Hualien Hospital

Hualian, Taiwan

Hualien Hospital

Hualian, Taiwan
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Wu H.-T.,National Dong Hwa University | Hsu P.-C.,National Dong Hwa University | Lin C.-F.,National Dong Hwa University | Wang H.-J.,National Dong Hwa University | And 5 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2011

This study proposed a dynamic pulse wave velocity (PWV)-based biomedical parameter in assessing the degree of atherosclerosis for the aged and diabetic populations. Totally, 91 subjects were recruited from a single medical institution between July 2009 and October 2010. The subjects were divided into four groups: young healthy adults (Group 1, n 22), healthy upper middle-aged adults (Group 2, n 28), type 2 diabetics with satisfactory blood sugar control (Group 3, n 21), and unsatisfactory blood sugar control (Group 4, n 20). A self-developed six-channel electrocardiography (ECG)-PWV-based equipment was used to acquire 1000 successive recordings of PWV foot values within 30 min. The data, thus, obtained were analyzed with multiscale entropy (MSE). Large-scale MSE index (MEI LS) was chosen as the assessment parameter. Not only did MEI LS successfully differentiate between subjects in Groups 1 and 2, but it also showed a significant difference between Groups 3 and 4. Compared with the conventional parameter of PWV foot and MEI on R-R interval i.e., MEI (RRI) in evaluating the degree of atherosclerotic change, the dynamic parameter, MEI LS (PWV), could better reflect the impact of age and blood sugar control on the progression of atherosclerosis. © 2011 IEEE.


Hsieh Y.-S.,Chung Shan Medical University | Tsai C.-M.,Hualien Hospital | Yeh C.-B.,Chung Shan Medical University | Yang S.-F.,Chung Shan Medical University | And 2 more authors.
Annals of Surgical Oncology | Year: 2012

Background: Early detection of hepatocellular carcinoma (HCC) is seldom available because of the lack of reliable markers. Survivin is an anti-apoptotic protein that is implicated in the regulation of apoptosis and cell cycle, and it is undetectable in normal adult tissues but is overexpressed in various types of cancers. Survivin is thus commonly considered to be a marker of malignancy. The aim of this study was to explore the association between survivin gene polymorphisms and the risk and diagnostic progress of HCC. Methods: A total of 135 patients with HCC and 496 healthy control subjects were recruited. Five single nucleotide polymorphisms (SNPs) of survivin genes were determined by real-time polymerase chain reaction (real-time PCR) and further analyzed statistically. Results: We first found that the -241 C/T and -235 G/A genetic polymorphisms of survivin did not occur frequently enough or even lacked in Taiwanese population. The +9809 C/C polymorphism exhibited a significant (P < .05) low risk of 0.525-fold (95% confidence interval [95% CI] = 0.297-0.930) to have HCC compared with the wild-type homozygotes and a low ratio of 0.214-fold (95% CI = 0.051-0.890) for positive anti-HCV was shown in the individuals with survivin +9809 polymorphic CC allele compared with the TT/TC genotypic subgroup. Conclusions: Survivin +9809 polymorphic genotype is associated with the risk of HCC, and the HCC patients with survivin +9809 CC homozygotes might have a low risk of developing infected HCV-dependent HCC. The results suggest that the survivin T9809C SNP might contribute to the prediction of susceptibility and pathological development to HCC. © 2011 Society of Surgical Oncology.


Chen M.-K.,Changhua Christian Hospital | Su S.-C.,University of Houston | Lin C.-W.,Chung Shan Medical University | Tsai C.-M.,Chung Shan Medical University | And 3 more authors.
Human Genetics | Year: 2012

