Nomogram for pneumonia prediction among children and young people with cerebral palsy: A population-based cohort study

BACKGROUND

Pneumonia is the leading cause of death among children and young people (CYP) with severe cerebral palsy (CP). Only a few studies used nomogram for assessing risk factors and the probability of pneumonia. Therefore, we aimed to identify risk factors and devise a nomogram for identifying the probability of severe pneumonia in CYP with severe CP.

METHODS

This retrospective nationwide population-based cohort study examined CYP with newly diagnosed severe CP before 18 years old between January 1st, 1997 and December 31st, 2013 and followed them up through December 31st, 2013. The primary endpoint was defined as the occurrence of severe pneumonia with ≥ 5 days of hospitalization. Logistic regression analysis was used for determining demographic factors and comorbidities associated with severe pneumonia. These factors were assigned integer points to create a scoring system to identify children at high risk for severe pneumonia.

RESULTS

Among 6,356 CYP with newly diagnosed severe CP, 2,135 (33.59%) had severe pneumonia. Multivariable logistic regression analysis revealed that seven independent predictive factors, namely age <3 years, male sex, and comorbidities of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications. A nomogram was devised by employing these seven significant predictive factors. The prediction model presented favorable discrimination performance.

CONCLUSIONS

The nomogram revealed that age, male sex, history of pressure ulcer, gastroesophageal reflux, asthma, seizures, and perinatal complications were potential risk factors for severe pneumonia among CYP with severe CP.

Effects of continuity of care on the postradiotherapy survival of working-age patients with oral cavity cancer: A nationwide population-based cohort study in Taiwan

Objectives

Cancer of the oral cavity, a well-known global health concern, remains one of most common causes of cancer mortality. Continuity of care (COC), a measurement of the extent to which an individual patient receives care from a given provider over a specified period of time, can help cancer survivors process their experiences of dealing with the illness and recuperation; however, limited research has focused on the survival rate of working-age patients with oral cancer.

Methods

A total of 14,240 working-age patients (20 <age ≤65 years) with oral cavity cancer treated with radiotherapy (RT) during 2000–2013 were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database. We evaluated the effects of the Continuity of Care Index (COCI) proposed by Bice and Boxerman, sociodemographic factors, and comorbidities on the survival rate. This study categorized COC into three groups—low (COCI < 0.23), intermediate (COCI = 0.23–0.37), and high (COCI ≥ 0.38)—according to the distribution of scores in our sample. A multivariate Cox proportional hazards regression model was used to determine the demographic factors and comorbidities associated with the survival rate.

Results

Among all the relevant variables, low COCI, male sex, low socioeconomic status, no receipt of prior dental treatment before RT, residence outside northern Taiwan, chemotherapy receipt, and a history of diabetes increased the risk of mortality. Pre-RT dental evaluation and management was significantly associated with reduced post-RT mortality (adjusted hazard ratio [aHR] = 0.767, 95% confidence interval [CI] = 0.729–0.806, p < 0.001). Compared with patients with a high COCI, those with a low COCI exhibited an increased risk of mortality (aHR = 1.170, 95% CI = 1.093–1.252, p < 0.001). The mortality risk in the intermediate COC group was significantly higher than that in the high COC group (aHR = 1.194, 95% CI = 1.127–1.266, p < 0.001). To balance the distribution of the potential risk factors, propensity-score matching was used for the high COC (COCI > 0.38) and non-high COC (COCI ≤ 0.38) groups. After propensity-score matching, the mortality risk in the low and intermediate COC groups was also found to be significantly higher than that in the high COC group (aHR = 1.178, 95% CI = 1.074–1.292, p < 0.001 and aHR = 1.189, 95% CI = 1.107–1.277, p = 0.001, respectively).

Conclusions

In Taiwan, COC and prior dental treatment before RT significantly affected the survival rate of working-age patients with oral cancer. This result merits policymakers’ attention.

Effects of income and residential area on survival of patients with head and neck cancers following radiotherapy: working age individuals in Taiwan

Objectives

The five-year survival rate of head and neck cancer (HNC) after radiotherapy (RT) varies widely from 35% to 89%. Many studies have addressed the effect of socioeconomic status and urban dwelling on the survival of HNC, but a limited number of studies have focused on the survival rate of HNC patients after RT.

