Out-of-hospital cardiac arrest and in-hospital mortality among COVID-19 patients: A population-based retrospective cohort study.

BACKGROUND/PURPOSE: Predictors for out-of-hospital cardiac arrest (OHCA) in COVID-19 patients remain unclear. We identified the predictors for OHCA and in-hospital mortality among such patients in community isolation centers. METHODS: From May 15 to June 20, 2021, this cohort study recruited 2555 laboratory-confirmed COVID-19 patients admitted to isolation centers in Taiwan. All patients were followed up until death, discharge from the isolation center or hospital, or July 16, 2021. OHCA was defined as cardiac arrest confirmed by the absence of circulation signs and occurring outside the hospital. Multinomial logistic regressions were used to determine factors associated with OHCA and in-hospital mortality. RESULTS: Of the 37 deceased patients, 7 (18.9%) had OHCA and 30 (81.1%) showed in-hospital mortality. The mean (SD) time to OHCA was 6.6 (3.3) days from the symptom onset. After adjusting for demographics and comorbidities, independent predictors for OHCA included age ≥65 years (adjusted odds ratio [AOR]: 13.24, 95% confidence interval [CI]: 1.85-94.82), fever on admission to the isolation center (AOR: 12.53, 95% CI: 1.68-93.34), and hypoxemia (an oxygen saturation level below 95% on room air) (AOR: 26.54, 95% CI: 3.18-221.73). Predictors for in-hospital mortality included age ≥65 years (AOR: 10.28, 95% CI: 2.95-35.90), fever on admission to the isolation centers (AOR: 7.27, 95% CI: 1.90-27.83), and hypoxemia (AOR: 29.87, 95% CI: 10.17-87.76). CONCLUSIONS: Time to OHCA occurrence is rapid in COVID-19 patients. Close monitoring of patients' vital signs and disease severity during isolation is important, particularly for those with older age, fever, and hypoxemia.

[Thyroidectomies: surgical site infection risk factors of using prophylactic antibiotics].

BACKGROUND: Surgical site infection is one of the most common types of nosocomial infection and an important factor in increased mortality and medical costs. The effectiveness of prophylactic antibiotics use on thyroidectomy wound sites merits further examination. PURPOSE: This study compared the influence of prophylactic antibiotics use or non-use on surgical site infection risk, average hospital stay length and average medical costs in thyroidectomy patients. METHODS: This cross-sectional study targeted patients undergoing thyroidectomies at the general surgery ward of a medical center during the period 2007 to 2008. Subjects were divided into two groups. The first comprised patients who received prophylactic antibiotics thirty minutes before receiving a thyroidectomy between January 1, 2007 and October 31, 2007. A retrospective review of patient charts and reports was conducted for this group. The second consisted of patients that did not receive prophylactic antibiotics 30 minutes before receiving a thyroidectomy between November 1, 2007 and October 31, 2008 in line with a new antibiotics policy enforced at the research hospital. RESULTS: A total of 310 subjects were enrolled in the study. All subjects were free of surgical site infection. Fifteen patients (4.8%) received a course in antibiotics after surgery and six (40.0%) of these showed surgical site swelling (x² = 120.33; p < .01). Statistically significant risk factors of post-surgery antibiotics use included diabetes mellitus (x² = 6.39; p = .03), a surgery duration in excess of 2 hours (x² = 4.40; p = .04), drainage tube remaining in place at the surgical site (x² = 4.58; p = .03) and drainage tube insertion for more than 2 days (x² = 6.24; p = .03). Significant reductions in average hospital stay length (3.65 days ± 1.04; p < .01) and medical costs (p < .01) were observed when prophylactic antibiotics were not used before surgery. The cost of post-operative antibiotics increased by $5,851 and medical costs increased from $32,436 to $63,895 when hospital stay length exceeded four days. If hospital stay length was kept within four days and post-operative antibiotics were used, this study found no significant difference in drug or medical costs. CONCLUSION: Not using prophylactic antibiotics before thyroidectomy does not increase surgical site infection risk.

Rottlerin inhibits migration of follicular thyroid carcinoma cells by PKCdelta-independent destabilization of the focal adhesion complex.

