Chang Gung Memorial Hospital Kaohsiung

Kaohsiung, Taiwan

Chang Gung Memorial Hospital Kaohsiung

Kaohsiung, Taiwan
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Chan S.H.H.,Chang Gung Memorial Hospital Kaohsiung | Chan J.Y.H.,Kaohsiung Veterans General Hospital | Hsu K.S.,National Cheng Kung University | Li F.C.H.,Chang Gung Memorial Hospital Kaohsiung | And 5 more authors.
British Journal of Pharmacology | Year: 2011

BACKGROUND AND PURPOSE Little information exists on the mechanisms that precipitate brain stem death, the legal definition of death in many developed countries. We investigated the role of tropomyocin receptor kinase B (TrkB) and its downstream signalling pathways in the rostral ventrolateral medulla (RVLM) during experimental brain stem death. EXPERIMENTAL APPROACH An experimental model of brain stem death that employed microinjection of the organophosphate insecticide mevinphos bilaterally into the RVLM of Sprague-Dawley rats was used, in conjunction with cardiovascular, pharmacological and biochemical evaluations. KEY RESULTS A significant increase in TrkB protein, phosphorylation of TrkB at Tyr 516 (pTrkB Y516), Shc at Tyr 317 (pShc Y317) or ERK at Thr 202/Tyr 204, or Ras activity in RVLM occurred preferentially during the pro-life phase of experimental brain stem death. Microinjection bilaterally into RVLM of a specific TrkB inhibitor, K252a, antagonized those increases. Pretreatment with anti-pShc Y317 antiserum, Src homology 3 binding peptide (Grb2/SOS inhibitor), farnesylthioacetic acid (Ras inhibitor), manumycin A (Ras inhibitor) or GW5074 (Raf-1 inhibitor) blunted the preferential augmentation of Ras activity or ERK phosphorylation in RVLM and blocked the up-regulated NOS I/protein kinase G (PKG) signalling, the pro-life cascade that sustains central cardiovascular regulation during experimental brain stem death. CONCLUSIONS AND IMPLICATIONS Activation of TrkB, followed by recruitment of Shc/Grb2/SOS adaptor proteins, leading to activation of Ras/Raf-1/ERK signalling pathway plays a crucial role in ameliorating central cardiovascular regulatory dysfunction via up-regulation of NOS I/PKG signalling cascade in the RVLM in brain stem death. These findings provide novel information for developing therapeutic strategies against this fatal eventuality. © 2011 The Authors.

Yu H.-J.,National Taiwan University Hospital | Lin A.T.-L.,Taipei Veterans General Hospital | Yang S.S.-D.,Buddhist Tzu Chi General Hospital | Tsui K.-H.,Chang Gung Memorial Hospital Linkou | And 5 more authors.
BJU International | Year: 2011

Study Type - Therapy (RCT) Level of Evidence 1b What's known on the subject? and What does the study add? Silodosin administered by 4 mg twice daily is as effective as tamsulosin 0.2 mg daily in treating patients with LUTS associated with BPH. Relative to tamsulosin, silodosin has less cardiovascular side effects as judged by the minimal changes of blood pressure and pulse rats after treatment. OBJECTIVE • To test the hypothesis that the efficacy of silodosin would not be inferior to tamsulosin in treating patients with lower urinary tract symptoms associated with benign prostate hyperplasia (BPH). PATIENTS AND METHODS • At nine medical centres, 209 patients with an International Prostate Symptom Score (IPSS) of ≥13 were randomized to silodosin (4 mg twice daily) or tamsulosin (0.2 mg once daily) for 12 weeks. • The primary efficacy measure was the mean change from baseline to endpoint in IPSS. • The non-inferiority margin of the IPSS change was set at 1.0. • Secondary efficacy measures included change in maximal urinary flow rate (Q max) and health-related quality of life (HRQL) score. RESULTS • Of the 170 (81.3%) patients who completed the study, 86.2% in the silodosin group vs 81.9% in the tamsulosin group achieved a ≥25% decrease in IPSS (P= 0.53). • The mean difference (silodosin minus tamsulosin) in IPSS change from baseline was -0.60 (95% confidence interval -2.15, 0.95), inferring the non-inferiority of silodosin to tamsulosin. • The mean changes in the Q max and HRQL score from baseline were comparable between the groups (both, P > 0.05). Although patients receiving silodosin had a significantly higher incidence of abnormal ejaculation (9.7% vs tamsulosin 1.0%, P= 0.009), only 1.9% discontinued treatment. • Tamsulosin treatment resulted in a significant reduction in mean systolic blood pressure (-4.2 mmHg, within-group P= 0.004) relative to the negligible change of silodosin (-0.1 mmHg, within-group P= 0.96) CONCLUSION • The trial shows the non-inferiority of silodosin 4 mg twice daily to tamsulosin 0.2 mg once daily in patients with symptoms of BPH. © 2011 BJU INTERNATIONAL.

