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TRIM28/KAP1/TIF1β is a crucial epigenetic modifier. Genetic ablation of trim28 is embryonic lethal, although RNAi-mediated knockdown in somatic cells yields viable cells. Reduction in TRIM28 abundance at the cellular or organismal level results in polyphenism. Posttranslational modifications such as phosphorylation and sumoylation have been shown to regulate TRIM28 activity. Moreover, several lysine residues of TRIM28 are subject to acetylation, but how acetylation of TRIM28 affects its functions remains poorly understood. Here, we report that, compared with wild-type TRIM28, the acetylation-mimic mutant TRIM28-K304Q has an altered interaction with Krüppel-associated box zinc-finger proteins (KRAB-ZNFs). The TRIM28-K304Q knock-in cells were created in K562 erythroleukemia cells by CRISPR-Cas9 (Clustered regularly interspaced short palindromic repeats/CRISPR-associated protein nuclease 9) gene editing method. Transcriptome analysis revealed that TRIM28-K304Q and TRIM28 knockout K562 cells had similar global gene expression profiles, yet the profiles differed considerably from wild-type K562 cells. The expression levels of embryonic-related globin gene and a platelet cell marker integrin-beta 3 were increased in TRIM28-K304Q mutant cells, indicating the induction of differentiation. In addition to the differentiation-related genes, many zinc-finger-proteins genes and imprinting genes were activated in TRIM28-K304Q cells; they were inhibited by wild-type TRIM28 via binding with KRAB-ZNFs. These results suggest that acetylation/deacetylation of K304 in TRIM28 constitutes a switch for regulating its interaction with KRAB-ZNFs and alters the gene regulation as demonstrated by the acetylation mimic TRIM28-K304Q.

Background/purpose In clinical operations, qualitative differences in the texture and operational feeling of the regular type and soft type back-filled gutta-percha are readily discernible. This study aimed to investigate and compare the thermal behavior and physical properties of the two gutta-percha materials. Materials and methods The chemical compositions of regular and soft type Gutta-Percha Obturator® pellets were examined via energy dispersive X-ray spectroscopy. The thermal behaviors of the pellets during heating and cooling were evaluated using a differential scanning calorimeter. Finally, the viscoelastic properties of the two materials during cooling were assessed using a modular compact rheometer. Results The soft type gutta-percha contained a greater atomic percentage of zinc than the regular type material. In addition, the soft type gutta-percha exhibited exothermic peaks during cooling, whereas the regular type gutta-percha did not. The two materials exhibited different viscoelastic behaviors under cooling. In particular, the rate of change of the loss factor for the soft type gutta-percha was more than that of the regular type gutta-percha at temperature lower than 80°C. Conclusion The soft type gutta-percha underwent significant crystallization during cooling, and therefore exhibited pronounced volume shrinkage. Furthermore, the soft type gutta-percha underwent a greater rate of change in viscoelasticity under cooling than the regular type gutta-percha, and exhibited poorer physical stability. Consequently, in the back-packing procedure, soft type gutta-percha must be compacted more often over time than regular type gutta-percha to ensure the same quality of root canal obturation.

Background An outbreak of SARS-CoV-2 Delta variant infection occurred in Pingtung, Taiwan, in June 2021. In this study, we aimed to elucidate the clinical characteristics of the Delta-variant SARS-CoV-2 infection and the treatment outcome of antiviral agents in patients from Pingtung County in Southern Taiwan. Methods A total of 11 patients with Delta-variant COVID-19 were consecutively admitted to a governmental hospital in June 2021. Baseline characteristics and treatment outcome were evaluated. Results All patients were symptomatic. The most common symptoms were cough (72.7%), followed by fever (54.5%), headache (18.2%) and dysosmia/dysgeusia (18.2%). Two patients developed pneumonia without mechanical ventilation requirement. Compared to patients without pneumonia, those with pneumonia had higher aspartate aminotransferase (AST) (21.0 vs. 126.0 IU/L, P = 0.03) and lactate dehydrogenase (LDH) (143.1 vs. 409.0 IU/mL, P = 0.03), and ferritin (0.2 vs. 2.0 mg/L, P = 0.046) levels. Pneumonia improved after 2-week treatment, and no mortality occurred after 30 days of diagnosis. The median duration of viral shedding duration of viral shedding was 16.5 days (range 11–42 days) (defined by time to repeated negative real-time reverse transcriptase polymerase chain reaction (RT-PCR) or a cycle threshold (CT) value ≥ 30). Conclusion We demonstrated the clinical characteristics of Delta-variant COVID-19 and treatment outcome of antiviral agents. The risk factors attributed to pneumonia were higher serum AST, ferritin, and LDH levels.

