Background and purpose
Physical activity is associated with a reduced incidence of first‐time stroke. However, few studies have examined the effect of pre‐stroke physical activity on post‐stroke ...complications and clinical outcomes.
Methods
A total of 39 835 cases of stroke registered in the nationwide stroke registry system of Taiwan between 2006 and 2009 were analyzed according to five levels of severity as determined by National Institutes of Health Stroke Scale score upon hospital admission. Pre‐stroke physical activity was defined in the Taiwan Stroke Registry as dedicated leisure‐time physical activity for at least 30 min/day for 3 days/week for more than 6 months. A Cox model was used to compare complications and outcomes between active and inactive groups.
Results
The active and inactive groups were similar in age distribution and stroke type distribution, but the active group had better National Institutes of Health Stroke Scale scores upon admission. The active group also had significantly fewer post‐stroke complications. Active patients had lower hospital mortality and better functional outcomes upon discharge as per the modified Rankin Scale. Improved functional status in the active group was significant at 1, 3 and 6 months post‐stroke.
Conclusion
Dedicated leisure‐time physical activity for at least 30 min/day, at least three times per week for more than 6 months was associated with decreased stroke severity, fewer post‐stroke complications, lower mortality and better outcomes.
Chronic hemodialysis (HD) patients manifest anemia and atherosclerosis with associated oxidative stress. We explored whether intravenous infusion of vitamin C (VC) and/or use of vitamin E (VE)-coated ...dialysis membrane could palliate HD-evoked oxidative stress. Eighty patients undergoing chronic HD were enrolled and randomly assigned into four groups: HD with intravenous VC (n=20), HD with VE-coated dialyzer (n=20), HD with both (n=20), and HD with neither (n=20). We evaluated oxidative stress in blood and plasma, erythrocyte methemoglobin/ferricyanide reductase (red blood cells (RBC)-MFR) activity, plasma methemoglobin, and pro-inflammatory cytokines in these patients. All patients showed marked increases (14-fold) in blood reactive oxygen species (ROS) after HD. The types of ROS were mostly hydrogen peroxide, and in lesser amounts, O2•− and HOCl. HD resulted in decreased plasma VC, total antioxidant status, and RBC-MFR activity and increased plasma and erythrocyte levels of phosphatidylcholine hydroperoxide (PCOOH) and methemoglobin. Intravenous VC significantly palliated HD-induced oxidative stress, plasma and RBC levels of PCOOH, and plasma methemoglobin levels and preserved RBC-MFR activity. The VE-coated dialyzer effectively prevented RBCs from oxidative stress, although it showed a partial effect on the reduction of total ROS activity in whole blood. In conclusion, intravenous VC plus a VE-coated dialyzer is effective in palliating HD-evoked oxidative stress, as indicated by hemolysis and lipid peroxidation, and by overexpression of proinflammation cytokines in HD patients. Using VE-coated dialyzer per se is, however, effective in reducing lipid peroxidation and oxidative damage to RBCs.
Summary Objectives Osteoarthritis (OA) is related to carotid atherosclerosis. Few studies have investigated the incidence of cerebrovascular diseases in patients with OA. Therefore, we conducted a ...population-based cohort study to determine the incidence and risk of stroke in patients with OA. Methods We used data from Taiwan's Longitudinal Health Insurance Database 2000 (LHID2000) to investigate the incidence of stroke in 43,635 patients with OA newly diagnosed between 2002 and 2003. The non-osteoarthritis (non-OA) cohort comprised 43,635 people from the general population. The follow-up period was from the index date of OA to the date of censoring date or stroke diagnosis, or to the end of 2010. Results The overall incidence of stroke was 36% higher in the OA cohort than in the non-OA cohort, with an adjusted hazard ratio (aHR) of 1.10 (95% confidence interval CI = 1.06–1.14) after adjustment for covariates. Men, age, comorbidity, non-selective nonsteroidal anti-inflammatory drugs (NSAIDs), and Cox-2 selective NSAIDs are independent risk factors of stroke. The OA adults with mild to moderate OA (aHR = 1.97, 95% CI = 1.70–2.28 for young adults; aHR = 1.33, 95% CI = 1.25–1.42 for middle-aged adults; aHR = 1.16, 95% CI = 1.12–1.21 for older adults) and severe OA (aHR = 3.78, 95% CI = 2.50–5.70 for young adults; aHR = 1.34, 95% CI = 1.16–1.56 for middle-aged adults; and aHR = 1.01, 95% CI = 0.92–1.10 for older adults) exhibited increased risks of stroke compared with their counterparts without OA. Conclusion OA may be associated with a slightly increased risk of stroke.
