Taichung, Taiwan
Taichung, Taiwan

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Yang S.-C.,Chung Shan Medical University | Chang W.-J.,Lees Medical Corporation | Chang Y.-H.,Chung Shan Medical University | Tsai Y.-S.,Chung Shan Medical University | And 4 more authors.
European Journal of Clinical Microbiology and Infectious Diseases | Year: 2010

This study analyzed the prevalence of antibiotics resistance and the distribution of genes responsible for carbapenems resistance in Acinetobacter baumannii isolates. Clinical A. baumannii isolates were cultured, identified, and collected during the period from May 2007 to February 2009. Antibiotics resistance rates of the clinical isolates were analyzed by antimicrobial susceptibility testing. The distribution of carbapenemase alleles were investigated in the multidrug-resistant (MDR) A. baumannii isolates by multiplex polymerase chain reaction (PCR) techniques. A total of 1,265 independent A. baumannii isolates were identified. Approximately 70% of the clinical isolates were resistant to ampicillin/sulbactam, followed by imipenem, meropenem, cefepime, piperacillin/tazobactam, ceftazidime, and cefoperazone. Overall, 15.18% (192/1,265) of the isolates were characterized as MDR strains. All of the MDR A. baumannii isolates carried the bla OXA51-like allele. The detection rate of the bla OXA23-like and bla OXA24-like alleles was 96.35% (185/192) and 0.52% (1/192), respectively. Most of the isolates (185/192, 96.35%) carried genes which encode more than one carbapenemase. This report demonstrated that approximately 15% of A. baumannii clinical isolates in central Taiwan are MDR strains, with most of them harboring multiple carbapenemases. This study provides updated data regarding the prevalence of β-lactam resistance and genotyping information of carbapenems resistance of A. baumannii in central Taiwan. © 2010 Springer-Verlag.


Hsu M.-S.,Lees Medical Corporation | Yu J.-C.,Tri Service General Hospital | Wang H.-W.,Academia Sinica, Taiwan | Chen S.-T.,Changhua Christian Hospital | And 6 more authors.
Annals of Surgical Oncology | Year: 2010

Background: Endogenous estrogen is suggested to initiate cell proliferation and cause oxidative DNA damage during breast tumorigenesis. Cells eliminate DNA damage by means of repair enzymes. Genotypic variants of DNA damage repair genes, participating in base excision repair (BER) and nucleotide excision repair (NER) pathways, may act as modifiers that affect the association between estrogen exposure and breast cancer. Methods: In a hospital-based case-control study of female breast cancer, DNA samples were obtained from 401 cases and 533 enrolled healthy controls, all of whom were Chinese women in Taiwan. Genotyping of polymorphisms of XRCC1 (Arg194Trp and Arg399Gln), OGG1 (Ser326Cys and Arg229Gln), ERCC2 Lys751Gln, ERCC4 Ser662Pro, and ERCC5 His1104Asp was performed and used to evaluate breast cancer susceptibility. Results: Of the nonsynonymous polymorphisms, the ERCC5 1104Asp variant was significantly associated with breast cancer (odds ratio = 1.42; 95% confidence interval = 1.08-1.97), and this association was more pronounced in women with lengthy estrogen exposure. A trend toward an increased risk of developing breast cancer was observed in women who carried greater numbers of combined high-risk genotypes of BER and NER genes (P trend = .038). The synergistic effect of multiple genes on the increase of risk was significant in women with a longer period of estrogen exposure (>26 years), greater age at first full-term pregnancy (>26 years), a longer menarche-to-first full-term pregnancy interval (>11 years), and higher body mass index (>22) (all P < .05). Conclusions: This study demonstrates that genotype polymorphisms related to DNA damage repair confer greater susceptibility to endogenous estrogen in the development of breast cancer in women. © 2009 Society of Surgical Oncology.


