Relative Energy Deficiency in Sport (RED-S) and Knee Injuries: Current Concepts for Female Athletes.

In athletes, a mismatch between caloric intake and energy expended in exercise can result in Low Energy Availability (LEA). LEA can lead to Relative Energy Deficiency in Sport (RED-S), where the athlete suffers from physiological derangements and decreased sport performance. The prevalence of RED-S is higher in females than males. RED-S more comprehensively describes the syndrome originally known as "Female Athlete Triad" (FAT). FAT encompasses the triad of LEA (with or without disordered eating), menstrual dysfunction and low bone mineral density. RED-S includes other physiological derangements such as poor cardiovascular health, abnormalities of metabolic rate, immunity, and protein synthesis. Females are already at a higher risk of knee injuries, which has been attributed to a multitude of factors such as hormonal influences, differences in musculoskeletal anatomy and neuromuscular control compared to males. The literature demonstrates an even higher risk of knee injuries in female athletes with symptoms of RED-S. We propose the various factors that influence this risk. A reduction in anabolic hormones can affect muscle development and tendon repair. A relationship between poor neuromuscular control and knee injury has been established, and this can be further worsened in patients with menstrual dysfunction. Chronic deficiency in nutrients such as collagen and vitamin D can result in poorer recovery from microtrauma in tendon and ligaments. All these factors may contribute to increasing the risk of knee injuries, which may include anterior cruciate ligament tears, patella tendinopathy and patellofemoral pain syndrome. This review aims to educate sports clinicians to have a high index of suspicion when treating knee injuries in females; to screen and then manage for RED-S if present, for holistic patient care.

25-Hydroxycholesterol regulates lysosome AMP kinase activation and metabolic reprogramming to educate immunosuppressive macrophages.

Macrophages are critical to turn noninflamed "cold tumors" into inflamed "hot tumors". Emerging evidence indicates abnormal cholesterol metabolites in the tumor microenvironment (TME) with unclear function. Here, we uncovered the inducible expression of cholesterol-25-hydroxylase (Ch25h) by interleukin-4 (IL-4) and interleukin-13 (IL-13) via the transcription factor STAT6, causing 25-hydroxycholesterol (25HC) accumulation. scRNA-seq analysis confirmed that CH25Hhi subsets were enriched in immunosuppressive macrophage subsets and correlated to lower survival rates in pan-cancers. Targeting CH25H abrogated macrophage immunosuppressive function to enhance infiltrating T cell numbers and activation, which synergized with anti-PD-1 to improve anti-tumor efficacy. Mechanically, lysosome-accumulated 25HC competed with cholesterol for GPR155 binding to inhibit the kinase mTORC1, leading to AMPKα activation and metabolic reprogramming. AMPKα also phosphorylated STAT6 Ser564 to enhance STAT6 activation and ARG1 production. Together, we propose CH25H as an immunometabolic checkpoint, which manipulates macrophage fate to reshape CD8+ T cell surveillance and anti-tumor response.

FBXO38 regulates macrophage polarization to control the development of cancer and colitis.

Macrophages are highly plastic cells that differentially regulate multiple pathological conditions, including cancer and autoimmune diseases. In response to various stimuli, macrophages activate different intrinsic signaling pathways and polarize into distinct macrophage subsets. We aimed to identify key new effectors that could control macrophage polarization and impact the development of cancer or colitis. Following treatment with the supernatants of tumor cells, macrophages showed an upregulation in Fbxo38 expression. Subsequently, we further identified that FBXO38 promotes macrophage immunosuppressive function by upregulating the expression of M2-like genes via MAPK and IRF4 signaling without affecting M1-like macrophage polarization. Deletion of Fbxo38 in macrophages was found to block tumor development and protect against DSS-induced colitis. Considering the distinct regulation of tumor development by FBXO38 in T cells and macrophages, we suggest that a comprehensive understanding of FBXO38 function in different cell types is critical for its further translational usage.

An overview of three-dimensional imaging devices in dentistry.

