Effect of Ezetimibe combined with Simvastatin in the treatment of coronary heart disease: a retrospective analysis.

OBJECTIVE: The aim of this study was to explore the effect of Ezetimibe combined with Simvastatin in the treatment of coronary heart disease (CHD). PATIENTS AND METHODS: Clinical data of 101 patients with CHD, admitted to our hospital from February 2022 to May 2023, were retrospectively analyzed. Among them, 49 patients received Simvastatin (Simvastatin group), and 52 patients received Simvastatin+Ezetimibe (Simvastatin+Ezetimibe group). Levels of blood lipid indicators, inflammatory factors, cardiac function indicators, and incidences of major adverse cardiovascular events (MACE) between the two groups were compared before and after the treatment. RESULTS: After the treatment, high-density lipoprotein cholesterol (HDL-C), cardiac index (CI), and left ventricular ejection fraction (LVEF) in both groups were higher than those before the treatment, and overall higher in the Simvastatin+Ezetimibe group. Levels of low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), total cholesterol (TC), monocyte chemoattractant protein-1 (MCP-1), chemokine ligand 19 (CCL19), high sensitivity C-reactive protein (hs-CRP), cardiac output (CO) in the two groups were lower than before the treatment. These indexes were significantly lower in the Simvastatin+Ezetimibe group (p<0.05) compared to the Simvastatin group. During the treatment, the incidence of MACE in the Simvastatin+Ezetimibe group (3.85%) was significantly lower than that in the Simvastatin group (16.33%) (p<0.05). CONCLUSIONS: Compared with Simvastatin alone, a combination of Ezetimibe and Simvastatin can more effectively regulate the level of blood lipids, reduce the inflammatory reaction in the body, improve heart function, and lower the risk of MACE.

Celecoxib and acetylbritannilactone interact synergistically to suppress breast cancer cell growth via COX-2-dependent and -independent mechanisms.

The use of celecoxib is associated with a significant decrease in breast cancer risk. However, the long-term use of high-dose celecoxib might be limited owing to cardiovascular side effects. In this study, we found that acetylbritannilactone (ABL), extract from a Chinese medicinal herb, could reduce celecoxib dose and potentiate the growth-inhibitory effect in breast cancer cells. ABL enhanced the apoptotic effect of celecoxib in COX-2-expressing cells, but had little effect in COX-2-negative cells. The apoptosis induced by the combination treatment disappeared when COX-2 was knocked down, whereas the lack of apoptotic effects in COX-2-negative cells was reversed after COX-2 transfection. However, the combination treatment induced a G(0)/G(1) phase arrest independent of whether or not the cells expressed COX-2. The G(0)/G(1) arrest was attributed to a decreased expression of cyclinD1, cyclinE, CDK2 and CDK6, especially the upregulation of p21. In addition, inhibition of Akt and p38 signaling pathways was required by the synergism, as the constitutively active Akt and p38 protected cells against apoptosis and cell cycle arrest induced by the combination treatment. In vivo, administration of celecoxib and ABL were more effective than the individual agents against xenograft tumor growth. Thus, our data suggested that the combinatorial approach of celecoxib and ABL might be helpful for breast cancer treatment.

Clinical characteristics of outpatients at a psycho-oncology clinic in a radiation oncology department.

BACKGROUND: Psychosocial care in cancer medicine has become increasingly important. The first psychiatric consultation-liaison (C-L) outpatient clinic in Taiwan was established in a department of radiation oncology in a medical center in Oct. 1998. METHODS: From October 1998 through January 2000, 121 patients were referred for psychosocial evaluation. Six referred patients were excluded because of cerebral complications of malignant disease or coincidental psychiatric disorder. The remaining 115 patients were referred because of psychological problems related to their malignant disease. These patients were divided into 'depression related disorder' and 'anxiety related disorder' groups according to psychiatric standard diagnoses. The records of these referred patients were retrospectively analyzed based on the psychiatric diagnoses. RESULTS: The outpatient utilization rate for psychiatric consultation escalated from 0% to 5.92% after the C-L clinic was established. Patients with nasopharynx, breast, and head and neck cancer had higher referral, rates (over 10%) than patients with other types of cancer. There were significant differences in major subjective psychiatric problems and psychological reactions between patients with psychiatric diagnosis and those without psychiatric diagnosis. Cancer patients who were diagnosed with 'depression related disorder' visited this clinic more times than those with 'anxiety related disorder'. The former received antidepressant drugs more frequently than the latter. There were also more multiple visits in the former group than the latter group. CONCLUSION: Locating a C-L clinic in a radiation oncology department improves access to psychiatric evaluation, early detection and continuous intervention can then be offered to cancer patients with anxiety or depression, especially those with 'depression related disorder'.

