The association of haemoglobin A1C levels with the clinical and CT characteristics of Klebsiella pneumoniae liver abscesses in patients with diabetes mellitus.

OBJECTIVES: To compare the characteristics of Klebsiella pneumoniae liver abscesses (KPLA) in diabetic patients with different levels of glycaemic control. METHODS: The institutional review board approved this retrospective study. A total of 221 patients with KPLA were included. Clinical features of KPLA were compared. We divided the 120 diabetic patients with KPLA into three subgroups based on haemoglobin A1C (HbA1C) concentration (good, HbA1C ≤ 7.0 %; suboptimal, 7.0 % < HbA1C ≤ 9.0 %; poor, HbA1C > 9.0 %). In this study, we used a semiautomated quantitative method to assess the gas and total abscess volumes in KPLA. Statistical analysis was performed with the chi-squared test and one-way analysis of variance. RESULTS: The mortality rate did not significantly differ between the nondiabetic and diabetic groups. However, patients with poor glycaemic control had significantly more complications and therefore a longer hospital stay (P < 0.05). In our study, CT and quantitative analyses found that patients in the group with poor glycaemic control had a significantly higher incidence of gas formation and hepatic venous thrombophlebitis and a higher gas-to-abscess volume ratio than patients with suboptimal and good glycaemic control (P < 0.05). CONCLUSIONS: Diabetic patients with a high HbA1C concentration (>9.0 %) have an association with hepatic venous thrombophlebitis, gas formation and metastatic infection complications associated with KPLA. KEY POINTS: • Poorly controlled diabetes is associated with complications in Klebsiella pneumoniae liver abscesses. • Hepatic venous thrombosis and gas are important signs of metastatic infection. • Hepatic venous thrombophlebitis is associated with 72.7 % of metastatic infections.

Importance of cyclooxygenase 2-mediated low-grade inflammation in the development of fructose-induced insulin resistance in rats.

This study was designed to examine the role of cyclooxygenase (COX) 2-mediated low-grade inflammation in the development of fructose-induced whole body and muscular insulin resistance in rats. The rats were on regular or fructose-enriched diets for 8 weeks. Fructose-fed rats were further divided into 3 groups (n = 8 per group). There were fructose-fed rats, fructose-fed rats with nimesulide (a selective COX2 inhibitor, 30 mg/kg/day, gavage) and fructose-fed rats with celecoxib (a selective COX2 inhibitor, 30 mg/kg/day, gavage). The present result showed that fructose-induced time-dependent increases in systolic blood pressure and fasting plasma insulin and triglyceride levels were significantly suppressed in rats treated with nimesulide or cerecoxib. The ratio of area under glucose curve divided by area under insulin curve obtained during the oral glucose tolerance test was significantly decreased in fructose-fed rats, which were markedly reversed in those co-treated with nimesulide or celecoxib. Accordingly, fructose-induced decrease in insulin-stimulated glucose uptake in soleus muscle was significantly reversed in those combined with nimesulide or celecoxib. Fructose-induced time-dependent increases in plasma 8-isoprostane and PGE metabolites were concomitantly suppressed by nimesulide or celecoxib co-treatment. The present study demonstrates that the COX2-mediated low-grade inflammation, especially mediated by increase in oxidative stress was important in the development of insulin resistance in fructose-fed rats.

Diminution of hypertriglyceridemia-induced pressor effect under hyperinsulinemic condition in normal and fructose-induced insulin resistant rats.