Materials and methods

During the period of 2000–2013, 40,985 working age individuals (20 < age < 65 years) with HNC patients treated with RT were included in this study from a registry of patients with catastrophic illnesses maintained by the Taiwan National Health Insurance Research Database (NHIRD).

Results

The cumulative survival rate of HNC following RT in Taiwan was 53.2% (mean follow-up period, 3.75 ± 3.31 years). The combined effects of income and geographic effect on cumulative survival rates were as follows: high income group > medium income group > low income group and northern > central > southern > eastern Taiwan. Patients with moderate income levels had a 36.9% higher risk of mortality as compared with patients with high income levels (hazard ratio (HR) = 1.369; p < 0.001). Patients with low income levels had a 51.4% greater risk of mortality than patients with high income levels (HR = 1.514, p < 0.001).

Conclusion

In Taiwan, income and residential area significantly affected the survival rate of HNC patients receiving RT. The highest income level group had the best survival rate, regardless of the geographic area. The difference in survival between the low and high income groups was still pronounced in more deprived areas.

Characterization of the dimer-monomer equilibrium of the papaya Copper/Zinc superoxide dismutase and its equilibrium shift by a single amino acid mutation

The coding region of the copper/zinc superoxide dismutase (Cu/Zn SOD) cDNA from papaya fruit, Carica papaya L. cv. Tainong 2, was cloned into an expression vector, pET-20b(+). The Cu/Zn SOD was expressed in Escherichia coli and purified by His-tag technique. Two active forms of the enzyme (30% dimer and 70% monomer) in equilibrium were observed. The activity of the dimeric enzyme was higher than that of the monomeric form. The thermal inactivation rate constant K(d) values calculated for the dimer and monomer at 90 degrees C were -0.0203 and -0.0216 min(-1), and the half-lives for inactivation were 41.9 and 31.8 min, respectively. This indicated that the dimeric enzyme was more stable than its monomeric form. The dimerization of the enzyme was inhibited under acidic pH (below 3.0) or imidazole buffer (above 0.5 M), whereas it was not affected under alkaline pH (above 9.0). Both activity and forms of the enzyme were not affected by 1-4% SDS. Furthermore, the dimeric enzyme was much more resistant to proteolytic attack after 3 h of incubation at 37 degrees C with trypsin or chymotrypsin. In addition, mutation of the papaya Cu/Zn SOD at position 48 from Leu to Phe (L48F) affected the association of monomer, whereas a mutant with Lys substitution (L48K) at the same position tended to dissociate into monomeric form.

Molecular Cloning of a cDNA Encoding Copper/Zinc Superoxide Dismutase from Papaya Fruit and Overexpression in Escherichia coli

A full-length complementary DNA (cDNA) clone encoding a putative copper/zinc superoxide dismutase (Cu/Zn SOD) of papaya fruit, Carica papaya L. cv. Tainong 2, was amplified according to the polymerase chain reaction technique from cDNA synthesized from fruit messenger RNA. Nucleotide sequence analysis of this cDNA clone revealed that it comprised a complete open reading frame coding for 152 amino acid residues. The deduced amino acid sequence showed higher identity (81.6-84.9%) with the sequences of the cytosolic Cu/Zn SODs than those of the chloroplast from other plant species, and no recognizable plastid targeting peptide was found. These suggest that the papaya fruit cDNA clone encodes a cytosolic Cu/Zn SOD. The residues required for coordinating copper (His-45, -47, -62, and -119) and zinc (His-62, -70, and -79 and Asp-82), as well as the two cysteines (56 and 145) that form a single disulfide bond, are conserved as they are among all reported Cu/Zn SOD sequences. In addition, the coding region of Cu/Zn SOD cDNA from papaya was introduced into an expression vetor, pET-20b(+), and transformed into Escherichia coli AD494(DE3)pLysS. A predominant protein band was detected by Coomassie blue staining of native PAGE, and activity staining confirmed the result of Coomassie blue staining. These indicate that this Cu/Zn SOD cDNA clone can overexpress active Cu/Zn SOD enzyme in E. coli.