Predictors of mortality in patients with pyogenic liver abscess

BACKGROUND

Pyogenic liver abscess (PLA) is uncommon but potentially life-threatening. The objective of this study was to identify the prognostic factors for PLA.

METHODS

The medical records of 253 patients, 148 men and 105 women with a mean age of 56.4 years (SD : 15.0 years), who were hospitalised due to a PLA between January 1995 and June 2007 were reviewed. The underlying medical disorders, clinical signs and symptoms, laboratory values, imaging studies, microbiological features, treatments, morbidity and mortality were recorded. Factors related to in-hospital case fatality were analysed.

RESULTS

The mean Acute Physiology And Chronic Health Evaluation (APACHE) II score at admission in patients with PLA was 8.7 points (SD 5.4 points). The most common co-existing disease was diabetes mellitus (41.9%), followed by biliary stone disorders (32.0%). Klebsiella pneumoniae was the most frequent pathogen, followed by Escherichia coli. The in-hospital case-fatality rate was 9.1%. Multivariate analysis revealed that gas-forming abscess (p=0.019), multi-drug resistant isolates (p=0.026), anaerobic infection (p=0.045), blood urea nitrogen level >7.86 mmol/l (p=0.004), and APACHE II score > or =15 (p= 0.004) were associated with mortality.

CONCLUSIONS

The prognosis of PLA may depend chiefly on the severity of the basic physical condition and underlying pathology. As the primary treatment for PLA is not completely effective, a more aggressive approach should be considered, especially for patients with poor prognosis.

Organization-based performance measures of cancer care quality: core measure development for breast cancer in Taiwan

The purpose of the study was to develop organization-based core performance measures (CPMs) for breast cancer patients treated in hospitals that participated in cancer quality improvement programmes in Taiwan. CPMs were developed in three stages that included a preparation, a consensus building stage, and two stages of stakeholder feedback. Three criteria and seven subcriteria were applied in the development process. Indicators listed in a Delphi questionnaire were based on a literature search, indicators developed by relevant institutions and discussion by authors. Each indicator needed to meet inclusion criteria as a final indicator. Evidence-based guidelines, expert opinions from panel group, 27 hospitals and empirical data were all applied to develop and revise the core measures. Fifteen out of 28 indicators were selected and modified after the three stages. There were two pre-treatment indicators for screening and diagnosis, nine treatment-related indicators, and four monitoring-related indicators. Six indicators were supported by evidence level I, and four indicators by level II evidence. The CPMs for breast cancer can be developed systematically and be applied for internal quality improvement and external surveillance. Our experience can be extended to other cancer sites and adapted to link with pay for performance or certification program in cancer care.

Effects of doping on an unusual smectic- C*alpha-smectic-C*FI2-smectic-C* phase sequence

The compound 10OHF has a partially inverted phase sequence, unique among the series of nOHF homologous compounds and all other known liquid crystals, with the smectic-C*FI2 (SmC*FI2) phase occurring at higher temperature than the smectic-C* (SmC*) phase. We present ellipsometric data to identify the phase sequences of 9OHF, 10OHF, 11OHF, and 12OHF. Binary mixtures of 10OHF with C11, a compound with the typical phase sequence among the smectic phases, show that the unusual phase sequence of 10OHF stabilizes upon mixing and that SmC*FI2 predominates over SmC* throughout the entire mixing phase diagram. In thin films of some mixtures, surface interactions induce a reentrant SmC*FI2-SmC*-SmC*FI2 transition in the rest of the film.

Malignant mixed müllerian tumor of primary mesenteric origin associated with a synchronous ovarian cancer: case report and literature review

Malignant mixed müllerian tumor (MMMT) is a rare tumor in females and extragenital MMMT is even more so. We report a patient with MMMT primarily in the mesentery with synchronous ovarian cancer. In the English literature, 42 cases of extragenital MMMT have been reported other than the presented case, and this is only the second MMMT arising from the mesentery. Furthermore, among the cases reviewed, MMMTs tend to be associated with synchronous or metachronous colonic cancer or gynecologic tumors originating from the müllerian duct, including ovarian tumors, fallopian tube cancer, endometrial cancer, cervical cancer, and serous carcinoma of the peritoneum (14 out of 43 patients; 32.6%). The risk factors for MMMT include obesity, nulliparity, exogenous estrogen, and long-term tamoxifen use. The prognosis of MMMT is catastrophic and the treatment is based on the experience of those of uterine sarcomas, which is composed of operation, radiotherapy and chemotherapy.

