Demographic differences in people living with HIV according to recruitment sources: comparison between health-care systems and social media networks

With the improvement of internet technology in health applications, the utilization of internet and social media as new survey methodologies and recruitment source for research participants have been encouraged, yet evidence of the feasibility in people living with HIV (PLHIV) study is still lacking. We conducted a cross-sectional survey to determine whether there are differences among PLHIV recruited from social media networks and health-care systems using an HIV stigma and discrimination questionnaire. The result revealed that PLHIV recruited from social media networks were younger, more sexually active, and had higher educational status and awareness of the country's HIV rights protection laws than those recruited from hospitals. By contrast, participants recruited from hospitals were more diverse regarding key population compositions, had lived with HIV for a longer duration, had a higher prevalence of concomitant physical disabilities than those recruited from social media networks, and fit Taiwan PLHIV characteristics described by 2016 census from Taiwan Centres for Disease Control. We conclude that sampling bias exists when utilizing social media networks for PLHIV studies.

Effect of benign prostatic hyperplasia on the development of spine, hip, and wrist fractures

Benign prostatic hyperplasia is one of the most common diseases in the elderly male population. The urinary tract symptoms may increase the risk of falls and fractures. The results indicated that patients with benign prostatic hyperplasia could increase the risk of vertebral compression fractures in both the thoracic and lumbar spine and also hip fractures, but did not increase the risk of wrist fracture.

INTRODUCTION

The relationship between benign prostatic hyperplasia and the development of fall-related fractures, especially vertebral compression fractures, has been seldom mentioned in the literature. This study aimed to evaluate the risk of developing vertebral compression fracture, hip fracture, and wrist fracture in patients with benign prostatic hyperplasia.

METHODS

This study obtained claims data retrospectively from the National Health Insurance Research Database of Taiwan and identified 48,114 patients who were diagnosed as having benign prostatic hyperplasia. Subjects of the control cohort were individually matched at a ratio of 4:1 with those in the benign prostatic hyperplasia cohort according to age and the index day. Comorbidities were classified as those existing before the index day and included a previous fracture history, osteoporosis, myocardial infarction, congestive heart failure, diabetes mellitus, hypertension, cerebrovascular accident, etc. The end of the follow-up period of the analyses was the day when the patient developed new vertebral compression fractures, hip fractures, or wrist fractures, terminated enrollment from the National Health Insurance, or died or until the end of 2012. The study used the Cox proportion hazard model to determine the hazard ratio for developing new hip fractures.

RESULTS

Patients with benign prostatic hyperplasia were significantly more likely than those in the control cohort to develop new vertebral compression fractures in the thoracic spine (0.43% vs. 0.40%, adjusted hazard ratio 3.03, confidence interval 2.12-4.31) and lumbar spine (1.26% vs. 1.23%, adjusted hazard ratio 4.12, confidence interval 3.39-5.01), and hip fracture (1.47% vs. 2.09%, adjusted hazard ratio 1.22, confidence interval 1.10-1.36), but does not increase the risk of wrist fracture (0.61% vs. 0.67%, adjusted hazard ratio 1.07, confidence interval 0.85-1.34).

CONCLUSIONS

Patients with benign prostatic hyperplasia exhibited an increased risk of developing vertebral compression fractures in both the thoracic and lumbar spine and also hip fractures, but did not increase the risk of wrist fracture. However, more research is needed to confirm this trend in the clinical setting.

[HIV Stigma and Spiritual Care in People Living With HIV]

HIV infection has been a manageable and chronic illness in Taiwan since the highly active antiretroviral therapy was introduced in 1997. HIV infection is a stigmatized disease due to its perceived association with risky behaviors. HIV often carries a negative image, and people living with HIV(PLWH) face discrimination on multiple fronts. Internalized HIV stigma impacts the spiritual health of people living with HIV in terms of increased levels of shame, self-blame, fear of disclosing HIV status, and isolation and decreased value and connections with God, others, the environment, and the self. Nursing professionals provide holistic care for all people living with HIV and value their lives in order to achieve the harmony of body, mind, and spirit. This article describes the stigma that is currently associated with HIV and how stigma-related discrimination affects the spiritual health of PLWH and then proposes how to reduce discrimination and stigma in order to improve the spiritual health of PLWH through appropriate spiritual care. Reducing HIV stigma and promoting spiritual well-being will enable Taiwan to achieve the 'Three Zeros' of zero discrimination, zero infection, and zero death advocated by the Joint United Nations Programme on HIV/AIDS for ending the AIDS epidemic in 2030.

