced the changes in the heart caused by the effects of DM. Furthermore, the Fas/Fas-associated protein with death domain pathway-induced caspase 8-mediated apoptosis that was observed in the cardiomyocytes of the STZ-induced DM rats was also found to be controlled in the probiotic-treated rats. The results highlight that L. reuteri GMN-32 treatment reduces blood glucose levels, inhibits caspase 8-mediated apoptosis and promotes cardiac function in DM rats as observed from their ejection fraction and fractional shortening values. In conclusion, the administration of L. reuteri GMN-32 probiotics can regulate blood glucose levels, protect cardiomyocytes and prevent DC in DM rats.
Vitamin D is essential for Ca absorption, prevention of falls and fracture, and maintenance of muscle strength and balance. Lack of awareness of the importance of vitamin D in bone health is common in Asia.
Objective
To define key statements, objectives and actions for improving osteoporosis management and vitamin D inadequacy in Asia.
Results and conclusion
This declaration was jointly produced by specialists at the Asia Metaforum on the Role of Vitamin D and the Management of Osteoporosis, held in September 2006 in Hong Kong, to define actions to prevent vitamin D insufficiency in Asia. Although developed specifically for Asia, some or all of these statements may be applicable to other regions of the world.
To investigate prognostic factors for survival and locoregional control in patients with stage I–IVA hypopharyngeal cancer treated with laryngeal preservation radiotherapy.
Methods:
This study was a retrospective analysis of 108 patients with stage I–IVA squamous cell carcinoma of the hypopharynx, treated with laryngeal preservation radiotherapy. Actuarial survival, disease-specific survival and local relapse-free survival were calculated, and multivariate analyses were performed using Cox's proportional hazards model.
Results:
After a median follow-up duration of 39 months, the five-year local relapse-free survival rate was 35 per cent for all patients, 66 per cent for those with stage I–II disease, 46 per cent for those with stage III disease and 20 per cent for those with stage IVA disease (p = 0.004). Multivariate analyses showed that tumour and node stages were independent prognostic factors.
Conclusions:
Patients with stage I–II disease were suitable for laryngeal preservation radiotherapy. For most patients with stage III–IVA disease, other than those who were T1 N1 or T2 N1, the treatment results were poor.
The affiliations for the authors were cited incorrectly in the November 2005 issue of the Journal of Materials Research. The correct affiliations appear above. The printer regrets this error.
Thin films of SiO2–TiO2 composite oxides with various SiO2:TiO2 compositions were prepared by the sol-gel method, using tetraethylorthosilicate (TEOS) and titanium tetraisopropoxide (TTIP) as precursors. The composition, crystal structure, and chemical bonding configuration of the as-deposited and annealed SiO2–TiO2 thin films were analyzed using Rutherford backscattering spectrometry (RBS), glancing incident angle x-ray diffraction (GIAXRD) and Fourier transform infrared spectroscopy (FTIR), respectively. Optical properties of the films were characterized by spectroscopic ellipsometry and ultraviolet-visible spectrophotometry. The Si/Ti ratios in the SiO2–TiO2 films agree with the TEOS/TTIP molar ratio in the sol-gel precursor. When the TEOS/(TEOS + TTIP) ratio is greater than 40%, the SiO2–TiO2 thin films remain amorphous (without formation of TiO2 crystalline phase) after annealing at temperatures as high as 700 °C. FTIR spectra indicate that the quantity of Si–O–Ti bonding can be maximized when the TEOS:TTIP in the precursor is 80%:20%. The refractive index of the SiO2–TiO2 films increases approximately linearly to the mixing ratio of TTIP/(TEOS + TTIP). However, SiO2-rich films possess higher ultraviolet-visible transmittance than the TiO2-rich films. The modification of microstructure and chemical bonding configuration in the SiO2–TiO2 films by the composition and its influence on the optical properties are discussed.
