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To identify whether urolithiasis with or without hydronephrosis has an impact on acute kidney injury (AKI) in patients with urinary tract infection (UTI). This study aimed to identify whether urolithiasis with or without hydronephrosis has an impact on AKI in patients with UTI. This retrospective study enrolled hospitalized UTI patients who underwent imaging in an acute care setting from January 2006 to April 2019. Of the 1113 participants enrolled, 191 (17.2%) had urolithiasis and 76 (6.8%) had ureteral stone complicated with hydronephrosis. Multivariate logistic regression analysis showed that in UTI patients with urolithiasis, the presence of ureteral stone with concomitant hydronephrosis was an independent risk factor for AKI (odds ratio [OR] 2.299, 95% confidence interval [CI] 1.112–4.755, P = 0.025). In addition, urolithiasis was associated with an increased risk for AKI (OR 2.451, 95% CI 1.369–4.389, P = 0.003) in UTI patients without hydronephrosis. The presence of ureteral stone with hydronephrosis increases the risk for AKI of UTI patients with urolithiasis, and urolithiasis remains a risk factor of AKI in UTI patients without hydronephrosis.

Secondary hyperparathyroidism (SHPT) is common in end-stage renal disease (ESRD) patients, and it can suppress erythropoiesis. We aimed to investigate the relationship between the consumption of erythropoiesis-stimulating agents (ESAs) and parathyroidectomy (PTX) in ESRD patients with SHPT and to determine the predictors for anemia improvement. The current standard of chronic kidney disease anemia therapy relies on the prescription of iron supplementation, and ESA. We retrospectively analyzed 81 ESRD patients with PTX at Ditmanson Medical Foundation Chiayi Christian Hospital from July 2004 to Dec 2018. The requirement of ESA therapy markedly declined from a dose of 41.6 (interquartile range [IQR], 0–91.2) to 10.3 (IQR, 0–59.5, p = 0.001) unit/kg/week. In addition, 63.7% of patients required iron replacement therapy preoperatively and the proportion reduced to 52.5% after PTX (p < 0.001). The hemoglobin (Hb) level showed an insignificant change from a median value of 10.7 g/dL (9.5–11.6 g/dL) before PTX to 10.5 g/dL (9.6–11.2 g/dL) at 6 months after PTX. A preoperative Hb level ≤ 10 mg/dL (odds ratio [OR], 20.1; 95% confidence interval [CI], 4.71–125, p < 0.001) and transferrin saturation (TSAT) < 25% (OR, 12.8; 95% CI, 2.51–129, p < 0.001) were predictors for anemia improvement. Our study demonstrated that PTX markedly decreased the requirement of ESA. Patients with a low preoperative Hb level or low TSAT showed an increase in the Hb level after PTX. PTX may be considered not only for SHPT with refractory anemia but also for high ESA-dependent patients.

Glioblastoma (GBM) is the most common malignant primary brain tumor in humans, exhibiting highly infiltrative growth and drug resistance to conventional chemotherapy. Cedrus atlantica (CAt) extract has been shown to decrease postoperative pain and inhibit the growth of K562 leukemia cells. The aim of this study was to assess the anti-GBM activity and molecular mechanism of CAt extract in vitro and in vivo. The results showed that CAt extract greatly suppressed GBM cells both in vitro and in vivo and enhanced the survival rate in subcutaneous and orthotopic animal models. Moreover, CAt extract increased the level of ROS and induced DNA damage, resulting in cell cycle arrest at the G0/G1 phase and cell apoptosis. Western blotting results indicated that CAt extract regulates p53/p21 and CDK4/cyclin D1 protein expression and activates extrinsic and intrinsic apoptosis. Furthermore, CAt extract enhanced the cytotoxicity of Temozolomide and decreased AKT/mTOR signaling by combination treatment. In toxicity assays, CAt extract exhibited low cytotoxicity toward normal cells or organs in vitro and in vivo. CAt extract suppresses the growth of GBM by induction of genotoxicity and activation of apoptosis. The results of this study suggest that CAt extract can be developed as a therapeutic agent or adjuvant for GBM treatment in the future.

