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1.
Mil Med ; 189(1-2): e148-e156, 2024 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-37256764

RESUMO

BACKGROUND: Taiwan has a substantial number of veterans, but knowledge regarding their emergency department (ED) visits during the coronavirus disease 2019 (COVID-19) pandemic remains limited. This study examined the characteristics of veterans' ED visits during Taiwan's COVID-19 epidemic. METHODS: This was a cross-sectional study conducted at the ED of a large veteran medical center located in Taipei, Taiwan, from May 2018 to October 2021. We analyzed the numbers and features of visits in summer and autumn according to the first wave of the COVID-19 epidemic in Taiwan in 2021. RESULTS: Medical institutions were positively associated with veteran status. Emergency department complaints of trauma (adjusted odds ratio [AOR] = 1.15, 95% CI: 1.06-1.25; summer P < .01) and chest pain/tightness (AOR = 1.65, 95% CI: 1.45-1.87; summer P < .01; AOR = 1.4, 95% CI: 1.26-1.55; P < .01) were associated with increased odds of being a veteran. Triage levels above 2 were positively associated with veteran status in the autumn model (AOR = 1.14, 95% CI: 1.07-1.22; P < .01). Patients hospitalized after ED visits were associated with reduced odds of veteran status (P < .01). Those who spent a long time in the ED were more likely to be veterans than those who spent a shorter time in the ED (P < .01). Veterans were less likely to visit the ED regardless of the time frame of the study period (P < .01), except during the COVID-19 outbreak in the autumn (2019-2020). CONCLUSIONS: The distinctions in ED visits highlighted the individuality of veterans' medical needs. Our findings suggest that the veteran medical system can add to the focus on improving senior-friendly care, fall prevention, quality of life of institutionalized veterans, access for homeless veterans, and care for ambulatory care-sensitive conditions.


Assuntos
COVID-19 , Veteranos , Humanos , Taiwan/epidemiologia , Pandemias , Qualidade de Vida , Estudos Transversais , COVID-19/epidemiologia , Serviço Hospitalar de Emergência
2.
Subst Use Misuse ; 59(4): 622-637, 2024.
Artigo em Inglês | MEDLINE | ID: mdl-38115559

RESUMO

BACKGROUND: There is limited research exploring the changing clinical practices among healthcare providers (HPs) care for patients with Emergency Department (ED)-initiated Medication for Opioid Use Disorder (MOUD). METHODS: This scoping review followed the methodological framework of Arksey and O'Malley to map relevant evidence and synthesize the findings. We searched PubMed, EMBASE, CINAHL, Web of Science, and Scopus for related studies from inception through October 12, 2022. Following the application of inclusion and exclusion criteria, 16 studies were included. Subsequently, they were charted and analyzed thematically based on ecological systems theory. RESULTS: The main determinants in the four ecological systems were generated as follows: (1) microsystem: willingness and attitude, professional competence, readiness, and preference; (2) mesosystem: ED clinical practices, departmental factors; (3) exosystem: multidisciplinary approaches, discharge planning, and (4) macrosystem: stigma, health insurance, policy. The findings have implications for HPs and researchers, as insufficient adoption, implementation, and retention of MOUD in the ED affect clinical practices. CONCLUSIONS: Across the four ecological systems, ED-initiated MOUD is shaped by multifaceted determinants. The microsystem underscores pivotal patient-HP trust dynamics, while the mesosystem emphasizes interdepartmental synergies. Exosystemically, resource allocation and standardized training remain paramount. The macrosystem reveals profound effects of stigma, insurance disparities, and evolving policies on treatment access and efficacy. Addressing these interconnected barriers is crucial for optimizing patient outcomes in the context of MOUD.