PubMed | Taichung Veterans General Hospital, Chung Shan Medical University, Taipei Veterans General Hospital, Lees Medical Corporation and 2 more.
Type: Journal Article | Journal: BMJ open | Year: 2016

To investigate the association between the trends of CT utilisation in an emergency department (ED) and changes in clinical imaging practice and patients disposition.A hospital-based retrospective observational study of a public 1520-bed referral medical centre in Taiwan.Adult ED visits (aged 18years) during 2009-2013, with or without receiving CT, were enrolled as the study participants.For all enrolled ED visits, we retrospectively analysed: (1) demographic characteristics, (2) triage categories, (3) whether CT was performed and the type of CT scan, (4) further ED disposition, (5) ED cost and (6) ED length of stay.In all, 269239 adult ED visits (148613 male patients and 120626 female patients) were collected during the 5-year study period, comprising 38609 CT scans. CT utilisation increased from 11.10% in 2009 to 17.70% in 2013 (trend test, p<0.001). Four in 5 types of CT scan (head, chest, abdomen and miscellaneous) were increasingly utilised during the study period. Also, CT was increasingly ordered annually in all age groups. Although ED CT utilisation rates increased markedly, the annual ED visits did not actually increase. Moreover, the subsequent admission rate, after receiving ED CT, declined (59.9% in 2009 to 48.2% in 2013).ED CT utilisation rates increased significantly during 2009-2013. Emergency physicians may be using CT for non-emergent studies in the ED. Further investigation is needed to determine whether increasing CT utilisation is efficient and cost-effective.


Chen C.-M.,Lees Medical Corporation | Chen C.-M.,Taipei Medical University Hospital | Chen C.-M.,Taipei Medical University | Wu M.-Y.,Taipei Medical University | And 3 more authors.
Pediatrics and Neonatology | Year: 2011

Background: Airway remodeling refers to the structural changes in the airways of asthma. Caveolin-1 reduces cell growth and negatively regulates smooth muscle cell proliferation. The aim was to investigate lung caveolin-1 status in a murine model of acute allergic airway disease. Methods: Six- to eight-week-old female BALB/c mice were sensitized by intraperitoneal injections of phosphate-buffered saline or ovalbumin (OVA) and aluminium hydroxide on Days 0 and 14, challenged with aerosolized saline or OVA (1%) on Days 21-25, 28-32, and 35. The mice were killed 1 day after the last OVA/saline challenge. Serum OVA-specific immunoglobulin E (IgE) was measured by enzyme-linked immunosorbent assay. Peribronchial inflammation was quantified by morphometric analysis. Lung caveolin-1 and Type I collagen mRNA expression was determined by real-time reverse-transcription polymerase chain reaction. Total lung collagen was measured using Sircol Assay Kit. Results: Serum OVA-specific IgE levels were significantly elevated in OVA-challenged mice when compared with saline-challenged mice. Percentage of inflammatory cells in the bronchoalveolar lavage was significantly higher in the OVA-challenged animals. The animals' lungs that were sensitized and challenged with OVA contained large numbers of inflammatory cells concentrated near the airways and in the perivascular areas. The thickness of the bronchial epithelial layer and smooth muscle layer and the numbers of total inflammatory cells and eosinophils significantly increased in OVA-challenged mice. Caveolin-1 mRNA expression significantly decreased and Type I collagen mRNA expression significantly increased in the lung tissue of OVA-challenged mice. Conclusion: These results suggest that caveolin-1 seems to be involved in the pathogenesis of airway remodeling of acute allergic airway disease. © 2011, Taiwan Pediatric Association.


Liu P.-Y.,Taichung Veterans General Hospital | Liu P.-Y.,Tunghai University | Liu P.-Y.,Tajen University | Shi Z.-Y.,Taichung Veterans General Hospital | And 10 more authors.
Journal of Infection in Developing Countries | Year: 2014

Introduction: The Clinical and Laboratory Standards Institute (CLSI) updated its antimicrobial susceptibility testing interpretation criteria for Enterobacteriaceae. This study assessed the effects of clinical breakpoint changes in the CLSI 2009 to 2012 guidelines on antibiotic susceptibility testing reports. Methodology: In total, 2,076 non-duplicate clinical isolates of Enterobacteriaceae were analyzed. The disk diffusion method was used for susceptibility testing. The CLSI 2009-12 clinical breakpoints were applied to determine susceptibility of cefotaxime and ertapenem. Combined-disk testing was used for phenotypic confirmation of extended-spectrum beta-lactamase (ESBL) production. Results: In total, Enterobacteriaceae resistance rates to cefotaxime increased from 13.1% using the CLSI 2009 guidelines to 23.6% with the CLSI 2010-12 guidelines, and the resistance rates to ertapenem were 0.4%, 1.0% and 0.8% with CLSI 2009, 2011 and 2012, respectively. Based on the 2010-12 CLSI criteria, all ESBL-producing Escherichia coli and Klebsiella pneumoniae were resistant to cefotaxime. Marked differences in susceptibility to ertapenem between the 2009 CLSI criteria and 2012-12 CLSI criteria were noted in ESBL-producing K. pneumoniae. Conclusions: Breakpoints changes in the updated CLSI guidelines resulted in higher resistance rates to cefotaxime and ertapenem. In addition, the effects were different in individual Enterobacteriaceae species. As a result, clinicians may opt to use alternative antimicrobial agents. Upon implementation of the newer CLSI guidelines, laboratories should be aware of the possible consequences and closely monitor the effects. © 2014 Liu et al.