Breast cancer is the second most common malignancy in women. Current clinical therapy for breast cancer has many disadvantages, including metastasis, recurrence, and poor quality of life. Furthermore, it is necessary to find a new therapeutic drug for breast cancer patients to meet clinical demand. n-Butylidenephthalide (BP) is a natural and hydrophobic compound that can inhibit several tumors. However, BP is unstable in aqueous or protein-rich environments, which reduces the activity of BP. Therefore, we used an LPPC (Lipo-PEG-PEI complex) that can encapsulate both hydrophobic and hydrophilic compounds to improve the limitation of BP. The purpose of this study is to investigate the anti-tumor mechanisms of BP and BP/LPPC and further test the efficacy of BP encapsulated by LPPC on SK-BR-3 cells. BP inhibited breast cancer cell growth, and LPPC encapsulation (BP/LPPC complex) enhanced the cytotoxicity on breast cancer by stabilizing the BP activity and offering endocytic pathways. Additionally, BP and LPPC-encapsulated BP induced cell cycle arrest at the G0/G1 phase and might trigger both extrinsic as well as intrinsic cell apoptosis pathway, resulting in cell death. Moreover, the BP/LPPC complex had a synergistic effect with doxorubicin of enhancing the inhibitory effect on breast cancer cells. Consequently, LPPC-encapsulated BP could improve the anti-cancer effects on breast cancer in vitro. In conclusion, BP exhibited an anti-cancer effect on breast cancer cells, and LPPC encapsulation efficiently improved the cytotoxicity of BP via an acceleration of entrapment efficiency to induce cell cycle block and apoptosis. Furthermore, BP/LPPC exhibited a synergistic effect in combination with doxorubicin.

Glioblastoma (GBM) is a common and aggressive brain tumor with a median survival of 12-15 months. Temozolomide (TMZ) is a first-line chemotherapeutic agent used in GBM therapy, but the occurrence of drug resistance limits its antitumor activity. The natural compound cedrol has remarkable antitumor activity and is derived from Cedrus atlantica. In this study, we investigated the combined effect of TMZ and cedrol in GBM cells in vitro and in vivo. The TMZ and cedrol combination treatment resulted in consistently higher suppression of cell proliferation via regulation of the AKT and MAPK signaling pathways in GBM cells. The combination treatment induced cell cycle arrest, cell apoptosis, and DNA damage better than either drug alone. Furthermore, cedrol reduced the expression of proteins associated with drug resistance, including O6-methlyguanine-DNA-methyltransferase (MGMT), multidrug resistance protein 1 (MDR1), and CD133 in TMZ-treated GBM cells. In the animal study, the combination treatment significantly suppressed tumor growth through the induction of cell apoptosis and decreased TMZ drug resistance. Moreover, cedrol-treated mice exhibited no significant differences in body weight and improved TMZ-induced liver damage. These results imply that cedrol may be a potential novel agent for combination treatment with TMZ for GBM therapy that deserves further investigation.

Hyperuricemia has been associated with chronic kidney disease (CKD) progression. The antihyperuricemic febuxostat's potential renoprotective effect has been demonstrated in stage 1–3 CKD. Large‐scale studies comparing the renoprotective potential of febuxostat and allopurinol in advanced CKD are lacking. We exclusively selected 6,057 eligible patients with predialysis stage 5 CKD prescribed either febuxostat or allopurinol using the National Health Insurance Research Database in Taiwan during 2012–2015. There were 69.57% of allopurinol users and 42.01% febuxostat users who required long‐term dialysis (P

Erythropoietic medications such as including erythropoietin (EPO) are known to be neuroprotective and to correlate with improved cognitive functions. However, it is not known whether supplementation with EPO reduces the risk of dementia in end-stage renal disease (ESRD) patients receiving hemodialysis (HD). Here, we determined whether EPO levels correlate with the incidence of different dementia subtypes, including Alzheimer's disease (AD), vascular dementia (VaD), and unspecified dementia (UnD), and whether such associations vary with annual cumulatively defined daily doses (DDDs) of EPO for ESRD patients receiving HD. This retrospective study included data from 43,906 adult ESRD patients who received HD between 1999 and 2010. Using hazard ratios and Cox regression models, we found that patients receiving EPO had a 39% lower risk of general dementia than those in the non-EPO group. Similarly, the risks of VaD and UnD was lower for patients in the EPO cohort. The risk of dementia was further reduced in HD patients treated with EPO in combination with iron. Our results suggest that the use of EPO medications in HD patients is associated with a reduced risk of VaD and UnD, but not AD, regardless of whether EPO is used alone or in combination with iron.

Background Targeting higher hemoglobin levels with erythropoietin to treat anemia in patients with chronic kidney disease is associated with increased cardiovascular risk, including that of stroke. The risks of the subtypes of stroke, ischemic, hemorrhagic, and unspecified, following the administration of erythropoietin in patients with end‐stage renal disease receiving hemodialysis remain unclear. Methods and results Overall, 12 948 adult patients with end‐stage renal disease treated during 1999 to 2010 who had undergone hemodialysis were included. The study end points were the incidences of stroke and its subtypes. We used Cox proportional hazards regression models to estimate hazard ratios (HRs) of stroke and its subtypes in erythropoietin recipients compared with nonrecipients. Patients in the erythropoietin cohort did not have an increased risk of stroke compared with those in the nonerythropoietin cohort (adjusted HR, 1.03; 95% CI, 0.92–1.15). Compared with patients in the nonerythropoietin cohort, the risks of ischemic, hemorrhagic, or unspecified stroke were not higher in patients in the erythropoietin cohort (adjusted HRs, 1.08 [95% CI, 0.93–1.26], 0.96 [95% CI, 0.78–1.18], and 1.03 [95% CI, 0.80–1.32], respectively). Increased risks of stroke and its subtypes were not observed with even large annual defined daily doses of erythropoietin (>201). Conclusions Erythropoietin in patients receiving hemodialysis is not associated with increased risk of stroke or any of its subtypes.

