A deep learning-based algorithm for pulmonary tuberculosis detection in chest radiography.

In tuberculosis (TB), chest radiography (CXR) patterns are highly variable, mimicking pneumonia and many other diseases. This study aims to evaluate the efficacy of Google teachable machine, a deep neural network-based image classification tool, to develop algorithm for predicting TB probability of CXRs. The training dataset included 348 TB CXRs and 3806 normal CXRs for training TB detection. We also collected 1150 abnormal CXRs and 627 normal CXRs for training abnormality detection. For external validation, we collected 250 CXRs from our hospital. We also compared the accuracy of the algorithm to five pulmonologists and radiological reports. In external validation, the AI algorithm showed areas under the curve (AUC) of 0.951 and 0.975 in validation dataset 1 and 2. The accuracy of the pulmonologists on validation dataset 2 showed AUC range of 0.936-0.995. When abnormal CXRs other than TB were added, AUC decreased in both human readers (0.843-0.888) and AI algorithm (0.828). When combine human readers with AI algorithm, the AUC further increased to 0.862-0.885. The TB CXR AI algorithm developed by using Google teachable machine in this study is effective, with the accuracy close to experienced clinical physicians, and may be helpful for detecting tuberculosis by CXR.

Validity of Diagnostic Support Model for Attention Deficit Hyperactivity Disorder: A Machine Learning Approach.

An accurate and early diagnosis of attention deficit hyperactivity disorder can improve health outcomes and prevent unnecessary medical expenses. This study developed a diagnostic support model using a machine learning approach to effectively screen individuals for attention deficit hyperactivity disorder. Three models were developed: a logistic regression model, a classification and regression tree (CART), and a neural network. The models were assessed by using a receiver operating characteristic analysis. In total, 74 participants were enrolled into the disorder group, while 21 participants were enrolled in the control group. The sensitivity and specificity of each model, indicating the rate of true positive and true negative results, respectively, were assessed. The CART model demonstrated a superior performance compared to the other two models, with region values of receiver operating characteristic analyses in the following order: CART (0.848) > logistic regression model (0.826) > neural network (0.67). The sensitivity and specificity of the CART model were 78.8% and 50%, respectively. This model can be applied to other neuroscience research fields, including the diagnoses of autism spectrum disorder, Tourette syndrome, and dementia. This will enhance the effect and practical value of our research.

Shortened neural conduction time in young adults with tinnitus as revealed by chirp-evoked auditory brainstem response.

Tinnitus is generally considered to be caused by neuroplastic changes in the central nervous system, triggered by a loss of input from the damaged peripheral system; however, conflicting results on auditory brainstem responses (ABRs) to clicks have been reported previously in humans with tinnitus. This study aimed to compare the effect of tinnitus on ABRs to chirps with those to clicks in normal-hearing young adults with tinnitus. The results showed that the tinnitus group had no significantly poorer hearing thresholds (0.25-16 kHz), click-evoked otoacoustic emissions (1-16 kHz), and speech perception in noise (SPIN) than the control group. Although chirps evoked significantly larger wave I and V amplitudes than clicks, people with tinnitus had no significantly smaller wave I amplitudes for either stimulus. Nevertheless, adults with tinnitus exhibited significantly smaller interpeak interval (IPI) between waves I and V for chirps (IPI-chirp) but not for clicks. In addition, the IPI-chirp correlated significantly with the SPIN for individuals with tinnitus when the signal-to-noise ratio was low. The present results suggest that the chirp-evoked ABR may be a valuable clinical tool for objectively assessing the SPIN in individuals with tinnitus. Further studies should be conducted to investigate possible etiologies of tinnitus.

Reversal of Pulmonary Fibrosis: Human Umbilical Mesenchymal Stem Cells from Wharton's Jelly versus Human-Adipose-Derived Mesenchymal Stem Cells.

