The Societal Influences and Quality of Life Among Healthcare Team Members During the COVID-19 Pandemic.

Background: The coronavirus infection disease 2019 (COVID-19) pandemic is likely to put healthcare professionals across the world in an unprecedented situation. Methods: A total of 683 healthcare workers were recruited in this study. Short form-12 items (SF-12), Societal Influences Survey Questionnaire (SISQ), and Disaster-Related Psychological Screening Test (DRPST) were used to survey participants. Multiple linear regression and structural equation model (SEM) were used to explore the possible factors to the societal influences and quality of life. Results: After multiple linear regression analysis, female, older, more education years, married, regular intake, and posttraumatic stress disorder (PTSD) frequency had positive association with SISQ. To physical component summary (PCS) of SF-12, chronic illness, sleep score, PTSD frequency, and social distance had negative association, and exercise habits had positive association. A mental component summary (MCS) value of SF-12, age, participate in social activities, and social information had positive association, and PTSD frequency, sleep score, social anxiety, and depression had negative association. Under SEM analysis, PTSD had positive influence on SISQ. Sleep score and MCS value had negative influences on SISQ. PTSD severity, older age, sleep score, smoking, and nursing staff had negative influences on PCS value. Young age, PTSD frequency, sleep score, and depression had negative influences on MCS value. Conclusion: Healthcare team members with severe PTSD symptoms suffered more societal influences. Relative to PTSD severity, PTSD frequency was more important to the quality of life. Members of older age who frequently participate in clubs, volunteers, or charity activities had better mental life quality.

COVID-related psychological distress fully mediates the association from social impact to sleep disturbance among patients with chronic schizophrenia.

The aims of the current study were to identify factors associated with sleep disturbance and Coronavirus disease-19 related psychological distress (CPD), and to develop a conceptual model to verify the mediating effect of CPD on the association between social impact and sleep disturbance. This study recruited patients with schizophrenia. Factors associated with the level of sleep disturbance and CPD were identified using univariate linear regression, and further selected into a stepwise multivariate linear regression model. Using structural equation modeling, a mediation model was developed to test the mediating effect of CPD on the association between social impact and sleep disturbance. After estimating with the stepwise and bootstrap regression, higher levels of CPD were associated with higher levels of social anxiety and subjects without a regular diet. Sleep disturbance was associated with a higher level of social anxiety, a history of psychological trauma, chronic disease, and those who did not smoke. The final model confirmed the mediating effects of CPD; whereas, the direct effect from social impact to sleep disturbance did not reach statistical significance. The current study manifests the crucial role of CPD on the association between social impact and sleep disturbance, and timely intervention for CPD is warranted.

Predictors for Depression, Sleep Disturbance, and Subjective Pain among Inpatients with Depressive Disorders during the COVID-19 Pandemic: A Cross-Sectional Study.

The coronavirus disease 2019 (COVID-19) pandemic can have a negative impact on patients with mood disorders. The aim of this study is to explore the societal influence of COVID-19 and associated impacts on levels of depression, sleep disturbance, and subjective pain among patients with mood disorders. This cross-sectional study recruited inpatients with depression and bipolar disorder. Levels of depression, sleep disturbance, subjective pain, and related demographic variables were collected through self-reported questionnaires. Potential factors associated with levels of depression, sleep disturbance, and subjective pain were identified using univariate linear regression and further entered into a stepwise multivariate linear regression model to identify the independent predictors. A total of 119 participants were included in the analysis, of whom 50.42% had bipolar disorder and 49.58% had unipolar depression. Multivariate analysis showed that a higher level of depression was associated with female subjects, subjects with partners, present history of psychological trauma, and drinking alcohol. Sleep disturbance was associated with subjects with partners and drinking alcohol. A higher level of subjective pain was associated with a higher level of social anxiety and a history of psychological trauma. The current study identified several predictors of psychological burden and subjective pain among inpatients with depression during the COVID-19 pandemic. Further investigations are warranted to extend the application and generalizability of our results.

Mental health in biological disasters: From SARS to COVID-19.

