Mackay Memorial Hospital Taitung Branch

Taitung City, Taiwan

Mackay Memorial Hospital Taitung Branch

Taitung City, Taiwan

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Chang C.-H.,China Medical University at Taichung | Chen S.-J.,Mackay Memorial Hospital Taitung Branch | Chen S.-J.,Tzu Chi University | Liu C.-Y.,National Taipei University of Nursing and Health Sciences
PLoS ONE | Year: 2015

Background & Aims: To evaluate the risk of depressive disorders among patients with Hepatocellular Carcinoma (HCC) using the National Health Insurance Research Database (NHIRD) in Taiwan. Methods: We conducted a retrospective study of a newly diagnosed HCC cohort of 55,973 participants who were selected from the NHIRD. Patients were observed for a maximum of 6 years to determine the rates of newly onset depressive disorders, and Cox regression was used to identify the risk factors associated with depressive disorders in HCC patients. Results: Of the total 55,973 HCC patients, 1, 041 patients (1.86%) were diagnosed with depressive disorders during a mean (SD) follow-up period of 1.1 (1.2) years. The Cox multivariate proportional hazards analysis showed that age of 40-59 (HR 1. 376, 95% CI1.049-1.805, p = 0.021), age of 60-79 (HR 1. 341, 95% CI 1.025-1.753, p = 0.032), women (HR 1.474 95% CI 1.301-1.669, p< 0.001), metastasis (HR 1. 916, 95% CI1.243-2.953, p =0.003), and HCV (HR 1. 445, 95% CI 1.231-1.697, p < 0.001) were independent risk factors for developing depressive disorders. Conclusions: Our study indicated a subsequent risk of depressive disorders in patients with HCC, and the risk increased for those with female gender, aged 40 to 59, aged 60 to 79, with metastasis, or with HCV. Psychological evaluation and support are two critical issues in these HCC patients with the risk factors. Copyright: © 2015 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Chang C.-H.,China Medical University at Taichung | Chang C.-H.,Chinese Institute of Clinical Medicine | Chang C.-H.,Sunshine Psychiatric Hospital | Chen S.-J.,Mackay Memorial Hospital Taitung Branch | And 2 more authors.
Journal of Affective Disorders | Year: 2015

Background Previous studies have posited conflicting results regarding depressive disorders among breast cancer survivors who received adjuvant therapies including chemotherapy, radiotherapy, selective estrogen receptor modulator (e.g. tamoxifen), third-generation aromatase inhibitors (AIs; e.g. anastrozole, letrozole or exemestane), and monoclonal antibody (e.g. trastuzumab). We therefore performed a population-based study with a defined breast cancer cohort to investigate the risk of depressive disorders in breast cancer patients who received adjuvant therapies. Methods We conducted a retrospective study of a breast cancer cohort of 36,586 participants who were selected from the National Health Insurance Research Database(NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidences of newly onset depressive disorders. Kaplan-Meier and Cox regression analyses were used to identify the risk factors associated with depressive disorders in breast cancer patients who underwent adjuvant therapies Results Of the total 36,586 patients, 1342 (3.7%) were ascertained with depressive disorders. The Cox multivariate proportional hazards analysis showed that age of 40-59 (adjusted hazard ratio (aHR) 1.327, 95% CI 1.123-1.567, p=0.001), chemotherapy (aHR 1.555, 95% CI 1.387-1.743, p<0.001), radiotherapy (aHR 1.385 95% CI 1.220-1.571, p<0.001), tamoxifen (aHR 1.458, 95% CI 1.110-1.914, p=0.007), AIs (aHR 1.360, 95% CI 1.193-1.550, p<0.001), and trastuzumab (aHR 1.458, 95% CI 1.110-1.914, p=0.007) were independent risk factors for developing depressive disorders. Limitations The dosage effect of adjuvant treatments, cancer staging, genetic or environmental confounders associated with the risk of depressive disorders were not comprehensively evaluated. Conclusion Developing depressive disorders are at higher risk in breast cancer survivors aged 40-59 who received adjuvant treatments including chemotherapy, radiotherapy, tamoxifen, AIs or trastuzumab. Psychological evaluation and support are necessarily needed in breast cancer survivors who received adjuvant therapies. © 2015 Elsevier B.V.All rights reserved.


