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Nell LA, Weng YM, Phillips JS, Botsch JC, Book KR, Einarsson Á, Ives AR, Schoville SD. Shared Features Underlying Compact Genomes and Extreme Habitat Use in Chironomid Midges. Genome Biol Evol 2024; 16:evae086. [PMID: 38662498 PMCID: PMC11076180 DOI: 10.1093/gbe/evae086] [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] [Accepted: 04/21/2024] [Indexed: 05/09/2024] Open
Abstract
Nonbiting midges (family Chironomidae) are found throughout the world in a diverse array of aquatic and terrestrial habitats, can often tolerate harsh conditions such as hypoxia or desiccation, and have consistently compact genomes. Yet we know little about the shared molecular basis for these attributes and how they have evolved across the family. Here, we address these questions by first creating high-quality, annotated reference assemblies for Tanytarsus gracilentus (subfamily Chironominae, tribe Tanytarsini) and Parochlus steinenii (subfamily Podonominae). Using these and other publicly available assemblies, we created a time-calibrated phylogenomic tree for family Chironomidae with outgroups from order Diptera. We used this phylogeny to test for features associated with compact genomes, as well as examining patterns of gene family evolution and positive selection that may underlie chironomid habitat tolerances. Our results suggest that compact genomes evolved in the common ancestor of Chironomidae and Ceratopogonidae and that this occurred mainly through reductions in noncoding regions (introns, intergenic sequences, and repeat elements). Significantly expanded gene families in Chironomidae included biological processes that may relate to tolerance of stressful environments, such as temperature homeostasis, carbohydrate transport, melanization defense response, and trehalose transport. We identified several positively selected genes in Chironomidae, notably sulfonylurea receptor, CREB-binding protein, and protein kinase D. Our results improve our understanding of the evolution of small genomes and extreme habitat use in this widely distributed group.
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Affiliation(s)
- Lucas A Nell
- Department of Integrative Biology, University of Wisconsin, Madison, WI 53706, USA
- Department of Biology, Stanford University, Stanford, CA 94305, USA
| | - Yi-Ming Weng
- Department of Entomology, University of Wisconsin, Madison, WI 53706, USA
- McGuire Center for Lepidoptera & Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL 32611, USA
| | - Joseph S Phillips
- Department of Integrative Biology, University of Wisconsin, Madison, WI 53706, USA
- Department of Biology, Creighton University, Omaha, NE 68178, USA
| | - Jamieson C Botsch
- Department of Integrative Biology, University of Wisconsin, Madison, WI 53706, USA
- North Central Agricultural Research Laboratory, USDA-ARS, Brookings, SD 57006, USA
| | - K Riley Book
- Department of Integrative Biology, University of Wisconsin, Madison, WI 53706, USA
| | | | - Anthony R Ives
- Department of Integrative Biology, University of Wisconsin, Madison, WI 53706, USA
| | - Sean D Schoville
- Department of Entomology, University of Wisconsin, Madison, WI 53706, USA
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2
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Weng YM, Shashank PR, Godfrey RK, Plotkin D, Parker BM, Wist T, Kawahara AY. Evolutionary genomics of three agricultural pest moths reveals rapid evolution of host adaptation and immune-related genes. Gigascience 2024; 13:giad103. [PMID: 38165153 PMCID: PMC10759296 DOI: 10.1093/gigascience/giad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 08/01/2023] [Accepted: 11/15/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Understanding the genotype of pest species provides an important baseline for designing integrated pest management (IPM) strategies. Recently developed long-read sequence technologies make it possible to compare genomic features of nonmodel pest species to disclose the evolutionary path underlying the pest species profiles. Here we sequenced and assembled genomes for 3 agricultural pest gelechiid moths: Phthorimaea absoluta (tomato leafminer), Keiferia lycopersicella (tomato pinworm), and Scrobipalpa atriplicella (goosefoot groundling moth). We also compared genomes of tomato leafminer and tomato pinworm with published genomes of Phthorimaea operculella and Pectinophora gossypiella to investigate the gene family evolution related to the pest species profiles. RESULTS We found that the 3 solanaceous feeding species, P. absoluta, K. lycopersicella, and P. operculella, are clustered together. Gene family evolution analyses with the 4 species show clear gene family expansions on host plant-associated genes for the 3 solanaceous feeding species. These genes are involved in host compound sensing (e.g., gustatory receptors), detoxification (e.g., ABC transporter C family, cytochrome P450, glucose-methanol-choline oxidoreductase, insect cuticle proteins, and UDP-glucuronosyl), and digestion (e.g., serine proteases and peptidase family S1). A gene ontology enrichment analysis of rapid evolving genes also suggests enriched functions in host sensing and immunity. CONCLUSIONS Our results of family evolution analyses indicate that host plant adaptation and pathogen defense could be important drivers in species diversification among gelechiid moths.