This study examined the effect of rottlerin on the focal adhesion-mediated cell migration of CGTH W-2 human follicular thyroid carcinoma cells. Rottlerin (10 microM) resulted in decreased adhesion of CGTH W-2 cells to matrix substance, which was correlated with metastatic potential. Rottlerin treatment also resulted in a marked reduction in the migration of CGTH W-2 cells. Protein levels of integrin beta1, FAK, and paxillin were decreased by rottlerin. Consistent with this, immunostaining of FAK, vinculin, and paxillin revealed disassembly of the focal adhesions. Disruption of actin stress fibers was noted, which was compatible with reduced expression levels and activities of Rac-1 and Rho. The effect of rottlerin on cell migration was not attributable to inhibition of PKCdelta activity since siRNA knockdown of PKCdelta did not recapitulate the effects of rottlerin on cell adhesion and migration. Furthermore, activation of PKCdelta by phorbol esters failed to restore the rottlerin-inhibited migratory ability. The mitochondrial uncoupler, carbonylcyanide-4-(trifluoromethoxy)-phenylhydrazone, was able to mimic several rottlerin's effects. In summary, we demonstrated that rottlerin inhibits the migration of CGTH W-2 cells by disassembly of focal adhesion complexes in a PKCdelta-independent manner, and might play as a mitochondrial uncoupler role in these events.

Imprint cytology in diagnosing-primary non-Hodgkin's lymphoma of the breast during intraoperative frozen consultation: a case report.

UNLABELLED: BACKGROUND; Primary non-Hodgkin's lymphoma of the breast is uncommon among primary malignant breast tumors. Here we present a case diagnosed as primary breast lymphoma with imprint cytology during intraoperative frozen consultation. CASE: A 67-year-old woman presented with a palpable, non-tender mass in her left breast that she had had for 2 weeks. The mammogram and ultrasound studies revealed 1 lobular mass in the left breast without axillary lymphadenopathy. Imprint cytology helped diagnose malignant lymphoma of the breast, preventing radical surgery. CONCLUSION: Frozen artifact may obscure the evaluation of cytomorphology during intraoperative consultation. Imprint cytology may help due to less artifact with the cytologic details. Primary breast lymphomas should be considered in the differential diagnosis of breast tumors. The current literature recommendation of intermediate to high grade lymphoma is combined partial mastectomy followed by chemotherapy with local radiotherapy.

An acidic extracellular pH disrupts adherens junctions in HepG2 cells by Src kinases-dependent modification of E-cadherin.

We have previously shown that culturing HepG2 cells in pH 6.6 culture medium increases the c-Src-dependent tyrosine phosphorylation of beta-catenin and induces disassembly of adherens junctions (AJs). Here, we investigated the upstream mechanism leading to this pH 6.6-induced modification of E-cadherin. In control cells cultured at pH 7.4, E-cadherin staining was linear and continuous at cell-cell contact sites. Culturing cells at pH 6.6 was not cytotoxic, and resulted in weak and discontinuous junctional E-cadherin staining, consistent with the decreased levels of E-cadherin in membrane fractions. pH 6.6 treatment activated c-Src and Fyn kinase and induced tyrosine phosphorylation of p120 catenin (p120ctn) and E-cadherin. Inhibition of Src family kinases by PP2 attenuated the pH 6.6-induced tyrosine phosphorylation of E-cadherin and p120ctn, and prevented the loss of these proteins from AJs. In addition, E-cadherin was bound to Hakai and ubiquitinated. Furthermore, pH 6.6-induced detachment of E-cadherin from AJs was blocked by pretreatment with MG132 or NH(4)Cl, indicating the involvement of ubiquitin-proteasomal/lysosomal degradation of E-cadherin. An early loss of p120ctn prior to E-cadherin detachment from AJs was noted, concomitant with a decreased association between p120ctn and E-cadherin at pH 6.6. PP2 pretreatment prevented the dissociation of these two proteins. In conclusion, pH 6.6 activated Src kinases, resulting in tyrosine phosphorylation of E-cadherin and p120ctn and a weakening of the association of E-cadherin with p120ctn and contributing to the instability of E-cadherin at AJs.

Adenosine-stimulated adrenal steroidogenesis involves the adenosine A2A and A2B receptors and the Janus kinase 2-mitogen-activated protein kinase kinase-extracellular signal-regulated kinase signaling pathway.

