Characteristics and local risk factors of community-acquired and health-care-associated Staphylococcus aureus pneumonia.

This study aims at identifying characteristics, risk factors and mortality of community-acquired (CAP) and health-care-associated pneumonia (HCAP) by Staphylococcus aureus (S. aureus). We retrieved adults with S. aureus CAP or HCAP diagnosed by blood or pleural effusion culture in 2.6 years, and compared with those of Streptococcus pneumoniae (S. pneumoniae) CAP or HCAP diagnosed by blood or respiratory culture, or urine antigen. We found 18 patients with CAP and 9 HCAP due to S. aureus (female 33%, 66.6 ± 12.4 years-old), and 48 patients with CAP and 15 HCAP due to S pneumoniae (female 41%, 69.5 ± 17.5 years). Diabetes mellitus (52% vs. 24%, p = 0.019), hemodialysis (11% vs. 0%, p = 0.046), skin lesions (44% vs. 0%, p < 0.001), cavitary nodules (37% vs. 1.6%, p < 0.001) and pleural effusions (48% vs. 18%, p = 0.007) were more common in staphylococcal than pneumococcal group. Three patients with staphylococcal pneumonia had acute myocardial infarction. Pneumonia severity index (139 ± 52 vs. 109 ± 43, p = 0.005) and 30-day mortality (41% vs. 9.5%, p = 0.001) were higher in staphylococcal group. Multivariate analysis showed underlying disease (especially cancer and cirrhosis), risk class 4/5, altered mentality, shock and bilateral pneumonia were risk factors for 30-day mortality.

High-flow nasal cannula improves respiratory impedance evaluated by impulse oscillometry in chronic obstructive pulmonary disease patients: a randomised controlled trial.

Non-pharmacological treatment with high-flow nasal cannula (HFNC) may play a vital role in treatment of patients with chronic obstructive pulmonary disease (COPD). To evaluate the efficacy of HFNC, impulse oscillation system (IOS) is a new noninvasive technique in measuring the impedance of different portions of lungs. It shows higher sensitivity in contrast to conventional pulmonary function tests (PFT). However, whether IOS is an appropriate technique to evaluate the efficacy of HFNC in improving the impedance of small airways or peripheral lung in patients with COPD is still unclear. We enrolled 26 stable COPD participants randomised into two groups receiving HFNC or nasal cannula (NC) for 10 min followed by a 4-week washout period and crossover alternatively. IOS was used to detect the difference of respiratory impedance after HFNC or NC interventions. IOS parameters, PFT results, transcutaneous partial pressure of carbon dioxide, peripheral oxygen saturation, body temperature, respiratory rate, pulse rate, and blood pressure at the time of pre-HFNC, post-HFNC, pre-NC, and post-NC, were collected and analysed using SPSS (version 25.0, IBM, Armonk, NY, USA). The IOS measurement indicated that HFNC significantly improved R5, R5% predicted, R5-R20, X5-predicted, and Fres compared with NC, whereas no significant difference was observed through the PFT measurement. The beneficial effect of HFNC in improving small airway resistance and peripheral lung reactance compared with that of NC in patients with stable COPD was confirmed through IOS measurement.Trial registration: ClinicalTrials.gov NCT05130112 22/11/2021.

Degree of convexity calculated from expiratory flow-volume curves for identifying airway obstruction in nonsedated and nonparalyzed ventilated patients.

The predictive performance of applying the degree of convexity in expiratory flow-volume (EFV) curves to detect airway obstruction in ventilated patients has yet to be investigated. We enrolled 33 nonsedated and nonparalyzed mechanically ventilated patients and found that the degree of convexity had a significant negative correlation with FEV1% predicted. The mean degree of convexity in EFV curves in the chronic obstructive pulmonary disease (COPD) group (n = 18) was significantly higher than that in the non-COPD group (n = 15; 26.37 % ± 11.94 % vs. 17.24 % ± 10.98 %, p = 0.030) at a tidal volume of 12 mL/kg IBW. A degree of convexity in the EFV curve > 16.75 at a tidal volume of 12 mL/kg IBW effectively differentiated COPD from non-COPD (AUC = 0.700, sensitivity = 77.8 %, specificity = 53.3 %, p = 0.051). The degree of convexity calculated from EFV curves may help physicians to identify ventilated patients with airway obstruction.

