[Correlation between prognostic nutritional index and pleural thickness with survival time of epithelial malignant pleural mesothelioma patients].

Objective: To explore the role of prognostic nutritional index (PNI) and pleural thickness in the prognostic evaluation of patients with epithelial malignant pleural mesothelioma (MPM) . Methods: In April 2022, a retrospective analysis was conducted on the data and laboratory data of 41 patients with epithelial MPM admitted to the cardiothoracic surgery department of Chuxiong Yi Autonomous Prefecture People's Hospital from January 2018 to May 2021. Univariate and multivariate analysis were used to evaluate the relationships between total survival time, clinical characteristics, PNI and pleural thickness in patients. Results: The 41 patients were mostly male (26 cases, 63.4%) , with a median age of 55 years old. The main clinical manifestations were chest pain (53.7%) , bloody pleural effusion (75.6%) , and chest pain combined with bloody pleural effusion (36.6%) . The median survival time of patients with different TNM stage, efficacy after 4 cycles of chemotherapy, PNI, maximum pleural thickness after chemotherapy (post max) , sum of post max in 3 zones after chemotherapy (post sum) were statistically different (χ(2)=3.89, 14.51, 15.33, 4.33, 12.05, P<0.05) . Compared with patients with high PNI and post sum<32.26 mm, MPM patients with low PNI and post sum≥32.26 mm have higher risk of death, and the differences were statistically significant (HR=1.52, 95%CI: 1.75-11.93, P=0.002; HR=1.70, 95%CI: 1.84-16.23, P=0.002) . Conclusion: PNI and post sum can be used to predict the prognosis of patients with epithelial MPM.

Early detection of Mycobacterium tuberculosis complex in BACTEC MGIT cultures using nucleic acid amplification.

We evaluated the application of nucleic acid amplification (NAA) in liquid cultures for the early detection of Mycobacterium tuberculosis. The Cobas TaqMan MTB test, IS6110 real-time PCR, and hsp65 PCR-restriction fragment length polymorphism (RFLP) analysis were used to detect BACTEC MGIT 960 (MGIT) cultures on days 3, 5, 7, and 14. The procedure was initially tested with a reference strain, H37Rv (ATCC 27294). Subsequently, 200 clinical specimens, including 150 Acid Fast bacillus (AFB) smear-positive and 50 AFB smear-negative samples, were examined. The Cobas TaqMan MTB test and IS6110-based PCR analysis were able to detect M. tuberculosis after 1 day when the inoculum of H37Rv was >3 x 10(-2) CFU/ml. After a 5-day incubation in the MGIT system, all three NAA assays had a positive detection regardless of the inoculum size. After a 1-day incubation of the clinical specimens in the MGIT system, the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for the Cobas TaqMan MTB assay were 70.2%, 100%, 100%, and 82.3% respectively. For IS6110-based PCR analysis, these values were 63.1%, 100%, 100%, and 78.9%, and were 88.1%, 100%, 100%, and 92.1% respectively for hsp65 PCR-RFLP analysis. After a 3-day incubation, the specificity and PPV were 100% for all three NAA tests; the Cobas TaqMan MTB assay had the best sensitivity (97.6%) and NPV (98.3%). The sensitivity, specificity, PPV, and NPV for conventional culture analysis were 98.8%, 100%, 100%, and 99.1%. Thus, NAA may be useful for the early detection of M. tuberculosis after 3 days in MGIT.

Trends in the susceptibility of methicillin-resistant Staphylococcus aureus to nine antimicrobial agents, including ceftobiprole, nemonoxacin, and tyrothricin: results from the Tigecycline In Vitro Surveillance in Taiwan (TIST) study, 2006-2010.

