Value of monocyte distribution width for predicting severe cholecystitis: a retrospective cohort study.

OBJECTIVES: Acute cholecystitis is a gallbladder inflammation, and the Tokyo Guidelines 2018 (TG18) can be used to predict its presence and severity with high sensitivity and specificity. However, TG18 grading require the collection of excessive parameters. Monocyte distribution width (MDW) is a parameter used to detect sepsis early. Therefore, we investigated the correlation between MDW and cholecystitis severity. METHODS: We conducted a retrospective study of patients with cholecystitis admitted to our hospital from November 1, 2020, to August 31, 2021. The primary outcome was severe cholecystitis analyzed as a composite of intensive care unit (ICU) admission and mortality. The secondary outcomes were length of hospital stay, ICU stay, and TG18 grade. RESULTS: A total of 331 patients with cholecystitis were enrolled in this study. The average MDWs for TG18 grades 1, 2, and 3 were 20.21 ± 3.99, 20.34 ± 3.68, and 25.77 ± 6.61, respectively. For patients with severe cholecystitis, the average MDW was 25.42 ± 6.83. Using the Youden J statistic, we set a cutoff MDW of 21.6. Multivariate logistic regression revealed that patients with an MDW≥21.6 had a higher risk of severe cholecystitis (odds ratio=4.94; 95 % CI, 1.71-14.21; p=0.003). The Cox model revealed that patients with an MDW≥21.6 were more likely to have a prolonged hospital stay. CONCLUSIONS: MDW is a reliable indicator of severe cholecystitis and prolonged length of stay. Additional MDW testing and a complete blood count may provide simple information for predicting severe cholecystitis early.

Emergence and Spread of Neisseria gonorrhoeae Strains with High-Level Resistance to Azithromycin in Taiwan from 2001 to 2018.

A total of 598 Neisseria gonorrhoeae isolates obtained from patients in Taiwan from 2001 to 2018 were evaluated. The MICs of ceftriaxone (CRO) and azithromycin (AZM) against the isolates were determined by the agar dilution method. N. gonorrhoeae isolates with AZM MICs of ≥1 µg/ml were identified and characterized by the presence of AZM resistance determinants. For high-level AZM-resistant (AZM-HLR) isolates (MIC ≥ 256 µg/ml), genotyping was performed using multilocus sequence typing (MLST) and N. gonorrhoeae multiantigen sequence typing (NG-MAST). Among the N. gonorrhoeae isolates studied, 8.7% (52/598) exhibited AZM MICs of ≥1 µg/ml. Thirteen of the 52 isolates contained A2059G (23S rRNA NG-STAR type 1) or C2611T (23S rRNA NG-STAR type 2) mutations. The prevalence of the A2059G mutation was higher in AZM-HLR isolates (P < 0.001). The -35A deletion in the promoter region of the mtrR gene did not differ between AZM-HLR isolates (100%, 10/10) and the isolates with AZM MICs of 1 µg/ml to 64 µg/ml (95.2%, 40/42) (P = 1.000). The presence of mutations in the mtrR coding region was significantly different between these two groups at 90% (9/10) and 26.2% (11/42), respectively (P < 0.001). The AZM-HLR isolates, all carrying four mutated A2059G alleles, a -35A deletion, and G45D, were classified as MLST 12039/10899 and NG-MAST 1866/16497. In conclusion, Taiwan is among the countries reporting gonococci with high-level resistance to AZM so that a single dose of 1 g ceftriaxone intramuscularly as the first choice for management of N. gonorrhoeae infection should be evaluated.

Pharmacological blood pressure control and outcomes in patients with hypertensive crisis discharged from the emergency department.

