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1.
Front Cardiovasc Med ; 9: 907539, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36440016

RESUMO

Background: Although a recent study reported that fibrates are associated with a low risk of cardiovascular (CV) death and can postpone the need for long-term hemodialysis in patients with advanced chronic kidney disease (CKD), little is known regarding whether the CV protective effects of fibrates extend to patients with end-stage renal disease (ESRD). The present study compared CV outcomes and mortality among patients with ESRD treated with fibrates, statins, neither, or their combination. Methods: This cohort study extracted data from Taiwan's National Health Insurance Research Database (NHIRD). Adult patients with ESRD and hyperlipidemia were identified and categorized into four groups (fibrate, statin, combination, and non-user groups) according to their use of different lipid-lowering therapies within 3 months prior to the commencement of permanent dialysis. Inverse probability of treatment weighting was used to balance the baseline characteristics of the groups. The follow-up outcomes were all-cause mortality, CV death, and major adverse cardiac and cerebrovascular events (MACCEs). Results: Compared with the non-user and statin groups, the fibrate group did not exhibit significantly lower risks of all-cause mortality [fibrate vs. non-user: hazard ratio (HR), 0.97; 95% confidence interval (CI), 0.92-1.03; statin vs. fibrate: HR, 0.95; 95% CI, 0.90-1.01], CV death (fibrate vs. non-user: HR, 0.97; 95% CI, 0.90-1.05; statin vs. fibrate: HR, 0.97; 95% CI, 0.90-1.06), and MACCEs (fibrate vs. non-user: HR, 1.03; 95% CI, 0.96-1.10; statin vs. fibrate: HR, 0.94; 95% CI, 0.87-1.004). The combination of fibrates and statins (specifically moderate- to high-potency statins) did not result in lower risks of all-cause mortality, CV death, or MACCEs compared with statins alone. Conclusion: In patients with ESRD, the use of fibrates might be not associated with reduced mortality or CV risks, regardless of whether they are used alone or in combination with statins.

2.
Artigo em Inglês | MEDLINE | ID: mdl-36445496

RESUMO

INTRODUCTION: Excessive version and inclination of the glenoid component during total shoulder arthroplasty can lead to glenohumeral instability, early loosening, and even failure. The orientation and position of the central pin determine the version and inclination of the glenoid component. The purpose of this study was to compare the differences in centerline position and orientation obtained using "3D preoperative planning based on the best-fit method for glenoid elements" and the surgeon's manipulation. MATERIALS AND METHODS: Twenty-nine CT images of glenohumeral osteoarthritis of the shoulder were reconstructed into a 3D model, and a 3D printer was used to create an in vitro model for the surgeon to drill the center pin. The 3D shoulder model was also used for 3D preoperative planning (3DPP) using the best-fit method for glenoid elements. The in vitro model was scanned and the version, inclination and center position were measured to compare with the 3DPP results. RESULTS: The respective mean inclinations (versions) of the surgeon and 3DPP were -2.63° ± 6.60 (2.87° ± 5.97) and -1.96° ± 4.24 (-3.21° ± 4.00), respectively. There was no significant difference in the inclination and version of the surgeon and 3DPP. For surgeons, the probability of the inclination and version being greater than 10° was 13.8% (4/29) and 10.3% (3/29), respectively. Compared to the 3DPP results, the surgeon's center position was shifted down an average of 1.63 mm. There was a significant difference in the center position of the surgeon and 3DPP (p < 0.05). CONCLUSION: The central pin drilled by surgeons using general instruments was significantly lower than those defined using 3D preoperative planning and standard central definitions. 3D preoperative planning prevents the version and inclination of the centerline from exceeding safe values (± 10°).

