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Abstract: Background: The most common serious complication following acute ischemic stroke is pneumonia, which may increase mortality and worsen clinical outcomes. The purpose of this study was to investigate the predictors of 30-day mortality in patients with pneumonia following acute ischemic stroke. Methods: From June 2006 to May 2011, we retrospectively included 51 patients with pneumonia following acute ischemic stroke. We analyzed the clinical features, microbiologic data, and outcomes. Predictors of 30-day mortality were investigated by univariate and multivariate analysis. Results: The acute ischemic strokes were caused by large-artery atherosclerosis in 37 (72.5%) of the 51 patients. We found that the most common pathogen responsible for poststroke pneumonia was Klebsiella pneumoniae, followed by Pseudomonas aeruginosa and Escherichia coli. Ultimately, 12 patients died of progressive sepsis due to pneumonia after the acute ischemic stroke. The 30-day mortality rate was 23.5%. In the univariate analysis, patients who died within 30 days had higher National Institutes of Health Stroke Scale scores, higher CURB-65 scores, elevated instability of hemodynamic status, and lower Glasgow Coma Scale (GCS) scores. In Cox regression analysis, a GCS score of <9 on the day of pneumonia onset was only significant indicator for 30-day mortality (hazard ratio, 6.72; 95% confidence interval, 2.12–21.30, p = 0.001). Conclusion: Pneumonia after acute ischemic stroke is a severe complication. Once stroke-related pneumonia develops, neurologic assessment, CURB-65 score, and shock can be used to predict the ultimate prognosis. [Copyright &y& Elsevier]

This study synthesized a series of titanium iminophenoxide complexes and investigated their suitability as catalysts for the ring-opening polymerization of L-lactide ( L-LA) and ε-caprolactone (CL). Complexes with bidentate ligands demonstrate higher catalytic activity than their tridentate counterparts since the third coordination atom needs to contend with L-LA and CL. Differences in the geometric framework of bidentate ligands also influence the catalytic activity. Type II ligands ( N, N-trans form of Ti complex) prevent the coordination of monomers to Ti thereby decreasing the initiation rate. © 2012 Wiley Periodicals, Inc. J Polym Sci Part A: Polym Chem, 2013 [ABSTRACT FROM AUTHOR]

Summary: Background: Tuberculous pleural effusion is the second most common form of extrapulmonary tuberculosis. The relationship between the geriatric population and tuberculous pleural effusion has rarely been studied. Methods: This is a retrospective study. From January 2005 through February 2009, we retrospectively enrolled 51 patients older than 18 years of age that were diagnosed with tuberculous pleurisy. We analyzed the clinical presentations and laboratory data of pleural effusion in elderly and adult groups. Results: Of these patients, 32 were more than 65 years of age (elderly group) and 19 were less than 65 years of age (adult group). Chest pain occurred more frequently in the adult group than the elderly group (52.6 % vs. 15.6 %; p < 0.01). Ziehl-Neelsen stain and Lowenstein-Jensen culturing of the pleural fluid demonstrated similar diagnostic sensitivities between the adult and elderly groups. The pleural fluid consists almost exclusively of exudates, with lymphocytes being the most predominant finding. Regardless, lower lactate dehydrogenase (LDH) and protein contents in the pleural effusion of the elderly group were noted. The duration between thoracentesis and administration of antituberculous therapy was significantly longer in elderly group (12.4 ± 15.4 vs. 4.4 ± 5.5 days; p = 0.03). Conclusion: Tuberculous pleurisy in elderly patients has less specific symptoms and laboratory findings. It may require a longer time to confirm diagnosis and start treatment. [ABSTRACT FROM AUTHOR]

Abstract: Triterpenoids, 1–3, 8 and 9, along with 24 known compounds were isolated from leaves and twigs of Fagus hayatae. Of these, compound 1, 1,10-seco-3β,10α,23-trihydroxyolean-12-ene-1,28-dioic acid 1,23-lactone, possesses a hitherto unknown 1,10-seco-oleanane skeleton. In addition, 2,3-seco-20(29)-lupene-2,3-dioic acid (16), previously described as a synthetic product, is now established as a plant natural product; the neolignan-9′-O-rhamnoside 19 is also characterized herein. Their structures were deduced mainly by 1D and 2D NMR spectroscopic analyses. Seven of these compounds possess moderate inhibitory activity against α-glucosidase type IV (Bacillus stearothermophilus). [Copyright &y& Elsevier]

