Trajectory, Perceived Causes and Efforts in Diabetes Selfmanagement: A Qualitative Study Among Young People With Type 2 Diabetes Mellitus and Caregivers

@#Introduction: Previous studies have suggested that young individuals with type 2 diabetes mellitus (T2DM) face challenges in achieving optimal diabetes self-management, leading to difficulties in attaining the recommended glycaemic target. The reasons behind these suboptimal practices remain unclear due to the limited number of studies conducted in Malaysia that focused on diabetes self-management among young people. This qualitative study aimed to understand the lived experience of young people with T2DM on self-management in Malaysia. Methods: Young people at the age of 10 to 24 years, who had been diagnosed with T2DM and the caregivers who managing young people with T2DM were interviewed. Data were thematically analysed with the aid of QSR NVivo version 12. Results: Sixteen young informants and eleven caregivers participated in this study. Three major themes conceptualised the lived experience of diabetes self-management: (1) the trajectory to T2DM diagnosis; (2) perceived causes of T2DM; (3) the efforts in diabetes self-management. The route of diagnosis and experiential knowledge about T2DM might determine their efforts in the self-management among the young people. Healthy eating, medication taking and physical activity were perceived as important tasks in diabetes self-management. The involvement of the caregivers in diabetes self-management evolved over time. Conclusion: The study highlighted the experience of young people and caregivers since the beginning of the diagnosis and their strategies in diabetes self-management. More understanding of the lived experiences of patients and caregivers in disease management within the socio-ecological context could help to improve health-care services and intervention for this population.

Perceptions and Beliefs Towards Mental Health and Mental Illness: A Qualitative Study among University Students in Malaysia

@#Introduction: University students’ perspectives on mental health issues remain scarce despite the growing prevalence of mental illness among this population. Therefore, this study aimed to explore university students’ perceptions and beliefs about mental health and mental illness. Methods: Virtual in-depth interviews were conducted from December 2021 to March 2022. All interviews were audio-recorded, transcribed verbatim and analysed using thematic analysis. Results: Sixteen informants from a Malaysian university were interviewed. Four major themes emerged: (1) understanding of mental health and mental illness; (2) perceived causes of mental illness; (3) attitudes towards mental illness; (4) strategies to maintain good mental health. Most informants related mental health to an individual’s thoughts, emotions and behaviours, while a minority equated ‘mental health’ with ‘mental illness’. The majority of informants cited socio-environmental factors as the primary cause of mental illness. Unexpectedly, informants did not view religious factors as a cause of mental illness, although it was thought to be deeply rooted in the older generation. Nearly all informants expressed positive attitudes and willingness to help people with mental illness. However, some informants decided to cover up their mental health problems to avoid the likelihood of experiencing negative emotions. Most informants believed that living a fulfilling and balanced life, staying optimistic and being religious could help them to maintain good mental health. Conclusion: To mitigate the deterioration of students’ mental health, it is necessary to understand their perceptions and beliefs about mental health and mental illness as these may influence their help-seeking behaviours. The study findings showed that university students have a basic understanding of mental health and mental illness and most of them are supportive in handling people with mental illness.

The Electroacoustic Performance of Digital Noise Reduction Systems in Commercial Hearing Aids with Malay Speech-Plus-Noise Test Signals (Prestasi Elektroakustik Sistem Pengurangan Hingar Digital dalam Alat Bantu Pendengaran Komersial dengan Isyarat Ujian Pertuturan-Dalam-Bising Bahasa Melayu) / Jurnal Sains Kesihatan Malaysia

