Background Contrast-induced nephropathy has become increasingly prevalent as the age and prevalence of comorbidities in the general population have increased. Most cases of contrast-induced nephropathy are reversible; however, some may progress to acute kidney disease, and subsequently, to chronic kidney disease. Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are known for their renoprotective effects. However, whether the use of these inhibitors affects the risk of contrast-induced kidney injury remains unclear. Methods Data were collected from the Taipei Medical University Clinical Research Database. We included patients with diabetes who had contrast exposure between 2016 and 2020 because of computed tomography or coronary angiography. The primary outcome was the risk of a major adverse kidney event (MAKE), which encompassed acute kidney disease, chronic kidney disease progression, and the need for renal replacement therapy. Overlap weighting was performed to reduce the effects of potential confounders. Results This study included 12 421 patients, who were divided into two groups: SGLT2i users (n = 920) and nonusers (n = 11 501). The follow-up period after contrast exposure was 6 months. The risk of a MAKE was lower in SGLT2i users than in nonusers (incidence, 36.9 vs. 49.9 per 1000 person-months, respectively; P = .0011). Furthermore, the incidence of acute kidney disease or chronic kidney disease progression was significantly lower in the SGLT2i users than in nonusers. However, no significant between-group difference was noted in the incidence of other MAKEs. Conclusions SGLT2i may be safely used in diabetic patients needing contrast exposure. The risk of a MAKE may be lower in SGLT2i users than in nonusers.
Life expectancy is likely to be substantially reduced in patients undergoing chronic hemodialysis (CHD). However, machine learning (ML) may predict the risk factors of mortality in patients with CHD by analyzing the serum laboratory data from regular dialysis routine. This study aimed to establish the mortality prediction model of CHD patients by adopting two-stage ML algorithm-based prediction scheme, combined with importance of risk factors identified by different ML methods. This is a retrospective, observational cohort study. We included 800 patients undergoing CHD between December 2006 and December 2012 in Shin-Kong Wu Ho-Su Memorial Hospital. This study analyzed laboratory data including 44 indicators. We used five ML methods, namely, logistic regression (LGR), decision tree (DT), random forest (RF), gradient boosting (GB), and eXtreme gradient boosting (XGB), to develop a two-stage ML algorithm-based prediction scheme and evaluate the important factors that predict CHD mortality. LGR served as a bench method. Regarding the validation and testing datasets from 1- and 3-year mortality prediction model, the RF had better accuracy and area-under-curve results among the five different ML methods. The stepwise RF model, which incorporates the most important factors of CHD mortality risk based on the average rank from DT, RF, GB, and XGB, exhibited superior predictive performance compared to LGR in predicting mortality among CHD patients over both 1-year and 3-year periods. We had developed a two-stage ML algorithm-based prediction scheme by implementing the stepwise RF that demonstrated satisfactory performance in predicting mortality in patients with CHD over 1- and 3-year periods. The findings of this study can offer valuable information to nephrologists, enhancing patient-centered decision-making and increasing awareness about risky laboratory data, particularly for patients with a high short-term mortality risk.
Background This study aimed to investigate the effectiveness of closed-loop stimulation (CLS) pacing compared to the traditional DDD mode in patients with chronotropic incompetence (CI) using bicycle-based cardiopulmonary exercise testing (CPET). Methods This single-center, randomized crossover trial involved 40 patients with CI. Patients were randomized to receive either DDD-CLS or DDD mode pacing for 2 months, followed by a crossover to the alternative mode for an additional 2 months. Bicycling-based CPET was conducted at the 3-month and 5-month follow-up visits to assess exercise capacity. Other cardiopulmonary exercise outcome measures and health-related quality of life were also assessed. Results DDD-CLS mode pacing significantly improved exercise capacity, resulting in a peak oxygen uptake (14.8 ± 4.0 mL/kg/min vs. 12.0 ± 3.6 mL/kg/min, p < 0.001) and oxygen uptake at the ventilatory threshold (10.0 ± 2.2 mL/kg/min vs. 8.7 ± 1.8 mL/kg/min, p <0.001) higher than those of the DDD mode. However, there were no significant differences in other cardiopulmonary exercise outcome measures such as ventilatory efficiency of carbon dioxide production slope, oxygen uptake efficiency slope, and end-tidal carbon dioxide between the two modes. Patients in the DDD-CLS group reported a better quality of life, and 97.5% expressed a preference for the DDD-CLS mode. Conclusion DDD-CLS mode pacing demonstrated improved exercise capacity and quality of life in patients with CI, highlighting its potential as an effective pacing strategy for this patient population.
