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To investigate whether preoperative skin cleaning of the chin, neck, and chest with chlorhexidine soap could reduce suture contamination by Cutibacterium acnes (C. acnes) in patients undergoing arthroscopic rotator cuff repair.This study included patients who underwent primary arthroscopic rotator cuff repair. Exclusion criteria included age18 years, previous shoulder surgery, history of shoulder infection, and allergy to chlorhexidine. Patients were randomized into three groups. Patients in the control group cleaned their skin with soap and water, as usual. Patients in the shoulder group cleaned their shoulders with chlorhexidine soap 3 days before surgery, whereas patients in the extended shoulder group additionally cleaned their chest, back, neck, and face with chlorhexidine soap. On the day of surgery, skin swab samples were obtained from the shoulder after surgical draping. After rotator cuff repair, sutures were cut from the anchor ends. Both traditional culture methods and polymerase chain reaction (PCR) were used.Ninety patients were enrolled (32 in the control group, 29 in the shoulder group, and 29 in the extended shoulder group) in the present study. The culture-positive rate from the posterior shoulder skin samples in the extended shoulder group (17.2%) was significantly lower than that in the control (40.6%) and shoulder (48.3%) groups (P = 0.036), whereas the culture-positive rates were not different among the three groups in other skin samples as well as the suture samples. The detection rates of C. acnes in suture samples were 12.5%, 13.8%, and 17.2% in the control, shoulder, and extended shoulder groups, respectively (P = 0.603).Extensive skin cleaning to the shoulder region with chlorhexidine helps reduce the shoulder cutaneous bacterial load, but the detection of C. acnes suture contamination in patients undergoing arthroscopic rotator cuff repair remained untouched regardless of the use of chlorhexidine soap in skin cleaning on the preoperative days.

Data about volumetric remodeling of the provisional extension to induce complete attachment (PETTICOAT) technique on DeBakey type IIIb aortic dissection in acute and subacute phases were scarce. The proper timing to perform this technique to promote false lumen reduction was also unknown.Patients with DeBakey type IIIb aortic dissection who underwent the PETTICOAT technique between December 2005 and March 2017 were reviewed and divided into acute (treatment occurred ≦14 days after symptom onset) and subacute (15-90 days) groups. Remodeling parameters of the true and false lumens were analyzed. Receiver operating characteristic curve was used to deduce the timing of this technique.In the 2-year follow-up, the acute group (N = 20) demonstrated significant true lumen expansion and false lumen regression in the thoracic, abdominal, and total aorta. However, the subacute group (N = 20) only showed significant shrinkage in the false lumen of the thoracic and total aorta. Using PETTICOAT technique within 36 days after the aortic event may result in better total false lumen reduction.For DeBakey type IIIb aortic dissection, more prominent true lumen expansion and false lumen reduction were noted when using the PETTICOAT technique in the acute phase. When performed within 36 days after symptoms onset, the PETTICOAT technique may potentiate better total false lumen regression.

BACKGROUND Atherosclerosis and vascular inflammatory response have been considered as risk factors for non-typhoidal Salmonella (NTS) vascular infection. The study aims to assess the risk of vascular infection by measuring atherosclerosis severity, NTS vascular infection (NTSVI) score, and serum levels of inflammatory markers in people with NTS bacteremia. METHODS A prospective observational study was conducted in two medical centers and two regional hospitals. Adults aged ≥50 years with NTS bacteremia who underwent computed tomography (CT) scan for revealing vascular infections were enrolled. The degree of atherosclerosis was scaled by a calcium score determined by a CT scan. Serum concentrations of inflammatory biomarkers were determined in the patients enrolled in a medical center. RESULTS Fourteen (20.3%) of 69 patients with NTS bacteremia had vascular infections. Calcium scores over the thoracic (12,540 vs. 3,261, P = 0.0005) and abdominal (9755 vs. 3,461, P = 0.0006) aorta of those with vascular infections were higher than those without vascular infection. All vascular infections were present in the high-risk group (NTSVI score ≥1), yielding a sensitivity of 100% and specificity of 30.9%. Among 17 low-risk patients (NTSVI score

Introduction The 2015 dengue outbreak in southern Taiwan caused substantial mortality. We analyzed the causes of death among these patients. Materials and methods This retrospective study was conducted at a medical center in Tainan from August 2015 to December 2015. Dengue was diagnosed based on the detection of serum dengue NS1 antigen, IgM, or viral RNA in the blood. Causes of death were retrieved from chart reviews by three clinicians. Results There were 4488 cases of dengue in the study hospital, with an in-hospital fatality rate of 1.3% (60 cases). The mean age of the 60 fatal cases was 73 years, among whom 90% were aged ≥65 years. Twenty-eight (46.7%) patients died of severe dengue, and 29 (48.3%) deaths were possibly related to dengue. Of the latter, 24 (40%) died of secondary infections. Thirteen cardiac arrest events, including out-of-hospital (5 events) and in-hospital (8) cardiac arrests in the emergency department, occurred during the dengue epidemic. Seven (53.8%) patients did not receive medical aid before the event. Of the 40 deaths that occurred within one week after hospitalization, 60% died of severe dengue. In contrast, 50% of 20 deaths that occurred one week after hospitalization were related to hospital-acquired infections, mainly pneumonia. Conclusion Of 60 fatal cases, with a predominance of elderly patients, deaths were related to severe dengue within the first week after admission and secondary infections thereafter. The absence of medical care before cardiac arrest events highlights the importance of health education for warning signs of dengue.

Coronavirus Disease-19 (COVID-19) has been in a global pandemic currently and relating symptoms were reported variously around the world. We reported a previously healthy man of COVID-19 presenting with anosmia as the obvious symptom with relevant radiological findings on brain magnetic resonance imaging.