OBJECTIVE: To review four types of three-dimensional imaging devices: intraoral scanners, extraoral scanners, cone-beam computed tomography (CBCT), and facial scanners, in terms of their development, technologies, advantages, disadvantages, accuracy, influencing factors, and applications in dentistry. METHODS: PubMed (National Library of Medicine) and Google Scholar databases were searched. Additionally, the scanner manufacturers' websites were accessed to obtain relevant data. Four authors independently selected the articles, books, and websites. To exclude duplicates and scrutinize the data, they were uploaded to Mendeley Data. In total, 135 articles, two books, and 17 websites were included. RESULTS: Research and clinical practice have shown that oral and facial scanners and CBCT can be used widely in various areas of dentistry with high accuracy. CONCLUSION: Although further advancement of these devices is desirable, there is no doubt that digital technology represents the future of dentistry. Furthermore, the combined use of different devices may bring dentistry into a new era. These four devices will play a significant role in clinical utility with high accuracy. The combined use of these devices should be explored further. CLINICAL SIGNIFICANCE: The four devices will play a significant role in clinical use with high accuracy. The combined use of these devices should be explored further.

A Novel Bayes Approach to Impervious Surface Extraction from High-Resolution Remote Sensing Images.

Impervious surface as an evaluation indicator of urbanization is crucial for urban planning and management. It is necessary to obtain impervious surface information with high accuracy and resolution to meet dynamic monitoring under rapid urban development. At present, the methods of impervious surface extraction are primarily based on medium-low-resolution images. Therefore, it is of theoretical and application value to construct an impervious surface extraction method that applies to high-resolution satellite images and can solve the shadow misclassification problem. This paper builds an impervious surface extraction model by Bayes discriminant analysis (BDA). The Gaussian prior model is incorporated into the Bayes discriminant analysis to establish a new impervious surface extraction model (GBDA) applicable to high-resolution remote sensing images. Using GF-2 and Sentinel-2 remote sensing images as experimental data, we discuss and analyze the applicability of BDA and GBDA in impervious surface extraction of high-resolution remote sensing images. The results showed that the four methods, SVM, RF, BDA and GBDA, had OA values of 91.26%, 94.91%, 94.64% and 97.84% and Kappa values of 0.825, 0.898, 0.893 and 0.957, respectively, in the extraction results of GF-2. In the results of effective Sentinel-2 extraction, the OA values of the four methods were 87.94%, 91.79%, 92.19% and 93.51% and the Kappa values were 0.759, 0.836, 0.844 and 0.870, respectively. Compared with the support vector machine (SVM), random forest (RF) and BDA methods, GBDA has significantly improved the extraction accuracy. GBDA enhances the robustness and generalization ability of the model and can improve the shadow misclassification phenomenon of high-resolution images. The model constructed in this paper is highly reliable for extracting impervious surfaces from high-resolution remote sensing images, exploring the application value of Bayes discriminant analysis in impervious surface extraction and providing technical support for impervious surface information of high spatial resolution and high quality.

Hypoglycemic mechanism of intestinal bypass surgery in type 2 diabetic rats.

To investigate the effect of duodenal-jejunal bypass (DJB) surgery on postoperative blood glucose in type 2 diabetic rats, and further explore possible mechanisms for the effect of surgical treatment of type 2 diabetes. Forty rats with type 2 diabetes were randomly assigned to 4 groups (n = 10 rats per group), which subsequently underwent DJB, new biliopancreatic diversion (NBPD) or duodenal-jejunal exclusion (DJE) surgery or a sham operation (SHAM). Fasting glucose, 2-h postprandial glucose and blood lipids were measured, and the mRNA in liver and intestinal tissue for bile acid receptor (FXR), as well as the FXR protein expression in the liver tissues were determined. Postprandial blood glucose and fasting TG and FFA in the DJB and NBPD groups were significantly lower than those in the SHAM group and preoperative (p < 0.05) at 8 weeks postoperation. Liver FXR protein was expressed at significantly higher in the DJB and NBPD groups than in the other two (p < 0.05), and the intestinal FXR mRNA in the DJE group were highest. DJB up-regulates the expression of bile acid receptors in the liver and down-regulates those receptors in the intestinal tract via biliopancreatic diversion. This process reduces TG levels, and subsequently any lipotoxicity to islet cells to produce a hypoglycemic effect.