Hepatocellular carcinoma (HCC) is the most common type of primary liver cancer and accounts for the fourth leading cause of all cancer deaths. Scientific evidence has found that plant extracts seem to be a reliable choice due to their multitarget effects against HCC. Juniperus communis has been used for centuries in traditional medicine and its anticancer properties have been reported. As a result, the purpose of the study was to investigate the anticancer effect and mechanism of J. communis extract (JCo extract) on HCC in vitro and in vivo. In the present study, we found that JCo extract inhibited the growth of human HCC cells by inducing cell cycle arrest at the G0/G1 phase, extensive apoptosis and suppressing metastatic protein expressions in HCC cells. Moreover, the combinational treatment of JCo and VP-16 was found to enhance the anticancer effect, revealing that JCo extract might have the potential to be utilized as an adjuvant to promote HCC treatment. Furthermore, in vivo study, JCo extract significantly suppressed HCC tumor growth and extended the lifespan with no or low systemic and pathological toxicity. JCo extract significantly up-regulated the expression of pro-apoptotic proteins and tumor suppressor p53, suppressed VEGF/VEGFR autocrine signaling, down-regulated cell cycle regulatory proteins and MMP2/MMP9 proteins. Overall, our results provide a basis for exploiting JCo extract as a potential anticancer agent against HCC.

Cedrus atlantica is widely used in herbal medicine. However, the anti-cancer activity of C. atlantica extract (CAt extract) has not been clarified in hepatocellular carcinoma. In the study, we elucidated the anti-hepatoma capacity of CAt extract on HCC in vitro and in vivo. To explore the anti-hepatoma mechanisms of the CAt extract in vitro, HCC and normal cells were treated with the CAt extract, which showed marked inhibitory effects on HCC cells in a dose-dependent manner, in contrast, the CAt extract treatment was less cytotoxic to normal cells. In addition, our results indicate that the CAt extract induced apoptosis via caspase-dependent and independent apoptosis pathways. Furthermore, the CAt extract inhibited HCC tumor cell growth by restraining cell cycle progression, and it reduced the signaling of the AKT, ERK1/2, and p38 pathways. In the xenograft model, the CAt extract suppressed HCC tumor cell growth and prolonged lifespan by inhibiting PCNA protein expression, repressing part of the VEGF-induced autocrine pathway, and triggering strong expression of cleaved caspase-3, which contributed to cell apoptosis. Moreover, the CAt extract did not induce any obvious changes in pathological morphology or body weight, suggesting it had no toxicity. CAt extract exerted anti-tumor effects on HCC in vitro and in vivo. Thus, CAt extract could be used as a potential anti-cancer therapeutic agent against HCC.

The presence of fever has long been a warning sign of severe urinary tract infection (UTI). However, we previously identified that inpatients with afebrile UTI had an increased risk of developing acute kidney injury (AKI). After expanding this cohort, 1132 inpatients with UTI diagnosed between January 2006 and April 2019 were analyzed. Overall, 159 (14%) of these patients developed AKI, bacteremia, urolithiasis, septic shock, hypertension, lower baseline renal function, marked leukocytosis, and the absence of fever were independently linked to AKI. When we further studied the cohort of inpatients with fever during hospitalization, we identified a group of &ldquo, delayed fever&rdquo, UTI inpatients who did not have fever as their initial presentation. Compared to patients presenting with fever at the emergency department, patients with delayed fever tended to be younger and have less frequent infection with Escherichia coli, more frequent AKI, upper tract infection, and a longer hospital stay. Despite the initial absence of fever, these patients demonstrated larger extents of elevations in both serum white blood cell counts and C-reactive protein levels. In short, besides UTI patients with lower baseline renal function that remain afebrile during their hospital stay, clinical awareness of the increased incidence of AKI in younger patients with &ldquo, should also be noted.