@#One of the most frequent complaints of individuals with hearing impairment is listening comfort in noisy environments. In order to improve listening comforts in background noise, digital noise reduction (DNR) systems are incorporated into hearing aids (HAs). Each hearing aid manufacturer has its proprietary algorithm for the DNR system. The amount of attenuation (dB) provided by the DNR system can be quantified using the hearing aid analyser. However, the standard test signals in the hearing aid analyser could not quantify the attenuation of DNR for speech mixed with noise signals. Therefore, this study aimed to (i) develop speech-plus-noise test signals that incorporate Malay sentences and (ii) quantify the efficacy of DNR systems in commercial hearing aids using the newly developed test signals. Six different brands of hearing aids with identical technology but from different manufacturers were subjected to electroacoustic testing utilising newly created Malay speech-in-noise test signals with and without DNR enabled. The total root-meansquare (RMS) gain reduction for each HA was calculated. The results show that the types of noise, the signal-to-noise ratio and the gender of the speaker have a significant effect (p<0.05) on the amount of gain reduction in the HA output as a result of the DNR system in each HA . In conclusion, the newly developed Malay speech-in-noise test signals can be used to verify the efficacy of DNR system in commercial hearing aids.

Bidirectional associations between hyperopia, myopia, astigmatism, and strabismus, and attention-deficit/hyperactivity disorder in children: a national population-based cohort study

Objectives: The present study analyzed the reciprocal relationships between four common pediatric ophthalmic diseases (i.e., hyperopia, myopia, astigmatism, and strabismus) and attention‐deficit/hyperactivity disorder (ADHD) in children. Methods: This study enrolled 86,028 children with ADHD and 1,798,673 children without ADHD in the Taiwan Maternal and Child Health Database who were born at any time from 2004 to 2017. Cox proportional hazards regression models were used to estimate the bidirectional relationships of the four ophthalmic diseases with ADHD in children after adjusting for age, sex, and gestational age at birth. Survival curves for time-to-event variables were estimated using the Kaplan-Meier method, and the log-rank test was used to compare the curves. Results: The results indicated that ADHD significantly predicted the occurrence of hyperopia, myopia, astigmatism, and strabismus. Furthermore, hyperopia, myopia, astigmatism, and strabismus significantly predicted the occurrence of ADHD. The time between enrollment and ADHD diagnosis was shorter for patients with ophthalmic diseases than for the control group, and the time between enrollment and ophthalmic disease diagnosis was also shorter for ADHD patients than for the control group. Sex differences were found in the associations between ADHD and ophthalmic diseases. Conclusion: Clinicians should monitor children with ADHD for hyperopia, myopia, astigmatism, and strabismus to ensure appropriate treatment, and vice versa.

Effects of different combinations of radical nephroureterectomy and bladder cuff excision procedures for upper tract urothelial carcinoma on bladder recurrence

ABSTRACT Purpose: To compare the effects of different combinations of radical nephroureterectomy (RNU) and bladder cuff excision (BCE) surgical procedures on intravesical recurrence (IVR) in patients with upper tract urothelial carcinoma (UTUC). Materials and Methods: This retrospective observational study included 452 patients who underwent RNU with BCE for UTUC between January 2010 and December 2020. The patients were classified into three groups based on different combinations of RNU and BCE surgical procedures: open RNU with open BCE (group 1, n=104), minimally invasive (MIS) RNU with open BCE (group 2, n=196), and MIS RNU with intracorporeal BCE (group 3, n=152). Data on demographics, body mass index, history, preoperative renal function, perioperative status, tumor characteristics, histopathology, and recurrence conditions were collected. Multivariate Cox regression analyses were performed to determine the impact of the surgical procedures on IVR. P-values <0.05 were considered statistically significant. Results: After a median follow-up of 29.5 months, the IVR rate was 29.6% and the IVR-free survival rate was the lowest in group 2 (group 1 vs. group 2 vs. group 3: 69.0% vs. 55.1% vs. 67.5%; log-rank P=0.048). The overall survival rate was comparable among the three groups. Multivariate analysis revealed that group 2 had a significantly higher risk of IVR than group 1 (hazard ratio=1.949, 95% confidence interval=1.082-3.511, P=0.026), while groups 1 and 3 had similar risks. Conclusions: For patients with UTUC, MIS RNU with open BCE is associated with a higher risk of IVR than open RNU with open BCE and MIS RNU with intracorporeal BCE.

