Severe sepsis is a potentially deadly illness and always requires intensive care. Do-not-resuscitate (DNR) orders remain a debated issue in critical care and limited data exist about its impact on ...care of septic patients, particularly in East Asia. We sought to assess outcome of severe sepsis patients with regard to DNR status in Taiwan.
A retrospective cohort study was conducted in intensive care units (ICUs) between 2008 and 2010. All severe sepsis patients were included for analysis. Primary outcome was association between DNR orders and ICU mortality. Volume of interventions was used as proxy indicator to indicate aggressiveness of care.
Sixty-seven (9.4%) of 712 patients had DNR orders on ICU admission, and these patients were older and had higher disease severity compared with patients without DNR orders. Notably, DNR patients experienced high ICU mortality (90%). Multivariate analysis revealed that the presence of DNR orders was independently associated with ICU mortality (odds ratio: 6.13; 95% confidence interval: 2.66-14.10). In propensity score-matched cohort, ICU mortality rate (91%) in the DNR group was statistically higher than that (62%) in the non-DNR group (p <0.001). Regarding ICU interventions, arterial and central venous catheterization were more commonly used in DNR patients than in non-DNR patients.
From the Asian perspective, septic patients placed on DNR orders on ICU admission had exceptionally high mortality. In contrast to Western reports, DNR patients received more ICU interventions, reflecting more aggressive approach to dealing with this patient population. The findings in some ways reflect differences between East and West cultures and suggest that DNR status is an important confounder in ICU studies involving severely septic patients.
Acinetobacter baumannii-induced nosocomial pneumonia has become a serious clinical problem because of high antibiotic resistance rates. Antimicrobial peptides (AMP) are an ideal alternative strategy ...due to their broad-spectrum of antimicrobial activity and low incidence of bacterial resistance. However, their application is limited by toxicity and stability in vivo. The present study used a mouse model to directly identify potential AMPs effective for treatment of A. baumannii-induced pneumonia. Fifty-eight AMPs were screened and two identified (SMAP-29 and TP4) to have prophylactic effects which prevented the death of mice with pneumonia. Furthermore, two TP4 derivatives (dN4 and dC4) were found to have therapeutic activity in pneumonia mouse models by peritoneal or intravenous administration. Both dN4 and dC4 also inhibited and/or eliminated A. baumannii biofilms at higher doses. Taken together, these data suggest the AMP derivatives dN4 and dC4 represent a potential treatment strategy for A. baumannii-induced pneumonia.
Recently, aluminum ion batteries (AIBs) have attracted great attention across the globe by virtue of their massive gravimetric and volumetric capacities in addition to their high abundance. Though ...carbon derivatives are excellent cathodes for AIBs, there is much room for further development. In this study, flexuous graphite (FG) was synthesized by a simple thermal shock treatment, and for the first time, an Al/FG battery was applied as a cathode for AIBs to reveal the real-time intercalation of AlCl4 – into FG with high flexibility by using in-situ scanning electron microscope (SEM) measurements exclusively. Similarly, in-situ X-ray diffraction (XRD) and in-situ Raman techniques have been used to understand the anomalous electrochemical behavior of FG. It was found that FG adopts a unique integrated intercalation–adsorption mechanism where it follows an intercalation mechanism potential above 1.5 V and an adsorption mechanism potential below 1.5 V. This unique integrated intercalation–adsorption mechanism allows FG to exhibit superior properties, like high capacity (≥140 mAh/g), remarkable long-term stability (over 8000 cycles), excellent rate retention (93 mAh/g at 7.5 A/g), and extremely rapid charging and slow discharging.
Growing evidence suggests the link between gut microbiota and mood regulation. The current study aimed to identify microbiota targets for major depressive disorder (MDD) and mood-related traits in ...Taiwanese samples, while taking into account the influence of dietary patterns. We recruited 36 MDD patients and 37 healthy controls for 16S rRNA gene sequencing. We assessed nutrient content using food frequency questionnaire, and mood related phenotypes, including depressive severity, anxiety, and perceived stress. Analysis of composition of microbiomes (ANCOM) models were performed to evaluate microbiota compositions between patients and controls, while adjusted for fat intake% and sequencing platforms. We found 23 taxa (4 phyla, 7 families and 12 genera) to be associated with depression and beta diversity was differed between groups. Phylum Actinobacteria and Firmicutes were overrepresented in MDD patients. At genus level, Bifidobacterium (7%) and Blautia (8%) had relatively high abundance among MDD patients, while Prevotella (16%) had high abundance in controls. Holdemania exhibited moderate correlation with anxiety (r = 0.65) and perceived stress level (r = 0.49) mainly in MDD patients but not controls. Pathway analyses revealed that pentose phosphate and starch and sucrose metabolism processes were important pathways for depression via microbiota functions. In conclusion, our results revealed microbiota targets for depression that are independent of fat intake. It is worthwhile to conduct further studies to replicate the current findings and to integrate with biochemistry and metabolomics data to better understand the functions of identified targets.