Predictors of readmission to a medical-psychiatric unit among patients with minor mental disorders.

BACKGROUND: Most studies on readmission have focused on patients with severe mental disorders such as schizophrenia and subjects were mostly collected in traditional psychiatric settings. This study investigated the predictors of readmission to a medical-psychiatric unit among patients with minor mental disorders in a general hospital. METHODS: All 164 patients admitted to a stress ward within a one-year period were recruited into this study. Data were retrospectively obtained by reviewing medical charts. Variables used to analyze and compare between patients who were and were not readmitted included patient characteristics, clinical features and multiple axes diagnoses of DSM-IV. RESULTS: Of 164 patients recruited, 135 were hospitalized only one time. The remaining 29 patients accounted for 61 admissions. The readmission rate was 17.7% (29/164). The significant predictors for readmission included Global Assessment of Functioning scores lower than 50 at admission, age under 40 years, previous psychiatric admission, alcohol dependence/abuse, dysthymia and comorbidity of borderline personality disorder. Using logistic regression to predict readmission within one year, we found the first four variables accurately differentiated 84.15% of patients who were readmitted from those who were not. CONCLUSIONS: Our results indicated the incidence of relapse in certain minor mental disorders is similar to that of severe mental disorders. By identifying predictors of readmission and intervening appropriately, unnecessary readmission may be prevented.

[Effect of yiqi jianpi drugs on apoptosis and relevant gene expression in cultured vascular smooth muscle cell].

OBJECTIVE: To explore the effect of Yiqi Jianpi (YQJP, supplementing Qi and invigorating Spleen) recipe on vascular smooth muscle cells (VSMC) apoptosis and it's mechanisms. METHODS: VSMC apoptosis was detected by terminal deoxynucleotidyl transferase mediated dUTP nicked labeling (TUNEL) analysis, transmission electron microscope (TEM), flow cytometry and DNA agarose electrophoresis. The expression activity of bcl-2, c-myc and p53 genes were determined using Northern blotting. RESULTS: The typical characteristics of apoptotic VSMC was observed following treatment by the YQJP drug serum. The DNA extracted from VSMC revealed a ladder pattern in electrophoresis. Flow cytometric analysis revealed G0/G1 stage cell blocking phenomena, the hypodiploid apoptotic cell increased, displayed typical peak of apoptosis, the rate of cell apoptosis and YQJP serum concentration were in a dose-dependent manner. The result of hybridization showed that 30% of YQJP serum could inhibit apoptotic gene bcl-2 expression, upregulated the level of apoptogenous gene c-myc and p53 mRNA. CONCLUSION: VSMC apoptosis could be induced by YQJP recipe and its mechanism might be through affecting the apoptosis related gene expression activity.

Molecular cloning and characterization of the promoter region of the inducible nitric oxide synthase gene of the rat.

To investigate the mechanism by which inducible nitric oxide synthase (iNOS) within vascular smooth muscle cells (VSMC) is expressed following exposure to proinflammatory cytokines, we cloned the promoter region of the rat iNOS gene by a single specific primer PCR cloning strategy. The 5;-flanking region of the rat iNOS gene contains interferon-gamma (IFN-gamma)- and tumor necrosis factor-alpha (TNF-alpha)-responsive elements and an NF-kappaB-binding consensus sequences. The position and alignment of these consensus sequences are distinct from those in the mouse iNOS and human iNOS genes. It was shown that some nuclear factor(s) which bound specifically to the fragment of the rat iNOS gene containing several consensus sequences were produced after VSMC were treated with interleukin 1 (IL-1) and IFN-gamma.

Change of core conflicts of schizophrenic patients who received brief psychodynamic psychotherapy: a pilot study in Taiwan.

