NEW START: THE LIFE EXPERIENCES OF RECOVERING SUICIDAL ADOLESCENTS

Background: Suicide is a serious global health problem and the second leading cause of death for adolescents in Taiwan. Previous studies have typically explored the causes of suicide; however, scant research has considered suicide recovery contexts, leading to the inability to developing effective suicide prevention strategies.Aim: Exploring the life experiences of adolescents during their suicide recovery processes.Method: A descriptive phenomenology research design was employed. The participants comprised 6 outpatient young adult who possessed histories of suicide and recovering from attempted suicide. Semi-structured, one-on-one in-depth interviews were conducted and Colaizzi’s (1978) methods were used for data analysis. Results: The main identified dimension was “new start” which comprised the following five major themes: conversion of suicidal thoughts, awareness of change, loving attachments, the emotional regulation, and the future prospects. Conclusion: Although adolescents are a high-risk population for suicide, they demonstrate recovery power. The results of this study should provide a reference for professional personnel to assist teenagers in recognizing and using internal and external resources, discovering the value of life and hopes for the future, and reducing the risk of suicide

Deranged Bioenergetics and Defective Redox Capacity in T Lymphocytes and Neutrophils Are Related to Cellular Dysfunction and Increased Oxidative Stress in Patients with Active Systemic Lupus Erythematosus

Urinary excretion of N-benzoyl-glycyl-Nε-(hexanonyl)lysine, a biomarker of oxidative stress, was higher in 26 patients with active systemic lupus erythematosus (SLE) than in 11 non-SLE patients with connective tissue diseases and in 14 healthy volunteers. We hypothesized that increased oxidative stress in active SLE might be attributable to deranged bioenergetics, defective reduction-oxidation (redox) capacity, or other factors. We demonstrated that, compared to normal cells, T lymphocytes (T) and polymorphonuclear neutrophils (PMN) of active SLE showed defective expression of facilitative glucose transporters GLUT-3 and GLUT-6, which led to increased intracellular basal lactate and decreased ATP production. In addition, the redox capacity, including intracellular GSH levels and the enzyme activity of glutathione peroxidase (GSH-Px) and γ-glutamyl-transpeptidase (GGT), was decreased in SLE-T. Compared to normal cells, SLE-PMN showed decreased intracellular GSH levels, and GGT enzyme activity was found in SLE-PMN and enhanced expression of CD53, a coprecipitating molecule for GGT. We conclude that deranged cellular bioenergetics and defective redox capacity in T and PMN are responsible for cellular immune dysfunction and are related to increased oxidative stress in active SLE patients

Carbon Dioxide Angiography in Lower Limbs: A Prospective Comparative Study With Selective Iodinated Contrast Angiography

This was a prospective comparison of the accuracy and image quality of carbon dioxide digital subtraction angiography (CO2 DSA) and iodinated contrast digital subtraction angiography (ICDSA) in evaluating lower extremity arteries and patient tolerance of the procedures. Selective DSA was performed in 14 Taiwanese patients who were diagnosed with peripheral artery occlusive disease (PAOD). Both contrast materials were administered through mechanical injectors. Post-processing of the image used pixel shifting. Images of vessels were divided into 22 anatomic segments and evaluated by two experienced radiologists. A four-point scale was used to classify diseased vessels. Two interpreters rated the CO2 DSA image against the ICDSA image on a three-point scale. Patient tolerance was assessed from verbal descriptions. Cohen's kappa was used to determine interobserver agreement and descriptive statistics were used to summarize patient experience. Interobserver agreement ranged from fair to excellent, with most being good or excellent. Three patients (21.4%) could not tolerate the whole procedure and nine patients (64.3%) reported discomfort during the CO2 DSA procedure. CO2 DSA image quality was better for the thigh than the distal runoff and pelvic regions. Our results showed that selective CO2 DSA cannot replace ICDSA as a routine diagnostic tool for PAOD because it does not give images of comparative quality

