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Chang CH, Chou PH, Chuang HY, Yao CY, Chen WJ, Tsai HC. Efficacy of Non-Invasive Brain Stimulation for Treating Depression in Patients with Traumatic Brain Injury: A Meta-Analysis and Meta-Regression of Randomized Controlled Trials. J Clin Med 2023; 12:6030. [PMID: 37762970 PMCID: PMC10531948 DOI: 10.3390/jcm12186030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE This meta-analysis aimed to ascertain the efficacy of non-invasive brain stimulation (NIBS)-comprising repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS)-for depression in traumatic brain injury (TBI) patients. METHODS Comprehensive searches were conducted in PubMed, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials up to 28 January 2023. Random-effects models assessed the treatment effects, and heterogeneity was evaluated through I2 statistics and funnel plot inspection. RESULTS From 10 trials (234 participants; 8 rTMS, 2 tDCS), NIBS was found significantly more effective than sham in alleviating depressive symptoms (SMD: 0.588, 95% CI: 0.264-0.912; p < 0.001). rTMS, specifically, showed higher efficacy (SMD: 0.707, 95% CI: 0.306-1.108; p = 0.001) compared to sham, whereas tDCS outcomes were inconclusive (SMD: 0.271, 95% CI: -0.230 to 0.771; p = 0.289). Meta-regression found no correlation with the number of sessions, treatment intensity, or total dose. Notably, while post-treatment effects were significant, they diminished 1-2 months post intervention. Adverse events associated with NIBS were minimal, with no severe outcomes like seizures and suicide reported. CONCLUSIONS rTMS emerged as a potent short-term intervention for depression in TBI patients, while tDCS findings remained equivocal. The long-term efficacy of NIBS is yet to be established, warranting further studies. The low adverse event rate reaffirms NIBS's potential safety.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung 406040, Taiwan;
- Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung 404327, Taiwan
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Po-Han Chou
- Department of Psychiatry, China Medical University Hsinchu Hospital, China Medical University, Hsinchu 302056, Taiwan
- Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung 404327, Taiwan
| | - Hao-Yu Chuang
- Department of Neurosurgery, An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
| | - Chi-Yu Yao
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Wei-Jen Chen
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan; (C.-Y.Y.); (W.-J.C.)
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970473, Taiwan
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Chou PH, Liu WC, Wang SC, Lin WH, Chung YL, Chang CH, Su KP. Associations between frontal lobe activity and depressive symptoms in patients with major depressive disorder receiving rTMS treatment: a near-infrared spectroscopy study. Front Psychiatry 2023; 14:1235713. [PMID: 37654993 PMCID: PMC10466407 DOI: 10.3389/fpsyt.2023.1235713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 08/04/2023] [Indexed: 09/02/2023] Open
Abstract
Introduction The effects of repetitive transcranial magnetic stimulation (rTMS) on the left dorsolateral prefrontal cortex (DLPFC) in patients with major depressive disorder (MDD) have been proved to have antidepressant effects. However, the absence of biomarkers to assess treatment response remains a challenge. This research aims to explore the relationship between frontal lobe activity, measured using near infrared spectroscopy (NIRS), and changes in symptoms among MDD patients following rTMS treatment. Methods A total of 26 MDD patients underwent 20 sessions of 10 Hz rTMS targeting the left DLPFC. NIRS was used to measure frontal lobe activity during a verbal fluency test at baseline, after 10 rTMS sessions, and after 20 rTMS sessions. Responders were defined as individuals with more than a 50% reduction in symptoms based on the 21-item Hamilton Depression Rating Scale after 20 rTMS sessions. Results Among the 14 responders, an increase in frontal lobe activity was significantly correlated with improvements in depressive symptoms following 10 (p = 0.0001) and 20 rTMS sessions (p = 0.007). Additionally, frontal lobe activity after 10 rTMS sessions was significantly associated with symptom improvement after 20 sessions (p = 0.001). These associations were not observed among non-responders. Conclusion The findings from this study indicate distinct patterns of frontal lobe activity between responders and non-responders to rTMS treatment, suggesting that NIRS has the potential to serve as a biomarker for monitoring treatment response in MDD patients undergoing rTMS.
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Affiliation(s)
- Po-Han Chou
- Department of Psychiatry, Hsinchu Hospital, China Medical University, Hsinchu, Taiwan
| | - Wen-Chun Liu
- An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Shao-Cheng Wang
- Department of Psychiatry, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
- Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Wei-Hao Lin
- Department of Psychiatry, Puli Branch, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Lun Chung
- An-Nan Hospital, China Medical University, Tainan, Taiwan
| | | | - Kuan-Pin Su
- An-Nan Hospital, China Medical University, Tainan, Taiwan
- Mind-Body Interface Research Center (MBI-Lab), China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
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Chang CH, Yen KT, Li AL, Li YR, Su KW. LED-pumped eye-safe pulse laser with an extracavity optical parametric oscillator. Opt Lett 2023; 48:3877-3880. [PMID: 37527072 DOI: 10.1364/ol.496161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 06/21/2023] [Indexed: 08/03/2023]
Abstract
An LED-side-pumped Nd:YAG/Cr4+:YAG passively Q-switched (PQS) laser containing an extracavity optical parametric oscillator (EOPO) is demonstrated. As far as we know, it is the first LED-pumped eye-safe laser. The Nd:YAG pump module is optimized to increase the PQS pulse energy to 24 mJ at 1064 nm. By using a single-pass EOPO design, the output energy of the signal pulse at 1573 nm is 7.44 mJ with a pulse width of 16 ns, the peak power is 434 kW, and the pump-to-signal conversion efficiency is 31%. For double-pass EOPO operation, the pump-to-signal conversion efficiency increases to 45.8%, the output energy of signal pulse is up to 10.98 mJ with a pulse width of 23.5 ns, and the peak power is 459 kW.
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Chang CH, Chen SJ, Chen YC, Tsai HC. A 30-Year-Old Woman with an 8-Week History of Anxiety, Depression, Insomnia, and Mild Cognitive Impairment Following COVID-19 Who Responded to Accelerated Bilateral Theta-Burst Transcranial Magnetic Stimulation Over the Prefrontal Cortex. Am J Case Rep 2023; 24:e938732. [PMID: 37004143 PMCID: PMC10077184 DOI: 10.12659/ajcr.938732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
BACKGROUND This report is of a 30-year-old woman with an 8-week history of anxiety, depression, insomnia, and mild cognitive impairment following COVID-19 infection, who responded to accelerated bilateral theta-burst transcranial magnetic stimulation (TBS) over the prefrontal cortex. CASE REPORT A previously healthy 30-year-old woman visited our psychiatric clinic for symptoms including anxiety, depression, insomnia, and brain fog (mild cognitive impairment) for more than 8 weeks after being diagnosed with COVID-19 on May 9, 2022. Continuous TBS of the right dorsolateral prefrontal cortex (DLPFC), followed by intermittent TBS of the left DLPFC, was performed twice daily over 5 days for a total of 10 sessions. The Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HAMD), Beck Anxiety Inventory (BAI), Pittsburgh Sleep Quality Index (PSQI), and subsets of the Wechsler Memory Scale (WMS)-Third Edition were administered at baseline and at the end of treatment. After 10 sessions of treatment, her BAI, BDI, HAMD, PSQI, WMS-Logical Memory, WMS-Faces, WMS-Verbal Paired Associates, and WMS-Family Pictures scores had improved from 4, 18, 10, 14, 8, 10, 12, and 8, respectively, to 0, 7, 1, 10, 15, 15, 15, and 10, respectively. CONCLUSIONS Accelerated TBS over the bilateral DLPFC may ameliorate long-COVID-associated neuropsychiatric symptoms. Additional trials are warranted to evaluate the effect of neuropsychiatric symptoms following COVID-19.
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Affiliation(s)
- Chun-Hung Chang
- Department of Psychiatry, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung, Taiwan
| | - Yu-Chi Chen
- Department of Psychiatry, An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien City, Taiwan
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Chang CH. Efficacy of non-invasive brain stimulation interventions in patients with generalized anxiety disorder : a systematic review and meta-analysis of double-blind randomized controlled trials. Brain Stimul 2023. [DOI: 10.1016/j.brs.2023.01.317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
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Chang CH, Liu CY, Chen SJ, Tsai HC. Accelerated theta-burst transcranial magnetic stimulation of the bilateral dorsolateral prefrontal cortex in a patient with post-traumatic stress disorder and major depressive disorder: Case report. Front Psychiatry 2023; 14:1061088. [PMID: 36816401 PMCID: PMC9932662 DOI: 10.3389/fpsyt.2023.1061088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Theta-burst transcranial magnetic stimulation has demonstrated promising effectiveness as treatment for post-traumatic stress disorder (PTSD) and depression. However, the effect of accelerated theta-burst stimulation (TBS) in comorbid with PTSD and depression remains unknown. CASE PRESENTATION We report a case of a 25-year-old woman with PTSD and depression whose symptoms markedly improved after continuous TBS of the right dorsolateral prefrontal cortex (DLPFC) and intermittent TBS (iTBS) over the left DLPFC, and then with 20 min break before the 2nd iTBS session. CONCLUSIONS Accelerated TBS over the bilateral DLPFC may improve severe PTSD and depression. Accelerated TBS may have more improvement of depression symptoms than PTSD symptoms. Further trials are warranted to investigate the effect and safety for patients with complicated PTSD and depression.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consulting Laboratory, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Kinoshita S, Cortright K, Crawford A, Mizuno Y, Yoshida K, Hilty D, Guinart D, Torous J, Correll CU, Castle DJ, Rocha D, Yang Y, Xiang YT, Kølbæk P, Dines D, ElShami M, Jain P, Kallivayalil R, Solmi M, Favaro A, Veronese N, Seedat S, Shin S, Salazar de Pablo G, Chang CH, Su KP, Karas H, Kane JM, Yellowlees P, Kishimoto T. Changes in telepsychiatry regulations during the COVID-19 pandemic: 17 countries and regions' approaches to an evolving healthcare landscape. Psychol Med 2022; 52:2606-2613. [PMID: 33243311 PMCID: PMC7750654 DOI: 10.1017/s0033291720004584] [Citation(s) in RCA: 50] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 10/24/2020] [Accepted: 11/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND During the COVID-19 pandemic, the use of telemedicine as a way to reduce COVID-19 infections was noted and consequently deregulated. However, the degree of telemedicine regulation varies from country to country, which may alter the widespread use of telemedicine. This study aimed to clarify the telepsychiatry regulations for each collaborating country/region before and during the COVID-19 pandemic. METHODS We used snowball sampling within a global network of international telepsychiatry experts. Thirty collaborators from 17 different countries/regions responded to a questionnaire on barriers to the use and implementation of telepsychiatric care, including policy factors such as regulations and reimbursement at the end of 2019 and as of May 2020. RESULTS Thirteen of 17 regions reported a relaxation of regulations due to the pandemic; consequently, all regions surveyed stated that telepsychiatry was now possible within their public healthcare systems. In some regions, restrictions on prescription medications allowed via telepsychiatry were eased, but in 11 of the 17 regions, there were still restrictions on prescribing medications via telepsychiatry. Lower insurance reimbursement amounts for telepsychiatry consultations v. in-person consultations were reevaluated in four regions, and consequently, in 15 regions telepsychiatry services were reimbursed at the same rate (or higher) than in-person consultations during the COVID-19 pandemic. CONCLUSIONS Our results confirm that, due to COVID-19, the majority of countries surveyed are altering telemedicine regulations that had previously restricted the spread of telemedicine. These findings provide information that could guide future policy and regulatory decisions, which facilitate greater scale and spread of telepsychiatry globally.