Background/Purpose: Multiple sclerosis is classified as a rare disease in Taiwan. This study evaluated the safety and effectiveness of fingolimod in patients with relapsing-remitting multiple sclerosis (RRMS) from routine clinical practice in Taiwan. Methods: In this retrospective, multicentre, observational study, we collected clinical data of patients treated with fingolimod 0.5 mg/day in routine clinical practice between September 2012 and December 2015. Primary outcome was the overall safety of fingolimod; secondary outcome was the annualized relapse rate (ARR). Results: Overall, 62/69 (86.1%) patients were on fingolimod by the end of data collection period. Mean age (±standard deviation [SD]) at inclusion was 37.7 ± 10.10 years; mean duration of MS was 5.4 ± 4.52 years and mean duration of fingolimod exposure was 135.8 patient-years. The most common adverse events (AEs) were bradycardia (21.7%; first-dose related), upper respiratory tract infection, dizziness, and hypoaesthesia (numbness) (11.6% each), followed by urinary tract infection and back pain (7.2% each). Seven patients had liver enzyme-related AEs. Eight patients had absolute lymphocyte counts

Purpose: Postoperative endophthalmitis caused by nontuberculous mycobacterium is a rare but devastating complication after intraocular surgery. However, optimal treatment strategies remain undetermined in view of its rarity. Methods: We investigated the cases of culture-proven postoperative Mycobacteroides abscessus subsp. abscessus endophthalmitis in southern Taiwan, focusing on clinical manifestations and microbiological study, and aimed to describe clinical staging and to propose a therapeutic modality for this disease. Results: Twelve cases, including two published cases, were treated in two medical centers in southern Taiwan between Aug. 2011 and Dec. 2016, and all ever received cataract surgery at one clinic. Their disease courses could be categorized into four distinct stages, i.e., the initial, quiescent, recurrent, and end stage, and some cases experienced 1–4 cycles of quiescent-recurrent stages. Although all eyes ended up with phthisis or were eviscerated, the affected eyes receiving pars plana vitrectomy (PPV) tended to become quiescent and survived longer than those without PPV (adjusted hazard ratio: 13.9, p

Purpose Infections caused by carbapenemase-producing Klebsiella pneumoniae are emerging causes of morbidity and mortality worldwide. Optimal treatment for non–carbapenemase-producing carbapenem-resistant K pneumoniae (nCP-CRKP) bacteremia remains undefined. The goal of this study was to assess the clinical outcome, predictors of mortality, and therapeutic strategy of carbapenems for nCP-CRKP bacteremia. Methods A retrospective study of monomicrobial bacteremia caused by nCP-CRKP, at a medical center between 2010 and 2015 was conducted. CRKP which was defined as a minimum inhibitory concentration (MIC) of ≥ 2 for ertapenem or ≥ 4 mg/L for meropenem, or imipenem. Multiplex polymerase chain was applied to detect carbapenemase genes. The patients definitively treated with combination therapy were compared with monotherapy using a propensity score–matched analysis to assess therapeutic effectiveness. The primary end point was the 30-day crude mortality and clinical prognostic factors were assessed. Findings Overall 171 patients met criteria were eligible for the study and their overall 30-day mortality rate was 38.6%. The multivariate logistic regression analysis showed that combination therapy was associated with a lower 30-day mortality rate (adjusted odds ratio [aOR], 0.11; 95% CI, 0.03–0.43; P = 0.001) and less clinical (aOR, 0.21; 95% CI, 0.08–0.58; P = 0.003) and microbiologic (aOR, 0.36; 95% CI, 0.19–0.71; P = 0.003) failure. However, the 30-day mortality rate in the cases infected by a pathogen with a meropenem MIC ≤8 mg/L receiving carbapenem-containing or carbapenem-sparing combination regimens was similar (15 of 58 [25.9%] vs 5 of 20 [23.3%]; P = 1.0). Implications Combination therapy, regardless of carbapenem-containing or carbapenem-sparing, with one or more active agents improved survival more than monotherapy and was more effective in patients with critical illness. (Clin Ther. 2020; 42:XXX–XXX) © 2020 Elsevier HS Journals, Inc.

Purpose To evaluate the effect of renal stent-graft placement on kidney function and size alternation in chronic aortic dissection. Materials and Methods Twenty-five consecutive patients with chronic aortic dissection after thoracic endovascular aortic repair who underwent renal stent-graft placement between January 2015 and December 2016 were retrospectively reviewed. Forty-three patients with chronic aortic dissection who received thoracic endovascular aortic repair in the same period were reviewed as a control group for kidney volume comparison. Results Twenty-five stent-grafts were deployed over 25 renal arteries. Overall renal function was assessed by the slope of the regression line constructed from the plots of creatinine clearance versus time within 2 years after the procedure (–0.2810 vs –0.3146 mL/min–1/mo–1, P = .868), kidney volume at 12 months (129.4 ± 40.9 vs 137.0 ± 44.2 cm2, P = .193) and effective renal plasma flow at 6 months (106.3 ± 46.9 vs 124.4 ± 55.5 mL/min, P = .050) and was not significantly deteriorated. Seven treated patients (87.5%) with a renal artery supplied by a false lumen had a decrease in kidney volume, as did 14 patients (56%) in the control group (P = .206). Three patients with a dissected renal artery (75%) in the stent-graft group had an increase in kidney volume compared with 1 patient (11.1%) in the control group (P = .052). Conclusions Occlusion of the re-entry tear by a stent-graft in the renal artery remains a safe strategy to promote false lumen thrombosis. The stent-graft poses a potential risk of reducing the kidney volume in kidneys supplied by the false lumen but may provide a positive effect in kidney volume with a concomitant dissected renal artery in chronic aortic dissection.

