Levofloxacin-resistant Stenotrophomonas maltophilia: risk factors and antibiotic susceptibility patterns in hospitalized patients.

BACKGROUND: Levofloxacin has been considered as an alternative treatment for Stenotrophomonas maltophilia infection. However, levofloxacin-resistant S. maltophilia (LRSM) are emerging worldwide. AIM: To investigate LRSM risk factors in hospitalized patients and to determine antibiotic susceptibility patterns of LRSM isolates. METHODS: In a retrospective matched case-control-control study, LRSM patients (the case group) were compared with two control groups: levofloxacin-susceptible S. maltophilia (LSSM) patients (control group A) and non-S. maltophilia-infected patients (control group B). Conditional logistic regression was used to analyse risk factors for LRSM occurrence. Tigecycline, ceftazidime, colistin, and trimethoprim/sulfamethoxazole (TMP/SMX) susceptibilities in collected LRSM clinical isolates were determined. FINDINGS: A total of 105 LRSM, 105 LSSM, and 105 non-S. maltophilia-infected patients were analysed. The first multivariate analysis (cases vs group A) revealed that previous fluoroquinolones use was significantly associated with LRSM occurrence, and the second multivariate analysis (cases vs group B) revealed that previous fluoroquinolone use, previous intensive care unit stay, and the number of previous exposures to different classes of antibiotics were significantly associated with LRSM occurrence. Of all the LRSM isolates tested for antibiotic susceptibility, ceftazidime, TMP/SMX, tigecycline, and colistin resistance rates were 42.0, 99.0, 78.0, and 40.0%, respectively. CONCLUSION: LRSM antibiotic susceptibility patterns revealed multiple-drug resistance, which further limits treatment options for clinicians. To reduce LRSM occurrence, proper use of antibiotics, especially fluoroquinolones, is mandatory.

Increased risk of glomerulonephritis and chronic kidney disease in relation to the severity of psoriasis, concomitant medication, and comorbidity: a nationwide population-based cohort study.

BACKGROUND: Few studies have examined the association between psoriasis and glomerulonephritis (GN) as well as chronic kidney disease (CKD). OBJECTIVES: To determine the risk of CKD in patients with psoriasis and evaluate the impact of the severity of psoriasis, comorbidities and concomitant drugs on the risk of GN and CKD in patients with psoriasis. METHODS: We identified 4344 patients with psoriasis for the study cohort and randomly selected 13,032 subjects as a control cohort. Each subject was individually followed for up for 5 years to identify those who subsequently developed GN and CKD. RESULTS: After adjustment for traditional CKD risk factors, psoriasis was found to be independently associated with an increased risk of CKD during the follow-up period [hazard ratio (HR) 1.28; 95% confidence interval (CI) 1.14-1.44]. The increased incidence of GN in patients with psoriasis (HR 1.50, 95% CI 1.24-1.81) may contribute to the positive association between psoriasis and CKD. Patients with mild and severe psoriasis had an increased risk of CKD and GN compared with the control cohort; the risk increased with severity. Patients with psoriasis and arthritis exhibited a higher risk of CKD than patients without arthritis (HR 1.62 vs. 1.26). Among drugs, nonsteroidal anti-inflammatory drugs (NSAIDs) have the strongest association with CKD in patients with psoriasis (adjusted odds ratio 1.69, 95% CI 1.14-2.49). CONCLUSIONS: Psoriasis was associated with a higher risk of developing CKD and GN. High severity, psoriatic arthritis involvement and concomitant NSAIDs use further increased the risk of CKD in patients with psoriasis.

Single domain m-plane ZnO grown on m-plane sapphire by radio frequency magnetron sputtering.

