Insights into Chinese perspectives on do-not-resuscitate (DNR) orders from an examination of DNR order form completeness for cancer patients

PURPOSE: Discussing end-of-life care with patients is often considered taboo, and signing a do-not-resuscitate (DNR) order is difficult for most patients, especially in Chinese culture. This study investigated distributions and details related to the signing of DNR orders, as well as the completeness of various DNR order forms. METHODS: Retrospective chart reviews were performed. We screened all charts from a teaching hospital in Taiwan for patients who died of cancer during the period from January 2010 to December 2011. A total of 829 patient records were included in the analysis. The details of the DNR order forms were recorded. RESULTS: The DNR order signing rate was 99.8 %. The percentage of DNR orders signed by patients themselves (DNR-P) was 22.6 %, while the percentage of orders signed by surrogates (DNR-S) was 77.2 %. The percentage of signed DNR forms that were completely filled out was 78.4 %. The percentage of DNR-S forms that were completed was 81.7 %, while the percentage of DNR-P forms that were completely filled out was only 67.6 %. CONCLUSION: Almost all the cancer patients had a signed DNR order, but for the majority of them, the order was signed by a surrogate. Negative attitudes of discussing death from medical professionals and/or the family members of patients may account for the higher number of signed DNR-S orders than DNR-P orders. Moreover, early obtainment of signed DNR orders should be sought, as getting the orders earlier could promote the quality of end-of-life care, especially in non-oncology wards

Necrotizing fasciitis in liver cirrhosis

SummaryBackgroundNecrotizing fasciitis (NF) is associated with a high mortality rate. Hepatitis is endemic in Taiwan, and liver cirrhosis is associated with the development of NF. The characteristics of these patients, however, have not been well documented or the predictors of mortality clearly identified. The purpose of this study is to identify predictors of mortality in patients with liver cirrhosis and necrotizing fasciitis.MethodsThis study was conducted at the Chi-Mei Medical Center in southern Taiwan. Demographic data, clinical characteristics, and the microorganisms responsible for NF in patients with liver cirrhosis were recorded. To identify independent predictors associated with mortality, univariate analysis followed by multivariate logistic regression modeling was performed.ResultsDuring the period 2003–2011, a total of 55 patients with liver cirrhosis and NF were treated at the Chi-Mei Medical Center. Most patients had infections by monomicrobial Gram-negative bacilli. Univariate analysis revealed that severity of liver cirrhosis, shock, band polymorphonuclear neutrophil (>10%), international normalized ratio (>1.5), serum creatinine (>2.0 mg/dL), serum albumin (<2.5 g/dL), and activated partial thromboplastin time (>60 seconds) were significantly associated with mortality. However, multivariate logistic regression analysis revealed that serum albumin of <2.5 g/dL was the only independent predictor of mortality in patients with liver cirrhosis and NF.ConclusionNF in the vast majority of cirrhotic patients was caused by Gram-negative bacilli. Hypoalbuminemia (serum albumin <2.5 g/dL) was associated with mortality in patients with liver cirrhosis and NF. Further studies are needed to assess whether resuscitation with albumin-containing solutions lowers the mortality rate in such patients

Algal blooms: how are they harming models used for climate management?

18th International Conference on Harmful Algae (ICHA 2018), 21-26 October 2018, Nantes, France.-- 4 pages, 2 figuresMicroalgae blooms are generally associated with bacterial secondary producers. They produce organic matter (OM), some of which associates with the sea surface microlayer (SML). OM in the SML below the actual surface reduces fluxes of energy, including heat and momentum, and substances, including greenhouse gases, aerosols, algae, bacteria and viruses. In addition to the SML-associated OM, another OM fraction, foam (including whitecaps), often lies above the primary SML when windspeeds exceed about 5 m s-1, trapping gas bubbles. Such foam also dramatically increases albedo, reflecting solar radiation back into space, thus reducing solar heating and penetration of photosynthetically active radiation. Mean coverage of the ocean surface by foam has been measured to range between 1-6%, particularly in zones of Trade Winds. Different types of OM, and particularly their mechanical properties, depend on ambient algal abundance, as well as on taxonomic composition, as do the dynamics of foam formation and decay. Air-sea fluxes may thus be influenced by genomic control through the blooming microalgae and Darwinian-type evolution. Bacteria may also play a role. In addition, foam patches on the ocean’s surface serve as a unique microbial habitat. Such blooms, particularly when their taxonomic composition changes unpredictably, are likely to be harming the usefulness of climate models. Some of this harm might be mitigated by studying the relevant effects of these blooms on fluxes, and incorporating these effects into climate modelsJS is supported by National Nature Science Foundation of China grant (41876134) and the Changjiang Scholar Program of Chinese Ministry of Educatio

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To evaluate the relationship between circulating adiponectin and insulin sensitivity in patients with hyperthyroid Graves&apos; disease, we studied 19 adult patients with this disease and 19 age-and sex-matched euthyroid controls. All hyperthyroid patients were treated with antithyroid drugs and were re-evaluated after thyroid function normalized. Before antithyroid treatment, the adiponectin plasma concentrations were not different comparing with those in control group. The adiponectin levels remained unchanged after treatment. The homeostasis model assessment of insulin resistance (HOMA-IR) in hyperthyroid group was higher before treatment than after treatment. There was no significant difference in serum glucose and insulin levels between hyperthyroid and control groups and in the hyperthyroid group before and after treatment. BMI-adjusted adiponectin levels were not different among three groups. On the other hand, BMI-adjusted insulin levels and HOMA-IR values were significantly decreased after management of hyperthyroidism. Pearson&apos;s correlation revealed that insulin and HOMA-IR values positively correlated with triiodothyronine (T3) and free thyroxine (FT4) levels. However, adiponectin did not correlate with T3, FT4, insulin, HOMA-IR and thyrotropin receptor autoantibody (TRAb) levels. In conclusion, insulin resistance associated with hyperthyroidism is not mediated by the levels of plasma adiponectin