Cardioverter-defibrillator reduces mortality risk in eligible ischemic and non-ischemic cardiomyopathy patients: Sub-analysis of the multi-center Improve SCA study

Background & Objective: Despite the burden of sudden cardiac arrest (SCA) worldwide, implantable cardioverter-defibrillators (ICDs) are underutilized, particularly in Asia, Latin America, Eastern Europe, the Middle East, and Africa. The Improve SCA trial demonstrated that primary prevention (PP) patients in these regions benefit from an ICD or a cardiac resynchronization therapy defibrillator (CRT-D). We aimed to compare the rate of device therapy and mortality among ischemic and non-ischemic cardiomyopathy (ICM and NICM) PP patients who met guideline indications for ICD therapy and had an ICD/CRT-D implanted. Methods: Improve SCA was a prospective, non-randomized, non-blinded multicenter trial that enrolled patients from the above-mentioned regions. All-cause mortality and device therapy were examined by cardiomyopathy (ICM vs NICM) and implantation status. Cox proportional hazards methods were used, adjusting for factors affecting mortality risk. Results: Of 1848 PP NICM patients, 1007 (54.5%) received ICD/CRT-D, while 303 of 581 (52.1%) PP ICM patients received an ICD/CRT-D. The all-cause mortality rate at 3 years for NICM patients with and without an ICD/CRT-D was 13.1% and 18.3%, respectively (HR 0.51, 95% CI 0.38e0.68, p < 0.001). Similarly, all-cause mortality at 3 years in ICM patients was 13.8% in those with a device and 19.9% in those without an ICD/CRT-D (HR 0.54, 95% CI 0.33e.0.88, p ¼ 0.011). The time to first device therapy, time to first shock, and time to first antitachycardia pacing (ATP) therapy were not significantly different between groups (p 0.263). Conclusions: In this large data set of patients with a guideline-based PP ICD indication, defibrillator device implantation conferred a significant mortality benefit in both NICM and ICM patients. The rate of appropriate device therapy was also similar in both groups.

Treatment Response Evaluation by Computed Tomography Pulmonary Vasculature Analysis in Patients With Chronic Thromboembolic Pulmonary Hypertension

Objective@#To quantitatively assess the pulmonary vasculature using non-contrast computed tomography (CT) in patients with chronic thromboembolic pulmonary hypertension (CTEPH) pre- and post-treatment and correlate CT-based parameters with right heart catheterization (RHC) hemodynamic and clinical parameters. @*Materials and Methods@#A total of 30 patients with CTEPH (mean age, 57.9 years; 53% female) who received multimodal treatment, including riociguat for ≥ 16 weeks with or without balloon pulmonary angioplasty and underwent both noncontrast CT for pulmonary vasculature analysis and RHC pre- and post-treatment were included. The radiographic analysis included subpleural perfusion parameters, including blood volume in small vessels with a cross-sectional area ≤ 5 mm 2 (BV5) and total blood vessel volume (TBV) in the lungs. The RHC parameters included mean pulmonary artery pressure (mPAP), pulmonary vascular resistance (PVR), and cardiac index (CI). Clinical parameters included the World Health Organization (WHO) functional class and 6-minute walking distance (6MWD). @*Results@#The number, area, and density of the subpleural small vessels increased after treatment by 35.7% (P < 0.001), 13.3% (P = 0.028), and 39.3% (P < 0.001), respectively. The blood volume shifted from larger to smaller vessels, as indicated by an 11.3% increase in the BV5/TBV ratio (P = 0.042). The BV5/TBV ratio was negatively correlated with PVR (r = -0.26; P = 0.035) and positively correlated with CI (r = 0.33; P = 0.009). The percent change across treatment in the BV5/TBV ratio correlated with the percent change in mPAP (r = -0.56; P = 0.001), PVR (r = -0.64; P < 0.001), and CI (r = 0.28; P = 0.049).Furthermore, the BV5/TBV ratio was inversely associated with the WHO functional classes I–IV (P = 0.004) and positively associated with 6MWD (P = 0.013). @*Conclusion@#Non-contrast CT measures could quantitatively assess changes in the pulmonary vasculature in response to treatment and were correlated with hemodynamic and clinical parameters.

