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1.
J Clin Med ; 11(9)2022 Apr 27.
Artigo em Inglês | MEDLINE | ID: mdl-35566577

RESUMO

The number of patients requiring prolonged mechanical ventilation (PMV) is increasing worldwide, placing a burden on healthcare systems. Therefore, investigating the pathophysiology, risk factors, and treatment for PMV is crucial. Various underlying comorbidities have been associated with PMV. The pathophysiology of PMV includes the presence of an abnormal respiratory drive or ventilator-induced diaphragm dysfunction. Numerous studies have demonstrated that ventilator-induced diaphragm dysfunction is related to increases in in-hospital deaths, nosocomial pneumonia, oxidative stress, lung tissue hypoxia, ventilator dependence, and costs. Thus far, the pathophysiologic evidence for PMV has been derived from clinical human studies and experimental studies in animals. Moreover, recent studies have demonstrated the outcome benefits of pharmacological agents and rehabilitative programs for patients requiring PMV. However, methodological limitations affected these studies. Controlled prospective studies with an adequate number of participants are necessary to provide evidence of the mechanism, prognosis, and treatment of PMV. The great epidemiologic impact of PMV and the potential development of treatment make this a key research field.

2.
Int J Mol Sci ; 23(3)2022 Jan 19.
Artigo em Inglês | MEDLINE | ID: mdl-35163007

RESUMO

Mechanical ventilation (MV) is essential for patients with sepsis-related respiratory failure but can cause ventilator-induced diaphragm dysfunction (VIDD), which involves diaphragmatic myofiber atrophy and contractile inactivity. Mitochondrial DNA, oxidative stress, mitochondrial dynamics, and biogenesis are associated with VIDD. Hypoxia-inducible factor 1α (HIF-1α) is crucial in the modulation of diaphragm immune responses. The mechanism through which HIF-1α and mitochondria affect sepsis-related diaphragm injury is unknown. We hypothesized that MV with or without endotoxin administration would aggravate diaphragmatic and mitochondrial injuries through HIF-1α. C57BL/6 mice, either wild-type or HIF-1α-deficient, were exposed to MV with or without endotoxemia for 8 h. MV with endotoxemia augmented VIDD and mitochondrial damage, which presented as increased oxidative loads, dynamin-related protein 1 level, mitochondrial DNA level, and the expressions of HIF-1α and light chain 3-II. Furthermore, disarrayed myofibrils; disorganized mitochondria; increased autophagosome numbers; and substantially decreased diaphragm contractility, electron transport chain activities, mitofusin 2, mitochondrial transcription factor A, peroxisome proliferator activated receptor-γ coactivator-1α, and prolyl hydroxylase domain 2 were observed (p < 0.05). Endotoxin-stimulated VIDD and mitochondrial injuries were alleviated in HIF-1α-deficient mice (p < 0.05). Our data revealed that endotoxin aggravated MV-induced diaphragmatic dysfunction and mitochondrial damages, partially through the HIF-1α signaling pathway.


Assuntos
Diafragma/lesões , Endotoxemia/terapia , Endotoxinas/efeitos adversos , Subunidade alfa do Fator 1 Induzível por Hipóxia/genética , Mitocôndrias/metabolismo , Respiração Artificial/efeitos adversos , Animais , Diafragma/metabolismo , Diafragma/fisiopatologia , Modelos Animais de Doenças , Endotoxemia/etiologia , Endotoxemia/metabolismo , Técnicas de Inativação de Genes , Subunidade alfa do Fator 1 Induzível por Hipóxia/metabolismo , Camundongos , Camundongos Endogâmicos C57BL , Contração Muscular , Estresse Oxidativo , Transdução de Sinais
3.
J Biosci Bioeng ; 132(4): 359-364, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34389241