Polarization studies of resonant forbidden reflections in liquid crystals

We report the results of resonant x-ray diffraction experiments performed on thick films of a biaxial liquid crystal made of achiral bent-core molecules. Polarization properties of forbidden reflections are observed as a function of the sample rotation angle phi about the scattering vector Q for the first time on a fluid material. The experimental data are successfully analyzed within a tensor structure factor model by taking the nonperfect alignment of the liquid crystal into account. The local structure of the B2 mesophase is hence determined to be SmC_{S}P_{A}.

Evaluation of the permeability of hair growing ingredient encapsulated PLGA nanospheres to hair follicles and their hair growing effects

This paper describes the process of encapsulating hair growing ingredients in the PLGA nanospheres by emulsion solvent diffusion method and investigates the feasibility of using the PLGA nanospheres as the DDS (Drug delivery System) carriers for delivering various hair growing ingredients to hair follicles. In-vitro and in-vivo tests were conducted to verify the performances of encapsulated PLGA nanospheres with three different hair growing ingredients. In the in-vitro tests, the scalp-pore permeability of hair growing ingredient encapsulated PLGA nanospheres (dispersed in the PBS solution) was examined using human scalp biopsies in a modified Bronaugh diffusion chamber in comparison to that of the control samples containing the hair growing ingredient in the PBS solution. Furthermore, the hair growing effect of the encapsulated PLGA nanospheres was evaluated with the C3H mice in the in-vivo tests. By observing the fluorescence intensity of the ingredients, as shown in the cross-section photographs of the human scalp biopsies, it was found that the dispersion liquids containing hair growing ingredient encapsulated PLGA nanospheres exerted a scalp-pore permeability 2.0- to 2.5-fold more marked than that of the control samples. Also, the hair growing activities were enhanced by using the encapsulated PLGA nanospheres, which transformed the hair growth cycle from the resting phase to the growing phase. As a result, the degree of hair growth was improved significantly. These results suggested that the PLGA nanosphere can be a new DDS carrier for delivering hair growing ingredients and drugs to the hair follicles.

Unique pitch evolution in the smectic-C+alpha phase

Employing resonant x-ray diffraction, we observed unique pitch evolutions in the smectic-C*(alpha) phase in mixtures of two antiferroelectric liquid crystals. Our results show that the pitch in this phase continuously evolves across 4 layers, contradicting a theoretical model that predicts that the smectic-C*(FI2) phase intervenes in the smectic-C*(alpha) phase. The phase sequences we found can be explained by another model that includes one type of long-range interaction among smectic layers.

Characterization of humic substances derived from swine manure-based compost and correlation of their characteristics with reactivities with heavy metals

Various composts contain a significant amount of humic substances including humic acid (HA) and fulvic acids (FAs). The FA fraction in soils is considered to be sensitive to agronomic and environmental factors. In this study, three fractions of humic substances, HA (MW > 1000 Da), FA (MW > 1000 Da), and FA (MW < 1000 Da) were extracted from swine manure-based compost and characterized, and then, their reactivities were correlated with heavy metals. Compositions of the three fractions of humic substances were characterized by elemental and total acidity analyses and electron spin resonance (ESR), Fourier transform infrared (FTIR), and 13C nuclear magnetic resonance with cross-polarization and magic-angle spinning spectroscopic techniques. Elemental analyses indicated that HA has higher contents of C, H, N, and S than those of FAs. However, FA (MW > 1000) and especially FA (MW < 1000) have higher contents of O than that of HA (MW > 1000). The g values of the ESR spectra of the three fractions showed that the organic free radical characteristics and the widths of the spectra and free radical concentrations of the three fractions are significantly different. The FTIR spectra indicated that HA (MW > 1000) is abundant in C=C bonds while FA (MW > 1000), especially FA (MW < 1000), are abundant in C=O bonds. In addition, 13C NMR spectra indicate that carboxyl contents of FA (MW > 1000), especially FA (MW < 1000), are higher than that of HA (MW > 1000). The sequence of the reactivity in terms of acidic functional groups was FA (MW < 1000) > FA (MW > 1000) > HA (MW > 1000). Elemental and functional group compositions of the three fractions significantly correlated with reported reactivities with heavy metals. The application of swine manure-based compost containing HA and FAs fractions to soil and associated environments may thus significantly affect the concerned reactions with organic and inorganic compounds including pollutants.

