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Chan MJ, Chen SW, Fan PC, Lee CC, Chen JJ, Kuo G, Chen YC, Chang CH. Long-Term Clinical Outcomes of Acute Kidney Disease in Patients Receiving Extracorporeal Membrane Oxygenation. Cardiorenal Med 2024:000539151. [PMID: 38697053 DOI: 10.1159/000539151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 04/22/2024] [Indexed: 05/04/2024] Open
Abstract
INTRODUCTION Extracorporeal membrane oxygenation (ECMO) is widely used; however, studies on the long-term outcomes of ECMO are scarce. We investigated the long-term clinical outcomes of acute kidney disease (AKD) in patients receiving ECMO. METHODS Electronic data (2009-2018) were retrospectively collected from a multicenter database. Patients were divided into two groups (AKD and non-AKD) according to their AKD status 8-90 days after the initiation of ECMO. Inverse probability of treatment weighting (IPTW) was used to balance baseline covariates between the two groups. The primary outcomes were major adverse kidney events (MAKEs) and major adverse cardiovascular events (MACEs), and the secondary outcomes were all-cause readmission, sepsis-related readmission, infection-related readmission, and dementia. RESULTS Total 395 patients were eligible for analysis; of them, 160 patients (40.5%) developed AKD. The AKD group had a higher risk of MAKEs (hazard ratio [HR]: 2.06; 95% confidence interval [CI]: 1.68-2.53) than did the non-AKD group. Subgroup analysis revealed that the observed unfavorable effect of AKD on the risk of MAKEs was more pronounced in patients receiving venovenous ECMO than in those receiving venoarterial ECMO (HR: 5.69 vs. 1.85, respectively; P for interaction = 0.004). AKD group had a higher risk of MACE during the initial 3-year post- ECMO in comparison to those without (HR: 1.68; 95% CI: 1.22-2.30). Moreover, the risks of all-cause, sepsis-related, and infection-related readmissions were high in AKD survivors. CONCLUSIONS AKD is associated with an increased risk of long-term MAKEs and initial 3-year MACE in ECMO recipients. In addition, AKD is associated with increased risks of all-cause, infection-related, and sepsis-related readmissions.
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Chan MJ, Hsieh CY, Su YJ, Huang CC, Huang WH, Weng CH, Yen TH, Hsu CW. Giant Pancreatic Pseudocyst after Coronary Artery Bypass Graft in a Hemodialysis Patient: A Case Report. Clin Pract 2023; 13:1236-1243. [PMID: 37887087 PMCID: PMC10605616 DOI: 10.3390/clinpract13050111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/27/2023] [Accepted: 09/29/2023] [Indexed: 10/28/2023] Open
Abstract
End-stage renal disease (ESRD) patients have a high prevalence of coronary artery disease, and coronary artery bypass graft (CABG) is one of the essential treatments. ESRD patients undergoing CABG surgery have an increased risk of postoperative complications, including acute pancreatitis. Here, we present the unique case of an exceptionally large pancreatic pseudocyst caused by pancreatitis in an ESRD patient after CABG surgery. A 45-year-old male with ESRD under maintenance hemodialysis received CABG surgery for significant coronary artery disease. Two weeks later, he experienced worsening abdominal pain and a palpable mass was noticed in the epigastric region. Computer tomography revealed an unusually large pseudocyst measuring 21 × 17 cm in the retroperitoneum due to necrotizing pancreatitis. The patient underwent percutaneous cystic drainage, and the symptoms were significantly improved without surgical intervention. Factors such as prolonged cardiopulmonary bypass time, postoperative hypotension, and intradialytic hypotension appeared to have contributed to the development of severe pancreatitis in this case. This report highlights the rarity of a giant pancreatic pseudocyst in an ESRD patient after CABG surgery and emphasizes the importance of vigilant postoperative care.
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Affiliation(s)
- Ming-Jen Chan
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan; (M.-J.C.); (C.-Y.H.); (C.-C.H.); (W.-H.H.); (C.-H.W.); (T.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
| | - Chun-Yih Hsieh
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan; (M.-J.C.); (C.-Y.H.); (C.-C.H.); (W.-H.H.); (C.-H.W.); (T.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
| | - Yi-Jiun Su
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan City 333423, Taiwan;
| | - Chien-Chang Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan; (M.-J.C.); (C.-Y.H.); (C.-C.H.); (W.-H.H.); (C.-H.W.); (T.-H.Y.)
| | - Wen-Hung Huang
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan; (M.-J.C.); (C.-Y.H.); (C.-C.H.); (W.-H.H.); (C.-H.W.); (T.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan; (M.-J.C.); (C.-Y.H.); (C.-C.H.); (W.-H.H.); (C.-H.W.); (T.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan; (M.-J.C.); (C.-Y.H.); (C.-C.H.); (W.-H.H.); (C.-H.W.); (T.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City 333423, Taiwan; (M.-J.C.); (C.-Y.H.); (C.-C.H.); (W.-H.H.); (C.-H.W.); (T.-H.Y.)
