1
|
Chen YK, Wen WL, Hsu HP, Tsai CL. Impact of discordant pain assessment between patients and physicians on patient outcomes: a prospective emergency department study. Eur J Emerg Med 2024; 31:220-222. [PMID: 38661504 DOI: 10.1097/mej.0000000000001107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Affiliation(s)
- Yen-Kai Chen
- Department of Medicine, College of Medicine, National Taiwan University, Taipei
| | - Wei-Lun Wen
- Department of Medicine, College of Medicine, National Taiwan University, Taipei
| | - Hao-Ping Hsu
- Department of General Medicine, Chi Mei Medical Center, Tainan
| | - Chu-Lin Tsai
- Department of Emergency Medicine, National Taiwan University Hospital
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
2
|
Wen WL, Lee YJ, Hwu DW, Chang YH. Age- and gender-adjusted estimated glomerular filtration rate definition reveals hyperfiltration as a risk factor for renal function deterioration in type 2 diabetes. Diabetes Obes Metab 2024; 26:1636-1643. [PMID: 38303103 DOI: 10.1111/dom.15465] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/02/2024] [Accepted: 01/09/2024] [Indexed: 02/03/2024]
Abstract
AIM To assess the role of hyperfiltration for diabetic kidney disease (DKD) progression. MATERIALS AND METHODS A retrospective observational cohort study enrolled type 2 diabetes (T2D) patients with an initial estimated glomerular filtration rate (eGFR) of 60 mL/min/1.73m2 or higher. Patients were categorized into two groups: hyperfiltration (eGFR exceeding the age- and gender-specific 95th percentile values from a prior national cohort study) and normofiltration. Rapid DKD progression was defined as an eGFR decline of more than 5 mL/min/1.73m2/year. We used a linear mixed effect model and Cox regression with time-varying covariate model to compare eGFR changes and identify factors associated with rapid DKD progression. RESULTS Of the enrolled 7563 T2D patients, 7.2% had hyperfiltration. The hyperfiltration group exhibited a higher rate of eGFR decline compared with the normofiltration group (-2.0 ± 0.9 vs. -1.1 ± 0.9 mL/min/1.73m2/year; P < .001). During an average follow-up period of 4.65 ± 3.86 years, 24.7% of patients with hyperfiltration experienced rapid DKD progression, compared with 15.7% of patients with normofiltration (P < .001). Cox regression analyses identified that initial hyperfiltration was a significant determinant of rapid DKD progression, with a hazard ratio of 1.66 (95% confidence interval: 1.41-1.95; P < .001). When combined with albuminuria, the risk of progression was further compounded (hazard ratio 1.76-3.11, all P < .001). CONCLUSIONS In addition to using the current Kidney Disease: Improving Global Outcomes CGA classification system, considering glomerular hyperfiltration status can improve the accuracy of predicting DKD progression.
Collapse
Affiliation(s)
- Wei-Lun Wen
- Department of Internal Medicine, Lee's Endocrinology Clinic, Pingtung City, Taiwan
| | - Yau-Jiunn Lee
- Department of Internal Medicine, Lee's Endocrinology Clinic, Pingtung City, Taiwan
| | - Der-Wei Hwu
- Department of Internal Medicine, Lee's Endocrinology Clinic, Pingtung City, Taiwan
| | - Yu-Hung Chang
- Department of Internal Medicine, Lee's Endocrinology Clinic, Pingtung City, Taiwan
| |
Collapse
|
3
|
Lin T, Wen WL, Du J, Wu Z, Kong XK, Duan WB, Zhang XY, Du B, Cai YL, Cui YQ. [Safety and efficacy of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis]. Zhonghua Nei Ke Za Zhi 2024; 63:272-278. [PMID: 38448190 DOI: 10.3760/cma.j.cn112138-20231031-00274] [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] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Objective: To investigate the efficacy and safety of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis. Methods: A retrospective analysis was carried out on 46 patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis who received endovascular treatment at the Strategic Support Force Medical Center from January 2015 to August 2022. Twenty-seven patients underwent balloon angioplasty alone and 19 patients underwent acute stent implantation. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of the responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality of the two groups were evaluated. Results: The proportion of effective recanalization of the offending vessels (mTICI≥2b) in the acute stenting group was slightly higher than that in the balloon angioplasty group (16/19 vs. 81.5%), but the difference was not statistically significant (P>0.05). Besides, there was no significant difference in the median of mRS between the acute stenting group [3.0(0, 4.0)] and the balloon angioplasty group [4.0(1.0, 5.0)] 90 days after operation (P>0.05). In terms of safety, the incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups (P>0.05). Conclusions: The effect of acute stent implantation during endovascular treatment for patients with emergent large vessel occlusion due to intracranial atherosclerotic stenosis is not inferior to that of balloon angioplasty, and it does not increase the risk of intracranial bleeding complications.