Background Tristetraprolin (TTP) family proteins contain conserved tandem CCCH zinc-finger binding to AU-rich elements and C-terminal NOT1-binding domain. TTP is phosphorylated extensively in cells, and its mRNA destabilization activity is regulated by protein phosphorylation. Methods We generated an antibody against phospho-Serine316 located at the C-terminal NOT1-binding site and examined TTP phosphorylation in LPS-stimulated RAW264.7 cells. Knockout of TTP was created in RAW264.7 cells using CRISPR/Cas9 gene editing to explore TTP functions. Results We demonstrated that Ser316 was phosphorylated by p90 ribosomal S6 kinase 1 (RSK1) and p38-activated protein kinase (MK2) and dephosphorylated by Protein Phosphatase 2A (PP2A). A phosphorylation-mimic mutant of S316D resulted in dissociation with the CCR4-NOT deadenylase complex through weakening interaction with CNOT1. Furthermore, Ser316 and serines 52 and 178 were independently contributed to the CCR4-NOT complex recruitment in the immunoprecipitation assay using phosphor-mimic mutants. In RAW264.7 macrophages, TTP was induced, and Ser316 was phosphorylated through RSK1 and MK2 by LPS stimulation. Knockout of TTP resulted in TNFα mRNA increased due to mRNA stabilization. Overexpression of non-phosphorylated S316A TTP mutant can restore TTP activity and lead to TNFα mRNA decreased. GST pull-down and RNA pull-down analyses demonstrated that endogenous TTP with Ser316 phosphorylation decreased the interaction with CNOT1. Conclusions Our results suggest that the TTP-mediated mRNA stability is modulated by Ser316 phosphorylation via regulating the TTP interaction with the CCR4-NOT deadenylase complex.

Background: Peritoneal dialysis (PD)-related infection is a serious complication of patients with PD. Refractory peritonitis may lead to failure of PD, shift to hemodialysis (HD) or death. Besides, microbiologic resistance increased worldwide that might impact the treatment choice for such infections. Investigating the causative pathogens and risk factors of PD-related infections in Taiwan was warranted. Methods: This is a retrospective study involving patients with PD from 2007 to 2016 in a southern Taiwan hospital. Patient characteristics, microbiological data, outcomes, and factors associated with refractory peritonitis were analyzed. Results: There were 190 episodes of PD-related peritonitis in 110 patients from this cohort. Gram-positive organisms were the leading cause of PD-related peritonitis, but gram-negative organisms, esp. Pseudomonas aeruginosa, were predominant for exit site infection and tunnel infection. The incidence of peritonitis was 0.25 episode per patient-year (1 episode per 47.69 months). The refractory rate was 14.2% (27/190). Methicillin resistance was noted in 2 (13.3%) of 15 Staphylococcus aureus isolates. Of 114 isolates, 72.8% (83) were susceptible to either cefazolin or gentamicin. Staphylococcus spp. and Escherichia coli infections were significantly associated with refractory peritonitis. Baseline hyponatremia (