3.
World J Clin Cases ; 10(32): 11775-11788, 2022 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-36405273

RESUMO

BACKGROUND: Cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS/ HIPEC) for peritoneal surface malignancy can effectively control the disease, however it is also associated with adverse effects which may affect quality of life (QoL). AIM: To investigate early perioperative QoL after CRS/HIPEC, which has not been discussed in Taiwan. METHODS: This single institution, observational cohort study enrolled patients who received CRS/HIPEC. We assessed QoL using the Taiwanese version of the MD Anderson Symptom Inventory (MDASI-T) and European Organization Research and Treatment of Cancer Core Quality of Life Questionnaire (EORTC QLQ-C30). Participants completed the questionnaires before CRS/HIPEC (S1), at the first outpatient follow-up (S2), and 3 mo after CRS/HIPEC (S3). RESULTS: Fifty-eight patients were analyzed. There was no significant perioperative difference in global health status. Significant changes in physical and role functioning scores decreased at S2, and fatigue and pain scores increased at S2 but returned to baseline at S3. Multiple regression analysis showed that age and performance status were significantly correlated with QoL. In the MDASI-T questionnaire, distress/feeling upset and lack of appetite had the highest scores at S1, compared to fatigue and distress/feeling upset at S2, and fatigue and lack of appetite at S3. The leading interference items were working at S1 and S2 and activity at S3. MDASI-T scores were significantly negatively correlated with the EORTC QLQ-C30 results. CONCLUSION: QoL and symptom severity improved or returned to baseline in most categories within 3 mo after CRS/HIPEC. Our findings can help with preoperative consultation and perioperative care.

4.
Nutrients ; 14(19)2022 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-36235673

RESUMO

BACKGROUND: Rigid dietary controls and pill burden make a very-low protein (0.3-0.4 g/kg body weight per day), vegetarian diet supplemented with ketoanalogues of amino acids (sVLPD) hard to follow in the long-term. This study aimed to evaluate whether a ketoanalogue supplemental low-protein diet (sLPD) (0.6 g/kg body weight per day) could also reduce the risks of dialysis among CKD stage 4 patients. METHODS: Patients aged >20 years with a diagnosis of stage 4 CKD who subsequently received ketosteril treatment, which is the most commonly used ketoanalogue of essential amino acids, between 2003 and 2018 were identified from the Chang Gung Research Database (CGRD). Then, these individuals were divided into two groups according to the continuation of ketosteril for more than three months or not. The primary outcome was ESKD requiring maintenance dialysis. RESULTS: With one-year follow-up, the continuation group (n = 303) exhibited a significantly lower incidence of new-onset end-stage kidney disease (ESKD) requiring maintenance dialysis (6.8% vs. 10.4%, hazard ratio [HR]: 0.62, 95% confidence interval [CI]: 0.41-0.94) in comparison to the discontinuation group (n = 238). CONCLUSIONS: This study demonstrated that initiating sLPDs since CKD stage 4 may additionally reduce the short-term risks of commencing dialysis without increasing CV events, infections, or mortality.


Assuntos
Falência Renal Crônica , Insuficiência Renal Crônica , Aminoácidos , Aminoácidos Essenciais , Peso Corporal , Dieta com Restrição de Proteínas/efeitos adversos , Humanos , Falência Renal Crônica/terapia , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/diagnóstico
5.
World J Gastrointest Surg ; 14(8): 809-820, 2022 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-36157361

RESUMO

BACKGROUND: Mesenteric ischemia is significantly more common in end-stage kidney disease patients undergoing chronic dialysis than in the general population and is associated with high morbidity and mortality. However, reports on prognostic factors in this population are limited. AIM: To elucidate the in-hospital outcomes of acute mesenteric ischemia in chronic dialysis patients and to analyze protective factors for survival. METHODS: The case data of 426 chronic dialysis patients who were hospitalized in a tertiary medical center for acute mesenteric ischemia over a 14-year period were retrospectively reviewed. Of these cases, 103 were surgically confirmed, and the patients were enrolled in this study. A Cox regression analysis was used to evaluate the protective factors for survival. RESULTS: The in-hospital mortality rate among the 103 enrolled patients was 46.6%. Univariate analysis was performed to compare factors in survivors and nonsurvivors, with better in-hospital outcomes associated with a surgery delay (defined as the time from onset of signs and symptoms to operation) < 4.5 d, no shock, a higher potassium level on day 1 of hospitalization, no resection of the colon, and a total bowel resection length < 110 cm. After 1 wk of hospitalization, patients with lower white blood cell count and neutrophil counts, higher lymphocyte counts, and lower C-reactive protein levels had better in-hospital outcomes. Following multivariate adjustment, a higher potassium level on day 1 of hospitalization (HR 1.71, 95%CI 1.19 to 2.46; P = 0.004), a lower neutrophil count (HR 0.91, 95%CI 0.84 to 0.99; P = 0.037) at 1 wk after admission, resection not involving the colon (HR 2.70, 95%CI 1.05 to 7.14; P = 0.039), and a total bowel resection length < 110 cm (HR 4.55, 95%CI 1.43 to 14.29; P = 0.010) were significantly associated with survival. CONCLUSION: A surgery delay < 4.5 d, no shock, no resection of the colon, and a total bowel resection length < 110 cm predicted better outcomes in chronic dialysis patients with acute mesenteric ischemia.