Assuntos
Buprenorfina , Transtornos Relacionados ao Uso de Opioides , Humanos , Serviço Hospitalar de Emergência , Pessoal de Saúde , Transtornos Relacionados ao Uso de Opioides/tratamento farmacológico , Alta do Paciente , Políticas
3.
Heliyon ; 9(11): e21306, 2023 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-38027584

RESUMO

Semiconductor development is a major driving force for global economic growth. However, synchronizing it with the Sustainable Development Goals (SDGs) set by the United Nations remains a critical challenge. To gain insight into this, we analyzed SDG-related publications on semiconductors from 2017 to 2022 using the SciVal database. The study found 77,706 documents related to SDGs in the field of semiconductor research, with an overall increase in the number of publications each year. The main focus of these publications was SDG 7 (Affordable and Clean Energy), accounting for 68.9 % of the total publication count. Additionally, the results indicate that semiconductors have multifaceted potential in advancing a range of SDGs. From fostering innovations in healthcare (SDG 3), ensuring clean water access (SDG 6), catalyzing transformative industrial growth (SDG 9), to contributing to climate mitigation strategies (SDG 13), semiconductors emerge as versatile drivers of sustainable development. The respective publication percentages for these goals were 7.3 %, 5.9 %, 9.7 %, and 4.4 %, underscoring their capacity to make substantial contributions across various facets of sustainability. It's worth noting that only 2.9 % of these publications stem from academia-industry collaborations. This indicates a pressing need to facilitate collaboration between academia and industry, as such partnerships have the potential to amplify the impact of semiconductor innovations on the SDGs. The novelty of this study lies in its specific exploration through a comprehensive analysis spanning five years, revealing the alignment between semiconductor advancements and the latest SDGs. It uncovers the significance of collaborative ecosystems involving research institutions, businesses, and governments. Through these results, our study addresses a gap in the existing literature and advances semiconductor contributions to the SDGs.

4.
J Acute Med ; 13(3): 125-128, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37841820

RESUMO

As a consequence of cirrhosis, portal hypertension causes resistance to blood flow and leads to the formation of varices. However, colonic variceal hemorrhages are rarely reported but could be a lethal cause of lower gastrointestinal hemorrhage. Currently, there is no consensus on the management of colonic variceal hemorrhage. Variceal ligation, injection sclerotherapy, transjugular intrahepatic portosystemic shunt placement, and balloon-occluded retrograde transvenous obliteration or a combination of the above therapies have been reported with inconsistent success rates. We advocate considering colonic variceal bleeding as a crucial differential diagnosis of lower gastrointestinal bleeding in cirrhotic patients and initiating time-sensitive, definite operative treatment or combination therapy as soon as possible in colonic variceal patients with life-threatening bleeding events, which are often refractory to conservative treatment.

5.
BMC Geriatr ; 23(1): 490, 2023 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-37580692

RESUMO

BACKGROUND: The number of emergency department (ED) visits has significantly declined since the COVID-19 pandemic. In Taiwan, an aged society, it is unknown whether older adults are accessing emergency care during the COVID-19 epidemic. Therefore, this study aimed to investigate the impact of COVID-19 on the ED visits and triage, admission, and intensive care unit (ICU) hospitalization of the geriatric population in a COVID-19-dedicated medical center throughout various periods of the epidemic. METHODS: A retrospective chart review of ED medical records from April 9 to August 31, 2021 were conducted, and demographic information was obtained from the hospital's computer database. The period was divided into pre-, early-, peak-, late-, and post-epidemic stages. For statistical analysis, one-way analysis of variance followed by multiple comparison tests (Bonferroni correction) were used. RESULTS: A statistically significant decrease in the total number of patients attending the ED was noted during the peak-, late-, and post-epidemic stages. In the post-epidemic stage, the number of older patients visiting ED was nearly to that of the pre-epidemic stage, indicating that older adults tend to seek care at the ED earlier than the general population. Throughout the entire epidemic period, there was no statistically significant reduction in the number of the triage 1& 2 patients seeking medical attention at the emergency department. In the entire duration of the epidemic, there was no observed reduction in the admission of elderly patients to our hospital or ICU through the ED. However, a statistically significant decrease was observed in the admission of the general population during the peak epidemic stage. CONCLUSIONS: During the peak of COVID-19 outbreak, the number of ED visits was significantly affected. However, it is noteworthy that as the epidemic was gradually controlled, the older patients resumed their ED visits earlier that the general population as indicated by the surge in their number. Additionally, in the patient group of triage 1& 2, which represents a true emergency, the number did not show a drastic change.


