COVID-19/drug therapy* ; Humans ; Integrative Medicine ; Pandemics

Background: Ultrasound-guided minimally invasive procedures are widely used to treat thyroid diseases. The objective of this study was to assess the efficacy and safety of ethanol ablation (EA) in comparison with other non-surgical options in the treatment of benign thyroid cystic nodules. Methods: We conducted a systematic search of studies on EA for thyroid cystic nodules, mainly in the Ovid-MEDLINE and Embase, Web of Science, and Cochrane databases. The standardized mean difference (SMD) of the volume reduction ratio (VRR) after EA versus other non-surgical treatments comprised the primary outcome, whereas the odds ratio (OR) of therapeutic success rates between the two groups comprised the secondary outcome. Results: The meta-analysis included 19 studies (four randomized controlled trials and 15 non-randomized studies) with 1,514 participants. The cumulative VRR of EA was 83.908% (95% confidence interval [CI], 79.358% to 88.457%). EA had a significantly higher pooled VRR (SMD, 0.381; 95% CI, 0.028 to 0.734; P=0.030), but not a significantly higher pooled therapeutic success rate (OR, 0.867; 95% CI, 0.132 to 5.689; P=0.880), than other forms of non-surgical management including radiofrequency ablation (RFA), polidocanol sclerotherapy, and simple aspiration with or without saline flush. However, the VRR and therapeutic success rate were not significantly different between EA and RFA. Major complications were recorded only in six patients (0.53%) with self-limiting dysphonia. Conclusion The role of EA as the first-line treatment for benign thyroid cysts and predominantly cystic nodules is supported by its high effectiveness and good safety profile compared to other currently available non-surgical options.

INTRODUCTIONRenal infarction is a rare and easily missed disease. There is even less meaningful information on renal infarction in the Asian population. Thus, the aim of this study was to clarify the clinical characteristics of the disease in Asian patients.

CLINICAL PICTUREOver a period of 10 years, 38 Chinese patients with renal infarction diagnosed by contract-enhanced CT or angiography were enrolled in this study. Their demographic data, clinical characteristics, laboratory and image results, risk factors or suspected causes, treatment and final outcomes were retrospectively reviewed. The results were also compared with the analogous Western data. The mean age of the sample population was 60.8 +/- 17.6 years, with patients aged over 50 years and males predominating. The most common symptoms/signs were abdominal (57.9%) and flank pain/tenderness (50%). Only 23.7% of patients had suffered previous thromboembolic events such as coronary or peripheral artery diseases, or cerebral infarction. Cardiogenic factors, such as atrial fibrillation, intra-cardiac thrombus, infective endocarditis and valvular heart disease, were the main causes of renal infarction (57.9%). The most common laboratory abnormalities were elevated serum LDH (92.1%) and proteinuria (76.3%). Only half of the cases involved haematuria at initial presentation.

TREATMENT AND OUTCOMEOne-third of the sample suffered renal impairment after the renal infarction. Overall mortality rate during admission was 13.2% (n = 5). The cause of death was usually not the renal infarction itself but rather the underlying disease and its complications. There was no difference in outcome for anticoagulation treatment with or without thrombolytics. Compared to their Western counterparts, the proportion of males (71.1% versus 48.3%) and bilateral renal infarctions (31.6% versus 12.4%) were significantly higher, and the percentage of leukocytosis (50% versus 85%) significantly lower in our Asian patients.

CONCLUSIONClinical presentation of renal infarction is usually non-specific and differs for Asian and Western populations. In our Asian patients, the most common clinical characteristics were abdominal pain/tenderness, flank pain/tenderness, elevated serum LDH and proteinuria. Early diagnosis and treatment are imperative because of the high rate of renal impairment and associated mortality. If this disease is suspected, contrast-enhanced CT is suggested to exclude or confirm renal infarction and anticoagulation alone is currently the favored treatment.