Uremic pruritus: pathophysiology, clinical presentation, and treatments

Uremic pruritus is one of the most common and bothersome symptoms in patients with end-stage renal disease. Most patients with uremic pruritus experience a prolonged and relapsing course and significant impairments of quality of life. The pathophysiology of uremic pruritus is not completely understood. A complex interplay among cutaneous biology and the nervous and immune systems has been implicated, with the involvement of various inflammatory mediators, neurotransmitters, and opioids. Uremic pruritus treatment outcomes are often unsatisfactory. Clinical trials have mostly been small in scale and have reported inconsistent results. Recent evidence shows that gabapentinoids, nalfurafine, and difelikefalin are effective for relieving uremic pruritus in hemodialysis patients. This review provides an overview of the epidemiology and proposed mechanisms of uremic pruritus, then highlights the manifestations of and clinical approach to uremic pruritus. Current evidence regarding treatment options, including topical treatments, treatment of underlying disease, phototherapy, and systemic treatments, is also outlined. With a better understanding of uremic pruritus, more therapeutic options can be expected in the near future.

Validation of Pharyngeal Acid Reflux Episodes Using Hypopharyngeal Multichannel Intraluminal Impedance-pH

Background/Aims@#Hypopharyngeal multichannel intraluminal impedance-pH (HMII-pH) technology incorporating 2 trans-upper esophageal sphincter impedance channels has been developed to detect pharyngeal reflux. We used the HMII-pH technique to validate the candidate pharyngeal acid reflux (PAR) episodes based on the dual-pH tracings and determined the interobserver reproducibility. @*Methods@#We conducted a cross-sectional study in tertiary centers in Taiwan. Ninety patients with suspected laryngopharyngeal reflux and 28 healthy volunteers underwent HMII-pH test when off acid suppressants. Candidate PAR episodes were characterized by pharyngeal pH drops of at least 2 units and reaching a nadir pH of 5 within 30 seconds during esophageal acidification. Two experts manually independently identified candidate PAR episodes based on the dual-pH tracings. By reviewing the HMII-pH tracings, HMII-pH-proven PAR episodes were subsequently confirmed. The consensus reviews of HMII-pH-proven PAR episodes were considered to be the reference standard diagnosis. The interobserver reproducibility was assessed. @*Results@#A total of 105 candidate PAR episodes were identified. Among them 84 (80.0%; 95% CI, 71.0-87.0%) were HMII-pH-proven PAR episodes (82 in 16 patients and 2 in 1 healthy subject). Patients tended to have more HMII-pH-proven PAR episodes than healthy controls (median and percentile values [25th, 75th, and 95th percentiles]: 0 [0, 0, 3] vs 0 [0, 0, 0], P = 0.067). The concordance rate in diagnosing HMII-pH-proven PAR episodes between 2 independent observers was 92.2%. @*Conclusion@#Our preliminary data showed that 80.0% (71.0-87.0%) of the proposed candidate PAR episodes were HMII-pH-proven PAR episodes, among which the interobserver reproducibility was good.

Aspirin Use Is Associated With Improved Outcomes in Inflammatory Breast Cancer Patients / 한국유방암학회지

