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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.
We recruited 82 cognitively-able young adults with ASD, randomized to the PEERS treatment or treatment-as-usual.
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.
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.
Studies have suggested the detrimental effects of obesity and systemic inflammation on the cognitive function of patients with bipolar or major depressive disorder. However, the complex associations between affective disorder, obesity, systemic inflammation, and cognitive dysfunction remain unclear.
Overall, 110 patients with affective disorder (59 with bipolar I disorder and 51 with major depressive disorder) who scored ≥61 on the Global Assessment of Functioning and 51 age- and sex-matched controls were enrolled. Body mass index ≥25 kg/m2 was defined as obesity or overweight. Levels of proinflammatory cytokines—including interleukin-6, tumor necrosis factor (TNF)-α, and C-reactive protein (CRP)—were measured, and cognitive function was assessed using various methods, including the Wisconsin Card Sorting Test (WCST) and go/no-go task.
Patients with bipolar I disorder or major depressive disorder were more likely to be obese or overweight, had higher CRP and TNF-α levels, and had greater executive dysfunction in the WCST than the controls. TNF-α level (P < .05) but not affective disorder diagnosis or obesity/overweight was significantly associated with cognitive function deficits, although obesity/overweight and diagnosis were significantly associated with increased TNF-α level.
Our findings may indicate that proinflammatory cytokines, but not obesity or overweight, have crucial effects on cognitive function in patients with bipolar I disorder or major depressive disorder, although proinflammatory cytokines and obesity or overweight were found to be strongly associated. The complex relationships between affective disorder diagnosis, proinflammatory cytokine levels, obesity or overweight, and cognitive function require further investigation.
The antidepressant effect of low-dose ketamine infusion on Taiwanese patients with anxious vs nonanxious treatment-resistant depression (ANX-TRD vs NANX-TRD) has remained unknown.
In total, 71 patients with TRD were randomized to three groups. Each group had participants who received saline infusions mixed with 0 (a normal saline infusion), 0.2, and 0.5 mg/kg of ketamine. Participants were followed up for 2 weeks. Anxious depression was defined as major depressive disorder with a total score of 7 or more on the 17-item Hamilton Depression Rating Scale Anxiety-Somatization factor. Generalized estimating equation models were used to investigate the effects of treatment (ketamine vs placebo) and depression type (ANX-TRD vs NANX-TRD) in the reduction of depressive symptoms during the follow-up period.
Patients with ANX-TRD were less likely to respond to a single low-dose ketamine infusion than those with NANX-TRD. Among patients with NANX-TRD, low-dose ketamine infusion was significantly superior to placebo for reducing depressive symptoms. However, among patients with ANX-TRD, ketamine was not superior to placebo; nonetheless, approximately 30% of the patients responded to ketamine infusion compared to 13% who responded to the placebo.
Low-dose ketamine infusion was effective for Taiwanese patients with NANX-TRD but not so effective for those with ANX-TRD. A higher level of anxiety severity accompanying depression was related to greater depression severity. This may confound and reduce the antidepressant effect of ketamine infusion.
This study aimed to describe outcomes in four women aged 28–34 years with central cytoplasmic granulation (CCG) of the oocytes who underwent in vitro fertilization/intracytoplasmic sperm injection (ICSI) using gonadotrophin-releasing hormone (GnRH) agonist to replace human chorionic gonadotrophin (hCG) as a trigger of final oocyte maturation. The initial ICSI procedure showed that all four women had CCG of the ooplasm and poor quality embryos. Subsequent ICSI used an antagonist protocol with a GnRH agonist trigger replacing the agonist protocol, plus hCG triggered ovulation. Ooplasm and embryo quality were improved in all four patients. All four became pregnant and gave birth to live infants. This study provides GnRH agonist triggering that may improve ooplasm granularity and embryo quality.
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.
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.
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.
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 on the risk of stroke following the use of mood stabilisers specific to patients with bipolar disorder is limited.
In this study, we investigated the risk of stroke following the exposure to mood stabilisers in patients with bipolar disorder.
Data for this nationwide population-based study were derived from the Taiwan National Health Insurance Research Database. Among a retrospective cohort of patients with bipolar disorder (n = 19 433), 609 new-onset cases of stroke were identified from 1999 to 2012. A case–crossover study design utilising 14-day windows was applied to assess the acute exposure effect of individual mood stabilisers on the risk of ischaemic, haemorrhagic and other types of stroke in patients with bipolar disorder.
Mood stabilisers as a group were significantly associated with the increased risk of stroke in patients with bipolar disorder (adjusted risk ratio, 1.26; P = 0.041). Among individual mood stabilisers, acute exposure to carbamazepine had the highest risk of stroke (adjusted risk ratio, 1.68; P = 0.018), particularly the ischaemic type (adjusted risk ratio, 1.81; P = 0.037). In addition, acute exposure to valproic acid elevated the risk of haemorrhagic stroke (adjusted risk ratio, 1.76; P = 0.022). In contrast, acute exposure to lithium and lamotrigine did not significantly increase the risk of any type of stroke.