Li et al. proposed that the prognosis of teratoma with nephroblastoma is relatively good if the lesion is completely excised. 5 According to the previous similar cases in Table 1, two cases received ...fertility-preserving surgery. 1,3 The other case showed intra-peritoneal dissemination shortly after primary excision of a ruptured tumor, and then complete remission after second complete staging surgery with adjuvant chemotherapy. 2 TABLE 1 Published cases of ovarian cystic teratoma with immature renal tissue component Author Age Clinical history Presentation Tumor size (cm) Treatment Diagnosis Prognosis Alexander et al., 2017 1 28 Right ovary cystic teratoma s/p OP Asymptomatic 13 Right oophorectomy Malignant immature teratoma, composed of a small element of Wilms tumor (immature component) arising within a mature teratoma No evidence of disease during the 11-month follow-up Nakabayashi et al., 2019 2 33 Bilateral ovary mature cystic teratoma s/p OP twice Abdominal pain 7.7 1st surgery: Complete staging and maximum cytoreductive surgery + C/T Mature cystic teratoma with nephroblastomatous component Intra-peritoneal dissemination at 48 days after 1st surgery No disease progression after 2nd surgery + C/T and 1-year follow-up Turashvili et al., 2020 3 36 No relevant clinical history Abdominal pain 16.1 Right salpingo-oophorectomy Extrarenal Wilms tumor of the ovary arising in a mature cystic teratoma Loss of follow-up Present case 25 Bilateral ovary mature cystic teratoma s/p OP twice Abdominal pain 5.7 Right partial oophorectomy Cystic teratoma with immature renal tissue No evidence of disease during the 2-year follow-up Abbreviations: C/T, chemotherapy; f/u, follow-up; OP, operation; s/p, status post. ...ovarian teratoma may contain immature renal tissue, which could be named as an immature component instead of nephroblastoma/Wilms tumor if no atypia or invasive growth is seen, as the nomenclature would affect the clinician in the evaluation of treatment.
Burkholderia cepacia complex (BCC) represents a group of multidrug-resistant gram-negative bacteria that cause infections among immunocompromised hosts. Bacteremia occurs in patients who are ...chronically ill and is associated with substantial morbidity and mortality. The aim of this study was to investigate the clinical characteristics and outcomes of BCC bacteremic patients without cystic fibrosis.
We conducted a retrospective study at the National Taiwan University Hospital. Adults with BCC bacteremia from January 2015 to May 2019 were enrolled. The primary outcome was 14-day mortality. Multivariable logistic regression was performed for outcome analysis.
One-hundred and ninety-five patients were analyzed and their mean age was 67 years. Over 95% of the BCC isolates were susceptible to trimethoprim/sulfomethoxazole (TMP/SXT). Levofloxacin resistance rates were high, with only 25.1% of isolates being susceptible. Pairwise comparisons were made between different definitive regimens including meropenem-monotherapy, ceftazidime-monotherapy, levofloxacin-monotherapy, TMP/SXT-monotherapy, tigecycline-monotherapy as well as combination versus monotherapy. No regimen was significantly associated with survival in our study. Multivariable logistic regression showed that the Pitt bacteremia score (adjust odds ratio aOR,1.46; 95% confidence interval CI,1.19–1.79; p < 0.001), underlying metastatic cancer (aOR, 2.73; 95% CI, 1.01–7.39; p = 0.047), inappropriate definitive treatment independently predicted greater 14-day mortality (aOR, 8.21; 95% CI, 2.49–27.08; p < 0.001).
No single regimen is associated with improved mortality. After adjusting for other potential confounders, our data suggest selection of an appropriate antibiotic provide better clinical outcomes among patients with BCC bacteremia.