Background: Asians with atrial fibrillation carry a higher risk of ischemic stroke than non-Asians even under treatment of nonvitamin K antagonist oral anticoagulants. The purpose of the study was to observe the feasibility of intravenous thrombolytic therapy after administering a reversal agent, idarucizumab, in dabigatran-treated patients with acute ischemic stroke in Taiwan. Methods: Dabigatran-treated patients with acute ischemic stroke who received intravenous recombinant tissue plasminogen activator (rt-PA) after idarucizumab reversal were enrolled in the retrospective nationwide study. The clinical data, treatment course, and outcomes were recorded. Stroke severity was evaluated using the National Institutes of Health Stroke Scale (NIHSS) score. Any intracerebral hemorrhage (ICH) after rt-PA was detected by neuroimaging studies. Results: Ten dabigatran-treated patients (6 men, mean age 71.10 ± 7.96 years) with acute ischemic stroke were included. Before stroke, the mean CHA2DS2-VASc score was 4.50 ± 1.57 and 8 patients (80%) received dabigatran 110 mg twice daily. All patients were treated with 5 g idarucizumab, following which the activated partial thromboplastin time normalized. Intravenous rt-PA (mean dose .78 mg/kg) was initiated a mean time of 11.11 minutes after idarucizumab infusion. The NIHSS score improved significantly after thrombolysis (16.0 ± 6.67 at admission to 9.38 ± 4.75 at discharge, P = .016). ICH developed in 3 patients (30%). Two of them were asymptomatic and 1 patient suffered from symptomatic ICH leading to mortality. Conclusion: Our data reconfirmed the feasibility of intravenous rt-PA for Asian stroke patients after reversal of dabigatran effect with idarucizumab.

Since the end of 2019, an increasing number of cases of pneumonia were reported in Wuhan, followed by other cities and provinces in China and many other countries [1], [2], [3], [4], [5], [6], [7], and the 2019 novel coronavirus (2019-nCoV) or severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [8], a new human pathogen, was identified as the cause of Wuhan pneumonia. The disease spectrum of SARS-CoV-2 infection, so-called coronavirus disease 2019 (COVID-19), was known to be diverse in severity, ranging from asymptomatic carriage to mild respiratory tract infection and severe or fatal pneumonia. Moreover, SARS-CoV-2 can be transmitted within the family, in the community, among cruise passengers and in hospitals, and has become a public-health emergency of international concern (PHEIC), declared by the World Health Organization (WHO) on 30 January 2020. As of 28 February 2020, laboratory-confirmed cases of COVID-19 have been reported in 56 countries and territories with more than 83 382 cases reported globally; more than 78 832 of these cases were reported from China (https://www.worldometers.info/coronavirus/). In the view of virologists, human and zoonotic coronaviruses belong to the family Coronaviridae in the order Nidovirales. Currently, there are four genera in the subfamily Coronavirinae of the family Coronaviridae: Alphacoronavirus, Betacoronavirus, Deltacoronavirus and Gammacoronavirus. Before the current COVID-19 epidemic, there were six recognised human respiratory coronaviruses, including HCoV-229E (Alphacoronavirus), HCoV-OC43 (Betacoronavirus), HCoV-NL63 (Alphacoronavirus) and HKU1 (Betacoronavirus) that often cause mild respiratory tract infection as well as SARS-CoV and MERS-CoV that in contrast can lead to severe or even fatal lower respiratory tract disease [9]. The seventh human coronavirus, SARS-CoV-2, belongs to the genus Betacoronavirus, which also contains SARS-CoV and MERS-CoV. So far, no drugs, monoclonal antibodies or vaccines have been approved to treat human infections due to coronaviruses. Several pre-existing and potential drug candidates, including chloroquine and remdesivir, have been considered [10], [11], [12]. The discovery and marketing of new compounds often require months to years. However, in the face of the global spread of COVID-19, effective interventions for severe cases of COVID-19 are urgently required. Although little is known about SARS-CoV-2, several insights may be gained from its more well-known family member, SARS-CoV [11]. Here we review the literature on an existing but not approved antiviral agent, remdesivir, which exhibits promising in vitro antiviral activity and preliminary clinical experiences in the treatment of COVID-19.

Human Ubiquinol-Cytochrome C Reductase Core Protein 1 (UQCRC1) is an evolutionarily conserved core subunit of mitochondrial respiratory chain complex III. We recently identified the disease-associated variants of UQCRC1 from patients with familial Parkinsonism, while its function remains unclear. Here we investigate the endogenous function of UQCRC1 in human neuronal cell line and Drosophila nervous system. Flies with neuronal knockdown of uqcrc1 exhibited age-dependent parkinsonism-resembling defects, including dopaminergic neuron reduction and locomotor decline, were ameliorated by UQCRC1 expression. Lethality of uqcrc1-KO was also rescued by neuron-expression of UQCRC1 but not the disease-causing variant, providing a platform to discern the pathogenicity of this mutation. Furthermore, UQCRC1 associated with the apoptosis trigger cytochrome c (cyt-c), and uqcrc1 deficiency increased cytoplasmic fraction of cyt-c and activated the caspase cascade. RNAi of cyt-c or expression of the anti-apoptotic P35 ameliorated uqcrc1-mediated neurodegeneration. Our findings thus identify a novel role of UQCRC1 in regulating cyt-c-induced apoptosis.

Outcomes of acute type A aortic dissection repair may be improved when VasoRing connectors (VRC [Sunwei Technology, Taipei, Taiwan]) are used to facilitate aortic anastomosis. In the present study, we compared the results of acute type A aortic dissection repair using VRC and conventional suture technique.A total of 68 patients who underwent acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure at our institution were enrolled. Records of patients receiving aorta anastomosis with VRC (n = 33) and conventional suture (n = 35) were retrospectively compared. All the surgical results were collected and analyzed.The results showed that the VRC group exhibited significance in total operative time (326 ± 80 minutes versus 362 ± 34 minutes, p = 0.023), cardiopulmonary bypass time (97 ± 10 minutes versus 134 ± 15 minutes, p0.001), aortic cross-clamp time (97 ± 10 minutes versus 134 ± 15 minutes, p0.001), and circulatory arrest time (15 ± 4 minutes versus 50 ± 8 minutes, p 0.001) compared with the suture group. Use of VRC for aortic anastomosis led to significantly less perioperative blood loss (442 ± 75 mL versus 849 ± 419 mL, p 0.001) compared with conventional suture for aortic anastomosis There was no reoperation for postoperative bleeding in the VRC group whereas reoperation for postoperative bleeding occurred in 20% of the suture group (0% versus 20%, p = 0.011). Postoperative blood loss, amount of blood transfusion, and acute kidney injury requiring hemodialysis were also significantly less in the VRC group than the suture group.Use of VRC shortened operative time and improved bleeding control incorporating standard methods for aortic anastomoses during acute type A aortic dissection repair by total arch replacement and antegrade frozen elephant trunk procedure. Long-term follow-up and randomized comparison are needed to confirm VRC efficacy.