Abdominal Pain ; etiology ; Aged ; Cerebral Angiography ; Cohort Studies ; Female ; Flank Pain ; etiology ; Humans ; Infarction ; complications ; diagnostic imaging ; ethnology ; Kidney ; blood supply ; diagnostic imaging ; Male ; Middle Aged ; Retrospective Studies ; Taiwan ; Tomography, X-Ray Computed

Background/Aims: Hypopharyngeal multichannel intraluminal impedance-pH (HMII-pH) technology incorporating 2 trans-upper esophageal sphincter impedance channels has been developed to detect pharyngeal reflux. We used the HMII-pH technique to validate the candidate pharyngeal acid reflux (PAR) episodes based on the dual-pH tracings and determined the interobserver reproducibility. Methods: We conducted a cross-sectional study in tertiary centers in Taiwan. Ninety patients with suspected laryngopharyngeal reflux and 28 healthy volunteers underwent HMII-pH test when off acid suppressants. Candidate PAR episodes were characterized by pharyngeal pH drops of at least 2 units and reaching a nadir pH of 5 within 30 seconds during esophageal acidification. Two experts manually independently identified candidate PAR episodes based on the dual-pH tracings. By reviewing the HMII-pH tracings, HMII-pH-proven PAR episodes were subsequently confirmed. The consensus reviews of HMII-pH-proven PAR episodes were considered to be the reference standard diagnosis. The interobserver reproducibility was assessed. Results: A total of 105 candidate PAR episodes were identified. Among them 84 (80.0%; 95% CI, 71.0-87.0%) were HMII-pH-proven PAR episodes (82 in 16 patients and 2 in 1 healthy subject). Patients tended to have more HMII-pH-proven PAR episodes than healthy controls (median and percentile values [25th, 75th, and 95th percentiles]: 0 [0, 0, 3] vs 0 [0, 0, 0], P = 0.067). The concordance rate in diagnosing HMII-pH-proven PAR episodes between 2 independent observers was 92.2%. Conclusion Our preliminary data showed that 80.0% (71.0-87.0%) of the proposed candidate PAR episodes were HMII-pH-proven PAR episodes, among which the interobserver reproducibility was good.

Background/Aims: Diagnosis of isolated laryngopharyngeal reflux symptoms (ILPRS), ie, without concomitant typical reflux symptoms (CTRS), remains difficult. Mean nocturnal baseline impedance (MNBI) reflects impaired mucosal integrity. We determined whether esophageal MNBI could predict pathological esophagopharyngeal reflux (pH+) in patients with ILPRS. Methods: In this cross-sectional study conducted in Taiwan, non-erosive or low-grade esophagitis patients with predominant laryngopharyngeal reflux symptoms underwent combined hypopharyngeal multichannel intraluminal impedance-pH monitoring when off acid suppressants. Participants were divided into the ILPRS (n = 94) and CTRS (n = 63) groups. Asymptomatic subjects without esophagitis (n = 25) served as healthy controls. The MNBI values at 3 cm and 5 cm above the lower esophageal sphincter (LES) and the proximal esophagus were measured. Results: Distal but not proximal esophageal median MNBI values were significantly lower in patients with pH+ than in those with pH– (ILPRS in pH+ vs pH–: 1607 Ω vs 2709 Ω and 1885 Ω vs 2563 Ω at 3 cm and 5 cm above LES, respectively; CTRS in pH+ vs pH–: 1476 vs 2307 Ω and 1500 vs 2301 Ω at 3 cm and 5 cm above LES, respectively, P < 0.05 for all). No significant differences of any MNBI exist between any pH– subgroups and healthy controls. The areas under the receiver operating characteristic curve in the ILPRS group were 0.75 and 0.80, compared to the pH– subgroup and healthy controls (P < 0.001 for both), respectively. Interobserver reproducibility was good (Spearman correlation 0.93, P < 0.0001). Conclusion Distal esophageal MNBI predicts pathological reflux in patients with ILPRS.

OBJECTIVEAccuracy of diagnostic methods for detecting Helicobacter pylori (H. pylori) infection among patients with bleeding peptic ulcers has not been thoroughly investigated. The aim of this study was to compare the diagnostic tests and their combined usage in detection of H. pylori infection in patients with bleeding gastric ulcers and without the use of nonsteroidal anti-inflammatory drugs.

METHODSA total of 57 patients who presented with bleeding gastric ulcers by endoscopy were enrolled. The status of H. pylori was identified by performing the rapid urease test (RUT), histology and (13)C-labeled urea breath test (UBT). The criteria for having H. pylori infection was a minimum of two positive tests.

RESULTSThe prevalence of H. pylori infection in our patient group was 80.7%. Among the three tests used: RUT, histology, and UBT, sensitivities were 56.5%, 97.8% and 100%, while specificities were 100%, 45.5% and 81.8%, respectively. The overall accuracies of the tests were 78.3%, 71.6% and 90.9%, respectively. Although UBT obtained significantly higher accuracy than histology (P = 0.02) as opposed to RUT (P = 0.11), UBT had significantly higher sensitivity than RUT (P < 0.001). In terms of combining any two of the three tests, more accuracy (98.9%) was achieved when both UBT and histology were used to confirm the diagnosis of the other. Conversely, failure to use combined tests generated the potential of missing a proper H. pylori diagnosis.