Association between spinal curvature disorders and injury: a nationwide population-based retrospective cohort study.

OBJECTIVES: Injury is an important issue in public health. Spinal curvature disorders are deformities characterised by excessive curves of the spine. The prevalence of spinal curvature disorders is not low, but its relationship with injury has not been studied. The aim of this study is to investigate whether spinal curvature disorders increase the risk of injury. DESIGN: Population-based retrospective cohort study. SETTING: Using data from the Taiwan National Health Insurance Research Database from 2000 to 2010. PARTICIPANTS AND EXPOSURE: Patients with spinal curvature disorders were selected using codes from the International Classification of Diseases, Ninth Revision, Clinical Modification. A cohort without spinal curvature was randomly frequency-matched to the spinal curvature disorders cohort at a ratio of 2:1 according to age, sex and index year. PRIMARY OUTCOME MEASURES: The risk of injury was analysed using Cox's proportional hazards regression models adjusting for age, sex, comorbidities, urbanisation level and socioeconomic status. RESULTS: A total of 20 566 patients with spinal curvature disorders and 41 132 controls were enrolled in this study. The risk of injury was 2.209 times higher (95% CI 2.118 to 2.303) in patients with spinal curvature disorders than in the control group. The spinal curvature disorders cohort exhibited higher risk of developing injury compared with the control group, regardless of age, sex, comorbidities, urbanisation level and subgroup of spinal curvature disorders. Based on the subgroup analysis, the spinal curvature disorders cohort had higher risks of unintentional injury and injury diagnoses such as fracture, dislocation, open wound, superficial injury/contusion, crushing and injury to nerves and spinal cord compared with the control cohort. CONCLUSIONS: Patients with spinal curvature disorders have a significantly higher risk of developing injury than patients without spinal curvature disorders. Aggressive detection and management of spinal curvature disorders may be beneficial for injury prevention.

Comparison of different functional EIT approaches to quantify tidal ventilation distribution.

OBJECTIVE: The aim of the study was to examine the pros and cons of different types of functional EIT (fEIT) to quantify tidal ventilation distribution in a clinical setting. APPROACH: fEIT images were calculated with (1) standard deviation of pixel time curve, (2) regression coefficients of global and local impedance time curves, or (3) mean tidal variations. To characterize temporal heterogeneity of tidal ventilation distribution, another fEIT image of pixel inspiration times is also proposed. MAIN RESULTS: fEIT-regression is very robust to signals with different phase information. When the respiratory signal should be distinguished from the heart-beat related signal, or during high-frequency oscillatory ventilation, fEIT-regression is superior to other types. fEIT-tidal variation is the most stable image type regarding the baseline shift. We recommend using this type of fEIT image for preliminary evaluation of the acquired EIT data. However, all these fEITs would be misleading in their assessment of ventilation distribution in the presence of temporal heterogeneity. SIGNIFICANCE: The analysis software provided by the currently available commercial EIT equipment only offers either fEIT of standard deviation or tidal variation. Considering the pros and cons of each fEIT type, we recommend embedding more types into the analysis software to allow the physicians dealing with more complex clinical applications with on-line EIT measurements.

Symptomatic pericardial schwannoma treated with video-assisted thoracic surgery: a case report.

Intrathoracic schwannomas are neurogenic tumors derived from the Schwann cells of the nerve sheath, most often seen in the posterior mediastinum with anatomical correlations to nerves. Although they are typically benign, a malignant transformation can occur, and thoracotomy instead of video-assisted thoracoscopic surgery (VATS) is required to achieve a complete resection. Only a few cases of pericardial schwannoma have been reported so far. We present a rare case of pericardial schwannoma confirmed by video-assisted thoracoscopic resection.

Impact of procedure on the post-operative infection risk of patients after elective colon surgery.