The oral cancer incidence rate is slowly increasing and is now the fifth leading cause of cancer-related death due to its high metastasis and recurrence rate. Juniperus communis is used as a traditional Chinese medicine and has been proven to have anti-cancer activity against neuroblastomas. In the present study, we further investigated the anti-cancer mechanisms of J. communis extract (JCo) on oral cancer and evaluated the synergistic effects of JCo combined with 5-fluorouracil (5-FU). We found that JCo inhibited oral cancer cell growth, and that JCo might be less cytotoxic to normal cells than to cancer cells. After JCo treatment, cell cycle arrest was observed at the G0/G1 phase through modulation of p53/p21 and Rb signaling. JCo also caused an increase in the sub-G1 phase and cell apoptosis via the intrinsic and extrinsic apoptosis pathways. JCo combined with 5-FU presented a synergistic effect to reduce cell viability. In conclusion, JCo inhibited oral cancer cell growth by inducing cell cycle arrest and activating cell apoptosis, and JCo significantly synergized with 5-FU. JCo might have the potential to be an adjuvant and a new therapeutic drug for oral cancer treatment.

Cedrus atlantica is widely used in herbal medicine. However, the anti-cancer activity of C. atlantica extract (CAt extract) has not been clarified in hepatocellular carcinoma. In the study, we elucidated the anti-hepatoma capacity of CAt extract on HCC in vitro and in vivo. To explore the anti-hepatoma mechanisms of the CAt extract in vitro, HCC and normal cells were treated with the CAt extract, which showed marked inhibitory effects on HCC cells in a dose-dependent manner; in contrast, the CAt extract treatment was less cytotoxic to normal cells. In addition, our results indicate that the CAt extract induced apoptosis via caspase-dependent and independent apoptosis pathways. Furthermore, the CAt extract inhibited HCC tumor cell growth by restraining cell cycle progression, and it reduced the signaling of the AKT, ERK1/2, and p38 pathways. In the xenograft model, the CAt extract suppressed HCC tumor cell growth and prolonged lifespan by inhibiting PCNA protein expression, repressing part of the VEGF-induced autocrine pathway, and triggering strong expression of cleaved caspase-3, which contributed to cell apoptosis. Moreover, the CAt extract did not induce any obvious changes in pathological morphology or body weight, suggesting it had no toxicity. CAt extract exerted anti-tumor effects on HCC in vitro and in vivo. Thus, CAt extract could be used as a potential anti-cancer therapeutic agent against HCC.

Breast cancer is the second most common malignancy in women. Current clinical therapy for breast cancer has many disadvantages, including metastasis, recurrence, and poor quality of life. Furthermore, it is necessary to find a new therapeutic drug for breast cancer patients to meet clinical demand. n-Butylidenephthalide (BP) is a natural and hydrophobic compound that can inhibit several tumors. However, BP is unstable in aqueous or protein-rich environments, which reduces the activity of BP. Therefore, we used an LPPC (Lipo-PEG-PEI complex) that can encapsulate both hydrophobic and hydrophilic compounds to improve the limitation of BP. The purpose of this study is to investigate the anti-tumor mechanisms of BP and BP/LPPC and further test the efficacy of BP encapsulated by LPPC on SK-BR-3 cells. BP inhibited breast cancer cell growth, and LPPC encapsulation (BP/LPPC complex) enhanced the cytotoxicity on breast cancer by stabilizing the BP activity and offering endocytic pathways. Additionally, BP and LPPC-encapsulated BP induced cell cycle arrest at the G0/G1 phase and might trigger both extrinsic as well as intrinsic cell apoptosis pathway, resulting in cell death. Moreover, the BP/LPPC complex had a synergistic effect with doxorubicin of enhancing the inhibitory effect on breast cancer cells. Consequently, LPPC-encapsulated BP could improve the anti-cancer effects on breast cancer in vitro. In conclusion, BP exhibited an anti-cancer effect on breast cancer cells, and LPPC encapsulation efficiently improved the cytotoxicity of BP via an acceleration of entrapment efficiency to induce cell cycle block and apoptosis. Furthermore, BP/LPPC exhibited a synergistic effect in combination with doxorubicin.

BackgroundUrolithiasis is a common cause of urinary tract obstruction and urinary tract infection (UTI). This study aimed to identify whether urolithiasis with or without hydronephrosis has an impact on acute kidney injury (AKI) in patients with UTI.Methods and findingsThis retrospective study enrolled hospitalized UTI patients who underwent imaging in an acute care setting from January 2006 to April 2019. Of the 1113 participants enrolled, 191 (17.2%) had urolithiasis and 76 (6.8%) had ureteral stone complicated with hydronephrosis. Multivariate logistic regression analysis showed that in UTI patients with urolithiasis, the presence of ureteral stone with concomitant hydronephrosis was an independent risk factor for AKI (odds ratio [OR] 2.345, 95% confidence interval [CI] 1.128–4.876, P = 0.023). In addition, urolithiasis was associated with an increased risk for AKI (OR 2.484, 95% CI 1.398–4.415, P = 0.002) in UTI patients without hydronephrosis.ConclusionThe presence of ureteral stone with hydronephrosis increases the risk for AKI of UTI patients with urolithiasis, and urolithiasis remains a risk factor of AKI in UTI patients without hydronephrosis.

