Different types of bullae of limbs with necrotizing fasciitis predict different outcome: a prospective study.

STUDY OBJECTIVE: Necrotizing fasciitis (NF) is an uncommon life-threatening necrotizing skin and soft tissue infection. Bullae are special skin manifestations of NF. This study was conducted to analyze the differences between different types of bullae of limbs with NF for providing the information to emergency treatment. METHODS: From April 2015 to August 2018, patients were initially enrolled based on surgical confirmation of limbs with NF. According to the presence of different bullae types, patients were divided into no bullae group (Group N), serous-filled bullae group (Group S), and hemorrhagic bullae group (Group H). Data such as demographics, clinical outcomes, microbiological results, presenting symptoms/signs, and laboratory findings were compared among these groups. RESULTS: In total, 187 patients were collected, with 111 (59.4%) patients in Group N, 35 (18.7%) in Group S, and 41 (21.9%) in Group H. Group H had the highest incidence of amputation, required intensive care unit care, and most patients infected with Vibrio species. In Group N, more patients were infected with Staphylococcus spp. than Group H. In Group S, more patients were infected with ß-hemolytic Streptococcus than Group H. Patients with bacteremia, shock, skin necrosis, anemia, and longer prothrombin time constituted higher proportions in Group H and S than in Group N. CONCLUSIONS: In southern Taiwan, patients with NF accompanied by hemorrhagic bullae appear to have more bacteremia, Vibrio infection, septic shock, and risk for amputation. If the physicians at the emergency department can detect for the early signs of NF as soon as possible, and more patient's life and limbs may be saved.

Copolymerization of Carbon Dioxide with Epoxides Catalyzed by Structurally Well-Characterized Dinickel Bis(benzotriazole iminophenolate) Complexes: Influence of Carboxylate Ligands on the Catalytic Performance.

A series of structurally well-defined dinickel carboxylate complexes based on the RBiIBTP derivatives [RBiIBTP = bis(benzotriazole iminophenolate), where R = 3C for the propyl-bridged backbone and 5C for the 2,2-dimethyl-1,3-propyl-bridged backbone] were synthesized and developed for copolymerization of CO2 and epoxides. The one-pot reactions of nickel perchlorate with the RBiIBTP-H2 proligands and an appropriate amount of carboxylic acid derivatives (CF3COOH or 4-X-C6H4CO2H; X = H, CF3, OMe) upon the addition of triethylamine in refluxing methanol (MeOH) afforded dinuclear nickel dicarboxylate complexes, which could be formulated as either [(RBiIBTP)Ni2(O2CCF3)2] (1 and 2) or [(RBiIBTP)Ni2(O2CC6H4-4-X)2] (3-7). The dinickel monobenzoate complexes [(RBiIBTP)Ni2(O2CPh)(ClO4)(H2O)] [R = 3C (8) and 5C (9)] were prepared by using a similar synthetic route in tetrahydrofuran under reflux with a ligand precursor to metal salt to benzoic acid ratio of 1:2:1 in the presence of NEt3. Recrystallization of neutral nickel perchlorate complex 8 in a saturated MeOH or ethanol (EtOH) solution gave ionic and alcohol-solvated monobenzoate bimetallic analogues [(3CBiIBTP)Ni2(O2CPh)(S)2]ClO4, where S = MeOH (10) and EtOH (11). Single-crystal X-ray crystallography of dinickel analogues 1-11 indicates that the BiIBTP scaffold performs as a N,O,N,N,O,N-hexadentate ligand to chelate two Ni atoms, and the ancillary carboxylate group adopts a bridging bidentate bonding mode. Catalysis for copolymerization of carbon dioxide (CO2) with cyclohexene oxide (CHO) by complexes 1-9 was systematically investigated, and the influence of carboxylate ligands on the catalytic behavior was also studied. Trifluoroacetate-ligated dinickel complex 1 efficiently catalyzed CO2 and CHO with a high turnover frequency (>430 h-1) in a controlled fashion, generating perfectly alternating poly(cyclohexenecarbonate) with large molecular weight (Mn > 50000 g/mol). In addition to CO2/CHO copolymerization, bimetallic complex 1 was found to effectively copolymerize CO2 with 4-vinyl-1,2-cyclohexene oxide (VCHO) or cyclopentene oxide, producing the high carbonate contents of poly(VCHC-co-VCHO)s and highly alternating poly(cyclopentene carbonate)s, respectively. This study also enabled us to compare the catalytic efficiency of using cyclic epoxides with different ring strains or functional groups as comonomers by the dinickel catalyst 1.

Improvement in the metabolic markers of prediabetic subjects due to the partial substitution of Taiken9 rice by RD43 rice in their daily diet: a randomized clinical trial.

