National Yang-Ming University Research Articles

The quantified analysis of the correlation between medical humanities curriculums and medical students’ performance

BackgroundA high-quality medical humanities (MH) education program is essential to developing a successful medical practitioner and can influence clinical performance. It is also vital to improve the evaluation of MH education to restore harmonious mutual relationships in medical care. However, studies have yet to discuss the correlation between the learning quality and quantity of medical humanities curriculums (MHC) and medical students' scores of clinical curriculums and clinical performance. The study aimed to assess the correlation between the learning quality and quantity of MHC and medical students' performance.MethodsWe conducted a retrospective cohort study by analyzing a dataset of students' learning records. After excluding students with missing demographic information (n = 1) and overseas Chinese students (n = 15), the study included six- and seven-year program medical school students (n = 354) at National Yang-Ming University who were admitted between 2012 and 2014. The correlation between learning quality and quantity in MHC and students' following performance was evaluated by multivariable-adjusted regression analyses.ResultsAfter adjusting for potential confounders (gender, residential area, age at enrollment, type of administration, and school program), the number of MHC with good learning outcomes was significantly correlated with clinical curriculum scores (p < 0.05), clerkship performance (p < 0.001), and weighted average mark (p < 0.001).ConclusionsOur study found a correlation between MHC with good learning outcomes and medical students' following performance. A future study of improving the quality of MH education is warranted.

Scientific Knowledge Graph of Dysmenorrhea: A Bibliometric Analysis from 2001 to 2021.

This study aims to help researchers master the most active hotspots and trends quickly through bibliometric analysis in the field of dysmenorrhea. We retrieved literature on Web of Science from 2001 to 2021, and bibliometric analysis software CiteSpace was used in combination with VOSviewer. We finally acquired 944 papers and an upward trend in articles continued in this field overall. Through the map, China contributed the most, followed by the USA and Turkey. For institutions, Beijing University of Chinese Medicine in China contributed the most, followed by National Yang-Ming University in Taiwan, China. Hsieh JC and Hellman KM were both the most prolific authors with 14 articles. Five major research groups, respectively, with Hsieh JC, Hellman KM, Zhu J, Liang F and Dun W were the key group. Dawood MY was the most dominant author and most frequently cited author. The Cochrane Database of Systematic Reviews Journal was the most productive, and the Fertility and Sterility Journal was the most cited. Advances in pathogenesis and management for primary dysmenorrhea written by Dawood MY was most cited and influential. Pathophysiology, the potential central mechanism, syndrome, evaluation index, diagnosis of adenomyosis-associated dysmenorrhea, treatment, etc., were the main trends and hotspots. Dysmenorrhea research has received a lot of attention from scholars. Strengthening international cooperation may promote the development of this field. The pathophysiology of dysmenorrhea, its impact on public health and its treatment are current research hotspots and are likely to be the focus of future study.

Medical school grades may predict future clinical competence.

In real-world medical education, there is a lack of reliable predictors of future clinical competencies. Hence, we aim to identify the factors associated with clinical competencies and construct a prediction model to identify "improvement required" trainees. We analyzed data from medical students who graduated from National Yang-Ming University with clerkship training and participated in the postgraduate year (PGY) interview at Taipei Veterans General Hospital. Clinical competencies were evaluated using grades of national objective structured clinical examination (OSCEs). This study used data from medical students who graduated in July 2018 as the derivation cohort (N = 50) and those who graduated in July 2020 (n = 56) for validation. Medical school grades were associated with the performance of national OSCEs (Pearson r = 0.34, p = 0.017), but the grades of the structured PGY interviews were marginally associated with the national OSCE (Pearson r = 0.268, p = 0.06). A prediction model was constructed to identify "improvement required" trainees, defined: trainees with the lowest 25% of scores in the national OSCEs. According to this model, trainees with the lowest 25% medical school grades predicted a higher risk of the "improvement required" clinical performance (Q1-Q3 vs Q4 = 15% vs 60%, odds ratio = 8.5 [95% confidence interval = 1.8-39.4], p = 0.029). In the validation cohort, our prediction model could accurately classify 76.7% "improvement required" and "nonimprovement required" students. Our study suggests that interventions for students with unsatisfactory medical school grades are warranted to improve their clinical competencies.

