Percutaneous embolization of refractory biliocutaneous fistula following radiofrequency ablation: A case report.

This case report presents a 73-year-old male with recurrent hepatocellular carcinoma who underwent serial surgical and interventional locoregional treatments, which resulted in asymptomatic intrahepatic bile duct dilatation. To address a recurrent tumor close to the pre-existing dilated bile ducts, radiofrequency ablation was performed, leading to a biliocutaneous fistula along the electrode tract. Attempts to close the refractory fistula by percutaneous transhepatic cholangial diversion and balloon dilatation of the stenotic central bile duct were unsuccessful. Ultimately, the fistula was successfully sealed with aggressive management, combining balloon-assisted retrograde fistulography and antegrade fistula embolization. This report aims to raise awareness of complex biliary complications after radiofrequency ablation in patients with preexisting bile duct dilatation, and emphasize the importance of aggressive intervention in cases of refractory biliocutaneous fistula based on our experience.

Experiences of Living in the Community for Older Aboriginal Persons With Dementia Symptoms in Taiwan.

BACKGROUND AND OBJECTIVES: Improving quality of life for community-dwelling older persons with dementia symptoms (PWDS) and family caregivers requires promoting dementia-friendly communities (DFC). However, little is known regarding older Taiwanese Aboriginal PWDS' experiences of living in the community. We explored these experiences for older Atayal PWDS and their families in Taiwan. RESEARCH DESIGN AND METHODS: This grounded theory research used in-depth interviews to explore the perspectives of older PWDS (n = 4), their family members (n = 3), and key persons (n = 10) in an Atayal community in northern Taiwan. Data were analyzed using constant comparative analysis. Participants were interviewed between January and May 2015. RESULTS: Participants' experiences were captured by the overarching concept of "low dementia awareness, high family-like ambience in the community." Despite the low/absent community awareness of dementia, older Atayal PWDS functioned as freely in the community as at home due to a family-like supportive environment. Aboriginal PWDS and their families also faced environmental challenges, e.g., environmental constraints and barriers to transportation access. DISCUSSION AND IMPLICATIONS: Our results suggest that this Aboriginal community and culture offer important DFC components, and these strengths could be further studied to enhance DFC models elsewhere. Despite these strengths in supporting PWDS, environmental challenges to transportation access still cause difficulties for PWDS and their families and need improvement. The Atayal community's low dementia awareness suggests that services introduced must be culturally appropriate and nondisruptive to existing supportive helping systems. Our study can be a model for future studies to understand and identify PWDS' needs in Indigenous communities.

A Large-Scale Serological Survey of Toxoplasma gondii Infection Among Persons Participated in Health Screening in Yunnan Province, Southwestern China.

Surveys of Toxoplasma gondii infection in animals have been reported in Yunnan province, southwestern China. However, limited information is available regarding the epidemiology of T. gondii infection among persons participated in health screening in Yunnan. From January 2014 to December 2016, a large-scale and cross-sectional serological survey was conducted to reveal the seroprevalence of T. gondii infection in persons participated in health screening in three major hospitals. A total of 64,533 serum samples were collected and anti-T. gondii antibodies were examined by commercially available enzyme-linked immunosorbent assay kits. The total seroprevalence of T. gondii infection was 6.67% (4306/64,533). Of these, 3721 persons (5.77%, 3721/64,533) were positive for Immunoglobulin G (IgG) only, 473 persons (0.73%, 473/64,533) were positive for Immunoglobulin M (IgM) only, and 112 persons (0.17%, 112/64,533) were positive for both IgG and IgM. Female seroprevalence (6.83%, 3167/46,389) was higher than male (6.28%, 1139/18,144). The highest seroprevalence of T. gondii infection was found in the age range of 41-50 years (10.60%, 228/2150) (p < 0.001). The seroprevalence in 2014, 2015, and 2016 were 6.39% (1083/16,946), 6.24% (1261/20,201), and 7.16% (1962/27,386), respectively. The results showed that T. gondii infection is common in persons participated in health screening in Yunnan province, which has significant public health concern. Thus, improved integrated measures should be executed to prevent and control T. gondii infection humans and animals in Yunnan province.

