Physicians are over optimistic in recognizing inpatients' survival and palliative care needs: a large-scale multi-center study in Taiwan.

BACKGROUND: Physicians' recognition of end of life (EOL) has key influences on patients' 'good death'. AIM: We aimed to study physicians' attitude toward EOL, and to analyze the relationship between physicians' assessment and patients' actual survival and the trigger effect on patient's access to palliative consultation and palliative care. DESIGN: This is a multi-center retrospective cohort study in seven community hospitals in Taiwan. METHODS: Inpatients admitted between 1 March 2016 and 31 December 2020, scored ≥4 points using Taiwan version-Palliative Care Screening Tool (TW-PCST), and expired before 31 December 2020 were enrolled. Physicians answered three questions regarding these inpatients: 'surprised of mortality within 6-12 months', 'EOL' and 'in need of palliative care'. We followed up patients' actual survival and access to palliative consultation and services. RESULTS: We enrolled 10 304 cases. There was high correlation among the three questions. The median survival of patients with 'not surprised of death within 6-12 months', 'EOL', and 'needing palliative care' were 68, 60 and 58 days, respectively. Those with opposite responses were 206, 166 and 186 days, respectively. Patients' main diagnosis, TW-PCST score, physicians' palliative care qualifications and reward measures were all associated with physicians' recognition of EOL. Physicians' assessment, physicians' training, disease characteristics and TW-PSCT scores were all associated with palliative consultation and palliative care. CONCLUSIONS: Physicians are still over optimistic in recognizing inpatients' survival and palliative care needs. EOL talks can be initiated when the TW-PCST score is high. Universal palliative care training can be integrated into medical education.

A standard technique with potential diagnostic value for estimating the quadriceps muscle strength of critically ill patients.

OBJECTIVE: Intensive care unit-acquired weakness (ICUAW) is common, and so far, there is no digital technology with a standard procedure to estimate the muscle strength of these patients. Quadriceps maximal isometric voluntary contraction (QMVC) is a precise and reliable procedure to detect quadriceps muscle strength. Therefore, this research aimed to explore whether QMVC measurements can be used in critically ill patients at the bedside as a potential diagnostic method. PATIENTS AND METHODS: Tailor-made computerized equipment was designed to measure the QMVC of critically ill patients at the bedside, following a standard procedure. A total of 22 critically ill patients and 22 age- and sex-matched healthy subjects were divided into group 1 and group 2, respectively. SPASS 21.0 (IBM, Armonk, NY, USA) software was used to analyze the data. RESULTS: All subjects showed good endurance with the QMVC measurements and there were no side effects among these subjects. There was a significant decline in QMVC between group 1 and group 2 (p=0.000). QMVC was correlated closely with the APACHE II Score in group 1 (Pearson correlation, r=-0.427, p=0.047). Among the 10 patients with a Medical Research Council sum score (MRC SS) less than 60 in group 1, it was also correlated closely with the MRC SS (Pearson correlation, r=0.837, p=0.003). CONCLUSIONS: This study describes a standard technique for quantifying quadriceps muscle strength that is feasible for use with critical patients. QMVC can accurately detect the decline of quadriceps muscle strength of critical patients, and it may also decline with the severity of the disease. In the future, this technique might be a potential diagnostic tool for ICUAW.

Age distribution of human papillomavirus infection and neutralizing antibodies in healthy Chinese women aged 18-45 years enrolled in a clinical trial.

