Mediating Effects of Academic Self-Efficacy and Depressive Symptoms on Prosocial/Antisocial Behavior Among Youths.

Adolescence is a critical period during which youth develop and shape their behaviors. Because differences between youths are strongly connected to environmental factors, we aimed to elucidate possible pathways from home-school regulation and atmosphere to youths' prosocial and antisocial behaviors. Data were derived from the China Education Panel Survey. This study involved a total of 9291 students aged 14-15 years (4834 boys, 4457 girls). We used structural equation modeling (SEM) with LISREL 8.80 and Monte Carlo resampling with R to conduct the analysis strategy. In the home-school regulation, parental supervision on the one hand and teacher criticism on the other hand have direct positive and negative predictive effects on youths' prosocial behaviors, respectively, while their direct effects on antisocial behavior are the opposite; teachers praise does not directly affect adolescents' prosocial and antisocial behaviors. In the home-school atmosphere, family interaction and perceived good class climate directly positively affect youths' prosocial behaviors, while the direct effects of both on antisocial behavior are not significant. The SEM results reveal that academic self-efficacy and depressive symptoms may be underlying mediating mechanisms through which home-school regulation and atmosphere during adolescence affect students' prosocial and antisocial behaviors. Intervention programs targeting home-school supportive environments and prevention programs targeting positive emotion and self-awareness may yield benefits for proper social behavior in adolescents. For example, by enhancing the way and frequency of parent-child interaction, teachers and students jointly create a good class climate of care and friendship to strengthen a home-school supportive environment. Improve adolescents' positive emotions such as contentment, optimism, and hope to reduce the possibility of depression.

The impact of time from injury to surgery in functional recovery of traumatic acute subdural hematoma.

BACKGROUND: The time from injury to surgery (TIS) is critical in the functional recovery of individuals with traumatic acute subdural hematoma (TASDH). However, only few studies have confirmed such notion. METHODS: The data of TASDH patients who were surgically treated in Chia-Yi Christian Hospital between January 2008 and December 2015 were collected. The significance of variables, including age, sex, traumatic mechanism, coma scale, midline shift on brain computed tomography (CT) scan, and TIS, in functional recovery was assessed using the student's t-test, Mann-Whitney U test, chi-square test, univariate and multivariate models, and receiver operating characteristic (ROC) curve. RESULTS: A total of 37 patients achieved functional recovery (outcome scale score of 4 or 5) and 33 patients had poor recovery (outcome scale score of 1-3) after at least 1 year of follow-up. No significant difference was observed in terms of age, sex, coma scale score, traumatic mechanism, or midline shift on brain CT scan between the functional and poor recovery groups. TIS was found to be significantly shorter in the functional recovery group than in the poor recovery group (145.5 ± 27.0 vs. 181.9 ± 54.5 min, P-value = 0.002). TIS was a significant factor for functional outcomes in the univariate and multivariate regression models. The analysis of TIS with the ROC curve between these two groups showed that the threshold time for functional recovery in comatose patients and those with TASDH who were surgically treated was 2 h and 57.5 min. CONCLUSIONS: TIS is an important factor l for the functional recovery of comatose TASDH patients who underwent surgery.

Efficient Prodrug Activator Gene Therapy by Retroviral Replicating Vectors Prolongs Survival in an Immune-Competent Intracerebral Glioma Model.