BACKGROUND: The outbreak of coronavirus disease 2019 (COVID-19), like severe acute respiratory syndrome (SARS), provokes fear, anxiety and depression in the public, which further affects mental health issues. Taiwan has used their experience of the SARS epidemic for the management of foreseeable problems in COVID-19 endemic. AIM/OBJECTIVE: This review summarizes issues concerning mental health problems related to infectious diseases from current literatures. RESULTS: In suspected cases under quarantine, confirmed cases in isolation and their families, health care professionals, and the general population and related effective strategies to reduce these mental health issues, such as helping to identify stressors and normalizing their impact at all levels of response as well as public information and communication messages by electronic devices. The importance of community resilience was also addressed. Psychological first aid, psychological debriefing, mental health intervention and psychoeducation were also discussed. Issues concerning cultures and religions are also emphasized in the management plans. CONCLUSION: Biological disaster like SARS and COVID-19 not only has strong impact on mental health in those being infected and their family, friends, and coworkers, but also affect wellbeing in general public. There are evidenced that clear and timely psychoeducation, psychological first aid and psychological debriefing could amileorate negative impact of disaster, thus might also be helpful amid COVID-19 pandemic.

Development and Implementation of Societal Influences Survey Questionnaire (SISQ) for Peoples during COVID-19 Pandemic: A Validity and Reliability Analysis.

The emergence of Coronavirus disease 2019 (COVID-19) had rapidly spread since FEB/MAR 2020. Policy to prevent transmission of COVDI-19 resulted in multi-dimensional impact on social interaction. We aimed to develop a beneficial survey tool with favorable quality and availability, the Societal Influences Survey Questionnaire (SISQ), to evaluate social influences on people during this pandemic. The SISQ was developed with 15 items and 4-point Likert scales consisting of five factors. These include social distance, social anxiety, social desirability, social information, and social adaptation. Construct validity and reliability were performed to verify the SISQ. A total of 1912 Taiwanese were recruited. The results demonstrated that the SISQ has acceptable reliability, with Cronbach's alphas ranging between 0.57 and 0.76. The SISQ accounted for 58.86% and satisfied the requirement of Kaiser-Mayer-Olkinvalues (0.78) and significant Bartlett's Test of sphericity. Moreover, the confirmatory factor analysis fit indices also indicated the adequacy of the model. As for multiple comparison, females scored higher than males in factor of social distance. Unemployed participants and those without partners scored higher in several domains of factors. The survey method and survey instrument prove reliable and valuable, also providing different categories of assessment results regarding social influences and their impacts. Further studies are warranted to extend the applicability of SISQ.

Challenge and strategies of infection control in psychiatric hospitals during biological disasters-From SARS to COVID-19 in Taiwan.

Psychiatric hospitals play an important role in supporting patients with mental illness to relieve symptoms and improve functioning in a physically and psychologically safe environment. However, these hospitals are also vulnerable to emerging infectious diseases. In early 2020, a psychiatric hospital and a psychiatric unit were reported to have nosocomial coronavirus disease 2019 (COVID-19) infection. A large number of patients and staff were severely impacted. This type of nosocomial infection threatens patient safety and quality of care. By learning from previous experiences of severe acute respiratory syndrome (SARS) and previous studies, psychiatric hospitals can provide safeguards to prevent nosocomial infection among patients and staff during an epidemic or biological disaster. These strategies include a series of actions such as following national guidelines for infection control, reserving adequate support for disinfection equipment, providing relevant and sufficient pro-service and in-service education and training, establishing regular surveillance of hand hygiene habits, proper communication and health education, and providing opportunities for vaccination if possible. Based on the harm reduction concept, staff division of office breaks and ward classification and shunting are recommended and should be further implemented.

Gender Disparity in the Risk of Hypertension in Subjects With Major Depressive Disorder.