OBJECTIVES: Data from clinical trials of human papillomavirus (HPV) vaccines showed that women naïve (negative for both type-specific antibodies and DNA) to vaccine types would derive benefit from vaccination; therefore, an understanding of the proportion of naïve women in different age groups is important for developing HPV vaccination strategies. METHODS: From November 2012 to April 2013, a total of 7372 healthy women aged 18-45 years were recruited in five provinces in China. Cervical specimens and serum samples were collected for each woman at entry. Cervical specimens were first tested by the HPV DNA enzyme immunoassay method; if positive, the specimens were then tested by reverse hybridization line probe assay and HPV-16 and HPV-18 specific polymerase chain reactions. Neutralizing antibodies against HPV-16 or HPV-18 were tested with a pseudovirion-based neutralization assay. RESULTS: The overall prevalence of high-risk HPV DNA was 14.8% (1088/7367, 95% CI 14.0-15.6), and the seroprevalence of neutralizing antibodies against HPV-16 and HPV-18 was 12.6% (925/7367) and 4.9% (364/7367), respectively. In younger women (18-26 years) and middle-aged women (27-45 years), 83.8% (3116/3719) and 81.4% (2968/3648) were naïve to both HPV-16 and HPV-18 (both neutralizing antibodies and DNA were negative), respectively. In addition, 98.5% (3664/3719) and 98.0% (3575/3648) of the younger or middle-aged women were naïve to at least one HPV type (HPV-16 or HPV-18). DISCUSSION: This study revealed that the majority of Chinese women aged 18-26 years and 27-45 years were naïve to both HPV-16 and HPV-18 and would thus derive full benefit from bivalent HPV vaccination.

Clinicopathological features and prognosis of esophageal squamous cell carcinoma in young patients.

Esophageal squamous cell carcinoma (ESCC) in the young patients is comparatively rare and has not been well studied. We analyzed the clinical and survival data of 127 ESCC patients <40 years at a single high-volume center and compared with those of 4109 ESCC patients ≥40 years who underwent surgery within the same period in this study. The average age was 36.5 ± 0.2 years for the young patient group, with the youngest aged 26 years. Young patients had a higher rate of family history, longer tumors, and a more advanced pT category than their older counterparts. Moreover, more patients in the young group underwent incomplete resection (19.7% vs. 8.9%, P < 0.001) and adjuvant therapy (40.9% vs. 30.8%, P = 0.015). The overall survival (OS) and cancer-specific survival (CSS) between patients <40 years and patients ≥40 years were not significant in the entire group. In the subgroup analysis, the OS and CSS rates for patients <40 years were significantly worse than patients ≥40 years in subgroups of pTNM stage III and incomplete resections. In conclusions, young patients with ESCC were more likely to have family history and present with advanced disease. The survival for young patients with ESCC was poorer than their older counterparts in patients with later stage diseases.

Impact of age on survival of locoregional nasopharyngeal carcinoma: An analysis of the Surveillance, Epidemiology, and End Results program database, 2004-2013.

OBJECTIVES: To determine the impact of age at diagnosis and other factors on survival in nasopharyngeal carcinoma (NPC). DESIGN, SETTING AND PARTICIPANTS: A retrospective, population-based cohort study of 3103 patients are selected, whose records were submitted to the Surveillance, Epidemiology, and End Results (SEER) database between 2004 and 2013. We evaluated the demographic and clinical characteristics of patients who were 20 years or older with a diagnosis of primary, non-metastatic NPC. MAIN OUTCOME MEASURES: Overall survival (OS) and risks of OS and NPC-specific survival. RESULTS: Overall survival rates at 1, 3, and 5 years were 85.8%, 71.0%, and 62.6%, respectively. Older age was a significant predictor of poor OS, as was Chinese ethnicity. We also determined that middle-aged white patients, but not middle-aged black or Chinese patients, were at a higher risk of death than were younger patients of the same race/ethnicity. Nodal (N) stage 0-1 disease was a significant predictor of poor OS when comparing survival of older patients with N0-1 vs N2-3 stage disease. Finally, we found that married patients had a decreased risk of death when compared to those who were single. CONCLUSIONS: The survival of older patients with NPC is inferior to that of younger patients. Race/ethnicity, marital status, and stage of disease are important modifiers of risk. Collectively, our results indicate that management of older patients requires optimisation.

Glipizide blocks renal interstitial fibrosis by inhibiting AKT signaling pathway.

