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Wu V.-C.,National Taiwan University Hospital | Wu C.-H.,Taipei Tzu Chi Hospital | Huang T.-M.,National Taiwan University Hospital | Wang C.-Y.,Fu Jen Catholic University | And 12 more authors.
Journal of the American Society of Nephrology | Year: 2014

The incidence rate of AKI in hospitalized patients is increasing. However, relatively little attention has been paid to the association of AKI with long-term risk of adverse coronary events. Our study investigated hospitalized patients who recovered from de novo dialysis-requiring AKI between 1999 and 2008 using patient data collected from inpatient claims from Taiwan National Health Insurance. We used Cox regression with time-varying covariates to adjust for subsequent CKD and ESRD after discharge. Results were further validated by analysis of a prospectively constructed database. Among 17,106 acute dialysis patients who were discharged, 4869 patients recovered from dialysis-requiring AKI (AKI recovery group) and were matched with 4869 patients without AKI (non-AKI group). The incidence rates of coronary events were 19.8 and 10.3 per 1000 person-years in the AKI recovery and non-AKI groups, respectively. AKI recovery associated with higher risk of coronary events (hazard ratio [HR], 1.67; 95% confidence interval [95% CI], 1.36 to 2.04) and all-cause mortality (HR, 1.67; 95% CI, 1.57 to 1.79) independent of the effects of subsequent progression to CKD and ESRD. The risk levels of de novo coronary events after hospital discharge were similar in patients with diabetes alone and patients with AKI alone (P=0.23). Our results reveal that AKI with recovery associated with higher long-term risks of coronary events and death in this cohort, suggesting that AKI may identify patients with high risk of future coronary events. Enhanced postdischarge follow-up of renal function of patients who have recovered from temporary dialysis may be warranted. Copyright © 2014 by the American Society of Nephrology.


Tsai M.-J.,Taipei Tzu Chi Hospital | Hsieh Y.-T.,Taipei Tzu Chi Hospital | Hsieh Y.-T.,National Taiwan University Hospital
Optometry and Vision Science | Year: 2014

PURPOSE: To evaluate the efficacy and safety using fluorescein angiography (FA)-guided half-time photodynamic therapy (PDT) for the treatment of acute or chronic central serous chorioretinopathy (CSC) and to evaluate the prognostic factors for visual acuity. METHODS: Sixteen eyes with CSC treated with the same protocol in a single hospital were retrospectively enrolled in the study; all eyes were treated using FA-guided half-time PDT (42 seconds). Logarithm of the minimal angle of resolution (logMAR) of the best-corrected visual acuity (BCVA) before and 3 months after PDT was measured. The time to complete subretinal fluid resorption was observed. Multiple regression analysis was used to evaluate the prognostic factors for logMAR of BCVA before and at 3 months after PDT and the change in logMAR after PDT. RESULTS: The mean (±SD) follow-up time after PDT was 12.1 (±9.2) months. The mean (±SD) logMAR of BCVA significantly improved from 0.28 (±0.21) before PDT to 0.21 (±0.21) at 3 months after PDT (p = 0.003). All eyes showed complete resolution of subretinal fluid and retinal pigmented epithelium detachment on optical coherence tomography within 5 weeks after PDT. No treatment-related complications were reported. The duration of symptoms before PDT was significantly correlated with the pre-PDT logMAR of BCVA (p = 0.004) and the post-PDT logMAR of BCVA (p = 0.0009) but not with the logMAR change after PDT (p = 0.25). CONCLUSIONS: Fluorescein angiography-guided half-time PDT was safe and effective in treating both acute and chronic CSC. Early treatment was important for preserving visual acuity. © American Academy of Optometry.


Chen K.-H.,Taipei Tzu Chi Hospital | Chen K.-H.,Tzu Chi University | Chen L.-R.,Mackay Memorial Hospital | Chen L.-R.,National Chiao Tung University | Wang Y.-K.,Taipei Tzu Chi Hospital
PLoS ONE | Year: 2014

Objective: This prospective study aims to identify and compare the incidence of bacterial contamination of hospital charts and the distribution of species responsible for chart contamination in different units of a tertiary hospital. Methods: All beds in medical, surgical, pediatric, and obstetric-gynecologic general wards (556) and those in corresponding special units (125) including medical, surgical, pediatric intensive care units (ICUs), the obstetric tocolytic unit and delivery room were surveyed for possible chart contamination. The outer surfaces of included charts were sampled by one experienced investigator with sterile cotton swabs rinsed with normal saline. Results: For general wards and special units, the overall sampling rates were 81.8% (455/556) and 85.6% (107/125) (p = 0.316); the incidence of chart contamination was 63.5% and 83.2%, respectively (p<0.001). Except for obstetric-gynecologic charts, the incidence was significantly higher in each and in all ICUs than in corresponding wards. Coagulase-negative staphylococci was the most common contaminant in general wards (40.0%) and special units (34.6%) (p>0.05). Special units had a significantly higher incidence of bacterial contamination due to Staphylococcus aureus (17.8%), Methicillin-resistant Staphylococcus aureus (9.3%), Streptococcus viridans (9.4%), Escherichia coli (11.2%), Klebsiella pneumoniae (7.5%), and Acinetobacter baumannii (7.5%). Logistic regression analysis revealed the incidence of chart contamination was 2- to 4-fold higher in special units than in general wards [odds ratios: 1.97-4.00]. Conclusions: Noting that most hospital charts are contaminated, our study confirms that a hospital chart is not only a medical record but also an important source of potential infection. The plastic cover of the medical chart can harbor potential pathogens, thus acting as a vector of bacteria. Additionally, chart contamination is more common in ICUs. These findings highlight the importance of effective hand-washing before and after handling medical charts. However, managers and clinical staff should pay more attention to the issue and may consider some interventions. © 2014 Chen et al.