Assuntos
COVID-19 , Humanos , Idoso , COVID-19/epidemiologia , COVID-19/terapia , Estudos Retrospectivos , Pandemias , Taiwan/epidemiologia , Serviço Hospitalar de Emergência
6.
J Med Ultrason (2001) ; 50(4): 521-529, 2023 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-37493921

RESUMO

PURPOSE: To assess the effectiveness of contrast-enhanced ultrasound (CEUS) in guiding biopsies of breast lesions that were detected on contrast-enhanced mammography (CEM) or contrast-enhanced breast MRI (CE-MRI) but were not clearly visible on B-mode ultrasound (B-US). METHODS: In this study, 23 lesions in 16 patients were selected for CEUS-guided biopsy due to poor visualization on B-US despite being detected on CEM (n = 20) or CE-MRI (n = 3). B-US, color Doppler ultrasound (CDUS), and CEUS were used to visualize the suspicious lesions, followed by a CEUS-guided core needle biopsy using Sonazoid as the contrast agent. The accuracy of the biopsy was assessed based on pathology-radiology concordance and 12-month imaging follow-up. The conspicuity scores for lesion visualization were evaluated using a 5-point conspicuity scale agreed upon by two breast radiologists. RESULTS: The enhancing lesions detected on CEM/CE-MRI had an average size of 1.6 ± 1.3 cm and appeared as mass-enhancing (61%) or non-mass-enhancing (39%). The lesions had mean conspicuity scores of 2.30 on B-US, 2.78 on CDUS, and 4.61 on CEUS, with 96% of the lesions showing contrast enhancement on CEUS. CEUS-guided biopsy showed increased visibility in 96% and 91% of the lesions compared to B-US and CDUS, respectively. The overall accuracy of CEUS-guided biopsy was 100% based on concordance with histology and 12-month follow-up. CONCLUSIONS: CEUS enhances the visibility of suspicious CEM/CE-MRI lesions that are poorly visible on B-US during biopsy procedures.


Assuntos
Meios de Contraste , Imageamento por Ressonância Magnética , Humanos , Mamografia , Biópsia Guiada por Imagem , Biópsia , Ultrassonografia de Intervenção/métodos
7.
Spectrochim Acta A Mol Biomol Spectrosc ; 300: 122918, 2023 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-37269653

RESUMO

Herbs containing aristolochic acids (AAs) have already been proven to be highly carcinogenic and nephrotoxic. In this study, a novel surface-enhanced Raman scattering (SERS) identification method was developed. Ag-APS nanoparticles with a particle size of 3.53 ± 0.92 nm were produced by combining silver nitrate and 3-aminopropylsilatrane. The reaction between the carboxylic acid group of aristolochic acid I (AAI) and amine group of Ag-APS NPs was used to form amide bonds, and thus, concentrate AAI, rendering it easy to detect via SERS and amplified to obtain the best SERS enhancement effect. Detection limit was calculated to be approximately 40 nM. Using the SERS method, AAI was successfully detected in the samples of four Chinese herbal medicines containing AAI. Therefore, this method has a high potential to be applied in the future development of AAI analysis and rapid qualitative and quantitative analysis of AAI in dietary supplements and edible herbs.


Assuntos
Ácidos Aristolóquicos , Medicamentos de Ervas Chinesas , Nanopartículas Metálicas , Nanopartículas , Ácidos Aristolóquicos/análise , Análise Espectral Raman/métodos , Nanopartículas/química , Medicamentos de Ervas Chinesas/análise , Nanopartículas Metálicas/química
8.
Adv Sci (Weinh) ; 10(17): e2206856, 2023 06.
Artigo em Inglês | MEDLINE | ID: mdl-37078788