Objects: The aim of our study was to investigate whether major depressive disorder (MDD) increased the risk of hypertension using propensity score matching (PSM) in patients with MDD in Taiwan. Methods: In this study, we recruited all samples from a random sample sub-dataset of one million insured individuals from 2005. A total of 743,114 outpatients were included in our study. We used PSM (nearest neighbor matching) stratified by age, hospital level, insurance amount, and Charlson Comorbidity Index score. Results: The hazard ratio (HR) of hypertension was significantly greater in the male MDD outpatients (HR = 1.116, P = 0.004) than in the female MDD outpatients (HR = 0.93, P = 0.02). Using PSM, we selected 27,988 outpatients with hypertension and 27,988 outpatients without hypertension for a nested case-control study. In this analysis, female outpatients with MDD (relative risk = 0.852) had lower risks of hypertension. Male outpatients without/with MDD (relative risk = 1.987/3.018) showed a synergistic interaction with gender in which male patients had a higher risk of hypertension in a multiplicative model. Furthermore, MDD appeared to have an interaction effect with gender (HR = 1.82, P < 0.001) in the proportional hazards model analysis. Antidepressant use also increased the risk of hypertension (HR = 1.16, P < 0.001). Conclusions: There was gender disparity in the risk of hypertension in subjects with MDD. MDD outpatients who used antidepressants had a higher risk of suffering from hypertension. A large-scale, population-based study is warranted to generalize these results in the future.

A gender-specific COMT haplotype contributes to risk modulation rather than disease severity of major depressive disorder in a Chinese population.

BACKGROUND: COMT rs4680 Val158 allele is associated with high MB-COMT protein expression and elevated activity compared to the Met158 allele in post-mortem brains. A meta-analysis study suggested the link between COMT SNPs and MDD risk; in addition, MB membrane-bound (MB-COMT) specific genetic variation was reported that influences predisposition to depression amongst females. METHODS: Four tagSNPs, including rs4680, were genotyped. 268 MDD subjects and 223 controls were enrolled. MDD severity was rated by HDRS. Total-COMT and MB-COMT mRNA were detected by quantitative PCR. COMT protein and activity were assayed by western blot and methyltransferase assay, respectively. RESULTS: Haplotype TG of rs4633-rs4680, rs4646312 C, and rs4633 T allele might be linked to MDD vulnerability. Haplotype TG may interact with gender and affect MDD risk, since female haplotype TG carriers were estimated for a 9.17-fold higher risk than counterparts. COMT SNPs were not associated with HDRS scores. Haplotype TG female controls had higher MB-COMT protein, whereas non-TG female controls had higher soluble cytoplasmic (S-COMT) protein than other groups. COMT activity was much higher in controls than in MDD subjects. LIMITATIONS: Restricted numbers of homozygous TG carriers were recruited and analyzed for COMT mRNA, protein and activity. Only peripheral blood samples were used. CONCLUSIONS: A female-specific haplotype (haplotype TG)-MDD vulnerability association was found. TG female controls had higher MB-COMT protein and S-COMT. Altogether, high COMT protein and activity in female TG controls may be predisposing factors for enhanced MDD risk, though not correlated to MDD severity as rated by HDRS.

Alcohol use disorders associated with an increased risk of mesenteric ischemia: A nationwide cohort study.

BACKGROUND: To evaluate the relationship of patients with a history of alcohol use disorders (AUD) and its diagnostic categories with risk of subsequent mesenteric ischemia in Taiwan. METHODS: A nationwide population-based cohort study was conducted using data from the Taiwan's National Health Insurance Research Database. We identified 73,583 patients hospitalized for AUD between 2001 and 2010, and matched each case with four comparison patients based on age, gender, Charlson comorbidity index, and the index date. Cox proportional hazard models were used to evaluate the risk of mesenteric ischemia between the AUD and non-AUD cohorts. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated. RESULTS: Patients with AUD exhibited a significantly increased risk of developing mesenteric ischemia (HR = 2.25; 95% CI 1.92-2.64) compared with those with non-AUD after adjustment for patient sociodemographic, coexisting comorbid conditions, and hospital characteristics. Furthermore, a 2.29- and 2.17-fold higher risk of mesenteric ischemia was observed in patients with alcohol abuse/dependence (HR = 2.29; 95% CI 1.94-2.71) and alcoholic psychosis (HR = 2.17; 95% CI 1.72-2.73), respectively, than in non-AUD comparisons after covariate adjustment. CONCLUSIONS: This study confirmed that the risk of mesenteric ischemia was significantly higher among patients with different diagnostic categories of AUD, particularly for those with alcohol abuse/dependence.

