Haemophilus Aphrophilus Associated Spleen Abscess: An Unusual Presentation of Subacute Endocarditis

The HACEK group of bacteria (Haemophilus spp., Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella spp.), is uncommon pathogens of infective endocarditis, but can cause life-threatening events such as heart failure or formation of lethal emboli. Here we report a 58-year-old Asian man with a past history of congenital valvular heart disease who presented with sudden onset of left flank pain followed by fever with chills for 2 weeks. Abdominal computed tomography (CT) indicated a 1.6 cm abscess in the spleen. Culturing indicated the presence of Haemophilus aphrophilus. We diagnosed the patient with subacute endocarditis complicated with spleen abscess. The patient recovered fully after two weeks antibiotic (Ceftriaxone) treatment. Clinicians should give further attention to infective endocarditis caused by bacteria in the HACEK group in patients with metastatic infection such as spleen abscess with suspected valvular heart disease

Water Resources Management in Practices at National Pingtung University of Science and Technology Campus

NPUST was the top Taiwan university for the 9th consecutive year on the UI GreenMetric World University Ranking, and placed 27th out of 1,050 schools from 85 countries. This achievement is the result of our commitments to sustainable development. NPUST has been building green transportation for carbon and air pollution reduction, green energy system for effective use of electricity generated by renewable energy, and campus waste water recycling system for the goal of zero discharge. We also implement policies on waste reduction and waste sorting and recycling, as well as encourage planting in school campus. The practice of water resources management is crucial in various aspects that contribute to this sustainable campus. The sustainable management strategies include water consumption management, water conservation and water saving, and water recycling management. In this paper, we are going to share our practical experience in waste water treatment, recycling system set-up, waste water reuse, sustainable development for water resources and how we implement the policies on water saving at campus and spread water resources knowledge. The information is prov

Association between use of non–vitamin k oral anticoagulants with and without concurrent medications and risk of major bleeding in nonvalvular atrial fibrillation

Importance:  Non–vitamin K oral anticoagulants (NOACs) are commonly prescribed with other medications that share metabolic pathways that may increase major bleeding risk. Objective:  To assess the association between use of NOACs with and without concurrent medications and risk of major bleeding in patients with nonvalvular atrial fibrillation. Design, Setting, and Participants:  Retrospective cohort study using data from the Taiwan National Health Insurance database and including 91 330 patients with nonvalvular atrial fibrillation who received at least 1 NOAC prescription of dabigatran, rivaroxaban, or apixaban from January 1, 2012, through December 31, 2016, with final follow-up on December 31, 2016. Exposures:  NOAC with or without concurrent use of atorvastatin; digoxin; verapamil; diltiazem; amiodarone; fluconazole; ketoconazole, itraconazole, voriconazole, or posaconazole; cyclosporine; erythromycin or clarithromycin; dronedarone; rifampin; or phenytoin. Main Outcomes and Measures:  Major bleeding, defined as hospitalization or emergency department visit with a primary diagnosis of intracranial hemorrhage or gastrointestinal, urogenital, or other bleeding. Adjusted incidence rate differences between person-quarters (exposure time for each person during each quarter of the calendar year) of NOAC with or without concurrent medications were estimated using Poisson regression and inverse probability of treatment weighting using the propensity score. Results:  Among 91 330 patients with nonvalvular atrial fibrillation (mean age, 74.7 years [SD, 10.8]; men, 55.8%; NOAC exposure: dabigatran, 45 347 patients; rivaroxaban, 54 006 patients; and apixaban, 12 886 patients), 4770 major bleeding events occurred during 447 037 person-quarters with NOAC prescriptions. The most common medications co-prescribed with NOACs over all person-quarters were atorvastatin (27.6%), diltiazem (22.7%), digoxin (22.5%), and amiodarone (21.1%). Concurrent use of amiodarone, fluconazole, rifampin, and phenytoin with NOACs had a significant increase in adjusted incidence rates per 1000 person-years of major bleeding than NOACs alone: 38.09 for NOAC use alone vs 52.04 for amiodarone (difference, 13.94 [99% CI, 9.76-18.13]); 102.77 for NOAC use alone vs 241.92 for fluconazole (difference, 138.46 [99% CI, 80.96-195.97]); 65.66 for NOAC use alone vs 103.14 for rifampin (difference, 36.90 [99% CI, 1.59-72.22); and 56.07 for NOAC use alone vs 108.52 for phenytoin (difference, 52.31 [99% CI, 32.18-72.44]; P < .01 for all comparisons). Compared with NOAC use alone, the adjusted incidence rate for major bleeding was significantly lower for concurrent use of atorvastatin, digoxin, and erythromycin or clarithromycin and was not significantly different for concurrent use of verapamil; diltiazem; cyclosporine; ketoconazole, itraconazole, voriconazole, or posaconazole; and dronedarone. Conclusions and Relevance:  Among patients taking NOACs for nonvalvular atrial fibrillation, concurrent use of amiodarone, fluconazole, rifampin, and phenytoin compared with the use of NOACs alone, was associated with increased risk of major bleeding. Physicians prescribing NOAC medications should consider the potential risks associated with concomitant use of other drugs