RESUMO

HLA-G is considered as an immune checkpoint protein and a tumor-associated antigen. In the previous work, it is reported that CAR-NK targeting of HLA-G can be used to treat certain solid tumors. However, the frequent co-expression of PD-L1 and HLA-G) and up-regulation of PD-L1 after adoptive immunotherapy may decrease the effectiveness of HLA-G-CAR. Therefore, simultaneous targeting of HLA-G and PD-L1 by multi-specific CAR could represent an appropriate solution. Furthermore, gamma-delta T (γδT) cells exhibit MHC-independent cytotoxicity against tumor cells and possess allogeneic potential. The utilization of nanobodies offers flexibility for CAR engineering and the ability to recognize novel epitopes. In this study, Vδ2 γδT cells are used as effector cells and electroporated with an mRNA-driven, nanobody-based HLA-G-CAR with a secreted PD-L1/CD3ε Bispecific T-cell engager (BiTE) construct (Nb-CAR.BiTE). Both in vivo and in vitro experiments reveal that the Nb-CAR.BiTE-γδT cells could effectively eliminate PD-L1 and/or HLA-G-positive solid tumors. The secreted PD-L1/CD3ε Nb-BiTE can not only redirect Nb-CAR-γδT but also recruit un-transduced bystander T cells against tumor cells expressing PD-L1, thereby enhancing the activity of Nb-CAR-γδT therapy. Furthermore, evidence is provided that Nb-CAR.BiTE redirectes γδT into tumor-implanted tissues and that the secreted Nb-BiTE is restricted to the tumor site without apparent toxicity.


Assuntos
Neoplasias , Receptores de Antígenos Quiméricos , Humanos , Linfócitos T , Antígeno B7-H1/metabolismo , Antígenos HLA-G/metabolismo , Receptores de Antígenos Quiméricos/metabolismo
9.
Public Health Nurs ; 40(4): 517-527, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36882994

RESUMO

Taiwan's National Health Insurance (NHI) is a widely acclaimed universal healthcare system. In the past few years, particularly following the COVID-19 outbreak, challenges related to maintaining the NHI system have surfaced. Since 2020, NHI has faced a series of challenges, including excessive patient visits to the hospital emergency department, a lack of an effective primary care and referral system, and a high turnover rate of healthcare workers. We review major problems related to Taiwan's NHI, emphasizing input from frontline healthcare workers. We provide recommendations for potential policies addressing the concerns around NHI, for example, strengthening the role of primary care services under the NHI administration, reducing the high turnover rate of healthcare workers, and increase the premium and copayments. We hope that this policy analysis may allow policymakers and scholars to understand both the merits and critical problems related to NHI from the clinical perspective.


Assuntos
COVID-19 , Humanos , Taiwan/epidemiologia , Programas Nacionais de Saúde , Formulação de Políticas , Serviço Hospitalar de Emergência
10.
J Exp Psychol Learn Mem Cogn ; 49(1): 130-176, 2023 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-35679219

RESUMO

Previous studies on spoken word production have shown that native English speakers used phoneme-sized units (e.g., a word-initial phoneme, C) to produce English words, and native Mandarin Chinese speakers employed syllable-sized units (e.g., a word-initial consonant and vowel, CV) as phonological encoding units in Chinese. With spoken word production, although spoken word recognition is a fundamental language skill of human beings, it is unknown whether a Chinese-English bilingual listener can adjust the phonological unit sizes depending on the language used. Using four mouse-tracking spoken word recognition experiments, participants listened to spoken words (either presented in English or Chinese) while viewing a display of two written words. In Experiment 1, Chinese-English bilinguals experienced a larger phonological competition in the CV condition than the control condition, indicating that they recruited syllables when listening to Chinese monosyllabic words. Experiment 2 extended the results of Experiment 1 with a set of Chinese disyllabic words and further revealed the temporal distribution of syllable overlap of a spoken word constrains phonological competition. In Experiment 3, Chinese-English bilinguals exhibited a greater phonological competition in both CV and C conditions that mirrored those reported with English monolinguals in Experiment 4. Our results across experiments demonstrated that Chinese-English bilinguals employed both phonemes and syllables to recognize English spoken words but exclusively relied on syllables to recognize Chinese words, suggesting that there is flexibility in selecting phonological units when recognizing spoken words in the two languages. Implications for models of monolingual and bilingual spoken recognition are also discussed. (PsycInfo Database Record (c) 2023 APA, all rights reserved).