BACKGROUND: This study examined the change of core conflicts of schizophrenic patients who received brief psychodynamic psychotherapy (BPP). METHODS: The change of core conflicts and relationship patterns over dynamic psychotherapy sessions were assessed by the core conflictual relationship theme (CCRT) method. Patients were enrolled either from the psychiatric outpatient department or day hospital in a medical center. Transcripts of psychotherapy sessions were used for CCRT analysis. In each extracted transcript, 3 components, i.e., wishes, responses from others and responses of self, were identified and were used to formulate the CCRT. CCRT pervasiveness was calculated to compare the change of each component from early to late sessions. RESULTS: The main other person most frequently mentioned was the family member. The changes of positive and negative responses of self were found to be statistically significant. Wishes were not so pervasive as those of non-psychotic patients. A high drop-out rate characterized the schizophrenic patients. CONCLUSION: Self-understanding and self-control may well explain the significant change in responses of self, even in patients with essentially poor ego strength like schizophrenics.

Comparison of sexual behaviors between male homosexuals and male heterosexuals in Taiwan.

BACKGROUND: Homosexuality and sexual behavior have attracted great attention in the acquired immunodeficiency syndrome (AIDS) epidemic. This study primarily explores the risky behaviors and patterns of sexual behavior of male homosexuals in Taiwan. METHODS: Comparison study methodology was adopted. Ninety-two male homosexuals, as the study group, were recruited from gay bars and gay organizations, and 91 male heterosexuals, with similar ages and educational levels, were recruited as a control group for comparison. Semi-structured interviews were carried out and anonymous questionnaires were self-administered. RESULTS: (1) The mean age at the time of first sexual intercourse of the study group was younger than that of the control group. (2) The rate of having two or more sexual partners in the study group was significantly higher. (3) However, the rate of condom use during recent intercourse was higher in the control group than in the study group. (4) Sexual knowledge and attitudes toward sexuality in the study group were more open, but their sexual desires, as rated by the questionnaire, were more suppressed than those of the control group. (5) In terms of courtship, the study group was less constrained by the social values of marriage and tended to separate sex from love. CONCLUSION: Similar to western studies, our study found that the study group in Taiwan adopted more risky sexual behaviors. Each group had its particular sexual behavioral pattern and subculture of sexuality. However, a longitudinal follow-up study with ethnographic perspective is necessary for a more sophisticated understanding of the trends and changes of sexual behavior in homosexuals.

Treatment refusal: analysis of 15 cases.

BACKGROUND: In this paper, we investigate the reasons for treatment refusal at Linkou and Kaohsiung Chang Gung Memorial Hospitals, and offer ways to improve the doctor-patient relationship. METHODS: Cases were collected during a 2-year period according to the criterion of notification of "refused treatment" on consultation sheets, with a total of 1631 consultation sheets. All cases were discussed once a week in detail by psychiatrists and the consulting medical staff, and were followed up from 1 to 4 weeks. All cases were treated by the processes of informed consent and crisis intervention. The final results for the reasons of treatment refusal and psychiatric diagnoses were made by psychiatrists and the consulting medical staff. RESULTS: The number of cases compatible with the criterion was 15 (10 men and 5 women). The reasons for treatment refusal included poor communication, inadequate information, lack of competency, denial and shock reaction, reappearance of the suffered experience, and autonomy of patients. The distribution of psychiatric diagnoses included 8 with major depressive disorders, 2 with delirium, 1 with schizophrenic disorder, 1 with adjustment disorder, 1 with acute stress disorder (post-traffic accident), 1 with alcohol dependence, and 1 was deferred. After adequate processes of informed consent and crisis intervention, 12 persons accepted medical treatment. CONCLUSION: We should give patients adequate informed consent and crisis intervention to establish a good doctor-patient relationship and to respect the patients' autonomy for their choice of treatment.

The study on core conflictual relationship of short-term counseling.