Smectic-C*alpha phase with two coexistent helical pitch values and a first-order smectic-C*alpha to smectic-C* transition

Previous results from Kundu using dielectric relaxation have suggested a reentrant antiferroelectric-ferroelectric-antiferroelectric transition in the compound LN36. Our comprehensive studies of this compound using differential optical reflectivity, nonadiabatic scanning calorimetry, null transmission ellipsometry, and resonant x-ray diffraction show that in fact LN36 exhibits the usual phase sequence for chiral smectic liquid crystals: SmA*-SmC*alpha-SmC*-SmC*FI1-SmC*A . Moreover, the SmC*alpha-SmC* transition is a first-order transition, characterized by a discontinuous change in the helical pitch. At temperatures just above the SmC*alpha-SmC* transition, two different values for the helical pitch are simultaneously observed for the first time.

Characterization of an H5N1 avian influenza virus from Taiwan

In 2003, an avian influenza (AI) virus of H5N1 subtype (A/Duck/China/E319-2/03; Dk/CHN/E319-2/03) was isolated from a smuggled duck in Kinmen Island of Taiwan. Phylogenetic analysis and pairwise comparison of nucleotide and amino acid sequences revealed that the virus displayed high similarity to the H5N1 viruses circulating in Asia during 2004 and 2005. The hemagglutinin (HA) protein of the virus contained multiple basic amino acid residues (-RERRRKR-) adjacent to the cleavage site between the HA1 and HA2 domains, showing the highly pathogenic (HP) characteristics. The HP phenotype was confirmed by experimental infection of chickens, which led up to 100% mortality within 24-72h postinfection. The virus replicated equally well in the majority of organs of the infected chickens with titers ranging from 10(7.5) to 10(4.7) 50% embryo lethal dose (ELD50) per gram of tissue. In a mouse model the virus exhibits low pathogenic characteristics with a lethal infection observed only after applying high inoculating dose (>or=10(7.6) ELD50) of the virus. The infectious virus particles were recovered only from the pulmonary system including trachea and lungs. Our study suggests that ducks infected with H5N1 AIV of HPAI pathotype showing no disease signs can carry the virus silently and that bird smuggling represent a serious risk for H5N1 HPAI transmission.

Efficient and sensitive capacitive readout of nanomechanical resonator arrays

Here we describe all-electronic broadband motion detection in radio frequency nanomechanical resonators. Our technique relies upon the measurement of small motional capacitance changes using an LC impedance transformation network. We first demonstrate the technique on a single doubly clamped beam resonator with a side gate over a wide range of temperatures from 20 mK to 300 K. We then apply the technique to accomplish multiplexed readout of an array of individually addressable resonators, all embedded in a single high-frequency circuit. This technique may find use in a variety of applications ranging from ultrasensitive mass and force sensing to quantum information processing.

The effect of poly (aspartic acid-co-lactic acid) nanospheres on the lung metastasis of B16BL6 melanoma cells by intravenous administration