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan City 333323, Taiwan
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Kang EYC, Lin TY, Garg SJ, Wang NK, Chen LJ, Huang PW, Chan MJ, Chen KJ, Wu WC, Lai CC, Hwang YS. The Association of Intravitreal Injections of Different Anti-Vascular Endothelial Growth Factor with Systemic Outcomes in Diabetic Patients. J Pers Med 2023; 13:jpm13030544. [PMID: 36983725 PMCID: PMC10057023 DOI: 10.3390/jpm13030544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/12/2023] [Accepted: 03/15/2023] [Indexed: 03/22/2023] Open
Abstract
This retrospective cohort study aimed to assess the systemic effects of three commonly available anti-vascular endothelial growth factor intravitreal injections in patients with diabetes, using data taken from a multi-institutional database in Taiwan. Patient data were sourced from the multi-institutional Chang Gung Research Database. Participants were divided into groups based on treatment with bevacizumab, ranibizumab, or aflibercept. Baseline characteristics were matched among the groups by the inverse probability of treatment weighting. The incidence rate of outcome events was calculated as the number of events divided by 100 person-years of follow-up. The cumulative incidence function was used to estimate the incidence rate of the outcome events among groups. The incidence of ischemic stroke was higher in the ranibizumab group than the bevacizumab and aflibercept groups (1.65, 0.92, and 0.61 per 100 person-years, respectively). The incidence of major adverse lower-limb events was higher in the bevacizumab group (2.95), followed by ranibizumab (2.00) and aflibercept (0.74). Major bleeding was relatively higher in bevacizumab (12.1) compared to ranibizumab (4.3) and aflibercept (3.8). All-cause death was higher for both bevacizumab (3.26) and aflibercept (2.61) when compared to ranibizumab (0.55), and all-cause admission was found to be highest with bevacizumab (58.6), followed by aflibercept (30.2), and ranibizumab (27.6). The bevacizumab group demonstrated a greater decrease in glycated hemoglobin compared to the baseline level (−0.33%). However, a few differences in the clinical condition between the groups were still observed after matching. In conclusion, this study suggests that different anti-vascular endothelial growth factor agents may be associated with various and differing systemic adverse events. The differences might also be attributed to differences in patient characteristics and clinical status.
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Affiliation(s)
- Eugene Yu-Chuan Kang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
| | - Tzu-Yi Lin
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Education, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Sunir J. Garg
- MidAtlantic Retina, The Retina Service of Wills Eye Hospital, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Nan-Kai Wang
- Department of Ophthalmology, Edward S. Harkness Eye Institute, Columbia University Medical Center, New York, NY 10032, USA
| | - Lee-Jen Chen
- Department of Ophthalmology, Mackay Memorial Hospital, Taipei 104, Taiwan
| | - Pei-Wei Huang
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Department of Oncology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Ming-Jen Chan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan 333, Taiwan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
| | - Kuan-Jen Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Wei-Chi Wu
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chi-Chun Lai
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Keelung Chang Gung Memorial Hospital, Keelung 204, Taiwan
| | - Yih-Shiou Hwang
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
- College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung 412, Taiwan
- Department of Ophthalmology, Xiamen Chang Gung Memorial Hospital, Xiamen 361000, China
- Correspondence: ; Tel.: +886-3-3281200 (ext. 8666)
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Deb M, Chen MY, Chang PY, Li PH, Chan MJ, Tian YC, Yeh PH, Soppera O, Zan HW. SnO 2-Based Ultra-Flexible Humidity/Respiratory Sensor for Analysis of Human Breath. Biosensors (Basel) 2023; 13:81. [PMID: 36671916 PMCID: PMC9856198 DOI: 10.3390/bios13010081] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 06/17/2023]
Abstract
Developing ultraflexible sensors using metal oxides is challenging due to the high-temperature annealing step in the fabrication process. Here, we demonstrate the ultraflexible relative humidity (RH) sensor on food plastic wrap by using 808 nm near-infrared (NIR) laser annealing for 1 min at a low temperature (26.2-40.8 °C). The wettability of plastic wraps coated with sol-gel solution is modulated to obtain uniform films. The surface morphology, local temperature, and electrical properties of the SnO2 resistor under NIR laser irradiation with a power of 16, 33, and 84 W/cm2 are investigated. The optimal device can detect wide-range RH from 15% to 70% with small incremental changes (0.1-2.2%). X-ray photoelectron spectroscopy reveals the relation between the surface binding condition and sensing response. Finally, the proposed sensor is attached onto the face mask to analyze the real-time human breath pattern in slow, normal, and fast modes, showing potential in wearable electronics or respiration monitoring.
