The occurrence of delayed neuropsychologic sequelae in acute carbon monoxide poisoning patients after treatment with hyperbaric or normobaric oxygen therapy.

ABSTRACT: This study aimed at assessing which one of the 2 therapies is better for treating carbon monoxide (CO) poisoning from the perspective of reducing delayed neuropsychologic sequelae (DNS).We used Taiwan's National Health Insurance Research Database (NHIRD) to conduct a nationwide population-based cohort study to assess which therapy is better for CO poisoning patients. To accurately identify patients with DNS, the definition of DNS is included neurological sequelae, and cognitive and psychological sequele. The independent variable was therapy and the dependent variable was DNS occurred within 1 year after discharge from a medical institution. The control variables were age, gender, the severity of CO poisoning, and comorbidities present before CO poisoning admission.The risk of developing DNS in patients treated with Hyperbaric Oxygen (HBO) was 1.87-fold (P < .001) than normobaric oxygen (NBO) therapy. The severity of CO poisoning and comorbidities were also found to have significant influences on the risk of developing DNS.HBO may be a risk therapy for treating CO poisoning.

Development of Alzheimer disease in old major depressive patients based upon their health status: A retrospective study in Taiwan.

This study is conducted to investigate the association between major depressive disorder and the subsequent development of Alzheimer disease (AD) in elderly patients with different health statuses using Taiwan's National Health Insurance Research Database (NHIRD).A retrospective cohort study was performed on subjects over 65 years old from 2002 to 2006 using a random sampling from the 1 million beneficiaries enrolled in the NHI. Patients who were diagnosed with major depressive disorder were selected as the case group. Subjects in the control group were selected from elderly patients who did not have depression during the study period by matching age, sex, and index date of depression with subjects in the case group using a ratio of 1:4 (case:control). Both groups of patients were checked annually over a period of 7 years to observe whether they subsequently developed AD.A total of 1776 subjects were included in the case group while 7104 subjects were in the control group. After the follow-up period, 59 patients (3.3%) with depression developed AD while 96 patients (1.4%) without depression developed AD. The Kaplan-Meier curves showed that the incidence rate of AD in both groups varied significantly depending on different health statuses (log-rank P < .001). Results of the generalized estimating equation model found that patients with depression (hazard ratio [HR] = 1.898; 95% confidence interval [CI] = 1.451-2.438), very severe health status (HR = 1.630; 95% CI = 1.220-2.177), or artery diseases (HR = 1.692; 95% CI = 1.108-2.584) were at a higher risk of developing AD than other groups.The association between major depressive disorder and the later development of AD varied depending on the health statuses of elderly patients. Clinicians should exercise caution when diagnosing and treating underlying diseases in elderly depressed patients, and then attempt to improve their health status to reduce the incidence rate of subsequent AD development.

Panax notoginseng Promotes Repair of Colonic Microvascular Injury in Sprague-Dawley Rats with Experimental Colitis.

To investigate the therapeutic effects of PN on intestinal inflammation and microvascular injury and its mechanisms, dextran sodium sulfate- (DSS-) or iodoacetamide- (IA-) induced rat colitis models were used. After colitis model was established, PN was orally administered for 7 days at daily dosage of 1.0 g/kg. Obvious colonic inflammation and mucosal injuries and microvessels were observed in DSS- and IA-induced colitis groups. DAI scores, serum concentrations of VEGFA121, VEGFA165, VEGFA165/VEGFA121, IL-6, and TNF-α, and expression of Rap1GAP and TSP1 proteins in the colon were significantly higher while serum concentrations of IL-4 and IL-10 and MVD in colon were significantly lower in the colitis model groups than in the normal control group. PN promoted repair of colonic mucosal injury and microvessels, attenuated inflammation, and decreased DAI scores in rats with colitis. PN also decreased the serum concentrations of VEGFA121, VEGFA165, VEGFA165/VEGFA121, IL-6, and TNF-α and increased the serum concentrations of IL-4 and IL-10, with the expression of Rap1GAP and TSP1 proteins in colonic mucosa being downregulated. The constituents of PN were identified with HPLC-DAD. To sum up, PN could promote repair of injuries of colonic mucosa and microvessels via downregulating VEGFA isoforms and inhibiting Rap1GAP/TSP1 signaling pathway.

Effects of initiating time and dosage of Panax notoginseng on mucosal microvascular injury in experimental colitis.

AIM: To investigate the effects of Panax notoginseng (PN) on microvascular injury in colitis, its mechanisms, initial administration time and dosage. METHODS: Dextran sodium sulfate (DSS)- or iodoacetamide (IA)-induced rat colitis models were used to evaluate and investigate the effects of ethanol extract of PN on microvascular injuries and their related mechanisms. PN administration was initiated at 3 and 7 d after the model was established at doses of 0.5, 1.0 and 2.0 g/kg for 7 d. The severity of colitis was evaluated by disease activity index (DAI). The pathological lesions were observed under a microscope. Microvessel density (MVD) was evaluated by immunohistochemistry. Vascular permeability was evaluated using the Evans blue method. The serum concentrations of cytokines, including vascular endothelial growth factor (VEGF)A121, VEGFA165, interleukin (IL)-4, IL-6, IL-10 and tumor necrosis factor (TNF)-α, were detected by enzyme-linked immunosorbent assay. Myeloperoxidase (MPO) and superoxide dismutase (SOD) were measured to evaluate the level of oxidative stress. Expression of hypoxia-inducible factor (HIF)-1α protein was detected by western blotting. RESULTS: Obvious colonic inflammation and injuries of mucosa and microvessels were observed in DSS- and IA-induced colitis groups. DAI scores, serum concentrations of VEGFA121, VEGFA165, VEGFA165/VEGFA121, IL-6 and TNF-α, and concentrations of MPO and HIF-1α in the colon were significantly higher while serum concentrations of IL-4 and IL-10 and MVD in colon were significantly lower in the colitis model groups than in the normal control group. PN promoted repair of injuries of colonic mucosa and microvessels, attenuated inflammation, and decreased DAI scores in rats with colitis. PN also decreased the serum concentrations of VEGFA121, VEGFA165, VEGFA165/VEGFA121, IL-6 and TNF-α, and concentrations of MPO and HIF-1α in the colon, and increased the serum concentrations of IL-4 and IL-10 as well as the concentration of SOD in the colon. The efficacy of PN was dosage dependent. In addition, DAI scores in the group administered PN on day 3 were significantly lower than in the group administered PN on day 7. CONCLUSION: PN repairs vascular injury in experimental colitis via attenuating inflammation and oxidative stress in the colonic mucosa. Efficacy is related to initial administration time and dose.