本研究目的在探討臺灣公民科技素養、科學興趣和科學參與之交互作用，並以分層隨機抽樣選取年滿18～70 歲公民共計1,831 人為研究樣本，填答信度與效度良好之公民科技素養試題。為瞭解臺灣民眾科技素養及科學興趣狀況，首先以極端組群法將公民的科技素養及科學興趣依據分數高低區分為四類組：「高科技素養、高科學興趣組」、「高科技素養、低科學興趣組」、「低科技素養、高科學興趣組」及「低科技素養、低科學興趣組」。再以百分比同質性檢定比較不同性別、年齡層及學歷在這四組的分布差異，發現「高科技素養、高科學興趣組」男性公民比例顯著高於女性公民、年齡層較輕、具大學畢業以上學歷；而「低科技素養、低科學興趣組」則是女性公民比例顯著高於男性公民、年齡層較高、具中學以下學 歷。接著以單因子變異數分析比較四類組公民在科學參與之差異，發現「高科技素養、高科學興趣組」公民的整體科學參與頻率最高；而「低科技素養、高科學興趣組」公民為「科技議題活動參與」涉入程度最高。這些結果顯示高科學興趣的公民對科學及科技議題的參與較為積極。因此本研究建議，提升未來公民科技素養當務之急宜先培養公民科學興趣，進一步鼓勵其科學參與，養成終身學習的習慣。 This study explored Taiwan citizens’ scientific literacy, interest in, and engagement in learning science. By using the stratified random sampling strategy, 1,831 citizens in the age group of 18-70 years were selected to respond to a questionnaire survey along with a paper-pencil test. For exploring the relationship between Taiwan citizens’ scientific literacy and their interest in science, the participants were divided into four groups on the basis of their scores for scientific literacy and interest in science. According to the essential results, the high scientific literacy and high science interest (HH) group was mainly represented by males, young citizens, and citizens with higher educational degrees. Conversely, the low scientific literacy and low science interest (LL) group was dominated by females, elderly citizens, and citizens with only a secondary school diploma. Among the four groups, citizens in the HH and LH groups exhibited higher frequency of engagement in science activities. Finally, citizens with high science interest tended to be enthusiastic in learning science and technology. This study contributed a novel insight that the interest in learning science plays a critical role in promoting adults’ engagement in learning science. Future studies are recommended for focusing on the citizens in the LH group to investigate how high engagement in learning science influences their scientific literacy.

Pediatric renal sonography is a non-radiation exposure and non-invasive procedure to evaluate kidneys and urinary tract structures. It is frequently performed in clinics and wards. Although there is no physical discomfort during ultrasounds, children would still experience agitation or crying due to unfamiliarity with medical environment. To provide comfortable medical experience and improve the quality of healthcare, we design a renal sonography process integrated with acoustic components specific for children. Patients under 7 years old are divided into three groups, under the age of 1, 1–3, and above 3. Pre-recorded music with nursery rhymes and fairy tales is played. Two time points are designed to evaluate acoustic integrated effect, along with preparing phase or real time of sonography starting. Data are collected from three timeframes: before, during, and after the exam. Physiological data will include heart rate, respiratory rate, and O2 saturation. Emotional behavior, such as agitation, crying, and smiling, will be recorded. This study will establish specific acoustic components and suitable intervention timeframe for children of different age groups. By having acoustic comfort, we hope children will have good experiences during sonography exam. As a result, the quality of medical examination and children wellbeing can be achieved.

Peritoneal dialysis (PD) is a treatment suitable for pediatric patients for less food restrictions, better school attendance and requires less hospital visits than hemodialysis. However, it may still cause stress and affect children’s wellbeing as children with end-stage renal disease have to undergo treatment four times a day, 30 min each time. Thus, sound interventions used to improve children’s comfort during PD treatments are worthy of investigating and are the aim of this study. Respondents will include PD patients under 18 years of age. Three types of sound will be played during PD treatment via headphone, including natural sound, classical music, and songs chosen by individual patient. Vital signs will be measured with oximeter to include heart rate, respiratory rate, O2 saturation, and blood pressure. Neurological activities will be recorded by electroencephalography (EEG). PD treatment efficiency will be measured by calculating fluid removal volume. Questionnaires will be given to measure the subjective wellbeing of respondents. Correlations among chosen music, vital signs, EEG readings, treatment efficiency, and patient’s subjective wellbeing will be investigated. The findings of this research will add knowledge to improve subjective patient wellbeing and dialysis efficiency by acoustic interventions.

With advances in the understanding of characteristics of molecules, specific antigens on the surface of hematological malignant cells were identified and multiple therapies targeting these antigens as neoplasm treatments were developed. Among them, chimeric antigen receptor (CAR) T-cell therapy, which got United States Food and Drug Administration (FDA) approval for relapsed/refractory (r/r) diffuse large B-cell lymphoma (DLBCL) as well as for recurrent acute lymphoblastic leukemia (ALL) within the past five years, and for r/r mantle cell lymphoma (MCL) this year, represents one of the most rapidly evolving immunotherapies. Nevertheless, its applicability to other hematological malignancies, as well as its efficacy and persistence are fraught with clinical challenges. Currently, more than one thousand clinical trials in CAR T-cell therapy are ongoing and its development is changing rapidly. This review introduces the current status of CAR T-cell therapy in terms of the basic molecular aspects of CAR T-cell therapy, its application in hematological malignancies, adverse reactions during clinical use, remaining challenges, and future utilization.

