Tainan, Taiwan
Tainan, Taiwan

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Chiang K.-F.,Kaohsiung Medical University | Chiang K.-F.,Tainan Sin Lau Hospital | Wang H.-H.,Kaohsiung Medical University
Molecular Ecology | Year: 2016

Aims and objectives: To examine nurses’ experiences regarding the benefits and obstacles of using a smart mobile device application in home care. Background: The popularity of mobile phones and Internet technology has established an opportunity for interaction between patients and health care professionals. Line is an application allowing instant communication that is available for free globally. However, the literature relating to use of Line in this area is limited. Design: A qualitative study involving individual in-depth interviews. Methods: Participants included community nurses (N = 17) from six home care facilities in southern Taiwan who had used Line for home care of chronically ill patients for at least six months. The study was conducted using semi-structured in-depth interviews, which were recorded and converted into transcripts for content analysis. Results: Seven themes emerged from data analysis: reduction in medical care consumption and costs, reduction in workload and stress, facilitating improvement in the quality of care, promotion of the nurse–patient relationship, perceived risk, lack of organisational incentives and operating procedures and disturbance to personal life. Conclusions: Nurses considered Line valuable for use in home care. While this application has diverse functions, its video transfer function could in particular help nursing staff make prompt decisions about patients’ problems and promote nurse–patient relationships. However, there might be hidden risks including legal consequences, safety risks to patients, possible violations of professionalism and increased risk of nurse burnout. Increasing nursing staff awareness of using mobile messaging software applications is necessary. Relevance to clinical practice: This study provides relevant information about the benefits, disadvantages, risks and limitations of nurses’ use of Line. The study also provides suggestions for software programmers and future organisational strategy and development. © 2016 John Wiley & Sons Ltd


Hsu Y.-C.,Chang Jung Christian University | Chang S.-J.,National Cheng Kung University | Wang M.-Y.,Chang Jung Christian University | Chen Y.-L.,Chang Jung Christian University | Huang T.-Y.,Tainan Sin Lau Hospital
Cell Biochemistry and Biophysics | Year: 2013

Deregulation of apoptosis alters the balance of cell proliferation and cell death, resulting in a variety of diseases, including cancer. In recent studies, sulforaphane (SFN) has demonstrated potent anti-tumor and chemopreventive activities. A possible signal transduction pathway has also been elucidated for SFN-induced apoptosis in human neuroblastoma SH-SY5Y cells. The present study further investigates the anti-proliferation activities of SFN through induced apoptosis in SH-SY5Y cells. We found that treating SH-SY5Y cells with SFN resulted in the depletion of mitochondrial membrane potential (Δψ), which in turn increased caspase 9, caspase 3, and the up-regulation of phosphorylated MEK/ERK without generating reactive oxygen species. Results were confirmed by MTT assay, which demonstrated the cytotoxic activity of SFN against SH-SY5Y cells (IC50 values of 20 μM). © 2013 Springer Science+Business Media New York.


Hsieh C.-Y.,Tainan Sin Lau Hospital | Hsieh C.-Y.,National Cheng Kung University | Chen C.-H.,National Cheng Kung University | Li C.-Y.,National Cheng Kung University | And 2 more authors.
Journal of the Formosan Medical Association | Year: 2015

Background/purpose: The National Health Insurance Research Database, which uses claims data from hospitals contracted with the National Health Insurance (NHI) program in Taiwan, has been widely used for stroke research. The diagnostic accuracy of the NHI claims data with regard to acute ischemic stroke (AIS) has rarely been validated. The aim of this study was to validate the diagnosis of AIS in NHI claims data using the Taiwan Stroke Registry (TSR) as a reference. Methods: We retrieved patients' data with a discharge diagnosis of AIS [five-digit International Classification of Diseases Code, 9th version (ICD-9 code): 433xx or 434xx] in a single medical center from August 2006 to December 2008. We then linked these patients to the TSR to validate their AIS diagnosis in the claims data. The positive predictive value (PPV) and sensitivity were determined. Results: We reviewed the claims data of 1736 consecutive AIS patients, of whom 1299 (74.8%) were linked successfully to the stroke registry database. After reviewing the medical records and imaging results of other patients not linked to the registry database (n=437), 235 patients were found to have had an AIS. The PPV was 88.4% [95% confidence interval (CI): 86.8-89.8%] and sensitivity was 97.3% (95% CI: 96.4-98.1%). Forty-four (21.8%) of the false-positive cases (n = 202) were coded as 433. x0 or 434. x0. Conclusion: The PPV of a diagnosis of AIS in the NHI claims data was high. Using five-digit ICD-9 codes to identify AIS cases will markedly decrease the false-positive rate compared with using the commonly used three-digit method. © 2013.


