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Pingtung, Taiwan

Lan C.-C.,Foundation Medicine | Chu W.-H.,Taipei zu Chi Hospital | Yang M.-C.,Foundation Medicine | Lee C.-H.,Foundation Medicine | And 2 more authors.
Respiratory Care | Year: 2013

BACKGROUND: Pulmonary rehabilitation (PR) is beneficial for patients with COPD, with improvement in exercise capacity and health-related quality of life. Despite these overall benefits, the responses to PR vary significantly among different individuals. It is not clear if PR is beneficial for patients with COPD and normal exercise capacity. We aimed to investigate the effects of PR in patients with normal exercise capacity on health-related quality of life and exercise capacity. METHODS: Twenty-six subjects with COPD and normal exercise capacity were studied. All subjects participated in 12-week, 2 sessions per week, hospital-based, out-patient PR. Baseline and post-PR status were evaluated by spirometry, the St George's Respiratory Questionnaire, cardiopulmonary exercise test, respiratory muscle strength, and dyspnea scores. RESULTS: The mean FEV1 in the subjects was 1.29 ± 0.47 L/min, 64.8 ± 23.0% of predicted. After PR there was significant improvement in maximal oxygen uptake and work rate. Improvements in St George's Respiratory Questionnaire scores of total, symptoms, activity, and impact were accompanied by improvements of exercise capacity, respiratory muscle strength, maximum oxygen pulse, and exertional dyspnea scores (all P <.05). There were no significant changes in pulmonary function test results (FEV1, FVC, and FEV1/FVC), minute ventilation, breathing frequency, or tidal volume at rest or exercise after PR. CONCLUSIONS: Exercise training can result in significant improvement in health-related quality of life, exercise capacity, respiratory muscle strength, and exertional dyspnea in subjects with COPD and normal exercise capacity. Exercise training is still indicated for patients with normal exercise capacity. © 2013 Daedalus Enterprises. Source

Lan C.-C.,Foundation Medicine | Lan C.-C.,Tzu Chi University | Hsu H.-H.,Tri Service General Hospital | Wu C.-P.,Li Shin Hospital | And 3 more authors.
Journal of Surgical Research | Year: 2014

Background Acute lung injury and acute respiratory distress syndrome (ALI/ARDS) cause substantial morbidity and mortality despite improvements in the understanding of lung injury and advances in treatment. Recruitment maneuver (RM) with high sustained airway pressures is proposed as an adjunct to mechanical ventilation to maintain alveolar patency. In addition, RM has been advocated to improve pulmonary gas exchange. However, many factors may influence responses to RM and the effect of pleural effusion (PLE) is unknown. Method There were four groups in this study (n = 6 in each group). Group A was the control group, group B was the PLE group, group C was ARDS with RM, and group D was ARDS with PLE and RM. RM was performed in groups C and D, consisting of a peak pressure of 45 cm H2O with positive end-expiratory pressure of 35 cm H2O sustained for 1 min. Arterial blood gas, systemic and pulmonary hemodynamics, lung water, and respiratory mechanics were measured throughout. Result After the induction of ALI/ARDS, there were significant decreases in partial pressure of oxygen in arterial blood, mean arterial pressure, systemic vascular resistance, and lung compliance. There were also significant increases in the alveolar-arterial O2 tension difference, partial pressure of arterial carbon dioxide, mean pulmonary arterial pressure, pulmonary vascular resistance, and lung water. The RM improved oxygenation, which was attenuated by PLE. Conclusions ALI/ARDS leads to poor oxygenation and hemodynamics. RM results in improved oxygenation, but this improvement is attenuated by PLE. © 2014 Elsevier Inc. All rights reserved. Source

Jimmy Juang J.-M.,National Taiwan University Hospital | Phan W.-L.,Li Shin Hospital | Chen P.-C.,National Taiwan University | Lai L.-P.,National Taiwan University Hospital | And 11 more authors.
Journal of the Formosan Medical Association | Year: 2011