OBJECTIVE: Diabetes affects the renal function at a certain stage. Oral medication glipizide plays a hypoglycemic effect mainly through releasing insulin, while more insulin is derived from islet ß cells. It is still controversy whether antidiabetics. This study mainly intends to investigate the role of glipizide in inhibiting renal interstitial fibrosis. MATERIALS AND METHODS: A total of 93 SD rats were purchased from Guangdong animal monitoring and established unilateral ureteral obstruction (UUO) model to simulate renal interstitial fibrosis. Forty rats in the experimental group received glipizide intraperitoneal injection for a week at 30 days after modeling, while another 40 rats in the control group received a normal saline injection. The last 10 rats were treated as blank group. Hematoxylin and eosin (HE) staining was applied to test renal interstitial fibrosis. Immunohistochemistry was used to detect fibronectin expression in glomerular and renal tubules. AKT signaling pathway related factors expression was measured by Western blot to determine AKT signal activation. RESULTS: HE staining showed that the entire kidney cytoplasm red dye becomes shallow, renal medulla gradually disappears, renal tubular epithelial cells enlarge, vacuoles degeneration, renal tubule and collecting tube expansion, inflammatory cells infiltration after UUO modeling. Glipizide treatment decreased dilated renal tubule number, improved glomerulus integrity, and reduced inflammatory infiltration. Fibronectin level in the experimental group was significantly lower than that in control (p<0.05). Western blot revealed that p-AKT expression downregulated after glipizide treatment. CONCLUSIONS: Glipizide blocks renal interstitial fibrosis by inhibiting AKT signaling pathway.

Persistence of antibodies acquired by natural hepatitis E virus infection and effects of vaccination.

OBJECTIVE: Naturally acquired anti-hepatitis E virus (HEV) immunity can protect against new HEV infections. The aim of this study was to analyse the persistence of naturally acquired anti-HEV immunoglobulin (Ig) G and anti-HEV IgG concentrations after vaccination. METHODS: We examined the seropositivity rates of participants included in a phase 3 clinical efficacy trial (67 months' follow-up) for a HEV vaccine (Hecolin; Xiamen Innovax Biotech, China) and predicted long-term persistence using mixed-effect models. RESULTS: The analysis focused on 2242 baseline seropositive participants in a control group (placebo recipients) and 2031 baseline seropositive participants in an vaccine group (vaccine recipients) who received 1 to 3 doses of Hecolin. Naturally acquired anti-HEV IgG levels decreased steadily independent of the initial antibody level; 50% of the placebo recipients were expected to have undetectable antibody concentrations after 14.5 years. After immunization with Hecolin, the power-law model and the modified power-law model predicted that 82.1 and 99.4% of the participants, respectively, would remain seropositive for anti-HEV IgG for 30 years after vaccination. CONCLUSIONS: Whereas naturally acquired anti-HEV IgG levels decrease steadily, HEV vaccination induces long-lasting, high-level anti-HEV IgG concentrations.

The association between miR-499a polymorphism and oral squamous cell carcinoma progression.

OBJECTIVE: To investigate the association of miR-499a genetic polymorphism with the risk of oral leukoplakia, oral submucous fibrosis (OSF), oral squamous cell carcinoma (OSCC), and clinicopathological outcomes of OSCC. METHODS: The genotyping of miR-499a T>C (rs3746444) using TagMan assay was conducted in two case-control studies of 1549 subjects. miR-499a-5p and miR-499a-3p were assayed using stem-loop RT-PCR for 63 paired OSCC and adjacent normal tissues. RESULTS: T/C+C/C genotypes [adjusted odds ratio (AOR) 1.84, P = 0.032] and C allelic type (AOR 1.91, P = 0.007) at miR-499a T>C were associated with an increased risk of BQ-related OSF as compared to those with T/T genotype or T allelic type, respectively. Conversely, T/C+C/C genotypes and C allelic type decreased the risk of OSCC, especially for non-BQ-related OSCC (for genotype: AOR 0.49, P = 0.010; for allelic type: AOR 0.50, P = 0.007). Additionally, downregulation of miR-499a-5p was found in OSCC tissues (P = 0.001) and correlated with the TT genotype (P = 0.001). CONCLUSION: The T/C+C/C genotypes of MiR-499a may contribute to an increased risk of BQ-related OSF, but a decreased risk of OSCC. miR-499a T>C influences the expression levels of miR-499a-5p during the tumorigenesis of OSCC.