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Affiliation(s)
- Shotaro Kinoshita
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Medicine, International University of Health and Welfare, Tokyo, Japan
| | - Kelley Cortright
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Allison Crawford
- Virtual Mental Health and Outreach, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Yuya Mizuno
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Kazunari Yoshida
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Pharmacogenetics Research Clinic, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Donald Hilty
- Mental Health, Northern California Veterans Administration Health Care System, Mather, CA, USA
- Department of Psychiatry & Behavioral Sciences, University of California Davis, Sacramento, CA, USA
| | - Daniel Guinart
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Christoph U. Correll
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - David J. Castle
- Department of Psychiatry, University of Melbourne, Parkville, Australia
- Department of Psychiatry, St Vincent's Hospital, Fitzroy, Australia
| | - Deyvis Rocha
- Psychoses Unit, Ambulatório de Psiquiatria Dra. Jandira Masur, São Paulo-SP, Brazil
| | - Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau Special Administrative Region, China
| | - Yu-tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau Special Administrative Region, China
| | - Pernille Kølbæk
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - David Dines
- Psychosis Research Unit, Aarhus University Hospital – Psychiatry, Aarhus, Denmark
| | | | - Prakhar Jain
- Department of Psychiatry, Grant Government Medical College, Mumbai, India
| | - Roy Kallivayalil
- Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla, India
| | - Marco Solmi
- Department of Neuroscience, University of Padua, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padua, Padua, Italy
- Padova Neuroscience Center (PNC), University of Padua, Padua, Italy
| | - Nicola Veronese
- Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Soraya Seedat
- Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Sangho Shin
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gonzalo Salazar de Pablo
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
- Early Psychosis: Interventions and Clinical-detection (EPIC) lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Kuan-Pin Su
- An Nan Hospital, China Medical University, Tainan, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Hakan Karas
- Department of Psychology, Istanbul Gelişim University, Istanbul, Turkey
| | - John M. Kane
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Peter Yellowlees
- Department of Psychiatry, University of California Davis, Sacramento, CA, USA
| | - Taishiro Kishimoto
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
- Department of Psychiatry, The Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
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Tsai IC, Hsu CW, Chang CH, Tseng PT, Chang KV. Effectiveness of Coenzyme Q10 Supplementation for Reducing Fatigue: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Front Pharmacol 2022; 13:883251. [PMID: 36091835 PMCID: PMC9449413 DOI: 10.3389/fphar.2022.883251] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Coenzyme Q10 (CoQ10) is a popular nutritional supplement, an antioxidant and an essential component of the mitochondrial electron transport chain. Several clinical studies have suggested that fatigue can be reduced by antioxidant supplementation. However, the data on this topic has been sparse to date. Hence, we conducted this meta-analysis with the aim of investigating the effectiveness of fatigue reduction via CoQ10 supplementation. More specifically, we searched electronic databases for randomized controlled trials (RCTs) published from the database inception to January 2022. A random effects model was implemented to conduct the meta-analysis among 13 RCTs (with a total of 1,126 participants). As compared with the placebo groups evaluated in each RCT, the CoQ10 group showed a statistically significant reduction in fatigue scores (Hedges’ g = −0.398, 95% confidence interval = −0.641 to −0.155, p = 0.001). The directions of the treatment effects were consistent between the healthy and diseased participants. Compared with the placebo group, the effect of reducing fatigue was statistically significant in the subgroup using the CoQ10-only formulation but not in the subgroup using CoQ10 compounds. The results of our meta-regression demonstrate that increases in the daily dose (coefficient = −0.0017 per mg, p < 0.001) and treatment duration (coefficient = −0.0042 per day, p = 0.007) of CoQ10 supplementation were correlated with greater fatigue reduction. There was only one adverse (gastrointestinal) event in the 602 participants who underwent the CoQ10 intervention. Based on the results of this meta-analysis, we conclude that CoQ10 is an effective and safe supplement for reducing fatigue symptoms. Systematic Review Registration:https://inplasy.com/inplasy-2022-1-0113/, identifier INPLASY202210113
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Affiliation(s)
- I-Chen Tsai
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul, Korea
- InnovaRad Inc., Taichung, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan, Taiwan
| | - Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
- Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
- An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology and Neurology, Kaohsiung, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei, Taiwan
- *Correspondence: Ke-Vin Chang,
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Ak M, Gumus S, Aghayev A, Chang CH, Fu B, Roberts MS, Woodard PK, Bae KT. The Resolution Rate of Pulmonary Embolism on CT Pulmonary Angiography: a Prospective Study. Eur J Radiol 2022; 155:110466. [PMID: 35986988 DOI: 10.1016/j.ejrad.2022.110466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To prospectively assess the rate of clot resolution from CT pulmonary angiography (CTPA) in patients with acute pulmonary embolism (PE). MATERIALS AND METHODS This prospective cohort study included 290 patients (136 men, 154 women; mean age, 51.9 years) with acute PE. All patients had a CTPA at the presentation and had at least one follow-up within 6 months (mean 72.7 days). Sixty-four percent of patients had follow-up scans for research purposes within a pre-determined period (between 28 and 184 days; mean, 78.27 days) and 36 % had (between 2 and 184 days; mean, 62.78 days) for a clinical indication. The volume of each clot was measured using a semi-automated quantification program. The resolution rate was evaluated by interval-censored analysis. RESULTS The overall estimated probability of complete resolution was 42 % at 7 days, 56 % at 10 days, and 71 % at 45 days. Achieving complete resolution was significantly faster in patients with peripheral clots (HR: 1.78; CI: 1.05-3.03, p = 0.032) but slower in patients with consolidation and history of venous thromboembolism (VTE), (HR: 0.37; CI: 0.18-0.79, p = 0.01 and HR: 0.57; CI: 0.35-0.91, p = 0.019, respectively). Although the patients with cancer showed a faster resolution rate (HR: 1.67; CI: 1.05-2.68, p = 0.032), the mortality rate was significantly higher than non-cancer patients. CONCLUSION The resolution rate of clot burden in acute PE was associated with patients' clinical presentation variables and CTPA imaging biomarkers. This information may be incorporated into designing a prediction rule and determining the appropriate duration of anticoagulation therapy in patients with acute PE.
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Affiliation(s)
- M Ak
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
| | - S Gumus
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States.
| | - A Aghayev
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - C H Chang
- Department of Medicine, School of Medicine, Department of Biostatistics, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, United States
| | - B Fu
- Data and Statistical Sciences, Abbvie, Inc., Lake Bluff, IL, United States
| | - M S Roberts
- Department of Medicine, School of Medicine, Department of Biomedical Informatics, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - P K Woodard
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, United States
| | - K T Bae
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, United States
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Kuo PY, Chang CH, Lai WH, Wang TH. The Characteristics Analysis of a Microfluid-Based EGFET Biosensor with On-Chip Sensing Film for Lactic Acid Detection. Sensors (Basel) 2022; 22:s22155905. [PMID: 35957458 PMCID: PMC9371425 DOI: 10.3390/s22155905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/03/2022] [Accepted: 08/04/2022] [Indexed: 05/27/2023]
Abstract
In this research, a microfluid-based extended gate field-effect transistor (EGFET) biosensor with an on-chip sensing window (OCSW) was fabricated. The detection window was composed of six metal layers, and a ruthenium dioxide (RuO2) film was spattered on the surface and functionalized with lactase to detect lactic acid (LA). To detect LA in a more diversified way, a microfluidic system was integrated with the biosensor. Moreover, a special package was used to seal the sensing window and microfluidic tube and insulate it from other parts to prevent water molecule invasion and chip damage. The sensitivity analysis of the EGFET biosensor was studied by a semiconductor parameter analyzer (SPA). The static and dynamic measurements of the EGFET with sensing windows on a chip were analyzed. The sensing characteristics of the EGFET biosensor were verified by the experimental results. The proposed biosensor is suitable for wearable applications due to the advantages of its low weight, low voltage, and simple manufacturing process.
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Affiliation(s)
- Po-Yu Kuo
- Correspondence: ; Tel.: +886-5-534-2601 (ext. 4334)
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Tsai YH, Yan YJ, Li YS, Chang CH, Haung CC, Chen TC, Lin SG, Ou-Yang M. Development and verification of the coaxial heterogeneous hyperspectral imaging system. Rev Sci Instrum 2022; 93:063105. [PMID: 35778029 DOI: 10.1063/5.0088474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
A hyperspectral imaging system (HIS) is a helpful tool that acquires spatial and spectral information from a target. This study developed a coaxial heterogeneous HIS (CHHIS) to collect spectral images with wavelengths ranging from 400 to 1700 nm. In this system, a visible (VIS) spectrometer and a short-wave infrared (SWIR) spectrometer are combined with a coaxial optical path to share the same field of view. This structure reduces the complexity of spatial registration and maintains the scanning duration of two spectrometers as that of a single spectrometer. The spectrometers are also replaceable for extending the detecting spectral range of the system. The calibration methodologies, including spatial correction, spectral calibration, and reflectance calibration, were developed for this system. The signal-to-noise ratio of VIS and SWIR spectrometers in the CHHIS was up to 40 and 60 dB when the exposure time of the VIS and SWIR imaging sensors was 1000 and 10 ms, respectively. When the target distance was at 600 mm, the spatial error of VIS and SWIR images in the scanning direction was less than 1 pixel; these results proved that the system was stable.
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Affiliation(s)
- Y H Tsai
- Institute of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Y J Yan
- Institute of Electrical and Control Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Y S Li
- Institute of Electrical and Control Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - C H Chang
- Institute of Biomedical Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - C C Haung
- Department of Tropical Fruit Trees (Fengshan Tropical Horticultural Experiment Branch), Taiwan Agricultural Research Institute, Kaohsiung 30010, Taiwan
| | - T C Chen
- Department of Aerospace and Systems Engineering, Feng Chia University, Taichung 30010, Taiwan
| | - S G Lin
- Department of Communication, Navigation and Control Engineering, National Taiwan Ocean University, Keelung, Taiwan
| | - M Ou-Yang
- Institute of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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12
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Chang CH, Liou MF, Liu CY, Lu WH, Chen SJ. Efficacy of Repetitive Transcranial Magnetic Stimulation in Patients With Methamphetamine Use Disorder: A Systematic Review and Meta-Analysis of Double-Blind Randomized Controlled Trials. Front Psychiatry 2022; 13:904252. [PMID: 35711590 PMCID: PMC9197111 DOI: 10.3389/fpsyt.2022.904252] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/27/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Repetitive transcranial magnetic stimulation (rTMS) has demonstrated therapeutic potential for treating patients with methamphetamine use disorder (MUD). However, the most effective target and stimulation frequency of rTMS for treating MUD remains unclear. This meta-analysis explored the effect of rTMS on MUD. METHODS In this study, PubMed, Cochrane Systematic Reviews, and the Cochrane Collaboration Central Register of Controlled Clinical Trials were searched electronically for double-blind randomized controlled trials that used rTMS for treating MUD. We used published trials to investigate the efficacy of rTMS in MUD up to March 5, 2022, and pooled studies using a random-effect model to compare rTMS treatment effects. Patients who were diagnosed with MUD according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders were recruited. Clinical craving scores between baseline and after rTMS were compared using the standardized mean difference (SMD) with 95% confidence intervals (CIs). The heterogeneity of the included trials was evaluated through a visual inspection of funnel plots and the I2 statistic. RESULTS We identified seven trials with 462 participants with MUD that met the inclusion criteria. All the studies evaluated craving scores, with rTMS demonstrating a more significant effect than the sham treatment on reducing craving scores (SMD = 0.983, CI = 0.620-1.345, p ≤ 0.001). A subgroup meta-analysis revealed that intermittent theta-burst stimulation (iTBS) had a greater positive effect than 10-Hz rTMS. A metaregression revealed that the SMDs increased with the increase in baseline craving scores, whereas they decreased with the increase in the proportion of men and duration of abstinence. CONCLUSION The meta-analysis suggests that rTMS may be associated with treatment effect on craving symptoms in patients with MUD. iTBS may have a greater positive effect on craving reduction than 10-z rTMS.
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Affiliation(s)
- Chun-Hung Chang
- An Nan Hospital, China Medical University, Tainan City, Taiwan.,Institute of Clinical Medical Science, China Medical University, Taichung City, Taiwan.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung City, Taiwan
| | - Meng-Fen Liou
- An Nan Hospital, China Medical University, Tainan City, Taiwan
| | - Chieh-Yu Liu
- National Taipei University of Nursing and Health Sciences, Taipei, Taiwan.,Biostatistical Consulting Lab, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Wei-Hsin Lu
- Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi City, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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13
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Chang CH, Wang WL, Shieh YH, Peng HY, Ho CS, Tsai HC. Case Report: Low-Frequency Repetitive Transcranial Magnetic Stimulation to Dorsolateral Prefrontal Cortex and Auditory Cortex in a Patient With Tinnitus and Depression. Front Psychiatry 2022; 13:847618. [PMID: 35356711 PMCID: PMC8959573 DOI: 10.3389/fpsyt.2022.847618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 02/07/2022] [Indexed: 11/13/2022] Open
Abstract
Repetitive transcranial magnetic stimulation (rTMS) has been widely used as a promising therapy for tinnitus. However, the exact target and stimulation sequence of rTMS that is most effective for treating tinnitus remains unclear. Here, we report a case of a 62-year-old man with treatment-refractory tinnitus and depression whose symptoms markedly improved after undergoing low-frequency rTMS over the right-side dorsolateral prefrontal cortex and left auditory cortex area. Our report indicates that low-frequency rTMS treatment that stimulates multiple brain regions sequentially is feasible and may clinically benefit patients with tinnitus and depression.