High-quality m-plane orientated ZnO films have been successfully grown on m-plane sapphire by using radio frequency magnetron sputtering deposition. The introduction of a nanometer-thick, low-temperature-grown ZnO buffer layer effectively eliminates inclusions of other undesirable orientations. The structure characteristics of the ZnO epi-layers were thoroughly studied by synchrotron X-ray scattering and transmission electron microscopy (TEM). The in-plane epitaxial relationship between ZnO and sapphire follows (0002)(ZnO) [parallel] (112[overline]0)(sapphire) and (112[overline]0)(ZnO) [parallel] (0006)(sapphire) and the ZnO/sapphire interface structure can be described by the domain matching epitaxy along the [112[overline]0](ZnO) direction. The vibrational properties of the films were investigated by polarization dependent micro-Raman spectroscopy. Both XRD and micro-Raman results reveal that the obtained m-ZnO layers are under an anisotropic biaxial strain but still retains a hexagonal lattice.

Differences in HIV disclosure by modes of transmission in Taiwanese families.

HIV serostatus disclosure is a crucial decision, and often perceived as a double-edged sword for people living with HIV. This study was intended to determine the extent of disclosure according to interpersonal relationships, compare the characteristics of disclosure by modes of HIV transmission, and to describe perceived consequences after disclosure to Taiwanese families. Data were collected by in-depth interviews and chart reviews at HIV primary care clinics in a university hospital in southern Taiwan from 2004 to 2005. Of 105 male participants interviewed, 76 (72.4%) had disclosed their HIV status to at least one person, including 62% to an immediate family member and 21% to friends. The HIV disclosure rates were different in three groups divided by modes of transmission, 36% in men having sex with men (MSM), 34% in heterosexuals, and 21% in injection drug users (IDUs). MSM were more likely than heterosexual men or male IDUs to disclose their HIV status directly to friends immediately after leaning of their HIV diagnosis. Heterosexual men and male injection drug users often disclosed to their immediate families a few days after obtaining an HIV diagnosis. Perceived consequences after disclosure included: increased substantial support from family, assistance with medical and healthcare, encouragement of living positively with HIV, being rejected, treated as contagion, and condemnation. Disclosure of HIV-positive status in a family-oriented Taiwanese society is a complex process and different by the modes of transmission.

The solution structure of [d(CGC)r(amamam)d(TTTGCG)]2.

The solution structure and hydration of a DNA.RNA hybrid chimeric duplex [d(CGC)r(amamam)d(TTTGCG)]2 in which the RNA adenines were substituted by 2'-O-methylated riboadenines was determined using two-dimensional NMR, simulated annealing, and restrained molecular dynamics. Only DNA residue 7T in the 2'-OMe-RNA.DNA junction adopted an O4'-endo sugar conformation, while the other DNA residues including 3C in the DNA.2'-OMe-RNA junction, adopted C1'-exo or C2'-endo conformations. The observed NOE intensity of 2'-O-methyl group to H1' proton of 4am at the DNA.2'-OMe-RNA junction is much weaker than those of 5am and 6am. The 2'-O-methyl group of 4am was found to orient towards the minor groove in the trans domain while the 2'-O-methyl groups of 5am and 6am were found to be in the gauche (+) domain. In contrast to the long-lived water molecules found close to the RNA adenine H2 and H1' protons and the methyl group of 7T in the RNA-DNA junction of [d(CGC)r(aaa)d(TTTGCG)]2, there were no long-lived water molecules found in [d(CGC)r(amamam)d(TTTGCG)]2. This is probably due to the hydrophobic enviroment created by the 2'-O-methylated riboadenines in the minor groove or due to the wider minor groove width in the middle of the structure. In addition, the 2'-O-methylation of riboadenines in pure chimeric duplex increses its melting temperature from 48.5 degrees C to 51.9 degrees C. The characteristic structural features and hydration patterns of this chimeric duplex provide a molecular basis for further therapeutic applications of DNA.RNA hybrid and chimeric duplexes with 2'-modified RNA residues.

Comparison of sexual behaviors between male homosexuals and male heterosexuals in Taiwan.