Cisd2 Plays an Essential Role in Corneal Epithelial Regeneration

Age-related changes affecting the cornea and ocular surface cause vision loss in the elderly. We investigated the role of Cisd2 in corneal health and disease. Five major discoveries were made. Firstly, in patients with corneal epithelial disease, CISD2 is down-regulated in their corneal epithelial cells. Secondly, using mouse cornea, Cisd2 deficiency causes a cycle of chronic injury and persistent repair resulting in exhaustion of the limbal progenitor cells. Thirdly, in human corneal epithelial cells, Cisd2 deficiency disrupts intracellular Ca2+ homeostasis, impairing mitochondrial function, thereby retarding corneal repair. Fourthly, cyclosporine A and EDTA facilitate corneal epithelial wound healing in Cisd2 knockout mice. Finally, cyclosporine A treatment restores corneal epithelial erosion in patients with dry eye disease, which affects the ocular surface. These findings reveal that Cisd2 plays an essential role in the cornea and that Ca2+ signaling pathways are potential targets for developing therapeutics of corneal epithelial disease. Keywords: corneal wound healing; Cisd2; calcium homeostasis; limbal stem cell deficiency; EDTA; cyclosporine A. Funding: We acknowledge the support provided by grants from the Ministry of Science and Technology (MOST104-2314-B-182-070, MOST105-2314-B-182-066-MY3, and MOST108-2314-B-182-049- MY3 to CCS; MOST 109-2327-B-010-002, MOST 109-2320-B-010-043 and MOST 107-2320-B-010- 037-MY3 to TFT), and from Chang Gung Medical Research Foundation (CORPG2L0011 to CCS). Declaration of Interest: None to declare. Ethical Approval: This study has been approved by the Institutional Review Board (#201509558B0, #201900646B0, #20200799B0, #202001685B0) at Chang Gung Memorial Hospital, Taiwan. The animal protocols were approved by the Institutional Animal Care and Use Committee of Chang Gung Memorial Hospital (approval no. 2015121606, 2020092211)and National Yang-Ming University (approval no. 1021218).

Value-Based Benefits and Quality of Life of Incorporating Multidomain Interventions into Integrated Primary Care: A Randomized Controlled Trial

Background: Hypothetically, incorporating multidomain interventions into primary healthcare might improve standard value-based health outcomes. Methods: The Taiwan Integrated Geriatric Care study recruited community-dwelling ≥65-year-olds with ≥3 chronic conditions, excluding people receiving cancer therapy, with life expectancy <12 months, or with insufficient communication ability. Participants were randomized 1:1 to usual care versus an integrated multidomain intervention, which entailed 16, 2 h sessions/year comprising communal physical exercise, cognitive training, nutrition and disease education, plus individualized treatment by specialists in integrated geriatric care. The primary outcomes were 36-item Short Form Health Survey (SF-36) quality of life scores. International Consortium for Health Outcomes Measurement Standard Set Older Person metrics were secondary outcomes, and Montreal Cognitive Assessment was an exploratory outcome. Intervention effects were analyzed with a generalized linear mixed model. Findings: From 25 June 2018 until 14 March 2020, 398/638 screened participants were assigned to integrated multidomain intervention (n=199) versus usual care (n=199); 335 (84.2%) completed the study. Compared with usual care recipients, integrated multidomain participants had significantly higher SF-36 physical component scores (0.8, 95% CI 0.2–1.5), were more likely to complete advance care planning (OR 1.40, 95% CI 1.04–1.88), and had lesser likelihoods of limited instrumental activities of daily living (OR 0.7, 95% CI 0.6–0.9), pain (OR 0.6, 95% CI 0.4–0.9), slowness (OR 0.81, 95% CI 0.66–1.00), and cognitive impairment (OR 0.5, 95% CI 0.4–0.7). Interpretation: Incorporating multidomain interventions into integrated healthcare increased quality of life and improved value-based health outcomes and cognitive performance. Trial Registration: TIGER was registered prospectively at ClincalTrials.gov, NCT03528005. Funding Statement: The National Health Research Institutes, Taiwan and the Ministry of Science and Technology, Taiwan. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: The institutional review boards of National Yang-Ming University (YM107042F), Taipei Veterans General Hospital (2018-05-002CC), Hualien Tzu Chi Hospital Buddhist Tzu Chi Medical Foundation (IRB 107- 90-B), and National Yang-Ming University Hospital (2018A023) approved the protocol.

