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Objective: Myocarditis is an inflammation of the myocardium. The condition is commonly associated with rapid disease progression and often results in profound shock. Impaired renal function is the result of impairment in end-organ perfusion and is highly prevalent among critically ill patients. The aim of this study was to evaluate the incidence of acute kidney injury (AKI) and identify the relationship between AKI and the prognosis of patients with acute myocarditis. Design, Measurements and Main Results: This retrospective study reviewed the medical records of 101 patients suffering from acute myocarditis between 1996 and 2011. Sixty of these patients (59%) developed AKI within 48 hours of being hospitalized. AKI defined as AKIN stage 3 (p = 0.007) and SOFA score (p = 0.03) were identified as predictors of in-hospital mortality in multivariate analysis. The conditional effect plot of the estimated risk against SOFA score upon admission categorized according to the AKIN stages showed that the risk of in-hospital mortality was highest among patients in AKIN stage 3 with a high SOFA score. Conclusions: Among patients with acute myocarditis, AKI defined as AKIN stage 3 and elevated SOFA score were associated with unfavorable outcomes. AKIN classification is a simple, reproducible, and easily applied evaluation tool capable of providing objective information related to the clinical prognosis of patients with acute myocarditis. [ABSTRACT FROM AUTHOR]

Cholesterol embolism (CE) is characterized by emboli containing cholesterol crystal in the arterioles, most commonly found in the skin and the kidney. The skin presentations of CE include livedo reticularis, blue toe syndrome, ulceration and gangrene. Cutaneous reactive angiomatosis (CRA) is a recently proposed term to describe a group of reactive vascular proliferation in skin caused by various diseases. Its occurrence in association with CE is extremely uncommon. An 82-year-old man with a history of cerebral infarction and on long-term warfarin therapy developed progressive, multiple violaceous papules and nodules on the dorsal feet, soles and toes, simulating Kaposi's sarcoma. Skin biopsy showed marked vascular endothelial cell proliferations characteristic of CRA affecting the full thickness of dermis. In addition, cholesterol crystal emboli were found in dermal arterioles. The skin lesions improved after the warfarin dose was reduced. We emphasize the possible presence of CE in a patient presented with CRA, especially in those with a pre-existing atherosclerotic disease, on anticoagulation therapy, or having a prior history of invasive vascular procedure. Yang Y-W, Chen C-L, Ho W-T, Wang K-H. Cutaneous reactive angiomatosis associated with cholesterol embolism. [ABSTRACT FROM AUTHOR]

The article assesses the outcomes of the National Hepatitis B Immunization Program for infants in Taiwan launched in July 1984. The program successfully reduced the prevalence of chronic hepatitis B virus (HBV) carriers, incidence of hepatocellular carcinoma (HCC) and infant fulminant hepatitis (IFH) mortality in vaccinated birth cohorts. The decline in IFH mortality rates coincided with the launch of the program and the change to recombinant vaccines in 1992.

BACKGROUND. Neurothekeoma is a rare cutaneous neoplasm, often occurring as a nondescript cutaneous nodule on the central face, shoulders, and upper extremities. OBJECTIVE. To present a patient with mixed-type neurothekeoma with an unusual clinical presentation. METHODS. We report a 29-year-old female who developed an asymptomatic, red, dermal nodule with satellite papules on the back over a period of 6 months. RESULTS. The coalescing papules on the back were excised, and the histopathology and immunohistochemical study revealed a mixed-type neurothekeoma. CONCLUSION. Neurothekeoma usually presents with a small, solitary, and slow-growing nodule or papule on the upper body. The case is interesting because of the unusual clinical manifestation of one dermal tumor with several satellite lesions. [ABSTRACT FROM AUTHOR]

This study derives an integrated model for three-echelon supply chain (i.e. single-supplier, single-vendor and multi-retailer) to minimise the joint costs of all participants associated with holding costs, ordering costs, and purchasing costs. We particularly emphasise that quantity discounts and joint replenishment policies can be utilised as coordination mechanisms among all parties. In addition, a linearisation approach and mixed integer method are developed not only to obtain an executable integer solution for a finite planning horizon problem but also to simplify the conventional multiple-step procedure used in the quantity discount. The result indicates that the coordination and consolidation of orders can lead to the total cost reduction. Finally, a numerical example is given to illustrate the benefits of orders coordination and consolidation. [ABSTRACT FROM AUTHOR]

Studies have found lower risk of childhood cancer among Asian children. We aim to characterize the recent incidence and incidence-trend of childhood cancer in Taiwan after the National Health Insurance program was launched in March 1995. Data were extracted from the Taiwan Cancer Registry, a population-based database established in 1979. Cases diagnosed at age 0-14 from 1996 to 2010 were analyzed and categorized according to the International Classification of Childhood Cancer, Third Edition (ICCC-3). In total, 8032 childhood cancer cases were included, with a microscopic verification rate of 93.9%. The overall age-standardized rate (ASR) of incidence adjusted to the 2000 World Standard Population is 125.0 cases/million, with a male-to-female ratio of 1.3. The top five cancer types (ICCC-3 subgroup[s]; ASR per million) are acute lymphoblastic leukemia (Ia, 30.3), acute myeloid leukemia (Ib; 9.4), non-Hodgkin lymphoma (IIb,c,e, 9.0), extracranial germ cell tumor (Xb,c; 8.3), and neuroblastoma (IVa; 7.8). The median age of diagnosis was 6 years for both genders. During the study period, the ASR of childhood cancer has been increasing at a rate of 1.2% per year (95% confidence interval, 0.6-1.7%). In contrast to Western countries, China, Japan, and Taiwan have lower incidence of childhood cancer; however, Taiwan's incidence rates of childhood germ cell tumors and hepatic tumors are higher. In conclusion, this population-based study reveals that the incidence rate of childhood cancer in Taiwan is rising consistently. The high incidence of germ cell tumors warrants further investigation. [ABSTRACT FROM AUTHOR]