Prodrug activator gene therapy mediated by murine leukemia virus (MLV)-based retroviral replicating vectors (RRV) was previously shown to be highly effective in killing glioma cells both in culture and in vivo. To avoid receptor interference and enable dual vector co-infection with MLV-RRV, we have developed another RRV based on gibbon ape leukemia virus (GALV) that also shows robust replicative spread in a wide variety of tumor cells. We evaluated the potential of GALV-based RRV as a cancer therapeutic agent by incorporating yeast cytosine deaminase (CD) and E. coli nitroreductase (NTR) prodrug activator genes into the vector. The expression of CD and NTR genes from GALV-RRV achieved highly efficient delivery of these prodrug activator genes to RG-2 glioma cells, resulting in enhanced cytotoxicity after administering their respective prodrugs 5-fluorocytosine and CB1954 in vitro. In an immune-competent intracerebral RG-2 glioma model, GALV-mediated CD and NTR gene therapy both significantly suppressed tumor growth with CB1954 administration after a single injection of vector supernatant. However, NTR showed greater potency than CD, with control animals receiving GALV-NTR vector alone (i.e., without CB1954 prodrug) showing extensive tumor growth with a median survival time of 17.5 days, while animals receiving GALV-NTR and CB1954 showed significantly prolonged survival with a median survival time of 30 days. In conclusion, GALV-RRV enabled high-efficiency gene transfer and persistent expression of NTR, resulting in efficient cell killing, suppression of tumor growth, and prolonged survival upon CB1954 administration. This validates the use of therapeutic strategies employing this prodrug activator gene to arm GALV-RRV, and opens the door to the possibility of future combination gene therapy with CD-armed MLV-RRV, as the latter vector is currently being evaluated in clinical trials.

Electrochromism and Nonvolatile Memory Device Derived from Triphenylamine-Based Polyimides with Pendant Viologen Units.

Three novel solution-processable polyimides containing triphenylamine and pendant viologen moieties are prepared from the newly synthesized diamine and three commercially available dianhydrides. The thermally stable polyimide with strong donor-acceptor charge-transfer possesses write-once read-many-times memory behavior with excellent operation stability. The obtained multicolored electrochromic polymer films reveal ambipolar electrochemical behavior with high optical transmittance contrast of coloration changed from transmissive neutral state to the cyan/magenta/yellow redox states, implying great potential for application in smart window and displays.

Spontaneous spinal epidural hemorrhage from intense piano playing.

Spontaneous spinal epidural hematoma (SSEH) is a rare but real neurosurgical emergency. It is caused by atraumatic rupture of the vertebral epidural vein that results in nerve root or spinal cord compression. Most cases of SSEH have a multifactorial etiology, including congenital and acquired coagulopathies; platelet dysfunction; vascular malformation; tumors; uncontrolled hypertension; pregnancy; and, very rarely, activities requiring Valsalva. Herein we reported the case of a young pianist who was attacked by SSEH during piano practice. Playing the piano is a joyful, relaxing entertainment; however, this musical activity can be a highly demanding physical and mental exercise for pianists. Emotional and expressive performance, especially in professional performing, has been reported to result in significant increase of sympathetic and decrease of parasympathetic activities and thus influence the cardiorespiratory variables. The increased biomechanical stress from fluctuating hemodynamics was thought to trigger the rupture of her spinal arteriovenous malformation.

Enhancing academic self-efficacy on decreasing adolescents' unmonitored internet usage and depressive mood.

Unmonitored internet use and depression are difficulties that adolescents experience. Efforts to promote healthy adolescent development tend to focus on reducing these two risk outcomes. Therefore, the purpose of this study was to examine how three important school-related factors (teachers, peers, and academics) affect adolescents' levels of unmonitored internet use and depression. For this study, a cross-sectional data analysis was conducted. The sample included 9297 students who participated in two waves of the China Education Panel Survey (CEPS). Structural equation modeling (SEM) was performed using LISREL 8.80 to analyze the data. Monte Carlo resampling was then performed using R to confirm the significance of the mediating effects. Teacher criticism and negative peers can increase unmonitored internet use and depression in adolescents, while academic stress can exacerbate depression. In contrast, teacher praise and positive peers can reduce those risk outcomes. Academic self-efficacy serves as a key mediator of the impacts of teachers, peers, and academics on adolescents' levels of unmonitored internet use and depression. We advocate that schools should establish a positive school climate, provide teacher feedback training and design physical activity programs to improve academic self-efficacy, thereby reducing the risk of unmonitored internet use and depression among adolescents, effectively preventing possible subsequent internet addiction and promoting the mental health of adolescents.

