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Hsieh Y.-W.,Chang Gung University | Lin K.-C.,National Taiwan University | Lin K.-C.,National Taiwan University Hospital | Wu C.-Y.,Chang Gung University | And 4 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2014

Objective To investigate the predictors of minimal clinically important changes on outcome measures after robot-assisted therapy (RT). Design Observational cohort study. Setting Outpatient rehabilitation clinics. Participants A cohort of outpatients with stroke (N=55). Interventions Patients with stroke received RT for 90 to 105min/d, 5d/wk, for 4 weeks. Main Outcome Measures Outcome measures, including the Fugl-Meyer Assessment (FMA) and Motor Activity Log (MAL), were measured before and after the intervention. Potential predictors include age, sex, side of lesion, time since stroke onset, finger extension, Box and Block Test (BBT) score, and FMA distal score. Results Statistical analysis showed that the BBT score (odds ratio[OR]=1.06; P=.04) was a significant predictor of clinically important changes in the FMA. Being a woman (OR=3.9; P=.05) and BBT score (OR=1.07; P=.02) were the 2 significant predictors of clinically significant changes in the MAL amount of use subscale. The BBT score was the significant predictor of an increased probability of achieving clinically important changes in the MAL quality of movement subscale (OR=1.07; P=.02). The R2 values for the 3 logistic regression models were low (.114-.272). Conclusions The results revealed that patients with stroke who had greater manual dexterity measured by the BBT appear to have a higher probability of achieving clinically significant motor and functional outcomes after RT. Further studies are needed to evaluate other potential predictors to improve the models and validate the findings. © 2014 by the American Congress of Rehabilitation Medicine.


Hung T.-H.,Chang Gung Memorial Hospital at Taipei | Hung T.-H.,Chang Gung University | Chen S.-F.,Cheng Hsin Rehabilitation Medical Center | Li M.-J.,Chang Gung Memorial Hospital at Taipei | And 2 more authors.
PLoS ONE | Year: 2010

Background: Concomitant supplementation of vitamins C and E during pregnancy has been reportedly associated with low birth weight, the premature rupture of membranes and fetal loss or perinatal death in women at risk for preeclampsia; however, the cause is unknown. We surmise that hypoxia-reoxygenation (HR) within the intervillous space due to abnormal placentation is the mechanism and hypothesize that concomitant administration of aforementioned vitamin antioxidants detrimentally affects trophoblast cells during HR. Methodology/Principal Findings: Using villous explants, concomitant administration of 50 mM of vitamins C and E was observed to reduce apoptotic and autophagic changes in the trophoblast layer at normoxia (8% oxygen) but to cause more prominent apoptosis and autophagy during HR. Furthermore, increased levels of Bcl-2 and Bcl-xL in association with a decrease in the autophagy-related protein LC3-II were noted in cytotrophoblastic cells treated with vitamins C and E under standard culture conditions. In contrast, vitamin treatment decreased Bcl-2 and Bcl-xL as well as increased mitochondrial Bak and cytosolic LC3-II in cytotrophoblasts subjected to HR. Conclusions/Significance: Our results indicate that concomitant administration of vitamins C and E has differential effects on the changes of apoptosis, autophagy and the expression of Bcl-2 family of proteins in the trophoblasts between normoxia and HR. These changes may probably lead to the impairment of placental function and suboptimal growth of the fetus. © 2010 Hung et al.


Hung T.-H.,Chang Gung Memorial Hospital at Taipei | Lo L.-M.,Chang Gung Memorial Hospital at Taipei | Chiu T.-H.,Chang Gung Memorial Hospital at Taipei | Li M.-J.,Chang Gung Memorial Hospital at Taipei | And 4 more authors.
Reproductive Sciences | Year: 2010

Pregnancy is associated with increased oxidative stress, and exaggeration of oxidative damage is considered important in pregnancy complications such as preeclampsia. There is, however, only scattered information regarding the longitudinal change of oxidative stress during pregnancy. We surmised that the placenta is the cause of the increased oxidative stress during pregnancy and hypothesized that the amount of placenta-derived cell-free fetal DNA in maternal plasma is correlated with maternal oxidative stress status. Blood and urine samples were collected at different stages of gestation and 6 to 8 weeks postpartum from 105 women with uncomplicated pregnancies. Additionally, 40 healthy women of reproductive age, but not pregnant, were recruited as controls. All oxidative stress markers, including urinary 8-hydroxydeoxyguanosine (8-OHdG), plasma 8-isoprostane, total antioxidant capacity (TAC), and erythrocyte glutathione peroxidase (GPX) and superoxide dismutase (SOD) activities, were increased in the third trimester, and most of them returned to nonpregnant levels postpartum. Furthermore, the DYS14 gene of the Y chromosome was quantified from plasma samples obtained at 26 to 30 weeks' gestation in 54 women who later delivered a male infant. Significant associations were noted between plasma concentrations of the DYS14 gene and the levels of urinary 8-OHdG and plasma 8-isoprostane, suggesting an association between the breakdown of syncytiotrophoblast and maternal oxidative stress during pregnancy.