5-HTT mRNA level as a potential biomarker of treatment response in patients with major depression in a clinical trial.

OBJECTIVES: To investigate whether the serotonin transporter (5-HTT or SERT or SLC6A4) mRNA level could be used as a biomarker of treatment response in patients with major depression treated with different antidepressants while controlling related factors. METHODS: One hundred and nineteen patients with major depression were recruited; all genotyped for the 5-HTT polymorphism concerning 5-HTTLPR, rs25531, and STin2 VNTR, provided demographic data and completed relevant questionnaires. Duloxetine and paroxetine were administered over 32 weeks to these patients. The Hamilton depression rating scale (HDRS) and 5-HTT mRNA level were evaluated at baseline (Week 0), and at 8, 16, 24 and 32 weeks. RESULTS: Improvement in depressive symptoms (HDRS score declined) and increasing in 5-HTT mRNA level were found with longer duration of antidepressant treatment in patients with major depression. Patients with more 5-HTTPR long-form alleles and STin2.12 alleles had poor antidepressant treatment response. Duloxetine may give a better treatment response than paroxetine. Using structural equation modeling (SEM), the 5-HTTLPR long-form had a direct positive association with the 5-HTT mRNA level and an indirect adverse relationship with the 5-HTT mRNA level through neuroticism and previous suicide attempts. CONCLUSION: The 5-HTT mRNA level increased and correlated with the treatment response (HDRS score improvement) under 32-weeks antidepressants treatment clinical trial. We speculate that the 5-HTT mRNA level may be used as a potential biomarker of antidepressant treatment response.

Association between HTR1B alleles and suicidal ideation in individuals with major depressive disorder.

Serotonin receptors, also known as 5-hydroxytryptamine receptors (HTRs), play a role in individuals' vulnerability to major depressive disorders (MDDs) and/or suicide attempts. In the first part of the study, we recruited 789 Taiwanese participants, which included 285 MDD patients, 191 MDD patients with a history of suicide attempts (MS), and 313 controls. The three groups were genotyped to identify HTR single nucleotide polymorphisms (SNPs) and we analyzed the correlations among the three groups. In the second part of the study, which involved a functional test of HTR1B allelic and haplotype variants, another 113 MDD patients were recruited. The rs6298-T allele was more frequent in the MS group than in the control group. The rs1923885-T allele occurred more frequently in the MS group than in the MDD group. Carriers of haplotype GT were estimated to have a 1.774-fold higher risk of suicide attempts. Younger age, alleles rs6296-C, rs6298-T and rs1923885-C, and haplotype CT were associated with a greater risk of MDD. Haplotypes GC and GT were directly associated with a lower risk of suicidal ideation. Haplotypes GC and GT also associated with higher levels of HTR1B mRNA, and haplotype GC was associated with extraversion, which caused a lower risk of suicidal ideation. The rs6296-C allele have directly and indirectly influenced a greater risk of suicidal ideation, which mediated by its negative effect on extraversion. Haplotype GT can be used to identify patients with a higher risk of suicide attempts. The rs6296-C allele lowered the level of HTR1B mRNA, causing individuals with MDD to display more hostility and aggressive behavior, which may lead to suicidal ideation.

No change of the lipid profile under the control of ApoE gene polymorphism in schizophrenics under paliperidone treatment.