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Affiliation(s)
- Yi-Ming Weng
- McGuire Center for Lepidoptera & Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL 32611, USA
| | - Pathour R Shashank
- McGuire Center for Lepidoptera & Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL 32611, USA
- Division of Entomology, ICAR-Indian Agricultural Research Institute, Pusa, New Delhi 110012, India
| | - R Keating Godfrey
- McGuire Center for Lepidoptera & Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL 32611, USA
| | - David Plotkin
- McGuire Center for Lepidoptera & Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL 32611, USA
| | - Brandon M Parker
- McGuire Center for Lepidoptera & Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL 32611, USA
| | - Tyler Wist
- Agriculture and Agri-Food Canada, Saskatoon, SK, S7N 0×2, Canada
| | - Akito Y Kawahara
- McGuire Center for Lepidoptera & Biodiversity, Florida Museum of Natural History, University of Florida, Gainesville, FL 32611, USA
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3
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Weng Y, Mao Y, Wang Y, Jiao Y, Xiang J, Le W. Simvastatin attenuates diabetes mellitus erectile dysfunction in rats by miR-9-5p-regulated PDCD4. Acta Biochim Pol 2023; 70:791-797. [PMID: 37929666 DOI: 10.18388/abp.2020_6315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 09/24/2023] [Indexed: 11/07/2023]
Abstract
DMED is a common complication of diabetes, for which new treatment methods are urgently required. Focused on DMED, the pharmacological mechanism of simvastatin (Sim) was probed. A model of DMED was made in rats with streptozotocin and orally medicated with Sim. Lentiviral vectors that interfere with miR-9-5p or PDCD4 were injected, and the erectile function, histopathology of cavernous tissue, and α-SMA expression were evaluated. Cavernous smooth muscle cells (CMSCs) obtained from DMED rats were treated with Sim and transfected with the plasmid vector that interferes with miR-9-5p or PDCD4 to observe cell viability and apoptosis. The binding relationship between miR-9-5p and PDCD4 was checked. After 8-week treatment with Sim, erectile function was improved and the corpus cavernosum injury was alleviated. Upregulating miR-9-5p or downregulating PDCD4 further improved erectile function and cavernous injury in rats. miR-9-5p targeted regulation of PDCD4. In vitro cell experiment results showed that Sim induced proliferation and reduced apoptosis of CSMCs by enhancing miR-9-5p-targeted regulating PDCD4 in vitro. Sim attenuates DMED in rats via miR-9-5p/PDCD4.
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Affiliation(s)
- YiMing Weng
- Department of Reproductive Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - YuanShen Mao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 201999, China
| | - YanQiu Wang
- Department of Reproductive Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - YuFan Jiao
- Department of Reproductive Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200065, China
| | - Jun Xiang
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200092, China
| | - Wei Le
- Department of Urology, Tongji Hospital, Tongji University School of Medicine, Shanghai, 200092, China
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4
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Huang HH, Stubbs B, Chen LJ, Ku PW, Hsu TY, Lin CW, Weng YM, Wu SH. The effect of physical activity on sleep disturbance in various populations: a scoping review of randomized clinical trials. Int J Behav Nutr Phys Act 2023; 20:44. [PMID: 37069626 PMCID: PMC10107572 DOI: 10.1186/s12966-023-01449-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [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: 09/19/2022] [Accepted: 04/04/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Promoting physical activity (PA) in different populations experiencing sleep disturbance may increase population PA levels and improve sleep. This scoping review aimed to examine the effect of various PA intervention strategies on sleep across different populations, identify key sleep outcomes, and analyze knowledge gaps by mapping the relevant literature. METHODS For this study, we systematically searched articles published till March 2022 from PubMed, Web of Science, Cochrane Library, and Embase databases for randomized clinical trials (RCTs) regarding the effect of physical activity on sleep. Two authors extracted key data and descriptively analyzed the data. Thematic analysis was used to categorize the results into themes by all authors. Arksey and O'Malley's scoping review framework was used to present the findings. RESULTS Twenty-one randomized controlled trials out of 3052 studies were finally included with 3677 participants (2852 females (78%)). Five trials were conducted in healthy working-age adults with sleep disturbance but without the diagnosis of insomnia, five in healthy older adults, two in perinatal women, four in patients with cancer, three in mental illness related subjects, and another two in other disease-related areas. PA interventions were diverse, including walking, resistance training, aerobic exercise, housework, water exercise, basketball, smartphone/tablet "apps", web, online videos or wearable actigraphy, and self-determined exercise. Three major themes were identified: (1) Sleep environment may be important to address prior to instituting PA interventions, (2) All types of PA were effective for improving sleep in all populations studied, (3) Self-tolerated PA is safe for improving sleep in the elderly and in co-morbid or perinatal populations. CONCLUSIONS PA is effective and safe for improving sleep in both healthy and co-morbid populations with sleep disturbance by increasing daily activity levels using a variety of strategies, even low intensity, such as housekeeping, sit-to-stand repetitions, along with encouraging PA through web pages, videos, and self-goal setting apps. In addition, this scoping review identifies the need for further therapeutic research and future exploration in populations with sleep initiation or sleep maintenance disturbance.