BackgroundTRIM28/KAP1/TIF1β is a key epigenetic modifier. Genetic ablation of trim28 is embryonic lethal although RNAi-mediated knockdown in somatic cells yields viable cells. Reduction in TRIM28 abundance at the cellular or organismal level results in polyphenism. Posttranslational modifications such as phosphorylation and sumoylation have been shown to regulate TRIM28 activity. Moreover, the methylation of DNA, RNA and histones and acetylation of histones are key epigenetic modifications that regulate gene expression. A number of lysine residues of TRIM28 are subject to acetylation, but how acetylation of TRIM28 affects its functions remains poorly understood. ResultsHere we report that, compared with wild-type TRIM28, the acetylation-mimic mutant TRIM28-K304Q has an altered interaction with Krüppel-associated box zinc-finger proteins (KRAB-ZNFs), with consequent effects on the phenotype of the erythroleukemic cell line K562. TRIM28-K304Q was comparable with its wild-type counterpart with respect to intracellular level, homodimerization, phosphorylation at S473 and S824, and interactions with heterochromatin-binding protein HP1. The expression of embryonic-related and fetal globin genes was activated in TRIM28-K304Q mutant cells. Transcriptome analysis revealed that TRIM28-K304Q and TRIM28 knockout K562 cells had similar global gene expression profiles, yet the profiles differed considerably from that of wild-type K562 cells. The gene expression ensemble of mutant K562 cells indicated a general induction of differentiation-promoting genes and attenuation of proliferation-promoting genes. ConclusionsThese results suggest that acetylation/deacetylation of K304 in TRIM28 or TRIM28-K304Q constitutes a switch for regulating its interaction with KRAB-ZNFs and alters the gene regulation of this key epigenetic modifier as demonstrated by the acetylation mimic TRIM28-K304Q.

Background/Purpose Although 2,3,5,4′-Tetrahydroxystilbene-2-O-beta-glucoside (THSG) reportedly has anti-inflammatory properties, its role in inducing the dedifferentiation of human dental pulp stem cells (DPSC) into pluripotent-like stem cells remains to be determined. The purpose of this study is to evaluate the effects of THSG on the pluripotent-like possibility and mechanism of DPSC. Materials and methods DPSCs were treated with THSG, and cell viability was determined using the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl-tetrazolium bromide (MTS) assay. Real-time polymerase chain reaction was used to analyze the mRNA expression levels of pluripotency-associated genes and oncogenes and to detect telomerase activity in the cells. Embryoid body formation assay was conducted, and pluripotency-related proteins were identified using Western blotting. Data were analyzed using one-way analysis of variance. Results Cell viability, telomerase activity, and embryoid body formation were enhanced in THSG-treated DPSCs. The mRNA expression levels of pluripotent-like genes (including Nanog homeobox [NANOG], SRY-box 2 [SOX2], and POU class 5 homeobox 1 [POU5F1/OCT4]) significantly increased after THSG treatment. The expression levels of pluripotency-related genes (Janus kinase-signal transducer 2 [JAK2] and signal transducer and activator of transcription 3 [STAT3]) increased, whereas those of oncogenes (Ras, SRC, HER2, and C-sis) decreased. Furthermore, the expression levels of the phosphorylated JAK2 and STAT3 proteins significantly increased after THSG treatment. Conclusion THSG treatment may enhance the pluripotent-like possibility of DPSC through the JAK2/STAT3 axis. Hence, it may be used as an alternative cell-based therapeutic strategy in regenerative dentistry.

Short noncoding endogenous RNAs, including microRNAs (miRNAs), are associated with the development and metastasis of multiple cancers. Epigallocatechin gallate (EGCG), the most active and abundant polyphenol in green tea, plays a crucial role in the modulation of miRNA expression, which is related to changes in cancer progression. In the present study, we explore whether EGCG exerts its suppressive effects on nasopharyngeal carcinoma (NPC) cells through miRNA regulation. The anoikis-resistant sphere-forming NPC cells grown under anchorage-independent conditions exhibit enhanced migratory properties, which were inhibited by EGCG treatment. The miR-296 level was lower in the anoikis-resistant cells than in the monolayer parental cells, however, miR-296 was significantly upregulated after EGCG treatment. We demonstrate that miR-296 is involved in the inhibitory effects of EGCG on the anoikis-resistant NPC cells through the downregulation of signal transducer and activator of transcription 3 (STAT3) activation. Our study is the first to demonstrate that EGCG inhibited the migratory properties of anoikis-resistant cells by modulating the expression of miRNA in NPC cells. Our results indicate the novel effects of EGCG on miRNA regulation to inhibit an invasive phenotype of NPC as well as the regulatory role of miR-296.

