Initial skin necrosis presentation at emergency room was associated with fulminant clinical course and mortality in patients with Vibrio necrotizing fasciitis.

Necrotizing fasciitis (NF) is a life-threatening infection. Skin necrosis is an important skin sign of NF. The purposes of this study was to investigate the initial skin conditions of Vibrio NF patients between emergency room (ER) to preoperative status, to compare the clinical and laboratory risk indicators of the skin necrosis group and non-skin necrosis group when they arrived at ER, and to evaluate whether initial cutaneous necrosis related to fulminant course and higher fatalities. From 2015 to 2019, seventy-two Vibrio NF patients with surgical confirmation were enrolled. We identified 25 patients for inclusion in the skin necrosis group and 47 patients for inclusion in the non-skin necrosis group due to the appearance of skin lesion at ER. Seven patients died, resulting in a mortality rate of 9.7%. Six patients of skin necrosis group and one patient of non-skin necrosis group died, which revealed the skin necrosis group had a significantly higher mortality rate than the non-skin necrosis group. All the patients in the skin necrosis group and 30 patients of non-skin necrosis group developed serous or hemorrhagic bullous lesions before operation (p = 0.0003). The skin necrosis group had a significantly higher incidence of APACHE score, postoperative intubation, Intensive care unit stay, septic shock, leukopenia, higher counts of banded leukocytes, elevated C-reactive protein (CRP), and lower serum albumin level. Vibrio NF patients presenting skin necrosis at ER were significantly associated with fulminant clinical courses and higher mortality. Physicians should alert the appearance of skin necrosis at ER to early suspect NF and treat aggressively by those clinical and laboratory risk indicators, such as elevated APACHE score, shock, leukopenia, higher banded leukocytes, elevated CRP, and hypoalbuminia.

Quantum Speedup for Inferring the Value of Each Bit of a Solution State in Unsorted Databases Using a Bio-Molecular Algorithm on IBM Quantum's Computers.

In this paper, we propose a bio-molecular algorithm with O( n 2) biological operations, O( 2n-1 ) DNA strands, O( n ) tubes and the longest DNA strand, O( n ), for inferring the value of a bit from the only output satisfying any given condition in an unsorted database with 2n items of n bits. We show that the value of each bit of the outcome is determined by executing our bio-molecular algorithm n times. Then, we show how to view a bio-molecular solution space with 2n-1 DNA strands as an eigenvector and how to find the corresponding unitary operator and eigenvalues for inferring the value of a bit in the output. We also show that using an extension of the quantum phase estimation and quantum counting algorithms computes its unitary operator and eigenvalues from bio-molecular solution space with 2n-1 DNA strands. Next, we demonstrate that the value of each bit of the output solution can be determined by executing the proposed extended quantum algorithms n times. To verify our theorem, we find the maximum-sized clique to a graph with two vertices and one edge and the solution b that satisfies b2 ≡ 1 (mod 15) and using IBM Quantum's backend.

Quantum Speedup and Mathematical Solutions of Implementing Bio-Molecular Solutions for the Independent Set Problem on IBM Quantum Computers.

In this paper, we propose a bio-molecular algorithm with O( n2 + m ) biological operations, O( 2n ) DNA strands, O( n ) tubes and the longest DNA strand, O( n ), for solving the independent-set problem for any graph G with m edges and n vertices. Next, we show that a new kind of the straightforward Boolean circuit yielded from the bio-molecular solutions with m NAND gates, ( m +n × ( n + 1 )) AND gates and (( n × ( n + 1 ))/2) NOT gates can find the maximal independent-set(s) to the independent-set problem for any graph G with m edges and n vertices. We show that a new kind of the proposed quantum-molecular algorithm can find the maximal independent set(s) with the lower bound Ω ( 2n/2 ) queries and the upper bound O( 2n/2 ) queries. This work offers an obvious evidence for that to solve the independent-set problem in any graph G with m edges and n vertices, bio-molecular computers are able to generate a new kind of the straightforward Boolean circuit such that by means of implementing it quantum computers can give a quadratic speed-up. This work also offers one obvious evidence that quantum computers can significantly accelerate the speed and enhance the scalability of bio-molecular computers. Next, the element distinctness problem with input of n bits is to determine whether the given 2n real numbers are distinct or not. The quantum lower bound of solving the element distinctness problem is Ω ( 2n×(2/3) ) queries in the case of a quantum walk algorithm. We further show that the proposed quantum-molecular algorithm reduces the quantum lower bound to Ω (( 2n/2 )/( [Formula: see text]) queries. Furthermore, to justify the feasibility of the proposed quantum-molecular algorithm, we successfully solve a typical independent set problem for a graph G with two vertices and one edge by carrying out experiments on the backend ibmqx4 with five quantum bits and the backend simulator with 32 quantum bits on IBM's quantum computer.

Cardiopulmonary Function Assessment in Children With Pulmonary Valve Stenosis.

