This case report describes a patient in their early 60s with chest pain during exertion.

As the scope of mental work continues to expand and technology continues to develop, people are more and more concerned about the issue of higher education. In order to measure the health status of the higher education system and evaluate the effectiveness of the policy, we establish the Health Evaluation System of Higher Education and the Prediction Model. task 1 In order to better quantify the criteria of health evaluation, we divide the model into four layers through AHP algorithm, select and define 13 fourth-layer indicators, and use Entropy Weight Method (EWM) to objectively calculate the fourth-layer indicators. The Analytic Hierarchy Process (AHP) is used to calculate the third-level weight. According to the population of different countries, we use the complex method of AHP and EWM and scale the indicator to create a scoring mechanism. In task 2 We firstly apply the model to a number of countries to test its suitability, and the results are in good agreement with the education assessment lists published by the United Nations. And we find that India is a country where there is still room for improvement in the education system. task 3 We propose an attainable and reasonable vison for India's system that supports a healthy and sustainable system of higher education. task 4 According to the scores of India in various indicators and the total score obtained in task 2, we judge that the score of India is unqualified. task 5 We select three of the lowest scores in India's higher education system out of 13 indicators, and propose targeted policies and a implementation timeline that will support the migration from current state to your proposed state. task 6 We establish a prediction model based on ARIMA, and substitute time series data into the prediction model to obtain the prediction results. Then, we use AHP and EWM algorithms to calculate the first-level targets for comparison, so as to evaluate the effectiveness of the policies. task 7 We reference and analyze the various situations in India and the real world impact of the implementation plan, find that the change is very difficult, and analyze the feasibility of the policy.

Serine/threonine kinase 39 (STK39) is overexpressed in various tumor tissues and plays an essential role in tumor progression. In this study, we investigated the clinical value, as well as the potential functions and mechanisms of STK39 in cholangiocarcinoma (CCA). The results showed that STK39 was overexpressed in CCA and negatively associated with the prognosis of patients with CCA. Functionally, STK39 knockdown suppressed cell proliferation, migration, and invasion, while STK39 overexpression facilitated tumor aggressiveness. The tumor-promoting effects of STK39 in CCA were also validated by in vivo experiments. Mechanistically, RNA-seq analysis identified that STK39 enhanced the progression of CCA by activating PI3K/AKT signaling pathway. Furthermore, overexpression of STK39 could induce gemcitabine resistance in CCA cells. Moreover, the increased expression of STK39 may be mediated by the dysregulation of miR-26a-5p. In summary, STK39 could be served as a valuable prognostic candidate and a potential therapeutic target of CCA.

Herpes zoster occurs with increased frequency in patients with systemic lupus erythematosus (SLE). The aim of this study was to identify and evaluate clinical and laboratory risk factors associated with development of herpes zoster in patients with SLE. A retrospective case-control study was performed in a population of patients with SLE. Patients were identified as cases if their first episode of herpes zoster occurred after diagnosis of SLE. Patients with SLE who never developed herpes zoster were enrolled as controls. Medical charts and laboratory data for both cases and control patients were comprehensively reviewed. A total of 65 cases and 105 controls were included. Risk factors associated with the development of herpes zoster in patients with SLE were found to be lymphopaenia, anti-Ro antibodies, anti-RNP antibodies, neuropsychiatric manifestations, renal involvement and cyclophosphamide use. Therefore, the presence of certain disease manifestations in patients with SLE represents risk factors for the development of herpes zoster.

ejd.2013.1965 Auteur(s) : Cheng-Che E. Lan1,2, Hsin-Su Yu1, Wan-Chen Li1, Ying-Chin Ko3, Ching-Shuang Wu4, Yi-Wei Lu1, Yi-Hsin Yang5, Gwo-Shing Chen1 d700086@kmu.edu.tw 1 Department of Dermatology and College of Medicine, 4 Department of Medical Laboratory Science and Biotechnology, 5 School of Pharmacy, College of Pharmacy, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Shih-Chuan 1st Rd, Kaohsiung, Taiwan 2 Department of Dermatology, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, [...]

Psoriasis is a chronic inflammatory disease. The aim of this study was to evaluate the effects of methotrexate and retinoid on risks for developing cerebrovascular disease among psoriatic patients. A population-based nested case-control study was conducted using the Taiwanese National Health Insurance database. Cox proportional hazards models were adopted. The hazard ratio (HR) of newly developed cerebrovascular disease was 1.28 (95% confidence interval (CI) = 1.162-1.413; p < 0.0001) for psoriatic vs. non-psoriatic subjects. In terms of the effects of methotrexate or retinoid on the occurrence of cerebrovascular disease, a significant protection effect (HR = 0.50; 95% CI = 0.27-0.92; p = 0.0264) was found for patients with methotrexate prescription. Retinoid prescription showed no protective effect. Further analyses revealed that a low cumulative methotrexate dose is associated with significant protective effect (HR = 0.53; 95% CI = 0.28-1.00; p = 0.0486) while a high cumulative dose was not (HR 0.80; 95% CI = 0.11-5.68; p = 0.8214). These results suggest that psoriatic patients receiving low-dose methotrexate treatment may have reduced risk for developing cerebrovascular disease. Further prospective study should be performed to validate the vasculoprotective effect of this treatment strategy.

