FGF17 protects cerebral ischemia reperfusion-induced blood-brain barrier disruption via FGF receptor 3-mediated PI3K/AKT signaling pathway

Maintaining blood-brain barrier (BBB) integrity is critical components of therapeutic approach for ischemic stroke. Fibroblast growth factor 17 (FGF17), a member of FGF8 superfamily, exhibits the strongest expression throughout the wall of all major arteries during development. However, its molecular action and potential protective role on brain endothelial cells after stroke remains unclear. Here, we observed reduced levels of FGF17 in the serum of patients with ischemic stroke, as well as in the brains of mice subjected to middle cerebral artery occlusion (MCAO) injury and oxygen-glucose deprivation/reoxygenation (OGD/R)-induced brain microvascular endothelial cells (bEnd.3) cells. Moreover, treatment with exogenous recombinant human FGF17 (rhFGF17) decreased infarct volume, improved neurological deficits, reduced Evans Blue leakage and upregulated the expression of tight junctions in MCAO-injured mice. Meanwhile, rhFGF17 increased cell viability, enhanced trans-endothelial electrical resistance, reduced sodium fluorescein leakage, and alleviated reactive oxygen species (ROS) generation in OGD/R-induced bEnd.3 cells. Mechanistically, the treatment with rhFGF17 resulted in nuclear factor erythroid 2-related factor 2 (Nrf2) nuclear accumulation and upregulation of heme oxygenase-1 (HO-1) expression. Additionally, based on in-vivo and in-vitro research, rhFGF17 exerted protective effects against ischemia/reperfusion (I/R) -induced BBB disruption and endothelial cell apoptosis through the activation of the FGF receptor 3/PI3K/AKT signaling pathway. Overall, our findings indicated that FGF17 may hold promise as a novel therapeutic strategy for ischemic stroke patients.

Non-alcoholic fatty liver disease causally affects the brain cortical structure: a Mendelian randomization study

Background

Reduced brain volume, impaired cognition, and possibly a range of psychoneurological disorders have been reported in patients with non-alcoholic fatty liver disease (NAFLD); however, no underlying cause has been specified. Here, Mendelian randomization (MR) was employed to determine the causative NAFLD effects on cortical structure.

Methods

We used pooled-level data from FinnGen's published genome-wide association study (GWAS) of NAFLD (1908 cases and 340,591 healthy controls), as well as published GWAS with NAFLD activity score (NAS) and fibrosis stage-associated SNPs as genetic tools, in addition to the Enigma Consortium data from 51,665 patients, were used to assess genetic susceptibility in relation to changes with cortical thickness (TH) and surface area (SA). A main estimate was made by means of inverse variance weighted (IVW), while heterogeneity and pleiotropy were detected using MR-Egger, weighted median, and MR Pleiotropy RESidual Sum and Outlier to perform a two-sample MR analysis.

Results

At the global level, NAFLD reduced SA (beta = -586.72 mm2, se = 217.73, p = 0.007) and several changes in the cortical structure of the cerebral gyrus were found, with no detectable pleiotropy.

Conclusion

NAFLD causally affects cortical structures, which supports the presence of an intricate liver-brain axis.

Construction and functional evaluation of oral long-acting insulin hydrogel microparticles based on physical and chemical double crosslinking

The objective of this study was to enhance the convenience and effectiveness of diabetes treatment by developing hydrogel microparticles as an oral insulin delivery system, aiming to reduce the necessity for frequent treatments. The hydrogel microparticles were prepared with polysaccharides through a combination of physical and chemical crosslinking method, they achieved good results in insulin loading efficiency (70 %), insulin release efficiency (98 %) and sustained release time (>20 h). The effective transmembrane transport was validated using an intestinal epithelial cell model, which demonstrated a continuous hypoglycemic effect lasting from 6 to 26 h in a type 2 diabetes mouse model. Additionally, the relative bioavailability of insulin reached 30.14 ± 2.62 %, representing a significant breakthrough in the field of oral insulin delivery carriers. Furthermore, oral insulin hydrogel exhibited a substantial improvement in insulin resistance, organ damage, and diabetes-related complications stemming from hyperglycemia. These compelling findings underscore the potential of hydrogel microparticles as a cost-effective and valuable strategy for oral drug delivery in diabetes treatment.

PD-L1 and AKT Overexpressing Adipose-Derived Mesenchymal Stem Cells Enhance Myocardial Protection by Upregulating CD25+ T Cells in Acute Myocardial Infarction Rat Model

This study explores the synergistic impact of Programmed Death Ligand 1 (PD-L1) and Protein Kinase B (Akt) overexpression in adipose-derived mesenchymal stem cells (AdMSCs) for ameliorating cardiac dysfunction after myocardial infarction (MI). Post-MI adult Wistar rats were allocated into four groups: sham, MI, ADMSC treatment, and ADMSCs overexpressed with PD-L1 and Akt (AdMSC-PDL1-Akt) treatment. MI was induced via left anterior descending coronary artery ligation, followed by intramyocardial AdMSC injections. Over four weeks, cardiac functionality and structural integrity were assessed using pressure-volume analysis, infarct size measurement, and immunohistochemistry. AdMSC-PDL1-Akt exhibited enhanced resistance to reactive oxygen species (ROS) in vitro and ameliorated MI-induced contractile dysfunction in vivo by improving the end-systolic pressure-volume relationship and preload-recruitable stroke work, together with attenuating infarct size. Molecular analyses revealed substantial mitigation in caspase3 and nuclear factor-κB upregulation in MI hearts within the AdMSC-PDL1-Akt group. Mechanistically, AdMSC-PDL1-Akt fostered the differentiation of normal T cells into CD25+ regulatory T cells in vitro, aligning with in vivo upregulation of CD25 in AdMSC-PDL1-Akt-treated rats. Collectively, PD-L1 and Akt overexpression in AdMSCs bolsters resistance to ROS-mediated apoptosis in vitro and enhances myocardial protective efficacy against MI-induced dysfunction, potentially via T-cell modulation, underscoring a promising therapeutic strategy for myocardial ischemic injuries.

Case report: Hemophagocytic lymphohistiocytosis complicated by multiple organ dysfunction syndrome following aseptic encephalitis

Hemophagocytic lymphohistiocytosis (HLH) is a rare but potentially life-threatening condition caused by excessive immune activation. Secondary HLH is usually triggered by infection, most often from viral infection or malignancy. Here, we present a case of secondary HLH, complicated by multiple organ dysfunction syndrome triggered by critical aseptic encephalitis. A 27-year-old man without any underlying disease presented to our hospital with fever, disturbance of consciousness, and generalized seizures. The patient was diagnosed with aseptic encephalitis with super-refractory status epilepticus. Although antiseizure medications and immunoglobulins were administered, the patient developed multiple organ dysfunction syndrome. HLH was later diagnosed based on hypertriglyceridemia, hyperferritinemia, splenomegaly, cytopenia, and phagocytosis of nucleated cells, as shown by a blood smear of bone marrow aspiration. Treatment with pulse steroid therapy and plasmapheresis was initiated rather than chemotherapy because of the patient's critical condition. However, the patient died of profound shock and multiple organ failure. Diagnosis of HLH is challenging in patients with severe infections because of similar clinical manifestations and laboratory findings. The early recognition of HLH provides patients with the opportunity to receive appropriate treatment, which can lead to increased survival and remission rates.

Risk factors of portal vein system thrombosis after splenectomy: a meta-analysis

BACKGROUND

The primary aim of the present study was to explore risk factors for portal vein system thrombosis following splenectomy.

METHODS

A systematic search of PubMed, Embase and Cochrane libraries was conducted to identify original studies that fulfilled the inclusion criteria. Raw data on potential risk factors for portal vein system thrombosis after splenectomy were extracted for meta-analysis. Subsequently, a sensitivity analysis was conducted to verify the stability of the results.

RESULTS

Eighteen studies with 626 thrombosis events from 1807 splenectomy met the inclusion criteria. Larger spleen volume (SMD 0.44, P = 0.000), broader splenic vein diameter (WMD 2.30, P = 0.000), broader portal vein diameter (WMD 2.08, P = 0.000), a lower velocity of portal blood flow (WMD -0.91, P = 0.001), decreased platelet count (WMD -5.14, P = 0.007), decreased white blood cell (WMD -0.40, P = 0.027), decreased haemoglobin (WMD -9.14, P = 0.002), ascites (OR 1.81, P = 0.003) and bleeding history before surgery (OR 1.88, P = 0.002) were identified to be factors that exacerbated the risk of portal vein system thrombosis after splenectomy. Sex, age, preoperative prothrombin time, postoperative platelet count, postoperative D-dimer, operation time and intraoperative blood loss, did not increase the risk of thrombosis.

CONCLUSION

Larger spleen volume, broader splenic vein diameter, broader portal vein diameter, a lower velocity of portal blood flow, ascites, bleeding history before surgery, decreased platelet count, white blood cell and haemoglobin may increase the risk of portal vein system thrombosis.