Augmented reality-assisted training with selected Tai-Chi movements improves balance control and increases lower limb muscle strength in older adults: A prospective randomized trial

Background/ObjectiveTai-Chi benefits older adults by enhancing balance control and increasing the muscle strength of the lower limbs. However, a complete set of traditional Tai-Chi exercises is sometimes too difficult for beginners. We investigated whether practicing augmented reality-assisted training with selected Tai-Chi movements tailored to the practitioner’s ability (selected Tai-Chi, or sTC) is as effective as performing a complete set of Tai-Chi sequences (complete traditional Tai-Chi, or tTC). MethodsIn this prospective randomized trial carried out in the Beitou District of Taipei City, Taiwan, community-dwelling adults aged ≥65 and without any debilitating diseases (n = 28) were included. Participants were randomly assigned to the sTC group (n = 14) or the tTC group (n = 14). Participants in the sTC group practiced selected Tai-Chi movements using the augmented reality Tai-Chi training system. Participants of the tTC group were asked to complete the 24-form Yang-style Tai-Chi following the instructions of Tai-Chi masters. Each training session lasted 30 min, with 3 sessions per week for 8 weeks. Pre- and post-intervention evaluations included functional balance tests, comprising the Berg Balance Scale (BBS), Timed Up and Go test (TUG), and Functional Reach Test (FRT), as well as muscle strength measurements of the lower extremities. ResultsPre-intervention evaluations showed significant differences in FRT (p = 0.034) and left hip abductor muscle strength (p = 0.046) between the sTC and tTC groups. After 8 weeks of training, the BBS, TUG, and FRT scores in the sTC group showed significant improvement overall. Although all three functional balance test scores improved in the tTC group, only the improvement in BBS was statistically significant (p = 0.001). After 8 weeks, all muscle strength measurements increased by an average of 3.1 ± 1.0 kgw in the sTC group and 1.6 ± 0.8 kgw in the tTC group. ConclusionsThe augmented reality-assisted training with selected Tai-Chi movements, designed based on objective measurements of the practitioner’s capability, improved balance control and muscle strength of lower limbs at least as effectively as the complete sequence of traditional Tai-Chi exercises. Trial registrationThis study was approved by the Institutional Review Board of National Yang-Ming University (IRB number: 1000087). Written informed consent was obtained from all participants.

Quality of Life of Women After a First Diagnosis of Breast Cancer Using a Self-Management Support mHealth App in Taiwan: Randomized Controlled Trial.

BackgroundThere are over 2 million newly diagnosed patients with breast cancer worldwide with more than 10,000 cases in Taiwan each year. During 2017-2018, the National Yang-Ming University, the Taiwan University of Science and Technology, and the Taiwan Breast Cancer Prevention Foundation collaborated to develop a breast cancer self-management support (BCSMS) mHealth app for Taiwanese women with breast cancer.ObjectiveThe aim of this study was to investigate the quality of life (QoL) of women with breast cancer in Taiwan after using the BCSMS app.MethodsAfter receiving a first diagnosis of breast cancer, women with stage 0 to III breast cancer, who were recruited from social networking sites or referred by their oncologists or oncology case managers, were randomized 1:1 into intervention and control groups. Intervention group subjects used the BCSMS app and the control group subjects received usual care. Two questionnaires—the European Organization for Research and Treatment of Cancer (EORTC) Quality-of-Life Questionnaire Core 30 (QLQ-C30) and the EORTC Breast Cancer-Specific Quality-of-Life Questionnaire (QLQ-BR23)—were distributed to subjects in both arms. Paper-based questionnaires were used at baseline; paper-based or Web-based questionnaires were used at 1.5-month and 3-month follow-up evaluations. All evaluations were self-assessed and anonymous, and participants were blinded to their allocation groups. Descriptive analysis, the Pearson chi-square test, analysis of variance, and the generalized estimating equation were used to analyze the data. Missing values, with and without multi-imputation techniques, were used for sensitivity analysis.ResultsA total of 112 women were enrolled and randomly allocated to either the experimental group (n=53) or control group (n=59). The follow-up completion rate was 89.3% (100/112). The demographic data showed homogeneity between the two groups in age (range 50-64 years), breast cancer stage (stage II), marital status (married), working status (employed), and treatment status (receiving treatments). The mean total QoL summary scores from the QLQ-C30 (83.45 vs 82.23, P=.03) and the QLQ-BR23 (65.53 vs 63.13, P=.04) were significantly higher among the experimental group versus the control group, respectively, at 3 months.ConclusionsThis research provides support for using a mobile health care app to promote the QoL among women in Taiwan after a first diagnosis of breast cancer. The BCSMS app could be used to support disease self-management, and further evaluation of whether QoL is sustained is warranted.Trial RegistrationClinicalTrials.gov NCT004174248; https://clinicaltrials.gov/ct2/show/NCT04174248