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Affiliation(s)
- Chun-Hung Chang
- An Nan Hospital, China Medical University, Tainan, Taiwan.,Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Wen-Lung Wang
- An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Yu-Hui Shieh
- An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Han-Yuan Peng
- An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chen-Syuan Ho
- An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien City, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien City, Taiwan
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14
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Tsai IC, Hsu CW, Chang CH, Tseng PT, Chang KV. The Effect of Curcumin Differs on Individual Cognitive Domains across Different Patient Populations: A Systematic Review and Meta-Analysis. Pharmaceuticals (Basel) 2021; 14:1235. [PMID: 34959636 PMCID: PMC8708668 DOI: 10.3390/ph14121235] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 12/28/2022] Open
Abstract
Curcumin is a polyphenol with strong antioxidant and anti-inflammatory effects that has been shown to be effective in ameliorating cognitive decline in animal studies. However, its clinical effectiveness is inconclusive, and relevant gastrointestinal adverse events (AEs) have been reported. The aim of this meta-analysis was to summarize the existing evidence from randomized controlled trials (RCTs) of effects of curcumin on overall cognitive function, individual cognitive domains, and gastrointestinal AE. The study includes 8 RCTs and 389 participants. A random-effects model was used for the meta-analysis. Compared with the placebo group, the curcumin group was associated with an improvement in working memory (Hedges' g = 0.396, 95% confidence interval (CI) = 0.078 to 0.714, p = 0.015) and a borderline benefit in processing speed (Hedges' g = 0.303, 95% CI = -0.013 to 0.619, p = 0.06). In the domains of language, episodic memory/visual learning, verbal memory, cognitive flexibility/problem solving, and overall cognitive function, no significant difference existed for the comparison between the curcumin and placebo groups. The curcumin group had a significantly higher risk of gastrointestinal AEs than the placebo group (odds ratio = 3.019, 95% CI = 1.118 to 8.150, p = 0.029). In the future, the effects of curcumin on working memory, processing speed, and gastrointestinal AE should be further investigated.
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Affiliation(s)
- I-Chen Tsai
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
- Congenital Heart Disease Study Group, Asian Society of Cardiovascular Imaging, Seoul 13572, Korea
- InnovaRad Inc., Taichung 407004, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83301, Taiwan;
- Department of Computer Science and Information Engineering, National Cheng Kung University, Tainan 70101, Taiwan
| | - Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung 404333, Taiwan;
- Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung 404332, Taiwan
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan
| | - Ping-Tao Tseng
- Prospect Clinic for Otorhinolaryngology & Neurology, Kaohsiung 811022, Taiwan;
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804201, Taiwan
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung 41354, Taiwan
| | - Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei 10048, Taiwan
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei 10845, Taiwan
- Center for Regional Anesthesia and Pain Medicine, Wang-Fang Hospital, Taipei Medical University, Taipei 11600, Taiwan
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15
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Chang CH, Liu CY, Chen SJ, Tsai HC. Effect of N-methyl-D-aspartate receptor enhancing agents on cognition in dementia: an exploratory systematic review and meta-analysis of randomized controlled trials. Sci Rep 2021; 11:22996. [PMID: 34836972 PMCID: PMC8626464 DOI: 10.1038/s41598-021-02040-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
Multiple N-methyl-D-aspartate (NMDA) receptor enhancing agents have had promising effects on cognition among patients with dementia. However, the results remain inconsistent. This exploratory meta-analysis investigated the effectiveness of NMDA receptor enhancing agents for cognitive function. PubMed, the Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews were searched for randomized controlled trials (RCTs). Controlled trials assessing add-on NMDA receptor enhancing agent treatment in patients with dementia and using cognition rating scales were eligible and pooled using a random-effect model for comparisons. The standardized mean difference (SMD) was calculated in each study from the effect size; positive values indicated that NMDA receptor enhancing agent treatment improved cognitive function. Funnel plots and the I2 statistic were evaluated for statistical heterogeneity. Moderators were evaluated using meta-regression. We identified 14 RCTs with 2224 participants meeting the inclusion criteria. Add-on NMDA receptor enhancing agents had small positive significant effects on overall cognitive function among patients with dementia (SMD = 0.1002, 95% CI 0.0105-0.1900, P = 0.02860). Subgroup meta-analysis showed patients with Alzheimer's Disease and trials using the Alzheimer Disease Assessment Scale-cognitive subscale as the primary outcome had small positive significant effects (SMD = 0.1042, 95% CI 0.0076-0.2007, P = 0.03451; SMD = 0.1267, 95% CI 0.0145-0.2388, P = 0.2686). This exploratory meta-analysis showed a very small, positive, and significant effect on overall cognition function in patients with dementia. Studies with larger samples are needed to evaluate different cognitive domains and phases of dementia.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan, ROC.,Department of Psychiatry and Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan, ROC.,An Nan Hospital, China Medical University, Tainan, Taiwan, ROC
| | - Chieh-Yu Liu
- Biostatistics Consultant Lab, Department of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung, Taiwan, ROC.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan, ROC
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien City, Taiwan, ROC. .,Institute of Medical Science, Tzu-Chi University, No. 707, Sec. 3, Chung Yang Rd., Hualien 970, Taiwan, ROC.
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16
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Chen YT, Liu WS, Su KY, Hsu YH, Chang CH. Acute heart failure with dilated cardiomyopathy as the first manifestation of eosinophilic granulomatosis with polyangiitis. J Eur Acad Dermatol Venereol 2021; 36:e125-e128. [PMID: 34553425 DOI: 10.1111/jdv.17693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/26/2021] [Accepted: 09/16/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Y T Chen
- Department of Dermatology, Skin Institute, Hualian Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - W S Liu
- Department of Cardiovascular Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - K Y Su
- Division of Allergy, Immunology and Rheumatology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Medicine, Tzu Chi University, Hualien, Taiwan
| | - Y H Hsu
- School of Medicine, Tzu Chi University, Hualien, Taiwan.,Department of Pathology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - C H Chang
- Department of Dermatology, Skin Institute, Hualian Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan.,Doctoral Degree Program in Translational Medicine, Tzu Chi University and Academia Sinica, Hualien, Taiwan
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17
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Abstract
This study evaluated the severe hepatic outcome (SHO) in patients with schizophrenia and viral hepatitis who received antipsychotics.Using the nationwide Taiwan National Health Insurance Research Database, patients first diagnosed with schizophrenia between 2002 and 2013 were identified. Patients diagnosed with schizophrenia who had viral hepatitis, including hepatitis B virus (HBV) or hepatitis C virus (HCV), were designated as the viral hepatitis group. A control group without viral hepatitis was matched for age, sex, and index year in a 2:1 ratio. Patients with severe hepatic outcomes before enrollment were excluded. The 2 cohorts were observed until December 31, 2013. The primary endpoint was occurrence of a SHO, including liver cancer, liver failure, liver decompensation, or transplantation.Among the 16,365 patients newly diagnosed with schizophrenia between January 2002 and December 2013, we identified 614 patients with viral hepatitis and 1228 matched patients without viral hepatitis. Of these 1842 patients, 41 (2.22%) developed SHOs, including 26 (4.23%) in the viral hepatitis group and 15 (1.22%) in the control group, during the mean follow-up period of 3.71 ± 2.49 years. Cox proportional hazard analysis indicated that the SHO risk increased by 3.58 (95% confidence interval [CI]: 1.859-6.754; P < .001) in patients with schizophrenia and viral hepatitis. Moreover, patients with schizophrenia having HCV had a higher SHO risk than those without viral hepatitis (hazard ratio: 5.07, 95% CI: 1.612-15.956; P < .0001). Patients having both schizophrenia and viral hepatitis, especially HCV, had a higher risk of SHOs.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University
- Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung
- An Nan Hospital, China Medical University, Tainan
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei
| | - Shaw-Ji Chen
- Department of Psychiatry, Taitung MacKay Memorial Hospital, Taitung
- Department of Medicine, Mackay Medical College, New Taipei
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien City
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, R.O.C
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18
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Chang CH, Lin CH, Liu CY, Huang CS, Chen SJ, Lin WC, Yang HT, Lane HY. Plasma d-glutamate levels for detecting mild cognitive impairment and Alzheimer's disease: Machine learning approaches. J Psychopharmacol 2021; 35:265-272. [PMID: 33586518 DOI: 10.1177/0269881120972331] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND d-glutamate, which is involved in N-methyl-d-aspartate receptor modulation, may be associated with cognitive ageing. AIMS This study aimed to use peripheral plasma d-glutamate levels to differentiate patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) from healthy individuals and to evaluate its prediction ability using machine learning. METHODS Overall, 31 healthy controls, 21 patients with MCI and 133 patients with AD were recruited. Serum d-glutamate levels were measured using high-performance liquid chromatography (HPLC). Cognitive deficit severity was assessed using the Clinical Dementia Rating scale and the Mini-Mental Status Examination (MMSE). We employed four machine learning algorithms (support vector machine, logistic regression, random forest and naïve Bayes) to build an optimal predictive model to distinguish patients with MCI or AD from healthy controls. RESULTS The MCI and AD groups had lower plasma d-glutamate levels (1097.79 ± 283.99 and 785.10 ± 720.06 ng/mL, respectively) compared to healthy controls (1620.08 ± 548.80 ng/mL). The naïve Bayes model and random forest model appeared to be the best models for determining MCI and AD susceptibility, respectively (area under the receiver operating characteristic curve: 0.8207 and 0.7900; sensitivity: 0.8438 and 0.6997; and specificity: 0.8158 and 0.9188, respectively). The total MMSE score was positively correlated with d-glutamate levels (r = 0.368, p < 0.001). Multivariate regression analysis indicated that d-glutamate levels were significantly associated with the total MMSE score (B = 0.003, 95% confidence interval 0.002-0.005, p < 0.001). CONCLUSIONS Peripheral plasma d-glutamate levels were associated with cognitive impairment and may therefore be a suitable peripheral biomarker for detecting MCI and AD. Rapid and cost-effective HPLC for biomarkers and machine learning algorithms may assist physicians in diagnosing MCI and AD in outpatient clinics.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry and Brain Disease Research Centre, China Medical University Hospital, Taichung, Taiwan.,An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Chieh-Hsin Lin
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chih-Sheng Huang
- Artificial Intelligence Research and Development Department, ELAN Microelectronics Corporation, Hsinchu, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Wen-Cheng Lin
- Department of Medical Informatics, Tzu Chi University, Hualien, Taiwan
| | - Hui-Ting Yang
- School of Food Safety, Taipei Medical University, Taipei, Taiwan
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry and Brain Disease Research Centre, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
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19
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Chang CH, Kuo HL, Ma WF, Tsai HC. Cerebrospinal Fluid and Serum d-Serine Levels in Patients with Alzheimer's Disease: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:jcm9123840. [PMID: 33256147 PMCID: PMC7761499 DOI: 10.3390/jcm9123840] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/23/2022] Open
Abstract
Objective: Alzheimer’s disease (AD) is a complex and severe neurodegenerative disease and still lacks effective methods of diagnosis. Dysfunction of the N-methyl-D-aspartate receptor (NMDAR) has been found to be involved in synapse dysfunction and neurotoxicity of AD mechanisms. d-Serine, an NMDAR receptor coagonist, is reported as a potential new biomarker for AD. However, the results of serum and cerebrospinal fluid (CSF) d-serine levels are conflicting. We conducted a meta-analysis to investigate the serum and CSF d-serine levels in patients with AD. Methods: We searched PubMed, the Cochrane central register of controlled trials, and the Cochrane database of systematic reviews for trials that measured d-serine levels both in patients with AD and in controls. We included controlled trials that analyzed d-serine levels in human samples (e.g., serum and CSF). Studies were pooled using a random-effect model for comparisons between AD and control group. We used effect size (ES; expressed as d-serine levels) in each selected meta-analysis to calculate standardized mean difference (SMD). Positive values indicated increased d-serine levels in AD group. We presented results with 95% confidence intervals (CIs). The heterogeneity of the included trials was evaluated through visually inspecting funnel plots and using the I2 statistic. Moderators of effects were explored using metaregression. Results: Seven trials with more than 1186 participants were included in this meta-analysis. d-serine levels in patients with AD were significantly higher than those in controls (SMD = 0.679, 95% CI = 0.335 to 1.022, p < 0.001). Subgroup analyses showed that the AD group had significantly higher d-serine levels in serum and CSF compared with the control group (SMD = 0.566 (serum) and 1.008 (CSF); 95% CI = 0.183 to 0.948 (serum) and 0.168 to 1.849 (CSF)). Moreover, a metaregression revealed a significant negative association between ES and mean mini-mental state examination score in AD group (slope = −0.1203, p = 0.0004). Conclusions: Our results revealed higher d-serine levels in the serum and CSF of patients with AD relative to the controls. Further studies with a larger sample size and longer follow-up are recommended to clarify this association.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung 40402, Taiwan;
- Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung 40402, Taiwan
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
| | - Hsiao-Lun Kuo
- An Nan Hospital, China Medical University, Tainan 709204, Taiwan;
- School of Nursing, China Medical University, Taichung 40402, Taiwan;
| | - Wei-Fen Ma
- School of Nursing, China Medical University, Taichung 40402, Taiwan;
- Ph.D Program for Health Science and Industry, China Medical University, Taichung 40402, Taiwan
- Adjunct Supervisor, Department of Nursing, China Medical University Hospital, Taichung 40402, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien 970473, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970473, Taiwan
- Correspondence: ; Tel.: +88-(60)-3856-1825; Fax: +88-(60)-3857-4049
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20
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Chang CH, Lin CS, Ho CL. Isolated intracardiac recurrence of diffuse large B-cell lymphoma successfully treated with rituximab and bendamustine chemotherapy regimen. J Postgrad Med 2020; 66:176-177. [PMID: 32675458 PMCID: PMC7542051 DOI: 10.4103/jpgm.jpgm_683_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/02/2020] [Accepted: 04/23/2020] [Indexed: 11/15/2022] Open
Affiliation(s)
- CH Chang
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - CS Lin
- Division of Cardiology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - CL Ho
- Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. E-mail:
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21
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Chang CH, Tsai SW, Wu PK, Chen CM, Chang MC, Chen WM, Chen CF. Suboptimal outcomes after internal fixation for displaced intracapsular femoral neck fractures in 50- to 60-year-old patients. Hip Int 2020; 30:474-480. [PMID: 31232109 DOI: 10.1177/1120700019859842] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to evaluate outcomes of internal fixation for displaced femoral neck fracture (FNF) between 50 and 60 years old. The patient and surgical factors for the failure were identified. METHODS We retrospectively reviewed the records of 102 displaced FNF patients between 50 and 60 years old (mean age 54.9 years) who had undergone internal fixation between 2005 and 2016. The minimum follow-up was 12 months. Primary end points included loss of reduction, non-union, and osteonecrosis of the femoral head (ONFH). Preoperative Pauwel's angle, fixation timing and methods, reduction quality, removal of implant and medical comorbidities were analysed. RESULTS The overall failure rate was 44.1%. In multivariate logistic regression analysis, poor reduction quality (adjusted odds ratio [aOR] 4.38; 95% confidence interval [CI], 1.54-12.46) and internal fixation delayed more than 6 hours (aOR 3.24; 95% CI, 1.08-9.69) were risk factors for all causes of failure. In a stratified analysis, poor reduction quality (aOR 3.81; 95% CI, 1.11-13.04) and a history of alcohol dependency (aOR 4.91; 95% CI, 1.09-22.13) were risk factors for loss of reduction. Internal fixation delayed >6 hours (aOR 3.67; 95% CI, 1.05-12.77) and removal of implant (aOR 3.32; 95% CI, 1.02-10.77) were risk factors for ONFH. CONCLUSIONS The outcome of internal fixation of displaced FNF in patients between 50 and 60 years old is suboptimal. The patient selection is important. Non-alcohol dependency lowered early failure. Implant retention reduced ONFH. Surgery within 6 hours and good quality of reduction yield better results.
