A 78-Year-Old Woman with Fecaloid Vaginal Discharge

A 78-year-old woman with a history of colon cancer with metastasis to the liver was presented to our emergency department because of bilateral groin pain and difficulty in walking, which had gradually increased during the previous 5 days. The pain was of sudden onset, radiating to the back, without aggravating or relieving factors. It was associated with constipation, dysuria and vaginal discharge. She reported passing fecal matter from the vagina one month ago. On physical examination, she appeared malnourished. Her blood pressure was 98/65 mmHg, with a 108 beats/min heart rate and 28 breaths/min respiratory rate. She was afebrile. Physical examinations were unremarkable, except for pale conjunctiva, abdominal distention, and diffuse tenderness especially over the umbilicus with guarding tenderness. Bowel sounds were decreased. Pelvic examination showed a yellowish odorous vaginal discharge from the external orifice of uterus. A complete blood cell count showed the following: leukocyte count, 34,200/mm3; segmented neutrophils, 87.5%; hemoglobin level of 7.4 mg/dl; hematocrit, 18.8%; and platelet, 180000/uL. Other laboratory studies included: glucose, 86 mg/dL; serum urea nitrogen, 28 mg/dL; serum creatinine, 0.87 mg/dL; sodium, 142 mEq/L; potassium, 4.8 mEq/L; albumin, 2.5g/dL; a carbohydrate antigen 19-9 level of 3,244 U/ml, and a carcinoembryonic antigen (CEA) level of 64.6 ng/ml. Coronal and axial cuts of patient’s abdominopelvic computed Tomography (CT) are shown in figures 1 and 2

Korean Red Ginseng Improves Blood Pressure Stability in Patients with Intradialytic Hypotension

Introduction. Intradialytic hypotension (IDH) is a common complication during hemodialysis which may increase mortality risks. Low dose of Korean red ginseng (KRG) has been reported to increase blood pressure. Whether KRG can improve hemodynamic stability during hemodialysis has not been examined. Methods. The 8-week study consisted of two phases: observation phase and active treatment phase. According to prehemodialysis blood pressure (BP), 38 patients with IDH were divided into group A (BP ≥ 140/90 mmHg, n = 18) and group B (BP < 140/90 mmHg, n = 20). Patients were instructed to chew 3.5 gm KRG slices at each hemodialysis session during the 4-week treatment phase. Blood pressure changes, number of sessions disturbed by symptomatic IDH, plasma levels of vasoconstrictors, blood biochemistry, and adverse effects were recorded. Results. KRG significantly reduced the degree of blood pressure drop during hemodialysis (P < 0.05) and the frequency of symptomatic IDH (P < 0.05). More activation of vasoconstrictors (endothelin-1 and angiotensin II) during hemodialysis was found. The postdialytic levels of endothelin-1 and angiotensin II increased significantly (P < 0.01). Conclusion. Chewing KRG renders IDH patients better resistance to acute BP reduction during hemodialysis via activation of vasoconstrictors. Our results suggest that KRG could be an adjuvant treatment for IDH

Pyogenic Liver Abscess as Endemic Disease, Taiwan

Increasing incidence and microbiologic shift might have changed the manifestation of this condition

[[alternative]]The Learning Effectiveness of Using a Concept Map Based Board Game to Teach Nurses Early Warning System