Collapse
Affiliation(s)
- T Lin
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - W L Wen
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - J Du
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - Z Wu
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - X K Kong
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - W B Duan
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - X Y Zhang
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - B Du
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - Y L Cai
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - Y Q Cui
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| |
Collapse
|
4
|
Tang N, Liu XT, Wen WL, Liang TS, Lv XT, Li QL, Wang GE, Wu YH. Restraint stress promotes monobenzone-induced depigmentation in mice via the activation of glucocorticoid receptor/macrophage migration inhibitory factor signaling pathway. Mol Immunol 2023; 161:33-43. [PMID: 37481827 DOI: 10.1016/j.molimm.2023.07.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023]
Abstract
Psychological stress triggers onset and development of vitiligo in humans. However, the mechanism of psychological stress on vitiligo remains unclear. The study aims to investigate whether psychological stress promotes vitiligo and explore the underlying mechanism. A depigmentation mouse model induced by applying a skin-bleaching reagent monobenzone to dorsal skin and an in vitro HaCaT keratinocyte death model induced by monobenzone were employed to explore the effect of restraint stress, which mimics psychological stress, on depigmentation. The results indicated that restraint stress promoted vitiligo-related depigmentation, vacuolisation, spongiosis, CD8+ T lymphocyte infiltration, and loss of melanocytes in the skin. Restraint stress activated cutaneous NLR family containing pyrin domain protein 3 (NLRP3) inflammasome. In addition, restraint stress aggravated anxiety-like behaviors and increased levels of macrophage migration inhibitory factor (MIF) and corticosterone in the circulation, accompanied with decreasing the expression of cutaneous 8-oxoguanine DNA glycosylase (OGG1) in depigmentation mice. In vitro experiments demonstrated that activation of glucocorticoid receptor (GR) by cortisol upregulated NLRP3 expression dependent on MIF, and directly decreased the transcription of OGG1. Blockade of MIF reversed the NLRP3 signal in restraint stress-induced depigmentation mice. In conclusion, restraint stress promotes vitiligo-related depigmentation in mice via the activation of GR/MIF signaling pathway. The findings provide a theoretical basis for prevention and treatments of vitiligo with therapies of targeting GR, MIF, and OGG1.
Collapse
Affiliation(s)
- Nan Tang
- Departments of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Xiao-Ting Liu
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, China
| | - Wei-Lun Wen
- Departments of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Tian-Shan Liang
- Departments of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China
| | - Xi-Ting Lv
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, China
| | - Qi-Lin Li
- Departments of Dermatology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
| | - Guo-En Wang
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, China.
| | - Yan-Hua Wu
- Departments of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, China.
| |
Collapse
|
5
|
Liang TS, Tang N, Xian MH, Wen WL, Huang CJ, Cai LH, Li QL, Wu YH. Identification of Critical Biomarkers and Mechanisms of Fructus Ligustri Lucidi on Vitiligo Using Integrated Bioinformatics Analysis. Clin Cosmet Investig Dermatol 2023; 16:2061-2071. [PMID: 37575147 PMCID: PMC10416786 DOI: 10.2147/ccid.s413733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 07/21/2023] [Indexed: 08/15/2023]
Abstract
Objective Vitiligo is an autoimmune disease of the skin that targets pigment-producing melanocytes and results in patches of depigmentation that are visible as white spots. Recent research studies have yielded a strong mechanistic understanding of this disease. Fructus Ligustri Lucidi (FLL) has been used for premature graying of hair since ancient China and is currently used to treat vitiligo. However, the key biomarkers and mechanisms underlying FLL in vitiligo remain unclear. This study aimed to identify the potential biomarkers and mechanisms of FLL in vitiligo using network pharmacology analysis. Methods The expression profiles of GSE65127 and GSE75819 were downloaded from the Gene Expression Omnibus database to identify differentially expressed genes (DEGs) between the vitiligo and healthy samples. Gene ontology and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment of DEGs were performed using R analyses. We performed R to further understand the functions of the critical targets. Cytoscape tools have facilitated network topology analysis. Molecular docking was performed using Auto Dock Vina software. Results The results showed that 13 DEGs were screened in vitiligo. Based on bioinformatics, network pharmacology and Western blot, we found that the critical targets of melanoma antigen recognized by 5,6-dihydroxyindole-2-carboxylic acid oxidase (TYRP1) may be related to the mechanism of action of FLL in the treatment of vitiligo. Conclusion TYRP1, as a melanocyte molecular biomarker, may be closely related to the underlying mechanism of FLL in the treatment of vitiligo via the inhibition of melanocyte death.