RESUMO

Macroalgae (seaweeds) are abundant in functional polysaccharides known for their unique biochemical activities. In this study, the antioxidant, anti-lipogenic, and anti-inflammatory activities of the fucoidan extracted from brown seaweed Sargassum siliquosum were investigated by 1,1-diphenyl-2-picrylhydrazyl (DPPH)-scavenging ability, lipid synthesis inhibition, and suppression of pro-inflammatory cytokine tumor necrosis factor-alpha (TNF-α) production, respectively. To examine the effect of molecular mass on fucoidan's bioactivities above, the extracted fucoidan was subject to hydrogen peroxide-mediated partial hydrolysis to obtain lower molecular mass compounds within the range of 107.3-3.2 kDa. Results indicated that fucoidan's antioxidant activity increased with a corresponding decrease in molecular mass; the dosage for the half-maximal response (EC50) dropped from 2.58 to 1.82 mg/mL when the molecular mass decreased from 107.3 to 3.2 kDa. In addition, both the anti-lipogenesis and anti-inflammatory activities of fucoidan were significantly enhanced by 71.1% and 36.7%, respectively, when the molecular mass decreased to about 3 kDa. To further test the effect of sulfation on fucoidan's bioactivities, low molecular mass fucoidan was treated with SO3-DMF to increase the sulfate content. The results indicated that when sulfate content increased from 18.7% to 32.1%, EC50 of DPPH decreased from 1.82 mg/mL to 0.86 mg/mL and the anti-inflammatory activity also increased by 35.2%; however, the anti-lipogenesis activity decreased.


Assuntos
Sargassum , Anti-Inflamatórios/farmacologia , Antioxidantes/farmacologia , Polissacarídeos/farmacologia , Sulfatos
4.
Sleep Breath ; 2021 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-34145538

RESUMO

PURPOSE: Continuous positive airway pressure (CPAP) is a standard treatment for obstructive sleep apnea (OSA). However, CPAP has limitations. High-flow nasal cannula (HFNC) is already in use for various types of respiratory diseases. As HFNC generates positive airway pressure, it may be a potential candidate for OSA treatment. This prospective study compared the therapeutic effects of HFNC to CPAP in patients with OSA. METHODS: Patients whose apnea-hypopnea index (AHI) was > 5 events/h were enrolled in this study. All participants were randomly divided into two groups. The first group underwent CPAP the first night and HFNC the second night. Conversely, the second group received HFNC the first night and CPAP the second night. Their respiratory events and sleep quality were compared using baseline polysomnography, CPAP, and HFNC. RESULTS: In total, 28 participants completed this study. Median [interquartile range] AHI (35.0 [20.0-48.6] vs. 10.8 [5.5-20.6] events/h; p < 0.001) was significantly improved by the HFNC. However, sleep quality was not improved. When CPAP was compared directly with HFNC, CPAP demonstrated a more favorable effect for respiratory events (AHI 5.0 [2.0-7.0] vs. 10.8 [5.5-20.6] events/h; p < 0.001) and sleep efficiency (88.1 [79.9-92.5] vs. 77.9 [69.2-86.6] %; p = 0.001). CONCLUSION: The efficacy of CPAP was superior to HFNC for both respiratory events and sleep quality. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03843372; URL: www.clinicaltrials.gov ; Date of registration: November 2, 2019.

5.
Enzyme Microb Technol ; 148: 109811, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34116745

RESUMO

Microbial production of industrial chemicals is a sustainable approach to reduce the dependence on petroleum-based chemicals such as acids, alcohols, and amines, in which the cadaverine is a natural diamide and serves as one of the key monomers for biopolymer production. In this study, the constitutive promoter J23100 driven lysine decarboxylase (CadA) for cadaverine production was established and compared in different Escherichia coli strains. The best chassis designed as JW, expressed the highest amount of CadA by using J23100 promoter, showing stable and high copy numbers (i.e., PCN > 100) when culture in the antibiotic-free medium. JW attained a CadA activity of 167 g-DAP/g-DCW-h and had the maximum biocatalyst of 45.6 g-DCW/L in fed-batch fermentation. In addition, JW was able to convert 2.5 M L-lysine to 221 g/L cadaverine, with 86 % yield and 55.3 g/L-h productivity. The whole-cell biocatalyst could be reused over four times at an average of 97 % conversion when supplied half of fresh cells in the reaction. This work developed a stable, constitutive expression, long-term preservation, high-level expression of CadA for DAP production, and paved an alternative opportunity of bio-nylon for industry in the future.