Background/purpose: Legionella pneumophila had been recognized as a pathogen for both healthcare-associated and community-acquired pneumonia. We aimed to evaluate clinical features and outcomes of patients with Legionnaires' disease at a tertiary medical center in southern Taiwan. Methods: From January 2005 to December 2013, a retrospective study of adult cases of Legionnaires' disease was conducted in a 1200-bed tertiary hospital. Their medical records were reviewed for further evaluation and analysis. Results: A total of 61 cases of Legionnaires' disease were identified during the study period. Their mean age was 61.1 years, with male predominance (43, 70.5%). Among them, 30 (49.2%) had healthcare-associated pneumonia (HCAP), 20 (32.8%) had community-acquired pneumonia, and notably 11 (18.0%) were caregivers. Patients with healthcare-associated pneumonia tend to have higher Charlson comorbidity scores than those with community-acquired pneumonia (3.6 ± 2.4 vs. 1.9 ± 1.9, p = 0.008) and caregivers (0.5 ± 0.5, p

Background In chronic type B aortic dissection, late distal stent graft–induced new entry (SINE) has a possible negative role in long-term aortic remodeling. This study aimed to investigate the impact of SINE occurrence on survival by evaluating true and false lumen remodeling in thoracic and abdominal segments at midterm surveillance. Methods This study enrolled 65 patients with chronic type B aortic dissection (DeBakey type IIIb), who had received hybrid thoracic endovascular aortic repair (TEVAR) and had completed surveillance for at least 3 years. The 3-year survival rate was 84.7%. The patients were classified into non-SINE (n = 47) and SINE (n = 18) groups. Serial computed tomography scans were used to analyze volumetric change, true and false lumens, and thrombus volume from arch to aortic bifurcation level. Results The SINE event occurred at a median of 22.5 months. In the SINE group, there was a significant interruption of the abdominal true lumen expansion in the second year (median 0.01 [interquartile range (IQR), –0.03 to 0.12] in the non-SINE group versus median –0.04 [IQR, –0.12 to 0.04] in the SINE group; p = 0.014). There was a significantly worse thoracic false lumen remodeling in the SINE group compared with the non-SINE group in the third year after the SINE event occurred (median 0 [IQR, –0.09 to 0.05] in the non-SINE group versus median 0.06 [IQR, 0 to 0.13] in the SINE group; p = 0.038). Conclusions For chronic aortic dissection, late occurrence of distal SINE could influence abdominal true lumen expansion and thoracic false lumen shrinkage. Early reintervention for distal SINE could improve aortic remodeling in chronic aortic dissection.

Background and aims Renal dysfunction is a potent risk factor for cardiovascular diseases, including stroke. This study aimed to evaluate the impact of admission estimated glomerular filtration rate (eGFR) levels on short-term (1-month) and long-term (1-year) mortality in patients with acute ischemic stroke. Methods From the Taiwan Stroke Registry data, we classified ischemic stroke patients, identified from April 2006 to December 2015, into 5 groups by eGFR at admission: ≥ 90, 60–89, 30–59, 15–29, and Results Among 52,732 ischemic stroke patients, 1480 died within one month. The 1-month mortality rate was over 5-fold greater in patients with eGFR Conclusions After acute ischemic stroke, patients with reduced eGFR are at elevated risks of short-term and long-term deaths in a graded relationship.

This research investigates the psychological capital (PsyCap), subjective well-being (SWB), and self-compassion (SC) components of mental health in a comparative study of overseas Chinese students (OCS) and Taiwanese students in a multicultural context. The participants in the study, which focuses broadly on the recent direction in psychology of positive psychology, were 1347 students from universities and colleges in Taiwan, including 362 Malaysian OCS, 213 Hong Kongese and Macanese OCS, and 772 Taiwanese students. A questionnaire using items from PsyCap, SC, and SWB was administered to the participants. The results of hierarchical regression analysis showed that the level of SC is more relevant for the influence of PsyCap on SWB in the range of PsyCap high scores than it is in the range of PsyCap scores at the low end, and SC is less relevant for the influence of PsyCap on depression at the high end of the PsyCap scale. The findings of the study offer useful insights and implications for researchers and practitioners who investigate well-being and the prevention and alleviation of depression and the specific relationships between PsyCap, SWB, and SC.

We investigated the impact of serum cholesterol levels on 30-day mortality after ischemic stroke in dialysis patients.From the Taiwan Stroke Registry data, we identified 46,770 ischemic stroke cases, including 1101 dialysis patients and 45,669 nondialysis patients from 2006 to 2013.Overall, the 30-day mortality was 1.46-fold greater in the dialysis group than in the nondialysis group (1.75 versus 1.20 per 1000 person-days). The mortality rates were 1.64, .62, 2.82, and 2.23 per 1000 person-days in dialysis patients with serum total cholesterol levels of 120 mg/dL, 120-159 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively. Compared to dialysis patients with serum total cholesterol levels of 120-159 mg/dL, the corresponding adjusted hazard ratios of mortality were 4.20 (95% confidence interval [CI] = 1.01-17.4), 8.06 (95% CI = 2.02-32.2), and 6.89 (95% CI = 1.59-29.8) for those with cholesterol levels of 120 mg/dL, 160-199 mg/dL, and ≥200 mg/dL, respectively.Dialysis patients with serum total cholesterol levels of ≥160 mg/dL or 120 mg/dL on admission are at an elevated hazard of 30-day mortality after ischemic stroke.