The Impact of the Shallow-Trench Isolation Effect on Flicker Noise of Source Follower MOSFETs in a CMOS Image Sensor

The flicker noise of source follower transistors is the dominant noise source in image sensors. This paper reports a systematic study of the shallow trench isolation effect in transistors with different sizes under high temperature conditions that correspond to the quantity of empty defect sites. The effects of shallow trench isolation sidewall defects on flicker noise characteristics are investigated. In addition, the low-frequency noise and subthreshold swing degrade simultaneously in accordance to the device gate width scaling. Both serious subthreshold leakage and considerable noise can be attributed to the high trap density near the STI edge. Consequently, we propose a coincidental relationship between the noise level and the subthreshold characteristic; its trend is identical to the experiments and simulation results.

Effects of Pre-Existing Liver Disease on Acute Pain Management Using Patient-Controlled Analgesia Fentanyl With Parecoxib After Major Liver Resection: A Retrospective, Pragmatic Study

BACKGROUND

The aim of this study was to compare the outcomes of pain management with the use of patient-controlled analgesia (PCA) fentanyl with IV parecoxib between patients with healthy liver with patients with diseased liver undergoing major liver resection.

METHODS

Patients with healthy liver undergoing partial hepatectomy as liver donors for liver transplantation (group 1) and patients with liver cirrhosis (Child's criteria A) undergoing major liver resection for hepatoma (group 2) were identified retrospectively. Both groups routinely received post-operative IV PCA fentanyl and a single dose of parecoxib 40 mg. They were followed up for 3 days or until PCA fentanyl was discontinued post-operatively. Daily Visual Analog Scale, PCA fentanyl usage, rescue attempts, and common drug side effects were collected and analyzed with the use of SPSS version 20.

RESULTS

One hundred one patients were included in the study: 54 in group 1, and 47 in group 2. There were no statistical differences between the two groups in terms of the daily and total fentanyl usage, VAS resting, and incidence of itchiness. The rate of rescue analgesia on post-operative day (POD) 1 was lower in group 2, with a value of P = .045. VAS dynamics were better on POD 1 and 2 for group 2, with P = .05 and P = .012, respectively.

CONCLUSIONS

We found that combining a single dose of IV parecoxib 40 mg with PCA fentanyl is an easy and effective method of acute pain control after major liver resection. We propose the careful usage of post-operative fentanyl and parecoxib in patients with diseased liver, given the difference in effect as compared with healthy liver.

Evaluation of nasal patency by visual analogue scale/nasal obstruction symptom evaluation questionnaires and anterior active rhinomanometry after septoplasty: a retrospective one-year follow-up cohort study

OBJECTIVE

To assess the efficacy of septoplasty and the correlation between the subjective evaluations of a visual analogue scale (VAS) and the Nasal Obstruction Symptom Evaluation (NOSE) questionnaire and active anterior rhinomanometry of the nasal airway after septoplasty.

DESIGN

A retrospective, individual cohort study.

SETTING

Ear, Nose and Throat Department, Taipei City Hospital, Taipei, Taiwan.

PARTICIPANTS

Fifty patients with chronic nasal obstruction were enrolled in the study. All 50 patients underwent septoplasty because of nasal septal deviation. Another 28 patients without nasal symptoms served as controls.

MAIN OUTCOME MEASURES

VAS, NOSE and active anterior rhinomanometry were used to measure the sensation of nasal obstruction. All measurements were performed in both groups preoperatively and then repeated on three postoperative visits (3, 6 and 12 months).

RESULTS

The mean VAS score, NOSE score and the nasal resistance in the narrow side of the nose in the study group showed reduced symptoms at 3, 6 and 12 months postoperatively compared with the respective preoperative measurements (P < 0.001, all). The VAS and NOSE scores did not significantly correlate with total nasal resistance preoperatively or postoperatively. The VAS and nasal resistance in the obstructed nasal cavity correlated significantly preoperatively (P < 0.05), but not postoperatively.