This present study was designed to investigate the combined modulatory effect of garlic oil (GO) and fish oil (FO) on the antioxidant and drug metabolism systems. Rats were fed either a low-maize oil (MO) diet (50 g MO/kg), high-MO diet (235 g MO/kg) or high-FO diet (205 g FO+30 g MO/kg) and received different doses of GO (0–200 mg/kg body weight) three times per week for 6 weeks. Fatty acid analysis showed that 20: 5n−3 and 22: 6n−3 were incorporated into serum lipid at the expense of 18: 2n−6 and 20: 4n−6 in rats fed the high-FO diet. GO dose-dependently increased hepatic glutathione S-transferase (GST), glutathione reductase, superoxide dismutase (SOD) and ethoxyresorufin O-deethylase (EROD) activities, but decreased glutathione peroxidase and N-nitrosodimethylamine demethylase (NDMAD) activities (P<0·05). With the exception of glutathione peroxidase, the activities of glutathione reductase, SOD, GST, EROD and NDMAD were modulated by the dietary fat. The high-FO group had greater SOD and EROD activity than either MO-fed group; it also had greater NDMAD activity than the low-MO group (P<0·05). GST activity was higher in rats fed high-FO or high-MO diets than rats fed the low-MO diet. Change in erythromycin demethylase activity, however, was not caused by either dietary fat or GO. Immunoblot assay showed that GO dose-dependently enhanced the protein level of the Ya, Yb1, Yc isoenzymes of GST and cytochrome P450 (CYP) 1A1 and 3A1, but GO suppressed CYP2E1 expression. Regardless of the dosage of GO, the high-FO diet increased CYP1A1, CYP3A1 and CYP2E1 levels compared with the high- and low-MO diets. Accompanying the changes observed in immunoblots, CYP1A1 and CYP3A1 mRNA levels were increased by GO in a dose-dependent manner and also increased additively in combination with FO feeding. These present results indicate that co-administration of GO and FO modulates the antioxidant and drug-metabolizing capacity of animals and that the effect of GO and FO on drug-metabolizing enzymes is additive.
The properties of ZnO thin film are currently of great commercial and scientific interest due to its particular properties such as highly conductive, transparent as well as chemical stability and nontoxic. The Ti doping ZnO thin films were deposited by simultaneously magnetron co-sputtering from both Zn and Ti targets in a mixture of oxygen and argon gases onto heated Corning 7059 glass substrates in this study. The experimental results show that deposition rate of ZnO films are strongly dependent on DC power of Ti target. The growth rate initially increases and changes to decrease when the DC power of Ti target further rises. The content of Ti in the ZnO films increases with the applied DC power of Ti target. The lattice constant of ZnO (002) increases with DC power of Ti target due to incorporated Ti into the lattice of ZnO. The crystalline size becomes smaller when the DC power of Ti target was raised. The visible transmittance is a little lowered when slight Ti incorporated but still average maintains above 80%. The lowest resistivity of undoped ZnO film obtained in this study is 4.14×10-3 ohm-cm and further decreased to 1.02×10-3 ohm-cm after being doped a trace of Ti.
This paper presents the experimental results of impedance analysis and longitudinal vibration measurement of micro-fabricated 0.5 MHz silicon-based ultrasonic nozzles. Each nozzle is made of a piezoelectric drive section and a silicon-resonator consisting of multiple Fourier horns each with half wavelength design and twice amplitude magnification. The experimental results verified the simulation prediction of one pure longitudinal vibration mode at the resonant frequency in excellent agreement with the design value. Furthermore, at the resonant frequency, the measured longitudinal vibration amplitude gain at the nozzle tip increases as the number of Fourier horns (n) increases in good agreement with the theoretical value of 2n. Using this design, very high vibration amplitude at the nozzle tip can be achieved with no reduction in the tip cross sectional area. Therefore, the required electric drive power should be drastically reduced, decreasing the likelihood of transducer failure in ultrasonic atomization.
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