National Defence Medical Center

Taipei, Taiwan

National Defence Medical Center

Taipei, Taiwan

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Lai C.-H.,Department of National Defence | Jaakkola J.J.K.,University of Oulu | Chuang C.-Y.,Department of National Defence | Liou S.-H.,Department of National Defence | And 4 more authors.
Journal of Exposure Science and Environmental Epidemiology | Year: 2013

Cooking oil fumes (COF) contain polycyclic aromatic hydrocarbons (PAHs), heterocyclic aromatic amines, benzene, and formaldehyde, which may cause oxidative damages to DNA and lipids. We assessed the relations between exposure to COF and subsequent oxidative DNA damage and lipid peroxidation among military cooks and office-based soldiers. The study population, including 61 Taiwanese male military cooks and a reference group of 37 office soldiers, collected urine samples pre-shift of the first weekday and post-shift of the fifth workday. We measured airborne particulate PAHs in military kitchens and offices and concentrations of urinary 1-OHP, a biomarker of PAH exposure, urinary 8-hydroxydeoxyguanosine (8-OHdG), a biomarkers of oxidative DNA damage, and urinary isoprostane (Isop). Airborne particulate PAHs levels in kitchens significantly exceeded those in office areas. The concentrations of urinary 1-OHP among military cooks increased significantly after 5 days of exposure to COF. Using generalized estimating equation analysis adjusting for confounding, a change in log(8-OHdG) and log(Isop) were statistically significantly related to a unit change in log(1-OHP) (regression coefficient (β), β0.06, 95% CI 0.001-0.12) and (β0.07, 95% CI 0.001-0.13), respectively. Exposure to PAHs, or other compounds in cooking oil fumes, may cause both oxidative DNA damage and lipid peroxidation. © 2013 Nature America, Inc. All rights reserved.


Chen Y.-C.,Taipei Veterans General Hospital | Chen Y.-C.,University of South Carolina | Chang Y.-J.,Taipei Veterans General Hospital | Chang Y.-J.,National Yang Ming University | And 6 more authors.
BMC Health Services Research | Year: 2013

Background: In order to improve treatment and care quality for cancer patients, nurse case management model has applied generally in the clinical practice. However there were only few evidence-based studies on the relative benefits in Taiwan. Further analysis and feedback application are needed. The aim of this study is to evaluate the effectiveness of care quality in cancer patients with nurse case management. Methods. This study was conducted with a quasi-experimental design in a national medical center in Northern Taiwan. Patients diagnosed as lung, liver, breast, colon, buccal or cervical cancers were eligible for inclusion. A total number of 600 subjects randomly selected from the cancer case management system enrolled in the case managed group, and 600 patients who received usual care were randomly selected from cancer registry and enrolled in the control group. The study instrument was developed to measure care effectiveness, including the rates of patient continuing treatment, non-adherence to treatment, prolonged hospitalization, unplanned readmission, and planned admission for active treatment. The content validity of expert was assessed as 0.9. Results: The nurse case management significantly decreased the unplanned readmission rate caused by infection (1.5% vs. 4.7% in the control group, p = 0.002). The rate of patient continuing treatment in the institution significantly increased in the case managed group (93.8% vs. 84.8% in the control group, p < 0.001). The planned admission rates in 14 days and in 15-30 days for active treatment also significantly increased in the case managed group (18.4.% vs. 3.9% in the control group and 34.5% vs. 10.4% in the control group, respectively, p < 0.001). The results indicated that nurse case management provided better control in timeliness and continuity of patient treatment. Conclusions: This study demonstrated that cancer case management could improve the effectiveness of cancer care services and concretely illustrated a comprehensive model for oncology patients in Taiwan. In addition, the model could be optimized for further application and improvement of cancer care. Future investigations are needed to develop precise and rigorous evaluation to optimize the utilization of cancer case management. © 2013 Chen et al.; licensee BioMed Central Ltd.


