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Hung SY, Yeh YM, Chiu CH, Armstrong DG, Lin CW, Yang HM, Huang SY, Huang YY, Huang CH. Microbiome of limb-threatening diabetic foot ulcers indicates the association of fastidious Stenotrophomonas and major amputation. J Microbiol Immunol Infect 2024; 57:156-163. [PMID: 37919171 DOI: 10.1016/j.jmii.2023.10.007] [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] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/05/2023] [Accepted: 10/24/2023] [Indexed: 11/04/2023]
Abstract
BACKGROUND Proper identification of the polymicrobial microorganisms in patients with limb-threatening diabetic foot ulcers (LTDFUs) using conventional culture is insufficient. This prospective study evaluates the potential value of adjuvant molecular testing assisting in identify fastidious micro-organisms in LTDFUs compared to standard treatment alone. METHODS Ninety patients with LTDFUs received interdisciplinary and standard antibiotic treatment in a referral diabetic foot center. A simultaneous 16S amplicon sequencing (16S AS) specimen along with conventional culture collected at admission was used to retrospectively evaluate the microbiological findings and its association with amputation outcomes. RESULTS The microorganism count revealed by 16S AS overwhelmed that of conventional culturing (17 vs. 3 bacteria/ulcer respectively). The Stenotrophomonas spp. revealed in 29 patients were highly correlated with major (above ankle) amputation (OR: 4.76, 95% CI 1.01-22.56), while only one had been concomitantly identified by conventional culturing. Thus, there were 27 cases without proper antibiotics coverage during treatment. CONCLUSIONS Adjuvant molecular testing assisted identification of fastidious pathogens such as Stenotrophomonas infection and might be associated with major amputation in patients with LTDFUs.
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Affiliation(s)
- Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yuan-Ming Yeh
- Genomic Medicine Core Laboratory, Chang Gung Memorial Hospital, Linkou, Taoyuan 333, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, USA (D.G.A.)
| | - Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Shu-Yu Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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Zhu JY, Zhang X, Huang CH, Wang L, Chen R, Ding XL. [Evaluation of thermal environment and human thermal comfort in 8 types of public places from 2019 to 2021]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2023; 41:189-197. [PMID: 37006144 DOI: 10.3760/cma.j.cn121094-20220428-00229] [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: 04/04/2023]
Abstract
Objective: To evaluate the thermal environment of different types of public places and the thermal comfort of employees, so as to provide scientific basis for the establishment of microclimate standards and health supervision requirements. Methods: From June 2019 to December 2021, 50 public places (178 times) of 8 categories in Wuxi were selected, including hotels, swimming pools (gymnasiums), bathing places, shopping malls (supermarkets), barber shops, beauty shops, waiting rooms (bus station) and gyms. In summer and winter, microclimate indicators such as temperature and wind speed were measured in all kinds of places, combined with the work attire and physical activity of employees in the places. Fanger thermal comfort equation and center for the built environment (CBE) thermal comfort calculation tool were used to evaluate the predicted mean vote (PMV), predicted percent dissatisfied (PPD) and standard effective temperature (SET) according to the American Society of Heating, Refrigerating and Air-Conditioning Engineers (ASHRAE) 55-2020. The modification effects of seasonal and temperature control conditions on thermal comfort were analyzed. The consistency of GB 37488-2019 "Hygienic Indicators and Limits in Public Places" and ASHRAE 55-2020 evaluation results on thermal environment was compared. Results: The thermal sensation of hotel, barber shop staff and the gym front-desk staff were moderate, while the thermal sensation of swimming place lifeguard, bathing place cleaning staff and gym trainer were slightly warm in summer and winter. Waiting room (bus station) cleaning and working staff, shopping mall staff felt slightly warm in summer and moderate in winter. Service staff in bathing places felt slightly warm in winter, while staff in beauty salons felt slightly cool in winter. The thermal comfort compliance of hotel cleaning staff and shopping mall staff in summer was lower than that in winter (χ(2)=7.01, 7.22, P=0.008, 0.007). The thermal comfort compliance of shopping mall staff in the condition of air conditioning off was higher than that in the condition of air conditioning on (χ(2)=7.01, P=0.008). The SET values of front-desk staff in hotels with different health supervision levels were significantly different (F=3.30, P=0.024). The PPD value and SET value of the front-desk staff, and the PPD value of cleaning staff of hotels above three stars were lower than those of hotels below three stars (P<0.05). The thermal comfort compliance of front-desk staff and cleaning staff in hotels above three stars was higher than that in hotels below three stars (χ(2)=8.33, 8.09, P=0.016, 0.018). The consistency of the two criteria was highest among waiting room (bus station) staff (100.0%, 1/1) and lowest among gym front-desk staff (0%, 0/2) and waiting room (bus station) cleaning staff (0%, 0/1) . Conclusion: There are different degrees of thermal discomfort in different seasons, under the condition of air conditioning and health supervision, and the microclimate indicators can not fully reflect the thermal comfort of human body. The health supervision of microclimate should be strengthened, the applicability of health standard limit value should be evaluated in many aspects, and the thermal comfort of occupational group should be improved.
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Affiliation(s)
- J Y Zhu
- Department of Environmental Health, Wuxi Center for Disease Control and Prevention (Wuxi Center for Disease Control and Prevention Affiliated to Nanjing Medical University), Wuxi 214023, China
| | - X Zhang
- Department of Environmental Health, Wuxi Center for Disease Control and Prevention (Wuxi Center for Disease Control and Prevention Affiliated to Nanjing Medical University), Wuxi 214023, China
| | - C H Huang
- Department of Environmental Health, Wuxi Center for Disease Control and Prevention (Wuxi Center for Disease Control and Prevention Affiliated to Nanjing Medical University), Wuxi 214023, China
| | - L Wang
- Department of Environmental Health, Wuxi Center for Disease Control and Prevention (Wuxi Center for Disease Control and Prevention Affiliated to Nanjing Medical University), Wuxi 214023, China
| | - R Chen
- Department of Environmental Health, Wuxi Center for Disease Control and Prevention (Wuxi Center for Disease Control and Prevention Affiliated to Nanjing Medical University), Wuxi 214023, China
| | - X L Ding
- Department of Environmental Health, Wuxi Center for Disease Control and Prevention (Wuxi Center for Disease Control and Prevention Affiliated to Nanjing Medical University), Wuxi 214023, China
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Lin CW, Armstrong DG, Huang CH, Lin CH, Hung SY, Liu PH, Huang YY. Diabetic foot disease in subjects with End-stage renal Disease: A nationwide study over 14 years highlighting an emerging threat. Diabetes Res Clin Pract 2022; 193:110134. [PMID: 36349589 DOI: 10.1016/j.diabres.2022.110134] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 10/03/2022] [Accepted: 10/20/2022] [Indexed: 11/17/2022]
Abstract
AIMS To disclose prevalence, demographic, foot characteristics as well as management and lower-extremity amputations (LEAs) of subjects with end-stage renal disease (ESRD) on diabetic foot diseases (DFDs). METHODS Data were derived from the Taiwan National Health Insurance Research Database between 2004 and 2017. DFDs were defined as ulcers, infections, or severe peripheral arterial diseases (PADs) in patients with type 2 diabetes. Clinical characteristics were analyzed between subjects with and without ESRD. RESULTS Subjects with ESRD have increased impacts on the DFD population either from annual prevalence (2.7 % to 10.42 %, P for trend < 0.001), or proportional representation in LEAs (7.91 % to 26.37 %, P < 0.001) over 14 years. The annual trends for major-LEAs rates have decreased in both subjects with and without ESRD (13.67 % to 5.82 % and 3.48 % to 1.47 %, both P < 0.001). Notably, the concomitant increase of endovascular treatments (EVTs) (7.09 % to 29.41 %, P < 0.001) was associated with the decrease of major-LEAs (P for interaction < 0.001) in subjects with ESRD. CONCLUSIONS As the annual prevalence of subjects with ESRD has increased 3.9-fold over years, they now account for more than 30% of annual major-LEA of the total DFD population. Interdisciplinary team approach and aggressive EVTs might reduce major-LEAs in these patients.
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Affiliation(s)
- Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, USA (D.G.A.)
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan
| | - Pi-Hua Liu
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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Lin CH, Armstrong DG, Liu PH, Lin CW, Huang CH, Huang YY. Survival of Patients Following First Diagnosis of Diabetic Foot Complications: A Nationwide 15-Year Longitudinal Analysis. Front Endocrinol (Lausanne) 2021; 12:801324. [PMID: 34966361 PMCID: PMC8711267 DOI: 10.3389/fendo.2021.801324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/22/2021] [Indexed: 01/22/2023] Open
Abstract
Background and Aims The long-term survival in people with type 2 diabetes following first diagnosis of diabetic foot complications (FDDFC) is unclear. The object is to evaluate the mortality rate in subjects with type 2 diabetes following FDDFC and the impacts of the major cardiovascular comorbidities. Methods Nationwide data were analyzed for subjects with T2D and DFC between 2003 and 2017 according to ICD-9 coding. DFC was defined with the codes of ulcers, infections, or severe peripheral artery disease that required intervention (PAD) to mimic the real world diagnosis. Criteria of FDDFC were preceded by a period without any DFC for at least 5 years. Major cardiovascular comorbidities: established PAD and cardiovascular diseases (CVD: including coronary heart disease (CHD), stroke, or heart failure) before the index date as well as lower-extremity amputations (LEA) at the index episode were analyzed. Results Among 300,115 subjects with DFC, a total of 103,396 patients had FDDFC. The mean 5-year survival rate of these subjects was 81.05%. Using subjects without associated major cardiovascular comorbidity as baseline, the adjusted hazard ratios (aHR) were1.43 (95% confidence interval 1.38-1.49) in group PAD-/CVD+, followed by 1.70 (1.59-1.80) in PAD+/CVD- and 1.98 (1.89-2.08) in PAD+/CVD+. The aHR was further increased in patients with PAD who additionally had heart failure (3.77, 3.50-4.05), stroke (2.06, 1.95-2.18), or CHD (1.89, 1.79-2.00). Subjects with PAD rather than other CVD were associated with LEA at FDDFC. Patients with major LEA (above the ankle) at FDDFC episode had lower 5-year survival rate (65.01%) followed by those with minor LEA (72.24%) and without LEA (81.61%). Conclusions Cardiovascular comorbidity as well as LEA status at the event of FDDFCs were both associated with patient survival outcomes. Earlier identification of this large population could lead to higher survival rates.