Collapse
Affiliation(s)
- Tian-Shan Liang
- Department of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, 510220, People’s Republic of China
| | - Nan Tang
- Department of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, 510220, People’s Republic of China
| | - Ming-Hua Xian
- School of Chinese Materia Medica, Guangdong Pharmaceutical University, Guangzhou, Guangdong, 510006, People’s Republic of China
| | - Wei-Lun Wen
- Department of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, 510220, People’s Republic of China
| | - Chang-Jin Huang
- Department of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, 510220, People’s Republic of China
| | - Lan-Hua Cai
- Department of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, 510220, People’s Republic of China
| | - Qi-Lin Li
- Department of Dermatology, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, 510220, People’s Republic of China
| | - Yan-Hua Wu
- Department of Traditional Chinese Medicine, Guangzhou Red Cross Hospital, Jinan University, Guangzhou, Guangdong, 510220, People’s Republic of China
| |
Collapse
|
6
|
Lin T, Du J, Liu L, Wu Z, Kong XK, Duan WB, Du B, Yu YJ, Wen WL, Cai YL. [Safety and efficacy of intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism undergoing endovascular reperfusion therapy]. Zhonghua Nei Ke Za Zhi 2022; 61:397-402. [PMID: 35340186 DOI: 10.3760/cma.j.cn112138-20210414-00279] [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: 06/14/2023]
Abstract
Objective: To evaluate the safety and efficacy of intra-arterial tirofiban infusion during endovascular reperfusion therapy in patients with acute cardiogenic cerebral embolism. Methods: Clinical data of 72 patients with acute cardiogenic cerebral embolism caused by large artery occlusion were retrospectively analyzed in Department of Neurology, Strategic Support Force Medical Center from August 2015 to August 2020.Among those, 52 patients were treated with intra-arterial tirofiban, the other 20 patients were treated with control medication. The baseline characteristics, modified thrombolysis in cerebral infarction (mTICI) score of responsible vessels, modified Rankin scale (mRS) score 90 days after operation, incidence of symptomatic intracranial hemorrhage and mortality were evaluated and compared in two groups. Results: The proportion of effective recanalization of the offending vessels (mTICI≥2b) in tirofiban group was higher than that in control group (92.3% vs. 75.0%), but the difference was not statistically significant (P=0.104). At 90 days after operation, the rate of patients with good prognosis (mRS≤2) in tirofiban group (61.5%) was significantly higher than that in control group (35.0%) (P<0.05). The incidence of symptomatic intracranial hemorrhage and mortality were comparable between the two groups (P>0.05). Conclusion: Intra-arterial tirofiban infusion in patients with acute cardiogenic cerebral embolism is effective and feasible, which improves the prognosis without increasing the risk of intracranial bleeding complications.