PubMed | Cheng Hsin General Hospital, Department of National Defence, Kaohsiung Armed Forces General Hospital Gangshan Branch and National Defence Medical Center
Type: | Journal: Nurse education today | Year: 2016

Because patients in disaster areas require the most critical care, mobilising hospital nurses has become a pivotal strategy. Given the importance of disaster nursing training programmes, understanding how well prepared hospital nurses are to provide disaster care is vital.This paper analyses the perceived readiness of hospital nurses for a disaster response and the factors influencing their report for work outside the hospital environment.A cross-sectional research design was used.This study was conducted at a military hospital in Taiwan.A sample of 311 registered nurses participated in this study.Data were collected on readiness for disaster responses using a 40-item researcher-designed, self-administered questionnaire found to have satisfactory reliability and validity. The questionnaire has four domains: personal preparation (16 items), self-protection (11 items), emergency response (6 items), and clinical management (7 items). Data were analysed using descriptive statistics, independent t-tests and generalised linear models.The majority of hospital nurses demonstrated poor readiness for disaster responses. Scores on the four domains were most associated with nurses disaster-related training, experience in disaster response and emergency/intensive care experience.Our results indicate that disaster-related training should be included in undergraduate programmes and continuing education courses to help hospital nurses recognise and improve their own readiness for disaster responses outside the hospital environment. Future research is needed to improve hospital nurses disaster-response readiness in Taiwan and other countries.


Lin F.-G.,National Defence Medical Center | Hsieh Y.-H.,National Defence Medical Center | Tung H.-J.,Asia University, Taiwan
Asia Pacific Journal of Clinical Nutrition | Year: 2012

Depression is an important health problem in children and the onset of depression is occurring at a younger age than previously suggested. The associations of being overweight and low socioeconomic status in childhood depression have been well documented; nevertheless few studies have addressed the combined effects of socioeconomic status and body weight, with depression in school-age children. We intended to examine if the relationship between socioeconomic status and childhood depression could be modified by abnormal body weight. A cross-sectional study was performed with a total of 559 subjects from 29 elementary schools in Taiwan. A depression scale was used to determine the depression status. Children receiving governmental monetary assistance for after-school class were categorized as being in the lower socioeconomic group. Data for depression-related demographic characteristics, family and school variables were collected. Children in the lower socioeconomic status group have a higher prevalence of depression (23.5%) than those in higher socioeconomic status groups(16.4%). Being overweight demonstrates the opposite effect on depression risk in the different socioeconomic groups. In lower socioeconomic families, the risk of depression in overweight children is three times higher than that for normal weight children; whereas in higher socioeconomic families, overweight children have a lower risk for depression than normal weight children. We concluded that a qualitative interactive effect existed between being overweight and socioeconomic status with childhood depression. More attention should be paid to overweight children from lower socioeconomic status families to prevent depression in school-age children.


Sheu W.H.-H.,Taichung Veterans General Hospital | Sheu W.H.-H.,National Yang Ming University | Sheu W.H.-H.,National Defence Medical Center | Brunell S.C.,Amylin Pharmaceuticals Inc. | Blase E.,Amylin Pharmaceuticals Inc.
Diabetes Research and Clinical Practice | Year: 2016