Background This study investigated the ability of different irrigation protocols to keep dentinal tubules (DT) open and avoid their blockage by the smear layer (SL) during the cleaning and shaping procedure (CSP). Methods Twenty-five extracted teeth were divided into five groups (n = 5): group 1, NaOCl was kept in the canal during instrumentation and then washed out with distilled water, and the canal was irrigated with NaOCl with EndoVac in between files; group 2, the same procedure as group 1, but NaOCl was replaced by EDTA; group 3, EDTA was kept in the canal during instrumentation and then washed out with distilled water, and the canal was irrigated with NaOCl with EndoVac in between files; group 4, the same as group 3, but NaOCl and EDTA were alternated; and group 5 (control), the procedure was the same with group 1, but NaOCl was replaced by distilled water. A scanning electron microscope was used to evaluate the cleanliness of DT at three different levels of the canals. Results Groups 3 and 4 showed better ability to keep DT open during CSP than the other groups. Group 4 only showed statistically significant better results than group 3 at middle third (P Conclusions Alternating the use of NaOCl and EDTA with water in between can keep DT open better and avoid their blockage by SL during CSP compared with the use of NaOCl or EDTA alone.

The objective of this study is to investigate the synergistic effects of acid etching and metal-ion chelation in dental smear layer removal using wasted Ganoderma tsugae derived chitosans. The wasted Ganoderma tsugae fruiting body was used to prepare both acid-soluble fungal chitosan (FCS) and alkali-soluble polysaccharide (ASP). To explore the effective irrigant concentration for smear layer removal, a chelating effect on ferrous ions was conducted. Specimens of various concentrations of EDTA, citric acid, and polysaccharide solutions were reacted with FerroZine™ then the absorbance was examined at 562 nm by a UV-visible spectrophotometer to calculate their metal chelating capability. Twenty extracted premolars were instrumented and individually soaked in the solutions of 15 wt% EDTA, 10 wt% citric acid, 0.04 wt% ASP, 0.04 wt% FCS, and normal saline were randomly divided into five groups (N=4). Next, each tooth was cleaved longitudinally and examined by scanning electron microscopy (SEM) to assay the effectiveness of smear layer removal. The chelating capability for EDTA, FCS, and ASP showed no significant difference over the concentration of 0.04 wt% (p > 0.05). The SEM results showed that 0.04 wt% FCS solution was effective in smear layer removal along the canal wall. These results indicated that Ganoderma tsuage derived FCS in acid solutions could be a potential alternative as a root canal irrigant solution due to its synergistic effect.

Immunotherapy, including chimeric antigen receptor (CAR) T-cell therapy, immune checkpoint inhibitors, cancer vaccines, and dendritic cell therapy, has been incorporated as a fifth modality of modern cancer care, along with surgery, radiation, chemotherapy, and target therapy. Among them, CAR T-cell therapy emerges as one of the most promising treatments. In 2017, the first two CAR T-cell drugs, tisagenlecleucel and axicabtagene ciloleucel for B-cell acute lymphoblastic leukemia (ALL) and diffuse large B-cell lymphoma (DLBCL), respectively, were approved by the Food and Drug Administration (FDA). In addition to the successful applications to hematological malignancies, CAR T-cell therapy has been investigated to potentially treat solid tumors, including pediatric brain tumor, which serves as the leading cause of cancer-associated death for children and adolescents. However, the employment of CAR T-cell therapy in pediatric brain tumors still faces multiple challenges, such as CAR T-cell transportation and expansion through the blood–brain barrier, and identification of the specific target antigen on the tumor surface and immunosuppressive tumor microenvironment. Nevertheless, encouraging outcomes in both clinical and preclinical trials are coming to light. In this article, we outline the current propitious progress and discuss the obstacles needed to be overcome in order to unveil a new era of treatment in pediatric brain tumors.