Assuntos
Percepção da Fala , Fala , Humanos , Fonética , Idioma , Percepção Auditiva
11.
Redox Biol ; 58: 102534, 2022 12.
Artigo em Inglês | MEDLINE | ID: mdl-36379180

RESUMO

Epidemiological studies have linked herbicides and Parkinson's disease (PD), with the strongest associations resulting from long exposure durations. Paraquat (PQ), an herbicide, induces PD-like syndromes and has widely been accepted as a PD mimetic. Currently, there is still no cure to prevent the progression of PD, and the search for effective therapeutic ways is urgent. Recently, the impairing activity of sirtuins (SIRTs), such as SIRT1, may correlate with PD etiology. However, the nonspecificity of SIRT1 agonists has made the protective mechanisms against PD unclear and hampered the therapeutic application of SIRT1. Thus, this study investigated the protective mechanism and therapeutic potential of SRT1720, a more specific agonist for SIRT1 synthesized by Sirtris, in alleviating the toxicity of PQ-induced cellular and animal models of PD. Here we show that SRT1720 alleviates PQ-induced toxicity in cell and animal models. Genetic silencing and pharmacological inhibition of SIRT1 attenuated SRT1720's protection against PQ-induced toxicity. Moreover, SRT1720 not only attenuated PQ-induced increased oxidative stress and mitochondrial free radical formations but also decreased mitochondrial membrane potential. Furthermore, SRT1720 reversed PQ-induced decreased PGC-1α levels and mitochondrial biogenesis. Although PQ and SRT1720 elevated NRF2 and antioxidative enzyme levels, only PQ decreased antioxidative enzyme activity but not SRT1720. NRF2 and PGC-1α silencing attenuated SRT1720 protection against PQ-induced toxicity. SRT1720 targeted SIRT1 and activated downstream PGC-1α and NRF2 signalings to prevent PQ-induced toxicity involving oxidative stress and mitochondrial dysfunction. Thus, SRT1720 might have therapeutic potential in preventing PD.


Assuntos
Herbicidas , Doença de Parkinson , Animais , Paraquat/farmacologia , Sirtuína 1/genética , Sirtuína 1/metabolismo , Doença de Parkinson/tratamento farmacológico , Doença de Parkinson/etiologia , Doença de Parkinson/metabolismo , Fator 2 Relacionado a NF-E2/genética , Fator 2 Relacionado a NF-E2/metabolismo , Mitocôndrias/metabolismo , Estresse Oxidativo , Herbicidas/toxicidade , Herbicidas/metabolismo
12.
J Acute Med ; 12(3): 113-121, 2022 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-36313609

RESUMO

Background: Hip fracture (HF) is a major challenge for healthcare systems in terms of increased costs and lengths of stay, and it has been estimated that by 2050, half of the projected 6.26 million global HFs will occur in Asia. Owing to the high morbidity and mortality associated with HF in elderly individuals, it is crucial to recognize at-risk elderly patients in the ED so that special precautions and preventive measures can be taken. While comprehensive geriatric assessment (CGA) has been shown to improve outcomes and prevent secondary fractures in elderly individuals with HF in outpatient settings, there is a lack of data to identify elderly Asian patients who are at risk of HF via using CGA in the emergency department (ED). The aim of this study is to identify the characteristics of elderly Asian patients in the ED who have an increased risk of HF via CGA. Methods: A case-control study was conducted in the ED at Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from October 2018 to December 2019. Patients > 75 years old with and without HF were compared using data obtained from CGAs conducted by trained nurses. Results: A total of 85 HF patients (cases) and 680 non-HF patients were enrolled, among whom 340 non-HF control individuals (controls) were selected by simple random sampling. HF occurred more frequently in women and in patients with depressive symptoms. An association between decreased handgrip strength and HF risk, especially in men, was also identified ( p = 0.011). The variables independently associated with the presence of HF in the multivariate analysis were female sex (odds ratio [OR]: 2.229; 95% confidence interval [CI]: 1.332-3.728) and decreased handgrip strength (OR: 2.462; 95% CI: 1.155-5.247). Conclusions: By performing CGAs in the ED, we found that female sex and decreased handgrip strength were associated with HF risk. Therefore, we propose that targeted assessment of handgrip strength in female patients aged > 75 years in the ED may identify those at greatest risk of HF, resulting in improved emergency care for geriatric patients.

