The objective was to compare the clinical efficacy of cefoperazone-sulbactam with piperacillin-tazobactam in the treatment of severe community-acquired pneumonia (SCAP). The retrospective study was conducted from March 1, 2018 to May 30, 2019. Clinical outcomes were compared for patients who received either cefoperazone-sulbactam or piperacillin-tazobactam in the treatment of SCAP. A total of 815 SCAP patients were enrolled. Among them, 343 received cefoperazone-sulbactam, and 472 received piperacillin-tazobactam. Patients who received cefoperazone-sulbactam presented with higher Charlson Comorbidity Index scores. (6.20 ± 2.77 vs 5.72 ± 2.61; P = .009). The clinical cure rates and effectiveness for patients receiving cefoperazone-sulbactam and piperacillin-tazobactam were 84.2% versus 80.3% (P = .367) and 85.4% versus 83.3% (P = .258), respectively. In addition, the overall mortality rate of the cefoperazone-sulbactam group was 16% (n = 55), which was also comparable to the piperacillin-tazobactam group (17.8%, n = 84, P = .572). The primary clinical outcomes for patients receiving cefoperazone-sulbactam were superior compared to those receiving piperacillin-tazobactam after adjusting disease severity status. The clinical efficacy of cefoperazone-sulbactam in the treatment of adult patients with SCAP is comparable to that of piperacillin-tazobactam. After adjusting for disease severity, cefoperazone-sulbactam tended to be superior to piperacillin-tazobactam.
Summary A group of 68 children was given a booster dose of 0.5 or 0.2 ml of DPT vaccine 11–15 mo after the primary vaccination. The serum antibody content of the three systems titrated 30–45 days after booster injection showed that all the children were adequately protected according to generally accepted criteria. Over the range of prevaccination titers studied, a rectilinear relationship was shown to exist in all the three systems between the log prevaccination titer and the log fold-increase in titer after booster injection. The slopes of the 0.2-ml dose were steeper than those of the 0.5-ml dose, moving beyond the hypothetical positions toward the higher initial titer side. The departure was ascribed to the interference effect of high levels of pre-existing antibodies upon the homologous antigens introduced. Some general problems in secondary immunization like the dose-response relationship, the comparison between groups, and the choice of use of large versus small dose, etc., were discussed in the light of the observations made.
BACKGROUNDCholangiocarcinoma is a highly lethal disease that had been underestimated in the past two decades.Many risk factors are well documented for in cholangiocarcinoma, but the impacts of advanced biliary interventions, like endoscopic sphincterotomy (ES), endoscopic papillary balloon dilatation (EPBD),
Th2 and Th17 cells are both associated with developing ankylosing spondylitis (AS) and asthma. Th2 cells are also associated with allergic rhinitis and atopic dermatitis (AD). The prevalence of such allergic diseases in AS patients is unknown. In this study, we intended to study the risk of allergic diseases in a 10-year follow-up population of newly diagnosed patients with AS. We used a nationwide 10-year population-based database retrieved from the Longitudinal Health Insurance Database 2005 (LHID2005) in Taiwan. The study cohort comprised 857 patients with AS who had at least 1 claim of inpatient admission or at least 2 claims of ambulatory visit. The comparison cohort consisted of 4285 randomly selected subjects matched with AS group at a ratio of 5:1. We used Cox proportional-hazards regression to determine the 10-year disease-free survival rates after adjusting for potentially confounding factors. The AS patients had a 1.31 times greater risk of developing asthma within 10 years of diagnosis when compared with non-AS age- and sex-matched subjects, after adjusting for other risk factors (95% confidence interval = 1.00–1.75). But the difference was not significantly different. The AS patients also had a 1.46 times and a 1.22 times greater risk of developing allergic rhinitis and AD significantly. AS patients also had a lower allergic disease-free survival rate compared to non-AS group. Our results showed that patients with AS had a higher risk of developing allergic diseases later in life.
Abstract Background : Pancreatic cancer is a fatal disease, andthe current risk factor survey is not suitable for sporadic pancreatic cancerthat lacks obvious family history orgenetic analysis data.The aim of the present study was to evaluate the roles of cholelithiasis and cholelithiasis treatmentson pancreatic cancer risk. Methods : Symptomatic adult patients with an index admission ofcholelithiasis diagnosis were selectedfrom one million random samples of National Health Insurance Research Database (NHIRD)obtained between January 2005 andDecember 2009. Exclusion criteria included pancreatic cancer, benign neoplasm or anomalies of the pancreas, orendoscopic sphincterotomy/endoscopic papillary balloon dilatation (ES/EPBD), cholecystectomy (CCY) before 2004. The control group was matched in a 1:1 ratio for sex, age,chronic pancreatitis and pancreatic cystic disease. The study group was divided into ES/EPBD, CCY, ES/EPBD&CCY, and no-intervention groupsfor subsequent pancreatic cancer evaluation. Results : Both the cholelithiasis group and the matched control group included 8,265 adult cases. The cholelithiasis group contained 86 (1.04%) cases of diagnosed pancreatic cancer and the control group contained8 (0.10%) cases (p<0.001). Exclusion of pancreatic cancer cases diagnosed in the first 6 months still resulted in asignificantly higher pancreatic cancer rate in the cholelithiasis group (0.22%) thanin the control group (0.05%)(p=0.003). The subsequent pancreatic cancer rates weresimilar,at0.17%, 0.11%, 0.26%, and 0.29%, in the ES/EPBD, CCY, ES/EPBD&CCY, and no-intervention groups, respectively. Conclusion: Symptomatic cholelithiasis is a risk factor for pancreatic cancer, and the risk is similar regardless of the intervention of cholelithiasis. Trial registration: This study was resisted on 23th August 2019 with registration number CS18136. The study design of this study is a retrospective database study.