BACKGROUND: The purpose of this study was to compare clinical characteristics and outcomes in individuals of different age groups with urinary tract infection (UTI), and to identify the relationships among advanced age and uroseptic shock. METHODS: This retrospective study compared clinical characteristics and outcomes in patients in different age groups with UTI and identified relationships between advanced age and uroseptic shock among hospitalized patients with UTI in an acute hospital care setting from January 2006 to October 2018. Patients were divided into young (age below 65 years), old (65–80 years), and very old (above 80 years) groups. RESULTS: Of 1,043 participants, 269 (25.8%) were very old and 200 (19.2%) developed uroseptic shock. Very old age [odds ratio (OR) 1.99, 95% confidence interval (CI): 1.25–3.19, P=0.004], male (OR 1.54, 95% CI: 1.07–2.24, P=0.022), presented flank pain (OR 1.54, 95% CI: 1.05–2.24, P=0.025), congestive heart failure (CHF) (OR 2.54, 95% CI: 1.27–5.06, P=0.008), acute kidney injury (AKI) (OR 4.19, 95% CI: 2.78–6.30, P

There is controversy regarding the extent of risk for dementia in patients with end stage renal disease (ESRD) who are undergoing hemodialysis (HD) or peritoneal dialysis (PD). We examined data from Taiwan's Longitudinal Health Insurance Database, and used Cox proportional hazard regression analysis to compare the development of dementia in 72,934 HD and PD patients with 72,934 matched controls from January 1, 1999 to December 31, 2010. The results indicate an increased risk for dementia overall in HD patients (adjusted hazard ratio [aHR] = 1.64, p < 0.0001) and PD patients (aHR = 2.21, p < 0.0001). HD and PD patients also had significantly greater aHRs for vascular dementia (VaD) and unspecified dementia (UnD), but only HD patients had a significantly greater aHR for Alzheimer's disease (AD). Further research is needed to confirm whether management of ESRD with PD can reduce the incidence of AD, and to identify the mechanisms by which ESRD increases the risk of dementia.

Background. An increased incidence of end-stage renal disease (ESRD) in stroke patients has not been confirmed. The aim of this population-based study was to examine the risk of ESRD in stroke patients in Taiwan. Methods. We conducted a nationwide cohort study of 442 355 patients newly diagnosed with stroke, but without prior history of ESRD. Data were collected from Taiwan’s National Health Insurance claims data during 2000–2008. Incidence and standardized incidence ratio (SIR) of ESRD were calculated using the general population of Taiwan as the reference. Results. Among all stroke patients, 7813 (1.77%) developed ESRD with a mean follow-up of 4.11 years. The SIR for ESRD was 2.78 [95% confidence interval (CI): 2.72–2.84] among stroke patients of all ages and was 22.73 (95% CI: 20.39–25.20) for patients aged 25–44 years. Male patients with stroke had a higher risk of ESRD (SIR: 2.94, 95% CI: 2.85–3.03) among stroke patients of all ages, and it was 23.41 (95% CI: 20.46– 26.36) for male patients aged 25–44 years. Conclusions. Increased risk of ESRD in stroke patients is confirmed in Taiwan, and male patients between ages 25 and 44 years were at higher risk of ESRD compared with their counterparts in the general population. The clinical implication of our results is to closely monitor renal function in stroke patients, particularly those of younger age.

Chronic kidney disease (CKD) has become a burden of health care globally. However, data on epidemiology, clinical features, and outcomes of urinary tract infection (UTI) in this population are scarce. This study aims to retrospectively review such data. Materials and methods: A retrospective cohort study was conducted from 1 January 2005 to 31 December 2011 in patients with CKD requiring hospitalization. Patients who had upper and lower UTIs were compared for demography and clinical data. Logistic regression was used to assess which variables were associated with upper UTI. Results: A total of 276 bacteriuria patients were admitted to our ward with upper and lower UTIs. The average ages of the upper and lower UTI patients were 59.21 ± 16.54 and 71.18 ± 14.77 years, respectively. The results of logistic regression analysis showed that age (OR 0.946, P < 0.001), female sex (OR 4.695, P < 0.001), and renal stones (OR 8.232, P < 0.001) were independently associated with upper UTI. Conclusion: This study shows that patients with CKD and UTIs were elderly, and that females were prone to have more bacteriuria and upper UTIs than males. In addition, patients who had renal stones were more prone to have upper UTI than other bacteriuria patients. Aggressive treatment of renal stones should be considered in these patients.

