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Chiou Y.-Y.,National Cheng Kung University | Wang S.-T.,Ditmanson Medical Foundation Chiayi Christian Hospital
Nephron - Clinical Practice | Year: 2012

Background/Aim: The effects of ω-3 fatty acids (O3FAs) on renal function and proteinuria in immunoglobulin A nephropathy (IgAN) are not fully understood. Thus, we conducted an up-to-date meta-analysis of the currently available randomized controlled trials (RCTs) to validate the effects of O3FA in IgAN. Methods: A literature search was performed in PubMed, Medline, Embase and the Cochrane Central Registry of Controlled Trials using an extended search strategy to identify RCTs that assessed the treatment efficacy of O3FA in IgAN. The dose-effect relationships of O3FA on renal function and proteinuria were also determined. Results: Five RCTs with a total of 233 patients were included in our analysis. Our results demonstrated that while O3FA does not have any beneficial effects in preserving renal function in IgAN, proteinuria was significantly reduced. Furthermore, patients who received a high dose of O3FA (>3 g/day) did not differ from those who received a low dose of O3FA (≤3 g/day) in renal function or proteinuria. Conclusion: The currently available evidence suggests that O3FA has no benefit in preserving renal function, but can ameliorate proteinuria in IgAN. However, the effects of O3FA on proteinuria are not dose dependent. Copyright © 2012 S. Karger AG, Basel.

Chang Y.-J.,Central Taiwan University of Science and Technology | Yao C.-H.,China Medical University at Taichung | Yao C.-H.,Asia University, Taiwan | Wu J.,National Yang Ming University | And 3 more authors.
Nuclear Instruments and Methods in Physics Research, Section A: Accelerators, Spectrometers, Detectors and Associated Equipment | Year: 2015

One of the problems in obtaining quality results is image registration when a gel dosimeter is used in conjunction with optical computed tomography (CT). This study proposes a passive alignment mechanism to obtain a precisely measured dose map. A holder plate with two pin-hole pairs is placed on the gel container cap. These two pin-hole pairs attach the gel container to the vertical shaft and can be precisely aligned with the rotation center of the vertical shaft at any time. Accordingly, a better reconstructed image quality is obtained. After obtaining a precisely measured dose map, the scale invariant feature transform (SIFT)-flow algorithm is utilized as an image registration method to align the treatment plan software (TPS) image with the measured dose map image. The results show that the gamma pass rate for the single-field irradiation increases from 83.39% to 94.03% when the algorithm is applied. And the gamma pass rate for the five-field irradiation treatment plan increases from 87.36% to 94.34%. The translation, scaling, and rotation occurring in the dose map image constructed using an optical CT scanner are also aligned with those in the TPS image using the SIFT-flow algorithm. Accordingly, improved gamma comparison results and a higher gamma pass rate are obtained. © 2014 Elsevier B.V.

Liao C.-S.,Ditmanson Medical Foundation Chiayi Christian Hospital
Formosan Journal of Surgery | Year: 2012

Spontaneous intestinal perforation due to tuberculous (TB) enteritis is rare, occurring in 1-15%. Much rarer are TB intestinal perforations among patients receiving their course of anti-TB treatment. This is the so-called paradoxical response phenomenon, e.g., the occurrence of clinical or radiological worsening of pre-existing TB lesions, or the development of new lesions not attributable to the normal course of the disease in a patient who initially improves from the anti-TB treatment. A 52-year-old male patient with three episodes of spontaneous small intestinal perforations in a span of 4.5 months while receiving anti-TB treatment is presented here and the intraperitoneal changes in each operation documented. On each occasion, he recovered uneventfully after resection of the involved segment of intestine. The pathological examination of the resected segments of bowel in the second and third operations failed to show remnant TB granuloma. Seven months after his last operation, he resumed his normal work routine and completed his TB treatment without further medical mishap. The number of spontaneous intestinal perforations in such a paradoxical response phenomenon does not appear to have any bearing on his prognosis for cure of the disease. © 2012.

Wu C.-C.,Buddhist Tzu Chi Medical Foundation | Hsu T.-W.,Buddhist Tzu Chi Medical Foundation | Hsu T.-W.,Tzu Chi University | Chang C.-M.,Buddhist Tzu Chi Medical Foundation | And 7 more authors.
Oncologist | Year: 2016

Introduction. Although palliative chemotherapy during endof-life care is used for relief of symptoms in patients with metastatic cancer, chemotherapy may lead to more aggressive end-of-life care and lessuse of hospice service.This is a population based study of the association between palliative chemotherapy and aggressiveness of end-of-life care. Patients and Methods. Using the National Health Insurance Research Database of Taiwan, we identified 49,920 patients with metastatic cancer who underwent palliative chemotherapy from January 1, 2009, to December 31, 2011. Patients who received chemotherapy 2-6 months before death were included. Aggressiveness of end-of-life care was examined by previously reported indicators. Cardiopulmonary resuscitation and endotracheal tube intubation were included as indicators of aggressive end-of-life care. The association between palliative chemotherapy and hospice care was studied. Results. Palliative chemotherapy was associated with more aggressive treatment. After adjustment for patient age, sex, Charlson Comorbidity Index score, cancer group, primary physician’s specialty, postdiagnosis survival, hospital characteristics, hospital caseload, urbanization, and geographic regions, more than one emergency room visit (p, .001), more than one intensive care unit admission (p, .001), and endotracheal intubation (p 5 .02) during end-of-life care were significantlymore common in patients receiving palliative chemotherapy. Patients who did not receive palliative chemotherapy received more hospice care in the last 6 months of life (p,.001). Conclusion. Although the decision to initiate palliative chemotherapy was made several months before death, this study showed that palliative chemotherapy was associated with more aggressive end-of-life care, including more emergency room visits and intensive care unit admissions, and endotracheal intubation. The patients who received palliative chemotherapy received less hospice service toward the end of life. © AlphaMed Press 2016.

Chuang P.W.,Foundation Medicine | Huang B.-M.,Foundation Medicine | Liu C.H.,Foundation Medicine | Chen C.-C.,Ditmanson Medical Foundation Chiayi Christian Hospital | And 2 more authors.
Indian Journal of Surgery | Year: 2015

Appendicitis is a common surgical abdominal disease with various presentations. Its diagnosis may be obscured by asymptomatic congenital anatomical anomalies like midgut malrotation. Midgut malrotation is a rare fetal anomaly resulting from incomplete or failure of midgut rotation and fixation. It is mostly presented with bowel obstruction or volvulus in early life. Presentation in adult is rare. Here, we report an elderly patient presented with left lower abdominal pain and urinary tract infection. Abdominal computed tomography revealed left-sided appendicitis with non-rotational-type midgut malrotation. Clinicians should bear in mind the possibility of underlying midgut malrotation, as appendicitis could be the first presentation of this rare congenital condition. © 2014, Association of Surgeons of India.

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