Experimental and Numerical Investigation of the Mechanical Properties of a Fiber-Reinforced Geopolymer Mortar Blast Resistant Panel

Geopolymer materials have excellent properties such as high strength, low thermal conductivity, fire resistance, acid and alkali resistance, and low carbon emissions. They can be used as protective engineering materials in places with explosion risks. At present, the common composite blast resistant panel is in the form of a sandwich: the outer layer isgalvanized steel plate, and fiber cement board or calcium carbonate board is used as the inner layer material, as these boards have the advantages of easy installation, good fire resistance, and explosion resistance. This study investigates the effect of adding different types of fibers to geopolymer mortar on the mortar's basic mechanical properties, such as compression strength, bending strength, and impact resistance. The explosive resistance of the fiber-reinforced geopolymer mortar blast resistant panels was evaluated through free-air explosion. In this paper, experimental procedures and numerical simulation have been performed to study the failure modes, maximum deflection, and dynamic response of the fiber-reinforced geopolymer mortar blast resistant panel under free-air explosion. The research results can provide a reference for the design and production of blast resistant panels.

Shared alterations in hippocampal structural covariance in subjective cognitive decline and migraine

Introduction

Subjective cognitive decline (SCD) and migraine are often comorbid. Hippocampal structural abnormalities have been observed in individuals with both SCD and migraine. Given the known structural and functional heterogeneity along the long axis (anterior to posterior) of the hippocampus, we aimed to identify altered patterns of structural covariance within hippocampal subdivisions associated with SCD and migraine comorbidities.

Methods

A seed-based structural covariance network analysis was applied to examine large-scale anatomical network changes of the anterior and posterior hippocampus in individuals with SCD, migraine and healthy controls. Conjunction analyses were used to identify shared network-level alterations in the hippocampal subdivisions in individuals with both SCD and migraine.

Results

Altered structural covariance integrity of the anterior and posterior hippocampus was observed in the temporal, frontal, occipital, cingulate, precentral, and postcentral areas in individuals with SCD and migraine compared with healthy controls. Conjunction analysis revealed that, in both SCD and migraine, altered structural covariance integrity was shared between the anterior hippocampus and inferior temporal gyri and between the posterior hippocampus and precentral gyrus. Additionally, the structural covariance integrity of the posterior hippocampus-cerebellum axis was associated with the duration of SCD.

Conclusion

This study highlighted the specific role of hippocampal subdivisions and specific structural covariance alterations within these subdivisions in the pathophysiology of SCD and migraine. These network-level changes in structural covariance may serve as potential imaging signatures for individuals who have both SCD and migraine.

[Hereditary pulmonary hypertension family with BMPR2 gene variation: a case report and literature review]

Objective: To describe the clinical characteristics, diagnosis, genetic features and treatment of hereditary pulmonary hypertension complicated with suspected hereditary hemorrhagic telangiectasia (HHT). Methods: Firstly, we summarized and analyzed the clinical data of two cases of suspected HHT admitted to the Department of Pulmonary and Critical Care Medicine, the Second Xiangya Hospital, Central South University. Secondly, the genes of peripheral blood of patients and their families were completely sequenced and sanger sequencing was performed to verify the variation sites, and then the mRNA deletion caused by the variation was further verified. Thirdly, "HHT" "FPAH" and "BMPR2 gene variation" were used as keywords,and the related literatures of Wanfang database and PubMed database from January 2000 to November 2021 were searched and reviewed. Results: We found two patients in a family from Yiyang, Hunan province, who had symptoms of hemoptysis or pulmonary hypertension without epistaxis or other clinical features of HHT. However, both patients had pulmonary vascular abnormalities and pulmonary hypertension in their lungs. We found that BMPR2 gene variation (NM_001204.7:c.1128+1G>T) was positive and ENG, ACVRL1 and SMAD4 genes were negative. Family analysis and Sanger verification were carried out on 16 individuals in 4 generations of the family (7 of whom were found to carry the mutant gene), and then transcriptional level mRNA sequencing further confirmed that the variation resulted in the deletion of exon 8 and exon 9, and amino acid sequence estimation revealed that the amino acids of the protein from 323 to 425 were deleted. We thought that the incomplete translation of BMPR2 gene could lead to BMPRⅡ dysfunction. Therefore, it was diagnosed as hereditary pulmonary hypertension with suspected HHT. Both patients were suggested to reduce the pulmonary artery pressure, and at the same time, the whole-body imaging examination should be performed to screen other arteriovenous malformations, and the annual cardiac color Doppler ultrasound should be reviewed to evaluate the changes of pulmonary artery pressure. Conclusions: Hereditary pulmonary hypertension (HPAH) is a group of diseases with increasing pulmonary vascular resistance caused by genetic factors, including familial PAH and simple PAH. Variation in the BMPR2 gene is an important pathogenic factor of HPAH. Therefore, we should pay attention to the inquiry of family history when we clinically encounter young patients with pulmonary hypertension. If the cause is unknown, genetic testing is recommended. HHT is a rare autosomal dominant genetic disease. The possibility of this disease should be considered in clinical manifestations such as familial pulmonary vascular abnormality, pulmonary hypertension and recurrent epistaxis. There is no effective specific treatment for HPAH and HHT, which are treated symptomatically (including blood pressure reduction and hemostasis, etc.). It is suggested for these patients that pulmonary artery pressure should be dynamically monitored and have genetic counseling before giving birth.

Risk of neurodegenerative diseases in patients with sleep disorders: A nationwide population-based case-control study

OBJECTIVE

Our study aimed to explore the associative relationship between neurodegenerative diseases and sleep disorders.

PATIENTS

This 15-year retrospective longitudinal nationwide population-based matched case-control study used data extracted from the National Health Insurance Research Database. We evaluated 25,589 patients diagnosed with neurodegenerative diseases between 2000 and 2015 and a matched control of 102,356 patients without neurodegenerative diseases.

RESULTS

Sleep disorders were an independent risk factor for the development of neurodegenerative diseases (adjusted odds ratio (OR): 1.794, 95% confidence interval (CI): 1.235-2.268, P < 0.001), with a positive dose-effect relationship (adjusted OR (95% CI): <1 year: 1.638 (1.093-2.872), P < 0.001; 1-5 years: 1.897 (1.260-3.135), P < 0.001; >5 years: 2.381 (1.467-3.681), P < 0.001. Moreover, patients with sleep disorder and comorbid depression had a significantly higher risk of neurodegenerative disorders (adjusted OR: 5.874). Subgroup analysis showed that insomnia was associated with Alzheimer's disease, Pick's disease and essential tremor (adjusted OR (95% CI): 1.555 (1.069-1.965), 1.934 (1.331-2.445) and 2.089 (1.439-2.648), respectively). Obstructive sleep apnea was associated with Parkinson's disease, essential tremor, and primary dystonia (adjusted OR (95% CI): 1.801 (1.239-2.275), 5.523 (3.802-6.977), and 4.892 (3.365-6.178), respectively). Other specific sleep disorders were associated with Pick's disease, Parkinson's disease, essential tremor, and primary dystonia (adjusted OR (95% CI): 8.901 (6.101-11.010), 1.549 (1.075-1.986), 2.791 (1.924-3.531), and 9.114 (6.283-10.506), respectively).

CONCLUSION

Sleep disorders are associated with the subsequent development of neurodegenerative disorders. Moreover, sleep disorder patients with comorbid depression have a higher risk of neurodegenerative diseases.

The lens of Yin-Yang philosophy: the influence of paradoxical leadership and emotional intelligence on nurses' organizational identification and turnover intention

PURPOSE

This study aims to use "both-and" thinking of Yin-Yang philosophy to extend the field of leadership literatures and explore the influences of paradoxical leadership and emotional intelligence on organizational identification and turnover intentions of nurses.

DESIGN/METHODOLOGY/APPROACH

The authors adopted a cross-sectional survey completed by 285 nurses in Taiwan. SPSS 22, PROCESS and AMOS 21 were used for data analysis.

FINDINGS

The results reveal that paradoxical leadership has a significant positive relationship with nurses' organizational identification and a significant negatively relationship with their turnover intentions, and organizational identification partially mediated the relationship between paradoxical leadership and turnover intentions. The results further show that emotional intelligence strengthens the effect of paradoxical leadership on organizational identification, and paradoxical leadership had a stronger indirect effect on turnover intentions through organizational identification under strong emotional intelligence.

ORIGINALITY/VALUE

Paradoxical leadership can strengthen managers' abilities in dealing with interrelated and substantial issues and correspond to organizing and belonging paradoxes in holistic thinking processes. Health-care organizations must shape a coordinated institution and offer training initiatives to increase managers' ability and attitude to control organizational rules and procedures while allowing employees' flexibility and autonomy according to the requirements of the situation, which will maintain both organizational short-term benefits and long-term growth.

The impact of temperature and precipitation on all-infectious-, bacterial-, and viral-diarrheal disease in Taiwan

BACKGROUND

The ongoing climate change will elevate the incidence of diarrheal in 2030-2050 in Asia, including Taiwan. This study investigated associations between meteorological factors (temperature, precipitation) and burden of age-cause-specific diarrheal diseases in six regions of Taiwan using 13 years of (2004-2016) population-based data.

METHODS

Weekly cause-specific diarrheal and meteorological data were obtained from 2004 to 2016. We used distributed lag non-linear model to assess age (under five, all age) and cause-specific (viral, bacterial) diarrheal disease burden associated with extreme high (99th percentile) and low (5th percentile) of climate variables up to lag 8 weeks in six regions of Taiwan. Random-effects meta-analysis was used to pool these region-specific estimates.