This study aimed to evaluate the effect of hyperinsulinemia on hypertriglyceridemia-induced pressor response in normal and fructose-induced insulin resistant rats. The rats were divided into six groups of eight rats and were fed a fructose-enriched diet (FINs, F(INS+TG)) or a regular chow diet (C, C(TG), C(INS), C(INS+TG)) for 8 wks. The acute experiment was conducted at the end of wk 8 and consisted of a 30-min basal period and followed by a 120-min test period. After the basal period, somatostatin (1.3 microg/kg/ min) combined with regular insulin (0.6 or 4 mU/kg/min) and variable glucose infusion were given to clamp euglycemia and euinsulinemia in C and C(TG) or euglycemia and hyperinsulinemia in CINs, C(INS+TG), F(INS) and F(INS+TG). During test period, lipofundin (a triglyceride emulsion) was infused into CTG, C(INS+TG), F(INS+TG) and saline instead was infused into C, C(INS), FINS. Plasma insulin and triglyceride levels were significantly higher in fructose-fed rats than in normal rats. During the test period, the lipofundin infusion (1.2 ml/kg/hr) increased plasma triglyceride levels by 368 +/- 39, 351 +/- 71 and 489 +/- 38 mg/dl compared with their baseline levels in lipid-infused groups. During the test period, low-dose insulin infusion kept plasma insulin at basal levels in C and C(TG) and high-dose insulin infusion increased plasma insulin levels about 6 times the baseline insulin level in C. Glucose infusion rate (GIR) was significantly higher in rats with high insulin infusion than those with low insulin infusion. The increase in GIR was lower in fructose-fed groups than in control groups under similar hyperinsulinemia. Rats with or without lipofundin infusion did not alter GIR during the test period. The present results demonstrated that hypertriglyceridemia-induced pressor response was diminished under hyperinsulinemic condition in both normal and fructose-induced insulin resistant rats.

Risk of anxiety and depressive disorders in patients with myocardial infarction: A nationwide population-based cohort study.

Anxiety and depressive symptoms are associated with adverse cardiovascular events after an acute myocardial infarction (MI). However, most studies focusing on anxiety or depression have used rating scales or self-report methods rather than clinical diagnosis. This study aimed to investigate the association between psychiatrist-diagnosed psychiatric disorders and cardiovascular prognosis.We sampled data from the National Health Insurance Research Database; 1396 patients with MI were recruited as the study cohort and 13,960 patients without MI were recruited as the comparison cohort. Cox proportional hazard regression models were used to examine the effect of MI on the risk of anxiety and depressive disorders.During the first 2 years of follow-up, patients with MI exhibited a significantly higher risk of anxiety disorders (adjusted hazard ratio [HR] = 5.06, 95% confidence interval [CI]: 4.61-5.54) and depressive disorders (adjusted HR = 7.23, 95% CI: 4.88-10.88) than those without MI did. Greater risk for anxiety and depressive disorders was observed among women and patients aged 45 to 64 years following an acute MI. Patients with post-MI anxiety had a 9.37-fold (95% CI: 4.45-19.70) higher risk of recurrent MI than those without MI did after adjustment for age, sex, socioeconomic status, and comorbidities.This nationwide population-based cohort study provides evidence that MI increases the risk of anxiety and depressive disorders during the first 2 years post-MI, and post-MI anxiety disorders are associated with a higher risk of recurrent MI.

Readiness of hospital nurses for disaster responses in Taiwan: A cross-sectional study.

BACKGROUND: Because patients in disaster areas require the most critical care, mobilising hospital nurses has become a pivotal strategy. Given the importance of disaster nursing training programmes, understanding how well prepared hospital nurses are to provide disaster care is vital. OBJECTIVES: This paper analyses the perceived readiness of hospital nurses for a disaster response and the factors influencing their report for work outside the hospital environment. DESIGN: A cross-sectional research design was used. SETTINGS: This study was conducted at a military hospital in Taiwan. PARTICIPANTS: A sample of 311 registered nurses participated in this study. METHODS: Data were collected on readiness for disaster responses using a 40-item researcher-designed, self-administered questionnaire found to have satisfactory reliability and validity. The questionnaire has four domains: personal preparation (16 items), self-protection (11 items), emergency response (6 items), and clinical management (7 items). Data were analysed using descriptive statistics, independent t-tests and generalised linear models. RESULTS: The majority of hospital nurses demonstrated poor readiness for disaster responses. Scores on the four domains were most associated with nurses' disaster-related training, experience in disaster response and emergency/intensive care experience. CONCLUSIONS: Our results indicate that disaster-related training should be included in undergraduate programmes and continuing education courses to help hospital nurses recognise and improve their own readiness for disaster responses outside the hospital environment. Future research is needed to improve hospital nurses' disaster-response readiness in Taiwan and other countries.

Functional interaction of AT1 and AT2 receptors in fructose-induced insulin resistance and hypertension in rats.