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Affiliation(s)
- Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - David G. Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, United States
| | - Pi-Hua Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Linkou, Taiwan
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Huang CH, Liu ZG, Zhang MC, Sun XG, Xu JJ, Liang LY, Lin X, Wang JS, Tian L, Wu SQ, Liu Y, Zhong TL. [Efficacy of a recombinant bovine basic fibroblast growth factor gel for the treatment of moderate dry eye: a multicenter randomized double-blind parallel controlled clinical trial]. Zhonghua Yan Ke Za Zhi 2021; 57:930-938. [PMID: 34865452 DOI: 10.3760/cma.j.cn112142-20201130-00784] [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] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Objective: To compare the clinical efficacy of a recombinant bovine basic fibroblast growth factor (rb-bFGF) gel and a gel matrix in the treatment of moderate dry eye. Methods: It was a prospective random double-blind controlled study. One hundred patients diagnosed as moderate dry eye in Eye Institute and Affiliated Xiamen Eye Center of Xiamen University, Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Beijing Tongren Hospital, Capital Medical University, Eye & ENT Hospital of Fudan University and Zhongshan Ophthalmic Center from August 2015 to April 2019 were divided into two groups: experimental group and control group. Two groups of patients were allocated to receive either a rb-bFGF gel or a gel matrix 4 times per day for 4 weeks. Subjective symptoms, break-up time of the tear film (BUT), Schirmer Ⅰ test (SⅠt) and corneal fluorescein sodium staining were assessed at baseline, 2 and 4 weeks after treatment. Bulbar impression cytology was evaluated at baseline and 4 weeks after treatment. Irritation of the rb-bFGF gel and the gel matrix was estimated after treatment. T test, Wilcoxon signed-rank test or Mann-Whitney U test was used for quantitative data, and Chi-square test was used for enumerative data. Results: Eighty-four subjects were included for statistical analyses after the exclusion of 16 subjects who were lost for followup, with an age of 43±14 years. There were 42 cases in the experimental group and the control group, respectively. There was no statistically significant difference between the two groups in demographic baseline characteristics before treatment (P>0.05). The total score of subjective symptoms was 7.17±3.60 and 5.95±3.25 at 2 and 4 weeks after therapy in the experimental group, which were lower than 9.48±3.88 before treatment (t=6.226, 6.563; both P<0.05); in the control group, it was 7.01±3.25 and 6.32±3.85 at 2 and 4 weeks after treatment, with a significant reduction in comparison with that before treatment (9.15±3.58; t=4.693, 4.726; both P<0.05). The median (lower quartile, upper quartile) BUT was 4.00 (2.40, 5.00) s and 4.64 (3.00, 5.00) s at 2 and 4 weeks after therapy in the experimental group, which were longer than 3.72 (2.00, 4.39) s before treatment (Z=-2.485, -3.152; both P<0.05). The BUT was 4.41 (2.79, 5.12) s at 2 weeks after therapy in the control group, which was of no statistical difference compared with 3.89 (2.09, 4.25) s before treatment (Z=-1.953, P>0.05). The BUT was 5.21 (3.00, 5.02) s at 4 weeks after therapy in the control group, which was longer than that before treatment (Z=-2.485, P<0.05). The SⅠt score was 7.31 (3.75, 10.00) mm and 8.50 (4.00, 11.00) mm at 2 and 4 weeks after therapy in the experimental group, which were significantly higher than 6.69 (2.00, 8.13) mm before treatment (Z=-2.031, -2.236; both P<0.05); in the control group, it was 6.82 (2.00, 8.25) mm and 6.86 (3.00, 9.25) mm at 2 and 4 weeks after therapy, which were not significantly increased compared with 6.50 (2.00, 7.75) mm before treatment (Z=-0.179, -1.161; both P>0.05). The corneal fluorescein sodium staining points were 5.00 (2.00, 5.00) and 3.71 (0.00, 5.00) at 2 and 4 weeks after therapy in the experimental group, which were significantly lower than 7.10 (5.00, 7.00) before treatment (t=-2.895, -4.639; both P<0.05); those in the control group were 5.52 (0.00, 7.00) and 6.19 (0.75, 6.25) at 2 and 4 weeks after treatment, with a significant reduction in comparison with 8.90 (5.00, 10.50) before treatment (t=-2.776, -1.991; both P<0.05). The differences in the average total score of subjective symptoms, BUT, SIt, and corneal fluorescein sodium staining points between both groups were not statistically significant at each time point. The impression cytology grade was decreased from 1.72 (1.00, 2.00) before treatment to 0.94 (0.00, 2.00) at 4 weeks after therapy in the experimental group (Z=-2.803, P<0.05). The staining grade of conjunctival imprinted cells in the control group was 1.42 (1.00, 2.00) at 4 weeks, which showed no statistical significance compared with 1.56 (1.00, 2.00) before treatment (Z=1.195, P>0.05). The impression cytology grade was significantly reduced in the experimental group compared with the control group at 4 weeks after treatment (Z=-3.308, P<0.05). The number of goblet cells was 10.90 (5.00, 20.00) at 4 weeks after therapy in the experimental group, which was significantly higher than 6.30 (5.00, 8.00) before treatment (Z=-2.383, P<0.05); in the control group, it was 8.36 (4.00, 12.00) at 4 weeks after treatment, with no significant increase in comparison with that before treatment [7.55 (5.00, 11.00)] (Z=-0.095, P>0.05). The number of goblet cells was not significantly increased in the experimental group compared with the control group at 4 weeks after treatment (Z=-1.162, P>0.05). Most patients indicated that the drug was non-irritating, and no patient had intolerable irritation affecting daily lives at 4 weeks after therapy; there was no difference between the two groups (Z=-0.290, P>0.05). Conclusions: Both the rb-bFGF gel and the gel matrix can effectively improve the symptoms and signs of moderate dry eye. However, compared with the gel matrix, the rb-bFGF gel shows obvious advantages in promoting conjunctival epithelial cell repair and increasing the number of goblet cells. (Chin J Ophthalmol, 2021, 57: 930-938).
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Affiliation(s)
- C H Huang
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen 361002, China
| | - Z G Liu
- Department of Ophthalmology, Xiang'an Hospital and Xiamen Eye Center Affiliated to Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen 361102, China
| | - M C Zhang
- Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China
| | - X G Sun
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Vision Science, Beijing 100730, China
| | - J J Xu
- Eye & ENT Hospital of Fudan University, Shanghai 361016, China
| | - L Y Liang
- Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, China
| | - X Lin
- Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Fujian Engineering and Research Center of Eye Regenerative Medicine, Xiamen 361002, China
| | - J S Wang
- Union Hospital Affiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430022, China
| | - L Tian
- Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Vision Science, Beijing 100730, China
| | - S Q Wu
- Eye & ENT Hospital of Fudan University, Shanghai 361016, China
| | - Y Liu
- Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510060, China
| | - T L Zhong
- National Institute for Data Science in Health and Medicine, Xiamen University, Xiamen 361005, China
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Tsao YT, Lee WC, Huang CH, Lin IH, Huang YY. A comprehensive investigation of nutritional status and psoas muscle mass in predicting five-year survival in patients with liver transplant. J Formos Med Assoc 2021; 121:1317-1324. [PMID: 34666924 DOI: 10.1016/j.jfma.2021.09.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 08/30/2021] [Accepted: 09/26/2021] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/PURPOSE Although nutrition and sarcopenia have impacts on the surgery outcome of patients who have received living donor liver transplant (LDLT), the use of the prognostic nutritional index (PNI) or psoas muscle mass index (PMI) as an indicator for five-year survival in those patients is still unclear. METHODS A total of 138 patients receiving LDLT were followed at a medical center in Taiwan. As well as analysis of clinical factors using Cox regression, time-varying PNI and PMI values as before surgery (0) and at 3-, 6-, and 12- months after LDLT were analyzed by time-dependent Cox analysis. For those 124 patients who survived after 3 months of LDLT, the values of PNI-3m, PMI-3m and their combination were further analyzed. RESULTS PNI and PMI were noted to be highly associated with mortality at three months post-LDLT (PNI-3m hazard ratio [HR] = 0.89, 95% confidence interval [CI]: 0.85-0.94, p < 0.001; PMI-3m HR = 0.58, 95% CI: 0.41-0.82, p = 0.002). Per the Youden index, the cut-off point of PNI-3m was 42.35, and that of PMI-3m was 1.94. Compared to the subjects with higher levels of PNI-3m and PMI-3m (N-high/M-high), the HRs for subjects with N-high/M-low, N-low/M-high, and N-low/M-low were 5.27 (p = 0.004), 4.46 (p = 0.010) and 12.97 (p < 0.001) respectively. CONCLUSION PNI and PMI at the third month post-LDLT serve as excellent predictors for 5-year survival. For patients with lower levels of PNI-3m or PMI-3m, combination use of these indexes is suggested to provide better prognostic information.
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Affiliation(s)
- Ya-Tzu Tsao
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Division of Liver and Transplantation Surgery, Department General Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - I-Hsin Lin
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Yao Huang
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan, Taiwan; College of Medicine, Chang Gung University, Taoyuan, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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Hung SY, Chiu CH, Huang CH, Lin CW, Yeh JT, Yang HM, Huang YY. Impact of wound microbiology on limb preservation in patients with diabetic foot infection. J Diabetes Investig 2021; 13:336-343. [PMID: 34418309 PMCID: PMC8847138 DOI: 10.1111/jdi.13649] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/01/2020] [Revised: 07/26/2021] [Accepted: 08/18/2021] [Indexed: 12/15/2022] Open
Abstract
AIMS/INTRODUCTION To investigate the association between specific bacterial pathogens and treatment outcome in patients with limb-threatening diabetic foot infection (LT-DFI). MATERIALS AND METHODS Consecutive patients treated for LT-DFI in a major diabetic foot center in Taiwan were analyzed between the years 2014 and 2017. Patients with positive wound culture results at first aid were enrolled. Clinical factors, laboratory data, and wound culture results were compared. Lower-extremity amputations and in-hospital mortality were defined as a poor outcome. RESULTS Among the 558 patients, 272 (48.7%) patients had lower extremity amputation and 22 (3.9%) patients had in-hospital mortality. Gram-negative bacterial (GNB) infection was the independent factor following factors adjustment. When all the 31 microorganisms were analyzed, only E. coli (adjusted odds ratio [aOR], 3.01; 95% CI, 1.60-5.65), Proteus spp. (aOR, 2.99; 95% CI, 1.69-5.29), and Pseudomonas aeruginosa (aOR, 2.00; 95% CI 1.20-3.32) were associated with poor outcome. The analysis of specific GNB species in association with major- or minor- amputation have been reported. No specific pathogen was associated with cause of death in patients with mortality within 30 days. The antimicrobial-resistant strains were not associated with a poor treatment outcome. CONCLUSIONS The presence of GNB was associated with limb amputations. This study provides insight into more timely and appropriate management of the diabetic foot infection.
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Affiliation(s)
- Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Jiun-Ting Yeh
- Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.,College of Medicine, Chang Gung University, Taoyuan City, Taiwan.,Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
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Wu JL, Liu ZG, Jin M, Liu J, Li Y, Bi HS, Xie XF, Zhang ML, Shi HJ, Gao XM, Li L, Huang CH. [A multicenter, randomized, double-masked, placebo-controlled trial of compound wild chrysanthemum eye masks for mild and moderate dry eye]. Zhonghua Yan Ke Za Zhi 2021; 57:601-607. [PMID: 34344121 DOI: 10.3760/cma.j.cn112142-20210413-00173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the clinical efficacy and safety of compound wild chrysanthemum eye masks for mild and moderate dry eye. Methods: In this double-masked, multicenter, placebo-controlled, randomized trial, middle-aged and elderly patients with mild and moderate dry eye were enrolled from six hospitals (Xiamen Eye Center of Xiamen University, China-Japan Friendship Hospital, Peking Union Medical College Hospital, Wangjing Hospital of China Academy of Chinese Medical Sciences, Affiliated Eye Hospital of Shandong University of Traditional Chinese Medicine and Hebei Eye Hospital). The patients were assigned to the compound wild chrysanthemum eye mask group and the eye mask simulator group based on the random number table. Subjective symptoms of dry eye, visual acuity, break-up time (BUT), Schirmer Ⅰ test, and corneal fluorescent staining were evaluated in all patients before treatment and at 1 and 2 weeks after treatment. All adverse reactions during the treatment and follow-up were recorded. Results: A total of 120 patients were enrolled. Among them, 112 subjects were included for statistical analyses after the exclusion of 8 subjects who were lost for follow-up or had an adverse event, with an age of (54.26±7.44) years. All the indicators were equally comparable between the two groups. Before treatment and at 1 and 2 weeks after treatment, the median (lower quartile, upper quartile) of total score of questionnaires in the eye mask group was 14.50 (10.00, 19.00), 9.00 (5.00, 14.00) and 7.00 (4.00, 10.00), respectively, and that in the control group was 14.00 (9.00, 22.50), 12.00 (6.00, 20.00) and 10.00 (3.50, 17.00), respectively. The score decreased significantly in both groups after 1 week (t=9.1604, S=398.00; P<0.01) and 2 weeks (S=681.00, 575.50; P<0.05) of treatment. The total score of questionnaires in the eye mask group was significantly lower than that in the control group (Z=3.27, 2.81; P<0.05) after treatment. After 1 week of treatment, the average BUT of the eye mask group was (5.71±2.31) s, which was significantly longer than that before treatment (5.06±2.00) s (S =208.50, P<0.05). But there was no significant difference in the control group (S=150.00, P>0.05). After 2 weeks of treatment, there was statistically significant difference in BUT between the two groups (S=407.00, t=3.07; P<0.01). After 1 week of the treatment, the amount of tear secretion in the eye mask group [(6.88±4.78) mm] was significantly larger than that before treatment (S=196.50, P<0.05), while the control group [(6.80±5.85) mm] showed no significant difference (S=55.00, P<0.05). After 2 weeks of the treatment, the amount increased significantly to (7.43±4.86) mm and (7.29±4.56) mm, respectively, in both groups (t=-3.29, -2.26; P<0.05). The difference in the average BUT, Schirmer Ⅰ test result and corneal fluorescent staining between both groups was not statistically significant at each time point. Five mild adverse events occurred, including 2 adverse events (2 times, 3.51%) in the eye mask group and 3 adverse events (4 times, 5.36%) in the control group. Conclusions: Compound wild chrysanthemum eye masks can effectively improve the symptoms and physical signs of mild and moderate dry eye and can be used as an auxiliary treatment. (Chin J Ophthalmol, 2021, 57: 601-607).
