Keelung, Taiwan
Keelung, Taiwan

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Chang S.-J.,Buddhist Tzu Chi General Hospital | Chang S.-J.,Tzu Chi University | Yang S.S.-D.,Buddhist Tzu Chi General Hospital | Yang S.S.-D.,Tzu Chi University | And 2 more authors.
Neurourology and Urodynamics | Year: 2011

Aim To report the cut-off value for large voided volume (LVV) suggestive of abnormal uroflow pattern or elevated post-void residual urine (PVR) in healthy kindergarteners. Methods From 2003 through 2008, we enrolled 417 healthy kindergarten children for evaluation of uroflowmetry tests and PVR. The uroflowmetry curves were interpreted if voided volumes (VV) were >50ml, and categorized as bell-shaped, staccato, plateau, and interrupted. Only bell-shaped curves were categorized as normal. After 2006, PVR was assessed within 5 min after each voiding with a VV >50ml. A PVR >20ml is regarded as elevated. Receiver operative characteristic (ROC) curves were constructed to evaluate the cut-off value of VV/expected bladder capacity (EBC) with regard to nonbell-shaped uroflowmetry curves, and/or elevated PVR. Results Of 385 children (mean age: 4.85 ± 0.96 years), 699 uroflowmetry, and 556 PVR data were eligible for analysis. There were 502 (71.8%) bell-shaped, 76 (10.9%) plateau, 102 (14.6%) staccato, and 19 (2.7%) interrupted curves. Mean and median PVR were 12.4± 21.2 and 5.5ml, respectively. Of 556 PVRs, 96 (17.3%) were >20ml. Based on the ROC curve for the nonbell-shaped curves and/or elevated PVR, VV >100% EBC was best defined as LVV. There were statistically more elevated PVR, and more nonbell-shaped curves in the voidings with than without LVV. There is a trend that peak flow rate decreased when VV was >150% EBC. Conclusions VV of more than 100% EBC can be defined as LVV which was associated with higher rates of abnormal uroflow pattern and/or elevated PVR. Neurourol. Urodyn. 30:58-61, 2011. © 2010 Wiley-Liss, Inc.


Yang S.S.-D.,Buddhist Tzu Chi General Hospital | Yang S.S.-D.,Tzu Chi University | Hsieh C.-H.,Buddhist Tzu Chi General Hospital | Hsieh C.-H.,Tzu Chi University | And 6 more authors.
Journal of Urology | Year: 2013

Purpose: We compared safety and surgical outcomes in patients with different prostate sizes treated with diode laser enucleation of the prostate. Materials and Methods: From 2008 to 2012 consecutive patients with benign prostatic obstruction undergoing diode laser prostate enucleation at our institution were enrolled for analysis. A single surgeon performed diode laser prostate enucleation with an end firing, continuous wave diode laser (980 nm). Based on preoperative prostate volume on transrectal ultrasound, patients were stratified into 2 groups, including group 1 - 65 with less than 60 ml and group 2 - 55 with 60 ml or greater. Baseline and perioperative characteristics, and postoperative surgical outcomes were compared between the 2 groups. Results: A total of 120 men with a mean ± SD age of 70.2 ± 9.0 years were enrolled for analysis. Compared with group 1 patients, those in group 2 had larger mean total prostate volume (85.0 ± 24.6 vs 40.9 ± 10.8 ml), longer mean operative time (117.7 ± 48.2 vs 60.7 ± 25.0 minutes), higher mean retrieved prostate weight (37.3 ± 16.1 vs 12.5 ± 7.3 gm) and a higher mean tissue retrieval ratio (74.4% ± 22.2% vs 58.8% ± 23.2%, p <0.01). There was no significant difference in the postoperative hemoglobin decrease in the 2 groups (median 0.5 vs 0.9 mg/dl, p = 0.11). The rate of temporary postoperative urinary retention after Foley catheter removal was significantly lower in group 2 (15.4% vs 3.6%, p = 0.04). Postoperative improvements in the peak flow rate, post-void residual urine volume and International Prostate Symptom Score were comparable in the 2 groups. Conclusions: Although patients with a larger prostate required significantly longer operative time and laser energy, voiding function improvements and surgical complication rates of diode laser prostate enucleation were comparable in patients with a larger vs smaller prostate. © 2013 American Urological Association Education and Research, Inc.


