Liver-specific metastases as an independent prognostic factor in cancer patients receiving hospice care in hospital.

BACKGROUND: Survival prediction is important in cancer patients receiving hospice care. Palliative prognostic index (PPI) and palliative prognostic (PaP) scores have been used to predict survival in cancer patients. However, cancer primary site with metastatic status, enteral feeding tubes, Foley catheter, tracheostomy, and treatment interventions are not considered in aforementioned tools. The study aimed to investigate the cancer features and potential clinical factors other than PPI and PaP to predict patient survival. METHODS: We conducted a retrospective study for cancer patients admitted to a hospice ward between January 2021 and December 2021. We examined the correlation of PPI and PaP scores with survival time since hospice ward admission. Multiple linear regression was used to test the potential clinical factors other than PPI and PaP for predicting survival. RESULTS: A total of 160 patients were enrolled. The correlation coefficients for PPI and PaP scores with survival time were -0.305 and -0.352 (both p < 0.001), but the predictabilities were only marginal at 0.087 and 0.118, respectively. In multiple regression, liver metastasis was an independent poor prognostic factor as adjusted by PPI (ß = -8.495, p = 0.013) or PaP score (ß = -7.139, p = 0.034), while feeding gastrostomy or jejunostomy were found to prolong survival as adjusted by PPI (ß = 24.461, p < 0.001) or PaP score (ß = 27.419, p < 0.001). CONCLUSIONS: Association between PPI and PaP with patient survival in cancer patients at their terminal stages is low. The presence of liver metastases is a poor survival factor independent of PPI and PaP score.

Association of Decreased Bone Density and Hyperlipidemia in a Taiwanese Older Adult Population.

Objective: This study aimed to determine if a combination of 2 abnormal lipid profiles revealed a stronger association with low bone mass than a single blood lipid abnormality alone. Methods: This study enrolled 1373 participants who had received a dual-energy x-ray absorptiometry scan from January 2016 to December 2016 in a medical center in southern Taiwan. Logistic regression was used to examine association between lipid profiles and osteopenia or osteoporosis after adjusting for covariates. Results: Compared to people with total cholesterol (TC) < 200 mg/dL, those with TC ≥ 240 mg/dL tended to have osteopenia or osteoporosis (OR 2.61; 95% CI, 1.44-4.71). Compared to people with low-density lipoprotein cholesterol (LDL-C) < 130 mg/dL, those with LDL-C ≥ 160 mg/dL tended to develop osteopenia or osteoporosis (OR 2.13; 95% CI, 1.21-3.74). The association of increased triglyceride and decreased bone mass was similar, although not statistically significant. Those with the combination of TG ≥ 200 mg/dL and TC ≥ 240 mg/dL had a stronger tendency to have osteopenia or osteoporosis (OR 3.51; 95% CI, 1.11-11.13) than people with only one blood lipid abnormality. Similarly, people with TG ≥ 200 mg/dL and LDL-C ≥ 160 mg/dL had a stronger tendency to have osteopenia or osteoporosis (OR 9.31; 95% CI, 1.15-75.42) than people with only one blood lipid abnormality, after adjustment for the same covariates. Conclusion: Blood levels of TC, LDL-C, and TG were associated with osteopenia or osteoporosis. Results indicate that individuals aged older than 50 years with abnormal lipid profiles should be urged to participate in a bone density survey to exclude osteopenia or osteoporosis.

Community-based cross-sectional study: the association of lipids with hepatitis C seropositivity and diabetes mellitus.