Laboratorial characteristics of patients with diarrhoea suffering from egg white allergy

BACKGROUND: Egg allergy is associated with diarrhoeal symptoms. However, the mechanism underlying allergic diarrhoea remains unclear. OBJECTIVE: To determine whether egg white-specific IgE antibodies coexist with egg white-specific IgG antibodies in patients with egg allergy featuring diarrhoeal symptoms, and whether there is any relationship between these two antibody types. METHODS: A total of 89 patients with egg allergy featuring diarrhoeal symptoms (average age, 23.2 years; range, 1-78 years), all of whom tested positive for egg white-specific IgG, were enrolled in this study. The concentration of total IgE, egg white-specific IgE and number of eosinophils in the serum were determined. RESULTS: Among the 89 egg white allergic patients tested, 49 (55.1%) patients showed high reactivity to egg white-specific IgG, 48 (53.9%) patients had elevated serum total IgE levels, and 25 (28.1%) patients had elevated absolute eosinophil numbers. Out of the 89 egg white allergic patients, 25 showed elevated egg white-specific IgE antibody levels. Of the 25 patients who were positive for egg white-specific IgE antibody, 21 presented high sensitive reaction to egg white-specific IgG, three presented moderate sensitive reaction to egg white-specific IgG, and one presented mild sensitive reaction to egg white-specific IgG. A moderate correlation between egg white-specific IgG and egg white-specific IgE, egg white-specific IgG and absolute eosinophil number was found in the egg white allergic patients (r = 0.438, P = 0.000; r = 0.322, P = 0.002). Egg white-specific IgE levels varied in different age groups; the egg white-specific IgE concentration of younger patients (age ≤ 18 years, mean rank 54.29) was significantly higher than that of the adult patients (age > 18 years, mean rank 34.61) (Z = −3.629, P = 0.000). CONCLUSION: Egg white-specific IgE antibody could coexist with egg white-specific IgG antibody in patients suffering from egg white allergy. Aberrant changes in the concentration of egg white-specific IgE antibody were associated with the presence of egg white-specific IgG antibody

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Protection against hepatitis E virus infection by naturally acquired and vaccine-induced immunity.

Immunity acquired from infection or vaccination protects humans from symptomatic hepatitis E. However, whether the risk of hepatitis E virus (HEV) infection is reduced by the immunity remains unknown. To understand this issue, a cohort with 12 409 participants randomized to receive the hepatitis E vaccine Hecolin(®) or placebo were serologically followed up for 2 years after vaccination. About half (47%) of participants were initially seropositive. A total of 139 infection episodes, evidenced by four-fold or greater rise of anti-HEV level or positive seroconversion, occurred in participants who received three doses of treatment. Risk of infection was highest among the baseline seronegative placebo group participants (2.04%). Pre-existing immunity and vaccine-induced immunity lower the risk significantly, to 0.52% and 0.30%, respectively. In conclusion, both vaccine-induced and naturally acquired immunity can effectively protect against HEV infection.

Laboratorial characteristics of patients with diarrhoea suffering from egg white allergy.