CONCLUSIONS

The subjective and objective symptoms of nasal obstruction had improved 1 year after septoplasty. A significant correlation between VAS scores and nasal resistance in the narrow side of the nose was found before surgery. The subjective and objective measurements of nasal obstruction lacked significant correlation postoperatively.

Foxp2 regulates neuronal differentiation and neuronal subtype specification

Mutations of the transcription factor FOXP2 in humans cause a severe speech and language disorder. Disruption of Foxp2 in songbirds or mice also leads to deficits in song learning or ultrasonic vocalization, respectively. These data suggest that Foxp2 plays important roles in the developing nervous system. However, the mechanism of Foxp2 in regulating neural development remains elusive. In the current study, we found that Foxp2 increased neuronal differentiation without affecting cell proliferation and cell survival in primary neural progenitors from embryonic forebrains. Foxp2 induced the expression of platelet-derived growth factor receptor α, which mediated the neurognic effect of Foxp2. In addition, Foxp2 positively regulated the differentiation of medium spiny neurons derived from the lateral ganglionic eminence and negatively regulated the formation of interneurons derived from dorsal medial ganglionic eminence by interacting with the Sonic hedgehog pathway. Taken together, our results suggest that Foxp2 regulates multiple aspects of neuronal development in the embryonic forebrain.

Differential effects of arsenic on calcium signaling in primary keratinocytes and malignant (HSC-1) cells

Arsenic is highly toxic to living cells, especially skin, and skin cancer is induced by drinking water containing arsenic. The molecular mechanisms of arsenic-induced cancer, however, are not well understood. To examine the initial processes in the development of arsenic-induced cancer, we analyzed calcium signaling at an early stage of arsenic treatment of human primary cells and compared the effects with those observed with arsenic treatment in carcinoma-derived cells. We found that arsenic inhibited inositol trisphosphate receptor (IP3R) function in the endoplasmic reticulum by inducing phosphorylation, which led to decreased intracellular calcium levels. Blockade of IP3R phosphorylation by the serine/threonine protein kinase Akt inhibitor wortmannin rescued calcium signaling. In contrast, arsenic treatment of cells derived from a carcinoma (human squamous carcinoma; HSC-1) for 1h had no obvious effect. Taken together, these results suggest that arsenic-induced reduction in calcium signaling is one of the initial mechanisms underlying the malignant transformation in the development of skin cancer.

Treating high-mercury-containing lamps using full-scale thermal desorption technology

The mercury content in high-mercury-containing lamps are always between 400 mg/kg and 200,000 mg/kg. This concentration is much higher than the 260 mg/kg lower boundary recommended for the thermal desorption process suggested by the US Resource Conservation and Recovery Act. According to a Taiwan EPA survey, about 4,833,000 cold cathode fluorescent lamps (CCFLs), 486,000 ultraviolet lamps and 25,000 super high pressure mercury lamps (SHPs) have been disposed of in the industrial waste treatment system, producing 80, 92 and 9 kg-mercury/year through domestic treatment, offshore treatment and air emissions, respectively. To deal with this problem we set up a full-scale thermal desorption process to treat and recover the mercury from SHPs, fluorescent tube tailpipes, fluorescent tubes containing mercury-fluorescent powder, and CCFLs containing mercury-fluorescent powder and monitor the use of different pre-heating temperatures and desorption times. The experimental results reveal that the average thermal desorption efficiency of SHPs and fluorescent tube tailpipe were both 99.95%, while the average thermal desorption efficiencies of fluorescent tubes containing mercury-fluorescent powder were between 97% and 99%. In addition, a thermal desorption efficiency of only 69.37-93.39% was obtained after treating the CCFLs containing mercury-fluorescent powder. These differences in thermal desorption efficiency might be due to the complexity of the mercury compounds contained in the lamps. In general, the thermal desorption efficiency of lamps containing mercury-complex compounds increased with higher temperatures.