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Affiliation(s)
- Hung-Hsin Huang
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London, SE5 8AZ, UK
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, London, SE5 8AF, Box, UK
| | - Li-Jung Chen
- Department of Exercise Health Science, National Taiwan University of Sport, 271, Lixing Road, Taichung City, 404, Taiwan
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Po-Wen Ku
- Graduate Institute of Sports and Health Management, National Chung Hsing University, 145 Xingda Rd., South Dist, Taichung City, 402, Taiwan
- Department of Kinesiology, National Tsing Hua University, Hsinchu, 300, Taiwan
| | - Tai-Yi Hsu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Department of Public Health, China Medical University, Taichung, Taiwan
| | - Chia-Wei Lin
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan
- Doctoral Degree Program in Artificial Intelligence, Asia University, Taichung, Taiwan
| | - Yi-Ming Weng
- Emergency department of Taoyuan General Hospital, MOHW, Taoyuan, Taiwan
| | - Shih-Hao Wu
- School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
- Department of Emergency Medicine, China Medical University Hospital, Taichung, Taiwan.
- Department of Exercise Health Science, National Taiwan University of Sport, 271, Lixing Road, Taichung City, 404, Taiwan.
- Attending Physician of Emergency Department, China Medical University Hospital, Taichung, 404, Taiwan.
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5
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Chen YH, Huang KY, Liu CC, Weng YM. Who Is at Risk? A Critical Case of Japanese Encephalitis. J Acute Med 2022; 12:122-125. [PMID: 36313605 PMCID: PMC9561487 DOI: 10.6705/j.jacme.202209_12(3).0005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 10/20/2021] [Accepted: 12/20/2021] [Indexed: 06/16/2023]
Abstract
Japanese encephalitis (JE) is critical epidemic encephalitis caused by the JE virus (JEV) in Southeast Asia. The World Health Organization defined "acute encephalitis syndrome" (AES) as an acute onset of fever with a change of mental status and/or new-onset seizure, mainly for the surveillance of JE. The key clues for the diagnosis include the patient age group of unvaccinated era or waning vaccine-induced immunity and the history of possible mosquito bites in epidemic areas. We report a 47-year old man who is in an unvaccinated era with potential waning immunity. The patient presented with fever and altered mental status for 2 days. He was speechless and could not follow commands. The patient had gone camping in the countryside a week before the visit. At the emergency department, neck stiffness was noted. There was a leukocytosis with a left shift by blood cell count. The brain computed tomography was essentially normal. The cerebrospinal fluid (CSF) sample via lumbar puncture showed leukocytosis, a high protein level, and a low sugar level in comparison to serum tests. Further antibody test of CSF confirmed the diagnosis. Magnetic resonance imaging (MRI) of the brain revealed a high signal in the right thalamus and a mildly swollen left caudate nucleus 4 days after admission. He was extubated and finally discharged with partial dependency on activities of daily living. This case reminds us of the JE in AES. Emergency physicians should be aware of the suspicious case of unvaccinated age or waning immunity and possible mosquito bites in epidemic areas. The role of MRI on JE was also discussed in this article.
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Affiliation(s)
- Yu-Hsiang Chen
- Taoyuan General Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Ko-Ying Huang
- Taipei Veterans General Hospital Department of Radiology Taipei Taiwan
| | - Chia-Chen Liu
- Department of Medicine Division of Neurology Taoyuan General Hospital, Taoyuan Taiwan
| | - Yi-Ming Weng
- Taoyuan General Hospital Department of Emergency Medicine Taoyuan Taiwan
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6
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Mao Y, Li W, Weng Y, Hua B, Gu X, Lu C, Xu B, Xu H, Wang Z. METTL3-Mediated m 6A Modification of lncRNA MALAT1 Facilitates Prostate Cancer Growth by Activation of PI3K/AKT Signaling. Cell Transplant 2022; 31:9636897221122997. [PMID: 36073002 PMCID: PMC9459491 DOI: 10.1177/09636897221122997] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [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: 12/04/2022] Open
Abstract
Accumulating data show that N6-methyladenosine (m6A) methyltransferase
METTL3 and long noncoding RNA MALAT1 act pivotal roles in multiple malignancies
including prostate cancer (PCa). However, the role and molecular mechanism
underlying METTL3-mediated m6A modification of MALAT1 in PCa remain
undocumented. The association of METTL3 and MALAT1 expression with
clinicopathological characteristics and prognosis in patients with PCa was
analyzed by quantitative real-time polymerase chain reaction (qRT-PCR), Western
blot, and public The Cancer Genome Atlas (TCGA) dataset. The in
vitro and in vivo experiments were executed to
investigate the role of METTL3 in PCa. m6A dot blot, methylated RNA
immunoprecipitation (MeRIP), RIP, and qRT-PCR assays were employed to observe
METTL3-mediated m6A modification of MALAT1. The effects of METTL3 on
MALAT1-mediated PI3K/AKT pathway were assessed by Western blot analysis. As a
result, we found that METTL3 was significantly upregulated in PCa tissues and
high expression of METTL3 was associated with Gleason score and tumor recurrence
in patients with PCa. Knockdown of METTL3 markedly repressed growth and invasion
of PCa cells in vitro and in vivo, whereas
ectopic expression of METTL3 showed the opposite effects. Moreover, knockdown of
METTL3 decreased the total m6A levels of PCa cells as well as the
MALAT1 m6A levels, leading to reduced MALAT1 expression.