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Affiliation(s)
- Moumita Deb
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, 1001 Ta Hsueh Rd., Hsinchu 30010, Taiwan
- Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, 1001 Ta Hsueh Rd., Hsinchu 30010, Taiwan
| | - Mei-Yu Chen
- Department of Physics, Tamkang University, 151, Yingzhuan Rd., Tamsui, New Taipei City 25137, Taiwan
| | - Po-Yi Chang
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, 1001 Ta Hsueh Rd., Hsinchu 30010, Taiwan
- Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, 1001 Ta Hsueh Rd., Hsinchu 30010, Taiwan
- Université de Haute-Alsace, CNRS, IS2M UMR 7361, F-68100 Mulhouse, France
- Université de Strasbourg, F-67081 Strasbourg, France
| | - Pin-Hsuan Li
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, 1001 Ta Hsueh Rd., Hsinchu 30010, Taiwan
- Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, 1001 Ta Hsueh Rd., Hsinchu 30010, Taiwan
| | - Ming-Jen Chan
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ya-Chung Tian
- Department of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Kidney Research Center and Department of Nephrology, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Ping-Hung Yeh
- Department of Physics, Tamkang University, 151, Yingzhuan Rd., Tamsui, New Taipei City 25137, Taiwan
| | - Olivier Soppera
- Université de Haute-Alsace, CNRS, IS2M UMR 7361, F-68100 Mulhouse, France
- Université de Strasbourg, F-67081 Strasbourg, France
| | - Hsiao-Wen Zan
- Department of Photonics, College of Electrical and Computer Engineering, National Yang Ming Chiao Tung University, 1001 Ta Hsueh Rd., Hsinchu 30010, Taiwan
- Department of Photonics, College of Electrical and Computer Engineering, National Chiao Tung University, 1001 Ta Hsueh Rd., Hsinchu 30010, Taiwan
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Chan MJ, Hu CC, Huang WH, Hsu CW, Yen TH, Weng CH. An artificial intelligence algorithm for analyzing globus pallidus necrosis after carbon monoxide intoxication. Hum Exp Toxicol 2023; 42:9603271231190906. [PMID: 37491827 DOI: 10.1177/09603271231190906] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2023]
Abstract
Globus pallidus necrosis (GPN) is one of typical neurological imaging features in patients with carbon monoxide (CO) poisoning. Current clinical guideline recommends neurological imaging examination for CO-intoxicated patients with conscious disturbance rather than routine screening, which may lead to undiagnosed GPN. We aimed to develop an artificial intelligence algorithm for predicting GPN in CO intoxication patients. We included CO intoxication patients with neurological images between 2000 and 2019 in Chang Gung Memorial Hospital. We collected 41 clinical and laboratory parameters on the first day of admission for algorithm development. We used fivefold cross validation and applied several machine learning algorithms. Random forest classifier (RFC) provided the best predictive performance in our cohort. Among the 261 patients with CO intoxication, 52 patients presented with GPN. The artificial intelligence algorithm using the RFC-based AI model achieved an accuracy = 79.2 ± 2.6%, sensitivity = 77.7%, precision score = 81.9 ± 3.4%, and F1 score = 73.2 ± 1.8%. The area under receiver operating characteristic was approximately 0.64. Top five weighted variables were Platelet count, carboxyhemoglobin, Glasgow Coma scale, creatinine, and hemoglobin. Our RFC-based algorithm is the first to predict GPN in patients with CO intoxication and provides fair predictive ability. Further studies are needed to validate our findings.
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Affiliation(s)
- Ming-Jen Chan
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Chih Hu
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wen-Hung Huang
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Ching-Wei Hsu
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Tzung-Hai Yen
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Cheng-Hao Weng
- Kidney Research Center, Department of Nephrology, Linkou Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
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Pan HC, Yang SY, Chiou TTY, Shiao CC, Wu CH, Huang CT, Wang TJ, Chen JY, Liao HW, Chen SY, Huang TM, Yang YF, Lin HYH, Chan MJ, Sun CY, Chen YT, Chen YC, Wu VC. Comparative accuracy of biomarkers for the prediction of hospital-acquired acute kidney injury: a systematic review and meta-analysis. Crit Care 2022; 26:349. [PMID: 36371256 PMCID: PMC9652605 DOI: 10.1186/s13054-022-04223-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/28/2022] [Indexed: 11/13/2022] Open
Abstract
Background Several biomarkers have been proposed to predict the occurrence of acute kidney injury (AKI); however, their efficacy varies between different trials. The aim of this study was to compare the predictive performance of different candidate biomarkers for AKI. Methods In this systematic review, we searched PubMed, Medline, Embase, and the Cochrane Library for papers published up to August 15, 2022. We selected all studies of adults (> 18 years) that reported the predictive performance of damage biomarkers (neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), liver-type fatty acid-binding protein (L-FABP)), inflammatory biomarker (interleukin-18 (IL-18)), and stress biomarker (tissue inhibitor of metalloproteinases-2 × insulin-like growth factor-binding protein-7 (TIMP-2 × IGFBP-7)) for the occurrence of AKI. We performed pairwise meta-analyses to calculate odds ratios (ORs) and 95% confidence intervals (CIs) individually. Hierarchical summary receiver operating characteristic curves (HSROCs) were used to summarize the pooled test performance, and the Grading of Recommendations, Assessment, Development and Evaluations criteria were used to appraise the quality of evidence. Results We identified 242 published relevant studies from 1,803 screened abstracts, of which 110 studies with 38,725 patients were included in this meta-analysis. Urinary NGAL/creatinine (diagnostic odds ratio [DOR] 16.2, 95% CI 10.1–25.9), urinary NGAL (DOR 13.8, 95% CI 10.2–18.8), and serum NGAL (DOR 12.6, 95% CI 9.3–17.3) had the best diagnostic accuracy for the risk of AKI. In subgroup analyses, urinary NGAL, urinary NGAL/creatinine, and serum NGAL had better diagnostic accuracy for AKI than urinary IL-18 in non-critically ill patients. However, all of the biomarkers had similar diagnostic accuracy in critically ill patients. In the setting of medical and non-sepsis patients, urinary NGAL had better predictive performance than urinary IL-18, urinary L-FABP, and urinary TIMP-2 × IGFBP-7: 0.3. In the surgical patients, urinary NGAL/creatinine and urinary KIM-1 had the best diagnostic accuracy. The HSROC values of urinary NGAL/creatinine, urinary NGAL, and serum NGAL were 91.4%, 85.2%, and 84.7%, respectively. Conclusions Biomarkers containing NGAL had the best predictive accuracy for the occurrence of AKI, regardless of whether or not the values were adjusted by urinary creatinine, and especially in medically treated patients. However, the predictive performance of urinary NGAL was limited in surgical patients, and urinary NGAL/creatinine seemed to be the most accurate biomarkers in these patients. All of the biomarkers had similar predictive performance in critically ill patients. Trial registrationCRD42020207883, October 06, 2020. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-022-04223-6.