The present study tried to explore the effects of Paliperidone on the lipid profiles of schizophrenia patients. One hundred twenty-nine subjects diagnosed with schizophrenia were enrolled into this study and completed the lipid profile evaluation. Their blood samples were obtained on the morning following a 12-hours fast. Cholesterol and triglyceride (TG) levels in plasma were determined, and lipoproteins were determined by enzymatic methods. All participants provided written informed consent, and underwent additional venous blood withdrawal for DNA extraction for genetic study of the ApoE gene polymorphism. Under T test, TC, TG and HDL levels all declined after Paliperidone treatment although with no statistically significant difference. The ratios of TC/HDL declined after Paliperidone treatment, but without statistically significant difference. After GEE-I analysis, we found that ApoE4 genotype (ß = 34.471; p < 0.001) had a positive effect on the total cholesterol (TC) level; female had positive effect on the high-density lipoprotein (HDL) level (ß = 15.361; p = 0.003); and age had a positive effect on the TG level (ß = 1.317; p = 0.030). Smoking (ß = 0.961; p = 0.016) had a positive effect on the ratio of TC/HDL change. Lipid profiles were not increased after Paliperidone treatment under the control of ApoE gene polymorphism.

Ultrafine ZnO nanoparticles/nanowires synthesized on a flexible and transparent substrate: formation, water molecules, and surface defect effects.

The ultrafine ZnO nanoparticles/nanowires were successfully synthesized on a flexible and transparent substrate by an ultraviolet-light decomposition process. We demonstrate that water molecules can affect the morphology of ZnO nanostructures. An ultraviolet lamp (λ ~ 380 nm, 75 mW cm(-2)) can be used to irradiate Zn(AcAc)2 and Zn(AcAc)2·H2O precursors, which rapidly synthesize ZnO nanoparticles and nanowires, respectively. High-resolution transmission electron microscopy (HRTEM) images and a selected-area electron diffraction pattern revealed that the single-crystal nanoparticles were comprised of wurtzite structure ZnO. The nanowires consisted of ultrafine nanoparticles. On the basis of the Debye-Scherrer formula, the particle size of ZnO was calculated as ~6-9 nm. The more water molecules the precursor had, the more OH(-) and Zn[(OH)4](2-) it put out. Moreover, due to the Zn[(OH)4](2-) and Zn(OH)2 species formed on the surface of the ZnO nanocrystals, they facilitated the one-dimensional nanowires during the crystal growth process. On the basis of our investigations, oxygen vacancies, hydroxyl, and zinc hydroxide all acted as key components in the formation processes that determined photoresponsive properties.

The activity of lowering intraocular pressure of cassiae seed extract in a DBA/2J mouse glaucoma model.

PURPOSE: To evaluate the activity of lowering intraocular pressure (IOP) by Cassiae seed in the DBA/2J mouse glaucoma model. METHODS: Young male (mean age: 3 months) inherited glaucoma mice (BDA/2J) were enrolled in this study. To evaluate the potential of Cassiae seed in the treatment of glaucoma, all subjects were divided into 6 groups. There were 1 sham group, positive control identified as group 2 topical brimonidine and group 3 oral acetazolamide, and groups 4-6 Cassiae seed extract (CSE) groups. The lactate dehydrogenase (LDH) level in the anterior aqueous humor and the changes of IOP were investigated. Contents of total polyphenol glycosides in the CSE were measured using a high-performance liquid chromatography (HPLC) method. Chromatographic separation was performed on a Cosmosil 5C(18)-MS reverse-phase HPLC column (4.6×250-mm i.d., 5 µm) with methanol/0.1% H(3)PO(4) as the mobile phases in a gradient elution mode at a flow rate of 1.0 mL/min and an injection volume of 10 µL. The wavelength of UV detector was set at 254 nm. RESULTS: The LDH level in the anterior aqueous humor and IOP significantly decreased after treatment with CSE. The IOP-lowering effect of CSE was comparable to those of oral acetazolamide and brimonidine instillation. There were no abnormal findings in the external appearance, and body weight change after treatment with CSE for 5 weeks. Chrysophanol and physcion were measured by an HPLC method to obtain total polyphenol glycosides of the CSE, and were involved in the IOP-lowering function. CONCLUSION: Cassiae seed may be safe and beneficial for treating glaucoma due to its significant IOP- and LDH-lowering activities.

The relationship between sex life satisfaction and job stress of married nurses.

