Pingtung Christian Hospital

Pingtung, Taiwan

Pingtung Christian Hospital

Pingtung, Taiwan

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Lin L.-F.,Pingtung Christian Hospital | Shen H.-C.,Pingtung Christian Hospital
Digestive Endoscopy | Year: 2013

Aim: The present prospective observational study investigates the safety of transnasal percutaneous endoscopic gastrostomy (T-PEG) carried out by a single physician using an ultrathin endoscope. Methods: A single endoscopist attempted the unsedated transnasal insertion of a 20-Fr PEG tube using a pull-method in 31 dysphagic patients: 11 females and 20 males aged 76.5 ± 10.6 (46-96) years, using a 5-mm-diameter endoscope. The indications for PEG, cardiopulmonary function before and after T-PEG, operation time, success or failure, and any immediate adverse events that occurred during each procedure were recorded. Complications, including peristomal infection, systemic infection, tube lifespan, and patient mortality were monitored throughout the post-T-PEG follow-up period. Results: Thirty (96.8%) of the transnasal PEG insertions were successful. The mean operation time was 14.7 ± 2.9 (10-20) min, and cardiopulmonary function did not change before and after T-PEG. Complications included three (10%) cases of epistaxis, eight (26.6%) cases of minor Pseudomonas wound infection and two cases of Foley-related urinary tract infection (UTI). No self-extubation was observed, and the mean lifespan of the PEG tubes was 10.7 ± 2.2 months. Four patients died from pneumonia 10 months after T-PEG insertion. Conclusion: Unsedated T-PEG insertion carried out by a single physician is a feasible and safe procedure. No major complications or mortality were observed following the procedures; only minor Pseudomonas aeruginosa wound infections were noted. It is an alternative method for dysphagic patients when transoral insertion of endoscopy is impossible. © 2012 The Authors. Digestive Endoscopy © 2012 Japan Gastroenterological Endoscopy Society.


Grant
Agency: European Commission | Branch: FP7 | Program: CP-FP | Phase: HEALTH.2012.2.3.2-4 | Award Amount: 3.87M | Year: 2013

In developing countries, most of the 11 million deaths per year of children under the age five years occur in areas where adequate medical care is not available. In Malawi the under-five mortality rate is 133 per 1,000 live births. First-level health facilities - the closest health care services available to most sick children in developing countries are generally run by local medical physicians. The WHO and UNICEF developed the Integrated Management of Childhood Illness (IMCI) as a strategy to improve childhood survival and disease control. The IMCI strategy uses simple signs and symptoms to assess and classify illness, thus allowing health workers at first-level facilities to identify which children have minor illnesses that need symptomatic treatment. Our proposal addresses the objectives of this call by assisting health care workers through the utilisation of established technologies to circumvent the absence of health infrastructures. It achieves this by utilising the cellular network, patient sensor technologies and decision support systems. Proposed is the Supporting Low-cost Intervention For disEase control (Supporting LIFE) project. It is designed to run in rural settings as a platform for delivering community level interventions to improve and manage disease control. This project has a target age group of children under the age of 5 years. Supporting LIFE targets disease control in a multi-target intervention. It helps to ensure accurate diagnosis for those most affected by malaria/infantile diarrhoea (children under 5 years) and helps to ensure accurate and prompt treatment thus providing accurate real time disease statistics in an area by monitoring symptom trends (e.g. fever/diarrhoea) centrally. It targets other common disease entities which are major causes of morbidity and mortality such as pneumonia thereby increasing its utility. It reduces barriers to care by providing expert systems at low cost to people at their closest point of contact.