Overexpression of MALAT1 reversed METTL3 knockdown-induced antitumor effects and
PI3K/AKT signaling inactivation. MALAT1 harbored a positive correlation with
METTL3 expression and tumor recurrence in PCa. In conclusion, our findings
demonstrate that METTL3-mediated m6A modification of lncRNA MALAT1
promotes growth and invasion of PCa cells by activating PI3K/AKT signaling.
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Affiliation(s)
- Yuanshen Mao
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wenfeng Li
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - YiMing Weng
- Reproductive Medical Center, Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Bao Hua
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xin Gu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chao Lu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huan Xu
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Zhong Wang
- Department of Urology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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7
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Weng YM, Francoeur CB, Currie CR, Kavanaugh DH, Schoville SD. A high-quality carabid genome assembly provides insights into beetle genome evolution and cold adaptation. Mol Ecol Resour 2021; 21:2145-2165. [PMID: 33938156 DOI: 10.1111/1755-0998.13409] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 04/13/2021] [Accepted: 04/26/2021] [Indexed: 12/13/2022]
Abstract
The hyperdiverse order Coleoptera comprises a staggering ~25% of known species on Earth. Despite recent breakthroughs in next generation sequencing, there remains a limited representation of beetle diversity in assembled genomes. Most notably, the ground beetle family Carabidae, comprising more than 40,000 described species, has not been studied in a comparative genomics framework using whole genome data. Here we generate a high-quality genome assembly for Nebria riversi, to examine sources of novelty in the genome evolution of beetles, as well as genetic changes associated with specialization to high-elevation alpine habitats. In particular, this genome resource provides a foundation for expanding comparative molecular research into mechanisms of insect cold adaptation. Comparison to other beetles shows a strong signature of genome compaction, with N. riversi possessing a relatively small genome (~147 Mb) compared to other beetles, with associated reductions in repeat element content and intron length. Small genome size is not, however, associated with fewer protein-coding genes, and an analysis of gene family diversity shows significant expansions of genes associated with cellular membranes and membrane transport, as well as protein phosphorylation and muscle filament structure. Finally, our genomic analyses show that these high-elevation beetles have endosymbiotic Spiroplasma, with several metabolic pathways (e.g., propanoate biosynthesis) that might complement N. riversi, although its role as a beneficial symbiont or as a reproductive parasite remains equivocal.
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Affiliation(s)
- Yi-Ming Weng
- Department of Entomology, University of Wisconsin - Madison, Madison, WI, USA
| | - Charlotte B Francoeur
- Department of Bacteriology, University of Wisconsin - Madison, Madison, WI, USA.,Department of Energy Great Lakes Bioenergy Research Center, University of Wisconsin - Madison, Madison, WI, USA
| | - Cameron R Currie
- Department of Bacteriology, University of Wisconsin - Madison, Madison, WI, USA.,Department of Energy Great Lakes Bioenergy Research Center, University of Wisconsin - Madison, Madison, WI, USA
| | - David H Kavanaugh
- Department of Entomology, California Academy of Sciences, San Francisco, CA, USA
| | - Sean D Schoville
- Department of Entomology, University of Wisconsin - Madison, Madison, WI, USA
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8
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Weng YM, Kavanaugh DH, Schoville SD. Drainage basins serve as multiple glacial refugia for alpine habitats in the Sierra Nevada Mountains, California. Mol Ecol 2020; 30:826-843. [PMID: 33270315 DOI: 10.1111/mec.15762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Revised: 11/19/2020] [Accepted: 11/26/2020] [Indexed: 12/13/2022]
Abstract
The evolutionary histories of alpine species are often directly associated with responses to glaciation. Deep divergence among populations and complex patterns of genetic variation have been inferred as consequences of persistence within glacier boundaries (i.e., on nunataks), while shallow divergence and limited genetic variation are assumed to result from expansion from large refugia at the edge of ice shields (i.e., massifs de refuge). However, for some species, dependence on specific microhabitats could profoundly influence their spatial and demographic response to glaciation, and such a simple dichotomy may obscure the localization of actual refugia. In this study, we use the Nebria ingens complex (Coleoptera: Carabidae), a water-affiliated ground beetle lineage, to test how drainage basins are linked to their observed population structure. By analysing mitochondrial COI gene sequences and genome-wide single nucleotide polymorphisms, we find that the major drainage systems of the Sierra Nevada Mountains in California best explain the population structure of the N. ingens complex. In addition, we find that an intermediate morphotype within the N. ingens complex is the product of historical hybridization of N. riversi and N. ingens in the San Joaquin basin during glaciation. This study highlights the importance of considering ecological preferences in how species respond to climate fluctuations and provides an explanation for discordances that are often observed in comparative phylogeographical studies.