Pharmacological blood pressure (BP) intervention for high blood pressure is controversial for a wide spectrum of hypertensive crisis in the emergency department (ED). We evaluated whether medical control of BP altered the short- and long-term outcomes among patients with hypertensive crisis who were discharged from the ED under universal health care. This retrospective cohort comprised 22 906 adults discharged from the ED of a tertiary hospital with initial systolic BP ≥ 180 mmHg or diastolic BP ≥ 120 mmHg between 2010 and 2016. The main exposure was the use of antihypertensive medication during the ED stay. Clinical endpoints were revisits to the ED or inpatient admission (at 7, 30, and 60 days), cardiovascular mortality (at 1, 3, and 5 years), and incident stroke (at 1, 3, and 5 years). The associations between pharmacological intervention for BP and outcomes were evaluated using multivariable Cox proportional-hazards models. Of the patient data analyzed, 72.2% were not treated pharmacologically and 68.4% underwent evaluation of end-organ damage. Pharmacological intervention for BP was significantly associated with a 11% and 11% reduced risk of hospital revisits within 30 or 60 days of discharge from ED, respectively, particularly among patients with polypharmacy. No association between pharmacological intervention for BP and incident stroke and cardiovascular mortality was observed. A revision of diagnostic criteria for hypertensive crisis is essential. Although pharmacological intervention for BP may not alter the long-term risk of cardiovascular mortality, it significantly reduces short-term health care utilization.

Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths.

Since the emergence of coronavirus disease 2019 (COVID-19) (formerly known as the 2019 novel coronavirus [2019-nCoV]) in Wuhan, China in December 2019, which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), more than 75,000 cases have been reported in 32 countries/regions, resulting in more than 2000 deaths worldwide. Despite the fact that most COVID-19 cases and mortalities were reported in China, the WHO has declared this outbreak as the sixth public health emergency of international concern. The COVID-19 can present as an asymptomatic carrier state, acute respiratory disease, and pneumonia. Adults represent the population with the highest infection rate; however, neonates, children, and elderly patients can also be infected by SARS-CoV-2. In addition, nosocomial infection of hospitalized patients and healthcare workers, and viral transmission from asymptomatic carriers are possible. The most common finding on chest imaging among patients with pneumonia was ground-glass opacity with bilateral involvement. Severe cases are more likely to be older patients with underlying comorbidities compared to mild cases. Indeed, age and disease severity may be correlated with the outcomes of COVID-19. To date, effective treatment is lacking; however, clinical trials investigating the efficacy of several agents, including remdesivir and chloroquine, are underway in China. Currently, effective infection control intervention is the only way to prevent the spread of SARS-CoV-2.

Clinical and microbiological characteristics of patients with bacteremia caused by Campylobacter species with an emphasis on the subspecies of C. fetus.

OBJECTIVES: This study was intended to investigate the clinical and microbiological characteristics of patients with bacteremia caused by Campylobacter species. METHODS: From April 1998 to May 2014, 56 adults with bacteremia caused by Campylobacter species were evaluated. These Campylobacter species isolates were confirmed to the species level using 16S rRNA gene sequencing (all isolates) and multiplex PCR analysis (for C. fetus only). The performance of identification for Campylobacter species by the Bruker Biotyper MALDI-TOF MS was evaluated. The genetic relatedness of C. fetus isolates was analyzed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). RESULTS: The leading underlying medical conditions of these patients were malignancy (46.4%), hypertension (35.7%), and liver cirrhosis (23.2%). The overall 30-day mortality rate was 5.4%. Using 16S rRNA sequencing analysis, 26 isolates of C. coli, 11 of C. jejuni, and 19 of C. fetus, including 15 C. fetus subsp. fetus and five C. fetus subsp. venerealis, were identified. Among the five C. fetus subsp. venerealis isolates recognized by 16S rRNA gene sequencing, only two isolates were C. fetus subsp. venerealis by multiplex PCR method. The Bruker Biotyper MALDI-TOF MS failed to correctly identify C. fetus subsp. venerealis isolates. MLST analysis of C. fetus isolates revealed three STs: ST20 (n = 12), ST11 (n = 5), and ST57 (n = 2), which were compatible with three major PFGE clusters. CONCLUSION: Database expansion of MALDI-TOF MS for the correct identification of C. fetus to subspecies levels is needed. A novel clone of ST57-PFGE Cluster C of C. fetus subsp. venerealis was noted.