Background: Cholecystectomy (CCY) is the only definitive therapy for acute cholecystitis. We conducted this study to evaluate which patients may not benefit from further CCY after percutaneous transhepatic gallbladder drainage (PTGBD) has been performed in acute cholecystitis patients. Methods: Acute cholecystitis patients with PTGBD treatment were selected from one million random samples from the National Health Insurance Research Database obtained between January 2004 and December 2010. Recurrent biliary events (RBEs), RBE-related medical costs, RBE-related mortality rate and an RBE-free survival curve were compared in patients who accepted CCY within 2 months and patients without CCY within 2 months after the index admission. Results: Three hundred and sixty-five acute cholecystitis patients underwent PTGBD at the index admission. A total of 190 patients underwent further CCY within 2 months after the index admission. The other 175 patients did not accept further CCY within 2 months after the index admission. RBE-free survival was significantly better in the CCY within 2 months group (60 vs. 42%, p < 0.001). The RBE-free survival of the CCY within 2 months group was similar to that of the no CCY within 2 months group in patients ≥ 80 years old and patients with a Charlson Comorbidity Index (CCI) score ≥ 9. Conclusions: We confirmed CCY after PTGBD reduced RBEs, RBE-related medical expenses, and the RBE-related mortality rate in patients with acute cholecystitis. In patients who accepted PTGBD, the RBE and survival benefits of subsequent CCY within 2 months became insignificant in patients ≥ 80 years old or with a CCI score ≥ 9.
Abstract Background: Prognoses for lung cancer deteriorate dramatically with the progression of cancer stages. Therefore, early screening by techniques such as low-dose computed tomography (LDCT) is critical. However, the epidemiology regarding the association between the popularization of CT and the prognosis for lung cancer is not known.Methods: Data were obtained from GLOBOCAN and the health data and statistics of World Health Organization. MIRs and the changes in MIR over time (𝛿MIR), which were calculated as the difference between MIRs in 2018 and 2012, were used to evaluate the correlation to CT density disparities via Spearman's rank correlation coefficient.Results: Countries with zero CT density presented a relatively low incidence crude rate and a relatively high MIR in 2018 and a negative 𝛿MIR. Conversely, countries with CT density over 30 had a positive 𝛿MIR. The CT density was significantly associated with human development index (HDI) score and MIR in 2018 but demonstrated no association with MIR in 2012. The linear correlation between CT density and 𝛿MIR also shows a significant association.Conclusion: CT density was significantly associated with MIR in 2018 and with 𝛿MIR, indicating favorable clinical outcomes in countries with popularization of CT.
Lung cancer is typically classified into small-cell carcinoma and non-small-cell carcinoma. Non-small-cell carcinoma accounts for approximately 85% of all lung cancers. Low-dose chest computed tomography (CT) can quickly and non-invasively diagnose lung cancer. In the era of deep learning, an artificial intelligence (AI) computer-aided diagnosis system can be developed for the automatic recognition of CT images of patients, creating a new form of intelligent medical service. For many years, lung cancer has been the leading cause of cancer-related deaths in Taiwan, with smoking and air pollution increasing the likelihood of developing the disease. The incidence of lung adenocarcinoma in never-smoking women has also increased significantly in recent years, resulting in an important public health problem. Early detection of lung cancer and prompt treatment can help reduce the mortality rate of patients with lung cancer. In this study, an improved 3D interpretable hierarchical semantic convolutional neural network named HSNet was developed and validated for the automatic diagnosis of lung cancer based on a collection of lung nodule images. The interpretable AI model proposed in this study, with different training strategies and adjustment of model parameters, such as cyclic learning rate and random weight averaging, demonstrated better diagnostic performance than the previous literature, with results of a four-fold cross-validation procedure showing calcification: 0.9873 ± 0.006, margin: 0.9207 ± 0.009, subtlety: 0.9026 ± 0.014, texture: 0.9685 ± 0.006, sphericity: 0.8652 ± 0.021, and malignancy: 0.9685 ± 0.006.
Summary The immune responses produced by the primary course of DPT vaccination were analyzed on the basis of known variables of the population under study. Observations extended over one year after the last dose show that the pre-existence of latent diphtheria immunity interfered with the speed of tetanus antitoxin response, and the magnitude and maintenance of pertussis agglutinin response. The tetanus antitoxin response was most seriously affected one month after the second dose, when the solid protection ratio between the normal and the diphtheriaimmune group was 87.0%:34.4%. The pertussis agglutinin response was most seriously affected one year after the third dose, with a solid protection ratio of 50.0%:13.8% between the groups. The data show that throughout the primary vaccination course, children younger than 24 months gave better diphtheria and tetanus antitoxin responses than the older children under a fixed dosage. Older children gave stronger pertussis agglutinin response than the younger children after the first dose, but weaker response after the third dose. Sex played no role in the immune responses to primary DPT vaccination.
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