The present study was performed to evaluate the potential role and functional interaction of angiotensin II AT1 and AT2 receptors (AT1R and AT2R) in the regulation of blood pressure and glucose homeostasis in fructose-induced insulin-resistant, hypertensive rats. Male Sprague-Dawley rats on fructose-enriched or regular diets for 4 weeks were subjected to 2-step euglycemic euinsulinemic (EEI) and euglycemic hyperinsulinemic (EHI) clamp studies with [3-3H]glucose infusion. After a 40-minute basal period, selective AT1R and AT2R antagonists, losartan (LOS, 10 mg/kg IV bolus) and PD123319 (PD, 50 microg/kg/min), alone or in combination were separately given to control and fructose-fed groups in the 2 clamp periods. The results showed that during the EEI period, LOS significantly reduced the elevated blood pressure in fructose-fed rats, whereas PD further increased fructose-induced high blood pressure. Coadministration of LOS and PD did not alter the elevated blood pressure in fructose-fed rats. Administration of LOS and/or PD failed to change the blood pressure in control rats. During the EHI period, blockade of both AT1R and AT2R eliminated the insulin-induced blood pressure elevation in control and fructose-fed rats. Hepatic glucose production (HGP) did not alter among groups in the basal and EEI periods. Insulin infusion (EHI period) markedly suppressed HGP in control rats, but this suppressive effect was significantly attenuated in fructose-fed rats. LOS administration further reduced the insulin-induced suppression of HGP in fructose-fed rats. The whole-body glucose uptakes (rates of glucose disappearance, Rd) during the basal and EEI periods were similar among groups. During the EHI period, Rd was markedly increased in all groups and the magnitude of increase was significantly greater in control rats than in fructose-fed rats except those with LOS treatment. LOS treatment also redirected Rd in favor of glycolysis in fructose rats, but not in control rats, during the EEI and EHI periods. The effects of LOS on glycolysis during the 2 clamp periods and on HGP during the EHI period were reversed when PD was concomitantly administered, but PD alone did not alter glucose metabolism throughout the experiment in fructose-fed rats. Administration of LOS and/or PD did not change the glucose metabolism in control rats. Our data suggest that AT2R can counterbalance the AT1R-mediated effects on blood pressure and glucose metabolism in fructose-induced insulin-resistant, hypertensive rats. Furthermore, AT1R- and AT2R-mediated effects on blood pressure are disassociated with their actions on glucose metabolism in this hypertensive model.

Complete body-neck torsion of the gallbladder: a case report.

Gallbladder torsion is a rare, acute abdominal disease. It was first reported by Wendell in 1898. Since then, only 500 cases have been reported. Gallbladder torsion occurs in all age groups, although it usually appears in the latter stages of life. The occurrence ratio between women and men is 3:1. Most cases are diagnosed during surgery. The main treatment is surgical detorsion and cholecystectomy. Despite progress in radiologic imaging diagnosis, it is not easy to obtain a precise preoperative diagnosis of gallbladder torsion. In previous reports, only 9.8% of all gallbladder torsion cases were diagnosed preoperatively. We present a case of acute body-neck gallbladder torsion in an elderly man, and we review the radiologic findings of magnetic resonance imaging, computed tomography, and ultrasonography. The radiologic findings in the present case were helpful in obtaining a preoperative diagnosis of gallbladder torsion. The diagnosis was confirmed by T2-weighted magnetic resonance images, which showed an intra-gallbladder segment located between the body and neck of the gallbladder, with a notable crease within this segment.

Hepatic effects among workers exposed to ethylene glycol monoethyl ether acetate.

Data about hepatic effects of ethylene glycol ethers had been limited and inconsistent. In this study, we determined whether ethylene glycol monoethyl ether acetate (EGEEA) was a hepatotoxin in exposed workers. Workers from one silk-screening shop (n=29), using EGEEA as the major cleaning solvent, were recruited as high exposure group. Another group of workers with indirect and low exposure to EGEEA (n=57) were selected as the comparison group. Air concentration of EGEEA was measured by 8-h personal sampling. The mean of air EGEEA concentration in the high exposure group was 7.41-16.5 ppm. The mean of air EGEEA concentration in the low exposure group was 0.07-3.62 ppm. Liver function profiles showed that the AST, ALT, ALP and gamma GT in both male and female EGEEA-exposed workers were not significantly different from those in the comparison group. After adjustment for potential confounders such as gender, body mass index, hepatitis B status, and duration of employment, no difference in hepatic dysfunction were found between exposed and comparison groups. In addition, a two-year follow-up study of these EGEEA-exposed workers, no significant change in hepatic function was noted either. The findings suggest that EGEEA is not a hepatotoxin in this workplace.