Background: Cardiovascular diseases are the second leading cause of death in the top ten leading causes of death in 2018 in Taiwan, and coronary artery disease is one of the main causes.Aim: To compare whether there are differences in patient knowledge, anxiety, and satisfaction between the utilization of patient decision aid for cardiac catheterization and routine health education.Subject and methods: Between July 2020 and September 2020, subjects were recruited in the clinics of the Department of Cardiology in a Veterans hospital in northern Taiwan. An experimental design was used for the study. Subjects were divided into two different education tool groups by randomization table. Subjects filled out the questionnaires before and after the education.Result: The patient knowledge before and after education in the RC group was improved by 2.30 points, and SDM group increased by 1.50 points (p-value

Background/purpose This study aims to examine the characteristics of Taiwanese children with chronic kidney disease (CKD) and delineate the factors that lead to disease progression in this population. Methods We reviewed the records of the Taiwan Pediatric Renal Collaborative Study, a multicenter database of Taiwanese children with CKD. Multivariate regression analysis was used to identify the main factors associated with disease progression. Results A total of 382 children aged 1-18 years were included in the study (median age was 10.6 years; interquartile range: 6.4-13.8). There were 197 males (51.6%) and 185 females. CKD Stage 1 was diagnosed in 159 children (41.6%), Stage 2 in 160 (41.9%), Stage 3 in 51 (13.4%), and Stage 4 in 12 (3.1%). Fifty-six children (14.7%) experienced CKD progression. A multivariate analysis for all patients indicated that the risk for disease progression was increased in children with CKD secondary to a structural abnormality, genetic disease, anemia, elevated diastolic blood pressure, or elevated blood urea nitrogen. Compared with children with Stage 1 CKD, those with Stage 2 and Stage 4 CKD had decreased risk for CKD progression in this short-term cohort follow-up. Conclusion CKD etiology affects disease progression. Careful monitoring and treatment of anemia and elevated blood pressure in children with CKD may slow disease progression.

The tripartite motif-containing protein 28 (TRIM28) is a transcription corepressor, interacting with histone deacetylase and methyltransferase complexes. TRIM28 is a crucial regulator in development and differentiation. We would like to investigate its function and regulation in adipogenesis. Knockdown of Trim28 by transducing lentivirus-carrying shRNAs impairs the differentiation of 3T3-L1 preadipocytes, demonstrated by morphological observation and gene expression analysis. To understand the molecular mechanism of Trim28-mediated adipogenesis, the RNA-seq was performed to find out the possible Trim28-regulated genes. Dlk1 (delta-like homolog 1) was increased in Trim28 knockdown 3T3-L1 cells both untreated and induced to differentiation. Dlk1 is an imprinted gene and known as an inhibitor of adipogenesis. Further knockdown of Dlk1 in Trim28 knockdown 3T3-L1 would rescue cell differentiation. The epigenetic analysis showed that DNA methylation of Dlk1 promoter and differentially methylated regions (DMRs) was not altered significantly in Trim28 knockdown cells. However, compared to control cells, the histone methylation on the Dlk1 promoter was increased at H3K4 and decreased at H3K27 in Trim28 knockdown cells. Finally, we found Trim28 might be recruited by transcription factor E2f1 to regulate Dlk1 expression. The results imply Trim28-Dlk1 axis is critical for adipogenesis.

There is little information available on the association between primary renal disease (PRD) and long-term mortality in the pediatric dialysis population. The objective of this study was to explore mortality risks in children and adolescents on chronic dialysis, specifically focused on the risk of various PRDs. The study cohort included children and adolescents with end-stage renal disease (ESRD) (aged &lt, 20 years) who had received dialysis for at least 90 days between 2000 and 2014 and were identified from Taiwan&rsquo, s National Health Insurance medical claims. A total of 530 children and adolescents were included in the study. The median age of the included patients was 13.6 years and 305 (57.5%) patients were males. One hundred and seven patients died during the follow-up period and the median survival time was 6.0 years. Mortality was highest in the youngest patients. For patients with the following PRDs, mortality was significantly higher than that in patients with primary glomerulonephritis: secondary glomerulonephritis (adjusted hazard ratio (aHR): 2.50, 95% confidence interval (CI): 1.03&ndash, 6.08), urologic disorder (aHR: 4.77, 95% CI: 1.69&ndash, 13.46), and metabolic diseases (aHR: 5.57, 95% CI: 1.84&ndash, 16.85). Several kinds of PRDs appear to have high mortality risks in the pediatric dialysis population. These differences in mortality risk highlight the importance of the focused clinical management of these high-risk subgroups.