Systematic review and meta-analysis of the therapeutic effects of minimally invasive transforaminal interbody fusion on spondylolisthesis.

BACKGROUND: Minimally invasive transforaminal interbody fusion (MI-TLIF) can minimize surgical incision, tissue damage, and intraoperative blood loss in the treatment of spondylolisthesis. However, there is a lack of evidence-based research to confirm its clinical efficacy. METHODS: Chinese and English databases were searched with "open", "minimally invasive transforaminal interbody fusion", "MIS-TLIF", "spondylolisthesis", and "open transforaminal interbody fusion" as search terms. Rev Man 5.3 provided by the Cochrane system was used to assess the quality of the literature. RESULTS: Of the 12 randomized controlled trials (RCTs), 7 references were level A (58.34%), 4 were B level (33.33%), and 1 reference was C level (8.33%). There was a statistically significant difference in intraoperative blood loss between MI-TLIF and open transforaminal interbody fusion (O-TLIF) in the treatment of spondylolisthesis [mean difference (MD) =-349.35, 95% confidence interval (CI): (-410.66, -288.03), P<0.00001]. There was also a statistically significant difference in visual analogue scale (VAS) scores before and after MI-TLIF at the last follow-up [MD =5.72, 95% CI: (4.83, 6.62), P<0.00001], and in the complication rate between MI-TLIF and O-TLIF [odds ratio (OR) =0.48, 95% CI: (0.30, 0.76), P<0.00001]. DISCUSSION: This meta-analysis confirmed that MI-TLIF could significantly reduce intraoperative blood loss, mitigate patient pain, and reduce the incidence of complications without increasing the operation time in the treatment of spondylolisthesis.

Electrocardiographic and Echocardiographic Insights From a Prospective Registry of Asian Elite Athletes.

Background: Asian representation in sport is increasing, yet there remains a lack of reference values for the Asian athlete's heart. Consequently, current guidelines for cardiovascular screening recommend using Caucasian athletes' norms to evaluate Asian athletes. This study aims to outline electrocardiographic and echocardiographic characteristics of the Asian athlete's heart using a Singaporean prospective registry of Southeast (SE) Asian athletes. Methods and Results: One hundred and fifty elite athletes, mean age of 26.1 ± 5.7 years (50% males, 88% Chinese), were evaluated using a questionnaire, 12-lead electrocardiogram (ECG) and transthoracic echocardiogram. All ECGs were analyzed using the 2017 International Recommendations. Echocardiographic data were presented by gender and sporting discipline. The prevalence of abnormal ECGs among SE Asian athletes was 6.7%-higher than reported figures for Caucasian athletes. The abnormal ECGs comprised mainly anterior T wave inversions (ATWI) beyond lead V2, predominantly in female athletes from mixed/endurance sport (9.3% prevalence amongst females). None had echocardiographic structural abnormalities. Male athletes had reduced global longitudinal strain compared to females (-18.7 ± 1.6 vs. -20.7 ± 2.1%, p < 0.001). Overall, SE Asian athletes had smaller left ventricular cavity sizes and wall thickness compared to non-Asian athletes. Conclusion: SE Asian athletes have higher abnormal ECG rates compared to Caucasian athletes, and also demonstrate structural differences that should be accounted for when interpreting their echocardiograms compared to athletes of other ethnicities.

Five-Strand Versus Four-Strand Hamstring Autografts in Anterior Cruciate Ligament Reconstruction-A Prospective Randomized Controlled Study.

