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Wan G.-H.,Chang Gung University | Chung F.-F.,Chang Gung Institute of Technology | Tang C.-S.,Fu Jen Catholic University
American Journal of Infection Control | Year: 2011

Background: Maintenance of adequate indoor air quality (IAQ) in operating rooms (ORs) is critical to the prevention of nosocomial infection in hospitalized patients. This study evaluated the characteristics of IAQ in various ORs in a medical center. Methods: Air temperature, relative humidity, carbon dioxide (CO 2), particulate matter (PM), and bacterial concentrations were monitored in the ORs, and monthly variations were noted. Results: The mean CO 2 concentrations in the ORs were lower than the suggested level (600 ppm average over 8 hours) set by Taiwan's Environmental Protection Agency. Positive relationships were found among the number of persons, temperature (Spearman's rho coefficient [r s] = 0.19; P < .01), and CO 2 concentration (r s = 0.34; P < .01) in the OR. Bacterial concentration was significantly associated with PM level when adjusted for OR category and the number of persons in the room. Gram-positive bacteria (eg, Bacillus spp, Micrococcus spp, Staphylococcus spp) were frequently found in the monitored ORs. Conclusion: The IAQ in the ORs varied significantly from month to month. The number of persons in the OR affected IAQ, and a decreased PM level might indicate reduced microbial contamination in the OR. Copyright © 2011 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.


Chu P.-J.,Taoyuan Armed Forces General Hospital | Shih J.-T.,Taoyuan Armed Forces General Hospital | Shih J.-T.,Chang Gung Institute of Technology
Arthroscopy - Journal of Arthroscopic and Related Surgery | Year: 2011

Purpose: The purpose of this study was to analyze the clinical follow-up results (minimum, 2 years) in patients with nonunions of the scaphoid with minimal sclerosis treated with arthroscopically assisted percutaneous internal fixation augmented by injection of a bone graft substitute. Methods: From January 2006 through November 2007, a consecutive series of 15 patients with fibrous union or nonunion of a carpal scaphoid fracture with minimal sclerosis or resorption at the nonunion site were treated with arthroscopically assisted percutaneous internal fixation combined with the use of injectable bone graft substitute. Preoperative and postoperative evaluations included measurement of clinical (grip strength and range of motion), radiographic, and functional (Mayo Modified Wrist Score) parameters, as well as satisfaction. The sample included 13 men and 2 women with a mean age of 31 years (range, 20 to 45 years). We recorded union and return to activity and analyzed data with regular clinical follow-up at a mean of 33 months (range, 24 to 46 months). Results: We confirmed union in 14 of 15 patients (93%) at a mean of 15.4 weeks according to clinical examinations and standard radiography. For the Mayo Modified Wrist Score, there were 10 excellent and 4 good results. A total of 14 of 15 patients (93%) returned to work or sports activities at their preinjury level. Conclusions: Arthroscopically assisted treatment with percutaneous internal fixation with injectable bone graft substitute is a reliable and minimally invasive method to achieve union and scaphoid healing. Level of Evidence: Level IV, therapeutic case series. Crown Copyright © 2011 Published by Elsevier Inc. on behalf of the Arthroscopy Association of North America. All rights reserved.


Wang H.-H.,Chang Gung University | Hsieh H.-L.,Chang Gung Institute of Technology | Yang C.-M.,Chang Gung University
Journal of Cellular Physiology | Year: 2011

The deleterious effects of endothelin-1 (ET-1) in the central nervous system (CNS) include disturbance of water homeostasis and blood-brain barrier (BBB) integrity. In the CNS, ischemic injury elicits ET-1 release from astrocytes, behaving through G-protein coupled ET receptors. These considerations raise the question of whether ET-1 influences cellular functions of astrocytes, the major cell type that provides structural and functional support for neurons. Uncontrolled nitric oxide (NO) production has been implicated in sterile brain insults, neuroinflammation, and neurodegenerative diseases, which involve astrocyte activation and neuronal death. However, the detailed mechanisms of ET-1 action related to NO release on rat brain astrocytes (RBA-1) remain unknown. In this study, we demonstrate that exposure of astrocytes to ET-1 results in the inducible nitric oxide synthase (iNOS) up-regulation, NO production, and matrix metalloproteinase-9 (MMP-9) activation in astrocytes. The data obtained with Western blot, reverse transcription-PCR (RT-PCR), and immunofluorescent staining analyses showed that ET-1-induced iNOS expression and NO production were mediated through an ETB-dependent transcriptional activation. Engagement of Gi/o- and Gq-coupled ETB receptors by ET-1 led to activation of c-Src-dependent phosphoinositide 3-kinase (PI3K)/Akt and p42/p44 mitogen-activated protein kinase (MAPK) and then activated transcription factor nuclear factor-κB (NF-κB). The activated NF-κB was translocated into nucleus and thereby promoted iNOS gene transcription. Ultimately, NO production stimulated by ET-1 enhanced the migration of astrocytes through the tyrosine nitration of MMP-9. Taken together, these results suggested that in astrocytes, activation of NF-κB by ETB-dependent c-Src, PI3K/Akt, and p42/p44 MAPK signalings is necessary for ET-1-induced iNOS gene up-regulation. © 2010 Wiley-Liss, Inc.