This study investigated the in vitro susceptibilities of methicillin-resistant Staphylococcus aureus (MRSA) to nine antimicrobial agents in Taiwan. A total of 1,725 isolates were obtained from 20 hospitals throughout Taiwan from 2006 to 2010. The minimum inhibitory concentrations (MICs) of the nine agents were determined by the agar dilution method. The MICs of mupirocin and tyrothricin were determined for 223 MRSA isolates collected from 2009 to 2010. For vancomycin, 99.7 % were susceptible; however, 30.0 % (n = 517) exhibited MICs of 2 µg/ml and 0.3 % (n = 6) demonstrated intermediate susceptibility (MICs of 4 µg/ml). Nearly all isolates (≥ 99.9 %) were susceptible to teicoplanin, linezolid, and daptomycin. The MIC90 values were 2 µg/ml for ceftobiprole and 1 µg/ml for nemonoxacin. The MIC90 values of mupirocin and tyrothricin were 0.12 and 4 µg/ml, respectively. MIC creep was noted for daptomycin during this period, but not for vancomycin, teicoplanin, linezolid, or tigecycline. For isolates with vancomycin MICs of 2 µg/ml, the MIC90 values were 2 µg/ml for teicoplanin, 0.5 µg/ml for daptomycin, and 0.5 µg/ml for tigecycline. Those values were four- to eight-fold higher than those among isolates with vancomycin MICs of 0.5 µg/ml (2, 0.06, and 0.12 µg/ml, respectively). Of the nine MRSA isolates exhibiting non-susceptibility to vancomycin (n = 6), teicoplanin (n = 1), daptomycin (n = 2), or tigecycline (n = 1), all had different pulsotypes, indicating the absence of intra-hospital or inter-hospital spread. The presence of a high proportion of MRSA isolates with elevated MICs (2 µg/ml) and MIC creep of daptomycin might alert clinicians on the therapy for serious MRSA infections in Taiwan.

A smooth muscle-specific monoclonal antibody recognizes smooth muscle actin isozymes.

Injection of chicken gizzard actin into BALB/c mice resulted in the isolation of a smooth muscle-specific monoclonal antibody designated CGA7. When assayed on methanol-Carnoy's fixed, paraffin-embedded tissue, it bound to smooth muscle cells and myoepithelial cells, but failed to decorate striated muscle, endothelium, connective tissue, epithelium, or nerve. CGA7 recognized microfilament bundles in early passage cultures of rat aortic smooth muscle cells and human leiomyosarcoma cells but did not react with human fibroblasts. In Western blot experiments, CGA7 detected actin from chicken gizzard and monkey ileum, but not skeletal muscle or fibroblast actin. Immunoblots performed on two-dimensional gels demonstrated that CGA7 recognizes gamma-actin from chicken gizzard and alpha- and gamma-actin from rat colon muscularis. This antibody was an excellent tissue-specific smooth muscle marker.

Antibiotic strategies and clinical outcomes in critically ill patients with pneumonia caused by carbapenem-resistant Acinetobacter baumannii.

OBJECTIVES: This study aimed to investigate antibiotic prescribing patterns and effectiveness of different anti-carbapenem-resistant Acinetobacter baumannii (CRAB) strategies for CRAB pneumonia. METHODS: We conducted a multicentre, retrospective study in three hospitals. During 2010-2015, adult ICU patients with CRAB pneumonia treated with at least one antimicrobial agent covering the CRAB isolate in vitro for more than 2 days were included. We used multivariate logistic regression to analyse the associations of anti-CRAB strategies with ICU mortality and other clinical outcomes. RESULTS: Among 238 patients with CRAB pneumonia, tigecycline monotherapy (84, 35.3%) was the most common antibiotic strategy, followed by tigecycline with colistin (43, 18.1%), colistin monotherapy (34, 14.3%), colistin combination without tigecycline (33, 13.9%), tigecycline combination without colistin (32, 13.4%), and sulbactam-based therapy without tigecycline and colistin (12, 5.0%). In multivariate analysis, tigecycline-based therapy was associated with higher ICU mortality than non-tigecycline therapy (adjusted OR 2.30, 95% CI 1.19-4.46). There was no difference between colistin-based therapy and non-colistin therapy. Compared with tigecycline monotherapy, colistin monotherapy was associated with lower ICU mortality (aOR 0.30, 95% CI 0.10-0.88). Treatment failure analyses showed similar trends. Tigecycline-based therapy was associated with higher treatment failure rate than non-tigecycline therapy (aOR 2.51, 95% CI 1.39-4.54), whereas colistin-based therapy was associated with lower treatment failure rate than non-colistin-based therapy (aOR 0.48, 95% CI 0.27-0.86). CONCLUSIONS: Tigecycline was commonly prescribed for CRAB pneumonia. However, tigecycline-based therapy was associated with higher ICU mortality and treatment failure. Our study suggests that colistin monotherapy may be a better antibiotic strategy for CRAB pneumonia.