PURPOSE: To compare the clinical outcomes of the routine use of 5-strand hamstring grafts (where possible) with those of 4-strand grafts in primary anterior cruciate ligament (ACL) reconstruction. METHODS: A total of 64 patients were enrolled in a prospective randomized controlled study comparing the use of 5-strand and 4-strand semitendinosus-gracilis autografts in single bundle ACL reconstruction (n = 32 in each group). Four participants in each group were lost to follow-up and were excluded from the outcome analysis. The outcomes of 28 patients in the 5-strand group and 28 patients in the 4-strand group were analyzed. The diameters of all grafts were measured intraoperatively. Patients were assessed postoperatively at 2 years with objective assessments (anterior knee laxity using the KT-2000 arthrometer, Lachman test, pivot-shift test, hop test) and patient-reported outcome scores (Lysholm knee score, Knee Injury and Osteoarthritis Outcome Score, International Knee Documentation Committee subjective knee score, SF-36 physical and mental components, Tegner activity scale). Postoperative graft ruptures were also noted. RESULTS: There were improvements in all outcome measures postoperatively regardless of the number of graft strands. When we compared the study and control groups, there were no significant differences in all subjective and objective outcome measures except the Knee Injury and Osteoarthritis Outcome Score symptoms score (5-strand group 93.3 ± 9.2 vs 4-strand group 86.2 ± 14.7, P = .04). The KT-2000 side-to-side difference was 2.79 ± 2.11 mm in the 5-strand group and 2.54 ± 1.75 mm in the 4-strand group (P = .63). The 5-strand study group had 2 graft ruptures at 1 year, whereas the 4-strand control group had one partial graft rupture at 6 months. CONCLUSIONS: At 2-year follow-up, the routine use of the 5-strand hamstring tendon autograft was not superior to that of the quadrupled or 4-strand graft in primary ACL reconstruction. LEVEL OF EVIDENCE: Level I, prospective randomized controlled trial.

The Impact Analysis of Land Features to JL1-3B Nighttime Light Data at Parcel Level: Illustrated by the Case of Changchun, China.

Nighttime lights (NTL) create a unique footprint left by human activities, which can reflect the economic index and demographic characteristics of a country or region to some extent. It is of great significance to explore the impact of land features related to social-economic indexes to NTL intensity in urban areas. At present, there are few studies on the impact factors of high-resolution NTL remote sensing data to analyze the influence of NTL intensity variation at a fine scale. In this paper, taking Changchun, China as a case study, we selected the new generation of high spatial resolution (0.92 m) and multispectral bands NTL image JL1-3B data to evaluate the relationship between NTL intensity and related land features such as the normalized difference vegetation index (NDVI), land use types and point of information (POI) at the parcel level, and combined Luojia 1-01 images for comparative analysis. After screening features by the Gini index, 17 variables were selected to establish the best random forest (RF) regression model for the Luojia 1-01 and JL1-3B data, corresponding to out-of-bag (oob) scores of 0.8304 and 0.9054, respectively. The impact of features on NTL was determined by calculating the features contribution. It was found that JL1-3B data perform better on a finer scale and provide more information. In addition, JL1-3B data are less affected by light overflow effect and saturation, and they could provide more accurate information at smaller parcels. Through the impact analysis of land features on the two kinds of NTL data, it is proven that JL1-3B images can be used to study effectively the relationship between NTL and human activities information. This paper aims to establish a regression model between the radiance of two types of NTL data and land features by RF algorithm, to further excavate the main land features that impact radiance according to the feature contribution, and compare the performance of two types of NTL data in regression. The study is expected to provide a reference to the further application of NTL data such as land feature inversion, artificial surface monitoring and evaluation, geographic information point estimation, information mining, etc., and a more comprehensive cognition of land feature impact to urban social-economic indexes from a unique perspective, which can be used to assist urban planning and related decision-making.

