Hypoxic Lung-Cancer-Derived Extracellular Vesicle MicroRNA-103a Increases the Oncogenic Effects of Macrophages by Targeting PTEN

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Cefepime Therapy for Monomicrobial Enterobacter cloacae Bacteremia: Unfavorable Outcomes in Patients Infected by Cefepime-Susceptible Dose-Dependent Isolates

A new category of cefepime susceptibility, susceptible dose dependent (SDD), for Enterobacteriaceae, has been suggested to maximize its clinical use. However, clinical evidence supporting such a therapeutic strategy is limited. A retrospective study of 305 adults with monomicrobial Enterobacter cloacae bacteremia at a medical center from 2008 to 2012 was conducted. The patients definitively treated with in vitro active cefepime (cases) were compared with those treated with a carbapenem (controls) to assess therapeutic effectiveness. The 30-day crude mortality rate is the primary endpoint, and clinical prognostic factors are assessed. Of 144 patients receiving definitive cefepime or carbapenem therapy, there were no significant differences in terms of age, sex, comorbidity, source of bacteremia, disease severity, or 30-day mortality (26.4% versus 22.2%; P = 0.7) among those treated with cefepime (n = 72) or a carbapenem (n = 72). In the multivariate analysis, the presence of critical illness, rapidly fatal underlying disease, extended-spectrum beta-lactamase (ESBL) producers, and cefepime-SDD (cefepime MIC, 4 to 8 μg/ml) isolates was independently associated with 30-day mortality. Moreover, those infected by cefepime-SDD isolates with definitive cefepime therapy had a higher mortality rate than those treated with a carbapenem (5/7 [71.4%], versus 2/11 [18.2%]; P = 0.045). Cefepime is one of the therapeutic alternatives for cefepime-susceptible E. cloacae bacteremia but is inefficient for cases of cefepime-SDD E. cloacae bacteremia compared with carbapenem therapy.     

Telbivudine and adefovir combination therapy for patients with chronic lamivudine-resistant hepatitis B virus infections

We evaluated second-line salvage therapy with adefovir + telbivudine (group 1), adefovir followed by adefovir + telbivudine (group 2), or lamivudine + adefovir followed by adefovir + telbivudine (group 3) in hepatitis B patients with an inadequate virologic response to lamivudine treatment. Simple linear regression analysis showed that for each additional month of treatment, the most significant reduction in viral load occurred in group 1 (HBV DNA [Log₁₀ IU/mL]: group 1, ?0.149; group 2, -0.081; group 3, ?0.123). Generalized estimating equation analysis revealed that compared to group 1, hepatitis B virus (HBV) DNA levels were 1.203 and 0.443 Log₁₀ IU/mL higher in groups 2 and 3, respectively. Overall, a significant reduction in viral load (?0.060 Log₁₀ IU/mL) was observed for each additional month of treatment. Adefovir + telbivudine treatment resulted in a significant reduction in HBV DNA levels. Moreover, telbivudine treatment resulted in a significant reduction in viral load (?0.050 Log₁₀ IU/mL) compared to lamivudine treatment after the emergence of lamivudine resistance.     

General paresis with reversible mesial temporal T2-weighted hyperintensity on magnetic resonance image: a case report

We report a patient with general paresis, whose magnetic resonance image (MRI) showed a T2 high-intensity lesion in bilateral mesial temporal regions. Serum rapid plasma reagin test showed reactive at 64 dilutions and serum Treponema pallidum haemagglutination test was 1:20480. Cerebrospinal fluid analysis showed: RBC 111/mm3, WBC 8/mm3, Venereal Disease Research Laboratory reactive at 1 dilution and protein 60 mg/dl. His neuropsychiatric symptoms recovered gradually after penicillin treatment two months later. Repeated MRI revealed resolution of the bilateral mesial temporal lesions. We demonstrated the first Taiwanese patient with general paresis whose clinical improvement was associated with the disappearance of the temporal lobe MRI abnormality. The diagnosis of neurosyphilis must be considered when MRI shows mesial temporal lesions. MRI may be used to predict prognosis in patients with general paresis.