6.
Medicine (Baltimore) ; 101(29): e29632, 2022 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-35866836

RESUMO

Adding protein-bound polysaccharide K (PSK) to adjuvant chemotherapy with mitomycin and fluorouracil after gastrectomy for gastric cancer was demonstrated to improve survival in a previous study in Japan. However, the efficacy of PSK outside Japan and in combination with other adjuvant chemotherapeutic agents remains unclear. The aims of this study were to evaluate the efficacy of PSK. We conducted a population-based historical cohort study using the National Health Insurance Research Database of Taiwan. We performed sensitivity analysis with propensity score matching to control for possible confounders. Patients who used PSK (PSK group) were matched at a 1:4 ratio to those who had never used PSK (control group) after adjusting for covariates including sex, age, urbanization, income and comorbidities. The primary outcome was overall survival. Multivariate hazard ratios from competing risk analysis were calculated by adjusting for demographic data and all confounding factors. From 1999 to 2008, we identified 10,617 patients with gastric cancer received gastrectomy and adjuvant chemotherapy. 1295 patients used PSK (PSK group) and 5180 patients never used PSK (control group) were analyzed after propensity score matching. The median overall survival was 6.49 years (95% confidence interval [CI] 5.22-7.63) in the PSK group and 3.59 years (95% CI 3.38-3.80) in the control group. After adjusting for age, sex, urbanization, income, and comorbidities, adding PSK to adjuvant chemotherapy was the most significant prognostic factor for improved survival (hazard ratio 0.76, P < .0001). Adjuvant chemotherapy combined with PSK significantly prolonged overall survival in gastric cancer patients after gastrectomy.


Assuntos
Neoplasias Gástricas , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Estudos de Coortes , Gastrectomia , Humanos , Neoplasias Gástricas/tratamento farmacológico , Neoplasias Gástricas/cirurgia
7.
Taiwan J Obstet Gynecol ; 61(3): 494-500, 2022 May.
Artigo em Inglês | MEDLINE | ID: mdl-35595444

RESUMO

OBJECTIVE: This study (Asian Gynecologic Oncology Group [AGOG]13-001/Taiwanese Gynecologic Oncology Group [TGOG]1006) was to validate human papillomavirus (HPV)16 as an independent good prognostic factor and investigate the impact of treatment modalities to cervical adenocarcinoma and adenosquamous carcinoma (AD/ASC). MATERIALS AND METHODS: Patients receiving primary treatment at AGOG and TGOG member hospitals for cervical AD/ASC were retrospectively (1993-2014) and prospectively (since 2014) enrolled. DNA extraction from paraffin-embedded tissue (FFPE) specimens was used for HPV genotyping. Those with suspected endometrial origin were excluded for analysis. RESULTS: A total of 354 patients with valid HPV results were enrolled, 287 (81.1%) of which had HPV-positive tumors. The top-3 types were HPV 18 (50.8%), HPV16 (22.9%) and HPV45 (4.0%). The HPV16-negativity rates varied widely across hospitals. 322 patients were eligible for prognostic analyses. By multivariate analysis, advanced stage (HR5.8, 95% confidence interval [CI] 2.1-15.8; HR5.8, 95% CI 1.6-20.5), lymph node metastasis (HR4.6, 95% CI 2.7-7.9; HR7.3, 95% CI 3.8-14.0), and HPV16-positivity (HR0.3, 95% CI 0.1-0.6; HR0.3, 95% CI 0.1-0.9) were independent prognostic factors for progression-free survival (PFS) and overall survival (OS). Stage I patients with primary surgery had better 5-year PFS (82.8% vs 50.0% p = 0.020) and OS (89.3% vs 57.1%, p = 0.017) than those with non-primary surgery, while the propensity scores distribution were similar among the treatment groups. CONCLUSION: This study confirmed that HPV16-positivity was a good prognostic factor for PFS and OS in AD/ASC, and patients seemed to have better outcome with primary surgery than non-primary surgery.