Paraclinoid Aneurysms: Part III—Lateral Aneurysms

Dr. Krisht is Professor and Director, Arkansas Neuroscience Institute, St. Vincent Hospital, #5 St. Vincent Circle, Suite 503, Little Rock, AR 72205; E-mail: [email protected]; and Dr. Hsu is Neurosurgeon, Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and Professor, National Yang-Ming University School of Medicine, Taipei, Taiwan. The authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this CME activity.This article is reprinted from a classic Contemporary Neurosurgery article published in 2008.Category: CerebrovasularLippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on November 29, 2021.

Paul H. Chen

Paul H. Chen, 80, died on Jan. 3, 2017, in Seattle. “Paul, a devoted Christian with great integrity, was an analytical chemist specialized in gas chromatography/mass spectrometry analysis of trace organic compounds in environmental pollutions. He worked as head of mass spectrometry for Philip Morris Research Center (1968), as a professor at National Yang-Ming University in Taiwan (1976), and as a visiting professor at Indiana University. He joined the Behavioral and Neurological Toxicology Lab at the National Institute of Environmental Health Sciences in Research Triangle Park (1983). He also worked as a group leader at QST Environmental in Gainesville, Florida (1985). He worked for the US Environmental Protection Agency (USEPA) in Athens, Georgia, until his retirement in 2000. He had 43 publications and received numerous awards, including the USEPA Bronze Medal.”—Melissa G. Chen, wife Most recent title: Chemist, US Environmental Protection Agency Education: BS, chemical engineering, Cheng Kung University...

Paraclinoid Aneurysms: Part I—Superior (True Ophthalmic) Aneurysms

Dr. Krisht is Professor and Director, Arkansas Neuroscience Institute, St. Vincent Hospital, #5 St. Vincent Circle, Suite 503, Little Rock, AR 72205; E-mail: [email protected]; and Dr. Hsu is Neurosurgeon, Division of General Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, and Professor, National Yang-Ming University School of Medicine, Taipei, Taiwan. The authors, faculty, and staff in a position to control the content of this CME activity and their spouses/life partners (if any) have disclosed that they have no financial relationships with, or financial interests in, any commercial organizations relevant to this CME activity.This article is reprinted from a classic Contemporary Neurosurgery article published in 2008.Category: CerebrovasularLippincott Continuing Medical Education Institute, Inc., is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.Lippincott Continuing Medical Education Institute, Inc., designates this enduring material for a maximum of 2.0 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity. To earn CME credit, you must read the CME article and complete the quiz and evaluation on the enclosed form, answering at least 70% of the quiz questions correctly. This activity expires on October 29, 2021.

A pilot study of integrating standardized patients in problem-based learning tutorial in Taiwan.

Problem-based learning (PBL) has been widely adopted in medical education; however, its application has been questioned due to the lack of interaction with a real patient. Standardized patients (SPs) might solve this problem. Herein, we tested the impact of integrating SPs in a PBL tutorial. In 2017, a total of 313 students, 66 facilitators, and 36 SPs were enrolled at National Yang-Ming University, Taiwan. The SPs presented the symptoms/signs of the cases then the students interviewed them to obtain the detail history. All students, facilitators, and SPs were invited to complete the questionnaires before and after this program. Most SPs considered that both the second-year dental medical student and third-year medical students participated actively and were competent enough but students and facilitators considered that the fourth-year medical students might be more prepared. Overall, the students thought highly of the interactions with the SPs. Only about one-fifth felt that this design caused unnecessary pressure among the students and facilitators. They agreed that this program significantly inspired the student's learning motivation (pre- vs post-course: 4.1 ± 0.7 vs 4.3 ± 0.7, p < 0.001), increased their confidence level in interviewing patients (4.0 ± 0.8 vs 4.2 ± 0.7, p < 0.001), and encouraging critical thinking (4.0 ± 0.7 vs 4.2 ± 0.7, p < 0.001). The SPs, facilitators, and students had different viewpoints with regards to integrating SPs in the PBL tutorial. However, a majority agreed that this design enhanced the motivation of students and supported such an application in PBL tutorials.