Hsieh H.-L.,Chang Gung Institute of Technology | Wang H.-H.,Chang Gung University | Wu C.-Y.,Chang Gung University | Yang C.-M.,Chang Gung University
Antioxidants and Redox Signaling | Year: 2010

Heme oxygenase-1 (HO-1) plays a crucial role in tissue pathological changes such as brain injuries. Our previous studies have demonstrated that bradykinin (BK) induces the expression of several inflammatory proteins, including matrix metalloproteinase-9 and COX-2, via mitogen-activated protein kinases and nuclear factor-κB (NF-κB) in rat brain astrocytes (RBA-1). However, the molecular mechanisms underlying BK-induced HO-1 expression in RBA-1 cells remain poorly defined. Here we demonstrated that BK induced HO-1 expression and enzymatic activity via a B2 BK receptor-activated reactive oxygen species (ROS)-dependent signaling pathway. NADPH oxidase (Nox)-dependent ROS generation led to activation of extracellular signal-regulated kinase 1/2 (ERK1/2) and c-Jun-N-terminal kinase (JNK) and then activated the downstream molecules NF-κB and c-Jun, respectively. The c-Fos, an activator protein 1 (AP-1) subunit, was upregulated by activation of NF-κB and c-Jun, which bound to HO-1 promoter and thereby turned on transcription of HO-1 gene. The rat HO-1 promoter containing a putative AP-1 cis-binding site was identified as a crucial domain linking to BK action. Taken together, these results suggested that in RBA-1 cells, activation of ERK/NF-κB and JNK/c-Jun cascades by a Nox/ROS-dependent event enhancing c-Fos/AP-1 activity is essential for HO-1 upregulation and activation induced by BK. Moreover, ROS-dependent NF-E2-related factor 2 activation also contributes to HO-1 induction by BK in astrocytes. © 2010 Mary Ann Liebert, Inc.


Tung W.-H.,Chang Gung University | Hsieh H.-L.,Chang Gung Institute of Technology | Yang C.-M.,Chang Gung University
Cellular Signalling | Year: 2010

The enterovirus 71 (EV71) causes severe neurological diseases that were mediated through cyclooxygenase-2 (COX-2) expression in brain. However, the mechanisms underlying EV71-initiated intracellular signaling pathways leading to COX-2 expression remain unknown in neurons. Here we report that exposure of SK-N-SH cells to EV71 increased COX-2 expression and PGE2 generation in a time- and virus titer-dependent manner, revealed by Western blot, real-time PCR, and PGE2 analyses. These EV71-induced responses were mediated through activation of p42/p44 MAPK, p38 MAPK, JNK, NF-κB, and AP-1, revealed by using selective pharmacological inhibitors or transfection with respective siRNAs. Consistently, EV71-stimulated translocation of NF-κB into the nucleus and degradation of IκBα in the cytosol was blocked by pretreatment with the selective inhibitors of MEK1/2 (U0126) and NF-κB (Bay11-7085), respectively, suggesting that MEK1/2-p42/p44 MAPK cascade linking to NF-κB was involved in COX-2 expression. In addition, EV71-induced AP-1 subunits (c-jun and c-fos mRNA) expression was also attenuated by pretreatment with a selective JNK inhibitor SP600125, suggesting that JNK cascade linking to AP-1 was involved in COX-2 expression induced by EV71. These findings suggested that up-regulation of COX-2 associated with the release of PGE2 from EV71-infected SK-N-SH cells which was mediated through activation of p38 MAPK, JNK, p42/p44 MAPK, NF-κB, and AP-1 pathways. © 2009 Elsevier Inc. All rights reserved.


Liou S.-R.,Chang Gung Institute of Technology | Cheng C.-Y.,Taipei Medical University
Journal of Clinical Nursing | Year: 2010

Aims and objectives: To examine: (1) Taiwanese nurses' perceptions of organisational climate, levels of organisational commitment and intention to leave, as well as relationships between these three variables; (2) demographic differences in the levels of these variables; and (3) mediating effects of organisational commitment on the relationship between organisational climate and intention to leave. Background: Organisational climate is related to organisational commitment and affects nurses' performances and attitudes towards an organisation. Design: A cross-sectional, descriptive design. Method: Registered nurses working in eight hospitals in southern Taiwan for more than six months were recruited. Data were collected using the Litwin and Stringer's Organisational Climate Questionnaire, Organizational Commitment Questionnaire and a five-item scale measuring intention to leave. Questionnaires were distributed to 612 potential participants; 486 valid returned questionnaires were analysed. Results: The study's participants were generally satisfied with their hospital's climate and yet claimed low commitment to their organisation and, nevertheless, reported low intention to leave their job. Single nurses were more satisfied with their hospital's climate and were more committed to their hospital and had a lower intention to leave their job compared to married nurses. Nurses working in district hospitals perceived a better hospital climate and had a lower intention to leave than nurses working in teaching or regional hospitals. Staff nurses perceived a better organisational climate than did nurse managers. Organisational climate, organisational commitment and intention to leave were intercorrelated. Organisational climate had almost 60% indirect effect on organisational commitment related to intention to leave. Conclusions: Creating a good organisational climate may increase nurses' organisational commitment and, in turn, decrease their intention to leave. Relevance to clinical practice: To motivate nurses' positive organisational behaviours and to address their diverse needs, hospital administrators are encouraged to understand nurses' work-climate perceptions and to address nurses' varied demographic factors. © 2010 Blackwell Publishing Ltd.


