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We hypothesize that the tumor necrosis factor-α (TNF-α) may play a role in disturbing the effect of selective serotonin reuptake inhibitor (SSRI) on the striatal connectivity in patients with major depressive disorder (MDD).
We performed a longitudinal observation by combining resting-state functional magnetic resonance imaging (rs-fMRI) and biochemical analyses to identify the abnormal striatal connectivity in MDD patients, and to evaluate the effect of TNF-α level on these abnormal connectivities during SSRI treatment. Eighty-five rs-fMRI scans were collected from 25 MDD patients and 35 healthy controls, and the scans were repeated for all the patients before and after a 6-week SSRI treatment. Whole-brain voxel-wise functional connectivity (FC) was calculated by correlating the rs-fMRI time courses between each voxel and the striatal seeds (i.e. spherical regions placed at the striatums). The level of TNF-α in serum was evaluated by Milliplex assay. Factorial analysis was performed to assess the interaction effects of ‘TNF-α × treatment’ in the regions with between-group FC difference.
Compared with controls, MDD patients showed significantly higher striatal FC in the medial prefrontal cortex (MPFC) and bilateral middle/superior temporal cortices before SSRI treatment (p < 0.001, uncorrected). Moreover, a significant interaction effect of ‘TNF-α × treatment’ was found in MPFC-striatum FC in MDD patients (p = 0.002), and the significance remained after adjusted for age, gender, head motion, and episode of disease.
These findings provide evidence that treatment-related brain connectivity change is dependent on the TNF-α level in MDD patients, and the MPFC-striatum connectivities possibly serve as an important target in the brain.
Bipolar disorder is a highly heritable mental illness that transmits intergeneratively. Previous studies supported that first-degree relatives (FDRs), such as parents, offspring, and siblings, of patients with bipolar disorder, had a higher risk of bipolar disorder. However, whether FDRs of bipolar patients have an increased risk of schizophrenia, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD) remains unclear.
Among the entire population in Taiwan, 87 639 patients with bipolar disorder and 188 290 FDRs of patients with bipolar disorder were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with bipolar disorder.
FDRs of patients with bipolar disorder were more likely to have a higher risk of major psychiatric disorders, including bipolar disorder (RR 6.12, 95% confidence interval (CI) 5.95–6.30), MDD (RR 2.89, 95% CI 2.82–2.96), schizophrenia (RR 2.64, 95% CI 2.55–2.73), ADHD (RR 2.21, 95% CI 2.13–2.30), and ASD (RR 2.10, 95% CI 1.92–2.29), than the total population did. These increased risks for major psychiatric disorders were consistent across different familial kinships, such as parents, offspring, siblings, and twins. A dose-dependent relationship was also found between risk of each major psychiatric disorder and numbers of bipolar patients.
Our study was the first study to support the familial coaggregation of bipolar disorder with other major psychiatric disorders, including schizophrenia, MDD, ADHD, and ASD, in a Taiwanese (non-Caucasian) population. Given the elevated risks of major psychiatric disorders, the public health government should pay more attention to the mental health of FDRs of patients with bipolar disorder.
Attention-deficit hyperactivity disorder (ADHD) increases the risk of suicidal behaviours through psychiatric comorbidities; however, a significant direct association has not been observed between ADHD and suicide attempts.
To evaluate the risk of suicide attempt in adolescents and young adults with ADHD.
Using a nationwide, population-based insurance claims database, this longitudinal cohort study enrolled 20 574 adolescents and young adults with ADHD and 61 722 age- and gender-matched controls between 2001 and 2009. Any suicide attempt was identified from enrolment to 31 December 2011. The association between ADHD medications and the likelihood of suicide attempt was assessed.
ADHD was an independent risk factor for any suicide attempt (hazard ratio = 3.84, 95% CI = 3.19–4.62) and repeated suicide attempts (hazard ratio = 6.52, 95% CI = 4.46–9.53). Subgroup analyses of men, women, adolescents and young adults demonstrated the same trend. Methylphenidate or atomoxetine treatment did not increase the risk of suicide attempt or repeated suicide attempts. Long-term methylphenidate treatment was associated with a significantly decreased risk of repeated suicide attempts in men (hazard ratio = 0.46, 95% CI = 0.22–0.97).