A novel intraday algorithmic trading strategy is developed based on various machine learning techniques and paralleled computing architectures in this paper. The proposed binary classification framework can predict the price trends of Taiwan stock index futures after thirty minutes. Traditional learning-based approaches collect all samples during the training period as the learning materials. The major contribution of this paper is to collect a subset of similar historical financial data to train the real-time trading model. This goal can be achieved by an on-line learning technique which is required to calculate an accurate model with training time limitation. In addition, the proposed joint-AdaBoost algorithm is to improve the system performance based on the concept of paired feature learning and planar weak classifier design. The core execution components in this algorithm can be further accelerated with the aid of Open Computing Language (OpenCL) parallel computing platform. The experimental results show that the proposed learning algorithm can improve the prediction accuracy of final classifier from 53.8% to 61.68%. Compared to the pure CPU implementation, the OpenCL version which uses CPU and GPGPU simultaneously can reduce the calculation time around 83.02 times. The efficiency improvement can decrease the delay of investment opportunity which is a critical issue in real-time financial decision support system application. To sum up, this paper proposed a novel learning framework based on joint-AdaBoost algorithm with similar learning samples and OpenCL parallel computation. The extended financial decision support system is also proven to work effectively and efficiently in our simulation experiments to trade the Taiwan stock index futures.

Aim: Only few studies have reported that betel nut (BN) chewing is independently associated with chronic kidney disease (CKD); however, the sample size was relatively small. This study was to explore further the association between BN chewing and CKD using a larger case series. Methods: We retrospectively reviewed the records of a health check-up program from 2003 to 2009. Laboratory tests, medical history and status of cigarette smoking, alcohol drinking and BN chewing were compared between CKD and non-CKD groups. We checked interaction effects between BN chewing and all other covariates, and conducted multivariate logistic regression analysis to explore the risk of CKD with BN chewing. Results: A total of 27 482 participants (15 491 females and 11 991 males, mean age 58.02 ± 11.85 years) were included in the study, of whom 4519 (16.4%) had CKD and 1608 (5.9%) chewed BN. CKD prevalence in the chewers was higher than in the non-chewers in all age groups per decade. BN chewing was significantly associated with CKD in overall subjects (odds ratio (OR) = 1.23, P = 0.027) and also in the male (OR = 1.23, P = 0.035), non-drinking (OR = 1.62, P = 0.000), non-diabetic (OR = 1.27, P = 0.021), and non-proteinuric groups (OR = 1.30, P = 0.013). This relationship was insignificant in female, drinking, diabetic and proteinuric groups. Conclusion: The association between BN chewing and CKD seemed conditional on demographics, health behaviours, and underlying co-morbidities. This association should be interpreted cautiously.

Background Phosphate burden in chronic kidney disease (CKD) leads to elevated serum fibroblast factor-23 (FGF-23) levels, secondary hyperparathyroidism and chronic kidney disease-mineral bone disorder (CKD-MBD). However dissociated hyperphosphatemia and low serum FGF-23 concentrations have been observed in experimentally parathyoridectomized rats. The relationships between serum mineral, hormone, and bone metabolism may be altered in the presence of CKD. The aim of our study was to investigate whether a consistent relationship existed between serum FGF-23 levels, specific serum biochemical markers, and histomorphometric parameters of bone metabolism in a parathyroidectomized CKD animal model. Results Sprague Dawley rats were divided into 3 groups: parathyroidectomy (PTX) and CKD (PTX+CKD, 9 rats), CKD without PTX (CKD, 9 rats), and neither PTX nor CKD (sham-operated control, 8 rats); CKD was induced by partial nephrectomy. At 8 weeks after partial nephrectomy, serum biomarkers were measured. Bone histomorphometries of the distal femoral metaphyseal bone were analyzed. The mean serum FGF-23 levels and mean bone formation rate were the highest in the CKD group and the lowest in the PTX+CKD group. Bone volume parameters increased significantly in the PTX+CKD group. Pearson’s correlation revealed that serum FGF-23 levels associated with those of intact parathyroid hormone, phosphate, collagen type I C-telopeptide, and calcium. Univariate linear regression showed that serum FGF-23 values correlated with bone formation rate, bone volume, and osteoid parameters. Stepwise multivariate regression analysis revealed that circulating FGF-23 values were independently associated with bone volume and thickness (β = -0.737; p < 0.001 and β = -0.526; p = 0.006, respectively). Serum parathyroid hormone levels independently correlated with bone formation rate (β = 0.714; p < 0.001) while collagen type I C-telopeptide levels correlated with osteoid parameter. Conclusion Serum FGF-23 levels independently correlated with bone volume parameters in rats with experimentally induced CKD.

