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Liao C.-C.,Taipei Medical University Hospital | Liao C.-C.,Taipei Medical University | Shen W.W.,Taipei Medical University | Chang C.-C.,Taipei Medical University Hospital | And 5 more authors.
Annals of Surgery | Year: 2013

Objective:: To validate the global features of postoperative adverse outcomes for surgical patients with schizophrenia. Background:: Patients with schizophrenia were known to have a higher risk of complications during hospitalization. Quality of care has become the key factor in reducing their potential mortality afterwards. METHODS:: We present a population-based study of 8967 schizophrenic patients receiving major surgery from the Taiwan National Health Insurance Research Database within the years 2004 and 2007 compared with 35,868 surgical patients without mental disorders. Eight major postoperative complications and mortality after complications were evaluated among schizophrenic patients with different severity. RESULTS:: Schizophrenic patients had significantly higher risk for postoperative complications, including acute renal failure, pneumonia, bleeding, septicemia, stroke, and 30-day postoperative mortality (adjusted OR = 2.70; 95% CI: 2.08-3.49), than surgical patients without mental disorders. Among surgical patients with 1 to 2, 3 to 18, 19 to 48, and more than 49 schizophrenia-related outpatient visits within 24-month period preoperatively, the adjusted ORs of 30-day mortality ranged from 1.95 (95% CI: 1.25-3.02) to 3.97 (95% CI: 2.66-5.92) in a frequency-dependent pattern when compared with controls. When compared with surgical patients with schizophrenia-related outpatient services only, OR of 30-day postoperative mortality increased from 2.54 (95% CI: 1.93-3.34) to 3.69 (95% CI: 2.25-6.03) in surgical patients with preoperative hospitalization or emergency visit because of schizophrenia. CONCLUSIONS:: Surgical patients with schizophrenia showed significantly higher postoperative adverse outcome rates with risk of 30-day mortality nearly threefold when compared with patients without mental disorders. Our findings suggest the urgency revising the protocol of postoperative care for this specific population. © 2013 by Lippincott Williams & Wilkins.

Chao J.-K.,Yuli Veterans Hospital | Chao J.-K.,Shu-Te University | Hwang T.I.-S.,Shin Kong Memorial Hospital | Hwang T.I.-S.,Fu Jen Catholic University | And 5 more authors.
Journal of Sexual Medicine | Year: 2011

Introduction. Obesity is receiving growing research attention. However, investigations concerning the potential impact of obesity and testosterone on erectile dysfunction (ED) in young men have not been completely clarified. Aim. To identify the relationship between ED, serum testosterone level, and obesity in draftees in Taiwan. Methods. Data were obtained from a baseline survey of 364 young adult military conscripts (19-24years old). Their demographic data, body mass index (BMI), serum testosterone, and ED status were assessed. Sixty-four subjects had ED, and 300 comprised the normal control group. Main Outcome Measures. The International Index of Erectile Function-5 (IIEF-5), Sexual Desire Inventory, and Sexual Behavior Scale were used to assess ED, sexual desire, and sexual function. Results. Three hundred sixty-four men were available for analysis. The mean age of the sample was 21.66±0.92years (19-24years). The IIEF total score had a mean of 21.99±2.34 and median of 23; 64 (17.6%) subjects had ED, although mild. The results showed an increased risk of ED among obese men and subjects with lower serum testosterone. Among the predictors of ED, obesity (odds ratio=83.97, 95% CI=16.17-436.03, degrees of freedom [d.f.]=1, P<0.001) and lower serum testosterone (odds ratio=679.84, 95% CI=108.48-4,260.58, d.f.=1, P<0.001) were significantly independent factors. Testosterone levels were lower in subjects with obesity (P<0.001). Conclusion. This study supports the idea that BMI and serum testosterone may provide warning signs of ED and, at the same time, an opportunity for early intervention in young men. © 2011 International Society for Sexual Medicine.

Lee C.-C.,Shin Kong Memorial Hospital | Lee C.-C.,Taipei Medical University | Lee C.-C.,Fu Jen Catholic University | Jan H.-J.,Taipei Medical University | And 9 more authors.
Oncogene | Year: 2010