Bilateral asymmetry in kinematic strategies for obstacle-crossing in adolescents with severe idiopathic thoracic scoliosis.

INTRODUCTION: Adolescent idiopathic scoliosis (AIS) is the most common three-dimensional spinal deformity pathology during adolescence, often accompanied with sensory integration and proprioception problems, which may lead to abnormal postural control and altered end-point control during functional activities. This paper identifies the effects of AIS on the end-point control and on angular kinematics of the trunk and pelvis-leg apparatus during obstacle-crossing for both the concave- and convex-side limb leading. MATERIALS AND METHODS: Sixteen adolescents with severe Lenke 1 AIS (age: 14.9 ±â€¯1.7 years, height: 154.7 ±â€¯5.0 cm) and sixteen healthy controls (age: 14.8 ±â€¯2.7 years, height: 154.9 ±â€¯5.6 cm) each walked and crossed obstacles of 3 heights with either the concave- (AIS-A) or convex-side (AIS-V) limb leading. Angular motions of the trunk, pelvis and lower limbs, and toe-obstacle clearances were measured. Two-way analyses of variance were used to study between-subject (group) and within-subject (limb and height) effects on the variables. Whenever a height effect was found, a polynomial test was used to determine the linear trend. α = 0.05 was set for all tests. RESULTS: Patients with AIS significantly reduced pelvic downward list but increased dorsiflexion in both stance and swing ankles at leading limb crossing when compared to controls (p < 0.05). During AIS-A, additional kinematic modifications were observed, i.e., increased stance hip adduction (4.2 ±â€¯0.8°, p = 0.005) and increased swing knee flexion (12.6 ±â€¯1.4°, p = 0.106), with significantly decreased leading toe-clearance (AIS-A: 121.4 ±â€¯6.7 mm, controls: 140.1 ±â€¯5.6 mm, p = 0.031). CONCLUSIONS: Patients with AIS adopted an altered kinematic strategy for successful obstacle-crossing. With the concave-side limb leading, more joint kinematic modifications with reduced toe-clearance were found when compared to those during the convex-side limb leading, suggesting an increased risk of tripping. Further studies on the kinematic strategies adopted by different types of AIS will be needed for a more complete picture of the functional adaptations in such patient group.

Effects of severity of degeneration on gait patterns in patients with medial knee osteoarthritis.

This study tested the hypothesis that patients with mild and severe medial knee osteoarthritis (OA) adopt different compensatory gait patterns to unload the deseased knee, in not only the frontal plane but also the sagittal plane. Fifteen patients with mild and 15 with severe bilateral medial knee OA, and 15 normal controls walked while the kinematic and kinetic data were measured. Compared to the normal group, both OA groups had significantly greater pelvic anterior tilt, swing-pelvis list, smaller standing knee abduction, as well as smaller standing hip flexor and knee extensor moments during stance. The severe group also had greater hip abduction, knee extension and ankle plantarflexion. The mild group successfully reduced the extensor moment and maintained normal abductor moment at the diseased knee mainly through listing and anterior tilting the pelvis. With extra compensatory changes at other joints and increased hip abductor moment, the severe group successfully reduced the knee extensor moment but failed to reduce the abductor moment. These results suggest that, apart from training of the knee muscles, training of the hip muscles and pelvic control are essential in the rehabilitative intervention of patients with knee OA, especially for more severe patients.

Antimicrobial susceptibilities and molecular typing of neisseria gonorrhoeae isolates at a medical centre in Taiwan, 2001-2013 with an emphasis on high rate of azithromycin resistance among the isolates.

