Tainan, Taiwan
Tainan, Taiwan

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Chen C.-Y.,National Taiwan University Hospital | Tai C.-H.,National Taiwan University Hospital | Cheng A.,National Taiwan University Hospital | Wu H.-C.,Chi Mei Hospital | And 7 more authors.
BMC Medicine | Year: 2012

Background: Clinical characteristics and outcomes of intracranial hemorrhage (ICH) among adult patients with various hematological malignancies are limited.Methods: A total of 2,574 adult patients diagnosed with hematological malignancies admitted to a single university hospital were enrolled into this study between 2001 and 2010. The clinical characteristics, image reports and outcomes were retrospectively analyzed.Results: A total of 72 patients (48 men and 24 women) with a median age of 56 (range 18 to 86) had an ICH. The overall ICH incidence was 2.8% among adult patients with hematological malignancies. The incidence of ICH was higher in acute myeloid leukemia (AML) patients than in patients with other hematological malignancies (6.3% vs 1.1%, P = 0.001). ICH was more common among patients with central nervous system (CNS) involvement of lymphoma than among patients with CNS involved acute leukemia (P <0.001). Sites of ICH occurrence included the cerebral cortex (60 patients, 83%), basal ganglia (13 patients, 18%), cerebellum (10 patients, 14%), and brainstem (5 patients, 7%). A total of 33 patients (46%) had multifocal hemorrhages. In all, 56 patients (77%) had intraparenchymal hemorrhage, 22 patients (31%) had subdural hemorrhage, 15 patients (21%) had subarachnoid hemorrhage (SAH), and 3 patients (4%) had epidural hemorrhage. A total of 22 patients had 2 or more types of ICH. In all, 46 (64%) patients died of ICH within 30 days of diagnosis, irrespective of the type of hematological malignancy. Multivariate analysis revealed three independent prognostic factors: prolonged prothrombin time (P = 0.008), SAH (P = 0.021), and multifocal cerebral hemorrhage (P = 0.026).Conclusions: The incidence of ICH in patients with AML is higher than patients with other hematological malignancies. But in those with intracranial malignant disease, patients with CNS involved lymphoma were more prone to ICH than patients with CNS involved acute leukemia. Mortality was similar regardless of the type of hematological malignancy. Neuroimaging studies of the location and type of ICH could assist with prognosis prediction for patients with hematological malignancies. © 2012 Chen et al; licensee BioMed Central Ltd.

Chen S.-W.,Taipei Medical University Hospital | Chen S.-W.,China Medical University at Taichung | Chen S.-W.,Taipei Medical University | Lin L.-C.,Chi Mei Hospital | And 6 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2014

Purpose This phase 2 study evaluated the efficacy of radiation therapy (RT) with concurrent and sequential sorafenib therapy in patients with unresectable hepatocellular carcinoma (HCC). Methods and Materials Forty patients with unresectable HCC unfit for transarterial chemoembolization were treated with RT with concurrent and sequential sorafenib. Sorafenib was administered from the commencement of RT at a dose of 400 mg twice daily and continued to clinical or radiologic progression, unacceptable adverse events, or death. All patients had underlying Child-Pugh A cirrhosis. The maximal tumor diameter ranged from 3.0 cm to 15.5 cm. Coexisting portal vein thrombosis was found in 24 patients and was irradiated simultaneously. The cumulative RT dose ranged from 40 Gy to 60 Gy (median, 50 Gy). Image studies were done 1 month after RT and then every 3 months thereafter. Results Thirty-three (83%) completed the allocated RT. During RT, the incidence of hand-foot skin reactions ≥ grade 2 and diarrhea were 37.5% and 25%, respectively, and 35% of patients had hepatic toxicities grade ≥2. Twenty-two (55.0%) patients achieved complete or partial remission at the initial assessment, and 18 (45%) had stable or progressive disease. The 2-year overall survival and infield progression-free survival (IFPS) were 32% and 39%, respectively. A Cancer of the Liver Italian Program (CLIP) score ≥2 was associated with an inferior outcome in overall survival. Six patients (15%) developed treatment-related hepatic toxicity grade ≥3 during the sequential phase, and 3 of them were fatal. Conclusions When RT and sorafenib therapy were combined in patients with unresectable HCC, the initial complete or partial response rate was 55% with a 2-year IFPS of 39%. A CLIP score ≥2 was associated with an inferior outcome in overall survival. Hepatic toxicities are a major determinant of the safety; the combination should be used with caution and needs further investigation. © 2014 Elsevier Inc. All rights reserved.