Use of carbamazepine and valproic acid, but not lithium and lamotrigine, is associated with increased risk of stroke in patients with bipolar disorder.
This study identified possible risk factors for newly diagnosed mood disorders, including depressive and bipolar disorders, in prostate cancer patients.
From 2000 to 2006, two cohorts were evaluated on the occurrence of mood disorder diagnosis and treatment. For the first cohort, data of patients diagnosed with prostate cancer was obtained from the Taiwan National Health Insurance (NHI) Research Database. As the second cohort, a cancer-free comparison group was matched for age, comorbidities, geographic region, and socioeconomic status.
Final analyses involved 12,872 men with prostate cancer and 12,872 matched patients. Increased incidence of both depressive (IRR 1.52, 95% CI 1.30–1.79, P <0.001) and bipolar disorder (IRR 1.84, 95% CI 1.25–2.74, P = 0.001) was observed among patients diagnosed with prostate cancer. Multivariate matched regression models show that cerebrovascular disease (CVD) and radiotherapy treatment could be independent risk factors for developing subsequent depressive and bipolar disorders.
We observed that the risk of developing newly diagnosed depressive and bipolar disorders is higher among Taiwanese prostate cancer patients. Clinicians should be aware of the possibility of increased depressive and bipolar disorders among prostate cancer patients in Taiwan. A prospective study is necessary to confirm these findings.
Voriconazole is a broad-spectrum azole exhibiting strong anti-Aspergillus activity and good long-term tolerance. However, the evidence for voriconazole efficacy against refractory Aspergillus otomycosis is weak.
We reviewed the medical records of patients with Aspergillus otomycosis treated with voriconazole from January 2008 to June 2012 in a Taiwanese regional hospital. Demographic data and information regarding underlying diseases, clinical features, treatment and outcome were assessed.
In total, 14 cases of Aspergillus otomycosis were treated with voriconazole, including 5 patients with Aspergillus invasive otitis externa. All patients had failed to respond to local treatment, antibiotics or topical agents. One case was lost to follow up. The symptoms of two patients recurred after voriconazole treatment: one patient received a second 12-week course of voriconazole and was cured; and symptoms of the other patient recurred after a second 12-week course of voriconazole, leading to surgical debridement. The remaining 11 patients were cured by voriconazole treatment without extensive surgical debridement.
This study demonstrates that voriconazole can be a very effective and convenient therapeutic option for the management of refractory Aspergillus otomycosis.
The association between autoimmune diseases and schizophrenia has rarely
been systematically investigated.
To investigate the association between schizophrenia and a variety of
autoimmune diseases and to explore possible gender variation in any such
Taiwan's National Health Insurance Research Database was used to identify
10 811 hospital in-patients with schizophrenia and 108 110 age-matched
controls. Univariate and multiple logistic regression analyses were
performed, separately, to evaluate the association between autoimmune
diseases and schizophrenia. We applied the false discovery rate to
correct for multiple testing.
When compared with the control group, the in-patients with schizophrenia
had an increased risk of Graves' disease (odds ratio (OR) = 1.32, 95% CI
1.04–1.67), psoriasis (OR = 1.48, 95% CI 1.07–2.04), pernicious anaemia
(OR = 1.71, 95% CI 1.04–2.80), celiac disease (OR = 2.43, 95% CI
1.12–5.27) and hypersensitivity vasculitis (OR = 5.00, 95% CI
1.64–15.26), whereas a reverse association with rheumatoid arthritis (OR
= 0.52, 95% CI 0.35–0.76) was also observed. Gender-specific variation
was found for Sjögren syndrome, hereditary haemolytic anaemia, myasthenia
gravis, polymyalgia rheumatica and dermatomyositis.
Schizophrenia was associated with a greater variety of autoimmune
diseases than was anticipated. Further investigation is needed to gain a
better understanding of the aetiology of schizophrenia and autoimmune
The impact of the outbreak of severe acute respiratory syndrome (SARS) was enormous, but few studies have focused on the infectious and general health status of healthcare workers (HCWs) who treated patients with SARS.
We prospectively evaluated the general health status of HCWs during the SARS epidemic.The Medical Outcome Study Short-Form 36 Survey was given to all HCWs immediately after caring for patients with SARS and 4 weeks after self-quarantine and off-duty shifts. Tests for detection of SARS Coronavirus antibody were performed for HCWs at these 2 time points and for control subjects during the SARS epidemic.
Tertiary care referral center in Taipei, Taiwan.
Ninety SARS-care task force members (SARS HCWs) and 82 control subjects.
All serum specimens tested negative for SARS antibody. Survey scores for SARS HCWs immediately after care were significantly lower than those for the control group (P < .05 by the t test) in 6 categories. Vitality, social functioning, and mental health immediately after care and vitality and mental health after self-quarantine and off-duty shifts were among the worst subscales. The social functioning, role emotional, and role physical subscales significantly improved after self-quarantine and off-duty shifts (P < .05, by paired t test). The length of contact time (mean number of contact-hours per day) with patients with SARS was associated with some subscales (role emotional, role physical, and mental health) to a mild extent. The total number of contact-hours with symptomatic patients with SARS was a borderline predictor (adjusted R2 = 0.069; P = .038) of mental health score.