Hsieh C.-Y.,National Cheng Kung University | Hsieh C.-Y.,Tainan Sin Lau Hospital | Lai E.C.-C.,National Cheng Kung University | Yang Y.-H.K.,National Cheng Kung University | Lin S.-J.,University of Illinois at Chicago
Epilepsia | Year: 2013

Purpose: Patients with epilepsy have higher stroke-related morbidity and mortality, leading to the suspicion that the increased stroke events may be associated with antiepileptic drug (AED) exposure. We evaluated the comparative risk of stroke in adult patients with epilepsy receiving phenytoin (PHT), valproic acid (VPA), or carbamazepine (CBZ) to help determine the stroke risk for Asian patients with specific AED exposure. Methods: We conducted a population-based, retrospective cohort study using the Taiwan National Health Insurance Research Database (NHIRD). The cohort consists of adult patients with epilepsy who were new to PHT, CBZ, or VPA monotherapy and without prior stroke history. Patients were followed for 5 years. The event of interest was a hospitalization or emergency visit due to stroke. Cox proportional hazard models were used to estimate the comparative risk of AEDs. Subanalyses included an evaluation of different subtypes of stroke, the propensity score matched technique, the intention-to-treat approach, and stratification analyses. Key Findings: Patients receiving PHT had a significantly higher stroke risk (adjusted hazard ratio [HR] 1.72; 95% confidence interval [CI] 1.20-2.47), followed by VPA (adjusted HR 1.27; 95% CI 0.78-2.07), when compared with CBZ. The results of all subanalyses showed a consistent trend of higher stroke risk with PHT use. In addition, there appeared to be a dose-response relationship between stroke risk and PHT prescriptions. Significance: The stroke risk was higher in PHT but not significantly different in VPA as compared to CBZ. Physicians should reconsider using PHT for patients with epilepsy who already have a higher risk of stroke. ©2012 International League Against Epilepsy.


Hsieh C.-Y.,Tainan Sin Lau Hospital | Hsieh C.-Y.,National Cheng Kung University | Chen C.-H.,National Cheng Kung University | Chen Y.-C.,National Cheng Kung University | Kao Yang Y.-H.,National Cheng Kung University
Journal of Stroke and Cerebrovascular Diseases | Year: 2013

Data on thrombolytic therapy at the national level is scarce in Asia. Understanding current practice pattern is important for a policy maker in decision making. This cross-sectional study analyzed the utilization pattern of thrombolytic therapy for acute ischemic stroke (AIS) in Taiwan from 2003 through 2010 and identified factors associated with post-therapy intracerebral hemorrhage (ICH) and mortality. From the Taiwan National Health Insurance Research Database, we retrieved inpatient claims for patients with AIS. The frequency of thrombolytic therapy in AIS admissions and its association with the characteristics of patients, physicians, and hospitals were analyzed. Factors predicting ICH and in-hospital mortality were also analyzed using multiple logistic regressions. Of 394,988 patients with AIS, 2385 (.60%) had received thrombolytic therapy. The utilization rate increased from.03% in 2003 to 1.51% in 2010. Thrombolytic therapy was adopted earlier in a belt of high-frequency counties across rural midwestern Taiwan, twice the rate in the Taipei and Kaohsiung cities. The neurology specialty and hospital's service volume were the most dominant factors related to higher utilization, in addition to weekend admission and the patient's age and comorbidities. ICH and in-hospital mortality rates were 3.48% and 7.71%, respectively. Patients given thrombolytic therapy in hospitals with thrombolysis cases more than the 5.5/year had a lower risk of ICH (odds ratio:.53; 95% confidence interval:.31-.88). Compared with most developed countries, there is indeed much unmet need for stroke thrombolysis in Taiwan. Effective mechanism should be implemented to increase the thrombolysis rate safely and improve outcome for patients with AIS. © 2013 Elsevier B.V. All rights reserved.