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Affiliation(s)
- Chun-Hung Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Chao-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei.,Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei
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Chang CH, Lin CH, Liu CY, Chen SJ, Lane HY. Efficacy and cognitive effect of sarcosine (N-methylglycine) in patients with schizophrenia: A systematic review and meta-analysis of double-blind randomised controlled trials. J Psychopharmacol 2020; 34:495-505. [PMID: 32122256 DOI: 10.1177/0269881120908016] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Sarcosine (N-methylglycine), a type 1 glycine transporter inhibitor (GlyT1), has shown therapeutic potential for treating schizophrenia; however, studies have reported conflicting results. This meta-analysis aimed to explore the efficacy and cognitive effect of sarcosine for schizophrenia. METHODS In this study, PubMed, Cochrane Systematic Reviews, and Cochrane Collaboration Central Register of Controlled Clinical Trials were searched electronically for double-blinded randomised controlled trials that used sarcosine for treating schizophrenia. We used the published trials up to November 2019 to investigate the efficacy of sarcosine in schizophrenia. We pooled studies by using a random-effect model for comparing sarcosine treatment effects. Patients who were diagnosed with schizophrenia according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition were recruited. Clinical improvement and cognitive function scores between baseline and after sarcosine use were compared using the standardised mean difference (SMD) with 95% confidence intervals (CIs). The heterogeneity of the included trials was evaluated through visual inspection of funnel plots and through the I2 statistic. RESULTS We identified seven trials with 326 participants with schizophrenia meeting the inclusion criteria. All these studies evaluated the overall clinical symptoms, and four of them evaluated overall cognitive functions. Sarcosine use achieved more significant effects than the use of its comparators in relieving overall clinical symptoms (SMD = 0.51, CI = 0.26-0.76, p < 0.01). Moreover, studies with the low Positive and Negative Syndrome Scale range of 70-79 showed significant effect size (ES)s of 0.67 (95% CI: 0.03-1.31, p = 0.04). In addition, trials enrolling patients with stable clinical symptoms had significant ESs: 0.53 (95% CI: 0.21-0.85, p < 0.01). Add-on sarcosine combined with first- and second-generation antipsychotics, except clozapine, had a positive effect. For overall cognitive functions, sarcosine showed a positive but insignificant effect compared with its comparators (SMD = 0.27, CI = -0.06 to 0.60, p = 0.10). The effects were correlated with increased female proportions and decreased illness duration, albeit nonsignificantly. CONCLUSIONS The meta-analysis suggests that sarcosine may be associated with treatment effect on overall clinical symptoms in patients with schizophrenia but not cognitive functions.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung.,An Nan Hospital, China Medical University, Tainan
| | - Chieh-Hsin Lin
- Institute of Clinical Medical Science, China Medical University, Taichung.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung.,Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung
| | - Chieh-Yu Liu
- Department of Speech Language Pathology and Audiology, Biostatistical Consulting Lab, National Taipei University of Nursing and Health Sciences, Taipei
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung.,Department of Medicine, Mackay Medical College, New Taipei
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University, Taichung.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung
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Lin JW, Chang CH, Caffrey JL. Examining the association between oral health status and dementia: A nationwide nested case-controlled study. Exp Biol Med (Maywood) 2020; 245:231-244. [PMID: 32039633 DOI: 10.1177/1535370220904924] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Alzheimer’s disease as a consequence of chronic brain inflammation mediated by infectious microbes including the oral microbiome continues to attract support. Taiwan’s National Insurance database was used to evaluate associations between dental health and Alzheimer’s disease; 209,112 new cases of Alzheimer’s disease were matched 1:4 with 836,448 dementia-free controls to test the hypothesis that better dental health would be associated with less occurrence of dementia. Ten year dental records and conditional logistic regression models were used to estimate the odds ratios associated with Alzheimer’s disease. Subgroup analyses compared vascular Alzheimer’s disease and sporadic Alzheimer’s disease. As the population aged, Alzheimer’s disease diagnoses were more frequent with a 10 fold upward inflection after 60. Nearly 56% of sporadic Alzheimer’s disease patients were women but less than 50% had vascular Alzheimer’s disease. Comorbidities were 10–20% higher in the Alzheimer’s disease patients than in controls, but stroke, chronic infection, and pneumonia were 40–45% more common in the vascular Alzheimer’s disease patients. Heart disease, hypertension, diabetes, stroke, peripheral artery disease, pneumonia, and herpetic disease (HSV) were all associated with higher odds of Alzheimer’s disease. HSV was not a factor in the vascular Alzheimer’s disease. Routine dental procedures tended to lower odds ratios. Root canals and extractions that restore oral homeostasis were associated with lower odds of dementia. However, when extractions exceeded four, the odds of Alzheimer’s disease rose. The fact that Alzheimer’s disease was not associated with periodontal procedures per se but with more frequent periodontal emergencies suggested again a chronic issue. Dental health costs suggest that good dental care was associated with lower odds of Alzheimer’s disease except for radiographic costs which were consistently associated with higher odds, independent of oral health. Common comorbid conditions were associated with higher odds of Alzheimer’s disease and oral health care was associated with lower odds, providing support for the hypothesis that the oral microbiome is a factor in the development of Alzheimer’s disease. Impact statement This study clearly demonstrates the power and value of a nationally applied digital medical record. Longitudinal studies of gradually developing pathologies like dementia have often been limited by sample size and narrow and incomplete medical histories. The Taiwan National Insurance database provides an unparalleled opportunity for detailed analyses of associations between current medical conditions and a spectrum of prior medical and dental events. The temporal impact of the database will only become more important as the past historical record progressively expands going forward. The inclusion of dental records in assessing the relationship with subsequent dementia is very important because this information is often unavailable or dependent on subject recall. This study clearly establishes associations between a variety of suspected cardiovascular and metabolic factors and the odds of dementia. A critical outcome should include the design of targeted interventions and the subsequent assessment of their efficacy.
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Affiliation(s)
- J W Lin
- Cardiovascular Center, National Taiwan University Hospital Yunlin Branch, Douliu City, Yunlin County 64051
| | - C H Chang
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10617
| | - J L Caffrey
- Physiology and Cardiovascular Research Institute, University of North Texas Health Science Center, TX 76107, USA
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Nehra R, Chang CH, Yu Q, Beling A, Pfister O. Photon-number-resolving segmented detectors based on single-photon avalanche-photodiodes. Opt Express 2020; 28:3660-3675. [PMID: 32122030 DOI: 10.1364/oe.380416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/16/2020] [Indexed: 06/10/2023]
Abstract
We investigate the feasibility and performance of photon-number-resolved photodetection employing single-photon avalanche photodiodes (SPADs) with low dark counts. While the main idea, to split n photons into m detection modes with a vanishing probability of more than one photon per mode, is not new, we investigate here a important variant of this situation where SPADs are side-coupled to the same waveguide rather than terminally coupled to a propagation tree. This prevents the nonideal SPAD quantum efficiency from contributing to photon loss. We propose a concrete SPAD segmented waveguide detector based on a vertical directional coupler design, and characterize its performance by evaluating the purities of Positive-Operator-Valued Measures (POVMs) in terms of number of SPADs, photon loss, dark counts, and electrical cross-talk.
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Chang CH, Lane HY, Liu CY, Chen SJ, Lin CH. Paliperidone is associated with reduced risk of severe hepatic outcome in patients with schizophrenia and viral hepatitis: A nationwide population-based cohort study. Psychiatry Res 2019; 281:112597. [PMID: 31629300 DOI: 10.1016/j.psychres.2019.112597] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Paliperidone, a second-generation antipsychotic, has been found to have minimal hepatotoxicity in patients with schizophrenia. However, long-term hepatic outcome in patients with schizophrenia and viral hepatitis remains unclear. METHODS Data obtained from the Taiwan National Health Insurance Research Database was used to enroll newly diagnosed schizophrenic patients between January 2007 and December 2013. Patients with schizophrenia and viral hepatitis who were receiving paliperidone were allocated to the paliperidone group while those who were not receiving paliperidone were allocated to the control group. Using a 1:2 ratio, we matched the age, sex, and index year to select the control participants. Patients with severe hepatic outcomes (SHOs) before enrollment were excluded. The two groups were studied until December 31, 2013. The primary endpoint was the occurrence of SHOs including liver failure, liver decompensation, liver transplantation, or liver cancer. RESULTS We identified 134 patients with schizophrenia and viral hepatitis who received paliperidone and 268 matched patients who did not receive paliperidone. Of the 402 patients, 22 (5.47%) developed SHOs during a mean follow-up period of 3.57 ± 1.62 years, including 2 (1.49%) from the paliperidone cohort and 20 (7.46%) from the control group. Furthermore, the Cox multivariate proportional hazards analysis revealed that the risk decreased with paliperidone use (adjusted hazard ratio [HR]: 0.155, 95% confidence interval [CI]: 0.032-0.737, p = 0.019) after adjusted for confounding factors. CONCLUSION Paliperidone treatment was associated with a reduced risk of SHOs in patients with schizophrenia and viral hepatitis.
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Affiliation(s)
- Chun-Hung Chang
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hsien-Yuan Lane
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan.
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab,Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan; Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Chieh-Hsin Lin
- Department of Psychiatry, Institute of Clinical Medical Science, China Medical University Hospital, No. 2, Yuh-Der Road, Taichung 404, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan; Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, No 123, Dapi Rd, Niaosong District, Kaohsiung 833, Taiwan.