PubMed | National Cheng Kung University, China Medical University at Taichung, Chi Mei Hospital and Taipei Medical University Hospital
Type: Journal Article | Journal: Oncotarget | Year: 2016

OxLDL facilitate reactive oxygen species (ROS) formation and up-regulation of the executioner caspase-3 via the mitochondrial apoptotic pathway involves several critical steps in human endothelial cells. Previous studies reported that oxLDL-facilitated endothelial oxidative stress is associated with impairment of eNOS and up-regulation of inducible nitric oxide synthase (iNOS). Baicalein is the most abundant component that has anti-HIV, anti-tumor, anti-oxidant and free radical scavenging functions. In this present study, we shown that baicalein hinibits oxLDL-caused endothelial dysfunction through suppression of endothelial inflammation and oxidative stress that causes to cellular apoptosis. Specifically, baicalein reduces the elevation of ROS concentration, which subsequently inhibits the oxLDL-decreased expression of anti-oxidant enzymes, enriches the bioavailability of NO, stabilizes the mitochondrial membrane, thereby inhibiting the discharge of cytochrome c from mitochondria, a molecule required for the activation of the pro-apoptotic protein caspase 3. However, inhibition of eNOS impairs the anti-apoptotic and anti-inflammatory effects of baicalein. These results provide new insight into the possible molecular mechanisms by which baicalein protects against atherogenesis by NO-related pathways.

PubMed | National Cheng Kung University, Taipei Medical University Hospital, China Medical University at Taichung and Chi Mei Hospital
Type: Journal Article | Journal: Oncotarget | Year: 2016

Atherosclerosis is considered to be a form of chronic inflammation and a disorder of lipid metabolism. Oxidative transformations in the lipid and apolipoprotein B (Apo B) constituent of low density lipoprotein drive the initial step in atherogenesis due to macrophage scavenger receptors identify oxidized LDL (oxLDL) but non-oxidized LDL. The human vascular endothelial cells fact a critical role in vasodilation, provides a nonadhesive surface for circulation, reduces vascular smooth muscle proliferation, inflammation, thrombus formation and platelet aggregation. Assembly of oxLDL contribute to stimulation of endothelial cells with up-regulation of adhesion molecules, increase oxidative stress to the vascular endothelium and inhibition of NO-mediated vasodilation. When adhesion molecules are over-expressed on the surface of endothelial cells under oxLDL stimulation, it will recruit monocytes to the arterial wall. Then adherent monocytes will migrate into the subendothelial space and subsequently differentiate into macrophages. In the subendothelial space, oxLDL will be taken up by macrophages, thereby causing the substantial cholesterol accumulation and the foam cells production.

PubMed | Kaohsiung Medical University, Chi Mei Hospital and Kaohsiung Municipal Ta Tung Hospital
Type: Journal Article | Journal: The Kaohsiung journal of medical sciences | Year: 2016

If portal vein stenosis (PVS) occurs within 1month after liver transplantation (LT), especially within 1week, it can be catastrophic and result in rapid loss of the grafts and mortality. Although surgical treatments have been considered standard treatment for PVS, patients are usually unable to receive operations or re-transplantations, because of their critical conditions and a shortage of grafts. Recently, primary percutaneous transhepatic portal vein stents (PTPS) were suggested as alternative and less-invasive treatments of PVS. However, because lethal complications may follow these primary stent placements for patients in early stages after LT, primary PTPS placements for patients suffering PVS 1month after LT has been suggested. From November 2009 to July 2015, 38 consecutive adult patients underwent LT at our institution. Among them, six recipients suffered PVS within 1month after LT. Technical success was achieved in all six patients. Clinical success was obtained in two of the four patients suffering PVS within 1week after LT, and in the other two patients suffering PVS>1week after LT. All surviving patients and their grafts were in good condition, and their stents remained patent. Our experience showed that primary PTPS placements can be used to effectively treat patients with PVS encountered within 1month, and even within 1week, after LT with acceptable short-term results. However, possible fatal complications should be kept in mind. Long-term results of these procedures need further follow-up.

