Prompt Oseltamivir Therapy Reduces Medical Care and Mortality for Patients With Influenza Infection: An Asian Population Cohort Study

There are limited population-based studies on the progress of oseltamivir therapy for influenza infection.Using insurance claims data of 2005, 2009, and 2010, the authors established an “in-time” cohort and a “lag-time” cohort representing influenza patients taking the medicine within and not within 1 week to examine the treatment progress. Incident outpatient visit, emergency care and hospitalization, and fatality were compared between the 2 cohorts in the first week and the second week of follow-up periods, after the oseltamivir therapy.A total of 112,492 subjects diagnosed with influenza on oseltamivir therapy in 2005, 2009, and 2010 were identified. The multivariate logistic regression analysis showed that the in-time treatment was superior to the lag-time treatment with less repeat outpatient visits, hospitalizations, and fatality. The overall corresponding in-time treatment to lag-time treatment odds ratios (OR) were 0.50, 0.54, and 0.71 (all P value < 0.05), respectively. The in-time to lag-time ORs of all events were 0.50 in 2009 and 0.54 in 2010.Our study demonstrates that the in-time oseltamivir therapy leads to significantly better treatment outcomes. Oseltamivir should be administered as early as the onset of influenza symptoms appears.     

Triglyceride to High-Density Lipoprotein Cholesterol Ratio Predicts Cardiovascular Outcomes in Prevalent Dialysis Patients

Triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) ratio, an indicator of atherogenic dyslipidemia, is a predictor of cardiovascular (CV) outcomes in the general population and has been correlated with atherosclerotic events. Whether the TG/HDL-C ratio can predict CV outcomes and survival in dialysis patients is unknown.We performed this prospective, observational cohort study and enrolled 602 dialysis patients (539 hemodialysis and 63 peritoneal dialysis) from a single center in Taiwan followed up for a median of 3.9 years. The outcomes were the occurrence of CV events, CV death, and all-cause mortality during follow-up. The association of baseline TG/HDL-C ratio with outcomes was explored with Cox regression models, which were adjusted for demographic parameters and inflammatory/nutritional markers.Overall, 203 of the patients experienced CV events and 169 patients died, of whom 104 died due to CV events. Two hundred fifty-four patients reached the composite CV outcome. Patients with higher TG/HDL-C levels (quintile 5) had a higher incidence of CV events (adjusted hazard ratio [HR] 2.03, 95% confidence interval [CI] 1.19–3.47), CV mortality (adjusted HR 1.91, 95% CI 1.07–3.99), composite CV outcome (adjusted HR 2.2, 95% CI 1.37–3.55), and all-cause mortality (adjusted HR 1.94, 95% CI 1.1–3.39) compared with the patients in quintile 1. However, in diabetic dialysis patients, the TG/HDL-C ratio did not predict the outcomes.The TG/HDL-C ratio is a reliable and easily accessible predictor to evaluate CV outcomes and survival in prevalent nondiabetic dialysis patients.ClinicalTrials.gov: {"type":"clinical-trial","attrs":{"text":"NCT01457625","term_id":"NCT01457625"}}NCT01457625     

Early Statin Use and the Progression of Alzheimer Disease: A Total Population-Based Case-Control Study

The protective effect of statin on Alzheimer disease (AD) is still controversial, probably due to the debate about when to start the use of statin and the lack of any large-scale randomized evidence that actually supports the hypothesis. The purpose of this study was to examine the protective effect of early statin use on mild-to-moderate AD in the total Taiwanese population.This was a total population-based case-control study, using the total population of Taiwanese citizens seen in general medical practice; therefore, the findings can be applied to the general population. The study patients were those with newly diagnosed dementia (ICD-9 290.x) and prescribed any acetylcholinesterase inhibitors (AChEI) from the Taiwan National Health Insurance dataset in 1997 to 2008. The newly diagnosed eligible mild-to-moderate AD patients were traced from the dates of their index dates, which was defined as the first day to receive any AChEI treatment, back to 1 year (exposure period) to categorize them into AD with early statin use and without early statin use. Early statin use was defined as patients using statin before AChEI treatment. Alzheimer disease patients with early statin use were those receiving any statin treatment during the exposure period. Then, we used propensity-score-matched strategy to match these 2 groups as 1:1. The matched study patients were followed-up from their index dates. The primary outcome was the discontinuation of AChEI treatment, indicating AD progression.There were 719 mild-to-moderate AD-paired patients with early statin use and without early statin use for analyses. Alzheimer disease progression was statistically lower in AD patients with early statin use than those without (P = 0.00054). After adjusting for other covariates, mild-to-moderate AD patients with early stain use exhibited a 0.85-risk (95% CI = 0.76–0.95, P = 0.0066) to have AD progression than those without.Early statin use was significantly associated with a reduction in AD progression in mild-to-moderate AD patients. The future randomized trial studies can confirm our findings.     

