Hsinchu, Taiwan
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Lin Y.-S.,Ton Yen General Hospital | Huang Y.-C.,Chang Gung Memorial Hospital | Lin T.-Y.,Chang Gung Memorial Hospital
Journal of Microbiology, Immunology and Infection | Year: 2010

Background/Purpose: Abdominal tuberculosis (TB) is a rare manifestation of childhood TB. Abdominal TB is characterized by long-lasting abdominal symptoms, which are usually confused with other conditions, and the diagnosis is usually delayed. Methods: During a 5-year period, we identified 10 cases of abdominal TB in a tertiary care children's hospital. Data including demographic characteristics, presenting symptoms, history of Bacille Calmette-Guérin vaccination, lesion sites, laboratory data, image findings, diagnosis, tuberculin skin test, risk factors, treatment, and outcome were collected and analyzed. Results: There were six female patients and four male patients, with a mean age of 14.7 years. One patient died due to the complication of disseminated TB with a pneumothorax. Household members with TB could be traced in six (60%) patients. The most common clinical presentations included fever (9/10), abdominal pain (8/10), and weight loss (8/9). The diagnosis of abdominal TB was suspected initially in only three patients; the others were not diagnosed until 7-36 days (mean=19 days) after hospitalization. The abnormal abdominal image findings, by either computed tomography or ultrasound, included lymphadenopathy (7/9), high-density ascites (6/9), thickening of the omentum or peritoneum (6/9), inflammatory mass (3/9), bowel wall thickening (1/9), and liver abscess (1/9). The chest radiography was abnormal in nine patients. Mycobacterium tuberculosis was isolated from ascites in two out of four patients, gastric aspirates in three, sputum in three, and intra-abdominal tissue specimens in two. Laparotomy was performed in three patients, laparoscopy in one, and colonoscopy in one. Conclusion: In Taiwan, abdominal TB should be considered in patients with fever, abdominal pain, weight loss, and abnormal chest radiography. Characteristic computed tomography findings of abdominal TB and a history of exposure to TB contribute to the diagnosis. © 2010 Taiwan Society of Microbiology.


Lee C.-H.,National Taiwan University | Lee C.-H.,Ton Yen General Hospital | Wang J.-D.,National Taiwan University | Wang J.-D.,National Cheng Kung University | And 2 more authors.
PLoS ONE | Year: 2011

Background: Chinese herbal products (CHPs) containing Radix bupleuriare often prescribed for chronic hepatitis. There have been no epidemiological studies in populations with hepatitis B virus (HBV) infection. Our study was conducted to determine the association between the use of CHPs containing Radix bupleuri and the risk of hospitalisation related to liver injury among HBV-infected patients in Taiwan. Methods: From a total of 639, 779 patients with diagnoses related to HBV infection, we included hospitalised adult cases with a primary diagnosis of liver injury in the database of Taiwan's national health insurance during the period 1997-2004. Case-control and case-crossover designs were used to assess the risk of hospitalisation with conditional logistic regression models constructed and adjusted for 270 conventionally hepatotoxic drugs. Cumulative doses of these CHPs and Radix bupleuri were assessed for any dose-response relationship. Findings: In total, we collected 1, 080 cases fulfilled the inclusion criteria. In the case-control design, the adjusted odds ratio was 1.90 (95% confidence interval [CI]: 1.30 to 2.77). The risks from prescribing the CHPs Xiao-Chai-Hu-Tang and Long-Dan-Xie-Gan-Tang were significantly high, and dose-response relationships were found. The risk of adding each 19 gm dose of Radix bupleuri was 2.19 (95% CI: 1.66 to 2.89). The results using the case-crossover design remained similar. Conclusions: Prescribing Xiao-Chai-Hu-Tang, Long-Dan-Xie-Gan-Tang, or CHPs containing more than 19 gram of Radix bupleuri in HBV-infected patients might increase their risks of liver injury. Further studies are indicated to corroborate the above findings. © 2011 Lee et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


Lee C.-H.,National Taiwan University | Lee C.-H.,Ton Yen General Hospital | Wang J.-D.,National Taiwan University | Wang J.-D.,National Taiwan University Hospital | Chen P.-C.,National Taiwan University
Pharmacoepidemiology and Drug Safety | Year: 2010