Abstract: This study was aimed to investigate thoroughly the diarylheptanoids in the n-BuOH soluble fraction of leaves of Alnus formosana in order to examine their anti-inflammatory activities. The application of HPLC-SPE-NMR as a preliminary chemical screening led to characterization of eleven compounds. Further separation resulted in isolation of 28 compounds, of which 10 diarylheptanoids and 2-coumaroylxyloside are new natural products. Compound 1 and alnuside A (27) were found to possess good activities against LPS-induced NO production with respective IC50 values of 7.99 and 8.08μM, and which were devoid of significant cytotoxicity. [Copyright &y& Elsevier]

Summary: Background: Psoas muscle abscess is a previously rare disease that has increased in its reported prevalence because of improved diagnostic tools. The literature on psoas muscle abscess mostly consists of case reports and case series. Methods: We analyzed medical records, such as characteristics, pathogens, and disease pattern, from our hospital in the past 8 years and report nine cases of psoas abscess. We also reviewed the literature for case series and performed a meta-analysis to assess the current characteristics of this disease since 1986. Results: We reviewed a total of 36 studies, with a total of 682 cases. The average age was 52.6 years, and the mortality rate was 8% (55 of 682). In 35 studies, a total of 274 cases (40.77%) received drainage (274 of 672), whereas 290 (43.15%) received surgery. In 522 cases, the ratio of primary to secondary etiologies was 1:1.71. In 209 cases, Staphylococcus aureus, and in 70 cases, Escherichia coli were identified as the pathogens from culture data. Compared with Ricci’s case series, we found an obvious increase in prevalence of secondary causes (63.2% compared with 21.8%) and higher mortality in recent study (6.7% in Ricci’s study and 8.1% in recent study). There was an obvious shift toward drainage as the treatment of choice. Conclusions: We conclude that a higher mortality has occurred in recent study, and psoas abscess is an infrequent and easily overlooked infectious disease requiring early diagnosis with favorable results with percutaneous drainage. [Copyright &y& Elsevier]

A letter to the editor is presented in response to the article "Psoriasis and thyroid profile: Analysis of the U.S. National Health and Nutrition Examination Survey database" that was published in the previous issue.

Objectives: To assess the consequences of renal ultrasonography (RUS) in the treatment of children younger than 5 years of age with a first febrile urinary tract infection. Methods: We retrospectively reviewed the results of imaging studies, including RUS, computed tomography, and voiding cystourethrography in children with a first febrile urinary tract infection during a 2-year period. Children with known urologic anomalies, other underlying diseases, or simultaneous combined illnesses were excluded. Children with nephromegaly were diagnosed with acute lobar nephronia by computed tomography. Results: A total of 390 children were included in this study. Of the 390 children, 112 (28.7%) had abnormal RUS findings. The children with abnormal RUS findings of nephromegaly, small kidney, intermittent hydronephrosis, or a double collecting system had a significantly greater incidence of vesicoureteral reflux than children with normal RUS findings. Additionally, the occurrence of high-grade vesicoureteral reflux in children with abnormal RUS findings was more frequent than in children with normal RUS findings. Conclusions: The results of our study indicate that it is worth performing RUS in children with a first febrile urinary tract infection because abnormal kidney size or other specific structural ultrasound findings should be investigated, in addition to isolated hydronephrosis. [Copyright &y& Elsevier]

Treatments of bis(diphenylphosphino)methylene (dppm) bridged dicobalt complex, Co2(CO)6(μ-Ph2PCH2PPh2), with alkynes, Ph2PC&z.tbnd6;CR (2: R=CMe3; 3: R=SiMe3), at 60 °C in THF for 6 h gave alkyne-bridged complexes [(μ-Ph2PCH2PPh2)Co2(CO)4][(μ-Ph2PC&z.tbnd6;CR)] (4: R=CMe3; 5: R=SiMe3). Further reactions of 4 and 5 with Co2(CO)8 at 80 °C in toluene for 3 h resulted in the formations of unexpected tetra-cobalt clusters, [(μ-Ph2PCH2PPh2)(μ-PPh2)Co4(CO)7(μ4,μ2-CCR)] (6: R=CMe3; 7: R=SiMe3). All these compounds were characterized by spectroscopic means; 5, 6 and 7 were studied by X-ray diffraction methods as well. The structure of 6 (or 7) can be looked upon as a tetra-cobalt arachno cluster being coordinated with phosphine ligands and linked by organic moiety. [Copyright &y& Elsevier]