Lin J.-M.,Keelung Hospital | Lai L.-P.,National Taiwan University Hospital | Lin C.-S.,National Chiao Tung University | Chou N.-K.,National Taiwan University Hospital | And 2 more authors.
Journal of Cardiovascular Electrophysiology | Year: 2010

Left Ventricular Remodeling in Pacing Dogs. Introduction: Right ventricle (RV) apical pacing is associated with increased incidence of heart failure due to left ventricle (LV) desynchronization. We aim to investigate extracellular matrix (ECM) remodeling of the LV in dogs with atria-sensed RV apical pacing. Methods and Results: Dogs with pacemakers underwent AV nodal ablation. After 12 weeks of atria-sensed obligatory RV pacing, LVs were separated into septum and lateral wall for analysis. Zymographic activity, including matrix metalloproteinase-2 (MMP-2), MMP-9, tissue inhibitors of metalloproteinase-1 (TIMP-1), TIMP-3, collagen transcript expression, and histology were examined in opposite portions of the LV to identify possible ECM remodeling changes by RV apical pacing. Compared with sham-operated dogs, increased interstitial fibrosis and fragmentation of myofibrils was found in the LV lateral wall in the pacing group. Collagen type II mRNA showed a significant 2-fold increase in the LV lateral wall in the pacing group. Although collagen type I mRNA was increased, the difference was not significant. Zymography demonstrated MMP-9 activity was enhanced in both the LV lateral wall and septum in the pacing group, but MMP-2 activity was enhanced in the LV lateral wall. Immunfluorescence stain confirmed the activation of MMP-2 and MMP-9 in the LV lateral wall in the pacing group. Protein expression of TIMP-1 and TIMP-3 showed regional differences in the pacing group and both proteins were increased in the LV lateral wall. Conclusion: LV dyssynchrony by RV apical pacing elicits heterogeneous ECM remodeling in the LV. These findings assist in the elucidation of the pathophysiology of LV desynchronization. (J Cardiovasc Electrophysiol, Vol. 21, pp. 1142-1149) © 2010 Wiley Periodicals, Inc.


Su Y.-C.,Buddhist Tzu Chi Dalin General Hospital | Chen C.-C.,Keelung Hospital | Lee Y.-K.,Buddhist Tzu Chi Dalin General Hospital | Lee J.-Y.,Harvard University | Lin K.J.,Jacobi Medical Center
European Journal of Anaesthesiology | Year: 2011

Background Video laryngoscopes have been introduced in recent years as an alternative choice to facilitate tracheal intubation. We conducted a meta-analysis to assess their value when compared with direct laryngoscopy. Methods PubMed and EMBASE were searched up until 24 September 2010. Randomised trials that reported data on the comparison of video laryngoscopes with direct laryngoscopy for tracheal intubation were included. Results Eleven trials with a total of 1196 participants were identified. During tracheal intubation, video laryngoscopes can achieve a better view of the glottis and have a similar success rate [rate ratio 1.0; 95% confidence interval (CI) 0.99-1.01]. Overall, the time to tracheal intubation was not different between the video laryngoscopes and direct laryngoscopy (standardised mean difference 0.19; 95% CI -0.37-0.75). However, in a subgroup analysis, video laryngoscopes shortened the time taken for difficult intubation (standardised mean difference, -0.75; 95% CI -1.24 to -0.25). Conclusion Video laryngoscopes are a good alternative to direct laryngoscopy during tracheal intubation. The advantage seems to be more prominent when difficult intubation is encountered. © 2011 Copyright European Society of Anaesthesiology.


Hung T.-Y.,Keelung Hospital | Chen C.-C.,Keelung Hospital | Wang T.-L.,Shin Kong Wu Ho Su Memorial Hospital | Wang T.-L.,Fu Jen Catholic University | And 3 more authors.
Epilepsia | Year: 2011