BACKGROUND: Homosexuality and sexual behavior have attracted great attention in the acquired immunodeficiency syndrome (AIDS) epidemic. This study primarily explores the risky behaviors and patterns of sexual behavior of male homosexuals in Taiwan. METHODS: Comparison study methodology was adopted. Ninety-two male homosexuals, as the study group, were recruited from gay bars and gay organizations, and 91 male heterosexuals, with similar ages and educational levels, were recruited as a control group for comparison. Semi-structured interviews were carried out and anonymous questionnaires were self-administered. RESULTS: (1) The mean age at the time of first sexual intercourse of the study group was younger than that of the control group. (2) The rate of having two or more sexual partners in the study group was significantly higher. (3) However, the rate of condom use during recent intercourse was higher in the control group than in the study group. (4) Sexual knowledge and attitudes toward sexuality in the study group were more open, but their sexual desires, as rated by the questionnaire, were more suppressed than those of the control group. (5) In terms of courtship, the study group was less constrained by the social values of marriage and tended to separate sex from love. CONCLUSION: Similar to western studies, our study found that the study group in Taiwan adopted more risky sexual behaviors. Each group had its particular sexual behavioral pattern and subculture of sexuality. However, a longitudinal follow-up study with ethnographic perspective is necessary for a more sophisticated understanding of the trends and changes of sexual behavior in homosexuals.

Hydration of [d(CGC)r(aaa)d(TTTGCG)](2).

We have studied the hydration and dynamics of RNA C2'-OH in a DNA. RNA hybrid chimeric duplex [d(CGC)r(aaa)d(TTTGCG)](2). Long-lived water molecules with correlation time tau(c) larger than 0.3 ns were found close to the RNA adenine H2 and H1' protons in the hybrid segment. A possible long-lived water molecule was also detected close to the methyl group of 7T in the RNA-DNA junction but not to the other two thymine bases (8T and 9T). This result correlates with the structural studies that only DNA residue 7T in the RNA-DNA junction adopts an O4'-endo sugar conformation (intermediate between B-form and A-form), while the other DNA residues including 3C in the DNA-RNA junction, adopt C1'-exo or C2'-endo conformations (in the B-form domain). Based on the NOE cross-peak patterns, we have found that RNA C2'-OH tends to orient toward the O3' direction, forming a possible hydrogen bond with the 3'-phosphate group. The exchange rates for RNA C2'-OH were found to be around 5-20 s(-1), compared to 26.7(+/-13.8) s(-1) reported previously for the other DNA.RNA hybrid duplex. This slow exchange rate may be due to the narrow minor groove width of [d(CGC)r(aaa)d(TTTGCG)](2), which may trap the water molecules and restrict the dynamic motion of hydroxyl protons. The distinct hydration patterns of the RNA adenine H2 and H1' protons and the DNA 7T methyl group in the hybrid segment, as well as the orientation and dynamics of the RNA C2'-OH protons, may provide a molecular basis for further understanding the structure and recognition of DNA.RNA hybrid and chimeric duplexes.

The solution structure of [d(CGC)r(aaa)d(TTTGCG)](2): hybrid junctions flanked by DNA duplexes.

The solution structure and hydration of the chimeric duplex [d(CGC)r(aaa)d(TTTGCG)](2), in which the central hybrid segment is flanked by DNA duplexes at both ends, was determined using two-dimensional NMR, simulated annealing and restrained molecular dynamics. The solution structure of this chimeric duplex differs from the previously determined X-ray structure of the analogous B-DNA duplex [d(CGCAAATTTGCG)](2)as well as NMR structure of the analogous A-RNA duplex [r(cgcaaauuugcg)](2). Long-lived water molecules with correlation time tau(c)longer than 0.3 ns were found close to the RNA adenine H2 and H1' protons in the hybrid segment. A possible long-lived water molecule was also detected close to the methyl group of 7T in the RNA-DNA junction but not with the other two thymines (8T and 9T). This result correlates with the structural studies that only DNA residue 7T in the RNA-DNA junction adopts an O4'-endo sugar conformation, while the other DNA residues including 3C in the DNA-RNA junction, adopt C1'-exo or C2'-endo conformations. The exchange rates for RNA C2'-OH were found to be approximately 5-20 s(-1). This slow exchange rate may be due to the narrow minor groove width of [d(CGC)r(aaa)d(TTTGCG)](2), which may trap the water molecules and restrict the dynamic motion of hydroxyl protons. The minor groove width of [d(CGC)r(aaa)d(TTTGCG)](2)is wider than its B-DNA analog but narrower than that of the A-RNA analog. It was further confirmed by its titration with the minor groove binding drug distamycin. A possible 2:1 binding mode was found by the titration experiments, suggesting that this chimeric duplex contains a wider minor groove than its B-DNA analog but still narrow enough to hold two distamycin molecules. These distinct structural features and hydration patterns of this chimeric duplex provide a molecular basis for further understanding the structure and recognition of DNA. RNA hybrid and chimeric duplexes.