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Affiliation(s)
- J L Wu
- Department of Ophthalmology, Xiang'an Hospital and Xiamen Eye Center affiliated to Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China
| | - Z G Liu
- Department of Ophthalmology, Xiang'an Hospital and Xiamen Eye Center affiliated to Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China
| | - M Jin
- China-Japan Friendship Hospital, Beijing 100069, China
| | - J Liu
- Wangjing Hospital, Chinese Academy of Chinese Medical Sciences, Beijing 100069, China
| | - Y Li
- Department of Ophthalmology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, China
| | - H S Bi
- Shandong University of Traditional Chinese Medicine Affiliated Eye Hospital, Jinan 250004, China
| | - X F Xie
- Shandong University of Traditional Chinese Medicine Affiliated Eye Hospital, Jinan 250004, China
| | - M L Zhang
- Hebei Eye Hospital, Xingtai 050011, China
| | - H J Shi
- Hebei Eye Hospital, Xingtai 050011, China
| | - X M Gao
- Pharmaceutical Research and Evaluation Technology Center of Chinese Association of Traditional Chinese Medicine, Beijing 100700, China
| | - L Li
- Pharmaceutical Research and Evaluation Technology Center of Chinese Association of Traditional Chinese Medicine, Beijing 100700, China
| | - C H Huang
- Department of Ophthalmology, Xiang'an Hospital and Xiamen Eye Center affiliated to Xiamen University, Eye Institute of Xiamen University, Fujian Provincial Key Laboratory of Ophthalmology and Visual Science, Xiamen 361102, China
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Huang CH, Okada K, Matsushita E, Uno C, Satake S, Arakawa Martins B, Kuzuya M. Dietary Patterns and Muscle Mass, Muscle Strength, and Physical Performance in the Elderly: A 3-Year Cohort Study. J Nutr Health Aging 2021; 25:108-115. [PMID: 33367470 DOI: 10.1007/s12603-020-1437-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES Nutritional support effectively prevents and treats sarcopenia; however, the influence of overall dietary patterns on sarcopenia parameters is less investigated. This study aimed to determine the association between adherence to Mediterranean-style diet (MD), Dietary Approaches to Stop Hypertension (DASH), Japanese Food Guide Spinning Top (JFG-ST), and modified JFG-ST (mJFG-ST) and muscle mass, muscle strength, and physical performance in community-dwelling Japanese elderly. DESIGN AND SETTINGS This prospective cohort study recruited individuals aged over 60 years from a community college in Nagoya, Japan. PARTICIPANTS AND MEASUREMENTS A total of 666 participants were followed up annually from 2014 to 2017. Demographic data, anthropometric measurements, and sarcopenia parameters including walking speed (WS), hand grip strength in the dominant hand (HGS), and skeletal mass index (SMI) were recorded. Self-recall dietary intake was assessed using a validated food frequency questionnaire comprising 29 food groups. Adherence to MD, DASH, JFG-ST, and mJFG-ST was determined by tertiles. RESULTS At baseline, the mean age of all participants (56.5% women) was 69.4±4.4 years. WS, HGS, and SMI were 1.4±0.2 (m/s), 28.9±8.1 (kg), and 6.7±1.0 (kg/m2), respectively. In longitudinal analysis, participants with higher JFG-ST adherence scores were more likely to have higher SMI (Q3 vs. Q1: mean difference, 0.048; p=0.04) after adjustment, and its benefits were more evident in men (Q2 vs. Q1: mean difference, 0.098; p=0.047; Q3 vs. Q1: mean difference, 0.091; p=0.017) than in women. WS and HGS were not associated with any type of dietary pattern. CONCLUSIONS Adherence to JFG-ST was positively associated with SMI in Japanese community-dwelling elderly adults aged over 60 years, specifically in men. The country-specific dietary recommendations are required to be developed for sarcopenia prevention.
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Affiliation(s)
- C H Huang
- Masafumi Kuzuya, MD, PhD, Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, Address: 65 Tsuruma-cho, Showa-ku, Nagoya, Aichi Prefecture, 466-8550, Japan, TEL: 052-744-2369, FAX: 052-744-2371, E-mail: ,
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Huang CH, Chen CP, Huang YY, Hsu BRS. Modifiable factors related to 7-year renal outcomes in subjects with type 2 diabetes and chronic kidney disease stage 3. J Postgrad Med 2020; 66:187-193. [PMID: 33037171 PMCID: PMC7819377 DOI: 10.4103/jpgm.jpgm_680_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 01/21/2023] Open
Abstract
Background and Aims Subjects with diabetes are prone to a rapid decline in renal function and major adverse cardiovascular events when they reach chronic kidney disease (CKD) stage 3. This study aimed to identify modifiable risk factors associated with the progression of CKD in this population. Settings and Design An observational cohort study. Methods and Materials A total of 320 type 2 diabetic patients with CKD stage 3 registered in the shared-care-system in our hospital in 2010 were regularly followed up for 7 years. Demographic, laboratory, medication, and fundus examination data of these subjects were collected and analyzed. Statistical Analysis Used Cox regression was used to identify factors associated with changes in CKD stage. Results During the 7-year follow-up period, 204 cases (63.7%) remained at CKD stage 3 while 79 cases (24.7%) progressed to stage 4 or 5 and 37 cases (11.6%) improved to stage 1 or 2. The change in estimated glomerular filtration rate (eGFR) in the first 2 years and variations in glycated hemoglobin (HbA1c) over 7 years were independent factors of both progression (hazard ratio (HR) 1.098 and 1.710, respectively) and improvement (HR 0.919 and 0.231, respectively) of CKD stage. Variations in systolic blood pressure (SBP) was also found as an independent factor for progression of renal function (HR 1.052). Conclusions Our results demonstrated that fluctuations in HbA1c and SBP, and changes in eGFR during the first 2 years of treatment were associated with the long-term renal outcomes in type 2 diabetic patients with CKD stage 3.
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Affiliation(s)
- C H Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - C P Chen
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Y Y Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - B R S Hsu
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taiwan
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Hayashi T, Umegaki H, Makino T, Huang CH, Inoue A, Shimada H, Kuzuya M. Combined Impact of Physical Frailty and Social Isolation on Rate of Falls in Older Adults. J Nutr Health Aging 2020; 24:312-318. [PMID: 32115613 DOI: 10.1007/s12603-020-1316-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVES The aim of this study was to examine the impact of the combination of physical frailty and social isolation on falling in community-dwelling older adults. DESIGN A cross-sectional study of data obtained at registration in a randomized control trial. SETTING Community-based study of participants recruited from Toyota, Japan. PARTICIPANTS 380 community-dwelling older adults (47.9% women, mean age = 72.3 ± 4.6 years). MEASUREMENTS Participants were categorized as non-frail or pre-frail/frail based on the Fried frailty criteria (slowness, weakness, exhaustion, low activity, and weight loss). Social isolation was examined using the Lubben Social Network Scale (LSNS-6), and scores lower than 12 points indicated social isolation. Participants were divided into four groups depending on pre-frail/frail status and social isolation, and experiences of multiple falls over the past year were compared between the groups. RESULTS Participants were classified into robust (n = 193), physical frailty (PF; n = 108), social isolation (SI; n = 43), and PF with SI (PF+SI; n = 36) groups. A total of 38 (10.0%) participants reported multiple falls. Logistic regression analysis showed that PF and SI groups were not independently associated with falling (PF: OR 1.64, 95% CI 0.65-4.16, SI: OR 2.25, 95% CI 0.77-6.58), while PF+SI group was significantly associated with falling compared with the robust group (OR 3.06, 95% CI 1.00-9.34, p = 0.049) after controlling for confounding factors. CONCLUSION Our findings support the assertion that coexistence with physical frailty and social isolation were associated with falling in the older adults.
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Affiliation(s)
- T Hayashi
- Hiroyuki Umegaki, Department of Community Healthcare and Geriatrics, Nagoya University Graduate School of Medicine, 65 Tsuruma-cho, Showa-ku, Nagoya 466-8550, Japan, Tel: +81-52-741-2364, Fax: +81-52-744-2371,
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Hung SY, Tsai JS, Yeh JT, Chen KH, Lin CN, Yang HM, Lin CW, Chen HY, Huang CH, Huang YY. Amino acids and wound healing in people with limb-threatening diabetic foot ulcers. J Diabetes Complications 2019; 33:107403. [PMID: 31375421 DOI: 10.1016/j.jdiacomp.2019.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/21/2019] [Accepted: 06/29/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Amino acids are associated with wound healing in traumatic wounds and burns, although their effects on healing in patients with diabetic foot ulcers (DFUs) are limited. This study aimed to evaluate and identify specific amino acids associated with healing outcomes of patients with DFUs. METHODS Sixty-two out of 85 patients who completed the in-hospital treatment for limb-threatening DFUs were enrolled. All ulcers had epithelialization without clinical evidence of infection at discharge. The patients and their families were instructed on foot-care techniques and committed to regular follow-up for 1 year. Baseline characteristics, PEDIS wound classification, laboratory data and serum amino acid levels were used to analyze their predictive power. RESULTS Fifty-seven patients completed the study in which 38 had healed and 19 had unhealed ulcers. The unhealed group had higher incidence of coronary artery disease and larger wound size. Most patients received endovascular therapy (81.6% healed group; 78.9% unhealed group) before enrollment. Following adjustments for clinical factors, the serum levels of arginine (326.4 μmol/L vs. 245.0 μmol/L, P = 0.045), isoleucine (166.7 μmol/L vs. 130.1 μmol/L, P = 0.019), leucine (325.8 μmol/L vs. 248.9 μmol/L, P = 0.039), and threonine (186.7 μmol/L vs. 152.0 μmol/L, P = 0.019) were significantly higher in the healed group. CONCLUSIONS The amino acids associated with wound healing in DFUs differ from those reported for traditional traumatic wounds. These findings affirm the necessity for future large-scaled studies for the application of these amino acids in DFU healing, either as prognostic predictors or supplemented regimens.
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Affiliation(s)
- Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Jir-Shiong Tsai
- Koo Foundation Sun Yat-Sen Cancer Center, Taipei City, Taiwan
| | - Jiun-Ting Yeh
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Kuan-Hsing Chen
- College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chia-Ni Lin
- Department of Laboratory Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; Department of Medical Biotechnology and Laboratory Science, College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Hsin-Yun Chen
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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Lin CW, Hung SY, Huang CH, Yeh JT, Huang YY. Diabetic Foot Infection Presenting Systemic Inflammatory Response Syndrome: A Unique Disorder of Systemic Reaction from Infection of the Most Distal Body. J Clin Med 2019; 8:jcm8101538. [PMID: 31557854 PMCID: PMC6832445 DOI: 10.3390/jcm8101538] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/14/2019] [Revised: 09/21/2019] [Accepted: 09/23/2019] [Indexed: 12/23/2022] Open
Abstract
Diabetic foot infection (DFI) is a major complication of diabetic foot that lead to nontraumatic lower-extremity amputation (LEA). Such distal infection of the body having systemic inflammatory response syndrome (SIRS) is rarely reported. Consecutive patients treated for limb-threatening DFI in a major diabetic foot center in Taiwan were analyzed between the years 2014 to 2017. Clinical factors, laboratory data, perfusion, extent, depth, infection and sensation (PEDIS) wound score in 519 subjects with grade 3 DFI and 203 presenting SIRS (28.1%) were compared. Major LEA and in-hospital mortality were defined as poor prognosis. Patients presenting SIRS had poor prognosis compared with those with grade 3 DFI (14.3% versus 6.6% for major LEA and 6.4% versus 3.5% for in-hospital mortality). Age, wound size, and HbA1c were independent risk factors favoring SIRS presentation. Perfusion grade 3 (odds ratio 3.37, p = 0.044) and history of major adverse cardiac events (OR 2.41, p = 0.036) were the independent factors for poor prognosis in treating patients with DFI presenting SIRS. SIRS when presented in patients with DFI is not only limb- but life-threatening as well. Clinicians should be aware of the clinical factors that are prone to develop and those affecting the prognosis in treating patients with limb-threatening foot infections.
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Affiliation(s)
- Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan.
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan.
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan.
| | - Jiun-Ting Yeh
- Department of Plastic surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan.
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital at Linkou, Taoyuan 33305, Taiwan.
- College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan.
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan.