BACKGROUND AND AIMS: Hepatitis C virus (HCV) infection is reported to be associated with or to cause type 2 diabetes mellitus (T2DM). Our study aimed to elucidate the role of triglyceride (TG) and cholesterol (CHOL) levels in the association between anti-HCV seropositivity and T2DM in an HCV-endemic area. METHODS: We analyzed a computerized dataset of 56 338 residents from a community-based comprehensive screening program in Tainan County in southern Taiwan. Fasting glucose, anti-HCV status, hepatitis B surface antigen (HBsAg) status, platelet counts, TG levels, CHOL levels, age, gender, and body mass index were included in the analyses. Multivariate logistic analysis was used to identify factors independently associated with T2DM. RESULTS: Older age, being overweight, thrombocytopenia, hypertriglyceridemia, hypercholesterolemia, anti-HCV seropositivity, and HBsAg seronegativity were common factors independently associated with diabetes. Among all models of multiple logistic regression analysis used for identifying factors independently associated with T2DM, anti-HCV seropositivity was only identified in the models that included either hypertriglyceridemia or hypercholesterolemia. When subjects were divided into hyperlipidemia (CHOL, > 200 or TG, > 150 mg/dL; n = 33 393) or non-hyperlipidemia subgroups (CHOL, < 200 and TG, < 150 mg/dL; n = 22 945), anti-HCV seropositivity was identified as an independent factor only in the non-hyperlipidemia subgroup. The odds ratio was 1.35, with a 95% confidence interval of 1.17-1.55. CONCLUSIONS: This study demonstrates that the lipid level is associated with the relationship between T2DM and anti-HCV seropositivity in non-hyperlipidemic individuals. However, the relationship between HCV and T2DM did not exist when the lipid level was not included in the analysis.

A Pilot Study of the Effects on an Inpatient Geriatric Consultation Team on Geriatric Syndrome Patients.

Purpose: To evaluate the effect of comprehensive geriatric assessment performed by an inpatient aging consultation team on older patients with geriatric syndromes. Methods: Fifty-nine patients with ≧65 years, Barthel Index score ≦60, at least one geriatric syndrome, and admitted to non-geriatric wards were enrolled. By their preference, 16 were in the intervention group with comprehensive geriatric assessment and instructions from the consultation team. And 43 were in the control group, receiving standard care from non-geriatric-specialist physicians. Outcomes were readmission and mortality within one year after discharge. Results: The mean age of the intervention and control groups was 78.35 (8.54) and 80.23 (6.36) years (p = 0.36), with female of 62.5% and 60.5%, respectively. Compared to control, intervention is not significantly associated with attenuated risk for readmission (adjusted hazard ratio (aHR): 0.256, 95% confidence interval (CI): 0.12-1.78, p = 0.256) and mortality (aHR: 2.13, 95% CI: 0.29-15.7, p = 0.457) within one year after discharge. Multivariate analysis showed that patients with a fall history ≧1 in the past one year had a lower risk of readmission (aHR: 0.28, 0.07-0.6, p = 0.004) or mortality (aHR: 0.11, 95% CI: 0.01-0.97, p = 0.047), and disability is associated with mortality (aHR: 5.37, 95% CI: 0.87-33.12, p = 0.07). Conclusion: Intervention is not significantly associated with outcomes in our pilot study. But fall history ≧1 in the recent one year is associated with a lower risk of readmission and mortality among all included patients. More participants and longer follow-up are needed for better elucidation.

Effectiveness and response differences of a multidisciplinary workplace health promotion program for healthcare workers.

Background: Workplace health promotion (WHP) in the healthcare industry is an important yet challenging issue to address, given the high workload, heterogeneity of work activities, and long work hours of healthcare workers (HCWs). This study aimed to investigate the effectiveness and response differences of a multidisciplinary WHP program conducted in HCWs. Methods: This retrospective cohort study included HCWs participating in a multidisciplinary WHP program in five healthcare facilities. The 20-week intervention included multiple easy-to-access 90-min exercise classes, one 15-min nutrition consultation, and behavioral education. Pre- and post-interventional anthropometrics, body composition, and physical fitness (PF) were compared with paired sample t-tests. Response differences across sex, age, weight status, and shiftwork status were analyzed with a generalized estimating equation. Results: A total of 302 HCWs were analyzed. The intervention effectively improved all anthropometric (body mass index, waist circumference, waist-hip ratio, and waist-to-height ratio), body composition (body fat percentage, muscle weight, visceral fat area), and PF (grip strength, high jump, sit-up, sit-and-reach, step test) parameters in all participants (all p < 0.05). Subgroup analyses revealed shift workers had a more significant mean reduction in body mass index than non-shift workers (adjusted p = 0.045). However, there was no significant response difference across sex, age, and weight subgroups. Conclusion: This study suggested that a multidisciplinary WHP program can improve anthropometric and PF profiles regardless of sex, age, and weight status for HCWs, and shifter workers might benefit more from the intervention.