Wu C.-Y.,National Taiwan University | Chang C.-K.,King's College London | Robson D.,King's College London | Jackson R.,King's College London | And 4 more authors.
PLoS ONE | Year: 2013

Background:High smoking prevalence is a major public health concern for people with mental disorders. Improved monitoring could be facilitated through electronic health record (EHR) databases. We evaluated whether EHR information held in structured fields might be usefully supplemented by open-text information. The prevalence and correlates of EHR-derived current smoking in people with severe mental illness were also investigated.Methods:All cases had been referred to a secondary mental health service between 2008-2011 and received a diagnosis of schizophreniform or bipolar disorder. The study focused on those aged over 15 years who had received active care from the mental health service for at least a year (N=1,555). The 'CRIS-IE-Smoking' application used General Architecture for Text Engineering (GATE) natural language processing software to extract smoking status information from open-text fields. A combination of CRIS-IE-Smoking with data from structured fields was evaluated for coverage and the prevalence and demographic correlates of current smoking were analysed.Results:Proportions of patients with recorded smoking status increased from 11.6% to 64.0% through supplementing structured fields with CRIS-IE-Smoking data. The prevalence of current smoking was 59.6% in these 995 cases for whom this information was available. After adjustment, younger age (below 65 years), male sex, and non-cohabiting status were associated with current smoking status.Conclusions:A natural language processing application substantially improved routine EHR data on smoking status above structured fields alone and could thus be helpful in improving monitoring of this lifestyle behaviour. However, limited information on smoking status remained a challenge. © 2013 Wu et al.


Chang C.-H.,China Medical University at Taichung | Chen S.-J.,Mackay Memorial Hospital Taitung Branch | Chen S.-J.,Tzu Chi University | Liu C.-Y.,National Taipei University of Nursing and Health Sciences
PLoS ONE | Year: 2015

Background: Breast cancer survivors have an increased risk of bone fracture. But the risk among young patients with adjuvant therapies remains unknown. This population-based study is aimed to assess the incidence and risk of fracture among young (age of 20 to 39 years) breast cancer patients who received adjuvant therapies. Methods: From January 2001 to December 2007, 5,146 newly diagnosed breast cancer patients were enrolled from the National Health Insurance Research Database (NHIRD) in Taiwan. Patients were observed for a maximum of 6 years to determine the incidence of newly onset fracture. Kaplan Meier and Cox regression analyses were used to evaluate the risk of fracture in young breast cancer patients who received adjuvant treatments. Results: Of the total 5,146 young (age of 20 to 39 years) breast cancer patients, the Cox multivariate proportional hazards analysis showed that AIs, radiotherapy, and monoclonal antibodies were significantly associated with a high risk of fracture. Moreover, patients who received AIs for more than 180 days had a high hazard ratio (HR) of 1.77 (95% CI = 0.68-4.57), and patients who received more than four radiotherapy visits had a high HR of 2.54 (95% CI = 1.07-6.06). Under the site-specific analysis, young breast cancer patients who received AIs had the highest risk of hip fracture (HR = 8.520, 95% CI = 1.711-42.432, p < 0.04), whereas patients who received radiotherapy had the highest risk of vertebral fracture (HR = 5.512, 95% CI = 1.847-16.451, p < 0.01). Conclusion: Young breast cancer patients who are receiving AIs, radiotherapy or monoclonal antibody need to be more careful for preventing fracture events. Breast cancer treatment plans are suggested to incorporate fracture prevention interventions. © 2015 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


PubMed | Chang Gung University and Mackay Memorial Hospital Taitung Branch
Type: | Journal: International journal of cardiology | Year: 2016