Introduction. Severe sepsis and septic shock are associated with substantial mortality. However, few studies have assessed the risk of septic shock among patients who suffered from urinary tract infection (UTI).Materials and Methods. This retrospective study recruited UTI cases from an acute care hospital between January 2006 and October 2012 with prospective data collection.Results. Of the 710 participants admitted for UTI, 80 patients (11.3%) had septic shock. The rate of bacteremia is 27.9%; acute kidney injury is 12.7%, and the mortality rate is 0.28%. Multivariable logistic regression analyses indicated that coronary artery disease (CAD) (OR: 2.521, 95% CI: 1.129–5.628,P=0.024), congestive heart failure (CHF) (OR: 4.638, 95% CI: 1.908–11.273,P=0.001), and acute kidney injury (AKI) (OR: 2.992, 95% CI: 1.610–5.561,P=0.001) were independently associated with septic shock in patients admitted with UTI. In addition, congestive heart failure (female, OR: 4.076, 95% CI: 1.355–12.262,P=0.012; male, OR: 5.676, 95% CI: 1.103–29.220,P=0.038, resp.) and AKI (female, OR: 2.995, 95% CI: 1.355–6.621,P=0.007; male, OR: 3.359, 95% CI: 1.158–9.747,P=0.026, resp.) were significantly associated with risk of septic shock in both gender groups.Conclusion. This study showed that patients with a medical history of CAD or CHF have a higher risk of shock when admitted for UTI treatment. AKI, a complication of UTI, was also associated with septic shock. Therefore, prompt and aggressive management is recommended for those with higher risks to prevent subsequent treatment failure in UTI patients.

Objective The purpose of this study is to compare the characteristics of those ertapenem-treated adult patients with and without development of seizures, and identify the associated factors for the development of seizures. Methods This retrospective study was conducted at Chia-Yi Christian Hospital from January 2012 to December 2014. Patients developing seizures during their ertapenem treatment course were identified as case patients. Those without seizures who had received ertapenem for at least five days were considered as the pool of control patients. For each case patient, four matched patients from the control pool were randomly selected as the final control group, based on age, gender, and the date of ertapenem prescription. Results A total of 1706 ertapenem-treated patients were identified, 33 (1.9%) individuals developed seizures with the enrollment of 132 matched control patients. Among these 33 patients, the average age was 79.3 ± 7.5 years, and 20 (60.6%) were male. The mean Charlson co-morbidity score was 4.5 ± 2.4, and the first episode of seizure happened 3.3 ± 2.6 days after receiving ertapenem. In multivariate logistic regression analysis, the independent predictors associated with the development of ertapenem-associated seizures were old stroke (OR, 14.36; 95% CI, 4.38–47.02; p < 0.0001), undergoing brain images within one year prior to the admission (OR, 5.73; 95% CI, 1.78–18.43; p = 0.0034), low hemoglobin level (OR, 3.88; 95% CI, 1.28–12.75; p = 0.0165) and low platelet count (OR, 4,94; 95% CI, 1.56–15.68; p = 0.0067) at presentations, and protective factors against the development of seizures were heart failure (OR, 0.04; 95% CI, 0.00–0.63; p = 0.0222), concomitant use of steroids (OR, 0.19; 95% CI, 0.05–0.77; p = 0.0201), or antiplatelet agents (OR, 0.12; 95% CI, 0.02–0.63, p = 0.0123) with ertapenem. Conclusions The development of ertapenem-associated seizures may occur more frequently and much earlier due to its widespread use in treating drug-resistant pathogens, especially when these pathogens emerged worldwide.Our study would help physician to estimate the risk of developing seizure among patients receiving ertapenem.

The purpose of this study is to compare the clinical features and treatment outcomes among patients with bacteremic urinary tract infection (UTI) caused by multidrug-resistant (MDR) and non-MDR Enterobacteriaceae and to identify whether MDR pathogens were independently associated with severe