Pulmonary fibrosis (PF) is a progressive, non-reversible illness with various etiologies. Currently, effective treatments for fibrotic lungs are still lacking. Here, we compared the effectiveness of transplantation of human mesenchymal stem cells from umbilical cord Wharton's jelly (HUMSCs) versus those from adipose tissue (ADMSCs) in reversing pulmonary fibrosis in rats. Bleomycin 5 mg was intratracheally injected to establish a severe, stable, single left lung animal model with PF. On Day 21 post-BLM administration, one single transplantation of 2.5 × 107 HUMSCs or ADMSCs was performed. Lung function examination of Injury and Injury+ADMSCs rats displayed significantly decreased blood oxygen saturation and increased respiratory rates, while Injury+HUMSCs rats showed statistical amelioration in blood oxygen saturation and significant alleviation in respiratory rates. Reduced cell number in the bronchoalveolar lavage and lower myofibroblast activation appeared in the rats transplanted with either ADMSCs or HUMSCS than that in the Injury group. However, ADMSC transplantation stimulated more adipogenesis. Furthermore, matrix-metallopeptidase-9 over-expression for collagen degradation, and the elevation of Toll-like receptor-4 expression for alveolar regeneration were observed only in the Injury+HUMSCs. In comparison with the transplantation of ADMSCs, transplantation of HUMSCs exhibited a much more effective therapeutic effect on PF, with significantly better results in alveolar volume and lung function.

Microplastics stimulated nitrous oxide emissions primarily through denitrification: A meta-analysis.

Microplastics can profoundly alter nitrogen cycling. However, it remains poorly understood how microplastics impact soil nitrogen processes and generate N2O. A meta-analysis was conducted for this investigation based on 60 published studies to elucidate the effects of microplastics on soil nitrogen cycling, from genes to processes. Under microplastic exposure, the emissions of soil N2O was significantly increased (140.6%), while the nitrate reductase activities increased by 4.8%. The denitrification rate and number of denitrifier genes were increased by 17.8% and 10.6%, respectively. Meanwhile, the nitrification rate and nitrifier genes were not significantly altered, so did the nitrogen immobilization and mineralization rates. The additional emission of soil N2O might primarily from stimulated denitrification. Soil N2O emission and denitrification genes were always increased, regardless of the concentrations of microplastic or experiment duration. As a result, the nitrite was increased by 38.8% and nitrate was decreased by 22.4%, respectively. Interestingly, the N2O emission increments and copy number of denitrifiers genes diminished over time. This study revealed divergent changes in soil nitrogen processes and highlighted N2O emissions with a greater denitrification rate under microplastic exposure. The negative impacts of microplastics on soil health were revealed from the perspective of soil nitrogen availability and N2O emissions.

Development of Internet suicide message identification and the Monitoring-Tracking-Rescuing model in Taiwan.

BACKGROUND: Suicide messages can be transmitted infinitely online; the Internet is influential in suicide prevention. Identifying suicide risks online via artificial technological advances may help predict suicide. METHODS: We built a classifier that detects open messages containing suicidal ideation or behavior-related words in social media via text mining methods and developed the Monitoring-Tracking-Rescuing model, which links data monitoring and tracking to high-risk suicide rescues. Natural language processing (NLP) techniques such as Long Short-Term Memory and Bidirectional Encoder Representations from Transformers were applied to online posts of common social media sites in Taiwan. This model uses a two-step high-risk identification procedure: an automatic prediction process using NLP to classify suicide-risk levels, followed by professional validation by a senior psychiatrist and a nursing faculty specialized in suicidology. RESULTS: From a dataset containing 404 high-risk and 2226 no- or low-risk articles, the sensitivity and specificity of our model reached 80 %. LIMITATIONS: The model is limited to data platforms that can be "crawled" and excludes suicide-risk content from graphics, video and audio files. Additionally, machine learning does not provide the best recognition rate from complex online messages. Keywords for high-risk suicide in long articles are difficult to interpret using this model. Finally, the model lacks keywords for suicide-protective factors. CONCLUSIONS: Artificial intelligence techniques may help detect and monitor high-risk suicide posts and inform mental health professionals of these posts. Periodic tracking plus manual validation to determine risk levels are recommended to enhance the reliability and effectiveness of Internet suicide-prevention tasks.

Integrating a Luminescent Porous Aromatic Framework into Indicator Papers for Facile, Rapid, and Selective Detection of Nitro Compounds.