Background: Epidemiological studies related to hospitalization due to the hepatotoxicity of traditional non-steroidal anti-inflammatory drugs (NSAIDs) are infrequent, and case reports of hepatotoxicity of nimesulide, celecoxib, and rofecoxib seem to be increasing. The reimbursement database of National Health Insurance (NHI) in Taiwan provided an opportunity for post-marketing surveillance. We conducted this study to determine the association between the use of hepatoxic NSAIDs and increased hospitalizations related to acute hepatitis. Methods: We included hospitalized subjects with a major diagnosis of acute or sub-acute necrosis of liver or toxic hepatitis and excluded viral and other causes of hepatobiliary diseases from the NHI database from 1 April 2001 to 31 December 2004. We applied two kinds of models to analyze by uni-directional and bi-directional case-crossover designs during the 28 days exposure periods and performed conditional logistic regression models. Results: There were 4519 cases of hospitalization relating to acute hepatitis, and the odds ratios of celecoxib, nimesulide, dicofenac, ibuprofen, and other hepatoxic NSAIDs were significantly increased. Compared with the adjusted odds ratios of other hepatoxic NSAIDs (OR = 2.13, 95%CI = 2.00, 2.28), celecoxib (OR = 1.92, 95%CI = 1.38, 2.69) was similar during the 28 days by our uni-directional case-crossover design. Conclusions: Our results provide evidence for an increased risk of hospitalization with acute hepatitis among hepatoxic NSAIDs including celecoxib users. Further mechanistic research is warranted in order to document celecoxib's hepatotoxicity. Copyright © 2010 John Wiley & Sons, Ltd.


Yang Y.-J.,National Cheng Kung University | Chuang C.-C.,National Cheng Kung University | Yang H.-B.,National Cheng Kung University | Yang H.-B.,Ton Yen General Hospital | And 2 more authors.
BMC Microbiology | Year: 2012

Background: H. pylori infection may trigger Smad7 and NFB expression in the stomach, whereas probiotics promote gastrointestinal health and improve intestinal inflammation caused by pathogens. This study examines if probiotics can improve H. pylori-induced gastric inflammation by inactivating the Smad7 and NFB pathways. Results: Challenge with H. pylori increased IL-8 and TNF- expressions but not TGF-1 in MKN45 cells. The RNA levels of Smad7 in AGS cells increased after H. pylori infection in a dose-dependent manner. A higher dose (MOI 100) of L. acidophilus pre-treatment attenuated the H. pylori-induced IL-8 expressions, but not TGF-1. Such anti-inflammatory effect was mediated via increased cytoplasmic IB and depletion of nuclear NFB. L. acidophilus also inhibited H. pylori-induced Smad7 transcription by inactivating the Jak1 and Stat1 pathways, which might activate the TGF-1/Smad pathway. L. acidophilus pre-treatment ameliorated IFN - induced Smad7 translation level and subsequently reduced nuclear NF-B production, as detected by western blotting. Conclusions: H. pylori infection induces Smad7, NFB, IL-8, and TNF- production in vitro. Higher doses of L. acidophilus pre-treatment reduce H. pylori-induced inflammation through the inactivation of the Smad7 and NFB pathways. © 2012 Yang et al; licensee BioMed Central Ltd.


Yang Y.-J.,National Cheng Kung University | Sheu B.-S.,National Cheng Kung University | Yang H.-B.,Ton Yen General Hospital | Yang H.-B.,National Cheng Kung University | And 2 more authors.
World Journal of Gastroenterology | Year: 2012

AIM: To determine whether Helicobacter pylori (H. pylori)-infected children have reduced body weight (BW) and height (BH) growth, and if H. pylori eradication may restore growth while improving serum acylated ghrelin. METHODS: This longitudinal cohort study with one-year follow-up enrolled 1222 children aged 4 to 12 years old into an observation cohort (18 with and 318 without H. pylori) and intervention cohort (75 with and 811 without). The 7-d triple therapy was used for eradication in the intervention cohort. The net increases of BW and BH as well serum acylated ghrelin after one-year follow-up were compared between successful eradicated H. pylori-infected children and controls. RESULTS: In the observation cohort, the H. pylori-infected children had lower z score of BW (-1.11 ± 0.47 vs 0.35 ± 0.69, P = 0.01) and body mass index (BMI) (0.06 ± 0.45 vs 0.44 ± 0.73, P = 0.02) at enrollment and lower net BW gain after one-year follow-up (3.3 ± 2.1 kg vs 4.5 ± 2.4 kg, P = 0.04) than the non-infected controls. In the intervention cohort, the H. pylori-infected children had lower z score of BMI (0.25 ± 1.09 vs 0.68 ± 0.87, P = 0.009) and serum acylated ghrelin levels (41.8 ± 35.6 pg/mL vs 83.6 ± 24.2 pg/mL, P < 0.001) than the non-infected controls. In addition to restoring decreased serum ghrelin levels (87.7 ± 38.0 pg/mL vs 44.2 ± 39.0 pg/mL, P < 0.001), the H. pylori-infected children with successful eradication had higher net gains (P < 0.05) and increase of z scores (P < 0.05) of both BW and BH as compared with non-infected controls after one-year follow-up. CONCLUSION: H. pylori-infected children are associated with low serum acylated ghrelin and growth retardation. Successful eradication of H. pylori restores ghrelin levels and increases growth in children. © 2012 Baishideng. All rights reserved.