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Huang YH, Chen ST, Liu FH, Hsieh SH, Lin CH, Liou MJ, Wang CC, Huang CH, Liu GH, Lin JR, Yang LY, Hsu TY, Lee MC, Huang CT, Wu YH. The efficacy and safety of concentrated herbal extract granules, YH1, as an add-on medication in poorly controlled type 2 diabetes: A randomized, double-blind, placebo-controlled pilot trial. PLoS One 2019; 14:e0221199. [PMID: 31415655 PMCID: PMC6695147 DOI: 10.1371/journal.pone.0221199] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/19/2019] [Indexed: 12/14/2022] Open
Abstract
Background In Asian countries, many patients with type 2 diabetes fail to achieve controlled glycated hemoglobin (HbA1c) levels while taking several classes of oral hypoglycemic agents (OHAs). Traditional Chinese medicine could be an alternative therapeutic option for poorly controlled type 2 diabetes. YH1 is a concentrated Chinese herbal extract formula that combines Rhizoma Coptidis and Shen-Ling-Bai-Zhu-San. This randomized, double-blind, placebo-controlled pilot study evaluated YH1 as an add-on medication for poorly controlled type 2 diabetes. Methods Forty-six patients with poorly controlled type 2 diabetes were randomly assigned 1:1 to the YH1 or placebo group. Before the trial, all subjects had received three or more classes of OHAs with HbA1c > 7.0% (53 mmol/mol) and a body mass index ≥ 23 kg/m2. During the 12-week trial, participants continued to take OHAs without any dose or medication changes. The primary endpoint was the percentage change in HbA1c level. Per-protocol analysis was applied to the final evaluation. Results At week 12, there was an 11.1% reduction in HbA1c from baseline and a 68.9% increase in homeostatic model assessment (HOMA) of β cell function in the YH1 group, which also exhibited significant reductions in two-hour postprandial glucose (-26.2%), triglycerides (-29.5%), total cholesterol (-21.6%), low-density lipoprotein cholesterol (-17.4%), body weight (-0.5%), and waist circumference (-1.1%). The changes in fasting plasma glucose, HOMA insulin resistance and symptom scores were not significantly different between the YH1 and placebo groups. No serious adverse events occurred during this clinical trial. Conclusions This pilot study indicates that YH1 together with OHAs can improve hypoglycemic action and β-cell function in overweight/obese patients with poorly controlled type 2 diabetes. YH1 is a safe add-on medication for OHAs and has beneficial effects on weight control and lipid metabolism. A larger study population with longer treatment and follow-up periods is required for further verification.
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Affiliation(s)
- Yueh-Hsiang Huang
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Szu-Tah Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Feng-Hsuan Liu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Sheng-Hwu Hsieh
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chia-Hung Lin
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Miaw-Jene Liou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chih-Ching Wang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Geng-Hao Liu
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Lan-Yan Yang
- Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | - Tzu-Yang Hsu
- Biostatistics and Informatics Unit, Clinical Trial Center, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
| | | | - Chun-Teng Huang
- Sanford Burnham Prebys Medical Discovery Institute, La Jolla, California, United States of America
| | - Yi-Hong Wu
- Division of Chinese Internal Medicine, Center for Traditional Chinese Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
- * E-mail:
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Wen YQ, Jiang YT, Liu ZY, Huang CH, Chen QY, Chen HS, Pan YF, Gu JR. [Gender difference in clinical manifestations and comorbidities in the patients with spondyloarthritis]. Zhonghua Yi Xue Za Zhi 2019; 99:812-817. [PMID: 30893722 DOI: 10.3760/cma.j.issn.0376-2491.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objectives: The aim of the study was to determine whether there was gender difference in clinical manifestations and comorbidities in the patients with Spondyloarthritis (SpA) in China. Methods: 346 patients fulfilling ASAS criteria for SpA were recruited from the Third Affiliated Hospital of Sun Yat-sen University, including 280 males and 66 females. A comparison was conducted in terms of age at onset, disease course, family history, HLA-B27 positivity, clinical manifestations, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP), the bath ankylosing spondylitis disease activity index (BASDAI) and AS disease activity score (ASDAS), and comorbidities between male and female patients. Results: Compared with female patients, male patients were younger at disease onset (22±7 vs 27±9, P<0.001),had higher rates of morning stiffness (74.3%), and higher scores of CRP and ASDAS-CRP (P<0.010, P=0.014). However, no significant gender difference was observed in other clinical parameters like clinical manifestations, family history, HLA-B27 positivity, BASDAI, and BASFI and treatment. Male SpA patients had a higher prevalence of Hepatitis B virus (HBV) infection (26.2%) than that of female patients (8.3%), and a higher prevalence of osteoporosis (30.5% vs 14.3%,P<0.01), especially with a lower lumbar T score. Logistic regression analysis reviewed that limited weight (OR=0.94, P<0.001), high ASDAS-CRP (OR=1.58, P=0.006) and male (OR=8.02, P=0.004) are more inclined to have osteoporosis. Conclusion: Compared with female patients, male patients were younger at disease onset and higher scores of CRP and ASDAS-CRP. No significant gender difference was observed in clinical manifestations, family history, HLA-B27 positivity, BASDAI, and BASFI and treatment. Male SpA patients had a higher prevalence of HBV infection and osteoporosis than female patients. Comorbidities should be paid more attention in the patients with SpA.
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Affiliation(s)
- Y Q Wen
- Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514000, China
| | - Y T Jiang
- Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Z Y Liu
- Department of Spine Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - C H Huang
- Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - Q Y Chen
- Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514000, China
| | - H S Chen
- Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Yuedong Hospital, Meizhou 514000, China
| | - Y F Pan
- Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
| | - J R Gu
- Department of Rheumatology, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China
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Lin CW, Armstrong DG, Lin CH, Liu PH, Hung SY, Lee SR, Huang CH, Huang YY. Nationwide trends in the epidemiology of diabetic foot complications and lower-extremity amputation over an 8-year period. BMJ Open Diabetes Res Care 2019; 7:e000795. [PMID: 31749971 PMCID: PMC6827817 DOI: 10.1136/bmjdrc-2019-000795] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/12/2019] [Accepted: 09/24/2019] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE To study the prevalence and trends of lower extremity complications of diabetes over an 8-year period in a single nation. RESEARCH DESIGN AND METHODS Nationwide data for people with type 2 diabetes (T2D) and diabetic foot complications (DFCs) were analyzed over an 8-year period (2007-2014) from National Health Insurance Research Database using the International Classification of Diseases, Ninth Revision disease coding. The DFCs were defined as ulcers, infections, gangrene, and hospitalization for peripheral arterial disease (PAD). Trends of patient characteristics, foot presentation, and the execution of major procedures were studied, including lower-extremity amputations (LEAs). RESULTS Along with the T2D population increasing over time, the absolute number of people with DFCs increased by 33.4%, but retained a prevalence of around 2% per year. The annual incident of LEAs decreased from 2.85 to 2.06 per 1000 T2D population (p=0.001) with the major LEA proportion decreasing from 56.2% to 47.4% (p<0.001).The mean age of patients increased from 65.3 to 66.3 years and most of the associated comorbidities of diabetes were increased. For example, end-stage renal disease increased from 4.9% to 7.7% (p=0.008). The incidence of gangrene on presentation decreased from 14.7% to 11.3% (p<0.001) with a concomitant increase in vascular interventions (6.2% to 19.5%, p<0.001). CONCLUSIONS DFCs remain a sustained major medical problem. These nationwide long-term data suggest trends toward older people with greater comorbidities such as PAD and renal disease. Nevertheless, promising trends of reducing gangrene on presentation paired with increases in vascular interventions support continued vigilance and rapid, coordinated interdisciplinary diabetic foot care.
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Affiliation(s)
- Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - David G Armstrong
- Southwestern Academic Limb Salvage Alliance (SALSA), Department of Surgery, Keck School of Medicine of University of Southern California (USC), Los Angeles, California, USA
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Pi-Hua Liu
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Shu-Ru Lee
- Clinical Informatics and Medical Statistics Research Center, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
- Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital Linkou Main Branch, Taoyuan, Taiwan
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17
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Zhang YH, Shen GL, Zhao XY, Qian HG, Huang CH, Xu J, Fan SW. [Clinical effects of adjacent fasciocutaneous flaps in repairing small wounds with bone or steel plate exposure in anterior tibia]. Zhonghua Shao Shang Za Zhi 2018; 34:907-909. [PMID: 30585056 DOI: 10.3760/cma.j.issn.1009-2587.2018.12.016] [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] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical effects of adjacent fasciocutaneous flaps in repairing small wounds with bone or steel plate exposure in anterior tibia. Methods: Twelve patients with small wounds of bone or steel plate exposure in anterior tibia covering area of 2 cm×2 cm to 5 cm×3 cm were admitted to our unit from January 2014 to December 2016. A circular or elliptical adjacent fasciocutaneous flap was designed on the normal skin located at the inside or outside of the wound according to the size of wound after thorough debridement. The pedicle of the flap was located at the proximal end and transferred through the subcutaneous tunnel to cover the wound. The sizes of flaps were 3 cm×3 cm to 6 cm×4 cm. Flaps were fixed with interrupted sutures and drainage rubber sheets were placed under the flaps. The drainage rubber sheets were removed within 24 to 48 hours. The donor area was repaired by medium-thickness skin graft collected from homolateral outer thigh. Results: All the flaps of 9 patients survived. Two patients had necrosis at the distal end of the flaps and were cured by changing dressing. One patient had tension blisters on the flap and was cured by removing blisters and improving microcirculation. All patients were followed up for 3 months, and the flaps were good in blood supply, appearance, and color, with hypaesthesia. Conclusions: Repair of small wounds with bone or steel plate exposure in anterior tibia by adjacent fasciocutaneous flap is simple in surgical procedure and does not damage the well-known blood vessels, and the appearance, texture, and thickness of flaps are close to the skin of anterior tibia region. It is a good choice for repairing this kind of wounds and worth promoting in clinic.
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Affiliation(s)
- Y H Zhang
- Department of Burns and Plastic Surgery, the First Affiliated Hospital of Soochow University, Soochow 215006, China
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18
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Huang CH, Huang YY, Hsu BRS. A short-term follow-up of glycemic and body weight changes in diabetic patients who replaced dipeptidyl peptidase-4 inhibitors with the sodium-glucose cotransporter 2. Ann Saudi Med 2018; 38:420-426. [PMID: 30531176 PMCID: PMC6302983 DOI: 10.5144/0256-4947.2018.420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Sodium-glucose cotransporter 2 inhibitors (SGLT2is, gliflozins) are associated with lower all-cause mortality than other anti-diabetic agents in patients with type 2 diabetes. In patients who may benefit from SGLT2is, but cannot add them to a dipeptidyl peptidase-4 inhibitor (DPP4i, gliptin) treatment for various reasons, replacement of the DPP4i with a SGLT2i may be considered. OBJECTIVES Evaluate changes in metabolic parameters in patients with diabetes after replacing a DPP4i with the SGLT2i empagliflozin. DESIGN Panel study (cross-sectional and cohort hybrid). SETTING The diabetes outpatient clinics of Chang Gung Memorial Hospital at Linkou, a university hospital in Taiwan. PATIENTS AND METHODS We reviewed the medical records of patients who had been treated with anti-diabetic agents including a DPP4i between May 2016 and May 2017. Patients who switched from DPP4is to empagliflozin (switched-to-empagliflozin group) without changes to other anti-diabetic agents for at least 6 months were compared patients who continued taking an original antidiabetic agent. The body weight (BW), body mass index (BMI), and glycated hemoglobin (HbA1c) level at baseline and after 3 and 6 months were collected for analysis. MAIN OUTCOME MEASURES BW, BMI, HbA1c at baseline, 3 and 6 months. SAMPLE SIZE 236 patients. RESULTS The HbA1c level and BMI of 110 patients (71%) in the switched-to-empagliflozin group were significantly reduced at 6 months after the switch, and there was a significant negative correlation between baseline HbA1c and change in HbA1c (rho=-0.537, P less than .001). In another 45 patients (29%) who switched to empagliflozin, HbA1c did not have improve, but BW decreased after the switch. No significant change in HbA1c occurred in the group that remained on DPP4is. In addition, BW and BMI decreased regardless of the degree of glucose reduction in the switched-to-empagliflozin group (P less than .001 for both variables at 6 months vs baseline), but not in the patients who remained on DPP4is. CONCLUSIONS The study demonstrated the metabolic impact of switching from a DPP4i to a well-known SGLT2i, but further large-scale trials are needed to study the long-term effects of replacing a DPP4i with a SGLT2i. LIMITATIONS Retrospective design, a short observation period, a small number of patients, no evaluations of the quality of life, side effects, or the cost, and data limited to only empagliflozin. CONFLICT OF INTEREST No any relationship or support from the manufacturer of empagliflozin or other agents.