A high prevalence of gonococcal resistance to various antimicrobials and Neisseria gonorrhoeae isolates exhibiting resistance to extended-spectrum cephalosporins have been reported in the past few decades. A total of 226 N. gonorrhoeae isolates obtained from the National Taiwan University Hospital from 2001 to 2013 were evaluated. The minimum inhibitory concentrations (MICs) of the isolates to antimicrobials were determined by the agar dilution method and interpreted using the 2017 clinical breakpoints or epidemiological cut-off values recommended by the Clinical and Laboratory Standards Institute (CLSI) and European Committee on Antimicrobial Susceptibility Testing (EUCAST). The genetic relatedness of these isolates was determined by multilocus sequence typing. None of the isolates was resistant to ceftriaxone and cefotaxime, and the resistance rates to cefixime, spectinomycin, cefpodoxime, ciprofloxacin, and penicillin were 0.4%, 0.4%, 13.3%, 91.6%, and 87.6%, respectively. The rate of isolates resistant to azithromycin was 14.6% (EUCAST criteria), which is higher than in previous surveillance studies. A total of 57 sequence types (ST) were identified, and ST1901, ST7365, and ST1927 prevailed. Isolates of ST8143 emerged after 2011. ST1901 isolates had relatively higher MIC values for ceftriaxone and azithromycin than those of the other STs. In conclusion, ceftriaxone remains an effective drug of choice for gonorrhoeal management in Taiwan. High rates of azithromycin resistance among N. gonorrhoeae isolates were found. The circulating ST1901 strains with high MIC values for ceftriaxone and azithromycin and the emerging ST8143 strains were alarming.

Immediate Effects of Acupuncture Treatment on Intra- and Inter-Limb Contributions to Body Support During Gait in Patients with Bilateral Medial Knee Osteoarthritis.

Knee osteoarthritis (OA) often leads to altered balance control, joint motion and loading patterns during gait. Acupuncture has been proven to be effective in pain relief but its effects on inter-joint load-sharing for body balance have not been reported. The current study bridged the gap by quantifying the immediate effects of acupuncture on the inter-joint and inter-limb load-sharing in patients with knee OA during level walking in terms of the total support moment (Ms) and the contribution of individual joints to the total support moment. Gait analysis was performed on fifteen healthy controls and on fifteen patients with mild to moderate bilateral medial knee OA. After acupuncture treatment the patients with bilateral knee OA walked with significantly increased speed ([Formula: see text]), and were able to resist greater and closer-to-normal knee flexion moments ([Formula: see text]). They also changed the inter-joint sharing of the support moments with increased knee ([Formula: see text]) contributions, but reduced hip contributions ([Formula: see text]) to the sagittal Ms during single-limb support. They showed an asymmetric inter-limb load-sharing similar to the normal controls, with increased sharing of the time integral of both the sagittal and frontal whole body support moment by the leading limb during double-limb support ([Formula: see text]). The altered intra- and inter-limb contributions to the demand of supporting the body during gait suggests that acupuncture treatment led to immediate changes in the control strategy toward a normal pattern. However, the effects of these changes on the progression of the disease in the long term would require further investigation.

Evaluation of the matrix-assisted laser desorption/ionization time-of-flight mass spectrometry Bruker Biotyper for identification of Penicillium marneffei, Paecilomyces species, Fusarium solani, Rhizopus species, and Pseudallescheria boydii.

We evaluated the performance of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS), the MALDI Bruker Biotyper system (microflex LT; Bruker Daltonik GmbH, Bremen, Germany), on the identification of 50 isolates of clinically encountered molds, including Penicillium marneffei (n = 28), Paecilomyces species (n = 12), Fusarium solani (n = 6), Rhizopus species (n = 3), and Pseudallescheria boydii (n = 1). The isolates were identified to species levels by sequence analysis of the internal transcribed spacer (ITS) regions using primers ITS1 and ITS4. None of the 28 genetically well characterized isolates of P. marneffei were identified as P. marneffei by MALDI-TOF MS, because P. marneffei was not present in either Bruker general library (DB 5627) or Bruker filamentous fungi library V1.0. However, the rate of accurate identification as P. marneffei (score value ≥ 2.000) was 85.7% based on newly created database from one P. marneffei strain (NTUH-3370) by MALDI Biotyper system. Sequencing analysis of these 22 non-P. marneffei isolates of molds revealed seven Paecilomyces variotii, six F. solani, four Paecilomyces lilacinus, and one each of Paecilomyces sinensis, Rhizopus arrhizus, R. oryzae, R. microspores, and P. boydii. Although all the seven P. variotii isolates, four of the six F. solani, two of the four P. lilacinus, and two of the three isolates of Rhizopus species, and the P. boydii isolate had concordant identification results between MALDI-TOF MS and sequencing analysis, the score values of these isolates were all of <1.700. This study indicated that the MALDI Bruker Biotyper is ineffective for identifying P. marneffei and other unusual molds because of the current database limitations. Therefore, it is necessary to continuously update the MALDI-TOF MS databases.