Porous aromatic framework materials with high stability, sensitivity, and selectivity have great potential to provide new sensors for optoelectronic/fluorescent probe devices. In this work, a luminescent porous aromatic framework material (LNU-23) was synthesized via the palladium-catalyzed Suzuki cross-coupling reaction of tetrabromopyrene and 1,2-bisphenyldiborate pinacol ester. The resulting PAF solid exhibited strong fluorescence emission with a quantum yield of 18.31%, showing excellent light and heat stability. Because the lowest unoccupied molecular orbital (LUMO) of LNU-23 was higher than that of the nitro compounds, there was an energy transfer from the excited LNU-23 to the analyte, leading to the selective fluorescence quenching with a limit of detection (LOD) ≈ 1.47 × 10-5 M. After integrating the luminescent PAF powder on the paper by a simple dipping method, the indicator papers revealed a fast fluorescence response to gaseous nitrobenzene within 10 s, which shows great potential in outdoor fluorescence detection of nitro compounds.

Optimization of the Field Plate Design of a 1200 V p-GaN Power High-Electron-Mobility Transistor.

This study optimized the field plate (FP) design (i.e., the number and positions of FP layers) of p-GaN power high-electron-mobility transistors (HEMTs) on the basic of simulations conducted using the technology computer-aided design software of Silvaco. Devices with zero, two, and three FP layers were designed. The FP layers of the HEMTs dispersed the electric field between the gate and drain regions. The device with two FP layers exhibited a high off-state breakdown voltage of 1549 V because of the long distance between its first FP layer and the channel. The devices were subjected to high-temperature reverse bias and high-temperature gate bias measurements to examine their characteristics, which satisfied the reliability specifications of JEDEC.

Introducing Polar Groups in Porous Aromatic Framework for Achieving High Capacity of Organic Molecules and Enhanced Self-Cleaning Applications.

Due to the frequent oil/organic solvent leakage, efficient oil/water separation has attracted extensive concern. However, conventional porous materials possess nonpolar building units, which reveal relatively weak affinity for polar organic molecules. Here, two different polarities of superhydrophobic porous aromatic frameworks (PAFs) were synthesized with respective orthoposition and paraposition C=O groups in the PAF linkers. The conjugated structure formed by a large number of alkynyl and benzene ring structures enabled porous and superhydrophobic quality of PAFs. After the successful preparation of the PAF solids, PAF powders were coated on polyester fabrics by a simple dip-coating method, which endowed the resulting polyester fabrics with superhydrophobicity, porosity, and excellent stability. Based on the unique structure, the oil/water separation efficiency of two superhydrophobic flexible fabrics was more than 90% for various organic solvents. Polar LNU-26 PAF showed better separation performance for the polar oils. This work takes the lead in adopting the polar groups as building units for the preparation of porous networks, which has great guiding significance for the construction of advanced oil/water separation materials.

Quality of life changes and their predictors in young adult narcolepsy patients after treatment: A real-world cohort study.

Background: We conducted a five-year prospective follow-up study to track the real-world quality of life of patients with narcolepsy after medication and analyzed predictors. Methods: The study ultimately included 157 participants who completed 5-year follow-up, 111 had type 1 narcolepsy (NT1) and 46 had type 2 narcolepsy (NT2). Polysomnography, multiple sleep latency test, actigraphy and HLA-typing were conducted. The Short Form 36 Health Survey Questionnaire (SF-36), the Stanford Center for Narcolepsy Sleep Inventory, the Epworth Sleepiness Scale (ESS), the visual analog for hypersomnolence (VAS), and Conners' Continuous Performance Test were used. Descriptive statistics, repeated measures, and hierarchical linear models were applied for analysis. Results: Most demographic and clinical data did not significantly differ between groups, but the NT1 group had significantly more overweight, more severe narcoleptic symptoms, more positive HLA typing, shorter mean sleep latency, and more sleep onset rapid eye movement periods. No significant change to the physical domains of SF-36 was found in the total group, but we observed significant changes in emotional role functioning and social function. The NT1 group showed significant improvements in physical role functioning, emotional role functioning, and social function. The NT2 group demonstrated significant improvements in emotional role functioning. At the baseline, the NT2 group had significantly better scores, but there was no significant group difference after treatment, except for physical and social function. ESS and VAS were significantly improved during follow-up. At the baseline, the NT1 group had significantly higher ESS and VAS scores, and continuously significantly higher ESS scores during follow-up. Narcolepsy types, HLA typing, age of onset, symptom severity, attention and vigilance were significantly correlated with SF-36. Conclusion: Symptom control greatly associates with the quality of life in narcoleptic patients, and medication can play the most important role. Management targeting narcoleptic symptoms, attention impairment, and drug adherence should be provided.