ADHD was a risk factor for suicide attempt and a stronger predictor of repeated suicide attempts, independent of comorbidities. Further investigation is warranted to explore the mechanism underlying the association between ADHD and suicidal behaviours.
Background: Among patients with schizophrenia, there is evidence of a negative association between self-stigma and subjective quality of life (SQoL), and self-esteem was an important mediator in the association. We attempted to use a longitudinal study to investigate the aforementioned mediation on a sample with schizophrenia. Methods: We used longitudinal data retrieved from medical records of a psychiatric centre between June 2014 and December 2015. In the data, we retrieved information of self-stigma using the Self-Stigma Scale — Short; SQoL, using the WHO questionnaire on the Quality of Life — Short Form; and self-esteem, using the Rosenberg Self-Esteem Scale. All the measures were evaluated five times. Linear mixed-effect models accompanied by Sobel tests were used to tackle the mediating effects. Results: Data from 74 patients (57 males) with schizophrenia were eligible for analysis; their mean (SD) age was 39.53 (10.67); mean age of onset was 22.95 (8.38). Self-esteem was a mediator for patients in physical (p = .039), psychological (p = .003), and social SQoL (p = .004), but not in environment SQoL (p = .051). Conclusion: Based on our findings, mental health professionals could tailor different programs to patients with schizophrenia, such as self-stigma reduction and self-esteem improvement programs. However, treatment as a whole should be sensitive to both self-stigma and self-esteem. Also, we should consider individuals’ health and wellbeing from social perspectives of disability rather than the medical model of disability emphasising symptoms and medications.
To develop a theoretical model explaining the longitudinal changes in the caregiving process for family caregivers of persons with mild cognitive impairment (MCI) in Taiwan.
A longitudinal, grounded theory approach using in-depth face-to-face interviews and an open-ended interview guide. We conducted 42 interviews over a two-year period; each participant was interviewed at least once every six months. All participants were interviewed in their home. The participants total of 13 family caregivers of persons with MCI.
One core theme emerged: “protective preparation.” This reflected the family caregiving process of preparation for a further decline in cognitive function, and protection from the impact of low self-esteem, accidents, and symptoms of comorbidities for the family member with MCI. Protective preparation contained three components: ambivalent normalization, vigilant preparation, and protective management.
Interventions to help family caregivers manage the changes in persons with MCI can reduce caregiver burden. Our findings could provide a knowledge base for use by healthcare providers to develop and implement strategies to reduce caregiver burden for family caregivers of persons with MCI.
Isolation of multidrug-resistant gram-negative bacteria (MDR-GNB) from patients in the community has been increasingly observed. A prediction model for MDR-GNB colonization and infection risk stratification on hospital admission is needed to improve patient care.
A 2-stage, prospective study was performed with 995 and 998 emergency department patients enrolled, respectively. MDR-GNB colonization was defined as isolates resistant to 3 or more classes of antibiotics, identified in either the surveillance or early (≤48 hours) clinical cultures.
A score-assigned MDR-GNB colonization prediction model was developed and validated using clinical and microbiological data from 995 patients enrolled in the first stage of the study; 122 of these patients (12.3%) were MDR-GNB colonized. We identified 5 independent predictors: age>70 years (odds ratio [OR], 1.84 [95% confidence interval (CI), 1.06–3.17]; 1 point), assigned point value in the model), residence in a long-term-care facility (OR, 3.64 [95% CI, 1.57–8.43); 3 points), history of cerebrovascular accidents (OR, 2.23 [95% CI, 1.24–4.01]; 2 points), hospitalization within 1 month (OR, 2.63 [95% CI, 1.39–4.96]; 2 points), and recent antibiotic exposure (OR, 2.18 [95% CI, 1.16–4.11]; 2 points). The model displayed good discrimination in the derivation and validation sets (area under ROC curve, 0.75 and 0.80, respectively) with the best cutoffs of<4 and ≥4 points for low- and high-risk MDR-GNB colonization, respectively. When applied to 998 patients in the second stage of the study, the model successfully stratified the risk of MDR-GNB infection during hospitalization between low- and high-risk groups (probability, 0.02 vs 0.12, respectively; log-rank test, P<.001).