Chen W.-C.,Chang Gung Memorial Hospital | Chen W.-C.,Chang Gung University | Lai C.-H.,Chang Gung Memorial Hospital | Lee T.-F.,National Kaohsiung University of Applied Sciences | And 8 more authors.
Oral Oncology | Year: 2013

Objective: We investigated salivary function using quantitative scintigraphy and sought to identify functional correlations between parotid dose and quality of life (QoL) for head and neck cancer (HNC) patients receiving intensity-modulated radiotherapy (IMRT). Materials and methods: Between August, 2007 and June, 2008, 31 patients treated IMRT for HNC were enrolled in this prospective study. Salivary excretion function (SEF) was previously measured by salivary scintigraphy at annual intervals for 2 years after IMRT. A dose-volume histogram of each parotid gland was calculated, and the normal tissue complication probability (NTCP) was used to determine the tolerance dose. QoL was longitudinally assessed by the EORTC QLQ-C30 and H&N35 questionnaires prior to RT, and at one, three, 12 and 24 months after RT. Results: A significant correlation was found between the reduction of SEF and the mean parotid dose measured at 1 year (correlation coefficient, R2 = 0.651) and 2 years (R2 = 0.310) after IMRT (p < 0.001). The TD 50 of the parotid gland at 1 year after IMRT is 43.6 Gy, comparable to results from western countries. We further found that contralateral parotid and submandibular gland function preservation was correlated with reduced sticky saliva and a better QoL compared to the functional preservation of both parotid glands, as determined by the EORTC QLQ-H&N35 questionnaire. Conclusion: A significant correlation was found between the reduction of SEF and the mean parotid dose. Preservation of contralateral parotid and submandibular gland function predicts a better QoL compared to preservation of the function of both parotid glands. © 2012 Elsevier Ltd. All rights reserved.

Weng C.-S.,Mackay Memorial Hospital | Chen M.-Y.,Chang Gung Memorial Hospital | Chen M.-Y.,Chang Gung University | Wang T.-Y.,Mackay Memorial Hospital | And 12 more authors.
Taiwanese Journal of Obstetrics and Gynecology | Year: 2013

Objective: To report the natural history and prognosis of the uncommon Sertoli-Leydig cell tumor (SLCT) of the ovary. Materials and Methods: A 20-year retrospective review was conducted by the Taiwanese Gynecologic Oncology Group (TGOG), including nine tertiary medical centers from different regions in Taiwan. The medical records for 40 cases of ovarian SLCT were collected. Pathology reviews were carried out by a panel of expert pathologists. Results: After pathological review, 17 patients were subsequently excluded because the pathology slides were unavailable in five cases, and discrepant results from the initial diagnosis were found in 12 cases (34%). For the remaining 23 patients, the median age was 41 years. The most common symptom was irregular vaginal bleeding followed by an abdominal mass or amenorrhea. Most of the tumors were unilateral and confined to the right ovary, with an average size of 8.2 cm. Preoperative serum markers were available for 12 patients and were elevated for three patients. All patients underwent primary surgery. Six patients accepted adjuvant chemotherapy, and bleomycin, etoposide, and cisplatin were used in four of them. Clinical follow-up information was available in 21 patients with a median of 19 months. Eighty-two percent of patients were alive and free of disease up to the date of the last follow-up. Two patients died of the disease. Conclusion: This study demonstrates the extreme rarity of ovarian SLCT in Taiwan. Histological discordance between the diagnosis and central review proves the need for expertise review before treatment. For an improved understanding of the biological behavior and treatment strategy for this unique tumor, international collaboration is imperative. © 2013.