Uncontrolled growth and diffused invasion are major causes of mortality in patients with malignant gliomas. Nodal has been shown to have a central role in the tumorigenic signaling pathways of malignant melanoma. In this study, we show that grade IV human glioma cell lines expressed different levels of Nodal, paralleled to the potential for cell invasiveness. Treatment of glioma cell lines with recombinant Nodal (rNodal) increased matrix metalloproteinase 2 (MMP-2) secretion and cell invasiveness. The ectopic expression of Nodal in GBM glioma cells that expressed Nodal at low level resulted in increased MMP-2 secretion, enhanced cell invasiveness, raised cell proliferation rates in vitro, increased tumor growth in vivo, and was associated with poor survival in a mice xenograft model. In contrast, the knockdown of Nodal expression in U87MG glioma cells with high Nodal expression level had reduced MMP-2 secretion, less cell invasiveness, lower tumor growth in vivo and longer lifespan in mice with U87MG/shNodal cell xenografts. In addition, Nodal knockdown promoted the reversion of malignant glioma cells toward a differentiated astrocytic phenotype. Furthermore, our data support the notion that Nodal may regulate glioma progression through the induction of the leukemia inhibitory factor (LIF) and Cripto-1 through activated Smad. © 2010 Macmillan Publishers Limited All rights reserved.

Lin J.-A.,Taipei Medical University Hospital | Lin J.-A.,Taipei Medical University | Liao C.-C.,Taipei Medical University Hospital | Liao C.-C.,Taipei Medical University | And 6 more authors.
PLoS ONE | Year: 2011

Background: Intellectually disabled patients have various comorbidities, but their risks of adverse surgical outcomes have not been examined. This study assesses pre-existing comorbidities, adjusted risks of postoperative major morbidities and mortality in intellectually disabled surgical patients. Methods: A nationwide population-based study was conducted in patients who underwent inpatient major surgery in Taiwan between 2004 and 2007. Four controls for each patient were randomly selected from the National Health Insurance Research Database. Preoperative major comorbidities, postoperative major complications and 30-day in-hospital mortality were compared between patients with and without intellectual disability. Use of medical services also was analyzed. Adjusted odds ratios using multivariate logistic regression analyses with 95% confidence intervals were applied to verify intellectual disability's impact. Results: Controls were compared with 3983 surgical patients with intellectual disability. Risks for postoperative major complications were increased in patients with intellectual disability, including acute renal failure (odds ratio 3.81, 95% confidence interval 2.28 to 6.37), pneumonia (odds ratio 2.01, 1.61 to 2.49), postoperative bleeding (odds ratio 1.35, 1.09 to 1.68) and septicemia (odds ratio 2.43, 1.85 to 3.21) without significant differences in overall mortality. Disability severity was positively correlated with postoperative septicemia risk. Medical service use was also significantly higher in surgical patients with intellectual disability. Conclusion: Intellectual disability significantly increases the risk of overall major complications after major surgery. Our findings show a need for integrated and revised protocols for postoperative management to improve care for intellectually disabled surgical patients. © 2011 Lin et al.

Lee C.-C.,Shin Kong Memorial Hospital | Lee C.-C.,Taipei Medical University | Lee C.-C.,Yuanpei University | Lai J.-H.,National Defense Medical Center | And 7 more authors.
Cancer Cell International | Year: 2013

Background: Glioblastoma stem-like cells (GSC) have been shown to promote tumor growth, tumor-associated neovascularization, therapeutic resistance, and metastasis. CXCR4 receptors have been found involved in the proliferation, metastasis, angiogenesis, and drug-resistant characteristics of glioblastoma. However, the role of CXCR4 in modulating the stem-like cell properties of rat glioblastoma remains ambiguous.Methods: To explore the role of the CXCL12/CXCR4 axis in maintaining rat GSC properties, we disrupted the CXCR4 signaling by using small hairpin interfering RNA (shRNA). To investigate the role of the CXCL12/CXCR4 axis in maintaining rat GSC properties, we used a spheroid formation assay to assess the stem cell self-renewal properties. A western blot analysis and PCR arrays were used to examine the genes involved in proliferation, self-renewal, and cancer drug resistance. Finally, DNA content and flow cytometry, an immunohistochemical analysis, and methylcellulose colony formation, in vitro invasive and intracranial injection xenograft assays were employed to examine the disruptive effect of CXCR4 on the characteristics of GSCs of the RG2 cell line.Results: Disrupting CXCR4 inhibited the proliferation of RG2 cells both in vitro and in vivo. The spheroid formation assay indicated that CXCR4 was vital for the self-renewal of RG2 GSCs. Disrupting the CXCL12/CXCR4 pathway also reduced the expression of GSC cell markers, including Nestin, ABCG2, and musashi (Msi), and the expression of genes involved in regulating stem cell properties, including Oct4, Nanog, maternal embryonic leucine zipper kinase (MELK), MGMT, VEGF, MMP2, and MMP9.Conclusion: The chemokine receptor CXCR4 is crucial for maintaining the self-renewal, proliferation, therapeutic resistance, and angiogenesis of GSCs of rat RG2 glioblastoma. © 2013 Lee et al.; licensee BioMed Central Ltd.

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