OBJECTIVE: Pulmonary valve (PV) stenosis affects cardiac pulmonary function and exercise performance. A cardiopulmonary exercise test (CPET) combined with a transthoracic echocardiogram (TTE) can measure exercise performance, disease progression, and treatment effects. We assessed the exercise capacity in children with PV stenosis by conducting CPET and TTE. METHODS: From 2005 to 2021, 84 patients with PV stenosis aged 6-18 years were enrolled; 43 were treated with balloon pulmonary valvuloplasty (BPV) (Group A), and 41 received follow-up care (Group B), and their CPET and pulmonary function test results were compared with 84 healthy, matched individuals (Control). We also conducted TTE to compare the peak pulmonary artery pulse wave velocity and pulmonary valve (PV) area before and after catheterization and follow-up care. RESULTS: There were no significant differences among the CPET parameters of the patient groups and controls in anaerobic metabolic equivalent (MET) (group A: 6.44 ± 0.58; group B: 6.28 ± 0.47, control: 6.92 ± 0.39, p = 0.110), peak MET (group A: 9.32 ± 0.74; group B: 9.13 ± 0.63; control: 9.80 ± 0.52, p = 0.263), and heart rate recovery (group A: 28.04 ± 4.70; group B: 26.44 ± 3.43, control:26.10 ± 2.42, p = 0.718). No significant differences were found in the pulmonary functions between the three groups. The pulmonary artery pulse wave velocity significantly decreased after catheterization (3.97 ± 1.50 vs. 1.95 ± 0.94, p < 0.0001), but not after follow-up care (1.67 ± 0.77 vs. 1.75 ± 0.66, p = 0.129). The pulmonary vale area significantly improved in group A (0.89 ± 0.71 vs. 1.16 ± 0.58, p < 0.0001), whereas only insignificant progression of PV stenosis was observed in group B (1.60 ± 0.64 vs. 1.57 ± 0.65, p = 0.110). CONCLUSIONS: Patients treated with BPV had a similar exercise capacity with that of patients under follow-up care and the healthy controls. Larger or multi-center studies should be conducted to confirm the physical fitness of pediatric patients with PV stenosis after management.

Treatment of lead and arsenic poisoning in anuric patients - a case report and narrative review of the literature.

BACKGROUND: Heavy metal poisoning can cause debilitating illness if left untreated, and its management in anuric patients poses challenges. Literature with which to guide clinical practice in this area is rather scattered. CASE PRESENTATION: We present a case of symptomatic lead and arsenic poisoning from use of Ayurvedic medicine in a 28-year-old man with end-stage kidney disease on chronic hemodialysis. We describe his treatment course with chelating agents and extracorporeal blood purification, and review the relevant literature to provide general guidance. CONCLUSION: Cumulative clinical experience assists in identifying preferred chelators and modalities of extracorporeal blood purification when managing such patients. However, a larger body of real-world or clinical trial evidence is necessary to inform evidence-based guidelines for the management of heavy metal poisoning in anuric patients.

Association of incident dialysis modality with mortality: a protocol for systematic review and meta-analysis of randomized controlled trials and cohort studies.

BACKGROUND: At least 2.6 million adults and children receive dialysis treatment for end-stage kidney disease (ESKD) worldwide. The large majority of these receive hemodialysis (HD), while the remaining receive peritoneal dialysis (PD). Peritoneal dialysis may be associated with similar mortality outcomes as HD, and patient-reported outcomes are potentially increased with PD. Existing evidence for the mortality associated with PD was summarized over 20 years ago, and there has been greater marginal improvement in survival with PD relative to HD since that time. It is therefore timely to reexamine the question of differential mortality by modality and summarize evidence from more contemporary practice settings. METHODS/DESIGN: Electronic databases will be systematically searched for publications that report the association between dialysis modality (HD or PD) with death from any cause and cause-specific death in incident patients with end-stage kidney disease. The database searches will be supplemented by searching through citations and references and consultation with experts. Studies published before 1995 will be excluded. Screening of both titles and abstracts will be done by two independent reviewers. All disagreements will be resolved by an independent third reviewer. A quantitative meta-analysis of effect sizes and standard errors will be applied. DISCUSSION: Our systematic review will update previous evidence summaries and provide a quantitative and standardized assessment of the contemporary literature comparing HD and PD including published and unpublished non-English studies from greater China, Taiwan, and Japan. This review will inform shared decision-making around initial dialysis modality choice and jurisdiction-level considerations of dialysis practice. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42018111829.

Outcomes of renal transplant recipients with BK virus infection and BK virus surveillance in the Auckland region from 2006 to 2012.

AIM: To evaluate incidence, risk factors and treatment outcome of BK polyomavirus nephropathy (BKVN) in a cohort of renal transplant recipients in the Auckland region without a formal BK polyomavirus (BKV) surveillance programme. METHODS: A cohort of 226 patients who received their renal transplants from 2006 to 2012 was retrospectively reviewed. RESULTS: Seventy-six recipients (33.6%) had a BK viral load (BKVL) test and 9 patients (3.9%) developed BKVN. Cold ischaemia time (HR = 1.18, 95%CI: 1.04-1.35) was found to be a risk factor for BKVN. Four recipients with BKVN had complete resolution of their BKV infection; 1 recipient had BKVL less than 625 copies/mL; 3 recipients had BKVL more than 1000 copies/mL and 1 had graft failure from BKVN. BKVN has a negative impact on graft function [median estimated glomerular filtration rate (eGFR) 22.5 (IQR 18.5-53.0) mL/min per 1.73 m2, P = 0.015), but no statistically significant difference (P = 0.374) in renal allograft function was found among negative BK viraemia group [median eGFR 60.0 (IQR 48.5-74.2) mL/min per 1.73 m2), positive BK viraemia without BKVN group [median eGFR 55.0 (IQR 47.0-76.0) mL/min per 1.73 m2] and unknown BKV status group [median eGFR 54.0 (IQR 43.8-71.0) mL/min per 1.73 m2]. The incidence and treatment outcomes of BKVN were similar to some centres with BKV surveillance programmes. CONCLUSION: Recipients with BVKN have poorer graft function. Although active surveillance for BKV has been shown to be effective in reducing incidence of BKVN, it should be tailored specifically to that transplant centre based on its epidemiology and outcomes of BKVN, particularly in centres with limited resources.