Predictive Performance of Scoring Systems for Mortality Risk in Patients with Cryptococcemia: An Observational Study.

Cryptococcal infection is usually diagnosed in immunocompromised individuals and those with meningeal involvement, accounting for most cryptococcosis. Cryptococcemia indicates a poor prognosis and prolongs the course of treatment. We use the scoring systems to predict the mortality risk of cryptococcal fungemia. This was a single hospital-based retrospective study on patients diagnosed with cryptococcal fungemia confirmed by at least one blood culture collected from the emergency department covering January 2012 and December 2020 from electronic medical records in the Taichung Veterans General Hospital. We enrolled 42 patients, including 28 (66.7%) males and 14 (33.3%) females with a mean age of 63.0 ± 19.7 years. The hospital stay ranged from 1 to 170 days (a mean stay of 44.4 days), and the overall mortality rate was 64.3% (27/42). In univariate analysis, the AUC of ROC for MEWS, RAPS, qSOFA, MEWS plus GCS, REMS, NEWS, and MEDS showed 0.833, 0.842, 0.848, 0.846, 0.846, 0.878, and 0.905. In the multivariate Cox regression analysis, all scoring systems, older age, lactate, MAP, and DBP, indicated significant differences between survivor and non-survivor groups. Our results show that all scoring systems could apply in predicting the outcome of patients with cryptococcal fungemia, and the MEDS displays the best performance. We recommend a further large-scale prospective study for patients with cryptococcal fungemia.

Comprehensive Geriatric Assessment and Clinical Outcomes in the Older People at the Emergency Department.

Visits by older people to the Emergency Department (ED) have increased in recent decades with higher revisiting and admission rates after discharge, particularly for those with frailties. This study used a before-after design aimed at evaluating Comprehensive Geriatric Assessment (CGA) screening in older ED patients (aged ≥ 75 years) during the 12-month preintervention period. Additionally, a CGA-based structured follow-up program after ED discharge was executed during the next 12-month intervention period. Amongst the 358 participants (median age 82 years), involving 122 in the preintervention period and 236 in the intervention period, 77 participants (21.5%) were identified as pre-frailty, while 274 (76.5%) were identified as frail using the Fried frailty phenotype. One-hundred ten (110) (30.7%) patients revisited the ED with 73 (20.4%) being admitted and 20 (5.6%) dying within three months after ED discharge. Compared with preintervention and intervention period, it was shown that the rates of admission at the index ED visit (50.8% vs. 23.1%), and mortality (10.7% vs. 3.0%), were both were significantly reduced. Using multivariate regression analysis, it was shown frailty was significantly associated with three-month mortality after adjusting for potential confounders. On the contrary, the program significantly decreased admission and death rate. It is suggested that frailty was prevalent amongst the older ED patients, and should be screened for in order to decrease revisits/admissions after ED discharge.

Renal actinomycosis with retroperitoneal abscess in a cirrhotic patient: A case report (CARE-complaint).

RATIONALE: Renal actinomycosis is a rare clinical infection, subacute to chronic presentation caused by the Actinomyces bacteria. Actinomyces israelii is diagnosed in the overpowering majority of reported cases. Abdominopelvic manifestation forms 10% to 20% of all actinomycosis, and may be misdiagnosed as either a malignancy or chronic inflammation due to the lower correct preoperative diagnostic rate (<10%). PATIENT CONCERNS: A 38-year-old man with alcoholic liver cirrhosis experienced right flank pain, abdominal pain, and fever for 3 days. Leukocytosis, acute kidney injury, and impaired liver function were found. A computed tomographic scan demonstrated multiple renal cystic lesions, along with fluid accumulation at the right subphrenic and retroperitoneal spaces. DIAGNOSES: Renal actinomycosis was confirmed via cultures of both the abscess and nephrectomy specimen which grew A israelii and the pathological findings of multiple renal abscesses of actinomycosis with the characteristics of sulfur granules. INTERVENTIONS: A nephrectomy was performed for an inadequate percutaneous drainage of renal abscess. OUTCOMES: A full course of antibiotics with intravenous penicillin G (3 million units every 4 hours) was prescribed for 2 weeks, followed by oral penicillin V given at a dose of 2 grams per day for 6 months at our out-patient facility. LESSONS: A precise diagnosis of primary renal actinomycosis depends on any histopathological findings and/or cultures of specimens. A high dose of intravenous penicillin G is the first choice, followed by oral penicillin V, with the duration of each being dependent upon the individual condition.

Synthesis and Electrochromism of Highly Organosoluble Polyamides and Polyimides with Bulky Trityl-Substituted Triphenylamine Units.

Two series of polyamides and polyimides containing bulky trityl-substituted triphenylamine units were synthesized from condensation reactions of 4,4'-diamino-4''-trityltriphenylamine with various dicarboxylic acids and tetracarboxylic dianhydrides, respectively. The polymers showed good solubility and film-forming ability. Flexible or robust films could be readily obtained via solution-casting. The use of aliphatic diacid or dianhydride reduces interchain charge transfer complexing and leads to colorless polyamide and polyimide films. These polymers showed glass-transition temperatures in the range of 206⁻336 °C. Cyclic voltammograms of the polyamide and polyimide films displayed reversible electrochemical oxidation processes in the range of 0⁻1.0 or 0⁻1.3 V. Upon oxidation, the color of polymer films changes from colorless to blue-green or blue. As compared to the polyimide counterparts, the polyamides showed lower oxidation potentials and thus a higher electrochromic stability and coloration efficiency. Simple electrochromic devices were also fabricated as a preliminary investigation for electrochromic applications of the prepared polymers.

Emotion identification using extremely low frequency components of speech feature contours.

The investigations of emotional speech identification can be divided into two main parts, features and classifiers. In this paper, how to extract an effective speech feature set for the emotional speech identification is addressed. In our speech feature set, we use not only statistical analysis of frame-based acoustical features, but also the approximated speech feature contours, which are obtained by extracting extremely low frequency components to speech feature contours. Furthermore, principal component analysis (PCA) is applied to the approximated speech feature contours so that an efficient representation of approximated contours can be derived. The proposed speech feature set is fed into support vector machines (SVMs) to perform multiclass emotion identification. The experimental results demonstrate the performance of the proposed system with 82.26% identification rate.

Sequential asymmetric catalysis in Michael-Michael-Michael-aldol reactions: merging organocatalysis with photoredox catalysis in a one-pot enantioselective synthesis of highly functionalized decalines bearing a quaternary carbon stereocenter.

An expedited method has been developed for the enantioselective synthesis of highly functionalized decaline systems containing seven contiguous stereogenic centers with high enantioselectivities (>99% ee). The one-pot methodology comprises a cascade of organocatalytic double Michael-photocatalyzed Michael-aldol reactions of ethyl 2-bromo-6-formylhex-2-enoate, ß-alkyl-α,ß-unsaturated aldehydes, and α-alkyl-α,ß-unsaturated aldehydes. The structure and absolute configuration of an appropriate product were confirmed by X-ray analysis.

One-pot organocatalytic enantioselective domino double-Michael reaction and Pictet-Spengler-lactamization reaction. A facile entry to the "inside yohimbane" system with five contiguous stereogenic centers.

An expedited method was developed for the enantioselective synthesis of dodecahydrobenz[a]indolo[3,2-h]quinolizine containing five contiguous stereogenic centers with high enantioselectivities (>99% ee). The methodology comprises a domino organocatalytic double Michael reaction and Pictet-Spengler-lactamization reaction. The structures and absolute configurations of the appropriate products were confirmed by X-ray analysis.