Introduction: Comprehensive next-generation sequencing (NGS) of non-small-cell lung cancer specimens can identify oncogenic driver mutations and their corresponding targeted therapies. Plasma cell-free DNA (cfDNA) genotyping is easy to perform; however, false negatives cannot be overlooked. We explored malignant pleural effusion (MPE), a rich source of cfDNA, as a non-inferior alternative to tumor tissues for genotyping. Methods: We conducted a prospective trial including 39 patients with newly diagnosed stage IV lung adenocarcinoma who presented with MPE. Tissue tests matching hotspot variants, including EGFR, ALK, and ROS1, were compared with the AlphaLiquid100 of PE-cfDNA. Results: Among the 39 PE-cfDNA samples successfully sequenced, 32 (82.1%) had a PE cell-block tumor content of < 10%. Standard tissue or cell-block testing for EGFR, ALK, and ROS1 identified 20 mutations (51.3%), whereas PE cfDNA identified 25 mutations (64.1%). Five EGFR mutations were observed in PE cfDNA but not in Cobas EGFR owing to coverage or insufficient tumor content issues. The overall rate of oncogenic mutations identified in the PE cfDNA was 92.3%, and the mutation distribution was as follows: even with a very low cfDNA input, high detection rates could be achieved. Otherwise, most patients harbored co-mutations. Comparison of pleural fluid NGS with traditional testing revealed differences in accuracy. We also followed up with patients with EGFR-sensitizing mutations who had a treatment response rate of 97.2% after 3 months. Conclusions: Genotyping of MPE supernatant cfDNA is feasible in clinical practice, in addition to plasma and tumor testing, to improve diagnostic yield and extend patients' benefit from targeted therapies. [ABSTRACT FROM AUTHOR]

Ubiquitous health management (UHM) is vital in the aging society. The UHM services with artificial intelligence of things (AIoT) can assist home-isolated healthcare in tracking rehabilitation exercises for clinical diagnosis. This study combined a personalized rehabilitation recognition (PRR) system with the AIoT for the UHM of lower-limb rehabilitation exercises. The three-tier infrastructure integrated the recognition pattern bank with the sensor, network, and application layers. The wearable sensor collected and uploaded the rehab data to the network layer for AI-based modeling, including the data preprocessing, featuring, machine learning (ML), and evaluation, to build the recognition pattern. We employed the SVM and ANFIS methods in the ML process to evaluate 63 features in the time and frequency domains for multiclass recognition. The Hilbert-Huang transform (HHT) process was applied to derive the frequency-domain features. As a result, the patterns combining the time- and frequency-domain features, such as relative motion angles in y- and z-axis, and the HHT-based frequency and energy, could achieve successful recognition. Finally, the suggestive patterns stored in the AIoT-PRR system enabled the ML models for intelligent computation. The PRR system can incorporate the proposed modeling with the UHM service to track the rehabilitation program in the future. [ABSTRACT FROM AUTHOR]

Characterizing light in microalgal cultivation vessels is needed for modeling and optimizing microalgal growth for large-scale cultivation. Dynamic changes in light intensity over space due to geometry, refraction/reflection, and the interactive impacts of algal growth and their biocomponents with light make this characterization challenging. Understanding which biocomponents within microalgal cultures are key variables in accurately estimating light attenuation is fundamentally important, yet, inconsistent and wide-ranging applications of the Beer-Lambert law are often used to estimate light attenuation. This research rigorously evaluated which biocomponents (total biomass, cell count, and chl a, chl b, and total photosynthesizing pigments), or biocomponent combinations, serve as best predictors for light attenuation when modeling with the Beer-Lambert law. Calibration and validation experiments were performed using salt-water species Dunaliella viridis microalgal cultures grown in 3-L flat-plate PBRs with continuous light monitoring. Results at the various light and nitrogen levels tested showed Beer-Lambert's law predicted photosynthetic light attenuation well when both biomass and chlorophyll a were considered as distinct attenuating components, providing light estimates with less than 6% error on average over validation experiments. If the model included only one component as a predictor for attenuation, pigments were best, with a 20% error in estimating light, as compared to ~70%, 60%, 40% for models that used solely biomass, cells, or chlorophyll a as an attenuating component., respectively. These results suggest that when using the Beer-Lambert's law to estimate photosynthetic light attenuation in microalgal cultures, both a chlorophyll a and biomass component should be consistently included. • Alternative Beer-Lambert law models for estimating light attenuation were compared (78). • Various light and nitrogen conditions were used for calibration and validation of models (77). • Models with chlorophyll(s) and biomass as distinct attenuating species gave best light estimates (85). • The biomass-only light model led to ~40% error in predicting the light validation data (74). • Given chlorophyll and light data, the chlorophyll a and biomass model predicted biomass within 11% (85). [ABSTRACT FROM AUTHOR]