The purpose of this quasi‐experimental study was to explore how seventh graders in a suburban school in the United States developed argumentation skills and science knowledge in a project‐based ...learning environment that incorporated a graph‐oriented, computer‐assisted application. A total of 54 students (three classes) comprised this treatment condition and were engaged in a project‐based learning environment that incorporated a graph‐oriented, computer‐assisted application, whereas a total of 57 students (three classes) comprised the control condition and were engaged in a project‐based learning environment without this graph‐oriented, computer‐assisted application. Verbal collaborative argumentation was recorded and the students' post essays were collected. A random effects analysis of variance (ANOVA) was conducted and a significant difference in science knowledge about alternative energies between conditions was observed. A multivariate analysis of variance (MANOVA) was conducted and there was a significant difference in counterargument and rebuttal skills between conditions. A qualitative analysis was conducted to examine how the graph‐oriented, computer‐assisted application supported students' development of argumentation skills and affected the quality of collaborative argumentation. The difference in argumentation structure and quality of argumentation between conditions might explain a difference in science knowledge as well counterargument and rebuttal skills (argumentation) between both conditions. This study concluded that a project‐based learning environment incorporating a graph‐oriented, computer‐assisted application was effective in improving students' science knowledge and developing their scientific argumentation skills.
Summary
Background
Hepatitis C virus (HCV) infection has been linked to an increased risk of insulin resistance and carotid atherosclerosis.
Aim
To investigate the association between HCV infection ...and stroke, and the effect of interferon‐based therapy (IBT) on stroke risk in chronic hepatitis C (CHC) patients.
Methods
We conducted a retrospective cohort study that followed up 3113 subjects with a newly detected HCV infection and 12 452 age‐ and gender‐matched subjects without HCV infection selected from a random sample of 106 beneficiaries from the Taiwan National Health Insurance Program up to 5 years. Use of IBT was defined as treatment with interferon alpha, pegylated interferon alpha‐2a or pegylated interferon alpha‐2b for at least 3 months. The hazard ratio (HR) for newly detected stroke was calculated for subjects with HCV compared to those without HCV, and for IBT‐treated HCV patients compared to non‐IBT‐treated HCV patients while adjusting for possible confounding factors.
Results
The overall person‐years of follow‐up were 8624.11 in patients with HCV, 54 533.69 in patients without HCV, 666.65 in IBT‐treated patients, and 7886.49 in nontreated patients. The multivariable‐adjusted hazard ratio (HR) for newly detected stroke was 1.23 for subjects with HCV compared to the age‐ and sex‐matched subjects without HCV (adjusted HR = 1.23, 95% CI = 1.06–1.42, P = 0.008). Moreover, use of IBT significantly reduced the risk of stroke in HCV patients (adjusted HR = 0.39, 95% CI = 0.16–0.95, P = 0.039) after adjusting for known prognostic factors.
Conclusions
Interferon‐based therapy may reduce the long‐term risk of stroke in patients with chronic HCV infection.