Asymmetric Dimethylarginine Exacerbates Lipid Accumulation in Macrophage Foam Cells by Impairing LXRα/ABCA1-Dependent Cholesterol Efflux

Background: Asymmetric dimethylarginine (ADMA) is an endogenous nitric oxide synthase inhibitor and has been proposed to be an independent risk factor for cardiovascular diseases. However, little is known about its role in the regulation of lipid metabolism. In this study, we investigated the effect of ADMA on cholesterol metabolism and its underlying molecular mechanism. Methods: Oxidized low-density lipoprotein (oxLDL)-induced macrophage foam cells were used as an in vitro model. Apolipoprotein E-deficient (ApoE−/−) hyperlipidemic mice were used as an in vivo model. Western blot analysis was used to evaluate protein expression. Luciferase reporter assays were used to assess the activity of promoters and transcription factors. Conventional assay kits were used to measure the levels of ADMA, cholesterol, triglycerides, and cytokines. Findings: Treatment with oxLDL decreased the protein expression of dimethylarginine dimethylaminotransferase-2 (DDAH-2) but not DDAH-1. Incubation with ADMA markedly increased oxLDL-induced lipid accumulation in macrophages. ADMA impaired cholesterol efflux following oxLDL challenge and downregulated the expression of ATP-binding cassette transporter A1 (ABCA1) and ABCG1 by interfering with liver X receptor α (LXRα) expression and activity. Additionally, this inhibitory effect of ADMA on cholesterol metabolism was mediated through the activation of the NADPH oxidase/reactive oxygen species pathway. In vivo experiments revealed that chronic administration of ADMA for 4 weeks exacerbated systemic inflammation, decreased the aortic protein levels of ABCA1 and ABCG1, and impaired the capacity of reverse cholesterol transport, ultimately, leading to the progression of atherosclerosis in apoE−/− mice. Interpretation: Our findings suggest that the ADMA/DDAH-2 axis plays a crucial role in regulating cholesterol metabolism in macrophage foam cells and atherosclerotic progression. Funding Statement: This study was supported by grants from the Ministry of Science and Technology of Taiwan (105-2320-B-010-036, 105-2811-B-010-022, 106-2320-B-002-057-MY3, 106-2320-B-002-056, and 106-2811-B-002-146). Declaration of Interests: The authors declare no conflict of interest. Ethics Approval Statement: All animal experiments were approved by the Animal Care and Utilization Committee of National Yang-Ming University (No. 990803).

Antioxidative effects of complementary therapy with Salvia miltiorrhiza in ischemic heart disease

Background: Salvia miltiorrhiza (SM) is a Chinese herb widely used for ischemic heart diseases (IHD), yet little is known about the cellular mechanisms. The aims of this study were to investigate mechanisms of SM. Methods: The rat A10 cells line, a vascular smooth muscle cells line isolated from rat thoracic embryonic aorta was as a study model. The SM roots aqueous extract , MTT assay, cytotoxicity assay, two-dimensional electrophoresis coupled with MALDI-TOF mass spectrometry , western blot analysis, and biological network analysis were applied for the elucidation of protein changes characterizing the response of the rat A10 cells into the homocysteine(Hcy) -induced oxidative stress. Results: Our study showed that a low dose (0.015 mg/mL) of the SM significantly inhibited growth (>60%, p < 0.05) of the Hcy stimulated rat A10 cells. In addition, concentration of intracellular reactive oxygen species obviously decreased in the rat A10 cells after its incubation with SM in terms of catalase increasing activity. Next, marked down-regulation of protein kinase C beta-1 and phosphorylated mitogen-activated protein kinase expression suggest that observed inhibitory effect of the SM on the Hcy-induced growth of rat A10 cells was realized via the PKC/p44/42 MAPK- dependent pathway. The intensity changes of 10 protein spots in response of the rat A10 cells to the Hcy-induced oxidative damage as alpha-4-tropomyosin, vimentin, F1F0- ATP synthase (beta subunit), glucose regulated protein 75, actin (fragment), prohibitin, capping protein, plakoglobin, endoplasmic reticulum protein 29, and peptidylprolyl isomerase A, were detected with statistical significance (p < 0.05). Meanwhile, it was showed that used here SM resist carbonylation of vimentin, alpha-4-tropomyosin and GRP75, respectively, leading to phenotype transformations in the rat A10 cells. Conclusion: These data suggest that SM may exert its protective effect in IHD through circulating ROS suppression and subsequent modulation of protein carbonylation in rat aortic smooth muscle cells. Biography Yu-Chiang Hung grew up in Taiwan and received his Bachelor's degree from the China Medical University in 1990 , another M.D . degree from the National Yang-Ming University in 1992 , and Ph.D. degree from the Chang Gung University in 2010. His PhD thesis was “Functional proteomic study in bioactive compounds of radix Salvia miltiorrhiza”. Dr. Hung had found that Salvia miltiorrhiza could inhibit vascular smooth muscle cell proliferation to treat atherosclerosis. He is an attending and director of Department of Chinese medicine in Kaohsiung Chang Gung Memorial Hospital now. His specialty is Chinese medicine , cardiovascular diseases ,Chinese herbs , and acupuncture. He has published 39 papers in SCI journals and has been serving as an editorial board member of repute.