Collapse
Affiliation(s)
- T Lin
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - J Du
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - L Liu
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - Z Wu
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - X K Kong
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - W B Duan
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - B Du
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - Y J Yu
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - W L Wen
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| | - Y L Cai
- Department of Neurology, Strategic Support Force Medical Center, Beijing 100101, China
| |
Collapse
|
7
|
Wen WL, Huang HC, Lin HC, Lo WC, Chen SC, Lee MY. Greater Glycemic Burden Is Associated with Further Poorer Glycemic Control in Newly-Diagnosed Type 2 Diabetes Mellitus Patients. Nutrients 2022; 14:nu14020320. [PMID: 35057503 PMCID: PMC8780525 DOI: 10.3390/nu14020320] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 01/09/2022] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
Aims: hyperglycemia impairs pancreatic β-cell function instantly, also known as glucotoxicity. It is unknown whether this insult is temporary or sustained, and little real-world evidence needs to reflect the relationship between hyperglycemic burden, per se, and glycemic durability. Materials and Methods: a retrospective observational cohort study was conducted to recruit newly-diagnosed type 2 diabetes mellitus (T2DM) patients. Durability was defined as the episode from first glycated hemoglobin A1c (HbA1c) below 7.0% to where it exceed 8.0% (with treatment failure) or where study ended (without treatment failure). Glycemic burden was defined with the area above a burden value line (HbA1c = 6.5%) but under the HbA1c curve (AUC), and it was then divided into two compartments with the demarcation timepoint once HbA1c was treated below or equal to 7.0%; the former AUC' represented the initial insult; the latter AUC" represented the residual part. Multivariable regression models assessed factors associated with durability in whole participants and two distinct subgroups: patients with baseline HbA1c > 7.0% or ≤7.0%. Results: 1048 eligible participants were recruited and analyzed: 291 patients with treatment failure (durability 26.8 ± 21.1 months); 757 patients without treatment failure (durability 45.1 ± 31.8 months). Besides age, glycemic burden was the only constant determinant in the two subgroups. AUC' or AUC" increased treatment failure, respectively, in baseline HbA1c > 7.0% or ≤7.0% subgroup [per 1%/90 days hazard ratio (95% confidence interval): 1.026 (1.018-1.034) and 1.128 (1.016-1.253)]. Other determinants include baseline HbA1c, initial OAD, and education level. Conclusions: in patients with newly-diagnosed T2DM, glycemic durability was negatively associated with greater glycemic burden.
Collapse
Affiliation(s)
- Wei-Lun Wen
- Department of Internal Medicine, Lee’s Endocrinology Clinic, Pingtung City 900, Taiwan;
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
| | - Hui-Chun Huang
- Department of Electronics Engineering, Institute of Electronics, National Chiao Tung University, Hsinchu 300, Taiwan;
- Hengchun Navaids Site, Kaohsiung Aviation Facilities Sector, Air Navigation and Weather Services, Ministry of Transportation and Communications, Hengchun 946, Taiwan
| | - Hsiu-Chu Lin
- Certified Diabetic Educator of Endocrinology & Metabolism Ward, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan;
| | - Wan-Ching Lo
- Department of Nursing, Kaohsiung Municipal Siaogang Hospital, Kaohsiung 812, Taiwan;
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (S.-C.C.); (M.-Y.L.)
| | - Mei-Yueh Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung 807, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Correspondence: (S.-C.C.); (M.-Y.L.)
| |
Collapse
|
8
|
Hsu WH, Sue SP, Liang HL, Tseng CW, Lin HC, Wen WL, Lee MY. Dipeptidyl Peptidase 4 Inhibitors Decrease the Risk of Hepatocellular Carcinoma in Patients With Chronic Hepatitis C Infection and Type 2 Diabetes Mellitus: A Nationwide Study in Taiwan. Front Public Health 2021; 9:711723. [PMID: 34604157 PMCID: PMC8484707 DOI: 10.3389/fpubh.2021.711723] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [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] [Received: 05/19/2021] [Accepted: 08/26/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction: Dipeptidyl peptidase 4 inhibitors (DPP-4 inhibitors) are incretin-based oral antidiabetic drugs. Previous studies have shown an association between increased plasma activity of DPP-4 and chronic hepatitis C virus (HCV) infection. Dipeptidyl peptidase 4 inhibitors may be associated with preventing the development of chronic HCV infection. The aim of this study was to investigate whether the use of DPP-4 inhibitors is associated with a decreased risk of hepatocellular carcinoma (HCC) in patients with diabetes mellitus (DM) and chronic HCV infection. Methods: In this retrospective cohort study, we enrolled patients with type 2 diabetes and chronic HCV infection from the National Health Insurance Research Database (NHIRD) in Taiwan. The patients were divided into two groups (DPP-4 inhibitor cohort and non-DPP-4 inhibitor cohort) according to whether or not they received DPP-4 inhibitor treatment. Results: Multivariate Cox proportional hazard regression analysis showed a significantly lower risk of HCC in the patients who took DPP-4 inhibitors compared to those who did not. Kaplan-Meier survival analysis demonstrated a significantly higher HCC-free rate in the DPP-4 inhibitor cohort than in the non-DPP-4 inhibitor cohort. Conclusion: The use of DPP-4 inhibitors was associated with a lower risk of HCC in patients with type 2 DM and chronic HCV infection.