A cluster of COVID-19 caused by a presymptomatic case in Haikou / 预防医学

Objective@#To investigate a cluster of coronavirus disease 2019(COVID-19)caused by latent infection in Haikou,so as to provide reference for the prevention and control of COVID-19 clusters. @*Methods@#An epidemiological investigation was conducted according to the COVID-19 Prevention and Control Program(Fourth Edition). The course of diagnosis and treatment,clinical characteristics and field investigation data were collected to analyze the transmission chain and the intergeneration between cases. @*Results @#Among 39 people involved,five confirmed cases and two asymptomatic infections were found,with an attack rate of 17.95%. The cases aged from 40 to 65 years and lived in the dormitories near the farm of Dongshan. The first case(named Case 1)closely contacted with a confirmed case of COVID-19 in Chengmai from January 28 to February 10,was isolated on February 13 and developed symptoms on February 16. The other six cases(Case 2 to Case 7)shared the water source with Case 1 from January 28 to February 13(within the incubation period of Case 1). They needed to open the power switch outside Case 1's room and the water valve in Case 1's washroom before the use of water. They might be infected by contacting the doorknob and the water valve contacted by Case 1,or by the aerosol formed after Case 1 used the washroom,then infected each other when living together. The onset of Case 2 to Case 7 was earlier than Case 1,and they had no travelling history in Hubei Province 14 days before and contacted no confirmed cases except Case 1. Therefore,Case 1 was the source of the cluster during his incubation period of COVID-19. @*Conclusion@#This was a cluster of COVID-19 due to latent transmission by living in the same area and touching the same objects indirectly,which indicated that COVID-19 was infectious in the incubation period.

Photopolymer-based coaxial holographic lens for spectral confocal displacement and morphology measurement.

A spectral confocal displacement and morphology measurement device with a photopolymer-based coaxial holographic lens as a high dispersion element is developed. The linear dependence of the axial spatial position on the peak wavelength of dispersion spectrum provides a high accuracy and large range for measuring displacement and morphology. In the linear dispersion region, accompanied with a 120 nm shift of peak wavelength, the measure position range exceeds 20 mm. The available experimental accuracy of displacement and morphology can reach 47.5 µm/0.5 nm using a commercial optical fiber spectrum with a resolution of 0.5 nm. Utilizing thin polymer-based holographic lens with high dispersion can effectively compact the device size. Simultaneously, it can provide a large axial dispersion for measuring the spatial position characterization compared with the traditional glass-based dispersion lens group. A holographic optical lens based on a photopolymer is expected to apply in high-precision surface morphology measurement of large-scale macroscopic objects. It will improve the measurement accuracy and accelerate the development of holographic optical elements.

Development and validation of a nomogram for urothelial cancer in patients with chronic kidney disease.

Urothelial cancer (UC) is a common kidney cancer in Taiwan and patients with chronic kidney disease (CKD) are more at risk for UC than the general population. The diagnostic value of urine analysis and urine cytology is limited, especially in CKD patients. The aim of the study is to develop a nomogram to predict the risk of UC in CKD patients. We enrolled 169 UC patients and 1383 CKD patients from 9 hospitals in Taiwan between 2012 and 2015. CA125, HE4, clinical characteristics, and medical history were analyzed using multivariable logistic regression for its association with UC. A nomogram was developed to predict the risk of UC and was validated using Bootstrap. CA125 was associated with UC in CKD patients (OR: 5.91, 95% CI: 3.24-10.77) but HE4 was not (OR: 1.29, 95% CI: 0.67-2.35). A nomogram based on patients' age, estimated glomerular filtration rate, CA125 (log transformed), smoking, exposure of environmental toxin, use of nonsteroid anti-inflammatory drugs, and use of traditional Chinese medicine was conducted. The AUC of the nomogram was 0.90 (95% CI: 0.86-0.92, p < 0.01). Serum CA125 may identify UC patients from CKD patients but has limited diagnostic value due to low sensitivity. The diagnostic value of serum CA125 level can be improved by the combination with clinical characteristics including age, renal function, and medical history.

Body Mass Changes Across a Variety of Running Race Distances in the Tropics.