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Hsu KH, Chang CH, Su YP, Chang MC. Radiographic risk factors for predicting failure of geriatric intertrochanteric fracture treatment with a cephalomedullary nail. J Chin Med Assoc 2019; 82:584-588. [PMID: 30893256 DOI: 10.1097/jcma.0000000000000042] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The cephalomedullary nail is the most common device used to treat unstable intertrochanteric fractures (ITFs) (AO/OTA 31-A2 and A3) in the geriatric population. However, there is lack of radiological parameter to evaluate the entry point; hence, this study reports a new radiological parameter to evaluate the entry point of the nail. Besides, other risk factors were also examined. METHODS A retrospective study on the geriatric population with unstable ITFs was conducted from July 2011 to December 2014. A total of 136 patients were enrolled in this study; they received treatment with Gamma-3 nails (Stryker, Mahwah, NJ, USA) and were followed for at least 1 year. Demographic data, radiological parameters, and side-difference of the distance from the piriformis fossa to the greater trochanteric tubercle in the anteroposterior view (dPG) were compared between the union and failure groups. Student's t test, χ test, and multiple logistic regression were used in the statistical analyses. RESULTS The overall failure rate was 13.23% (18 patients). Sex, tip-apex distance (TAD), and dPG were significantly different between the failure and union groups in multivariate analyses. Using a dPG > 6 mm as a reference, patients with a dPG > 6 mm had an odds ratio of 7.64 for failure relative to a dPG < 6 mm. CONCLUSION This study provides additional evidence demonstrating that sex and TAD have significant effects on the outcomes of unstable ITFs after nailing. Moreover, the newly reported radiological parameter, dPG, can be used to predict the failure of ITFs treated using cephalomedullary nails.
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Affiliation(s)
- Kuei-Hsiang Hsu
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chun-Hung Chang
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yu-Ping Su
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Orthopedics & Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Orthopedics, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
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Abstract
BACKGROUND We compared the clinical efficacy of normal C-reactive protein (CRP) expression (<1.0 mg/dL), with a 2-week drug holiday test (DHT) and no drug holiday test (DHT) as a reimplantation criterion, based on subsequent infections after a two-stage revision of a total knee arthroplasty of a periprosthetic joint infection (PJI). METHODS In a 10-year review of 58 patients (mean age: 73.3-years-old; mean follow-up: 46.2 months), there were 31 patients in the DHT group and 27 patients in the DHT group. Primary outcome was recurrent infection rate. Secondary outcomes included length of hospital stay in the revision stage and CRP resurge one day before revision. RESULTS We reported that the CRP resurge rate in the DHT group (0%) was significantly (p = 0.029) lower than that in the DHT group (16.1%) one day before the revision. The DHT group also had a significantly shorter mean length of stay (LOS) in the hospital (9.6 vs 12.7 days, p = 0.015) and a nonsignificantly lower subsequent infection rate (14.8% vs 29%, p = 0.195). CONCLUSION We found that disciplined use of DHT as a reimplantation criterion reduced CRP resurges before reimplantation and yielded a shorter LOS afterward. DHT positively affected the subsequent mid-term infection rate after PJI treatment.
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Affiliation(s)
- Chun-Hung Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shang-Wen Tsai
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Kuei-Hsiang Hsu
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Yu-Ping Su
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Surgery, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Institute of Biomedical Engineering, National Yang-Ming University, Taipei, Taiwan, ROC
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Chang CH, Lane HY, Tseng PT, Chen SJ, Liu CY, Lin CH. Effect of N-methyl-D-aspartate-receptor-enhancing agents on cognition in patients with schizophrenia: A systematic review and meta-analysis of double-blind randomised controlled trials. J Psychopharmacol 2019; 33:436-448. [PMID: 30730250 DOI: 10.1177/0269881118822157] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Multiple N-methyl-d-aspartate (NMDA)-receptor-enhancing agents have demonstrated promising effects for cognition in schizophrenia. However, the results of studies have been conflicting. This updated meta-analysis explored the effect of NMDA-receptor-enhancing agents on cognitive function. METHODS We searched PubMed, the Cochrane Collaboration Central Register of Controlled Clinical Trials and Cochrane Systematic Reviews for studies on the effect of NMDA-receptor-enhancing agents on cognitive function in patients with schizophrenia up to September 2018. Double-blind randomised placebo trials with cognition rating scales were included. We pooled studies by using a random-effect model for comparisons with add-on NMDA-receptor-enhancing agents. Cognitive function scores were compared between baseline and subsequent levels, and NMDA-receptor-positive modulators were assessed using the standardised mean difference (SMD) with 95% confidence intervals (CIs). We evaluated statistical heterogeneity through visual inspection of funnel plots and by using the I2 statistic. RESULTS We identified 25 trials with 1951 participants meeting the inclusion criteria. NMDA-receptor-enhancing agents had a small but nonsignificant effect compared with the placebo on overall cognitive function (SMD = 0.068, CI = -0.056 to 0.193, P = 0.283). We identified trials enrolling patients aged between 30 and 39 years old, which reported significant positive effects (SMD: 0.163, 95% CI: 0.016-0.310, P = 0.030). Men were associated with a smaller effect of NMDA-receptor-positive modulators on overall cognitive function. Moreover, subgroup meta-analysis of cognitive domains revealed that N-acetyl cysteine (NAC) had a significant effect on working memory ( P-value for interaction = 0.038; SMD = 0.679, CI = 0.397-0.961, P < 0.001). CONCLUSIONS Our meta-analysis revealed no significant effect of NMDA-enhancing agents on overall cognition. However, subgroup analysis suggested that NMDAR-enhancing agents may benefit young patients with schizophrenia, and NAC may have an effect on working memory. Additional trials with larger samples are suggested to evaluate these cognitive domains and ascertain the possible mechanisms.
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Affiliation(s)
- Chun-Hung Chang
- 1 Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,2 Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsien-Yuan Lane
- 1 Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,2 Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,3 Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,4 Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Ping-Tao Tseng
- 5 Department of Psychiatry, Tsyr-Huey Mental Hospital, Kaohsiung Jen-Ai's Home, Kaohsiung, Taiwan.,6 WinShine Clinics in Specialty of Psychiatry, Kaohsiung, Taiwan
| | - Shaw-Ji Chen
- 7 Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan.,8 Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Chieh-Yu Liu
- 9 Biostatistical Consulting Lab, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Chieh-Hsin Lin
- 1 Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,3 Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,10 Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Akiyama TE, Skelhorne-Gross GE, Lightbody ED, Rubino RE, Shi JY, McNamara LA, Sharma N, Zycband EI, Gonzalez FJ, Liu H, Woods JW, Chang CH, Berger JP, Nicol CJB. Endothelial Cell-Targeted Deletion of PPAR γ Blocks Rosiglitazone-Induced Plasma Volume Expansion and Vascular Remodeling in Adipose Tissue. J Pharmacol Exp Ther 2019; 368:514-523. [PMID: 30606762 PMCID: PMC11047031 DOI: 10.1124/jpet.118.250985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 12/06/2018] [Indexed: 12/13/2022] Open
Abstract
Thiazolidinediones (TZDs) are peroxisome proliferator-activated receptor γ (PPARγ) agonists that represent an effective class of insulin-sensitizing agents; however, clinical use is associated with weight gain and peripheral edema. To elucidate the role of PPARγ expression in endothelial cells (ECs) in these side effects, EC-targeted PPARγ knockout (Pparg ΔEC) mice were placed on a high-fat diet to promote PPARγ agonist-induced plasma volume expansion, and then treated with the TZD rosiglitazone. Compared with Pparg-floxed wild-type control (Pparg f/f) mice, Pparg ΔEC treated with rosiglitazone are resistant to an increase in extracellular fluid, water content in epididymal and inguinal white adipose tissue, and plasma volume expansion. Interestingly, histologic assessment confirmed significant rosiglitazone-mediated capillary dilation within white adipose tissue of Pparg f/f mice, but not Pparg ΔEC mice. Analysis of ECs isolated from untreated mice in both strains suggested the involvement of changes in endothelial junction formation. Specifically, compared with cells from Pparg f/f mice, Pparg ΔEC cells had a 15-fold increase in focal adhesion kinase, critically important in EC focal adhesions, and >3-fold significant increase in vascular endothelial cadherin, the main component of focal adhesions. Together, these results indicate that rosiglitazone has direct effects on the endothelium via PPARγ activation and point toward a critical role for PPARγ in ECs during rosiglitazone-mediated plasma volume expansion.
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Affiliation(s)
- Taro E Akiyama
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Graham E Skelhorne-Gross
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Elizabeth D Lightbody
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Rachel E Rubino
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Jia Yue Shi
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Lesley A McNamara
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Neelam Sharma
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Emanuel I Zycband
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Frank J Gonzalez
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Haiying Liu
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - John W Woods
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - C H Chang
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Joel P Berger
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
| | - Christopher J B Nicol
- Cardiometabolic Disorders Department, Merck Research Laboratories, Kenilworth, New Jersey (T.E.A., L.A.M., N.S., E.I.Z., H.L., J.W.W., C.H.C., J.P.B.); Department of Pathology and Molecular Medicine (G.E.S.-G., E.D.L., C.J.B.N.), Cancer Biology and Genetics Division, Cancer Research Institute (R.E.R., C.J.B.N.), and Department of Biomedical and Molecular Sciences (J.Y.S., C.J.B.N.), Queen's University, Kingston, Ontario, Canada; National Cancer Institute, National Institutes of Health, Bethesda, Maryland (F.J.G.); and Takeda Pharmaceuticals International, Inc., Cambridge, Massachusetts (J.P.B.)
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Chang CH, Liu CY, Chen SJ, Tsai HC. Efficacy of light therapy on nonseasonal depression among elderly adults: a systematic review and meta-analysis [Corrigendum]. Neuropsychiatr Dis Treat 2019; 15:1427. [PMID: 31213816 PMCID: PMC6549794 DOI: 10.2147/ndt.s214219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 05/02/2019] [Indexed: 11/23/2022] Open
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Chang CH, Lane HY, Liu CY, Cheng PC, Chen SJ, Lin CH. C-reactive protein is associated with severity of thought and language dysfunction in patients with schizophrenia. Neuropsychiatr Dis Treat 2019; 15:2621-2627. [PMID: 31571879 PMCID: PMC6750161 DOI: 10.2147/ndt.s223278] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Accepted: 08/26/2019] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Numerous studies have demonstrated an association between C-reactive protein (CRP) levels and schizophrenia. However, the findings on psychotic severity and cognition remain inconsistent. The relationship between CRP and formal thought disorder in subdomains remains unclear. METHODS We enrolled stable patients (defined as those who had no treatment changes during the 4-week period before evaluation) with a diagnosis of schizophrenia or schizoaffective disorder, according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. We used the 30-item Thought and Language Disorder (TALD) scale to evaluate thought and language dysfunction over four subscales. We assessed psychotic symptoms using the Positive and Negative Syndrome Scale (PANSS). We collected fasting venous blood and measured plasma CRP levels. RESULTS We enrolled 60 patients with schizophrenia. All patients received TALD and PANSS evaluation, and 33 of them had their CRP levels checked. The multivariate regression analysis indicated that CRP levels were significantly associated with the total score on the TALD (t=2.757, P=0.010) and the TALD Objective Positive subscale (t=2.749, P=0.011), after sex, age, duration of illness (in years), and use of atypical antipsychotics were adjusted for. Additionally, CRP was significantly associated with the PANSS positive subscale (t=2.102, P=0.045). A significantly positive correlation was observed between the total scores on the TALD scale and PANSS (ρ =0.751, P<0.001). CONCLUSION Our results suggest that abnormal CRP levels are significantly associated with formal thought and language dysfunction in the Objective Positive subdomain and positive psychotic symptoms.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,An Nan Hospital, China Medical University, Tainan, Taiwan
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consulting Laboratory, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Po-Chih Cheng
- Biostatistical Consulting Laboratory, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Chieh-Hsin Lin
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Chang CH, Tsai SW, Chen CF, Wu PK, Wong WW, Chang MC, Chen WM. Optimal timing for elective total hip replacement in HIV-positive patients. Orthop Traumatol Surg Res 2018; 104:671-674. [PMID: 29908354 DOI: 10.1016/j.otsr.2018.05.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/09/2018] [Accepted: 05/21/2018] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Evidence about the optimal timing for total hip replacement (THR) in HIV-positive patients is scant. HYPOTHESIS Preoperative criteria: cluster of differentiation 4 (CD4) counts>200cells/mm3 and an undetectable HIV virus load before THR, improve infection rates, aseptic loosenings, and functional outcomes. MATERIALS AND METHODS We recruited 16 HIV-positive patients who had undergone 25 THRs between 2003 and 2015. None had hemophilia, and none were intravenous drug users (IVDUs). RESULTS Their mean age was 41.2 years (range: 24-60); minimum follow-up was 12 months (mean: 64.6); mean duration of prophylactic antibiotics was 2.9 days (range: 1-5); and mean hospital length of stay was 6.0 days (range: 4-11). No patients were treated with subsequent oral antibiotics. The mean preoperative CD4 count was 464.1±237.0 (range: 235-904)cells/mm3. There were no early superficial surgical site infections, late periprosthetic joint infections, or aseptic loosenings. Post-surgery Harris Hip score was significantly (p<0.001) better. DISCUSSION A preoperative CD4 count>200cell/mm3 and an undetectable HIV virus load might indicate optimal timing for elective THRs in HIV-positive patients without hemophilia and not IVDUs. LEVEL OF EVIDENCE IV, retrospective or historical series.