A model was developed to optimize both the decision to initiate antimicrobial therapy and the infection control interventions to mitigate threats from MDR-GNB.
Babesiosis is an emerging tick-transmitted zoonosis prevalent in large parts of the world. This study was designed to determine the rates of Babesia microti infection among small rodents in Yunnan province, where human cases of babesiosis have been reported. Currently, distribution of Babesia in its endemic regions is largely unknown. In this study, we cataloged 1672 small wild rodents, comprising 4 orders, from nine areas in western Yunnan province between 2009 and 2011. Babesia microti DNA was detected by polymerase chain reaction in 4·3% (72/1672) of the rodents analyzed. The most frequently infected rodent species included Apodemus chevrieri and Niviventer fulvescens. Rodents from forests and shrublands had significantly higher Babesia infection rates. Genetic comparisons revealed that Babesia was most similar to the Kobe- and Otsu-type strains identified in Japan. A variety of rodent species might be involved in the enzootic maintenance and transmission of B. microti, supporting the need for further serological investigations in humans.
This paper investigates the focal location effects on the penetration depth of molten region surrounding a paraboloid of revolution-shaped cavity (i.e. keyhole of this model) irradiated by a moving focused energy beam, which profile of intensity is assumed to be Gaussian distribution. Considering the momentum balance at the base of the keyhole, a quasi-steady-state thermal model relative to a constant-speed moving high-energy beam and paraboloid of revolution-shaped cavity is developed in a parabolic coordinate system. The analytical solution is obtained for this model with the adiabatic condition directly set on the workpiece surface for semi-infinite domain instead of the image method for infinite domain using the separation-of-variables method. The analytical solution of this model gives a reasonable prediction for the cavity temperatures. The predicted relation of the penetration depth to the focal location agrees with the available measured data. The effects of focal convergence angle and spot size on the penetration depth are also discussed.
Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated.
DESIGN, SETTING, AND PARTICIPANTS
A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University—Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled.
Surgical hand cleansing with conventional 10% povidone–iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol).
Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, P<0.01) and waterless hand rub groups (1.4±0.7, P<0.05) were significantly lower than that of the conventional povidone group (4.3±1.3). No significant difference was observed in the mean CFU count among the groups after surgery. Similar results were obtained when preexisting differences before disinfection were considered in the analysis of covariance. Furthermore, multivariate regression indicated that the antiseptic method (P=.0036), but not other variables, predicted the mean CFU count.
Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone–iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable.
We aimed to clarify whether invasive dental treatment is associated with increased risk of prosthetic joint infection (PJI) and whether prophylactic antibiotics may lower the infection risk remain unclear.
Retrospective cohort study.
All Taiwanese residents (N=255,568) who underwent total knee or hip arthroplasty between January 1, 1997, and November 30, 2009, were screened.
The dental cohort consisted of 57,066 patients who received dental treatment and were individually matched 1:1 with the nondental cohort by age, sex, propensity score, and index date. The dental cohort was further divided by the use or nonuse of prophylactic antibiotics. The antibiotic and nonantibiotic subcohorts comprised 6,513 matched pairs.
PJI occurred in 328 patients (0.57%) in the dental subcohort and 348 patients (0.61%) in the nondental subcohort, with no between-cohort difference in the 1-year cumulative incidence (0.6% in both, P=.3). Multivariate-adjusted Cox regression revealed no association between dental procedures and PJI. Furthermore, PJI occurred in 13 patients (0.2%) in the antibiotic subcohort and 12 patients (0.18%) in the nonantibiotic subcohorts (P=.8). Multivariate-adjusted analyses confirmed that there was no association between the incidence of PJI and prophylactic antibiotics.
The risk of PJI is not increased following dental procedure in patients with hip or knee replacement and is unaffected by antibiotic prophylaxis.