Sacral nerve stimulation for constipation and fecal incontinence in children: Long-term outcomes, patient benefit, and parent satisfaction.

OBJECTIVE: To evaluate the long-term efficacy of sacral nerve stimulation (SNS) in children with constipation and describe patient benefit and parent satisfaction. METHODS: Using a prospective patient registry, we identified patients <21 years old with constipation treated with SNS for >2 years. We compared symptoms, medical treatment, PedsQL Gastrointestinal Symptom Scale (GSS), Fecal Incontinence Quality of Life Scale (FIQL), and Fecal Incontinence Severity Index (FISI) before SNS and at follow-up. We contacted parents to administer the Glasgow Children's Benefit Inventory (GCBI) and a parent satisfaction questionnaire. KEY RESULTS: We included 25 children (52% male, median age 10 years): 16 had functional constipation, six anorectal malformation, two tethered spinal cord, and one Hirschsprung's disease. Defecation frequency did not change after SNS but patients reporting fecal incontinence decreased from 72% to 20% (P<.01) and urinary incontinence decreased from 56% to 28% (P=.04). Patients using laxatives decreased from 64% to 44% (ns) and patients using antegrade enemas decreased from 48% to 20% (P=.03). GSS, most FIQL domains, and FISI were improved at follow-up. Six (24%) patients had complications requiring further surgery. Of the 16 parents contacted, 15 (94%) parents indicated positive health-related benefit and all would recommend SNS to other families. CONCLUSIONS & INFERENCES: Sacral nerve stimulation is a promising and durable treatment for children with refractory constipation, and appears particularly effective in decreasing fecal incontinence. Although a quarter of patients experienced complications requiring additional surgery, nearly all parents reported health-related benefit. Future studies to identify predictors of treatment response and complications are needed.

The rising cost of hospital care for children with gastroparesis: 2004-2013.

BACKGROUND: The cost of hospital care for adults with gastroparesis (GP) is increasing. Our objective was to evaluate the cost of hospital care for children with GP. METHODS: Using the Pediatric Health Information System, we selected hospitalizations with a diagnosis of GP (ICD-9 536.3), dyspepsia and other specified disorders of function of stomach (DYS, 536.8) and unspecified functional disorder of stomach (UFD, 536.9) from 2004 to 2013. We recorded dates of hospitalization, demographics, costs, and length of stay (LOS). KEY RESULTS: From 2004 to 2013, 4015 patients were admitted for GP (54.2% female, median age 8 years). Total cost of hospitalization for GP increased 5.8 fold from $6 185 390 to $35 654 075 (p = 0.0001). Cost per hospitalization did not change. Cost of initial hospitalization was highest in patients 0-5 years and lowest in patients 16-21 years (p < 0.0001). Number of hospitalizations each year for GP increased from 252 to 1310 (p < 0.0001) and unique patients hospitalized increased from 174 to 723 (p < 0.0001). Number of hospitalizations and unique patients for DYS/UFD also increased (p < 0.0001). LOS for GP did not change with time. Females and younger GP patients had more repeat hospitalizations (p < 0.0001, p < 0.0001). CONCLUSIONS & INFERENCES: The financial burden of hospitalization for pediatric GP has increased dramatically from 2004 to 2013, driven by a rise in number of hospitalizations and unique patients hospitalized each year. Cost and LOS per hospitalization remain stable. Unlike in adults, hospitalizations for DYS/UFD have also increased, suggesting that the increase in hospitalizations for GP is not secondary to changing diagnostic practices.