Renal cysts are typically a benign condition, and parapelvic cysts are a type of renal cyst that occur adjacent to the renal pelvis or renal sinus. Parapelvic cysts can increase the risk for injury to adjacent organs or urine leakage during laparoscopic surgery. Flexible ureteroscopes with laser assistance were used to make internal incisions in cysts. Perioperative outcomes of this method were compared with those of laparoscopic surgery. Eight-three patients, who underwent surgical treatment for renal cysts at the authors’ medical center between January 2019 and June 2022, were evaluated. Two patients were excluded because they originally opted for RIRS but subsequently converted to laparoscopic surgery. Patients were divided into 2 groups based on surgery type: laparoscopic; and RIRS for internal incision. Outcomes in both groups were analyzed. Of the 81 patients analyzed, 60 [74% (group 1)] underwent laparoscopic surgery and 21 [26% (group 2)] underwent RIRS for internal incision. The median operative durations for groups 1 and 2 were 87 and 56 min, respectively (p < 0.001). Relative to RIRS, laparoscopic surgery resulted in greater postoperative painkiller use (laparoscopic surgery versus [vs.] RIRS, 43% vs. 19%; p = 0.047). The median length of hospital stay was 2 and 1 days, respectively (p < 0.001). RIRS demonstrated several advantages over laparoscopic surgery for the internal incision of parapelvic cysts, including shorter operative duration, shorter hospital stay, and less postoperative pain control. These findings may guide the selection of appropriate surgical approaches for patients with renal cysts.
Benign neoplasms of the small intestine are covered in this chapter. Small intestine tumors accounted for 5% of all gastrointestinal tract tumors. Approximately 60% of these tumors were benign. All these cases were collected by the experts of gastroenterology and very interesting and clinical practical to the clinical physicians. The authors presented clinical history, pictures of enteroscopy or capsule endoscopy, finding of pathology, and key features of radiology study in various cases including Cronkhite-Canada Syndrome, hamartoma, pyogenic granuloma, juvenile polyp, lipoma, Brunner gland hyperplasia of duodenum, inflammatory myofibroblastic tumor of the ileum, duodenal lipoma with bleeding, small intestine leiomyoma, and duodenal adenoma with bleeding.
Background Although older patients with atrial fibrillation are at heightened risk of thromboembolic and bleeding events, their optimal treatment choice remains uncertain. Methods and Results This meta‐analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses guidelines. We searched the PubMed, EMBASE, and Cochrane databases for randomized controlled trials that compared thromboembolic or bleeding outcomes between a direct oral anticoagulant (DOAC) and a vitamin K antagonist (VKA) and reported outcomes for patients aged ≥75 years with atrial fibrillation. The efficacy outcome was the composite of stroke and systemic embolism. Safety outcomes included major bleeding, any clinically relevant bleeding, and intracranial hemorrhage. Each DOAC and VKA was compared pairwise in a network meta‐analysis. High‐ and low‐dose regimens and factor IIa and Xa inhibitors were also compared. Seven randomized controlled trials were included in the analysis. Stroke and systemic embolism risks did not differ significantly among DOACs. There were no significant differences in major bleeding between each DOAC and VKA. Intracranial hemorrhage risk was significantly lower with dabigatran, apixaban, and edoxaban than with VKA and rivaroxaban, which had similar risks. High‐dose regimens led to lower risks of stroke or systemic embolism compared with VKA and low‐dose regimens, with both doses having similar bleeding risks. Conclusions In patients aged ≥75 years with atrial fibrillation, DOACs were associated with fewer thromboembolic events compared with VKA, whereas dabigatran, apixaban, and edoxaban were associated with lower risks of intracranial hemorrhage compared with VKA and rivaroxaban. Registration URL: www.crd.york.ac.uk/prospero/ . Unique identifier: CRD42022329557.