Assuntos
Adenocarcinoma , Carcinoma Adenoescamoso , Infecções por Papillomavirus , Neoplasias do Colo do Útero , Adenocarcinoma/patologia , Adenocarcinoma/terapia , Carcinoma Adenoescamoso/terapia , Feminino , Papillomavirus Humano 16/genética , Humanos , Estadiamento de Neoplasias , Papillomaviridae/genética , Infecções por Papillomavirus/complicações , Prognóstico , Estudos Retrospectivos , Neoplasias do Colo do Útero/patologia
8.
Int J Gen Med ; 15: 2991-3001, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35308570

RESUMO

Purpose: The incidence of bloodstream infection among end-stage kidney disease (ESKD) patients on chronic hemodialysis (HD) was 26-fold higher than population controls, causing higher morbidity and costs. The aim of this investigation was to clarify the prognostic factors, in-hospital outcomes and recurrence of infectious spondylitis of patients with and without chronic HD. Patients and Methods: This nationwide study analyzed 2592 patients who admitted for first-time infectious spondylitis between January 1, 2003, and December 31, 2015. Patients were classified into the chronic HD or the non-HD group. The logistic regression model and the general linear model were utilized to determine the impact of chronic HD on in-hospital mortality and recurrence. The Cox proportional hazard model was used to estimate the predictive factors of in-hospital mortality and recurrence. Results: Compared to the non-HD group, patients in the chronic HD group had a higher risk of respiratory failure, sepsis, in-hospital mortality, longer hospital stay, and higher medical spending. Chronic HD was an independent risk factor for in-hospital mortality (hazard ratio 2.21, 95% confidence interval 1.34-3.65, p=0.0019), but not for recurrence. Intravascular device implantation or revision was a prognosticator for the mortality of both groups and a predictor for recurrence of the non-HD group. Surgical treatment was associated with a decreased risk of recurrence, whereas treatment with CT-guided abscess drainage was associated with an increased risk of recurrence in both groups. Conclusion: Patients with infectious spondylitis who were receiving chronic HD had a higher in-hospital mortality compared to those without HD. Intravascular device implantations or revision within 6 months was a significant predictor of in-hospital mortality and disease recurrence. Surgical treatment of infectious spondylitis had a lower risk of recurrence than those with CT-guided abscess drainage in both patient groups.

9.
Phys Chem Chem Phys ; 24(12): 7323-7330, 2022 Mar 23.
Artigo em Inglês | MEDLINE | ID: mdl-35262113

RESUMO

With an urgent demand for low-energy-consumption and wearable devices, it is desirable to find an easy, effective, and low-cost method to fabricate self-powered flexible photodetectors with simple configurations and high-performance. Self-powered photodetectors are normally fabricated based on either two different materials or the same material in contact with two different metal electrodes. Here, a flexible MoS2 photodetector with the same Au electrodes was fabricated on a polyethylene terephthalate (PET) substrate which exhibits self-powered properties. To our knowledge, its configuration is the simplest, and the fabrication process is easy to implement. At a bias of 0 V, the photodetector exhibits a high responsivity of 431 mA W-1, a short response/recovery time of 40 ms/40 ms, and excellent flexibility. Compared with those at a bias of 2 V, a dark current is sufficiently suppressed, and the response/recovery speed is significantly improved. It is found that the driving force of the self-powered photodetector is provided by the asymmetric Schottky barriers originating from the spontaneous generation of two van der Waals gaps with different widths. The asymmetric barriers exist stably at the interfaces between the 2D material and Au electrodes as further observed for ReS2 or GaSe flakes, which show the generality of asymmetric Schottky barriers between the 2D material and Au electrodes. The discovery here thus gives a new way to generate asymmetric Schottky barriers and develop high-performance self-powered photodetectors.

10.
Appl Bionics Biomech ; 2022: 4470153, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-35222692

RESUMO

PDC (polycrystalline diamond compact) bit is the key equipment for drilling holes inside the rock in oil and mining industry. Inspired by the shape and structure of Capra sibirica horn, a bionic lateral PDC reamer bit with variable lateral reaming radius was developed. Side view of Capra sibirica horn was employed for fitting the horn shape curve based on picture processing method. PDC teeth were arranged on the horn shape blade imitating the transverse ridges on the horn to cut the rock material, found with only 30% utilization rate of the total teeth and load concentration of the last tooth. A bionic blade curve evolved from the Capra sibirica horn was defined with geometric method for the lateral reamer bit; the utilization rate of the teeth on the bionic blade curve was improved to 90% with uniformly distributed reaming load. Multigroup simulations were conducted with the finite element method; the effects of bit revolution speed and rotation feed speed of the bionic blade to reaming load were emphatically studied. Concrete sample was reamed indoors from 240 mm to 407 mm in diameter, and the bionic lateral PDC reamer bit was approved by the test result.

