Enteric bacterial loads are associated with interleukin-6 levels in systemic inflammatory response syndrome patients

AbstractBackgroundLoss of intestinal integrity is a critical contributor to excessive inflammation following severe trauma or major surgery. In the case of enterocyte damage, intestinal fatty acid-binding protein (IFABP) is released into the extracellular space. Excessive production of interleukin (IL)-6 can induce systemic inflammatory response syndrome (SIRS). However, the correlation of IL-6 with gut barrier failure and bacterial translocation in critically ill patients has not been well characterized.PurposesTo define the relationship between enteric bacterial loads and IL-6 levels in patients with SIRS.MethodsVariables related to prognosis and treatment were measured in 85 patients with SIRS upon admission to the emergency room. IL-6 and IFABP were measured using an enzyme-linked immunosorbent assay. Enteric bacterial loads in blood were measured through quantitative real-time polymerase chain reaction with primers specific for enteric bacteria.ResultsMultivariate analysis revealed a positive correlation between enteric bacterial loads and IL-6 levels in blood. Elevated IFABP concentration was associated with low blood pressure, high respiration rate, hyperglycemia, and high Sequential Organ Failure Assessment score. Elevated C-reactive protein concentrations were associated with higher soluble CD14 levels in blood.ConclusionEnterocyte damage is associated with hypotension and tachypnia in patients with SIRS. Gut function failure may permit enteric bacteria to enter the blood, thereby elevating IL-6 levels and inducing a systemic inflammatory response, resulting in multiple organ failure

Neurological Complications in Young Infants With Acute Bacterial Meningitis

We aimed to evaluate the occurrence, treatment, and outcomes of neurological complications after bacterial meningitis in young infants. A case series study from a retrospective cohort from two tertiary-level medical centers in Taiwan between 2007 and 2016 was conducted. Eighty-five young infants aged < 90 days with bacterial meningitis were identified. 25 (29.4%) were born at preterm. Group B Streptococcus (GBS) and Escherichia coli caused 74.1% of identified cases. Despite the majority (90.6%) initially received microbiologically appropriate antibiotics, 65 (76.5%) had experienced at least one neurological complication identified at a median of 6 days (range: 1–173) after onset of bacterial meningitis. The most common neurological complication was seizure (58.8%), followed by subdural effusion (47.1%), ventriculomegaly (41.2%), subdural empyema (21.2%), hydrocephalus (18.8%), ventriculitis (15.3%), periventricular leukomalacia (11.8%), and encephalomalacia (10.6%). Nine patients (10.6%) died (including 4 had critical discharge on request) and 29/76 (38.2%) of the survivors had major neurological sequelae at discharge. Nighteen (22.4%) received surgical intervention due to these complications. After multivariate logistic regression, initial seizure (adjusted odds ratio [aOR]: 4.76, 95% confidence interval [CI]: 1.7–13.0, P = 0.002) and septic shock (aOR: 6.04; 95% CI: 1.35–27.0, P = 0.019) were independent predictors for final unfavorable outcomes.Conclusions: Neurological complications and sequelae are common in young infants after bacterial meningitis. Patients presented with early seizure or septic shock can be an early predictor of final unfavorable outcomes and require close monitoring. Further research regarding how to improve clinical management and outcomes is warranted

Growth and Characteristics of High-quality InN by Plasma- Assisted Molecular Beam Epitaxy

The high-quality InN epifilms and InN microdisks have been grown with InGaN buffer layers at low temperatures by plasma-assisted molecular beam epitaxy. The samples were analyzed using X-ray diffraction, scanning electron microscopy, high-resolution transmission electron microscopy, and photoluminescence. The characteristics of the InN epifilms and InN microdisks were studied, and the role of InGaN buffer was evaluated