Oral cancer is causally associated with environmental carcinogens, and the susceptibility to carcinogen- mediated tumorigenesis is proposed to be genotypedependent. Cathepsin B (CTSB) is a lysosomal cysteine protease and may serve as a candidate biomarker of oral cancer. The current study aimed to explore the influences of three single nucleotide polymorphisms (SNPs) in CTSB gene, combined with environmental carcinogens on the risk and clinicopathological development of oral cancer. Three SNPs of CTSB, CTSB C76G (rs12338), CTSB A4383C (rs13332), and CTSB A8422G (rs8898), from 444 male patients with oral cancer and 426 control participants (males not diagnosed with cancer) in Taiwan were analyzed. These three CTSB SNPs all exhibited insignificant (P[0.05) effects on the risk of oral cancer. However, the risk for developing the poor clinical stage of moderately or poorly differentiated cells was significantly (P\0.001) increased to 3.325-fold in patients with oral cancer carrying the polymorphic genotype of rs8898 compared to patients with the ancestral genotype. Additionally, while considering the exposure of environmental carcinogens, the presence of these three CTSB SNPs, combined with betel quid chewing [adjusted odds ratio (AOR) was 36.570, 21.772, and 43.962 for rs12338, rs13332, and rs8898, respectively] and/or tobacco use (AOR was 3.794, and 8.972 for rs12338 and rs13332, respectively), robustly elevated the susceptibility to oral cancer. These results suggest that the genetic polymorphism of CTSB A8422G (rs8898) was associated with a high risk for the clinicopathological development of oral cancer and CTSB gene polymorphisms may increase the susceptibility to environmental carcinogens-mediated oral cancer. © Springer-Verlag 2012.


Tsai C.-M.,Chung Shan Medical University | Tsai C.-M.,Tainan Hospital | Tsai C.-M.,Hualien Hospital | Sun F.-M.,Health Science University | And 4 more authors.
European Journal of Pharmaceutical Sciences | Year: 2013

Dietary polyphenols have been reported as an effective phytochemical for health protection and cinnamic acid (CA) is one of the polyphenols that has been demonstrated having chemopreventive potential. It was known that the early and distal metastasis might lead to the high mortality of patients with lung adenocarcinoma. We previously compared and verified the inhibitory effect of cis-CA and trans-CA on phorbol- 12-myristate-13-acetate (PMA)-induced invasion of human lung adenocarcinoma A549 cells. The aim of this study was to explore the underlying molecular mechanism. By gelatin zymography and semi-quantitative RT-PCR, the activities and mRNA of MMP-9/MMP-2 exerted a significantly (p < .05) dose-dependent reduction by treating with cis-CA and trans-CA. Western blots further showed that the cis-CA- and trans-CA-inhibited MMPs might partly through modulating TIMP-1 and the PAI-2-regulated uPA activity. In molecular level, the AP-1 and NF-jB as well as the downstream of the MAPK pathway might be involved in cis-CA- and trans-CA-inhibited MMPs expression. This study disclosed the molecular mechanism underlying the anti-invasive activity of cis-CA and trans-CA and concluded the cis- and trans-form of CA should be a safe and potential agent to prevent lung tumor cells from metastasizing. © 2012 Elsevier B.V. All rights reserved.


Chung S.-D.,Far Eastern Memorial Hospital | Liao C.-H.,Fu Jen Catholic University | Chen Y.-C.,Hualien Hospital | Kuo H.-C.,Far Eastern Memorial Hospital
Neurourology and Urodynamics | Year: 2011

Aims To evaluate the correlation between an urgency severity scale (USS) based on a voiding diary with detrusor overactivity (DO) in a videourodynamic study in patients with an overactive bladder (OAB). Methods We prospectively enrolled 190 consecutive patients with OAB. All patients were assessed using a USS and completed a 3-day voiding diary that recorded urgency and urgency urinary incontinence (UUI) episodes and the degree of urgency severity. The highest recorded USS score in the voiding diary was considered as the USS score. A videourodynamic study was performed, and the presence of increased bladder sensation (IBS) or DO was recorded. These clinical findings and videourodynamic data were analyzed. Results This study enrolled 65 men and 125 women. The mean patient age was 66.4 years (21-88). Among them, 82.6% had urodynamic DO, 7.9% had IBS, and 9.5% had normal urodynamic findings. The prevalence of DO was 50%, 76%, and 94% in patients with a USS = 2, 3, and 4, respectively. Multivariate analysis indicated that OAB wet, high USS and UUI were significantly associated with the presence of DO. Urodynamic DO was present in most patients with OAB wet (94.1%) or USS = 4 (95.5%); however, only 63.9% of OAB dry patients had DO. In the OAB dry patients, 11/25 (44%) with USS = 2, 30/42 (71%) with USS = 3, and 5/5 (100%) with USS = 4 had DO. Conclusions A high USS recorded in conjunction with a voiding diary and OAB wet were strongly associated with urodynamic DO. Copyright © 2011 Wiley-Liss, Inc.