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Lee CC, Kuo G, Chan MJ, Fan PC, Chen JJ, Yen CL, Tsai TY, Chen YC, Tian YC, Chang CH. Characteristics of and Outcomes After Dialysis-Treated Acute Kidney Injury, 2009-2018: A Taiwanese Multicenter Study. Am J Kidney Dis 2022; 81:665-674.e1. [PMID: 36252882 DOI: 10.1053/j.ajkd.2022.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Accepted: 08/17/2022] [Indexed: 11/06/2022]
Abstract
RATIONALE & OBJECTIVE Dialysis-treated acute kidney injury (AKI) is increasingly common in intensive care units (ICUs) and is associated with poor outcomes. Few studies have explored the temporal trends in severity of acute illness at dialysis initiation, indications for dialysis, and their association with patient outcomes. STUDY DESIGN Multicenter retrospective cohort study. SETTING & PARTICIPANTS 9,535 adult patients admitted to the ICU who received their first dialysis treatment from Chang Gung Memorial Hospital system in Taiwan from 2009 through 2018. EXPOSURE Calendar year. OUTCOMES ICU mortality and dialysis treatment at discharge among hospital survivors. ANALYTICAL APPROACH The temporal trends during the study period were investigated using test statistics suited for continuous or categorical data. The association between the study year and the risk of mortality was analyzed using multivariable Cox regression with adjustment for relevant clinical variables, including the severity of acute illness, defined by Sequential Organ Failure Assessment (SOFA) score. RESULTS The mean SOFA score at dialysis initiation decreased slightly from 14.0 in 2009 to 13.6 in 2018. There was no significant trend in the number of indications for dialysis initiation that were fulfilled over time. Observed ICU mortality decreased over time, and the curve appeared to be reverse J-shaped, with a substantial decrease from 56.1% in 2009 to 46.3% in 2015 and a slight increase afterward. The risk of mortality was significantly reduced from 2013 to 2018 compared with 2009 in adjusted models. The decreasing trend in ICU mortality over time remained significant. There was an increase in dialysis treatment at discharge among survivors, mainly in patients with estimated glomerular filtration rate<60mL/min/1.73m2, from 36.8% in 2009 to 43.9% in 2018. LIMITATIONS Residual confounding from unmeasured factors over time such as severity of comorbidities, detailed medication interventions, and delivered dialysis dose. CONCLUSIONS We observed reductions in mortality among ICU patients with dialysis-treated acute kidney injury between 2009 and 2018, even after adjusting for dialysis indication and severity of illness at dialysis initiation. However, dialysis treatment at discharge among survivors has increased over time, mainly in patients with preexisting kidney disease.
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Affiliation(s)
- Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - George Kuo
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Ming-Jen Chan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jia-Jin Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chieh-Li Yen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Tsung-Yu Tsai
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taoyuan, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
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Chan MJ, Chen YC, Fan PC, Lee CC, Kou G, Chang CH. Predictive Value of Urinary Aquaporin 2 for Acute Kidney Injury in Patients with Acute Decompensated Heart Failure. Biomedicines 2022; 10:biomedicines10030613. [PMID: 35327416 PMCID: PMC8945460 DOI: 10.3390/biomedicines10030613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 02/04/2023] Open
Abstract
Acute kidney injury (AKI) is frequently encountered in people with acute decompensated heart failure (ADHF) and is associated with increased morbidity and mortality. Early detection of a urinary biomarker of kidney injury might allow a prompt diagnosis and improve outcomes. Levels of urinary aquaporin 2 (UAQP2), which is also associated with several renal diseases, are increased with ADHF. We aimed to determine whether UAQP2 predicted AKI in patients with ADHF. We conducted a prospective observation study in the coronary care unit (CCU) in a tertiary care university hospital in Taiwan. Individuals with ADHF admitted to the CCU between November 2009 and November 2014 were enrolled, and serum and urinary samples were collected. AKI was diagnosed in 69 (36.5%) of 189 adult patients (mean age: 68 years). Area under the receiver operating characteristic curve (AUROC) of biomarkers was evaluated to evaluate the diagnostic power for AKI. Both brain natriuretic peptide and UAQP2 demonstrated acceptable AUROCs (0.759 and 0.795, respectively). A combination of the markers had an AUROC of 0.802. UAQP2 is a potential biomarker of AKI in CCU patients with ADHF. Additional research on this novel biomarker is required.