Background: Psoriasis is an inflammatory skin condition. Epidemiology studies from different parts of the world have shown that psoriasis is associated with different components of metabolic syndrome. The association between psoriasis and development of cancer has not yet been clearly established.Objective: We hypothesize that chronic inflammation is the driving force that enhances the risk of malignancy in psoriatic patients and suspect that psoriatic patients have higher risks for developing cancers that are most prevalent in the studied population.Methods: Using the nested case-control approach derived from the Taiwanese population-based cohort, the current study was launched to validate this hypothesis. Results 8180 psoriatic patients and 163,600 age-matched controls were included in this study. Psoriatic patients were 1.20 folds (95% CI = 1.06-1.36; p = 0.004) more likely than controls to develop cancer. Further analyses revealed that incident cancers derived from digestive tract, the most common cancer origin found in Taiwanese population, were most significantly associated psoriasis. Patients with psoriasis and diabetes mellitus, a frequent comorbid condition independently associate with both psoriasis and cancer, conferred the highest risk for developing digestive tract cancers, having risks of 1.98 folds (95% CI: 1.11-3.52) and 1.68 folds (95%CI: 1.23-2.28) for the 41-60 years-old and 61-80 years-old age group, respectively. Both psoriasis and diabetes were independently associated with development of digestive tract cancers in the 41-60 years-old patient group.Conclusion: Prevalent cancers in the population should be carefully monitored in the psoriatic patients after middle age (beyond 40 years of age) especially for those with concomitant diabetic conditions. (c) 2012 Japanese Society for Investigative Dermatology. Published by Elsevier Ireland Ltd. All rights reserved.

Background Psoriasis is an important systemic inflammatory disease that often leads to severe vascular diseases. This study was launched to determine if joint involvement affects incidence of vascular comorbidities in psoriatic patients. In addition, potential vasculo-protective effects of methotrexate in psoriatic patients were also evaluated. Method A population-based retrospective cohort study was conducted using the Taiwanese National Health Insurance database spanning from 1996 to 2006. Accordingly, 7648 and 284 psoriatic patients without or with arthritis, respectively, were identified. To ensure the temporal relationship between different events, those with date of first diagnosis psoriasis during the year of 1996 were excluded from subsequent analyses. In addition, those with diagnosis of cerebrovascular or cardiovascular diseases prior to onset of psoriasis were also excluded from relevant subsequent analyses. Result Taking psoriatic patients without arthritis as the referent group, the hazard ratio for incident cerebrovascular disease was 1.82 (95% CI=1.17-2.82) for psoriatic patient with arthritis. In addition, psoriatic patients without arthritis who had methotrexate treatment showed reduced risks for incident cerebrovascular disease as compared with those with no arthritis and had received no methotrexate/retinoid treatment. Similar analyses were performed on cardiovascular diseases, and equivalent results were obtained. Conclusion Our study indicated that arthritis is a potential determinant for psoriatic patients in terms of incident vascular comorbidities. In addition, methotrexate treatment may be associated with reduced risks for development of severe vascular diseases in psoriatic patients without arthritis. Further studies should focus on the clinical complications associated with psoriatic patients with or without arthritis.

Chronic hand eczema is an important occupational skin disease with atopic dermatitis (AD) and wet work being the most important risk factors. This study was launched to analyse the potential association between AD-related inflammation genes and development of non-atopic hand eczema among nurses in University Hospital. Atopic eczema, non-atopic hand dermatitis and control groups were identified. The association between occurrence of non-atopic hand eczema and interleukin (IL)-13, IL-4 and IL-5 gene variants was analysed. IL13 rs20541 A allele [assuming recessive model; odds ratio (OR) = 3.38, 95% CI: (1.637.00)] showed association with development of non-atopic hand eczema. Additive score analyses showed combination of this gene variant with previously identified risk factors including certain SPINK5 polymorphism and more than 10 years of work experience conferred highest risk for development of non-atopic hand eczema. As non-atopic hand eczema made up significant portion of occupational skin diseases, further studies should be focused on this commonly encountered skin condition.