Lee T.-W.,Lees Medical Corporation | Northoff G.,Ottawa Health Research Institute | Wu Y.-T.,National Yang Ming University
Neuroscience | Year: 2014

In resting state, the dynamics of blood oxygen level-dependent signals recorded by functional magnetic resonance imaging (fMRI) showed reliable modular structures. To explore the network property, previous research used to construct an adjacency matrix by Pearson's correlation and prune it using stringent statistical threshold. However, traditional analyses may lose useful information at middle to moderate high correlation level. This resting fMRI study adopted full connection as a criterion to partition the adjacency matrix into composite sub-matrices (neural patterns) and investigated the associated community organization and network features. Modular consistency across subjects was assessed using scaled inclusivity index. Our results disclosed two neural patterns with reliable modular structures. Concordant with the results of traditional intervention, community detection analysis showed that neural pattern 1, the sub-matrix at highest correlation level, was composed of sensory-motor, visual associative, default mode/midline, temporal limbic and basal ganglia structures. The neural pattern 2 was situated at middle to moderate high correlation level and comprised two larger modules, possibly associated with mental processing of outer world (such as visuo-associative, auditory and sensory-motor networks) and inner homeostasis (such as default-mode, midline and limbic systems). Graph theoretical analyses further demonstrated that the network feature of neural pattern 1 was more local and segregate, whereas that of neural pattern 2 was more global and integrative. Our results suggest that future resting fMRI research may take the neural pattern at middle to moderate high correlation range into consideration, which has long been ignored in extant literature. The variation of neural pattern 2 could be relevant to individual characteristics of self-regulatory functions, and the disruption in its topology may underlie the pathology of several neuropsychiatric illnesses. © 2014 IBRO.


Lee C.-H.,Lees Medical Corporation | Kuo C.-Y.,Chung Shan Medical University | Kuo C.-Y.,Tai An Hospital | Wang C.-J.,Chung Shan Medical University | And 4 more authors.
Bioscience, Biotechnology and Biochemistry | Year: 2012

Oxidative stress is the major contributor to acetaminophen (AAP)-caused liver damage. It promotes mitochondrial oxidative stress and collapses the mitochondrial membrane potential to cause cell death. We have previously shown that a polyphenol extract of Hibiscus sabdariffa L. (HPE) potentiated the antioxidative effect. We further examined in this study the possible mechanism of HPE against AAP-caused liver damage. BABL/c mice were orally fed with HPE (100, 200 or 300 mg/kg) for two weeks prior to an i.p. injection of 1000 mg/kg of AAP. The mice were decapitated 6 h after the AAP injection to collect the blood and liver for further determination. The results show that pretreating with HPE increased the level of glutathione (GSH), decreased the level of lipid peroxidation, and increased catalase activity in the liver. A histopathological evaluation shows that HPE could decrease AAP-induced liver sterosis accompanied by a decreased expression of AIF, Bax, Bid, and p-JNK in the liver. An in vitro assay revealed that HPE could reduce AAP-induced death of BABL/c normal liver cells (BNLs), reverse the lost mitochondrial potency and improve the antioxidative status, similarly to the results of the in vivo assay. We show in this study that HPE possessed the ability to protect the liver from AAP-caused injury. The protective mechanism might be regulated by decreasing oxidative stress and attenuating the mitochondrial dysfunction.