Clinical and pathological correlates of severity classifications in trigger fingers based on computer-aided image analysis

BACKGROUND: The treatment of trigger finger so far has heavily relied on clinicians’ evaluations for the severity of patients’ symptoms and the functionality of affected fingers. However, there is still a lack of pathological evidence supporting the criteria of clinical evaluations. This study’s aim was to correlate clinical classification and pathological changes for trigger finger based on the tissue abnormality observed from microscopic images. METHODS: Tissue samples were acquired, and microscopic images were randomly selected and then graded by three pathologists and two physicians, respectively. Moreover, the acquired images were automatically analyzed to derive two quantitative parameters, the size ratio of the abnormal tissue region and the number ratio of the abnormal nuclei, which can reflect tissue abnormality caused by trigger finger. A self-developed image analysis system was used to avoid human subjectivity during the quantification process. Finally, correlations between the quantitative image parameters, pathological grading, and clinical severity classification were assessed. RESULTS: One-way ANOVA tests revealed significant correlations between the image quantification and pathological grading as well as between the image quantification and clinical severity classification. The Cohen’s kappa coefficient test also depicted good consistency between pathological grading and clinical severity classification. CONCLUSIONS: The criteria of clinical classification were found to be highly associated with the pathological changes of affected tissues. The correlations serve as explicit evidence supporting clinicians in making a treatment strategy of trigger finger. In addition, our proposed computer-aided image analysis system was considered to be a promising and objective approach to determining trigger finger severity at the microscopic level

Tumour inflammasome-derived IL-1b recruits neutrophils and improves local recurrence-free survival in EBV-induced nasopharyngeal carcinoma

Inflammasomes sense infection and cellular damage and are critical for triggering inflammation through IL-1β production. In carcinogenesis, inflammasomes may have contradictory roles through facilitating antitumour immunity and inducing oncogenic factors. Their function in cancer remains poorly characterized. Here we show that the NLRP3, AIM2 and RIG-I inflammasomes are overexpressed in Epstein-Barr virus (EBV)-associated nasopharyngeal carcinoma (NPC), and expression levels correlate with patient survival. In tumour cells, AIM2 and RIG-I are required for IL-1β induction by EBV genomic DNA and EBV-encoded small RNAs, respectively, while NLRP3 responds to extracellular ATP and reactive oxygen species. Irradiation and chemotherapy can further activate AIM2 and NLRP3, respectively. In mice, tumour-derived IL-1β inhibits tumour growth and enhances survival through host responses. Mechanistically, IL-1β-mediated anti-tumour effects depend on infiltrated immunostimulatory neutrophils. We show further that presence of tumour-associated neutrophils is significantly associated with better survival in NPC patients. Thus, tumour inflammasomes play a key role in tumour control by recruiting neutrophils, and their expression levels are favourable prognostic markers and promising therapeutic targets in patients

Increased Risk for Entamoeba histolytica Infection and Invasive Amebiasis in HIV Seropositive Men Who Have Sex with Men in Taiwan

Entamoeba histolytica, morphologically identical to but genetically different from E. dispar and E. moshkovskii, is the causative agent of amebiasis. Recently there have been reports of increased risk for amebiasis among men who have sex with men (MSM) due to oral-anal sexual contact in several developed countries. In this longitudinal follow-up study, the incidence of amebiasis was determined among HIV-infected patients using serological and specific amebic antigen assays. DNA extracted from stool samples containing E. histolytica were analyzed by PCR, sequenced, and compared. Clinical manifestations and treatment response of invasive amebiasis in HIV-infected patients were reviewed. The results demonstrated that HIV-infected MSM were at significantly higher risk of amebiasis than patients from other risk groups. Clustering of E. histolytica isolates by sequencing analyses from geographically unrelated patients suggested person-to-person transmission. Despite immunosuppression, amebic liver abscesses and colitis responded favorably to metronidazole therapy. It is important to investigate in areas of high incidence of both amebiasis and HIV (sub-Saharan Africa) how generalizable these findings are

Antimicrobial Drug Resistance in Pathogens Causing Nosocomial Infections at a University Hospital in Taiwan, 1981-1999

To determine the distribution and antimicrobial drug resistance in bacterial pathogens causing nosocomial infections, surveillance data on nosocomial infections documented from 1981 to 1999 at National Taiwan University Hospital were analyzed. During this period, 35,580 bacterial pathogens causing nosocomial infections were identified. Candida species increased considerably, ranking first by 1999 in the incidence of pathogens causing all nosocomial infections, followed by Staphylococcus aureus and Pseudomonas aeruginosa. Candida species also increased in importance as bloodstream infection isolates, from 1.0% in 1981-1986 to 16.2% in 1999. The most frequent isolates from urinary tract infections were Candida species (23.6%), followed by Escherichia coli (18.6%) and P. aeruginosa (11.0%). P. aeruginosa remained the most frequent isolates for respiratory tract and surgical site infections in the past 13 years. A remarkable increase in incidence was found in methicillin-resistant S. aureus (from 4.3% in 1981-1986 to 58.9% in 1993-1998), cefotaxime-resistant E. coli (from 0% in 1981-1986 to 6.1% in 1993-1998), and cefotaxime-resistant Klebsiella pneumoniae (from 4.0% in 1981-1986 to 25.8% in 1993-1998). Etiologic shifts in nosocomial infections and an upsurge of antimicrobial resistance among these pathogens, particularly those isolated from intensive care units, are impressive and alarming