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Affiliation(s)
- Chun-Hung Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shang-Wen Tsai
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Cheng-Fong Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Po-Kuei Wu
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wing-Wai Wong
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chau Chang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Ming Chen
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Orthopaedics, School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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Wu VC, Chen SW, Ting PC, Chang CH, Lin MS, Hsieh MJ, Wang CY, Chang SH, Chu PH, Lin YS. P5585Selection of beta-blocker in patients with cirrhosis and acute myocardial infarction: a 13-year nationwide population-based study in Asia. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- V C Wu
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - S W Chen
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - P C Ting
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - C H Chang
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - M S Lin
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - M J Hsieh
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - C Y Wang
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - S H Chang
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - P H Chu
- Chang Gung Memorial Hospital Tapei, Department of Cardiology, Taipei, Taiwan ROC
| | - Y S Lin
- Chang Gung Memorial Hospital, Department of Cardiology, Chiayi, Taiwan ROC
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Zhang Q, Li Z, Chang CH, Lou JL, Zhao MR, Lu C. Potential human exposures to neonicotinoid insecticides: A review. Environ Pollut 2018; 236:71-81. [PMID: 29414376 DOI: 10.1016/j.envpol.2017.12.101] [Citation(s) in RCA: 116] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 11/21/2017] [Accepted: 12/25/2017] [Indexed: 05/19/2023]
Abstract
Due to their systemic character and high efficacy to insect controls, neonicotinoid insecticides (neonics) have been widely used in global agriculture since its introduction in early 1990. Recent studies have indicated that neonics may be ubiquitous, have longer biological half-lives in the environment once applied, and therefore implicitly suggested the increasing probability for human exposure to neonics. Despite of neonics' persistent characters and widespread uses, scientific literature in regard of pathways in which human exposure could occur is relatively meager. In this review, we summarized results from peer-reviewed articles published prior to 2017 that address potential human exposures through ingestion and inhalation, as well as results from human biomonitoring studies. In addition, we proposed the use of relative potency factor approach in order to facilitate the assessment of concurrent exposure to a mixture of neonics with similar chemical structures and toxicological endpoints. We believe that the scientific information that we presented in this review will aid to future assessment of total neonic exposure and subsequently human health risk characterization.
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Affiliation(s)
- Q Zhang
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Providence, College of Environment, Zhejiang University of Technology, Hangzhou, Zhejiang, People's Republic of China; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - Z Li
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Providence, College of Environment, Zhejiang University of Technology, Hangzhou, Zhejiang, People's Republic of China; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - C H Chang
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA
| | - J L Lou
- Institute of Occupational Diseases, Zhejiang Academy of Medical Sciences, Hangzhou, People's Republic of China
| | - M R Zhao
- Key Laboratory of Microbial Technology for Industrial Pollution Control of Zhejiang Providence, College of Environment, Zhejiang University of Technology, Hangzhou, Zhejiang, People's Republic of China
| | - C Lu
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston MA, USA; College of Resources and Environment, Southwest University, Chongqing, 400715, People's Republic of China.
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Chang CH, Fried NM. LASER PROBE WITH INTEGRATED CONTACT COOLING FOR SUBSURFACE TISSUE THERMAL REMODELING. J Miss Acad Sci 2018; 63:202-205. [PMID: 30814766 PMCID: PMC6388701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Over 6.5 million women in the United States suffer from female stress urinary incontinence (SUI). Only ~200,000 women choose surgery. There may be a role for a non-surgical, minimally invasive procedure that provides thermal shrinkage/remodeling of submucosal collagen in the endopelvic fascia. This study describes design, characterization, and preliminary testing of a novel probe with integrated contact cooling for potential use in transvaginal laser treatment of SUI. Laser energy at a deeply penetrating, near-infrared wavelength of 1075 nm was delivered through a 600-μm-core fiber optic patchcord into a 90° side-firing probe head (19 × 22 mm) with integrated flow cell and sapphire window cooled to -2°C by circulating an alcohol-based solution. An inflatable balloon attached to the probe insured contact with vaginal wall. A force sensor and thermocouples monitored pressure and temperature. Thermal lesions were created in vaginal tissue of three cadavers (power = 4.6-6.4 W; spot diameter = 5.2 mm; time = 30 s). Thermal lesion areas measured 3.1-4.6 mm2, while preserving the vaginal wall to a depth of 0.8-1.1 mm. Consistent tissue contact and cooling was maintained using the force sensors. Preliminary cadaver studies demonstrated subsurface treatment of endopelvic fascia with partial preservation of the vaginal wall. Future studies will optimize parameters for thermal remodeling with further tissue surface preservation.
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Affiliation(s)
- Chun-Hung Chang
- Department of Physics and Optical Science, University of North Carolina at Charlotte, USA
| | - Nathaniel M Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, USA
- McKay Department of Urology, Carolinas Medical Center, Charlotte, NC, USA
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Abstract
PURPOSE The purpose of this study was to investigate the incidence and risk of suicidal drug overdose (SDO) after stroke in older patients. METHODS We enrolled patients aged 60-99 years who were diagnosed with new-onset stroke between 2002 and 2013 and age-, sex-, and index-year-matched controls who did not have stroke. Patients with a history of SDO before enrollment were excluded. Both groups were observed until December 31, 2013. The primary end point was the occurrence of newly diagnosed SDO. The cumulative incidence rates of the study and control groups were estimated using the Kaplan-Meier method. Furthermore, we used the Cox proportional hazards model to identify risk factors for SDO. RESULTS We selected 22,770 individuals. Among them, 11,385 were older patients (aged 60-99 years) who had newly diagnosed stroke and 11,385 were controls. Of the 22,770 individuals, 275 (1.21%) had SDO during a mean follow-up period of 5.33±3.30 years, comprising 191 (1.68%) from the stroke group and 84 (0.74%) from the control group. Older patients with stroke had a significantly higher risk of SDO than the controls (adjusted hazard ratio: 2.288, 95% confidence interval [CI]: 1.746-2.999, p<0.001). Moreover, in older patients with stroke, the risk significantly increased with the number of stroke events. Patients with depressive disorder or coronary disease had an increased risk of SDO. Additionally, benzodiazepines and anticoagulants were the two most commonly prescribed medications for SDO. CONCLUSION Clinicians should be aware of the risk of SDO and risk factors in older patients with stroke. Psychological assessment and medication monitoring should be incorporated into current clinical diagnoses in neurology and treatments following stroke.
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Affiliation(s)
- Chun-Hung Chang
- Brain Disease Research Center, Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan
- Mackay Junior College of Medicine, Nursing and Management, Taipei, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Institute of Nursing-Midwifery, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan
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Chang CH, Hardy LA, Peters MG, Bastawros DA, Myers EM, Kennelly MJ, Fried NM. Optical Clearing of Vaginal Tissues in Cadavers. Proc SPIE Int Soc Opt Eng 2018; 10468:104680K. [PMID: 30774176 PMCID: PMC6377076 DOI: 10.1117/12.2285079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
A nonsurgical laser procedure is being developed for treatment of female stress urinary incontinence (SUI). Previous studies in porcine vaginal tissues, ex vivo, as well as computer simulations, showed the feasibility of using near-infrared laser energy delivered through a transvaginal contact cooling probe to thermally remodel endopelvic fascia, while preserving the vaginal wall from thermal damage. This study explores optical properties of vaginal tissue in cadavers as an intermediate step towards future pre-clinical and clinical studies. Optical clearing of tissue using glycerol resulted in a 15-17% increase in optical transmission after 11 min at room temperature (and a calculated 32.5% increase at body temperature). Subsurface thermal lesions were created using power of 4.6 - 6.4 W, 5.2-mm spot, and 30 s irradiation time, resulting in partial preservation of vaginal wall to 0.8 - 1.1 mm depth.
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Affiliation(s)
- Chun-Hung Chang
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
| | - Luke A. Hardy
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
| | - Michael G. Peters
- Women’s Center for Pelvic Health, Carolinas Medical Center, Charlotte, NC
| | - Dina A. Bastawros
- Women’s Center for Pelvic Health, Carolinas Medical Center, Charlotte, NC
| | - Erinn M. Myers
- Women’s Center for Pelvic Health, Carolinas Medical Center, Charlotte, NC
| | - Michael J. Kennelly
- Women’s Center for Pelvic Health, Carolinas Medical Center, Charlotte, NC
- McKay Department of Urology, Carolinas Medical Center, Charlotte, NC
| | - Nathaniel M. Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, NC
- McKay Department of Urology, Carolinas Medical Center, Charlotte, NC
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Abstract
Brain stimulation techniques can modulate cognitive functions in many neuropsychiatric diseases. Pilot studies have shown promising effects of brain stimulations on Alzheimer's disease (AD). Brain stimulations can be categorized into non-invasive brain stimulation (NIBS) and invasive brain stimulation (IBS). IBS includes deep brain stimulation (DBS), and invasive vagus nerve stimulation (VNS), whereas NIBS includes transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), transcranial alternating current stimulation (tACS), electroconvulsive treatment (ECT), magnetic seizure therapy (MST), cranial electrostimulation (CES), and non-invasive VNS. We reviewed the cutting-edge research on these brain stimulation techniques and discussed their therapeutic effects on AD. Both IBS and NIBS may have potential to be developed as novel treatments for AD; however, mixed findings may result from different study designs, patients selection, population, or samples sizes. Therefore, the efficacy of NIBS and IBS in AD remains uncertain, and needs to be further investigated. Moreover, more standardized study designs with larger sample sizes and longitudinal follow-up are warranted for establishing a structural guide for future studies and clinical application.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Hsien-Yuan Lane
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Department of Psychology, College of Medical and Health Sciences, Asia University, Taichung, Taiwan
| | - Chieh-Hsin Lin
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.,Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Abstract
OBJECTIVE The aim of this study was to examine the effectiveness of light therapy in the treatment of geriatric depression. METHODS A systematic review and meta-analysis were carried out. Data sources for the literature search were PubMed, Cochrane Collaboration's Central Register of Controlled Clinical Trials, Cochrane Systematic Reviews, and ClinicalTrials.gov. Controlled trials of light therapy on older patients with nonseasonal depression and depression rating scales were eligible. Studies were pooled using a random-effect model for comparisons with light therapy. We used effect size (ES), which expresses changes in depression severity, in each selected meta-analysis to calculate the standardized mean difference on the basis of Hedges' adjusted g; positive values indicated that the depression severity improved after light therapy. All results were presented with 95% CIs. Statistical heterogeneity was explored through visual inspection of funnel plots and the I2 statistic. Moderators of effects were explored using meta-regression. RESULTS We identified eight trials involving 395 participants that met the inclusion criteria. Light therapy was significantly more effective than comparative treatments, including placebo or dim light, with an ES of 0.422 (95% CI: 0.174-0.709, P=0.001). In addition, six of the eight trials used bright (white) light, resulting in significantly reduced severity of geriatric depression (N=273, ES: 0.460, 95% CI: 0.085-0.836, P=0.016). Furthermore, pale blue light therapy reduced the severity of geriatric depression (N=89, ES: 0.464, 95% CI: 0.046-0.882, P=0.030). CONCLUSION Our results highlighted the significant efficacy of light therapy in the treatment of geriatric depression. Additional well-designed, controlled studies are necessary to adopt standard parameters, adequate group sizes, and randomized assignment to evaluate more thoroughly the efficacy of light therapy for treating geriatric depression.
