Organ transplantation from donors with immune thrombocytopenia (ITP), a condition involving the autoantibody-mediated destruction of platelets, is a topic of debate due to the potential for transplantation-mediated autoimmune thrombocytopenia (TMAT), a rare but potentially fatal complication. Previous reports have described transplants from deceased liver donors with ITP who had very low platelet counts and disease largely refractory to treatment. Here, we present the first case of living kidney transplantation from a donor with ITP who underwent preoperative treatment, with concurrent splenectomy performed to reduce the long-term risk of spontaneous hemorrhage.To ensure the safety of the procedure, we monitored perioperative rotational thromboelastometry parameters and platelet counts, leading to the normalization of the donor’s platelet levels. The recipient experienced an uneventful recovery of renal function without perioperative bleeding or the development of TMAT. Our report suggests that kidney transplantation from a donor with well-managed ITP is safe, and such a condition should not be considered a contraindication for donation.

Posterior lumbar fusion surgery is a well-established procedure for treating degenerative lumbar spine diseases. Despite its surgical success over the decades, adjacent segment degeneration persisted as a problem, causing significant morbidity in patients. Various surgical fusion techniques, including open and minimally invasive procedures, have been reported for treating adjacent segment disease. Recently, endoscopic lumbar interbody fusion, including fully endoscopic lumbar interbody fusion through the uniportal approach and biportal endoscopic transforaminal lumbar interbody fusion (BE-TLIF), has been attempted as a minimally invasive surgical technique for lumbar fusion. This study describes the BE-TLIF technique and presents a review of the literature on this technique for treating adjacent segment disease. Our case illustration demonstrates that BE-TLIF could be a viable minimally invasive technique for addressing adjacent segment disease in revision lumbar spinal fusion surgery.

Background: The turnover rate of nurse aides in Taiwan is high. However, the predictors of turnover behavior in the newly employed are still unclear. Objective: To examine the predictors of turnover behavior in newly employed licensed nurse aides. Methods: A longitudinal study design was used and subjects were newly employed certified nurse aides from a nurse aid training association in Taiwan. A total of five questionnaire surveys were conducted. The questionnaire was mainly used to collect information on turnover behavior, personal socioeconomic background, workplace psychosocial hazards, worker health hazards, and musculoskeletal disorders. Results: A total of 300 participants were recruited in the study. Cox regression analysis results showed that short working experience (hazard ratio [HR] = 0.21, p < 0.01), work as non-home nurse aides (HR = 0.58, p = 0.01), low monthly salary (HR = 0.68, p < 0.01), high work mental load (HR = 1.01, p = 0.01), low workplace justice (HR = 0.97, p < 0.01), high workplace violence (HR = 1.60, p < 0.01), high burnout (HR = 1.01, p = 0.04), poor mental health (HR = 1.06, p = 0.04), and high total number of musculoskeletal disorder sites (HR = 1.08, p = 0.01) contribute to a higher risk of turnover. Conclusion The results indicated that employment period, work as a home nurse aide, monthly salary, work mental load, workplace justice, workplace violence, work-related burnout, mental health, and total number of musculoskeletal disorder sites are predictors of turnover behavior in newly employed certified nurse aides.

PURPOSE: Fungi have been known to be important aeroallergens for hundreds of years. Most studies have focused on total fungal concentration; however, the concentration of specific allergenic fungi may be more important on an individual basis. METHODS: Ten fungal allergic patients and 2 non-fungal allergic patients were enrolled. The patients with a decrease in physician or patient global assessment by more than 50% of their personal best were considered to have an exacerbation of allergic symptoms and to be in the active stage. Those who maintained their physician and patient global assessment scores at their personal best for more than 3 months were considered to be in the inactive stage. The concentrations of dominant fungi in the patients' houses and outdoors were measured by direct and viable counts at active and inactive stages. RESULTS: The exacerbation of allergic symptoms was not correlated with total fungal spore concentration or the indoor/outdoor ratio (I/O). Specific fungi, such as Cladosporium oxysporum (C. oxyspurum), C. cladosporioides, and Aspergillus niger (A. niger), were found to be significantly higher concentrations in the active stage than in the inactive stage. Presumed allergenic spore concentration threshold levels were 100 CFU/m3 for C. oxysporum, and 10 CFU/m3 for A. niger, Penicillium brevicompactum and Penicillium oxalicum. CONCLUSIONS: The major factor causing exacerbation of allergic symptoms in established fungal allergic patients may be the spore concentration of specific allergenic fungi rather than the total fungal concentration. These results may be useful in making recommendations as regards environmental control for fungal allergic patients.
Aspergillus niger ; Cladosporium ; Colony Count, Microbial* ; Family Characteristics ; Fungi ; Humans ; Hypersensitivity* ; Niger ; Penicillium ; Spores* ; Spores, Fungal

After bathing at a hot spring resort, a 75-year-old man presented to the emergency department because of seizure-like attack with loss of conscious. This is the first case of primary amebic meningoencephalitis (PAM) caused by Naegleria fowleri in Taiwan. PAM was diagnosed based on detection of actively motile trophozoites in cerebrospinal fluid using a wet-mount smear and the Liu's stain. The amoebae were further confirmed by PCR and gene sequencing. In spite of administering amphotericin B treatment, the patient died 25 days later.
Aged ; Amebiasis/*diagnosis/parasitology/*pathology ; Central Nervous System Protozoal Infections/*diagnosis/parasitology/*pathology ; Cerebrospinal Fluid/parasitology ; DNA, Protozoan/chemistry/genetics ; Fatal Outcome ; Humans ; Male ; Microscopy ; Naegleria fowleri/classification/genetics/*isolation & purification ; Polymerase Chain Reaction ; Sequence Analysis, DNA ; Taiwan