Lee M.-S.,National Defense Medical Center | Lee M.-S.,Monash University | Wahlqvist M.L.,National Defense Medical Center | Wahlqvist M.L.,Monash University | And 3 more authors.
Asia Pacific Journal of Clinical Nutrition | Year: 2015

The health relevance of dairy products has mostly been judged by their abundant nutrients (protein, calcium and riboflavin) and recommendations for these derived in lactase-persistent Caucasian populations. Extrapolation to Asians who are generally lactase non-persisters may not be biologically, culturally or environmentally sound. A number of studies, especially among north-east Asians as in Taiwan, provide guidance for their optimal dairy intakes. In Taiwan, the NAHSIT (Nutrition and Health Surveys in Taiwan) linked to the National Health Insurance and Death Registry data bases provide most of the evidence. Cultural and socio-economic barriers create population resistance to increase dairy consumption beyond one serving per day as reflected in food balance sheet and repeat survey trend analyses. For the morbidity and mortality patterns principally seen in Asia, some, but not too much, dairy is to be preferred. This applies to all-cause and cardiovascular, especially stroke, mortality, to the risk of overfatness (by BMI and abdominal circumference) and diabetes and very likely to fracture and its sequelae. In Taiwan, there is no apparent association with total cancer mortality, but among Europeans, there may be protection. Historically, while fermented mammalian milks have been consumed in south Asia and various Asian subgroups and regions, most of the uptake of dairy in Asia after World War 2 has been from imported powdered milk or fresh liquid milk, encouraged further by the use of yogurts and popularization of milk teas and coffee. Asian dietary guidelines and clinical nutrition protocols need to encourage a modest, asymptomatic dairy intake.

Tsai M.-S.,Kuo General Hospital | Shaw H.-M.,Kuo General Hospital | Li Y.-J.,Chia Nan University of Pharmacy and Science | Lin M.-T.,Kuo General Hospital | And 2 more authors.
Nephrology | Year: 2014

Aim Visceral fat is more significantly correlated with inflammation markers and oxidative stress than is subcutaneous fat. Myeloperoxidase is one inflammatory signal secreted after polymorphonuclear leukocytes are stimulated. However, few studies discuss the correlation between visceral fat and the inflammatory response in patients with chronic kidney disease (CKD). Methods Sixty-six patients with CKD were enrolled and 60 healthy participants. Visceral fat levels were obtained using bioelectrical impedance analysis. Traditional risk factors for myeloperoxidase were analyzed. Results Baseline myeloperoxidase levels were significantly different between patients and controls, and were correlated with visceral fat after they had been adjusted for residual renal function. A multivariate linear regression model revealed that the neutrophil count and visceral fat and serum albumin levels were significant predictors of plasma myeloperoxidase in patients with CKD, but not in controls. The neutrophil count was correlated with myeloperoxidase only in the CKD group. Conclusion Visceral fat predicted plasma myeloperoxidase in patients with CKD, but not in healthy controls. Myeloperoxidase was probably contributed by primed and activated neutrophils that had been irritated by visceral fat in patients with CKD. Summary at a Glance Myeloperoxidase associated with body fat in patients with chronic kidney disease (CKD) and not in those without CKD indicating a role of inflammation/oxidative stress linking visceral obesity with CKD. Interesting hypothesis-generating work and good effort, limitations acknowledged. © 2013 Asian Pacific Society of Nephrology.