[[abstract]]辨識和管理病人病情惡化已成為護理人員照護病人重中之重，臺灣自2005年以後，將評估病人非預期緊急醫療警訊症狀的作業列入常規照護模式。運用觀察圖表式的警訊工具，有助於新進護理人員早期識別和通報病人惡化，而藉由實際操作桌遊的過程中，增進批判性思考、自信心及認知能力。本研究旨在驗證「概念構圖式預警系統桌遊」教學策略介入方案，對提升新進護理人員對於預警系統認知、自覺緊急情境照護能力、及預警系統評估自我效能之學習成效探討。研究以北部某醫學中心護理人員為研究對象，採類實驗研究設計，進行雙組前後測研究。實驗組進行「概念構圖式預警系統桌遊教學課程」，對照組進行「案例討論預警系統教學課程」，共收案43位臨床工作年資二年以內之病房護理人員，回收問卷43份，有效問卷為43份。 本研究結果顯示：在課程介入後，實驗組在預警系統認知、自覺緊急情境照護能力及預警系統評估自我效能得分皆高於對照組。於課程介入後三週再進行預警系統認知、自覺緊急情境照護能力之延宕測驗，實驗組得分皆高於對照組，達統計上顯著差異(p<.05)。 依據研究結果建議：「概念構圖式預警系統桌遊」教學，藉由圖文、影片及實際操作桌遊的過程中，引導新進護理人員將理解的預警系統相關概念組織起來，並於桌遊過程中檢視自己對緊急情境判斷的認知，於課程中達到趣味學習及專注力。臨床護理人員在職教育中可依職級及年資將概念構圖教學策略搭配桌遊教材，輔以臨床情境進行相關教學，能有效提升護理人員自覺緊急情境照護能力與預警系統評估自我效能，進而提升授課成效及臨床照護知能。關鍵字:護理人員、預警系統、概念構圖式桌遊、緊急情境照護能力、自我效能[[abstract]]Recognizing and managing patients' deteriorating conditions has become the top priority for nursing staff in caring for patients. Since 2005, Taiwan has included the evaluation of unexpected emergency medical warning symptoms as part of its routine care model. Using an observation chart-style warning tool can help new nursing staff to identify and report patient deterioration early on, while the process of playing an actual board game can enhance critical thinking, self-confidence, and cognitive ability. This study aims to verify the effectiveness of the concept mapping plus board game teaching intervention in improving the learning outcomes of nursing staff, including their understanding of warning systems, awareness of emergency situation care ability, and self-efficacy in evaluating warning systems. The study was conducted at a medical center in northern Taiwan, using a quasi-experimental research design with a pre-test and post-test for two groups. The experimental group attended the concept mapping plus board game course,&quot; while the control group attended the case discussion course. A total of 43 ward nursing staff with less than two years of clinical experience were recruited, and 43 questionnaires were collected, all of which were valid. The results of this study showed that the experimental group scored higher than the control group in terms of their recognition of the warning system, their awareness of emergency situations, and their self-efficacy in evaluating the warning system. Three weeks after the course intervention, when delayed tests were conducted on the recognition of the warning system and the ability to care for emergency situations, the experimental group remained scored higher than the control group, with a statistically significant difference (p < .05). Based on the findings, it is recommended that the concept map-based warning system along with a board game be used in clinical teaching. Through the process of using graphics, videos, and playing the board game, the nursing staff can be guided to form their understanding of the warning system-related concepts, and assess their own cognitive abilities in emergency situation when engaging in the board game. This approach can achieve enjoyable learning and improve concentration in the course. Nursing staff can use concept map teaching strategies combined with board game materials for in-service education according to their job level and years of experience. This, along with relevant clinical situations, can effectively enhance the nursing staff's awareness of emergency situation care and self-efficacy in evaluating the warning system, thereby improving teaching and clinical care knowledge and skills.Keywords: Nursing staff, Early warning system, Concept map based board game, Acute care situations, Self-efficac

A Miniature Magnetic-Force-Based Three-Axis AC Magnetic Sensor with Piezoelectric/Vibrational Energy-Harvesting Functions

In this paper, we demonstrate a miniature magnetic-force-based, three-axis, AC magnetic sensor with piezoelectric/vibrational energy-harvesting functions. For magnetic sensing, the sensor employs a magnetic–mechanical–piezoelectric configuration (which uses magnetic force and torque, a compact, single, mechanical mechanism, and the piezoelectric effect) to convert x-axis and y-axis in-plane and z-axis magnetic fields into piezoelectric voltage outputs. Under the x-axis magnetic field (sine-wave, 100 Hz, 0.2–3.2 gauss) and the z-axis magnetic field (sine-wave, 142 Hz, 0.2–3.2 gauss), the voltage output with the sensitivity of the sensor are 1.13–26.15 mV with 8.79 mV/gauss and 1.31–8.92 mV with 2.63 mV/gauss, respectively. In addition, through this configuration, the sensor can harness ambient vibrational energy, i.e., possessing piezoelectric/vibrational energy-harvesting functions. Under x-axis vibration (sine-wave, 100 Hz, 3.5 g) and z-axis vibration (sine-wave, 142 Hz, 3.8 g), the root-mean-square voltage output with power output of the sensor is 439 mV with 0.333 μW and 138 mV with 0.051 μW, respectively. These results show that the sensor, using this configuration, successfully achieves three-axis magnetic field sensing and three-axis vibration energy-harvesting. Due to these features, the three-axis AC magnetic sensor could be an important design reference in order to develop future three-axis AC magnetic sensors, which possess energy-harvesting functions, for practical industrial applications, such as intelligent vehicle/traffic monitoring, processes monitoring, security systems, and so on

Obsessive-Compulsive Symptoms Associated with Clozapine and Risperidone Treatment: Three Case Reports and Review of the Literature

Treatment-emergent obsessive-compulsive symptoms (OCSs) have raised concern since the widespread introduction of serotonin-dopamine antagonists (SDAs) for the treatment of schizophrenia. Further investigations of SDA-emergent OCSs and their response to anti-obsessional agents will be beneficial for clinicians in helping patients who suffer from this problem. We present three cases of schizophrenia in which distressing OCSs occurred during clozapine or risperidone treatment. OCSs were assessed consecutively using the Yale-Brown Obsessive-Compulsive Scale. The OCSs of these three patients were responsive to anti-obsessional agents, including fluvoxamine, clomipramine, and paroxetine. We also review the current literature and discuss the possible pathophysiology and psychopathology of SDA-emergent OCSs

