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The retention of patients under methadone maintenance treatment (MMT) is an indication for the effectiveness of the therapy. We aimed to explore the relation between mortality and the cumulative MMT duration.
A retrospective cohort analysis was performed using Taiwan Illicit Drug Issue Database (TIDID) and National Health Insurance Research Database (NHIRD) during 2012–2016. We included 9149 and 11 112 MMT patients as the short and long groups according to the length of their cumulative MMT duration, 1–364 and ⩾365 days, respectively. The risk of mortality was calculated by Cox proportional hazards regression model with time-dependent exposure to MMT, and the survival probability was plotted with the Kaplan-Meier curve.
The mortality rates were 2.51 and 1.51 per 100 person-years in the short and long cumulative MMT duration groups, respectively. After adjusting for on or off MMT, age, sex, marital status, education level, maximum methadone dose, and comorbidities (human immunodeficiency virus, depression, hepatitis C virus, hepatitis B virus, alcoholic liver disease, and cardiovascular disease), the long group had a lower risk of death (hazard ratio = 0.67; 95% confidence interval 0.60–0.75) than the short group. Increased risk was observed in patients with advanced age, being male, unmarried, infected by HIV, HCV, and HBV, and diagnosed with depression, ALD, and CVD. Causes of death were frequently related to drug and injury.
Longer cumulative MMT duration is associated with lower all-cause and drug-related mortality rate.
The risk of antipsychotic-associated cardiovascular and metabolic events may differ among countries, and limited real-world evidence has been available comparing the corresponding risks among children and young adults. We, therefore, evaluated the risks of cardiovascular and metabolic events in children and young adults receiving antipsychotics.
We conducted a multinational self-controlled case series (SCCS) study and included patients aged 6–30 years old who had both exposure to antipsychotics and study outcomes from four nationwide databases of Taiwan (2004–2012), Korea (2010–2016), Hong Kong (2001–2014) and the UK (1997–2016) that covers a total of approximately 100 million individuals. We investigated three antipsychotics exposure windows (i.e., 90 days pre-exposure, 1–30 days, 30–90 days and 90 + days of exposure). The outcomes were cardiovascular events (stroke, ischaemic heart disease and acute myocardial infarction), or metabolic events (hypertension, type 2 diabetes mellitus and dyslipidaemia).
We included a total of 48 515 individuals in the SCCS analysis. We found an increased risk of metabolic events only in the risk window with more than 90-day exposure, with a pooled IRR of 1.29 (95% CI 1.20–1.38). The pooled IRR was 0.98 (0.90–1.06) for 1–30 days and 0.88 (0.76–1.02) for 31–90 days. We found no association in any exposure window for cardiovascular events. The pooled IRR was 1.86 (0.74–4.64) for 1–30 days, 1.35 (0.74–2.47) for 31–90 days and 1.29 (0.98–1.70) for 90 + days.
Long-term exposure to antipsychotics was associated with an increased risk of metabolic events but did not trigger cardiovascular events in children and young adults.
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.
The goal of this research is to develop a low-cost face robot which has a lower degree-of-freedom facial expression mechanism. Many designs of facial robots have been announced and published in the past. Face robots can be classified into two major types based on their respective degrees of freedom. The first type has various facial expressions with higher degrees of freedom, and the second has finite facial expressions with fewer degrees of freedom. Due to the high cost of the higher-degree-of-freedom face robot, most commercial face robot products are designed in the lower-degrees-of-freedom form with finite facial expressions. Therefore, a face robot with a simplified facial expression mechanism is proposed in this research. The main purpose of this research is to develop a device with a lower degree-of-freedom mechanism that is able to generate many facial expressions while keeping one basic mouth shape variation. Our research provides a new face robot example and development direction to reduce costs and conserve energy.
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.