Aims: The efficacy and safety of exenatide twice daily (BID) and once weekly (QW) were assessed in Asian versus White patients with type 2 diabetes mellitus (T2DM). Methods: This post-hoc pooled analysis evaluated patients receiving 10. μg exenatide BID for 12-30 weeks or 2. mg exenatide QW for 24-30 weeks in exenatide clinical development program trials. Race was self-identified. Results: A total of 4625 patients were included (exenatide BID: Asian, n = 787; White, n = 2223; exenatide QW: Asian, n = 511; White, n = 1104). At study end, glycated hemoglobin (HbA1c), fasting glucose (FG), body weight, post-prandial glucose (PPG), and PPG excursions were significantly reduced (all P <. 0.0001 vs baseline). For exenatide BID, HbA1c reduction was greater in Asians (P <. 0.0001 vs Whites), whereas HbA1c reduction did not differ by race for exenatide QW. FG reduction did not differ by race for either exenatide formulation. Weight reduction was significantly greater in Whites (P <. 0.0001 vs Asians), regardless of exenatide formulation. PPG reduction was greater in Asians (P <. 0.0001 vs Whites) for exenatide BID but did not differ by race for exenatide QW. For exenatide BID, reductions in PPG excursions for all meals were significantly greater in Asians (P <. 0.0001 vs Whites), whereas only post-breakfast and post-lunch excursions were significantly greater in Asians for exenatide QW (P = 0.0009 and P = 0.0189 vs Whites, respectively). Common adverse events included nausea, headache, and diarrhea. Conclusions: Exenatide BID and QW improved glycemic control, including PPG, in Asian and White patients with T2DM. With exenatide BID, Asian patients exhibited significantly greater reductions in HbA1c and PPG than White patients. Both exenatide formulations were well tolerated in both groups. © 2016 The Authors.


Wu H.-S.,Centers for Disease Control | Wu H.-S.,Taipei Medical University | Yang J.-R.,Centers for Disease Control | Liu M.-T.,Centers for Disease Control | And 4 more authors.
Emerging Infectious Diseases | Year: 2014

Six persons in Taiwan who had contact with poultry infected with influenza A(H5N2) showed seroconversion for the virus by hemagglutinin inhibition or microneutralization testing. We developed an ELISA based on nonstructural protein 1 of the virus to differentiate natural infection from cross-reactivity after vaccination; 2 persons also showed seroconversion by this test.


Chen C.-C.,National Taiwan Ocean University | Wu C.-J.,National Taiwan Ocean University | Yeh M.-K.,National Defence Medical Center
International Journal of Nanotechnology | Year: 2013

Cancer is a major cause of deaths. More recently, drug delivery systems (DDSs) using gold nanoparticles (GNPs) have been widely developed in cancer therapy for their easily synthesised, functionalised, better biocompatible, and low toxicity properties. Gold nanoparticle-based platforms as cancer-targeted molecules delivery to tumour tissues have been proposed as an effective strategy by overcoming various biological barriers and increasing retention effect. Coupled with the active targeting on the specific sites during cancer process they can facilitate anticancer effects. This review is focused on the current applications of GNPs as improving cancer-targeted delivery platforms. © 2013 Inderscience Enterprises Ltd.


Lo C.-H.,Tri Service General Hospital | Huang W.-Y.,Tri Service General Hospital | Lee M.-S.,National Defence Medical Center | Lin K.-T.,Tri Service General Hospital | And 4 more authors.
European Journal of Gastroenterology and Hepatology | Year: 2014

BACKGROUND: The role of stereotactic ablative radiotherapy (SABR) in patients with hepatocellular carcinoma (HCC) who are refractory to or unsuitable for transarterial chemoembolization remains unclear. We examined the efficacy and safety of Cyberknife SABR and its effect on survival in this group of HCC patients. MATERIALS AND METHODS: From June 2008 to June 2011, 53 patients with 68 tumors of unresectable HCC were treated using Cyberknife SABR. The tumors measured 1.1-13 cm (median, 4.3 cm). The median prescribed dose was 40 Gy in four to five fractions over 4-5 consecutive working days. RESULTS: The median follow-up period was 13.1 months for all patients and 18.1 months for the living patients. Objective responses were observed in 48 of 67 tumors (71.6%), including 22 tumors (32.8%) with complete responses. The 1- and 2-year in-field failure-free rate was 73.3 and 66.8%, respectively. Out-field intrahepatic recurrence was the main cause of treatment failure (28/52 patients). The median survival time was 20.0 months, and the 1- and 2-year overall survival rate was 70.1 and 45.4%, respectively. Multivariable analysis showed that Eastern Cooperative Oncology Group performance status (≤1 vs. >1) and tumor response (responder vs. nonresponder) were independent prognostic factors for overall survival. Radiation-induced liver disease, including classic and nonclassic types, developed in five patients (9.4%). Other acute toxicities were generally mild and tolerable. CONCLUSION: Our findings supported the feasibility of SABR as a salvage treatment for HCC when transarterial chemoembolization was ineffective or technically unsuitable. Additional efforts to improve the response rate and reduce out-field recurrence are required. © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins.