Tain Y.-L.,Chang Gung University | Hsieh C.-S.,Pingtung Christian Hospital | Chen C.-C.,Chang Gung University | Sheen J.-M.,Chang Gung University | And 2 more authors.
Journal of Pineal Research | Year: 2010

Identifying and treating kidney injury in cirrhosis is important. Bile duct ligation (BDL) is a commonly used cholestatic liver disease model. We hypothesized that asymmetric dimethylarginine (ADMA) is involved in BDL-induced oxidative stress and kidney injury, which can be prevented by melatonin. We also intended to elucidate whether increased ADMA is due to increased protein arginine methyltransferase-1 (PRMT1, ADMA-synthesizing enzyme) and/or decreased dimethylarginine dimethylaminohydrolase (DDAH, ADMA-metabolizing enzyme). Three groups of young rats were studied, sham (N = 7), untreated BDL rats (N = 9), and melatonin-treated BDL rats (N = 6, BDL + M). Melatonin-treated BDL rats received daily melatonin 1 mg/kg/day via intraperitoneal injection. One-third of the young BDL rats died compared with none in the BDL + M group. All surviving rats were killed 14 days after surgery. BDL rats had higher plasma aspartate aminotransferase, alanine aminotransferase, direct and total bilirubin, and ammonia levels than shams. They also had kidney injury characterized by increased tubulointerstitial injury scores and plasma creatinine and symmetric dimethylarginine levels, which melatonin prevented. Plasma ADMA levels were elevated in BDL rats, combined with increased hepatic PRMT1 and decreased renal DDAH activity. In addition, melatonin increased hepatic DDAH2 expression, increased DDAH activity and concomitantly decreased ADMA contents in both the liver and kidney. In conclusion, melatonin therapy decreased mortality and prevented kidney injury induced by BDL via reduction of ADMA (by increasing DDAH activity) and oxidative stress. © 2010 John Wiley & Sons A/S.


Tain Y.-L.,Chang Gung University | Kao Y.-H.,I - Shou University | Hsieh C.-S.,Pingtung Christian Hospital | Chen C.-C.,Chang Gung University | And 3 more authors.
Free Radical Biology and Medicine | Year: 2010

Asymmetric dimethylarginine (ADMA) is a competitive inhibitor of nitric oxide synthase, and its increase is associated with many systemic diseases. We recently found that increases in plasma and hepatic ADMA levels were associated with oxidative stress in young bile-duct-ligation (BDL) rats; these increases were prevented by melatonin therapy. Therefore, we used an in vivo BDL model and in vitro cultured hepatocytes to elucidate the protective mechanisms of melatonin against oxidative stress-induced increase in ADMA. We found that the presence of reactive oxygen species (ROS) in young rats with BDL leads to downregulation of dimethylarginine dimethyaminohydrolase (DDAH)-1 and -2 as well as DDAH activity. Melatonin prevented ADMA increases in the liver mainly by regulating DDAH-1 and -2. The expression and activity of DDAH were suppressed in vitro by superoxide and hydrogen peroxide (H2O2) in a time-dependent manner, whereas melatonin could block H2O2-induced downregulation of DDAH-2 as well as decreased DDAH activity, thereby preventing increases in hepatic ADMA. Our findings reveal a mechanistic basis of DDAH downregulation by ROS and suggest that melatonin might be a potential therapy for various diseases with elevated cellular ADMA. © 2010 Elsevier Inc.


Tain Y.-L.,Chang Gung University | Hsieh C.-S.,Pingtung Christian Hospital | Lin I.-C.,Chang Gung University | Chen C.-C.,Chang Gung University | And 2 more authors.
Nitric Oxide - Biology and Chemistry | Year: 2010

Maternal undernutrition can cause reduced nephron number and glomerular hypertrophy, consequently leading to adult kidney disease. We intended to elucidate whether NO deficiency evolves to kidney disease vulnerability in offspring from mothers with caloric restriction diets and whether maternal l-citrulline (l-Cit) supplementation can prevent this. Using a rat model with 50% caloric restriction, four groups of 3-month-old male offspring were sacrificed to determine their renal outcome: control, caloric restriction (CR), control treated with 0.25% l-citrulline solution during the whole period of pregnancy and lactation (Cit), and CR treated in the same way (CR + Cit group). The CR group had low nephron numbers, increased glomerular diameter, and an increased plasma creatinine level compared with the control group. Maternal l-Cit supplementation prevented these effects. The CR + Cit and Cit groups developed hypertension beginning at 4 and 8 weeks of age, respectively. Plasma asymmetric and symmetric dimethylarginine (ADMA and SDMA) levels were increased, but l-arginine/ADMA ratios (AAR) were decreased in the CR group vs the control group. This was prevented by maternal l-Cit supplementation. Renal cortical neuronal NOS-α (nNOSα) protein abundance was significantly decreased in the Cit and CR + Cit groups. Collectively, reduced nephron number, reduced renal nNOSα expression, increased ADMA, and decreased AAR contribute to the developmental programming of adult kidney disease and hypertension. Although maternal l-Cit supplementation prevents caloric restriction-induced low nephron number and renal dysfunction, it also induces hypertension. © 2010 Elsevier Inc. All rights reserved.