The incidence of acute kidney injury (AKI) in critically ill children varies among countries. Here we used claims data from the Taiwanese National Health Insurance program from 2006 to 2010 to investigate the epidemiological features and identify factors that predispose individuals to developing AKI and mortality in critically ill children with AKI. Of 60,338 children in this nationwide cohort, AKI was identified in 850, yielding an average incidence rate of 1.4%. Significant independent risk factors for AKI were the use of extracorporeal membrane oxygenation, mechanical ventilation or vasopressors, intrinsic renal diseases, sepsis, and age more than 1 year. Overall, of the AKI cases, 46.5% were due to sepsis, 36.1% underwent renal replacement therapy, and the mortality rate was 44.2%. Multivariate analysis showed that the use of vasopressors, mechanical ventilation, and hemato-oncological disorders were independent predictors of mortality in AKI patients. Thirty-two of the 474 patients who survived had progression to chronic kidney disease or end-stage renal disease. Thus, although not common, AKI in critically ill children still has a high mortality rate associated with a variety of factors. Long-term close follow-up to prevent progressive chronic kidney disease in survivors of critical illnesses with AKI is mandatory.

Background Enterobacter species has emerged as an important pathogen of nosocomial bacteremia. The purpose of this study is to review the clinical characteristics of bacteremia in pediatric patients. Materials and methods We reviewed retrospectively the medical records of patients (under the age of 18 years) having Enterobacter bacteremia who were treated at Taipei the Veterans General Hospital from January 2001 to June 2011. Results In total, 853 positive blood cultures were obtained from 620 patients during the study period. Among them, 96 episodes of Enterobacter bacteremia were found in 83 patients, accounting for 11.3% of all bacteremia. Eighty-two cases (98.8%) were nosocomial infections. Most of the cases were neonates (62 cases, 74.7%) and premature infants (51 cases, 61.5%). The common sources of bacteremia were the respiratory tract (53.0%), followed by intravascular catheter (10.8%), multiple sources (10.8%), and the gastrointestinal tract (8.4%). The overall case fatality rate was 18.1%, with the highest rate being reported among premature infants. The factors responsible for the deaths were leukocytosis and a higher median number of underlying diseases. Conclusion Based on the findings of the present study, it can be concluded that Enterobacter species are probably an important pathogen of nosocomial bacteremia in premature neonates. The number of underlying diseases should be considered a major factor influencing the prognosis.

The toxic effect of urethane dimethacrylate (UDMA), a major dental resin monomer, on human dental pulp is not fully clear. In this study, we investigated the influence of UDMA on the cytotoxicity, cell cycle distribution, apoptosis and related gene expression of dental pulp cells. The role of reactive oxygen species, hemeoxygenase-1 (HO-1) and carboxylesterase (CES) in UDMA cytotoxicity, was evaluated. UDMA induced morphological changes of pulp cells and decreased cell viability by 29-49% at concentrations of 0.1-0.35 mM. UDMA induced G0/G1, G2/M cell cycle arrest and apoptosis. The expression of cdc2, cyclinB1 and cdc25C was inhibited by UDMA. Moreover, UDMA stimulated COX-2, HO-1 and CES2 mRNA expression of pulp cells. The cytotoxicity of UDMA was attenuated by N-acetyl-l-cysteine, catalase and esterase, but was enhanced by Zn-protoporphyrin (HO-1 inhibitor), BNPP (CES inhibitor) and loperamide (CES2 inhibitor). Exposure of UDMA may potentially induce the inflammation and toxicity of dental pulp. These findings are important for understanding the clinical response of human pulp to resin monomers after operative restoration and pulp capping, and also provide clues for improvement of dental materials.