Association of &lt;i&gt;Helicobacter pylori &lt;/i&gt;Treatment with Hepatic Encephalopathy Risk in Cirrhotic Patients: A Population-Based Cohort Study

Background: Helicobacter pylori treatment may reduce the risk of hepatic encephalopathy (HE) by reducing ammonia production and changing the gut microbiota; however, a large-scale clinical study remains lacking. We aimed to investigate the effect of H. pylori treatment on HE risk through a cohort study. Methods: Using Taiwan's National Health Insurance Research Database from the years 1997 to 2011, 215,288 cirrhotic patients were screened. In order to avoid immortal time bias, patients in the H. pylori-treated and untreated cohorts were followed up from the last day of H. pylori treatment and the matched dates of starting their follow-up, respectively. After excluding patients aged < 18 years, those without underlying cirrhosis, those with an HE history, and those with any malignancies; 1,229 patients (the treated group) were randomly matched 1:2 with 2,458 patients (the untreated group) by means of propensity scores. Both cumulative incidences of, and hazard ratios (HRs) for, HE occurrence were analyzed after adjusting for competing mortality risk. Findings: The cumulative incidence of HE in the treated group was significantly lower than that in the untreated group after 1 year (3.00%, 95% confidence interval [CI]: 1.99-4.01 vs. 6.42%, 95% CI: 5.41-7.43), and after 3 years (6.33%, 95% CI: 4.82-7.85 vs. 11.21%, 95% CI: 9.84-12.58; P< 0.001). In multivariable regression analysis, H. pylori treatment was independently associated with a reduced HE risk (HR 0.54, 95% CI: 0.41-0.71; P< 0.001). Sensitivity subgroup analyses also verified this association, including those patients with (HR 0.53, 95% CI: 0.35-0.81) or without (HR 0.56, 95% CI: 0.39-0.81) liver decompensation. Interpretation: H. pylori treatment was significantly associated with a reduced risk of HE in cirrhotic patients. Funding Statement: The Ministry of Science and Technology (108-2321-B-075-002), National Yang-Ming University (107F-M01), the Ministry of Health and Welfare (MOHW108-TDU-B-211-124019), and Taipei Veterans General Hospital (V108E-004-1 and 107VACS-003), Taiwan. Declaration of Interests: The authors who have taken part in this study declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript. Ethics Approval Statement: The Institutional Review Board of Taichung Veterans General Hospital approved the present study (CE19004B).

Chinese Olive ( &lt;i&gt;Canarium album L.&lt;/i&gt;) Fruit Regulates Glucose Utilization by Activating Amp-Activated Protein Kinase

Background: A growing body of evidence demonstrates obesity-induced insulin resistance is considered to promote the development of metabolic diseases. This study was designed to investigate ethyl acetate fraction of Chinese olive fruit extract (CO-EtOAc) mediated attenuation of obesity and hyperglycemia in a mouse model. Methods: 60% of HFD-fed mice were treated intragastrically with CO-EtOAc for at last six weeks, and body weight, blood biochemical parameters as well as hepatic inflammation response were investigated. On the other hands, we also investigated the molecular mechanism involved in glucose homeostasis and cellular energy balance using L6 myotubes. Findings: Our results showed that CO-EtOAc treatment significantly reduced the formation of hepatic lipid droplets, body weight gain, blood glucose and improved serum biochemical parameters in HFD induced obese and insulin resistant mice. We further explored the molecular mechanism underlying the blood glucose modulating the effect of CO-EtOAc using L6 myotubes model. We concluded that CO-EtOAc effectively increased glycogen content and glucose uptake by stimulating the membrane translocation of glucose transporter 4. In addition, CO-EtOAc depolarized the mitochondrial membrane potential and decreased mitochondrial oxygen consumption, which may result in AMPK activation and the consequent mitochondrial fission. Interpretation: This study shows that CO-EtOAc prevents the development of obesity in mice fed with HFD and is also capable of stimulating glucose uptake. The possible mechanism might be due to the effects of CO-EtOAc on activation of AMPK and promotion of mitochondrial fission. Funding: This work was supported by grants 36 from the Ministry of Science and Technology (MOST 104‐3011‐B‐010‐001‐1‐4‐2, MOST 104‐2320‐B‐002‐039), Taiwan. Declaration of Interest: The authors declare no competing financial interests. Ethical Approval: All study protocols were approved by the Institutional Animal Care and Use Committee of National Yang-Ming University. In addition, all experiments were performed in accordance with relevant guidelines and regulations.