Adenosine promotes adrenal steroidogenesis in vitro and in vivo. However, the underlying signaling mechanisms of this event and the function of the adenosine receptor subtypes in adrenal cells remain to be elucidated. Expression of A1, A2A, A2B, and A3 adenosine receptor mRNA in rat adrenal cells was shown by reverse transcription-polymerase chain reaction. Adenosine increased corticosterone production in a time- and dose-dependent manner, and this adenosine effect was mediated by the A2 adenosine receptors, since the antagonists specific for the A2A and A2B adenosine receptors, and specific silencing the A2A adenosine receptor expression with small interfering RNA significantly blocked the adenosine-induced steroidogenesis. Using pharmacological approaches, we further demonstrated that Janus kinase 2 was the downstream molecule next to the A2A and A2B adenosine receptors. Inhibition of Janus kinase 2 prevented the adenosine-induced steroidogenesis and phosphorylation of mitogen-activated protein kinase kinase 1/2 and extracellular signal-regulated kinase 1/2, demonstrating that Janus kinase 2 was the upstream effector of the mitogen-activated protein kinase kinase pathway. Pretreatment with A2 adenosine receptor, Janus kinase 2, or mitogen-activated protein kinase kinase inhibitors significantly decreased the adenosine-induced phosphorylation of 3',5'-cyclic adenosine monophosphate responsive element binding protein. In conclusion, these data show that adenosine-stimulated steroidogenesis is mediated via the A2A and A2B adenosine receptors, activation of which triggers the Janus kinase 2-mitogen-activated protein kinase kinase-extracellular signal-regulated kinase cascade and 3',5'-cyclic adenosine monophosphate responsive element binding protein phosphorylation. Based on its stimulatory effect on glucocorticoid production, adenosine is a potential candidate as anti-inflammatory agent.

An acidic extracellular pH induces Src kinase-dependent loss of beta-catenin from the adherens junction.

Little attention has been paid to the role of adherens junctions (AJs) in acidic extracellular pH (pHe)-induced cell invasion. Incubation of HepG2 cells in acidic medium (pH 6.6) induced cell dispersion from tight cell clusters, and this change was accompanied by downregulation of beta-catenin at cell junctions and a rapid activation of c-Src. Pretreatment with PP2 prevented the acidic pH-induced downregulation of beta-catenin at AJ and in the membrane fractions. The acidic pHe-induced c-Src activation increased tyrosine phosphorylation of beta-catenin and decreased the amount of beta-catenin-associated E-cadherin. The depletion of membrane-bound beta-catenin coincided with enhanced cell migration and invasion, and this acidic pHe-increased cell migration and invasion was prevented by PP2. In conclusion, this study characterizes a novel signaling pathway responsible for acidic microenvironment-promoted migration and invasive behaviors of cancer cells.

Impact of previous abdominal surgery on laparoscopic appendectomy for acute appendicitis.

BACKGROUND: Laparoscopic appendectomy is one of the most commonly performed laparoscopic procedures. Impact of previous abdominal surgery on laparoscopic appendectomy has not been previously reported. METHODS: From January 2001 to December 2005, 2029 patients with clinically suspected acute appendicitis underwent laparoscopic surgery in our hospital. Of these, 234 patients (11.5%) were found to have other pathology by intraoperative or histologic findings and were excluded from the study. The 1795 patients who underwent laparoscopic appendectomy for acute appendicitis were divided into three groups: group 1, patients without a history of previous abdominal surgery (n = 1652, 92%); group 2, patients with a history of upper abdominal surgery (n = 20, 1.1%); group 3, patients with a history of lower abdominal surgery (n = 123, 6.8%). Data were collected retrospectively by chart review and analyzed for conversion rate, operative time, intraoperative and postoperative complications, and hospital stay. RESULTS: Of the 1795 patients, 13 (0.7%) were converted to open appendectomy because of technical difficulty. Overall mean operative time was 57.2 (range, 20-225) min. There was no mortality or intraoperative complications. Overall postoperative complication rate was 10.7% (n = 193): rate of surgical wound infection was 8.2% (n = 147), surgical wound seroma 1.3% (n = 24), and intra-abdominal abscess 0.8% (n = 14). Overall postoperative hospital stay averaged 3.2 (range, 0-39) days. There were no significant differences between the three groups regarding the conversion rate (0.8% vs. 0% vs. 0%, p = 0.567), operative time (57.3 vs. 55.8 vs. 56.9 min, p = 0.962), postoperative complication rates (10.7 vs. 10 vs. 12.2%, p = 0.863), and hospital stay (3.2 vs. 3.6 vs. 3.1 days, p = 0.673). CONCLUSIONS: Previous abdominal surgery, whether upper or lower abdominal, has no significant impact on laparoscopic appendectomy for acute appendicitis.