Background Monoterpenes, a class of organic compounds with the molecular formula C10H16, have been the subject of considerable research due to their promising medicinal properties. Recent experiments suggest that they may have beneficial effects on skeletal muscles. However, the effects of exposure to monoterpenes on muscle strength and mass in humans remain unknown. Methods To address this knowledge gap, we included 1,202 adults (aged ≥ 18 years) from the 2013–2014 National Health and Nutrition Examination Survey (NHANES) to investigate the potential relationship between serum levels of three specific monoterpenes (α-pinene, β-pinene, and limonene), hand grip strength, and lean muscle mass. Results Our analysis showed that except for test 2 of hand 1, all other grip strength measures showed a positive correlation with ln-limonene levels. The coefficient (ß) for combined grip strength was 2.409 (S.E. = 0.891, P = 0.015). We also observed positive associations between serum limonene levels and lean muscle mass in several areas, including arms, legs, trunk, and total body. The ß coefficient for the appendicular skeletal muscle mass index (ASMI) was 0.138 (S.E. = 0.041, P = 0.004). In addition, we found an interaction between sex and limonene, as well as between body mass index and limonene, with respect to the association with combined grip strength. Conclusions Our findings suggest a plausible association between exposure to limonene, hand grip strength, and lean muscle mass among adults in the United States. Further investigation is needed to fully understand the underlying mechanisms and medical significance of this association.
Objective In patients with obstructive sleep apnea (OSA), epiglottic collapse (EC) constitutes a major factor in the failure of continuous positive airway pressure therapy and uvulopalatopharyngoplasty. This study explored treatments that can improve EC in patients with OSA through drug‐induced sleep endoscopy with target‐controlled infusion (TCI‐DISE). Study Design Retrospective cohort study. Setting Tertiary center. Methods This study screened 352 OSA patients who underwent TCI‐DISE between 2016 and 2022. Fifty‐four patients with EC were included in the final analysis. EC severity was assessed multiple times through TCI‐DISE with different interventions. Results The application of these interventions in patients with anteroposterior epiglottic collapse (apEC) led to a significant decrease in apEC severity from total to partial or no obstruction in 60.0% of patients by head rotation, in 53.6% by mouth closure, in 47.4% who received oral appliances (OA), and in 28.0% who received intermittent negative airway pressure (iNAP). With simultaneous head rotation, apEC severity decreased more significantly from total to partial or no obstruction in 77.8% of patients by mouth closure, in 70.3% who received OA, and in 68.0% who received iNAP. Lateral epiglottic collapse (latEC) severity decreased in 53.8% of patients after OA use and in 61.5% of patients with OA use and head rotation. Conclusion This study identified head rotation with mouth closure as the most effective treatment for apEC through TCI‐DISE. Patients with latEC had higher weight, apnea‐hypopnea index, and body mass index compared with patients with apEC. OA use with head rotation appeared more effective in latEC through TCI‐DISE.
Arteriovenous fistula and arteriovenous graft are the most common types of vascular access for dialysis; stenosis and thrombosis are major complications leading to access failure and to an incresed risk of mortality. The aim of the present study was to assess the results of integrating strict vascular access blood flow surveillance with routine clinical monitoring for predicting vascular access stenosis in chronic hemodialysis patients. In this retrospective study, chronic dialysis patients with arteriovenous fistula or arteriovenous graft were included from a setting in which all patients underwent quarterly blood flow surveillance in 2017. The results of blood flow surveillance were confirmed by thorough physical examination. Predictive performance of blood flow surveillance models in detecting stenosis in patients with arteriovenous fistula or arteriovenous graft was evaluated. The predictive performance of the quarterly blood flow surveillance model was described by confusion matrix. Differences in accuracy, positive predictive value (PPV), and negative predictive value (NPV) between blood flow surveillance models with distinct blood flow thresholds were evaluated. Of 397 included patients, 336 had an arteriovenous fistula and 61 had an arteriovenous graft. In 2017, 106 percutaneous transluminal angioplasty procedures were performed in patients with an arteriovenous fistula, and 63 in patients with an arteriovenous graft. The results revealed similar predictive performance of surveillance models using an absolute blood flow threshold of < 500 or < 400 mL/min in predicting stenosis in patients with arteriovenous fistula. Blood flow surveillance models for patients with an arteriovenous fistula had significantly higher accuracy than those for patients with an arteriovenous graft. Furthermore, the use of a relative threshold, defined as blood flow < 1000 mL/min and a 25% decline in blood flow, did not affect the predictive performance of blood flow surveillance models. Blood flow surveillance models using thresholds of < 400 and < 600 mL/min, followed by thorough physical examination, showed an accuracy of 91.54% and 72.15% in predicting stenosis in patients with arteriovenous fistula and arteriovenous graft, respectively. These two blood flow surveillance models may be integrated with routine clinical monitoring to improve early detection and treatment of stenosis in hemodialysis patients.