[Concerns and nursing care of a family living with AIDS].

AIDS is not solely a medical issue but also has profound implications for family relationships. This case report using the concepts of family nursing and case management presents the concerns of a family living with AIDS. The data was collected through continuous contacts with a patient during December 1994 to August 1996. This report's findings indicate that the concerns of the family living with AIDS fall into seven categories: The reasons for HIV infection, how to meet the patient's sexual needs, suffering during health care seeking, the effectiveness and side-effects of anti-viral drugs, home care skills, the light of hope, death issues. Professional nurses should provide care to both the AIDS patient and the family members. Using social resources and cooperating with other health professionals can promote the quality of life for families living with AIDS.

Current seroepidemiology of hepatitis D virus infection among hepatitis B surface antigen carriers of general and high-risk populations in Taiwan.

In order to assess the current seroepidemiology of hepatitis D virus (HDV) infection in Taiwan where hepatitis B virus (HBV) is hyperendemic, a total of 756 voluntary blood donors, 641 prostitutes, 1,014 patients with sexually transmitted diseases (STDs), and 628 drug abusers were studied. Radioimmunoassays were used for testing HBV infection markers and antibody against HDV (anti-HDV) among HBsAg carriers. The anti-HDV prevalence among HBsAg carriers was significantly higher in STD patients (9.6%), prostitutes (33.1%), and drug abusers (68.1%) than in blood donors from the general population (2.2%). The prevalence gradually increased with age in blood donors and STD patients, but reached a plateau at a young age in prostitutes and drug abusers. Males had a higher prevalence than females in blood donors (2.7% vs. 0), STD patients (8.2% vs. 7.5%), and drug abusers (69.0% vs. 57.1%), but the difference was not statistically significant. STD patients with syphilis had a higher prevalence (19.5%) than those affected with non-ulcerating STDs (5.3%). While unlicensed prostitutes had a lower prevalence (13.6%) than licensed prostitutes (44.9%), intravenous drug abusers had a higher prevalence (73.1%) than non-intravenous drug abusers (34.6%). There was a twofold increase in anti-HDV prevalence from 1986 to 1989 among prostitutes, but the prevalence remained unchanged in the general population and drug abusers. HDV infection remains limited to the high-risk groups and spread mainly by promiscuity and needle sharing in Taiwan.

Generation of neutrophil-chemoattractant by degradation of tumor cell membrane protein.

Polymorphonuclear leukocytes (PMN) infiltrating into tumors are assumed to be the result of a migration in response to a tumor-derived chemotactic factor. It is hypothesized that tumor-derived chemotactic factors, which are supposed to be in aggregates, can be exposed by proteolytic degradation of the tumor cell membrane protein (TCM). The TCM suspension made from either Sarcoma 180 or Ehrlich ascites tumor after incubation with Varidase at 37 degrees C for six to eight weeks is referred to as a degraded TCM protein (DTCM). The purpose of this study was to detect whether or not the DTCM was chemotactic for PMNs. Chemotactic activity was assayed by a sponge-matrix model and expressed in the number of PMNs infiltrating into the sponge per mouse after intrasponge injection of the DTCM, dose range, 0.4-0.005 mL. Maximal response to DTCM was restricted to the limited dose between 0.01 and 0.02 mL. Quantities of DTCM > 0.02 mL caused a response in roughly reciprocal proportion to the dose of DTCM. Changes in the circulating leukocyte count in response to an intravenous (i.v.) injection of DTCM was biphasic. The initial relative leukopenia was followed by leukocytosis within 24 hours in rats surviving the effect of DTCM doses < 0.5 mL. However, in rats with i.v. injections of higher doses, profound leukopenia was present at death. The mice, after an intraperitoneal (i.p.) injection of DTCM, dose range, 0.5-1.0 mL, died between 16 and 24 hours after the injection. The bone marrow of these mice showed complete depletion of PMNs.(ABSTRACT TRUNCATED AT 250 WORDS)

Hepatitis B virus e antigen and primary hepatocellular carcinoma.