Radiofrequency catheter ablation (RFCA) of ventricular arrhythmias (VAs) originating from the left ventricular (LV) papillary muscles (PMs) is challenging.We enrolled 16 consecutive patients who received RFCA for VAs from LV PMs. Three-dimensional electroanatomical mapping was used to construct activation and/or pace maps. RFCA was performed first at the earliest activation site or at the best matched site in the pace maps. When an acceleration or reduction in the incidence of VAs was observed during the first few seconds of the application, the ablation energy was delivered continuously for 60-120s. Additional ablation was then circumferentially delivered at the base of the PMs.RFCA was successfully performed in all 16 patients with no cases of recurrence of VAs after a mean follow-up of 2012months. VAs originated from the anterior (n=8) and posterior (n=8) PMs. Purkinje potentials were identified at the target sites in seven patients. All VAs were temporarily suppressed by one to two long-duration shots of RFCA at the initial targeted site, but recurrence was subsequently noted. In six patients, the QRS morphologies of the VAs changed after the initial RFCA. A subsequent circumferential approach with multiple ablations applied to the base of the PMs completely eliminated all VAs. In all but one patient, successful RFCA was achieved using an open-irrigated ablation catheter.Circumferential RFCA at the base of the PMs overcame anatomical limitations, leading to a high success rate of RFCA for VAs from LV PMs.


Chen S.-J.,Mackay Memorial Hospital Taitung Branch | Chen S.-J.,Tzu Chi University | Chang C.-H.,China Medical University at Taichung | Tsai H.-C.,Tzu Chi University | And 5 more authors.
Neuropsychiatric Disease and Treatment | Year: 2013

Depression is a major psychiatric disorder. The standard treatment for depression is antidepressant medication, but the responses to antidepressant treatment are only partial, even poor, among 30%-45% of patients. Refractory depression is defined as depression that does not respond to antidepressant therapy after 4 weeks of use. There is evidence that repetitive transcranial magnetic stimulation (rTMS) may exert effects in treating psychiatric disorder through moderating focal neuronal functions. High-frequency rTMS on the left prefrontal area and low-frequency rTMS on the right prefrontal area were shown to be effective in alleviating depressive symptoms. Given the statistically significant antidepressant effectiveness noted, the clinical application of rTMS as a depression treatment warrants further studies. Application of rTMS as an add-on therapy would be a practical research model. High-frequency (5-20 Hz) rTMS over the left dorsolateral prefrontal cortex was found to have a significant effect on medication-resistant depression. In the present study, we not only measured the acute antidepressant effect of rTMS during treatment and immediately after its completion but also evaluated participants 1 month after completion of the treatment protocol. Study participants were divided into two groups: an active rTMS group (n = 10) and a sham group (n = 10). The active rTMS group was defined as participants who received the rTMS protocol, and the sham group was defined as participants who received a sham rTMS procedure. A significant Hamilton Depression Rating Scale score reduction was observed in both groups after the fifth and tenth treatments. However, those in the active rTMS group maintained their improvement as measured one month after completion of the rTMS protocol. Participants who received active rTMS were more likely to have persistent improvement in depression scores than participants who received sham rTMS. © 2013 Chen et al, publisher and licensee Dove Medical Press Ltd.


Ho C.-S.,Mackay Memorial Hospital | Ho C.-S.,Nursing and Management College | Chiu N.-C.,Mackay Memorial Hospital | Chiu N.-C.,Nursing and Management College | And 2 more authors.
Pediatrics and Neonatology | Year: 2014

Background/purpose The purpose of this study was to evaluate the effectiveness and tolerability of aripiprazole in short-term treatment of children and adolescents with tic disorder (TD). Methods This was a 14-week, prospective, open-label flexible dose trial of aripiprazole. We enrolled patients with TD aged between 4 years and 18 years. They received aripiprazole (dose: 2.5 mg/day) initially, which was then adjusted according to clinical response. The severity was assessed by the Yale Global Tic Severity Score (YGTSS) at 0, 2, 6, 10, and 14 weeks. The linear mixed models were used for evaluation of the YGTSSs at each follow-up, which were compared with baseline scores. Results Eighty-one patients were enrolled in this study. Nine patients withdrew from the study with complaints of adverse side effects. Of the remaining 72 patients, 15 patients discontinued medications prematurely due to being free of symptoms for over 2 weeks. Two patients discontinued medications due to no significant improvement. The mean scores had significantly decreased since the 2nd week (p < 0.01). The mean reduction was 51.0% in the motor tic scores, 67.1% in the vocal tic scores, and 70.0% in the total YGTSSs. The common adverse effects were sedation (32.1%) and increased appetite (22.2%). A slight increase in average body weight was noted, from 32.7 to 33.7 kg (+1.0 kg, p < 0.05). Conclusion Aripiprazole is effective for short-term treatment of TD, especially vocal tics, in children and adolescents with mild adverse effects. However, further double-blind trials against placebo or other medications are needed to verify the efficacy of aripiprazole in the pharmacotherapy of TD. © 2013, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.