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Affiliation(s)
- Ming-Jen Chan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.C.); (Y.-C.C.); (P.-C.F.); (C.-C.L.); (G.K.)
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.C.); (Y.-C.C.); (P.-C.F.); (C.-C.L.); (G.K.)
| | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.C.); (Y.-C.C.); (P.-C.F.); (C.-C.L.); (G.K.)
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.C.); (Y.-C.C.); (P.-C.F.); (C.-C.L.); (G.K.)
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - George Kou
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.C.); (Y.-C.C.); (P.-C.F.); (C.-C.L.); (G.K.)
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Linkou Chang Gung Memorial Hospital, Taoyuan 333, Taiwan; (M.-J.C.); (Y.-C.C.); (P.-C.F.); (C.-C.L.); (G.K.)
- Graduate Institute of Clinical Medical Science, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
- Correspondence: ; Tel.: +886-(0)3-328-1200 (ext. 8181)
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Yang SY, Chiou TTY, Shiao CC, Lin HYH, Chan MJ, Wu CH, Sun CY, Wang WJ, Huang YT, Wu VC, Chen YC, Fang JT, Hwang SJ, Pan HC. Nomenclature and diagnostic criteria for acute kidney injury - 2020 consensus of the Taiwan AKI-task force. J Formos Med Assoc 2021; 121:749-765. [PMID: 34446340 DOI: 10.1016/j.jfma.2021.08.005] [Citation(s) in RCA: 3] [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: 09/15/2020] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022] Open
Abstract
Acute kidney injury (AKI) is a common syndrome that has a significant impact on prognosis in various clinical settings. To evaluate whether new evidence supports changing the current definition/classification/staging systems for AKI suggested by the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline, the Taiwan AKI-TASK Force, composed of 64 experts in various disciplines, systematically reviewed the literature and proposed recommendations about the current nomenclature and diagnostic criteria for AKI. The Taiwan Acute Kidney Injury (TW-AKI) Consensus 2020 was established following the principles of evidence-based medicine to investigate topics covered in AKI guidelines. The Taiwan AKI-TASK Force determined that patients with AKI have a higher risk of developing chronic kidney disease, end-stage renal disease, and death. After a comprehensive review, the TASK Force recommended using novel biomarkers, imaging examinations, renal biopsy, and body fluid assessment in the diagnosis of AKI. Clinical issues with regards to the definitions of baseline serum creatinine (sCr) level and renal recovery, as well as the use of biomarkers to predict renal recovery are also discussed in this consensus. Although the present classification systems using sCr and urine output for the diagnosis of AKI are not perfect, there is not enough evidence to change the current criteria in clinical practice. Future research should investigate and clarify the roles of the aforementioned tools in clinical practice for AKI.
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Affiliation(s)
- Shao-Yu Yang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Terry Ting-Yu Chiou
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan; Chung Shan Medical University School of Medicine, Taichung, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillians Saint Mary's Hospital Luodong, Saint Mary's Junior College of Medicine, Nursing and Management, Luodong, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan
| | - Hugo You-Hsien Lin
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Jen Chan
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Che-Hsiung Wu
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chiao-Yin Sun
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wei-Jie Wang
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Vin-Cent Wu
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Chang Chen
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ji-Tsung Fang
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Heng-Chih Pan
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
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10
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Su YJ, Huang CC, Hsieh CY, Hung YS, Chan MJ. Hyperkalemia in a Patient With Leukemia. Am J Kidney Dis 2021; 77:A13-A14. [PMID: 33894919 DOI: 10.1053/j.ajkd.2020.08.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/20/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Yi-Jiun Su
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Chien-Chang Huang
- Division of Nephrology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Chun-Yih Hsieh
- Division of Nephrology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Yu-Shin Hung
- Division of Hematology-Oncology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
| | - Ming-Jen Chan
- Division of Nephrology, Department of Internal Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
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11
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Lee CC, Chen SW, Cheng YL, Fan PC, Tsai TY, Chan MJ, Chang SW, Hsu HH, Fang JT, Chang CH. The impact of CRRT modality in patients with AKI receiving ECMO: A nationwide registry study in Taiwan. J Crit Care 2020; 57:102-107. [PMID: 32088523 DOI: 10.1016/j.jcrc.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 01/15/2020] [Accepted: 02/06/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Patients receiving extracorporeal membrane oxygenation (ECMO) commonly develop acute kidney injury (AKI) and frequently require continuous renal replacement therapy (CRRT). The impact of different CRRT modalities on survival in patients receiving ECMO remains unclear. MATERIALS AND METHODS Using claims data from Taiwan's National Health Insurance Research Database, a total of 1077 patients who received ECMO and either continuous venovenous hemofiltration (CVVH) or continuous venovenous hemodialysis (CVVHD) for AKI were identified. Inverse probability of treatment weighting was applied using propensity scores to balance the baseline covariates of the two groups. The primary outcome was in-hospital morality. RESULTS We identified 1077 patients (mean age 57.9; 71.8% men). Postcardiotomy shock (49.2%) was the most frequently reported indication for ECMO. The CVVH group had a lower risk of in-hospital mortality (68.4% vs. 76.9%; odds ratio 0.65; 95% confidence interval [CI] 0.50-0.85) compared with the CVVHD group. The CVVH group also had a shorter mean ICU stay compared with the CVVHD group (mean difference -4.59 days, 95% CI -9.15 to -0.03 days). CONCLUSION Our results suggest that compared with CVVHD, CVVH may be associated with a lower risk of in-hospital mortality in patients with AKI who receive ECMO.