Collapse
Affiliation(s)
- Wei-Hao Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Ping Sue
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Ling Liang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chin-Wei Tseng
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsiu-Chu Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Lun Wen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Yueh Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
9
|
Tu CL, Sue SP, Hsu WH, Huang HY, Wen WL, Lin IT, Chen KH, Sheu NW, Huang SH, Lee MY. Causes of in-hospital death in patients with type 2 diabetes with microvascular and macrovascular complications in Taiwan. Int J Clin Pract 2021; 75:e14491. [PMID: 34115914 DOI: 10.1111/ijcp.14491] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 06/10/2021] [Indexed: 11/29/2022] Open
Abstract
AIMS Diabetes mellitus is a major cause of death worldwide, including Taiwan. The mortality data of the subsets of patients who suffered from microvascular or macrovascular complications is limited. The aim of this study was to investigate the causes of in-hospital death of patients with type 2 diabetes, especially the patients with microvascular, macrovascular and both micro-macrovascular complications. METHODS A total of 12 159 patients with type 2 diabetes were identified from the Taiwan National Health Insurance Research Database (NHIRD) to analyse the causes of death. Type 2 diabetic subjects with microvascular, macrovascular and both micro-macrovascular complications were further classified and compared to patients without microvascular and macrovascular complications in the logistic regression analysis of the risk of death. RESULTS Pneumonia increased risk of in-hospital death in patients with microvascular, macrovascular and both micro-macrovascular complications, with adjusted odds ratios (AORs) of 2.13 (95% confidence interval [CI] 1.09-4.18), 3.26 (1.71-6.24) and 3.96 (2.17-7.22), respectively. Septicaemia increased risk of in-hospital death in patients with macrovascular (AOR 2.57 [1.31-5.04]) and both micro-macrovascular complications (AOR 4.69 [2.58-8.50]). CONCLUSION Pneumonia increased risk of in-hospital death among the type 2 diabetic patients with microvascular, macrovascular and both micro-macrovascular complications. Therefore, efforts aim at preventing pneumonia or decreasing its severity may increase survival.
Collapse
Affiliation(s)
- Ching-Ling Tu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Shu-Ping Sue
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Hao Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hsing-Yi Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Wei-Lun Wen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ting Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kuan-Hsuan Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Nai-Wei Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Shu-Heng Huang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Yueh Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
10
|
Ou YL, Lee MY, Lin IT, Wen WL, Hsu WH, Chen SC. Obesity-related indices are associated with albuminuria and advanced kidney disease in type 2 diabetes mellitus. Ren Fail 2021; 43:1250-1258. [PMID: 34461808 PMCID: PMC8409948 DOI: 10.1080/0886022x.2021.1969247] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Obesity is an important risk factor for the development of diseases including diabetes, hypertension, and cardiovascular disease. However, few reports have investigated the relationships between these obesity-related indices and diabetic nephropathy. The aim of this study was to evaluate associations between obesity-related markers with albuminuria and advanced kidney disease in patients with type 2 diabetes mellitus (DM). Obesity-related indices including body mass index (BMI), waist-to-hip ratio (WHR), waist-to-height ratio (WHtR), body roundness index (BRI), conicity index (CI), lipid accumulation product (LAP), visceral adiposity index (VAI), body adiposity index (BAI), abdominal volume index (AVI), body shape index (BSI), and triglyceride glucose (TyG) index were measured. Albuminuria was defined as a urine albumin/creatinine ratio of ≥30 mg/g. Advanced kidney disease was defined as an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73 m2. A total of 1872 patients with type 2 DM (mean age 64.0 ± 11.3 years, 809 males and 1063 females) were enrolled. In multivariable analysis, 11 high obesity-related indices (BMI, WHR, WHtR, LAP, BRI, CI, VAI, BAI, AVI, ABSI, and TyG index) were significantly associated with albuminuria. In addition, high BMI, WHR, WHtR, LAP, BRI, CI, VAI, and AVI were significantly associated with eGFR <30 ml/min/1.73 m2. The results of this study showed that various obesity-related indices were significantly associated with albuminuria and advanced kidney disease in patients with type 2 DM. Screening may be considered in public health programs to recognize and take appropriate steps to prevent subsequent complications.