Tsai Y.-C.,National Cheng Kung University | Tsai Y.-C.,Tainan Hospital | Hsiao W.-H.,National Cheng Kung University | Yang H.-B.,National Cheng Kung University | And 5 more authors.
Alimentary Pharmacology and Therapeutics | Year: 2013

Background To eradicate Helicobacter pylori before the occurrence of precancerous changes is important to prevent gastric carcinogenesis. Aim To validate whether the corpus-predominant gastritis index (CGI) can serve as an early marker to identify the H. pylori-infected patients at risk of gastric carcinogenesis. Methods This study enrolled 188 subjects, including 43 noncardiac gastric cancer patients, 63 of their first-degree relatives and 82 sex- and age-matched duodenal ulcer patients as controls. All received endoscopy to provide topographic gastric specimens to test for H. pylori infection and its related histological features, translated into the operative link on gastritis assessment (OLGA), operative link on gastric intestinal metaplasia assessment (OLGIM) stages, and the presence of CGI. Spasmolytic polypeptide-expressing metaplasia (SPEM) was assessed by immunohistochemistry staining of trefoil factor 2. Results Gastric cancer patients had higher prevalence of CGI and OLGIM stage II-IV, but not OLGA stage II-IV, than the controls (P = 0.001, OR = 3.4[95% CI: 1.4-8.1] for CGI; OR = 5.0[95% CI: 2.0-12.8] for OLGIM). In patients with the combined presence of CGI and OLGIM stage II-IV, the risk of gastric cancer increased to 9.8 (P < 0.001). The first-degree relatives of the gastric cancer patients had a higher rate of the presence of CGI, but not OLGA or OLGIM stage II-IV than the duodenal ulcer controls (P = 0.001). Of the first-degree relatives, the presence of CGI increased the risk of SPEM (P = 0.003, OR = 5.5[95% CI: 1.8-17.0]). Conclusion The corpus-predominant gastritis index, which is highly correlated to SPEM, may serve as an early marker to identify the H. pylori-infected patients at a higher risk of gastric cancer. © 2013 Blackwell Publishing Ltd.


Chang W.-L.,National Cheng Kung University | Yang H.-B.,Ton Yen General Hospital | Cheng H.-C.,National Cheng Kung University | Chuang C.-H.,National Cheng Kung University | And 2 more authors.
Helicobacter | Year: 2011

Background: Osteopontin (OPN) is involved in the gastric cancer progression. The study validated whether OPN expressions correlate with Helicobacter pylori-related chronic gastric inflammation and the precancerous change as intestinal metaplasia (IM). Methods: This study included 105 H. pylori-infected patients (63 without and 42 with IM) and 29 H. pylori-negative controls. In each subject, the gastric OPN expression intensity was evaluated by immunohistochemistry, and graded from 0 to 4 for the epithelium, lamina propria, and areas with IM, respectively. For the H. pylori-infected subjects, the gastric inflammation was assessed by the Updated Sydney System. Forty-nine patients received follow-up endoscopy to assess OPN change on gastric mucosa after H. pylori eradication. The in vitro cell-H. pylori coculture were performed to test the cell origin of OPN. Results: The H. pylori-infected patients had higher gastric OPN expression than the noninfected controls (p<001). For the H. pylori-infected patients, an increased OPN expression correlated with more severe chronic gastric inflammation (p<001) and the presence of IM (OR: 2.6, 95% CI: 1.15-5.94, p=02). Within the same gastric bits, lamina propria expressed OPN stronger than epithelium (p<001), suggesting OPN predominantly originates from inflammatory cells. The in vitro assay confirmed H. pylori stimulate OPN expression in the monocytes, but not in the gastric epithelial cells. After H. pylori eradication, the gastric OPN expression could be decreased only in areas without IM (p<05). Conclusions: Increased gastric OPN expression by H. pylori infection can correlate with a more severe gastric inflammation and the presence of IM. © 2011 Blackwell Publishing Ltd.