Purpose@#Inflammatory breast cancer (IBC) is the most aggressive form of breast cancer and has a high propensity for distant metastases. Our previous data suggested that aspirin (acetylsalicylic acid, ASA) use may be associated with reduced risk of distant metastases in aggressive breast cancer; however, there are no reported studies on the potential benefit of ASA use in patients with IBC. @*Methods@#Data from patients with non-metastatic IBC treated between 2000–2017 at two institutions, were reviewed. Overall survival (OS), disease-free survival (DFS), and distant metastasis-free survival (DMFS) were performed using Kaplan-Meier analysis. Univariate and multivariable logistic regression models were used to identify significant associated factors. @*Results@#Of 59 patients meeting the criteria for analysis and available for review, 14 ASA users were identified. ASA users demonstrated increased OS (p = 0.03) and DMFS (p = 0.02), with 5-year OS and DMFS of 92% (p = 0.01) and 85% (p = 0.01) compared to 51% and 43%, respectively, for non-ASA users. In univariate analysis, pT stage, pN stage, and ASA use were significantly correlated (p < 0.05) with OS and DFS. On multivariable analysis, ASA use (hazard ratio [HR], 0.11; 95% confidence interval [CI], 0.01–0.8) and lymph node stage (HR, 5.9; 95% CI, 1.4–25.9) remained significant for OS and DFS ASA use (HR, 0.13; 95% CI, 0.03–0.56) and lymph node stage (HR, 5.6; 95% CI, 1.9–16.4). @*Conclusion@#ASA use during remission was associated with significantly improved OS and DMFS in patients with IBC. These results suggest that ASA may provide survival benefits to patients with IBC. Prospective clinical trials of ASA use in patients with high-risk IBC in remission should be considered.

Risk of Hepatitis B Virus (HBV) Reactivation in HBsAg-Negative, Anti-HBc-Negative Patients Receiving Rituximab for Autoimmune Diseases in HBV Endemic Areas

Background/Aims@# Rituximab is known to be associated with high hepatitis B virus (HBV) reactivation rate in patients with resolved HBV infection and hematologic malignancy. However, data regarding HBV reactivation (HBVr) in rheumatic patients receiving rituximab is limited. To assess the HBVr rate in hepatitis B surface antigen (HBsAg)-negative patients receiving rituximab for autoimmune diseases in a large real-world cohort. @*Methods@# From March 2006 to December 2019, 900 patients with negative HBsAg receiving at least one cycle of rituximab for autoimmune diseases in a tertiary medical center in Taiwan were retrospectively reviewed. Clinical outcome and factors associated with HBVr were analyzed. @*Results@#After a median follow-up period of 3.3 years, 21 patients developed HBVr, among whom 17 patients were positive for hepatitis B core antibody (anti-HBc) and four were negative. Thirteen patients had clinical hepatitis flare, while eight patients had HBsAg seroreversion without hepatitis. Old age, anti-HBc positivity, undetectable serum hepatitis B surface antibody level at rituximab initiation and a higher average rituximab dose were associated with a higher HBVr rate. There was no significant difference in the HBVr risk between rheumatoid arthritis and other autoimmune diseases. Among anti-HBc-negative patients, subjects without HBV vaccination at birth had an increased risk of HBVr (4/368, 1.1%) compared with those who received vaccination (0/126, 0%). @*Conclusions@#In HBV endemic areas where occult HBV is prevalent, anti-HBc-negative patients, may still be at risk for HBVr after rituximab exposure. HBVr may still be considered in HBsAgnegative patients developing abnormal liver function after rituximab exposure, even in patients with negative anti-HBc.

Harm Avoidance is Correlated with the Reward System in Adult Patients with Attention Deficit Hyperactivity Disorder: A Functional Magnetic Resonance Imaging Study

Objective@#Hypoactivity in the reward system among patients with attention deficit hyperactivity disorder (ADHD) is a well-known phenomenon. Whether the activity in the reward pathway is related to harm avoidance, such as in sensitivity to punishment, is unclear. Evidence regarding the potential difference between ADHD patients and controls in terms of this association is scarce. @*Methods@#Event-related functional magnetic resonance imaging was conducted on subjects performing the Iowa gambling test. Fourteen adults with ADHD and 14 controls were enrolled in the study. @*Results@#Harm avoidance was found to be positively correlated with the activities of the bilateral orbitofrontal cortex and right insula in individuals with ADHD. A group difference was also confirmed. @*Conclusion@#Understanding the roles of harm avoidance and brain activation during risk tasks is important.