Assuntos
Carboxiliases , Escherichia coli , Cadaverina , Carboxiliases/genética , Escherichia coli/genética , Lisina
6.
PLoS One ; 16(2): e0245286, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33544751

RESUMO

The use of magnetic nanoparticles (MNPs) magnetized on applying an alternating magnetic field (AMF) to stimulate the thermal characteristics and to induce tumor apoptosis is a currently active area of research in cancer treatment. In previous work, we developed biocompatible and superparamagnetic polystyrene-sulfonic-acid-coated magnetic nanoparticles (PSS-MNPs) as applications for magnetically labeled cell trapping, but without assessment of treatment effects on tumor diseases. In the present work, we examined PSS-MNP-induced magnetic fluid hyperthermia (MFH) on SK-Hep1 hepatocellular carcinoma (HCC) cells for lethal thermal effects with a self-made AMF system; an adjustable AMF frequency generated a variable intensity of magnetic field and induced MNP relaxation. The extracellular and intracellular MFH treatments on a SK-Hep1 cell line were implemented in vitro; the result indicates that the lethal effects were efficient and caused a significantly decreased cell viability of SK-Hep1 cells. As the PSS-MNP concentration decreased, especially in intracellular MFH treatments, the MFH effects on cells, however, largely decreased through heat spreading to the culture medium. On controlling and decreasing the volume of culture medium, the problem of heat spreading was solved. It can be consequently expected that PSS-MNPs would be a prospective agent for intracellular cancer magnetotherapy.


Assuntos
Carcinoma Hepatocelular/terapia , Hipertermia Induzida/métodos , Neoplasias Hepáticas/terapia , Nanopartículas de Magnetita/uso terapêutico , Poliestirenos/uso terapêutico , Linhagem Celular Tumoral , Sobrevivência Celular , Humanos
7.
Int J Mol Sci ; 22(4)2021 Feb 08.
Artigo em Inglês | MEDLINE | ID: mdl-33567713

RESUMO

Mechanical ventilation (MV) is required to maintain life for patients with sepsis-related acute lung injury but can cause diaphragmatic myotrauma with muscle damage and weakness, known as ventilator-induced diaphragm dysfunction (VIDD). Hypoxia-inducible factor 1α (HIF-1α) plays a crucial role in inducing inflammation and apoptosis. Low-molecular-weight heparin (LMWH) was proven to have anti-inflammatory properties. However, HIF-1α and LMWH affect sepsis-related diaphragm injury has not been investigated. We hypothesized that LMWH would reduce endotoxin-augmented VIDD through HIF-1α. C57BL/6 mice, either wild-type or HIF-1α-deficient, were exposed to MV with or without endotoxemia for 8 h. Enoxaparin (4 mg/kg) was administered subcutaneously 30 min before MV. MV with endotoxemia aggravated VIDD, as demonstrated by increased interleukin-6 and macrophage inflammatory protein-2 levels, oxidative loads, and the expression of HIF-1α, calpain, caspase-3, atrogin-1, muscle ring finger-1, and microtubule-associated protein light chain 3-II. Disorganized myofibrils, disrupted mitochondria, increased numbers of autophagic and apoptotic mediators, substantial apoptosis of diaphragm muscle fibers, and decreased diaphragm function were also observed (p < 0.05). Endotoxin-exacerbated VIDD and myonuclear apoptosis were attenuated by pharmacologic inhibition by LMWH and in HIF-1α-deficient mice (p < 0.05). Our data indicate that enoxaparin reduces endotoxin-augmented MV-induced diaphragmatic injury, partially through HIF-1α pathway inhibition.