RESULTS

Extreme low temperature (15.30 °C) was associated with risks of all-infectious and viral diarrhea, with the highest risk for all-infectious diarrheal found at lag 8 weeks among all age [Relative Risk (RR): 1.44; 95 % Confidence Interval (95 % CI): 1.24-1.67]. The highest risk of viral diarrheal infection was observed at lag 2 weeks regardless the age. Extreme high temperature (30.18 °C) was associated with risk of bacterial diarrheal among all age (RR: 1.07; 95 % CI: 1.02-1.13) at lag 8 weeks. Likewise, extreme high precipitation (290 mm) was associated with all infectious diarrheal, with the highest risk observed for bacterial diarrheal among population under five years (RR: 2.77; 95 % CI: 1.60-4.79) at lag 8 weeks. Extreme low precipitation (0 mm) was associated with viral diarrheal in all age at lag 1 week (RR: 1.08; 95 % CI: 1.01-1.15)].

CONCLUSION

In Taiwan, extreme low temperature is associated with an increased burden of viral diarrheal, while extreme high temperature and precipitation elevated burden of bacterial diarrheal. This distinction in cause-specific and climate-hazard specific diarrheal disease burden underscore the importance of incorporating differences in public health preparedness measures designed to enhance community resilience against climate change.

Quantifying the effects of anomalies of temperature, precipitation, and surface water storage on diarrhea risk in Taiwan

Objectives

Diarrheal disease continues to be a significant cause of morbidity and mortality. We investigated how anomalies in monthly average temperature, precipitation, and surface water storage (SWS) impacted bacterial, and viral diarrhea morbidity in Taiwan between 2004 and 2015.

Methods

A multivariate analysis using negative binomial generalized estimating equations was employed to quantify age- and cause-specific cases of diarrhea associated with anomalies in temperature, precipitation, and SWS.

Results

Temperature anomalies were associated with an elevated rate of all-cause infectious diarrhea at a lag of 2 months, with the highest risk observed in the under-5 age group (incidence rate ratio [IRR]=1.03, 95% CI, 1.01-1.07). Anomalies in SWS were associated with increased viral diarrhea rates, with the highest risk observed in the under-5 age group at a 2-month lag (IRR= 1.27; 95% CI: 1.14, 1.42) and a lesser effect at a 1-month lag (IRR=1.18; 95% CI, 1.06-1.31). Furthermore, cause-specific diarrheal diseases were significantly affected by extreme weather events in Taiwan. Both extremely cold and hot conditions were associated with an increased risk of all-cause infectious diarrhea regardless of age, with IRRs ranging from 1.03 (95% CI, 1.02-1.12) to 1.18 (95% CI, 1.16-1.40).

Conclusion

The risk of all-cause infectious diarrhea was significantly associated with average temperature anomalies in the population aged under 5 years. Viral diarrhea was significantly associated with anomalies in SWS. Therefore, we recommend strategic planning and early warning systems as major solutions to improve resilience against climate change. .

[Scimitar syndrome with pulmonary sequestration containing carcinoma: a case report]

We reported the manifestations, auxiliary examination, and treatment courses of a case of scimitar syndrome with pulmonary sequestration containing carcinoma. The clinical characteristics of scimitar syndrome with pulmonary sequestration, pulmonary sequestration containing carcinoma were summarized based on the data of this case and the related literatures before January 2022. Scimitar syndrome can coexist with ipsilateral pulmonary sequestration. Because sequestered lung tissue has a risk of malignant transformation, a cancer screening test is useful for early diagnosis and timely treatment.

Case Report: Severe rebound after withdrawal of fingolimod in a patient with neuromyelitis optica spectrum disorder

Purpose

Fingolimod, an oral treatment for relapsing-remitting multiple sclerosis (RRMS), has been associated with a significant rebound in disease activity after therapy cessation. We described a patient with neuromyelitis optica spectrum disorder (NMOSD) who was previously diagnosed with RRMS and experienced fatal rebound syndrome after cessation of fingolimod.

Case report

A 54-year-old woman, previously diagnosed with RRMS, experienced relapse after orthopedic surgery. The diagnosis was later revised to NMOSD based on a positive aquaporin-4 antibody. Three weeks after converting the immunomodulator from fingolimod to azathioprine, severe disease reactivation was observed. Considering the multiple new and enlarging magnetic resonance imaging lesions, the temporal relationship between fingolimod cessation and symptom onset, and the relatively low possibility of disease reactivation within a short time, the diagnosis of fingolimod withdrawal syndrome was proposed. Although immediate steroid pulse therapy and plasma exchange were performed, the patient eventually died owing to a fulminant clinical course.

Conclusion

Fingolimod withdrawal syndrome is well known in patients with multiple sclerosis (MS). It can also occur in patients with NMOSD. Recognizing patients with NMOSD who present with MS-like manifestations, and avoiding drugs that may be harmful to patients with NMOSD, are important.

Invisible Erosion of Human Capital: The Impact of Emotional Blackmail and Emotional Intelligence on Nurses' Job Satisfaction and Turnover Intention

Emotion is a compelling factor in the retention and job satisfaction of professionals, and the impacts of emotional feelings and reactions have become an indispensable issue in the nursing workforce. Drawing on the cognitive theory of emotions, this study bridges the research gap to investigate the relationships among emotional blackmail, emotional intelligence, job satisfaction, and turnover intentions of nurses. A cross-sectional design was used to collect data from a sample of 374 full-time nurses in Northern Taiwan. Hypotheses were tested and analyzed by means of SPSS 22, structural equation modeling (SEM), and PROCESS v3.3. The results revealed the direct relationships between emotional blackmail, job satisfaction, and turnover intentions, and job satisfaction partially mediated the relationship between emotional blackmail and turnover intentions. However, there is no statistical support that emotional intelligence moderates the relationships between emotional blackmail and job satisfaction and turnover intentions. Healthcare organizations must take the initiative and form strategies that will help balance nurses' work stresses. These strategies should aim to reduce unnecessary demands from supervisors, patients, and co-workers, as well as in the socio-emotional domain.

The optimal pulse pressures for healthy adults with different ages and sexes correlate with cardiovascular health metrics

Background

Pulse pressure (PP) may play a role in the development of cardiovascular disease, and the optimal PP for different ages and sexes is unknown. In a prospective cohort, we studied subjects with favorable cardiovascular health (CVH), proposed the mean PP as the optimal PP values, and demonstrated its relationship with healthy lifestyles.

Methods and results

Between 1996 and 2016, a total of 162,636 participants (aged 20 years or above; mean age 34.9 years; 26.4% male subjects; meeting criteria for favorable health) were recruited for a medical examination program. PP in male subjects was 45.6 ± 9.4 mmHg and increased after the age of 50 years. PP in female subjects was 41.8 ± 9.5 mmHg and increased after the age of 40 years, exceeding that of male subjects after the age of 50 years. Except for female subjects with a PP of 40-70 mmHg, PP increase correlates with both systolic blood pressure (BP) increase and diastolic BP decrease. Individuals with mean PP values are more likely to meet health metrics, including body mass index (BMI) <25 kg/m² (chi-squared = 9.35, p<0.01 in male subjects; chi-squared = 208.79, p < 0.001 in female subjects) and BP <120/80 mmHg (chi-squared =1,300, p < 0.001 in male subjects; chi-squared =11,000, p < 0.001 in female subjects). We propose a health score (Hscore) based on the sum of five metrics (BP, BMI, being physically active, non-smoking, and healthy diet), which significantly correlates with the optimal PP.

Conclusion

The mean PP (within ±1 standard deviation) could be proposed as the optimal PP in the adult population with favorable CVH. The relationship between health metrics and the optimal PP based on age and sex was further demonstrated to validate the Hscore.

Increased risk of sleep-related movement disorder in patients with Helicobacter pylori infection: A nationwide population-based study

Background and purpose

Evidence increasingly suggests that Helicobacter pylori infection (HPI) is associated with movement disorders such as Parkinson's disease (PD). However, the relationship between HPI and sleep-related movement disorders (SRMD) remains unknown. This nationwide population-based study tried to demonstrate whether patients with HPI have a higher risk of developing SRMD in a general adult population.

Methods

The study cohort enrolled 9,393 patients who were initially diagnosed with HPI between 2000 and 2013. Notably, 37,572 age- and sex-matched controls without prior HPI were selected as the reference. A Cox proportional hazard regression analysis was performed for multivariate adjustment.

Results

Patients with HPI had a higher risk of developing SRMD (adjusted hazard ratio [HR] = 2.18, 95% confidence interval [CI] = 1.26–3.82, p < 0.01). Patients with HPI aged ≥65 years exhibited the highest risk (HR = 3.01, 95% CI = 1.90–5.30, p < 0.001), followed by patients aged 45–64 years (HR = 1.69, 95% CI = 1.26–2.90, p <0.01) and <45 years (HR = 1.49, 95% CI = 1.12–2.49, p < 0.01). Patients were most likely to develop SRMD 5 years or more after diagnosis of HPI (HR = 3.33, 95% CI = 1.97–5.89, p < 0.001). The increased risk of SRMD in male patients with HPI (HR = 2.73, 95% CI = 1.53–4.79, p < 0.001) was greater than in female patients (HR = 1.14, 95% CI = 1.04–1.65, p < 0.05).

Conclusion

Patients with HPI were associated with an increased risk for SRMD, with a higher risk in men, aged ≥65 years, and diagnosed for more than 5 years.