BACKGROUND: The purpose of this study was to investigate the relationship among work stress, sex life satisfaction, and mental health of married nurses. Demographic information, work stress, sex life satisfaction, sexual desire and mental health measured using the Chinese Health Questionnaire, data were collected from 100 married nurses in Taiwan. FINDINGS: Sex life satisfaction and age were negatively correlated, but sex life satisfaction and sexual desire were positively correlated. The mental health of over-committed nursing staff was not affected. Higher reward for effort was positively correlated with sex life satisfaction. CONCLUSIONS: No matter whether job stress was high or low, receiving a higher reward for effort led to better sex life satisfaction, which had a satisfying positive effect on the nurses' lives. To improve nursing care quality at the hospital, nursing administrators should assist nurses in confronting work stress via positive adjustment, which is associated with the nurses' sexual harmony, and quality of life.

Association of DRD4 uVNTR and TP53 codon 72 polymorphisms with schizophrenia: a case-control study.

BACKGROUND: The tumour supressor gene TP53 is thought to be involved in neural apoptosis. The polymorphism at codon 72 in TP53 and the long form variants of the upstream variable number of tandem repeats (uVNTR) polymorphism in the dopamine D4 receptor (DRD4) gene are reported to confer susceptibility to schizophrenia. METHODS: We recruited 934 patients with schizophrenia and 433 healthy individuals, and genotyped the locus of the TP53 codon 72 and DRD4 uVNTR polymorphisms by combining the polymerase chain reaction-restriction fragment length polymorphism method (PCR-RFLP) with direct sequencing. RESULTS: No significant differences were found in the frequency of the genotype of the TP53 codon72 polymorphism between patients with schizophrenia and their controls. However, the long form alleles (> or = 5 repeats) of the DRD4 uVNTR polymorphism were more frequent in patients with schizophrenia than in controls (p = 0.001). Hence, this class of alleles might be a risk factor for enhanced vulnerability to schizophrenia (odds ratio = 3.189, 95% confidence interval = 1.535-6.622). In the logistic regression analysis, the long form variants of the DRD4 polymorphism did predict schizophrenia after the contributions of the age and gender of the subjects were included (p = 0.036, OR = 2.319), but the CC and GG genotypes of the codon 72 polymorphism of TP53 did not. CONCLUSIONS: The long form variants of the uVNTR polymorphism in DRD4 were associated with schizophrenia, in a manner that was independent of the TP53 codon 72 polymorphism. In addition, given that the genetic effect of the TP53 codon 72 polymorphism on the risk of developing schizophrenia was very small, this polymorphism is unlikely to be associated with schizophrenia. The roles that other single nucleotide polymorphisms (SNPs) in the TP53 gene or in other apoptosis-related genes play in the synaptic dysfunction involved in the pathogenesis of schizophrenia should be investigated.

Angiotensinogen M235T associated with mitral valve prolapse in young Han Chinese male.

BACKGROUND: A potential role for the renin-angiotensin system (RAS) in mitral valve prolapse (MVP) has been reported. The RAS genes are good candidates for evaluating the association with MVP. The angiotensinogen (AGT) gene has an important role in RAS and was shown to be related to MVP. However, no study on the association of AGT M235T in men with MVP has been reported. In this article, we investigated the potential role of AGT M235T polymorphism in men with MVP. METHODS: Seventy-one unrelated study subjects with MVP, 236 control subjects (matched with respect to age and sex), and 178 community subjects from southern Taiwan were included in this study. All participants were male Han Chinese population. All cases fulfilled the criteria of MVP and the new echocardiographic criteria for MVP. The AGT M235T polymorphism was detected by polymerase chain reaction-restricted fragment length polymorphism. RESULTS: There was a statistically significant difference in the M235 allelic frequency between MVP study subjects and control subjects (chi = 4.390; P = 0.036). The chi test for trend also showed that the MM genotype frequency had a statistically significant increase with MVP study subjects (chi = 4.339; P = 0.037). CONCLUSIONS: The results suggest a significant association between MM genotype of AGT M235T polymorphism and MVP in men. Therefore, this study indirectly supports the idea that the polymorphism of AGT M235T should be considered when interpreting and designing genetic studies which underlie differences in blood pressure.