Growth patterns of urban Malaysian children under 24 months of age in Selangor, Malaysia

@#Introduction: To identify the growth patterns of young children during the first two years of life according to gestational age, birth weight, and growth status at 24 months of age. Methods: This was a retrospective cohort study of 4,570 young children in Selangor. Data were extracted from children’s health records in government health clinics. Growth data were analysed using the Anthro Plus software that utilises the World Health Organization growth standards. Results: Generally, wasting prevalence was the highest at birth and 24 months, but stunting was more predominant from 1 to 21 months. Weight-for-age z-scores (WAZ), lengthfor-age z-scores (LAZ), and weight-for-length z-scores (WLZ) from birth to 24 months were within -3.00 to 0.00 standard deviation (SD) for pre-term low birth weight children, –1.50 to 0.00 SD for pre-term normal birth weight children, and –2.50 to 0.50 SD for full-term low birth weight children. While WAZ, LAZ, and WLZ from birth to 24 months for underweight/stunted/wasted children were within –2.50 to 0.50 SD, the values for overweight/obese (OV/OB) children were within –1.00 to 2.00 SD. For normal children, WAZ, LAZ, and WLZ exhibited comparable trends, with values within –1.00 to 0.00 SD from birth to 24 months. Conclusion: While stunting and wasting persisted as the most common forms of malnutrition in this sample of young children, the prevalence of OV/OB increased by 24 months. Interventions to promote child growth should focus not only on the prevention of undernutrition, but also on OV/OB.

Characteristics of children with newly diagnosed type 1 diabetes mellitus in Brunei Darussalam / Journal of the ASEAN Federation of Endocrine Societies

Objective@#This study aims to characterize the presentation, biochemical status of children with T1DM at diagnosis, the type of subcutaneous insulin regimens initiated, and to determine the incidence of T1DM in Bruneian children aged 18 years and younger.@*Methodology@#A retrospective electronic and paper medical chart review was performed on patients aged 18 years and younger diagnosed with T1DM from 2013 to 2018 in Brunei Darussalam.@*Results@#A total of 31 children with a mean age of 10.2 ± 3.6 years old were diagnosed with T1DM, of which 66.7% presented with diabetic ketoacidosis (DKA), a majority in severe DKA with an intercurrent illness (p=0.021). The mean HbA1c was 13.6 ± 2.7% with a mean serum glucose of 37.0±14.9 mmol/L at diagnosis. In the majority of the children (67.7%), multiple daily injections of subcutaneous insulin were initiated. The incidence of T1DM in children aged 18 years and younger was 4.9 per 100,000 for the year 2018.@*Conclusions@#The majority of the patients in this study presented with severe DKA with an intercurrent illness. This highlights the importance of childhood T1DM awareness among the public and healthcare providers. The incidence of childhood T1DM in Brunei Darussalam is similar to other countries in the Asian region, being relatively low, compared to the rest of the world.

Comparison of changes in the nasal cavity, pharyngeal airway, and maxillary sinus volumes after expansion and maxillary protraction with two protocols: Rapid palatal expansion versus alternate rapid maxillary expansion and constriction / 대한치과교정학회지

Objective@#To evaluate and compare a series of volume changes in the nasal cavity (NC), nasopharynx, oropharynx, and maxillary sinuses (MS) in growing Class III patients after either rapid palatal expansion (RPE) or alternate rapid maxillary expansion and constriction (Alt-RAMEC) followed by facemask (FM) therapy, by using conebeam computed tomography (CBCT). @*Methods@#Forty growing Class III patients were retrospectively selected and divided into two matched groups: RPE/FM (14 females, 6 males; mean age, 9.66 ± 1.23 years) and Alt-RAMEC/FM groups (14 females, 6 males; mean age, 10.28 ± 1.45 years). The anteroposterior and vertical displacements of Point A, the volumes of the NC, nasopharyngeal, oropharyngeal, and MS were measured at different time points: pretreatment (T1), postexpansion (T2), and postprotraction (T3). @*Results@#Both groups demonstrated significant maxilla advancement (by 1.3 mm) during expansion, with a statistically significant intergroup difference during protraction (RPE/FM, 1.1 mm; Alt-RAMEC/FM, 2.4 mm; p < 0.05) and throughout the treatment (RPE/FM, 2.4 mm; Alt-RAMEC/FM, 3.7 mm; p < 0.05). NC and nasopharyngeal airway volumes increased significantly in both groups after expansion, protraction, and treatment. The oropharyngeal and MS volumes increased in both groups after protraction and post-treatment. However, no volumetric differences were observed between the two groups. @*Conclusions@#There was no significant difference in airway volume changes, including NC, nasopharyngeal, oropharyngeal airway, and MS, between RPE/FM and Alt-RAMEC/FM groups at different time points. Although there was significantly more forward movement after protraction in the Alt-RAMEC/FM group, the difference was deemed too small to be clinically relevant.