Poly (aspartic acid-co-lactic acid) (PAL) has been investigated as a new biodegradable material for Drug Delivery Systems (DDS). Similar to the poly (lactic acid-co-glycolic acid) (PLGA) nanospheres, the PAL nanospheres can control-release encapsulated drugs by hydrolysis and adhere to the mucous membranes to improve the drug absorption. In this study, the vitamin encapsulated PAL nanospheres were applied on mice to examine their effect on tumor metastasis and safety as an injectable DDS material for anti-cancer and other drugs. In the experiment, 6 C57BL/6 mice per group were intravenously administered with B16BL6 melanoma cells (1 x 10(5) per mouse) and non-encapsulated PAL nanospheres or pro-vitamin encapsulated nanospheres respectively, while the control group was administered with B16BL6 cells alone. Two weeks later, the lungs of the mice were excised and metastatic foci on the lung surface were counted. The melanoma cell metastasis to lungs was prevented by intravenous co-injection of B16BL6 melanoma cells with 1.7 microg of pro-vitamin E encapsulated PAL nanospheres. Its metastatic foci count (mean +/- SD) was 127+/-80, which was better than the control (246+/-95, p<0.02). Also, applying the pro-vitamin C and pro-vitamin A encapsulated PAL nanospheres as well as the non-encapsulated PAL nanospheres slightly decreased the number of metastasis colonies in the lungs as compared to that of the control. These results suggested that PAL nanospheres did not promote the lung metastasis of B16BL6 melanoma cells. Thus, the PAL nanospheres are safe material for injection applications.

Optical studies on the surface-induced tilted layers in freestanding films of two no-layer-shrinkage liquid crystal compounds

Null transmission ellipsometry has been employed to study the molecular arrangements in freestanding films of two no-layer-shrinkage liquid crystal homologous compounds above the bulk smectic A-smectic C* (Sm C*) transition temperature. An unusual nonplanar-parallel or nonplanar-antiparallel-parallel transition has been observed in both compounds under a proper electric field. With the addition of one CH2 group, while the SmC* phase is more stable thermally, the magnitude of the critical field needed to induce a parallel-antiparallel transition decreases dramatically.

Smectic-Calpha*-smectic-C* phase transition and critical point in binary mixtures

We have investigated the smectic-Calpha*-smectic-C* (SmCalpha*-SmC*) transition in a series of binary mixtures with resonant x-ray diffraction, differential optical reflectivity, and heat capacity measurements. Results show that the phases are separated by a first-order transition that ends at a critical point. We report the observation of such a critical point. We have proposed the appropriate order parameter and obtained values of two critical exponents associated with this transition. The values of the critical exponents suggest that long-range interactions are present in the SmCalpha*-SmC* critical region.

Reactions of compost-derived humic substances with lead, copper, cadmium, and zinc

Thermodynamic stability constants of the formation of complexes from the reactions of humic substances with various metals are usually used as parameters to judge the reactivities of both humic substances and metals. However, in calculating the thermodynamic stability constants, complicated processes for the acquisition of activities of components in reactions are absolutely inevitable. In this study, we investigated the average conditional concentration quotients of the complexes formed from the reaction of metals with humic substances and the relations of these quotients to thermodynamic stability constants. The characterized humic substances including HA (MW>1,000), FA (MW>1,000), and FA (MW<1,000) extracted from a swine compost were prepared to react with Pb, Cu, Cd, and Zn at 25 degrees C and at pH 4.00 and 6.50. Reactions of HA (MW>1,000), FA (MW>1,000), and FA (MW<1,000) with the four metals were carried out at 1:0.1, 1:0.5, 1:1, 1:5, and 1:10 ligand:metal stoichiometry. The concentrations of the free ions of Pb, Cu, Cd, and Zn in the reaction systems of metal-HA suspensions and metal-FA solutions were measured by anodic stripping voltammetry (ASV). The sequence of the average conditional concentration quotients of the formed complexes from the reaction of humic substances with metals was FA(MW<1,000)>FA(MW>1,000)>HA(MW>1,000), showing the relative reactivities of the fractions of swine compost-derived humic substances. The sequence of reacting metals with humic substances was Pb>Cu>Cd>Zn, which is in good agreement with the sequence reported by judging the thermodynamic stability constants. The average conditional concentration quotients of the formed complexes from the reaction of humic substances with metals were thus useful parameters that can be directly related to thermodynamic stability constants and other parameters.

Role of molecular weight and phase sequence in the temperature variation of film tension above the bulk isotropic transition in freestanding liquid-crystal films

Building upon our previous report [Veum, Phys. Rev. E 17, 020701(R) (2005)] involving two compounds, we have performed a systematic study of the temperature variation of film tension above the bulk isotropic transition in freestanding films to include a total of six smectic liquid-crystal compounds. Consistent with the previous results, the tension increases sharply with temperature above the transition, the tension-temperature slope is proportional to the film's thickness, and the data can be interpreted in the context of theoretical models for layer thinning. Our data suggest that both molecular weight and bulk phase appearing below its isotropic phase play important roles in the slope values.

