Out-of-hospital cardiac arrest and in-hospital mortality among COVID-19 patients: A population-based retrospective cohort study.

BACKGROUND/PURPOSE: Predictors for out-of-hospital cardiac arrest (OHCA) in COVID-19 patients remain unclear. We identified the predictors for OHCA and in-hospital mortality among such patients in community isolation centers. METHODS: From May 15 to June 20, 2021, this cohort study recruited 2555 laboratory-confirmed COVID-19 patients admitted to isolation centers in Taiwan. All patients were followed up until death, discharge from the isolation center or hospital, or July 16, 2021. OHCA was defined as cardiac arrest confirmed by the absence of circulation signs and occurring outside the hospital. Multinomial logistic regressions were used to determine factors associated with OHCA and in-hospital mortality. RESULTS: Of the 37 deceased patients, 7 (18.9%) had OHCA and 30 (81.1%) showed in-hospital mortality. The mean (SD) time to OHCA was 6.6 (3.3) days from the symptom onset. After adjusting for demographics and comorbidities, independent predictors for OHCA included age ≥65 years (adjusted odds ratio [AOR]: 13.24, 95% confidence interval [CI]: 1.85-94.82), fever on admission to the isolation center (AOR: 12.53, 95% CI: 1.68-93.34), and hypoxemia (an oxygen saturation level below 95% on room air) (AOR: 26.54, 95% CI: 3.18-221.73). Predictors for in-hospital mortality included age ≥65 years (AOR: 10.28, 95% CI: 2.95-35.90), fever on admission to the isolation centers (AOR: 7.27, 95% CI: 1.90-27.83), and hypoxemia (AOR: 29.87, 95% CI: 10.17-87.76). CONCLUSIONS: Time to OHCA occurrence is rapid in COVID-19 patients. Close monitoring of patients' vital signs and disease severity during isolation is important, particularly for those with older age, fever, and hypoxemia.

Comparison of skin and soft tissue infections caused by Vibrio and Aeromonas species.

BACKGROUND: The aim of this study was to compare skin and soft tissue infections (SSTIs) caused by Vibrio and Aeromonas spp. METHODS: Patients whose cultures yielded Vibrio or Aeromonas spp. from July 2004 to June 2010 were retrieved from the computerized database of the bacteriology laboratory at a hospital in southern Taiwan. The medical records were reviewed for all patients fulfilling the criteria of monomicrobial Vibrio or Aeromonas spp. SSTIs and the clinical characteristics were analyzed. RESULTS: During the study period, there were 28 patients with Vibrio spp. and 26 patients with Aeromonas spp., respectively. Vibrio vulnificus (n=25) and A. hydrophila (n=14) were the most common spp. There were no significant differences in age, gender, underlying diseases between patients with Vibrio and Aeromonas SSTIs. In comparison to Aeromonas SSTIs, more patients with Vibrio SSTIs were complicated with acute respiratory failure (39.3% vs. 3.8%, p=0.002) and required intensive care unit admission (50.0% vs. 7.7%, p<0.001). Furthermore, patients with Aeromonas SSTIs had a higher likelihood of discharge alone within 30 days than Vibrio SSTIs (p=0.049). The difference in in-hospital mortality among the two groups was not statistically significant (p=0.11). CONCLUSION: Both Aeromonas and Vibrio spp. cause SSTIs in southern Taiwan and the pathogenicity of Vibrio spp. might be higher than Aeromonas spp.

Relationship between betel quid chewing and risks of cardiovascular disease in older adults: a cross-sectional study in Taiwan.

BACKGROUND: The association between betel quid (BQ) chewing and oral cancer is well established. However, evidence regarding the relationship between BQ chewing and cardiovascular disease (CVD) is still insufficient. METHODS: This cross-sectional study included 2002 men and 1175 women aged 50 and older in a city-level health examination survey of an agricultural and fishing population in 2013. In addition to anthropometric parameters, CVD risks were estimated using high-sensitivity C-reactive protein (hs-CRP), brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index. Age, gender, smoking and alcohol drinking status were all incorporated into the multivariate logistic regression model to delineate the effect of BQ chewing on CVD risks. RESULTS: Two hundred forty-one (12%) males and eight (0.7%) females were ever chewers. BQ chewing was an independent risk factor for general obesity (odds ratio [OR] 1.43, 95% confidence interval [CI] 1.07-1.91, p=0.017), central obesity (OR 2.27, 95% CI 1.53-3.37, p<0.001) and an elevated hs-CRP level (OR 1.38, 95% CI 1.03-1.85, p=0.029). Subjects who chewed more frequently had a higher systolic blood pressure (p=0.025) and baPWV (p=0.006). The waist circumference (p=0.015) and waist-to-height ratio (p=0.022) were greater in current chewers than in former chewers. CONCLUSION: These findings suggest that BQ chewing is associated with obesity and a higher CVD risk as estimated by hs-CRP. Furthermore, potential beneficial effects of BQ chewing cessation on central obesity were also found.