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Affiliation(s)
- Yi-Ming Weng
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
| | - David H Kavanaugh
- Department of Entomology, California Academy of Sciences, San Francisco, CA, USA
| | - Sean D Schoville
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
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9
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Chien CY, Fang SY, Tsai LH, Tsai SL, Chen CB, Seak CJ, Weng YM, Lin CC, Chien WC, Huang CH, Lin CY, Chaou CH, Liu PH, Tseng HJ, Chen JC, Peng SY, Cheng TH, Hsu KH, Ng CJ. Traditional versus blended CPR training program: A randomized controlled non-inferiority study. Sci Rep 2020; 10:10032. [PMID: 32572100 PMCID: PMC7308401 DOI: 10.1038/s41598-020-67193-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [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: 12/30/2019] [Accepted: 06/03/2020] [Indexed: 11/09/2022] Open
Abstract
Cardiopulmonary resuscitation (CPR) training and its quality are critical in improving the survival rate of cardiac arrest. This randomized controlled study investigated the efficacy of a newly developed CPR training program for the public in a Taiwanese setting. A total of 832 adults were randomized to either a traditional or blended (18-minute e-learning plus 30-minute hands-on) compression-only CPR training program. The primary outcome was compression depth. Secondary outcomes included CPR knowledge test, practical test, quality of CPR performance, and skill retention. The mean compression depth was 5.21 cm and 5.24 cm in the blended and traditional groups, respectively. The mean difference in compression depth between groups was -0.04 (95% confidence interval -0.13 to infinity), demonstrating that the blended CPR training program was non-inferior to the traditional CPR training program in compression depth after initial training. Secondary outcome results were comparable between groups. Although the mean compression depth and rate were guideline-compliant, only half of the compressions were delivered with adequate depth and rate in both groups. CPR knowledge and skill retained similarly in both groups at 6 and 12 months after training. The blended CPR training program was non-inferior to the traditional CPR training program. However, there is still room for improvement in optimizing initial skill performance as well as skill retention. Clinical Trial Registration: NCT03586752; www.clinicaltrial.gov.
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Affiliation(s)
- Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Shao-Yu Fang
- Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, 105, Taiwan
| | - Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Shang-Li Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, 105, Taiwan
| | - Chen-Bin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, 330, Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Wei-Che Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, 105, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, 330, Taiwan
| | - Cheng-Yu Lin
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, 105, Taiwan
| | - Hsiao-Jung Tseng
- Biostatistics Unit, Clinical Trial Center, Chang Gung Memorial Hospital, Linkou, Taoyuan, 333, Taiwan
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, 330, Taiwan
| | - Shu-Yuan Peng
- Department of nursing, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Tsung-Hsuan Cheng
- Department of nursing, Ton-Yen General Hospital, Zhubei, 302, Taiwan
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.,Laboratory for Epidemiology, Chang Gung University, Taoyuan, 333, Taiwan.,Department of Urology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Taoyuan, 333, Taiwan.