Collapse
Affiliation(s)
- Yu-Lun Ou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Mei-Yueh Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - I-Ting Lin
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Lun Wen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Wei-Hao Hsu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Szu-Chia Chen
- Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
11
|
Wen WL, Wang CW, Wu DW, Chen SC, Hung CH, Kuo CH. Associations of Heavy Metals with Metabolic Syndrome and Anthropometric Indices. Nutrients 2020; 12:nu12092666. [PMID: 32882911 PMCID: PMC7551496 DOI: 10.3390/nu12092666] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 08/28/2020] [Accepted: 08/28/2020] [Indexed: 12/21/2022] Open
Abstract
Previous studies have revealed associations between heavy metals and extensive health problems. However, the association between heavy metals and metabolic problems remains poorly defined. This study aims to investigate relationships between heavy metals and metabolic syndrome (MetS), lipid accumulation product (LAP), visceral adiposity index (VAI), and anthropometric indices, including body roundness index (BRI), conicity index (CI), body adiposity index (BAI), and abdominal volume index (AVI). We conducted a health survey of people living in southern Taiwan. Six heavy metals were measured: lead (Pb) in blood and nickel (Ni), chromium (Cr), manganese (Mn), arsenic (As), and copper (Cu) in urine. A total of 2444 participants (976 men and 1468 women) were enrolled. MetS was defined according to the Adult Treatment Panel III for Asians. Multivariable analysis showed that participants with high urine Ni (log per 1 μg/L; odds ratio (OR): 1.193; 95% confidence interval (CI): 1.019 to 1.397; p = 0.028) and high urine Cu (log per 1 μg/dL; OR: 3.317; 95% CI: 2.254 to 4.883; p < 0.001) concentrations were significantly associated with MetS. There was a significant trend of a stepwise increase in blood Pb and urine Ni, As, and Cu according to the number of MetS components (from 0 to 5, a linear p ≤ 0.002 for trend). For the determinants of indices, urine Cu was positively correlated with LAP, BRI, CI, and VAI; blood Pb was positively correlated with BRI, BAI, and AVI; urine Ni was positively correlated with LAP. High urine Cu and urine Ni levels were significantly associated with MetS, and there was a significant trend for stepwise increases in blood Pb and urine Ni, As, and Cu, accompanied by an increasing number of MetS components. Furthermore, several indices were positively correlated with urine Cu, urine Ni, and blood Pb.
Collapse
Affiliation(s)
- Wei-Lun Wen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (W.-L.W.); (C.-W.W.); (D.-W.W.); (C.-H.K.)
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Chih-Wen Wang
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (W.-L.W.); (C.-W.W.); (D.-W.W.); (C.-H.K.)
- Division of Hepatobiliary, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Da-Wei Wu
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (W.-L.W.); (C.-W.W.); (D.-W.W.); (C.-H.K.)
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| | - Szu-Chia Chen
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (W.-L.W.); (C.-W.W.); (D.-W.W.); (C.-H.K.)
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Correspondence: ; Tel.: +886-7-8036783-3440
| | - Chih-Hsing Hung
- Research Center for Environmental Medicine, Kaohsiung Medical University, Kaohsiung 807, Taiwan;
- Department of Pediatrics, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
- Department of Pediatrics, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan
| | - Chao-Hung Kuo
- Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung 812, Taiwan; (W.-L.W.); (C.-W.W.); (D.-W.W.); (C.-H.K.)
- Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 807, Taiwan
| |
Collapse
|
12
|
Feng NY, Shen XL, Wang YX, Wen WL, Guo HQ. [The outcomes comparison between autologous incus and titanium PORP in Austin A and C type ossicle defect cases]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2018; 32:1499-1501. [PMID: 30550197 DOI: 10.13201/j.issn.1001-1781.2018.19.014] [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] [Received: 05/04/2018] [Indexed: 11/12/2022]
Abstract
Objective: A series of otitis media patients with Austin A and C type ossicles defects received ossicular chain reconstruction surgery using either autologous incus or titanium partial ossicular replacement prosthesis (PORP).The hearing outcomes and exclusion rate of prosthesis were compared between these two groups. Method: One hundred and seventy-six patients with chronic otitis media underwent ossiculoplasty in our hospital during 2016-2017. These patients were divided into 2 groups: group A consisted of those receiving autologous incus replacement (n=85), and group B consisted of those receiving titanium PORP (n=91). All the patients received CWD mastoidectomy and ossiculoplasty in one stage and were followedup in postoperative 3, 6 and 12 months. Result: The postoperative hearing improvement rates in group A and B were 85.88% and 92.31%, respectively, and there was no statistical difference. No statistical difference of the postoperative hearing improvement rates was observed between Austin A and C type in 2 groups. Three cases (3.29%) had ossicle exclusion in B group, and 0 case in A group, which was not statistical different (P>0.05). Conclusion: Patients receiving ossicular chain reconstruction surgery using autologous incus show similar hearing outcomes as those using titanium PORP. The risk of prosthesis exclusion is lower for autologous incus than titanium PORP. The residual handle of malleus has no obvious influence on the postoperative hearing improvement.