Symptoms have been used to diagnose conditions such as frailty and mental illnesses. However, the diagnostic accuracy of the numbers of symptoms has not been well studied. This study aims to use equations and simulations to demonstrate how the factors that determine symptom incidence influence symptoms' diagnostic accuracy for disease diagnosis. Assuming a disease causing symptoms and correlated with the other disease in 10,000 simulated subjects, 40 symptoms occurred based on 3 epidemiological measures: proportions diseased, baseline symptom incidence (among those not diseased), and risk ratios. Symptoms occurred with similar correlation coefficients. The sensitivities and specificities of single symptoms for disease diagnosis were exhibited as equations using the three epidemiological measures and approximated using linear regression in simulated populations. The areas under curves (AUCs) of the receiver operating characteristic (ROC) curves was the measure to determine the diagnostic accuracy of multiple symptoms, derived by using 2 to 40 symptoms for disease diagnosis. With respect to each AUC, the best set of sensitivity and specificity, whose difference with 1 in the absolute value was maximal, was chosen. The results showed sensitivities and specificities of single symptoms for disease diagnosis were fully explained with the three epidemiological measures in simulated subjects. The AUCs increased or decreased with more symptoms used for disease diagnosis, when the risk ratios were greater or less than 1, respectively. Based on the AUCs, with risk ratios were similar to 1, symptoms did not provide diagnostic values. When risk ratios were greater or less than 1, maximal or minimal AUCs usually could be reached with less than 30 symptoms. The maximal AUCs and their best sets of sensitivities and specificities could be well approximated with the three epidemiological and interaction terms, adjusted R-squared ≥ 0.69. However, the observed overall symptom correlations, overall symptom incidence, and numbers of symptoms explained a small fraction of the AUC variances, adjusted R-squared ≤ 0.03. In conclusion, the sensitivities and specificities of single symptoms for disease diagnosis can be explained fully by the at-risk incidence and the 1 minus baseline incidence, respectively. The epidemiological measures and baseline symptom correlations can explain large fractions of the variances of the maximal AUCs and the best sets of sensitivities and specificities. These findings are important for researchers who want to assess the diagnostic accuracy of composite diagnostic criteria. [ABSTRACT FROM AUTHOR]

Heatstroke is a life-threatening disease; however, no pharmacologic treatment has proven to be effective. In severe cases with multiple organ dysfunction, the mortality remains high and many patients inevitably develop permanent neurologic damage. We report a near-fatal case of exertional heatstroke with multiple organ dysfunction, including generalized convulsions, acute lung injury, and disseminated intravascular coagulation, successfully treated with induced therapeutic hypothermia (33°C [91.4°F]) by a noninvasive external cooling system. After treatment, the patient completely recovered, without any neurologic sequelae during 1 year of follow-up. To our knowledge, this is the first reported case of using therapeutic hypothermia in heatstroke. [ABSTRACT FROM AUTHOR]

