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Major depressive disorder (MDD) is highly heterogeneous and can be classified as treatment-resistant depression (TRD) or antidepressant-responsive depression (non-TRD) based on patients' responses to antidepressant treatment. Methods for distinguishing between TRD and non-TRD are critical clinical concerns. Deficits of cortical inhibition (CI) have been reported to play an influential role in the pathophysiology of MDD. Whether TRD patients' CI is more impaired than that of non-TRD patients remains unclear.
Paired-pulse transcranial magnetic stimulation (ppTMS) was used to measure cortical inhibitory function including GABAA- and GABAB-receptor-related CI and cortical excitatory function including glutamate-receptor-related intracortical facilitation (ICF). We recruited 36 healthy controls (HC) and 36 patients with MDD (non-TRD, n = 16; TRD, n = 20). All participants received evaluations for depression severity and ppTMS examinations. Non-TRD patients received an additional ppTMS examination after 3 months of treatment with the SSRI escitalopram.
Patients with TRD exhibited reduced short-interval intracortical inhibition (SICI) and long-interval intracortical inhibition (LICI), as shown by abnormally higher estimates, than those with non-TRD or HC (F = 11.030, p < 0.001; F = 10.309, p < 0.001, respectively). After an adequate trial of escitalopram treatment, the LICI of non-TRD reduced significantly (t = − 3.628, p < 0.001), whereas the ICF remained lower than that of HC and showed no difference from pretreatment non-TRD.
TRD was characterized by relatively reduced CI, including both GABAA- and GABAB-receptor-mediated neurons while non-TRD preserved partial CI. In non-TRD, SSRIs may mainly modulate GABAB-receptor-related LICI. Our findings revealed distinguishable features of CI in antidepressant-resistant and responsive major depression.
Information systems (IS) have facilitated workflow in the health care system for years. However, the utilization of IS in disaster medical assistance teams (DMATs) has been less studied.
In Taiwan, we started a program in 2008 to build up an information system, MEDical Assistance and Information Dashboard (MED-AID), to improve the capability and increase the efficiency of our national DMAT.
Method: The mission of our national DMAT was to provide acute trauma care and subacute outpatient care in the field after an emergency event (e.g., earthquakes). We built the IS through a user-oriented process to fit the need of the DMAT. We first analyzed the response work in the DMAT missions and reviewed the current paperwork. We evaluated the eligibility and effectiveness of the core functions of DMATs by experts in Taiwan and then developed the IS. The IS was then tested and revised each year in two table-top exercises and one regional full-scale exercise by the DMAT staffs who came from different hospitals in Taiwan.
During the past 10 years, we identified several core concepts of IS of DMAT: patient tracking, medical record, continuity of care, integration of referral resources, disease surveillance, patient information reporting, and medical resources management. The application of the IS facilitate the DMAT in providing safe patient care with continuous recording and integrate patient referral resources based on geographic information. The IS also help the planning in real-time disease surveillance and logistic function in the medical resources monitoring.
Information systems could facilitate patient care and relieve the workload on information analysis and resources management for DMATs.
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.
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.
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.
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.
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.
Aberrant right subclavian artery is the most common congenital aortic arch anomaly. There are a few reports concerning the clinical manifestations and follow-up of this CHD detected by echocardiographic screening.
A total of 1737 full-term neonates, with a male-to-female ratio of 900:837, received echocardiographic screening. Neonates with or without isolated aberrant right subclavian artery were studied during infancy.
Among the 1737 cases, a total of 15 (0.86%) female-predominant neonates, with a male-to-female ratio of 6:9, had isolated aberrant right subclavian artery. They were compared with 20 age- and gender-matched normal neonates. There were no significant differences in maternal age, gestational age, or para gravity between the two groups, except for birth size (birth length- and weight-for-age percentiles, p = 0.006 and 0.045, respectively), which was smaller in the aberrant right subclavian artery group. Although there were no significant differences in developmental history, gastrointestinal, or respiratory symptoms, neonates with aberrant right subclavian artery had a higher incidence of mild developmental delay and feeding difficulty than normal infants (21 versus 0%, p = 0.061; 36 versus 20%, p = 0.264, respectively). The growth rates of body length and weight during infancy were not significantly different between the two groups.