Background: Diagnosis of spontaneous intracranial hypotension (SIH) relies on the ability of medical staff to recognize cerebrospinal fluid (CSF) leakage at the spine. However, difficulties with interobserver discrepancy sometimes occurred while reading magnetic resonance myelography (MRM) because clear image definition was lacking. In this study, we tried to determine which pattern of CSF distribution is more reliable for diagnosis of CSF leakage by using MRM. Methods: From January 2012 to August 2014, 19 SIH patients and 27 healthy controls (HC) were recruited into our study; 10 of the 19 patients were recovered (SIH-R) after treatment. Whole spine MRM was performed using the 3D-SPACE (three-dimensional sampling perfection with application-optimized contrasts using different flip-angle evolutions) sequence, and interpreted by two experienced neuroradiologists. Two 4-point classification systems of CSF distribution were used to evaluate the three-dimensional maximum intensity projection (3D MIP) and the thin-slice axial multiplanar reconstruction (MPR) images, respectively. Results: The interobserver agreement between the two readers interpreting the 3D MIP and thin-slice axial MPR MRM were moderate to good (κ=0.60–0.78). Grade 3 of 3D MIP and Type D of axial MPR MRM were only noticed in the SIH. Overall, Grade 3 of MIP and Type D of MPR showed significant difference (p 70%. Conclusion: Grade 3 on 3D MIP and Type D on axial MPR MRM were definite criteria of MRM for localizing CSF leakage, and Type C in the T-spine was a probable leakage sign with high sensitivity and NPV.

A new ammonia (NH3) gas sensor, based on the incorporation of platinum nanoparticles (Pt NPs) and an amorphous In-Ga-Zn-O (a-IGZO) thin film, is fabricated by thermal evaporation (TE) and sputtering approaches. Due to the increased specific surface area and remarkable catalytic activity of Pt NPs, excellent ammonia sensing properties, including a very high sensing response of 1467 (in 1000 ppm NH3/air gas at 250 °C), an extremely low detecting level of 1 ppm NH3/air, a relatively low optimum operating temperature of 250 °C, and a relatively fast sensing speed, are obtained. In addition, the studied Pt NP/a-IGZO device exhibits the advantages of a simple structure, easy fabrication, and a high selectivity towards ammonia gas. The studied device is, therefore, promising for high-performance ammonia sensing applications.

Objective This study investigated predisposing factors of distal stent graft-induced new entry (SINE). Methods Data from November 2006 to May 2012 were abstracted retrospectively from the records of 73 patients with complicated type B aortic dissection who had received stent graft treatment in our institution. Diameters of the true and false lumen, area and circumference of the true lumen, prestent and poststent oversize, taper, and mismatch ratio were recorded and analyzed to see if there were any significant differences between the SINE (n = 19) and non-SINE (n = 54) population and between those in whom the initial endograft was inserted from the proximal thoracic aorta (n = 49) or the distal thoracic aorta (n = 24). Results A distal-first sequence of stent graft deployment produced significantly fewer instances of distal SINE. The area oversizing ratio of the distal end of the stent graft was greater in the SINE vs non-SINE groups (3.76 ± 1.7 vs 2.63 ± 2.57; P = .002) and in the proximal-first vs distal-first deployment sequence groups (3.67 ± 2.57 vs 1.39 ± 0.90; P Conclusions Minimizing the preprocedure distal oversizing ratio with a distal small graft-first procedure could reduce the risk of late distal SINE for Stanford type B aortic dissection. Furthermore, the area ratio is a potentially more sensitive modality for size assessment and prediction of distal SINE occurrence.

Background/PurposeAeromonas and Vibrio are important water-borne pathogens causing substantial morbidity and mortality in cirrhotic patients in Taiwan, but the differences in clinical manifestations of Aeromonas and Vibrio bacteremia have not been reported in detail.MethodsFrom January 2003 to September 2013, cirrhotic patients with monomicrobial Aeromonas or Vibrio bacteremia at a medical center in Taiwan were included in this study.ResultsThe study population consisted of 77 cirrhotic patients with Aeromonas bacteremia and 48 patients with Vibrio bacteremia. Both pathogens clustered during the summer season; Vibrio bacteremia was more correlated with higher temperatures (Vibrio: r2 = 0.95, p

Background This study was conducted to test the hypothesis that elevated blood pressure at the early stage is associated with unfavorable outcome in acute ischemic stroke patients with stenosis of less than 50% of the culprit artery. Methods Patients with acute ischemic stroke onset within 48 hours and stenosis of less than 50% of the culprit artery from a prospective stroke registry were analyzed. A modified Rankin Scale score of 1 or lower at 3 months was defined as a favorable late outcome. Univariate and multivariate logistic regression analyses were used to analyze the association between hemodynamic parameters and outcome. Results One hundred thirty-six patients fulfilled the selection criteria. Patients with favorable outcome had lower pulse pressure at emergency department (ED) triage, lower systolic blood pressure (SBP) at 24 hours, lower pulse pressure at 24 hours, and lower heart rate (HR) at 24 hours. The univariate logistic regression analysis showed that history of stroke, elevated SBP at 24 hours, elevated HR at 24 hours, elevated pulse pressure at 24 hours, and higher National Institutes of Health Stroke Scale score at ED triage were associated with a less favorable late outcome. Two separate models of multivariate logistic regression analyses showed that pulse pressure at ED triage and pulse pressure at 24 hours, respectively, were significantly associated with less favorable outcome. Conclusions Elevated pulse pressure at the early stage is independently associated with unfavorable late outcome in acute ischemic stroke patients with culprit artery stenosis less than 50%.