Effects of 9 weeks of hindlimb unloading on motor performances in adult rats

It has been reported that abnormal steps associated with an ankle hyper-extension during walking were observed in adult rats after 2 weeks of hindlimb suspension (Canu and Falempin, 1997 & 1998). But such phenomena were normalized after 7 days of reambulation recovery. Canu and Falempin (1996) suggested that the spinal cord has a capacity to generate a well-organized pattern of locomotion even after a period of muscle disuse. There are, however, no reports about the effects of more prolonged suspension on motor performances. In the present study, 7 weeks old male rats were hindlimb-unloaded by tail suspension for 9 consecutive weeks and landing performances in response to drop from head-down, head-up, or supine position were investigated during 8 weeks of recovery. Posture maintenance during right-left translation was also checked.

Changes in valvular resistance, power dissipation and myocardial reserve with aortic valvuloplasty

Balloon aortic valvuloplasty results in small changes in valve area with great symptomatic improvement in some patients, while others have little relief with greater increases in valve area. Alternative indices to valve area may help explain this clinical discrepancy. A calculation of valve area does not provide a means of assessing the load imposed by a stenotic valve, while the complementary index valve resistance, defined as the quotient of mean pressure difference divided by flow, allows many other hemodynamic calculations and may provide an additional measure of the hemodynamic importance of valvular obstructions. To assess the value of these calculations, we studied hemodynamic changes in thirty elderly patients undergoing valvuloplasty for aortic stenosis. The valve area, as calculated by the Gorlin formula, increased by an average 67% (0.59 cm2 to 0.95 cm2), while hemodynamic resistance decreased by an average 52% (453 to 207 dyne.sec.cm5). The values of resistance were used to predict pressure gradients and work loads at different cardiac outputs. The increase in myocardial reserve with valvuloplasty was calculated as the increase in cardiac output that could be achieved at the pre-valvuloplasty value of either total ventricular pressure or ventricular work. These calculations assumed that valvular resistance did not change with cardiac output and that peripheral resistance varied inversely to cardiac output so as to maintain a constant aortic (systemic) pressure. The increase in myocardial reserve was 18% when ventricular work rate was the limiting factor, and 103% when pressure was limiting. The increase in reserve may be closer to the higher value since the myocardial work rate is probably not limited by myocardial energy in the absence of coronary artery disease. Four patients who did not do well clinically were characterized by small increases in reserve, either because of inadequate dilatation of the valve or because the original stenosis was not severe. Valve resistance, myocardial reserve, and ventricular work may be calculated using standard hemodynamic measurements. In conjunction with aortic valve area, these indices provide significant complimentary information and may further elucidate the hemodynamic consequences of valvular obstruction.

Power-afterload relation in the failing human ventricle

Animal studies have shown that the power output of the left ventricle is related to afterload by a bell-shaped curve. Furthermore, the normal ventricle operates at the maximum power point, whereas the diseased ventricle operates off the maximum power point because of increased afterload. We studied this relation in eight patients with dilated cardiomyopathy. A high-fidelity catheter with micromanometer pressure and electromagnetic velocity transducers was used to measure blood pressure and flow velocity in the ascending aorta. The latter was converted into volumetric flow by calibrating with the simultaneously determined thermodilution cardiac output. Ventricular power was calculated by dividing the integral of the aortic blood pressure-flow product by the duration of the cardiac cycle. Intravenous nitroprusside was used to alter afterload and the power-afterload relation was obtained by plotting power against mean aortic blood pressure. In all patients, as blood pressure was lowered initially, the power output of the left ventricle increased. As the dose of nitroprusside was increased further, the total power either plateaued or actually decreased. The averaged power and the mean blood pressure at control were 1.00 +/- 0.62 W and 92 +/- 9.3 mm Hg, respectively. The averaged maximum increase in power with nitroprusside was 22%, to 1.22 +/- 0.73 W, and this occurred at a mean pressure of 80 +/- 8.8 mm Hg. This study showed that the power-afterload relation in the human ventricle has a maximum power point at some intermediate level of afterload, similar to that found in animal studies.(ABSTRACT TRUNCATED AT 250 WORDS)