Purpose: To investigate the incidence and duration of transient hyperammonemia in seizures and to verify the significant confounders related to transient hyperammonemia in seizures. Methods: One hundred twenty-one noncirrhotic adult patients with seizures admitted to the emergency department were enrolled in the study. Laboratory examination was performed, including plasma ammonia level assessment. In addition, the basic parameters, underlying systemic diseases, and seizure-related conditions were assessed. The patients were classified into a group with hyperammonemia on arrival and a group without, in order to compare seizure-related adverse events that occurred during a 9-month period. Key Findings: The incidence of hyperammonemia in patients with seizures was 67.77%. Plasma ammonia levels in patients with generalized tonic-clonic (GTC) seizures were significantly higher than those in patients in the non-GTC seizure group (median 174.5 vs. 47 μg/dl; proportion 76.5% vs. 21.1%; p < 0.001). Median plasma ammonia levels decreased spontaneously from 250 to 54 μg/dl (p < 0.00001) in an average interval of 466.79 min. GTC seizures (p < 0.0001), male gender (p < 0.0001), bicarbonate (p < 0.0001), diabetes (p = 0.0139), and alcohol-related seizures (p = 0.0002) were significant factors associated with hyperammonemia on arrival. No significant differences related to admission rates or mortalities were found between the two groups. Significance: The presence of transient hyperammonemia in patients with seizures is significantly related to GTC seizures, male gender, bicarbonate, diabetes, and alcohol-related seizures. The appropriate period to study ammonia levels following a seizure event is within 8 h. Because these phenomena are self-limited, ammonia-lowering management are not necessary. Hyperammonemia on arrival is not necessarily related to adverse outcomes. © Wiley Periodicals, Inc. © 2011 International League Against Epilepsy.


Tang R.-B.,Cheng Hsin General Hospital | Tang R.-B.,National Yang Ming University | Chang J.-K.,Cheng Hsin General Hospital | Chang J.-K.,National Yang Ming University | Chen H.-L.,Keelung Hospital
Journal of the Chinese Medical Association | Year: 2015

Probiotics are proprietary formulations of specific microorganisms and quantified populations of live bacteria that are intended to confer a health benefit on the host. These different strains and combinations of microorganisms have a wide and varying range of clinical and immunologic capacities that can modify intestinal microbial populations in ways that can benefit the host. The enhanced presence of probiotic bacteria in the intestinal microbiota has been found to correlate with protection against atopy. The prevalence of allergic diseases such as asthma, allergic rhinitis, and atopic dermatitis has increased sharply over the past 2-3 decades in many countries, and allergies are now the most common chronic disease among children throughout the world. In the past few years, probiotics have been advocated for the management of allergic diseases in many parts of the world. So far, probiotics have shown more promise, albeit limited, in the primary prevention of allergic disease rather than in the treatment of established disease. © 2014.


Chen H.-L.,Keelung Hospital | Tang R.-B.,Cheng Hsin General Hospital
Journal of the Chinese Medical Association | Year: 2016

Prior to 2015, Zika Virus (ZIKV) outbreaks had occurred in areas of Africa, Southeast Asia, and the Pacific Islands. Although a causal relationship between Zika infection during pregnancy and microcephaly is strongly suspected, such a connection has not yet been scientifically proven. In May 2015, the outbreak of ZIKV infection in Brazil led to reports of syndrome and pregnant women giving birth to babies with birth defects and poor pregnancy outcomes; the Pan American Health Organization (PAHO) issued an alert regarding the first confirmed ZIKV infection in Brazil. Currently, ZIKV outbreaks are ongoing and it will be difficult to predict how the virus will spread over time. ZIKV is transmitted to humans primarily through the bite of infected mosquitos, Aedes aegypti and Aedes albopictus. These mosquitoes are the principle vectors of dengue, and ZIKV disease generally is reported to include symptoms associated with acute febrile illnesses that clinically resembles dengue fever. The laboratory diagnosis can be performed by using reverse-transcriptase polymerase chain reaction (RT-PCR) on serum, viral nucleic acid and virus-specific immunoglobulin M. There is currently no vaccine and antiviral treatment available for ZIKV infection, and the only way to prevent congenital ZIKV infection is to prevent maternal infection. In February 2016, the Taiwan Centers for Disease Control (Taiwan CDC) activated ZIKV as a Category V Notifiable Infectious Disease similar to Ebola virus disease and MERS. © 2016.


Yeh H.-J.,Taoyuan General Hospital | Yeh H.-J.,National Yang Ming University | Chou Y.-J.,National Yang Ming University | Yang N.-P.,Keelung Hospital | Huang N.,National Yang Ming University
Archives of Physical Medicine and Rehabilitation | Year: 2015

