Thousands of millions of people faced devastating impacts around the world during COVID-19 pandemic. Not only anxiety or fear of COVID-19 dominated the negative psychological impacts, mental disorders such as depression, posttraumatic stress disorder, and sleep disturbance increasingly appeared during or after the pandemic. Apart from the confirmed patients, survivors of the viral infection, close family members, elders, children and adolescents, people quarantined, people with preexisting psychiatric conditions, frontline police, emergency medical services, and health-care workers, mental distress specific to the vulnerable groups should be recognized. Preventive strategies including self-regulations, leadership, and teamwork were highlighted. Specific evaluations for at-risk population and efficacious treatment such as cognitive behavioral treatment could be considered. This article delineated directions for mental health workers during pandemic.

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Background: Cardiac hypertrophy (CH) is the asymptomatic enlargement of ventricular walls witnessed in diabetes and hypertension, for which early metabolite differences and prediction are less stated previously. Aim: The aim of the study was (i) to understand the metabolic and ventricular events in diabetes and nondiabetes induced CH at the end of 2 weeks and (ii) to identify significant metabolite predictors and pathways that influence the seven metabolic and physiological responders of CH, namely, 3-hydroxybutyrate (3-HB); lactic acid; urea; and electrocardiography (ECG) waves (QRS complex, R amplitude, R-R interval, and heart rate). Methods: Diabetic rat models of CH using streptozotocin (40 mg/kg, i. p., single dose), and nondiabetic models using adrenaline (0.3 mg/kg, i. p, 2 weeks) were developed. Blood glucose levels, ECG, heart weight/body weight ratio, histopathological analysis, and serum metabolite analysis using gas chromatography mass spectrometry were performed at the end of 2 weeks. Strong metabolite predictors and pathways were identified using Pearson's correlation, multiple regression (MRA) and metabolite set enrichment (MSEA) analyses. Results: The prevalence of CH was observed through preliminary screenings at the end of 2 weeks. Galactose, leucine, erythrose, sorbitol, and valine were identified as significant (P < 0.05) predictors in SZ model, whereas isoleucine, galactose, leucine, inositol, and palmitic acid were identified in ADR model. However, galactose metabolism, branched-chain amino acid, and lactose degradation pathways were mapped as the highly influential apparent pathways during early CH remodeling in both the models. Conclusion: This study identified putative initial metabolite shifts, significant predictors pathways that can aid in forecasting, intervention, and prevention of CH.

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Background: Homicidal offenders with schizophrenia who went through psychiatric evaluations are a small but significant group during a criminal appeal. Aim: Our aims are to explore whether the types of crime, such as homicide or not, would be related to the verdicts for the alleged offenders with schizophrenia in Taiwan. Our hypothesis was that homicide cases, rather than other alleged offenses, would be more likely to be regarded as no responsibility (legal insanity) or diminished responsibility for those defendants in the forensic psychiatric evaluation opinions or the court verdicts. Methods: A retrospective comparison of the homicide offenders with the nonhomicide offenders with schizophrenia, registered between December 2000 and November 2009, was conducted in the web-based, national, open-access court verdict databank. Results: There were 33 (3.4%) in 9691 criminal homicide offenders that had a diagnosis of schizophrenia. There were 33 in the homicide group and 22 in the nonhomicide group. Among these defendants in the homicide group, 3 (9.1%) were regarded as legal insanity, and 21 (63.6%) were regarded as diminished responsibility in comparison to the zero (0%) as legal insanity and nine (40.9%) as diminished responsibility in the nonhomicide group (P = 0.029). In addition, the group with multiple evaluations tended to receive forensic psychiatric opinions as legal insanity (N = 3; 33.3%), and the group with single evaluation tended to receive forensic psychiatric opinions as diminished responsibility (N = 16; 66.67%) (P = 0.017). The group with multiple evaluations tended to be ruled as legal insanity in the court (P = 0.001). Conclusion: Homicide cases would be more likely to be regarded as legal insanity or diminished responsibility for the defendants with schizophrenia in the forensic psychiatric evaluation opinions or the court verdicts.