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Affiliation(s)
- Cheng-Chia Lee
- Kidney Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou Branch, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ya-Lien Cheng
- Kidney Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Pei-Chun Fan
- Kidney Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Tsung-Yu Tsai
- Kidney Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ming-Jen Chan
- Kidney Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Su-Wei Chang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan 333, Taiwan; Division of Allergy, Asthma, and Rheumatology, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 333, Taiwan
| | - Hsiang-Hao Hsu
- Kidney Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Ji-Tseng Fang
- Kidney Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan
| | - Chih-Hsiang Chang
- Kidney Research Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 333, Taiwan.
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12
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Fan PY, Chan MJ, Lin SH, Wu HH, Chang MY, Tian YC, Kuo G. Prophylactic Antibiotic Reduces the Risk of Peritonitis after Invasive Gynecologic Procedures. Perit Dial Int 2019; 39:356-361. [PMID: 31028109 DOI: 10.3747/pdi.2018.00218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/26/2019] [Indexed: 01/18/2023] Open
Abstract
Background:Peritonitis is a serious complication after invasive procedures in patients undergoing peritoneal dialysis (PD). Most studies that have investigated peritonitis following invasive gynecologic procedures enrolled small patient populations. This study focuses on the clinical presentation, outcomes, and effects of prophylactic antibiotic use before invasive techniques.Methods:A retrospective study was conducted on patients who underwent invasive gynecologic procedures between 2005 and 2015 in a tertiary medical center. Eligible patients were identified and enrolled and their demographic data were collected. The use of prophylactic antibiotics and the outcomes of peritonitis were recorded.Results:Twenty-six gynecologic procedures were performed on 18 PD patients. Seven episodes of peritonitis occurred in 6 patients after invasive gynecologic procedures. Eleven procedures were preceded by prophylactic antibiotic treatment (6 oral cefadroxil, 1 oral cefuroxime, 1 oral clindamycin, 1 intravenous [IV] ceftriaxone, 1 IV ceftazidime, and 1 IV cefazolin). The pathogens were diverse (group B Streptococcus, group D Streptococcus, E. coli, and Enterococcus). All episodes of peritonitis were successfully treated using intraperitoneal antibiotics without recurrence, technique failure, or mortality. The odds ratio of peritonitis in the non-prophylaxis group was 20.29 (95% confidence interval 1.01 - 406.35, p = 0.0103).Conclusion:The use of prophylactic antibiotic treatment considerably reduced the risk of peritonitis after invasive gyne co logic procedures.
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Affiliation(s)
- Pei-Yi Fan
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ming-Jen Chan
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Sheng-Hsuan Lin
- Institute of Statistics, National Chiao-Tung University, Hsinchu, Taiwan
| | - Hsin-Hsu Wu
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ming-Yang Chang
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Ya-Chung Tian
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - George Kuo
- Department of Nephrology, Kidney Research Center, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taoyuan, Taiwan
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13
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Chan MJ, Weng CH, Hsu CW, Huang WH, Yen TH. Dapagliflozin associated ketoacidosis: A must know fact for nephrologists. Nephrology (Carlton) 2019; 23:192. [PMID: 29346842 DOI: 10.1111/nep.13039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 03/01/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Ming-Jen Chan
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Ching-Wei Hsu
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
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14
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Hsu CW, Weng CH, Chan MJ, Lin-Tan DT, Yen TH, Huang WH. Association Between Serum Aluminum Level and Uremic Pruritus in Hemodialysis Patients. Sci Rep 2018; 8:17251. [PMID: 30467375 PMCID: PMC6250692 DOI: 10.1038/s41598-018-35217-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 10/31/2018] [Indexed: 12/17/2022] Open
Abstract
Uremic pruritus (UP) is a common symptom in patients undergoing hemodialysis (HD). The pathogenesis of UP is complex. Aluminum (Al) is a common metal and is toxic to patients undergoing HD. Al is also a known human allergen which can induce immune reactions. However, the correlation between Al and UP remains unclear in dialysis patients. A total of 866 patients on maintenance HD were enrolled for analysis. The HD patients with higher serum Al levels had higher a prevalence of UP than those with lower serum Al levels. After adjusting for confounding variables, the serum Al level was significantly associated with UP. Overall, each 10-fold increase in serum Al level was associated with a 5.64-fold increase in the risk of developing UP in these subjects. The results of this cross-sectional study suggest that serum Al level may be associated with the development of UP in patients on maintenance HD.
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Affiliation(s)
- Ching-Wei Hsu
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Hao Weng
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Jen Chan
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Dan-Tzu Lin-Tan
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Wen-Hung Huang
- Department of Nephrology and Clinical Poison Center, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,Chang Gung University College of Medicine, Taoyuan, Taiwan.