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Affiliation(s)
- Chun-Hung Chang
- Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.,Department of Psychiatry & Brain Disease Research Center, China Medical University Hospital, Taichung, Taiwan
| | - Chieh-Yu Liu
- Biostatistical Consulting Laboratory, Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei, Taiwan
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital, Hualien City, Taiwan, .,Department of Psychiatry, School of Medicine, Tzu-Chi University, Hualien City, Taiwan,
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Chang CH, Lin HJ, Liao YY, Chu FY, Chen KT. Elevated Aminotransferases are Predictors of Hepatic Injury in Blunt Abdominal Trauma Patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Objective Computed tomography (CT) scan is currently the most commonly used tool for evaluating solid-organ injuries in trauma management. However, liberal use of CT scanning increases the risk of excess radiation exposure and toxicity from contrast material. Animal studies and clinical research on the paediatric population indicated that liver enzymes elevations were related to hepatic injury. The present study was undertaken to determine whether elevated liver enzymes were associated with the occurrence of hepatic injury in adult patients with blunt abdominal trauma. Methods This is a cross-sectional study from August 2003 to October 2006. All adult patients with blunt injury to abdomino-pelvic organs documented by CT or surgery who were admitted to Chi-Mei Medical Centre in the captioned period were included. The study population sorted to hepatic injury (HI) and no hepatic injury (NHI) groups according to the presence or absence of hepatic injury. Variables including liver enzymes were compared between the groups. Results Totally 419 patients were included, including 150 patients in the HI group and 269 patients in the NHI group. The HI group was younger and had a lower rate of laparotomy (36.3 years old vs 41.4 years old; 26% vs 42%, respectively). The mean levels of aspartate aminotransferase (AST) and alanine aminotransferase (ALT) in the HI group were significantly higher than levels in the NHI group (439.6 IU/L vs 104.7 IU/L; 353.5 IU/L vs 76.6 IU/L, p<0.01). We define AST >200 IU/L or ALT level >125 IU/L as abnormal according to previous studies. The diagnostic characteristics of hepatic injury were 87.3% sensitivity, 80.3% specificity, 71.2% positive predictive value, and 91.9% negative predictive value. Conclusion In adults who have experienced blunt abdominal trauma, AST >200 U/L or of ALT >125 U/L are practical predictors of hepatic injury. Screening serum aminotransferases will have a role in detecting occult hepatic injury and may reduce the hazards of excessive CT scanning. (Hong Kong j.emerg.med. 2013;20:337-342)
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Affiliation(s)
| | - HJ Lin
- Sourthern Tainan University of Technology, Department of Biotechnology, Tainan, Taiwan
| | - YY Liao
- Chi-Mei Medical Centre, Emergency Department, Liouying, Taiwan
| | - FY Chu
- Chi-Mei Medical Centre, Emergency Department, Chiali, Taiwan
| | - KT Chen
- Taipei Medical University, Department of Emergency Medicine, Taipei, Taiwan
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Hsiao KY, Li WC, Chang CH, Lin MHC, Yang JT, Wang PC, Chen KH. An Evaluation of the ACEP Guideline for Mild Head Injuries in Taiwan. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791702400204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction Traumatic brain injury (TBI) is an important issue in the emergency department. In the United States, the American College of Emergency Physicians (ACEP) published clinical guideline to select patients with mild head injuries for head computed tomography (CT) scans in 2008. The aim of this study was to identify the possible benefits of compliance with these guidelines for mild head injury patients in Taiwan. Method This was a secondary analysis on our previous study published for association of hypertension and head injuries. In our previous study, we collected data about 1290 patients with head injuries who received brain CT scans in the emergency department from September 2012 to August 2013 for a study regarding the association between head injury and hypertension. In present study, we subjected this data to further analysis to try to validate the ACEP clinical policy for mild head injuries. Results Of these 1,290 patients, 154 were found to have brain haemorrhage on the initial brain CT scan, and 5 were in need of neurosurgical intervention. A total of 859 patients met the ACEP guideline criteria, and 117 of these had brain haemorrhages. The sensitivity and specificity of the ACEP guideline to predict brain haemorrhage were 75.97% (95% confidence interval [CI], 68.44% to 82.48%) and 34.68% (95% CI, 31.91% to 37.53%), respectively. In predicting neurosurgical intervention, the sensitivity and specificity of the guideline were 100% (95% CI, 47.82% to 100%) and 33.54% (95% CI, 30.96% to 36.2%), respectively. Conclusion Although adoption of the ACEP clinical policy may reduce the number of brain CT scans in mild head injury patients who may need neurosurgical interventions, it is not a good selection tool in Taiwan.
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Affiliation(s)
- KY Hsiao
- Chang Gung Memorial Hospital, Department of Emergency Medicine; and Chang Gung University of Science and Technology, Department of Nursing, Chiayi, Taiwan
| | - WC Li
- Chang Gung Memorial Hospital, Department of Occupation Medicine, Taipei, Taiwan
| | - CH Chang
- Chang Gung University of Science and Technology, College of Nursing &the Chronic Diseases and Health Promotion Research Center, Chiayi Campus, Chiayi, Taiwan
| | - MHC Lin
- Chang Gung Memorial Hospital, Department of Neurosurgery, Chiayi, Taiwan
| | - JT Yang
- Chang Gung Memorial Hospital, Department of Neurosurgery, Chiayi; and Chang Gung University, College of Medicine, Tao-Yuan, Taiwan
| | - PC Wang
- Chang Gung Memorial Hospital, Department of Cardiology, Chiayi, Taiwan
| | - KH Chen
- Chang Gung University, College of Medicine, Tao-Yuan; and Chang Gung Memorial Hospital, Department of Physical Medicine and Rehabilitation, Chiayi, Taiwan
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Lin CY, Chang FW, Yang JJ, Chang CH, Yeh CL, Lei WT, Huang CF, Liu JM, Hsu RJ. Increased risk of bipolar disorder in patients with scabies: A nationwide population-based matched-cohort study. Psychiatry Res 2017; 257:14-20. [PMID: 28709117 DOI: 10.1016/j.psychres.2017.07.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 06/17/2017] [Accepted: 07/04/2017] [Indexed: 02/09/2023]
Abstract
Both scabies and bipolar disorder (BD) are common and troublesome disorders. There are several similarities in both diseases: pruritus, a higher prevalence in crowded environments, and cytokine-mediated inflammatory processes in the pathophysiology. We conducted this nationwide population-based study to investigate the possible relationship between scabies and BD. Based on the National Health Insurance Research Database (NHIRD) of Taiwan, a total of 7096 patients with scabies were identified as a study group and 28,375 matched patients as a control. We tracked the patients in both groups for a 7-year period to identify those newly diagnosed with BD. The demographic characteristics and comorbidities of the patients were analyzed, and Cox proportional hazard regressions were performed to calculate the hazard ratio (HR) of BD. Of the 35,471 patients in this study, 183 (0.5%) patients with newly diagnosed BD were identified, with 58 (0.8%) from the scabies group and 125 (0.4%) from the control group. The patients with scabies had a higher risk of subsequent BD, with a crude hazard ratio of 1.86 and an adjusted hazard ratio of 1.55 (95% confidence interval: 1.12-2.09, P < 0.05). This study shows there is an increased risk for BD among patients with scabies. Immunopathology may contribute to this association.
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Affiliation(s)
- Chien-Yu Lin
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan; Division of Infection and Pathway Medicine, College of Medicine and Veterinary Medicine, the University of Edinburgh, Scotland, UK.
| | - Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
| | - Jing-Jung Yang
- Department of Psychiatry, Cardinal Tien Hospital, New Taipei City, Taiwan; Institute of Biomedical Engineering, College of Medicine and College of Engineering, National Taiwan University, Taipei, Taiwan.
| | - Chun-Hung Chang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan; Institute of Clinical Medicine, China Medical University, Taichung, Taiwan.
| | - Chia-Lun Yeh
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan.
| | - Wei-Te Lei
- Department of Pediatrics, Hsinchu MacKay Memorial Hospital, Hsinchu, Taiwan.
| | - Chun-Fa Huang
- School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; Department of Nursing, College of Medical and Health Science, Asia University, Taichung, Taiwan.
| | - Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Biobank Management Center of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Pathology and Graduate Institute of Pathology and Parasitology, the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Abstract
RATIONAL The therapeutic effect of deep brain stimulation (DBS) for refractory obsessive-compulsive disorder (OCD) has been studied, but complications after this treatment have rarely been noted. PATIENT CONCERNS A 28-year-old man with treatment-resistant OCD received bilateral ventral capsule/ventral striatum stimulation for 12 months. DIAGNOSIS Compulsive skin-picking behavior and infection were noted following 12-month DBS treatment. INTERVENTION We removed the implanted right-side pulse generator. OUTCOMES The local inflammation and skin-picking behavior gradually improved. The stimulator device was re-implanted 4 months later. LESSONS We suggest that patients with the OC spectrum should be evaluated for skin-picking behaviors during presurgical and postsurgical follow-up to reduce the infection and device removal rates.
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Affiliation(s)
- Chun-Hung Chang
- Department of Psychiatry, China Medical University Hospital
- Institute of Clinical Medicine, China Medical University, Taichung
| | - Shin-Yuan Chen
- Department of Neurosurgery
- Institute of Medical Sciences, Tzu-Chi University, Hualien City, Hualien, Taiwan, Republic of China
| | - Sheng-Tzung Tsai
- Department of Neurosurgery
- Institute of Medical Sciences, Tzu-Chi University, Hualien City, Hualien, Taiwan, Republic of China
| | - Hsin-Chi Tsai
- Department of Psychiatry, Tzu-Chi General Hospital
- Institute of Medical Sciences, Tzu-Chi University, Hualien City, Hualien, Taiwan, Republic of China
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Chang CH, Chen SJ, Liu CY. Pediatric sleep apnea and depressive disorders risk: A population-based 15-year retrospective cohort study. PLoS One 2017; 12:e0181430. [PMID: 28708880 PMCID: PMC5510869 DOI: 10.1371/journal.pone.0181430] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2017] [Accepted: 06/30/2017] [Indexed: 01/08/2023] Open
Abstract
Background Studies have shown a higher risk of depressive disorders in children with sleep apnea than in those without sleep apnea. However, the association between sleep apnea and subsequent depressive disorders in the pediatric population remains undetermined. Thus, this study investigated the risk of depressive disorders among pediatric patients with sleep apnea. Methods In this study, the population-based National Health Insurance Research Database of Taiwan was used to identify patients who had first been diagnosed with sleep apnea between 1999 and 2013. Patients with sleep apnea who were younger than 18 years were included in the sleep apnea group. Controls (those without sleep apnea) were matched to patients with sleep apnea at a 1:10 ratio by age, sex, and index year. Patients who had baseline or inherited depressive disorders before the enrollment date were excluded. The two groups were followed up until December 31, 2013. The primary endpoint was the occurrence of one or more depressive disorders. Results At the end of this study, 6,237 children had been enrolled, comprising 567 children with sleep apnea and 5,670 children without sleep apnea. During the mean follow-up period of 5.87 years, a total of 77 children (1.23%) developed one or more depressive disorders; 14 (2.46%) from the sleep apnea group and 63 (1.11%) from the control group. Kaplan–Meier analysis showed that children with sleep apnea had a significantly higher risk of depressive disorders (log-rank test, p = 0.002). After adjusting for covariates, the risk of subsequent depressive disorders among children with sleep apnea was still significantly higher (hazard ratio [HR] = 2.25; 95% confidence interval [CI] = 1.25–4.05; p = 0.006). Moreover, boys with sleep apnea had a significantly higher risk than those without sleep apnea (adjusted HR = 3.77; 95% CI, 1.82–7.54; p < 0.001). Furthermore, in sleep apnea group, children older than 12 years of age had more risk to depression (hazard ratio (HR) = 7.1833, 95% confidence interval (CI), 2.3734 to 21.7411; p = 0.0004). Conclusions This study found a significantly higher subsequent risk of depressive disorders in children with sleep apnea, particularly boys and those older than 12 years of age. The study findings strongly suggest that clinicians should provide psychological evaluation and supportive care for children with sleep apnea, in addition to medical treatment.