Objective To explore major patient and provider characteristics influencing the receipt of physical therapy (PT) among patients newly diagnosed with osteoarthritis. Design A population-based, cross-sectional study on outpatient PT for patients newly diagnosed with osteoarthritis within the period of 2005 to 2010. Setting Sample of 1 million National Health Insurance enrollees. Participants People aged ≥18 years with an incidence of osteoarthritis and receiving initial outpatient treatment. A total of 29,012 patients were included (N=29,012). Interventions Not applicable. Main Outcome Measures The outcome variable of interest was the probability of receiving PT within 1 year of osteoarthritis diagnosis. Both individual and provider characteristics were investigated to determine their influence on PT receipt. Results Of the 29,012 included patients with osteoarthritis, only 24.8% of them received PT within the first year of diagnosis. Men and older adults were less likely to receive PT. In addition, low-income patients with osteoarthritis were less likely to receive PT. Furthermore, PT receipt was increased in patients treated by physicians who were women and by physicians who specialized in rehabilitation medicine. In addition, we observed a pattern indicating that the lower the accreditation level of the practice setting, the greater the probability of receiving PT. Conclusions Because of the National Health Insurance program in Taiwan, direct medical costs of PT have been substantially reduced; however, variations are still observed among different patient and provider characteristics. The major role of providers in PT receipt for patients with osteoarthritis should not be ignored. © 2015 American Congress of Rehabilitation Medicine.


Chen K.H.,Keelung Hospital
The Chinese journal of physiology | Year: 2012

The purpose of this study was to determine the effects of an extract from Moringa oleifera (MO) on the development of monocrotaline (MCT)-induced pulmonary hypertension (PH) in Wistar rats. An ethanol extraction was performed on dried MO leaves, and HPLC analysis identified niaziridin and niazirin in the extract. PH was induced with a single subcutaneous injection of MCT (60 mg/kg) which resulted in increases in pulmonary arterial blood pressure (Ppa) and in thickening of the pulmonary arterial medial layer in the rats. Three weeks after induction, acute administration of the MO extract to the rats decreased Ppa in a dose-dependent manner that reached statistical significance at a dose of 4.5 mg of freeze-dried extract per kg body weight. The reduction in Ppa suggested that the extract directly relaxed the pulmonary arteries. To assay the effects of chronic administration of the MO extract on PH, control, MCT and MCT+MO groups were designated. Rats in the control group received a saline injection; the MCT and MCT+MO groups received MCT to induce PH. During the third week after MCT treatment, the MCT+MO group received daily i.p. injections of the MO extract (4.5 mg of freeze-dried extract/kg of body weight). Compared to the control group, the MCT group had higher Ppa and thicker medial layers in the pulmonary arteries. Chronic treatments with the MO extract reversed the MCT-induced changes. Additionally, the MCT group had a significant elevation in superoxide dismutase activity when normalized by the MO extract treatments. In conclusion, the MO extract successfully attenuated the development of PH via direct vasodilatation and a potential increase in antioxidant activity.


Chen K.H.,Keelung Hospital
The Chinese journal of physiology | Year: 2012

Perinatal hypoxia has been observed to cause more aggressive pulmonary hypertension in human. Several mediators such as reactive oxygen species (ROS) and substance P are believed to be crucial in the mechanism of inducing pulmonary hypertension. This study was designed to test whether substance P and ROS play a role in perinatal hypoxia-exaggerated, monocrotaline (MCT)-induced pulmonary hypertension. Normoxic Wistar rats (weighing 258 ± 9 g, n = 31) were divided into two groups: control (n = 16) and MCT (n = 15). Perinatal hypoxia Wistar rats (weighing 260 ± 19 g, n = 49) were divided into six groups: Hypoxia (n = 8), Hypoxia+MCT (n = 8), Hypoxia+capsaicin (CP)+MCT (n = 7), Hypoxia+MCT+1,3-dimethyl-2-thiourea (DMTU)E (n = 10), Hypoxia+MCT+DMTUL (n = 9), and Hypoxia+MCT+ hexa(sulfobutyl) fullerenes (HSF) (n = 7). Rats in the control group received saline injections. MCT (60 mg/kg, s.c.) was given three weeks prior to the functional examination. Chronic capsaicin pretreatment was performed to deplete substance P. Hydroxyl radical scavenger DMTU (500 mg/kg) was intraperitoneally (i.p.) injected early (DMTUE ) or late (DMTUL ) after MCT. Antioxidant HSF (10 mg/kg, i.p.) was given once daily for three weeks following MCT. MCT treatment caused significant increases in pulmonary arterial pressure (Ppa) and substance P level in lung tissue in normoxic rats. The MCT-induced increase in pulmonary arterial blood pressure was exaggerated by perinatal hypoxia, but this exaggeration was attenuated by either capsaicin pretreatment or antioxidant administrations. These results suggest that both ROS and substance P are involved in perinatal hypoxia-augmented, MCT-induced pulmonary hypertension.

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