Background Transcatheter aortic valve implantation (TAVI) has emerged as an alternative to surgical aortic valve replacement for patients with symptomatic severe aortic stenosis (AS) who have a high surgical risk. In Taiwan, this is the first study reporting TAVI outcomes at a single center offering two different transcatheter heart valve technologies via four types of approaches. Our aim was to compare 30-day and 6-month Valve Academic Research Consortium-2 (VARC-2) outcomes of the two valves. Methods We reported the procedural, 30-day, and 6-month VARC-2 outcomes of high-risk patients who were consecutively treated with the Medtronic CoreValve (MCV) or with the Edwards SAPIEN valve or SAPIEN XT valve (ESV; Edwards Lifesciences, Irvine, CA, USA) delivered via four types of approaches. Results From May 2010 to December 2013, 30 consecutive patients with severe AS underwent TAVI: 15 patients were treated with the MCV and 15 patients were treated with the ESV. The transfemoral approach was the most frequently used route (13 MCV and 6 ESV), followed by the transapical approach (9 ESV), trans-subclavian approach (1 MCV), and direct aortic approach (1 MCV). There were no procedural deaths. “Device success” was achieved in 29 (96.7%) patients, and is defined as the absence of procedural mortality, correct positioning of one prosthetic heart valve into the proper anatomical location, and intended performance of the heart valve without moderate or severe regurgitation. The VARC-2–defined combined safety endpoint at 30 days was comparable between patients treated with the ESV and the MCV (33.3% vs. 20%, respectively; group, p = 0.409). At the 6-month follow up, the combined efficacy endpoint was not significantly different between the two groups (13.3% in the ESV group vs. 20% in the MCV group; p = 0.624). There was only one (3.3%) patient who required permanent pacemaker implantation. Conclusion For the first time in Taiwan, we have demonstrated that TAVI using either device is complementary and feasible for treating a wide range of patients by using a careful selection of approaches. Favorable overall procedural success rates and 30-day and 6-month outcomes were achieved with both devices.

To investigate the clinical outcomes of patients with septic shock related to community-onset monomicrobial Enterobacteriaceae (CoME) bacteremia as categorized by the strategy of antimicrobial therapy, a retrospective and observational study was conducted. Clinical information on the patients was obtained from medical records. Antibiotic regimens were ranked according to their activity spectrum against Enterobacteriaceae (category IV, highest; I, lowest). De-escalation was defined as a switch to a category with a narrower spectrum of coverage within 5days after the bacteremic onset. Of the 189 eligible patients, 86 (45.5%) patients received de-escalation antibiotic therapy, and most (48, 55.8%) of the patients were empirically treated first with a category IV antibiotic. In a multivariate analysis for 28-day mortality, of several independent predictors, the de-escalation strategy was protective (odds ratio, 0.37; P=0.04). In conclusion, for patients with CoME bacteremia and available susceptibility data, de-escalation of antimicrobial therapy was beneficial for improving clinical outcome.

BackgroundTo determine clinical predictors and impact of Gram-negative nonfermenters (GNNFs) infections among adults with community-onset bacteremia in the emergency department (ED).MethodsAdults with bacteremia visiting the ED from January 2007 to June 2008 were identified retrospectively. Demographic characteristics, underlying illnesses, clinical conditions, bacteremic pathogens, antimicrobial agents, and outcome, were retrieved from chart records.ResultsAfter the exclusion of 261 patients with contamination of blood cultures and 24 patients referred from other hospitals, 518 adults with community-onset bacteremia were eligible; their mean age was 65.1 years, with slight predominance of female (262 patients, 50.6%). Of a total of 565 bacteremic isolates, Escherichia coli (228 isolates, 40.4%) and Klebsiella pneumoniae (100, 17.7%) were the major microorganisms. GNNFs caused bacteremia in 31 (6.0%) patients. A higher proportion of inappropriate antibiotic therapy in the ED (87.1% vs. 26.5%, p

This study investigates the impact of gate bias stress with and without light illumination in a-Si:H thin film transistors. It has been observed that the I–V curve shifts toward the positive direction after negative and positive gate bias stress due to interface state creation at the gate dielectric. However, this study found that threshold voltages shift negatively and that the transconductance curve maxima are anomalously degraded under illuminated positive gate bias stress. In addition, threshold voltages shift positively under illuminated negative gate bias stress. These degradation behaviors can be ascribed to charge trapping in the passivation layer dominating degradation instability and are verified by a double gate a-Si:H device.

The amorphous indium gallium zinc oxide thin film transistors (a-IGZO TFTs) passivated by sputtered non-stoichiometric aluminum oxide (AlOx) and titanium oxide (TiOx) layers were comparatively investigated in this letter. The devices with TiOx passivation layers exhibited better long-time storage stability compared with those passivated by AlOx films. Although both a-IGZO TFTs with AlOx and TiOx showed quite stable properties for negative bias-stress tests, the device passivated by TiOx film exhibited abnormal Vth shift during positive bias-stress tests. A novel passivation-layer structure consisting of both AlOx (~15 nm, bottom side) and TiOx film (~85 nm, top side) was proposed, which could perform better than either sing layers and might be preferred in mass production of a-IGZO TFTs.

The aim of the investigation was to describe the incidence of Aeromonas bacteremia in a city with a population of about 1.87 million inhabitants, located in southern Taiwan, between 2008 and 2010. Such data were compared with the incidences of Vibrio and Salmonella bacteremia in the same period and the incidence of Aeromonas bacteremia in other countries in the literature. The data revealed the average annual incidences of bacteremia due to Aeromonas, Vibrio, and Salmonella species were 76, 38, and 103 cases/million inhabitants, respectively. The incidence of Aeromonas bacteremia was higher than those in Western countries.