Sleep Quality and Self-Stigma Mediate the Association Between Problematic Use of Social Media and Quality of Life Among People With Schizophrenia in Taiwan: A Longitudinal Study

Objective@#Problematic use of social media (PUSM) may affect sleep quality and self-stigma in people with schizophrenia and consequently reduce their quality of life (QoL). This longitudinal study investigated if sleep quality and self-stigma mediated relationships between PUSM and QoL. @*Methods@#One-hundred-and-ninety-three outpatients with schizophrenia were recruited from a psychiatric center in Taiwan from April 2019 to August 2021 and participated in a longitudinal study at intervals of three months between measurements. QoL was assessed using the World Health Organization Quality of Life Questionnaire Brief Version; sleep quality using the Pittsburgh Sleep Quality Index; self-stigma using the Self-Stigma Scale-Short; and PUSM using the Bergen Social Media Addiction Scale. Via SPSS 20.0, general estimating equation models assessed temporal associations between variables. Via R software, mediating effects of self-stigma and sleep quality were examined through Monte Carlo simulations with 20,000 repetitions. @*Results@#Mean scores of physical, psychological, social and environmental QoL ranged from 11.86 to 13.02. Mean scores of sleep quality and self-stigma were 9.1±4.5 and 2.2±0.8, respectively. Sleep quality and self-stigma were directly related to QoL (p<0.001) and mediated indirect relationships between PUSM and all components of QoL with a range of 95% confidence intervals spanning from -0.0591 to -0.0107 for physical QoL; -0.0564 to -0.0095 for psychological QoL; -0.0292 to -0.0035 for social QoL; and -0.0357 to -0.0052 for environmental QoL. @*Conclusion@#Sleep quality and self-stigma mediated relationships between PUSM and QoL in people with schizophrenia. Developing interventions targeting PUSM, sleep, and self-stigma may help improve QoL in people with schizophrenia.

Effect of patient decision aids on choice between sugammadex and neostigmine in surgeries under general anesthesia: a multicenter randomized controlled trial / 대한마취과학회지

Background@#Shared decision making using patient decision aids (PtDAs) was established over a decade ago, but few studies have evaluated its efficacy in Asian countries. We therefore evaluated the application of PtDAs in a decision conflict between two muscle relaxant reversal agents, neostigmine and sugammadex, and sequentially analyzed the regional differences and operating room turnover rates. @*Methods@#This multicenter, outcome-assessor-blind, randomized controlled trial included 3,132 surgical patients from two medical centers admitted between March 2020 and August 2020. The patients were randomly divided into the classical and PtDA groups for pre-anesthesia consultations. Their clinicodemographic characteristics were analyzed to identify variables influencing the choice of reversal agent. On the day of the pre-anesthesia consultation, the patients completed the four SURE scale (sure of myself, understand information, risk-benefit ratio, encouragement) screening items. The operating turnover rates were also evaluated using anesthesia records. @*Results@#Compared with the classical group, the PtDA group felt more confident about receiving sufficient medical information (P < 0.001), felt better informed about the advantages and disadvantages of the medications (P < 0.001), exhibited a superior understanding of the benefits and risks of their options (P < 0.001), and felt surer about their choice (P < 0.001). Moreover, the PtDA group had a significantly greater tendency to choose sugammadex over neostigmine (P < 0.001). @*Conclusions@#PtDA interventions in pre-anesthesia consultations provided surgical patients with clear knowledge and better support. PtDAs should be made available in other medical fields to enhance shared clinical decision-making.

