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Koenig K.L.,University of California at Irvine | Lim H.C.S.,Changi General Hospital | Tsai S.-H.,Shuang Ho Hospital | Tsai S.-H.,Taipei Medical University
Journal of Experimental and Clinical Medicine | Year: 2011

When medical and health needs of a disaster-stricken population exceed currently available resources, surge capacity must be created. The 3S Surge System consists of staff (personnel), stuff (supplies and equipment), and structure (physical location and incident management). Because it is not feasible to deliver health care in the usual way during a catastrophe, the goal shifts from optimizing individual to maximizing population medical and health outcomes. Allocation of scarce resources requires an evidence-based approach that encompasses national and international standards while maintaining regional and local flexibility. At some point in time following a catastrophe, it may become imperative to implement a crisis standard of care putting protocols, such as rationing of health care supplies and medications into action. In developing and defining this crisis standard of care, there are a multiple considerations, including medical, ethical, legal, and implementation/deactivation procedures. This manuscript reviews the origin of the concept of crisis standard of care with a discussion of its development, changes in health care delivery goals during emergencies, when to adopt crisis care policies and protocols, issues to address in catastrophic disaster planning, ethical and legal considerations, and directions for future research. © 2011.

Huang K.-C.,Chi Mei Medical Center | Cherng Y.-G.,Shuang Ho Hospital | Cherng Y.-G.,Taipei Medical University | Chen L.-J.,National Cheng Kung University | And 3 more authors.
Hormone and Metabolic Research | Year: 2014

A marked decrease of klotho expression was observed in the kidney of streptozotocin-induced diabetic rats (STZ rats) showing diabetic nephropathy. It has been documented that klotho is the target gene of PPARγ. However, the effect of PPARγ agonist on klotho expression in kidney of STZ rats remains obscure. Thus, we used rosiglitazone (TZD) as PPARγ agonist to investigate the effect on renal dysfunction in STZ rats. Treatment of TZD reversed the lower levels of PPARγ, klotho, and FGFR1 expressions in kidneys of STZ rats without the correction of hyperglycemia. Also, renal functions and structural defeats were improved by TZD treatment. Taken together, oral administration of TZD may improve STZ-induced diabetic nephropathy due to restoration of the expression of klotho axis through an increase in PPARγ expression without changing blood glucose in rats. © Georg Thieme Verlag KG Stuttgart New York.

Lin F.-H.,National Defense Medical Center | Chu N.-F.,National Defense Medical Center | Hsieh A.-T.,Shuang Ho Hospital | Hsieh A.-T.,Taipei Medical University
Journal of Human Hypertension | Year: 2012

This study evaluates prevalence of hypertension in 1996 and 2006, and examines the relationship between hypertension and weight of Taiwanese young adolescents. Two cross-sectional surveys, administered in 1996 and 2006, to junior-high school in Taipei were included. Anthropometric and blood pressure were measured using standard methods, and structured questionnaire was used to collect personal history and lifestyle characteristics. Overweight and obesity are defined based on Taiwan's Department of Health criteria and bases pre-hypertension and hypertension on the 90th and 95th percentile distribution of blood pressure of the population of both surveys. The prevalence of pre-hypertension in Taiwan between 1996 and 2006 increased from 12.0 to 14.4% for boys and decreased from 9.5 to 9.4% for girls. Hypertension increased from 22.8-29.7% and 12.5-20.7% for both boys and girls, respectively. In 1996, compared with normal young adolescents, the risk of hypertension for overweight was 1.8 times higher for boys and 3.4 times for girls. However, the risk of hypertension for overweight in 2006 was 1.7 times higher for boys and 1.5 times higher for girls compared with normal. Every unit increment of body mass index and waist circumference was associated with 17-27% and 6-11% risk of hypertension in both genders in 1996, and was associated with 9-13% and 4% risk of hypertension among young adolescents in 2006, respectively. The prevalence of hypertension has increased significantly in young adolescents, especially for overweight. It is necessary to enrol young adolescents in weight management programs to prevent hypertension-related co-morbidities. © 2012 Macmillan Publishers Limited. All rights reserved.

Chang K.-H.,Shuang Ho Hospital | Yan M.-D.,Wang Fan Hospital | Yao C.-J.,Taipei Medical University | Lin P.-C.,Taipei Medical University | And 2 more authors.
Oncology Letters | Year: 2013

Honokiol, a hydroxylated biphenyl compound isolated from the Chinese herb Magnolia officinalis, has been reported to have anticancer activities in a variety of cancer cell lines. The present study aimed to evaluate the anticancer effect and possible molecular mechanisms of honokiol in a glioblastoma multiforme (GBM) cell line. The anticancer activities of honokiol were investigated in the DBTRG-05MG GBM cell line. The effect of honokiol on cell growth was determined using a sulforhodamine B assay. Flow cytometry and immunoblotting were used to measure honokiol-induced apoptosis (programmed cell death type I) and autophagy (programmed cell death type II). Honokiol was observed to reduce DBTRG-05MG cell viability in a dose-dependent manner. At a dose of 50 μM, honokiol markedly decreased the expression of Rb protein and led to the cleavage of poly(ADP-ribose) polymerase and Bcl-xL to promote apoptosis in the cancer cells. In addition, markers of autophagy, including Beclin-1 and LC3-II, were also significantly increased. In addition to apoptosis, honokiol was also able to induce autophagy in the DBTRG-05MG cells. The mechanisms that are responsible for the correlation between honokiol-induced apoptosis and autophagy require further investigation. Such efforts may provide a potential strategy for improving the clinical outcome of GBM treatment.

Tsai K.-L.,Kaohsiung Medical University | Liang H.-J.,Chang Gung Memorial Hospital | Yang Z.-D.,Shuang Ho Hospital | Lue S.-I.,Kaohsiung Medical University | And 2 more authors.
Journal of Surgical Research | Year: 2014

Background Sepsis is usually accompanied by cardiomyocyte apoptosis and myocardial depression. Protein kinase C (PKC) has been reported to be important in regulating cardiac function and apoptosis; however, which PKC isoform is involved in sepsis-induced myocardial apoptosis remains unknown. Materials and methods A rat model of sepsis by cecal ligation and puncture was used. Early and late sepsis refers to those rats sacrificed at 9 and 18 h after cecal ligation and puncture, respectively. Ventricular septum (Sep), left ventricle (LV), and right ventricle were fractionated into membrane, mitochondrial, and cytosolic fractions, individually. The protein levels of PKC isoforms (-α, -β, -δ, -ε, -ζ, -ι, -λ, and -μ) and mitochondrial translocation of Bad were quantified by Western blot analysis. Apoptosis was detected by terminal deoxynucleotidyl transferase-mediated dUTP in situ nick-end labeling. The morphology of mitochondria was examined by electron microscopy. Results The membrane/cytosol ratio of PKCε was predominantly higher in the Sep, LV, and right ventricle under physiological conditions. At early sepsis, the membrane/cytosol ratio of PKCε was significantly decreased in Sep and LV. At late sepsis, cardiomyocyte apoptosis associated with severe mitochondrial swelling and crista derangement were observed in Sep and LV at late sepsis. Additionally, mitochondria/cytosol ratio of Bad was significantly increased in Sep and LV. Conclusions The early inactivation of PKCε in the ventricle may affect the mitochondrial translocation of Bad and subsequent mitochondrial disruption and apoptosis at late sepsis. This finding opens up the prospect for a potential therapeutic strategy targeting PKCε activation to prevent myocardial depression in septic patients. © 2014 Elsevier Inc. All rights reserved.

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