Yi Y.-C.,Chung Shan Medical University | Chou P.-T.,Lees Medical Corporation | Chen L.-Y.,Chung Shan Medical University | Kuo W.-H.,Central Taiwan University of Science and Technology | And 3 more authors.
Clinical Chemistry and Laboratory Medicine | Year: 2010

Background: The goal of our study was to evaluate the influence of genetic polymorphisms of matrix metalloproteinases (MMP)-2, MMP-3 and MMP-7 on susceptibility to endometrial cancer. Methods: In the present study, we enrolled a total of 118 patients with endometrial cancer confirmed by histopathology, and 229 unrelated healthy individuals. Polymorphism for the MMP-2 (rs2285053), MMP-3 (rs3025058) and MMP-7 (rs11568818) genes was genotyped by polymerase chain reaction-restriction enzyme length polymorphism. Results: The frequencies of MMP-7 -181 G/G and A/G genotypes were found to be significantly higher in cancer patients compared with healthy controls (p=0.017). Stratification showed that individuals with MMP-7 -181 G allele were at increased risk for endometrial cancer when >50 years of age [odds ratios (OR)=2.03; 95% confidence interval (CI) 1.21-3.39], endometrioid (OR=1.80; 95% CI 1.11-2.92), low (stage I-II) (OR=1.73; 95% CI 1.05-2.83) or high stage (stage III-IV) (OR=2.69; 95% CI 1.16-6.24). Compared with the A/A genotype, the A/G+G/G genotype modified the risk of developing endometrial carcinoma and significance was detected in patients over 50 years old, and those with endometrioid type and high stage endometrial cancer. However, no significant difference in MMP-2 (-735 C/T) and MMP-3 (6A/5A) genotypes was observed between endometrial carcinoma cases and controls. Conclusions: This is the first report on the association of MMP-2, MMP-3 and MMP-7 gene polymorphisms in endometrial cancer. Our results suggest that individuals with the MMP-7 -181 G/G and A/G genotype may have an increased risk of developing endometrial cancer. © 2010 by Walter de Gruyter.


Hsieh B.-T.,Central Taiwan University of Science and Technology | Chiang C.-T.,Central Taiwan University of Science and Technology | Chiang C.-T.,Cheng Ching Hospital | Hung P.-H.,Lees Medical Corporation | And 2 more authors.
Journal of Radioanalytical and Nuclear Chemistry | Year: 2011

Radiotherapy widely uses the polymer gel dosimeter. The advantage of polymer gel dosimetry is the mapped 3D absorbed dose distribution that other dosimeters cannot achieve. The Acrylamide (AAm) is a frequently used monomer; however, the extreme toxicity of Acrylamide (ORL-RAT LD50: 124 mg/kg) raises a concern. Therefore, this study developed a new type of Propylene acid based gel dosimeter, named DEMBIG gel. The following outlines the aim of this study: (1) using two-point formulation to find the optimal scan parameter of MRI according to the best sensitivity and linearity (correlation coefficient) of DEMBIG gel, (2) using the optimal scan parameter of MRI to observe the properties of DEMBIG gel, and (3) verifying the three-dimensional (3D) dose distributions of radiotherapy. This study obtained three major results: 1. The scan protocol of MRI was established. 2. The preliminary results of DEMBIG gel were: (1) The range of absorbed dose of DEMBIG gel: 0-20 Gy. (2) The sensitivity and correlation coefficient of DEMBIG gel at verification as slope: 0.181 sGy -1, R 2:0.997. (3) There is no energy dependency of the DEMBIG gel. 3. The dose difference was 3% in the three-dimensional (3D) isocenter dose in clinical radiotherapy. These data show that DEMBIG gel is a potential candidate for the 3D dosimeter. © 2011 Akadémiai Kiadó.


PubMed | China Medical University at Taichung, Lees Medical Corporation and Nantou Hospital
Type: Journal Article | Journal: Journal of alternative and complementary medicine (New York, N.Y.) | Year: 2015

Transcutaneous electrical nerve stimulation (TENS) has been widely used for pain relief; however, the effect remains controversial. The authors hypothesized that TENS can relieve acute pain. Therefore, a single-blinded, randomized, controlled preliminary study was designed on postoperative pain in patients with Colles fracture.In total, 36 patients were assigned to a real TENS or sham TENS group (18 patients in each group). TENS (50Hz, 15min/day) was applied near the Quchi (LI11) and Waiguan (TE5) surfaces of the operative side continuously for 5 days after surgical treatment.The visual analog scale (VAS) scores did not differ significantly between the real and sham TENS groups before the TENS period, from the first to fifth day after surgical treatment (all p>0.05), whereas the VAS scores were lower for the real TENS group than for the sham TENS group in the post-TENS period, on the first, third, fourth, and fifth days after surgical treatment (all p0.01).TENS might be valuable as a treatment of postoperative pain, but clinicians and researchers should know that it is no different than a treatment with placebo. Especially, since this form of treatment and sham treatment has a great chance of working under the mechanism of the placebo effect due to its single-blindedness.

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