Comparison study of three laparoscopic ligation procedures for pediatric inguinal hernia: a multicenter cohort of 5523 cases.

PURPOSE: Single-site laparoscopic percutaneous extraperitoneal ligation (SLPEL) for pediatric inguinal hernia has gained popularity worldwide. However, complications associated with extraperitoneal knotting are not rare. This study evaluated the effectiveness of a modified SLPEL (M-SLPEL) to decrease adverse events associated with ligation knotting by comparing it with two other methods: classical SLPEL (C-SLPEL) and intracorporeal purse-string suturing (IPS). METHODS: A multicenter retrospective comparative study was conducted among 5523 pediatric inguinal hernia patients. Cases were divided into three groups according to the surgical procedure: the M-SLPEL, C-SLPEL, and IPS groups. Data describing the clinical characteristics, operative time, and complications were collected. RESULTS: All procedures were performed uneventfully. There were no significant differences in the age at operation (mean 2.62 ± 1.38 years). The operative time was shorter in the M-SLPEL group both for unilateral hernias (12.5 ± 1.8 min in C-SLPEL, 11.7 ± 1.3 min in M-SLPEL, and 17.6 ± 2.9 min in IPS) and for bilateral hernias (15.1 ± 2.1 min, 14.6 ± 1.7 min, and 23.9 ± 2.3 min, respectively). The overall incidence of adverse events in the inguinal region was 0% for M-SLPEL, 2.2% for C-SLPEL, and 0.5% for IPS. All patients were followed up for 12-93 months (mean 54 months). Recurrence occurred in 8 cases in the C-SLPEL group, 1 case in the M-SLPEL group, and 8 cases in the IPS group, with no significance between groups. No scrotal hematoma, testicular atrophy, or iatrogenic cryptorchidism occurred in any group. CONCLUSION: The M-SLPEL procedure has time-consumption efficiency equivalent to that of C-SLPEL and even fewer adverse events in the inguinal region than IPS and C-SLPEL.

High-affinity human leucocyte antigen class I binding variola-derived peptides induce CD4+ T cell responses more than 30 years post-vaccinia virus vaccination.

Interferon-gamma secreting T lymphocytes against pox virus-derived synthetic 9-mer peptides were tested by enzyme-linked immunospot in peripheral blood of individuals vaccinated with vaccinia virus more than 30 years ago. The peptides were characterized biochemically as high-affinity human leucocyte antigen (HLA) class I binders (K(D)

Trends in quality of end-of-life care for Taiwanese cancer patients who died in 2000-2006.

BACKGROUND: Quality of end-of-life care received by cancer patients has never been explored in an entire Asian country for all ages and cancer groups. PATIENTS AND METHODS: Retrospective cohort study to examine trends in quality of end-of-life care among a cohort of 242 530 Taiwanese cancer patients who died in 2000-2006. RESULTS: In the last month of life, cancer care tended to become increasingly aggressive as shown by (i) intensive use of chemotherapy (15.45%-17.28%), (ii) frequent emergency room visits (15.69%-20.99%) and >14-day hospital stays (41.48%-46.20%), (iii) admissions to intensive care units (10.04%-12.41%), and (iv) hospital deaths (59.11%-65.40%). Use of cardiopulmonary resuscitation (13.09%-8.41%), intubation (26.01%-21.07%), and mechanical ventilation (27.46%-27.05%) decreased, whereas use of hospice services increased considerably (7.34%-16.83%). Among those receiving hospice services, rates of referrals to hospice services in the last 3 days of life decreased from 17.88% to 17.13% but remained steady after adjusting for selected covariates. CONCLUSIONS: The quality of end-of-life care for Taiwanese cancer decedents was substantially inferior to that previously reported and to that recommended as benchmarks for not providing overly aggressive care near the end of life.

MHC-I-restricted epitopes conserved among variola and other related orthopoxviruses are recognized by T cells 30 years after vaccination.