BACKGROUND: Post-operative infection impacts the quality of patient care, prolongs the length of hospital stay, and utilizes more health care resources. The purpose of this study was to compare the rates of surgical site infection among three major surgical procedures for treating patients with colon pathology. HYPOTHESIS: The location of colon resection impacts the post-operative infection rate. METHODS: A retrospective cohort study was conducted by using the 2006 Nationwide Inpatient Sample. Adult patients (age ≥18 yr) with colon diseases are the population of interest. The disease status and procedures were categorized according to the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM). Patients with a primary diagnosis of diverticulosis of the colon without hemorrhage (ICD-9-CM codes: 562.11 and 562.12) or malignant neoplasm of the colon (ICD-9-CM codes: 153.x, where x represents the possible digits within this ICD-9-CM code category), with procedures of open and other right hemicolectomy (ORH; ICD-9-CM code: 45.73) or open and other left hemicolectomy (OLH; ICD-9-CM code: 45.75), or open and other sigmoidectomy (OS; ICD-9-CM code: 45.76) were included for this study. The primary measured outcome for the study was surgical site infection. RESULTS: There were an estimated 26,381 ORH procedures, 9,558 OLH procedures, and 31,656 OS procedures performed in 2006. There was a significant difference among procedures with respect to their age distributions (mean [standard error]: ORH vs. OLH vs. OS=70.5 [0.2] vs. 63.8 [0.3] vs. 59.5 [0.2] yr, p<0.0001) and the gender distributions (female percentage ORH vs. OLH vs. OS=56.1% vs. 51.5% vs. 50.9%, p<0.0001). There was a significant difference among the surgical procedures (infection rates: ORH vs. OLH vs. OS=2.9% vs. 5.6% vs. 4.9%, p<0.0001). From a logistic regression model, after controlling for age, gender, primary diagnosis, comorbidities, and hospital teaching status, OLH had a higher chance of SSI (adjusted odds ratio [AOR] [95% confidence interval {CI}]=1.54 [1.16-2,05], p=0.003) compared with ORH. However, OS did not have different SSI rates (AOR [95% CI]=1.18 [0.90-1.54], p=0.234) compared with ORH. There was a higher rate of infection for OLH (AOR [95% CI]: 1.31 [1.04-1.64], p=0.02) compared with OS. CONCLUSIONS: Different sites of colon operations were associated with different risks of surgical site infections. Accordingly, appropriate pre-operative measures should address these differences.

Laparoscopic cholecystectomy is the preferred approach in cirrhosis: a nationwide, population-based study.

BACKGROUND/AIM: To assess the impact of open versus laparoscopic surgery in cirrhotic patients undergoing a cholecystectomy using the Nationwide Inpatient Sample (NIS). METHODS: All patients with cirrhosis who underwent a cholecystectomy (open or laparoscopic) between 2003 and 2006 were queried from the NIS. Associated complications including infection, transfusion, reoperation, liver failure and mortality were determined. RESULTS: A total of 3240 patients with cirrhosis underwent a cholecystectomy: 383 patients underwent an open cholecystectomy (OC) whereas 2857 patients underwent a laparoscopic cholecystectomy (LC), which included 412 patients converted (LCC) from a LC to an OC. Post-operative infection was higher in OC as opposed to a laparoscopic cholecystectomy (TLC) or LCC (3.5% versus 0.7% versus 0.2%, P < 0.0001). The need for a blood transfusion was significantly higher in the OC and LCC groups as compared with the TLC group (19.2% versus 14.4% versus 6.2%, P < 0.0001). Reoperation was more frequent after OC or LCC versus TLC (1.5% versus 2.5% versus 0.8%, P = 0.007). In-hospital mortality was higher after OC as compared with TLC and LCC (8.3% versus 1.3% versus 1.4%, P < 0.0001). CONCLUSION: Patients with cirrhosis have increased in-hospital morbidity and mortality after an open as opposed to a laparoscopic or conversion to an open cholecystectomy. LC should be the preferred initial approach in cirrhotic patients.

Room-temperature super-extraction system (RTSES) optimizes the anxiolytic- and antidepressant-like behavioural effects of traditional Xiao-Yao-San in mice.