Relative contributions of natural and anthropogenic factors to the distribution patterns of nature reserves in mainland China.

Nature reserves (NRs) are designated as a result of the ecosystem, species, economy, population, and land use coordination. However, the extent to which these factors influence the geographical pattern of NRs is unclear. Here, 11 indices (seven natural and four anthropogenic) were examined to identify these relationships in over 2600 terrestrial NRs in mainland China at the provincial level. Correlation analysis between natural and anthropogenic factors and NRs showed that desert and grassland had a positive correlation with NR coverage and area, and a negative correlation with NR density. This result was reversed in the correlation analysis between forest wetland coverage, endangered species, wildlife and NR coverage, area, and density. Similar results were found in the correlation analysis of all anthropogenic factors (population density, agricultural land, roads, and per capita GDP) with the coverage, area, and density of NRs. Canonical correspondence analysis (CCA) showed that three significant natural indicators (desert ecosystems, grasslands ecosystems, and forested and wetlands ecosystems) could explain 64.2 % of the pattern of NRs. The largest contributor was desert coverage, explaining 48.3 % (P = 0.002) of all indicators, followed by grassland coverage, explaining 8.6 % (P = 0.012), and forest and wetland coverage, explaining 7.3 % (P = 0.008). Human activities were significantly positively correlated with forest and wetland coverage, flora, and fauna, and negatively correlated with desert and grassland coverage. Compared with sand and grassland in the western region, the forest wetlands and wildlife in the eastern and central provinces were under greater pressure from anthropogenic activities. Therefore, natural factors determine the general layout of NRs, while the influence of anthropogenic activities makes the distribution of NRs patchy. When establishing national parks, governments must design strategies to coordinate areas with high biodiversity and high levels of human activity.

Mycoplasma pneumonia Infection Is Associated With an Increased Risk of Systemic Lupus Erythematosus: A Nationwide, Retrospective Cohort Study.

Background: Infections may play a role in the development of systemic lupus erythematosus (SLE). Objective: To assess the link between Mycoplasma pneumonia (M. pneumonia) infection and the incidence of SLE. Method: We conducted a retrospective cohort study, which identified 116,043 hospitalized patients with M. pneumoniae between 2000 and 2012 from the Taiwan National Health Insurance Research Database and compared them with 447,839 matched inpatients who had never been diagnosed with M. pneumonia infection (at a 1:4 ratio, matched by age, gender, and index year). Their comparative risk of developing SLE was evaluated. The follow-up period was defined as the time from the initial diagnosis of M. pneumonia infection to the date of SLE diagnosis, or December 31, 2013. The incidence rates of SLE were assessed in people with and without M. pneumoniae infection. Cox proportional hazard models were used to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs), with the uninfected group used as the reference. Results: The adjusted HR of SLE for the M. pneumoniae group was 2.97 with 95% CI = 2.18-4.05 compared with the uninfected group. The risk was most significantly higher within 0.5 years after the M. pneumoniae infection with an adjusted HR of 6.18 (95% CI = 3.82-9.97, p < 0.01). The adjusted HR for SLE from 0.5 to 2 years and from 2 to 5 years after M. pneumoniae infection was 1.59 (95% CI = 0.70-3.59, p = 0.27) and 2.42 (95% CI = 1.22-4.81, p = 0.01), respectively. Conclusion: The incidence of SLE was significantly higher in subjects infected with M. pneumoniae.

Genome-wide analysis identified novel susceptible genes of restless legs syndrome in migraineurs.