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of hepatocellular carcinoma (HCC) was published in ...2018, and covered the diagnosis, management, treatment and follow-up of early, intermediate and advanced disease. At the ESMO Asia Meeting in November 2018 it was decided by both the ESMO and the Taiwan Oncology Society (TOS) to convene a special guidelines meeting immediately after the Taiwan Joint Cancer Conference (TJCC) in May 2019 in Taipei. The aim was to adapt the ESMO 2018 guidelines to take into account both the ethnic and the geographic differences in practice associated with the treatment of HCC in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with intermediate and advanced/relapsed HCC representing the oncology societies of Taiwan (TOS), China (CSCO), India (ISMPO) Japan (JSMO), Korea (KSMO), Malaysia (MOS) and Singapore (SSO). The voting was based on scientific evidence, and was independent of the current treatment practices, the drug availability and reimbursement situations in the individual participating Asian countries.
We present a UV to mid-infrared multi-wavelength catalog in the CANDELS/GOODS-S field, combining the newly obtained CANDELS HST/WFC3 F105W, F125W, and F160W data with existing public data. The ...catalog is based on source detection in the WFC3 F160W band. The F160W mosaic includes the data from CANDELS deep and wide observations as well as previous ERS and HUDF09 programs. The mosaic reaches a 5σ limiting depth (within an aperture of radius 0farcs17) of 27.4, 28.2, and 29.7 AB for CANDELS wide, deep, and HUDF regions, respectively. The catalog contains 34,930 sources with the representative 50% completeness reaching 25.9, 26.6, and 28.1 AB in the F160W band for the three regions. In addition to WFC3 bands, the catalog also includes data from UV (U band from both CTIO/MOSAIC and VLT/VIMOS), optical (HST/ACS F435W, F606W, F775W, F814W, and F850LP), and infrared (HST/WFC3 F098M, VLT/ISAAC Ks, VLT/HAWK-I Ks, and Spitzer/IRAC 3.6, 4.5, 5.8, 8.0 μm) observations. The catalog is validated via stellar colors, comparison with other published catalogs, zero-point offsets determined from the best-fit templates of the spectral energy distribution of spectroscopically observed objects, and the accuracy of photometric redshifts. The catalog is able to detect unreddened star-forming (passive) galaxies with stellar mass of 10(exp 10) M(sub ☉) at a 50% completeness level to z ~ 3.4 (2.8), 4.6 (3.2), and 7.0 (4.2) in the three regions. As an example of application, the catalog is used to select both star-forming and passive galaxies at z ~ 2-4 via the Balmer break. It is also used to study the color-magnitude diagram of galaxies at 0 < z < 4.
We present the public release of the stellar mass catalogs for the GOODS-S and UDS fields obtained using some of the deepest near-IR images available, achieved as part of the Cosmic Assembly ...Near-infrared Deep Extragalactic Legacy Survey project. We combine the effort from 10 different teams, who computed the stellar masses using the same photometry and the same redshifts. Each team adopted their preferred fitting code, assumptions, priors, and parameter grid. The combination of results using the same underlying stellar isochrones reduces the systematics associated with the fitting code and other choices. Thanks to the availability of different estimates, we can test the effect of some specific parameters and assumptions on the stellar mass estimate. The choice of the stellar isochrone library turns out to have the largest effect on the galaxy stellar mass estimates, resulting in the largest distributions around the median value (with a semi interquartile range larger than 0.1 dex). On the other hand, for most galaxies, the stellar mass estimates are relatively insensitive to the different parameterizations of the star formation history. The inclusion of nebular emission in the model spectra does not have a significant impact for the majority of galaxies (less than a factor of 2 for ~80% of the sample). Nevertheless, the stellar mass for the subsample of young galaxies (age <100 Myr), especially in particular redshift ranges (e.g., 2.2 < z < 2.4, 3.2 < z < 3.6, and 5.5 < z < 6.5), can be seriously overestimated (by up to a factor of 10 for <20 Myr sources) if nebular contribution is ignored.