Cheng H.-C.,Taipei Tzu Chi Hospital | Hsieh Y.-T.,Taipei Tzu Chi Hospital | Hsieh Y.-T.,National Taiwan University Hospital
Optometry and Vision Science | Year: 2014

PURPOSE: To explore short-term refractive and ocular parameter changes and their correlations after cycloplegia with tropicamide. METHODS: This study prospectively enrolled 114 right eyes of 114 participants (mean [±SD] age, 9.1 [±2.8] years). Spherical equivalent of refractive error (SER), axial length (AL), corneal curvature (CC), and anterior chamber depth (ACD) were measured before and after 30 minutes from instillation of 0.4% tropicamide. A partial optical coherence interferometry (Zeiss IOLMaster) was used for ocular parameter measurement. Refractive change and ocular parameter changes after cycloplegia and their correlations were evaluated. RESULTS: Spherical equivalent of refractive error, AL, and ACD all positively shifted significantly at 30 minutes after application of 0.4% tropicamide (p < 0.0001 for each parameter measured). After cycloplegia, 28 eyes (24.6%) had a hyperopic shift of more than 0.25 diopters (D), 3 eyes (2.6%) had a myopic shift of more than 0.25 D, and 83 eyes (72.8%) had their SER changes within -0.25 to 0.25 D. The mean, maximum, and minimum keratometric values all decreased (p = 0.005, 0.03, and 0.05, respectively), whereas corneal astigmatism did not change significantly. The changes in AL, ACD, or mean keratometric values contributed little to the refractive changes after cycloplegia by tropicamide (p > 0.05, pr ≤ 0.01 for all values). CONCLUSIONS: Spherical equivalent of refractive error, AL, and ACD all positively shifted after cycloplegia with tropicamide. Corneal curvature became flattened after cycloplegia with tropicamide, but the corneal astigmatism did not change significantly. Refractive changes did not correlate with changes in AL, ACD, or CC after cycloplegia with tropicamide. © American Academy of Optometry.


Huang P.-S.,Taipei Tzu Chi Hospital | Chang W.-C.,National Taiwan University Hospital | Huang S.-C.,Taipei Tzu Chi Hospital | Huang S.-C.,Tzu Chi University
Taiwanese Journal of Obstetrics and Gynecology | Year: 2014

Objective: To investigate the possible causes of iatrogenic parasitic myoma and methods to prevent its occurrence. Case report: A 27-year-old nulliparous unmarried patient underwent laparoscopic myomectomy with morcellation for a submucosal myoma at the National Taiwan University Hospital (Taipei, Taiwan). Seven years later, an asymptomatic pelvic tumor was noted during a regular annual follow up. Two pelvic tumors were detected and excised by laparoscopic surgery. The masses were confirmed by histopathology to be cellular leiomyomas. Conclusion: In the past 7 years, the incidence of iatrogenic parasitic myomas has increased because of the increased use of minimally invasive surgery using a morcellator. Forty-one cases of iatrogenic parasitic myoma were reviewed from 23 published studies. Parasitic myoma frequently occurs in the dependent part of the abdominal cavity, which suggests seeding of myometrial tissues during morcellation. In situ morcellation and vigorous irrigation with concomitant changes in position may decrease the incidence of retained myoma tissue in the abdomen during surgery. © 2014.


Chan L.-W.,Taipei Tzu Chi Hospital | Hsieh Y.-T.,Taipei Tzu Chi Hospital | Hsieh Y.-T.,National Taiwan University Hospital
Optometry and Vision Science | Year: 2014

PURPOSE: To report a patient with circumscribed choroidal hemangioma with serous macular detachment successfully treated with photodynamic therapy (PDT) after being unresponsive to treatment with intravitreal ranibizumab. CASE REPORT: A 63-year-old Asian woman was incidentally found to have a circumscribed choroidal hemangioma without symptoms in the left eye during a routine health examination. Blurred vision of the left eye developed 3.5 years later, and a serous macular detachment was observed. Two consecutive intravitreal ranibizumab injections were administered, but the subretinal fluid (SRF) persisted and the vision did not improve. One PDT session was then given, and the SRF resolved completely within 1 month. The best-corrected visual acuity improved from 20/50 before treatment to 20/25 at 4 months after the PDT. The tumor thickness also decreased from 3.84 mm before treatment to 2.86 mm at 14 months after PDT. CONCLUSIONS: Circumscribed choroidal hemangioma with serous macular detachment may not respond to anti-vascular endothelial growth factor agents. Photodynamic therapy may be an effective choice in such cases to remove SRF and improve vision. © American Academy of Optometry.