BACKGROUND: Restless legs syndrome is a highly prevalent comorbidity of migraine; however, its genetic contributions remain unclear. OBJECTIVES: To identify the genetic variants of restless legs syndrome in migraineurs and to investigate their potential pathogenic roles. METHODS: We conducted a two-stage genome-wide association study (GWAS) to identify susceptible genes for restless legs syndrome in 1,647 patients with migraine, including 264 with and 1,383 without restless legs syndrome, and also validated the association of lead variants in normal controls unaffected with restless legs syndrome (n = 1,053). We used morpholino translational knockdown (morphants), CRISPR/dCas9 transcriptional knockdown, transient CRISPR/Cas9 knockout (crispants) and gene rescue in one-cell stage embryos of zebrafish to study the function of the identified genes. RESULTS: We identified two novel susceptibility loci rs6021854 (in VSTM2L) and rs79823654 (in CCDC141) to be associated with restless legs syndrome in migraineurs, which remained significant when compared to normal controls. Two different morpholinos targeting vstm2l and ccdc141 in zebrafish demonstrated behavioural and cytochemical phenotypes relevant to restless legs syndrome, including hyperkinetic movements of pectoral fins and decreased number in dopaminergic amacrine cells. These phenotypes could be partially reversed with gene rescue, suggesting the specificity of translational knockdown. Transcriptional CRISPR/dCas9 knockdown and transient CRISPR/Cas9 knockout of vstm2l and ccdc141 replicated the findings observed in translationally knocked-down morphants. CONCLUSIONS: Our GWAS and functional analysis suggest VSTM2L and CCDC141 are highly relevant to the pathogenesis of restless legs syndrome in migraineurs.

Delta/Jagged-mediated Notch signaling induces the differentiation of agr2-positive epidermal mucous cells in zebrafish embryos.

Teleosts live in aquatic habitats, where they encounter ionic and acid-base fluctuations as well as infectious pathogens. To protect from these external challenges, the teleost epidermis is composed of living cells, including keratinocytes and ionocytes that maintain body fluid ionic homeostasis, and mucous cells that secret mucus. While ionocyte progenitors are known to be specified by Delta-Notch-mediated lateral inhibition during late gastrulation and early segmentation, it remains unclear how epidermal mucous cells (EMCs) are differentiated and maintained. Here, we show that Delta/Jagged-mediated activation of Notch signaling induces the differentiation of agr2-positive (agr2+) EMCs in zebrafish embryos during segmentation. We demonstrated that agr2+ EMCs contain cytoplasmic secretory granules and express muc5.1 and muc5.2. Reductions in agr2+ EMC number were observed in mib mutants and notch3 MOs-injected notch1a mutants, while increases in agr2+ cell number were detected in notch1a- and X-Su(H)/ANK-overexpressing embryos. Treatment with γ-secretase inhibitors further revealed that Notch signaling is required during bud to 15 hpf for the differentiation of agr2+ EMCs. Increased agr2+ EMC numbers were also observed in jag1a-, jag1b-, jag2a- and dlc-overexpressing, but not jag2b-overexpressing embryos. Meanwhile, reductions in agr2+ EMC numbers were detected in jag1a morphants, jag1b mutants, jag2a mutants and dlc morphants, but not jag2b mutants. Reduced numbers of pvalb8-positive epidermal cells were also observed in mib or jag2a mutants and jag1a or jag1b morphants, while increased pvalb8-positive epidermal cell numbers were detected in notch1a-overexpressing, but not dlc-overexpressing embryos. BrdU labeling further revealed that the agr2+ EMC population is maintained by proliferation. Cell lineage experiments showed that agr2+ EMCs are derived from the same ectodermal precursors as keratinocytes or ionocytes. Together, our results indicate that specification of agr2+ EMCs in zebrafish embryos is induced by DeltaC/Jagged-dependent activation of Notch1a/3 signaling, and the cell population is maintained by proliferation.

The Impact of Global Budgeting on the Efficiency of Healthcare under a Single-Payer System in Taiwan.