Hung T.-H.,Chang Gung Memorial Hospital at Taipei | Hung T.-H.,Chang Gung University | Hsieh T.-T.,Chang Gung Memorial Hospital at Taipei
PLoS ONE | Year: 2015

Background In 2010, the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) recommended a new strategy for the screening and diagnosis of gestational diabetes mellitus (GDM). However, no study has indicated that adopting the IADPSG recommendations improves perinatal outcomes. The objective of this study was to evaluate the effects of implementing the IADPSG criteria for diagnosing GDM on maternal and neonatal outcomes. Methodology/Principal Findings Previously, we used a two-step approach (a 1-h, 50-g glucose challenge test followed by a 3-h, 100-g glucose tolerance test when indicated) to screen for and diagnose GDM. In July 2011, we adopted the IADPSG recommendations in our routine obstetric care. In this study, we retrospectively compared the rates of various maternal and neonatal outcomes in all women who delivered after 24 weeks of gestation during the periods before (P1, between January 1, 2009 and December 31, 2010) and after (P2, between January 1, 2012 and December 31, 2013) the IADPSG criteria were implemented. Pregnancies complicated by multiple gestations, fetal chromosomal or structural anomalies, and pre-pregnancy diabetes mellitus were excluded. Our results showed that the incidence of GDM increased from 4.6% using the two-step method to 12.4%using the IADPSG criteria. Compared to the women in P1, the women in P2 experienced less weight gain during pregnancy, lower birth weights, shorter labor courses, and lower rates of macrosomia (<4000 g) and large-for-gestational age (LGA) infants. P2 was a significant independent factor against macrosomia (adjusted odds ratio [OR] 0.63, 95% confidence interval [CI] 0.43-0.90) and LGA (adjusted OR 0.74, 95% CI 0.61-0.89) after multivariable logistic regression analysis. Conclusions/Significance The adoption of the IADPSG criteria for diagnosis of GDM was associated with significant reductions in maternal weight gain during pregnancy, birth weights, and the rates of macrosomia and LGA. © 2015 Hung Hsieh.


Hung T.-H.,Chang Gung Memorial Hospital at Taipei | Hung T.-H.,Chang Gung University | Hsieh T.-T.,Chang Gung Memorial Hospital at Taipei | Liu H.-P.,Chang Gung Memorial Hospital at Taipei
PLoS ONE | Year: 2015

Background: Epidural analgesia is considered one of the most effective methods for pain relief during labor. However, it is not clear whether similar effects of epidural analgesia on the progression of labor, modes of delivery, and perinatal outcomes exist between nulliparous and multiparous women. Methodology/Principal Findings: A retrospective cohort study was conducted to analyze all deliveries after 37 weeks of gestation, with the exclusion of pregnancies complicated by multiple gestations and fetal anomalies and deliveries without trials of labor; these criteria produced a study population of n=16,852. A multivariable logistic regression model was constructed to control for confounders. In total, 7260 of 10,175 (71.4%) nulliparous and 2987 of 6677 (44.7%) multiparous parturients were administered epidural analgesia. The independent factors for intrapartum epidural analgesia included a low prepregnancy body mass index, genetic amniocentesis, group B streptococcal colonization of the genito-rectal tract, and augmentation and induction of labor. In the nulliparous women, epidural analgesia was a significant risk factor for operative vaginal delivery (adjusted odds ratio [OR] 2.14, 95% confidence interval [CI] 1.80-2.54); however, it was a protective factor against Caesarean delivery (adjusted OR 0.62, 95% CI 0.55-0.69). Epidural analgesia remained a significant risk factor for operative vaginal delivery (adjusted OR 2.17, 95% CI 1.58-2.97) but not for Caesarean delivery (adjusted OR 1.09, 95% CI 0.77-1.55) in the multiparous women. Furthermore, the women who were administered epidural analgesia during the trials of labor had similar rates of adverse perinatal outcomes compared with the women who were not administered epidural analgesia, except that a higher rate of 1-minute Apgar scores less than 7 was noted in the nulliparous women who were administered epidural analgesia. Conclusions/Significance: Intrapartum epidural analgesia has differential effects on the modes of delivery between nulliparous and multiparous women, and it is not associated with adverse perinatal outcomes. © 2015 Hung et al.