Pathophysiology of Chronic Migraine: Insights from Recent Neuroimaging Research

PURPOSE OF REVIEW

Chronic migraine (CM) is a highly disabling primary headache disorder with a substantial impact on patients' quality of life. Episodic migraine (EM) and CM are dynamic states; CM usually evolves from EM alongside increased headache frequency, comorbidities, and medication overuse, supporting the notion that migraine is a spectrum disorder. This narrative review aims to summarize neuroimaging studies to better understand the pathophysiology of CM.

RECENT FINDINGS

Positron emission tomography studies have revealed abnormal energy metabolism and metabolic changes in the dorsal rostral pons in individuals with CM, suggesting that this structure has a key role in the pathophysiology of migraine generation and chronification. Magnetic resonance spectroscopy studies have suggested that thalamocortical pathway dysfunction may contribute to migraine chronification, while functional magnetic resonance imaging studies have highlighted that hypothalamic activity may be involved. Recent evidence highlights functional and structural alterations in cortical and subcortical pain-related brain regions in patients with CM. Whether these functional and structural abnormalities of the brain cause migraine chronification or are a consequence of repeated attacks is still debated. In the future, imaging patterns that predict the transformation from EM to CM should be identified.

First-in-human pilot trial of combined intracoronary and intravenous mesenchymal stem cell therapy in acute myocardial infarction

Background

Acute ST-elevation myocardial infarction (STEMI) elicits a robust cardiomyocyte death and inflammatory responses despite timely revascularization.

Objectives

This phase 1, open-label, single-arm, first-in-human study aimed to assess the safety and efficacy of combined intracoronary (IC) and intravenous (IV) transplantation of umbilical cord-derived mesenchymal stem cells (UMSC01) for heart repair in STEMI patients with impaired left ventricular ejection fraction (LVEF 30-49%) following successful reperfusion by percutaneous coronary intervention.

Methods

Consenting patients received the first dose of UMSC01 through IC injection 4-5 days after STEMI followed by the second dose of UMSC01 via IV infusion 2 days later. The primary endpoint was occurrence of any treatment-related adverse events and the secondary endpoint was changes of serum biomarkers and heart function by cardiac magnetic resonance imaging during a 12-month follow-up period.

Results

Eight patients gave informed consents, of whom six completed the study. None of the subjects experienced treatment-related serious adverse events or major adverse cardiovascular events during IC or IV infusion of UMSC01 and during the follow-up period. The NT-proBNP level decreased (1362 ± 1801 vs. 109 ± 115 pg/mL, p = 0.0313), the LVEF increased (52.67 ± 12.75% vs. 62.47 ± 17.35%, p = 0.0246), and the wall motion score decreased (26.33 ± 5.57 vs. 22.33 ± 5.85, p = 0.0180) at the 12-month follow-up compared to the baseline values. The serial changes of LVEF were 0.67 ± 3.98, 8.09 ± 6.18, 9.04 ± 10.91, and 9.80 ± 7.56 at 1, 3, 6, and 12 months, respectively as compared to the baseline.

Conclusion

This pilot study shows that combined IC and IV transplantation of UMSC01 in STEMI patients with impaired LVEF appears to be safe, feasible, and potentially beneficial in improving heart function. Further phase 2 studies are required to explore the effectiveness of dual-route transplantation of UMSC01 in STEMI patients.

Factors determining the flow erosion/part deformation of film insert molded thermoplastic products

Flow erosion and part deformation are unsolved molding problems that restrict the overall success of film insert molding. This work investigated, both experimentally and numerically, the factors that affect flow erosion and part deformation in film inset molded products. Three plate-with-thickness-variation geometries, namely flat, thin-to-thick, and thick-to thin, were molded for the products. Polystyrene films and polyethylene terephthalate (PET) resins were employed in the experiments. It was found that the thin-to-thick specimens exhibited the most severe flow erosion. Increasing the injection pressure or melt temperature worsened flow erosion. Meanwhile, for the processing parameters adopted in the experiments, part deformation generally increased with melt temperature and hold time, while it decreased with injection pressure and hold pressure. Additionally, a numerical software (Moldex® 3-D) was employed to simulate the temperature and shear stress distributions in molded products. The calculated results suggested that part deformation in insert molded products results mainly from the non-uniform temperature profile during the cooling stage, owing to the product configuration and the insert film, while flow erosion is induced by the high shear stress of the polymer melt in the filling stage.

Biomarkers with Plasma Amyloid β and Tau Protein Assayed by Immunomagnetic Reduction in Patients with Amnestic Mild Cognitive Impairment and Alzheimer's Disease

This review addresses recent developments in the analyses of plasma amyloid beta (Aβ) and total tau (t-tau) protein levels as biomarkers for discriminating amnestic mild cognitive impairment (aMCI) from Alzheimer disease (AD), using immunomagnetic reduction (IMR). Recent studies have focused on the differential diagnosis of normal controls (NCs) with aMCI or AD. Results of 15 clinical studies have demonstrated decrease in plasma Aβ1-40 and increase in plasma Aβ1-42 and t-tau levels in patients with aMCI and AD. For a given biomarker, effect size is determined by comparing the mean ratios of biomarker levels between two diagnostic groups. Effect sizes are less than 1 for Aβ1-40 (0.606-1.032) but >1 for Aβ1-42 (1.018-2.167) and t-tau (1.030-4.147) in aMCI and AD compared with NCs. The effect size of the plasma tau significantly increases the most as aMCI progresses to AD. Studies into the application of IMR to determine plasma Aβ and tau levels as biomarkers for aMCI or AD have recently progressed. Future investigations should validate recently published results, preferably in patients with pathologically confirmed AD. In addition, effort should be directed toward standardizing the design of such studies and data analysis. Keywords: amyloid beta, plasma tau, Alzheimer disease, biomarker, mild cognitive impairment.

A Metallomic Approach to Assess Associations of Plasma Metal Levels with Amnestic Mild Cognitive Impairment and Alzheimer's Disease: An Exploratory Study

Alzheimer’s disease (AD) involves the abnormal activity of transition metals and metal ion dyshomeostasis; however, the potential of trace metal biomarkers in predicting cognitive decline has not been evaluated. This study aimed to assess the potential of 36 trace elements in predicting cognitive decline in patients with amnestic mild cognitive impairment (aMCI) or AD. Participants (9 controls, 23 aMCI due to AD, and 8 AD dementia) underwent comprehensive cognitive tests, including the Mini-Mental State Examination (MMSE) and trace metal analysis. The correlations between the plasma trace element levels and annual MMSE changes during follow-up were analyzed. We found that an increase in disease severity was linked to lower plasma levels of boron (B), bismuth (Bi), thorium (Th), and uranium (U) (adjusted p < 0.05). Higher baseline calcium levels (r = 0.50, p = 0.026) were associated with less annual cognitive decline; those of B (r = −0.70, p = 0.001), zirconium (r = −0.58, p = 0.007), and Th (r = −0.52, p = 0.020) with rapid annual cognitive decline in the aMCI group; and those of manganese (r = −0.91, p = 0.035) with rapid annual cognitive decline in the AD group. Overall, our exploratory study suggests that plasma metal levels have great potential as in vivo biomarkers for aMCI and AD. Larger sample studies are necessary to confirm these results.

Genetic Variants Associated With Subjective Cognitive Decline in Patients With Migraine

The genetic association between subjective cognitive decline (SCD) and migraine comorbidity remains unclear. Furthermore, single nucleotide polymorphisms (SNP) associated with SCD have not been identified previously. Migraineurs were genotyped using an Affymetrix array. The correlation between different SNP variants in migraineurs with or without SCD and non-migraine controls was investigated. Migraineurs with or without SCD were further divided for the analysis of relevant SNP variants linked to migraine with aura (MA), migraine without aura (MoA), episodic migraine (EM), and chronic migraine (CM). Significant connectivity between SNPs and clinical indices in migraineurs and non-migraine controls with SCD were assessed using multivariate regression analysis. The rs144191744 SNP was found in migraineurs (p = 3.19E-08), EM (p = 1.34E-07), and MoA(p = 7.69E-07) with and without SCD. The T allele frequency for rs144191744 in TGFBR3 was 0.0054 and 0.0445 in migraineurs with and without SCD (odds ratio, 0.12), respectively. rs2352564, rs6089473 in CDH4, rs112400385 in ST18, rs4488224 and rs17111203 in ARHGAP29 SNPs were found, respectively, in non-migraineurs (p = 4.85E-06, p = 8.28E-06), MoA (p = 3.13E-07), and CM subgroups (p = 1.05E-07, 6.24E-07) with and without SCD. Rs144191744 closely relates to SCD with the all-migraine group and the EM and MoA subgroups. In conclusion, rs144191744 in TGFBR3 was significantly associated with SCD in migraineurs, especially in the EM, MoA, and female patient subgroups. Furthermore, three SNPs (rs112400385, rs4488224, and rs17111203) were associated with SCD in migraineurs but not in non-migraine controls.