Although RD43 rice is characterized by high amounts of undigestible starch, its potential health benefits for prediabetic individuals remain unknown. Thus, the effect of regular consumption of RD43 rice on the glycemic response, body composition, and metabolic markers was investigated in a sample of 34 participants with prediabetes (aged from 32 to 68 years) who were randomly allocated to either the treatment or the control group. The first were required to consume RD43 rice (Glycemic Index [GI] = 78) containing 14.1 g of undigestible starch daily as a substitute for two meals per day while the second were given the Taiken9 rice (GI = 98) for 12 continuous weeks. The evaluations were performed at baseline, at the end of week 6 and 12, and at follow-up conducted two weeks after the intervention had ended. The results obtained at the week 12 assessment clearly showed a significant decrease in fasting plasma glucose, insulin, HbA1c, and HOMA-IR in the group that consumed RD43 rice. In addition, daily ingestion of RD43 rice markedly reduced body weight, Body Mass Index (BMI), total fat mass, and waist circumference at both week 6 and 12 compared with the baseline. When compared with the controls, the treatment group also exhibited a significant decrease in fasting plasma insulin and HOMA-IR at week 12. However, no significant inter- or intra-group differences in lipid profiles were detected. These findings suggest that RD43 rice could be a potential staple food with the capacity to improve glycemic control and body composition in prediabetic individuals.

Genitourinary tuberculosis in Taiwan: A 15-year experience at a teaching hospital.

BACKGROUND: Genitourinary tuberculosis (GUTB) is rare but fatal if not diagnosed early. The purpose of this study was to investigate the outcomes of GUTB in Taiwan. METHODS: We retrospectively reviewed medical records of 57 patients who were diagnosed as GUTB from January 2002 to December 2016, over a 15-year period. Demographic data and clinical manifestations were recorded for analysis. RESULTS: There were 37 males and 20 females with a median age of 71 years. Kidney (24.6%) was the most involved organ. Fever (56.1%) was the major presentation. Sixteen (28.1%) patients presented unfavorable outcome. Compared with the favorable outcome group, the unfavorable outcome group had more malignancy (p = 0.013), fever (p = 0.020), anemia (p = 0007), thrombocytopenia (p = 0.003), and hypoalbuminemia (p = 0.015). In a multivariate analysis, fever (odds ratio: 42.716, 95% confidence interval: 1.032-1767.569; p = 0.048) was identified as prognostic factors for unfavorable outcome. CONCLUSION: GUTB is often in advanced stages with a high mortality in Taiwan. Establishing a diagnosis is difficult and requires thorough investigation. Fever is associated with unfavorable outcome.

Implementation and outcomes of hospital-wide computerized antimicrobial approval system and on-the-spot education in a traumatic intensive care unit in Taiwan.

BACKGROUND/PURPOSE: Inappropriate prescribing of antibiotics is a major health-care problem in intensive care units (ICUs). This study evaluates the impact of a direct hospital-wide computerized antimicrobial approval system (HCAAS) and on-the-spot education for practitioners in a neurosurgical ICU in Taiwan. METHODS: We retrospectively analyzed the medical records monthly of patients who were admitted to the neurosurgical ICU during a period of 7 years and 7 months. A pretest-post-test time series analysis, comparing the three periods: period I (no infectious disease (ID) physician), period II (part-time ID physicians), and period III (full-time ID physician). Antimicrobial consumption and expenditure, incidence of hospital-associated infections, prevalence of healthcare-associated bacterial isolates, in-hospital mortality rates, and indication of antibiotics usage were analyzed. RESULTS: Full-time ID physician can increase the consumption of narrow-spectrum antimicrobials (cefazolin, and cefuroxime), and decrease the consumptions of broad-spectrum antimicrobials (ceftazidime, cefepime, and vancomycin) compared to part-time ID physicians. From period I to period III, the expenditure of antimicrobials, incidence of hospital-associated pneumonia, and the in-hospital mortality rates (crude, sepsis-related, and overall infection-related mortality) decreased statistically. The prevalence of extended-spectrum ß-lactamase-producing Escherichia coli and Klebsiella pneumoniae, and Carbapenems-resistant Pseudomonas aeruginosa remained at low level after HCAAS implementation. From 2007 to 2009, the rational antibiotics usage continued to increase, resulting from to more prophylaxis and appropriate microbiologic proof, but less empiric antimicrobial therapy. CONCLUSION: Implementation of HCAAS and long-term on-the-spot education by full-time ID physician can reduce antimicrobial consumption, cost, and improve inappropriate antibiotic usage whilst not compromising healthcare quality.

Parenteral nutrition combined with enteral feeding improves the outcome of cancer patients.