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15
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Chan MJ, Lee CC, Chen SW, Tsai FC, Lin PJ, Fan PC, Hsu HH, Chang MY, Chen YC, Chang CH. Effect of different surgical type of coronary artery bypass grafting on kidney injury: A propensity score analysis. Medicine (Baltimore) 2017; 96:e8395. [PMID: 29137024 PMCID: PMC5690717 DOI: 10.1097/md.0000000000008395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Acute kidney injury (AKI) after coronary artery bypass grafting (CABG) is associated with a less favorable outcome. Off-pump surgery results in lower kidney dysfunction than conventional on-pump arrest surgery. On-pump arrest surgery results in a lower revascularization rate compared with off-pump surgery. On-pump beating heart (OPBH) CABG combines the advantages of beating heart surgery and cardiopulmonary bypass. This study compared the renal outcomes of 3 cardiac surgical methods. From January 2010 to December 2012, 373 patients who underwent on-pump CABG were enrolled. Propensity analysis was performed to compare the postoperative outcomes of postoperative AKI, renal replacement therapy (RRT), intensive care unit (ICU) stay, mortality, and extubating time. In total, 98 patients received conventional on-pump surgery, 160 received OPBH surgery, and 115 received off-pump surgery. The Society of Thoracic Surgeons scores of these 3 groups were 6.1 ± 13.6, 7.4 ± 13.6, and 5.6 ± 10.9, respectively. Propensity analysis revealed lower AKI incidence in the off-pump group than in the on-pump surgery group. No substantial differences were observed in mortality, RRT, and the ICU stay between the off-pump and OPBH surgery groups. Among the 3 surgical methods, off-pump surgery results in lower AKI incidence. The short-term outcome, including kidney function, of OPBH surgery is similar to that of the off-pump group. Therefore, OPBH surgery is a considerable choice for patients with a high surgical risk.
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Affiliation(s)
| | - Cheng-Chia Lee
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | - Shao-Wei Chen
- Department of Cardiothoracic and Vascular Surgery
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | | | | | - Pei-Chun Fan
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | | | | | - Yung-Chang Chen
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
| | - Chih-Hsiang Chang
- Kidney Research Center, Department of Nephrology
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan City, Taiwan, R.O.C
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16
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Weng CH, Hsu CW, Hu CC, Yen TH, Chan MJ, Huang WH. Blood lead level is a positive predictor of uremic pruritus in patients undergoing hemodialysis. Ther Clin Risk Manag 2017; 13:717-723. [PMID: 28652758 PMCID: PMC5476754 DOI: 10.2147/tcrm.s135470] [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] [Indexed: 11/23/2022] Open
Abstract
Although uremic pruritus (UP) is a common and annoying symptom for end-stage renal disease patients on hemodialysis (HD) and peritoneal dialysis, its pathogenesis is poorly understood. However, systemic inflammation is one of the possible pathogenesis of UP, and blood lead level (BLL) has been noted to be associated with inflammation and nutritional status in long-term HD patients. There might be an interaction or association, therefore, between BLL and UP through systemic inflammation. We analyzed cross-sectional data among 866 participants. All of the 866 patients in this study were stratified into groups with low-normal (<10 μg/dL), high-normal (10-20 μg/dL), and abnormal BLLs (>20 μg/dL). The associations between UP and BLL and the clinical data were analyzed. Multivariate logistic regression demonstrated that HD duration, non-anuria, log ferritin, serum low-density lipoprotein, log BLL, high-normal BLL, and high BLL were associated with UP. In conclusion, BLL was positively associated with UP.
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Affiliation(s)
- Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ching-Chih Hu
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan.,Department of Hepatogastroenterology and Liver Research Unit, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Ming-Jen Chan
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology, Chang Gung Memorial Hospital, Linkou Medical Center.,Department of Medicine, Chang Gung University College of Medicine, Taoyuan
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Liu MH, Chan MJ, Hsu CW, Weng CH, Yen TH, Huang WH. Association of uremic pruritus in hemodialysis patients with the number of days of high mean 24-hour particulate matter with a diameter of <2.5 μm. Ther Clin Risk Manag 2017; 13:255-262. [PMID: 28260912 PMCID: PMC5328135 DOI: 10.2147/tcrm.s129133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Uremic pruritus (UP) is a common and incapacitating symptom in patients undergoing hemodialysis (HD). The pathogenesis of UP is multifactorial and complex. Particulate matter (PM), a major air pollutant, is a mixture of particles with various chemical compositions. PM is associated with several allergic diseases, including dermatitis. To assess the role of PM (PM with a diameter of <10 μm [PM10] and PM with a diameter of <2.5 μm [PM2.5]) and other clinical variables in UP in patients on HD, we recruited 866 patients on maintenance HD (MHD). We analyzed the number of days of mean 24-hour PM10 ≥125 μg/m3/12 months (NDPM10) or the number of days of mean 24-hour PM2.5 ≥35 μg/m3/12 months (NDPM2.5) exceeding the standard level in the past 12 months respectively to determine the association with UP. In a multivariate logistic regression, HD duration, serum ferritin levels, low-density lipoprotein (LDL) levels, and NDPM2.5 ≥116 days/12 months were positively associated with UP. This cross-sectional study showed that the number of days on which the environmental PM2.5 exceeds the standard level might be associated with UP in patients on MHD.