Allyl isothiocyanate (AITC) is abundant in cruciferous vegetables and it present pharmacological activity including anticancer activity in many types of human cancer cells in vitro and in vivo. Currently, no available information to show AITC affecting DNA damage and repair‐associated protein expression in human gastric cancer cells. Therefore, in the present studies, we investigated AITC‐induced cytotoxic effects on human gastric cancer in AGS and SNU‐1 cells whether or not via the induction of DNA damage and affected DNA damage and repair associated poteins expressions in vitro. Cell viability and morphological changes were assayed by flow cytometer and phase contrast microscopy, respectively, the results indicated AITC induced cell morphological changes and decreased total viable cells in AGS and SNU‐1 cells in a dose‐dependently. AITC induced DNA condensation and damage in a dose‐dependently which based on the cell nuclei was stained by 4′, 6‐diamidino‐2‐phenylindole present in AGS and SNU‐1 cells. DNA damage and repair associated proteins expression in AGS and SNU‐1 cells were measured by Western blotting. The results indicated AITC decreased nuclear factor erythroid 2‐related factor 2 (NRF2), heme oxygenase‐1 (HO‐1), glutathione, and catalase, but increased superoxide dismutase (SOD (Cu/Zn)), and nitric oxide synthase (iNOS) in AGS cells, however, in SNU‐1 cells are increased HO‐1. AITC increased DNA‐dependent protein kinase (DNA‐PK), phosphorylation of gamma H2A histone family member X on Ser139 (γH2AX pSer139 ), and heat shock protein 90 (HSP90) in AGS cells. AITC increased DNA‐PK, mediator of DNA damage checkpoint protein 1 (MDC1), γH2AX pSer139 , topoisomerase II alpha (TOPIIα), topoisomerase II beta (TOPIIβ), HSP90, and heat shock protein 70 (HSP70) in SNU‐1 cells. AITC increased p53, p53 pSer15 , and p21 but decreased murine double minute 2 (MDM2) pSer166 and O ⁶ ‐methylguanine‐DNA methyltransferase (MGMT) in AGS cells; however, it has a similar effect of AITC except increased ataxia telangiectasia and Rad ³ ‐related protein (ATR) pSer428 , checkpoint kinase 1 (CHK1), and checkpoint kinase 2 (CHK2) in SNU‐1 cells. Apparently, both cell responses to AITC are different, nonetheless, all of these observations suggest that AITC inhibits the growth of gastric cancer cells may through induction off DNA damage in vitro.
The clinical term dengue refers to a viral disease-causing pyrexia which occurs after a patient is bitten by a mosquito of the Aedes aegypti or Aedes albopictus species. There are four types of flavivirus which may cause dengue, namely dengue viruses 1, 2, 3 and 4 (hereafter abbreviated as DENV-1 etc.). Infection with any of these types can cause dengue haemorrhagic fever or dengue shock syndrome, both of which are severe illnesses. Dengue has endemic status in at least 125 different countries within the tropics or subtropical zones. There are thought to be 390 million cases each year, of which 96 million are symptomatic .
(1) Background: The hippocampus (HP) and amygdala are essential structures in obsessive–compulsive behavior (OCB); however, the specific role of the HP in patients with behavioral variant frontotemporal dementia (bvFTD) and OCB remains unclear. (2) Objective: We investigated the alterations of hippocampal and amygdalar volumes in patients with bvFTD and OCB and assessed the correlations of clinical severity with hippocampal subfield and amygdalar nuclei volumes in bvFTD patients with OCB. (3) Materials and methods: Eight bvFTD patients with OCB were recruited and compared with eight age- and sex-matched healthy controls (HCs). Hippocampal subfield and amygdalar nuclei volumes were analyzed automatically using a 3T magnetic resonance image and FreeSurfer v7.1.1. All participants completed the Yale–Brown Obsessive–Compulsive Scale (Y-BOCS), Neuropsychiatric Inventory (NPI), and Frontal Behavioral Inventory (FBI). (4) Results: We observed remarkable reductions in bilateral total hippocampal volumes. Compared with the HCs, reductions in the left hippocampal subfield volume over the cornu ammonis (CA)1 body, CA2/3 body, CA4 body, granule cell layer, and molecular layer of the dentate gyrus (GC-ML-DG) body, molecular layer of the HP body, and hippocampal tail were more obvious in patients with bvFTD and OCB. Right subfield volumes over the CA1 body and molecular layer of the HP body were more significantly reduced in bvFTD patients with OCB than in those in HCs. We observed no significant difference in amygdalar nuclei volume between the groups. Among patients with bvFTD and OCB, Y-BOCS score was negatively correlated with left CA2/3 body volume (τb = −0.729, p < 0.001); total NPI score was negatively correlated with left GC-ML-DG body (τb = −0.648, p = 0.001) and total bilateral hippocampal volumes (left, τb = −0.629, p = 0.002; right, τb = −0.455, p = 0.023); and FBI score was negatively correlated with the left molecular layer of the HP body (τb = −0.668, p = 0.001), CA4 body (τb = −0.610, p = 0.002), and hippocampal tail volumes (τb = −0.552, p < 0.006). Mediation analysis confirmed these subfield volumes as direct biomarkers for clinical severity, independent of medial and lateral orbitofrontal volumes. (5) Conclusions: Alterations in hippocampal subfield volumes appear to be crucial in the pathophysiology of OCB development in patients with bvFTD.