Assuntos
Diafragma/efeitos dos fármacos , Modelos Animais de Doenças , Endotoxemia/complicações , Heparina de Baixo Peso Molecular/farmacologia , Subunidade alfa do Fator 1 Induzível por Hipóxia/fisiologia , Estresse Oxidativo/efeitos dos fármacos , Lesão Pulmonar Induzida por Ventilação Mecânica/tratamento farmacológico , Animais , Endotoxemia/induzido quimicamente , Endotoxemia/patologia , Lipopolissacarídeos/toxicidade , Camundongos , Camundongos Endogâmicos C57BL , Camundongos Knockout , Lesão Pulmonar Induzida por Ventilação Mecânica/etiologia , Lesão Pulmonar Induzida por Ventilação Mecânica/metabolismo , Lesão Pulmonar Induzida por Ventilação Mecânica/patologia
8.
ACS Omega ; 5(50): 32447-32455, 2020 Dec 22.
Artigo em Inglês | MEDLINE | ID: mdl-33376882

RESUMO

Fucoidans are heterologous polysaccharides commonly seen in brown macroalgae and are known for their biological activity including anticancer, antiangiogenic, immunomodulation, and antiviral properties. The brown macroalga Sargassum siliquosum was used for the extraction and analysis of fucoidan in this study. The S. siliquosum fucoidan was indicated as a galactofucoidan composed of sugars, uronate, and sulfate at a ratio of 12:1:4 and its purity was 85% based on the abovementioned three major components. Structural analysis by electrospray ionization collision-induced dissociation tandem mass spectroscopy revealed that the purified fucoidan consisted of a carbohydrate chain composed of (1→3)-linked or (1→4)-linked l-fucose residues, with sulfate groups at C-2 and C-4 positions. Galactose residues with (1→4)-linkages function as the branch points and they are located at the C-3 or C-4 position of fucose residues. Galactose residues are sulfated mainly at C-4 and C-6, while some sulfation can also be seen at C-2. The fucoidan purified from S. siliquosum demonstrated antioxidant, anti-inflammatory, and antilipogenic activities.

9.
J Healthc Eng ; 2020: 9180856, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32676177

RESUMO

Background: A conventional centrally inserted central catheter (CICC) is frequently used to measure central venous pressure (CVP) to monitor the cardiocirculatory status of patients. The tip of the totally implanted port (TIP) is inserted at the same location in the superior vena cava as that of a CICC, and the TIP has been implanted in many patients with cancer. Measurements of CVP using CICC (CICCP) and TIP (TIPP) may be closely related. Material and Methods. Ten patients with TIPs in an intensive care unit were prospectively studied, and 121 records of 4536 paired CICCP and TIPP measurements were collected. A bench test in a static or dynamic setting was performed, and 598 paired measurements taken using CICC and TIP were recorded. Results: The measurement of TIPP was highly correlated with that of CICCP in patients with cancer, especially those in a calm state. Patients with a calm state and ≥3 consecutive identical TIPP were recorded (≥30 seconds), and 90% of the mean difference between CICCP and TIPP was ≤2 mmHg. The pressure measurements recorded using CICC and TIP were identical in both the static and dynamic bench tests. Conclusions: TIP may be an alternative to CICC for measuring CVP.


Assuntos
Cateterismo Venoso Central , Pressão Venosa Central/fisiologia , Próteses e Implantes , Dispositivos de Acesso Vascular , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
10.
J Formos Med Assoc ; 119(1 Pt 2): 276-281, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31153724

RESUMO

BACKGROUND/PURPOSE: Patients with cancer are eligible for hospice care when their life expectancy is 180 days or shorter. This study investigated the prognostic factors of patients with cancer and sepsis who were admitted to an intensive care unit (ICU) to assist with clinical decisions of hospice care. METHODS: A series of 279 patients admitted to the medical ICU with cancer and sepsis were included. Another series of 109 patients with cancer and sepsis admitted to the other medical ICU in the different branch of our hospital was included to verify the results. RESULTS: Among 279 patients, the 30-, 90-, and 180-day mortality rates were 47.3%, 72.0%, and 81.0%, respectively. APACHE II score and the cancer control status (controlled or remission (CR), active newly diagnosed (AND) and active recurrent or progressive (ARP)) were significant predictors of 30- and 90-day mortality(30-day: AND(odds ratio: 5.66; 95% confidence interval: 2.12-15.15), ARP(6.24; 2.92-13.33), APACHE II( 1.07; 1.03-1.11); 90-day: AND(4.78; 1.91-11.99), ARP( 24.03; 11.11-51.99), APACHE II( 1.07; 1.02-1.19)) and were associated with a poor 180-day outcome. The 180-day mortality were significantly different among the patients with different cancer control status in the series of 279 patients (CR: 29.8%; AND: 69.4%; and ARP: 98.9 %) and that of 109 patients (46.4%; 96.8%; and 94.0%). CONCLUSION: APACHE II score and the cancer control status may be the prognostic factors for critically ill patients with cancer and sepsis, and they may be helpful for evaluating hospice care.