Serum samples from 243 cases of primary hepatocellular carcinoma (PHC) and 302 non-PHC hospital controls were tested for hepatitis B virus (HBV) surface antigen (HBsAg), antibody to HBsAg (anti-HBs), antibody to HBV core antigen (anti-HBc), HBV e antigen (HBeAg) and antibody to HBeAg (anti-HBe) with radioimmunoassays using commercial kits. A total of 236 (97%) PHC cases and 302 (100%) hospital controls were positive for one or more HBV markers. While 188 (77%) PHC cases and 57 (19%) controls were positive for HBsAg, 44 (18%) PHC cases and 5 (2%) controls were positive for both BHsAg and HBeAg. Statistically significant associations with PHC were observed for HBsAg and HBeAg with an odds ratio (OR) of 10.0 and 3.2, respectively, when age, sex and other markers were adjusted. The stratification analysis of interactive effects of HBV infection markers on the development of PHC showed that HBeAg carrier status may increase PHC risk associated with HBsAg status.

Propionic acid fermentation of lactose by Propionibacterium acidipropionici: effects of pH.

Batch propionic acid fermentation of lactose by Propionibacterium acidipropionici were studied at various pH values ranging from 4.5 to 7.12. The optimum pH range for cell growth was between 6.0 and 7.1, where the specific growth rate was approximately 0.23 h(-1). The specific growth rate decreased with the pH in the acids have been identified as the two major fermentation products from lactose. The production of propionic acid was both growth and nongrowth associated, while acetic acid formation was closely associated with cell growth. The propionic acid yield increased with decreasing pH; It changed from approximately 33% (w/w) at pH 6.1-7.1 to approximately 63% at pH 4.5-5.0. In contrast, the acetic acid yield was not significantly affected by the pH; it remained within the range of 9%-12% at all pH values. Significant amounts of succinic and pyruvic acids were also formed during propionic acid fermentation of lactose. However, pyruvic acid was reconsumed and disappeared toward the end of the fermentation. The succinic acid yield generally decreased with the pH, from a high value of 17% at pH 7.0 to a low 8% at pH 5.0 Effects of growth nutrients present in yeast ex-tract on the fermentation were also studied. In general, the same trend of pH effects was found for fermentations with media containing 5 to 10 g/L yeast extract. However, More growth nutrients would be required for fermentations to be carried out efficienytly at acidic pH levels.

Role of atrial natriuretic peptide in hemoconcentration during exercise.

Changes in plasma levels of atrial natriuretic peptide (ANP) and albumin, and blood hematocrit (Hct) during treadmill exercise were studied in 6 healthy men before and after beta-adrenergic blockade. Plasma ANP levels increased during exercise and then gradually decreased. There was a concomitant increase in both Hct and plasma albumin concentrations. Prior administration of a long-acting propranolol, 160 mg daily for 3 consecutive days, markedly elevated plasma ANP levels before, during and after exercise. In addition, the mean basal Hct increased significantly and further rose during exercise after propranolol administration. When increments in plasma ANP concentrations during exercise in individual subjects were compared with those in Hct, there was a significant positive correlation between the two variables before and after propranolol administration. The results indicate a close relationship between the changes in plasma ANP and those in Hct during exercise at different ANP levels, and suggest that ANP may be at least one of the factors involved in the hemoconcentration associated with exercise.

Preparation of spherical encapsulation of activated carbons and their adsorption capacity of typical uremic toxins.

A method has been designed for making spherical microencapsulation of activated-carbon particles for use in the removal of metabolic wastes and/or toxins from blood. This bench-scale method was able to make better uniformity in particle size, and at a higher particle production rate. The material properties such as particle size, particle porosity, electromicroscopy of surface morphology, surface hardness, and pore-size distribution were characterized in order to conclude with their adsorption capacity for specific toxin solutes. The performance characteristics of these self-prepared particle encapsulation was also evaluated against the commercially available hemoperfusion particles, e.g., Kuraray's DHP (Japan). The encapsulation particles were also coated with polyhydroxyethyl methacrylate (PHEMA) for blood compatibility purpose.