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10
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Chien CY, Tsai SL, Tsai LH, Chen CB, Seak CJ, Weng YM, Lin CC, Ng CJ, Chien WC, Huang CH, Lin CY, Chaou CH, Liu PH, Tseng HJ, Fang CT. Impact of Transport Time and Cardiac Arrest Centers on the Neurological Outcome After Out-of-Hospital Cardiac Arrest: A Retrospective Cohort Study. J Am Heart Assoc 2020; 9:e015544. [PMID: 32458720 PMCID: PMC7429006 DOI: 10.1161/jaha.119.015544] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Background Should all out‐of‐hospital cardiac arrest (OHCA) patients be directly transported to cardiac arrest centers (CACs) remains under debate. Our study evaluated the impacts of different transport time and destination hospital on the outcomes of OHCA patients. Methods and Results Data were collected from 6655 OHCA patients recorded in the regional prospective OHCA registry database of Taoyuan City, Taiwan, between January 2012 and December 2016. Patients were matched on propensity score, which left 5156 patients, 2578 each in the CAC and non‐CAC groups. Transport time was dichotomized into <8 and ≥8 minutes. The relations between the transport time to CACs and good neurological outcome at discharge and survival to discharge were investigated. Of the 5156 patients, 4215 (81.7%) presented with nonshockable rhythms and 941 (18.3%) presented with shockable rhythms. Regardless of transport time, transportation to a CAC increased the likelihoods of survival to discharge (<8 minutes: adjusted odds ratio [aOR], 1.95; 95% CI, 1.11–3.41; ≥8 minutes: aOR, 1.92; 95% CI, 1.25–2.94) and good neurological outcome at discharge (<8 minutes: aOR, 2.70; 95% CI, 1.40–5.22; ≥8 minutes: aOR, 2.20; 95% CI, 1.29–3.75) in OHCA patients with shockable rhythms but not in patients with nonshockable rhythms. Conclusions OHCA patients with shockable rhythms transported to CACs demonstrated higher probabilities of survival to discharge and a good neurological outcome at discharge. Direct ambulance delivery to CACs should thus be considered, particularly when OHCA patients present with shockable rhythms.
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Affiliation(s)
- Cheng-Yu Chien
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan
| | - Shang-Li Tsai
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
| | - Li-Heng Tsai
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Chen-Bin Chen
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Taoyuan General Hospital Ministry of Health and Welfare Taoyuan Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Wei-Che Chien
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Taoyuan General Hospital Ministry of Health and Welfare Taoyuan Taiwan
| | - Cheng-Yu Lin
- Department of Emergency Medicine Ton-Yen General Hospital Zhubei Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine Chang Gung Memorial Hospital Linkou and College of Medicine Chang Gung University Tao-Yuan Taiwan.,Department of Emergency Medicine Chang Gung Memorial Hospital Taipei Branch Taipei Taiwan
| | - Hsiao-Jung Tseng
- Biostatistics Unit Clinical Trial Center Chang Gung Memorial Hospital Linkou Taiwan
| | - Chi-Tai Fang
- Department of Internal Medicine National Taiwan University Hospital Taipei Taiwan.,Institute of Epidemiology and Preventive Medicine College of Public Health National Taiwan University Taipei Taiwan
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11
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Lin YK, Niu KY, Seak CJ, Weng YM, Wang JH, Lai PF. Comparison between simple triage and rapid treatment and Taiwan Triage and Acuity Scale for the emergency department triage of victims following an earthquake-related mass casualty incident: a retrospective cohort study. World J Emerg Surg 2020; 15:20. [PMID: 32156308 PMCID: PMC7065314 DOI: 10.1186/s13017-020-00296-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 02/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Triage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI. METHODS We retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge. RESULTS We enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%). CONCLUSIONS The present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.
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Affiliation(s)
- Yun-Kuan Lin
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Kuang-Yu Niu
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Prehospital Care Division, Taoyuan General Hospital, Taoyuan, Taiwan.,Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan
| | - Pei-Fang Lai
- Department of Emergency Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan. .,Department of Medicine, Tzu Chi University, Hualien, Taiwan.
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12
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Weng YM, Veire BM, Dudko RY, Medeiros MJ, Kavanaugh DH, Schoville SD. Rapid speciation and ecological divergence into North American alpine habitats: the Nippononebria (Coleoptera: Carabidae) species complex. Biol J Linn Soc Lond 2020. [DOI: 10.1093/biolinnean/blaa014] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Abstract
The climate-driven species pump hypothesis has been supported in a number of phylogeographic studies of alpine species. Climate-driven shifts in distribution, coupled with rapid demographic change, have led to strong genetic drift and lineage diversification. Although the species pump has been linked to rapid speciation in a number of studies, few studies have demonstrated that ecological divergence accompanies rapid speciation. Here we examine genetic, morphological and physiological variation in members of the ground beetle taxon Nippononebria, to test three competing hypotheses of evolutionary diversification: isolation and incomplete lineage sorting (no speciation), recent speciation without ecological divergence, or recent speciation with ecological divergence into alpine habitats. Genetic data are consistent with recent divergence, with major lineages forming in the last million years. A species tree analysis, in conjunction with morphological divergence in male reproductive traits, support the formation of three recognized Nippononebria taxa. Furthermore, both morphological and physiological traits demonstrate ecological divergence in alpine lineages, with convergent shifts in body shape and thermal tolerance breadth. This provides strong evidence that the climate-driven species pump can generate ecological novelty, though it is argued that spatial scale may be a key determinant of broader patterns of macroevolution in alpine communities.