Laparoscopic caudate hepatectomy for cancer--an innovative approach to the no-man's land.

BACKGROUND: Caudate hepatectomy remains a surgical challenge in spite of recent advances in laparoscopic technique. Hepatic tumor in the caudate lobe is usually deeply located in the center of the liver and close to the vena cava and hepatic hilum. Thus, lesion in this region was considered as a contraindication of laparoscopic hepatectomy. Only sporadic reports could be found in the literature. The aim of this study is to review the safety and feasibility of laparoscopic hepatectomy for lesions in the caudate lobe. METHODS: Nine consecutive patients with caudate hepatic tumor received laparoscopic caudate hepatectomy in our institute from February 2006 to July 2010. One patient with hepatic adenoma was excluded from the analysis. Demographic data, intraoperative parameters, and postoperative outcomes of the remaining eight patients were assessed. RESULTS: All procedure for these eight patients with caudate hepatic tumors (size 0.9-4.5 cm) were completed with totally laparoscopic technique except one in which additional left hepatectomy was also done. The average operative time was 254 min (range 210-345 min) and estimated blood loss was 202 ml (range 10-1,000 ml), and average length of postoperative hospital stay was 6.9 days (range 4-11 days). There was no perioperative complications and patient mortality in this series. CONCLUSIONS: Our experience demonstrated that laparoscopic hepatectomy is a safe and feasible procedure for caudate hepatic tumors in selected patients.

Cartilage fragments from osteoarthritic knee promote chondrogenesis of mesenchymal stem cells without exogenous growth factor induction.

Extracellular matrix (ECM) is thought to participate significantly in guiding the differentiation process of mesenchymal stem cells (MSCs). In this study, we hypothesized that cartilage fragments from osteoarthritic knee could promote chondrogenesis of MSCs. Nonworn parts of cartilage tissues were obtained during total knee arthroplasty (TKA) surgery. Cartilage fragments and MSCs were wrapped into fibrin glue; and the constructs were implanted subcutaneously into nude mice. Histological analysis showed neocartilage-like structure with positive Alcian blue staining in the cartilage fragment-fibrin-MSC constructs. However, constructs with only MSCs in fibrin showed condensed appearance like MSCs in the pellet culture. Gene expression of type II collagen in the constructs with 60 mg cartilage fragments were significantly elevated after 4 weeks of implantation. Conversely, the constructs without cartilage fragments failed to express type II collagen, which indicated MSCs did not differentiate into a chondrogenic lineage. In conclusion, we demonstrated the effect of cartilage fragments from osteoarthritic knee in promoting chondrogenic differentiation of MSCs. This may be a favorable strategy for MSC chondrogenesis without exogenous growth factor induction.

[Thyroidectomies: surgical site infection risk factors of using prophylactic antibiotics].