Wang J.-J.,National Cheng Kung University | Hsiao C.-H.,Chi Mei Hospital
Hu li za zhi The journal of nursing | Year: 2015

Abstract available from the publisher.The impact of aging on society is comprehensive and profound. Dementia is a key representative disease / condition of aging societies. The complexity of the course, behavior, and psychiatric symptoms of this disease often burdens families and challenges professional caregivers. Thus, dementia is a growing problem in healthcare that cannot be ignored. As nurses are the healthcare professionals that are most frequently in contact with dementia patients and their families, they occupy a pivotal position in the dementia care team. The present study analyzes the current problems encountered in caring for dementia patients in different care settings, highlights the current difficulties encountered in dementia-care policy and practice in Taiwan, and reviews the development and role of clinical nurse specialists in dementia care in several developed countries. Finally, we propose relevant policy, practice, organizational, and future research recommendations. The content of this paper may be used as a reference for related policymaking and in the promotion of the advanced nursing care role in dementia care.

Tsai M.-C.,National Cheng Kung University | Lin S.-H.,National Cheng Kung University | Chou Y.-Y.,National Cheng Kung University | Lin S.-J.,Chi Mei Hospital
European Journal of Pediatrics | Year: 2014

There have been few reports about adolescent experiences with and expectations of health service utilization in an Asian societal setting. The aim of this study is to analyze the use of healthcare services in relation to health status and explore adolescents' preferences for youth-friendly service among Taiwanese high school students. A cross-sectional questionnaire-based survey was conducted on Taiwanese adolescents aged 12-18 years in 2010. We invited participants to rate their health status, report their previous healthcare service use, and rank their health service preferences. We used logistic regression analysis to investigate the association between self-rated health status and healthcare utilization and used nonparametric analysis to compare health service preferences among sociodemographic subgroups. A total of 4,907students (97.2 % response rate) returned valid questionnaires for analysis. Poor health status and chronic illness were most salient factors independently associated with frequent healthcare service use. Only 40 % of respondents reported having a regular doctor, and pediatrics (57.7 %) was the most commonly identified professional source of medical care. A great majority (86.2 %) of respondents made clinical visits with parents. For characteristics of youth-friendly clinician, the top-ranked items included competency and patience, while having helpful and friendly personnel was highlighted for clinical setting. Conclusion: Family participation is critical in healthcare for adolescents in Asian cultures. Health service use is significantly influenced by health status and chronic illness in the general health insurance system. Understanding these background influences on expectations for healthcare may help to create youth-friendly health services that are more culturally appropriate. © 2013 Springer-Verlag Berlin Heidelberg.

Yang L.-T.,National Cheng Kung University | Yang L.-T.,Tainan Hospital | Liu Y.-W.,National Cheng Kung University | Shih J.-Y.,Chi Mei Hospital | And 4 more authors.
Journal of the American Society of Echocardiography | Year: 2015

Background Impaired left atrial (LA) deformation is noted in patients with severe primary mitral regurgitation (MR), but its prognostic value is unknown. The aim of this study was to investigate the prognostic significance of LA deformation parameters in patients with chronic severe primary MR. Methods A total of 104 patients with asymptomatic chronic severe primary MR (Carpentier type II) and preserved left ventricular systolic function were prospectively recruited. Global peak positive strain of the left atrium (LASp) and strain rate in the LA filling phase (LASRr) as well as strain rate in the LA conduit phase were identified using two-dimensional speckle-tracking echocardiography. Results During a mean follow-up period of 13.2 ± 9.5 months, 22 patients reached a composite end point of death and mitral valve repair or replacement prompted by heart failure development. Among the clinical and echocardiographic parameters, LV end-systolic volume index (19.5 ± 9.5 vs 15.7 ± 6.3 mL/m2, P =.028), LASp (22.7 ± 10.4% vs 27.2 ± 9.1%, P =.049), and LASRr (1.97 ± 0.6 vs 2.33 ± 0.6 1/sec, P =.013) varied between the two groups in terms of end points but not age, LA volume index, left ventricular ejection fraction, pulmonary artery systolic pressure, and presence of atrial fibrillation. After multivariate analysis, low LASp (odds ratio, 3.606; 95% CI, 1.294-10.052; P =.014) and low LASRr (odds ratio, 2.857; 95% CI, 1.078-7.572; P =.035) remained powerful outcome indicators. Conclusions In patients with asymptomatic severe primary MR, reduced LASp and LASRr predicted a worse prognosis. These findings may offer additional information to guide early surgery. © 2015 American Society of Echocardiography.

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