BACKGROUND: Xiao-Yao-San (XYS) is a Chinese medicinal formula for treating anxiety and depression. This study aims to evaluate the use of a room-temperature super-extraction system (RTSES) to extract the major active components of XYS and enhance their psycho-pharmacological effects. METHODS: The neuroprotective roles of XYS/RTSES against reserpine-derived neurotoxicity were evaluated using a glial cell injury system (in vitro) and a depression-like C57BL/6 J mouse model (in vivo). The anxiolytic-behavioural effects were measured by the elevated plus-maze (EPM) test and the antidepressant effects were evaluated by the forced swimming test (FST) and tail suspension test (TST). Glucose tolerance and insulin resistance were assayed by ELISA. The expression of 5-HT1A receptors in the prefrontal cortex was examined by western blotting. RESULTS: XYS/RTSES (300 µg/mL) diminished reserpine-induced glial cell death more effectively than either XYS (300 µg/mL) or fluoxetine (30 µM) at 24 h (P = 0.0481 and P = 0.054, respectively). Oral administration of XYS/RTSES (500 mg/kg/day) for 4 consecutive weeks significantly elevated the ratios of entries (open arms/closed arms; P = 0.0177) and shuttle activity (P = 0.00149) on the EPM test, and reduced the immobility time by 90% on the TST (P = 0.00000538) and FST (P = 0.0000053839). XYS/RTSES also improved the regulation of blood glucose (P = 0.0305) and increased the insulin sensitivity (P = 0.0093). The Western blot results indicated that the activation of cerebral 5-HT1A receptors may be involved in the mechanisms of XYS/RTSES actions. CONCLUSION: The RTSES could provide a novel method for extracting effective anxiolytic- and antidepressant-like substances. XYS/RTSES improved the regulation of blood glucose and increased the insulin sensitivity in reserpine-induced anxiety and depression. Neuroprotection of glial cells and activation of cerebral 5-HT1A receptors were also involved.

Report card on Surgical Care Improvement Project (SCIP): nationwide inpatient sample infection data 2001-2006.

BACKGROUND: The administration of appropriate antibiotics in a timely fashion with discontinuation post-operatively is the first of the Surgical Care Improvement Project (SCIP) initiatives and was expected to reduce post-operative infections significantly. This study aimed at determining whether SCIP has had an effect on surgical site infections (SSIs). METHODS: A retrospective cohort study was conducted to evaluate the infection rates of adult patients (age≥18 years) having elective cholecystectomies, laparoscopic cholecystectomies, and colectomies from 2001-2006 using the Nationwide Inpatient Sample (NIS) database. The population consisted of all patients older than 18 years who had colon resection or cholecystectomy and were discharged from a hospital included in the NIS. Annual infection rates were determined for each of the operations. RESULTS: Post-operative infections rose steadily and significantly (p<0.0001) in colon surgery from 2001 to 2006. A significant increase in SSIs also was seen in open (p=0.0001) and laparoscopic (p<0.0001) cholecystectomy from 2001 to 2006. Length of stay was significantly longer in infected than in non-infected patients. CONCLUSION: The factors that contributed to the observed increase in the infection rate should be identified to improve the SCIP initiatives.

Melatonin decreases neurovascular oxidative/nitrosative damage and protects against early increases in the blood-brain barrier permeability after transient focal cerebral ischemia in mice.

We have recently shown that melatonin decreases the late (24 hr) increase in blood-brain barrier (BBB) permeability and the risk of tissue plasminogen activator-induced hemorrhagic transformation following ischemic stroke in mice. In the study, we further explored whether melatonin would reduce postischemic neurovascular oxidative/nitrosative damage and, therefore, improve preservation of the early increase in the BBB permeability at 4 hr after transient focal cerebral ischemia for 60 min in mice. Melatonin (5 mg/kg) or vehicle was given intraperitoneally at the beginning of reperfusion. Hydroethidine (HEt) in situ detection and immunohistochemistry for nitrotyrosine were used to evaluate postischemic accumulation in reactive oxygen and nitrogen species, respectively, in the ischemic neurovascular unit. BBB permeability was evaluated by spectrophotometric and microscopic quantitation of Evans Blue leakage. Relative to controls, melatonin-treated animals not only had a significantly reduced superoxide accumulation in neurovascular units in boundary zones of infarction, by reducing 35% and 54% cytosolic oxidized HEt in intensity and cell-expressing percentage, respectively (P < 0.001), but also exhibited a reduction in nitrotyrosine by 52% (P < 0.01). Additionally, melatonin-treated animals had significantly reduced early postischemic disruption in the BBB permeability by 53% (P < 0.001). Thus, melatonin reduced postischemic oxidative/nitrosative damage to the ischemic neurovascular units and improved the preservation of BBB permeability at an early phase following transient focal cerebral ischemia in mice. The findings further highlight the ability of melatonin in anatomical and functional preservation for the ischemic neurovascular units and its relevant potential in the treatment of ischemic stroke.