This study utilizes the Core Conflictual Relationship Theme Method (CCRT; Luborsky and Crits-Christoph, 1997) on process study of short-term counseling. The purpose was to evaluate the formation and variation of interpersonal conflicts presented by nine clients, so as to enhance the understanding of the core conflicts of each client and how these clients were influenced by short-term counseling. CCRT was conducted by two raters to analyze the content of core conflictual relationship themes. The raters started with taking a twenty-minute vignette from four tapes of the counseling sessions which were the 1st, 2nd, 11th and the 12th. A transcript was taken for each session and the raters searched for relationship episodes (REs) in it. Further, other main persons were identified in REs. Three components, including wish(W), response from others(RO), and response of self(RS) were investigated and analyzed. The raters calculated the appearance frequency of each component and transferred them into formulation of relationship theme in written language. The findings are as follows. (1) The interrater reliabilities between the two raters over W, RO, RS are significant (Kappa = .21-.82, P < .01) (2) The most frequently described other main persons in 201 REs were 'clleague' (N = 87, 43. 3%), the second 'self' (N = 42, 32.8%) and the third 'family members' (N = 41, 20. 4%). The first three described wishes were 'to assert self and be independent' (N = 66, 32.8%), 'to be close and accepted' (N = 48, 23.9%), and 'to be loved and understood' (N = 35, 17.4%) (3) The change of pervasiveness scores of each component in terms of positive and negative responses evaluated by t-test were found to decrease significantly in NRO (r = -2.73, p < .05). The score was most significantly decreased in 'rejecting and opposing' item (t = -3.83, p < .01). Conclusions and suggestions regarding application of the Core Conflictual Relationship Theme analytical and categorization methods in the Chinese context are presented.

Comparative study of induction of iNOS mRNA expression in vascular cells of different species.

To determine the difference in induction of inducible nitric oxide synthase (iNOS) mRNA expression in cultured vascular cells of different species, the expression of iNOS genes and their regulatory mechanisms in rat, human, bovine, and rabbit vascular endothelial cells and smooth muscle cells (SMC) were studied by Northern blotting, chloramphenicol acetyltransferase (CAT) assay, and electrophoretic mobility shift assay (EMSA). Qualitative estimation of iNOS mRNA by Northern-blot analysis demonstrated that the combination of interleukin-1 beta (IL-1 beta), tumor necrosis factor-alpha (TNF-alpha), and lipopolysaccharides (LPS) drastically induces iNOS expression in rat and human SMC, and a more moderate effect was observed for endothelial cells; the effect of IL-1 beta alone was much weaker than that of the three factors. IL-1 beta alone or a mixture of IL-1 beta, TNF-alpha, and LPS both showed negligible effect on iNOS expression in bovine and rabbit vascular endothelial cells and SMC. Results of CAT assay corresponded well with Northern analysis indicating 7-fold increase in CAT activity by the mixture of IL-1 beta, TNF-alpha, and LPS in SMC and more moderate, 2-fold increase, in endothelial cells. IL-1 beta alone produced an intermediate effect (less than 2-fold) on vascular SMC of rats and humans. The results of EMSA showed that two shifted bands appeared when the nuclear protein from rat and human vascular endothelial cells bound to the region from -1037 to -787 of the rat iNOS gene, while vascular SMC nuclear protein only produced a single shifted band under the same conditions. These results suggest that cell- and species-specific mechanisms exist in the induction of iNOS expression.

Mitochondrial DNA variation in cattle of south China: origin and introgression.

Ten restriction endonucleases were used to investigate the mitochondrial DNA restriction fragment length polymorphism (mtDNA RFLP) of 11 native cattle breeds and one cultivated cattle breed in South China. Twenty-three restriction morphs were detected, which can be sorted into five haplotypes. A phylogenetic tree of the haplotypes was constructed by using the 'upgMa' method. Our study showed that haplotype I and II are identical to the zebu (Bos indicus) and taurine (Bos taurus) haplotypes, respectively. Zebu and taurine were the two major origins of cattle populations in South China, and the zebu probably had more influence on the native cattle population than taurine did. Haplotype III is identical to haplotype I of yak (Bos grunniens), which was only detected in the Diqing cattle breed. Haplotype IV was detected for the first time. This haplotype, found only in Dehong cattle, might be from an independent domestication event, probably from another Bos indicus population. Divergence of haplotypes I and IV occurred about 268,000-535,000 years ago, much earlier than the 10,000-year history of cattle husbandry. Our results also suggest a secondary introgession of mtDNA from yak to Diqing cattle.

Genetic diversity of cattle in south China as revealed by blood protein electrophoresis.

Genetic variation of 31 blood protein loci in 236 cattle from eight South China populations (including mithan, Bos frontalis) and a Holstein population was investigated by means of horizontal starch gel electrophoresis. Thirteen loci (ALB, CAR, Hb-b, Np, PGM, Amy-I, PEP-B, AKP, 6PGD, Cp, Pa, EsD, and TF) were found to be polymorphic. The comparison of average heterozygosities (H) shows that all the native cattle embrace a rich genetic diversity. Our results on protein polymorphism suggest that cattle in China originated mainly from Bos indicus and Bos taurus; Xuwen, Hainan, Wenshan, and Dehong cattle and the Dehong zebu are close to zebu-type cattle, and Diqing and Zhaotong cattle are close to the taurine. The mithan was very different from other native cattle, and we suggest that its origin was complicated and may be influenced by other cattle species.

