Limited data is available on long-term outcome predictions for patients with acute-on-chronic liver failure (ACLF) in an intensive care unit (ICU) setting. Assessing the reliability and accuracy of several mortality prediction models for these patients is helpful. Two hundred forty-nine consecutive patients with ACLF and admittance to the liver ICU in a single center in northern Taiwan between December 2012 and March 2015 were enrolled in the study and were tracked until February 2017. Ninety-one patients had chronic hepatitis B-related cirrhosis. Clinical features and laboratory data were collected at or within 24 h of the first ICU admission course. Eight commonly used clinical scores in chronic liver disease were calculated. The primary endpoint was overall survival. Acute physiology and chronic health evaluation (APACHE) III and chronic liver failure consortium (CLIF-C) ACLF scores were significantly superior to other models in predicting overall mortality as determined by time-dependent receiver operating characteristic (ROC) curve analysis (area under the ROC curve (AUROC): 0.817). Subgroup analysis of patients with chronic hepatitis B-related cirrhosis displayed similar results. CLIF-C organ function (OF), CLIF-C ACLF, and APACHE III scores were statistically superior to the mortality probability model III at zero hours (MPM0-III) and the simplified acute physiology (SAP) III scores in predicting 28-day mortality. In conclusion, for 28-day and overall mortality prediction of patients with ACLF admitted to the ICU, APACHE III, CLIF-OF, and CLIF-C ACLF scores might outperform other models. Further prospective study is warranted.
Introduction: Caustic substance ingestion is frequently life-threatening, and its pathological mechanisms of tissue damage are well documented. However, few studies have assessed the combined effects of pH and the ingested dose on patient outcomes. Additionally, the miscellaneous chemical properties are not immediately available for providing predictive insights to physicians. This study aimed to provide a new perspective of the risk assessment of caustic substance ingestion based on the pH and dose. Methods: The retrospective study analyzed adults treated for caustic substance ingestion at Chang Gung Memorial Hospital between January 1999 and December 2018. Uniformly strict inclusion/exclusion criteria and a double-checked process during chart review were adopted. All patients underwent urgent esophagogastroduodenoscopy (EGD) within 24 h. Caustic mucosal damage was graded using Zargar's modified endoscopic classification. The pH and ingested dose of caustic substances were clearly recorded. Statistical analyses were conducted using IBM SPSS, version 22. Results: Based on the 468 enrolled cases, the pH and dose were valuable predictors of the extent of gastrointestinal tract injury, commonly encountered complications, and long-term overall survival outcomes. Risks of mortality and perforation were dose-dependent for acids and pH-dependent for alkalis. The severe EGD findings (grade ! 2b) in this study were pH-dependent for both substances and additionally dose-dependent for acids. Conclusion: Combining pH and dose, we proposed a new perspective for the risk assessment of caustic substance ingestion. Such findings may provide predictive insights for resolving clinical uncertainty before the availability of examination results. "Large doses of acids" and "high pH of alkalis" deserve special attention. This new perspective with a retrospective nature requires further validation.
Polymerizable nematic liquid crystal ͑LC͒ was adopted as a resist for our newly developed nanoimprinting lithography process. Liquid crystal molecules were self-aligned during imprinting process without precoated alignment layer. The large patterned area was able to achieve 4 ϫ 4 cm 2 at very low impriting pressure, 1.5 bar. The optical anisotropic was verified through polarized optical microscopy and the retardation was measured by polarized ultraviolet/visible spectrometer. The micrograted LC films prepared by this novel method offer the potential applications for a LC alignment layer within LC cells, as well as preparation of optical anisotropic films.
This study developed a nutritionally valuable product with bioactive activity that improves the quality of bread. Djulis (Chenopodium formosanum), a native plant of Taiwan, was fermented using 23 different lactic acid bacteria strains. Lactobacillus casei BCRC10697 was identified as the ideal strain for fermentation, as it lowered the pH value of samples to 4.6 and demonstrated proteolysis ability 1.88 times higher than controls after 24 h of fermentation. Response surface methodology was adopted to optimize the djulis fermentation conditions for trolox equivalent antioxidant capacity (TEAC). The optimal conditions were a temperature of 33.5 °C, fructose content of 7.7%, and dough yield of 332.8, which yielded a TEAC at 6.82 mmol/kg. A 63% increase in TEAC and 20% increase in DPPH were observed when compared with unfermented djulis. Subsequently, the fermented djulis was used in different proportions as a substitute for wheat flour to make bread. The total phenolic and flavonoid compounds were 4.23 mg GAE/g and 3.46 mg QE/g, marking respective increases of 18% and 40% when the djulis was added. Texture analysis revealed that adding djulis increased the hardness and chewiness of sourdough breads. It also extended their shelf life by approximately 2 days. Thus, adding djulis to sourdough can enhance the functionality of breads and may provide a potential basis for developing djulis-based functional food.
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