Lai E.C.-C.,National Cheng Kung University | Yang Y.-H.K.,National Cheng Kung University | Lin S.-J.,University of Illinois at Chicago | Hsieh C.-Y.,National Cheng Kung University | Hsieh C.-Y.,Tainan Sin Lau Hospital
Pharmacoepidemiology and Drug Safety | Year: 2013

Purpose: This study aimed to investigate the risk of clinically significant hypothyroidism among all the currently available antiepileptic drugs (AED). Methods: The Taiwan National Health Insurance Research Database (NHIRD) from 2004 to 2010 was analyzed using a prescription sequence symmetry analysis, and thyroxine treatment was used as a proxy to identify a hypothyroidism event. A cohort of patients who have been treated with both AED and thyroxine was selected, and the chronological order of AED and thyroxine use constituted the basis of the prescription sequence symmetry analysis. A causal relationship was suspected if there was a significantly higher proportion of patients who initiated thyroxine after AED than those who initiated thyroxine before AED. The ratio of the two proportions was described as a sequence ratio. To benchmark the effect size of AEDs on thyroid function, amiodarone was selected as the reference indicator. Results: A total of 1,878,189 AED users was found in the database, with 16,200 of them also used thyroxine. The adjusted sequence ratio of thyroxine use after each AED was 1.75 (99% confidence interval, 1.58-1.94) for phenytoin, 1.34 (1.20-1.49) for valproate, 1.25 (1.15-1.36) for phenobarbital, 1.21 (1.08-1.34) for carbamazepine, and 1.22 (1.03-1.46) for oxcarbazepine. The risk of hypothyroidism from phenytoin use within a shorter time frame was similar that associated with amiodarone use. No association was shown in most of the new generation AEDs. Conclusion: The results indicated an increased risk of hypothyroidism among patients using AEDs, especially phenytoin, valproate, phenobarbital, carbamazepine, and oxcarbazepine. The findings also provided strong grounds for further investigations on acute thyroid adverse effect induced by phenytoin. © 2013 John Wiley & Sons, Ltd.


Hsu Y.-C.,Chang Jung Christian University | Huang T.-Y.,Tainan Sin Lau Hospital | Chen M.-J.,Chi Mei Medical Center | Chen M.-J.,Chia Nan University of Pharmacy and Science
Cell Death and Disease | Year: 2014

Cucurbitacin E (CuE) or α-elaterin is a natural compound previously shown to be an antifeedant as well as a potent chemopreventive agent against several types of cancer. The present study investigated the anticancer effects of CuE on colorectal cancer (CRC) using primary cell lines isolated from five CRC patients in Taiwan, Specifically, we explored the anti-proliferation and cell cycle G2/M arrest induced by CuE in CRC cells. MPM-2 flow cytometry tests show that CuE-treated cells accumulated in metaphase (CuE 2.5-7.5 μM). Results further indicate that CuE produced G2/M arrest as well as the downregulation of CDC2 and cyclin B1 expression and dissociation. Both effects increased proportionally with the dose of CuE; however, the inhibition of proliferation, arrest of mitosis, production of reactive oxygen species (ROS), and loss of mitochondrial membrane potential (Δm) were found to be dependent on the quantity of CuE used to treat the cancer cells. In addition, cell cycle arrest in treated cells coincided with the activation of the gene GADD45(α, β, γ). Incubation with CuE resulted in the binding of GADD45γ to CDC2, which suggests that the delay in CuE-induced mitosis is regulated by the overexpression of GADD45γ. Our findings suggest that, in addition to the known effects on cancer prevention, CuE may have antitumor activities in established CRC. © 2014 Macmillan Publishers Limited All rights reserved.