Temporal changes in urinary 1-hydroxypyrene concentrations in coke-oven workers.

Coke-oven workers are exposed to high concentrations of coke-oven emissions, which are comprised mainly of polycyclic aromatic hydrocarbons. We conducted a pilot study to determine the time changes in urinary 1-hydroxypyrene (1-OHP) concentrations, as a metabolite of pyrene, in coke-oven workers after exposure to a benzene-soluble fraction (BSF) of total particulates. Thirteen subjects, including 2 men (referents) from an administrative area, 6 workers who work at the sideoven, and 5 who work on the top of the oven in one coke-oven plant were studied. After 1.5 to 2 days off, subjects were monitored individually for breathing zone air BSF over 3 consecutive days in August 1995. Seven spot urine samples, including preshift and postshift urine over 3 days and preshift urine on a fourth-day morning, were collected to determine 1-OHP concentrations by fluorescent spectrophotometry. The mean ambient BSF concentrations in the sideoven and topside oven workers ranged from 18 to 159 microg/m3 and from 251 to 1362 microg/ m3, respectively, whereas the BSF concentrations in the referents were low but detectable (11 and 29 microg/m3). Urinary 1-OHP concentrations increased during the work period, from 10+/-3 and 41+/-9 microg/g creatinine (mean+/-SE) on the preshift first day to 57+/-26 and 334+/-63 microg/g creatinine on the postshift third day in the sideoven and topside oven workers, respectively. However, the urinary 1-OHP concentrations were relatively flat in the two referents. The across-shift change in urinary 1-OHP defined as postshift 1-OHP on the third day minus preshift 1-OHP on the first day was highly associated with individual mean occupational exposure to air BSF (r = 0.80, P = 0.001). Repeated-measures regression analyses revealed that daily postshift 1-OHP concentrations were marginally associated with daily air BSF. A 10-fold increase of daily air BSF resulted in a 1.67-fold increase of daily postshift 1-OHP levels (95% confidence interval = 0.99-2.83; P = 0.07). After adjusting for daily preshift 1-OHP concentrations, we found that a 10-fold increase of daily air BSF resulted in a 1.90-fold increase of daily postshift 1-OHP levels (95% confidence interval = 1.10-3.28; P = 0.03). Although the sample size is small in this study, these results indicate that daily postshift 1-OHP levels in urine are determined mainly by current occupational exposure to coke-oven emissions.

Pulmonary function among cotton textile workers. A study of variability in symptom reporting, across-shift drop in FEV1, and longitudinal change.

Longitudinal variability in respiratory responses, including symptom reporting and across-shift change in ventilatory function, were examined in relation to long-term loss of ventilatory function in a group of 447 cotton textile workers in Shanghai, China. The study used a standardized respiratory questionnaire and standardized spirometric testing before and after a work shift on the first day of the workweek. Prediction equations for FEV1 were generated from a group of silk textile workers from the same city. Environmental samples included both vertical elutriated cotton dust and endotoxin levels. There was considerable variability in symptom reporting between the baseline and 5-year follow-up survey for all symptoms. However, subjects who consistently reported symptoms had a significantly accelerated 5-year loss in FEV1 compared with those who never reported symptoms. Subjects with symptoms of chest tightness or dyspnea at one survey lost FEV1 at a rate intermediate between the never or both groups. Moreover, subjects with an across-shift change in FEV1 of more than 5 percent at both surveys had the greatest loss in FEV1 over 5 years (-267 ml) when compared with one-time responders (-224 ml), and nonresponders (-180 ml), though the differences were not significant. Workers with chest tightness and chronic bronchitis in both surveys were overrepresented in the high dust and endotoxin areas. Our results indicate that even with substantial survey-to-survey variability in responses, there is important information contained in both questionnaires and across-shift spirometry. Among cotton workers, consistent responders to either symptom questionnaire or across-shift FEV1 decrements of > or = 5 percent appear to be at increased risk for lung function impairment.