Background and purpose: Acurhagin, a member of versatile metalloproteinase disintegrins from Agkistrodon acutus venom, has been identified as a platelet aggregation inhibitor, previously. Here, acurhagin-C, the C-terminal Glu-Cys-Asp (ECD)-containing fragment of acurhagin, was evaluated for its biological activities and potential applications in anti-angiogenic therapy. Experimental approach: Human umbilical vein endothelial cells (HUVECs) were treated with acurhagin-C to assay effects on viability, apoptosis, adhesion, migration, invasion, proliferation and angiogenesis. The recognition site and signalling involved for the interactions of acurhagin-C with HUVEC were determined using flow cytometric, electrophoresis and immunoblotting analyses. Key results: Acurhagin-C decreased viability and induced apoptosis in HUVEC. It also dose-dependently inhibited HUVEC adhesion to immobilized extracellular matrices fibronectin, collagen I and vitronectin with respective IC50 values of approximately 0.6, 0.3 and 0.1 μM. Acurhagin-C prevented migration and invasion of HUVEC through vitronectin- and Matrigel-coated barriers respectively. Furthermore, acurhagin-C attenuated fibroblast growth factor-2-primed angiogenesis both in vitro and in vivo, and specifically blocked the binding of anti-αvβ3 monoclonal antibody 23C6 to HUVEC in an ECD-dependent manner. However, purified αvβ3 also dose-dependently bound to immobilized acurhagin and acurhagin-C with a saturable pattern. Interference with integrin αvβ3-mediated functions and promotion of caspase-3 activation by acurhagin-C affected morphology of HUVEC and induced apoptosis. Conclusions and implications: Acurhagin-C elicited endothelial anoikis via disruption of αvβ3/focal adhesion kinase/ phosphatidylinositol 3-kinase/Akt survival cascade and subsequent initiation of the procaspase-3 apoptotic signalling pathway. © 2010 The British Pharmacological Society.


Hsu M.-H.,Chang Gung Institute of Technology
Expert Systems with Applications | Year: 2011

This paper proposes a recommender system to assist second-language nurses, especially student nurses, in patient care charting. Using data mining association rules, the system automatically provides optimal words or terms for the nurse to choose from as she or he proceeds with the documentation. The system, having been tested on Taiwanese nursing students who needed to chart in their practicum at hospitals, has been found to be highly effective for the intended purpose. © 2011 Published by Elsevier Ltd.


Hsu M.-H.,Chang Gung Institute of Technology
Expert Systems with Applications | Year: 2010

This paper proposes a web-based interactive speaking improvement system for EFL learners. Using fuzzy matching, the system automatically compares the learner's and the system's pronunciation and immediately provides corrective interaction whereby the student can improve speaking via continuous imitation and practice at the computer. The system, having been tested on Taiwanese students who needed to achieve a speaking proficiency equivalent to CEF Level A2, is found to be highly effective for the intended purpose. © 2009 Elsevier Ltd. All rights reserved.


Hsieh C.H.,Chang Gung Institute of Technology
American Journal of Chinese Medicine | Year: 2010

Auricular acupressure is widely used to reduce body weight. The current study was designed to test the efficacy of auricular acupressure on weight reduction and serum total cholesterol (TC), total triglycerides (TG), high density lipids (HDL) and low density lipids (LDL) in an eight-week, randomized controlled trial of three groups of 84 adolescents aged 1820 with a body mass index (BMI) of 23 or higher. The control group received tape treatment only and the other two experimental groups were administered acupressure using either Japanese Magnetic Pearls or vaccaria seeds. All three groups were educated on reduced calorie diets, physical activity, weight loss, and lifestyle modification. During the eight-week trial, all participants were seen weekly for 10 min per session. Anthropometric measurements of BMI and TC, TG, HDL, and LDL were performed at weeks 0 and 8 for all participants. Changes in BMI, TC, TG, HDL, and LDL were calculated from baseline to trial completion. BMI was significantly increased in the control group by +0.0457 (p < 0.0001), it was decreased in the Japanese Magnetic Pearl group by -0.6982 (p < 0.0001) and the vaccaria seed group by -1.2341 (p < 0.0001). All three groups showed significant increases in TC, TG, HDL, and LDL. In conclusion, the current study shows that auricular acupressure employing Japanese Magnetic Pearls or vaccaria seeds can decrease BMI, with the vaccaria seed method showing the greatest reduction. Auricular acupressure did not result in decreased TC, TG, HDL, or LDL in the current eight-week protocol. © 2010 World Scientific Publishing Company & Institute for Advanced Research in Asian Science and Medicine.

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