Huang L.-T.,Chang Gung University | Hsieh C.-S.,Pingtung Christian Hospital | Hsieh C.-S.,MeiHo University | Chang K.-A.,Chang Gung University | Tain Y.-L.,Chang Gung University
International Journal of Molecular Sciences | Year: 2012

Nitric oxide (NO) regulates placental blood flow and actively participates in trophoblast invasion and placental development. Asymmetric dimethylarginine (ADMA) can inhibit NO synthase, which generates NO. ADMA has been associated with uterine artery flow disturbances such as preeclampsia. Substantial experimental evidence has reliably supported the hypothesis that an adverse in utero environment plays a role in postnatal physiological and pathophysiological programming. Growing evidence suggests that the placental nitrergic system is involved in epigenetic fetal programming. In this review, we discuss the roles of NO and ADMA in normal and compromised pregnancies as well as the link between placental insufficiency and epigenetic fetal programming. © 2012 by the authors; licensee MDPI, Basel, Switzerland.


Wang C.-C.,Chang Gung University | Jawade K.,Chang Gung University | Yap A.Q.,Chang Gung University | Concejero A.M.,Chang Gung University | And 2 more authors.
World Journal of Surgery | Year: 2010

Background: Resection of a large hepatocellular carcinoma (HCC) is difficult and is associated with a poor outcome. Herein we describe our experience with the use of a liver hanging maneuver (LHM) in conjunction with the anterior approach (AA) in patients with large HCC (>10 cm) and compare the perioperative outcome with the conventional method (CM) for hepatic resection. Methods: Patients who underwent major hepatic resections for large HCC (>10 cm) were categorized as group 1 (n = 14), treated with LHM and AA, versus group 2 (n = 11), treated with CM. Variables including patient age, tumor size, operative time and transection time, blood loss, blood transfusion requirements, and postoperative ICU and hospital stay were used to compare the two groups. Results: There were 14 and 11 patients in groups 1 and 2, respectively. The variables in group 1 and 2 of median tumor size, median operative time, median transection time, median ICU stay, and median hospital stay were comparable. In contrast, the intraoperative blood loss and the blood transfusion requirements were significantly higher in group 2. Patients under LHM and AA and CM had a median blood loss of 375 ml (237.5-850) and 1,000 ml (500-1,200), requirement of blood transfusion of 3 (21.42%) and 8 (72.7%), respectively. Postoperative complications were comparable in the two groups. There were no deaths in the series. Conclusions: The liver hanging maneuver in conjunction with AA is a safe and highly feasible procedure, particularly in patients with sizable (>10 cm) tumors and tumors found to be adherent to the diaphragm and retroperitoneum. The use of the procedure eventuated in lower blood loss as well as fewer blood transfusion requirements when compared to the conventional method. © 2010 Société Internationale de Chirurgie.


Shy C.-G.,National Pingtung University of Science and Technology | Shy C.-G.,Pingtung Christian Hospital | Shy C.-G.,Tajen University | Huang H.-L.,National Cheng Kung University | And 2 more authors.
International Journal of Hygiene and Environmental Health | Year: 2012