Novel Low-Cost Endoscopic Cap for Esophageal Foreign Objects: A Case Report

A 57-year-old man presented to the hospital because of swallowing of a small marble precipitated by a hallucination. He subsequently developed chest discomfort. He had a history of psychiatric problem and an esophageal corrosive injury complicated by stricture of the middle esophagus.This report describes the novel idea of endoscopic intervention for the retrieval of an esophageal foreign body. Its inventiveness and the use of limited resources, by adapting a 30-mm aseptic common tubing into an endoscopic retrieving device, make the method novel. This novel low-cost endoscopic cap (NLCEC) was adapted to 25 mm of the front end of the endoscope, with 5 mm maintained for the soft part to prevent esophageal mucosal injury during the retrieval process. An 8-mm green marble was found impacted in the esophagus 32 cm from the incisors. The use of forced suction allowed for the successful retrieval of the marble within minutes. The patient had an uneventful recovery without any serious complications.This NLCEC may be a viable and safe tool for the endoscopic retrieval of esophageal foreign objects without general anesthesia. This innovative design is beneficial in terms of patient safety, easy preparation, and low cost.     

Energy and material flows of megacities

Understanding the drivers of energy and material flows of cities is important for addressing global environmental challenges. Accessing, sharing, and managing energy and material resources is particularly critical for megacities, which face enormous social stresses because of their sheer size and complexity. Here we quantify the energy and material flows through the world’s 27 megacities with populations greater than 10 million people as of 2010. Collectively the resource flows through megacities are largely consistent with scaling laws established in the emerging science of cities. Correlations are established for electricity consumption, heating and industrial fuel use, ground transportation energy use, water consumption, waste generation, and steel production in terms of heating-degree-days, urban form, economic activity, and population growth. The results help identify megacities exhibiting high and low levels of consumption and those making efficient use of resources. The correlation between per capita electricity use and urbanized area per capita is shown to be a consequence of gross building floor area per capita, which is found to increase for lower-density cities. Many of the megacities are growing rapidly in population but are growing even faster in terms of gross domestic product (GDP) and energy use. In the decade from 2001–2011, electricity use and ground transportation fuel use in megacities grew at approximately half the rate of GDP growth.The remarkable growth of cities on our planet during the past century has provoked a range of scientific inquires. From 1900–2011, the world’s urban population grew from 220 million (13% of the world’s population) to 3,530 million (52% of the world’s population) (1, 2). This phenomenon of urbanization has prompted the development of a science of cities (3, 4), including interdisciplinary contributions on scaling laws (5, 6), networks (7), and the thermodynamics of cities (8, 9). The growth of cities also has been strongly linked to global challenges of environmental sustainability, making the study of urban energy and material flows, e.g., for determining greenhouse gas emissions from cities and urban resource efficiency (10–19), important.At the pinnacle of the growth of cities is the formation of megacities, i.e., metropolitan regions with populations in excess of 10 million people. In 1970, there were only eight megacities on the planet (SI Appendix, Fig. S1). By 2010, the number had grown to 27, and a further 10 megacities likely will exist by 2020 (20). In 2010, 460 million people (6.7% of the global population) lived in the 27 megacities. The sheer size and complexity of megacities gives rise to enormous social and environmental challenges. Megacities often are perceived to be areas of high global risk (i.e., threatened by economic, environmental, geopolitical, societal, and technological risks with potential impacts across entire countries) with extreme levels of poverty, vulnerability, and social–spatial fragmentation (21–24). To provide adequate water and wastewater services, many megacities require massive technical investment and appropriate institutional development (25, 26). Many inhabitants of megacities also suffer severe health impacts from air pollution (27). However, these factors present only one side; the megacities include some of the wealthiest cities in the world (albeit with large disparities between citizens). Even the poorer megacities are seen by some as potential centers of innovation, where high levels of resource efficiency might reduce global environmental burdens (21, 28, 29). Whether megacities can develop as sustainable cities depends to a large extent on how they obtain, share, and manage their energy and material resources.The aims of our study are first to quantify the energy and material flows for the world’s 27 megacities, based on 2010 population, and second to identify physical and economic characteristics that underlie these resource flows at multiple scales. This goal entailed developing a common data-collection process applied to all the megacities. The cities were identified based on Brinkhoff’s database of metropolitan regions (www.citypopulation.de/world/Agglomerations.html; SI Appendix, Fig. S2). The megacities are essentially common commuter-sheds of more than 10 million people; most are contiguous urban regions, but a contiguous area is not a requirement; for example, the London megacity includes a ring of commuter towns outside the Greater London area. Megacities can spread across political borders. They include large tracts of suburban regions, which can have higher per capita resource flows than central areas (30, 31). We quantify energy flows for the dominant direct forms of consumption in megacities. A wide and complex range of materials flow through cities; here the focus is on water, concrete, steel, and waste. We show how values of aggregate resource use of all megacities generally are consistent with the scaling laws that have been developed for cities (5, 6). We then analyze factors correlated with energy and material flow at macro- and microscales; discuss megacities with low, high, and efficient use of resources; and examine changes over time.