Glycogen stored in skeletal muscle is the main fuel for endurance exercise. The present study examined the effects of oral hydroxycitrate (HCA) supplementation on post-meal glycogen synthesis in exercised human skeletal muscle. Eight healthy male volunteers (aged 22·0 (se 0·3) years) completed a 60-min cycling exercise at 70–75 % and received HCA or placebo in a crossover design repeated after a 7 d washout period. They consumed 500 mg HCA or placebo with a high-carbohydrate meal (2 g carbohydrate/kg body weight, 80 % carbohydrate, 8 % fat, 12 % protein) for a 3-h post-exercise recovery. Muscle biopsy samples were obtained from vastus lateralis immediately and 3 h after the exercise. We found that HCA supplementation significantly lowered post-meal insulin response with similar glucose level compared to placebo. The rate of glycogen synthesis with the HCA meal was approximately onefold higher than that with the placebo meal. In contrast, GLUT4 protein level after HCA supplementation was significantly decreased below the placebo level, whereas expression of fatty acid translocase (FAT)/CD36 mRNA was significantly increased above the placebo level. Furthermore, HCA supplementation significantly increased energy reliance on fat oxidation, estimated by the gaseous exchange method. However, no differences were found in circulating NEFA and glycerol levels with the HCA meal compared with the placebo meal. The present study reports the first evidence that HCA supplementation enhanced glycogen synthesis rate in exercised human skeletal muscle and improved post-meal insulin sensitivity.
We fabricated a nanostructured brush by carrying out Ni deposition on a through-channel anodic aluminum oxide (AAO) template, followed by removal of the AAO skeleton. The AAO was prepared by a two-step anodization process resulting in pore diameter and thickness of 350 nm and 40 μm, respectively. Subsequently, the AAO underwent an electroless deposition involving sensitization, activation, and Ni plating, in conjunction with polyethylene glycol used as the inhibitor to prevent premature closing of pore opening. After deliberate control in relevant parameters, we obtained a conformal Ni overcoat along every pore channel leading to a reduced average pore diameter of 78 nm. Afterward, the sample was immersed in a KOH solution to remove the AAO structure, forming freestanding Ni tubules in a brush configuration. The nanostructured brush revealed considerable enhancement for hydrogen evolution reaction in both current-potential polarization and galvanostatic measurements, which were attributed to the increment in apparent surface area.
The pathological mechanism of restenosis is primarily attributed to excessive proliferation of vascular smooth muscle cells (VSMC). The preventive effects of ethanol extract of Dunaliella salina (EDS) on balloon injury-induced neointimal formation were investigated. To explore its molecular mechanism in regulating cell proliferation, we first showed that EDS markedly reduced the human aortic smooth muscle cell proliferation via the inhibition of 5′-bromo-2′-deoxyuridine (BrdU) incorporation at 40 and 80 μg/ml. This was further supported by the G0/G1-phase arrest using a flow cytometric analysis. In an in vivo study, EDS at 40 and 80 μg/ml was previously administered to the Sprague–Dawley rats and found that the thickness of neointima, and the ratio of neointima:media were also reduced. EDS inhibited VSMC proliferation in a dose-dependent manner following stimulation of VSMC cultures with 15 % fetal bovine serum (FBS). Suppressed by EDS were 15 % FBS-stimulated intracellular Raf, phosphorylated extracellular signal-regulated kinases (p-Erk) involved in cell-cycle arrest and proliferating cell nuclear antigen. Phosphorylated focal adhesion kinase (p-FAK) was also suppressed by EDS. Also active caspase-9, caspase-3 and cleaved poly(ADP-ribose) polymerase (PARP) protein expression levels were increased by administration with EDS; the apoptotic pathway may play an important role in the regulatory effects of EDS on cell growth. These observations provide a mechanism of EDS in attenuating cell proliferation, thus as a potential intervention for restenosis.
To investigate a nosocomial outbreak of infection with multidrug-resistant (MDR) Acinetobacter baumannii in the intensive care units at China Medical University Hospital in Taiwan.
Prospective outbreak investigation.
Three intensive care units in a 2,000-bed university hospital in Taichung, Taiwan.
Thirty-eight stable patients in 3 intensive care units, all of whom had undergone an invasive procedure, were enrolled in our study. Ninety-four A. baumannii strains were isolated from the patients or the environment in the 3 intensive care units, during the period from January 1 through December 31, 2006. We characterized A. baumannii isolates by use of repetitive extragenic palindromic–polymerase chain reaction (REP-PCR) and random amplified polymorphic DNA (RAPD) fingerprinting. The clinical characteristics of the source patients and the environment were noted.