In vivo studies indicate that prenatal or neonatal exposure of rodents to polybrominated diphenyl ethers (PBDEs) disrupts thyroid hormone balance, but few studies have reported an association of PBDEs and insulin-like growth factor 1 (IGF-1). The goal was to examine whether PBDEs exposure affects the levels of thyroid hormones and IGF-1 in cord blood. Study participants were healthy pregnant women recruited from the general population in central Taiwan between 2000 and 2001 and in southern Taiwan from 2007 to 2009. One-hundred-forty-nine breast milk samples (n=149), which were collected within one month after delivery, were analyzed using a high resolution gas chromatograph equipped with a high resolution mass spectrometer. The average and median levels of breast milk Σ 14PBDEs were 5.34 and 3.38ng/g lipid in 2000-2001 and 5.22 and 3.13ng/g lipid in 2007-2009, respectively. In general, levels of PBDE congeners were very low in this study population and not significantly different between the years 2000-2001 and 2007-2009. Breast milk Σ 14PBDEs were not significantly correlated with thyroid hormones and IGF-1 in cord blood. After examining multiple stepwise linear regression models with adjustment for maternal age, pre-pregnancy body mass index (BMI), parity, gestational age, and region (namely, central and southern Taiwan), we found that log of T4 in cord blood was significantly but slightly correlated with higher BDE-154 (B=0.113, p=0.017) in breast milk. The log of FT4 concentration was significantly related to a decrease in the log of BDE-99 level (B=-0.137, p=0.043) and an increase in the log of BDE-154 level (B=0.158, p=0.008). Meanwhile, the log of IGF-1 level was also significantly linked to an increase in the log of BDE-196 level (B=0.532, p=0.028) and decrease in the log of BDE-85 level (B=-0.235, p=0.018). Few epidemiological studies report an association between PBDEs exposure and IGF-1. Based on our findings, further in vivo and epidemiological studies are encouraged and needed to explore associations between PBDEs exposure and levels of thyroid hormones and IGF-1. © 2011 Elsevier GmbH.


Davis J.M.,Johnson University | Kuo Y.-H.,Johnson University | Ahmed N.,Johnson University | Kuo Y.-L.,Pingtung Christian Hospital
Surgical Infections | Year: 2011

Background: The administration of appropriate antibiotics in a timely fashion with discontinuation post-operatively is the first of the Surgical Care Improvement Project (SCIP) initiatives and was expected to reduce post-operative infections significantly. This study aimed at determining whether SCIP has had an effect on surgical site infections (SSIs). Methods: A retrospective cohort study was conducted to evaluate the infection rates of adult patients (age≥18 years) having elective cholecystectomies, laparoscopic cholecystectomies, and colectomies from 2001-2006 using the Nationwide Inpatient Sample (NIS) database. The population consisted of all patients older than 18 years who had colon resection or cholecystectomy and were discharged from a hospital included in the NIS. Annual infection rates were determined for each of the operations. Results: Post-operative infections rose steadily and significantly (p<0.0001) in colon surgery from 2001 to 2006. A significant increase in SSIs also was seen in open (p=0.0001) and laparoscopic (p<0.0001) cholecystectomy from 2001 to 2006. Length of stay was significantly longer in infected than in non-infected patients. Conclusion: The factors that contributed to the observed increase in the infection rate should be identified to improve the SCIP initiatives. © 2011, Mary Ann Liebert, Inc.


Wu K.-D.,Pingtung Christian Hospital | Hsing L.-L.,Pingtung Christian Hospital | Huang Y.-F.,Pingtung Christian Hospital
Clinical Laboratory | Year: 2013

Background: The inclining incidence of chronic kidney disease which has led to high mortality and immense medical burden over the past decades has become a distressing concern in epidemiology. Unfortunately, the number of biomarkers that allow the monitoring of chronic kidney disease (CKD) is limited. Neutrophil gelatinase-associated lipocalin (NGAL) is an emerging biomarker which has been shown to be able to diagnose kidney injuries. Methods: Eighty-one nondiabetic patients with chronic kidney disease, stage 2 to 5, were recruited for this study, and 17 healthy volunteers with eGFR greater than 90mL/minute/1.73m 2 were selected as the control group. Results: Our study demonstrated that the pNGAL level is elevated during CKD, and the pNGL level has a strong correlation with the concentration of sCr and eGFR. Conclusions: Plasma neutrophil gelatinase-associated lipocalin is a potent tool in the diagnosis of chronic kidney diseases and is shown to have high correlation with serum creatinine and estimated glomerular filtration rate.

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