Estimating Forest Canopy Height by Airborne LiDAR System

摘要 林業上求取林分參數的方法，過去多以人工地面施測而得，耗時費工且無法大面積獲取重要林分參數資料，如林分高、材積、生物量等。其中，林分高可用以了解林分狀況，更為大部分參數之推算基礎，能精確求得林分高度，即可依此推得其他相關重要參數。 空載光達系統(Airborne LiDAR System, ALS)於近年蓬勃發展，多使用於生產數值地形模型(DTM)及房屋萃取等；應用於森林地區，則可用於大面積計算林分高度。本研究首先確認光達產生最低點與實測DTM之相關性，並建立迴歸模型，用以推估光達產生之DTM，並與光達產生之最高點建立林分高度模型，研究成果顯示光達於特定假設下，可有效用於台灣地區林分高度之獲取。目 錄 摘要 1 Abstract 2 壹、 前言 3 貳、 研究動機與目的 5 一、 研究動機 5 二、 研究目的 6 參、 文獻回顧 7 一、 光達之原理與應用 7 (一) 遙感探測於森林之應用 7 (二) 雷射掃瞄測距原理 9 (三) 衛載雷射掃瞄系統 11 (四) 空載雷射掃瞄系統 14 (五) 地面雷射掃瞄系統 19 二、 應用光達於森林資源之文獻回顧 19 (一) 資料處理 20 (二) 數值地表模型(DTM)生產 22 (三) 林分高之估算與樹冠高度模型(CHM)建構 23 (四) 應用潛力、限制與討論 27 肆、 研究材料 28 一、 試區概述 28 二、 研究材料 29 (一) 空載雷射掃瞄資料 29 (二) 航空像片資料 30 (三) 地面調查資料 31 伍、 研究方法 32 一、 研究流程圖 32 (一) 資料分析與模式建立 32 (二) 模式驗證 33 二、 資料前處理 33 三、 建立數值表面模型 34 四、 建立光達產生最低點數值模型與實測DTM之關聯 36 五、 建立光達最低點與實測DTM之關係 36 六、 回復模型建構 36 七、 模式驗證與誤差分析 36 陸、 結果與討論 38 一、 研究成果 38 (一) 雜訊濾除 38 (二) 光達與實測CHM資料網格化 39 (三) 實測DTM與光達網格內最小值之相關程度分析 41 (四) 建立光達網格最小值與實測DTM之迴歸模型 43 (五) 初始CHM與實測CHM之比較 46 (六) 回復模型建立 47 二、 討論 50 三、 結論 50 柒、 參考文獻 54 捌、 附錄 5

Solitary fibrous tumor: An evolving and unifying entity with unsettled issues

Solitary fibrous tumor (SFT) is a distinct fibroblastic neoplasm of intermediate biological potential, prototypically presenting as a pleuraassociated tumor characterized by patternless proliferation of generally banal oval to spindle cells with hemangiopericytoma-like staghorn vessels in fibrocollagenous stroma. Over the past decades, the clinicopathological spectrum of SFT has been everexpanding with the incorporation of cases exhibiting myxoid, giant cell-containing, and fat-forming histology, as well as those from extrathoracic sites, including the meninx. Atypical, frankly malignant and even dedifferentiated variants have also been recognized in a subset of SFTs. Notably, the recent groundbreaking discovery of the disease-defining NAB2-STAT6 gene fusion, resulting from intrachromosomal inversion involving 12q13.3, has largely unified tumors with the aforementioned variations. The derived immunohistochemical detection of nuclear STAT6 expression has high diagnostic value in distinguishing SFTs from histologic mimics, although some relevant pitfalls have been proposed as a precaution. NAB2-STAT6 fusions yield numerous transcript subtypes associated with the clinicopathological variations. Despite mostly following a favorable course, SFT is notoriously difficult for prognostication because of the propensity for late relapse or even metastases in 10-40% of cases, which prompts several proposed schemes incorporating age, size, mitosis, and/or necrosis as factors for risk stratification. Mitotic figures >4/10 HPFs, TERT promoter and/or TP53 mutations have been considered as variables that are better correlated with aggressiveness. Although radiotherapy and chemotherapy provide unsatisfactory responses, a better understanding of SFT tumorigenesis may pave the way for new treatment modalities. In this review, we comprehensively discuss the recent advances of SFTs in diagnostic and molecular pathology

[[alternative]]The Construction of Indicators of a Friendly Environment in Hospitals for Hospital Outpatients-An example of CHENG HSIN GENERAL HOSPITAL