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Affiliation(s)
| | - Ming-Jen Chan
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center
| | - Ching-Wei Hsu
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center; Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Cheng-Hao Weng
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center; Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Tzung-Hai Yen
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center; Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
| | - Wen-Hung Huang
- Department of Nephrology and Division of Clinical Toxicology and Toxicology Laboratory, Chang Gung Memorial Hospital, Linkou Medical Center; Chang Gung University College of Medicine, Taoyuan, Taiwan, Republic of China
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18
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Abstract
Inflammation is highly prevalent among peritoneal dialysis (PD) patients. High-sensitivity C-reactive protein (hs-CRP) is the most widely used inflammatory marker in clinical medicine and is correlated with mortality in PD patients. Air pollution is associated with systemic inflammation. The aim of this cross-sectional study was to assess the role of air pollutants and other clinical variables on hs-CRP values in PD patients.We recruited a total of 175 patients who had been undergoing continuous ambulatory PD or automated PD for at least 4 months and regularly followed up. Air pollution levels were recorded by a network of 27 monitoring stations near or in the patients' living areas throughout Taiwan. The 12-month average concentrations of particulate matter (PM) with an aerodynamic diameter of <10 and <2.5 μm (PM10 and PM2.5), sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), and ozone (O3) were included.In stepwise linear regression, after adjustment for related factors, white blood cell count (β: 0.27, 95% confidence interval [CI] [0.71, 2.11]) and CO level (β: 0.17, 95% CI [2.5, 21.32]) were positively associated with hs-CRP and serum albumin levels (β: -0.25, 95% CI [-13.69, -3.96]) and normalized protein nitrogen appearance (β: -0.18, 95% CI [-17.7, -2.51]) was negatively associated with hs-CRP. However, serum indoxyl sulfate and p-cresyl sulfate levels were not significantly associated with hs-CRP (P > 0.05).In PD patients, the environmental CO level was positively correlated with hs-CRP level.
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Affiliation(s)
- Wen-Hung Huang
- From the Department of Nephrology and Division of Clinical Toxicology (W-HH, T-HY); Department of Internal Medicine (M-JC, Y-JS), Chang Gung Memorial Hospital, Linkou; and Chang Gung University College of Medicine (W-HH, T-HY), Taoyuan, Taiwan
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Abstract
In patients undergoing peritoneal dialysis (PD), PD-related infection is a major cause of PD failure and hospital admission. Good air quality is required when dialysate exchange or exit site wound care is performed. To our knowledge, investigation of air pollution as a factor for PD-related infection in patients undergoing dialysis is limited. This study aimed to assess the effect of environmental particulate matter (PM) and other important risk factors on 1-year PD-related infection in patients undergoing PD.A total of 175 patients undergoing PD were recruited in this 1-year retrospective observational study. Differences in environmental PMs (PM10 and PM2.5) were analyzed with respect to the patients' living areas. The patients undergoing PD were categorized into 2 groups according to PM2.5 exposure: high (n = 61) and low (n = 114). Demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data were analyzed. Multivariate binary logistic and multivariate Cox regression analyses were used to analyze 1-year PD-related infection.A total of 175 patients undergoing PD (50 men and 125 women) were enrolled. Thirty-five patients had PD-related infection within 1 year. Multivariate Cox regression analysis showed that high environmental PM2.5 exposure (hazard ratio (HR): 2.0, 95% confidence interval [CI] [1.03-3.91]; P = .04) and female sex (HR: 2.77, 95% CI [1.07-7.19]; P = .03) were risk factors for 1-year PD-related infection.Patients undergoing PD with high environmental PM2.5 exposure had a higher 1-year PD-related infection rate than that in those with low exposure. Therefore, air pollution may be associated with PD-related infection in such patients.
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Affiliation(s)
- Wen-Hung Huang
- From the Department of Nephrology and Division of Clinical Toxicology (W-HH, T-HY); Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center (M-JC, Y-JS); and Chang Gung University College of Medicine, Taoyuan (W-HH, T-HY), Taiwan, Republic of China
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Chan MJ. New patient confidentially rules--good or bad. N Z Med J 1993; 106:481. [PMID: 8233198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
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Chan MJ. Thin end of the wedge. N Z Med J 1993; 106:390. [PMID: 8367100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
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22
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Chan MJ. Health goals and responsibility of patients. N Z Med J 1992; 105:437-8. [PMID: 1297949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Abstract
The intramuscular haemangioma is a relatively uncommon benign vascular tumour which accounts for less than 1% of all haemangiomas. It is a rare lesion in the orofacial muscles. A case is reported arising in the orbicularis oris muscle presenting in a 9-month-old child.
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Affiliation(s)
- M J Chan
- Department of Plastic Surgery, Newcastle General Hospital, Newcastle upon Tyne
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Chan MJ. Silicone breast implants and cancer. N Z Med J 1992; 105:181. [PMID: 1589170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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Chan MJ. Paediatric fees. N Z Med J 1989; 102:447-8. [PMID: 2590298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Chan MJ. Physiotherapists--a professional body. N Z Med J 1989; 102:418. [PMID: 2761883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Chan MJ. Who disciplines the disciplinary committee? N Z Med J 1988; 101:669. [PMID: 3186009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Chan MJ. Patient waiting times. N Z Med J 1988; 101:644. [PMID: 3173881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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29
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Chan MJ. Transfer of medical records. N Z Med J 1988; 101:430. [PMID: 3393337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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