Background: Lung cancer misdiagnosed as tuberculosis (TB) is not rare, but the factors associated with early diagnosis revision remain unclear. Methods: We screened the cases with TB notification from 2007 to 2018 and reviewed those with misdiagnosis with a revised diagnosis to lung cancer. We analyzed the factors associated with early diagnosis revision (≤1 months) and early obtained pathology (≤1 months) using multivariable Cox regression. Results: During the study period, 45 (0.7%) of 6683 patients were initially notified as having TB, but later diagnosed with lung cancer. The reasons for the original impression of TB were mostly due to image suspicion (51%) and positive sputum acid-fast stain (AFS) (27%). Using multivariable Cox proportional regression, early diagnosis revision was associated with obtaining the pathology early, lack of anti-TB treatment, and negative sputum AFS. Furthermore, the predictors for early obtained pathology included large lesion size (>3 cm), presence of a miliary radiological pattern, no anti-TB treatment, and a culture-negative result when testing for nontuberculous mycobacteria (NTM) using multivariable Cox regression. Conclusion: In patients who are suspected to have TB but no mycobacterial evidence is present, lung cancer should be kept in mind and pathology needs to be obtained early, especially for those with small lesions, radiological findings other than the miliary pattern, and a culture positive for NTM. [ABSTRACT FROM AUTHOR]

The article describes the case of a 43-year-old woman with symptoms of chronic cough, progressive dyspnea on exertion and purulent sputum. The patient was admitted for the treatment of pneumonia and was given with intravenous levofloxacin for five days. The image pattern of her chest was found to be compatible with cylindrical bronchiectasis. Also mentioned are chief complaints of patients with bronchiectasis and treatment plan for patients diagnosed with bronchiectasis.

Abstract: Introduction: Rosacea is a common chronic facial skin disease. A multiethnic society such as Singapore provides an opportunity to evaluate the demographic characteristics and their impact on clinical outcome in rosacea. Aims: The aim of this study was to evaluate characteristics and outcome of rosacea in a multiracial population in Singapore. Methods: Records of all rosacea patients between January 2009 and December 2013 were retrospectively retrieved from the electronic medical records (EMR). Descriptive analysis was performed to understand the characteristics of patients with rosacea. Multivariate logistic regression was used to evaluate the associations between the various variables and types of rosacea as well as the clinical outcome. Results: A total of 1340 patients were identified. The mean age at presentation was 42.8 years with a female predominance (65%). Most of the patients had erythematotelangiectatic rosacea (ETR) (56.3%) followed by papulopustular rosacea (PPR) (37%). With multinomial logistic regression, controlling for age, gender, and known triggers, Indians and Caucasians were more likely to have PPR compared to ETR (OR: 3.4, P = 0.01 and OR: 2.1, P = 0.01 respectively). Patients who had phymatous rosacea are also more likely to be older males (OR: 3.82 95% CI 1.64–8.92, P = 0.002). Conclusion: The epidemiology and outcome of rosacea among local patients were studied. Rosacea is more common among certain racial groups such as Chinese, Caucasian, and other races. The clinical subtypes also seem to be related to races of certain skin colors and might be related to varied natural intrinsic responses to the sun among different racial groups. [ABSTRACT FROM AUTHOR]

In this paper, we report a promising approach for the gate recess process with a suppressed current collapse in GaN-based high electron mobility transistors (HEMTs) by means of neutral beam (NB). A recessed gate structure has been widely studied as a way to realize normally-off operation in GaN, InP, and GaAs-based HEMTs. Since GaN-based materials are usually etched by dry process, plasma-induced damage is a serious concern. NB is free from electrical charges and UV photons, resulting in an accurate control of etching depth and less plasma-induced damages. In this work, we introduce NB irradiation to the gate interface and measured DC and gate-pulsed output characteristics. The results suggest that NB is applicable for the gate recess etching with suppressing the current collapse. [ABSTRACT FROM AUTHOR]

Neuropsychological tests (NPTs), which are routinely used in clinical practice for assessment of dementia, are also considered to be essential for differential diagnosis of Alzheimer's disease (AD) and frontotemporal lobar degeneration (FTLD), especially the behavioral variants of frontotemporal dementia (bvFTD) and primary progressive aphasia (PPA) at their initial clinical presentations. However, the heterogeneous features of these diseases, which have many overlapping signs, make differentiation between AD and FTLD highly challenging. Moreover, NPTs were primarily developed in Western countries and for native speakers of non-tonal languages. Hence, there is an ongoing dispute over the validity and reliability of these tests in culturally different and typologically diverse language populations. The purpose of this case series was to examine which of the NPTs adjusted for Taiwanese society may be used to distinguish these two diseases. Since AD and FTLD have different effects on individuals' brain, we combined NPTs with neuroimaging. We found that participants diagnosed with FTLD had lower scores in NPTs assessing language or social cognition than AD participants. PPA participants also had lower measures in the Free and Cued Selective Reminding Test than those diagnosed with bvFTD, while bvFTD participants showed poorer performances in the behavioral measures than PPA participants. In addition, the initial diagnosis was supported by the standard one-year clinical follow-up. [ABSTRACT FROM AUTHOR]