Assuntos
Mortalidade Hospitalar , Neoplasias/mortalidade , Sepse/mortalidade , APACHE , Idoso , Tomada de Decisão Clínica , Estado Terminal/mortalidade , Feminino , Cuidados Paliativos na Terminalidade da Vida , Humanos , Unidades de Terapia Intensiva , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Neoplasias/diagnóstico , Prognóstico , Indução de Remissão , Estudos Retrospectivos , Sepse/diagnóstico , Taiwan , Fatores de Tempo
11.
Int J Chron Obstruct Pulmon Dis ; 14: 2257-2266, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31631995

RESUMO

Background: The BODE index is a multidimensional grading system for predicting the prognoses of patients with chronic obstructive pulmonary disease (COPD). This study investigated whether an amino acids-based metabolic profile developed for heart failure patients (including histidine, ornithine, phenylalanine, and leucine) could identify COPD patients and further discriminates COPD patients in advanced BODE stages. Methods: Ultra-performance liquid chromatography was performed on 119 participants, including 75 COPD patients at different BODE stages and 44 normal controls. Albumin, pre-albumin, transferrin, high sensitivity C-reactive protein, and hand grip strength were also measured. Receiver operating characteristic curves and area under curves were used for estimation. Results: The BODE points in our patients were 3.29 [95% confidence interval (CI) = 2.74-3.85]. Compared to normal controls, COPD patients had lower leucine but higher ornithine levels. A COPD score, developed based on leucine and ornithine, significantly discriminated COPD from normal controls [odds ratio (OR) = 2.71, 95% CI = 1.83-4.04, p <0.001]. A COPD score of ≥ 3.00 had an OR of 15.58 (95% CI = 5.96-40.73, p <0.001). In COPD patients from BODE 1 to BODE 4, the levels of histidine, ornithine and phenylalanine increased significantly. In multivariable analysis, histidine and phenylalanine were independently able to distinguish BODE stages 3 and 4 from BODE 1 and were adopted to develop a metabolic score. Metabolic scores identified patients at BODE 3 and 4 (OR = 2.74, 95% CI =1.41-5.29, p = 0.003) better than hand grip strength, high sensitive C-reactive protein, albumin, pre-albumin, and transferrin value. A metabolic score of ≥9.53 significantly discriminated BODE 3 and 4 from BODE 1 and 2 (OR = 8.56, 95% CI = 2.77-26.39, p <0.001). Conclusion: Amino acid-based COPD score and metabolic score discriminate COPD patients from normal controls, and identify patients in advanced stages of COPD.


Assuntos
Aminoácidos/metabolismo , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/metabolismo , Idoso , Idoso de 80 Anos ou mais , Técnicas e Procedimentos Diagnósticos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Índice de Gravidade de Doença
12.
Neuropsychiatr Dis Treat ; 15: 2129-2136, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31413578

RESUMO

Objective: Periodic leg movement in sleep (PLMS) is common among patients with obstructive sleep apnea (OSA). The PLMS frequency changes after continuous positive airway pressure (CPAP) titration. This study investigated the effects of two PLMS diagnostic criteria on PLMS prevalence and the restless leg syndrome (RLS) detection rate in patients with OSA before and after CPAP titration. Methods: This retrospective study included patients with OSA who received polysomnography (PSG) and successful CPAP titration from December 2012 to December 2014. Their clinical variables and sleep parameters were evaluated using the PLMS diagnostic criteria: PLMS index (PLMI) ≥5 and ≥15. PLMS prevalence and the RLS detection rate were analyzed according to the PLMI before and after CPAP. Results: In patients with OSA with a PLMI of ≥5 and ≥15 after PSG with CPAP titration, the PLMS prevalence was 20.1% (76/378) and 4.5% (17/378), respectively, which revealed CPAP titration increased PLMI. Moreover, in terms of PLMI ≥5 and ≥15, PSG with CPAP titration led to significantly higher PLMS prevalence than PSG alone (20.1% vs 7.1% and 4.5% vs 0.8%, respectively; both P<0.001). PLMI ≥5 also demonstrated a higher RLS detection rate than PLMI ≥15 did (69.2% vs 15.4%; P=0.016). Conclusion: In patients with OSA, CPAP titration increases PLMS prevalence and the PLMI regardless of whether PLMI is ≥5 or ≥15. The use of the current diagnostic criteria, PLMI ≥15, for PLMS may lead to underestimation of PLMS prevalence and the RLS detection rate in patients with OSA.