Juang K.D.,Taichung Veterans General Hospital | Juang K.D.,National Yang Ming University | Yang C.-Y.,Ton Yen General Hospital
Current Pain and Headache Reports | Year: 2014

The fifth edition of the Diagnostic and Statistic Manual (DSM-5) reclassified some mental disorders recently. Post-traumatic stress disorder (PTSD) is in a new section termed "trauma- and stressor-related disorder". Community-based studies have shown that PTSD is associated with a notably high suicidal risk. In addition to previous findings of comorbidity between chronic daily headache (CDH) and both depressive disorders and anxiety disorders, recent data suggest that frequency of childhood maltreatment, PTSD, and suicidality are also increased in CDH. CDH patients with migraine aura are especially at risk of suicidal ideation. Research suggests that migraine attack, aura, frequency, and chronicity may all be related to serotonergic dysfunction. Vulnerability to PTSD and suicidality are also linked to brain serotonin function, including polymorphisms in the serotonin transporter gene (5-HTTLPR). In the present review, we focus on recent advances in knowledge of traumatic experiences in childhood, PTSD, and suicidality in relation to migraine and CDH. We hypothesize that vulnerability to PTSD is associated with migraine attack, migraine aura, and CDH. We further postulate that these associations may explain some of the elevated suicidal risks among patients with migraine, migraine aura, and/or CDH. Field studies are required to support these hypotheses. © Springer Science+Business Media New York 2014.


Chen I.C.,Ton Yen General Hospital
The journal of nursing research : JNR | Year: 2010

Nursing home residents usually suffer from a variety of medical conditions and are prescribed a wider variety of medications than any other subpopulation. Polypharmacy is associated with the occurrence of adverse events. The purposes of this study were to describe the medication prescription patterns of residents who died in a nursing home, to examine how this pattern changed as residents progressed toward death, and to identify correlates of increased medication prescriptions. Thirty-one residents who had lived at one nursing home for more than 6 months before death were included in the study. Medication records for participants were obtained at four data collection points: on admission, 6 months before death, 3 months before death, and at death. The mean number of medications prescribed immediately before death was 7.90 (SD = 3.27), and there was an upward trend in number of prescriptions written as patients neared death. The most frequent prescription was for medication for constipation, pulmonary care, and hypertension. There was a significant correlation between residents with heart disease and increased medication use. Medication prescribed for pulmonary care and hypertension increased from admission to death, but a decreased use of medication for pain relief in the time before death in these cases was found. CONCLUSIONS/IMPLICATIONS FOR PRACTICE: This study surveyed and described the pattern of medication use in nursing home residents from admission to the end of life. Results can be used to reinforce clinician and nursing staff awareness of prescription frequency, amounts of medication, and change over time for elderly residents under their care. In addition to safer prescribing practices for the older people, nonpharmacological strategies (e.g., lifestyle modification and physiotherapy for function training) may be used to address common symptoms and complaints during chronic care.


Lin R.-Z.,National Tsing Hua University | Wang T.-P.,National Tsing Hua University | Hung R.-J.,National Tsing Hua University | Chuang Y.-J.,National Tsing Hua University | And 2 more authors.
Journal of Cellular Physiology | Year: 2011

Many tumor cells are capable of migrating through endothelial cell (EC) junctions and disintegrating sub-endothelial extracellular matrix to achieve extravasation. We demonstrate in this study that certain solid tumor cells can induce EC apoptosis to facilitate their escape from the circulation. The EC apoptosis is triggered by elevated intracellular reactive oxygen species (ROS) levels and direct contacts with tumor cells are required. Treating ECs with antioxidants, such as ascorbate and N-acetyl-L-cysteine (NAC), and a glutathione precursor can rescue the ECs from tumor-induced apoptosis and reduce the number of tumor cells migrating across endothelial barriers. NAD(P)H oxidase was identified as the major ROS producer in the event since inhibitors and small interference RNA specific to the enzyme could abrogate the tumor-induced ROS production and hence EC death. This study also provides evidence showing that the interaction between tumor and EC increases intracellular Ca2+ concentration and activates protein kinase C (PKC) activity, which leads to NAD(P)H oxidase activation through the serine-phosphorylation of p47phox subunit. These findings suggest that blocking the tumor-induced EC apoptosis is a potential way to prevent tumor metastasis. © 2010 Wiley-Liss, Inc.

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