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Background: Coronary artery calcification (CAC) is a well-validated parameter reflecting the extent of subclinical atherosclerosis. Atherosclerosis manifestations are commonly presented in atrial fibrillation (AF) patients. Nevertheless, the long-term cardiovascular risks in AF patients with concomitant CAC are limited. Aim: The aim of this study is to identify the prognostic impact of CAC in patients with AF. Methods: A total of 646 eligible patients who underwent noncontrast coronary computed tomography (nCCT) from January 2012 to December 2018 were evaluated and retrospectively followed up for 2 years. The patients were assessed for cardiovascular outcomes, including nonfatal myocardial infarction, nonfatal stroke, late coronary revascularization, major adverse cardiovascular event (MACE), and total coronary and total composite events, by a multivariable Cox regression hazards model with adjusting for significant confounding factors. Results: AF patients with severe CAC (CAC score [CACS] >400 Agatston units) had significantly higher risks of composite cardiovascular outcomes, including MACEs (adjusted hazard ratio [HR]: 57.18, 95% confidence interval [CI]: 2.28–1434.41, P = 0.014), total coronary events (adjusted HR: 16.48, 95% CI: 1.21–224.15, P = 0.035), and total composite events (adjusted HR: 26.35, 95% CI: 2.45–283.69, P = 0.007), than sinus rhythm patients without CAC. Moreover, severe CAC in AF patients was a significant predictor of total composite events (adjusted HR: 59.1, 95% CI: 2.16–1616.33, P = 0.016). Conclusion: Severe CAC in AF patients may cause significantly higher cardiovascular risks, highlighting the role of nCCT in determining CACs for early risk evaluation to facilitate aggressive risk modification and thereby to prevent subsequent cardiovascular events. Further, large, prospective studies are needed to validate the impact of CAC in patients with AF.

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Spontaneous lumbar facet joint bleeding is rarely observed in patients with hemophilia. Since it is categorized as a spinal epidural hematoma, surgery is the main treatment. Conservative treatment was successful in patients with minor or absent neurological deficits. We aimed to present the case of a patient with severe hemophilia who suffered from acute sciatica caused by lumbar facet joint hematoma. Nonsurgical treatment using a multidimensional approach was provided. The hemarthrosis is completely resolved. The patient recovered from clinical neurological symptoms without recurrence throughout the 4-year follow-up period. Spontaneous lumbar facet joint hemarthrosis in patients with severe hemophilia who present with mild neurological symptoms can be conservatively treated if the hemarthrosis is recognized early. Moreover, a multidisciplinary team approach is paramount in achieving good patient outcomes.

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We present the case of a single, retired, 51-year-old Taiwanese female who had left groin pain when squatting, sitting, and walking for months. She visited our outpatient department (OPD) for further evaluation. During physical examination at the OPD, limited hip flexion and abduction were observed in comparison with the contralateral hip in the supine position. Impingement tests including flexion, abduction, and external rotation test and flexion, adduction, and internal rotation test were positive. In addition, the extension external pain and Patrick test results were positive. Pelvis radiography revealed a crossover sign and lateral center-edge angle of 40.6°. Magnetic resonance imaging revealed a degenerative tear of the anterosuperior labrum with a prominent pincer lesion. Consequently, she was admitted for arthroscopy-assisted rim resection of the pincer-type lesion and labral refixation. After surgery, the patient recovered well.

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Respiratory syncytial virus (RSV) is a common pathogen that causes respiratory tract infection and has been found to co-infect with other bacteria. Although the virus can cause morbidity and mortality in the elderly, RSV-bacteria co-infection had rarely been reported. In this paper, we reported the case of an elderly woman with RSV and Streptococcus pneumoniae co-infection in a familial cluster during the COVID-19 pandemic era. The patient was treated appropriately and showed complete recovery.

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Obturator hernia (OH) is uncommon. With its low incidence, diagnosis can be difficult with physical exams and laboratory data only. Imaging study with computer tomography significantly improved diagnosis accuracy and lower bowel resection and mortality rate. We present a rare case of a 70-year-old female with OH and managed by laparoscopic nonmesh repair method.

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