BACKGROUND: Current literature evaluating body mass (BM) changes across a variety of running race distances is limited. The primary objective of this study was to profile the range of BM changes across race distances. The secondary objective was to evaluate the prevalence of exercise-associated hyponatremia (EAH) in runners admitted to the on-site medical tent following participation of race events of different distances. METHODS: A total of 1934 runners across seven footrace categories (10-, 21-, 25-, 42-, 50-, 84-, and 100-km) were included in the study. One thousand eight hundred eighty-seven runners had their BM measured before and after each race. Blood sodium concentrations were measured from the remaining 47 symptomatic runners admitted to the on-site medical tents and did not complete the race. RESULTS: In terms of hydration status, 106 (6 %) were overhydrated, 1377 (73 %) were euhydrated, and 404 (21 %) were dehydrated. All race distances exhibited similar percentage of overhydrated runners (5 % in 10 km, 3 % in 21 km, 5 % in 25 km, 6 % in 42 km, 8 % in 50 km, 7 % in 84 km, and 6 % in 100 km). Forty-seven runners were admitted to the medical tents. Eight (17 %) were diagnosed with EAH (4 from 42 km, 2 from 84 km, 2 from 100 km), 38 (81 %) were normonatremic, and 1 (2 %) was hypernatremic. The % ΔBM across all races ranged from -8.0 to 4.1 % with a greater decrement noted in the 42-, 50-, 84-, and 100-km categories. CONCLUSIONS: Approximately 3-8 % runners had increased post-race BM, suggesting overhydration regardless of race distance. Symptomatic EAH was seen at race distances at or above 42 km, where BM changes demonstrated the widest range of values.

Sandmeier model based topographic correction to lunar spectral profiler (SP) data from KAGUYA satellite.

The Moon may be considered as the frontier base for the deep space exploration. The spectral analysis is one of the key techniques to determine the lunar surface rock and mineral compositions. But the lunar topographic relief is more remarkable than that of the Earth. It is necessary to conduct the topographic correction for lunar spectral data before they are used to retrieve the compositions. In the present paper, a lunar Sandmeier model was proposed by considering the radiance effect from the macro and ambient topographic relief. And the reflectance correction model was also reduced based on the Sandmeier model. The Spectral Profile (SP) data from KAGUYA satellite in the Sinus Iridum quadrangle was taken as an example. And the digital elevation data from Lunar Orbiter Laser Altimeter are used to calculate the slope, aspect, incidence and emergence angles, and terrain-viewing factor for the topographic correction Thus, the lunar surface reflectance from the SP data was corrected by the proposed model after the direct component of irradiance on a horizontal surface was derived. As a result, the high spectral reflectance facing the sun is decreased and low spectral reflectance back to the sun is compensated. The statistical histogram of reflectance-corrected pixel numbers presents Gaussian distribution Therefore, the model is robust to correct lunar topographic effect and estimate lunar surface reflectance.

Radial growth of two dominant montane conifer tree species in response to climate change in North-Central China.

North-Central China is a region in which the air temperature has clearly increased for several decades. Picea meyeri and Larix principis-rupprechtii are the most dominant co-occurring tree species within the cold coniferous forest belt ranging vertically from 1800 m to 2800 m a.s.l. in this region. Based on a tree-ring analysis of 292 increment cores sampled from 146 trees at different elevations, this study aimed to examine if the radial growth of the two species in response to climate is similar, whether the responses are consistent along altitudinal gradients and which species might be favored in the future driven by the changing climate. The results indicated the following: (1) The two species grew in different rhythms at low and high elevation respectively; (2) Both species displayed inconsistent relationships between radial growth and climate data along altitudinal gradients. The correlation between radial growth and the monthly mean temperature in the spring or summer changed from negative at low elevation into positive at high elevation, whereas those between the radial growth and the total monthly precipitation displayed a change from positive into negative along the elevation gradient. These indicate the different influences of the horizontal climate and vertical mountainous climate on the radial growth of the two species; (3) The species-dependent different response to climate in radial growth appeared mainly in autumn of the previous year. The radial growth of L. principis-rupprechtii displayed negative responses both to temperature and to precipitation in the previous September, October or November, which was not observed in the radial growth of P. meyeri. (4) The radial growth of both species will tend to be increased at high elevation and limited at low elevation, and L. principis-rupprechtii might be more favored in the future, if the temperature keeps rising.

The Patient-Centred Medical Home: A Narrative Review

The “patient-centred medical home” is a model of healthcare delivery first conceived in the United States. It seeks to bring the values and principles of family medicine back into focus in this age of subspecialisation and fragmentation of care. This model is based on the following principles: a personal physician, physician-directed medical practice, whole person orientation, coordinated and integrated care, quality and safety, enhanced access to care and appropriate payment. Locally, should this model of care be implemented, a corresponding change in care delivery and funding model is needed. However, the patient-centred medical home has been associated with positive health outcomes at the primary care level in the United States. It will be interesting to see the potential impact on our healthcare system if such a model were to be implemented in Singapore.