CONCLUSIONSUBT is superior to the other two tests in bleeding gastric ulcers. RUT lacks sensitivity for detection of H. pylori infection. However, the concomitant use of UBT and histology seems to be more accurate when gastric ulcers present with bleeding.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Breath Tests ; Female ; Helicobacter Infections ; diagnosis ; pathology ; Helicobacter pylori ; Humans ; Male ; Middle Aged ; Peptic Ulcer Hemorrhage ; complications ; Sensitivity and Specificity ; Stomach Ulcer ; complications ; Urea

BACKGROUNDPrior studies have demonstrated worse results of women in both hospital and short-term outcomes post-percutaneous coronary intervention. However, with advanced devices like drug-eluting stents (DESs) available, there are no consistent data revealing gender impact in outcome. This study examined whether gender affected hospital outcome and showed one-year single-center patient results of coronary stenting.

METHODSThe study group included 969 consecutive patients (250 women and 719 men) undergoing coronary stenting for stable or unstable angina. Clinical events were assessed for at least 1 year post-procedure.

RESULTSCompared to men, women were older, presented more often with diabetes, hypertension, dyslipidemia, and lower creatinine clearance rate (Ccr); they had less percutaneous transluminal coronary angioplasty (PTCA) history, smaller vessel size, and shorter lesions. The hospital major adverse cardiovascular event (MACE) rate was 2.8% of women and 0.97% of men (P = 0.037). The one-year MACE rate was 10.0% of women and 10.4% of men (P = 0.874). After adjusting other covariates, women still had significantly higher hospital MACE rates (P = 0.034) and odds ratios (0.18; 95% confidence interval: 0.036-0.874). In women (n = 250), there was no statistically significant difference in hospital or one-year MACE between bare metal stent (BMS) and DES groups. Meanwhile, in men (n = 719), DES had a significant one-year improvement of MACE compared to BMS (P = 0.004). The female hospital MACE rate was five times greater than male results. However, there were similar one-year outcomes between women and men. DES currently have an advantage in long-term outcome.

CONCLUSIONSCurrently, with the use of BMS and DES, adverse hospital post-procedure cardiovascular event rate has occurred more often in women than in men. However, the MACE rate differences between women and men resolved with one year follow-up.

Aged ; Angina Pectoris ; therapy ; Angina, Unstable ; therapy ; Angioplasty, Balloon, Coronary ; adverse effects ; Female ; Humans ; Male ; Middle Aged ; Sex Factors ; Treatment Outcome

Leptin is a peptide hormone, which has a central role in the regulation of body weight; it also exerts many potentially atherogenic effects. Ferulic acid ethyl ester (FAEE) has been approved for antioxidant properties. The aim of this study was to investigate whether FAEE can inhibit the atherogenic effects of leptin and the possible molecular mechanism of its action. Both of cell proliferation and migration were measured when the aortic smooth muscle cell (A10 cell) treated with leptin and/or FAEE. Phosphorylated p44/42MAPK, cell cycle-regulatory protein (for example, cyclin D1, p21, p27), beta-catenin and matrix metalloproteinase-9 (MMP-9) proteins levels were also measured. Results demonstrated that leptin (10, 100 ng ml-1) significantly increased the proliferation of cells and the phosphorylation of p44/42MAPK in A10 cells. The proliferative effect of leptin was significantly reduced by the pretreatment of U0126 (0.5 muM), a MEK inhibitor, in A10 cells. Meanwhile, leptin significantly increased the protein expression of cyclin D1, p21, beta-catenin and decreased the expression of p27 in A10 cells. In addition, leptin (10 ng ml-1) significantly increased the migration of A10 cells and the expression of MMP-9 protein. Above effects of leptin were significantly reduced by the pretreatment of FAEE (1 and 10 muM) in A10 cells. In conclusion, FAEE exerts multiple effects on leptin-induced cell proliferation and migration, including the inhibition of p44/42MAPK phosphorylation, cell cycle-regulatory proteins and MMP-9, thereby suggesting that FAEE may be a possible therapeutic approach to the inhibition of obese vascular disease.
Animals ; Antioxidants/*pharmacology ; Aorta/cytology/*drug effects ; Caffeic Acids/*pharmacology ; Cell Line ; Cell Movement/*drug effects ; Cell Proliferation/*drug effects ; Leptin/*metabolism ; Matrix Metalloproteinase 9/metabolism ; Muscle, Smooth, Vascular/cytology/drug effects ; Myocytes, Smooth Muscle/cytology/*drug effects ; Rats ; beta Catenin/metabolism

BACKGROUNDIdentification of hospitalized carbapenem-resistant Enterobacteriaceae (CRE)-positive patient is important in preventing nosocomial transmission. The objective of this study was to illustrate the implementation of proactive infection control measures in preventing nosocomial transmission of CRE in a healthcare region of over 3200 beds in Hong Kong between October 1, 2010 and December 31, 2011.