Ou T.-T.,Chung Shan Medical University | Wang C.-J.,Chung Shan Medical University | Lee Y.-S.,Mackay Memorial Hospital Taitung Branch | Wu C.-H.,China Medical University at Taichung | Lee H.-J.,Chung Shan Medical University
Molecular Nutrition and Food Research | Year: 2010

Scope: Cell cycle regulation is a critical issue in cancer treatment. Previously, gallic acid (GA) has been reported to possess anticancer ability. Here, we have evaluated the molecular mechanism of GA on cell cycle modulation in a human bladder transitional carcinoma cell line (TSGH-8301 cell). Methods and results: Using flow cytometer analysis, exposure of the cells to 40 μM GA resulted in a statistically significant increase in G2/M phase cells, which was accompanied by a decrease in G0/G1 phase cells. GA-treated cells resulted in significant growth inhibition in a dose-dependent manner accompanied by a decrease in cyclin-dependent kinases (Cdk1), Cyclin B1, and Cdc25C, but significant increases in p-cdc2 (Tyr-15) and Cip1/p21 by western blotting. Additional mechanistic studies showed that GA induces phosphorylation of Cdc25C at Ser-216. This mechanism leads to its translocation from the nucleus to the cytoplasm resulting in an increased binding with 14-3-3β. When treated with GA, phosphorylated Cdc25C can be activated by ataxia telangiectasia-mutated checkpoint kinase 2 (Chk2). This might be a DNA damage response as indicated by Ser-139 phosphorylation of histine H2A.X. Furthermore, treatment of the cells with a Chk2 inhibitor significantly attenuated GA-induced G2/M phase arrest. Conclusion: These results indicate that GA can induce cell cycle arrest at G2/M phase via Chk2-mediated phosphorylation of Cdc25C in a bladder transitional carcinoma cell line. Copyright © 2010 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.


Lee J.-N.,Cheng Shiu University | Chang K.-Y.,Mackay Memorial Hospital Taitung Branch
Life Science Journal | Year: 2010

In this paper, an integrated approach of CAD/CAM was presented for the concurrent development of custom-made femoral stem. The femoral stem is developed on a prescription basis and is unique for each patient. The geometric parameters and the necessary constrains based on surgical experience were integrate into the CAD system. The rapid prototyped model was built as the reference for review. Through the application of CAM software, the interference-free toolpath and the cutter location for multi-axis NC machining are generated. The cutting simulations with solid model are performed to verify the generated toolpath. It is also verified through the trial-cut with model material on a five-axis machine tool.


Lee J.-N.,Cheng Shiu University | Chen H.-S.,Cheng Shiu University | Luo C.-W.,Cheng Shiu University | Chang K.-Y.,Mackay Memorial Hospital Taitung Branch
Life Science Journal | Year: 2010

In this paper, a design system combining clinical experience and engineering knowledge was developed for the manufacture for femoral component of knee prosthesis. The femoral component is developed on a prescription basis and is unique for each patient. The medical image of the femoral component obtained according to the patient CT. The necessary constrains based on surgical experience were integrate into the CAD system. The rapid prototyped model was built as the reference for review. In the process planning, the fixture is designed and the cutting sequence for rough and finish machining is arranged. Through the application of CAM software, the interference-free toolpath and the cutter location file for multi-axis NC machining are generated. The cutting simulations with solid model are performed to verify the generated toolpath and NC program. The result of this work can be of crucial benefit in research and development.

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