Long-term results of a prospective, randomized trial comparing retroperitoneoscopic partial versus total adrenalectomy for aldosterone producing adenoma.

PURPOSE: The indication for laparoscopic total or partial adrenalectomy in patients with aldosterone producing adrenal adenoma remains controversial. We compared retroperitoneoscopic partial and total adrenalectomy for aldosterone producing adrenal adenoma in a prospective, randomized, multicenter trial. MATERIALS AND METHODS: Patients with aldosterone producing adrenal adenoma were randomized to retroperitoneoscopic partial or total adrenalectomy. Patient characteristics, surgical data, complications and postoperative clinical results were analyzed statistically. RESULTS: From July 2000 to March 2004, 212 patients were enrolled in this study, including 108 and 104 who underwent total and partial adrenalectomy, respectively. The 2 groups were comparable in patient age, gender, body mass index and tumor site. Mean followup was 96 months in each group. No conversion to open surgery was needed and no major complications developed. Partial adrenalectomy required a shorter operative time than total adrenalectomy but this did not attain statistical significance. Intraoperative blood loss in the partial adrenalectomy group was significant higher than in the total adrenalectomy group (p <0.05) but no patient needed blood transfusion. All patients in each group showed improvement in hypertension, and in all plasma renin activity and aldosterone returned to normal after surgery. No patient required potassium supplements postoperatively. In the total and partial adrenalectomy groups 32 (29.6%) and 29 patients (27.9%), respectively, were prescribed a decreased dose of or fewer antihypertensive medicines at final followup. CONCLUSIONS: Retroperitoneoscopic partial adrenalectomy is technically safe. It has therapeutic results similar to those of total adrenalectomy in patients with primary aldosteronism due to aldosteronoma.

An innovative combined on-site process for the remote rural solid waste treatment--a pilot scale case study in China.

The aim of this study was to find a feasible method for the treatment of solid waste generated in the remote rural, where the transportation costs are prohibitive and the resources to construct and maintain conventional treatment plants are not available. This process, consisted of two types of simulated bioreactor landfill (one was recirculated bioreactor landfill, and the other was comprised of fresh and aged refuse reactor) and a soil infiltration system, was operated in ambient temperature for 180 days all together. After treated by the system of fresh and aged refuse reactor, the refuse and leachate reached a strongly degraded and stable state. The remaining leachate can be treated by the soil infiltration system, and 87.5 ± 2.1%, 98.6 ± 1.0% and 95.7 ± 1.7% were achieved by 60 cm soil depths for organic matter, ammonium nitrogen and total nitrogen removal, respectively.

Antituberculosis drug resistance among retreatment tuberculosis patients in a referral center in Taipei.

BACKGROUND AND PURPOSE: To determine the prevalence of antituberculosis drug resistance among retreatment tuberculosis patients in a referral center in Taipei. METHODS: We reviewed the register of susceptibility testing of the mycobacteriology laboratory of the Chronic Disease Control Bureau to identify patients with positive culture for Mycobacterium tuberculosis in the year 2000-2001. Medical charts were reviewed to determine patients' tuberculosis treatment histories. Patients who had multidrug-resistant (MDR) tuberculosis, defined as documentation of isolates resistant to at least isoniazid and rifampin, were identified. Retreatment tuberculosis patients without prior evidence of MDR tuberculosis were classified into 3 categories, i.e., relapse, treatment after default and treatment after failure, and the frequency and patterns of antituberculosis drug resistance were determined. RESULTS: A total of 317 patients who had received antituberculosis treatment for more than 1 month were identified. Among them, 183 were retreatment cases without prior evidence of MDR tuberculosis, including 93 with relapse, 57 with treatment after default, and 33 with treatment after failure. Among the 183 patients, the prevalence of resistance to any drug was 42.6%; 14.2% were resistant to 1 drug, 13.7% to 2 drugs, 7.1% to 3 drugs, 7.7% to 4 drugs or more, and 24.6% had MDR tuberculosis. The prevalence of any drug resistance among patients with relapse, treatment after default and treatment after failure was 33.3%, 42.1%, and 69.7%, respectively, while the prevalence of MDR tuberculosis in these groups was 12.9%, 19.3% and 66.7%, respectively. CONCLUSIONS: If susceptibility results are unavailable, the World Health Organization-recommended retreatment regimen may be used in retreatment tuberculosis patients. However, the high proportion of MDR tuberculosis among patients with treatment after failure poses a challenge to the efficacy of the retreatment regimen.