The objective of this study is to investigate the synergistic effects of acid etching and metal-ion chelation in dental smear layer removal using wasted Ganoderma tsugae derived chitosans. The wasted Ganoderma tsugae fruiting body was used to prepare both acid-soluble fungal chitosan (FCS) and alkali-soluble polysaccharide (ASP). To explore the effective irrigant concentration for smear layer removal, a chelating effect on ferrous ions was conducted. Specimens of various concentrations of EDTA, citric acid, and polysaccharide solutions were reacted with FerroZine&trade, then the absorbance was examined at 562 nm by a UV-visible spectrophotometer to calculate their metal chelating capability. Twenty extracted premolars were instrumented and individually soaked in the solutions of 15 wt% EDTA, 10 wt% citric acid, 0.04 wt% ASP, 0.04 wt% FCS, and normal saline were randomly divided into five groups (N=4). Next, each tooth was cleaved longitudinally and examined by scanning electron microscopy (SEM) to assay the effectiveness of smear layer removal. The chelating capability for EDTA, FCS, and ASP showed no significant difference over the concentration of 0.04 wt% (p &gt, 0.05). The SEM results showed that 0.04 wt% FCS solution was effective in smear layer removal along the canal wall. These results indicated that Ganoderma tsuage derived FCS in acid solutions could be a potential alternative as a root canal irrigant solution due to its synergistic effect.

Chronic graft-versus-host disease (cGVHD) is one of the most frequent and serious complications of allogeneic hematopoietic stem cell transplantation (HSCT). Nephrotic syndrome (NS) is an uncommon and underrecognized manifestation of cGVHD. We report a patient who developed NS 18 months after allogeneic bone marrow transplantation. The onset of NS was accompanied by active manifestations of cGVHD, and immunosuppressants had not been tapered recently. Renal biopsy revealed membranous nephropathy. The patient failed to improve with three combined immunosuppressants (prednisolone, cyclosporine, and mycophenolate mofetil), but achieved partial remission after intravenous immunoglobulin (IVIG) infusion. Twenty-four months after the diagnosis of NS, the patient was still in hematological remission, with normal serum creatinine level, urinary protein loss of 0.7–1.9 g/day and mild oral mucositis. Our report suggests that NS can be a cGVHD-related immune disorder in HSCT patients. Monitoring of renal parameters, especially proteinuria, is important in cGVHD patients. Our case indicated that post-transplant NS, occurring without history of tapering or following immunosuppressant withdrawal, presents a more severe activity of cGVHD and a relatively severe clinical course. IVIG may modify and control the refractory GVHD-related NS, and can be one of the choices of treatment.

Background Peritonitis is the most serious complication of peritoneal dialysis (PD). We previously showed that high levels of interleukin (IL)-12 and IL-18 in PD effluents (PDE) during the early phase of peritonitis correlated with a predominant Type 1 immune response and a favorable outcome in PD-related peritonitis. To further clarify the longitudinal changes of peritoneal immunity during PD-related peritonitis, we examined the kinetic production of IL-17 in PDE during peritonitis. The correlation between the IL-17 expression pattern and peritonitis outcome was analyzed. Methods The levels of IL-17 were measured in PDE during various phases of peritonitis in 38 patients undergoing PD. The patients were divided into two groups, according to whether they had a rapid versus a delayed response to antibiotic treatment. Results The kinetic expression of IL-17, as measured by enzyme-linked immunosorbent assay, differed between the two groups. In the rapid response group, high level of IL-17 was detected in PDE initially and progressively decreased during treatment. In the delayed response group, IL-17 levels in PDE were persistently low throughout the whole course of treatment. In the early phase of peritonitis, the IL-17 levels in PDE were significantly higher in the rapid response group ( p Conclusion These data suggested that local IL-17 production is part of a protective early immune response to PD-related peritonitis. High levels of IL-17 in PDE during the early phase of peritonitis correlated with a favorable outcome. Manipulation of IL-17 cytokine expression in patients with peritonitis may modulate peritoneal immune response and affect peritonitis outcome.

Rhabdomyolysis is a life-threatening condition that involves muscle cell destruction. Among its etiologies, severe hyper-natremia is a less common cause. We report a teenage girl with congenital central hypoventilation syndrome and hypothalamus dysfunction syndrome who presented with extreme hypernatremia (sodium, 211 mmol/L) with rhabdomyolysis (creatine kinase, 32,850 U/L) and acute renal failure (creatinine, 6.1 mg/dL) following gastroenteritis with 7-kg weight loss. Rhabdomyolysis subsequently led to acute renal failure and hyperkalemia. Acute hemodialysis was initiated on hospital day 3 for hyperkalemia. This resulted in a 13 mmol/L fall in serum sodium in 3 hours despite using a 156 mmol/L sodium bath, but without the development of cerebral edema or neurological defect. This report highlights an unusual cause of rhabdomyolysis in children and the experience of managing such a difficult clinical situation. [J Chin Med Assoc 2009;72(10):555–558]