Association of a Common NOS1AP Variant with Attenuation of QTc Prolongation in Men with Heroin Dependence Undergoing Methadone Treatment

Background: The effects of methadone-induced severe prolongation of the corrected QT interval (QTc) and sudden cardiac death appear unpredictable and sex-dependent. Genetic polymorphisms in the nitric oxide synthase 1 adaptor protein (NOS1AP) have been implicated in QTc prolongation in general populations. We investigated whether common NOS1AP variants interact with methadone in relation to QTc prolongation in patients with heroin dependence. Methods: We genotyped 17 NOS1AP variants spanning the entire gene in heroin-dependent patients who received a 12-lead electrocardiography (ECG) examination both at baseline and during maintenance methadone treatment in Cohort 1 and only during maintenance methadone treatment in Cohort 2. The QT interval was measured automatically by the Marquette 12SL program, and was corrected for heart rate using Bazett’s formula. Results: Cohort 1 consisted of 122 patients (age: 37.65 ± 8.05 years, 84% male, methadone dosage: 42.54 ± 22.17 mg/day), and Cohort 2 comprised of 319 patients (age: 36.9 ± 7.86 years, 82% male, methadone dosage: 26.08 ± 15.84 mg/day), with complete genotyping data for analyses. Before methadone, the QTc intervals increased with increasing age (r = 0.3541, p < 0.001); the age-adjusted QTc showed dose-dependent prolongation in men (r = 0.6320, p < 0.001), but abbreviation in women (r = −0.5348, p = 0.018) in Cohort 1. The pooled genotype-specific analysis of the two cohorts revealed that the QTc interval was significantly shorter in male carriers of the rs164148 AA variant than in male carriers of the reference GG genotype (GG: n = 262, QTc = 423 ± 1.4 ms; AA: n = 10, QTc = 404.1 ± 7 ms, p = 0.009), according to univariate analysis. The QTc remained shorter in male carriers of the rs164148 AA variant compared to GG genotype (423 ± 1.4 ms vs. 405.9 ± 6.9 ms, p = 0.016) in multivariate analysis after adjusting for age and methadone dosage. A cut-off QTc interval of <410 ms identifies 100% of AA carriers compared to none of GG carriers when receiving a daily methadone dosage of 30.6 ± 19.3 mg. There was no significant gene-drug interaction in contributing to the adjusted QTc (p = 0.2164) in male carriers of the rs164148 variants. Conclusions: Carriers of a common NOS1AP rs164148 AA genotype variant were associated with a shorter QTc interval in men receiving maintenance methadone treatment. This genetic polymorphism attenuates the QTc-prolonging effect by methadone, and thus may explain at least in part the unpredictable and heterogeneous risks for severe QTc prolongation and sudden cardiac death in patients on methadone.

Interpreting the Evidence of Body Mass Index in Relation to Mental Health Status in Community-Dwelling Older Adults

INTRODUCTION

Maintaining a better physical and mental health status is an important issue for older adults in their later life. Thus, the study's purpose was to evaluate the association between body mass index (BMI) and mental health status in older adults aged 65 years old or above residing in communities of Taipei City, Taiwan.

METHODS

We carried out secondary data analysis with data from a volunteer-based health examination project for older adults >65 years old residing in Taipei City from 2006 to 2010 with a retrospective study design. BMI, calculated by standardized measuring procedures for height and weight, and mental health status, evaluated by 5-item Brief Symptom Rating Scale (BSRS-5), were collected at their first visits of health examination. A BSRS-5 score ≥6 was considered an inferior mental health status for the outcome. In statistical analysis, univariable and multivariable logistic regressions were adopted to estimate the relative risk of inferior mental health status, treating BMI as the major exposure of interest.

RESULTS

A total of 90,576 subjects were involved, with a mean age of 73.38 years old (SD = 6.64 years) and 49.21% females. With confounders controlled, compared to normal or overweight (23 ≤ BMI <30), an adjusted OR of 1.23 (95% CI: 1.18, 1.29) on inferior mental health status was detected for the underweight group (BMI <23) significantly. Adjusted OR for those obese (BMI ≧30) was 0.87 (95% CI: 0.79, 0.96). Significantly elevated ORs of underweight were found for both genders, but the significantly protective effect of obese was only detected for females.

CONCLUSION

Keeping an appropriate weight or even being overweighted might be beneficial for older adults dwelling in the community, especially for males.

The Effectiveness of Mental Health Literacy Curriculum among Undergraduate Public Health Students

Mental health literacy (MHL) plays an important role in public health. Improving MHL can promote mental health at the individual and public levels. To date, no published studies have assessed the effectiveness of MHL curriculum interventions among undergraduate public health students. The participants in this study were undergraduate public health students (n = 48) who were enrolled in an 18-week MHL curriculum for 100 min per week. MHL was assessed using the Mental Health Literacy Scale for Healthcare Students. A paired sample t-test was performed to examine the immediate and delayed effects of the MHL curriculum. The total MHL score significantly improved, and a moderate effect size was found directly after the intervention and six weeks later. There were significant differences in the recognition of mental illness (p < 0.01), help-seeking efficacy (p < 0.05), and help-seeking attitude (p < 0.05) in the five components of MHL between pre- and post-test. Furthermore, significant improvements were obtained for the maintenance of positive mental health (p < 0.05) and reduction of mental illness stigma (p < 0.001) between the pre-test and follow-up. Our findings provide evidence for the development and implementation of an MHL curriculum for public health education.

Effects of Sacubitril/Valsartan Versus Telmisartan in Type 2 Diabetic or Pre-Diabetic Patients with Hypertension and Without Heart Failure: The Rationale and Design of A Randomized Clinical Trial

BACKGROUND

Sacubitril/valsartan has revealed superior glycemic and blood pressure control compared with enalapril and irbesartan in patients with heart failure and type 2 diabetes and in individuals with chronic kidney disease. However, whether the effects of sacubitril/valsartan remain the same in those without heart failure is unknown.

METHODS

A multicenter randomized double-blinded trial will be carried out in five military hospitals in Taiwan for a period of 1 year. Participants with prior cardiovascular diseases and heart failure will be excluded. The purpose of the study is to compare the effects of sacubitril/valsartan (97/103 mg once or twice daily) on the temporal changes in fasting blood glucose, HbA1c, insulin resistance and blood pressure levels with telmisartan (40 mg once or twice daily) in individuals with stage 1-3 hypertension and newly diagnosed type 2 diabetes or prediabetes who have an HbA1c ≥6.0% and a systolic blood pressure ≥130 mmHg or a diastolic blood pressure ≥85 mmHg. The inclusion criteria include the age of 35-70 years, women who are not pregnant, estimated glomerular filtration rate ≥45 ml/min per 1.73m2 and B-type natriuretic peptide levels <400 pg/ml.

RESULTS

The sample size is estimated to be 502 participants for randomization according to an assumption of between-person standard deviation in systolic blood pressure of 15 mmHg or in HbA1c of 1.5%, which provides ≥80% power (at p =0.05) to detect a difference in systolic blood pressure of 4 mmHg or in HbA1c of 0.3% at the final follow-up. All participants will receive a comprehensive physical examination and tests for blood cell counts, blood biochemistry, urine analysis, 12-lead electrocardiography and an echocardiography every 3 months.

CONCLUSION

All analyses will be performed based on the intention-to-treat principle among all randomized participants.

Athlete's Heart Assessed by Sit-Up Strength Exercises in Military Men and Women: The CHIEF Heart Study

Background

Greater changes in cardiac structure and function in response to physical training have been observed more often in male athletes than in female athletes compared with their sedentary controls. However, studies for the sex-specific cardiac remodeling related to strength exercises in Asian athletes are rare.

Methods

This study included 580 men and 79 women, with an average age of 25 years, for a 6-month military training program in Taiwan. Both men and women attended a 2-min sit-up test to assess muscular strength after the training. The test performance falling one standard deviation above the mean (16%) was to define the superior eliteness of athletes. Cardiac structure and function were investigated by electrocardiography and echocardiography for men and women. Multiple logistic regression was used to determine the predictors of elite athlete status.

Results

In men, greater QTc interval, left ventricular mass adjusted to body surface area (LVMI), lateral mitral E'/A' ratio and right ventricular systolic pressure, and lower diastolic blood pressure were independent predictors of elite strength athletes in the sit-up test [odds ratio (OR) and 95% confidence intervals: 1.01 (1.00, 1.02), 1.02 (1.00, 1.04), 1.45 (1.06, 1.98), 1.13 (1.06, 1.23), and 0.96 (0.93, 0.99), respectively. In contrast, in women, the greater right ventricular outflow tract dimension was the only independent predictor of elite strength athletes in the sit-up test [OR: 1.26 (1.04, 1.53)].

Conclusions

In the 2-min sit-up test, cardiac characteristics differ between elite male and female athletes. While greater QTc interval, LVMI, and diastolic function of left ventricle predict the eliteness of male strength athletes, greater right ventricular chamber size characterizes elite female strength athletes.

Neuroendocrine Carcinoma of the Endometrium with Ectopic Secretion of Parathyroid Hormone Presenting as Hypercalcemia- Related Posterior Reversible Encephalopathy syndrome: A Case Report

PURPOSE

Posterior reversible encephalopathy syndrome (PRES) displayed various acute neurological symptoms. PRES is a rare presentation of hypercalcemia. Here we present a case with ectopic secretion of parathyroid hormone from neuroendocrine carcinoma of the endometrium presenting as hypercalcemia-related PRES.

CASE REPORT

A 67-year-old woman presented with acute generalized tonic-clonic seizure followed by post-ictal confusion and neuropsychiatric behaviors. The diagnosis is PRES. Investigations showed uterine cervical region with multiple liver metastasis complicated with hypercalcemia, elevated intact parathyroid hormone. Further pathology concluded as a poorly differentiated adenocarcinoma of the endometrium with neuroendocrine differentiation and immunoreactive for PTH. The patient's neurologic manifestations had resolved. Serum free calcium level and intact-PTH had declined after first course of definitive chemoradiation.

