Saccharomonospora piscinae sp. nov., a novel actinobacterium from fishpond sediment in Taiwan

Strain 06168H-1^T was isolated from a fishpond sediment sample collected from the southern area of Taiwan, and a polyphasic approach was used to determine its taxonomic position. The isolate grew between 20-40 °C and 0-8 % (w/v) NaCl. It produced branched and unfragmented substrate mycelia. Short spore chains (3-10 spores per chain) formed on branched aerial mycelia. The spore chains contained non-motile, smooth-surfaced, oval spores. Galactose, arabinose and ribose were the whole-cell sugars and meso-diaminopimelic acid was present in its peptidoglycan. The polar lipids were diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, phosphatidylmethylethanolamine, phosphatidylcholine, hydroxyphosphati dylethanolamine and a ninhydrin-positive phosphoglycolipid. The predominant menaquinone was MK-9(H4) and minor components were MK-8(H4) and MK-9(H6). Mycolic acids were not detected. The major cellular fatty acids were iso-C16 : 0 and C17 : 1ω6c and C17 : 0ω8c. The DNA G+C content of the strain was 70.6 mol%. Phylogenetic analysis based on 16S rRNA gene sequences showed this strain clustered with the members of the genus Saccharomonospora and was closely related to Saccharomonospora xinjiangensis, Saccharomonospora azurea and Saccharomonosporacyanea. The levels of similarity between this strain and the closely related species were: Sxinjiangensis BCRC16887^T, 98.34 %; S. azurea BCRC 16220^T, 98.27 %; and S. cyanea BCRC 16886^T, 97.99 %. Based on phylogenetic characteristics, strain 06168H-1^T represents a novel species of the genus Saccharomonospora. We thus propose the name Saccharomonospora piscinae sp. nov. for this novel strain, with strain 06168H-1^T (=BCRC 16893^T=KCTC 19743^T) as the type strain.

The importance of region 2.1 in sustaining the functional structure of the Bacillus subtilis sigma(A) factor

Region 2.1 of the sigma factor is once proposed to be involved in core binding, and certain bulky hydrophobic amino acids in region 2.1 are thought to make contact with the conserved isoleucine residues in the promoter -10 binding region on the same protein. To examine the roles of the contact between these two regions in sigma(A) structure and function, sigma(A )factor with L145A, I149A, or Y153A was created, and the effects of each substitution on the growth of Bacillus subtilis and on the structural and functional properties of sigma(A) were analyzed. Our data revealed that the growth potential of B. subtilis was significantly affected by each of the substitutions of sigma(A) at elevated temperature. The growth defect was most pronounced with the strain containing L145A-sigma(A); it possessed a low growth potential even at 37 degrees C. In parallel, changes in the structural stability and core-binding activity of sigma(A) and in the promoter-binding and transcription activities of sigma(A)-RNA polymerase were observed for each of the substitutions, with the most drastic effects exerted by L145A. Clearly, region 2.1 of sigma(A) has extra functions, such as the binding of RNA polymerase to promoter DNA, other than the known core-binding ability. Moreover, the multiple effects of each of the substitutions on sigma(A) demonstrate that the contacts between the hydrophobic amino acids in region 2.1 and those in the promoter -10 binding region are critical to the maintenance of the functional sigma(A) structure and that L145 in region 2.1 plays an important role in this respect.

Adrenal insufficiency in critically ill emergency department patients: a Taiwan preliminary study

OBJECTIVE

Unrecognized adrenal insufficiency can have serious consequences in critically ill emergency department (ED) patients. This prospective pilot study of adrenal function in patients with severe illness was undertaken to determine the prevalence of adrenal dysfunction and any relation to prior herbal drug use.

METHODS

In a high-volume urban tertiary care ED, adult patients with sepsis or acute myocardial infarction (AMI) were eligible for the study. Over a two-month period, a convenience sample was enrolled by the authors on arrival to the ED. Inclusion criteria were systemic inflammatory response syndrome (SIRS) criteria plus evidence of at least one organ dysfunction or cardiac marker plus electrocardiogram-proven AMI. Exclusion criteria included known corticosteroid use. Serum cortisol was measured on arrival and for those patients with a level of <15 microg/dL (<414 nmol/L), an adrenocorticotropic hormone (ACTH) stimulation test was performed.

RESULTS

Of the 30 enrolled patients, 23 (77%) were suffering from severe sepsis and the other seven (23%) had an AMI. Thirteen of the 30 patients (43%; 95% CI = 25% to 65%) had serum cortisol levels of <15 microg/dL, consistent with adrenal insufficiency, nine with severe sepsis and four with an AMI. Eight (62%; 95% CI = 32% to 86%) of the 13 patients with low cortisol levels reported using herbal medications, while only two (12%; 95% CI = 1% to 36%) of the 17 with normal cortisol levels reported taking herb drugs (p = 0.01). Only two (15%; 95% CI = 2% to 45%) of the patients with low cortisol levels failed their corticotropin stimulation test, suggestive of true adrenocortical insufficiency. Both reported using herbal preparations.

CONCLUSIONS

These results indicate that adrenal dysfunction is common among a group of critically ill patients seen in this Taiwanese ED. Moreover, the use of herbal drugs was high in the patients with low serum cortisols. Further studies are required to both confirm these findings and clarify whether a number of herbal medications contain corticosteroids.