11.
Materials (Basel) ; 15(3)2022 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-35160725

RESUMO

In order to present the multiple reflow process during electronic packaging, the influence of the different short-time reheating temperatures on the microstructure and shear strength of the Cu/Au80Sn20/Cu solder joints was studied and discussed. The results showed that high-quality Cu/Au80Sn20/Cu solder joints were obtained with 30 °C for 3 min. The joints were mainly composed of the ζ-(Au,Cu)5Sn intermetallic compound (IMC) with an average thickness of 8 µm between Cu and solder matrix, and (ζ-(Au,Cu)5Sn +δ-(Au,Cu)Sn) eutectic structure in the solder matrix. With an increase in the multiple reflow temperature from 180 °C to 250 °C, the microstructure of the joint interface showed little change due to the barrier effect of the formed ζ IMC layer and the limitation of short-time reheating on the element diffusion. The eutectic structures in the solder matrix were coarsened and transformed from lamellar to the bulk morphology. The shear strength of the as-welded joint reached 31.5 MPa. The joint shear strength decreased slightly with reheating temperatures lower than 200 °C, while it decreased significantly (by about 10%) with reheating temperatures above 250 °C compared to the as-welded joint. The shear strength of the joints was determined by the brittle solder matrix, showing that the joint strength decreased with the coarsening of the δ phase in the eutectic structure.

12.
J Microbiol Immunol Infect ; 55(1): 114-122, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33610510

RESUMO

BACKGROUND: To elucidate the linkage between organisms and visual outcome in cases of endogenous endophthalmitis. METHODS: Patients who presented with signs of endogenous endophthalmitis between January 2008 and December 2015 and underwent a vitreous tapping were enrolled. The patients' demographics and clinical findings were recorded. The outcomes include visual acuity and enucleation. RESULTS: A total of 175 consecutive patients with endogenous endophthalmitis were enrolled. Forty-four percent of the patients had a known distal focus of infection. The most common focus was liver abscess (24.6%), and the major intravitreal isolate was Klebsiella pneumoniae (34.4%). In this series, 51.4% of the intravitreal cultures were positive. The visual acuity of fungal ophthalmitis were better than in bacterial ophthalmitis. Multivariate logistic regression showed that Gram negative vitreous isolates, compared with the negative vitreous culture, were associated with higher risk of enucleation (Odds ratio [OR]: 10.424, 95% confidence interval [95% CI]: 3.019-35.995). The use of intravitreal antibiotics, compared non-users, was associated with a reduced risk of enucleation (OR:0.084, 95% CI: 0.026-0.268). Trans pars plana vitrectomy was not associated with risk of enucleation (OR: 0.307, 95% CI: 0.035-2.693). The post-treatment VA was positively correlated with the presenting VA (r = 0.718, p = 0.0001). CONCLUSION: Our study demonstrated that liver abscess is the most common source of endogenous endophthalmitis in Taiwan. The visual outcome is good when the presenting visual acuity is relatively well preserved and when the infecting organism is fungus. The use of intra-vitreal antibiotics reduces the risk of enucleation.


Assuntos
Endoftalmite , Infecções Oculares Bacterianas , Antibacterianos/uso terapêutico , Endoftalmite/tratamento farmacológico , Endoftalmite/epidemiologia , Endoftalmite/microbiologia , Infecções Oculares Bacterianas/tratamento farmacológico , Infecções Oculares Bacterianas/microbiologia , Infecções Oculares Bacterianas/cirurgia , Humanos , Estudos Retrospectivos , Taiwan/epidemiologia , Centros de Atenção Terciária , Vitrectomia , Corpo Vítreo/microbiologia , Corpo Vítreo/cirurgia
13.
Healthcare (Basel) ; 9(11)2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34828498