Determination of pulse wave velocities with computerized algorithms

Careful determination of pulse wave velocity is important in the study of arterial viscoelastic properties, wave reflections, and ventricular-arterial interactions. In spite of its increasingly widespread use, there is as yet no standardized method for its determination. Most studies have manually identified the transit time of the pressure wave front as it travels over a known distance in the arterial system, but the issues of accuracy and reproducibility have not been addressed. This study was designed to investigate the efficacy of four computerized algorithms in the determination of pulse wave velocities in invasive as well as in noninvasive pressure determinations. The four methods were the identification of: (1) the point of minimum diastolic pressure, (2) the point at which the first derivative of pressure is maximum, (3) the point at which the second derivative of pressure is maximum, and (4) the point yielded by the intersection of a line tangent to the initial systolic upstroke of the pressure tracing and a horizontal line through the minimum point. High-fidelity aortic pressure recordings were obtained in 26 patients with a multi-sensor micromanometer catheter. Noninvasive brachial and radial pressure waveforms were recorded in 11 volunteers with external piezoelectric transducers. The results show that the first derivative method consistently provided results that were different from the other methods for both the invasive and noninvasive methods because of changes in the structure of the upstroke as the arterial pulse propagates distally. Although the minimum method worked well for the invasive determinations, it was erratic with the noninvasive determinations, probably because of the higher amount of noise and reflection in the latter. Among the four algorithms, the second derivative and the intersecting tangents methods worked well with both invasive and noninvasive determinations with mean variation coefficients of less than 7% and correlation coefficients between the methods of greater than 0.90 for all data. In conclusion, computerized algorithms allow accurate determination of pulse wave velocity in invasively and noninvasively measured arterial pressure waveforms.

Hemodynamic resistance as a measure of functional impairment in aortic valvular stenosis

Calculated valve area depicts anatomical stenosis but does not quantify hemodynamic impairment. We propose that hemodynamic resistance, defined as the mean pressure gradient across the valve divided by mean flow rate during systolic ejection, gives a better indication of hemodynamic obstruction. This index was compared with Gorlin valve area in 40 patients with aortic stenosis. Calculated area ranged from 0.22 to 1.26 cm2, and mean transvalvular resistance ranged from 117 to 1,244 dyne.sec.cm-5. In general, resistance varied inversely with calculated area, but there was substantial variation about the mean relation. All of the variation could be accounted for by variations in the pressure gradients at each value of calculated area. Resistance was higher in proportion to area when flow and pressure gradient were high. Analysis of five published studies of a total of 83 valves showed that calculated area changed at least three times more than resistance when pressure gradient was varied. The utility of resistance as an index of stenosis is demonstrated by example calculations that show how during exercise a stenotic valve increases the ventricular work rate out of proportion to the work done on the peripheral resistance. These calculations are possible because hemodynamic resistance defines functional impairment in units commonly used for quantification of opposition to flow. Furthermore, resistance appears to be less dependent than area on conditions of measurement and does not require an empirical constant.

Comparison of the effects of different inotropic interventions on force, velocity, and power in rabbit myocardium

To gain some insight into inotropic mechanisms, we compared the effects of several classes of inotropic interventions on the isometric twitch and force-velocity properties of isolated rabbit myocardium. Postextrasystolic potentiation was chosen as one of the interventions in the belief that its onset is so rapid that it would be unlikely to cause substantial chemical changes in the contractile proteins and that most of the effects would be due to changes in the level of activation. The effects of a digitalis analogue (acetylstrophanthidin), an adrenergic agent (isoproterenol), and a methylxanthine (caffeine) were then compared with those of postextrasystolic potentiation. The conditions were chosen so that each agent caused a twofold increase in twitch force. Acetylstrophanthidin and postextrasystolic potentiation caused twitch force to increase with only a slight (11%) decrease in time to peak force. Isoproterenol caused the peak of the twitch to occur substantially (40%) earlier with marked abbreviation of the twitch. Caffeine had the opposite effect: time to peak force was delayed (by 60%), and the twitch was markedly prolonged. In contrast to the marked differences in the time course of the twitch, there was no significant difference between the instantaneous force-velocity curves obtained with the different interventions. All four interventions caused maximum velocity to increase slightly (1-9%) and maximum power to increase only slightly more than twitch force (5-21%). All of the changes observed can be accounted for by changes in activation, either by an increase in the amount of calcium released into the myofilament space or by a change in the sensitivity of the myofilaments to calcium. There was no need to postulate direct changes in the contractile machinery to account for these results.