Antigenic diversity of Neisseria meningitidis isolated in Taiwan between 1995 and 2002.

The geographic distribution of N. meningitidis is diverse. Information on the antigenic variation of N. meningitidis is important for the development of an outer membrane protein-based vaccine. As a first step towards vaccine development, serological typing was performed to determine the antigenic properties of 127 invasive N. meningitidis isolates collected in Taiwan between 1995 and 2002. With 31.5% non-serotypeable and 32.3% non-serosubtypeable, the 127 isolates fell into 51 phenotypes, with W135:NT:P1.5,2:L3,7,9, Y:14P1.5,2, and B:1:NST:L3,7,9 being the 3 most prevalent. Among the 37 serogroup B isolates, 15 serosubtypes were found, with P1.5,2 and P1.12,13 being the most prevalent. The high diversity of Por A among serogroup B isolates circulating in Taiwan poses a great challenge for the development of a PorA-based vaccine. Because 85% of the serogroup B isolates had the L3,7,9 immunotype, inclusion of L3,7,9 lipooligosaccharides in a PorA-based vaccine may be a promising approach. In addition, based on the phenotypic characterization, we suggest that both serogroup B and W135 isolates were endemic and that serogroup A, C, and Y isolates were imported, which may reflect increased international travel.

Melatonin attenuates the postischemic increase in blood-brain barrier permeability and decreases hemorrhagic transformation of tissue-plasminogen activator therapy following ischemic stroke in mice.

Melatonin protects against transient middle cerebral artery (MCA) occlusion and may be suited as an add-on therapy of tissue plasminogen activator (t-PA) thrombolysis. Herein, we examined whether melatonin would reduce postischemic increase in the blood-brain barrier (BBB) permeability and, therefore, attenuate the risk of hemorrhagic transformation after t-PA therapy in experimental stroke. Twelve mice were subjected to transient occlusion of the MCA for 1 hr, followed by 24 hr of reperfusion. Melatonin (5 mg/kg, i.p.) or vehicle was given at the beginning of reperfusion. BBB permeability was evaluated by quantitation of Evans Blue leakage. An additional 32 mice underwent photothrombotic occlusion of the distal MCA, and were administered vehicle or t-PA (10 mg/kg, i.v.), alone or in combination with melatonin (5 mg/kg, i.p.), at 6 hr postinsult. The animals were then killed after 24 hr for the determination of infarct and hemorrhage volumes. Relative to controls, melatonin-treated animals had significantly reduced BBB permeability (by 52%; P < 0.001). Additionally, we found that at 6 hr after photo-irradiation, either t-PA or melatonin, or a combined administration of t-PA plus melatonin, did not significantly affect brain infarction (P > 0.05), compared with controls. Mice treated with t-PA alone, however, had significantly increased hemorrhagic formation (P < 0.05), and the event was effectively reversed by co-treatment with melatonin (P < 0.05). Thus, melatonin improved postischemic preservation of the BBB permeability and a decreased risk of adverse hemorrhagic transformation after t-PA therapy for ischemic stroke. The findings further highlight melatonin's potential role in the field of thrombolytic treatment for ischemic stroke patients.

Primary malignant mesothelioma of the greater omentum: report of a case.

We report a rare case of primary malignant mesothelioma of the greater omentum. To our knowledge, only one other such case has been described in the English literature. The patient was a 61-year-old Taiwanese woman without any history of exposure to asbestos, who presented with lower back pain. Abdominal sonography and computed tomography showed a 12 x 9 x 9-cm(3) mass occupying the lower abdomen. Laparotomy revealed a tumor in the greater omentum, invading the posterior wall of the uterus, without diffuse mesenteric thickening or multiple small nodules in the peritoneum. We performed en bloc resection of the mass, which involved omentectomy, hysterectomy, and bilateral salpingo-oophorectomy. Microscopically, the tumor cells were arranged in a tubulopapillary pattern lined by a single layer of uniform, cuboidal cells. A pattern of sclerotic stroma with irregular glandular elements was also recognized. Immunohistochemically, the tumor cells showed strong positivity for calretinin. The final pathologic diagnosis was malignant mesothelioma. The patient did not receive chemotherapy or radiotherapy, and has remained in good health without any evidence of recurrence for almost 3 years since her operation.