[MAC-ELISA for the detection of IgM antibodies to dengue type I virus (rapid diagnosis of dengue type I virus infection)].

The commercial rapid diagnostic reagents for Dengue virus infection is still not available at present. An ABC MAC-ELISA (Avidin Biotin Complex IgM Antibody Capture Enzyme Linked Immunosorbent Assay) for the detection of Dengue type I virus infection has been described. IgG purified from high titer (HI = 2560) human anti-flavivirus serum is labelled with biotin for the rapid diagnosis of Dengue type I virus infection. 389 serum specimens of suspected Dengue Fever patients including 226 HI(+) paired sera and 163 HI(-) paired sera which were collected from 1 to 150 days after onset of the disease in 1988 have been assayed for IgM antibodies to Dengue type I virus. Cut off value is based on the mean of OD490 of 162 Dengue negative serum specimens plus 4 SD. The positivity of IgM antibody increased as the viremia disappeared and IgM antibody for Dengue-1 serum specimens collected 9 days after onset of the disease is 100% detectable.

[Concentration changes in PCB isomers in the blood in patients with PCB poisoning].

The blood of 3 yu-cheng patients sampled from 1980 to 1985 and of 14 yusho patients sampled from 1982 to 1988 were analyzed for 7 polychlorinated biphenyl (PCB) isomers by gas chromatography with a capillary column. The concentrations of PCBs in yu-cheng patients were up to 400 ppb and much higher than those of yusho patients. The high concentration of PCBs were decreased at biological half lives of about 50 months and 2,4,3',4'-tetra-CB and 2,4,5,3',4'-penta-CB were first decreased with time at half lives of about 12 months. Therefore, peculiar gas chromatographic pattern for yusho patients would be formed 3 years after the onset. The concentration and patterns of blood PCBs of yusho patient kept in similar levels during 1982 to 1988.

Hepatitis B virus markers in Chinese twins.

Chinese same-sex twins were recruited in order to study the distribution of different markers of hepatitis B virus (HBV) infection, including HBV surface antigen (HBsAg), antibody to HBV core antigen (anti-HBc), antibody to HBsAg (anti-HBs), HBV e antigen (HBeAg) and antibody to HBeAg (Anti-HBe), as well as to compare the concordance of these markers in pair-wise fashion among monozygotic (MZ) and dizygotic (DZ) twins and singleton controls. A total of 289 pairs of MZ twins, 102 pairs of DZ twins and 375 pairs of age-sex-matched singleton controls were studied. More than 50 percent of the members of each group (64.71% of MZ twins, 51.96% of DZ twins and 62.13% of controls) were found to be infected with HBV. In general, the patterns of the response to HBV infection in the 3 groups were similarly distributed. 20.17% of the members of the 3 groups (21.45% of MZ twins, 14.22% of DZ twins, and 20.80% of controls) were HBsAg carriers. Among the HBsAg carriers, 49.19% (44.35% of MZ twins, 34.48% of DZ twins and 55.77% of controls) were HBeAg carriers. No significant difference in the concordance of HBV infection was observed in the MZ and DZ twins. However, highly significant differences were noted between MZ twins and controls, and between DZ twins and controls. Highly significant differences were also observed in the concordance of carrier status between MZ and DZ twins and between MZ twins and controls, but not between DZ and controls. As for the other HBV markers, no significant differences were observed. It is concluded that the genetic influence in response to HBV infection markers is not well-characterized and requires further study.

A one-compartment single-pore model for extracorporeal hemoperfusion.

A one-compartment single-pore model is proposed for the dynamic analysis and performance evaluation of a hemoperfusion column under operation. Experimental data obtained from binary systems containing creatinine and uric acid may be well predicted by the theoretically computed curves. This theory offers a means for the preclinical evaluation of any prototype hemoperfusion column.