Streptococcal Pneumonia Associated Haemolytic Uraemic Syndrome (SP-HUS) in a 4-year-old boy - A rare but serious condition. What should primary care physicians know?

We report a case of streptococcal pneumonia associated haemolytic uraemic syndrome (SP-HUS) in a 4-year old child. It is a rare complication of invasive streptococcus pneumonia infection. This article touches on the how the patient's mother was unusually calm after hearing the bad news. Factors that could account for her reaction are explored. Other issues triggered by this case were questions on the pathophysiology, clinical features, treatment and prognosis of this complication. We also discussed "catch-up" vaccination for children immunised with the old 7-valent pneumococcal vaccine, early diagnosis of community acquired pneumonia, recognising antibiotic failure and SP-HUS.

[Exploring the lived experiences of middle-aged males diagnosed with chronic kidney disease].

BACKGROUND: The majority of studies addressing chronic kidney disease (CKD) have been quantitative. The lived experiences of patients with early stage CKD have not been explored in the literature. Due to the lack of symptoms during the early stages of CKD, the progress of this disease is often ignored. PURPOSE: This study explores the lived experiences of middle-aged males diagnosed with CKD. Research focuses on the work experiences, interpersonal relationships, and dietary habits of this group. METHODS: This qualitative study used a narrative research method with purposive sampling. Ten middle-aged male patients were interviewed. We employed the 3 strategies of member checks, peer review, and debriefing in order to enhance the trustworthiness of the data analysis. RESULTS: Four major themes were identified: (1) keeping the same life pace as usual with concerns of deterioration; (2) continuing to support their family and play the role of father; (3) hoping to participate in family and friend relationships despite the illness; and (4) being challenged to maintain a healthy diet. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: Although the physical status of participants was similar to the general middle-aged adult population, participants were concerned regarding disease deterioration. The results of this study suggest that health professionals: (1) provide appropriate information based on patients' personality, particularly at the first onset or apparent deterioration of the disease; (2) offer specialized healthcare information to patients relevant to their career choices; and (3) understand CKD-patient difficulties in daily life such as eating out habits and challenges faced in maintaining a healthy diet. Results may provide important information to healthcare providers in education planning and implementation and support programs for patients and families.

Pneumocystis jirovecii pneumonia in systemic lupus erythematosus from southern Taiwan.

BACKGROUND: Opportunistic infection has been documented in systemic lupus erythematosus with special attention paid to Pneumocystis jirovecii because of the significant morbidity and high mortality. OBJECTIVES: The limited large-scale investigations covering P. jirovecii pneumonia (PCP) in systemic lupus erythematosus following biologics or immunosuppressants therapy prompted us to perform this study in southern Taiwan. METHODS: A retrospective study was completed in 858 hospitalized lupus patients from January 2000 to December 2011. The definite diagnosis of PCP was made by the laboratory detection of Pneumocystis organisms together with consistent clinical and radiological manifestations of PCP. Positive polymerase chain reaction results of sputum samples were not regarded as infection in this study, unless P. jirovecii was the sole pathogen found and pulmonary manifestations resolved following antibiotics for PCP treatment alone. RESULTS: The laboratory identification of Pneumocystis organisms depended on lung biopsy in 2 cases and bronchoalveolar lavage in 3 patients. Five cases, 2 women and 3 men aged 30 to 50 years (41.8 ± 8.8 years), were identified with a 0.6% incidence. None received chemoprophylactics against P. jirovecii infection. All had lupus nephritis and lymphopenia with low CD4 T-cell counts. Prior usages of higher daily prednisolone dosages and concomitant biologics or immunosuppressants were observed in all patients. Pneumocystis jirovecii pneumonia contributed to a high mortality rate (60%). CONCLUSIONS: We report the rare occurrence but high mortality of PCP infection in this study. A consensus guideline addressing prophylactic antibiotics against Pneumocystis organisms in highest-risk lupus patients on biologics or immunosuppressants could be helpful in guiding their management.