Cinnamic aldehyde, an anti-inflammatory component in Du-Huo-Ji-Sheng-Tang, ameliorates arthritis in II collagenase and monosodium iodoacetate induced osteoarthritis rat models.

Background and aim: Du-Huo-Ji-Sheng-Tang (DHJST) is a Chinese herbal formula used for arthralgia and arthritis treatment clinically. This study aims to evaluate the joint-protecting efficacy of DHJST and to identify the active constituents as the evaluation marker. Experimental procedure: DHJST can be categorized into three recipes: Blood-tonifying-herbs Si-Wu-Tang (SWT), Wind-dampness-dispelling-herbs (WDH) and Qi-tonifying-herbs (TH). All formulas were used to explore the joint-protecting efficacies. Results and conclusion: s: Firstly, DHJST could decrease the arthritis progression in the monosodium-iodoacetate-induced rat and cure arthritis in the type II collagenase-induced rat. Further, in lipopolysaccharide-stimulated RAW 264.7 cells, DHJST, TH and Cinnamomum cassia (CC), an ingredient in TH, were the most potent nitric oxide (NO) and prostaglandin E2 (PGE2) inhibitors. The major components, cinnamic aldehyde, showed the strongest NO and PGE2 inhibition. Up-regulated inducible NO synthase (iNOS) and cyclooxygenase-2 were inhibited by DHJST, TH, CC, and cinnamic aldehyde. In interleukin-1ß-stimulated primary chondrocytes, upregulated iNOS was inhibited by DHJST, TH, Cinnamomum cassia, and cinnamic aldehyde. Upregulated matrix metalloprotease-13 was only inhibited by DHJST and TH and Eucommia ulmoides (EU) extract. Results suggest that DHJST presented joint-protective and cure arthritis effects. TH presented equal joint-protective effects as DHJST. The major anti-inflammatory ingredient in TH was Cinnamomum cassia in TH. And cinnamic aldehyde was the potent anti-inflammatory active compound in Cinnamomum cassia. Therefore, this study may facilitate the modern use of DHJST with TH as a simplified version but equally effective anti-osteoarthritic agents with cinnamic aldehyde as a quality control marker of DHJST and TH in osteoarthritis prevention or treatment.

Chemopreventive effects of Xiang Sha Liu Jun Zi Tang on paclitaxel-induced leucopenia and neuropathy in animals.

Paclitaxel frequently induces peripheral neuropathy and myelosuppression during cancer treatment. According to the National Health Insurance Research Database of Taiwan, traditional Chinese medicine doctors widely use Xiang Sha Liu Jun Zi Tang (XSLJZT) to treat breast cancer patients who have received paclitaxel. We explored the combined therapeutic effects of XSLZJT with paclitaxel. XSLJZT did not exhibit significant cytotoxic effects on P388-D1 cells; however, the combination of XSLJZT (100 and 500 mg/kg) with paclitaxel prolonged the survival rate in P388-D1 tumor-bearing mice compared to paclitaxel-only. In addition, XSLJZT was found to enhance white blood cells (WBC) counts and promote leukocyte rebound in paclitaxel-induced leukopenia in mice. XSLJZT also reduced paclitaxel-induced mechanical pain and inhibited c-Fos protein expression in the L4-6 spinal cords of Wistar rats. Moreover, paclitaxel-induced shortening of the nerve fibers of dorsal root ganglion cells was ameliorated by pre-treatment with XSLJZT. Therefore, we suggest that XSLJZT could be used as an adjunct for cancer patients, as the formula could decrease paclitaxel-induced neuropathy and myelosuppression.

The role of collective integration and parental involvement on adolescent anxiety-A multilevel analysis.