Folk belief, illness behavior and mental health in Taiwan.

In this paper, an overview of the literature relevant to the issues of illness behavior and help-seeking behavior in relation to mental health and illness, focusing on the Taiwan area is presented. Arguments for the prioritization and appreciation of the folk perspective of mental illness and health are addressed. The traditional medical beliefs in the Chinese culture that emphasize integration and continuity, instead of differentiation, of/between body and mind, person and nature, nature and super-nature, the visible (with form) and the invisible (without form), and yang and yin, have laid the basis for the theoretical framework of somatization as normative illness behavior rather than psychologization, and also dissociation as normative illness behavior rather than repression. A case report on folk psychotherapy is given here to illustrate the argument. The continuum models illustrated in this paper, either the shen-kuei syndrome in its broad sense extending from koro to neurasthenia, frigophobia or the spirit possession syndrome in its broad sense extending from the pathological and peripheral (Hsieh-ping) to the normative and ritual (shamanism), could well remind us of the powerful influence of the folk and popular contexts of culture that underlie illness behavior in relation to mental health in Taiwan.

Prevalences and related factors of substances use in female aborigines in southern Taiwan.

Alcohol use and betel quid chewing are common in aborigines in Taiwan. The aims of this study were to evaluate the patterns of drinking, smoking, betel quid chewing and to assess the related factors of the above substance use among female aborigines. Three hundred female Bunun aborigines aged between 17 and 50 years were recruited into this study via a stratified-random sampling. Subjects were interviewed at their homes by trained interviewers using a structured questionnaire. Prevalences of various substances use were estimated as follows: alcohol, 67.7%; betel quid chewing, 36.4%; smoking, 11.6%; and over-the-counter drugs, 8%. Related factors of substances use were analyzed by multiple logistic regression as follows. Alcohol use was significantly related to low educational level, where the spouse was a drinker and there was an attitude in favor of female drinking. Significant factors related to smoking were folk religion and where the spouse was a smoker. Significant factors related to betel chewing were low educational level, and where the spouse was a betel chewer, and poor knowledge about the adverse health effects of betel chewing. We also found women who consumed alcohol and chewed betel quid were significantly to show more external health locus control. About 80% of women recognized the adverse effects of alcohol consumption and smoking to pregnancy outcomes. Although they knew the harmful effects of substance use, only half of them stopped using these substances during their pregnancy. Health education on the harmful effects of alcohol, betel quid, and cigarettes, especially during pregnancy is essential in primary care.

Prevalence and related risk factors of betel quid chewing by adolescent students in southern Taiwan.

The prevalence and related risk factors of betel quid chewing among adolescent students were studied in a junior high school (group 1) and in a vocational school (group 2) in southern Taiwan. Group 1 consisted of 3548 participants (89.7% response rate) and group 2 of 1358 (97.6% response rate). The students were asked to complete a questionnaire anonymously. In the junior high school 1.9% of students including all grades (13-15 years old) and both sexes was found to be a current betel quid chewer and 14% was an ex-chewer, whereas 10.2% of vocational school students (16-18 years old) was a current chewer and 31% was an ex-chewer. The prevalence of betel chewing was significantly higher among boys than girls. A high proportion of chewers was also a smoker and alcohol drinker. A statistical analysis of sociodemographic factors showed that male students who smoked tobacco, consumed alcohol and were friends or classmates of students who were betel quid chewers, were the likeliest adolescents to chew betel quid.

[Effect of bushen shengxue recipe on EPO gene expression of chronic renal insufficiency anemia in rats].

The rats were fed with adenine to establish the chronic renal insufficiency anemia model, and the relationship between renal functional impairment and reticulocytes, hemoglobin and erythropoietin (EPO) synthesis was observed to explore the mechanism of Bushen Shengxue drugs in improving the hemopoietic function. The results showed that the Bushen Shengxue drugs could significantly lower the serum creatinine and blood urea nitrogen of renal insufficiency rats, and through the promotion of EPO gene expression, the animals' anemic status was improved.