Molecular epidemiology and mutations at gyrA and parC genes of ciprofloxacin-resistant Escherichia coli isolates from a Taiwan medical center.

Sixty-five ciprofloxacin-resistant clinical Escherichia coli isolates were collected from a Taiwan Medical Center from December 1998 to February 1999. All 65 clinical isolates were resistant (MICs > or = 4 microg/mL) to the following fluoroquinolones: ofloxacin, levofloxacin, sparfloxacin, and trovafloxacin. These isolates were cross-resistant to chloramphenicol (65 isolates, 100%), tetracycline (65 isolates, 100%), cefuroxime (64 isolates, 98.5%), ampicillin (57 isolates, 87.7%), gentamicin (53 isolates, 81.5%), and cephalothin (24 isolates, 36.9%). Pulsed-field gel electrophoresis (PFGE) revealed a high diversity among the genomes of these isolates and indicated that clonal spread was not responsible for the prevalence of ciprofloxacin resistance in the hospital. Sequencing of the polymerase chain reaction (PCR) amplified products of the quinolone resistance determining regions (QRDRs) of gyrA and parC showed that all isolates carrying double mutations in gyrA at codon 83 and 87 and at least one parC mutation at codon 80 and/or 84. The mutation at codon 83 of GyrA from serine to leucine (S83L) was present in all the clinical isolates. The most prevalent pattern was the S83L mutation and the mutation at codon 87 from an aspartate to an asparagine (D87N) of GyrA plus a mutation from a serine to an isoleucine (S80I) at codon 80 of ParC (63.2%). This indicated that the presence of high-level resistance to quinolones in clinical E. coli isolates were associated with mutations at hot spots, codon 83 and 87 in GyrA and followed by subsequent mutation in either codon 80 and/or 84 in ParC.

Application of pulsed-field gel electrophoresis to the investigation of a nosocomial outbreak of Vibrio parahaemolyticus.

The method of pulsed-field gel electrophoresis (PFGE) for Vibrio parahaemolyticus was first published in 1996. Since then, its application has been seldom reported in the literature. A food poisoning outbreak due to V. parahaemolyticus occurred in five wards of a hospital was investigated using this method. Twenty-five patients were involved and all of them had eaten food supplied by the hospital. Of the 15 cases whose stools were available for culture, only four cultures yielded V. parahaemolyticus. All four isolates were serotype K6 and were indistinguishable or closely related to each other based on PFGE patterns. Two isolates from food were recovered and they presented different characterizations from the patient isolates in both serotype and PFGE pattern. Successful typing by PFGE to identify the outbreak strain and differentiate V. parahaemolyticus strains between patient and food isolates in this study suggests the usefulness of PFGE for V. parahaemolyticus, the leading cause of food poisoning in Taiwan.

Lung function studies of asbestos workers.

Pulmonary function tests have been conducted on 155 asbestos workers and 130 referents. It was found that the lung function impairment in asbestos workers is predominantly a restrictive ventilatory defect appearing even when radiographic changes are not detectable. There was, however, no evidence of airway obstruction. As the disease progressed, all the pulmonary function indices, including vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1.0), maximal ventilation volume (MVV), total lung capacity (TLC), and pulmonary diffusing capacity (DLCO), were reduced dramatically, with the exception of FEV1.0/FVC(%). It is suggested that both radiographic examination and pulmonary function tests should be used as early detection measures of asbestos-induced lung disorders. VC, FVC, and FEV1.0 are the simplest, most reproducible, and most valid indices for the health surveillance of asbestos workers, while the FVC test is the most valuable for epidemiologic study. With stepwise regression analysis a quantitative relationship between dust exposure and pulmonary function was demonstrated. There was no significant difference in the small airway function of the exposed workers and the referents. Further study is needed to investigate the possibility of asbestos-induced small airway obstruction and to estimate the roles played by cigarette smoking and air pollution.