13.
Clin Interv Aging ; 14: 241-247, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30774323

RESUMO

Objectives: To assess the effect of continuous positive airway pressure (CPAP) on nocturia in ischemic stroke patients with obstructive sleep apnea (OSA). Methods: This was a prospective and non-randomized controlled study in which ischemic stroke patients with OSA being treated in a rehabilitation ward were enrolled. The participants who tolerated CPAP were classified as the CPAP group, while those who refused or could not tolerate CPAP were classified as the control group. The percentage change of nocturia before and after 2 weeks of CPAP therapy between the two groups were compared. Results: A total of 44 participants were enrolled in and 35 participants (mean age= 59.8±11.7 years old; mean apnea hypopnea index=42.9±16.7/h) completed the study (control group: 14, CPAP group: 21). Overall, 69% of the participants had nocturnal polyuria and 69% of them had more than one nocturia episode per night. The baseline and initial nocturia characteristics did not differ significantly between the two groups. As compared to the control group, CPAP therapy significantly decreased the nocturnal polyuria index (mean percentage change: 9% vs -21% (P=0.005)) and nocturnal urine output (mean percentage change: 6% vs -26% (P=0.04)), but not the nocturia episodes or 24-hours total urine output. Conclusion: Nocturia due to nocturnal polyuria is very common in post-stroke patients with OSA. Treating OSA by CPAP significantly reduces nocturnal polyuria, but not nocturia frequency, in ischemic stroke patients.


Assuntos
Pressão Positiva Contínua nas Vias Aéreas , Noctúria/terapia , Poliúria/terapia , Apneia Obstrutiva do Sono/complicações , Apneia Obstrutiva do Sono/terapia , Acidente Vascular Cerebral/complicações , Idoso , Isquemia Encefálica/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Noctúria/etiologia , Poliúria/etiologia , Estudos Prospectivos , Resultado do Tratamento
14.
Appl Opt ; 56(15): 4466-4473, 2017 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-29047876

RESUMO

Single-point diamond turning machines are capable of generating high-quality spherical and freeform surfaces. However, there are inevitable tool marks on the diamond-turned surfaces. Although several models have been proposed to describe the surface topography of a flat surface, there is a lack of a more general model to describe spherical and freeform surfaces. In this paper, we propose a model to estimate the surface topography of the diamond-turned spherical and freeform surfaces. The model takes into consideration the basic cutting parameters as well as the dominant relative vibration components between the diamond tool and the workpiece in both infeed and feeding directions. We first discuss the principles and create a model for spherical surfaces. The model is then extended to describe more general freeform surfaces. We also show how the micro-waviness of the diamond tool impacts the surface topography. Finally, we conduct a series of face cutting experiments and conclude that there is good correlation between the model and the experimental results.

15.
Biomed J ; 40(4): 226-231, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-28918911

RESUMO

BACKGROUND: Patients with severe sepsis frequently require intensive care unit (ICU) admission and different ICU care models may influence their outcomes. The mortality of severe septic patients between physician's high and low care volume remains unclear. METHODS: We analyzed the data from a three-year prospective observation study, which was performed in an adult medical ICU of Chung Gung Memorial Hospital, Keelung. The data included initial bundle therapies based on the Surviving Sepsis Campaign (SSC) guidelines for patients with severe sepsis. RESULTS: Clinical data of total 484 patients with severe sepsis were recorded. Cox regression model showed that physician's care volume was an independent factor for lowering mortality in ICU patients with severe sepsis (hazard ratio 0.708; 95% confidence interval 0.514-0.974; p = 0.034). Patients treated by high care volume physician had four out of nine bundle therapies that were significantly higher in percentage following the SSC guidelines. These four therapies were renal replacement therapy, administration of low-dose steroids for septic shock, prophylaxis of gastro-intestinal bleeding, and control of hyperglycemia. CONCLUSION: High care volume physician may decrease mortality in ICU patients with severe sepsis through fitting bundle therapies for sepsis.