Laparoscopy-assisted resection of ileoileal intussusception caused by intestinal lipoma.

Intussusception is the second most common abdominal emergency in children. In contrast, it is rare in adults. Adult intussusception represents only 1%-3% of patients with bowel obstruction. Although 95% of intussusception in children is idiopathic, merely 7% of adult intussusception is considered idiopathic. Owing to vague symptoms and signs, the preoperative diagnosis of adult intussusception is difficult. Once adult intussusception is diagnosed, surgical intervention is indicated because about half of both colonic and small intestinal intussusceptions are caused by malignant lesions. In this paper, we describe a case of ileoileal intussusception caused by an intestinal lipoma that was diagnosed preoperatively by computed tomography scans and was treated successfully by laparoscopy-assisted surgery. The patient was discharged uneventfully 4 days after the operation. We recommend laparoscopy-assisted surgery as a feasible therapeutic option for adult intussusception.

Macrophage activation increases the invasive properties of hepatoma cells by destabilization of the adherens junction.

Tumor-associated macrophages play an important role in tumor progression, but whether they exert a tumor-progressive effect remains controversial. Here, we demonstrated that activated macrophage-conditioned medium (AMCM) obtained from RAW macrophages (RAW/AMCM) induced epithelial-mesenchymal transition (EMT) and stimulated the migratory and invasive activities of HepG2 cells, whereas control conditioned media had no effect. Epithelial-cadherin (E-cadherin) and beta-catenin staining patterns were altered at the adherens junctions by RAW/AMCM treatment, with an approximately 50% decrease in E-cadherin and beta-catenin in the cell membrane. Importantly, levels of beta-catenin-associated E-cadherin were also decreased. Following RAW/AMCM treatment, enhanced activation of c-Src was seen prior to increased tyrosine phosphorylation of beta-catenin, and this led to the destabilization of adherens junctions. Pretreatment of HepG2 cells with the Src kinase inhibitor, PP2, completely abolished the effects of RAW/AMCM on the EMT, migration, invasion, and expression and association of E-cadherin and beta-catenin. AMCMs obtained from human THP-1 monocytes and mouse peritoneal macrophages also caused disassembly of the adherens junctions and migration of HepG2 cells. Furthermore, inhibition of the epidermal growth factor receptor (EGFR) with gefitinib partially prevented the downregulation of E-cadherin and beta-catenin at the adherens junctions and migration behavior induced by RAW/AMCM. Our results suggest that activated macrophages have a tumor-progressive effect on HepG2 cells which involves the c-Src- and EGFR-dependent signaling cascades.

Laparoscopic versus open appendectomy for perforated appendicitis.

The role of laparoscopic appendectomy (LA) for perforated appendicitis is under investigation. A retrospective study was conducted to compare the outcomes of laparoscopic versus open appendectomy (OA) for perforated appendicitis. From January 2001 through December 2003, 229 patients with perforated appendicitis were treated at Far-Eastern Memorial Hospital. LA was successfully completed in 91 of 99 patients. OA was performed in 130 patients. Operation time was longer in the LA group (mean +/- SD = 96.1 +/- 43.1 vs. 67.8 +/- 32.2 minutes, P < 0.01). Return of oral intake was faster in the LA group (3.2 +/- 2.4 vs. 5.0 +/- 7.0 days, P < 0.01). The intravenous antibiotic usage period was shorter in the LA group (4.4 +/- 2.8 vs. 6.3 +/- 7.1 days, P < 0.01). The postoperative wound infection rates were 15.2 % (LA group) and 30.7% (OA group). The overall infectious complication rates were 19% in the LA group and 37% in the OA group (P < 0.01). Hospital stay days were shorter for the LA group (6.3 +/- 2.9 vs. 9.3 +/- 8.6 days, P < 0.01). Our results indicated that laparoscopic appendectomy is a safe and effective procedure for treating patients with perforated appendicitis.