13.
J Dermatol Sci ; 107(3): 142-150, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36075780

RESUMO

BACKGROUND: Lysosomal cell death is induced by lysosomal membrane permeabilization (LMP) and the subsequent release of lysosomal proteolytic enzymes, including cathepsins (CTSs), which results in mitochondrial dysfunction and apoptosis. Imiquimod (IMQ), a synthetic TLR7 ligand, has both antiviral and antitumor activity against various skin malignancies in clinical treatment. Previously, we demonstrated IMQ not only caused lysosomal dysfunction but also triggered lysosome biogenesis to achieve lysosomal adaptation in cancer cells. OBJECTIVE: To determine whether lysosomes are involved in IMQ-induced apoptosis. METHODS: The human skin cancer cell lines BCC, A375 and mouse melanoma cell line B16F10 were used in all experiments. Cell death was determined by the Cell Counting Kit-8 (CCK-8) assay and DNA content assay. Protein expression was determined by immunoblotting. Caspase-8 activity was assessed using a fluorescence caspase-8 kit and determined by flow cytometry and confocal microscopy. RESULTS: IMQ not only induced lysosome damage but also abrogated lysosome function in skin cancer cells. IMQ-induced caspase-8 activation contributed to the processes of lysosomal cell death. Moreover, the use of ROS scavengers significantly abolished caspase-8 activation and inhibited IMQ-induced LMP. Additionally, pharmacological inhibition of CTSD not only abrogated caspase-8 activation but also rescued IMQ-induced cell death. Finally, lysosome-alkalizing agents enhanced the cytotoxicity of IMQ in vitro and in vivo. CONCLUSIONS: IMQ-induced ROS accumulation promotes LMP, releases CTSs into the cytosol, stimulates caspase-8 activation and finally causes lysosomal cell death. Lysosomal cell death and the CTSD/caspase-8 axis may play a crucial role in IMQ-induced cell death.


Assuntos
Neoplasias Cutâneas , Receptor 7 Toll-Like , Animais , Antivirais/uso terapêutico , Apoptose , Caspase 8/metabolismo , Caspase 8/farmacologia , Caspase 8/uso terapêutico , Catepsinas/metabolismo , Catepsinas/farmacologia , Catepsinas/uso terapêutico , DNA/metabolismo , Humanos , Imiquimode/farmacologia , Ligantes , Lisossomos/metabolismo , Camundongos , Espécies Reativas de Oxigênio/metabolismo , Transdução de Sinais , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/metabolismo , Receptor 7 Toll-Like/metabolismo
14.
Spectrochim Acta A Mol Biomol Spectrosc ; 283: 121729, 2022 Dec 15.
Artigo em Inglês | MEDLINE | ID: mdl-35985226

RESUMO

Formaldehyde has an extremely reactive carbonyl group, commonly used as an antibacterial agent to sterilize and prevent food to spoil. This article describes an efficient and rapid detection method of formaldehyde from an aqueous solution by synthesizing 3-Aminopropyltriethoxysilane (APTES) quantum dots (Nano A) which react with formaldehyde to generate a Schiff base reaction. The photoinduced electron transfer produced by the quantum dots themselves results in fluorescence quenching to detect formaldehyde. The detection limit can reach 10-9 M, and it can further be used to detect formaldehyde content in foods, such as baby vegetables, mushrooms, and vermicelli among other daily foods.