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Affiliation(s)
| | | | - Brend Ray-Sea Hsu
- Dr. Brend Ray-Sea Hsu, Division of Endocrinology and Metabolism,, Department of Internal Medicine,, Chang Gung Memorial Hospital and, Chang Gung University,, No. 5 Fuxing St., Guishan Dist., Taoyuan City 333, Taiwan, T: +886.3281200 ext. 8821, bh0658@cloud. cgmh.org.tw, ORCID: http://orcid. org/0000-0001-7568-4599
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19
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Ding XL, Zhu PF, Huang CH, Zhang Q, Zhu JY, Liu WW, Zhou WJ. [The transformation of microcystin-LR during tap water treatment process and analysis of its degradation products]. Zhonghua Yu Fang Yi Xue Za Zhi 2018; 52:898-903. [PMID: 30196635 DOI: 10.3760/cma.j.issn.0253-9624.2018.09.006] [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] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Objective: To establish a liquid chromatography-tandem mass spectrometry (LC/MS/MS) method for the determination of microcystin-LR (MC-LR) in drinking water, investigate its removal efficiency during tap water advanced treatment process and analyze its degradation products in the tap water. Methods: Two parallel water samples were collected from each point of tap water advanced treatment process in September 2015, November 2015 and January 2016, respectively, and treated by mixing, filtration, concentration, elution, nitrogen blow and re-dissolvement. The samples were analyzed by LC/MS/MS to determine the MC-LR concentration and its removal efficiency during treatment process. The combination of actual water enrichment (including source water enrichment of 50 times and 1 500 times concentrated, finished water enrichment of 50 times and 2 500 times concentrated) and laboratory simulated water (including the mixture of MC-LR and liquid chlorine in the mass ratio of 1∶10, 1∶20, 1∶100 and 1∶1 000, respectively) were used to qualitative analyze the MC-LR degradation products by Orbitrap mass spectrometry. Results: The linearity of MC-LR ranged from 2 to 200 μg/L with the detection limit of 0.007 9 μg/L and the limit of quantification of 0.026 3 μg/L. The recovery rate of MC-LR from different contration in drinking water were from 94.88%-101.47%. The intra-day precision was 2.51%-7.93% and the intra-day precision was 3.24%-8.41%. The average concentration of MC-LR in source water was (0.631±0.262) μg/L, 94.0% of which can be removed by ozone exposure while the concentrate was (0.038±0.016) μg/L, biological pre-treatment and chlorination. The remaining can hardly be removed by sand filtration, ozone exposure, activated carbon, ultrafiltration and other processes. The MC-LR average concentration in the finished water maintained at about (0.036±0.016) μg/L. Degradation products including hydroxy-microcystin, methyl-hydroxy-microcystin, methyl-microcystin were identified in the laboratory simulated water of the mixture of MC-LR and liquid chlorine in the mass ratio of 1∶10. Conclusion: The established MC-LR detection method can be well applied to the monitoring of MC-LR in drinking water due to its simple pre-treatment process and good methodological validation parameters. The degradation products of treatment processes was different.
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Affiliation(s)
- X L Ding
- Department of Public Health, Wuxi Center for Disease Control and Prevention, Wuxi 214023, China
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20
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Pao HY, Wu CY, Huang CH, Wen CM. Development, characterization and virus susceptibility of a continuous cell line from the caudal fin of marbled eel (Anguilla marmorata). J Fish Dis 2018; 41:1331-1338. [PMID: 30003544 DOI: 10.1111/jfd.12816] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 03/28/2018] [Accepted: 03/29/2018] [Indexed: 06/08/2023]
Abstract
A continuous cell line consisting mostly of epithelioid cells was established from the caudal fin of marbled eels (Anguilla marmorata) and designated as marbled eel caudal fin (MECF)-1. The cells multiplied well in Leibovitz's L-15 medium containing 2% to 15% foetal bovine serum at temperatures of 20°C to 35°C and were subcultured for >90 passages during a 5-year period from 2012 to 2017. Transcripts of ictacalcin, keratin 13, cd146, nestin, ncam1 and myod1 were demonstrated in the cells using reverse transcription polymerase chain reaction. The results indicated that MECF-1 was composed of epidermal and mesenchyme stem and progenitor cells including myoblasts. MECF-1 was susceptible to Japanese eel herpesvirus HVA980811, marbled eel polyoma-like virus (MEPyV), aquabirnavirus MEIPNV1310 and aquareovirus CSV. By contrast, MECF-1 was noted refractory to megalocytiviruses RSIV-Ku and GSIV-K1 infection. Moreover, the cells were resistant to betanodavirus infection. In conclusion, MECF-1 derived from marbled eel is suitable for studies on anguillid viruses and interaction with host cells.
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Affiliation(s)
- H Y Pao
- Department of Life Sciences, National University of Kaohsiung, Kaohsiung, Taiwan
| | - C Y Wu
- Department of Life Sciences, National University of Kaohsiung, Kaohsiung, Taiwan
| | - C H Huang
- Department of Life Sciences, National University of Kaohsiung, Kaohsiung, Taiwan
| | - C M Wen
- Department of Life Sciences, National University of Kaohsiung, Kaohsiung, Taiwan
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21
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Huang CH, Chiu CH, Chen IW, Hung SY, Lin CW, Hsu BRS, Huang YY. Antimicrobial resistance and outcomes of community-onset bacterial bloodstream infections in patients with type 2 diabetes. J Glob Antimicrob Resist 2018; 15:271-276. [PMID: 30121344 DOI: 10.1016/j.jgar.2018.08.008] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Revised: 08/07/2018] [Accepted: 08/09/2018] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES Antimicrobial resistance of bacterial pathogens in the diabetic population with infection is seldom investigated. This study evaluated the antimicrobial resistance and outcomes of community-onset bloodstream infections (CO-BSIs) in patients with diabetes. METHODS From 2007-2014, 1271 monomicrobial CO-BSIs and 178 polymicrobial CO-BSIs were identified in patients with type 2 diabetes from three teaching hospitals in Taiwan. Antimicrobial-resistant strains of the ten most prevalent bacterial pathogens in monomicrobial CO-BSIs were recorded and were defined according to individual drug resistance. The 30-day mortality rate and factors associated with outcome were analysed. RESULTS Antimicrobial-resistant strains were found in 33.7% (379/1125) of monomicrobial CO-BSIs involving the 10 most prevalent pathogens. The leading pathogens in these monomicrobial CO-BSIs were Staphylococcus spp. (33.8%; 430/1271), Escherichia coli (20.9%; 266/1271) and Klebsiella spp. (9.6%; 122/1271); antimicrobial-resistant strains accounted for 61.9%, 18.4% and 10.7% of each, respectively. A higher overall 30-day mortality rate was observed for patients infected by antimicrobial-resistant strains compared with antimicrobial-susceptible strains (9.5% vs. 5.5%; P=0.011, log-rank test). A lower serum albumin level was a predictor of mortality after adjusting for antimicrobial-resistant strains and C-reactive protein level. CONCLUSIONS Antimicrobial-resistant bacterial pathogens pose a serious threat to diabetic patients with CO-BSIs owing to a higher risk of mortality.
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Affiliation(s)
- Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Cheng-Hsun Chiu
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - I-Wen Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan
| | - Brend Ray-Sea Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Taoyuan City, Taiwan; College of Medicine, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Taoyuan City, Taiwan.
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22
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Soh JY, Chiang WC, Huang CH, Woo CK, Ibrahim I, Heng K, Pramanick A, Lee BW. An unusual cause of food-induced anaphylaxis in mothers. World Allergy Organ J 2017; 10:3. [PMID: 28232856 PMCID: PMC5301318 DOI: 10.1186/s40413-016-0136-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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: 09/18/2016] [Accepted: 12/14/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Galacto-oligosaccharides (GOS) are prebiotics added to commercial milk formula of infants and mothers. In recent years, cases of allergy related to GOS in atopic children have been reported in the South East Asian region. CASE PRESENTATIONS We describe a series of pregnant (n = 4) and lactating mothers (n = 2) who developed anaphylactic reactions after consumption of maternal milk formula containing GOS. All six subjects had pre-existing atopy and a positive skin prick test to GOS and 5/5 of the subjects who were tested had positive basophil activation tests to GOS. All of the mothers and their babies had normal neonatal outcomes after the reactions. CONCLUSIONS The supplementation of GOS into milk and beverages in the Asian region should take into account the rare chance of allergenicity of GOS in the atopic population.
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Affiliation(s)
- J Y Soh
- Department of Paediatrics, National University Hospital, Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228 Singapore ; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - W C Chiang
- Department of Paediatrics, Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore
| | - C H Huang
- Department of Paediatrics, National University Hospital, Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228 Singapore ; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - C K Woo
- Department of Medicine, Gleneagles Hospital Kuala Lumpur, Kuala Lumpur, Malaysia
| | - I Ibrahim
- Emergency Medicine Department, National University Hospital, National University Health System, Singapore, Singapore ; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - K Heng
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore ; Emergency Department, Tan Tock Seng Hospital, Singapore, Singapore
| | - A Pramanick
- Department of Obstetrics and Gynaecology, Kandang Kerbau Women's and Children's Hospital, Singapore, Singapore
| | - B W Lee
- Department of Paediatrics, National University Hospital, Tower Block Level 12, 1E Kent Ridge Road, Singapore, 119228 Singapore ; Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Ding XL, Zhang J, Zhang Q, Huang CH, Zhou WJ. [Endocrine disrupting effects of drinking water analyzed by report gene assay]. Zhonghua Yu Fang Yi Xue Za Zhi 2017; 51:180-182. [PMID: 28219160 DOI: 10.3760/cma.j.issn.0253-9624.2017.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- X L Ding
- Department of Public Health, Wuxi Center for Disease Control and Prevention, Wuxi 214023, China
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Lin CW, Hsu BRS, Tsai JS, Yang HM, Lin JR, Lin CH, Huang CH, Hung SY, Huang YY. Effect of limb preservation status and body mass index on the survival of patients with limb-threatening diabetic foot ulcers. J Diabetes Complications 2017; 31:180-185. [PMID: 27751708 DOI: 10.1016/j.jdiacomp.2016.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 09/22/2016] [Accepted: 09/24/2016] [Indexed: 10/20/2022]
Abstract
AIMS To evaluate the effect of limb preservation status and body mass index (BMI) on the survival of patients with diabetic foot ulcers (DFUs). METHODS A total of 1346 patients treated for limb-threatening DFUs at a major diabetic foot center in Taiwan from 2002 to 2009 were tracked until December 2012. The patients were classified into three groups: limb-preserved (n=858), minor lower-extremity amputation (LEA) (n=249), and major LEA (n=239). Clinical data during treatment were used for survival analysis. RESULTS With 729 deaths, the median survival time (MST) was 6.14 (95% CI 5.63-6.65) years. Major LEA and BMI were two independent factors associated with mortality after adjusting for age, diabetic duration, HbA1c level, comorbidities and peripheral artery diseases. The mortality hazard ratios for the minor and major LEA groups were 0.92 (95% CI 0.74-1.16) and 1.34 (95% CI 1.07-1.68), respectively, to the reference group (limb-preserved). After stratifying BMI into four categories (underweight, normal weight, overweight and obesity, according to the Taiwanese definition), the MSTs for each category were 2.57, 5.24, 7.47 and 7.85years, respectively (P for trend <0.01). This "obesity paradox" was not observed in the major LEA group (P for trend 0.25). For patients with LEA, the obesity patients had lower MST than those in overweight category (7.97 and 8.84 in minor and 3.25 and 5.42 in major LEA, respectively). CONCLUSIONS For the patients treated for DFUs, major - but not minor - LEA was associated with poor survival compared with the limb-preserved group. The MST had positive correlation with BMI levels for patients with limb-preserved and minor LEA, but not for those with major LEA.
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Affiliation(s)
- Cheng-Wei Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Brend Ray-Sea Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | | | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan City, Taiwan
| | - Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan; Department of Medical Nutrition Therapy, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan.
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Gau BR, Chen HY, Hung SY, Yang HM, Yeh JT, Huang CH, Sun JH, Huang YY. Erratum to "The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers" [Journal of Diabetes and Its Complications 30 (2016) 138-142]. J Diabetes Complications 2016; 30:971. [PMID: 27118162 DOI: 10.1016/j.jdiacomp.2016.04.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/30/2022]
Affiliation(s)
- Bing-Ru Gau
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan; Division of Endocrinology and Metabolism, DaLin Tzu Chi Buddhist Hospital, Tzu Chi University, Taiwan
| | - Hsin-Yun Chen
- Medical Nutrition Therapy, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Jiun-Ting Yeh
- Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Jui-Hung Sun
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
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Huang CH, Huang YY, Hsu BRS. Pitavastatin improves glycated hemoglobin in patients with poorly controlled type 2 diabetes. J Diabetes Investig 2016; 7:769-76. [PMID: 27181110 PMCID: PMC5009141 DOI: 10.1111/jdi.12483] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [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: 10/05/2015] [Revised: 12/22/2015] [Accepted: 01/09/2016] [Indexed: 11/29/2022] Open
Abstract
Aims/Introduction To investigate the effect of pitavastatin on glucose control in patients with type 2 diabetes. Materials and Methods Medical records of 340 patients with type 2 diabetes treated with pitavastatin or atorvastatin between 1 August 2013 and 31 May 2014 were reviewed. A total of 96 patients who had not received statins were treated with pitavastatin (N to P group). A total of 100 patients who had previously used atorvastatin were switched to pitavastatin (A to P group). A total of 144 patients continued with atorvastatin treatment. Data were collected at baseline, 3 and 6 months of treatment. Changes in glycated hemoglobin (HbA1c) level were analyzed in 222 patients who did not change their antidiabetic agent during 6 months of treatment. Results A negative correlation between baseline HbA1c and delta HbA1c at 6 months was found in the pitavastatin‐treated patients (N to P group: ρ = −0.329, P = 0.006; A to P group: ρ = −0.480, P < 0.001). The correlation remained similar after adjusting for age, body mass index, dose of pitavastatin, estimated glomerular filtration rate and high‐density lipoprotein cholesterol. After 6 months of treatment, the benefit of pitavastatin on HbA1c in the patients with poorly controlled diabetes was significant in both the N to P (8.1 vs 7.4%, P = 0.018) and A to P (9.7 vs 9.0%, P = 0.015) groups. Conclusions Pitavastatin decreases HbA1c in patients with type 2 diabetes with a higher baseline HbA1c level. The benefit on HbA1c was also observed in patients with previous use of atorvastatin.