Laparoscopic preperitoneal mesh repair of incarcerated obturator hernia and contralateral direct inguinal hernia.

Most cases of obturator hernia are diagnosed during surgery for treatment of acute small bowel obstruction resulting from incarceration. We present the case of a patient with incarcerated obturator hernia that was correctly diagnosed by computed tomography preoperatively. Laparoscopic preperitoneal mesh repair of the incarcerated obturator hernia and a contralateral direct inguinal hernia found incidentally was successfully performed.

Laparoscopic diagnosis and treatment of small bowel obstruction caused by postoperative intussusception.

Small bowel obstruction is a common problem, especially for patients who have had previous abdominal surgery possibly complicated by postoperative adhesions. In contrast to adhesions, postoperative intussusception is an unusual cause of small bowel obstruction. We report a case of small bowel obstruction that occurred one month after antrectomy for duodenal ulcer with massive bleeding. Laparoscopic surgery was attempted after conservative treatment failed. A segment of jejunojejunal intussusception about 50 cm below the ligament of Treitz was identified and laparoscopic reduction of the intussusception was performed. The patient had an uneventful postoperative course and remained asymptomatic at 10-month follow-up. Although not frequently encountered, postoperative intussusception should be considered a possible etiology in patients with postoperative small bowel obstruction. In experienced hands, the laparoscopic approach offers a feasible option for correct diagnosis and appropriate treatment in this situation.

Laparoscopic appendectomy in pregnancy.

BACKGROUND: Laparoscopic appendectomy (LA) is a safe, effective, and beneficial procedure for the treatment of acute appendicitis. However, limited data are available regarding the safety and feasibility of LA during pregnancy. METHODS: Between January 2001 and August 2004, 1235 patients with clinically suspected appendicitis underwent laparoscopic surgery at our hospital. Eleven patients (0.9%) were pregnant women (mean age, 25 years; age range, 19-37 years; range of gestational age, 4-30 weeks). Clinical data collected retrospectively included demographic information; preoperative, procedural, and postoperative information; and outcome of the pregnancy. RESULTS: All 11 pregnant women underwent laparoscopic surgery without need of conversion. Ten patients underwent LA and were found to have acute appendicitis on histologic analysis. One patient had torsion of the right fallopian tube and a healthy-looking appendix; she underwent detorsion of the fallopian tube and incidental appendectomy. Mean operative time was 50.5 minutes (range, 20-135 minutes). Length of postoperative hospital stay averaged 4.2 days (range, 1-11 days). One patient had a surgical wound infection, which was managed conservatively. Mean follow-up period was 14 months (range, 2-46 months). Seven pregnant women delivered healthy term infants, 2 had planned abortions, and 1 experienced fetal loss due to uterine infection and premature contractions 1 month after LA. Another patient had normal results at prenatal examination. CONCLUSION: Our data support the accumulating evidence that LA is a safe and feasible procedure for the treatment of acute appendicitis in all trimesters of pregnancy. Close maternal and fetal monitoring is essential during and after the operation.

Laparoscopic diagnosis and treatment of acute small bowel obstruction resulting from a congenital band.

Acute small bowel obstruction is a common problem, especially for those patients with previous abdominal surgery that can cause postoperative adhesions. Acute, non-postoperative small bowel obstruction is less common and has various etiologies. We report a case of acute small bowel obstruction without previous abdominal surgery. The patient underwent laparoscopic exploration, and a congenital band was found to cause direct compression of the ileum and entrapment of a segment of bowel loop. There was evidence of bowel strangulation. The color and peristalsis of the entrapped bowel loop recovered gradually after division of the band, and segmental bowel resection was avoided. He has remained asymptomatic since the procedure. We suggest early and aggressive surgical intervention for patients with acute, non-postoperative small bowel obstruction to avoid possible complications of bowel strangulation and gangrene. A laparoscopic approach may be a safe, feasible, and favorable option for correct diagnosis and appropriate treatment in this situation.

Three-dimensional cytomorphology in fine needle aspiration biopsy of parathyroid lesions.