CONCLUSION

Immunostaining of the tumor tissue can be used to estimate the ectopic PTH production within the tumor cells. Early detection and appropriate clinical treatment hold the potential to improve the prognosis of refractory hypercalcemia and hypercalcemia related PRES. Keyword: Posterior reversible encephalopathy syndrome; hypercalcemia; intact-parathyroid hormone; parathyroid hormone-related peptide; neuroendocrine carcinoma of endometrium.

Identification of genetic risk loci for depression and migraine comorbidity in Han Chinese residing in Taiwan

INTRODUCTION

The genetic association between depression and migraine has not been well investigated in Asian populations. Furthermore, the genetic basis of depression and comorbid migraine subtypes remains nebulous. Hence, in the current study we investigate the susceptibility loci associated with depression and migraine comorbidity in the Han Chinese population in Taiwan.

METHODS

We perform a genome-wide association study involving 966 migraine patients, with or without comorbid depression. Genotyping is performed using participant genomic DNA. Association analyses are performed for the entire migraine cohort (subgroups: episodic migraine, chronic migraine, and migraine with or without aura).

RESULTS

Results show that the single nucleotide polymorphism variants of the CDH4 intron region (rs78063755), NTRK3-AS1 downstream region (rs57729223), and between LINC01918 and GPR45 (rs2679891) are suggestively associated with depression. Twenty additional susceptibility loci occur within the subgroups. A multivariate association study demonstrated that a variant in the intron region of CDH4 rs78063755 was associated with Beck Depression Inventory and Migraine Disability Assessment scores.

DISCUSSION

The findings of this study identify several genetic loci suggestively associated with depression among migraine patients in the Han Chinese population. Moreover, a potential genetic basis has been characterized for depression and migraine comorbidity, thus providing genetic candidates for further investigation.

Identification of Novel Genetic Variants Associated with Insomnia and Migraine Comorbidity

PURPOSE

Although insomnia and migraine are often comorbid, the genetic association between insomnia and migraine remains unclear. This study aimed to identify susceptibility loci associated with insomnia and migraine comorbidity.

PATIENTS AND METHODS

We performed a genome-wide association study (GWAS) involving 1063 clinical outpatients at a tertiary hospital in Taiwan. Migraineurs with and without insomnia were genotyped using the Affymetrix Axiom Genome-Wide TWB 2.0. We performed association analyses for the entire cohort and stratified patients into the following subgroups: episodic migraine (EM), chronic migraine (CM), migraine with aura (MA), and migraine without aura (MoA). Potential correlations between SNPs and clinical indices in migraine patients with insomnia were examined using multivariate regression analysis.

RESULTS

The SNP rs1178326 in the gene HDAC9 was significantly associated with insomnia. In the EM, CM, MA, and MoA subgroups, we identified 30 additional susceptibility loci. Multivariate regression analysis showed that SNP rs1178326 also correlated with higher migraine frequency and the Migraine Disability Assessment (MIDAS) questionnaire score. Finally, two SNPs that had been previously reported in a major insomnia GWAS were also significant in our migraineurs, showing a concordant effect.

CONCLUSION

In this GWAS, we identified several novel loci associated with insomnia in migraineurs in a Han Chinese population in Taiwan. These results provide insights into the possible genetic basis of insomnia and migraine comorbidity.

Information Control for Creator Brand Management in Subscription-Based Crowdfunding

Digital content creators, such as podcasters, musicians, writers, and YouTubers, are increasingly using subscription-based crowdfunding (SBC) platforms to attract backers and obtain recurring funding from them. Unlike conventional crowdfunding, a hallmark of SBC is the recurring funding scheme structured as a creator-centered freemium model. Empowering creators to build their person brands, SBC platforms are providing creators with novel features to control the information that they share with their backers or fans or conceal from them. Based on a large-scale study on Patreon, an SBC platform, we show how creators can effectively leverage two types of information controls—earnings concealment and private postings—to build their person brands and thereby develop their backer base and fan engagement. Interestingly, we also find a reinforcing relationship in which the increases in backer base and fan engagement further stimulate creators to leverage information controls in their SBC campaigns to grow their person brands. In sum, although information controls are effective in aggregate to build person brands on SBCs, creators need to dynamically adjust the extent of use of information controls based on changes in their backer base and fan engagement.

Erythrocyte Indices and Long-term Blood Pressure Variability in Military Males

BACKGROUNDS

Severe microcytic anemia has been associated with BP changes.

AIMS AND OBJECTIVES

Whether the erythrocyte indices are associated with long-term BPV is unknown. This study aimed to investigate the association of hemoglobin levels and erythrocyte size with long-term blood pressure variability (BPV) in young males.

METHODS

This study included 1,112 healthy military males, averaging 32 years of age, in Taiwan. All participants took a measurement of systolic and diastolic BP (SBP and DBP) every two-year from 2012 to 2018 (2012-14, 2014-15, 2015-16, 2016-18). Lev-els of hemoglobin and mean corpuscular volume (MCV) of erythrocytes were obtained at the first visit. Long-term BPV was assessed by the standard deviation (SD) and aver-age real variability (ARV). Multivariate linear regression analysis with adjustment for the baseline BP levels and other covariates was used to elucidate the association.

RESULTS

Hemoglobin levels were borderline positively correlated with SD DBP (β and standard errors = 0.016 (0.009), P =0.06). In those with hemoglobin levels of 10.0-13.9 g/dL, hemoglobin was negatively correlated with SDSBP (β= -0.039 (0.018), P =0.03). In contrast, MCV levels were borderline positively correlated with SDSBP (β =0.085 (0.052), P =0.09). In those with MCV levels <80 fL, MCV was positively correlated with SDSBP and ARVSBP (β= 0.445 (0.210) and 0.286 (0.149), p = 0.03 and 0.05, re-spectively).

CONCLUSION

There were inconsistent patterns for the associations of erythrocyte indices with long-term BPV. We found a U-shaped relationship of hemoglobin levels with sys-tolic BPV, whereas there was a positive linear relationship of hemoglobin and MCV levels with diastolic BPV, respectively.

The effects of extreme temperatures on emergency room visits-a population-based analysis by age, sex, and comorbidity

This study evaluated the effect of extreme temperatures on events requiring emergency room visits (ERVs) for hypertensive disease, ischemic heart disease (IHD), cerebrovascular disease, and chronic kidney disease (CKD) for population stratified by sex and age living in Taiwan's metropolitan city from 2000 to 2014. The distributed lag non-linear model was adopted to examine the association between ambient temperature and area-age-sex-disease-specific ERVs for a population aged 40 years and above. The reference temperature was defined by a percentile value to describe the temperature in each city. Area-age-sex-disease-specific relative risk (RR) and 95% confidence intervals (CI) were estimated in association with extreme high (99th percentile) and low (5th percentile) temperatures. Temperature-related ERV risks varied by area, age, sex, and disease. Patients with CKD tend to have comorbidities with hypertensive disease. All study populations with hypertensive disease have significant risk associations with extreme low temperatures with the highest RR of 2.64 (95% CI: 2.08, 3.36) appearing in New Taipei City. The risk of IHD was significantly associated with extreme high temperature for male subpopulation aged 40-64 years. A less significant association was observed between the risks of cerebrovascular disease with extreme temperature. The risk of CKD was most significantly associated with extreme high temperature especially for a subpopulation aged 40-64 years. All study subpopulations with hypertensive disease have significant risk associations with extreme low temperature. Male subpopulations were more vulnerable to extreme temperatures, especially for those aged 40-64 years.

Open Source Collaboration in Digital Entrepreneurship

Emerging digital technologies give rise to digital entrepreneurship and the widespread phenomenon of open source collaboration (OSC) on GitHub for entrepreneurial pursuits. Although openness is a common theme in digital entrepreneurship, it is unclear how digital startups—that is, startups that that have digital artifacts at the core of their business model for value creation and capture—actually realize value from their OSC engagement. We develop a theoretical framework to explain how the engagement in OSC may affect the value of digital startups and how the effect is contingent on the stage of venture maturity (conception, commercialization, or growth) and the mode of OSC engagement (inbound or outbound). In analyses that pool 17,552 matched digital startups with monthly panel observations between 2008 and 2017, we find digital startups in the conception and commercialization stages benefit more from inbound OSC whereas the ones in the growth stage benefit more from outbound OSC. As digital startups increasingly use OSC for ideation, experimentation, and scaling, our contribution is to show whether, when, and how knowledge flows through OSC might affect the value of digital startups. We discuss implications for research on organizing for digital entrepreneurship as well as open innovation.

Obesity Phenotypes and Electrocardiographic Characteristics in Physically Active Males: CHIEF Study

Background: Metabolically unhealthy obesity (MUO) has been associated with surface electrocardiographic (ECG) left ventricular hypertrophy (LVH), left atrial enlargement (LAE), and inferior T wave inversions (TWI) in the middle- and old-aged populations. However, the relationship between obesity phenotypes and these ECG abnormalities in physically active young adults is yet to be determined.