Echocardiography can be applied as a first-line investigation in the diagnostic work-up for aberrant right subclavian artery. Neonates with aberrant right subclavian artery had a smaller size at birth, although growth rates were not significantly different from those of normal infants. This study does not support an active surgical policy for asymptomatic infants with isolated aberrant right subclavian artery. A larger study and longer follow-up of affected infants is recommended.
Acute myocardial infarction is rarely reported in children. Most of the cases are secondary to congenital anomalies or Kawasaki disease. Coronary artery total occlusion caused by fibromuscular dysplasia has never been reported in young children. Here we report a case of a 12-year-old boy with fibromuscular dysplasia, who underwent successful coronary intervention for acute myocardial infarction.
The electrode materials for VRFB should possess higher electric conductivity, corrosion resistance and hydrophilic properties in sulfuric acid. The characteristics of the electrode materials affect the stability and the energy efficiency of VRFB. Carbon materials are the best suited for VRFB applications. In this study, the calcined treatment, acid treatment and ozone treatment were used to modify the surface of carbon papers. The redox reaction of [VO]2+/[VO2]+ on the modified carbon papers was evaluated by cyclic voltammetry (CV). The surface compositions of carbon materials were analyzed by X-ray photoelectron spectrometry (XPS). The experimental results reveal that three oxidative methods enhance the redox reaction of [VO]2+/[VO2]+. The calcined treatments and acid treatments also enhanced hydrolysis reaction. The mole ratio of O/C apparently increased, but the binding energy of C1s and O1s were not chemically shifted in the acid treatment. The intensity of binding energy of O1s, between 532 eV and 534 eV, apparently increased in the ozone and calcined treatments. The Ox treated samples were more hydrophilic than the Oz treated samples. In the Ox treated samples, the decrease of Rct value indicates that was contributed from the redox reaction of [VO]2+/[VO2]+ and hydrolysis reaction. It does not completely benefit the energy efficiency of VRFB. The 5 x 5 cm2 modified carbon papers were used as electrode materials in the VRFB. The voltage efficiency, coulomb efficiency and energy efficiency reached 93 %, 90 % and 83 %, respectively, at a current density of 12 mA．cm-2 at 0.8-1.8 V.
Congenital anomalies of the coronary arteries are present in 0.2–1.4% of the general population. These anomalies represent one of the most confusing issues in the field of cardiology and challenges for interventional cardiologists and cardiac surgeons if the anomalies are unrecognised. Double right coronary artery is one of the rarest coronary arteries. Previously, the probability of developing atherosclerotic changes in patients with a double right coronary artery was considered to be equal to that in those without it. In reality, however, a high prevalence of atherosclerotic coronary artery disease was found in patients with a double right coronary artery originating from a single ostium after our comprehensive literature search through the PubMed database. Owing to the fact that double right coronary artery is both a congenital and potentially atherosclerotic coronary artery disease at diagnosis, coronary intervention or cardiac operation is more complicated than previously believed. Individuals with a double right coronary artery may be unaware of its presence until an accidental finding during coronary angiography or cardiac operation and are at risk for unsuspected complications of atherosclerotic coronary artery disease or during cardiac operation. Therefore, it is important to obtain information on the anatomic variants of this congenital coronary anomaly in patients who are undergoing either coronary intervention, aortic root operation or myocardial revascularisation. To our knowledge, this is the first comprehensive article to discuss the anomalies and their clinical implications.
Strong influence of the applied or self-induced (i.e. self-biasing) electric field on the alignment, orientation and structures was found in the carbon nano-structure deposition process. This study applied microwave-plasma electron-cyclotron-resonance CVD (ECR-CVD) technique for carbon nano-structure deposition. The deposited structures and properties were characterized with SEM and field emission I–V measurements. The result shows that a negative dc bias applied on the substrate is a necessary condition. In this condition, all carbon nanostructures were well aligned and perpendicular to the substrate surfaces and independent to the plasma/gas flowing directions. Interestingly, when applied an additional electric field near the substrate surface by a guiding metal plate, the CNT growth direction could be manipulated from perpendicular to nearly parallel to the substrate surface. Moreover, a rattan-like CNT would form when prolonging the deposition time or increasing the plasma carbon concentration. These novel nanostructures are expected to have high potential in energy storage, field emission display, nanoelectronics and gas sensing applications accordingly.