All of the clinical isolates were determined to belong to the same epidemic strain of MDR A. baumannii by the use of antimicrobial susceptibility tests, REP-PCR, and RAPD fingerprinting. All patients involved in the infection outbreak had undergone an invasive procedure. The outbreak strain was also isolated from the environment and the equipment in the intensive care units. Moreover, an environmental survey of one of the intensive care units found that both the patients and the environment harbored the same outbreak strain.
The outbreak strain of A. baumannii might have been transmitted among medical staff and administration equipment. Routine and aggressive environmental and equipment disinfection is essential for preventing recurrent outbreaks of nosocomial infection with MDR A. baumannii.
We compare the turn-on voltage, P-I, and EL responses between the MISLEDs made by Si-rich SiNx and SiOx films. Active layer thickness enlarged from 120 to 360 nm is achieved by lengthening deposition time from 10 to 30 min, which inevitably increases the forward turn-on voltage from 3 to 41 V. We observe that the forward turn-on voltage of SiNx based MISLED is only 10.43 V and that of SiOx based one is 69 V with the same film thickness of 100 nm. The tunneling-based carrier transport mechanism is dominated due to the exponential like V-I behavior, while the tunneling probability is strongly dependent on the height of the barriers between metal/dielectric and dielectric/nc-Si matrices. The P-I slope of SiNx and SiOx based MISLEDs are 1.6 and 115.2 mW/A, respectively. The SiNx MISLED reveals threshold current and voltage of only 4 A and 12 V due to lower barrier height of both ITO/SiNx and SiNx/nc-Si, whereas the threshold current and voltage of SiOx based MISLED are 400 A and 78 V, respectively. In comparison, the higher tunneling current through the SiNx MISLED fails to promote the larger external quantum efficiency of the MISLED, indicating that such lower barriers are not beneficial to the confinement of tunneling carriers and the enhancement of light-emission efficiency.
In this paper, we use a perylene diimide derivative serving as a destructive and an absorption layer of the “black cathode” of an organic light-emitting device (OLED). A thin and semitransparent metal between the electron transport layer and the perylene diimide is used for better electron injection and also serves as the destructive interference. The thickness of such layer is critical since thinner metal results in lower reflectance, but higher diving voltage due to worse electron injection. To enhance the electron injection capability, the thickness of the thin metal increases which in turns to increase the reflectance. Here, we used a double-metal configuration to decrease the reflectance and maintain the electron injection capability at the same time.
Strenuous exercise is known to induce oxidative stress leading to the generation of free radicals. The purpose of the present study was to investigate the effects of lycopene, an antioxidant nutrient, at a relatively low dose (2·6 mg/kg per d) and a relatively high dose (7·8 mg/kg per d) on the antioxidant status of blood and skeletal muscle tissues in rats after exhaustive exercise. Rats were divided into six groups: sedentary control (C); sedentary control with low-dose lycopene (CLL); sedentary control with high-dose lycopene (CHL); exhaustive exercise (E); exhaustive exercise with low-dose lycopene (ELL); exhaustive exercise with high-dose lycopene (EHL). After 30 d, the rats in the three C groups were killed without exercise, but the rats in the three E groups were killed immediately after an exhaustive running test on a motorised treadmill. The results showed that xanthine oxidase (XO) activities of plasma and muscle, and muscular myeloperoxidase (MPO) activity in group E were significantly increased compared with group C. Compared with group E, the elevations of XO and MPO activities of muscle were significantly decreased in group EHL. The malondialdehyde concentrations of plasma and tissues in group E were significantly increased by 72 and 114 %, respectively, compared with those in group C. However, this phenomenon was prevented in rats of the ELL and EHL groups. There was no significant difference in the GSH concentrations of erythrocytes in each group; however, exhaustive exercise resulted in a significant decrease in the GSH content of muscle. In conclusion, these results suggested that lycopene protected muscle tissue from oxidative stress after exhaustive exercise.
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