Background Androgenetic alopecia (AGA), one of the most common types of hair loss, is associated with oxidative stress, inflammation and aging. Derinat, a transient receptor potential canonical channels (TRPCs) inhibitor, restrains TRPCs-mediated increase intracellular Ca²⁺ signaling, which initiates the skin aging process with intracellular reactive oxygen species (ROS) accumulation. This study investigated whether Derinat protected skin from oxidative stress-induced damage and aging, thus inhibiting AGA pathogenesis. Methods The lifespan of Caenorhabditis elegans was measured to examine the capacity of Derinat to oppose the oxidative stress induced-aging process, which drives the hair cycle from anagen to catagen phase. The experiments that used BALB/c-nu and C57BL/6 mice determined the effects of Derinat on hair cycle and oxidative stress in skin. To further apply Derinat to clinical study, the resulting relationship between AGA pathogenesis and TRPCs-regulated oxidative stress was confirmed using the bioinformatics approach. We consequently used the parameters of hair density, hair diameter, hair recovery and quality of life index to evaluate the effect of Derinat treatment on AGA subjects. Results Derinat restrained the oxidative stress induced-aging process sufficiently to extend the lifespan of worms. Derinat also changed the hair growth patterns of mice by maintenance of the hair cycle at the anagen phase. This efficacy was due to reduction of TRPCs-mediated ROS accumulation. Because the bioinformatics analysis found that AGA pathogenesis is associated with TRPCs-regulated oxidative stress and inflammation, treatment with Derinat in AGA subjects increased positive outcomes of oral medication while mitigating the impairment of AGA subjects’ quality of life. Conclusions Derinat restrains AGA pathogenesis and may provide a new therapeutic approach for treating AGA. ClinicalTrials.gov Identifier NCT05450861, https://register.clinicaltrials.gov, date of registration 07/11/2022. Trial registration ClinicalTrials.gov Identifier NCT05450861, https://register.clinicaltrials.gov, date of registration 07/11/2022
Background pneumonia patients afflicted with cardiac disease were frequented with higher rates of short-term mortality. Furthermore, the most common arrhythmia (25%) in critically ill patients is atrial fibrillation and its increased incidences in hospital mortality and extended length of hospital stays. The early detection of the occurrence of atrial fibrillation and other CV events is important among these severely pneumonia patients. Purpose The purpose of this article is to determine the appropriate risk assessments and to make a comparison of predictive performance among four common practice risk scores: APACHE II, CURB-65, pneumonia severity index and CHA2DS2-VASc. Methods This was a retrospective, observational study from consecutive critical pneumonia patients admitted to medical intensive care unit. Heart failure, acute coronary syndrome, atrial fibrillation, ventricular tachycardia or stroke are defined as a cardiovascular event. Those who had the missing data about APACHE II, CURB-65, PSI and CHA2DS2-VASc scores had already been excluded from this study. The baseline characteristics of patients between the disease groups (CV vs. non-CV; AF vs. non-AF) were compared by using the independent sample t-test for continuous variables and the chi-square test for categorical variables, respectively. The performance of discriminating in-hospital CV and AF events for the four risk scores was evaluated using the ROC curve analysis. The areas under the ROC curve (AUC) of the four risk scores were compared using the Delong’s non-parametric method. Results 252 (22.6%) of the 1,117 patients suffered from CV events during the hospitalization. Compared to patients averting CV events, those who experienced CV events during hospitalization were older, more likely to smoke, experiencing more altered mental states, of poor renal function, of higher prevalence of all comorbidities except liver disease, of a long duration of ICU and yielded higher values of the four risk scores. There were 99 patients who suffered from CV events other than an AF episode. After excluding the 99 patients, 153 (15%) of the remaining 1,018 patients had an AF event during hospitalization. The values of the four risk scores were also significantly greater in the AF group. The performance of discriminating CV events for the four risk scores was fair with the values of AUC ranging from 61.8% of APACHE II to 64.8% of CURB 65 (Fig 1). However, no significant difference of the AUC values between any two risk scores. In terms of discriminating AF episode (Fig 2) for the four risk scores, the performance was obviously poorer with the values of AUC less than 60%, except for the CURB 65. Conclusion CURB 65 is simple and effective tool for predicting new onset cardiovascular events, including atrial fibrillation, in ICU patients with pneumonia.new onset CV eventonw onset AF event