Peng G.-S.,Tri Service General Hospital | Chen Y.-C.,Taipei Tzu Chi Hospital | Wang M.-F.,National Defense Medical Center | Lai C.-L.,Chang Gung University | Yin S.-J.,National Defense Medical Center
Pharmacogenetics and Genomics | Year: 2014

It has been well documented that variant alleles of both ADH1B∗2 of alcohol dehydrogenase (ADH) and ALDH2∗2 of aldehyde dehydrogenase (ALDH) protect against the development of alcoholism in East Asians. However, it remains unclear whether ADH1B∗2 contributes significantly toward the accumulation of systemic blood acetaldehyde and whether it plays a critical role in the alcohol flushing reaction. PARTICIPANTS AND METHODS: Sixty-one adult Han Chinese men were recruited and divided into six combinatorial genotypic groups: ALDH2∗1/∗1-ADH1B∗1/∗1 (12), ALDH2∗1/∗1-ADH1B∗1/∗2 (11), ALDH2∗1/∗1-ADH1B∗2/∗2 (11); ALDH2∗1/∗2-ADH1B∗1/∗1 (9), ALDH2∗1/∗2-ADH1B∗1/∗2 (9), and ALDH2∗1/∗2-ADH1B∗2/∗2 (9). After ingesting 0.3â ‰g/kg of alcohol, blood ethanol, acetaldehyde, and acetate concentrations, as well as the facial skin blood flow (FSBF) and pulse rate were measured for 130â ‰min. RESULTS: The ALDH2∗1/∗2 heterozygotes carrying three ADH1B allelotypes showed significantly higher peak levels and areas under the concentration curve (AUCs) of the blood acetaldehyde as well as significantly greater increases in the peak pulse rate and peak FSBF compared with the ALDH2∗1/∗1 homozygotes. However, no significant differences in peak levels and AUCs of blood ethanol, acetaldehyde or acetate, or the peak cardiovascular responses, were found between the ADH1B allelotypes carrying ALDH2∗1/∗1 or between those with ALDH2∗1/∗2. Partial correlation analyses showed that peak blood acetaldehyde, rather than the blood ethanol or acetate, was correlated significantly with the peak responses of pulse rate and FSBF. CONCLUSION: Findings indicate that ALDH2∗2, rather than ADH1B2∗2, is a causal variant allele for the accumulation of blood acetaldehyde and the resultant facial flushing during low alcohol consumption. © 2014 Wolters Kluwer Health | Lippincott Williams and Wilkins.


Patent
Taipei Tzu Chi Hospital and National Taiwan University | Date: 2014-03-28

The present invention provides a handheld robot for orthopedic surgery and a control method thereof. The handheld robot of the present invention includes a main body, a grip, a kinematic mechanism, a tool connector, a tool, a force sensor and a positioning unit. The handheld robot of the present invention combines the position/orientation information of the tool acquired by the positioning unit with the force/torque information acquired by the force sensor, and utilizes the combined information to adjust the position of the tool so as to keep the tool within the range/path of a predetermined operation plan. In this way, the precision of the orthopedic surgery can be enhanced, and the error occurred during the surgery can be minimized.


Patent
National Taiwan University and Taipei Tzu Chi Hospital | Date: 2015-07-01

The present invention provides a handheld robot for orthopedic surgery and a control method thereof. The handheld robot of the present invention includes a main body, a grip, a kinematic mechanism, a tool connector, a tool, a force sensor and a positioning unit. The handheld robot of the present invention combines the position/orientation information of the tool acquired by the positioning unit with the force/torque information acquired by the force sensor, and utilizes the combined information to adjust the position of the tool so as to keep the tool within the range/path of a predetermined operation plan. In this way, the precision of the orthopedic surgery can be enhanced, and the error occurred during the surgery can be minimized.


Tsai K.-T.,Taipei Tzu Chi Hospital | Tsai K.-T.,Tzu Chi University | Shen T.-C.,Taipei Tzu Chi Hospital
Journal of Endovascular Therapy | Year: 2014

Purpose: To report a challenging carotid intervention after total arch rerouting and hybrid zone 0 elephant trunk repair. Case Report: A 54-year-old man developed symptomatic left carotid artery restenosis 2 weeks after total arch rerouting and hybrid zone 0 elephant trunk repair for acute retrograde type A aortic dissection with left carotid malperfusion. Because the origins of the 3 supraaortic branches were already transected and rerouted to the proximal end of the reconstructed ascending aortic graft, the peripheral access routes for carotid intervention were deemed difficult, with little chance of success due to acute angles between these rerouted supra-aortic branches and the ascending aortic graft. Emergent carotid artery stenting was therefore performed via sternal reentry with successful restoration of cerebral perfusion. Conclusion: Total arch rerouting, facilitating hybrid endovascular repair for extensive thoracic aortic disease, creates an extremely deformed arch anatomy that renders subsequent carotid intervention a challenging task. © 2014 by the International Society of Endovascular Specialists.

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