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Affiliation(s)
- Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Brend Ray-Sea Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
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Gau BR, Chen HY, Hung SY, Yang HM, Yeh JT, Huang CH, Sun JH, Huang YY. The impact of nutritional status on treatment outcomes of patients with limb-threatening diabetic foot ulcers. J Diabetes Complications 2016; 30:138-42. [PMID: 26490754 DOI: 10.1016/j.jdiacomp.2015.09.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2015] [Revised: 08/31/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
AIM This study aimed to investigate the nutritional status of patients with limb-threatening diabetic foot ulcers (DFUs) and its impact on treatment outcomes. METHODS A total of 478 consecutive patients (mean age, 65.4years) treated for limb-threatening DFUs were enrolled. Nutritional status assessment using the Mini Nutritional Assessment (MNA) and Geriatric Nutritional Risk Index (GNRI) was performed by three qualified dieticians within 48hours of admission. Limb-preservation outcomes were stratified into major lower extremity amputation (LEA) (above the ankle, n=33), minor LEA (distal to ankle, n=117) and no amputation (non-LEA, n=328). RESULTS Most patients were identified as being at risk of malnutrition (70.5%) or malnourished (14.6%) (mean MNA score, 20.6±3.4). MNA scores decreased with increasing severity of LEA (mean, 21.1, 20.0, and 17.9, respectively; P for linear trend <0.001), associated inversely with the tendency to require LEA (P for linear trend was 0.001), and associated independently with both major and minor LEA outcomes (adjusted odds ratio [aOR]=0.80, 95% confidence interval [CI], 0.65-0.99, P=0.042 and aOR=0.89, 95% CI, 0.80-0.99, P=0.032, respectively). The predictive value was sustained in patients younger than age 65years. Though GNRI results had similar associations with outcomes, its predictive value was limited in minor LEA and younger population. CONCLUSIONS Patients' nutritional status was shown to have significant influence on limb-preservation outcomes for limb-threatening DFUs. Nutritional assessment of this patient population using the MNA is recommended.
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Affiliation(s)
- Bing-Ru Gau
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan; Division of Endocrinology and Metabolism, DaLin Tzu Chi Buddhist Hospital, Tzu Chi University, Taiwan
| | - Hsin-Yun Chen
- Medical Nutrition Therapy, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Shih-Yuan Hung
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Hui-Mei Yang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Jiun-Ting Yeh
- Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Chung-Huei Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Jui-Hung Sun
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
| | - Yu-Yao Huang
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan.
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Jao Y, Wu SW, Lin TY, Hung CT, Yang PW, Huang CH, Lin CY, Lin WR, Chen YH, Lu PL. Free-flow duration prior as an influential factor on microorganism and endotoxin amount of reverse osmosis water for dialysis. Antimicrob Resist Infect Control 2015. [PMCID: PMC4474847 DOI: 10.1186/2047-2994-4-s1-p65] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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29
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Wu SW, Jao YT, Hung CT, Yang PW, Hung TH, Lin SH, Huang CH, Lin CY, Chen YH. Evaluation of terminal room cleaning and disinfection after patients infected/colonized with vancomycin-resistant enterococci (VRE) discharge in an adult intensive care unit of a medical center. Antimicrob Resist Infect Control 2015. [PMCID: PMC4475092 DOI: 10.1186/2047-2994-4-s1-p202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Chen IW, Yang HM, Chiu CH, Yeh JT, Huang CH, Huang YY. Clinical Characteristics and Risk Factor Analysis for Lower-Extremity Amputations in Diabetic Patients With Foot Ulcer Complicated by Necrotizing Fasciitis. Medicine (Baltimore) 2015; 94:e1957. [PMID: 26554804 PMCID: PMC4915905 DOI: 10.1097/md.0000000000001957] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Patients with diabetes are at a higher risk of having diabetic foot ulcers (DFUs) or necrotizing fasciitis (NF). The present study aims to examine the clinical characteristics and associated risk factors for lower-extremity amputation (LEA) in patients with DFU complicated by NF.We retrospectively reviewed patients treated at a major diabetic foot center in Taiwan between 2009 and 2014. Of the 2265 cases 110 had lower-extremity NF. Limb preservation outcomes were classified as major LEA, minor LEA, or limb-preserved. Clinical characteristics, laboratory data, and bacterial culture results were collected for analysis.Of the 110 patients with NF, 100 had concomitant DFUs (NF with DFU) and the remaining 10 had no DFU (NF without DFU). None of the NF patients without DFU died nor had their leg amputated. Two NF patients with DFU died of complications. The amputation rate in the surviving 98 NF patients with DFU was 72.4% (46.9% minor LEA and 25.5% major LEA). Seventy percent of the NF patients without DFU had monomicrobial infections (60% with Streptococcus species), and 81.4% NF patients with DFU had polymicrobial infections. Anaerobic organisms were identified in 66% of the NF patients with DFU. Multinomial logistic regression analysis revealed an association between high-grade Wagner wound classification (Wagner 4 and Wagner 5) and LEA (adjusted odds ratio [aOR] = 21.856, 95% confidence interval [95% CI] = 1.625-203.947, P = 0.02 and aOR = 20.094, 95% CI = 1.968-205.216, P = 0.01 for major and minor LEA, respectively) for NF patients with DFU. In addition, a lower serum albumin level was associated with major LEA (OR = 0.066, P = 0.002).In summary, once DFUs were complicated by NF, the risk of amputation increased. Empirical treatment for NF patients with DFU should cover polymicrobial infections, including anaerobic organisms. The high-grade wound classification and low serum albumin level were associated with LEA.
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Affiliation(s)
- I-Wen Chen
- From the Division of Endocrinology and Metabolism, Department of Internal Medicine (I-WC, H-MY, C-HH, Y-YH), Molecular Infectious Disease Research Center, Division of Pediatric Infectious Diseases, Department of Pediatrics (C-HC); and Division of Trauma Plastic Surgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan City, Taiwan (J-TY)
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Huang CH, Tsai JS, Chen IW, Hsu BRS, Huang MJ, Huang YY. Risk factors for in-hospital mortality in patients with type 2 diabetes complicated by community-acquired Klebsiella pneumoniae bacteremia. J Formos Med Assoc 2015; 114:916-22. [DOI: 10.1016/j.jfma.2015.07.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 07/07/2015] [Accepted: 07/08/2015] [Indexed: 01/26/2023] Open
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Huang CH. Derivation of exemption formulas for air quality regulatory applications. J Air Waste Manag Assoc 2015; 65:358-364. [PMID: 25947131 DOI: 10.1080/10962247.2014.993003] [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] [Indexed: 06/04/2023]
Abstract
UNLABELLED The regulatory agencies and the industries have the responsibility for assessing the environmental impact from the release of air pollutants, and for protecting environment and public health. The simple exemption formula is often used as a criterion for the purpose of screening air pollutants. That is, the exemption formula is used for air quality review and to determine whether a facility applying for and described in a new, modified, or revised air quality plan is exempted from further air quality review. The Bureau of Ocean Energy Management's (BOEM) air quality regulations are used to regulate air emissions and air pollutants released from the oil and gas facilities in the Gulf of Mexico. If a facility is not exempt after completing the air quality review, a refined air quality modeling will be required to regulate the air pollutants. However, at present, the scientific basis for BOEM's exemption formula is not available to the author. Therefore, the purpose of this paper is to provide the theoretical framework and justification for the use of BOEM's exemption formula. In this paper, several exemption formulas have been derived from the Gaussian and non-Gaussian dispersion models; the Gaussian dispersion model is a special case of non-Gaussian dispersion model. The dispersion parameters obtained from the tracer experiments in the Gulf of Mexico are used in the dispersion models. In this paper, the dispersion parameters used in the dispersion models are also derived from the Monin-Obukhov similarity theory. In particular, it has been shown that the total amount of emissions from the facility for each air pollutant calculated using BOEM's exemption formula is conservative. IMPLICATIONS The operation of offshore oil and gas facilities under BOEM's jurisdiction is required to comply with the BOEM's regulations. BOEM's air quality regulations are used to regulate air emissions and air pollutants released from the oil and gas facilities in the Gulf of Mexico. The exemption formulas have been used by BOEM and other regulatory agencies as a screening tool to regulate air emissions emitted from the oil and gas and other industries. Because of the BOEM's regulatory responsibility, it is important to establish the scientific basis and provide the justification for the exemption formulas. The methodology developed here could also be adopted and used by other regulatory agencies.
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Affiliation(s)
- C H Huang
- a The Bureau of Ocean Energy Management , Gulf of Mexico Outer Continental Shelf Region , New Orleans , LA , USA
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Abstract
Syringaldehyde is one of the active principles from the stems of Hibiscus taiwanensis (Malvaceae) that has been mentioned to lower hyperglycemia. However, the potential mechanisms for this action of syringaldehyde remain obscure. In the present study, we used streptozotocin to induce diabetic rats (STZ-diabetic rats) as type 1-like diabetic rats and fed fructose-rich chow to rats as type 2-like diabetic rats. Then, we performed the postprandial glucose test and applied the hyperinsulinemic euglycemic clamp to investigate the actions of syringaldehyde. Also, the changes of gene expressions of enzyme relating to glucose homeostasis in muscle and liver were characterized. Syringaldehyde significantly decreased the postprandial plasma glucose in rats, while the plasma insulin was not modified by syringaldehyde. The glucose infusion rate (GIR) in fructose chow-fed rats using hyperinsulinemic euglycemic clamp was markedly improved by syringaldehyde. Additionally, repeated administration of syringaldehyde for 3 days in STZ-diabetic rats resulted in a marked reduction of phosphoenolpyruvate carboxykinase (PEPCK) expression in liver and an increased expression of glucose transporter subtype 4 (GLUT 4) in skeletal muscle. Our results suggest that syringaldehyde may increase glucose utilization to lower hyperglycemia in diabetic rats.
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Affiliation(s)
- S C Kuo
- Department of Ophthalmology, Chi-Mei Medical Center, Yong Kang, Tainan City, Taiwan
| | - H H Chung
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - C H Huang
- Department of Biological Science and Technology, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - J T Cheng
- Department of Medical Research, Chi-Mei Medical Center, Yung Kang, Tainan City, Taiwan
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Chang KP, Tsai TW, Huang KY, Huang CH, Wang SY, Cheng CW, Chen JK, Tzou DY. Thermal response of a dental tissue induced by femtosecond laser pulses. Appl Opt 2013; 52:6626-6635. [PMID: 24085159 DOI: 10.1364/ao.52.006626] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 08/06/2013] [Indexed: 06/02/2023]
Abstract
This paper reports a theoretical and experimental study for thermal transport in a thin slice of human tooth induced by a 120 fs, 800 nm pulse laser at a repetition rate of 1 kHz. The surface reflectivity of enamel and the convection heat transfer coefficient were determined using an inverse heat transfer analysis. Instead of a fully three-dimensional modeling, two simplified two-dimensional (2D) planar and axisymmetric heat conduction models were proposed to simulate the temperature fields. The temperature responses obtained from the 2D planar and axisymmetric model agree well with the experimental measurements. On the other hand, the one-dimensional (1D) result significantly differs from the 2D axisymmetric one, suggesting that care should be taken when a 1D thermal model is considered for estimating temperature response.