Association between Shock Index and Emergency Department Cardiac Arrest.

BACKGROUND: In the emergency department (ED), early identification of patients at risk of cardiac arrest is paramount, especially in the context of overcrowding. The shock index (SI) is defined as the ratio of heart rate to systolic blood pressure. It is a tool used for predicting the prognosis of critically ill and injured patients. In this study, we have discussed the relationship between SI and cardiac arrest in the ED. METHODS: Patients who experienced cardiac arrest in the ED were classified into two groups, SI ≥ 0.9 and < 0.9, according to their triage vital signs. The association between SI ≥ 0.9 and in-hospital mortality was analyzed in five different etiologies of cardiac arrest, including hypoxia, cardiac cause, bleeding, sepsis, and other metabolic problems. RESULTS: In total, 3,313 patients experienced cardiac arrest in the ED. Among them, 1,909 (57.6%) had a SI of ≥0.9. The incidence of SI ≥ 0.9 in the five etiologies was 43.5% (hypoxia), 58.1% (cardiac cause), 56.1% (bleeding), 58.0% (sepsis), and 65.5% (other metabolic problems). SI was associated with in-hospital mortality (adjusted odds ratio (aOR), 1.6; 95% confidence interval (CI), 1.5-1.8). The aOR (CI) in the five etiologies was 1.3 (1.1-1.6) for hypoxia, 1.8 (1.6-2.1) for cardiac cause, 1.3 (0.98-1.7) for bleeding, 1.3 (1.03-1.6) for sepsis, and 1.9 (1.5-2.1) for other metabolic problems. CONCLUSION: More than half of the patients who experienced cardiac arrest in the ED had a SI ≥ 0.9. The SI was also associated with in-hospital mortality after cardiac arrest in the ED. SI maybe used as a screening tool to identify patients at risk of cardiac arrest in the ED and a predictor of mortality in those experiencing cardiac arrest in the ED.

Risk factors for seizures after first-time ischemic stroke by magnetic resonance imaging.

BACKGROUND: Seizures are important neurological complications of ischemic stroke. There is a need to further clarify the risk factors of seizures following ischemic stroke and predict those who will require treatment. METHODS: One hundred and forty-three (143) first-time ischemic stroke patients were enrolled in this one-year (2002) retrospective study. Prognostic variables were analyzed based on the Cox's proportional hazards model after a minimum follow-up period of six years. RESULTS: Seizures occurred in 13 first-time ischemic stroke patients, including acute symptomatic seizures in two (1.4%) and unprovoked seizures in 11 (7.7%). Only one progressed to status epilepticus during hospitalization. After six years of follow-up, the median (inter-quartile range) Glasgow Outcome Scale (GOS) was 3 (3,4) for patients with seizures and 4 (3,4) for those without seizures. Regarding seizure control after discharge in the 13 cases, 12 were seizure-free with or without anti-epileptic drugs and one had 1-3 seizures per year. Only the presence of cortical distribution of ischemic infarction (p=0.009, OR=5.549, 95% CI=1.53-20.19) was independently associated with seizures by the Cox's proportional hazards model. DISCUSSION: The incidence of seizures following first-time ischemic stroke is low and may have delayed manifestation. Cortical distribution of the ischemic infarction is a risk factors for seizures.

The Role of Monocyte Percentage in Osteoporosis in Male Rheumatic Diseases.