RESUMO

BACKGROUND: Anemia and pancytopenia are not uncommon in patients with chronic kidney disease (CKD). Nevertheless, there is insufficient literature analyzing bone marrow pathology in patients with CKD or end-stage kidney disease (ESKD) receiving dialysis. METHODS: This observational cohort study included 22 patients with ESKD and 23 patients with CKD that received bone marrow biopsy and aspiration at Chang Gung Memorial Hospital. Demographic, hematological, and biochemical data were collected at the time of bone marrow study for analysis. RESULTS: Bone marrow aspiration demonstrated that patients with ESKD had a lower percentage of blasts than patients with CKD (0.52 ± 0.84 versus 1.06 ± 0.78 %, p = 0.033). Bone marrow biopsy revealed that the overall incidence of hypocellular bone marrow was 55.6%. Furthermore, patients with ESKD had higher proportion of hypocellular bone marrow than patients with CKD (72.7% versus 39.1%, p = 0.023). In a multivariate logistic regression model, it was revealed that ESKD status (odds ratio 9.43, 95% confidence interval 1.66-53.63, p = 0.011) and megakaryocyte count within bone marrow (odds ratio 0.48, 95% confidence interval 0.29-0.79, p = 0.004) were significant predictors for bone marrow hypocellularity. CONCLUSION: Bone marrow hypocellularity is common in patients with kidney dysfunction. Hypocellular marrow occurs more frequently in patients with ESKD than patients with CKD.

14.
Phys Rev Lett ; 127(12): 126402, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34597091

RESUMO

The spin polarization in nonmagnetic materials is conventionally attributed to the outcome of spin-orbit coupling when the global inversion symmetry is broken. The recently discovered hidden spin polarization indicates that a specific atomic site asymmetry could also induce measurable spin polarization, leading to a paradigm shift in research on centrosymmetric crystals for potential spintronic applications. Here, combining spin- and angle-resolved photoemission spectroscopy and theoretical calculations, we report distinct spin-momentum-layer locking phenomena in a centrosymmetric, layered material, BiOI. The measured spin is highly polarized along the Brillouin zone boundary, while the same effect almost vanishes around the zone center due to its nonsymmorphic crystal structure. Our work demonstrates the existence of momentum-dependent hidden spin polarization and uncovers the microscopic mechanism of spin, momentum, and layer locking to each other, thus shedding light on the design metrics for future spintronic materials.

15.
Nutrients ; 13(9)2021 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-34578879

RESUMO

BACKGROUND: Although several studies suggest the benefit of a low-protein diet supplemented with amino acids and keto acids (sLPD) in delaying the initiation of hemodialysis, evidence on whether these nutritional approaches could delay the timing of preemptive transplantation is lacking. METHODS: Retrospective nationwide cohort study, from Taiwan's National Health Insurance Research Database. Patients having undergone a first preemptive kidney transplantation between 2001 and 2017 were identified and divided into two groups according to the presence of sLPD treatment or not. The primary outcome was the time between the diagnosis of advanced CKD and transplantation. Secondary outcomes were post-transplantation adverse events. RESULTS: A total of 245 patients who received their first preemptive kidney transplantation were identified from the nationwide database; 63 of them had been on an sLPD prior to transplantation (sLPD group). The duration between the day of advanced CKD diagnosis and the day of transplantation was significantly longer in the sLPD group compared with the non-sLPD group (median duration: 345 vs. 220 days, p = 0.001). The risk of post-transplantation adverse events did not differ between the two groups. CONCLUSIONS: Within the limits of its observational, retrospective design, this is the first study to suggest that nutritional management with sLPDs can safely delay the timing of preemptive kidney transplantation.


Assuntos
Aminoácidos/uso terapêutico , Dieta com Restrição de Proteínas , Suplementos Nutricionais , Cetoácidos/uso terapêutico , Transplante de Rim , Terapia Nutricional , Insuficiência Renal Crônica/terapia , Adulto , Progressão da Doença , Feminino , Humanos , Rim/patologia , Rim/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pré-Operatórios , Diálise Renal , Estudos Retrospectivos
16.
Med Image Anal ; 73: 102134, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34246847