BACKGROUND: Surgical site infection is one of the most common types of nosocomial infection and an important factor in increased mortality and medical costs. The effectiveness of prophylactic antibiotics use on thyroidectomy wound sites merits further examination. PURPOSE: This study compared the influence of prophylactic antibiotics use or non-use on surgical site infection risk, average hospital stay length and average medical costs in thyroidectomy patients. METHODS: This cross-sectional study targeted patients undergoing thyroidectomies at the general surgery ward of a medical center during the period 2007 to 2008. Subjects were divided into two groups. The first comprised patients who received prophylactic antibiotics thirty minutes before receiving a thyroidectomy between January 1, 2007 and October 31, 2007. A retrospective review of patient charts and reports was conducted for this group. The second consisted of patients that did not receive prophylactic antibiotics 30 minutes before receiving a thyroidectomy between November 1, 2007 and October 31, 2008 in line with a new antibiotics policy enforced at the research hospital. RESULTS: A total of 310 subjects were enrolled in the study. All subjects were free of surgical site infection. Fifteen patients (4.8%) received a course in antibiotics after surgery and six (40.0%) of these showed surgical site swelling (x² = 120.33; p < .01). Statistically significant risk factors of post-surgery antibiotics use included diabetes mellitus (x² = 6.39; p = .03), a surgery duration in excess of 2 hours (x² = 4.40; p = .04), drainage tube remaining in place at the surgical site (x² = 4.58; p = .03) and drainage tube insertion for more than 2 days (x² = 6.24; p = .03). Significant reductions in average hospital stay length (3.65 days ± 1.04; p < .01) and medical costs (p < .01) were observed when prophylactic antibiotics were not used before surgery. The cost of post-operative antibiotics increased by $5,851 and medical costs increased from $32,436 to $63,895 when hospital stay length exceeded four days. If hospital stay length was kept within four days and post-operative antibiotics were used, this study found no significant difference in drug or medical costs. CONCLUSION: Not using prophylactic antibiotics before thyroidectomy does not increase surgical site infection risk.

Acidic extracellular pH induces p120-catenin-mediated disruption of adherens junctions via the Src kinase-PKCδ pathway.

An acidic microenvironment induces disruption of adherens junctions (AJs) of hepatoma cells. This study investigated the impact of an acidic extracellular pH (pHe) on p120-catenin (p120-ctn) serine phosphorylation. pH 6.6 treatment increased intracellular calcium levels, activated protein kinase C (PKC)α and PKCδ, and decreased serine phosphorylation of p120-ctn. Further knockdown of PKCα and δ by small interference RNA (siRNA) prevented the pH 6.6-induced downregulation of p120-ctn at AJ and the serine dephosphorylation of p120-ctn. Moreover, PP2 pretreatment and siRNA of c-Src abrogated the pH 6.6-induced PKCδ activation. Together, the c-Src-PKCδ cascade and PKCα regulate the acidic pHe-induced AJ disruption.

Imprint cytology in diagnosing-primary non-Hodgkin's lymphoma of the breast during intraoperative frozen consultation: a case report.

UNLABELLED: BACKGROUND; Primary non-Hodgkin's lymphoma of the breast is uncommon among primary malignant breast tumors. Here we present a case diagnosed as primary breast lymphoma with imprint cytology during intraoperative frozen consultation. CASE: A 67-year-old woman presented with a palpable, non-tender mass in her left breast that she had had for 2 weeks. The mammogram and ultrasound studies revealed 1 lobular mass in the left breast without axillary lymphadenopathy. Imprint cytology helped diagnose malignant lymphoma of the breast, preventing radical surgery. CONCLUSION: Frozen artifact may obscure the evaluation of cytomorphology during intraoperative consultation. Imprint cytology may help due to less artifact with the cytologic details. Primary breast lymphomas should be considered in the differential diagnosis of breast tumors. The current literature recommendation of intermediate to high grade lymphoma is combined partial mastectomy followed by chemotherapy with local radiotherapy.

Cordycepin induces apoptosis of CGTH W-2 thyroid carcinoma cells through the calcium-calpain-caspase 7-PARP pathway.

Cordycepin, a nucleoside isolated from Cordyceps sinensis, is an inhibitor of polyadenylation and has an antitumor effect. We used CGTH W-2, a follicular thyroid carcinoma cell line, to study the mechanism of the anticancer effect of cordycepin. Cordycepin decreased cell viability and resulted in apoptosis but not necrosis. Cordycepin increased intracellular calcium levels triggering calpain activation, which led to apoptosis. BAPTA/AM and calpeptin inhibited the cordycepin-induced cleavage of caspase 7 and poly (ADP-ribose) polymerase (PARP), implying an upstream role of calcium and calpain. CGTH W-2 cells expressed four subtypes of adenosine receptors (AR), A1AR, A2AAR, A2BAR, and A3AR. Specific antagonists to AR subtypes all blocked cordycepin-induced apoptosis to different degrees. Small interfering RNA for A1AR and A3AR abrogated cordycepin-induced apoptosis. In conclusion, the cordycepin-induced apoptosis of CGTH W-2 cells is mediated by the calcium-calpain-caspase 7-PARP pathway, and ARs are involved in the apoptotic effect of cordycepin.