Investigations of nanoscale helical pitch in smectic-C*alpha and smectic-C* phases of a chiral smectic liquid crystal using differential optical reflectivity measurements

Differential optical reflectivity (DOR) was used to study the temperature dependence of the short helical pitch in freestanding films of a liquid crystal compound. The experimentally measured DOR signal was fitted using Berreman's 4 x 4 matrix method to get the pitch value in the smectic-C*alpha (sMC*alpha) phase. The results show continuous evolution of the pitch between the smectic-C*alpha and sMC*alpha phases. In sMC*alpha, the pitch decreases as temperature increases and is found to level off at 16+/-1 smectic layers at the sMC*alpha to smectic-A* transition.

Non-ketotic hyperglycaemia-related paroxysmal bilateral hand paraesthesia misdiagnosed as diabetic neuropathy

Non-ketotic hyperglycaemia (NKH)-related partial seizure disorders are not uncommon in clinical practice but still deserve attention as they significantly affect neurologic outcome if unnoticed. The atypical presentation of sensorimotor symptoms can be seen in this setting, with paroxysmal character as the rule. Atypical manifestations could cause confusion and might lead to improper diagnosis and treatment. We report a case of inadequately controlled diabetes mellitus and NKH presenting as paroxysmal paraesthesia of both hands, which was misdiagnosed as diabetic neuropathy.

Optical properties and carrier dynamics of self-assembled GaN/Al(0.11)Ga(0.89)N quantum dots

GaN quantum dots were grown on an Al(0.11)Ga(0.89)N buffer layer by using flow rate modulation epitaxy. The Stranski-Krastanov growth mode was identified by an atomic force microscopy study. The thickness of the wetting layer is about 7.2 monolayers. The temperature dependent photoluminescence studies showed that at low temperature the localization energy, which accounts for de-trapping of excitons, decreases with the reducing dot size. The decrease in emission efficiency at high temperature is attributed to the activation of carriers from the GaN dot to the nitrogen vacancy (V(N)) state of the Al(0.11)Ga(0.89)N barrier layer. The activation energy decreases with reducing dot size.

Surface-induced multiple reentrant transitions

We have studied tilted surface layers in the bulk SmA temperature window of one liquid crystal using null transmission ellipsometry. Five distinct nonplanar surface structures were observed. We present analyses of the tilt and azimuthal profiles of the structures and examine the transitions between the structures. The transitions are identified as a double reentrant synclinic-anticlinic-synclinic-anticlinic transition. Meanwhile, the transitions also display reentrant ferroelectric-antiferroelectric-ferroelectric behavior.

Weber–Christian disease presenting with intractable fever and periorbital swelling mimicking angioedema

A 22-year-old male patient with Weber-Christian disease (WCD) presenting with periorbital swelling is a very rare occurrence. Lobular panniculitis in the periorbital and anterior tibial skin was diagnosed in this patient, based on the histological findings from biopsy specimens. The differential diagnosis was done before administering systemic corticosteroid. A dramatic response was achieved several days later, but relapse with intractable fever occurred 1 month later. The use of other immunosuppressive agents failed, and he died of septic shock 2 months later. The preceding infection may have been the immunopathologic factor in the development of WCD. Other effective treatments for WCD may be described in the future.

Optical and resonant X-ray diffraction studies confirm a SmC*FI2-SmC* liquid crystal phase sequence reversal

Employing both null transmission ellipsometry and resonant x-ray diffraction, we confirmed the SmC*FI2-SmC* phase sequence reversal in one liquid crystal compound and specially prepared binary mixtures. This phase sequence reversal was predicted by two recent theoretical advances. Moreover, the temperature range for the SmC*FI2 phase increases significantly in the mixture suggesting that such a phase sequence may exist in other compounds.