Activation of the innate immune system is commonly associated with depression. Immunomodulatory drugs may have efficacy for depressive symptoms that are co-morbidly associated with inflammatory ...disorders. We report a large-scale re-analysis by standardized procedures (mega-analysis) of patient-level data combined from 18 randomized clinical trials conducted by Janssen or GlaxoSmithKline for one of nine disorders (N = 10,743 participants). Core depressive symptoms (low mood, anhedonia) were measured by the Short Form Survey (SF-36) or the Hospital Anxiety and Depression Scale (HADS), and participants were stratified into high (N = 1921) versus low-depressive strata based on baseline ratings. Placebo-controlled change from baseline after 4-16 weeks of treatment was estimated by the standardized mean difference (SMD) over all trials and for each subgroup of trials targeting one of 7 mechanisms (IL-6, TNF-α, IL-12/23, CD20, COX2, BLγS, p38/MAPK14). Patients in the high depressive stratum showed modest but significant effects on core depressive symptoms (SMD = 0.29, 95% CI 0.12-0.45) and related SF-36 measures of mental health and vitality. Anti-IL-6 antibodies (SMD = 0.8, 95% CI 0.20-1.41) and an anti-IL-12/23 antibody (SMD = 0.48, 95% CI 0.26-0.70) had larger effects on depressive symptoms than other drug classes. Adjustments for physical health outcome marginally attenuated the average treatment effect on depressive symptoms (SMD = 0.20, 95% CI: 0.06-0.35), but more strongly attenuated effects on mental health and vitality. Effects of anti-IL-12/23 remained significant and anti-IL-6 antibodies became a trend after controlling for physical response to treatment. Novel immune-therapeutics can produce antidepressant effects in depressed patients with primary inflammatory disorders that are not entirely explained by treatment-related changes in physical health.
Summary
Background
Phase III studies showed that some patients maintained response for ≥ 6 months following ustekinumab discontinuation.
Objectives
To assess clinical responses with extended ...ustekinumab maintenance dosing intervals.
Methods
Adults with moderate‐to‐severe plaque psoriasis received ustekinumab at weeks 0, 4 and 16 during open‐label treatment. Patients achieving a week‐28 Physician's Global Assessment (PGA) score of cleared/minimal (PGA = 0/1) were randomized 1 : 4 to group 1 approved every 12 weeks (q12 wk) maintenance or group 2 (q12–24 wk; response‐based dosing determined by time to loss of PGA = 0/1). Key end points included the number of visits with PGA = 0/1 (primary end point) and ≥ 75% improvement in Psoriasis Area and Severity Index (PASI 75) between weeks 88 and 112, and PGA/PASI responses between weeks 28 and 112.
Results
Overall, 378 patients achieved PGA = 0/1 at week 28 and were randomized to group 1 (n = 76) or group 2 (n = 302). Patients in group 1 had numerically greater mean numbers of visits with PGA = 0/1 than group 2 and also with PASI 75 from week 88 to 112. A higher proportion of patients in group 1 (55%) than group 2 (39%) had PGA = 0/1 at all seven visits from week 88 to 112. Maintenance of response was observed with dose‐interval extension beyond q12 wk in a subset of patients. Extending the dosing interval did not affect antibody development or safety.
Conclusions
Efficacy was better maintained among week‐28 PGA responders randomized to continue q12 wk ustekinumab vs. extending maintenance dosing based on clinical response, although some patients maintained high levels of efficacy with up to q24 wk dosing.
What's already known about this topic?
Ustekinumab maintenance doses are typically administered every 12 weeks, although earlier studies and clinical practice suggest that some patients may maintain high levels of efficacy with extended dosing intervals.
What does this study add?
Patients better maintained higher levels of efficacy when ustekinumab was given every 12 weeks compared with longer dosing intervals.
A subset of patients, however, continued to achieve high levels of efficacy with dosing intervals as long as every 24 weeks.
Overall, these findings further our understanding of clinical response to ustekinumab in patients with moderate‐to‐severe psoriasis.
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