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Abstract
BACKGROUND Clozapine, an atypical antipsychotic drug, induces derangements in glucose homeostasis in certain patients. This study investigated the mechanisms of clozapine-induced beta-cell toxicity. METHODS Fifty-two healthy C57BL/6 male mice were randomized into 4 groups to study the effects of clozapine (group C, D) and a high-fat diet (group B, D). Three mice from each group were randomly selected to determine the amount of food intake on days 8-10, and their pancreases were removed for histological examination on day 11. The remaining 10 mice in each group were sacrificed at the 8th week to measure pancreatic insulin content (PIC). RESULTS Mice given clozapine for 8 weeks demonstrated trends of lower PIC. The histological examination of the pancreases retrieved on day 11 already revealed apoptotic changes and suppression of cell proliferation. Although mice fed high-fat chow gained weight, mice given both clozapine and a high-fat diet showed less weight gain and more severe histological deterioration, and had the lowest PIC levels of the 4 groups. CONCLUSION Pancreatic beta-cell apoptosis, suppression of cell proliferation, and trends of reduction in pancreatic insulin content were observed in mice taking clozapine. The findings of clozapine induced beta-cell toxicity were further aggravated when mice were concomitantly fed a high-fat diet.
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Affiliation(s)
- Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Tsai CY, Chu SY, Wen YW, Hsu LA, Chen CC, Peng SH, Huang CH, Sun JH, Huang YY. The value of Doppler waveform analysis in predicting major lower extremity amputation among dialysis patients treated for diabetic foot ulcers. Diabetes Res Clin Pract 2013; 100:181-8. [PMID: 23540680 DOI: 10.1016/j.diabres.2013.03.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [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] [Received: 12/04/2012] [Revised: 02/03/2013] [Accepted: 03/06/2013] [Indexed: 01/22/2023]
Abstract
AIMS This study examined the predictors for lower extremity amputation (LEA) in patients with diabetic foot ulcers according to kidney function and, in the case of dialysis patients, specifically evaluated the vasculature with the ankle-brachial index (ABI) and Doppler waveforms. METHODS Among 658 diabetic patients admitted to the Diabetic Foot Care Center, 286 had an estimated glomerular filtration rate (eGFR)≥ 60 ml/min per 1.73 m(2), 275 had an eGFR<60, and 97 patients were under maintenance dialysis. All clinical variables were analyzed. A specialist retrospectively reviewed Doppler images of 78 of the patients in dialysis to evaluate peripheral arterial disease. RESULTS Forty-two percent of patients with eGFR<60 presented with ABI≤0.90. For ABI values>1.40, the proportion of dialysis patients (31.3%) was greater than the proportion of patients with eGFR<60 (5.3%). Wagner wound classifications, reduced serum albumin levels, and low ABI values were the predictors for major LEA among patients in the non-dialysis groups. Nevertheless, these indicators were not predictive of the risk of amputation in diabetic patients on dialysis. The presence of poor monophasic waveforms in the dorsalis pedis artery or posterior tibial artery served as an independent predictor (odds ratio: 7.61; P=0.008) for major LEA among dialysis patients. The sensitivity and specificity were 88.0% and 59.6%, respectively. CONCLUSIONS Poor monophasic Doppler waveforms of below-the-knee arteries, commonly found among dialysis patients in treatment for diabetic foot ulcers, can serve as an independent predictor for major LEA.
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Affiliation(s)
- Chih-Yiu Tsai
- Division of Endocrinology and Metabolism, Chang Gung Memorial Hospital, Chang Gung University, Taiwan
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Kuo WY, Huang CH, Liu AC, Cheng CP, Li SH, Chang WC, Weiss C, Azem A, Jinn TL. CHAPERONIN 20 mediates iron superoxide dismutase (FeSOD) activity independent of its co-chaperonin role in Arabidopsis chloroplasts. New Phytol 2013; 197:99-110. [PMID: 23057508 DOI: 10.1111/j.1469-8137.2012.04369.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2012] [Accepted: 09/03/2012] [Indexed: 05/08/2023]
Abstract
Iron superoxide dismutases (FeSODs; FSDs) are primary antioxidant enzymes in Arabidopsis thaliana chloroplasts. The stromal FSD1 conferred the only detectable FeSOD activity, whereas the thylakoid membrane- and nucleoid-co-localized FSD2 and FSD3 double mutant showed arrested chloroplast development. FeSOD requires cofactor Fe for its activity, but its mechanism of activation is unclear. We used reversed-phase high-performance liquid chromatography (HPLC), gel filtration chromatography, LC-MS/MS, protoplast transient expression and virus-induced gene silencing (VIGS) analyses to identify and characterize a factor involved in FeSOD activation. We identified the chloroplast-localized co-chaperonin CHAPERONIN 20 (CPN20) as a mediator of FeSOD activation by direct interaction. The relationship between CPN20 and FeSOD was confirmed by in vitro experiments showing that CPN20 alone could enhance FSD1, FSD2 and FSD3 activity. The in vivo results showed that CPN20-overexpressing mutants and mutants with defective co-chaperonin activity increased FSD1 activity, without changing the chaperonin CPN60 protein level, and VIGS-induced downregulation of CPN20 also led to decreased FeSOD activity. Our findings reveal that CPN20 can mediate FeSOD activation in chloroplasts, a role independent of its known function in the chaperonin system.
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Affiliation(s)
- W Y Kuo
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - C H Huang
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - A C Liu
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - C P Cheng
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
| | - S H Li
- Department of Medical Research, Mackay Memorial Hospital, Tamshui, 25160, Taiwan
| | - W C Chang
- Genomics Research Center, Academia Sinica, Taipei, 11529, Taiwan
| | - C Weiss
- Department of Biochemistry and Molecular Biology, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, 69978, Israel
| | - A Azem
- Department of Biochemistry and Molecular Biology, George S. Wise Faculty of Life Sciences, Tel Aviv University, Tel Aviv, 69978, Israel
| | - T L Jinn
- Institute of Plant Biology and Department of Life Science, National Taiwan University, Taipei, 10617, Taiwan
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Huang CH, Chao TC, Hseuh C, Lin KJ, Ho TY, Lin SF, Lin JD. Therapeutic outcome and prognosis in young patients with papillary and follicular thyroid cancer. Pediatr Surg Int 2012; 28:489-94. [PMID: 22274547 DOI: 10.1007/s00383-012-3054-1] [Citation(s) in RCA: 12] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/09/2012] [Indexed: 01/28/2023]
Abstract
BACKGROUND Papillary and follicular thyroid cancer is a common malignancy in young patients, and the incidence of this cancer has been increasing. The aims of this study are to assess the clinical characteristics of papillary and follicular thyroid cancer in young patients and evaluate the long-term therapeutic outcomes and prognostic factors for cancer mortality and recurrence. METHODS We performed a retrospective analysis of 116 patients aged ≤20 years who underwent thyroidectomy and a mean follow-up of 11.1 ± 0.6 years. RESULTS There were 28 (24.1%) patients classified into the residual cancer or relapse groups. The progression-free survival rate for the young patients was lower than that of the patients between 20 and 45 years of age; however, the difference between the thyroid cancer survival rates was not statistically different. Two of the 28 patients died of thyroid cancer. Thirteen patients who showed relapsed underwent (131)I whole-body scan; 6 of the 13 patients were diagnosed with distant metastases to the lung and 1 was diagnosed with distant metastases to the bones. Among the young patients, the 5- and 10-year progression-free survival rates were 79.1 and 73.4%, respectively, and the corresponding cancer survival rates were 99.1, and 96.5%, respectively. CONCLUSION The progression-free survival in young patients with papillary and follicular thyroid cancer was lower than the patients of age 20-45 years; otherwise, cancer survival was higher than age group over or equal to 45 years.
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Affiliation(s)
- Chung-Huei Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5, Fu-Shin St., Taoyuan Hsien, Kweishan County, Taiwan, ROC
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Sun JH, Tsai JS, Huang CH, Lin CH, Yang HM, Chan YS, Hsieh SH, Hsu BRS, Huang YY. Risk factors for lower extremity amputation in diabetic foot disease categorized by Wagner classification. Diabetes Res Clin Pract 2012; 95:358-63. [PMID: 22115502 DOI: 10.1016/j.diabres.2011.10.034] [Citation(s) in RCA: 78] [Impact Index Per Article: 6.5] [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] [Received: 07/22/2011] [Revised: 10/07/2011] [Accepted: 10/24/2011] [Indexed: 01/08/2023]
Abstract
AIMS To elucidate the risk factors for lower extremity amputation (LEA) in patients of diabetic foot disease with different Wagner gradings. METHODS This study was conducted in a multidisciplinary diabetic foot care center. Demographic characteristics, laboratory data, disease history, ankle brachial pressure index (ABI) and Wagner classification were considered as independent variables to predict the therapeutic outcome (major LEA, minor LEA, and non-amputation). Risk factors for LEA in different Wagner grades were further analyzed. Multivariate stepwise ordinal logistic regression was performed. RESULTS Of 789 study subjects, 19.9% received major LEA and 22.9% received minor LEA. Higher Wagner grade, lower ABI, serum albumin and hemoglobin, and elevated white blood cell (WBC) count were significantly associated with an increased risk of LEA. When stratified by Wagner classification, most of the above predictors and estimated glomerular filtration (eGFR) were detected only in grade 3. While in grades 2 and 4, WBC count was identified as primary predictor positively associated with an increased risk of LEA. CONCLUSIONS Wagner classification remarkably influenced the potential risk factors for LEA, showing different predictors in different grades. The traditionally recognized predictors for diabetic foot amputation such as lower ABI, albumin or eGFR were almost exclusively found in patients with Wagner grade 3.
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Affiliation(s)
- Jui-Hung Sun
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, 5 Fusing St., Gueishan Township, Taoyuan County 333, Taiwan, ROC
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Wu CC, Lin TS, Yang TT, Hsu HW, Chang CL, Huang CH, Lin WY. Seasonal variation and health risk assessment of polycyclic aromatic hydrocarbons in Miaoli city, Taiwan. Bull Environ Contam Toxicol 2012; 88:433-437. [PMID: 22048669 DOI: 10.1007/s00128-011-0456-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 10/24/2011] [Indexed: 05/31/2023]
Abstract
The ambient PAHs levels in the downtown area of a traditional small city were analyzed for winter and summer seasons. A total of 16 PAHs in gaseous and particulate phase were quantified. The average gaseous PAHs were 2,189 ± 1,194 and 623.8 ± 545.1 ng/m(3) in winter and summer seasons, respectively. For the PAHs in particulate phase, they were 40.32 ± 12.15 and 11.99 ± 5.63 ng/m(3) in winter and summer seasons, respectively. These values were comparable to those reported for large cities or even higher. The estimated BaPeq was 12.32 ± 6.34 ng/m(3). As low-molecular-weight PAHs primarily existed in gaseous phase, high-molecular-weight PAHs in particulate phase became a significant fraction of total particulate phase PAHs. Particulate phase PAHs was significantly inversely associated with the ambient temperature for each individual PAHs species. However, this relationship did not exist for high-molecular-weight PAHs in gaseous phase. The results indicated the photo-degradation of high-molecular-weight PAHs should warrant a further thoughtfully investigation.
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Affiliation(s)
- C C Wu
- Department of Public Health, China Medical University, Taichung, Taiwan
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Chen KR, Chu WH, Fang HC, Liu CP, Huang CH, Chui HC, Chuang CH, Lo YL, Lin CY, Hwung HH, Fuh AYG. Beyond-limit light focusing in the intermediate zone. Opt Lett 2011; 36:4497-4499. [PMID: 22139221 DOI: 10.1364/ol.36.004497] [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] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We experimentally verify that a new nanolens of a designed plasmonic aperture can focus visible light to a single line with its width smaller than the limit of half the wavelength in the intermediate zone. The experimental measurement indicates that while the near field plays a role to increase the spot size in the near zone, it is negligible at the beyond-limit focused region; i.e., the focused light is dominated by the radiative fields. The image taken by the optical microscope shows that the fields focused have propagated to the far zone. Besides being of academic interest, the nanolens capable in achieving a lower diffraction limit in the intermediate zone is important for application possibilities.
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Affiliation(s)
- K R Chen
- Department of Physics, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan.
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Huang CH, Hu RH, Shih FJ, Chen HM, Shih FJ. Motivations and decision-making dilemmas of overseas liver transplantation: Taiwan recipients' perspectives. Transplant Proc 2011; 43:1754-6. [PMID: 21693272 DOI: 10.1016/j.transproceed.2011.03.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2010] [Revised: 02/21/2011] [Accepted: 03/09/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE This study sought to explore the motivation and dilemmas in the decision-making process encountered by Taiwan overseas orthotopic liver transplant (OLT) recipients. PATIENTS AND METHODS We used an exploratory qualitative research method on a sample of transplant recipients. Face-to-face in-depth interviews were performed with a semistructured interview guide. Data were evaluated by qualitative content analysis. RESULTS We interviewed 15 patients including 11 males and 4 females aged between 41 and 68 years (mean = 57.3) including 14 who received OLT in China and one in the United States. The most important motivations were saving lives from end-stage liver disease and avoiding a hopeless sense of their residual lives with the psychological torture of a waiting death. Their decision-making process leading to overseas OLT could be divided into several phases among which the phase of transplant data evaluation and decision was the most critical one. Nevertheless, every stage and phase had its unique contents, factors, and dilemmas. CONCLUSION This study demonstrated that patients encountered various dilemmas at different phases in the decision-making process of considering overseas OLT. This information is important for care providers and policy makers in dealing with patients who consider overseas OLT.