Methods: A total of 2,156 physically active military males aged 18–50 in Taiwan were analyzed. Obesity and metabolically unhealthy status were, respectively, defined as the body mass index ≥27 kg/m² and the presence of metabolic syndrome based on the ATPIII criteria for Asian male adults. Four groups were classified as the metabolically healthy non-obesity (MHNO, n = 1,484), metabolically unhealthy non-obesity (MUNO, n = 86), metabolically healthy obesity (MHO, n = 376), and MUO (n = 210). ECG-LVH was based on the Sokolow–Lyon and Cornell voltage criteria, ECG-LAE was defined as a notched P wave ≥0.12 s in lead II or a notch of ≥0.04 s, and inferior TWI was defined as one negative T wave axis in limb leads II, III, or aVF. Physical performance was evaluated by time for a 3-km run. Multiple logistic regression analysis with adjustment for age, smoking, alcohol drinking, and physical performance was utilized to investigate the associations between obesity phenotypes and the ECG abnormalities.

Results: As compared to MHNO, MUNO, MHO, and MUO were associated with lower risk of Sokolow–Lyon-based ECG-LVH [odds ratios (OR) and 95% confidence intervals: 0.80 (0.51–1.25), 0.46 (0.36–0.58), and 0.39 (0.28–0.53), respectively; p for trend <0.001], and with greater risk of ECG-LAE [OR: 0.87 (0.44–1.72), 2.34 (1.77–3.10), and 3.02 (2.13–4.28), respectively; p for trend <0.001] and inferior TWI [OR: 2.21 (0.74–6.58), 3.49 (1.97–6.19), and 4.52 (2.38–8.60), respectively; p for trend <0.001]. However, no associations between obesity phenotypes and Cornell-based ECG-LVH were found.

Conclusion: In physically active young males, obesity was associated with higher risk of ECG-LAE and inferior TWI, whereas the risk between obesity and ECG-LVH might vary by the ECG criteria, possibly due to a high prevalence of exercise induced-LVH in military and greater chest wall thickness in obesity. The cardiovascular prognosis of ECG-LVH in physically active obese adults requires further study.

Cerebral Venous Sinus Thrombosis, Pulmonary Embolism, and Thrombocytopenia After COVID-19 Vaccination in a Taiwanese Man: A Case Report and Literature Review

Objective: Coronavirus disease (COVID-19) vaccine-induced immune thrombotic thrombocytopenia (VITT) is a rare but fatal complication observed within 2 weeks of adenovirus-vectored vaccination.

Case Report: A 52-year-old male patient, with a family history of autoimmune diseases, presented with a new onset of worsening headache with nausea and vomiting post-vaccination. The patient was diagnosed with VITT based on laboratory findings demonstrating thrombocytopenia, elevated D-dimer, and dural sinus thrombosis identified on neuroimaging. The patient was successfully treated with high-dose immunoglobulin, steroids, and non-heparin anticoagulants, without any neurologic sequelae. Finally, a confirmatory test with anti-platelet factor 4 antibody was strongly positive.

Conclusion: Physicians should be vigilant when treating patients presenting with new-onset thunderclap headache, progressive worsening headache, and awakening headache accompanied by nausea or vomiting after vaccination, even if no definite clinical neurological deficits are identified. Emergency laboratory test results for demonstrating elevated D-dimer levels, decreased platelet count, and neuroimaging correlation are integral for diagnosis and must be the standard protocol. Treatment with non-heparin anticoagulants, high-dose intravenous immunoglobulin, and steroids that halt or slow the immune-mediated prothrombotic process should be initiated immediately. Considering the high mortality rate of VITT, treatment should be initiated prior to confirmatory test results.

Identifying genetic variants for age of migraine onset in a Han Chinese population in Taiwan

Background

Considering the involvement of genetics in migraine pathogenesis in diverse ethnic populations, genome-wide association studies (GWAS) are being conducted to identify migraine-susceptibility genes. However, limited surveys have focused on the onset age of migraine (AoM) in Asians. Therefore, in this study, we aimed to identify the susceptibility loci of migraine considering the AoM in an Asian population.

Methods

We conducted a GWAS in 715 patients with migraine of Han Chinese ethnicity, residing in Taiwan, to identify the susceptibility genes associated with AoM. Based on our standard demographic questionnaire, the population was grouped into different subsets. Single-nucleotide polymorphism (SNP) associations were examined using PLINK in different AoM onset groups.

Results

We discovered eight novel susceptibility loci correlated with AoM that reached the GWAS significance level in the Han Chinese population. First, rs146094041 in ESRRG was associated with AoM \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\le$$\end{document}≤ 12 years. The other SNPs including rs77630941 in CUX1, rs146778855 in CDH18, rs117608715 in NOL3, rs150592309 in PRAP1, and rs181024055 in NRAP were associated with the later AoM.

Conclusions

To our knowledge, this is the first GWAS to investigate the AoM in an Asian Han Chinese population. Our newly discovered susceptibility genes may have prospective associations with migraine pathogenesis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s10194-021-01301-y.

A rare case of a middle-age Asian male with cerebral venous thrombosis after COVID-19 AstraZeneca vaccination

Vaccine-associated cerebral venous thrombosis has become an issue following the extensive vaccination program of the Coronavirus Disease of 2019 (COVID-19) Vaccine AstraZeneca (ChAdOx1 vaccine). The importance of early diagnosis should be emphasized due to the high mortality rate without appropriate treatment. Young female populations in western countries have been reported to be at a greater risk of this vaccine related thrombotic event, but cases in East Asia are lacking. Herein, we present the first case of cerebral venous sinus thrombosis 10 days after ChAdOx1 vaccination in a middle-age Asian male in Taiwan.

Mortality and morbidity of asthma and chronic obstructive pulmonary disease associated with ambient environment in metropolitans in Taiwan

Background

This study investigated risks of mortality from and morbidity (emergency room visits (ERVs) and outpatient visits) of asthma and chronic obstructive pulmonary disease (COPD) associated with extreme temperatures, fine particulate matter (PM_2.5), and ozone (O₃) by sex, and age, from 2005 to 2016 in 6 metropolitan cities in Taiwan.

Methods

The distributed lag non-linear model was employed to assess age (0–18, 19–39, 40–64, and 65 years and above), sex-cause-specific deaths, ERVs, and outpatient visits associated with extreme high (99^th percentile) and low (5^th percentile) temperatures and PM_2.5 and O₃ concentrations at 90^th percentile. Random-effects meta-analysis was adopted to investigate cause-specific pooled relative risk (RR) and 95% confidence intervals (CI) for the whole studied areas.

Results

Only the mortality risk of COPD in the elderly men was significantly associated with the extreme low temperatures. Exposure to the 90^th percentile PM_2.5 was associated with outpatient visits for asthma in 0–18 years old boys [RR = 1.15 (95% CI: 1.09–1.22)]. Meanwhile, significant elevation of ERVs of asthma for females aged 40–64 years was associated with exposure to ozone, with the highest RR of 1.21 (95% CI: 1.05–1.39).

Conclusions

This study identified vulnerable subpopulations who were at risk to extreme events associated with ambient environments deserving further evaluation for adaptation.

Better Identification of Cognitive Decline With Interleukin-2 Than With Amyloid and Tau Protein Biomarkers in Amnestic Mild Cognitive Impairment

The rate of cognitive decline among patients with amnestic mild cognitive impairment (aMCI) varies, and it is thus crucial to accurately predict the probability of cognitive deterioration in patients with MCI. We compared the potential of cytokines with amyloid beta (Aβ) and tau biomarkers for predicting cognitive decline in patients with aMCI or Alzheimer’s disease (AD). All participants (controls, aMCI, and AD patients) underwent plasma biomarker examinations for Aβ_1–40, Aβ_1–42, total tau (t-tau), tau phosphorylated at threonine 181 [p-Tau181]), and 29 cytokines and baseline cognitive tests, including Mini-Mental State Examination (MMSE). The correlation between biomarker levels and annual MMSE change during the follow-up was examined. Receiver operating characteristic (ROC) curve analysis was performed to determine whether the statistically significant plasma biomarkers could identify cognitive decline. Higher baseline levels of IL-2, sCD40L, IL-8, and VEGF were associated with a lower annual cognitive decline in the aMCI group, and higher baseline levels of Aβ_1–40, IFNγ, IL-5, IL-17A, IL-25, and FGF were associated with a rapid annual cognitive decline in the AD group. IL-2 had a high discriminatory capacity for identifying cognitive decline, with an area under curve (AUC) of 85.7% in the aMCI group, and the AUC was slightly increased when combining IL-2 with Aβ or tau biomarkers. However, none of the biomarkers had a satisfactory discriminatory capacity in the AD group. IL-2 may have a better discriminatory capacity for identifying cognitive decline than Aβ and tau biomarkers in patients with aMCI.

Circular RNA circ-MTO1 serves as a novel potential diagnostic and prognostic biomarker for gallbladder cancer

OBJECTIVE

Primary gallbladder carcinoma (GBC) is one of the most common biliary malignancies in the gastrointestinal tract. In this work, we examined the roles of circular-mitochondrial translation optimization 1 (circ-MTO1) in GBC tissues and patient plasma.

PATIENTS AND METHODS

Circ-MTO1 expression in GBC tissues and patient plasma was evaluated by quantitative Real Time-PCR (qRT-PCR). The relationships between circ-MTO1 expression and the pathological characteristics of GBC were analyzed. Kaplan-Meier survival curve was applied to calculate overall survival (OS) and progression-free survival (PFS) in GBC patients with different circ-MTO1 expression. The univariate COX regression curve analysis method was employed to analyze the potential relationships between high circ-MTO1 expression and OS and PFS. At last, we assessed the diagnostic value of the circ-MTO1 level in GBC patient plasma.