An improved catheter design for crossing stenosed aortic valves

Retrograde catheterization of the left ventricle in patients with aortic valve stenosis is commonly performed using a pigtail or coronary arterial catheter. This approach, although usually ultimately successful, may be highly tedious. To overcome the limitations of these conventional catheter shapes, we have designed a catheter specifically for crossing stenotic aortic valves. In a group of 17 patients, mean aortic valve area 0.75 cm2, the average time to cross the aortic valve was 2 minutes 45 seconds and the median time 30-40 seconds. Once the proper size catheter was selected, the average time to cross was 59 seconds. The success of this catheter is based on the operator's ability to "scan" or interrogate the surface of the valve thoroughly by manipulating the catheter and a moveable core straight tip guidewire.

Force, velocity, and power changes during normal and potentiated contractions of cat papillary muscle

The instantaneous force-velocity relations of cat papillary muscles were studied at different times in the twitch in normal and in postextrasystolic potentiated contractions. Fourteen to sixteen different loads were used to define each of the force-velocity curves. The curves were fitted by a least-squares procedure to the hyperbolic (Hill equation). The hyperbolae were extrapolated to obtain maximum velocity and isometric force and interpolated to obtain maximum power. All three of these values rose more quickly than developed force. Maximum velocity reached 77% of its peak at the earliest time studied, 20-25% of the time to peak force. Developed force achieved 22% of its final value at this time, while extrapolated isometric force and maximum power both reached 44% of their peak values. Postextrasystolic potentiation sufficient to produce a 1.5 to twofold increase in peak developed force produced less than a 20% increase in extrapolated maximum velocity. The results can be interpreted in terms of a model in which the maximum velocity of the contractile elements remains constant during the twitch. Variation in maximum velocity is attributed to a small internal load, equivalent to 6% of twitch force. Since maximum velocity is relatively constant, it does not give a good measure of changes in the force-velocity curves. By contrast, the extrapolated isometric force and maximum power are much more sensitive to changes in the force-velocity curves, and they vary in proportion to each other. The advantage of using interpolated maximum power rather than isometric force to define changes in the curves is that it can be normalized to muscle mass.

Myocardial infarction with topical cocaine anesthesia for nasal surgery

Cocaine, the active alkaloid in coca leaf, is widely used as local anesthetic for otolaryngologic procedures. Our patient suffered an acute nontransmural myocardial infarction following clinical use of cocaine as topical anesthesia for nasal surgery, the first such case to be documented, to our knowledge. Although evidence documenting its cardiovascular toxicity is listed in contemporary pharmacologic literature, clinical cardiac injury has been reported to date only with the recreational use of cocaine. Authentic documentation of drug composition when received through the intervention of illicit vendors is always difficult. The literature is reviewed, justifying the use of cocaine as the most popular topical anesthetic in otolaryngologic practice. However, we hope that awareness of this possible complication will create a resurgence of research interest in topical cocaine anesthesia.

System for automatic activation of skinned muscle fibers

A system is described for automatically changing the solutions surrounding skinned muscle fibers at a controlled temperature. The system consists of a complex muscle chamber and solenoid valve-controlled vacuum-driven syringe pumps. The chamber has a muscle trough, a conduit for circulating coolant, and channels for precooling solutions. After traveling through the cooling channels, the solutions are injected into one end of the muscle trough and removed by suction at the other. The volume of the trough (approximately 40 microliter) is kept as low as possible to minimize the amount of solution required for complete solution exchange (approximately 400 microliter). Solution changes are complete within 400 ms. The timing of the sequence of solution changes is precisely controlled by digital timers that activate the solenoid valves of the pumps. By exposing the fibers briefly to a high concentration of free calcium and then changing to a buffered calcium solution, it is possible to achieve steady tension levels in 1-2 s, even when partially activating the fibers. Such rapid partial activation is possible because the exposure to free calcium can be precisely timed. The timers also allow the solution changes to be synchronized with other perturbations.