Effects of bilateral medial knee osteoarthritis on intra- and inter-limb contributions to body support during gait.

Patients with knee OA show altered gait patterns, affecting their quality of living. The current study aimed to quantify the effects of bilateral knee OA on the intra-limb and inter-limb sharing of the support of the body during gait. Fifteen patients with mild, 15 with severe bilateral knee OA, and 15 healthy controls walked along a walkway while the kinematic and kinetic data were measured. Compared with the controls, the patients significantly reduced their knee extensor moments and the corresponding contributions to the total support moment in the sagittal plane (p<0.05). For compensation, the mild OA group significantly increased the hip extensor moments (p<0.05) to maintain close-to-normal support and a more symmetrical inter-limb load-sharing during double-limb support. The severe OA group involved compensatory actions of both the ankle and hip, but did not succeed in maintaining a normal sagittal total support moment during late stance, nor a symmetrical inter-limb load-sharing during double-limb support. In the frontal plane, the knee abductor moments and the corresponding contributions to the total support moment were not affected by the changes in the other joints, regardless of the severity of the disease. The observed compensatory changes suggest that strengthening of weak hip muscles is essential for body support during gait in patients with knee OA, but that training of weak ankle muscles may also be needed for patients with severe knee OA.

Amino acid substitutions of quinolone resistance determining regions in GyrA and ParC associated with quinolone resistance in Acinetobacter baumannii and Acinetobacter genomic species 13TU.

BACKGROUND AND PURPOSE: Amino acid substitutions in GyrA and ParC are associated with resistance to quinolones in Acinetobacter baumannii (A baumannii), but this association is rarely elucidated in Acinetobacter genomic species (AGS) 13TU. This study aims to compare the association of amino acid substitutions in GyrA and ParC with quinolone resistance in A baumannii and AGS 13TU in Taiwan. METHODS: Eleven representative strains of A baumannii and 13 strains of AGS 13TU were selected from 402 bacteremic isolates. The sequences of quinolone resistance determining regions of gyrA and parC were determined. Minimal inhibitory concentrations (MICs) of nalidixic acid, ciprofloxacin, levofloxacin and moxifloxacin were determined by agar dilution method. RESULTS: Ser83Leu substitution in GyrA in A baumannii (one strain) was associated with resistance to all tested quinolones. This substitution plus a Ser80Leu or Ser80Tyr in ParC in A baumannii (four strains) and AGS 13TU (two strains) were associated with higher MICs of all quinolones. All but one quinolone MICs of A baumannii (one strain) and AGS 13TU (two strains) carrying a single substitution Ser56Asn in ParC remained in the susceptibility breakpoint. The Ser83Leu substitution in GyrA, even with additional Ser56Asn substitution in ParC, was associated with resistance to only nalidixic acid, but not other newer quinolones in AGS 13TU (two strains). CONCLUSION: A baumannii and AGS 13TU possessed similar quinolone resistance associated with amino acid substitutions in GyrA and ParC. Further study with more strains is needed to determine whether a single Ser83Leu substitution in GyrA was associated with a high level of quinolone MIC only in A baumannii, but not in AGS 13TU.

Intelligent complementary sliding-mode control for LUSMS-based X-Y-theta motion control stage.