Collapse
Affiliation(s)
- N Y Feng
- Department of Otolaryngology Head and Neck Surgery,General Hospital of Ningxia Medical University,750004,Yinchuan,China
| | - X L Shen
- Department of Otolaryngology Head and Neck Surgery,General Hospital of Ningxia Medical University,750004,Yinchuan,China
| | - Y X Wang
- Department of Otolaryngology Head and Neck Surgery,General Hospital of Ningxia Medical University,750004,Yinchuan,China
| | - W L Wen
- Department of Otolaryngology Head and Neck Surgery,General Hospital of Ningxia Medical University,750004,Yinchuan,China
| | - H Q Guo
- Department of Otolaryngology Head and Neck Surgery,General Hospital of Ningxia Medical University,750004,Yinchuan,China
| |
Collapse
|
13
|
Wen WL, Ma RX, Yang ZC, Zhou Y. [Clinical application of iodine solution staining in the diagnosis of early laryngeal cancer with electronic endoscope]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:873-877. [PMID: 29797932 DOI: 10.13201/j.issn.1001-1781.2016.11.009] [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] [Received: 01/12/2016] [Indexed: 11/12/2022]
Abstract
Objective:To discuss the feasibility and clinical application value of the laryngeal iodine staining under the electronic fiber laryngoscope.Method:Will meet the inclusion criteria of 90 patients, randomly divided into three groups, set to a, b, c group.a ,all patients in the a group were examined by electronic fiber mirror, NBI mode and 0.5% Lugol liquid iodine staining method in three ways. b, all patients in the b group were examined by electronic fiber mirror, NBI mode and 1.0% Lugol liquid iodine staining method in three ways. c,all patients in the c group were examined by electronic fiber mirror, NBI mode and 1.5% Lugol liquid iodine staining method in three ways. The location and range of positive lesions were recorded in each person of the three groups, positive lesions were biopsy, if the positive lesion is repeated, the site can only take a biopsy. As a diagnostic gold standard, the results of the other tests were compared with the results of other tests. And to observe the color of iodine in the throat, all patients were followed up for 24 hours in the presence of dyspnea, severe pain in the throat and other symptoms, and 24 hours after the examination again electronic fiber optic examination. Biopsy was performed in all patients, as gold standard. Using chi square test, inspection standardP <0.05.Result:As the solution of the iodine concentration increased, the rate of the laryngeal was cancer gradually increased. Ninety people take part in the experiment, no one has serious complications. All the patients have no significant inflammation on the mucous membrane of the throat and the subglottic airway afer 24 hours, by the electronic fiber laryngoscope. 1% and the following concentration of Lugol solution for iodine staining, sensitivity to the diagnosis of early laryngeal cancer was higher than that of electronic fiber,the two methods were compared, and the statistical analysis was performed(P >0.05). No statistical significance. There was no significant difference in the diagnosis of early laryngeal cancer. Contrast between iodine stain with 1.5% Lugol solution and electronic fiber sus pension, after statistical calculation(P <0.05);both are statistically significant, and the difference is significant.Comparison of iodine stain with 1.5% Lugol solution and NBI examination, make statistical analysis,P >0.05, there was no significant difference between the both.Conclusion:The 1.5% and below the concentration of the iodine staining under the electronic fiber laryngoscope can be safely applied to inspect the throat, and 1.5% Lugol iodine solution in the diagnosis of laryngeal cancer in the early stage of laryngeal cancer is better than using electronic, and has a certain value in clinical application.
Collapse
Affiliation(s)
- W L Wen
- Department of Otolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - R X Ma
- Department of Otolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Z C Yang
- Department of Otolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| | - Y Zhou
- Department of Otolaryngology Head and Neck Surgery, General Hospital of Ningxia Medical University, Yinchuan, 750004, China
| |
Collapse
|