OBJECTIVE: To elucidate three-dimensional (3-D) cytomorphology in fine needle aspiration biopsy (FNAB) of parathyroid lesions. STUDY DESIGN: Ultrasound-guided FNAB was performed on parathyroid lesions from 10 patients with hyperparathyroidism. The aspirates were stained and observed under a light microscope (LM). The aspirates were also fixed, dehydrated, critical point dried, spattered with gold ions and observed with a scanning electron microscope (SEM). Findings under SEM were correlated with the appearances under LM as well as with serum parathyroid hormone (PTH) concentrations. RESULTS: Under LM, nine cases displayed isokaryosis and one case, anisokaryosis. These appearances corresponded to isocytosis or anisocytosis under SEM. Under SEM, 3-D cytomorphology of parathyroid lesions displayed isocytotic, scattered cells in five cases, uniform cellular arrangements in four cases and anisocytotic, scattered cells in one case. The cell surface was rather smooth in five cases. The other five cases had significant granules on the cell surfaces; these all had serum PTH concentrations > or = 268 pg/mL. CONCLUSION: 3-D cytomorphology in FNAB of parathyroid lesions was a rather smooth cell surface in cases with low serum PTH and a granular cell surface in cases with significantly increased serum PTH. These characteristics and the absence of microvilli might be helpful in the differential diagnosis between parathyroid and follicular thyroid lesions.

Factors affecting long-term survival of Taiwanese patients with medullary thyroid carcinoma.

BACKGROUND AND PURPOSE: Long-term survival of patients with postoperative recurrence of medullary thyroid carcinoma (MTC) is not uncommon. This study assessed whether local or distant recurrence after operation is a significant factor affecting long-term survival in Taiwanese patients with MTC. The benefit of family screening for MTC patients on survival was also evaluated. METHODS: A total of 54 patients with a diagnosis of MTC by pathology or cytology during the period from 1977 to 2000 were included in the study. Survival curves were compared between different groups according to age, gender, tumor size, metastasis, recurrence after surgical intervention, or diagnosis before and after the performance of family screening for MTC patients. RESULTS: The 5-year survival rate using the Kaplan-Meier method was 84.1% (95% confidence interval, 73.9% to 94.2%), and the 10-year survival rate was 77.6% (95% confidence interval, 64.9% to 90.3%). Patients with lymph node metastasis and distant metastasis before operation had significantly shorter survival. Surprisingly, recurrence was not associated with shorter survival. Patients diagnosed after the start of family screening in 1991 had fewer lymph node metastases before operation, and lived longer. CONCLUSIONS: Patients with lymph node or distant metastasis before operation had poor prognosis. However, local or distant recurrence after operation did not influence survival. Efforts to obtain early diagnosis and surgical intervention before tumor metastasis, such as family screening, resulted in improved survival.

Comparison of skin and soft tissue infections caused by Vibrio and Aeromonas species.

BACKGROUND: The aim of this study was to compare skin and soft tissue infections (SSTIs) caused by Vibrio and Aeromonas spp. METHODS: Patients whose cultures yielded Vibrio or Aeromonas spp. from July 2004 to June 2010 were retrieved from the computerized database of the bacteriology laboratory at a hospital in southern Taiwan. The medical records were reviewed for all patients fulfilling the criteria of monomicrobial Vibrio or Aeromonas spp. SSTIs and the clinical characteristics were analyzed. RESULTS: During the study period, there were 28 patients with Vibrio spp. and 26 patients with Aeromonas spp., respectively. Vibrio vulnificus (n=25) and A. hydrophila (n=14) were the most common spp. There were no significant differences in age, gender, underlying diseases between patients with Vibrio and Aeromonas SSTIs. In comparison to Aeromonas SSTIs, more patients with Vibrio SSTIs were complicated with acute respiratory failure (39.3% vs. 3.8%, p=0.002) and required intensive care unit admission (50.0% vs. 7.7%, p<0.001). Furthermore, patients with Aeromonas SSTIs had a higher likelihood of discharge alone within 30 days than Vibrio SSTIs (p=0.049). The difference in in-hospital mortality among the two groups was not statistically significant (p=0.11). CONCLUSION: Both Aeromonas and Vibrio spp. cause SSTIs in southern Taiwan and the pathogenicity of Vibrio spp. might be higher than Aeromonas spp.