RESUMO

Segmentation of ovary and follicles from 3D ultrasound (US) is the crucial technique of measurement tools for female infertility diagnosis. Since manual segmentation is time-consuming and operator-dependent, an accurate and fast segmentation method is highly demanded. However, it is challenging for current deep-learning based methods to segment ovary and follicles precisely due to ambiguous boundaries and insufficient annotations. In this paper, we propose a contrastive rendering (C-Rend) framework to segment ovary and follicles with detail-refined boundaries. Furthermore, we incorporate the proposed C-Rend with a semi-supervised learning (SSL) framework, leveraging unlabeled data for better performance. Highlights of this paper include: (1) A rendering task is performed to estimate boundary accurately via enriched feature representation learning. (2) Point-wise contrastive learning is proposed to enhance the similarity of intra-class points and contrastively decrease the similarity of inter-class points. (3) The C-Rend plays a complementary role for the SSL framework in uncertainty-aware learning, which could provide reliable supervision information and achieve superior segmentation performance. Through extensive validation on large in-house datasets with partial annotations, our method outperforms state-of-the-art methods in various evaluation metrics for both the ovary and follicles.


Assuntos
Ovário , Aprendizado de Máquina Supervisionado , Benchmarking , Feminino , Humanos , Ovário/diagnóstico por imagem , Ultrassonografia , Incerteza
17.
Front Microbiol ; 12: 629153, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34122355

RESUMO

Viral DNA integrated in host cells is a major barrier to completely curing HIV-1. However, genome editing using the recently developed technique of clustered regularly interspaced short palindromic repeats (CRISPR)/Cas9 has the potential to eradicate HIV-1. The present study aimed to use a lentiviral vector-based CRISPR/Cas9 system combined with dual-small/single guide RNAs (sgRNAs) to attack HIV-1 DNA in the latency reactivation model J-Lat 10.6 cell line and to assess off-target effects using whole-genome sequencing (WGS). We designed 12 sgRNAs targeting HIV-1 DNA, and selected high-efficiency sgRNAs for further pairwise combinations after a preliminary evaluation of the editing efficiency. Three combinations of dual-sgRNAs/Cas9 with high editing efficiency were screened successfully from multiple combinations. Among these combinations, the incidences of insertions and deletions in the sgRNA-targeted regions reached 76% and above, and no credible off-target sites were detected using WGS. The results provided comprehensive basic experimental evidence and methodological recommendations for future personalized HIV-1 treatment using CRISPR/Cas9 genome editing technology.

18.
J Clin Med ; 10(10)2021 May 13.
Artigo em Inglês | MEDLINE | ID: mdl-34068144

RESUMO

Among hemodialysis patients aged more than 40 years old, previous large-scale studies showed statin treatment had no effect on reducing cardiovascular adverse events. However, young-adult-onset end-stage renal disease (ESRD) patients have different physicosocial factors compared to older ESRD patients. The benefit of statins in such a specific group has not been well evaluated. Through the use of Taiwan's National Health Insurance Research Database (NHIRD), young adult patients aged 20-40 with incident ESRD requiring permanent dialysis between 1 January 2003 and 31 December 2015 were identified. The enrollees were further divided into two groups depending on whether they received statin therapy for more than 90 days (statin group) or never received any statin (nonstatin group) in the first year after initiation of dialysis. Propensity score weighting (PSW) was used to balance the baseline characteristics between the two groups. After PSW, the statin group (n = 771) exhibited a higher rate of major adverse cardiac and cerebrovascular events (MACCEs) (2.65% vs. 1.44%, hazard ratio (HR): 1.87, 95% confidence interval (CI): 1.43-2.45), and acute myocardial infarction (1.51% vs. 0.30%, HR: 5.34, 95% CI: 3.40-8.39) compared to the nonstatin group (n = 1709). The risk of all-cause mortality, cardiovascular (CV) death. and stroke did not significantly differ between the two groups. Similar to older patients, this study demonstrated that statin therapy cannot offer any protective effects in reducing CV outcomes among young adult ESRD patients undergoing dialysis.