Huang T.Y.,Tainan Sin Lau Hospital | Huang T.Y.,Graduate Institute of Medical Science | Tsai T.H.,Tainan Sin Lau Hospital | Hsu C.W.,Chang Jung Christian University | Hsu Y.C.,Graduate Institute of Medical Science
Journal of Agricultural and Food Chemistry | Year: 2010

Curcuminoids, natural plant components, have been recently shown to display antioxidant and antiinflammatory activities. They also produce potent chemo-preventive action against several types of cancer. In the present study, the anti-proliferative and induced apoptosis effects of curcuminoids have been investigated in human brain glioblastoma multiforme (GBM) 8401 cells. Results indicated that curcuminoids have produced an inhibition of cell proliferation in a dose-dependent manner as dosage increased from 12.5 to 100 μM (n = 6) via the 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay as well as activation of apoptosis in GBM 8401 cells. Both effects were observed to increase in proportion with the dose of curcuminoids. We have studied the mitochondrial membrane potential (m), DNA fragmentation, caspase-3, caspase-8, and caspase-9 activation, and nuclear factor γB (NF-γB) transcriptional factor activity to analyze apoptosis in GBM 8401 cells. From these approaches, apoptosis was induced by curcuminoids in human brain GBM 8401 cells via mitochondria and a caspase-dependent pathway. The results observed with proliferation inhibition (y = 94.694e-0.025x, R2 = 0.9901, and n = 6) and apoptosis (y = 0.9789e-0.0102x, R2 = 0.99854, and n = 3) depend upon the amount of curcuminoid treatment in the cancer cells.


Hsu Y.-C.,Chang Jung Christian University | Chen M.-J.,Chi Mei Medical Center | Huang T.-Y.,Chang Jung Christian University | Huang T.-Y.,Tainan Sin Lau Hospital
Cell Death and Disease | Year: 2014

Cucurbitacin E (CuE) is a natural compound previously shown to have anti-feedant, antioxidant and antitumor activities as well as a potent chemo-preventive action against cancer. The present study investigates its anti-proliferative property using MTT assay; CuE demonstrated cytotoxic activity against malignant glioma GBM 8401 cells and induced cell cycle G2/M arrest in these cells. CuE-treated cells accumulated in metaphase (CuE 2.510 μM) as determined using MPM-2 by flow cytometry. We attempted to characterize the molecular pathways responsible for cytotoxic effects of CuE in GBM 8401 cells. We studied the genome-wide gene expression profile on microarrays and molecular networks by using pathway analysis tools of bioinformatics. The CuE reduced the expression of 558 genes and elevated the levels of 1354 genes, suggesting an existence of the common pathways involved in induction of G2/M arrest. We identified the RB (GADD45b and GADD45c) and the p53 (GADD45a) signaling pathways as the common pathways, serving as key molecules that regulate cell cycle. Results indicate that CuE produced G2/M arrest as well as the upregulation of GADD45 γ and binding with CDC2. Both effects increased proportionally with the dose of CuE, suggesting that the CuE-induced mitosis delay is regulated by GADD45c overexpression. Our findings suggest that, in addition to the known effects on cancer prevention, CuE may have antitumor activity in glioma therapy. © 2014 Macmillan Publishers Limited.


Chang C.-C.,Tainan Sin Lau Hospital | Chang C.-C.,I - Shou University | Chang C.-C.,Chang Jung Christian University | Hung C.-M.,I - Shou University | And 3 more authors.
Journal of Ovarian Research | Year: 2013

Background: Malignant tumors are the single most common cause of death and the mortality rate of ovarian cancer is the highest among gynecological disorders. The excision of benign tumors is generally followed by complete recovery; however, the activity of cancer cells often results in rapid proliferation even after the tumor has been excised completely. Thus, clinical treatment must be supplemented by auxiliary chemotherapy or radiotherapy. Sulforaphane (SFN) is an extract from the mustard family recognized for its anti-oxidation abilities, phase 2 enzyme induction, and anti-tumor activity. Methods. This study investigated the cell cycle arrest in G2/M by SFN and the expression of cyclin B1, Cdc2, and the cyclin B1/CDC2 complex in PA-1 cells using western blotting and co-IP western blotting. Results: This study investigated the anticancer effects of dietary isothiocyanate SFN on ovarian cancer, using cancer cells line PA-1. SFN-treated cells accumulated in metaphase by CDC2 down-regulation and dissociation of the cyclin B1/CDC2 complex. Conclusion: Our findings suggest that, in addition to the known effects on cancer prevention, SFN may also provide antitumor activity in established ovarian cancer. © 2013 Chang et al.; licensee BioMed Central Ltd.

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