Urinary Neutrophil Gelatinase-Associated Lipocalin Is a Potential Biomarker for Renal Damage in Patients with Systemic Lupus Erythematosus

Neutrophil gelatinase-associated lipocalin (NGAL) has been demonstrated to be a novel biomarker in acute and chronic kidney disease. We hypothesized that 24-hour urinary NGAL excretion may be a predictor for renal damage in patients with systemic lupus erythematosus (SLE). Thirty-four SLE patients with renal involvement (SLE-renal group), 8 SLE patients without renal involvement (SLE-nonrenal group), 14 patients with non-SLE autoimmune diseases (disease control or DC group), and 12 healthy volunteers (normal control or NC group) were compared for 24-hour urinary excretion of NGAL and different cytokines. We found that the 24-hour urinary NGAL excretion in the SLE-renal group was higher than that in the SLE-non-renal, DC, and NC groups. However, the excretion of interleukin-10, transforming growth factor-β1, and tumor necrosis factor-α was not different between the SLE-renal and SLE-non-renal groups. Furthermore, NGAL excretion in the SLE-renal group was correlated with serum creatinine levels and creatinine clearance, but not with the SLE Disease Activity Index score. Multivariate logistic regression analysis and receiver operating characteristic curve analysis revealed that 24-hour urinary NGAL excretion is a potential biomarker for renal damage in SLE patients, with higher sensitivity and specificity than anti-dsDNA antibody titers

Statistical mechanics approach to some problems in conformal geometry

A weak law of large numbers is established for a sequence of systems of N classical point particles with logarithmic pair potential in \bbR^n, or \bbS^n, n\in \bbN, which are distributed according to the configurational microcanonical measure $\delta(E-H)$, or rather some regularization thereof, where H is the configurational Hamiltonian and E the configurational energy. When $N\to\infty$ with non-extensive energy scaling E=N^2 \vareps, the particle positions become i.i.d. according to a self-consistent Boltzmann distribution, respectively a superposition of such distributions. The self-consistency condition in n dimensions is some nonlinear elliptic PDE of order n (pseudo-PDE if n is odd) with an exponential nonlinearity. When n=2, this PDE is known in statistical mechanics as Poisson-Boltzmann equation, with applications to point vortices, 2D Coulomb and magnetized plasmas and gravitational systems. It is then also known in conformal differential geometry, where it is the central equation in Nirenberg's problem of prescribed Gaussian curvature. For constant Gauss curvature it becomes Liouville's equation, which also appears in two-dimensional so-called quantum Liouville gravity. The PDE for n=4 is Paneitz' equation, and while it is not known in statistical mechanics, it originated from a study of the conformal invariance of Maxwell's electromagnetism and has made its appearance in some recent model of four-dimensional quantum gravity. In differential geometry, the Paneitz equation and its higher order n generalizations have applications in the conformal geometry of n-manifolds, but no physical applications yet for general n. Interestingly, though, all the Paneitz equations have an interpretation in terms of statistical mechanics.Comment: 17 pages. To appear in Physica

Oxidized-monolayer Tunneling Barrier for Strong Fermi-level Depinning in Layered InSe Transistors

In 2D-semiconductor-based field-effect transistors and optoelectronic devices, metal-semiconductor junctions are one of the crucial factors determining device performance. The Fermi-level (FL) pinning effect, which commonly caused by interfacial gap states, severely limits the tunability of junction characteristics, including barrier height and contact resistance. A tunneling contact scheme has been suggested to address the FL pinning issue in metal-2D-semiconductor junctions, whereas the experimental realization is still elusive. Here, we show that an oxidized-monolayer-enabled tunneling barrier can realize a pronounced FL depinning in indium selenide (InSe) transistors, exhibiting a large pinning factor of 0.5 and a highly modulated Schottky barrier height. The FL depinning can be attributed to the suppression of metal- and disorder-induced gap states as a result of the high-quality tunneling contacts. Structural characterizations indicate uniform and atomically thin surface oxidation layer inherent from nature of van der Waals materials and atomically sharp oxide-2D-semiconductor interfaces. Moreover, by effectively lowering the Schottky barrier height, we achieve an electron mobility of 2160 cm$^2$/Vs and a contact barrier of 65 meV in two-terminal InSe transistors. The realization of strong FL depinning in high-mobility InSe transistors with the oxidized monolayer presents a viable strategy to exploit layered semiconductors in contact engineering for advanced electronics and optoelectronics