Osteoporosis is easily overlooked in male patients, especially in the field of rheumatic diseases mostly prevalent with female patients, and its link to pathogenesis is still lacking. Attenuated monocyte apoptosis from a transcriptome-wide expression study illustrates the role of monocytes in osteoporosis. This study tested the hypothesis that the monocyte percentage among leukocytes could be a biomarker of osteoporosis in rheumatic diseases. Eighty-seven males with rheumatic diseases were evaluated in rheumatology outpatient clinics for bone mineral density (BMD) and surrogate markers, such as routine peripheral blood parameters and autoantibodies. From the total number of 87 patients included in this study, only 15 met the criteria for diagnosis of osteoporosis. Both age and monocyte percentage remained independently associated with the presence of osteoporosis. Steroid dose (equivalent prednisolone dose) was negatively associated with BMD of the hip area and platelet counts were negatively associated with BMD and T score of the spine area. Besides age, monocyte percentage meets the major requirements for osteoporosis in male rheumatic diseases. A higher monocyte percentage in male rheumatic disease patients, aged over 50 years in this study, and BMD study should be considered in order to reduce the risk of osteoporosis-related fractures.

Circulating endothelial progenitor cells may predict outcomes in adult patients with severe sepsis in the emergency department.

BACKGROUND: Dysfunctional and decreased numbers of endothelial progenitor cells (EPCs) may play an essential role in the initiation of organ dysfunction caused by severe sepsis. We evaluated the role of serial circulating EPCs in outcomes of patients with severe sepsis. METHODS: In total, 101 adult patients with severe sepsis and septic shock were evaluated. Circulating levels of EPCs (CD133(+)/CD34(+) and KDR(+)/CD34(+) cells) were determined at different time points. RESULTS: The levels of CD133(+)/CD34(+) and KDR(+)/CD34(+) EPCs were significantly higher in the severe sepsis group than in the healthy controls. Levels of CD133(+)/CD34(+) EPCs were significantly higher in the mortality group than in the survival group on day 1 of admission (p<0.05), but decreased significantly with time among non-survivors (p<0.05), and were lowest on day 4 at the emergency department. The Sequential Organ Failure Assessment score and number of CD133(+)/CD34(+) EPCs on admission were independently associated with in-hospital mortality. CONCLUSION: The level of CD133(+)/CD34(+) EPCs on admission is independently associated with in-hospital mortality, and the trend of a sharp decrease in the number of EPCs is related to outcomes in patients with severe sepsis.

Betel-quid and alcohol use were associated with lipid accumulation product among male factory workers in Taiwan.

BACKGROUND: In this study, cardiometabolic risk associated with betel-quid, alcohol and cigarette use, based on a simple index-lipid accumulation product (LAP), was investigated in Taiwanese male factory workers. METHODS: Male factory workers were recruited during their annual routine health examination at a hospital in south Taiwan. The risk of cardiometabolic disorders was estimated by the use of LAP, calculated as (waist circumference [cm]-65)×(triglyceride concentration [mmol/l]). Multiple linear regression analyses were conducted to assess the risk factors of natural logarithm-transformed LAP. RESULTS: Of the 815 participants, 40% (325/815) were current alcohol users, 30% (248/815) were current smokers and 7% (53/815) were current betel-quid users. Current betel-quid use, alcohol use, older age, lack of exercise and higher body mass index were found to be significant and independent factors associated with natural logarithm-transformed LAP. CONCLUSIONS: Betel-quid and alcohol, but not cigarette use, were independent risk factors of logarithm-transformed LAP, adjusting for age, exercise and body mass index in male Taiwanese factory workers. LAP can be considered as a simple and useful method for screening of cardiometabolic risk.

Increased circulating endothelial progenitor cells and anti-oxidant capacity in obstructive sleep apnea after surgical treatment.

BACKGROUND: Obstructive sleep apnea (OSA) has increased risk of cardiovascular diseases. Profiles of endothelial progenitor cells (EPCs) reflect the degree of endothelial impairment. This study tested the hypothesis that surgical treatment not only improves clinical outcomes but also increases the number of circulating EPCs and antioxidant capacity. METHODS: The number of circulating EPCs (CD133(+)/CD34(+) [%], KDR(+)/CD34(+) [%]), biomarkers for oxidative stress (thiols and TBARS), and polysomnography (PSG) study was prospectively evaluated in 62 OSA patients at two time points (pre-operative and at least 3-month post-operative). The biomarkers and PSG were compared with those of 31 age- and body mass index (BMI)-matched healthy controls. RESULTS: Levels of HbA1c and LDL-C were significantly higher while CD133(+)/CD34(+) (%) and HDL were significantly lower in OSA patients than in healthy controls. The levels of CD133(+)/CD34(+) (%) and thiols significantly increased in both mild/moderate and severe OSA. The TBAR levels also significantly decreased in severe OSA patients after >3months of follow-up. The number of CD133(+)/CD34(+) (%) negatively correlated with both age and mO2 of <90% but positively correlated with thiols. Clinical efficiency after OSA surgery assessed by PSG showed improvement and mean systolic blood pressure (SBP) (night and morning) reduction and improved lipid profile in the severe OSA group while only the snoring index improved in the mild/moderate OSA group. CONCLUSIONS: OSA surgery not only improves clinical outcomes, SBP reduction and improved lipid profile but also increases the number of circulating EPCs and antioxidant capacity, especially in patients with severe OSA.