Clinical presentations of elderly patients at emergency departments: a comparison between a medical center and a community hospital

BACKGROUND

The utilization of emergency services is expected to increase in parallel with an increase of the elderly population. This article compares the elderly patient Emergency Department (ED) utilization at a 3500-bed medical center with that of a 600-bed community hospital serviced by the same group of emergency physicians.

METHODS

We retrospectively reviewed all patients over 64 years old who presented to Linkou Chang Gung Memorial Hospital (CGMH) and Keelung CGMH between July 1, 1995 and June 30, 1996 by using the 2 ED's real-time computer logs. Data comparisons included age, gender, mode of arrival, arriving source, triage category, chief complaint, impression, and final disposition.

RESULTS

There were 18,285 patients in the Linkou ED and 8038 in Keelung. Significant differences in arrival mode, arriving source, triage category, disease pattern, and final disposition were observed between the Linkou and Keelung CGMH EDs.

CONCLUSION

Significant differences reflected the different roles between the Linkou and Keelung CGMH EDs. Hospital EDs should be prepared to adapt to meet the needs of the elderly based on their roles in the medical care system, at the elderly population grows in the 21st century.

Differences of disease characteristics between genders in emergency department elderly of a community hospital in Taiwan

BACKGROUND

The purpose of this study was to catalog the chief complaints and diagnoses of elderly patients visiting to a Taiwanese emergency department (ED), and to compare gender differences.

METHODS

ED computer log data of patients 65 years and older, who visited the ED from July 1995 to June 1996, were retrospectively reviewed. The computer log data for each patient was entered prospectively by the doctor providing the ED care. All patient data were separated by gender, and then subdivided into trauma and non-trauma groups for analysis.

RESULTS

There were 8038 elderly patients treated during the study period. The most common male chief complaint was dyspnea, and for females, it was abdominal pain, followed by injuries for both genders. Falls were the most common mechanism of injury for both genders, but they were more common among females (63.2% vs. 46.1%, p < 0.001). Motorbike accidents, however, were 3 times as frequent among males (16.05% vs. 5.45%, p < 0.001). Males presented most commonly with COPD (12.2%), compared to only 4.16% for females (p < 0.001), with urinary retention the second most common diagnosis (5.04% vs. 0.72%, p < 0.001). Females suffered a greater number of urinary tract infections (5.42% vs. 2.03%, p < 0.001), presentations for renal failure (2.98% vs. 1.56% p < 0.001), and diabetes-associated problems (4.58% vs. 2.48%, p < 0.001).

CONCLUSION

Elderly females presented to the ED more frequently with urinary tract and diabetic problems; while their male counterparts presented with complications of COPD, urinary retention, and motorbike accidents.

Rates and causes of emergency department revisits within 72 hours

The purpose of this study was to determine the rates and causes of revisits to the emergency department (ED) of a 3,500-bed referral hospital, to identify areas for improvement, and to generate baseline data for the development of a computerized, automatic monthly audit system. We identified all patients returning within 72 hours of their initial ED visits, from 1 July 1995 to 30 June 1997, and monthly revisit rates were calculated. To determine the reasons for revisits, two independent reviewers examined the charts of revisit cases from 1 July 1996 to 30 June 1997. A one-in-three sampling method was used to select charts. A total of 485 revisit charts were reviewed. The monthly revisit rates ranged from 1.32% to 2.38%, with no particular seasonal or event-specific pattern. Most revisits were attributed to disease factors (79.0%). Those felt to be medical errors only accounted for 7.8% of the revisits but led to a higher hospital admission rate (73.7%) subsequently. By contrast, the overall hospital admission rates for revisit patients (36.5%) and all ED patients (36.2%) were similar. We suggest setting baseline monthly ED revisit rates at 2% for future computer-programmed audit filters. While this study indicates that most revisits are disease-related, further prospective studies are needed to evaluate the most common and serious causes of revisits to see if improvements can be made.

Splenic artery aneurysm rupture in pregnancy--a review and case report

Spontaneous rupture of a splenic artery aneurysm in the third trimester of pregnancy is a catastrophic event associated with a very high fetal and maternal mortality rate. Review of the literature reveals nine reported cases of combined maternal and fetus survival. None were diagnosed prior to rupture and the need for an emergency laparotomy. They survived due to early surgery after fetal distress was noted. We present a 29-year-old female presenting at 33 weeks gestation seeking emergency assistance for vomiting, diarrhea and epigastralgia. During her evaluation and initial management she into shock. At laparotomy a ruptured splenic artery aneurysm was found and ligated. After splenectomy the mother recovered well but unfortunately fetus did not survive.

Preliminary experience with growth factor and porcine graft-young collagenous wettable membrane in the treatment of chronic diabetic ulcer

Chronic ulcers are well-known complication of diabetes mellitus, often compounded by infection. Healing of lesions is problematic in some cases using conventional treatment. We have treated a group of six hospitalized diabetic patients with chronic ulcer by a combined regimen consisting of metabolic control, parenteral antibiotics, growth factor and porcine graft-young collagenous wettable membrane (YCWM) treatment. Five of our uncontrolled group had their ulcers improved at 87 +/- 37.6 hospital days after 45.8 +/- 20.2 days of growth factor and YCWM treatment. In conclusion, growth factor and porcine graft-YCWM therapy may be promising as an alternative choice in treatment of chronic diabetic ulcer.