It is many years since the general population has been vaccinated against smallpox virus. Here, we report that human leukocyte antigen (HLA) class I restricted T cell epitopes can be recognized more than 30 years after vaccination. Using bioinformatic methods, we predicted 177 potential cytotoxic T lymphocyte epitopes. Eight epitopes were confirmed to stimulate IFN-gamma release by T cells in smallpox-vaccinated subjects. The epitopes were restricted by five supertypes (HLA-A1, -A2, -A24 -A26 and -B44). Significant T cell responses were detected against 8 of 45 peptides with an HLA class I affinity of K(D) less than or equal to 5 nM, whereas no T cell responses were detected against 60 peptides with an HLA affinity of K(D) more than 5 nM. All epitopes were fully conserved in seven variola, vaccinia and cowpox strains. Knowledge of the long-term response to smallpox vaccination may lead to a better understanding of poxvirus immunity and may aid in the development of new improved vaccines and diagnostic tools.

Organization-based performance measures of cancer care quality: core measure development for breast cancer in Taiwan.

The purpose of the study was to develop organization-based core performance measures (CPMs) for breast cancer patients treated in hospitals that participated in cancer quality improvement programmes in Taiwan. CPMs were developed in three stages that included a preparation, a consensus building stage, and two stages of stakeholder feedback. Three criteria and seven subcriteria were applied in the development process. Indicators listed in a Delphi questionnaire were based on a literature search, indicators developed by relevant institutions and discussion by authors. Each indicator needed to meet inclusion criteria as a final indicator. Evidence-based guidelines, expert opinions from panel group, 27 hospitals and empirical data were all applied to develop and revise the core measures. Fifteen out of 28 indicators were selected and modified after the three stages. There were two pre-treatment indicators for screening and diagnosis, nine treatment-related indicators, and four monitoring-related indicators. Six indicators were supported by evidence level I, and four indicators by level II evidence. The CPMs for breast cancer can be developed systematically and be applied for internal quality improvement and external surveillance. Our experience can be extended to other cancer sites and adapted to link with pay for performance or certification program in cancer care.

Industrial wideband noise reduction for hearing aids using a headset with adaptive-feedback active noise cancellation.

High-intensity noises are a health hazard for industrial workers, and hearing protection is necessary to prevent hearing loss. Passive methods, such as ear muffs, are ineffective against low-frequency noise. Moreover, many hearing-impaired workers must wear hearing aids to enable communication at their workplace, and such aids can amplify ambient noise. To overcome this problem, the present study developed a headset equipped with a digital signal processing system to implement adaptive-feedback active noise cancellation (AFANC) to reduce low-frequency noise. The proposed AFANC headset was effective against wideband industrial noise, with a maximum noise spectrum power reduction of 30 dB. Furthermore, when used with a hearing aid, it improved the speech signal-to-noise ratio by up to 14 dB. These results suggest that a headset with AFANC would be useful for hearing protection in workplaces with high levels of low-frequency industrial noise, especially for hearing-impaired workers.

Rapid prototyping strategy for a surgical data warehouse.

OBJECTIVES: Healthcare processes typically generate an enormous volume of patient information. This information largely represents unexploited knowledge, since current hospital operational systems (e.g., HIS, RIS) are not suitable for knowledge exploitation. Data warehousing provides an attractive method for solving these problems, but the process is very complicated. This study presents a novel strategy for effectively implementing a healthcare data warehouse. METHODS: This study adopted the rapid prototyping (RP) method, which involves intensive interactions. System developers and users were closely linked throughout the life cycle of the system development. The presence of iterative RP loops meant that the system requirements were increasingly integrated and problems were gradually solved, such that the prototype system evolved into the final operational system. RESULTS: The results were analyzed by monitoring the series of iterative RP loops. First a definite workflow for ensuring data completeness was established, taking a patient-oriented viewpoint when collecting the data. Subsequently the system architecture was determined for data retrieval, storage, and manipulation. This architecture also clarifies the relationships among the novel system and legacy systems. Finally, a graphic user interface for data presentation was implemented. CONCLUSIONS: Our results clearly demonstrate the potential for adopting an RP strategy in the successful establishment of a healthcare data warehouse. The strategy can be modified and expanded to provide new services or support new application domains. The design patterns and modular architecture used in the framework will be useful in solving problems in different healthcare domains.

3 x 3 matrix for unitary optical systems.