Hu C.-S.,National Taiwan University of Science and Technology | Chiang C.-H.,National Defence Medical Center | Hong P.-D.,National Taiwan University of Science and Technology | Yeh M.-K.,National Taiwan University of Science and Technology | Yeh M.-K.,National Defence Medical Center
International Journal of Nanomedicine | Year: 2012

Background and methods: Chondroitin sulfate-chitosan (ChS-CS) nanoparticles and positively and negatively charged fluorescein isothiocyanate-conjugated bovine serum albumin (FITC-BSA)-loaded ChS-CS nanoparticles were prepared and characterized. The properties of ChS-CS nanoparticles, including cellular uptake, cytotoxicity, and transepithelial transport, as well as findings on field emission-scanning electron microscopy, transmission electron microscopy, and confocal laser scanning microscopy were evaluated in human epithelial colorectal adenocarcinoma (Caco-2) fibroblasts. ChS-CS nanoparticles with a mean particle size of 250 nm and zeta potentials ranging from -30 to +18 mV were prepared using an ionic gelation method. Results: Standard cell viability assays demonstrated that cells incubated with ChS-CS and FITC-BSA-loaded ChS-CS nanoparticles remained more than 95% viable at particle concentrations up to 0.1 mg/mL. Endocytosis of nanoparticles was confirmed by confocal laser scanning microscopy and measured by flow cytometry. Ex vivo transepithelial transport studies using Caco-2 cells indicated that the nanoparticles were effectively transported into Caco-2 cells via endocytosis. The uptake of positively charged FITC-BSA-loaded ChS-CS nanoparticles across the epithelial membrane was more efficient than that of the negatively charged nanoparticles. Conclusion: The ChS-CS nanoparticles fabricated in this study were effectively endocytosed by Caco-2 fibroblasts without significant cytotoxicity at high nanoparticle concentrations. ChS-CS nanoparticles represent a potential novel delivery system for the transport of hydrophilic macromolecules. © 2012 Hu et al, publisher and licensee Dove Medical Press Ltd.


PubMed | National Defence Medical Center
Type: Journal Article | Journal: Asia Pacific journal of clinical nutrition | Year: 2012

Depression is an important health problem in children and the onset of depression is occurring at a younger age than previously suggested. The associations of being overweight and low socioeconomic status in childhood depression have been well documented; nevertheless few studies have addressed the combined effects of socioeconomic status and body weight, with depression in school-age children. We intended to examine if the relationship between socioeconomic status and childhood depression could be modified by abnormal body weight. A cross-sectional study was performed with a total of 559 subjects from 29 elementary schools in Taiwan. A depression scale was used to determine the depression status. Children receiving governmental monetary assistance for after-school class were categorized as being in the lower socioeconomic group. Data for depression-related demographic characteristics, family and school variables were collected. Children in the lower socioeconomic status group have a higher prevalence of depression (23.5%) than those in higher socioeconomic status groups(16.4%). Being overweight demonstrates the opposite effect on depression risk in the different socioeconomic groups. In lower socioeconomic families, the risk of depression in overweight children is three times higher than that for normal weight children; whereas in higher socioeconomic families, overweight children have a lower risk for depression than normal weight children. We concluded that a qualitative interactive effect existed between being overweight and socioeconomic status with childhood depression. More attention should be paid to overweight children from lower socioeconomic status families to prevent depression in school-age children.

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