Since 1995, a national health insurance (NHI) program has been in operation in Taiwan, which provides uniform comprehensive coverage. Forced by severe financial deficit, global budgeting reimbursement was adopted in the healthcare sector to control healthcare expenditures in 2002. A two-stage data envelopment analysis (DEA) approach was used to measure the efficiency of hospital resource allocation among stakeholders in Taiwan's NHI system, and to further explore the changes in resource allocation after the introduction of a global budgeting payment scheme. The dataset was collected from the annual statistical reports of Taiwan's Ministry of Health and Welfare (MOHW) and was used to estimate the efficiency of resource allocation in hospital-based healthcare services under global budgeting. In terms of efficiency during the period from 2003 to 2009, one-third of decision-making units (DMUs) improved their productivity in stage I, and seven out of the total of eighteen DMUs saw falls in financial efficiency in stage II. After global budgeting was implemented, there were significant positive impacts on the efficiency of hospital resource allocation in Taiwan. The two-stage DEA model for analyzing the effects of the global budgeting reimbursement system on productivity and financial efficiency represents a key decision-making tool for hospital administrators and policymakers.

Update on guidelines for the treatment of COPD in Taiwan using evidence and GRADE system-based recommendations.

Chronic obstructive pulmonary disease (COPD) has significant contributions to morbidity and mortality world-wide. Early symptoms of COPD are not readily distinguishable, resulting in a low rate of diagnosis and intervention. Different guidelines and recommendatations for the diagnosis and treatment of COPD exist globally. The first edition of clinical practice guidelines for COPD was published in 2016 by the Ministry of Health and Welfare in Taiwan in collaboration with the Taiwan evidence-based medicine association and Cochrane Taiwan, and was revised in 2019 in order to update recent diagnostic and therapeutic modalities for COPD and its acute exacerbation. This revised guideline covered a range of topics highlighted in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, including strategies for the diagnosis, assessment, monitoring, and management of stable COPD and exacerbations, with particular focus on evidence from Taiwan. The recommendations included in the revised guideline were formed based on a comprehensive systematic review or meta-analysis of specific clinical issues identified by an expert panel that surveyed relevant scientific evidence in the literature and guidelines published by the clinical communities and organizations nationally and internationally. The guidelines and recommendations are applicable to the clinical settings in Taiwan. We expect this revised guideline to facilitate the diagnosis, treatment and management of patients with COPD by physicians and health care professionals in Taiwan. Adaptations of the materials included herein for educational and training purposes is encouraged.

Update on guidelines for the treatment of COPD in Taiwan using evidence and GRADE system-based recommendations

Chronic obstructive pulmonary disease (COPD) has significant contributions to morbidity and mortality world-wide. Early symptoms of COPD are not readily distinguishable, resulting in a low rate of diagnosis and intervention. Different guidelines and recommendatations for the diagnosis and treatment of COPD exist globally. The first edition of clinical practice guidelines for COPD was published in 2016 by the Ministry of Health and Welfare in Taiwan in collaboration with the Taiwan evidence-based medicine association and Cochrane Taiwan, and was revised in 2019 in order to update recent diagnostic and therapeutic modalities for COPD and its acute exacerbation. This revised guideline covered a range of topics highlighted in the Global Initiative for Chronic Obstructive Lung Disease (GOLD) report, including strategies for the diagnosis, assessment, monitoring, and management of stable COPD and exacerbations, with particular focus on evidence from Taiwan. The recommendations included in the revised guideline were formed based on a comprehensive systematic review or meta-analysis of specific clinical issues identified by an expert panel that surveyed relevant scientific evidence in the literature and guidelines published by the clinical communities and organizations nationally and internationally. The guidelines and recommendations are applicable to the clinical settings in Taiwan. We expect this revised guideline to facilitate the diagnosis, treatment and management of patients with COPD by physicians and health care professionals in Taiwan. Adaptations of the materials included herein for educational and training purposes is encouraged.

Development of biotinylated and magnetic bead-immobilized enzymes for efficient glyco-engineering and isolation of antibodies.