Diabetes mellitus, metabolic syndrome and obesity are not significant risk factors for hepatocellular carcinoma in an HBV- and HCV-endemic area of Southern Taiwan.

A prominent factor in hepatocellular carcinoma (HCC) is chronic infection with hepatitis B virus (HBV) and hepatitis C virus (HCV). Diabetes mellitus (DM), metabolic syndrome (MetS), and obesity have also been implicated in HCC development, but these associations are not observed in all HBV- and HCV-endemic areas. We attempted to clarify the role of these factors in HCC development in an HBV- and HCV-endemic area in southern Taiwan. A community-based health examination was conducted in 2004 in Tainan County. After individuals with incomplete data and those with known HCC were excluded, there were 56,231 participants who were over 40 years of age. A further 262 HCC cases were identified from the National Cancer Registration Database records from 2005 to 2007. The hepatitis B surface antigen (HBsAg) seropositivity, anti-HCV seropositivity, platelet count, serum biochemical data, blood pressure, sociodemographic information, and anthropometric measurements were analyzed. Survival analyses were used to identify the associations between these factors and HCC. For the 262 HCC cases, male gender and age greater than 65 years were risk factors. Furthermore, a high alanine aminotransferase level, chronic HBV and/or HCV infection, and liver cirrhosis were also risk factors for HCC. However, DM, MetS and obesity were not associated with HCC development in the non-HBV-/non-HCV-infected, HBV, HCV, or dual B/C groups. In this HBV- and HCV- endemic area, DM, MetS and obesity were not risk factors for developing HCC.

Prediction of the binding mode between GSK3ß and a peptide derived from GSKIP using molecular dynamics simulation.

GSK3ß plays an important role in many physiological functions; dysregulated GSK3ß is involved in human diseases such as diabetes, cancer, and Alzheimer's disease. This study uses MD simulations to determine the interaction between GSK3ß and a peptide derived from GSKIP, a novel GSK3ß interacting protein. Results show that GSKIPtide is inlaid in a binding pocket consisting of an α-helix and an extended loop near the carboxy-terminal end. This binding pocket is hydrophobic, and is responsible for the protein-protein interaction of two other GSK3ß interacting proteins: FRAT and Axin. The GSKIPtide binding mode is closer to that of AxinGID (in the Axin-GSK3-interacting domain). The single-point mutations of V267G and Y288F in GSK3ß differentiate the binding modes between GSK3 and GSKIPtide, AxinGID, and FRATide. The V2677G mutation of GSK3ß reduces the GSKIPtide binding affinity by 70% and abolishes the binding affinity with AxinGID, but has no effect on FRATide. However, GSK3ß Y288F completely abolishes the FRATide binding without affecting GSKIPtide or AxinGID binding. An analysis of the GSK3ß-GSKIPtide complex structure and the X-ray crystal structures of GSK3ß-FRATide and GSK3ß-AxinGID complexes suggests that the hydroxyl group of Y288 is crucial to maintaining a hydrogen bond network in GSK3ß-FRATide. The hydrophobic side chain of V267 maintains the integrity of helix-helix ridge-groove hydrophobic interaction for GSK3ß-GSKIPtide and GSK3ß-AxinGID. This study simulates these two mutant systems to provide atomic-level evidence of the aforementioned experimental results and validate the wild-type complex structure prediction.