Hung T.-H.,Chang Gung Memorial Hospital at Taipei | Hung T.-H.,Chang Gung University | Chen S.-F.,Cheng Hsin Rehabilitation Medical Center | Lo L.-M.,Chang Gung Memorial Hospital at Taipei | And 3 more authors.
PLoS ONE | Year: 2012

Background: Unexplained intrauterine growth restriction (IUGR) may be a consequence of placental insufficiency; however, its etiology is not fully understood. We surmised that defective placentation in IUGR dysregulates cellular bioenergic homeostasis, leading to increased autophagy in the villous trophoblast. The aims of this work were (1) to compare the differences in autophagy, p53 expression, and apoptosis between placentas of women with normal or IUGR pregnancies; (2) to study the effects of hypoxia and the role of p53 in regulating trophoblast autophagy; and (3) to investigate the relationship between autophagy and apoptosis in hypoxic trophoblasts. Methodology/Principal Findings: Compared with normal pregnant women, women with IUGR had higher placental levels of autophagy-related proteins LC3B-II, beclin-1, and damage-regulated autophagy modulator (DRAM), with increased p53 and caspase-cleaved cytokeratin 18 (M30). Furthermore, cytotrophoblasts cultured under hypoxia (2% oxygen) in the presence or absence of nutlin-3 (a p53 activity stimulator) had higher levels of LC3B-II, DRAM, and M30 proteins and increased Bax mRNA expression compared with controls cultured under standard conditions. In contrast, administration of pifithrin-α (a p53 activity inhibitor) during hypoxia resulted in protein levels that were similar to those of the control groups. Moreover, cytotrophoblasts transfected with LC3B, beclin-1, or DRAM siRNA had higher levels of M30 compared with the controls under hypoxia. However, transfection with Bcl-2 or Bax siRNA did not cause any significant change in the levels of LC3B-II in hypoxic cytotrophoblasts. Conclusions/Significance: Together, these results suggest that there is a crosstalk between autophagy and apoptosis in IUGR and that p53 plays a pivotal and complex role in regulating trophoblast cell turnover in response to hypoxic stress. © 2012 Hung et al.


Chen H.-F.,Chang Gung Institute of Technology | Chen H.-F.,Chang Gung University | Tsai Y.-F.,Chang Gung University | Tsai Y.-F.,Chang Gung Memorial Hospital at Taipei | And 2 more authors.
Epilepsy Research | Year: 2011

The objective of the study was to validate the Chinese version of The Liverpool Adverse Events Profile (LAEP) in patients with epilepsy. The scale was translated from the English version into a Chinese version and was then back-translated to examine its accuracy. Content validity, concurrent validity, and construct validity were then used to examine the overall validity of this scale. A cross-sectional design with convenience sampling was used to recruit participants from three medical centers. The LAEP Chinese version was tested with respect to validity and reliability in 357 patients with epilepsy, and another 28 patients were invited to evaluate the test-retest reliability of the scale in a 2-week interval. There was a good content validity index (CVI=1.0). Patients undergoing polytherapy had more adverse effects (χ2=6.10, p<0.01) and higher LAEP scores (t=-2.91, p<0.01) than patients undergoing monotherapy, indicating a good concurrent validity. Factor analysis included three factors classified by symptoms in the 22-item Chinese version of the LAEP. The total variance of these three factors was 39.3% for the scale. Internal consistency (Cronbach's α=0.92) and the intraclass correlation coefficient (ICC=0.80) were satisfactory. Moreover, the LAEP can be completed in a short time, is perceived as easy to complete, and there was no relevant information missing. The results indicated that the Chinese version of the LAEP yielded highly acceptable parameters of validity and reliability and can be used for measuring adverse effects of antiepileptic drugs among Chinese-speaking patients with epilepsy in Taiwan. © 2011 Elsevier B.V.