Generally, the obvious work hardening, dynamic recrystallization (DRX), and dynamic recovery behaviors can be found during hot deformation of Ni-based superalloys. In the present study, the classical dislocation density theory is improved by introducing a new dislocation annihilation item to represent the influences of DRX on dislocation density evolution for a Ni-based superalloy. Based on the improved dislocation density theory, the peak strain corresponding to peak stress and the critical strain for initiating DRX can be determined, and the improved DRX kinetics equations and grain size evolution models are developed. The physical framework and algorithmic idea of the improved dislocation density theory are clarified. Moreover, the deformed microstructures are characterized and quantitatively correlated to validate the improved dislocation density theory. It is found that the improved dislocation density-based models can precisely characterize hot deformation and DRX behaviors for the studied superalloy under the tested conditions.
Psychiatric disorders such as schizophrenia and major depressive disorder
(MDD) are likely to be caused by multiple susceptibility genes, each with
small effects in increasing the risk of illness. Identifying DNA variants
associated with schizophrenia and MDD is a crucial step in understanding
the pathophysiology of these disorders.
To investigate whether the SP4 gene plays a significant
role in schizophrenia or MDD in the Han Chinese population.
We focused on nine single nucleotide polymorphisms (SNPs) harbouring the
SP4 gene and carried out case–control studies in 1235
patients with schizophrenia, 1045 patients with MDD and 1235 healthy
controls recruited from the Han Chinese population.
We found that rs40245 was significantly associated with schizophrenia in
both allele and genotype distributions (Pallele = 0.0005, Pallele = 0.004 after Bonferroni correction; Pgenotype = 0.0023, Pgenotype = 0.0184 after Bonferroni correction). The rs6461563
SNP was significantly associated with schizophrenia in the allele
distributions (Pallele = 0.0033, Pallele = 0.0264 after Bonferroni correction).
Our results suggest that common risk factors in the SP4
gene are associated with schizophrenia, although not with MDD, in the Han
To investigate the reciprocal relationship between unhealthy eating behaviours and depressive symptoms from childhood to adolescence.
Unhealthy eating behaviours were measured by the frequencies of eating foods with excess salt, sugar or fat in the past week. Depressive symptoms in the past two weeks were measured using a seven-item scale. Hierarchical linear growth models were used to analyse longitudinal associations between unhealthy eating behaviours and depressive symptoms. Time-fixed variables (sex, parents’ education level and household monthly income) and time-varying variables (parents’ marital status, family activities, body weight, vegetable or fruit consumption, exercising and smoking) were controlled for.
The Child and Adolescent Behaviors in Long-Term Evolution study, which commenced in 2001 and has annual follow-up.
Students (n 2630) followed from 2nd grade (8 years old in 2002) to 11th grade.
The frequency of unhealthy eating behaviours in the previous year and the difference between the frequency in the previous and successive year were positively associated with the initiation and growth rate of depressive symptoms. Depressive symptoms in the previous year and the difference in depressive symptoms between the previous and successive year were positively associated with the initial state and growth rate of unhealthy eating behaviours.
Our results suggest a reciprocal relationship between depressive symptoms and unhealthy eating behaviours. This relationship should be considered when developing programmes targeting depressive symptoms and unhealthy diet in children and adolescents.
The strain hardening effect and dynamic recovery behavior of a Ni-based superalloy are studied by isothermal compressive tests. A new unified dislocation-density based constitutive model is developed to characterize the strain hardening effect and dynamic recovery behavior of the studied superalloy. In the developed constitutive model, some material parameters (yield stress, strain hardening coefficient, and dynamic recovery coefficient) are assumed as functions of initial grain size, deformation temperature, and strain rate. An iterative algorithm is designed to predict the high-temperature deformation behaviors under time-variant hot working conditions. The hot deformation parameters and material parameters can be updated in each strain increment. Comparisons between the experimental and calculated flow stresses indicate that the developed constitutive model can accurately describe the high-temperature deformation behavior of the studied superalloy. Furthermore, the developed constitutive model is also successfully used for analyzing time-variant hot working processes.