Assuntos
Unidades de Terapia Intensiva , Sepse/mortalidade , Choque Séptico/mortalidade , Adulto , Feminino , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Médicos/estatística & dados numéricos , Estudos Prospectivos , Recursos Humanos
16.
J Virol ; 91(4)2017 02 15.
Artigo em Inglês | MEDLINE | ID: mdl-27974554

RESUMO

Herpes simplex virus 1 (HSV-1) establishes latency in neural tissues of immunocompetent mice but persists in both peripheral and neural tissues of lymphocyte-deficient mice. Thymidine kinase (TK) is believed to be essential for HSV-1 to persist in neural tissues of immunocompromised mice, because infectious virus of a mutant with defects in both TK and UL24 is detected only in peripheral tissues, but not in neural tissues, of severe combined immunodeficiency mice (T. Valyi-Nagy, R. M. Gesser, B. Raengsakulrach, S. L. Deshmane, B. P. Randazzo, A. J. Dillner, and N. W. Fraser, Virology 199:484-490, 1994, https://doi.org/10.1006/viro.1994.1150). Here we find infiltration of CD4 and CD8 T cells in peripheral and neural tissues of mice infected with a TK-negative mutant. We therefore investigated the significance of viral TK and host T cells for HSV-1 to persist in neural tissues using three genetically engineered mutants with defects in only TK or in both TK and UL24 and two strains of nude mice. Surprisingly, all three mutants establish persistent infection in up to 100% of brain stems and 93% of trigeminal ganglia of adult nude mice at 28 days postinfection, as measured by the recovery of infectious virus. Thus, in mouse neural tissues, host T cells block persistent HSV-1 infection, and viral TK is dispensable for the virus to establish persistent infection. Furthermore, we found 30- to 200-fold more virus in neural tissues than in the eye and detected glycoprotein C, a true late viral antigen, in brainstem neurons of nude mice persistently infected with the TK-negative mutant, suggesting that adult mouse neurons can support the replication of TK-negative HSV-1. IMPORTANCE: Acyclovir is used to treat herpes simplex virus 1 (HSV-1)-infected immunocompromised patients, but treatment is hindered by the emergence of drug-resistant viruses, mostly those with mutations in viral thymidine kinase (TK), which activates acyclovir. TK mutants are detected in brains of immunocompromised patients with persistent infection. However, answers to the questions as to whether TK-negative (TK-) HSV-1 can establish persistent infection in brains of immunocompromised hosts and whether neurons in vivo are permissive for TK- HSV-1 remain elusive. Using three genetically engineered HSV-1 TK- mutants and two strains of nude mice deficient in T cells, we found that all three HSV-1 TK- mutants can efficiently establish persistent infection in the brain stem and trigeminal ganglion and detected glycoprotein C, a true late viral antigen, in brainstem neurons. Our study provides evidence that TK- HSV-1 can persist in neural tissues and replicate in brain neurons of immunocompromised hosts.


Assuntos
Herpes Simples/virologia , Herpesvirus Humano 1/fisiologia , Tecido Nervoso/virologia , Timidina Quinase/genética , Proteínas Virais/genética , Animais , Tronco Encefálico/metabolismo , Tronco Encefálico/virologia , Linhagem Celular , Modelos Animais de Doenças , Herpes Simples/imunologia , Herpes Simples/patologia , Humanos , Camundongos , Camundongos Nus , Mutação , Subpopulações de Linfócitos T/imunologia , Subpopulações de Linfócitos T/metabolismo , Timidina Quinase/deficiência , Gânglio Trigeminal/metabolismo , Gânglio Trigeminal/virologia , Carga Viral , Latência Viral , Replicação Viral
17.
Opt Express ; 24(17): 19671-81, 2016 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-27557245