BACKGROUND: Egg allergy is associated with diarrhoeal symptoms. However, the mechanism underlying allergic diarrhoea remains unclear. OBJECTIVE: To determine whether egg white-specific IgE antibodies coexist with egg white-specific IgG antibodies in patients with egg allergy featuring diarrhoeal symptoms, and whether there is any relationship between these two antibody types. METHODS: A total of 89 patients with egg allergy featuring diarrhoeal symptoms (average age, 23.2 years; range, 1-78 years), all of whom tested positive for egg white-specific IgG, were enrolled in this study. The concentration of total IgE, egg white-specific IgE and number of eosinophils in the serum were determined. RESULTS: Among the 89 egg white allergic patients tested, 49 (55.1%) patients showed high reactivity to egg white-specific IgG, 48 (53.9%) patients had elevated serum total IgE levels, and 25 (28.1%) patients had elevated absolute eosinophil numbers. Out of the 89 egg white allergic patients, 25 showed elevated egg white-specific IgE antibody levels. Of the 25 patients who were positive for egg white-specific IgE antibody, 21 presented high sensitive reaction to egg white-specific IgG, three presented moderate sensitive reaction to egg white-specific IgG, and one presented mild sensitive reaction to egg white-specific IgG. A moderate correlation between egg white-specific IgG and egg white-specific IgE, egg white-specific IgG and absolute eosinophil number was found in the egg white allergic patients (r=0.438, P=0.000; r=0.322, P=0.002). Egg white-specific IgE levels varied in different age groups; the egg white-specific IgE concentration of younger patients (age≤18 years, mean rank 54.29) was significantly higher than that of the adult patients (age>18 years, mean rank 34.61) (Z=-3.629, P=0.000). CONCLUSION: Egg white-specific IgE antibody could coexist with egg white-specific IgG antibody in patients suffering from egg white allergy. Aberrant changes in the concentration of egg white-specific IgE antibody were associated with the presence of egg white-specific IgG antibody.

High prevalence of azithromycin resistance to Treponema pallidum in geographically different areas in China.

Treatment with effective antibiotics is one important strategy for syphilis control in China. This study aimed to evaluate the prevalence of azithromycin resistance to T. pallidum in China. A cross-sectional study was conducted among 391 patients with early syphilis recruited from STD clinics in eight cities during October 2008 and October 2011. The swabs were obtained from the moist lesions of the participating patients. A touchdown/nested PCR of the 23S ribosomal RNA (rRNA) gene was performed on DNA samples extracted from these specimens. The presence or absence of the A2058G point mutation, conferring resistance to azithromycin, was determined by restriction enzyme digestion analysis of the PCR amplicon by MboII. Two hundred and eleven patients with primary or secondary syphilis were found to have T. pallidum DNA in their moist lesions by PCR assays. The A2058G mutation was present in 91.9% (194/211, 95% CI, 87.2-95.1%) of these patients, with no significant differences noted between patients from the eastern part (93.8%), southern part (88.6%) and northern part (95.2%) of China (χ(2) = 2.303, p 0.316). Compared with patients who had not taken macrolides in previous years before study entry, the patients who had taken the antibiotics had a significantly higher prevalence of azithromycin resistance (97.0% vs. 62.5%), with an odds ratio of 19.65 (95% CI, 5.77-66.93). It can be concluded that prevalence of azithromycin resistance is substantial in China and consequently that the macrolides should not be used as a treatment option for early or incubating syphilis in China.

Few-body bound states in dipolar gases and their detection.

We consider dipolar interactions between heteronuclear molecules in a low-dimensional setup consisting of two one-dimensional tubes. We demonstrate that attraction between molecules in different tubes can overcome intratube repulsion and complexes with several molecules in the same tube are stable. In situ detection schemes of the few-body complexes are proposed. We discuss extensions to many tubes and layers, and outline the implications on many-body physics.

Randomized clinical trial of single-incision laparoscopic cholecystectomy versus minilaparoscopic cholecystectomy.

BACKGROUND: Transumbilical single-incision laparoscopic cholecystectomy (SILC) and minilaparoscopic cholecystectomy (MLC) are both increasingly being used to treat symptomatic gallstones. The present study compared SILC and MLC with respect to outcome in a prospective randomized trial. METHODS: Seventy patients with symptomatic cholelithiasis were randomized to SILC or MLC (35 in each group). The primary outcome measure was postoperative pain. Secondary outcomes were duration of operation, complications, postoperative analgesic requirements, length of hospital stay, cosmetic result, wound length and time to return to work. RESULTS: Surgical complications, postoperative pain scores, analgesic requirements and time to return to work were similar for both procedures. Statistically significant advantages of SILC were a shorter hospital stay, shorter total wound length and better cosmetic appearance. Duration of operation was significantly shorter for MLC. CONCLUSION: SILC is superior to MLC in terms of cosmetic outcome, but not in postoperative pain and requirement for analgesics.