BACKGROUND: Adolescent anxiety should receive more attention than it currently does since it might have long-term impacts that develop across the entire lifespan. We aim to clarify how school-, class- and individual-level factors affect adolescent anxiety and to try to identify the key mediators and moderators that help alleviate adolescent anxiety. METHODS: We used data from the China Education Panel Survey (CEPS), which is a longitudinal survey. A total of 7582 students aged 14-15 years (in 257 classes within 98 schools) were followed across two survey waves. Since the data are structured hierarchically, we utilized multilevel modeling with HLM 7.0 and Monte Carlo resampling with R to confirm the significance of the mediation effects. Then, we drew interaction diagrams to explain the effects of the moderator. RESULTS: A higher share of interprovincial migrant students in the school, greater respect for teachers in the classroom, and greater self-confidence in one's personal appearance all reduce adolescent anxiety. Collective integration, as a key mediator, explains how the school-/individual-level factor affects adolescent anxiety. Parental involvement moderates the relationship between collective integration and adolescent anxiety. LIMITATIONS: Most of the variables were self-reported by the students. The findings of this study should be applied with caution to cross-cultural contexts. CONCLUSIONS: We advocate for a multipronged approach, particularly an approach that uses different strategies at school, class, and individual levels, to help students develop the skills needed to enhance their social inclusion and sense of personal belonging.

Low cost multifunctional 3D printed image quality and dose verification phantom for an image-guided radiotherapy system.

PURPOSE: Image-guided radiation therapy (IGRT) is used to precisely deliver radiation to a tumour to reduce the possible damage to the surrounding normal tissues. Clinics use various quality assurance (QA) equipment to ensure that the performance of the IGRT system meets the international standards set for the system. The objective of this study was to develop a low-cost and multipurpose module for evaluating image quality and dose. METHODS: A multipurpose phantom was designed to meet the clinical requirements of high accuracy, easy setup, and calibration. The outer shell of the phantom was fabricated using acrylic. Three dimensional (3D) printing technology was used to fabricate inner slabs with the characteristics of high spatial resolution, low-contrast detectability, a 3D grid, and liquid-filled uniformity. All materials were compatible with magnetic resonance (MR). Computed tomography (CT) simulator and linear accelerator (LINAC) modules were developed and validated. RESULTS: The uniformity slab filled with water is ideal for the assessment of Hounsfield units, whereas that filled with wax is suitable for consistency checks. The high-spatial-resolution slab enables measurements with a resolution up to 5 lp/cm. The low-contrast detectability slab contains rods of 5 different sizes that can be clearly visualised. These components meet the American College of Radiology (ACR) standards for QA of CT simulators and LINACs. CONCLUSIONS: The multifunctional phantom module meets the ACR recommended QA guidelines and is suitable for both LINACs and CT-sim. Further measurements in an MR simulator and an MR linear accelerator (MR-LINAC) will be arranged in the future.

Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma.

BACKGROUND: Decompressive craniectomy (DC) is helpful in lowering the intracranial pressure in patients with severe head injuries. However, it is still unclear which surgical approach (DC or craniotomy) is the optimal treatment strategy for severely head-injured patients with acute subdural hematoma (SDH). To clarify this point, we compared the outcomes and complications of the patients with acute SDH and low Glasgow Coma Scale (GCS) score treated with craniotomy or DC. METHODS: We analyzed 102 patients with acute SDH and GCS scores of 4 to 8. Of them, 42 patients (41.2%) were treated with craniotomy and 60 (58.8%) treated with DC for evacuation of hematoma. The demographic and clinical data were analyzed including patient age, sex, injury mechanism, GCS score, pupil size and light reflex, time interval from injury to operation, types of surgical procedures, intracranial findings in pre- and postoperative computed tomography scan, intracranial pressure, complications, requirement of permanent cerebrospinal fluid diversion, and Glasgow Outcome Scale score after at least 1 year of follow-up. RESULTS: The craniotomy and DC groups showed no difference in the demographic and clinical data. There was no difference in the outcomes and complication rates between these two groups except that the DC group had higher mortality than the craniotomy group (23.3% vs. 7.1%, p = 0.04). CONCLUSION: Both craniotomy and DC were feasible treatment strategies for acute SDH. The patients with acute SDH and low GCS score treated with craniotomy or DC showed no difference in the outcomes and complications.