RESUMO

The deflectometry provides a feasible way for surface testing with a high dynamic range, and the calibration is a key issue in the testing. A computer-aided testing method based on reverse Hartmann test, a fringe-illumination deflectometry, is proposed for high-accuracy testing of reflective surfaces. The virtual "null" testing of surface error is achieved based on ray tracing of the modeled test system. Due to the off-axis configuration in the test system, it places ultra-high requirement on the calibration of system geometry. The system modeling error can introduce significant residual systematic error in the testing results, especially in the cases of convex surface and small working distance. A calibration method based on the computer-aided reverse optimization with iterative ray tracing is proposed for the high-accuracy testing of reflective surface. Both the computer simulation and experiments have been carried out to demonstrate the feasibility of the proposed measurement method, and good measurement accuracy has been achieved. The proposed method can achieve the measurement accuracy comparable to the interferometric method, even with the large system geometry calibration error, providing a feasible way to address the uncertainty on the calibration of system geometry.

18.
J Chin Med Assoc ; 79(8): 428-34, 2016 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27234975

RESUMO

BACKGROUND: Predicting acute renal failure in patients with severe sepsis is important, because patients may need renal replacement therapy (RRT). Neutrophil gelatinase-associated lipocalin (NGAL) has been evaluated for its ability to detect and predict acute kidney injury (AKI) in critically ill patients. This study aimed to assess the predictive value of plasma NGAL for acute renal failure in adult severely septic patients. METHODS: Thirty healthy adults and 85 adult patients admitted to the medical intensive care unit (ICU) were enrolled. Serum creatinine, plasma NGAL, and interleukin (IL)-6, IL-10, and IL-17 levels were evaluated. AKI was classified as Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease (RIFLE). RESULTS: RIFLE-Failure (RIFLE-F) developed in 30 of 76 (39.5%) patients with severe sepsis without chronic kidney disease within 7 days after ICU admission. Serum creatinine, plasma NGAL, IL-6, and IL-10 could predict RIFLE-F within 7 days after ICU admission. The discriminatory power of plasma NGAL was not significant for predicting hospital mortality. The area under the receiver operating characteristic curve of plasma NGAL was not higher than that of serum creatinine in predicting RIFLE-F within 7 days. CONCLUSION: Plasma NGAL is a useful tool for predicting acute renal failure in adult patients with severe sepsis. Serum creatinine has a similar ability to detect RIFLE-F occurrence.


Assuntos
Injúria Renal Aguda/diagnóstico , Lipocalina-2/sangue , Sepse/complicações , Injúria Renal Aguda/sangue , Injúria Renal Aguda/etiologia , Adulto , Idoso , Biomarcadores , Creatinina/sangue , Citocinas/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
19.
J Biomed Opt ; 20(9): 096010, 2015 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-26358823

RESUMO

A wearable all-plastic imaging system for real-time fluorescence image-guided surgery is presented. The compact size of the system is especially suitable for applications in the operating room. The system consists of a dual-mode imaging system, see-through goggle, autofocusing, and auto-contrast tuning modules. The paper will discuss the system design and demonstrate the system performance.


Assuntos
Processamento de Imagem Assistida por Computador/métodos , Imagem Óptica/métodos , Cirurgia Assistida por Computador/métodos , Desenho de Equipamento , Humanos
20.
Appl Opt ; 54(23): 6979-85, 2015 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-26368364

RESUMO

Surface roughness is an important factor in characterizing the performance of high-precision optical surfaces. In this paper, we propose a model to estimate the surface roughness generated by a single-point diamond turning machine. In this model, we take into consideration the basic tool-cutting parameters as well as the relative vibration between the tool and the workpiece in both the infeed and feeding directions. Current models focus on the relative tool-workpiece vibration in the infeed direction. However, based on our experimental measurements, the contribution of relative tool-workpiece vibration in the feeding direction is significant and cannot be ignored in the model. The proposed model is able to describe the surface topography for flat as well as cylindrical surfaces of the workpiece. It has the potential to describe more complex spherical surfaces or freeform surfaces. Our experimental study with metal materials shows good correlation between the model and the diamond-turned surfaces.

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