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Affiliation(s)
- C H Huang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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Chen WH, Chiu CH, Huang CH, Lin CH, Sun JH, Huang YY, Wang CC. Pyogenic liver abscess caused by Pseudomonas aeruginosa: Clinical analysis of 20 cases. ACTA ACUST UNITED AC 2011; 43:877-82. [DOI: 10.3109/00365548.2011.599332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Lin CP, Wang YC, Lin FS, Huang CH, Sun WZ. Ultrasound-assisted percutaneous catheterization of the axillary vein for totally implantable venous access device. Eur J Surg Oncol 2011; 37:448-51. [PMID: 21345637 DOI: 10.1016/j.ejso.2011.01.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2010] [Revised: 01/21/2011] [Accepted: 01/25/2011] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Placing a totally implantable venous access device (TIVAD) using the classical subclavian vein puncture method carries the risk of certain complications including hemothorax, pneumothorax and pinch-off syndrome. We set out to determine whether percutaneous axillary vein catheterization can decrease the incidence of these complications. METHOD This is a prospective, observational, uni-institutional study. We analyzed the outcome of 113 TIVADs performed by ultrasound-assisted percutaneous axillary vein catheterization from Jun. 2008 to Dec. 2008. Junior residents novice to subclavian and axillary vein catheterization performed the procedures. Insertion and indwelling catheter complications were recorded. RESULT In our study population, 100% of TIVAD placements were successful. 27 patients (23.9%) required 3 or more repeated punctures; only one patient (0.9%) had clinically insignificant pneumothorax. Neither arterial puncture nor brachial plexus injury was recorded in our study. CONCLUSION Ultrasound-assisted percutaneous axillary vein catheterization for TIVAD is a safe and relatively simple method for inexperienced operators.
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Affiliation(s)
- C P Lin
- Department of Anesthesiology, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan.
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Lin CH, Huang CH, Tsai JS, Hsieh SH, Sun JH, Huang BY, Huang MJ, Huang YY. Effects of a novel short-term continuous subcutaneous insulin infusion program evaluated by continuous glucose monitoring on young adult type 1 diabetic patients in Taiwan. Endocr J 2011; 58:835-40. [PMID: 21828934 DOI: 10.1507/endocrj.ej11-0036] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [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: 11/23/2022] Open
Abstract
The aim of this study is to evaluate the effectiveness of blood sugar control by a short-course reinforcement program, consisting of using continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring (CGM) for young adult type 1 diabetic patients. Twenty-six pump-naïve type 1 diabetic patients were successively enrolled in two years. The mean disease duration was 13 years and the mean HbA1c was 8.8 %. Initially, a 3-day course of CGM was used to evaluate the baseline glycemic status of the subjects, followed by 6-day intensive insulin adjustment by CSII therapy. Thereafter, a second course of CGM was performed to evaluate the effectiveness of our outcomes in comparison to the initial measurements. All participants received necessary education and instruction as required throughout the course of the program. The glucose variability as measured by standard deviation of plasma glucose and mean amplitude of glucose excursion decreased significantly (67.8 ± 2.7 to 52.0 ± 1.8 mg/dL and 140.4 ± 6.5 to 105.5 ± 5.3 mg/dL, p < 0.001). The hypoglycemic events noted per patient were reduced by 46.4% (p = 0.003) and occurred significantly less often during nocturnal periods (-63.2%, p = 0.002). Following the adjustment, the mean daily insulin requirement was reduced by 28.05% (from 0.82 to 0.59 IU/kg) and the new proportion of 40% as basal insulin was found. The short-term CSII program provided significant improvement in blood sugar control for type 1 diabetic patients, by reducing hypoglycemic events, glucose excursion, and insulin dosage in our examined subjects.
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Affiliation(s)
- Chia-Hung Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital and Chang Gung University, Taoyuan, Taiwan
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Huang CH, Tsou YK, Lin CH, Tang JH. Endoscopic retrograde cholangiopancreatography (ERCP) for intradiverticular papilla: endoclip-assisted biliary cannulation. Endoscopy 2010; 42 Suppl 2:E223-4. [PMID: 20931451 DOI: 10.1055/s-0029-1215008] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [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: 02/08/2023]
Affiliation(s)
- C H Huang
- Department of Hepato-Gastroenterology, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taipei, Taiwan
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Wang HK, Huang CH, Chen KS, Peng YP, Lai CH. Measurement and source characteristics of carbonyl compounds in the atmosphere in Kaohsiung city, Taiwan. J Hazard Mater 2010; 179:1115-1121. [PMID: 20427126 DOI: 10.1016/j.jhazmat.2010.03.122] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2009] [Revised: 03/29/2010] [Accepted: 03/30/2010] [Indexed: 05/29/2023]
Abstract
The concentrations of eighteen atmospheric carbonyls species were measured by the LpDNPH-Cartridge and the microcomputer air sampling device at Nan-Chie (northern part) and Hsiung-Kong (southern part) sites in Kaohsiung city, southern Taiwan. These samples were then analyzed using a high performance liquid chromatography (HPLC). Measurements showed that the highest concentrations of carbonyls were formaldehyde (18.33 and 18.74 microg m(-3)) at the Nan-Chie and Hsiung-Kong site, followed by acetaldehyde (14.90 and 15.71 microg m(-3)). The concentrations of total carbonyls were higher at Hsiung-Kong site (66.96 microg m(-3)) than at Nan-Chie site (60.41 microg m(-3)). The concentrations of total carbonyls at Nan-Chie site (or Hsiung-Kong site) were 74.06 microg m(-3) (89.99 microg m(-3)) in summer and 37.14 microg m(-3) (46.50 microg m(-3)) in winter, due to the fact that photochemical activities are stronger in summer than in winter. The results of principal component analysis (PCA)/absolute principal component scores (APCS) suggest that the primary pollution sources at Nan-Chie were vehicle exhausts (gasoline and diesel engines), stationary emissions (petrochemical and food industry) and restaurant emissions, and the primary pollution sources at Hsiung-Kong were vehicle exhausts (gasoline and diesel engines), stationary emissions (metal assembly and petrochemical industry) and restaurant emissions.
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Affiliation(s)
- H K Wang
- Institute of Environmental Engineering, National Sun Yat-Sen University, 70 Lein_hei Road, Ku-San District, Kaohsiung 80424, Taiwan, ROC
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Victor J, Huang CH. DEPRESSION OF ANAEROBIC GLYCOLYSIS OF EMBRYONIC TISSUE BY WESTERN STRAIN OF EQUINE ENCEPHALOMYELITIS VIRUS. PREVENTION OF THIS EFFECT BY SPECIFIC IMMUNE SERUM. ACTA ACUST UNITED AC 2010; 79:129-35. [PMID: 19871358 PMCID: PMC2135444 DOI: 10.1084/jem.79.2.129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Studies were made on the effect of mixing the Western strain of equine encephalomyelitis virus (W.E.E.) and embryonic tissue on the rate of anaerobic glycolysis of the tissue. Whole chick embryo, chick embryo from which brain and spinal cord had been removed, and embryonic skeletal muscle were employed. 1. W.E.E. virus depressed the rate of anaerobic glycolysis of embryonic tissues within 2 days after its addition to the tissue. The decrease in anaerobic glycolysis varied from 17 to 82 per cent and was apparent 2 to 4 days after the addition of the virus. No significant effect of the virus was observed 4 hours and 6 days after mixing it with the tissue. 2. Anti-W.E.E. immune serum prevented the inhibiting action of W.E.E. virus on the anaerobic glycolysis of embryonic skeletal muscle.
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Affiliation(s)
- J Victor
- Research Service, First Division, Goldwater Memorial Hospital, Department of Hospitals, City of New York, and the Department of Medicine, College of Physicians and Surgeons, Columbia University, New York
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Abstract
1. Titration and neutralization of the Western strain of equine encephalomyelitis virus can be carried out in vitro by means of tissue culture. 2. The in vitro titration test as presented is a more sensitive method than animal inoculation. 3. Tissue culture may be better than animal inoculation for the detection of small amounts of virus. 4. The neutralization obtained in tissue culture is 100 to 1,000 times greater than that observed in the intracerebral test in mice and is comparable to the potency obtained by the intraperitoneal route of inoculation. 5. The possibility of applying this method to the study of other viruses, known and unknown, is discussed. 6. Further applications of the method described above to evaluation and standardization of bacterial toxins and antitoxins and to the testing of the toxicity of biological and chemical products are suggested. 7. Evidence for the reactivation in vitro as well as in vivo of virus in neutral mixtures by dilution is presented.
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Affiliation(s)
- C H Huang
- Departments of Medicine and Bacteriology, College of Physicians and Surgeons, Columbia University, New York
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Chen CC, Huang CH, Cheng YH, Chen TC, Yeh SD, Chang CA. First Report of Capsicum chlorosis virus Infecting Amaryllis and Blood Lily in Taiwan. Plant Dis 2009; 93:1346. [PMID: 30759525 DOI: 10.1094/pdis-93-12-1346a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Capsicum chlorosis virus (CaCV), a thrips-transmitted, tentative species in the genus Tospovirus, family Bunyaviridae, was first identified in solanaceous crops, but also infects several ornamental crops such as orchid (4), gloxinia (3), and calla lily (1). From 2005 to 2007, virus-like yellow ringspots were observed on the leaves of amaryllis (Hippeastrum hybridum Hort.) and blood lily (Haemanthus multiflorus Martyn.) plants cultured in screenhouses and a private garden, respectively. Three of several hundred amaryllis plants in screenhouses from two places were observed as showing yellow ringspot symptoms and one of six blood lily plants was observed as showing similar yellow ringspot symptoms. Sap extracts from symptomatic leaves were inoculated to Chenopodium quinoa Willd. and the resulting local lesions were passaged three successive times to C. quinoa for virus isolation. Using the tospovirus genus-specific primers gL3637 and gL4435c designed from the conserved region in the L RNA (2), DNA fragments of the expected size of 800 bp were amplified by reverse transcription (RT)-PCR from field samples and local lesions from C. quinoa. Extracts from the diseased plants and local lesions of C. quinoa reacted strongly with antiserum against the nucleocapsid (N) protein of CaCV in ELISA and western blotting. To confirm the identity of this virus, we amplified the N gene from three amaryllis and one blood lily source using primer pair WN2328 and WN3534 designed from the S RNA of Watermelon silver mottle virus (1), and these products were cloned and sequenced. The sequence from each virus isolate was determined from three independent clones. The nucleotide and deduced amino acid sequences of N genes for the blood lily isolate (GenBank Accession No. EF101344) and three amaryllis isolates (GenBank Accession Nos. EF101343, EF137177, and FJ185170) had identities greater than 97% with that of a CaCV isolate infecting Capsicum spp. found in Australia (GenBank Accession No. AY036057). Phylogenetic analysis using maximum parsimony showed that these sequences clustered with CaCV. These results show that the virus identified from amaryllis and blood lily that were expressing yellow ringspot symptoms are isolates of CaCV. To our knowledge, this is the first report of CaCV naturally infecting amaryllis and blood lily and it could become an important threat to ornamental production in Taiwan. References: (1) C. C. Chen et al. Plant Dis. 91:1201, 2007. (2) F. H. Chu et al. Phytopathology 91:361, 2001. (3) H. T. Hsu et al. J. Gen. Plant Pathol. 66:167, 2000. (4) Y. X. Zheng et al. Eur. J. Plant Pathol. 120:199, 2008.
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Affiliation(s)
- C C Chen
- Division of Plant Pathology, Agricultural Research Institute, Wufeng, Taichung, Taiwan
| | - C H Huang
- Division of Plant Pathology, Agricultural Research Institute, Wufeng, Taichung, Taiwan
| | - Y H Cheng
- Division of Plant Pathology, Agricultural Research Institute, Wufeng, Taichung, Taiwan
| | - T C Chen
- Department of Biotechnology, Asia University, Wufeng, Taichung, Taiwan
| | - S D Yeh
- Department of Plant Pathology, National Chung Hsing University, Taichung, Taiwan
| | - C A Chang
- Graduate Institute of Biochemical Science and Technology, Chaoyang University of Technology, Wufeng, Taichung, Taiwan
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