Carbapenem-nonsusceptible Enterobacteriaceae in Taiwan.

A total of 1135 carbapenem-resistant (nonsusceptible) Enterobacteriaceae (CRE) isolates were recovered between November 2010 and July 2012 (517 from 2010-2011 and 618 from 2012) from 4 hospitals in Taiwan. Carbapenemase-producing Enterobacteriaceae (CPE) comprised 5.0% (57 isolates), including 17 KPC-2 (16 Klebsiella pneumoniae and 1 Escherichia coli), 1 NDM-1 (K. oxytoca), 37 IMP-8 (26 Enterobacter cloacae, 4 Citrobacter freundii, 4 Raoultella planticola, 1 K. pneumoniae, 1 E. coli and 1 K. oxytoca), and 2 VIM-1 (1 E. cloacae, 1 E. coli). The KPC-2-positive K. pneumoniae were highly clonal even in isolates from different hospitals, and all were ST11. IMP-8 positive E. cloacae from the same hospitals showed higher similarity in PFGE pattern than those from different hospitals. A total of 518 CRE isolates (45.6%) were positive for blaESBL, while 704 (62.0%) isolates were blaAmpC-positive, 382 (33.6% overall) of which carried both blaESBL and blaAmpC. CTX-M (414, 80.0%) was the most common blaESBL, while DHA (497, 70.6%) and CMY (157, 22.3%) were the most common blaAmpC. Co-carriage of blaESBL and blaAmpC was detected in 31 (54.4%) and 15 (26.3%) of the 57 CPE, respectively. KPC-2 was the most common carbapenemase detected in K. pneumoniae (2.8%), while IMP-8 was the most common in E. cloacae (9.7%). All KPC-2-positive CRE were resistant to all three tested carbapenems. However, fourteen of the 37 IMP-8-positive CRE were susceptible to both imipenem and meropenem in vitro. Intra- and inter-hospital spread of KPC-2-producing K. pneumoniae and IMP-8-producing E. cloacae likely occurred. Although the prevalence of CPE is still low, careful monitoring is urgently needed. Non-susceptibility to ertapenem might need to be considered as one criterion of definition for CRE in areas where IMP type carbapenemase is prevalent.

Ogilvie syndrome: a potentially life-threatening phenotype of immobilization hypercalcemia.

Ogilvie syndrome, also known as acute colonic pseudo-obstruction, is characterized by the clinical presentation and imaging evidence of acute colonic obstruction in the absence of a mechanical cause. Several comorbidities and serious associated medical or surgical conditions have been described to be relevant to this syndrome. In general, a preferred initial management with favorable treatment outcomes is virtually to correct underlying disorders. Although disrupted electrolyte homeostasis may induce impaired colonic motility, hypercalcemia secondary to immobilization as a major culprit in this syndrome has rarely been studied. In this report, we profiled radiographic features, therapeutic strategies, and pathogenetic hypothesis of this clinical entity and highlighted the need for clinicians to maintain awareness of this distinct manifestation.

Characterization of the type 3 fimbriae with different MrkD adhesins: possible role of the MrkD containing an RGD motif.

Four novel mrkD alleles namely mrkD(V1), mrkD(V2), mrkD(V3), and mrkD(V4) were identified in seventeen Klebsiella pneumoniae meningitis strains using PCR-RFLP and sequence determination. Comparative analysis revealed a most variable region containing an RGD motif in the receptor domain of MrkD(V3). In order to determine if the sequence confers the K. pneumoniae mrkD(V3) the highest level of the fimbrial activity, a type 3 fimbriae display system was constructed in Escherichia coli. The E. coli JM109[pmrkABCD(V3)F] displaying meshwork-like fimbriae also had the most fimbrial activity, supporting a possible role of the varied sequences. In a dose-dependent manner, the GRGDSP hexapeptide appeared to inhibit the adhesion of the E. coli JM109[pmrkABCD(V3)F] to HCT-8, an ileocecal epithelial cell line. In addition, the adhesion activity was reduced by the addition of anti-alpha5beta1 integrin monoclonal antibody, indicating that the RGD containing region in MrkD(V3) is responsible for the binding of type 3 fimbriae to integrin.