Association of Low Serum Albumin Level with Higher Hepatocellular Carcinoma Recurrence in Patients with Hepatitis B Virus Pre-S2 Mutant after Curative Surgical Resection

Hepatocellular carcinoma (HCC) is, globally, one of the most prevalent and deadly human cancers; despite curative surgical resection, its high recurrence rate after surgery remains a large threat, resulting in poor patient survival. The hepatitis B virus (HBV) pre-S2 mutant that harbors deletions spanning the pre-S2 gene segment has emerged as an important oncoprotein for HCC development and a valuable prognostic biomarker for HCC recurrence; however, its relationship with clinicopathological factors is largely unexplored. In this study, the correlation of the deletion spanning the pre-S2 gene segment with clinicopathological factors and the association of such correlation with HCC recurrence after curative surgical resection were examined in HBV-related HCC patients. Inverse correlation between serum albumin level and the deletion spanning the pre-S2 gene segment was identified. HCC patients with the presence of the deletion spanning the pre-S2 gene segment and a low serum albumin level were associated with higher HCC recurrence than patients with either factor alone or neither factor were. Moreover, a combination of the serum albumin level and the deletion spanning the pre-S2 gene segment exhibited better performance than that of either factor alone in predicting HCC recurrence. Collectively, this study shows an association of low serum albumin level with pre-S2 mutant-positive HCC patients, and validates the prognostic value of this association in identifying patients with higher HCC recurrence after curative surgical resection

Evaluation of white sweet potato tube-feeding formula in elderly diabetic patients: a randomized controlled trial

White sweet potato;Type 2 diabetes mellitus; Tube feeding;Enteral nutritionBackground Elderly people with type 2 diabetes mellitus (T2DM) have an increased risk of diabetes-related microvascular and macrovascular complications, thus diabetic patients with a functioning gastrointestinal tract but without sufficient oral intake require enteral nutrition (EN) formulas to control blood glucose. White sweet potato (WSP) was a kind of sweet potato could provide a healthy carbohydrate source to EN formula. The aim of this study was to examine at risk of malnutrition T2DM patients whether a WSP-EN would attenuate glucose response and elevate nutritional index compared to a standard polymeric formulas. Methods In this randomized, parallel, placebo-controlled, pilot clinical trial to investigate the effects of EN with WSP on aged residents with T2DM in long-term care institutions. In total, 54 eligible participants were randomly assigned to either the non-WSP-EN or WSP-EN group. For 60 days, the WSP-EN group received a WSP formula through nasogastric tube via a stoma with a large-bore syringe. The participants received EN of standard polymeric formulas without WSP in the non-WSP-EN group. Results The body weight, body mass index, Mini Nutritional Assessment score, and Geriatric Nutritional Risk Index were significantly higher in the WSP-EN group (p < 0.05). Moreover, the WSP-EN intervention reduced glycated hemoglobin levels (6.73% +/- 1.47% vs. 6.40% +/- 1.16%), but increased transferrin (223.06 +/- 38.85 vs. 245.85 +/- 46.08 mg/dL), high-density lipoprotein cholesterol (42.13 +/- 10.56 vs. 44.25 +/- 8.43 mg/dL), and vitamin A (2.45 +/- 0.77 vs 2.74 +/- 0.93 mu M) levels (p < 0.05). In addition, there was no important side effects including gastrointestinal intolerance with prescribed doses in our WSP-EN treated patients when compared with control ones. Conclusions The results suggest WSP incorporated into enteral formulas can improve nutrition status and glycemic control in elderly diabetic patients

rs657075 (CSF2) Is Associated with the Disease Phenotype (BAS-G) of Ankylosing Spondylitis

Ankylosing spondylitis (AS) is a systemic autoimmune disease mainly affecting the lumbar spine and sacroiliac joints, and exhibits peripheral inflammatory arthropathy. More than 25 loci have been identified as associated with AS. Because both AS and rheumatoid arthritis (RA) are autoimmune diseases that may share some common genetic factors, we therefore examined if the newly identified RA genetic polymorphisms were associated with AS in a Taiwanese population. In this study, we enrolled 475 AS patients and 11,301 healthy subjects from a Taiwanese biobank as controls. Although none of single-nucleotide polymorphisms (SNPs) were associated with the susceptibility to AS, the AS disease index Bath AS Global (BAS-G) clinical phenotype was observed as significantly correlated to the AA genotype of rs657075 (CSF2). The significance remains after gender/age/disease duration adjustment and after group categorization by human leukocyte antigen-B 27 (HLA-B27) genotype. We further investigated the possible functions of rs657075 through bioinformatics approaches. Results revealed that polymorphism of rs657075 is able to influence the expression of acyl-CoA synthetase long-chain family member 6 (ACSL6). In conclusion, our study indicated that rs657075 (CSF2) is strongly associated with the AS disease index Bath AS Global (BAS-G) clinical phenotype