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Affiliation(s)
- Yi-Ming Weng
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
| | - Benton M Veire
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
| | - Roman Yu Dudko
- Institute of Systematics and Ecology of Animals, Siberian Branch of the Russian Academy of Sciences, Novosibirsk, Russia
- Tomsk State University, Tomsk, Russia
| | - Matthew J Medeiros
- Urban School of San Francisco, San Francisco, CA, USA
- School of Life Sciences, University of Nevada Las Vegas, S. Maryland Parkway, Las Vegas, NV, USA
| | - David H Kavanaugh
- Department of Entomology, California Academy of Sciences, San Francisco, CA, USA
| | - Sean D Schoville
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
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13
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Ng CJ, Chien CY, Seak JCJ, Tsai SL, Weng YM, Chaou CH, Kuo CW, Chen JC, Hsu KH. Validation of the five-tier Taiwan Triage and Acuity Scale for prehospital use by Emergency Medical Technicians. Emerg Med J 2020; 36:472-478. [PMID: 31358550 DOI: 10.1136/emermed-2018-207509] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/20/2019] [Accepted: 06/09/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVES This study aimed to determine the inter-rater reliability of the five-level Taiwan Triage and Acuity Scale (TTAS) when used by emergency medical technicians (EMTs) and triage registered nurses (TRNs). Furthermore, it sought to validate the prehospital TTAS scores according to ED hospitalisation rates and medical resource consumption. METHODS This was a prospective observational study. After training in five-level triage, EMTs triaged patients arriving to the ED and agreement with the nurse triage (TRN) was assessed. Subsequently, these trained research EMTs rode along on ambulance calls and assigned TTAS scores for each patient at the scene, while the on-duty EMTs applied their standard two-tier prehospital triage scale and followed standard practice, blinded to the TTAS scores. The accuracy of the TTAS scores in the field for prediction of hospitalisation and medical resource consumption were analysed using logistic regression and a linear model, respectively, and compared with the accuracy of the current two-tier prehospital triage scale. RESULTS After EMT's underwent initial training in five-level TTAS, inter-rater agreement between EMTs and TRNs for triage of ED patients was very good (κw=0.825, CI 0.750 to 0.900). For the outcome of hospitalisation, TTAS five-level system (Akaike's Information Criteria (AIC)=486, area under the curve (AUC)=0.75) showed better discrimination compared with TPTS two-level system (AIC=508, AUC=0.66). Triage assignments by the EMTs using the the five-level TTAS was linearly associated with hospitalisation and medical resource consumption. CONCLUSIONS A five-level prehospital triage scale shows good inter-rater reliability and superior discrimination compared with the two-level system for prediction of hospitalisation and medical resource requirements.
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Affiliation(s)
- Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.,Department of Emergency Medicine, Ton-Yen General Hospital, Zhupei, Taiwan
| | - Julian Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Shang-Li Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.,Department of Emergency Medicine, Chang Gung Memorial Hospital Taipei Branch, Taipei, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan, Taiwan
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.,Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Tao-Yuan, Taiwan
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou and Chang Gung University College of Medicine, Tao-Yuan, Taiwan.,Laboratory for Epidemiology, Chang Gung University, Kwei-Shan, Taiwan.,Department of Urology, Chang Gung Memorial Hospital, Linkou and College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.,Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Tao-Yuan, Taiwan.,Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.,Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
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14
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Chou YS, Lin HY, Weng YM, Goh ZNL, Chien CY, Fan HJ, Li CH, Chen HY, Hsieh MS, Seak JCY, Seak CK, Seak CJ. Step-down units are cost-effective alternatives to coronary care units with non-inferior outcomes in the management of ST-elevation myocardial infarction patients after successful primary percutaneous coronary intervention. Intern Emerg Med 2020; 15:59-66. [PMID: 30706252 DOI: 10.1007/s11739-019-02037-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 01/17/2019] [Indexed: 10/27/2022]
Abstract
Percutaneous coronary interventions (PCIs) within a door-to-balloon timing of 90 min have greatly decreased mortality and morbidity of ST-elevation myocardial infarction (STEMI) patients. Post-PCI, they are routinely transferred into the coronary care unit (CCU) regardless of the severity of their condition, resulting in frequent CCU overcrowding. This study assesses the feasibility of step-down units (SDUs) as an alternative to CCUs in the management of STEMI patients after successful PCI, to alleviate CCU overcrowding. Criteria of assessment include in-hospital complications, length of stay, cost-effectiveness, and patient outcomes up to a year after discharge from hospital. A retrospective case-control study was done using data of 294 adult STEMI patients admitted to the emergency departments of two training and research hospitals and successfully underwent primary PCI from 1 January 2014 to 31 December 2015. Patients were followed up for a year post-discharge. Student t test and χ2 test were done as univariate analysis to check for statistical significance of p < 0.05. Further regression analysis was done with respect to primary outcomes to adjust for major confounders. Patients managed in the SDU incurred significantly lower inpatient costs (p = 0.0003). No significant differences were found between the CCU and SDU patients in terms of patient characteristics, PCI characteristics, in-hospital complications, length of stay, and patient outcomes up to a year after discharge. The SDU is a viable cost-effective option for managing STEMI patients after successful primary PCI to avoid CCU overcrowding, with non-inferior patient outcomes as compared to the CCU.