Background: Clostridium difficile infection (CDI) is well-known as the major cause of infectious diarrhea in hospitalized patients. Community-onset CDI (CO-CDI) is an emerging threat. However, clinical information of CO-CDI in Taiwan remains scarce. Methods: A retrospective study was conducted at a medical center in southern Taiwan. Symptomatic patients between 2007 and 2015 with C. difficile toxin or tcdB detected in stool were identified as CDI, and were classified as CO-CDI [including community-associated CDI (CA-CDI) and community-onset health care facility-associated CDI (CO-HCFA-CDI)] and health care facility-onset CDI (HCFO-CDI). Results: Of 427 patients, 15 (3.5%) were CA-CDI, 49 (11.5%) CO-HCFA-CDI, and 363 (85.0%) HCFO-CDI. Despite major involvement of the elderly (mean age: 66.1 years vs. 69.9 years, p = 0.46), no significant differences were noted between CA-CDI and CO-HCFA-CDI groups, except that solid organ cancer was more common in the CO-HCFA-CDI group. The CO-CDI group more often presented with abdominal pain but had shorter hospital stays and less exposure of proton-pump inhibitors or broad-spectrum antibiotics than the HCFO-CDI group did. The mortality rate related to CDI was 4.7% (3 patients) in the CO-CDI group. Despite a lower in-hospital mortality rate in the CO-CDI group (10.9% vs. 22.0%; p = 0.04), the recurrence rate was similar (10.9% vs. 7.2%; p = 0.3). Conclusions: CO-CDI is not common but associated with substantial morbidity and mortality. Physicians should put CDI into consideration among patients who present community-onset fever, diarrhea, or abdominal pain alone or in combination. Keywords: Clostridium difficile infection, community onset, diarrhea, Taiwan

An 85 year-old male initially admitted for septic shock due to urinary tract infection experienced Clostridium difficile-associated diarrhea during hospitalization and was treated by oral vancomycin. His clinical course was complicated by cytomegalovirus colitis and then vancomycin-resistant Clostridium innocuum bacteremia, which was cured by uneventfully parenteral piperacillin-tazobactam therapy.

Aeromonas species, aquatic Gram-negative bacilli, distributed globally and ubiquitously in the natural environment, may be implicated in a variety of human diseases. They can produce various β-lactamases which confer resistance to a broad spectrum of β-lactams, and therefore in vitro susceptibility testing must be used to guide antimicrobial therapy. However, conventional in vitro susceptibility tests may sometimes fail to detect these β-lactamases, and hence raise a therapeutic challenge. In this review article, two chromosomally mediated β-lactamases (i.e., AmpC β-lactamases and metallo-β-lactamases) and acquired extended-spectrum β-lactamases in aeromonads are reviewed, and the clinical implications of the complexity of β-lactamases are discussed.

Background/PurposeNontyphoidal Salmonella (NTS) is a crucial pathogen in immunocompromised patients, especially those with connective tissue disease (CTD) and corticosteroid or immunosuppressant therapy. The aim of this study is to identify the clinical characteristics and outcomes of patients with CTD and NTS bacteremia, and the clinical variations between systemic lupus erythematosus (SLE) and other CTDs.MethodsDuring a 15-year study period, from 1994 to 2009, NTS bacteremia patients were reviewed from the database of clinical microbiology laboratory. Medical records were reviewed for clinical information and only patients with underlying CTD were included.ResultsFrom 1994 to 2009, there were 299 patients with NTS bacteremia. Forty-six (15.4%) patients had certain connective tissue diseases, and SLE was the major CTD, accounting for 73.9% (34) of 46 patients. In comparison with patients without CTD, the patients with CTD were younger (p

BackgroundClinical information about non-typhoidal Salmonella (NTS) bacteremia in patients with malignancy has rarely been described. This study investigated clinical characteristics and prognostic variables of patients with malignancy while complicated with NTS bacteremia.MethodsThe study included demographic data, clinical information, and outcome in adults (≥18 years old) with and without malignancy complicated with NTS bacteremia at a medical center from 2000 to 2009.ResultsThere were 206 patients with NTS bacteremia. The serogroups of NTS isolates included group B (40.2%), group D (30.9%), group C (26.5%), and group E (1.5%). Extraintestinal infections were noted in 66 (32.4%) patients and were mainly endovascular (26/206, 12.7%) or pleuropulmonary (17/206, 8.3%) infections. On multivariate analysis, independent factors for in-hospital mortality included shock (odds ratio [OR] 9.13; 95% confidence interval [CI] 3.81–21.83; p

Objectives Bacteremia is a severe bacterial infection with significant mortality and morbidity. Clinical parameters that reliably predict the presence of community-onset bacteremia are less elucidated. Methods During 96 randomly selected days between August 2006 and July 2007, a prospective study was conducted to analyze the risk factors of community-onset bacteremia among febrile adults who visited the emergency department (ED) of a medical center. Patients hospitalized in the 30 days prior to the study, patients experiencing consciousness alteration, and nursing facility residents were excluded. Results The mean age of the 396 febrile adults enrolled in the study was 53.8 years (range, 18–95 years), and 60 (15.2%) patients had true bacteremia, with the predominance of monomicrobial Gram-negative pathogens (42 patients). In a multivariate analysis, several factors were independently associated with community-onset bacteremia, including an age of >65 years (odds ratio [OR], 2.81; 95% confidence interval [CI], 1.25–6.33), the presence of rigor (OR, 13.7; 95% CI, 4.47–42.0) or chills (OR, 6.04; 95% CI, 1.10–32.9), a body temperature >39.9 °C (OR, 2.68; 95% CI, 1.03–6.94), blood urea nitrogen >20 mg/dL (OR, 5.56; 95% CI, 2.03–15.7), a blood urea nitrogen/creatinine ratio >16 (OR, 2.29; 95% CI, 1.03–5.11), and thrombocytopenia (OR, 6.09; 95% CI, 1.84–20.0). After scoring each risk factor, a logistic regression model for the prediction of bacteremia was developed, and the area under the receiver operating characteristic curve was 0.91. Conclusions Some easily determined clinical parameters were independently associated with community-onset bacteremia among febrile adults, and the most significant predictor was the presence of rigor. Although the proposed predictive model needs further validation, it may be of use for the early identification of bacteremic episodes in ED practice.