Attendance-related healthcare resource utilisation and costs in patients with Brugada Syndrome in Hong Kong: A retrospective cohort study.

Understanding healthcare resource utilisation and its associated costs are important for identifying areas of improvement regarding resource allocations. However, there is limited research exploring this issue in the setting of Brugada syndrome (BrS). This was a retrospective territory-wide study of BrS patients from Hong Kong. Healthcare resource utilisation for accident and emergency (A&E), inpatient and specialist outpatient attendances were analysed over a 19-year period, with their associated costs presented in US dollars. A total of 507 BrS patients with a mean presentation age of 49.9 ± 16.3 years old were included. Of these, 384 patients displayed spontaneous type 1 electrocardiographic (ECG) Brugada pattern and 77 patients had presented with ventricular tachycardia/ventricular fibrillation (VT/VF). At the individual patient level, the median annualised costs were 110 (52-224) at the (A&E) setting, 6812 (1982-32414) at the inpatient setting and $557 (326-1001) for specialist outpatient attendances. Patients with initial VT/VF presentation had overall greater costs in inpatient ($20161 [9147-189215] vs. $5290 [1613-24937],p<0.0001) and specialist outpatient setting ($776 [438-1076] vs. $542 [293-972],p=0.015) compared to those who did not present VT. In addition, patients without Type 1 ECG pattern had greater median costs in the specialist outpatient setting ($7036 [3136-14378] vs. $4895 [2409-10554],p=0.019). There is a greater healthcare demand in the inpatient and specialist outpatient settings for BrS patients. The most expensive attendance type was inpatient setting stay at$6812 per year. The total median annualised cost of BrS patients without VT/VF presentation was 78% lower compared to patients with VT/VF presentation. [Abstract copyright: Copyright © 2022 The Authors. Published by Elsevier Inc. All rights reserved.

High levels of serum macrophage migration inhibitory factor and interleukin 10 are associated with a rapidly fatal outcome in patients with severe sepsis

SummaryObjectivesThe aim of this study was to delineate the association between high macrophage migration inhibitory factor (MIF) and interleukin 10 (IL-10) levels in the early phase of sepsis and rapidly fatal outcome.MethodsOne hundred and fifty-three adult subjects with the main diagnosis of severe sepsis (including septic shock) admitted directly from the emergency department of two tertiary medical centers and one regional teaching hospital between January 2009 and December 2011, were included prospectively. MIF and IL-10 levels were measured and outcomes were analyzed by Cox regression analysis according to the following outcomes: rapidly fatal outcome (RFO, death within 48h), late fatal outcome (LFO, death between 48h and 28 days), and survival at 28 days.ResultsAmong the three outcome groups, IL-10 levels were significantly higher in the RFO group (p < 0.001) and no significant differences were seen between the LFO and survivor groups. After Cox regression analysis, each incremental elevation of 1000 pg/ml in both IL-10 and MIF was independently associated with RFO in patients with severe sepsis. Each incremental elevation of 1000 pg/ml in IL-10 increased the RFO risk by a factor of 1.312 (95% confidence interval 1.094–1.575; p=0.003); this was the most significant factor leading to RFO in patients with severe sepsis.ConclusionsPatients with RFO exhibited simultaneously high MIF and IL-10 levels in the early phase of severe sepsis. Incremental increases in both IL-10 and MIF levels were associated with RFO in this patient group, and of the two, IL-10 was the most significant factor linked to RFO