Background: People receive electrocardiogram (ECG) examination for various reasons in a hospital setting. An important clinical practice issue may be that cardiologists need to be consulted for Brugada-type ECGs identified through routine screening. We investigated the prevalence and prognosis of patients with Brugadatype ECG in a hospital-based population in an attempt to improve the management of these patients. Methods: In 20,562 patients seeking medical care for non-cardiovascular reasons, 74,955 ECGs were performed from December 1999 to February 2001. The diagnostic criteria for Brugada-like ECG from the European Society of Cardiology were used. International Statistical Classification of Diseases codes and city residents' records were documented to indicate the reasons for visiting clinics or hospitalization and mortality outcome. Medical records were reviewed and telephone interviews were conducted. Results: Twenty-six (0.13%) of the 20,562 patients were confirmed to have Brugada-type ECGs. None of these patients had ever experienced syncope, near syncope or sudden cardiac death. After 57.1 ± 15.8 months of follow-up, there were four deaths out of the 26 patients with Brugada-type ECG (15.4%, 95% CI: 1.53-2.9%) compared with 2899 of those without (14.1%, 95% CI: 13.6-14.5%; p = 0.89, log-rank test). Neither sudden cardiac death (p = 0.61) nor hospitalized death (p = 0.55) was different between patients with and without Brugada-type ECG. Conclusion: Patients with Brugada-type ECGs are not rare in a hospital-based population. The presence of Brugada-type ECGs in patients without syncope or sudden cardiac death was not associated with hospitalized mortality. © 2011 Elsevier & Formosan Medical Association. Source

Lan C.-C.,Graduate Institute of Medical science | Hsu H.-H.,Tri Service General Hospital | Wu C.-P.,Li Shin Hospital | Huang K.-L.,Tri Service General Hospital | And 4 more authors.
Journal of Surgical Research | Year: 2011

Background: Pneumonectomy is a major surgery. Severe hypoxemia sometimes occurs after pneumonectomy. Effective gas exchange depends on perfect pulmonary ventilation (V ̇A) and perfusion (Q̇) matching. The effect of position on V ̇A/Q̇ matching after pneumonectomy is not clear. We therefore conducted this study to examine the effects of supine, left lateral decubitus (LLD), and right lateral decubitus (RLD) positions on V ̇A/Q̇ matching and gas exchange after pneumonectomy in a porcine model. Methods: Twelve pigs were anesthetized and mechanically ventilated; six pigs received right pneumonectomy and six pigs received left pneumonectomy. The positions of the pigs were changed to supine, LLD, and RLD in random order after pneumonectomy. We applied intravenous and aerosolized high-resolution fluorescent microsphere technique (FMT) to mark V ̇A and Q̇ in conjunction with arterial blood gas analysis to study these variables at different positions. Mechanical ventilation was kept constant throughout. Results: Different positions after pneumonectomy lead to significant changes in heterogeneity and matching of V ̇A/Q̇. In right pneumonectomized pigs, the highest PaO 2, lowest V ̇A/Q̇heterogeneity, and highest matching of V ̇A/Q̇ was in RLD. In left pneumonectomized pigs, the highest PaO 2, lowest V ̇A/Q̇ heterogeneity, and highest matching of V ̇A/Q̇ was in LLD. Conclusions: The lateral position with the remaining lung uppermost leads to the highest V ̇A/Q̇ matching and best gas exchange after pneumonectomy. © 2011 Elsevier Inc. All rights reserved. Source

Higuchi A.,National Central University | Higuchi A.,National Health Research Institute | Yang S.-T.,National Central University | Li P.-T.,National Central University | And 7 more authors.
Journal of Membrane Science | Year: 2010

We have developed a direct ex vivo hematopoietic stem cell (HSC) expansion method involving filtration of umbilical cord blood (UCB) through polyurethane foaming membranes. Most of the red blood cells and mononuclear cells flow through the membranes, but HSCs remain on the membranes. The use of this method reduces the working time to less than 30 min before culture of HSCs, while conventional purification of HSCs from UCB that have been purified by the Ficoll-Paque procedure, followed by magnetic-activated cell sorting, results in loss of cells (i.e., a yield less than 15% of HSCs), damages HSCs, and takes a long time to perform (e.g., 5-8 h). Following filtration of the UCB and washing of the membranes, the membranes can be placed into culture medium where the HSCs can be expanded in a three-dimensional (3D) environment ex vivo, such as the bone marrow niche. Direct ex vivo expansion of HSCs from UCB resulted in an increased number of cells (i.e., 6.6- to 45.7-fold), and the expanded cell populations showed good hematopoietic ability in colony-forming unit assays. © 2010 Elsevier B.V. All rights reserved. Source

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