Circulating level of lipocalin 2 as a predictor of severity in patients with community-acquired pneumonia.

BACKGROUND: The aim of this study was to investigate the differential plasma levels of lipocalin 2 (LCN2) and its complex with MMP-9 (where MMP is matrix metalloproteinase) before and after antibiotic treatment in hospitalized adult patients with community-acquired pneumonia (CAP). METHOD: Plasma LCN2 and LCN2/MMP-9 complex levels were measured in 61 adult patients with CAP and 60 healthy controls using commercial enzyme-linked immunosorbent assay (ELISA). RESULTS: A decrease in the number of white blood cells (WBCs) and neutrophils and decreases in the levels of C-reactive protein (CRP), LCN2, and LCN2/MMP-9 complex were observed after antibiotic treatment. The plasma level of LCN2, but not that of CRP, was correlated with the severity of CAP based on the Pneumonia Severity Index (PSI; r = 0.333, P = 0.009), confusion, urea, respiratory rate and blood pressure (CURB)-65 (r = 0.288, P = 0.024), and Acute Physiology And Chronic Health Evaluation II (APACHE II) scores (r = 0.328, P = 0.010). LCN2 levels were also significantly correlated with LCN2/MMP-9 levels and the numbers of WBCs or neutrophils. CONCLUSIONS: Plasma levels of LCN2 and the LCN2/MMP-9 complex can act as adjuvant diagnostic biomarkers for CAP. Plasma LCN2 might play a further role in the clinical assessment of the severity of CAP, which could potentially guide the development of future treatment strategies.

Significantly increased concentration of soluble urokinase-type plasminogen activator receptor in the blood of patients with pelvic inflammatory disease.

BACKGROUND: To determine expression levels of urokinase-type plasminogen activator (uPA), soluble urokinase-type plasminogen activator receptor (suPAR), plasminogen activator inhibitor-1 (PAI-1) in plasma and to identify gene polymorphisms specific to patients with pelvic inflammatory disease (PID) and healthy controls. METHODS: Enzyme-linked immunosorbent assay and polymerase chain reaction-restriction fragment length polymorphism were used to measure plasma levels and polymorphisms in uPA, suPAR, and PAI-1 among seventy healthy controls and 64 PID patients before and after they received routine treatment protocols. RESULTS: The levels of plasma uPA (ng/ml) and soluble suPAR (pg/ml) were significantly increased in PID patients (uPA: 0.57±0.03; suPAR: 1372.04±68.20) when compared to that in normal controls (uPA: 0.55±0.06, p=0.002; suPAR: 1192.46±51.98, p=0.04); moreover, suPAR decreased significantly after treatment when compared to levels noted in the same patients (1220.06±58.14; p=0.003) after they received treatment. The increased expression of suPAR was significantly correlated with WBC counts (r=0.382, p=0.002, n=64) in blood as well as the plasma levels of CRP (r=0.441, p<0.0001, n=64) and uPA (r=0.426, p<0.0001, n=64) of PID patients prior to receiving treatment. CONCLUSIONS: Increased plasma suPAR could be a biological marker for the diagnosis of PID and may reflect a new focus in targeted therapy for pelvic inflammatory disease.

Relationship of insulin-like growth factors system gene polymorphisms with the susceptibility and pathological development of hepatocellular carcinoma.

BACKGROUND: Hepatocellular carcinoma (HCC) is one of the major causes of cancer-related death worldwide. The insulin-like growth factors (IGFs) system consists of a group of proteins which may induce cell proliferation and inhibit cell apoptosis through several signal pathways, leading to transformation of normal cells into cancer cells. However, the impact of genetic polymorphisms of the IGFs system on HCC has not been clarified. METHODS: In this case-control study, a total of 102 HCC patients and 306 age- and gender-matched controls were recruited. The genetic polymorphisms of the IGFs system genes, including IGF-1, IGF-2, IGF-1receptor (IGF-1R), IGF-2R, IGF binding protein (IGFBP-3), and insulin (INS) genes, were analyzed by polymerase chain reaction restriction fragment length polymorphism (PCR-RFLP) and real-time PCR genotyping analysis. RESULTS: A significant difference (p = 0.02) between case and control group in the distribution frequency of IGF-2 +3580 polymorphism was observed. Multiple regression model analysis showed that the presence of AA or AG at IGF-2R may exhibit a potential protective effect against hepatitis C [odds ratio (OR) = 0.35, 95% confidence interval (CI) = 0.15-0.82]. The combination of IGF-2 +3580 AA genotype and IGF-2R GG genotype may present a significantly lower risk of HCC (OR = 0.20, 95% CI = 0.05-0.87). Additionally, no polymorphisms of any IGFs system genes were associated with liver-related clinicopathological markers in serum. CONCLUSIONS: Among IGFs system genes, IGF-2 and IGF-2R gene polymorphisms and combination could be considered as the most important factors contributing to increased susceptibility and pathological development of HCC.

Measuring patient's expectation and the perception of quality in LASIK services.

BACKGROUND: LASIK is the use of excimer lasers to treat therapeutic and refractive visual disorders, ranging from superficial scars to nearsightedness (myopia), and from astigmatism to farsightedness (hyperopia). The purposes of this study are to checking the applicability and psychometric properties of the SERVQUAL on Lasik surgery population. Second, use SEM methods to investigate the loyalty, perceptions and expectations relationship on LASIK surgery. METHODS: The method with which this study was conducted was questionnaire development. A total of 463 consecutive patients, attending LASIK surgery affiliated with Chung Shan Medical University Eye Center, enrolled in this study. All participants were asked to complete revised SERVQUAL questionnaires. Student t test, correlation test, and ANOVA and factor analyses were used to identify the characters and factors of service quality. Paired t test were used to test the gap between expectation and perception scores and structural equation modeling was used to examine relationships among satisfaction components. RESULTS: The effective response rate was 97.3%. Validity was verified by several methods and internal reliability Cronbach's alpha was > 0.958. The results from patient's scores were very high with an overall score of 6.41(0.66), expectations at 6.68(0.47), and perceptions at 6.51(0.57). The gap between expectations and perceptions was significant, however, (t = 6.08). Furthermore, there were significant differences in the expectation scores among the different jobs. Also, the results showed that the higher the education of the patient, the lower their perception score (r = -0.10). The factor loading results of factor analysis showed 5 factors of the 22 items of the SERVQUAL model. The 5 factors of perception explained 72.94% of the total variance there; and on expectations it explained 77.12% of the total variance of satisfaction scores.The goodness-of-fit summary, of structure equation modeling, showed trends in concept on expectations, perceptions, and loyalty. CONCLUSION: The results of this research appear to show that the SERVQUAL instrument is a useful measurement tool in assessing and monitoring service quality in LASIK service, and enabling staff to identify where improvements are needed, from the patients' perspective. There were service quality gaps in the reliability, assurance, and empathy. This study suggested that physicians should increase their discussions with patients; which has, of course, already been proven to be an effective way to increase patient's satisfaction with medical care, regardless of the procedure received.