Assuntos
Pontos Quânticos , Transferência Ressonante de Energia de Fluorescência/métodos , Formaldeído , Limite de Detecção
15.
Dement Geriatr Cogn Disord ; 51(4): 310-321, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35995033

RESUMO

INTRODUCTION: Cognitive impairment (COIM) is a major challenge for healthcare systems and is associated with an increased risk of adverse outcomes in older people visiting emergency departments (EDs). Owing to global aging, both cognitive screening and comprehensive geriatric assessment (CGA) application in ED settings are developing areas of geriatric emergency medicine. Meanwhile, the association between clinical outcomes of COIM; cognitive impairment, no dementia (CIND); and dementia in the ED could be better investigated. Our study aims to identify individuals with COIM from older patients in the ED via CGA and to describe the association of CIND and dementia with prognosis in ED visits. METHODS: A prospective cross-sectional study was conducted in the ED of the Taipei Veterans General Hospital, a medical center located in Taipei, Taiwan, from August 2018 to November 2020. Patients aged ≥75 years with and without COIM were compared using data obtained from the CGAs conducted by trained nurses. RESULTS: A total of 823 older patients were enrolled in the study and underwent CGA. Of these, 463 (56.3%) were diagnosed with COIM, of which 292 (35.5%) were diagnosed with dementia; and 171 (20.8%), CIND. Between the no-COIM and COIM groups, the COIM group had a higher rate of hospital admission (p = 0.002) and mortality at 3 months (p < 0.05). Among the no-COIM, CIND, and dementia groups, ED disposition (p = 0.001) and the rate of revisit/readmission (p < 0.05) showed significant differences. In particular, the dementia group had a significantly higher rate of revisit/readmission as compared to the CIND group among the three groups. DISCUSSION/CONCLUSION: Older patients with COIM had a higher rate of hospital admission and mortality at the 3-month follow-up than older patients without COIM. Among the no-COIM, CIND, and dementia groups, patients with dementia had significantly increased risks of hospital admission and revisit/readmission. The early detection of COIM, and even dementia, could help ED physicians formulate strategies with geriatric specialists to improve mortality outcomes and revisit/readmission.


Assuntos
Avaliação Geriátrica , Readmissão do Paciente , Idoso , Humanos , Estudos Prospectivos , Seguimentos , Estudos Transversais , Serviço Hospitalar de Emergência , Fatores de Risco , Hospitais , Cognição
16.
J Chin Med Assoc ; 85(10): 987-992, 2022 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-35727104

RESUMO

BACKGROUND: Targeted temperature management (TTM) has been reported to improve outcomes in in-hospital cardiac arrest (IHCA) patients but little has been investigated into the relationship between prognoses and the blood urea nitrogen to creatinine ratio (BCR). METHODS: A retrospective analysis of data from IHCA survivors treated with TTM between 2011 and 2018 was conducted based on the Research Patient Database Registry of the Partners HealthCare system in Boston. Serum laboratory data were measured during IHCA and within 24 hours after TTM completion. Intra-arrest and post-TTM BCRs were calculated, respectively. The primary outcome was neurologic status at discharge. The secondary outcome was in-hospital mortality. RESULTS: The study included 84 patients; 63 (75%) were discharged with a poor neurologic status and 40 (47.6%) died. Regarding poor neurological outcome at discharge, multivariate analysis revealed that post-TTM BCR was a significant predictor (adjusted OR, 1.081; 95% CI, 1.002-1.165; p = 0.043) and intra-arrest BCR was a marginal predictor (adjusted OR, 1.067; 95% CI, 1.000-1.138; p = 0.050). Post-TTM BCR had an acceptably predictive ability to discriminate neurological status at discharge, with an area under the receiver-operating characteristic curve of 0.644 (95% CI, 0.516-0.773) and a post-TTM BCR cutoff value of 16.7 had a sensitivity of 61.9% and a specificity of 70.0%. CONCLUSION: Post-TTM BCR was a significant predictor of the neurologic outcome at discharge among IHCA patients receiving TTM. IHCA patients with elevated intra-arrest BCR also had a borderline poor neurological prognosis at discharge.