An intelligent complementary sliding-mode control (ICSMC) system using a recurrent wavelet-based Elman neural network (RWENN) estimator is proposed in this study to control the mover position of a linear ultrasonic motors (LUSMs)-based X-Y-theta motion control stage for the tracking of various contours. By the addition of a complementary generalized error transformation, the complementary sliding-mode control (CSMC) can efficiently reduce the guaranteed ultimate bound of the tracking error by half compared with the slidingmode control (SMC) while using the saturation function. To estimate a lumped uncertainty on-line and replace the hitting control of the CSMC directly, the RWENN estimator is adopted in the proposed ICSMC system. In the RWENN, each hidden neuron employs a different wavelet function as an activation function to improve both the convergent precision and the convergent time compared with the conventional Elman neural network (ENN). The estimation laws of the RWENN are derived using the Lyapunov stability theorem to train the network parameters on-line. A robust compensator is also proposed to confront the uncertainties including approximation error, optimal parameter vectors, and higher-order terms in Taylor series. Finally, some experimental results of various contours tracking show that the tracking performance of the ICSMC system is significantly improved compared with the SMC and CSMC systems.

Immediate effects of acupuncture on gait patterns in patients with knee osteoarthritis.

BACKGROUND: Acupuncture has been shown to be effective in pain relief and anesthesia, and has been suggested for treating various kinds of functional disabilities in traditional Chinese medicine, including knee osteoarthritis (OA). The study aimed to investigate the immediate effects of acupuncture on gait patterns in patients with knee OA. METHODS: Twenty patients with bilateral medial knee OA were assigned evenly and randomly to a sham group and an experimental group. During the experiment, the experimental group underwent a 30-minute formula electro-acupuncture treatment while the sham group received a sham treatment. Before and after treatment, each subject was evaluated for their knee pain using visual analog scales (VAS) and then their performance of level walking using gait analysis. For all the obtained variables, the independent t-test was used for between-group comparisons, while paired t-test was used to investigate the before and after changes. RESULTS: All the measured data before acupuncture treatment between the groups were not significantly different. The VAS scores were decreased significantly after acupuncture in both groups, and the mean change of the VAS values of the experiment group was 2 times greater than that of the sham group. After formula acupuncture stimulation, while no significant changes were found in all the gait variables in the sham group, the experimental group had significant increases in the gait speed, step length, as well as in several components of the joint angles and moments. CONCLUSIONS: The results of the study suggest that significantly improved gait performance in the experimental group may be associated with pain relief after treatment, but the relatively small decrease of pain in the sham group was not enough to induce significant improvements in gait patterns. Gait analysis combined with the VAS can be useful for the evaluation of the effect of acupuncture treatment for patients with neuromusculoskeletal diseases and movement disorder.

Bilateral knee osteoarthritis does not affect inter-joint coordination in older adults with gait deviations during obstacle-crossing.

Fifteen elderly subjects with bilateral medial knee osteoarthritis (OA) and 15 healthy elderly subjects walked and crossed obstacles with heights of 10%, 20%, and 30% of their leg lengths while sagittal angles and angular velocities of each joint were measured and their phase angles (phi) calculated. Continuous relative phase (CRP) were also obtained, i.e., phi(hip-knee) and phi(knee-ankle). The standard deviations of the CRP curve points were averaged to obtain deviation phase (DP) values for the stance and swing phases. Significant differences between the OA and control groups were found in several of the peak and crossing angles, and angular velocities at the knee and ankle. Both groups had similar CRP patterns, and the DP values of the hip-knee and knee-ankle CRP curves were not significantly different between the two groups. Despite significant changes in the joint kinematics, knee OA did not significantly change the way the motions of the lower limb joints are coordinated during obstacle-crossing. It appears that the OA groups adopted a particular biomechanical strategy among all possible strategies that can accommodate the OA-induced changes of the knee mechanics using unaltered inter-joint coordination control. This enabled the OA subjects to accommodate reliably the mechanical demands related to bilateral knee OA in the sagittal plane during obstacle-crossing. Maintaining normal and reliable inter-joint coordination may be considered a goal of therapeutic intervention, and the patterns and variability of inter-joint coordination can be used for the evaluation of treatment effects.