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Liu P.-F.,Kaohsiung Veterans General Hospital | Liu P.-F.,University of California at San Diego | Cheng J.-S.,Kaohsiung Veterans General Hospital | Sy C.-L.,Kaohsiung Veterans General Hospital | And 7 more authors.
Journal of Investigative Dermatology | Year: 2015

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a major nosocomial pathogen that is widespread in both health-care facilities and in the community at large, as a result of direct host-to-host transmission. Several virulence factors are associated with pathogen transmission to naive hosts. Immunodominant surface antigen B (IsaB) is a virulence factor that helps Staphylococcus aureus to evade the host defense system. However, the mechanism of IsaB on host transmissibility remains unclear. We found that IsaB expression was elevated in transmissible MRSA. Wild-type isaB strains inhibited autophagic flux to promote bacterial survival and elicit inflammation in THP-1 cells and mouse skin. MRSA isolates with increased IsaB expression showed decreased autophagic flux, and the MRSA isolate with the lowest IsaB expression showed increased autophagic flux. In addition, recombinant IsaB rescued the virulence of the isaB deletion strain and increased the group A streptococcus (GAS) virulence in vivo. Together, these results reveal that IsaB diminishes autophagic flux, thereby allowing MRSA to evade host degradation. These findings suggest that IsaB is a suitable target for preventing or treating MRSA infection. © 2015 The Society for Investigative Dermatology.

Yeh Y.-T.,Cardiovascular Medical Center | Huang C.-Y.,Cardiovascular Medical Center
American Journal of Emergency Medicine | Year: 2016

As the most dramatic and fatal complication, left ventricular free-wall rupture (LVFWR) used to present in approximately 3% of patients with acutemyocardial infarction. After the introduction of primary percutaneous coronary intervention, the incidence of LVFWRdecreased but remained approximately 1.7% [1]. Left ventricular free-wall rupture occurs in patients with transmural myocardial infarction, which is almost exclusively STelevation myocardial infarction (STEMI) [2]. This condition carries a high mortality as a result of hemopericardiumand cardiac tamponade. Left ventricular free-wall rupture rarely occurs in patients with non-ST-elevation myocardial infarction, but the risk of it cannot be ignored. This case describes early development LVFWR after non-ST-elevation myocardial infarction to evoke high vigilance of clinicians to this condition. © 2015 Elsevier Inc. All rights reserved.

Lai C.-C.,Cardiovascular Medical Center | Hwang H.-R.,Cardiovascular Medical Center | Mar G.-Y.,Cardiovascular Medical Center | Chiou C.-W.,Cardiovascular Medical Center | Liu C.-P.,Kaohsiung Veterans General Hospital
Journal of Internal Medicine of Taiwan | Year: 2014

Effective hypertension treatment decreases cardiovascular and renal events. However, a proportion of hypertensive patients who have been treated with three or more kinds of antihypertensive drugs containing diuretic regimen at maximally tolerated doses do not reach the goal of blood pressure control. They are so-called patients with resistant hypertension. For the patients, the standard management contains clinical reevaluation, aggressive lifestyle modification and adjustment of antihypertensive drugs. Renal artery sympathetic nerve denervation (RDN) considered as a new treatment strategy has been reported for safely and effectively controlling blood pressure. The technique was domestically permitted in early 2013. Bhatt DL, et al. reported the results of SYMPLICITY HTN-3, a randomized single-blinded controlled trial in the New England Journal of Medicine this March. The results revealed unpredicted similarity in systolic blood pressure between the RDN group and sham-procedure control group. This brings us to cautiously think over critical issues regarding clinical application of RDN. As the experience and evidence are increasingly documented, physicians need to update the knowledge with respect to the new modality for treating patients with resistant hypertension. Therefore, our team integrates the data and presents the review article here to show the essential studies related to the procedure. The article is expected to be helpful for readers to understand RDN and the related studies. (J Intern Med Taiwan 2014; 25:316-324).

Kuo F.-Y.,Cardiovascular Medical Center | Huang W.-C.,Cardiovascular Medical Center | Huang W.-C.,National Yang Ming University | Chiou K.-R.,Cardiovascular Medical Center | And 11 more authors.
BMJ Quality and Safety | Year: 2013

Background Door-to-balloon (D2B) time is an important factor in the outcome of ST segment elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention. We aimed to use failure mode and effect analysis to reduce the D2B time for patients with STEMI and to improve clinical outcomes. Methods There were three stages in this study. In Stage 0, data collected from 2005-2006 was used to identify failures in the process, and during Stage 2 (2007) and Stage 3 (2008) the efficacy of intrahospital and interhospital strategies to reduce the D2B time were evaluated. This study enrolled 385 patients; 86 from 2005-2006; 80 in 2007; and 219 in 2008. Results By making improvements in these steps, the median D2B time was reduced from 146 min to 32 min for all patients. The proportion of patients with a D2B time of <90 min significantly increased from Stage 0 to Stage 1 and from Stage 1 to Stage 2, for all patients as well as for the non-transferred and transferred subgroups of patients (all p values <0.0001). For non-transferred patients, only reinfarction-free survival showed significant difference among the three stages (p=0.0225), and for transferred patients, only overall survival showed significant difference among the three stages (p=0.0322). Cox's proportional hazards regression analysis showed Stage 2 was associated with a lower risk of reinfarction and mortality compared with Stage 0. Conclusions This study found that failure mode and effect analysis is a powerful method for identifying weaknesses in D2B processes and evaluating strategies to reduce the D2B time.

Chung C.-C.,Cardiovascular Medical Center | Huang W.-C.,Cardiovascular Medical Center | Huang W.-C.,National Yang Ming University | Chiou K.-R.,Cardiovascular Medical Center | And 8 more authors.
Journal of Rehabilitation Medicine | Year: 2010

Objective: To use the ratio of early mitral inflow peak velocity (E) to mitral flow propagation velocity (FPV) measured in the early phase of myocardial infarction (early phase E/FPV) to evaluate the training effects of 8 weeks' cardiopulmonary rehabilitation in patients post-myocardial infarction. Design: Single-blinded, randomized control trial. Participants: Eighty-seven patients with acute myocardial infarction who had undergone primary coronary intervention. Methods: Participants were enrolled randomly to either the cardiac rehabilitation or the control group. The rehabilitation group followed an 8-week supervised rehabilitation programme. All patients completed exercise testing and echocardiography at both the beginning and at 8-week follow-up. Results: The value of E/FPV was significantly reduced at 8-week follow-up in the rehabilitation group (p=0.005). After cardiac rehabilitation, the increase in peak VO2 (p=0.002) and cardiac clinical outcome (composition of mortality, cardiac readmission rate, and revascularization rate) (p=0.001) were significantly greater in patients with an early phase E/FPV <1.5 than in patients with early phase E/FPV ≥1.5. There were no significant differences in the increase in peak VO2 and cardiac clinical outcome in patients with early phase E/FPV ≥ 1.5. Conclusion: Early phase E/FPV <1.5 predicts more beneficial effects of cardiac rehabilitation in post-acute myocardial infarction patients who have undergone primary coronary intervention. © 2010 Foundation of Rehabilitation Information.

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