[[abstract]]早在1993年臺灣就已達到世界衛生組織（World Health Organizations, WHO）所認定「高齡化社會」的門檻（7%）也就是指65歲以上老人佔總人口的7%，由於長者普遍有慢性病，因此前來就診的機率相對較高；加上開始實施全民健康保險後醫療資源更加廣泛地被使用使得早期的設計已逐漸變得不若當時的友善與方便。依據世界衛生組織所定義高齡友善城市是一個兼容且無障礙，能增進活躍老化的生活環境，加上友善環境一直是政府單位所重視的一環由此可見友善之重要趨勢，因此若藉由世界衛生組織在2007年提出「Global Age-friendly Cities: A Guide」所定義的高齡友善城市中八項構面，加上「通用設計」的理念：為大多數人所使用，且平等的保障所有人的權利。再擷取生活品質QOL（quality of life）裡身、心、社會、環境四個面相，藉文獻回顧篩選出相關候選問題，探討其必須性，經由德爾菲法獲得專家資料，達成共識得出最終相關指標。 本研究目的為探討長者來就醫時對於友善環境的需求，於2019年4月至5月執行共二回合修正式德爾菲法，每次發放問卷21份，回收有效問卷21份，有效回收率 100% ，使用SPSS 20統計軟體進行矩陣分析計算出平均數、標準差、眾數、四分位數作為判別標準。研究結果顯示四項構面裡得出：身（8題）、心（9題）、社會（6題）、環境（13題）總共36題項指標。 研究結果顯示，現有醫院門診友善環境中，患者仍存在身、心、社會、環境需求，例:身-保暖及隱私、心-候診時間及指示清晰、社會-工作人員之溝通態度、環境-侯診資訊及道路設計。但醫院友善環境建構之研究在國內屬少見，且實際參與之專業領域專家人數及研究執行時間均有限，故本研究僅是醫院友善環境指標建構之先驅研究，用以發覺現有不足之處，經歸納整理，期望能成為臨床上參考之指標，提供來診患者更加友善的門診就醫環境。研究結果須進一步進行實務應用並經指標建構相關信效度之檢驗，方能成為醫院管理實務上有用之參考指標。[[abstract]]As early as 1993, Taiwan had reached the threshold of “aged society” (7%) as determined by the World Health Organizations (WHO). It means that the elderly over 65 years old accounted for 7% of the total population. Because the elderly generally have chronic diseases. Therefore, the probability of coming to the clinic is relatively high; coupled with the wider use of medical resources after the implementation of universal health insurance, the early design has gradually become less friendly and convenient. According to the definition from the World Health Organization, the age-friendly city is a compatible and accessible environment that enhances the active and aging environment. The friendly environment has always been an important trend that government agencies have attached to. This is because of the importance of world health. In 2007, the organization proposed eight facets in the age-friendly city defined by the "Global Age-friendly Cities: A Guide", plus the concept of "universal design": used by most people, and equal protection for everyone. right. Then take the life quality QOL (quality of life) body, heart, society, environment four aspects, through the literature review to screen out the relevant candidate questions, explore its necessity, obtain expert information through Delphi method, reach a consensus and finally Related indicators. The purpose of this study was to explore the need for a friendly environment for the elderly to seek medical treatment. From April to May 2019, a total of two rounds of modified Delphi method were implemented. 21 questionnaires were issued each time, and 21 valid questionnaires were collected. The effective recovery rate was 100 %, by using SPSS 20 statistical software for statistical analysis to calculate the mean, standard deviation, mode, quartile as the criteria. The results of the study show that there are a total of 36 items in the four facets: physical (8 questions), psychological (9 questions), social(6 questions), and environment (13 questions). The results of the study show that in the friendly environment of existing hospital outpatients, patients still have physical,psychological, social and environmental needs.Like: body-warmness and privacy, heart-waiting time and clear instructions, social-worker communication attitude, environment-hours information and road design. However, the research on the hospital's friendly environment construction is rare in Taiwan, and the number of experts in the professional field and the research execution time are limited. Therefore, this study is only a pioneering study on the construction of hospital friendly environmental indicators to detect existing deficiencies. Inductively sorted out, it is expected to become an example for clinical reference, and to provid a more friendly outpatient medical environment for visiting patients. The research results must be further applied in practice and tested by the relevant reliability and validity of the indicators to become a useful reference indicator for hospital management practice

Lactobacillus paragasseri BBM171 Ameliorates Allergic Airway Inflammation Induced by Ovalbumin in Mice via Modulating the Th1/Th2 Balance

Supplementation with specific probiotics has been shown to improve allergic airway symptoms. This study aimed to investigate immunomodulatory effects of a potential probiotic strain isolated from breast milk, Lactobacillus paragasseri BBM171 (BBM171), in an ovalbumin (OVA)-induced allergic mouse model. OVA-sensitized and OVA-challenged BALB/c mice were orally administered live or heat-inactivated BBM171 for 48 consecutive days. After the last allergen challenge, serum immunoglobulin (Ig) levels, inflammatory cell levels in the lungs, and cytokine levels in bronchoalveolar lavage fluid (BALF) were assessed. The results showed that oral administration of live or heat-inactivated BBM171 decreased serum levels of total IgE, OVA-specific IgE, and OVA-specific IgG1, while increasing OVA-specific IgG2a and reducing the extent of airway inflammation in OVA-induced allergic mice. In addition, both live and heat-inactivated BBM171 modulated the cytokine profile in BALF to a type 1 T helper (Th1) response. Furthermore, ex vivo experiments using OVA-induced allergic mouse splenocytes showed that both live and heat-inactivated BBM171 could regulate the Th1/Th2 balance, decrease the proinflammatory cytokine interleukin (IL)-17 level, and increase the anti-inflammatory cytokine IL-10 level. Taken together, these results suggest that oral administration of live or heat-inactivated BBM171 improved allergen-induced airway inflammation symptoms by modulating the host immune response toward Th1 dominance