Single dose hepatitis A virus (HAV) vaccine had been proven its efficacy in immunocompetent but not immunocompromised hosts. We aim to investigate the effectiveness of one dose versus 2 doses HAV ...vaccine among people living with HIV (PLHIV).
We conducted a 1:1 single center retrospective case–control study for PLHIV in Northern Taiwan. Case patients were those who received single dose HAV vaccine and controls were those who completed standard 2 doses HAV vaccine. Nationwide campaign of single dose HAV vaccine had been practiced for high risk population including PLHIV and those who had newly diagnosed sexually transmitted diseases.
During February 2016 and December 2017, 90 cases received single dose HAV vaccine provided while the other 90 age-matched controls received 2 doses vaccine were enrolled. We found more injection drug users (22.22% vs. 1.11%, p < 0.0001), more co-infection with viral hepatitis C (28.89% vs. 5.56%, p < 0.0001), and history of syphilis infection (56.67% VS 30%, p = 0.0003) in single dose group than 2 doses group. Seroconversion rate at one year was significantly higher in 2 doses group (97.78% vs 56.67%, p < 0.0001). Among single dose group, people with hepatitis B or C virus co-infection (HBV: p = 0.02, aOR: 0.03, 95% CI: 0.002–0.55; HCV: p = 0.002, aOR: 0.22, 95% CI: 0.08–0.58) were less likely to achieve seropositivity, while those who had higher CD4 count at baseline and one year, had better response to vaccine.
Two doses HAV vaccine is necessary among PLHIV to achieve sustained seroresponse rather than single dose.
Objectives This study sought to derive and validate outcome-driven thresholds of central blood pressure (CBP) for diagnosing hypertension. Background Current guidelines for managing patients with ...hypertension mainly rely on blood pressure (BP) measured at brachial arteries (cuff BP). However, BP measured at the central aorta (central BP CBP) may be a better prognostic factor for predicting future cardiovascular events than cuff BP. Methods In a derivation cohort (1,272 individuals and a median follow-up of 15 years), we determined diagnostic thresholds for CBP by using current guideline-endorsed cutoffs for cuff BP with a bootstrapping (resampling by drawing randomly with replacement) and an approximation method. To evaluate the discriminatory power in predicting cardiovascular outcomes, the derived thresholds were tested in a validation cohort (2,501 individuals with median follow-up of 10 years). Results The 2 analyses yielded similar diagnostic thresholds for CBP. After rounding, systolic/diastolic threshold was 110/80 mm Hg for optimal BP and 130/90 mm Hg for hypertension. Compared with optimal BP, the risk of cardiovascular mortality increased significantly in subjects with hypertension (hazard ratio: 3.08, 95% confidence interval: 1.05 to 9.05). Of the multivariate Cox proportional hazards model, incorporation of a dichotomous variable by defining hypertension as CBP ≥130/90 mm Hg was associated with the largest contribution to the predictive power. Conclusions CBP of 130/90 mm Hg was determined to be the cutoff limit for normality and was characterized by a greater discriminatory power for long-term events in our validation cohort. This report represents an important step toward the application of the CBP concept in clinical practice.
Triple-negative breast cancer (TNBC) patients usually lead to poor prognosis and survival because of metastasis. The major sites for TNBC metastasis include the lungs, brain, liver, and bone. Long ...non-coding RNAs (lncRNAs) are non-protein-coding transcripts longer than 200 nucleotides and have been reported as important regulators in BC metastasis. However, the underlying mechanisms for lncRNAs regulating TNBC metastasis are not fully understood. Here we found that linc-ZNF469-3 was highly expressed in lung-metastatic LM2-4175 TNBC cells and overexpression of linc-ZNF469-3 enhanced invasion ability and stemness properties in vitro and lung metastasis in vivo. Furthermore, we found linc-ZNF469-3 physically interacted with miR-574-5p and overexpression of miR-574-5p attenuated ZEB1 expression. Importantly, endogenous high expressions of linc-ZNF469-3 and ZEB1 were correlated with tumor recurrence in TNBC patients with lung metastasis. Taken together, our findings suggested that linc-ZNF469-3 promotes lung metastasis of TNBC through miR-574-5p-ZEB1 signaling axis and may be used as potential prognostic marker for TNBC patients.
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