PubMed | Tainan Municipal Hospital, Far Eastern Memorial Hospital, Chang Gung Memorial Hospital Kaohsiung, National Taiwan University Hospital and 3 more.
Type: Journal Article | Journal: Trials | Year: 2016

The prevalence of significant obstructive coronary artery disease with complex lesions is high in patients who have low extremity artery disease (LEAD). However, intermediate- or long-term cardiovascular prognosis of LEAD patients undergoing percutaneous transluminal angioplasty (PTA) remains poor. Accordingly, prophylactic coronary revascularization may modify short- and long-term cardiovascular outcomes of LEAD patients receiving PTA. Because myocardial ischemic symptoms are often masked in LEAD and the accuracy of non-invasive stress tests is usually limited, a high-quality randomized controlled trial aimed at the investigation of the prognostic role of coronary evaluation strategies before PTA is warranted.The proposed study is designed as a prospective, multi-center, open-label, superiority, randomized controlled trial. The study is conducted in high-volume centers for PTA and coronary revascularization in Taiwan. To meet the inclusion criteria, the patients must be at least 20 years old, have known LEAD, and have been admitted for elective PTA. We plan to enroll 450 participants who are randomly allocated to a routine group (routine coronary angiography without a previous non-invasive stress test before PTA) and a selective group (selective coronary angiography based on the results of non-invasive stress tests before PTA) with 1:1 ratio. Besides, we expect to enroll about 250 additional participants, who are not willing to be randomly assigned, in the registration group. The choice of revascularization procedure depends on the operators or cardiovascular teams suggestion and the patients decision. Clinical follow-up will be performed 30 days after PTA and every 6 months until the end of the 1-year follow-up for the last randomly assigned participant. The primary endpoint is the composite major adverse cardiac event on long-term follow-up. Pre-specified secondary and other endpoints are also evaluated. Those assessing biomarkers and clinical endpoints are all blinded after assignment to interventions.The results of the trial will, for the first time, support better decision-making for coronary evaluation before PTA in LEAD. If favorable, routine coronary angiography followed by revascularization will improve cardiovascular outcomes in LEAD patients undergoing identifier: NCT02169258 (registered on 21 June 2014); registry name: Routine Coronary Catheterization in Low Extremity Artery Disease Undergoing Percutaneous Transluminal Angioplasty (PIROUETTE-PTA).

Chang H.-Y.,Chang Gung Memorial Hospital Kaohsiung | Yang Y.-M.,Kaohsiung Medical University | Kuo Y.-L.,Chang Gung Memorial Hospital Kaohsiung
Journal of Nursing Research | Year: 2013

Background: Community health nurses are on the frontline of providing healthcare to multiethnic groups. Managing and providing effective, culture-specific healthcare can increase the health quality of Taiwan's recently immigrant women, a significant component of this country's population. Purpose: This study analyzes the cultural sensitivity of community health nurses and related factors. Methods: A cross-sectional survey was applied in this study. Participants were nurses who work at health centers in Kaohsiung City and Pingtung County. A total of 230 valid questionnaires were completed. Structure questionnaires used inthis study included (a) scale of nurses' cultural sensitivity, (b) scale of multicultural sources, (c) scale of multicultural competence training programs, and (d) table of personal characteristics. Statistical software SPSS 14.0 was used for statistical analysis. Results: Survey results show an average score of community health nurse cultural sensitivity of 49.41 (SD = 7.48). The index score was 65.88. Thus, survey participants in this study earned a cultural sensitivity score below the index score. "Interaction confidence" earned the lowest item score. "Multicultural resources," "self-perceived English proficiency," "multicultural competence training programs," and "having friends with different cultural backgrounds" were significant predictor variables of cultural sensitivity and, together, explained 34.9% of total variance. Conclusions: Study results may be referenced in designing future in-service and cultural care education programs for community health nurses to improve healthcare quality for new immigrants. Copyright © 2013 Taiwan Nurses Association.

Chen S.H.,Chang Gung Memorial Hospital Kaohsiung | Tsai M.H.,Chang Gung Memorial Hospital Kaohsiung | Tseng Y.-L.,Chang Gung Memorial Hospital Kaohsiung | Lui C.-C.,Chang Gung Memorial Hospital Kaohsiung Medical Center | And 2 more authors.
Acta Neurologica Taiwanica | Year: 2010

Purpose: Star fruit has been reported to contain neurotoxins that often cause severe neurological complications in patients with uremia or severe chronic renal insufficiency. However, the occurrence of neurotoxicity in patients with mild or moderate renal insufficiency has rarely been mentioned. Case report: A 67-year-old woman who had diabetes mellitus and moderate renal insufficiency presented with acute onset of hiccups and nausea two hours after ingestion of one fresh star fruit. She further presented with progressively incoherent speech, echolalia and bizarre behavior. On the next day, her consciousness level declined to deep coma and she experienced two seizures. Brain magnetic resonance imaging examinations revealed a focal cerebral lesion over the left occipital area. The clinical symptoms recovered and the brain lesion reversed after emergency hemodialysis. Conclusion: The clinicians should be aware that star fruit intoxication must be considered when patients with a chronic renal disease, even mild or moderate chronic renal insufficiency, present with unexplained neurological or psychiatric symptoms. Emergency hemodialysis or other replacement therapies may be required for the management of acute star fruit intoxication.