Background Ticagrelor has been recommended in place of clopidogrel as part of dual antiplatelet therapy (DAPT) in diabetic patients with acute coronary syndrome (ACS). Chronic kidney disease (CKD) patients also have a worse prognosis in the setting of ACS, but the safety and efficacy data for the use of P2Y12 inhibitors in moderate to severe CKD patients (eGFR <60 mL/min/1.73m2) are insufficient. Purpose There has been limited data on the outcome of prescribing ticagrelor compared to clopidogrel in ACS-DM patients with chronic kidney disease (CKD). Methods This prospective, nationwide, multi-center, observational study, the Acute Coronary Syndrome-Diabetes Mellitus Registry (ACS-DM Registry) was compiled from consecutive patients between October 1, 2013 and September 30, 2016. The primary end point was repeated revascularisation and the composite outcome was CV death, repeat revascularisation and CV-related readmission, was stratified by renal function stages. The Cox proportional hazards models and propensity score models were applied to six-months, one-year, and two-year post ACS, respectively. Results There were 539 patients with moderate to severe CKD or on dialysis identified from ACS-DM Registry. There were 451 patients eligible for inclusion criteria of which 116 patients were taking ticagrelor and 335 patients were taking clopidogrel. At our two-year follow-up, the unadjusted incidence of primary end point resulted higher in Ticagrelor group (HR 2.09, 95% CI 1.37-3.18, p = 0.001). After adjustment, ticagrelor also had poor primary end point event and composite outcome as compared to clopidogrel (HR 2.24, 95% CI 1.36-3.68, p = 0.002; HR 1.63, 95% CI 1.06-2.48, p = 0.024, respectively). In regards to the repeated revascularisation issue, the clopidogrel was preferable within the eGFR strata (CKD stage III: HR 2.53, 95% CI 1.32-4.84, CKD stage IV: 1.06 (0.09-12.51), CKD stage V: 1.91 (0.80-4.59), P for interaction=0.684). Conclusions Cardiovascular benefits associated with ticagrelor may not be as significant as in the landmark trial. Our results show that patients taking ticagrelor was associated with increased CV events as compared to clopidogrel in ACS-DM patients with stage III-V CKD.propensity score matchingForest plots
Phthalate exposure is widespread and has a global impact. Growing evidence shows that mono-2-ethylhexyl phthalate (MEHP) exposure has a negative impact on human health. However, whether MEHP exposure is associated with mortality and other adverse outcomes in hemodialysis patients remains unknown. This study prospectively enrolled 217 patients on maintenance hemodialysis from June 30, 2021, to August 16, 2022. Baseline serum MEHP, di-2-ethylhexyl phthalate (DEHP), and indoxyl sulfate (IS) concentrations were measured. Primary endpoints were all-cause mortality or composite adverse outcomes, including all-cause death plus hospitalization due to cardiovascular disease, heart failure, stroke, infection, or cancer. Serum MEHP concentrations were positively associated with DEHP but not indoxyl sulfate concentrations in hemodialysis patients. Additionally, serum MEHP concentrations were significantly and independently associated with all-cause mortality and composite adverse outcomes (adjusted hazard ratios [HRs], 1.04 and 1.03 per ng/mL, 95% confidence intervals [CIs], 1.01–1.07 and 1.00–1.05; p = 0.016 and 0.015, respectively). We found a cutoff value of MEHP for predicting both endpoints. Patients with serum MEHP concentrations of ≥ 41.8 ng/mL had much higher risks for all-cause mortality and composite adverse outcomes (adjusted HRs, 39.2 and 13; 95% CIs, 2.44–65.7 and 2.74–61.4; p = 0.011 and 0.001, respectively). MEHP exposure is significantly associated with higher risks for all-cause mortality and composite adverse outcomes. Hemodialysis patients with serum MEHP concentrations above 41.8 ng/mL had much poorer prognoses regarding both outcomes.