Abstract:  The term ‘hand dermatitis’ describes inflammatory skin condition localized to the hands. Nurses working at hospital settings are prone to develop hand dermatitis. The current study aimed to evaluate whether certain genetic polymorphisms were associated with the development of atopic eczema or non‐atopic hand dermatitis in Taiwanese population. Nurses of Kaohsiung Medical University Hospital were recruited. Atopic eczema, non‐atopic hand dermatitis and normal control groups were identified. The serine protease inhibitor Kazal type 5 (SPINK5), filaggrin and interleukin‐31 (IL‐31) gene variants were compared between the diseased and control groups. Our results showed that rs2303070 T allele of SPINK5 (assuming recessive model; OR = 3.58, 95% CI 1.63–7.84; P = 0.0014) and rs7977932 G allele of IL‐31 (assuming recessive model; OR = 18.25, 95% CI = 3.27–101.94; P = 0.0009) were associated with increased risks of developing atopic eczema, while rs6892205 G allele of SPINK5 (assuming dominant model; OR = 3.79, 95% CI 1.55–9.28; P = 0.0036) was associated with the development of non‐atopic hand dermatitis. In summary, our results showed that distinct SPINK5 and IL‐31 gene variants were associated with the development of atopic eczema and non‐atopic hand dermatitis. The barrier function, particularly those regulated by SPINK5, may play an important role in the development of both atopic eczema and non‐atopic hand dermatitis.

BACKGROUND:Nurses are prone to develop hand dermatitis. Although an atopic constitution has been identified as a genetic risk factor, the behavioural risk factors associated with hand dermatitis in wet work conditions have not been fully explored.OBJECTIVES:This study aimed to clarify the impact of atopic eczema (fulfilling the diagnostic criteria during the past 1 year) on the occurrence of hand dermatitis and to identify the behavioural risk factors among non-atopic nurses with hand dermatitis.METHODS:From August 2007 to July 2009, nurses from Kaohsiung Medical University Hospital were recruited. The associations between different risk factors and hand dermatitis were documented. In addition, the behavioural risk factors among non-atopic nurses were evaluated via observational study.RESULTS:One thousand one hundred and thirty-two nurses participated in the first part of the study, which revealed that individuals with atopic eczema had a 3.76-fold increased risk for hand dermatitis. However, among 248 nurses with hand dermatitis, only 43 had atopic eczema. The observational study performed on 140 non-atopic nurses identified frequency of hand washing as the behavioural risk factor associated with hand dermatitis.CONCLUSIONS:Although atopic eczema is the major risk factor for hand dermatitis, those with atopic eczema constitute only 17% of nurses with hand dermatitis. Decreasing hand washing frequency is the most effective strategy to reduce the occurrence of hand dermatitis among non-atopic nurses.

Background: Atopic dermatitis (AD) is a chronic, relapsing dermatosis. Previous Studies have focused mostly on pediatric patients, and investigations emphasizing adult AD have been limited.Objective: We set Out to determine the I-year prevalence and evaluate the validity of the International Study of Asthma and Allergies in Childhood (ISAAC) and United Kingdom Working Party (UKWP) AD questionnaires of adult AD in Taiwan.Methods: We conducted a cross-sectional Study among nursing staff at a university hospital. The I-year prevalence of AD was assessed by ISAAC and UKWP questionnaires. Subsequently, the dermatologists' diagnosis based on Hanifin and Rajka criteria was used as a reference for validation.Results: The overall response rate was 92.9%, equivalent to 1131 complete questionnaires. Ninety adult patients with AD (81%) were identified by dermatologists' diagnosis whereas ISAAC identified 107 (9-5%); sensitivity and specificity were 36.7% and 92.9%, respectively. UKWP identified 42 (3.7%) patients with AD; sensitivity and specificity were 42.2% and 99.6%, respectively. Using the receiver operating characteristic Curve analysis, the UKWP criteria performed significantly better than its ISAAC counterpart. Further analysis indicated that modification of these criteria resulted in significant improvement in their diagnostic efficacy. More specifically, modified ISAAC showed 90.0% and 55.2% sensitivity and specificity, respectively, whereas modified UKWP demonstrated 82.2% and 94.2% sensitivity and specificity, respectively.Limitation: Most Of the Study Subjects were female with a high educational background.Conclusion: Currently available questionnaire instruments do not perform well in the identification of adult patients with AD. Modification of the original questionnaires may allow for future large-scale epidemiologic Studies. (J Am Acad Dermatol 2009;61:806-12.)

BACKGROUND:Hand eczema is a commonly encountered occupational disease and has a negative impact on life quality. OBJECTIVE:This study aimed to identify the specific conditions that may pose a higher risk for occurrence of hand eczema and evaluate the impact of hand eczema on life quality. METHOD:Nursing staff from a university hospital were invited to participate in a cross-sectional study. Validated questionnaires for hand eczema and life quality were used to evaluate the point prevalence and determine the impacts of hand eczema, respectively. RESULTS:The overall response rate was 93%, equivalent to 1132 completed questionnaires. Two hundred and forty-eight (22%) reported occurrence of hand eczema. Occurrence of hand eczema was significantly associated with nursing for >10 years and working in a special care unit, with prevalences of 27% and 26%, respectively. In addition, hand eczema was associated with suboptimal life quality; pruritus or burning sensations were associated with a lower quality of life among those with hand eczema. CONCLUSION:Hand eczema is a work-related problem for nursing staff; proper preventive programmes should be implemented for those nursing staff working in high-risk areas to avoid further lowering of their quality of life.