A Pair of Disjoint 3-GDDs of type g^t u^1

Pairwise disjoint 3-GDDs can be used to construct some optimal constant-weight codes. We study the existence of a pair of disjoint 3-GDDs of type $g^t u^1$ and establish that its necessary conditions are also sufficient.Comment: Designs, Codes and Cryptography (to appear

Klebsiella pneumoniae Bacteremia and Capsular Serotypes, Taiwan

Capsular serotypes of 225 Klebsiella pneumoniae isolates in Taiwan were identified by using PCR. Patients infected with K1 serotypes (41 isolates) had increased community-onset bacteremia, more nonfatal diseases and liver abscesses, lower Pittsburgh bacteremia scores and mortality rates, and fewer urinary tract infections than patients infected with non–K1/K2 serotypes (147 isolates)

An Obesity Paradox of Asian Body Mass Index after Cardiac Surgery: Arterial Oxygenations in Duration of Mechanic Ventilation

Background. Numerous studies have documented an obesity paradox that overweight of Caucasian patients has better prognosis after cardiac surgery. This study is to examine Asian patients’ BMI to see whether an obesity paradox exists in DMV after cardiac surgery. Methods. A retrospective study consisted of 428 patients after cardiac surgery from January 2006 to December 2010 in the medical center of Taiwan. The Asian BMI was divided into 3 groups: under-normal weight patients (; ), overweight patients (BMI 24 to <27; ), and obese patients (; ). Multivariable analysis and paired were used to compare all variables. Results. Overweight patients were significantly associated with the shortest DMV. Under-normal weight patients had significantly better oxygenations of AaDO2 and P/F ratio in the DMV; however, they correlated with the longest DMV, older age, more female, lower LVSV, higher BUN, more dialysis-dependent, and poorer outcomes, namely, 1-year mortality, HAP, reintubation, tracheotomy, and LOS. Conclusions. Asian overweight patients after cardiac surgery have better prognosis. Under-normal weight patients have higher risk factors, longer DMV, and poorer outcomes; even though they have better arterial oxygenations, they seem to need better arterial oxygenations for successful weaning ventilator

Exfoliation of Quasi-Two-Dimensional Nanosheets of Metal Diborides

Metal diborides are a class of ceramic materials with crystal structures consisting of hexagonal sheets of boron atoms alternating with planes of metal atoms held together with mixed character ionic/covalent bonds. Many of the metal diborides are ultrahigh-temperature ceramics such as HfB2, TaB2, and ZrB2, which have melting points above 3000 °C, high mechanical hardness and strength at high temperatures, and high chemical resistance, while MgB2 is a superconductor with a transition temperature of 39 K. Here, we demonstrate that this diverse family of non-van der Waals (vdW) materials can be processed into stable dispersions of quasi-two-dimensional (2D) nanosheets using ultrasonication-assisted exfoliation. We generate quasi-2D nanosheets of the metal diborides AlB2, CrB2, HfB2, MgB2, NbB2, TaB2, TiB2, and ZrB2 and use electron and scanning probe microscopy techniques to characterize their structures, morphologies, and compositions. The exfoliated layers have a distribution of lateral dimensions from tens of nanometers up to several micrometers and a distribution of thicknesses from as low as 2-3 nm up to tens of nanometers, all while retaining their hexagonal atomic structure and chemical composition. We exploit the convenient solution-phase dispersions of exfoliated CrB2 nanosheets to incorporate them directly into polymer composites. In contrast to the hard and brittle bulk CrB2, we find that CrB2 nanocomposites remain very flexible and simultaneously provide increases in the elastic modulus and the ultimate tensile strength of the polymer. The successful liquid-phase production of quasi-2D metal diborides enables their processing using scalable low-temperature solution-phase methods, extending their use to previously unexplored applications, and reveals a new family of non-vdW materials that can be efficiently exfoliated into quasi-2D forms