Design of a motion simulation system to assist respiratory gating for radiation therapy.

Stereotactic ablative radiotherapy (SABR) aims to deliver high doses of radiation to kill cancer cells and shrink tumors in less than or equal to 6 fractions. However, organ motion during treatment is a challenging issue for this kind of technique. We develop a control system via Bluetooth technology to simulate and correct body motion during SABR. METHODS: Radiation doses were analyzed, and the radiation damage protection capability was checked by external beam therapy 3 (EBT3) films irradiated by a linear accelerator. A wireless signal test was also performed. A validation was performed with 8 previously treated patient respiratory pattern records and 8 healthy volunteers. RESULTS: The homemade simulation system consisted of 2 linear actuators, one movable stage with a maximal moving distance of 6.5 cm × 12.5 cm × 5 cm to simulate the respiratory pattern of 8 patients precisely with a median error of 0.36 mm and a maximal motion difference of 1.17 mm, and 3.17 and chipset transited signals to display them as a waveform. From the test with 8 volunteers, the chip could detect deep respiratory movement up to 3 cm. The effect of the chip on a radiation dose of 400 monitor units (MUs) by 6 MV photons and 200 MUs by 10 MV photons showed high penetration rates of 98.8% and 98.6%, respectively. CONCLUSIONS: We invented a tubeless and wireless respiratory gating detection chip. The chip has minimal interference with the treatment angles, good noise immunity and the capability to easily penetrate a variety of materials. The simulation system consisting of linear actuators also successfully simulates the respiratory pattern of real patients.

Flunarizine, a drug approved for treating migraine and vertigo, exhibits cytotoxicity in GBM cells.

Glioblastoma multiforme (GBM) is the most aggressive brain tumor with a poor prognosis. The current treatment regimen, including surgical resection, radiation, and temozolomide (TMZ) chemotherapy, is still not curative. Therefore, there is an emerging need to develop a drug to treat GBM or synergistic enhance TMZ effect on GBM cells. Flunarizine (FLN), a drug approved for treating migraine and vertigo, was analyzed for its cytotoxicity and synergistic effect with TMZ on GBM cells in this study. Cell proliferation, clonogenic assay, flow cytometry, and Western blotting were used to determine the effects of FLN on three GBM cells, U-87 MG, LN-229, and U-118 MG cells. We found that FLN induced GBM cell death. FLN also interfered with U-87 MG cell cycle progression. Flow cytometric analysis showed an increase of apoptotic cells after FLN treatment. Caspase 9, caspase 3, and Poly (ADP-ribose) polymerase (PARP) activation were involved in apoptosis induction in U-87 MG and LN-229, suggesting the possible involvement of an intrinsic apoptotic pathway. We found that FLN treatment inhibited Akt pathway activation in U-87 MG cells, and synergistically increased the cytotoxicity of three GBM cells when combined with TMZ treatment. In conclusion, our current data suggested that FLN inhibited cell viability by inducing apoptosis. FLN inhibited Akt activation and enhanced the sensitivity of GBM cells to TMZ. These findings may provide important information regarding the application of FLN in GBM treatment in the future.

Appropriate Strategies for Reducing the Negative Impact of Online Reports of Suicide and Public Opinion From Social Media in China.