BACKGROUND AND OBJECTIVES: This study investigated whether total parenteral nutrition combined with enteral nutrition is associated with improved biochemical and clinical outcomes in cancer patients with gastrointestinal dysfunction. METHODS AND STUDY DESIGN: From January to December 2014, the clinical data of 68 patients in a cancer ward were retrospectively collected, and these patients were classified into two groups according to nutrition delivery, through parenteral nutrition, combined with enteral nutrition more (group A) or less (group B) than 250 kcal/day. The following variables were analyzed: the route and percentage of nutritional support, total caloric intake, age, gender, body weight, body mass index, diagnosis at admission, complications of intestinal failure, modified Glasgow Prognostic Score, co-morbidities, duration of total parenteral nutrition support, performance status scale, and plasma nutritional markers. RESULTS: A significant difference was observed between the two groups in functional capacity, including the Karnofsky index, World Health Organization/Eastern Cooperative Oncology Group score, body-weight loss, and serum albumin levels. However, no significant difference was observed in the modified Glasgow Prognostic Score. CONCLUSIONS: Cancer patients receiving total parenteral nutrition who were fed enterally more than 250 kcal/d exhibited more favorable clinical outcomes than those who were fed enterally less than 250 kcal/d. Enteral nutrition should be considered for these severely ill patients.

Facilely synthesized benzotriazole phenolate zirconium complexes as versatile catalysts for copolymerization of carbon dioxide with cyclohexene oxide and lactide polymerization.

A family of zirconium complexes containing bis-, tri- or tetra-BTP ligands (BTP = benzotriazole phenolate) were synthesized and structurally characterized. Treatment of Zr(O(i)Pr)4((i)PrOH) with 2.0 molar equivalents of 2-(2H-benzotriazol-2-yl)-4-(2,4,4-trimethylpentan-2-yl)phenol ((C8)BTP-H) or 2-(2H-benzotriazol-2-yl)-4,6-di-tert-butylphenol ((t-Bu)BTP-H) afforded zirconium alkoxide ([((C8)BTP)2Zr(O(i)Pr)2] (1); [((t-Bu)BTP)2Zr(O(i)Pr)2] (2)) in good yield. Similarly, the bis-adduct Zr amide [((t-Bu)BTP)2Zr(NMe2)2] (3) resulted from amine elimination of Zr(NMe2)4 as the metal precursor and (t-Bu)BTP-H as the pro-ligand under a similar synthetic method with a metal to ligand precursor ratio of 1:2 at 0 °C. The reaction of Zr(NMe2)4 with (C8)BTP-H or (t-Bu)BTP-H (4.0 mol equiv.) gave the tetra-adduct zirconium complex ([((C8)BTP)4Zr] (4); [((t-Bu)BTP)4Zr] (5)) in ≧70% yield. Interestingly, the tri-adduct Zr amide [((t-Bu)BTP)3Zr(NMe2)] (6) could be prepared by treatment of 3 with a stoichiometric amount of (t-Bu)BTP-H. The solid-state structure of 6 reveals a monomeric Zr(IV) amide with three (t-Bu)BTP ligands and one -NMe2 group, and the bonding modes between the BTP moiety and the metal centre adopt both N,O-bidentate and O-monodentate types. Zr complexes 1 and 4 incorporating sterically less bulky (C8)BTP ligands were demonstrated to efficiently catalyse not only copolymerization of epoxide with CO2 but also lactide polymerization. The tetra-BTP Zr catalyst 4 was able to copolymerize cyclohexene oxide and CO2 in a controllable manner, generating the high-molecular-weight copolymer (Mw > 10,000 g mol(-1)) and a high degree of carbonate linkages (>90%). Single-site zirconium alkoxide 1 is the most active catalyst for living lactide polymerization in solution among these complexes, giving poly(lactide)s with the expected molecular weights and narrow molecular weight distributions (PDI ≦ 1.25). This is a successful example of utilizing versatile benzotriazole phenolate Zr(IV) catalysts for either the production of biodegradable poly(lactide) or poly(cyclohexene carbonate-co-cyclohexene oxide).

The Malnutrition Universal Screening Tool (MUST) and a nutrition education program for high risk cancer patients: strategies to improve dietary intake in cancer patients.

Four hundred and forty-four high-risk oncology patients with malnutrition participated in this study aimed at assessing the effectiveness of nutrition education on improving an oncology patient's dietary intake. We used a nutritional risk screening to select oncology patients in need of nutritional care. Team Nutrition provides technical assistance for foodservice, nutrition education for patients and their caregivers, and support for healthy eating and physical activity to improve their diets and their lives. The average contribution of protein and total energy of each patient increased after imparting the nutritional education to them. Thus, nutritional education is an effective measure to bring about a favorable and significant change in oncology patients' nutrient intake.

Synthesis, characterization and catalytic activity of magnesium and zinc aminophenoxide complexes: catalysts for ring-opening polymerization of L-lactide.

A series of novel magnesium and zinc aminophenoxide complexes were successfully synthesized and one zinc complex was characterized by X-ray crystallography. They were also investigated as initiators for the ring opening polymerization of L-lactide. The complexes are effective in forming polylactides with good conversions. The nature and steric bulk of the ligands coordinated to the central metal ions enormously influenced the polymer properties. Among all the complexes, the zinc aminophenoxide complexes as initiators produced polymers with good molecular weight control and relatively narrow PDIs.