The effects of beta2 adrenergic receptor gene polymorphism in lipid profiles.

BACKGROUND: Explore the interaction between apolipoprotein E (Apo E), phospholipase A2 (PLA2) and beta2 adrenergic receptor (beta2-AR) gene polymorphisms and lipid profiles in an elderly Chinese population. METHODS: Five hundred subjects aged 65 to 74 years were randomly selected from a community in southern Taiwan to assess the relationship between Apo E, PLA2 and beta2-AR gene polymorphisms and lipid profiles. Two hundred sixty-seven participants agreed to have venous blood drawn for DNA studies. RESULTS: Two statistically significant differences were noted in TC and LDL-C in the Gln27Glu of the beta2-AR gene polymorphism (P = 0.007, P = 0.022). The low-income group had a higher HDL-C level (p = 0.076). The Gln27Glu polymorphism Glu/Glu or Gln/Glu subjects had lower TC levels compared to the Gln27Glu polymorphism Gln/Gln subjects (p = 0.092). Lower TC levels (p = 0.082) and lower LDL-C levels (p = 0.045) in subjects with the Cys19Arg16Glu27 haplotype. Lower TC levels (p = 0.06) were also noted in subjects with the Cys19Gly 16Glu27 haplotype. On the other hand, higher VLDL-C levels (p = 0.185) and higher triglyceride (TG) levels (p = 0.190) were noted in subjects with the Cys19Gly 16Gln27 haplotype. The epsilon2 allele combined with low income had a positive effect on HDL-C (p = 0.0011), after adding the income factor in this study. CONCLUSION: When the effects of Apo E and PLA2 on lipid profiles were included in this study, beta2-AR gene polymorphisms reduced significant effect on lipid profiles. Similarly, low income increased effect on HDL-C. This study appeared that the results of gene-gene and gene-environment interaction, it should be considered in further studies for lipid profiles.

A module map showing interaction between apolipoprotein E and phospholipase A2 polymorphism in lipid profiles.

OBJECTIVE: Establish a possible conceptual relationship among Apo E and PLA2 polymorphism and lipid profiles. METHODS: Five hundred subjects aged 65 to 74 years were randomly selected from a community in southern Taiwan to assess the relationship between Apo E and PLA2 polymorphisms and lipid profiles. Two hundred fifty-six participants agreed to have venous blood drawn for DNA studies. RESULTS: By multiple linear regression, the PLA2 A2 allele showed a statistically significant influence on LDL-C (p = 0.0097), and the Apo epsilon2 allele showed a statistically significant influence on HDL-C (p = 0.0004), however, the interaction between the PLA2 A2 allele and the Apo epsilon2 allele was found to be significant in the blood fraction of HDL-C (p = 0.0388) and LDL-C (p = 0.0002). Decreasing HDL-C and increasing LDL-C were found when the PLA2 A2 and Apo epsilon2 allele co-existed. CONCLUSION: The presence of a physiologic balance contributes significantly to homeostatic and compensatory responses regulating blood HDL-C and LDL-C profiles. A module map of the generation-control cycle and conditional activity among Apo E, PLA2, and lipid levels is presented, and both behaviours and biological perspectives under the consilience model may suggest a new approach to many kinds of complex disorders.

Priapism associated with typical and atypical antipsychotic medications.

Priapism is a urologic emergency, and a urologic consultation should be obtained as early as possible. Its etiologies are numerous and diverse. Patients who use antipsychotic drugs should be informed about the complications of priapism, especially those patients with a history of prolonged erections associated with other alpha-adrenergic blocking agents or a history of sickle cell disease. If antipsychotic medication is considered to be needed in the treatment of patients with a history of priapism, physicians should select a drug with a low peripheral alpha-adrenergic blocking property. Physicians should be aware of this rare but potentially serious complication of antipsychotic drugs. Early intervention and appropriate treatment are essential to prevent permanent impotence and other serious complications.