Medical humanities education in China: an exploratory cross-sectional study

BackgroundGovernmental policies in China have strengthened education in the medical humanities. Previous publications have highlighted the inadequacy of medical humanities education in China and have promoted their advancement and evaluation. Medical disputes and mistrust between doctors and patients in China have been ascribed to a paucity of proper medical humanities education at the medical student level. However, no studies to date have specifically examined the frequency, structure, and characteristics of the medical humanities curricula at all Chinese medical schools, making it difficult to draw a comprehensive understanding of its current state. We therefore aim to provide such an understanding of the current role of the medical humanities at Chinese medical schools. MethodsWe did an exploratory cross-sectional study of medical humanities education in China. We did a comprehensive web-based search of records and curricula to identify all medical humanities courses at all tier-one western medicine Chinese medical schools. In China, only tier-one colleges can offer an education in clinical medicine. All medical schools' compulsory public curricula and the schools' medical humanities curricula were included in our analyses. The primary outcome was to categorise both quantitatively and qualitatively the role of the humanities at Chinese medical schools. We categorised all course data and analysed it using SPSS (version 20). Ethical approval was obtained by the Institutional Review Board of the National Yang-Ming University. FindingsBetween July 1, 2017, and April 30, 2018, we identified 138 tier-one Chinese medical schools with compulsory public curricula, of which 93 (67%) had a medical humanities curricula. Eight medical humanities course types were identified. On average, each school offers 3·84 types of different medical humanities courses. The types of courses that are offered the most are medical psychology or clinical psychology (72 [77%] of 94), medical ethics (68 [72%]), hygienic or medical jurisprudence (56 [60%]), and doctor–patient communication (46 [49%]). Medical humanities courses account for 3–10% of the total credits medical students are required to obtain to graduate in China. The compulsory Ideological and Political Theory curriculum accounts for 6–8% of credits required to graduate. This curriculum includes Mao Zedong Thought, Modern Chinese History, Marxism, Socialism with Chinese Characteristics, and Moral Education and Law, and is required of all students, not solely medical students. InterpretationMedical humanities courses at western medical schools such as the University of Oxford and Harvard Medical School account for 15% and 25% of the total credits required to graduate, respectively. In China, medical humanities education accounts for a substantially smaller portion of the curriculum. Despite ongoing medical disputes and doctor–patient tension, only half of medical schools offer doctor–patient communication type courses. However, China's Ideological and Political Theory curriculum also has a humanistic intent, and when added with medical humanities courses, the two together account for 9–18% of the total credits required to graduate. These unique curricular components serve to support governmental priorities, including developing leaders who follow the so-called rule of law and the rule of virtue. These traits of China's medical humanities curricula match China's national political ideology. However, a more coherent longitudinal medical humanities framework specifically aimed at strengthening the patient–doctor relationship would be useful. China's endeavours to foster medical humanities education reform should be actively promoted at the research, policy, and practice level. FundingThe Republic of China Ministry of Science and Technology (grant MOST 105-2511-S-010 -002 -MY2).