Chern E.,Chang Gung Memorial Hospital Kaohsiung | Chern E.,Chang Gung University | Cheng Y.-W.,Chang Gung Memorial Hospital Kaohsiung | Cheng Y.-W.,Chang Gung University
Journal of Dermatological Treatment | Year: 2010

Viral warts, caused by human papilloma virus (HPV), are commonly seen in dermatology clinics. However, treatment for warts can be challenging, and there is no single method of treatment that is universally effective. Conventional therapies involve the physical destruction of lesions, including cryotherapy, electrodesiccation, CO2 laser, and topical keratolytic agents. Successful treatment of recalcitrant warts, especially periungual lesions and verruca plana of the face, had been limited with the conventional modalities. These painful procedures resulting in poor compliance, cosmetic disfiguration, and residual indolent lesions usually led to incomplete treatment. Use of high-dose cimetidine in the treatment of viral warts has been reported in the literature in recent years; however, with conflicting results. Herein, we present a 12-year-old girl with recalcitrant periungual warts, successfully treated with cimetidine for 4 months without subsequent recurrence and side effects. © 2010 Informa UK, Ltd.

Hu M.-L.,Chang Gung Memorial Hospital Kaohsiung | Tai W.-C.,Chang Gung Memorial Hospital Kaohsiung | Chuah S.-K.,Chang Gung Memorial Hospital Kaohsiung | Chiu Y.-C.,Chang Gung Memorial Hospital Kaohsiung | And 5 more authors.
Journal of Gastroenterology and Hepatology (Australia) | Year: 2010

Background and Aim: Hepatocellular carcinoma (HCC) tends to metastasize to extrahepatic organs. Stomach involvement has been seldom reported and has always been considered as direct invasion. This study aims to propose a possible existing pathway for the hematogenous metastasis of HCC to the stomach. Methods: Only seven cases with stomach involvement were found from 8267 HCC patients registered at our hospital between 2000 and 2007. Their laboratory data, the findings of computed tomography and upper endoscopy, therapeutic procedures, such as esophageal variceal banding ligation (EVL), and transhepatic arterial embolization (TAE) were further studied. Results: All seven patients were male. Liver cirrhosis was found in six patients (6/7 = 85.7%), HCC with portal vein thrombosis (PVT) in six patients (6/7 = 85.7%), splenomegaly in five patients (5/7 = 71.4%) and esophageal varices in five patients (5/7 = 71.4%). Six patients underwent TAE and one patient underwent EVL before the development of HCC in the stomach. Four patients had HCC at the cardia, one patient at the anterior wall of the high body and two patients at the greater curvature of the high body, far away from the original HCC. Six patients eventually developed distant metastasis. HCC with gastric metastasis developed 53-126 days after TAE in five patients and 74 days after EVL in one patient. Conclusions: When cirrhotic patients with portal hypertension have HCC with PVT, a hematogenous pathway can exist for gastric metastasis of tumor thrombi involving hepatofugal flow to the stomach after TAE or EVL apart from the major pathway of direct invasion. © 2009 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd.

Chuang Y.-C.,Chang Gung Memorial Hospital Kaohsiung
Acta Neurologica Taiwanica | Year: 2010

Epilepsy is considered one of the most common neurological disorders worldwide. The burst firing associated with prolonged epileptic discharges could lead to a large number of changes and cascades of events at the cellular level. From its role as the cellular powerhouse, the mitochondrion is emerging as a key participant in cell death because of its association with an ever-growing list of apoptosis-related proteins. Prolonged seizures may result in the mitochondrial dysfunction and increased production of reactive oxygen species and nitric oxide (NO) precede neuronal cell death and cause subsequent epileptogenesis. Emerging evidences also showed that intrinsic mitochondrial apoptotic pathway may contribute to the neuropathology of human epilepsy, particularly in the hippocampus. Subsequent laboratory studies in the animal model of status epilepticus provide credence to the notion that activation of nuclear factor- x B upregulates NO synthase (NOS) II gene expression with temporal correlation of NOS II derived NO-, superoxide anion- and peroxynitrite-dependent reduction in mitochondrial Complex I activity, leading to apoptotic neuronal cell death in the hippocampus. These results will broaden our understanding on the intimate link between mitochondrial function, oxidative stress and mitochondria-dependent apoptotic signaling triggered by epileptic seizures. It will open a new vista in the development of more effective neuroprotective strategies against seizure-induced brain damage by modification of bioenergetic failure in the mitochondria and in the design of novel treatment perspectives for therapy-resistant forms of epilepsy.

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