METHODSThe program included active surveillance culture in patients with history of medical tourism with hospitalization and surgical operation outside Hong Kong within 12 months before admission, and "added test" as an opportunistic CRE screening in all fecal specimens submitted to the laboratory. Outbreak investigation and contact tracing were conducted for CRE-positive patients. Serial quantitative culture was performed on CRE-positive patients and the duration of fecal carriage of CRE was analyzed.

RESULTSDuring the study period, a total of 6533 patients were screened for CRE, of which 76 patients were positive (10 from active surveillance culture, 65 from "added test", and 1 secondary case from contact tracing of 223 patients with no nosocomial outbreak), resulting in an overall rate of CRE fecal carriage of 1.2%. The median time of fecal carriage of CRE was 43 days (range, 13-119 days). Beta-lactam-beta-lactamase-inhibitors, cephalosporins, and fluoroquinolones were associated significantly with high fecal bacterial load when used 90 days before CRE detection, while use of cephalosporins, carbapenems, and fluoroquinolones after CRE detection are significantly associated with longer duration of carriage. The duration of fecal carriage of CRE also correlates significantly with the initial fecal bacterial load (Pearson correlation: 0.53; P = 0.02).

CONCLUSIONProactive infection control measures by enhanced surveillance program identify CRE-positive patients and data obtained are useful for the planning of and resource allocation for CRE control.

Anti-Bacterial Agents ; therapeutic use ; Carbapenems ; therapeutic use ; Cephalosporins ; therapeutic use ; Drug Resistance, Bacterial ; Enterobacteriaceae ; drug effects ; Enterobacteriaceae Infections ; prevention & control ; transmission ; Fluoroquinolones ; therapeutic use ; Humans ; Infection Control ; methods

BACKGROUNDProactive infection control management is crucial in preventing the introduction of multiple drug resistant organisms in the healthcare setting. In Hong Kong, where vancomycin-resistant enterococci (VRE) endemicity is not yet established, contact tracing and screening, together with other infection control measures are essential in limiting intra- and inter-hospital transmission. The objective of this study was to illustrate the control measures used to eradicate a VRE outbreak in a hospital network in Hong Kong.

METHODSWe described an outbreak of VRE in a healthcare region in Hong Kong, involving a University affiliated hospital and a convalescent hospital of 1600 and 550 beds respectively. Computer-assisted analysis was utilized to facilitate contact tracing, followed by VRE screening using chromogenic agar. Multi-locus sequence typing (MLST) was performed to assess the clonality of the VRE strains isolated. A case-control study was conducted to identify the risk factors for nosocomial acquisition of VRE.

RESULTSBetween November 26 and December 17, 2011, 11 patients (1 exogenous case and 10 secondary cases) in two hospitals with VRE colonization were detected during our outbreak investigation and screening for 361 contact patients, resulting in a clinical attack rate of 2.8% (10/361). There were 8 males and 3 females with a median age of 78 years (range, 40 - 87 years). MLST confirmed sequence type ST414 in all isolates. Case-control analysis demonstrated that VRE positive cases had a significantly longer cumulative length of stay (P < 0.001), a higher proportion with chronic cerebral and cardiopulmonary conditions (P = 0.001), underlying malignancies (P < 0.001), and presence of urinary catheter (P < 0.001), wound or ulcer (P < 0.001), and a greater proportion of these patients were receiving β-lactam/β-lactamase inhibitors (P = 0.009), carbapenem group (P < 0.001), fluoroquinolones (P = 0.003), or vancomycin (P = 0.001) when compared with the controls.

CONCLUSIONExtensive contact tracing and screening with a "search-and-confine" strategy was a successful tool for outbreak control in our healthcare region.

Aged ; Aged, 80 and over ; Enterococcus faecium ; growth & development ; pathogenicity ; Female ; Gram-Positive Bacterial Infections ; epidemiology ; prevention & control ; Hong Kong ; epidemiology ; Humans ; Male ; Middle Aged ; Vancomycin Resistance