The goal of this study was to compare the clinical and pathological features of urothelial carcinoma (UC) identified in patients with end-stage renal disease (ESRD) and advanced-stage chronic kidney disease (CKD). The predictive value of CKD on patient mortality in these UC patients was also analyzed.From January 1997 to December 2008, 141 patients with pathologically proven UC with stage 4/5 CKD (predialysis) and patients with ESRD receiving long-term dialysis were identified under an institutional review board approval protocol. The medical records and survival outcome of these patients were reviewed.A total of 141 UC patients with renal diseases (n = 97, 68.8%, of stage 4/5 CKD; n = 44, 31.2%, at dialysis) were enrolled. Patients with stage 4/5 CKD were significantly older, male gender, less anemic and more likely to have higher prevalence of diabetes mellitus (P0.05). We noticed a more significant increase in the frequency of high-stage UC (24.7% and 6.8%) and a larger tumor size (50.5% and 27.3%) in patients with stage 4/5 CKD, compared with patients with ESRD (P0.05). Old age at the time of dialysis initiation in patients with ESRD [hazard ratio (HR) = 1.121, P = 0.039], male gender (HR = 6.822, P = 0.016) and high-stage tumors (HR = 5.012, P = 0.008) in patients with stage 4/5 CKD were independent predictors of mortality from UC.Patients with stage 4/5 CKD had more aggressive histological UC patterns than did patients with ESRD.

Only few studies have reported that betel nut (BN) chewing is independently associated with chronic kidney disease (CKD); however, the sample size was relatively small. This study was to explore further the association between BN chewing and CKD using a larger case series.We retrospectively reviewed the records of a health check-up program from 2003 to 2009. Laboratory tests, medical history and status of cigarette smoking, alcohol drinking and BN chewing were compared between CKD and non-CKD groups. We checked interaction effects between BN chewing and all other covariates, and conducted multivariate logistic regression analysis to explore the risk of CKD with BN chewing.A total of 27 482 participants (15 491 females and 11 991 males, mean age 58.02 ± 11.85 years) were included in the study, of whom 4519 (16.4%) had CKD and 1608 (5.9%) chewed BN. CKD prevalence in the chewers was higher than in the non-chewers in all age groups per decade. BN chewing was significantly associated with CKD in overall subjects (odds ratio (OR) = 1.23, P = 0.027) and also in the male (OR = 1.23, P = 0.035), non-drinking (OR = 1.62, P = 0.000), non-diabetic (OR = 1.27, P = 0.021), and non-proteinuric groups (OR = 1.30, P = 0.013). This relationship was insignificant in female, drinking, diabetic and proteinuric groups.The association between BN chewing and CKD seemed conditional on demographics, health behaviours, and underlying co-morbidities. This association should be interpreted cautiously.

Taiwan is a highly endemic area for urothelial carcinoma (UC) and chronic kidney disease (CKD). We evaluate the gender effect on the relationship between renal outcome and clinical characteristics of CKD patients with UC.The clinical and pathologic records of 404 patients were retrospectively analyzed. We calculated glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) equation, and staged CKD status according to K/DOQI guideline.The female group had a significantly higher proportion (67.6% vs 29.0%, P 0.001) of upper urinary tract urothelial carcinoma (UUT-UC). Pathologically, the frequency of high T stage UC (32.4% and 19.1%; P = 0.003), high-grade UC (89.4% and 75.6%; P = 0.001), and larger UC (51.4% and 37.8%; P = 0.009) in the female patients were significantly higher, when compared with the male group. Male gender, diabetes, anemia, poor preoperative renal function, UUT-UC, and low-grade tumor were independent risk factors of poor renal outcome by multivariate analysis in these UC patients. Diabetes was a risk factor of poor renal outcome in male UUT-UC patients, but not in the female patients (P = 0.009).Female gender had a more aggressive histological urothelial carcinoma pattern than male patients did, but paradoxically had a more favorable renal outcome.

Acute kidney injury (AKI) is associated with high morbidity and mortality. Urinary tract infection (UTI) may be associated with sepsis or septic shock, and cause sudden deterioration of renal function. This study investigated the clinical characteristics and change of renal function to identify the risk factors for development of AKI in UTI patients. This retrospective study was conducted in a tertiary referral center. From January 2006 to January 2013, a total of 790 UTI patients necessitating hospital admission were included for final analysis. Their demographic and clinical characteristics and comorbidities were collected and compared. Multivariate logistic regression analysis was performed to evaluate the risk factors for AKI in UTI patients. There were 97 (12.3%) patients developing AKI during hospitalization. Multivariate logistic regression analysis showed that patients with older age (OR 1.02, 95% CI 1.00-1.04, P = 0.04), diabetes mellitus (DM) (OR 2.23, 95% CI 1.35-3.68, P = 0002), upper UTI (OR 2.63, 95% CI 1.53-4.56, P = 0001), afebrile during hospitalization (OR 1.71, 95% CI 1.04-2.83, P = 0036) and lower baseline eGFR [baseline eGFR 45-59 mL/min/1.73 m2 (OR 2.12, 95% CI 1.12-4.04, P = 0.022), baseline eGFR 30-44 mL/min/1.73 m2 (OR 4.44, 95% CI 2.30-8.60 P < 0.001) baseline eGFR < 30 mL/min/1.73 m2 (OR 4.72, 95% CI 2.13-10.45, P