Wu H.-T.,National Dong Hwa University | Lee C.-H.,National Dong Hwa University | Liu A.-B.,National Dong Hwa University | Liu A.-B.,Buddhist Tzu Chi General Hospital | And 6 more authors.
IEEE Transactions on Biomedical Engineering | Year: 2011

Although current technique of photoplethysmography (PPG) is a popular noninvasive method of waveform contour analysis in assessing arterial stiffness, data obtained are frequently affected by various environmental and physiological factors. We proposed an easily operable air pressure sensing system (APSS) for radial arterial signal capturing. Totally, 108 subjects (young, the aged with or without diabetes) were recruited from July 2009 to May 2010. Arterial waveform signals from the wrist were obtained and analyzed using HilbertHuang transformation (HHT). Through ensemble empirical mode decomposition (EEMD), the signals were decomposed into eight intrinsic mode functions (IMF18) of which IMF5 was found to be the desired signal with a discernible diastolic peak. The results showed significant differences in reflection index (RI) and stiffness index (SI) from the young subjects and those from the aged participants with or without diabetes. Significant differences in RI and SI were also noted between subjects with well-controlled diabetes and those without. Good reproducibility and correlation were demonstrated. In conclusion, the present study proposed the application of radial arterial signal capturing subsystem and HHT in acquiring more reliable data on RI and SI compared with the conventional PPG method. © 2010 IEEE.


Wu H.-T.,National Dong Hwa University | Lee C.-H.,National Dong Hwa University | Sun C.-K.,I - Shou University | Hsu J.-T.,National Dong Hwa University | And 2 more authors.
IEEE Transactions on Instrumentation and Measurement | Year: 2012

Although air pressure sensing system (APSS) is a reliable means of assessing vascular endothelial function with high reproducibility, it cannot distinguish between the effects of age and diabetes. This paper aimed at investigating the potential benefit of utilizing signal-processing technique in improving the clinical validity of APSS. Arterial waveforms acquired from the left wrist before and after induction of reactive hyperemia over the left arm were recorded using APSS. Values of dilatation index (DI) were calculated and compared before (DI ORIGINAL) and after (DI EEMDensemble empirical mode decomposition (EEMD). Compared with ORIGINALDI EEMD showed better negative correlations with anthropometric, hemodynamic, and biochemical parameters (all P < 0.05). Instead of DI ORIGINALDI EEMD significantly distinguished between the two groups of testing subjects (P = 0.008) EEMD further refined the validity of DI obtained through APSS, which is a simple self-operable system in evaluating endothelial function for the general public. It may also serve as an assessment tool for clinicians to implement timely therapeutic measures for diabetic patients. © 2011 IEEE.


Wu H.-T.,National Dong Hwa University | Lee C.-H.,National Dong Hwa University | Chen C.-J.,Hualien Hospital | Sun C.-K.,I - Shou University
Journal of Sexual Medicine | Year: 2012

Introduction. High prevalence of erectile dysfunction in young adults has raised much concern regarding early identification of risk factors for timely intervention. Aim. This study aimed at identifying young males at risk through a novel penile arterial waveform analyzing system. Methods. Between July 2009 and December 2010, 30 young adult volunteers of age 18 to 29 without known history of vascular diseases or erectile dysfunction were recruited. Main Outcome Measures. Basic demographic and anthropometric characteristics (i.e., age, body weight, body height, body mass index, waist circumference) were recorded. Blood samples were obtained for determining levels of testosterone, glycosylated hemoglobin, triglyceride, fasting sugar, low- and high-density lipoproteins (HDL). Data obtained from visual sexual stimulation (VSS) RigiScan and the penile arterial waveform amplitude (PAWA) ratios were compared in terms of their correlations with anthropometric and serum biochemical parameters using Pearson's correlation analysis. Results. PAWA ratios were found to correlate with Rigidity (tip and base) (r=0.425, P=0.019 and r=0.664, P<0.001, respectively). Significant associations of PAWA ratios were noted not only with serum testosterone level but also with risk factors for metabolic and cardiovascular diseases including total triglyceride, HDL, age, waist circumference, body mass index, and diastolic blood pressure. However, VSS RigiScan failed in identifying significant correlations with HDL, age, and diastolic blood pressure. Conclusions. Not only could the penile waveform analyzing system assess penile endothelial function in young adults, but the results also showed significant associations with their serum testosterone levels and metabolic parameters. The findings suggest that PAWA ratio may serve as an indicator for early identification and treatment of young adults at risk of erectile dysfunction. © 2012 International Society for Sexual Medicine.