Assuntos
Reanimação Cardiopulmonar , Parada Cardíaca , Hipotermia Induzida , Nitrogênio da Ureia Sanguínea , Creatinina , Hospitais , Humanos , Hipotermia Induzida/efeitos adversos , Prognóstico , Estudos Retrospectivos
17.
Nutrients ; 14(9)2022 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-35565864

RESUMO

Sarcopenia has serious clinical consequences and poses a major threat to older people. Gastrointestinal environmental factors are believed to be the main cause. The aim of this study was to describe the relationship between sarcopenia and gastric mobility and to investigate the relationship between sarcopenia and the concentration of gastrointestinal hormones in older patients. Patients aged ≥ 75 years were recruited for this prospective study from August 2018 to February 2019 at the emergency department. The enrolled patients were tested for sarcopenia. Gastric emptying scintigraphy was conducted, and laboratory tests for cholecystokinin(CCK), glucagon-like peptide-1 (GLP-1), peptide YY (PYY), nesfatin, and ghrelin were performed during the fasting period. We enrolled 52 patients with mean age of 86.9 years, including 17 (32.7%) patients in the non-sarcopenia group, 17 (32.7%) patients in the pre-sarcopenia group, and 18 (34.6%) in the sarcopenia group. The mean gastric emptying half-time had no significant difference among three groups. The sarcopenia group had significantly higher fasting plasma concentrations of CCK, GLP-1, and PYY. We concluded that the older people with sarcopenia had significantly higher plasma concentrations of CCK, GLP-1, and PYY. In the elderly population, anorexigenic gastrointestinal hormones might have more important relationships with sarcopenia than orexigenic gastrointestinal hormones.


Assuntos
Hormônios Gastrointestinais , Sarcopenia , Idoso , Idoso de 80 Anos ou mais , Colecistocinina , Esvaziamento Gástrico , Grelina , Peptídeo 1 Semelhante ao Glucagon , Humanos , Peptídeo YY , Estudos Prospectivos
18.
Anal Bioanal Chem ; 414(18): 5217-5237, 2022 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-35469098

RESUMO

Triplex DNA nanostructures are one of the most emerging and fascinating self-assembled nanostructures due to their unique nanoparticle-like organization and inherit characteristics. They have attracted numerous interests recently because of their versatile and powerful utility in diverse areas of science and technology, such as clinical or disease diagnosis and stimuli-based drug delivery. This review addresses particularly the utilization of DNA triplexes in the development of biosensors for detecting nucleic acid; strategies in sensing pH, protein activity, ions, or molecules. Finally, an outlook for potential applications of triplex DNA nanoswitches is provided.


Assuntos
Técnicas Biossensoriais , Nanoestruturas , DNA/química , Nanoestruturas/química , Conformação de Ácido Nucleico
19.
Anal Chim Acta ; 1198: 339516, 2022 Mar 15.
Artigo em Inglês | MEDLINE | ID: mdl-35190129

RESUMO

Plastic cups and bottles used for mineral water packaging may release plastic particles during continuous exposure to heat, light, or unfavorable chemical environments during transportation and storage. Surface-enhanced Raman spectroscopy (SERS) can be used to detect and analyze these plastic particles in a highly sensitive and quantitative manner. In this study, we used copper oxide/silver nanoparticles (CuO/Ag NPs) as the SERS substrate to monitor the release of plastic particles in packaged mineral water samples under irradiation as a function of exposure time. The lower detection limit for plastic particles using this CuO/Ag NP SERS system was 1.6 ng/mL. Our results showed that both plastic cups and bottles released particles under irradiation, however, the plastic cup samples degraded much more readily, with the particle concentration increasing considerably from 5.37 ± 0.11 ng/mL to 3751 ± 0.19 ng/ml over the total exposure time period of 240 min. In this study, we have demonstrated that SERS can provide a highly sensitive, rapid, and economical method for detecting plastic particle contamination caused by degradation of the plastic materials used in mineral water packaging.


Assuntos
Água Potável , Nanopartículas Metálicas , Água Potável/análise , Nanopartículas Metálicas/química , Plásticos , Prata/química , Análise Espectral Raman/métodos
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