RESULTS

Circ-MTO1 expression was significantly upregulated in tumor tissues and plasma in GBC patients. In addition, circ-MTO1 expression was associated with clinical-pathological characteristics in GBC. High circ-MTO1 expression served as an independent prognostic factor for poor OS and PFS in GBC patients. Moreover, upregulated plasma circ-MTO1 level was significantly associated with tumor development.

CONCLUSIONS

Circ-MTO1 is a potential early diagnostic and prognostic biomarker for patients with gallbladder cancer. Thus, our present work might provide a new understanding of the diagnosis and treatment of GBC.

Identifying neuroanatomical signatures in insomnia and migraine comorbidity

STUDY OBJECTIVES

While insomnia and migraine are often comorbid, the shared and distinct neuroanatomical substrates underlying these disorders and the brain structures associated with the comorbidity are unknown. We aimed to identify patterns of neuroanatomical substrate alterations associated with migraine and insomnia comorbidity.

METHODS

High-resolution T1-weighted images were acquired from subjects with insomnia, migraine, and comorbid migraine and insomnia, respectively, and healthy controls (HC). Direct group comparisons with HC followed by conjunction analyses identified shared regional gray matter volume (GMV) alterations between the disorders. To further examine large-scale anatomical network changes, a seed-based structural covariance network (SCN) analysis was applied. Conjunction analyses also identified common SCN alterations in two disease groups, and we further evaluated these shared regional and global neuroanatomical signatures in the comorbid group.

RESULTS

Compared with controls, patients with migraine and insomnia showed GMV changes in the cerebellum and the lingual, precentral, and postcentral gyri (PCG). The bilateral PCG were common GMV alteration sites in both groups, with decreased structural covariance integrity observed in the cerebellum. In patients with comorbid migraine and insomnia, shared regional GMV and global SCN changes were consistently observed. The GMV of the right PCG also correlated with sleep quality in these patients.

CONCLUSION

These findings highlight the specific role of the PCG in the shared pathophysiology of insomnia and migraine from a regional and global brain network perspective. These multilevel neuroanatomical changes could be used as potential image markers to decipher the comorbidity of the two disorders.

Effects of extreme temperatures, fine particles and ozone on hourly ambulance dispatches

There is a dearth of research on the hourly risk of ambulance dispatches with respect to ambient conditions. We evaluated hourly relative risks (RR) and 95% confidence interval (CI) of ambulance dispatches in Taiwan to treat respiratory distress, coma and unconsciousness, and out-of-hospital cardiac arrest (OHCA), from 2006 to 2015. We considered island-wide ambient temperatures, fine particulate matter (PM_2.5), and ozone (O₃) at lag 0-180 h while using a distributed lag nonlinear model and meta-analysis. Results showed the pooled risks peaked at lag 16-18 h for all ambulance dispatches at 99th percentile of hourly temperature (32 °C, versus reference temperature of 25 °C), with significant excess risk of 0.11% (95% CI; 0.06, 0.17) for coma and unconsciousness, and 0.06% (95% CI; 0.01, 0.11) for OHCA. The risks of exposure to 90th percentile of hourly O₃ of 52.3 ppb relative to the Q1 level of 17.3 ppb peaked at lag 14 h, with excess risk of 0.17% (95% CI; 0.11, 0.23) for respiratory distress, 0.11% (95% CI; 0.06, 0.16) for coma and unconsciousness, and 0.07% (95% CI; 0.01, 0.14) for OHCA. The population exposed to reference temperatures of 28 °C, 20 °C, and 26 °C were exposed to the lowest levels of ambulance dispatches risk for respiratory distress, coma and unconsciousness, and OHCA, respectively; the highest cumulative 0-96 h RRs of ambulance dispatches were 1.27 (95% CI; 1.19, 1.35) for OHCA at 5th percentile temperatures and 1.25 (95% CI; 1.11, 1.41) for OHCA at 99th percentile temperatures. Following an accumulating lag of 0-96 h, no significant risk was identified for hourly levels of PM_2.5 and O₃. In conclusion, the analytical results of hourly data speak to immediate and real-time responses to environmental changes, rather than to short-term relationships. In our analyses, we emphasized health events in extreme heat; thus, we recommend a comparative study of daily versus hourly associations.

Clinical Features of Cluster Headache: A Hospital-Based Study in Taiwan

Most previous studies on cluster headache (CH) focus on Western populations. This study aimed to investigate the clinical characteristics of CH in a neurology outpatient population in Taiwan. A cross-sectional survey was conducted from July 2015 to June 2019 in a medical college affiliated with a tertiary care hospital (Tri-Service General Hospital) in Taiwan. All consecutive patients reporting headache as their chief complaint were asked to participate in a face-to-face interview with a qualified headache specialist and to complete a detailed self-administered questionnaire. The diagnosis of CH was made according to the Third edition of the International Classification of Headache Disorders. The subjects comprised 80 consecutive new CH patients (13 women and 67 men; ratio, 1:5). The mean age at presentation was 36.0 ± 10.8 years (range, 16-64 years), mean age at onset was 27.2 ± 12.1 years (range, 5-65 years), and mean time lag before diagnosis was 9.3 ± 10.5 years (range, 0-46.4 years). Of the total CH patients, 25.3% reported feelings of restlessness during headache episodes. A seasonal predilection was reported by 18% of the CH patients. The use of tobacco was the most common (44/80 patients). Chronic CH was only observed in 5% of the patients and only one patient (1.3%) reported both a positive family history for CH and aura. Features of CH in Taiwanese patients differed from that of Caucasian patients; a lower prevalence of chronic CH, positive family history of CH, and occurrence of aura may be less common in the former than in the latter.

Prevalence and association of lifestyle and medical-, psychiatric-, and pain-related comorbidities in patients with migraine: A cross-sectional study

BACKGROUND AND OBJECTIVES

Migraine has been associated with many comorbidities. However, lifestyle factors and the presence of comorbid diseases have not previously been extensively studied in the same sample. This study aimed to compare the prevalence of unhealthy lifestyle factors and comorbid diseases between patients with migraine and migraine-free controls with subgroup analyses to determine the pathophysiology and possible consequences.

METHODS

This cross-sectional study recruited 1257 patients with migraine between the ages of 20 and 65 years from a headache outpatient clinic in Taiwan and 496 non-migraine controls. All participants completed questionnaires regarding demographics, migraine diagnosis, sleep, headache burden, and medical, pain, and psychiatric conditions. Participants also underwent a structured interview. The associations between comorbidities and migraine were investigated and further stratified by sex and aura.

RESULTS

Patients with migraine with aura had an unhealthier lifestyle compared with controls in the form of current smoking status (15.5% [67/431] vs. 11.5% [57/496], p = 0.013). Furthermore, medical- (e.g., thyroid disease; 7.2% [91/1257 vs. 2.8% [14/496]; p = 0.006), psychiatric- (e.g., depression; 6% [76/1257 vs. 2.6% [13/496]; p = 0.031), and pain-related (e.g., fibromyalgia; 8% [101/1257 vs. 3.2% [16/496]; p = 0.006) comorbidities were more prevalent in patients compared with controls. Subgroup analyses revealed that chronic migraine, migraine with aura, and female sex were associated with a greater number of significant comorbidities than episodic migraine, migraine without aura, and male patients with migraine, respectively.

CONCLUSION

Individuals seeking treatment for migraine reported greater levels of smoking and medical, psychiatric, and pain conditions than non-treatment-seeking healthy controls who were recruited from the community. Understanding the relationship between migraine and comorbid diseases may improve medical care as well as the quality of life.

Risk of ambulance services associated with ambient temperature, fine particulate and its constituents

Short-term adverse health effects of constituents of fine particles with aerodynamic diameters less than or equal to 2.5 μm (PM_2.5) have been revealed. This study aimed to evaluate the real-time health outcome of ambulance services in association with ambient temperature and mass concentrations of total PM_2.5 level and constituents in Kaohsiung City, an industrialized city with the worst air quality in Taiwan. Cumulative 6-day (lag0-5) relative risk (RR) and 95% confidence interval (CI) of daily ambulance services records of respiratory distress, coma and unconsciousness, chest pain, headaches/dizziness/vertigo/fainting/syncope, lying at public, and out-of-hospital cardiac arrest (OHCA) in association with ambient temperature and mass concentrations of total PM_2.5 level and constituents (nitrate, sulfate, organic carbon (OC), and elemental carbon (EC)) from 2006 to 2010 were evaluated using a distributed lag non-linear model with quasi-Poisson function. Ambulance services of chest pain and OHCA were significantly associated with extreme high (30.8 °C) and low (18.2 °C) temperatures, with cumulative 6-day RRs ranging from 1.37 to 1.67 at the reference temperature of 24–25 °C. Daily total PM_2.5 level had significant effects on ambulance services of lying at public and respiratory distress. After adjusting the cumulative 6-day effects of temperature and total PM_2.5 level, RRs of ambulance services of lying at public associated with constituents at 90th percentile versus 25th percentile were 1.35 (95% CI: 1.08, 1.68) for sulfate and 1.20 (95% CI: 1.02, 1.41) for EC, while RR was 1.31 (95% CI: 1.09–1.58) for ambulance services of headache/dizziness/vertigo/fainting/syncope in association with OC at 90th percentile versus 25th percentile. Cause-specific ambulance services had various significant association with daily temperature, total PM_2.5 level, and concentrations of constituents. Elemental carbon may have stronger associations with increased ambulance services than other constituents.