The impact of the SARS outbreak on SARS HCWs was significant in many dimensions of general health. The vitality and mental health status of SARS HCWs 1 month after self-quarantine and off-duty shifts remained inferior to those of the control group.
The electrical properties of Al/LaAlO3/GaAs metal-oxide-semiconductor capacitors were investigated. A thick arsenic (As2) capping layer was used to protect the GaAs from oxidation and contamination during the air exposure that occurred between the deposition of the GaAs and LaAlO3 layers in different molecular-beam epitaxy systems. Amorphous LaAlO3 was deposited on c(4×4)- and (2×4)-reconstructed (100) GaAs surfaces. Post dielectric deposition annealing was found to improve the capacitance-voltage (C-V) characteristics by eliminating frequency dispersion in the depletion and weak inversion regimes and diminished the bi-directional C-V hysteresis to 210 mV. Reasonably low gate leakage current was maintained after annealing.
The microstructure and composition of aluminum oxide films, formed by a two-step anodization process in various electrolytes at 100 V then subject to an intermediate heat treatment (500 °C, 2 min), were investigated. The anodization electrolytes used included ammonium adipate electrolyte, phosphoric acid electrolyte, ammonium dihydrogen phosphate electrolyte, and their mixtures. The cross-section morphologies, crystal structure, and chemical composition of aluminum anodic oxides were examined by transmission electron microscopy. X-ray photoelectron spectroscopy was carried out to study the surface chemical state of the anodic films. The corresponding capacitances and retention voltages of these oxide films were also explored. The results indicated that amorphous-to-crystalline transformation of the oxide, primarily in films formed in ammonium adipate electrolyte, was induced by the heat treatment. Electron diffraction analyses further revealed the oxide films consisted of two distinct zones, which included an inner amorphous layer and an outer layer containing crystalline γ′-Al2O3. This study found that the phosphorous species in either the primary or the re-anodization electrolytes had a potential to cause changes of Al and O distributions within the oxides. The oxide film primarily anodized in ammonium adipate and re-anodized in phosphoric acid had the highest capacitance due to its high degree of crystallinity and thinness compared to oxides formed in other electrolytes. The presence of phosphorus, from the primary anodization electrolytes, in the oxides could inhibit the formation of crystalline γ′-Al2O3 and, consequently, decrease the capacitances of the anodic films. At the same time, the retention voltage and hydration resistance of these oxide films were improved.
To determine risk factors for hemodialysis catheter-related bloodstream infections (HCRBSIs) and investigate whether use of maximal sterile barrier precautions would prevent HCRBSIs.
Tertiary-care medical center hemodialysis unit.
Open trial with historical comparison and case-control study of risk factors for HCRBSIs.
Prospective surveillance was used to compare HCRBSI rates for 1 year before and after implementation of maximal sterile barrier precautions. A case–control study compared 50 case-patients with HCRBSI with 51 randomly selected control-patients.
The HCRBSI rate was 1.6% per 100 dialysis runs (CI95, 1.1%–2.3%) in the first year and 0.77% (CI95, 0.5%–1.1%) in the second year (P = .0106). The most frequent cause of HCRBSI was MRSA in the first year (15 of 32) and MSSA in the second year (13 of 18). Ten MRSA blood isolates in the first year were identical by PFGE. Diabetes mellitus was a risk factor for HCRBSI. Age, gender, site of hemodialysis central venous catheter (CVC), other underlying diseases, coma score, APACHE II score, serum albumin level, and cholesterol level were not associated with HCRBSI and did not change between the 2 years. Hospital stay was prolonged for case-patients (32.78 ± 20.96 days) versus control-patients (22.75 ± 17.33 days), but mortality did not differ.
Use of maximal sterile barrier precautions during the insertion of CVCs reduced HCRBSIs in dialysis patients and seemed cost-effective. Diabetes mellitus was associated with HCRBSI. An outbreak of MRSA in the first year was likely caused by cross-infection via medical personnel.
Both the longitudinal (LA) Brillouin back-scattering spectra and dielectric permittivity along the  direction have been measured as a function of temperature for a relaxor ferroelectric single crystal (PbMg1/3Nb2/3O3)0.68(PbTiO3)0.32 (PMN-32%PT). A sharp ferroelectric phase transition (which is associated with a Landau-Khalatnikov-like phonon damping maximum) was observed near 445 K. As temperature increases, a diffuse phase transition was detected near 280 K. In addition, the nature of the thermal hysteresis for the dielectric permittivity confirms that these transitions (near 280 and 445 K for heating procedure) are diffuse first-order and first-order, It respectively. The dielectric data prove the existence of an electric dipolar relaxation process below 300 K.
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