Suicide events may have a negative impact on all of society. The media plays a significant role in suicide prevention. Therefore, the aims of this study are (a) to understand the association between characteristics of suicide events and characteristics of who committed suicide, and event impact indexes (EIIs) of suicide reported on the internet; (b) to analyze violation of recommendations for reporting suicide by Weibo, and (c) to investigate the effect of online reports of suicide on public opinion. We carried out a content analysis of online reports of suicide. This study analyzed 113 suicide events, 300 news reports of suicide, and 2,654 Weibo comments about suicide collected from the WeiboReach between 2015 and 2020. We used a t-test and analysis of variance (ANOVA) to explore the potential factors associated with the EIIs of suicide events. The results found that (a) The suicide events reported on the internet during COVID-19 and those related to celebrities and students tend to have higher EIIs; (b) suicide reports on Weibo frequently violated WHO recommendations for suicide reporting in the media; and (c) public opinion of suicide reporting in the online media was mostly emotional and irrational, which is not beneficial for public mental health and suicide prevention. In conclusion, first, the situation of many people working from home or studying from home and spreading more time online during COVID-19 may lead to suicide events obtain more public attention. Online media could further improve public responsible reporting and daily media-content surveillance, especially taking particular care in those suicide events during COVID-19, and related to celebrities and students, which may have a higher event impact on the internet. Second, health managers should regular assessment of observance of the WHO recommendations for suicide reporting by online social media to prevent suicide. Third, health communication managers should use big data to identify, assess, and manage harmful information about suicide; and track anyone affected by suicide-related reports on social media to reduce the negative impact of public opinion to intervene suicide in the early stage of suicide.

Post-traumatic osteomyelitis with spinal epidural abscess of cervical spine in a young man with no predisposing factor.

Spinal osteomyelitis with epidural abscess is a rare disease. Most patients have 1 or more predisposing factors, such as impaired immune system secondary to diabetes mellitus, chemotherapy for cancer, immunological compromised disease, and chronic renal or hepatic impairment. We present a case of a physically steady young man without any predisposing risk factor who suffered from cervical osteomyelitis with epidural abscess after neck blunt injury. This patient recovered well after one-stage anterior surgical debridement with implant instrumentation and proper antibiotics treatment. The initial accurate diagnosis rate of spinal epidural abscess is low, even in patients with predisposing factor(s). We present this case to raise the attention of medical staff to this disease in patients with or without any predisposing factor(s) in order to establish early diagnosis and treatment. Our case report also indicates that with adequate debridement and antibiotic coverage, one-stage surgery is a safe and efficacious method to treat patients with cervical spinal epidural abscess.

Analytics-statistics mixed training and its fitness to semisupervised manufacturing.

While there have been many studies using machine learning (ML) algorithms to predict process outcomes and device performance in semiconductor manufacturing, the extensively developed technology computer-aided design (TCAD) physical models should play a more significant role in conjunction with ML. While TCAD models have been effective in predicting the trends of experiments, a machine learning statistical model is more capable of predicting the anomalous effects that can be dependent on the chambers, machines, fabrication environment, and specific layouts. In this paper, we use an analytics-statistics mixed training (ASMT) approach using TCAD. Under this method, the TCAD models are incorporated into the machine learning training procedure. The mixed dataset with the experimental and TCAD results improved the prediction in terms of accuracy. With the application of ASMT to the BOSCH process, we show that the mean square error (MSE) can be effectively decreased when the analytics-statistics mixed training (ASMT) scheme is used instead of the classic neural network (NN) used in the baseline study. In this method, statistical induction and analytical deduction can be combined to increase the prediction accuracy of future intelligent semiconductor manufacturing.

Anti-inflammatory Principles from Sarcandra glabra.

Sarcandra glabra (Thunb.) Nakai (Chloranthaceae) is a medicinal plant used as herbal tea or food supplement to promote human health. We isolated 14 phenolic compounds from the n-butanol fraction of S. glabra and investigated their anti-inflammatory potential using lipopolysaccharide (LPS)-activated RAW264.7 macrophages. We demonstrated that methyl isorinate, a previously uncharacterized compound in S. glabra, is able to suppress NF-κB activation and reduce the expression of iNOS and COX-2 as well as the phosphorylation of IκB in LPS-treated RAW264.7 cells. In addition, the production of two inflammatory cytokines (IL-6 and TNF-α), as well as release of reactive oxygen species, in the LPS-stimulated macrophages was also inhibited by this compound. Furthermore, the structure-activity relationships of all of the isolated phenolic compounds present were analyzed. Overall, this study revealed several anti-inflammatory compounds that were present in S. glabra, and the results suggest that these diverse phenolic compounds are associated with the anti-inflammatory effects of S. glabra.