The effects of weight load and joint immobilization on reorganization of postural tremor

To investigate change in coordinative strategies due to wrist immobilization and index loading, postural tremors from the index, hand, and forearm were recorded during different postural holding tasks. The wrist joint was immobilized with a thermoplastic splint in the constrained condition, and a copper mass of 100 grams was applied to the index finger in the loaded condition. The structures of the postural tremors of all upper limb segments among the unloaded-unconstrained, unloaded-constrained, loaded-unconstrained, and loaded-constrained conditions were compared. Index loading exaggerated index/forearm postural tremor, while the load-induced tremor enhancement was no longer evident for wrist immobilization. In the unloaded condition, wrist immobilization resulted specifically in enhancement of carpal postural tremor, rather than in the index and forearm. Index loading induced a marked tremor peak and relative power in the range of 5-8 Hz. Wrist immobilization potentiated the carpal tremor peak of 1-4 Hz in association with enhancement of carpal-forearm mechanical coupling. In light of structural changes in postural tremor, our data suggest that (1) a wrist splint is effective to counteract load-induced enhancement of postural tremor, and (2) freezing of the wrist joint might facilitate compensatory strategies to minimize passive fluctuation transmission from the carpal to index.

Comparison of the severity of illness scoring systems for critically ill cirrhotic patients with renal failure

BACKGROUND

Mortality rates of cirrhotic patients with renal failure admitted to the medical intensive care unit (ICU) are high. End-stage liver disease is frequently complicated by disturbances of renal function. This investigation is aimed to compare the predicting ability of acute physiology, age, chronic health evaluation II and III (APACHE II and III), sequential organ failure assessment (SOFA), and Child-Pugh scoring systems, obtained on the first day of ICU admission, for hospital mortality in critically ill cirrhotic patients with renal failure.

METHODS

Sixty-seven patients with liver cirrhosis and renal failure were admitted to ICU from April 2001-March 2002. Information considered necessary for computing the Child-Pugh, SOFA, APACHE II and APACHE III score on the first day of ICU admission was prospectively collected.

RESULTS

The overall hospital mortality rate was 86.6%. Liver disease was most commonly attributed to hepatitis B viral infection. The development of renal failure was associated with a history of gastrointestinal bleeding. Goodness-of-fit was good for SOFA, APACHE II and APACHE III scores. The APACHE III and SOFA models reported good areas under receiver operating characteristic curve (0.878 +/- 0.050 and 0.868 +/- 0.051, respectively).

CONCLUSION

Renal failure is common in critically ill patients with cirrhosis. The prognosis for cirrhotic patients with renal failure is poor. APACHE III and SOFA showed excellent discrimination power in this group of patients. They are superior to APACHE II and Child-Pugh scores in this homogenous group of patients.

Functional analysis of genetic variants in the human concentrative nucleoside transporter 3 (CNT3; SLC28A3)

The human concentrative nucleoside transporter, CNT3 (SLC28A3), plays an important role in mediating the cellular entry of a broad array of physiological nucleosides and synthetic anticancer nucleoside analog drugs. As a first step toward understanding the genetic basis for interindividual differences in the disposition and response to antileukemic nucleoside analogs, we examined the genetic and functional diversity of CNT3. In all, 56 variable sites in the exons and flanking intronic region of SLC28A3 were identified in a collection of 270 DNA samples from US populations (80 African-Americans, 80 European-Americans, 60 Asian-Americans, and 50 Mexican-Americans). Of the 16 coding region variants, 12 had not been previously reported. Also, 10 resulted in amino-acid changes and three of these had total allele frequencies of >/=1%. Nucleotide diversity (pi) at nonsynonymous and synonymous sites was estimated to be 1.81 x 10(4) and 18.13 x 10(4), respectively, suggesting that SLC28A3 is under negative selection. All nonsynonymous variants, constructed by site-directed mutagenesis and expressed in Xenopus laevis oocytes, transported purine and pyrimidine model substrates, except for c. 1099G>A (p. Gly367Arg). This rare variant alters an evolutionarily conserved site in the putative substrate recognition domain of CNT3. The presence of three additional evolutionarily conserved glycine residues in the vicinity of p. Gly367Arg that are also conserved in human paralogs suggest that these glycine residues are critical in the function of the concentrative nucleoside transporter family. The genetic analysis and functional characterization of CNT3 variants suggest that this transporter does not tolerate nonsynonymous changes and is important for human fitness.