Hsieh T.-T.,Chang Gung Memorial Hospital at Taipei | Chen S.-F.,Cheng Hsin Rehabilitation Medical Center | Lo L.-M.,Chang Gung Memorial Hospital at Taipei | Li M.-J.,Chang Gung Memorial Hospital at Taipei | And 3 more authors.
Reproductive Sciences | Year: 2012

Objective: To investigate the association between maternal oxidative stress at mid-gestation and subsequent development of pregnancy complications. Study design: A total of 503 healthy pregnant women provided their blood and urine samples at 24 to 26 weeks of gestation and were prospectively followed through postpartum. These samples were used to assess a variety of oxidative stress markers, including plasma total antioxidant capacity, 8-isoprostane, erythrocyte glutathione peroxidase and superoxide dismutase activity, and urinary 8-hydroxydeoxyguanosine (8-OHdG). Results: Compared with women with uncomplicated pregnancies, significantly higher plasma 8-isoprostane levels were noted in women who developed preeclampsia (P =.008) and small-for-gestational age infants (P =.002), while higher urinary 8-OHdG concentrations were noted in women who subsequently had low-birth-weight neonates (<2500 g, P =.043). Conclusion: Increased maternal oxidative stress at mid-gestation was associated with subsequent pregnancy complications. © The Author(s) 2012.


Hung T.-H.,Chang Gung Memorial Hospital at Taipei | Hung T.-H.,Chang Gung University | Chen S.-F.,Cheng Hsin Rehabilitation Medical Center | Lo L.-M.,Chang Gung Memorial Hospital at Taipei | And 3 more authors.
Placenta | Year: 2012

Myeloperoxidase (MPO) is a heme protein produced and released by activated neutrophils and monocytes, and increased MPO is considered important in the pathophysiology of cardiovascular diseases (CVD). Accumulating evidence suggests that preeclampsia (PE), idiopathic intrauterine growth restriction (IUGR), and CVD share many similar metabolic disturbances, including an enhanced systemic inflammatory response and endothelial dysfunction. We hypothesized that MPO plays an important role in the development of PE and IUGR. Plasma samples were collected mid-gestation and at delivery from women with normal pregnancies (n = 40) and those who subsequently developed PE (n = 20), IUGR (n = 11) or both (PE + IUGR, n = 8). Placental samples were obtained immediately after delivery from 22 women with normal pregnancies, 19 women with PE, 14 women with IUGR, and 14 women with PE + IUGR. The MPO concentrations were measured using ELISA. Women with PE + IUGR had significantly higher plasma MPO before delivery than normal pregnant women. There was no difference in plasma levels at mid-gestation or the placental concentrations between women with normal pregnancies and those who developed PE, IUGR, or PE + IUGR. Using explants prepared from the placentas of 8 women with normal pregnancies and 8 women with PE, we found no difference in the levels of MPO in the tissue homogenates and culture media between these two groups of women. Together, these results indicate that increased maternal circulating MPO in women with PE + IUGR is likely a result of enhanced systemic inflammation caused by the established disease rather than a primary pathophysiological factor. © 2012 Elsevier Ltd. All rights reserved.


Chang C.-J.,Chang Gung Memorial Hospital at Taipei
Biomedical Journal | Year: 2013

Background : The objective of this retrospective analysis was to assess the treatment of endoscope abdominoplasty for diastasis recti deformity patients. Methods : From January 1999 to January 2011, 88 patients ranging from 35 to 46 years in age were treated with videoendoscopy-assisted minimally invasive surgery. All patients were Asian. Early (< 3 months) and late (> 6 months) complications were assessed throughout a follow-up period of up to 66 months. Results : Observations were conducted at the end of three weeks, six months, and 66 months. Early on, all patients experienced numbness with local paresthesia (100%) closely after treatment, and reported the feelings to subside by six months post-treatment. Four patients (4.5%) experienced ecchymosis, and three patients (3.4%) were affected by seroma. One patient (1.1%) had dyspnea immediately after surgery, which recovered after oxygen (O 2 ) administration. Only one patient (1.1%) experienced minimal skin loss, which recovered after 3 months of surgery, and there were no further complications. Hypertrophic scars were apparent in three patients (3.4%) who showed no unwanted signs or further complications after post-operative scar care. No hematoma had been reported. All complications subsided (> 6 months) postoperatively. Conclusions : Videoendoscopy-assisted abdominoplasty can be used for diastasis recti deformity with minimal excess skin. Our study demonstrated effects against the formation of seroma and other complications.

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