Clinical practices on acute post-operative and endogenous endophthalmitis (EnE) are highly variable among clinicians due to a lack of up-to-date, high-quality evidential support. An expert consensus is thus much needed. A panel consisting of ten retinal specialists in Taiwan was organized. They evaluated relevant literature and developed key questions regarding acute post-operative and EnE that are cardinal for practice but yet to have conclusive evidence. The panel then attempted to reach consensus on all the key questions accordingly. There were eight key questions proposed and their respective consensus statements were summarized as follows: Gram staining and culture are still the standard procedures for the diagnosis of endophthalmitis. Vitrectomy is recommended to be performed earlier than the timing proposed by the Endophthalmitis Vitrectomy Study (EVS). Routine intracameral antibiotic injection for post-cataract surgery endophthalmitis prophylaxis is not recommended because of potential compounding error hazards and a lack of support from high-quality studies. Routine fundus examination is recommended for all patients with pyogenic liver abscess. In EnE, vitrectomy is recommended if diffused and dense vitritis is present, or if the disease progresses. These consensus statements may work as handy guidance or reference for clinical practices of acute post-operative and EnE.
BACKGROUND: Current evidence of nonpharmacological intervention for patients with treatment-resistant depression (TRD) is lacking. AIMS: To examine whether an 8-week nurse-led cognitive-behavioral based group intervention would enhance resilient coping and life quality among community-based patients with TRD. METHOD: The participants were randomly sampled from a cohort of TRD recruited from two general teaching hospitals. The two groups were assessed with multiple outcome measures at baseline (T0); 8-week post-baseline (T1); and at 3, 6, and 9 months after T1 (T2–4). Psychoeducation was nested in the cognitive behavioral group intervention to facilitate discussion. RESULTS: Of the 23 participants (mean age 56 years, 69.6% female) in the experimental group, higher resilient coping and lower mental distress levels at T1 as well as later improved quality of life and community integration at T2–4 were observed compared to the controls across COVID-19 (T3). Overall, the scores of resilience and community integration were higher throughout the four follow-up points of observations for the experimental group. CONCLUSION: The findings indicated that an 8-week nurse-led cognitive-behavioral based group intervention may enhance the TRD patients’ resilient coping and mental distress levels while providing the potentials for community reintegration after mental health psychoeducation engagement. It is imperative for the nurses caring for patients with TRD to extend from clinical-based intervention to community-based self-care approach, with the importance of short-term stress management and healthy lifestyle development highlighted during the community reintegration trajectory.
Using arch support insoles for children with motor developmental delays requires further evidence. This study aims to evaluate the short-term effects of customized arch support insoles on these children, adopting the International Classification of Functioning, Disability, and Health (ICF) framework for our analysis. Participants were randomly assigned to either the treatment group, which received customized insoles, or the control group (waitlisted), which did not receive any insoles during a 12-week intervention. The primary outcome focused on physical health, measured using the Pediatric Outcome Data Collection Instrument-Parent (PODCI). Secondary outcomes included balance (measured via the Berg Balance Scale), physical functional performance (10-meter walking test, stair climbing test, and Timed Up and Go test), and health-related quality of life (assessed using the Pediatric Quality of Life Inventory, PedsQL). A significant improvement was observed in the regular walking speed of the treatment group compared to the control group (0.13 m/s vs. 0.013 m/s, P < .001), and nearly met the criteria for minimal clinically important difference. However, no significant differences were noted between the groups regarding changes in scores from the PODCI, Berg Balance Scale, Timed Up and Go test, most physical functional performance, and PedsQL. Conclusion: The 12-week use of customized arch support insoles in children with motor developmental delays showed a marginal improvement in regular walking speed, and the improvement did not extend to physical health status, most physical functional performance, or health-related quality of life. Thus, we do not recommend arch support insoles for children with motor developmental delays. Trial registration ClinicalTrials.gov: NCT03191006 (Registered June 22, 2017).
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