Injury and suicide in people aged 60 years and over in China: an analysis of nationwide data

Abstracts Background Of China's population of 1·37 billion, 16.1% are elderly people (aged 60 years or over), and of those over 65 years, 16·4% live alone. Most studies agree that with urbanization has come a decline in the suicide rate, except in elderly people. This study aims to examine the morbidity and mortality associated with injury and suicide among elderly people in China. Methods Injury data for elderly people (aged 60 and over) in China (according to the International Classification of Diseases tenth revision [ICD-10] for injury data) from 2006 to 2015 were obtained from the annual reports of the Chinese National Health and Family Planning Commission published by the government of China and the Peking Union Medical College. These reports compiled the causes of death of residents from all 31 provinces. The institutional review board of National Yang-Ming University approved this study. Findings From 2006 to 2015, the likelihood of death due to injury in elderly people in China increased with age in those over 65 years old. On average, mean rates of death due to injury were higher in rural areas (53·95 [SD 3·49] per 100 000 population) than in urban areas (35·71 [2·67] per 100 000), and were higher in males (58·91 [14·36] per 100 000) than in females (30·29 [5·30] per 100 000). Mortality rates due to injury in those aged 65–70 years, 70–75 years, 75–80 years, and 80 years and over were 1·6, 2·2, 3·3, and 5·8 times that of the general population. Furthermore, mortality rates secondary to accidental falls for those aged 80–85 and 85 years and over were 11·45 and 39·05 times that of the general population, respectively. In 2015, suicide rates in people aged 60–85 were 9·7–41·09 per 100 000 in urban areas. In rural areas, the suicide rate was 65·60 per 100 000 in people aged 85 and over. On average, mortality from suicide in Chinese people aged 65–85 was 2·75–7·08 times that of the general population. Interpretation Morbidity and mortality due to suicide and injury in elderly people in China continues to rise. As the Chinese population ages, the problem is set to worsen. Policies to reduce injury and prevent suicide in elderly people in China are needed urgently. Funding This study was supported by the ROC Ministry of Science and Technology Grant (number MOST 105-2511-S-010-002-MY2 ).

Corrigendum

International Wound JournalVolume 15, Issue 5 p. 855-855 CORRIGENDUMOpen Access Corrigendum This article corrects the following: Enhanced wound-healing performance of a phyto-polysaccharide-enriched dressing – a preclinical small and large animal study Chih-Hsin Wang, Shu-Jen Chang, Yuan-Sheng Tzeng, Yu-Jen Shih, Chang Adrienne, Shyi-Gen Chen, Tim-Mo Chen, Niann-Tzyy Dai, Juin-Hong Cherng, Volume 14Issue 6International Wound Journal pages: 1359-1369 First Published online: September 21, 2017 First published: 19 September 2018 https://doi.org/10.1111/iwj.12987AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat In Wang et al.,1 an error was published in the author affiliations. ‘National Defense Medical Center’ was wrongly included in affiliation 2 instead of in affiliation 1. The correct affiliations are as follows: 1Department of Plastic and Reconstructive Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan (R.O.C). 2Department of Dentistry, National Yang-Ming University, Taipei, Taiwan (R.O.C). We apologize for these errors. REFERENCE 1Wang C-H, Chang S-J, Tzeng Y-S, et al. Enhanced wound-healing performance of a phyto-polysaccharide-enriched dressing – a preclinical small and large animal study. Int Wound J. 2017; 14: 1359- 1369. Volume15, Issue5October 2018Pages 855-855 ReferencesRelatedInformation

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Effects of Kinesiology Taping on Scapular Reposition Accuracy, Kinematics, and Muscle Activity in Athletes With Shoulder Impingement Syndrome: A Randomized Controlled Study.

Scapular proprioception is a key concern in managing shoulder impingement syndrome (SIS). However, no study has examined the effect of elastic taping on scapular proprioception performance. To investigate the immediate effect of kinesiology taping (KT) on scapular reposition accuracy, kinematics, and muscle activation in individuals with SIS. Randomized controlled study. Musculoskeletal laboratory, National Yang-Ming University, Taiwan. Thirty overhead athletes with SIS. KT or placebo taping over the upper and lower trapezius muscles. The primary outcome measures were scapular joint position sense, measured as the reposition errors, in the direction of scapular elevation and protraction. The secondary outcomes were scapular kinematics and muscle activity of the upper trapezius, lower trapezius, and serratus anterior during arm elevation in the scapular plane (scaption). Compared with placebo taping, KT significantly decreased the reposition errors of upward/downward rotation (P = .04) and anterior/posterior tilt (P = .04) during scapular protraction. KT also improved scapular kinematics (significant group by taping effect for posterior tilt, P = .03) during scaption. Kinesiology and placebo tapings had a similar effect on upper trapezius muscle activation (significant taping effect, P = .003) during scaption. Our study identified the positive effects of KT on scapular joint position sense and movement control. Future studies with a longer period of follow-up and clinical measurement might help to clarify the clinical effect and mechanisms of elastic taping in individuals with SIS.