OBJECTIVE: Clozapine is known as an atypical antipsychotic drug which has less side effects in the extrapyramidal system than typical antipsychotic drugs and recommended as a treatment of choice in severe tardive dyskinesia (TD). However, it has been reported that the existing TD was worsened or new TD appeared in some cases where the antipsychotic drugs were switched to clozapine. METHODS: We experienced a single case in which TD was appeared in the tongue and jaw 5 months after chlorpromazine was switched to clozapine. RESULTS: The subject was 57 years old male patient with bipolar disorder. He had been treated intermittently with lithium and chlorpromazine for over 30 years. Five months after switching from chlorpromazine to clozapine, TD appeared in the tongue and jaw. Using Extrapyramidal Symptom Rating Scale (ESRS), the dyskinesia score was 10. Hence, clozapine was stopped and chlorpromazine was re-administrated resulting gradual improvement of TD. The dyskinesia score of ESRS was dropped to 6. CONCLUSION: It is speculated that this case is most likely a withdrawal tardive dyskinesia but other possibilities should be considered too. The question "Does withdrawal tardive dyskinesia occur more easily when switched to clozapine which has a weak dopamine antagonism?" should be addressed in future study.
Male ; Humans

BACKGROUND AND OBJECTIVES: The aim of this study was to identify clinical, lesional, and procedural predictors for adverse outcomes of coronary angioplasty and stenting in coronary bypass candidates. SUBJECTS AND METHODS: This cohort study included 107 consecutive candidates for coronary artery bypass surgery who underwent percutaneous coronary intervention with multiple coronary stents between Jan 2004 and Dec 2011. The study endpoint was major adverse cardiovascular events (MACEs) including all-cause mortality, nonfatal myocardial infarction, repeat revascularization, and stent thrombosis. Follow up was from the date of index percutaneous coronary intervention to the date of the first MACE, date of death, or December 31, 2015, whichever came first. RESULTS: In this study (age 62.3±11.2 years, 86% male), 38 patients (36%) had MACE. Among baseline, angiographic, and procedural parameters, there were significant differences in lower left ventricular ejection fraction (LVEF) and worse renal function. In a Cox regression model, LVEF and chronic kidney disease (CKD) were significant predictors for MACE. After a multivariate adjustment, CKD remained a significant predictor of MACEs (hazard ratio: 2.97, 95% confidence interval: 1.50-5.90). CONCLUSIONS: For coronary bypass candidates who were treated with coronary angioplasty and stenting, CKD seems to be the strongest predictor for adverse outcomes compared with other traditional factors.
Angioplasty ; Cohort Studies ; Coronary Artery Bypass ; Coronary Artery Disease ; Follow-Up Studies ; Humans ; Mortality ; Myocardial Infarction ; Percutaneous Coronary Intervention* ; Renal Insufficiency, Chronic* ; Stents ; Stroke Volume ; Thrombosis

OBJECTIVETo examine the changes of the mechanical properties of 7 different light-cured composite resins after thermal cycling and the correlations between these properties.

METHODSSeven different light-cured composite resins, including 2 microfilled composites (A110:AH and ESTELITE :ET), 3 microhybrid composites (AELITE:AT, Z250:ZS, and CharmFil plus:CP), and 2 nanohybrid composites (Z350:ZH and Grandio:GD), were prepared into test specimens with a diameter of 12 mm and a thickness of 1.0 mm. The specimens were stored in distilled water at 37 degrees celsius; for 24 h prior to 1 000 thermal cycles of 5 degrees celsius; for 15 s and 55 degrees celsius; for 15 s. The biaxial flexural strength (δ(f)) was tested using the ball-on-three-ball method at a crosshead speed of 0.5 mm/min (ISO4049). The fracture surface was observed under scanning electron microscope (SEM), and the remaining specimens underwent Knoop hardness test with a 50-g loading for 10 s.

RESULTSThe highest and lowest Weibull modulus was observed in AH (18.752) and AT (5.290) group, respectively. The highest and lowest biaxial flexural strength was observed in ZS (158.2 MPa) and ET (54.0 MPa) groups, respectively. The δ(f) of the tested materials decreased in the order of microhybrid composite, nanohybrid composite, and microfiller composite, and the δ(f) showed no significant difference between the composites with a similar filler (P>0.05). The fracture number was positively correlated to the strength of the material. The Knoop hardness numbers (H) was the highest in GD group (110.81∓14.77 kg/mm(2)) and the lowest in AH group (42.81∓1.91 kg/mm(2)). SEM showed that the interface region of the matrix and the filler was vulnerable to crack formation.

CONCLUSIONThe nanohybrid composite resins better suit clinical applications than microhybrid composites. The applicability of Knoop hardness test in hardness measurement of the composite resins needs to be further demonstrated.