19.
Sci Rep ; 11(1): 11615, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34079035

RESUMO

This study analysed the clinical patterns and outcomes of elderly patients with organophosphate intoxication. A total of 71 elderly patients with organophosphate poisoning were seen between 2008 and 2017. Patients were stratified into two subgroups: survivors (n = 57) or nonsurvivors (n = 14). Chlorpyrifos accounted for 33.8% of the cases, followed by methamidophos (12.7%) and mevinphos (11.3%). Mood, adjustment and psychotic disorder were noted in 39.4%, 33.8% and 2.8% of patients, respectively. All patients were treated with atropine and pralidoxime therapies. Acute cholinergic crisis developed in all cases (100.0%). The complications included respiratory failure (52.1%), aspiration pneumonia (50.7%), acute kidney injury (43.7%), severe consciousness disturbance (25.4%), shock (14.1%) and seizures (4.2%). Some patients also developed intermediate syndrome (15.5%) and delayed neuropathy (4.2%). The nonsurvivors suffered higher rates of hypotension (P < 0.001), shock (P < 0.001) and kidney injury (P = 0.001) than survivors did. Kaplan-Meier analysis indicated that patients with shock suffered lower cumulative survival than did patients without shock (log-rank test, P < 0.001). In a multivariate-Cox-regression model, shock was a significant predictor of mortality after intoxication (odds ratio 18.182, 95% confidence interval 2.045-166.667, P = 0.009). The mortality rate was 19.7%. Acute cholinergic crisis, intermediate syndrome, and delayed neuropathy developed in 100.0%, 15.5%, and 4.2% of patients, respectively.


Assuntos
Injúria Renal Aguda/tratamento farmacológico , Antídotos/uso terapêutico , Inseticidas/toxicidade , Intoxicação por Organofosfatos/tratamento farmacológico , Pneumonia Aspirativa/tratamento farmacológico , Insuficiência Respiratória/tratamento farmacológico , Injúria Renal Aguda/induzido quimicamente , Injúria Renal Aguda/mortalidade , Injúria Renal Aguda/fisiopatologia , Afeto/efeitos dos fármacos , Idoso , Atropina/uso terapêutico , Clorpirifos/antagonistas & inibidores , Clorpirifos/toxicidade , Feminino , Humanos , Inseticidas/antagonistas & inibidores , Masculino , Mevinfós/antagonistas & inibidores , Mevinfós/toxicidade , Pessoa de Meia-Idade , Intoxicação por Organofosfatos/etiologia , Intoxicação por Organofosfatos/mortalidade , Intoxicação por Organofosfatos/fisiopatologia , Compostos Organotiofosforados/antagonistas & inibidores , Compostos Organotiofosforados/toxicidade , Pneumonia Aspirativa/induzido quimicamente , Pneumonia Aspirativa/mortalidade , Pneumonia Aspirativa/fisiopatologia , Compostos de Pralidoxima/uso terapêutico , Transtornos Psicóticos/tratamento farmacológico , Transtornos Psicóticos/etiologia , Transtornos Psicóticos/mortalidade , Transtornos Psicóticos/fisiopatologia , Insuficiência Respiratória/induzido quimicamente , Insuficiência Respiratória/mortalidade , Insuficiência Respiratória/fisiopatologia , Estudos Retrospectivos , Convulsões/induzido quimicamente , Convulsões/tratamento farmacológico , Convulsões/mortalidade , Convulsões/fisiopatologia , Choque/induzido quimicamente , Choque/tratamento farmacológico , Choque/mortalidade , Choque/fisiopatologia , Análise de Sobrevida , Resultado do Tratamento
20.
Med Image Anal ; 72: 102119, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34144345

RESUMO

3D ultrasound (US) has become prevalent due to its rich spatial and diagnostic information not contained in 2D US. Moreover, 3D US can contain multiple standard planes (SPs) in one shot. Thus, automatically localizing SPs in 3D US has the potential to improve user-independence and scanning-efficiency. However, manual SP localization in 3D US is challenging because of the low image quality, huge search space and large anatomical variability. In this work, we propose a novel multi-agent reinforcement learning (MARL) framework to simultaneously localize multiple SPs in 3D US. Our contribution is four-fold. First, our proposed method is general and it can accurately localize multiple SPs in different challenging US datasets. Second, we equip the MARL system with a recurrent neural network (RNN) based collaborative module, which can strengthen the communication among agents and learn the spatial relationship among planes effectively. Third, we explore to adopt the neural architecture search (NAS) to automatically design the network architecture of both the agents and the collaborative module. Last, we believe we are the first to realize automatic SP localization in pelvic US volumes, and note that our approach can handle both normal and abnormal uterus cases. Extensively validated on two challenging datasets of the uterus and fetal brain, our proposed method achieves the average localization accuracy of 7.03∘/1.59mm and 9.75∘/1.19mm. Experimental results show that our light-weight MARL model has higher accuracy than state-of-the-art methods.


Assuntos
Redes Neurais de Computação , Útero , Feminino , Humanos , Imageamento Tridimensional , Ultrassonografia
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