Yilan, Taiwan
Yilan, Taiwan

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Chen P.-K.,China Medical University at Taichung | Chiu P.-Y.,Lin Shin Hospital | Tsai I.-J.,Data Management | Tseng H.-P.,Lo Hsu Foundation Inc | And 14 more authors.
Stroke | Year: 2013

BACKGROUND AND PURPOSE - : The study aimed to assess whether onset headache is an ominous sign in patients with first-ever ischemic stroke. METHODS - : A large population of ischemic stroke patients was obtained from the Taiwan Stroke Registry. Stroke subtypes were classified by the Trial of ORG 10172 in Acute Stroke Treatment (TOAST) criteria. On the basis of the International Classification of Headache Disorders, second version, onset headache was defined as a new headache that developed at the onset of ischemic stroke. Clinical features and impact on stroke outcomes, including in-hospital stroke in evolution, changes in National Institutes of Health Stroke Scale on discharge, and Barthel index and modified Rankin scale ≤6 months after stroke were compared between those with and without onset headache. RESULTS - : Among 11 523 patients with first-ever ischemic stroke, 848 had onset headache (7.4%). Patients with specific cause, large-Artery atherosclerosis, or cardioembolism were more likely to have onset headache. Patients with onset headache were younger, predominantly female, and more likely to have posterior circulation ischemic lesions. Compared with patients without onset headache, those with onset headache had a lower frequency of stroke in evolution (4.5% versus 6.7%; adjusted relative risk, 0.64; 95% confidence interval, 0.52-0.79), greater improvement in National Institutes of Health Stroke Scale score on discharge (0.08 versus -0.20; P=0.02), higher mean Barthel index scores (86.5±20.0 versus 83.9±23.3; adjusted difference, 1.43; 95% confidence interval, 0.28-2.89), and a lower frequency of modified Rankin scale higher than 2 (27.6% versus 31.5%; adjusted relative risk, 0.85; 95% confidence interval, 0.72-0.95) at 1-month follow-up. There was also a trend for better functional outcome in 3- and 6-month follow-ups. CONCLUSIONS - : By adopting standard classification criteria, this large-scale study demonstrated that onset headache was associated with modest but significantly better outcomes after ischemic stroke. © 2013 American Heart Association, Inc.


Tsai M.S.,National Health Research Institute | Yang Y.L.,National Chiao Tung University | Wang A.H.,National Health Research Institute | Wang L.S.,Buddhist Tzu Chi General Hospital | And 10 more authors.
Mycopathologia | Year: 2012

A total of 35 Trichosporon isolates were collected from the Taiwan Surveillance of Antimicrobial Resistance of Yeasts (TSARY) project from 1999 to 2006, and their identifications as well as drug susceptibilities were determined. The most frequently isolated species was T. asahii (62. 9%), and the most common clinical sample that yielded Trichosporon isolates was urine (37. 1%). The etiology of all seven invasive trichosporonosis was T. asahii. For the 22 T. asahii isolates, the MIC 50 and MIC 90 for amphotericin B were 0. 25 and 1 μg/mL, respectively. Those for fluconazole were 2 and 4 μg/mL, respectively, and for voriconazole 0. 031 and 0. 063 μg/mL, respectively. When the intraclass correlation coefficients (ICCs) and agreements were calculated, we found that the MICs of fluconazole obtained from different methods were similar and the inter-method discrepancies were low. Nevertheless, no unanimous MIC of amphotericin B and voriconazole was obtained among different methods. © 2012 Springer Science+Business Media B.V.


Hsieh Y.-C.,Taipei Medical University | Hwang L.-C.,Mackay Memorial Hospital | Hwang L.-C.,Nursing and Management College | Hsieh F.-I.,Taipei Medical University | And 7 more authors.
International Journal of Gerontology | Year: 2010

Background: Results from previous studies regarding relationships between age at menarche and cardiovascular disease remain controversial. This study investigated the association between endogenous estrogen exposure and ischemic stroke risk. Methods: A total of 189 ischemic stroke patients and 192 age-matched healthy postmenopausal women were recruited. Age at menarche and menopause and risk factors of ischemic stroke were recorded through structured questionnaires by well-trained research assistants. Lifetime estrogen exposure was calculated as the number of years between age of menarche and menopause. Results: Study subjects with a history of hypertension and diabetes mellitus have a 2.8- and 6.2-fold increased risk for ischemic stroke, respectively. In addition, study subjects with waist circumferences ≥80 cm also have a 2.6-fold increased risk of ischemic stroke. Conversely, subjects who experienced menarche at an early age may have a significantly decreased risk of 0.3-fold for ischemic stroke. Moreover, there was a significant and joint protective effect for study subjects without any risk factors of ischemic stroke, including a history of hypertension and diabetes mellitus, late age at menarche, and shorter lifetime estrogen exposure; these subjects were found to have the lowest risk (0.03-fold) for the development of ischemic stroke. Conclusion: Our study provides strong evidence that a significant joint protective effect was observed for patients who undergo early menarche, have longer estrogen exposure and no history of hypertension or diabetes mellitus on the risk of ischemic stroke. © 2010 Taiwan Society of Geriatric Emergency & Critical Care Medicine.

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