Objectives. To compare 4 COVID-19 surveillance metrics in a major metropolitan area. Methods. We analyzed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in wastewater influent and primary solids in Raleigh, North Carolina, from April 10 through December 13, 2020. We compared wastewater results with lab-confirmed COVID-19 cases and syndromic COVID-like illness (CLI) cases to answer 3 questions: (1) Did they correlate? (2) What was the temporal alignment of the different surveillance systems? (3) Did periods of significant change (i.e., trends) align? Results. In the Raleigh sewershed, wastewater influent, wastewater primary solids, lab-confirmed cases, and CLI were strongly or moderately correlated. Trends in lab-confirmed cases and wastewater influent were observed earlier, followed by CLI and, lastly, wastewater primary solids. All 4 metrics showed sustained increases in COVID-19 in June, July, and November 2020 and sustained decreases in August and September 2020. Conclusions. In a major metropolitan area in 2020, the timing of and trends in municipal wastewater, lab-confirmed case, and syndromic case surveillance of COVID-19 were in general agreement. Public Health Implications. Our results provide evidence for investment in SARS-CoV-2 wastewater and CLI surveillance to complement information provided through lab-confirmed cases. (Am J Public Health. 2023;113(1):79–88. https://doi.org/10.2105/AJPH.2022.307108) [ABSTRACT FROM AUTHOR]

Background: Frailty is associated with major health outcomes. However, the relationships between frailty and frailty symptoms haven't been well studied. This study aims to show the associations between frailty and frailty symptoms. Methods: The Health and Retirement Study (HRS) is an ongoing longitudinal biannual survey in the United States. Three of the most used frailty diagnoses, defined by the Functional Domains Model, the Burden Model, and the Biologic Syndrome Model, were reproduced according to previous studies. The associations between frailty statuses and input symptoms were assessed using odds ratios and correlation coefficients. Results: The sample sizes, mean ages, and frailty prevalence matched those reported in previous studies. Frailty statuses were weakly correlated with each other (coefficients = 0.19 to 0.38, p < 0.001 for all). There were 49 input symptoms identified by these three models. Frailty statuses defined by the three models were not significantly correlated with one or two symptoms defined by the same models (p > 0.05 for all). One to six symptoms defined by the other two models were not significantly correlated with each of the three frailty statuses (p > 0.05 for all). Frailty statuses were significantly correlated with their own bias variables (p < 0.05 for all). Conclusion: Frailty diagnoses lack significant correlations with some of their own frailty symptoms and some of the frailty symptoms defined by the other two models. This finding raises questions like whether the frailty symptoms lacking significant correlations with frailty statuses could be included to diagnose frailty and whether frailty exists and causes frailty symptoms. [ABSTRACT FROM AUTHOR]

Abstract: Oregonin, existing primarily in the Alnus plants, displayed anti-inflammatory and antioxidative activities. The capillary zone electrophoresis (CZE) method was developed in this study to quantitatively determine oregonin content in the Alnus plants for the first time. Various parameters, including buffer concentration, pH and applied voltage, were evaluated for their optimum analytical conditions. The optimized buffer was composed of 30mM sodium tetraborate at pH 8.0. The separation voltage was set at 30kV and the UV detection wavelength was set at 220nm. Oregonin could be determined within 6min under such optimized conditions. Relative standard deviation (R.S.D.) of the run-to-run repeatability and intermediate precision of the retention time of oregonin was within 1.36%. Run-to-run repeatability and intermediate precision of the peak area ratios of oregonin to internal standard, theophylline, were both within 1.55% R.S.D. The presented method was applied to analyze oregonin in leaves of Alnus formosana, seeds of various Alnus plants as well as biological samples. The stability of oregonin in biological system was indicated in this study. It demonstrates the potential of this developed method in natural product research. [Copyright &y& Elsevier]