Composite Resins ; chemistry ; Materials Testing ; Nanocomposites ; Nanoparticles ; Stress, Mechanical ; Temperature ; Tensile Strength

BACKGROUND: Measles is a highly contagious disease caused by measles virus. Although the introduction of live attenuated measles vaccines has dramatically abrogated the endemic incidence of measles in world-wide, there are still 30 million measles cases and nearly one million deaths from measles annually. In this study, we characterized the measles outbreak in Gwangju Metropolitan City during the 2000~200 1 epidemic. METHODS: Study population included measles patients in Gwangju Metropolitan City from April, 2000 to May, 200 1. We conducted a questionnaire survey on the patients and analyzed the records based on the clinical guideline of World Health Organization (WHO). Furthermore, we isolated the measles viruses from clinical specimens of patients and analyzed the nucleotide sequences of nucleoprotein (N) gene. RESULTS: During the April 2000 to May 2001, measles epidemic, a total of 3,2 17 measles patients were reported in Gwangju Metropolitan City. The first patient of measles was reported on April, 2000. The incidence reached its peak in November, 2000 and decreased thereafter. The age distribution of the patients were various, which was ranged from 1 month after birth to 30 year adult and the peak incidence was observed at 7~13 year old. Various complications were developed in 232 patients and 2 of them died. Phylogenetic analyses of nucleotide sequences and deduced amino acid sequences of the N genes of isolated viruses revealed that all viruses isolated in Gwangju Metropolitan City were grouped into the clade H1. This suggests that a single, predominant viral genotype was responsible for the measles epidemic in Gwangju Metropolitan City. CONCLUSION: In this study, we characterized the measles outbreak in Gwangju Metropolitan City during 2000~200 1. The measles outbreak in Gwangju Metropolitan City was considered to be caused by single genotype of measles virus (clade H1). After a massive vaccination campaign among 7~16 years old children to eliminate indigenous measles from this country, it is important to continue measles vaccination and intensive surveillance clinically as well as virologically.
Adult ; Age Distribution ; Amino Acid Sequence ; Base Sequence ; Child ; Genotype ; Gwangju* ; Humans ; Incidence ; Measles virus ; Measles* ; Nucleoproteins ; Parturition ; Vaccination ; Vaccines ; World Health Organization ; Surveys and Questionnaires

Background/Aims: Chronic hepatitis C (CHC) patients who failed antiviral therapy are at increased risk for hepatocellular carcinoma (HCC). This study assessed the potential role of metformin and statins, medications for diabetes mellitus (DM) and hyperlipidemia (HLP), in reducing HCC risk among these patients. Methods: We included CHC patients from the T-COACH study who failed antiviral therapy. We tracked the onset of HCC 1.5 years post-therapy by linking to Taiwan’s cancer registry data from 2003 to 2019. We accounted for death and liver transplantation as competing risks and employed Gray’s cumulative incidence and Cox subdistribution hazards models to analyze HCC development. Results: Out of 2,779 patients, 480 (17.3%) developed HCC post-therapy. DM patients not using metformin had a 51% increased risk of HCC compared to non-DM patients, while HLP patients on statins had a 50% reduced risk compared to those without HLP. The 5-year HCC incidence was significantly higher for metformin non-users (16.5%) versus non-DM patients (11.3%; adjusted sub-distribution hazard ratio [aSHR]=1.51; P=0.007) and metformin users (3.1%; aSHR=1.59; P=0.022). Statin use in HLP patients correlated with a lower HCC risk (3.8%) compared to non-HLP patients (12.5%; aSHR=0.50; P<0.001). Notably, the increased HCC risk associated with non-use of metformin was primarily seen in non-cirrhotic patients, whereas statins decreased HCC risk in both cirrhotic and non-cirrhotic patients. Conclusions Metformin and statins may have a chemopreventive effect against HCC in CHC patients who failed antiviral therapy. These results support the need for personalized preventive strategies in managing HCC risk.

Objectives: This study aimed to present the Asia-Pacific consensus on long-term and sequential therapy for osteoporosis, offering evidence-based recommendations for the effective management of this chronic condition.The primary focus is on achieving optimal fracture prevention through a comprehensive, individualized approach. Methods: A panel of experts convened to develop consensus statements by synthesizing the current literature and leveraging clinical expertise. The review encompassed long-term anti-osteoporosis medication goals, first-line treatments for individuals at very high fracture risk, and the strategic integration of anabolic and anti resorptive agents in sequential therapy approaches. Results: The panelists reached a consensus on 12 statements. Key recommendations included advocating for anabolic agents as the first-line treatment for individuals at very high fracture risk and transitioning to anti resorptive agents following the completion of anabolic therapy. Anabolic therapy remains an option for in dividuals experiencing new fractures or persistent high fracture risk despite antiresorptive treatment. In cases of inadequate response, the consensus recommended considering a switch to more potent medications. The consensus also addressed the management of medication-related complications, proposing alternatives instead of discontinuation of treatment. Conclusions This consensus provides a comprehensive, cost-effective strategy for fracture prevention with an emphasis on shared decision-making and the incorporation of country-specific case management systems, such as fracture liaison services. It serves as a valuable guide for healthcare professionals in the Asia-Pacific region, contributing to the ongoing evolution of osteoporosis management.