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Fengshan, Taiwan

Ashok K.,Linkou Medical Center | Wang A.,Chang Gung University
Obstetrical and Gynecological Survey

Nocturia is a common symptom in women which has profound negative impact on the quality of life. With the increase in aging population, nocturia is becoming an important clinical problem. A proper understanding of cardio-respiratory, metabolic, and neurological patho-physiology of nocturia is imperative for appropriate management of nocturia. When managing a patient with nocturia it is important to evaluate the patient as a whole rather than from urological perspective only. In this article we attempt to discuss the definition, etiology, clinical features and management of nocturia so that a comprehensive approach to management can be adopted when faced with a woman complaining of nocturia. TARGET AUDIENCE: Obstetricians & Gynecologists, Family Physicians LEARNING OBJECTIVES: After completion of this educational activity, the participant should be better able to evaluate the causes of Nocturia, perform a work up for a patient with Nocturia and develop clinical management of a patient with Nocturia. © 2010 by Lippincott Williams & Wilkins. Source

Lin Y.-H.,Linkou Medical Center | Lin Y.-H.,Chang Gung University | Liu G.,SUNY Upstate Medical University | Li M.,Cleveland Clinic | And 2 more authors.
European Urology

Background: The natural history and the mechanisms behind the alteration of vaginal distension (VD) in a mouse model are not clear. Objective: We examined the temporal sequelae of VD and pudendal nerve transection (PNT) on leak-point pressure (LPP) and the muscular and nerve components of the urethra in mice. Design, setting, and participants: Seventy-two virgin female C57BL/6 mice were equally distributed into three groups. The VD group underwent VD for 1 h. The PNT group received bilateral PNT. A control group underwent sham VD. Intervention: Each group was divided into four subgroups of six mice for measurement of LPP at 0, 4, 10, and 20 d after VD or PNT. Measurements: LPP was measured. Morphology and neurofilament-immunoreactive nerve of the urethra were assessed. Results and limitations: LPP was decreased at 0, 4, and 10 d but not at 20 d after VD. Decreased LPP persisted to 20 d in the PNT group. The external urethral striated muscle appeared disrupted and/or wavy in two mice at 0 d, in three mice at 4 d, in one mouse at 10 d, and in one mouse in 20 d after VD. The density of neurofilament-immunoreactive nerve in the urethra was reduced at 4 and 10 d after VD, but not at 20 d, and at 4, 10, and 20 d after PNT compared with the corresponding values of the sham VD group. The limitation of this animal model is that the pelvic floor structure of the mouse is different from that of female humans. Therefore, results of this study should be carefully applied to human subjects. Conclusions: VD causes reversible stress urinary incontinence in female mice. Recovery of continence function following VD is associated with repair of the external urethral sphincter and reinnervation of the urethra. This mouse model will be useful for mechanistic investigation and targeting of therapeutic intervention by taking advantage of genetic manipulation. © 2009 European Association of Urology. Source

Wu T.-I.,Chang Gung University | Yen T.-C.,Linkou Medical Center | Lai C.-H.,Chang Gung University
Best Practice and Research: Clinical Obstetrics and Gynaecology

Uterine sarcomas are uncommon tumours from mesenchymal elements. They are thought to arise primarily from endometrial stroma and uterine muscle, respectively. When endometrial stroma undergoes malignant transformation, it might be accompanied by a malignant epithelial component. Thus, malignant mesenchymal uterine tumours comprise leiomyosarcoma, endometrial stromal sarcoma, undifferentiated uterine sarcoma and carcinosarcoma. In this chapter, we discusses preoperative presentation, diagnosis and current progress in different imaging modalities, including ultrasonography, computed tomography, magnetic resonance image and positron emission tomography scan. We summarise advances in new technology, which might improve preoperative detection and enhance referral to gynaecologic oncologists for optimal staging surgery and treatment. © 2011 Elsevier Ltd. All rights reserved. Source

Lin C.-J.,Linkou Medical Center
Journal of Internal Medicine of Taiwan

Gastric acid played an important role on human protein digestion, absorption of some minerals and vitamin B12, as well as bactericidal effect. However excess acid might cause serious implication on health, such as peptic ulcer and perforation, which were used to resort to surgical intervention since industrial revolution. Following the elucidation of neurophysiology and endocrinology, gastric acid secretion was known to be mainly controlled by vagal nerve and gastrin. Through the research of acid manufactory-parietal cells, histamine2 blockers and proton pump inhibitors were introduced and marketed as main regulators of gastric acid, resulting in successful medical treatment on almost whole acid-related diseases. Then the discovery of Helicobacter pylori in stomach and its pathogenesis on gastritis and peptic ulcer made the eradication of bacteria and peptic ulcer disease possible. However the evolution of gastroesophageal reflux disease (GERD) takeover worldwide as main acid-related disease, affecting the quality of life on millions of people nowadays. Despite of the refinement of new PPIs, there is still unmet clinical need on treatment. GERD will be highlighted as increased trends as Barrett's esophagus and esophageal adenocarcinoma after eradication of H. pylori. Following the emerging resistant strain from widespread antibiotic administration and increased usage of NSAID on elderly, peptic ulcer and gastrointestinal bleeding seemed to resurge again. This article will cover the histological perspective, concerning acid research and introduce some contributory studies from Taiwan, as well as update on management consensus of acid-related diseases. This brief text was expected to give us some important clinical insights into these issues for better future practice. Source

Twu Y.-C.,National Taiwan University | Hsieh C.-Y.,National Taiwan University | Lin M.,Transfusion Medicine Laboratory | Tzeng C.-H.,Taipei Veterans General Hospital | And 5 more authors.

The cell-surface straight and branched repeats of N-acetyllactosamine (LacNAc) units, called poly-LacNAc chains, characterize the histo-blood group i and I antigens, respectively. The transition of straight to branched poly-LacNAc chain (i to I) is determined by the I locus, which expresses 3 IGnT transcripts, IGnTA, IGnTB, and IGnTC. Our previous investigation demonstrated that the i-to-I transition in erythroid differentiation is regulated by the transcription factor CCAAT/enhancer binding protein α (C/EBPα). In the present investigation, the K-562 cell line was used as a model to show that the i-to-I transition is determined by the phosphorylation status of the C/EBPα Ser-21 residue, with dephosphorylated C/EBPα Ser-21 stimulating the transcription of the IGnTC gene, consequently resulting in I branching. Results from studies using adult erythropoietic and granulopoietic progenitor cells agreed with those derived using the K-562 cell model, with lentiviral expression of C/EBPα in CD34+ hematopoietic cells demonstrating that the dephosphorylated form of C/EBPα Ser-21 induced the expression of I antigen, granulocytic CD15, and also erythroid CD71 antigens. Taken together, these results demonstrate that the regulation of poly-LacNAc branching (I antigen) formation in erythropoiesis and granulopoiesis share a commonmechanism, with dephosphorylation of the Ser-21 residue on C/EBPα playing the critical role. © 2010 by The American Society of Hematology. Source

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