Wu H.-T.,National Dong Hwa University | Lee C.-H.,National Dong Hwa University | Chen C.-J.,Hualien Hospital | Sun C.-K.,I - Shou University
Annals of Biomedical Engineering | Year: 2011

Not only does erectile dysfunction (ED) reflect penile vascular disorder in the majority of patients, but it also implicates their high systemic cardiovascular risk. Based on the principle of reactive hyperemia after a brief period of penile ischemia, in this study, we tested the validity of a new Penile Arterial Waveform Analyzer (PAWA) in assessing the relative increase in post-ischemic penile perfusion. Twenty young adult males (mean age 24.24 ± 2.45) without known history of cardiovascular diseases were recruited, whose anthropometric characteristics were recorded and their serum testosterone levels as well as biochemical profiles were determined. A penile cuff was applied to each subject, with cuff pressure being increased from 80 to 250 mmHg, each for 4 min, followed by reperfusion for 7 min. By dividing the area under waveform contour of hyperemic and baseline signals after Ensemble Empirical Mode Decomposition (EEMD), a Penile Perfusion Index (PPI) was calculated. Penile Brachial Index (PBI) was also obtained for comparison. The results not only showed a significant agreement between PPI and serum testosterone levels, but also a superiority of PPI to PBI in distinguishing the high- and low-risk groups for potential ED (PPI: p = 0.039 vs. PBI: p = 0.147). PPI was also demonstrated to show significant correlations with waist circumference (p < 0.001), body mass index (p = 0.005), body weight, total triglyceride, high-density lipoprotein, and systolic and diastolic pressures (all p < 0.05). In conclusion, we proposed a portable and easy-to-operate system in assessing the relative increase in penile perfusion after brief ischemia. The PPI thus obtained correlated significantly with serum testosterone levels as well as key anthropometric and serum biochemical parameters even in apparently healthy young adults, suggesting its potential as a sensitive tool in monitoring penile vascular function and risk for ED. © 2011 Biomedical Engineering Society.


Chen Y.-C.,Hualien Hospital | Kuo H.-C.,Tzu Chi University
LUTS: Lower Urinary Tract Symptoms | Year: 2012

Objectives: Intravesical injection of onabotulinumtoxinA (i.e. Botox) provides effective treatment for overactive bladder. However, treatment-related adverse events (AEs) remain problems. This study investigated the effect of AEs after onabotulinumtoxinA injection on the success rate for idiopathic detrusor overactivity (IDO). Methods: A total of 174 patients who received the first single intravesical onabotulinumtoxinA 100U injection for refractory IDO were included. The onabotulinumtoxinA related AEs including acute urinary retention (AUR), large postvoid residual (PVR, ≥150 mL), difficult urination, urinary tract infection, gross hematuria and general weakness were recorded. The success rate was determined based on patient perception of bladder condition improved by two scales. The short-term (3 months) and long-term (up to 24 months) success rates were analyzed according to the occurrence of these AEs. Results: A successful outcome was reported by 138 (79.3%) patients at 3 months. AUR occurred in 12 (6.9%) patients, large PVR developed in 81 (46.6%) and 73 (42%) needed straining to void. Gross hematuria occurred in 17 (9.8%) patients, urinary tract infection developed in 27 (15.5%) and general weakness was noted in 6 (3.4%). The occurrence of AUR did not affect the therapeutic results. Patients having large PVR and difficult urination had a significantly higher success rate at 3 months. Long-term success rates up to 24 months showed no significant difference between patients with and without AEs. Conclusions: AEs after intravesical 100U onabotulinumtoxinA for IDO were frequently encountered. However, the occurrence of AUR, large PVR or difficult urination did not affect the final therapeutic outcome. © 2011 Blackwell Publishing Asia Pty Ltd.

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