The chemoenzymatic remodeled monoclonal antidodies with well-defined glycan structure at the Fc domain display improved biological activities, such as ADCC and ADCP, and are more likely to yield a better safety profile by eliminating the non-human glycans derived from CHO cell culture. We covalently immobilize wild type endoglycosidase S (EndoS), fucosidase, and EndoS2 mutant on magnetic beads through a linker to efficiently generate homogeneous antibody glycoforms without additional purification step to remove endoglycosidase and fucosidase. We also used the biotinylated wild type EndoS2 and EndoS2 mutant in combination with covalently immobilized fucosidase on magnetic beads to allow the sequential removal of endoglycosidases and fucosidase for efficient glyco-engineering and isolation of antibodies without purifying deglycosylated antibody intermediate. Notably, the relatively expensive fucosidase can be recovered to reduce the cost, and the strong affinity of streptavidin to biotin would complete the isolation of biotinylated enzymes. We used Trastuzumab as a model to demonstrate both approaches were reliable for the large-scale production and isolation of antibodies without the residual contamination of endoglycosidase to avoid deglycosylation over storage time.

Different circadian rest-active rhythms in Kleine-Levin syndrome: a prospective and case-control study.

STUDY OBJECTIVES: Kleine-Levin syndrome (KLS) is a rare recurrent hypersomnia. Our study aimed at monitoring the movements of patients with KLS using actigraphy and evaluating their circadian rhythm. METHODS: Twenty young patients with KLS and 14 age-matched controls were recruited. Each individual wore an actigraphy for more than 6 months to monitor at least two attacks. Controls kept wearing the device for at least 7 days. The activity counts were averaged in hourly basis and the day-to-night amplitude was quantified by the differences of the averaged activity counts during daytime and nighttime. The hourly activities of different days were aligned and averaged to construct the circadian profile. Parametric and nonparametric estimation of circadian rhythm was calculated. We applied detrended fluctuation analysis to evaluate the temporal correlations beneath the activity fluctuations at multiple time scales. RESULTS: Circadian rhythm in asymptomatic period showed no significant difference compared to the controls. During hypersomnia attack, the amplitude of the circadian rest-active rhythms drastically decreased and decreased interdaily stability (IS) was found, as well as significant decreased M10 and short-time fractal correlation (α1). Drastically decreased mean and standard deviation of activity were noted, compared to the pre-attack phase and recovery phase. α1 and M10 increased during the late attack phase, and overcompensated IS was noted in the recovery phase. CONCLUSIONS: This study confirmed that circadian rest-active rhythms was affected when KLS hypersomnia attack. Several parameters including M10, IS, and α1 may be physiological markers of KLS, which can help to predict the end of hypersomnia episodes.

Increased risk of glaucoma amongst new-onset gout patients aged 20-39 years: A nationwide population-based cohort study in Taiwan.

OBJECTIVES: To provide epidemiologic evidence of whether gout increases the risk of new-onset glaucoma. METHODS: We conducted a 13-year nationwide, population-based, retrospective cohort study to examine the association between the history of gout and risk of glaucoma by using the Longitudinal Health Insurance Database (LHID) of Taiwan. The gout cohort included 52 943 patients with newly diagnosed gout who were recruited between 2000 and 2012. Each patient was propensity score matching with 1:1 person without gout from the LHID. To determine glaucoma occurrence, the study population was followed up until the end of 2013. Cumulative incidence, hazard ratios (HRs), and 95% confidence intervals (CIs) were calculated after adjusting for age, sex, comorbidities, and ever ophthalmic visit. A Cox proportional hazard model was used to analyse the association between gout and incidence of glaucoma amongst patients with different potential risks. RESULTS: The adjusted HR for newly diagnosed glaucoma in the gout cohort was 1.00 (95% CI = 0.93-1.07, P = .931), compared with the non-gout cohort. Stratified subgroup analysis revealed that the HRs of glaucoma were 1.36 (95% CI = 1.09-1.70, P = .007), 0.99 (95% CI = 0.87-1.12, P = .871), and 0.95 (95% CI = 0.87-1.03, P = .235) in patients with gout aged 20-39, 40-54, and ≥55 years, respectively (P for interaction = .011). CONCLUSION: This nationwide population-based cohort study revealed that gout patients in the age group 20-39 years had a higher risk of glaucoma than non-gout controls.