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Affiliation(s)
- Chun-Hung Chang
- Department of Psychiatry, China Medical University Hospital, Taichung, Taiwan, R.O.C
- Institute of Clinical Medicine, China Medical University, Taichung, Taiwan, R.O.C
- Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, Taipei, Taiwan, R.O.C
| | - Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung, Taiwan, R.O.C
- Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan, R.O.C
- Institute of Medical Sciences, Tzu Chi University, Hualien, Taiwan, Taiwan, R.O.C
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Department of Midwifery and Women Health Care, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
- Department of Speech Language Pathology and Audiology, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
- * E-mail:
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Hardy LA, Hutchens TC, Larson ER, Gonzalez DA, Chang CH, Nau WH, Fried NM. Rapid sealing of porcine renal blood vessels, ex vivo, using a high power, 1470-nm laser, and laparoscopic prototype. J Biomed Opt 2017; 22:58002. [PMID: 28550708 DOI: 10.1117/1.jbo.22.5.058002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 04/28/2017] [Indexed: 06/07/2023]
Abstract
Energy-based, radiofrequency (RF) and ultrasonic (US) devices currently provide rapid sealing of blood vessels during laparoscopic procedures. We are exploring infrared lasers as an alternate energy modality for vessel sealing, capable of generating less collateral thermal damage. Previous studies demonstrated feasibility of sealing vessels in an in vivo porcine model using a 1470-nm laser. However, the initial prototype was designed for testing in open surgery and featured tissue clasping and light delivery mechanisms incompatible with laparoscopic surgery. In this study, a laparoscopic prototype similar to devices currently in surgical use was developed, and performance tests were conducted on porcine renal blood vessels, ex vivo. The 5-mm outer-diameter laparoscopic prototype featured a traditional Maryland jaw configuration that enables tissue manipulation and blunt dissection. Laser energy was delivered through a 550 - ? m -core-diameter optical fiber with side-delivery from the lower jaw and beam dimensions of 18 - mm ? length × 1.2 - mm ? width . The 1470-nm diode laser delivered 68 W with 3-s activation time, consistent with vessel seal times associated with RF and US-based devices. A total of 69 fresh porcine renal vessels with mean diameter of 3.3 ± 1.7 ?? mm were tested, ex vivo. Vessels smaller than 5-mm diameter were consistently sealed (48/51) with burst pressures greater than malignant hypertension blood pressure (180 mmHg), averaging 1038 ± 474 ?? mmHg . Vessels larger than 5 mm were not consistently sealed (6/18), yielding burst pressures of only 174 ± 221 ?? mmHg . Seal width, thermal damage zone, and thermal spread averaged 1.7 ± 0.8 , 3.4 ± 0.7 , and 1.0 ±
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Affiliation(s)
- Luke A Hardy
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Thomas C Hutchens
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | | | - David A Gonzalez
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | - Chun-Hung Chang
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
| | | | - Nathaniel M Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, Charlotte, North Carolina, United States
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Hardy LA, Chang CH, Myers EM, Kennelly MJ, Fried NM. Computer simulations of thermal tissue remodeling during transvaginal and transurethral laser treatment of female stress urinary incontinence. Lasers Surg Med 2017; 49:198-205. [PMID: 26900038 PMCID: PMC6095190 DOI: 10.1002/lsm.22491] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/31/2016] [Indexed: 11/08/2022]
Abstract
BACKGROUND AND OBJECTIVES A non-surgical method is being developed for treating female stress urinary incontinence by laser thermal remodeling of subsurface tissues with applied surface tissue cooling. Computer simulations of light transport, heat transfer, and thermal damage in tissue were performed, comparing transvaginal and transurethral approaches. STUDY DESIGN/MATERIALS AND METHODS Monte Carlo (MC) simulations provided spatial distributions of absorbed photons in the tissue layers (vaginal wall, endopelvic fascia, and urethral wall). Optical properties (n,μa ,μs ,g) were assigned to each tissue at λ = 1064 nm. A 5-mm-diameter laser beam and incident power of 5 W for 15 seconds was used, based on previous experiments. MC output was converted into absorbed energy, serving as input for finite element heat transfer simulations of tissue temperatures over time. Convective heat transfer was simulated with contact probe cooling temperature set at 0°C. Variables used for thermal simulations (κ,c,ρ) were assigned to each tissue layer. MATLAB code was used for Arrhenius integral thermal damage calculations. A temperature matrix was constructed from ANSYS output, and finite sum was incorporated to approximate Arrhenius integral calculations. Tissue damage properties (Ea ,A) were used to compute Arrhenius sums. RESULTS For the transvaginal approach, 37% of energy was absorbed in the endopelvic fascia target layer with 0.8% deposited beyond it. Peak temperature was 71°C, the treatment zone was 0.8-mm-diameter, and 2.4 mm of the 2.7-mm-thick vaginal wall was preserved. For transurethral approach, 18% energy was absorbed in endopelvic fascia with 0.3% deposited beyond the layer. Peak temperature was 80°C, treatment zone was 2.0-mm-diameter, and 0.6 mm of 2.4-mm-thick urethral wall was preserved. CONCLUSIONS Computer simulations suggest that transvaginal approach is more feasible than transurethral approach. Lasers Surg. Med. 49:198-205, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Luke A. Hardy
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Chun-Hung Chang
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, North Carolina
| | - Erinn M. Myers
- McKay Department of Urology, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael J. Kennelly
- McKay Department of Urology, Carolinas Medical Center, Charlotte, North Carolina
| | - Nathaniel M. Fried
- Department of Physics and Optical Science, University of North Carolina at Charlotte, Charlotte, North Carolina
- McKay Department of Urology, Carolinas Medical Center, Charlotte, North Carolina
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Chang CH, Myers EM, Kennelly MJ, Fried NM. Optical clearing of vaginal tissues, ex vivo, for minimally invasive laser treatment of female stress urinary incontinence. J Biomed Opt 2017; 22:18002. [PMID: 28301637 PMCID: PMC5228554 DOI: 10.1117/1.jbo.22.1.018002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 12/22/2016] [Indexed: 05/12/2023]
Abstract
Near-infrared laser energy in conjunction with applied tissue cooling is being investigated for thermal remodeling of the endopelvic fascia during minimally invasive treatment of female stress urinary incontinence. Previous computer simulations of light transport, heat transfer, and tissue thermal damage have shown that a transvaginal approach is more feasible than a transurethral approach. However, results were suboptimal, and some undesirable thermal insult to the vaginal wall was still predicted. This study uses experiments and computer simulations to explore whether application of an optical clearing agent (OCA) can further improve optical penetration depth and completely preserve the vaginal wall during subsurface treatment of the endopelvic fascia. Several different mixtures of OCA’s were tested, and 100% glycerol was found to be the optimal agent. Optical transmission studies, optical coherence tomography, reflection spectroscopy, and computer simulations [including Monte Carlo (MC) light transport, heat transfer, and Arrhenius integral model of thermal damage] using glycerol were performed. The OCA produced a 61% increase in optical transmission through porcine vaginal wall at 37°C after 30 min. The MC model showed improved energy deposition in endopelvic fascia using glycerol. Without OCA, 62%, 37%, and 1% of energy was deposited in vaginal wall, endopelvic fascia, and urethral wall, respectively, compared with 50%, 49%, and 1% using OCA. Use of OCA also resulted in 0.5-mm increase in treatment depth, allowing potential thermal tissue remodeling at a depth of 3 mm with complete preservation of the vaginal wall.
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Affiliation(s)
- Chun-Hung Chang
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223, United States
| | - Erinn M. Myers
- Carolinas Medical Center, Women's Center for Pelvic Health, 2001 Vail Avenue, Suite 360, Charlotte, North Carolina 28207, United States
| | - Michael J. Kennelly
- Carolinas Medical Center, Women's Center for Pelvic Health, 2001 Vail Avenue, Suite 360, Charlotte, North Carolina 28207, United States
| | - Nathaniel M. Fried
- University of North Carolina at Charlotte, Department of Physics and Optical Science, 9201 University City Boulevard, Charlotte, North Carolina 28223, United States
- Carolinas Medical Center, Women's Center for Pelvic Health, 2001 Vail Avenue, Suite 360, Charlotte, North Carolina 28207, United States
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Hsu SL, Lee PY, Chang CH, Chen CH. Immunological impression cytology of the conjunctival epithelium in patients with thyroid orbitopathy-related dry eye. Genet Mol Res 2016; 15:gmr9011. [PMID: 27706674 DOI: 10.4238/gmr.15039011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Thyroid orbitopathy (TO) is an autoimmune disease that is complicated by ocular surface disorders, leading to discomfort. Dry eye is very prevalent in patients with TO. Recent studies on the pathogenesis of dry eye have focused on the inflammatory process, and some supporting evidence has been discovered. Because TO is a disorder of autoimmune origin, we assumed that the association between TO and dry eye is related to inflammation. Inflammation of the ocular surface in TO-related dry eye has not been well studied. In this study, we assessed cellular inflammation of the ocular surface and the cytokine profiles in patients with TO-related dry eye. Conjunctival impression cytology (CIC) was assessed with an immunofluorescent assay. TO-related dry eye was diagnosed by using the Schirmer test, tear break-up time, thyroid function, and clinical signs. CIC was combined with immunological staining of interleukin-1a (IL-1a), IL-1b, and IL- 6. The immunological impression cytology (IC) grade was compared to the clinical activity score of TO. All TO patients with dry eye were positive for IL-1a, IL-1b, and IL-6. However, the normal controls were also positive for IL-1a. A trend was observed between the clinical inflammatory score and immunological IC grade. This study was the first to delineate the immunological IC of TO-related dry eye. Our study aimed to investigate the pathogenesis of dry eye in TO. Our findings suggest that the conjunctival cytokines IL-1a, IL-1b, and IL-6 may play a role. The results of this study will be useful for future studies of additional inflammatory cytokines, and the levels of these cytokines could be used as an outcome to assess the efficacy of treatment, such as anti-cytokine or immunosuppression therapy, in patients with TO-related dry eye or other ocular surface inflammatory disorders.
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Affiliation(s)
- S L Hsu
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - P Y Lee
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - C H Chang
- Department of Ophthalmology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - C H Chen
- Department of Medical Imaging and Radiological Sciences, Central Taiwan University of Science and Technology, Taichung, Taiwan.,Department of Medical Imaging and Radiological Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
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Abstract
The aim of the study was to investigate the association between depressive disorders and risk of tumor recurrence in patients with breast cancer after curative surgery.A nationwide cohort study between January 2001 and December 2007 was conducted. Data were taken from the Taiwan National Health Insurance Research Database. Among 30,659 newly diagnosed breast cancer patients, we identified 1147 breast cancer patients with depressive disorders and 2294 matched breast cancer patients without depressive disorders, both of whom received curative breast surgery between January 2003 and December 2007.The risk of first tumor recurrence was compared between patients who developed depressive disorders after breast surgery (depressive disorder cohort, n = 1147) and matched patients who did not develop depressive disorders (matched nondepressive disorder cohort, n = 2294). Cumulative incidences and hazard ratios (HRs) were calculated after adjusting for competing mortality.The depressive disorder cohort had a higher rate of recurrence when compared with the matched nondepressive disorder cohort (17.1% vs 12.5%; P < .001). The Kaplan-Meier analysis revealed a predisposition of patients with depressive disorders to suffer from recurrence (log-rank test, P < .001). After multivariate adjustment, the HR for subsequent recurrence among the depressive disorder cohort was 1.373 (95% confidence interval 1.098-1.716, P = 0.005). Moreover, the depressive disorder cohort had higher risk of overall mortality even though not significant after adjusted (adjusted HR 1.271, 95% confidence interval 0.930-1.737, P = 0.132).Depressive disorder was associated with a higher risk of breast cancer recurrence among patients after curative breast surgery.
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Affiliation(s)
- Shaw-Ji Chen
- Department of Psychiatry, Mackay Memorial Hospital Taitung Branch, Taitung
- Mackay Junior College of Medicine, Nursing, and Management, Taipei
- Institute of Medical Sciences, Tzu Chi University, Hualien
| | - Chun-Hung Chang
- Department of Psychiatry, China Medical University Hospital
- Institute of Clinical Medicine, China Medical University
- Sunshine Psychiatric Hospital, Taichung
| | - Kuang-Chi Chen
- Institute of Medical Sciences, Tzu Chi University, Hualien
| | - Chieh-Yu Liu
- Biostatistical Consulting Lab, Institute of Nursing-Midwifery, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, R.O.C
- Correspondence: Chieh-Yu Liu, 365, Min-der Rd., Beitou district, Taipei City, Taiwan, R.O.C. (e-mail: )
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Chang HT, Liu CS, Chou CT, Hsieh CH, Chang CH, Chen WC, Liu SI, Hsu SS, Chen JS, Jiann BP, Huang JK, Jan CR. Econazole induces increases in free intracellular Ca2+ concentrations in human osteosarcoma cells. Hum Exp Toxicol 2016; 24:453-8. [PMID: 16235734 DOI: 10.1191/0960327105ht558oa] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Econazole is an antifungal drug with different in vitro effects. However, econazole's effect on osteoblast like cells is unknown. In human MG63 osteosarcoma cells, the effect of econazole on intracellular Ca2+ concentrations ([Ca2+]i) was explored by using fura-2. At a concentration of 0.1 μM, econazole started to cause a rise in [Ca2+]i in a concentration-dependent manner. Econazole-induced [Ca2+]i rise was reduced by 74% by removal of extracellular Ca2+. The econazole-induced Ca2+ influx was mediated via a nimodipine-sensitive pathway. In Ca2+ free medium, thapsigargin, an inhibitor of the endoplasmic reticulum Ca2+ ATPase, caused a [Ca2+]i rise, after which the increasing effect of econazole on [Ca2+]i was abolished. Pretreatment of cells with econazole to deplete Ca2+ stores totally prevented thapsigargin from releasing Ca2+. U73122, an inhibitor of phospholipase C, abolished histamine (an inositol 1,4,5-trisphosphate dependent Ca2+ mobilizer)-induced, but not econazoleinduced, [Ca2+]i rise. Econazole inhibited 76% of thapsigargin-induced store-operated Ca2+ entry. These findings suggest that in MG63 osteosarcoma cells, econazole increases [Ca2+]i by stimulating Ca2+ influx and Ca2+ release from the endoplasmic reticulum via a phospholipase C-independent manner. In contrast, econazole acts as a potent blocker of store-operated Ca2+ entry.
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Affiliation(s)
- H T Chang
- Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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