The microstructure and field emission properties of multi walled carbon nanotubes (MWNTs) were investigated. The comparisons are made between MWNTs synthesized by high temperature arc methods and low temperature CVD methods. The results of the HRTEM image clearly exhibit characteristic features of a multi walled carbon nanotube. Raman spectrum shows a stronger peak at about 1580 cm-1 indicating the formation of a well-graphitized carbon nanotube. It also shows the high temperature arc process can produce MWNT that has perfect graphitic layer structure and high I(G)/I(D) ratio. The Ratio of G-line (sp2 bond) and D-line(sp3 bond) of these MWNTs are about 2.8 to 5.2. From the field emission measurement, the low onset field is about 1.4 to 2.4 V/ m, and can be attributed to highly sharp tips and high electric conductivity of MWNTs.
The effects of NH3 and H2 plasma passivation on the characteristics of poly-Si thin-film transistors with source/drain extensions induced by a bottom sub-gate were studied. Our results show that significant improvements in device performance can be obtained by both passivation methods. Moreover, NH3-plasma-treatment appears to be more effective in reducing the off-state leakage, subthreshold swing, compared to H2 plasma passivation. NH3 plasma treatment is also found to be more effective in reducing the anomalous subthrehold hump phenomenon observed in non-plasma-treated short-channel devices. Detailed analysis suggests that all these improvements can be explained by the more effective passivation of the traps distributed in both the front and back sides of the channel by NH3 plasma treatment.
Prolonged fever, 5 days or more, is the cardinal feature of Kawasaki disease. We described a 5-year-old boy with initial presentations of fever, conjunctivitis, and strawberry tongue. The fever only lasted for 3 days. However, giant coronary aneurysms developed later. This patient reminds us that coronary complications could happen even the fever is less than 5 days. Criteria of fever duration might need reconsideration.
We have fabricated La0.6Ca0.4MnO3 periodic arrays exhibiting tunable optical properties and magnetic properties using nontoxic and environmentally friendly electron beam resist made from La0.6Ca0.4MnO3 sol-gel precursor. We studied their unique optical properties by using the spectral microreflectometer and their magnetic properties using the superconducting quantum interference device and magnetic force microscopy. Additionally, the resist has the ability to demonstrate both positive and negative resist behaviors depending on the electron beam dosage. With these special characteristics, we can fabricate periodic structure on a thin film possessing controlled optical reflectance properties with one fixed design electron beam pattern without changing the structural parameters but changing the electron beam dosage only. Our approach provides an uncomplicated route for the fabrication of nanometer scale magnetic patterns, which serve as the building blocks in the search for novel properties of periodic magnetic arrays.
The high sensitivity and spatial resolution enabled by two-photon excitation fluorescence lifetime imaging microscopy/fluorescence resonance energy transfer (2PE-FLIM/FRET) provide an effective approach that reveals protein-protein interactions in a single cell during stimulated exocytosis. Enhanced green fluorescence protein (EGFP)–labeled synaptosomal associated protein of 25 kDa (SNAP25A) and red fluorescence protein (mRFP)–labeled Rabphillin 3A (RPH3A) were co-expressed in PC12 cells as the FRET donor and acceptor, respectively. The FLIM images of EGFP-SNAP25A suggested that SNAP25A/RPH3A interaction was increased during exocytosis. In addition, the multidimensional (three-dimensional with time) nature of the 2PE-FLIM image datasets can also resolve the protein interactions in the z direction, and we have compared several image analysis methods to extract more accurate and detailed information from the FLIM images. Fluorescence lifetime was fitted by using one and two component analysis. The lifetime FRET efficiency was calculated by the peak lifetime (τpeak) and the left side of the half-peak width (τ1/2), respectively. The results show that FRET efficiency increased at cell surface, which suggests that SNAP25A/RPH3A interactions take place at cell surface during stimulated exocytosis. In summary, we have demonstrated that the 2PE-FLIM/FRET technique is a powerful tool to reveal dynamic SNAP25A/RPH3A interactions in single neuroendocrine cells.