Background Long-term retention of patients in care is emerging as an important factor for the mortality among persons with human immunodeficiency virus (HIV) infection. Objectives The study was to determine the impact of the case management with retention in care on mortality among HIV infected patients. Design and settings A longitudinal prospective cohort study was conducted at a tertiary referral HIV-designated hospital in Taiwan. Participants Charts from 1040 patients who had made at least one visit for HIV care at the HIV Clinic in the study hospital in 2009 were abstracted. Methods A computerized data collection form was used to retrospectively retrieve the electronic demographic and clinical data generated during each clinic visit. Follow-up ended at death or at the last clinic visit as of December 31, 2009. Results Less than half (44.2%) of 961 HIV-infected patients were retained for follow-up from 2005 to 2009. Patients who received case management were 4.78 times more likely to remain consistently in care than those who did not receive case management, after controlling for other confounding variables. In the Cox proportional hazard analysis, higher hazards of death were independently associated with older age (hazard ratio [HR]: 1.04; 95% confidence interval [CI]: 1.026–1.055), entering care before 2005 (HR: 1.73; 95% CI: 1.035–2.885), low baseline CD4 cell count (HR: 0.997; 95% CI: 0.995–0.998), without antiretroviral therapy (HR: 0.55; 95% CI: 0.334–0.909), irregular attendance of HIV care or loss to follow-up (HR: 0.058; 95% CI: 0.023–0.148), acquisition of HIV infection through sexual contact (HR: 2.95; 95% CI: 1.517–5.746), and irregular attendance or lost to follow-up and did not enrolled in the case management program (HR: 3.76; 95% CI: 1.015–14.777). Conclusion Retention in care is independently predictive of survival, and case management is a mediator affecting retention on survival. Case managers need to identify high risk patients for irregular attendance and to retain them in HIV care in order to maximize their health outcomes.

The diagnostic performance of serum C-reactive protein (CRP) in prediction of bacteremia among febrile patients visiting an emergency department (ED) was analyzed.During randomly selected 96 days between August 2006 and July 2007, a prospective study of febrile adults visiting the ED of a medical center was conducted to analyze the clinical characters associated with bacteremia.Of the total 454 febrile adults enrolled, their mean age was 54.1 years, and 232 (54.6%) were women. Major comorbidities included cardiovascular disease (137 patients, or 30.1%) and diabetes mellitus (105, or 23.1%). Seventy-four patients (16.2%) had true bloodstream infections with the predominance of monomicrobial gram-negative bacteremia in 49 patients (10.7%). Four risk factors, including low platelet count (100 000/mm(3); odds ratio [OR], 4.19; 95% confidence interval [CI], 1.85-9.47; P = .001), high blood urea nitrogen (20 mg/dL; OR, 4.61; 95% CI, 2.56-8.31; P.001), high fever (39.0°C; OR, 3.67; 95% CI, 2.05-6.59; P.001), and high Pittsburg bacteremia scores (≧4 points; OR, 2.95; 95% CI, 1.01-8.57; P = .04) were independently associated with bacteremic episodes. Of note, high CRP (150 mg/dL; OR, 1.75; 95% CI, 0.73-3.99; P = .21) was not an independent risk factor. In further analysis, the difference of serum CRP levels between bacteremic and nonbacteremic adults was significant only when the period from fever onset to ED arrival was more than 12 hours.The CRP level was not reliable to distinguish the bacteremia from nonbacteremic infection, whereas duration after fever onset was less than 12 hours. Clinicians must consider the history of fever onset to improve the accuracy of early prediction of serum CRP before the microbiological results of blood cultures is available.

Introduction Connexin 37, encoded by the GJA4 gene, protects against atherosclerosis. A recent study reported an association between polymorphism rs1764391 at GJA4 and ischemic stroke in a Chinese population. We aimed to replicate this result. Materials and Methods A total of 958 ischemic stroke patients and 2196 controls were enrolled for the study. All participants were Chinese residing in Taiwan. Logistic regression analysis with adjustment for traditional risk factors was used to estimate the genetic effect. We also performed stratification analyses by sex and stroke subtypes. Literature reviews were conducted for available genetic association studies investigating rs1764391 and cardiovascular phenotypes. Results We did not find any significant association for overall stroke (p = 0.87) or from any subset analyses. Eight studies addressing the associations between rs1764391 and cardiovascular phenotypes had a sample size greater than 1000. Including the present study, five out of the eight large-scale studies found no association. Conclusions GJA4 polymorphism is not associated with stroke risk in the Taiwanese population.

In Taiwan, the tuberculin skin test (TST) is not recommended as a screening test for Mycobacterium tuberculosis (TB) infections. The aim of this study is to determine the prevalence and predictors of positive tuberculin reactivity and its association with TB infections among nursing home residents in Taiwan. A cross-sectional study and review of medical records were conducted at four nursing homes in Tainan City. A one-stage TST was performed by study nurses using two tuberculin units of purified protein derivative (PPD) of the RT23 strain. An induration ≥10 mm at 72 h was considered to be a positive reaction. Chest radiographs, acid-fast stains and mycobacterial cultures of three sputum samples were performed for those with a positive TST result. Of 115 residents (66.5% participation, mean age 73.1 years) who underwent a TST, 26 (22.6%) had a positive reaction. One woman was microbiologically diagnosed to have pulmonary TB. On multivariate analysis, a Bacille Calmette-Guerin (BCG) scar and a history of myocardial infarction were significantly associated with a positive TST. In conclusions, this study shows a considerable rate of positive TST among nursing home residents in southern Taiwan. A BCG scar and a history of myocardial infarction were associated with a positive TST.