Respiratory disease in cotton textile workers in the People's Republic of China. I. Respiratory symptoms.

The prevalence of byssinosis and nonspecific respiratory symptoms was studied in 887 textile workers with at least two years of employment in two cotton mills and one silk mill in Shanghai, the People's Republic of China. A standardized respiratory questionnaire was used, and environmental sampling was performed with vertical elutriators and colorimeter grading. Eight percent of the cotton textile workers complained of byssinosis. The reports of byssinosis were mostly mild (grade 1/2), more prevalent among women, and unrelated to duration of employment or elutriator dust levels. Nonspecific respiratory symptoms were significantly more prevalent among cotton textile workers than silk workers. After adjustment for age, gender, and smoking in logistic regression models, the odds ratios for the effect of working in cotton textile mills on chronic bronchitis, chronic cough, and frequent chest illness were 3.3, 2.9 and 4.7, respectively. Although none of the symptoms were related to current dust levels, the range of exposures was narrow, and information was only available on current levels of cotton dust. This study represents the first respiratory survey of the textile industry in China using diagnostic criteria similar to that used in the United States and England; it defines a cohort for prospective investigation.

Respiratory disease in cotton textile workers in the People's Republic of China. II. Pulmonary function results.

Pulmonary function tests were performed pre and post workshift on 887 textile workers with at least two years of employment in two cotton mills and one silk mill in Shanghai, the People's Republic of China. Environmental sampling was performed with vertical elutriators, and pulmonary function was performed with standardized techniques. Cotton textile workers were found to have greater across-shift decrements in forced expiratory volume in 1 s (FEV1.0) than silk workers. Increasing duration of exposure resulted in increasing acute decrements in FEV1.0, although significant acute decrements were found in workers with less than five years of exposure. The acute changes in FEV 1.0 were noted in both symptomatic and asymptomatic cotton workers, though the difference between the across-shift change in FEV1.0 (delta FEV1.0%) of the byssinotics and nonbyssinotics increased as work duration increased. There was no difference in preshift FEV1.0 between the cotton and silk workers, but several selection factors likely influenced the observations.

Changes in health conditions in the Huainan coal mine in the past three decades.

Health conditions in the Huainan Coal Mine have improved greatly since 1950. In particular, the work and living environments, the underground dust concentration, the water supply and waste disposal systems, and the nutritional value of miners' food have become much better. Thus the rates of occupational, infectious, and parasitic diseases and nutritional deficiency diseases have decreased considerably among miners. The decreases in the prevalence of anthracosilicosis and hookworm have been especially striking.

Respiratory symptoms and pulmonary function among Chinese rice-granary workers.

The authors conducted a cross-sectional study of 474 rice-granary workers and 235 non-granary worker controls in a rural area near Shanghai, the People's Republic of China. Responses to a respiratory-symptom questionnaire and pre- and post-shift spirometry were obtained for all subjects. Area sampling was performed for total and vertically elutriated (

Pulmonary function study of retired cotton textile workers and the relationship to cigarette smoking.

A group of 173 retired cotton textile workers from one cotton mill in Shanghai was surveyed. A modified British Medical Research Council (BMRC) questionnaire was administered, and lung function tests were performed using an LR-80 flow-volume machine made in China. All workers had worked in the preparatory and spinning departments for more than 25 years. A group of 373 healthy age-matched individuals with similar social, economic, and educational backgrounds but with no history of dust or any toxic agent exposure was selected as the control group. Pulmonary function parameters from the forced expiratory effort were recorded. Prediction equations were derived from 157 controls who had never smoked and had no history of respiratory or cardiovascular disorders. The ratios of observed to predicted values in the male and female cotton textile workers and controls were examined using two-way analysis of variance and Student's t test. There was no significant difference between the cotton textile workers and the controls in lung function parameters, whereas cigarette smoking had a distinct impact on all the parameters except forced vital capacity. The effects of cotton dust exposure and cigarette smoking appeared to be additive. It is suggested that the effect of cigarette smoking on the respiratory tract may be located mainly in the small airways.