Melatonin acts synergistically with pazopanib against renal cell carcinoma cells through p38 mitogen-activated protein kinase-mediated mitochondrial and autophagic apoptosis

Mounting evidence indicates that melatonin has possible activity against different tumors. Pazopanib is an anticancer drug used to treat renal cell carcinoma (RCC). This study tested the anticancer activity of melatonin combined with pazopanib on RCC cells and explored the underlying mechanistic pathways of its action. Methods: The 786-O and A-498 human RCC cell lines were used as cell models. Cell viability and tumorigenesis were detected with the MTT and colony formation assays, respectively. Apoptosis and autophagy were assessed using TUNEL, annexin V/propidium iodide, and acridine orange staining with flow cytometry. The expression of cellular signaling proteins was investigated with western blotting. The in vivo growth of tumors derived from RCC cells was evaluated using a xenograft mouse model. Results: Together, melatonin and pazopanib reduced cell viability and colony formation and promoted the apoptosis of RCC cells. Furthermore, the combination of melatonin and pazopanib triggered more mitochondrial, caspase-mediated, and LC3-II-mediated autophagic apoptosis than melatonin or pazopanib alone. The combination also induced higher activation of the p38 mitogen-activated protein kinase (p38MAPK) in the promotion of autophagy and apoptosis by RCC cells than melatonin or pazopanib alone. Finally, tumor xenograft experiments confirmed that melatonin and pazopanib cooperatively inhibited RCC growth in vivo and predicted a possible interaction between melatonin/pazopanib and LC3-II. Conclusion: The combination of melatonin and pazopanib inhibits the growth of RCC cells by inducing p38MAPK-mediated mitochondrial and autophagic apoptosis. Therefore, melatonin might be a potential adjuvant that could act synergistically with pazopanib for RCC treatment.

Clinical Characteristics, Genetic Features, and Long-Term Outcome of Wilson’s Disease in a Taiwanese Population: An 11-Year Follow-Up Study

Objective@#aaWilson’s disease (WD) is a rare genetic disorder of copper metabolism, and longitudinal follow-up studies are limited. We performed a retrospective analysis to determine the clinical characteristics and long-term outcomes in a large WD cohort. @*Methods@#aaMedical records of WD patients diagnosed from 2006–2021 at National Taiwan University Hospital were retrospectively evaluated for clinical presentations, neuroimages, genetic information, and follow-up outcomes. @*Results@#aaThe present study enrolled 123 WD patients (mean follow-up: 11.12 ± 7.41 years), including 74 patients (60.2%) with hepatic features and 49 patients (39.8%) with predominantly neuropsychiatric symptoms. Compared to the hepatic group, the neuropsychiatric group exhibited more Kayser-Fleischer rings (77.6% vs. 41.9%, p < 0.01), lower serum ceruloplasmin levels (4.9 ± 3.9 vs. 6.3 ± 3.9 mg/dL, p < 0.01), smaller total brain and subcortical gray matter volumes (p < 0.0001), and worse functional outcomes during follow-up (p = 0.0003). Among patients with available DNA samples (n = 59), the most common mutations were p.R778L (allelic frequency of 22.03%) followed by p.P992L (11.86%) and p.T935M (9.32%). Patients with at least one allele of p.R778L had a younger onset age (p = 0.04), lower ceruloplasmin levels (p < 0.01), lower serum copper levels (p = 0.03), higher percentage of the hepatic form (p = 0.03), and a better functional outcome during follow-up (p = 0.0012) compared to patients with other genetic variations. @*Conclusion@#aaThe distinct clinical characteristics and long-term outcomes of patients in our cohort support the ethnic differences regarding the mutational spectrum and clinical presentations in WD.