We introduce a 3 x 3 matrix for the study of unitary optical systems. This 3 x 3 matrix is a submatrix of the 4 x 4 Mueller matrix. The elements of this 3 x 3 matrix are real, and thus complex-number calculations can be avoided. The 3 x 3 matrix is useful for illustrating the polarization state of an optical system. One can also use it to derive the conditions for linear and circular polarization output for a general optical system. New characterization methods for unitary optical systems are introduced. It is shown that the trajectory of the Stokes vector on a Poincaré sphere is either a circle or an ellipse as the optical system or input polarizer is rotated. One can use this characteristic circle or ellipse to measure the equivalent optical retardation and rotation of any lossless optical system.

Beneficial effect of HCL-31D in murine models of endotoxaemia.

We evaluated the effect of HCL-31D, a novel cAMP-specific phosphodiesterase inhibitor, on the induction of inducible nitric oxide synthase (iNOS) in lipopolysaccharide (LPS) and interferon-gamma (IFN-gamma)-treated rat aortic smooth muscle cells (RASMC) and on survival in a murine model of severe endotoxaemia. Treatment of cultured RASMC with LPS and IFN-gamma resulted in an increase of nitrite, tumour necrosis factor (TNF-alpha) production and induction of iNOS mRNA. However, incubation with HCL-31D (1 approximately 50 microM) for 24 h caused significant attenuation of nitrite and TNF-alpha formation as well as iNOS mRNA induction in a dose-dependent manner but no effect on iNOS activity in RASMC. In addition, administration of HCL-31D (5 mg/kg, i.p.) resulted in that the increase of both plasma nitrate and TNF-alpha levels induced by LPS in vivo was significantly reduced in LPS-treated rats. Treatment of conscious mice with a high dose of LPS (60 mg/kg, i.p.) to ICR mice resulted in a 24-h survival rate of only 10%. However, administration of HCL-31D (5 mg/kg, i.p. at 0 h and 6 h after LPS) improved the 24-h survival to 50%, indicating that HCL-31D has a beneficial effect in murine model endotoxaemia. These effects may be mainly due to inhibition of TNF-alpha formation and of the induction of iNOS. We proposed that the elevation of cAMP levels by HCL-31D may be involved in the prevention of TNF-alpha formation and iNOS induction.

Determinants of place of death for terminal cancer patients.

Approximately two-third of cancer patients, when asked about the preferred place of death, wish to die in their own homes. However, the majority of deaths from cancers in most western countries occur in a hospital. When a person dies from other than sudden or traumatic causes, the death appears to be a function of a complex interplay of personal and cultural values and physical and medical factors, as well as various health care systems forces. This article reviews the determinants of place of death for terminal cancer patients from published studies in hopes of shedding light on the difficulties of dying patients to realize their preferences for place of death. These insights may contribute to modification of hospice care systems so health professionals will be more responsive to the needs of their dying patients to retain control and die with dignity and help health professionals achieve the proposed outcome of hospice care.

[High performance liquid chromatographic determination of domoic acid in shellfish samples].

Domoic acid in shellfish samples was determined by HPLC with DAD/UV detector at 242 nm. Samples were extracted with methanol-water followed by clean-up of the extracts with strong anion exchange solid phase extraction cartridge(3 mL LC-SAX). Zorbax SB-C18 column, 150 mm x 4.6 mm i.d., and mobile phase of acetonitrile-0.1% aqueous trifluoroacetic acid(13:87, V/V) were used for the assay. The quantitative analysis was performed with external standard. The calibration curve of domoic acid was linear in the range of 1.0 m/L-25.0 mg/L and the detection limit was ca. 0.2 microgram/g.

Meanings of dying at home for Chinese patients in Taiwan with terminal cancer: a literature review.

To maintain dignity, patients with terminal cancer must be able to do things in their own way, to make their own decisions, and to preside over their own dying. Among the tasks considered essential for patients with terminal cancer is deciding where they prefer to die. The actual place of death has been recognized in hospice care as indicating quality of care. Approximately two-thirds of patients with cancer, when asked about the preferred place of death, say they wish to die in their own homes. Patients with terminal cancer dying at home may find physical and emotional comfort there. Home is a place where people may feel safety and a sense of belonging. In dying at home, patients with terminal cancer also may have a greater chance to control their environment, more autonomy and privacy, and a sense of normality. In this article, special cultural meaning of dying at home for the Chinese patient and the family is reviewed. It is essential for health care professionals to understand Chinese cultural beliefs and values related to dying at home in order to provide culturally sensitive care for Chinese dying patients and their families and to enhance their sense of control over the unknown process of dying.