Epidemiology of burns in Taiwan: a nationwide report including inpatients and outpatients.

INTRODUCTION: The aim of the study is to understand the incidence of burns among outpatients and inpatients of Taiwan in 2010. Characteristics of the burned patients were also studied in terms of gender, age, burn sites, burn degree, reconstructive surgical treatment, as well as which specialty and medical facility they are treated in. METHODS: Burned patients were identified from the 1,000,000-person cohort dataset sampled from the Taiwan National Health Insurance database. Ones who had been hospitalized with discharge diagnoses related to burns were categorized as inpatients and others who had only ambulatory visits and emergency room visits were classified as outpatients. RESULTS: 7630 burn-injury patients were found, presenting an annual incidence of burns as 670.8/10(5) in males (n=3303) and 852.5/10(5) in females (n=4327). Only 3.4% (156 males and 107 females) of them were hospitalized. Higher incidence of burns were found in females and young children, while males and the elderly tended to have more severe burns, based on high-degree burns, admission rate, and incidence of hospitalizations for burns. CONCLUSION: This is a population-based study demonstrating the epidemiology of burns among outpatients and inpatients in Taiwan, leading us closer to the reality of burns treated in different settings of medical facilities.

Epidemiology of adrenal insufficiency: a nationwide study of hospitalizations in Taiwan from 1996 to 2008.

BACKGROUND: Adrenal insufficiency (AI) is an uncommon but life-threatening disorder if it progresses to adrenal crisis. The nationwide trend of AI epidemiology in Taiwan has been infrequently reported. METHODS: Based on complete hospitalization datasets from the National Health Insurance Research Database, the trend of the annual incidence of AI from 1996 to 2008 in Taiwan was retrospectively analyzed. Special attention was paid to age-specific incidence, contributing factors as well as comorbidity at the time of AI diagnosis. RESULTS: Of the existing 35,884,231 hospitalization records, there were 52,660 with AI diagnosis in 32,085 patients (15,914 women and 16,163 men). The annual incidence of AI increased over time from 6.4/10(5) (n = 1280) in 1996 to 15.2/10(5) (n = 3494) in 2008. Nearly four-fifths (77%, n = 24,688) of the patients were aged at least 60 years at the time of their first AI diagnosis. The increase of the annual incidence of AI during the study period was largely attributed to disease prevalence in patients aged 60 years and over, with the most marked increase in the population aged 80 years of age from 51.1/10(5) in 1996 to 179.9/10(5) in 2008. Most patients with newly diagnosed AI were treated at internal medicine wards (81.1%, n = 26,032), at academic medical centers (51.9%, n = 16,648) and in southern Taiwan (54%, n = 17,334). The most common comorbidity was pneumonia (6.4%, n = 2051), followed by urinary tract infection (6.4%, n = 2049), diabetes mellitus (6.2%, n = 1985), electrolyte imbalance (4.8%, n = 1551), and chronic obstructive pulmonary disease (4.5%, n = 1428). CONCLUSION: The annual incidence of AI in Taiwan had continuously increased in recent years, and elderly patients accounted for the majority of the increase. In the face of an increasingly aging population, Taiwanese physicians should pay more attention to this easily overlooked disease.

Neuronavigation-guided intubated wake-up craniotomy for a patient with a brain astrocytoma.

Computer-assisted neuronavigation (an image-guided technique that facilitates brain tumor surgery) reduces the risk of neurological morbidity. Postoperative neurological dysfunction is also minimized by performing intraoperative neurological testing during awake craniotomy with proper surgical resection of a brain tumor. However, when the patient's airway is not secured, an awake craniotomy can be hazardous if emergent intubation is necessary. The present report describes a young man with a brain tumor who underwent neuronavigation-guided wake-up craniotomy and surgical resection of an astrocytoma. The patient was intubated throughout the course of the procedure, during which modified intraoperative neurological tests were performed for cortical mapping. The patient recovered well after the operation and without any neurological deficits.