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Affiliation(s)
- Yu-Shao Chou
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, No. 5, Fusing St., Guei-shan Township, Taoyuan, 333, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsin-Yueh Lin
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, No. 5, Fusing St., Guei-shan Township, Taoyuan, 333, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Division of Prehospital Care, Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | | | - Cheng-Yu Chien
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Hsinchu County, Taiwan
| | - Hsuan-Jui Fan
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, No. 5, Fusing St., Guei-shan Township, Taoyuan, 333, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chih-Huang Li
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, No. 5, Fusing St., Guei-shan Township, Taoyuan, 333, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Hsien-Yi Chen
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, No. 5, Fusing St., Guei-shan Township, Taoyuan, 333, Taiwan, ROC
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | | | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, No. 5, Fusing St., Guei-shan Township, Taoyuan, 333, Taiwan, ROC.
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
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15
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Yap XH, Ng CJ, Hsu KH, Chien CY, Goh ZNL, Li CH, Weng YM, Hsieh MS, Chen HY, Chen-Yeen Seak J, Seak CK, Seak CJ. Predicting need for intensive care unit admission in adult emphysematous pyelonephritis patients at emergency departments: comparison of five scoring systems. Sci Rep 2019; 9:16618. [PMID: 31719593 PMCID: PMC6851397 DOI: 10.1038/s41598-019-52989-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [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: 11/12/2018] [Accepted: 10/27/2019] [Indexed: 12/22/2022] Open
Abstract
This study assesses the performance of National Early Warning Score (NEWS), Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS), and Rapid Acute Physiology Score (RAPS) in predicting emphysematous pyelonephritis (EPN) patients' need for intensive care unit (ICU) admission. A retrospective analysis was conducted at four training and research hospitals' emergency departments (EDs) on all EPN adult patients from January 2007 to August 2017. Data extracted were used to calculate raw scores for five physiologic scoring systems. Mann-Whitney U tests and χ2 tests were done for numerical and categorical variables respectively to examine differences between characteristics of ICU and non-ICU patient populations. Predictability of ICU admission was evaluated with AUROC analysis. ICU patients had lower GCS scores, SpO2, platelet counts, and estimated glomerular filtration rate; and higher bands, blood urea nitrogen, creatinine, and incidences of septic shock and nephrectomy. NEWS performed best, with 73.85% accuracy at optimal cut-off of 3. In this multicentre ED EPN series, we recommend using NEWS in early identification of critical EPN patients and advance planning for ICU admission. This would reduce delays in ICU transfer and ultimately improve patient outcomes.
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Affiliation(s)
- Xiao-Han Yap
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chip-Jin Ng
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei City, Hsinchu County, Taiwan
| | | | - Chih-Huang Li
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Prehospital Care Division, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Ming-Shun Hsieh
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsien-Yi Chen
- College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | | | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Chen-June Seak
- College of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan. .,Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan.
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16
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Chien CY, Chien WC, Tsai LH, Tsai SL, Chen CB, Seak CJ, Chou YS, Ma M, Weng YM, Ng CJ, Lin CY, Tzeng IS, Lin CC, Huang CH. Impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest recognition and dispatcher-assisted cardiopulmonary resuscitation. Emerg Med J 2019; 36:595-600. [PMID: 31439715 DOI: 10.1136/emermed-2018-208353] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 07/24/2019] [Accepted: 08/02/2019] [Indexed: 11/04/2022]
Abstract
ObjectiveThis study determined the impact of the caller’s emotional state and cooperation on out-of-hospital cardiac arrest (OHCA) recognition and dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) performance metrics.MethodsThis was a retrospective study using data from November 2015 to October 2016 from the emergency medical service dispatching centre in northern Taiwan. Audio recordings of callers contacting the centre regarding adult patients with non-traumatic OHCA were reviewed. The reviewers assigned an emotional content and cooperation score (ECCS) to the callers. ECCS 1–3 callers were graded as cooperative and ECCS 4–5 callers as uncooperative and highly emotional. The relation between ECCS and OHCA recognition, time to key events and DA-CPR delivery were investigated.ResultsOf the 367 cases, 336 (91.6%) callers were assigned ECCS 1–3 with a good inter-rater reliability (k=0.63). Dispatchers recognised OHCA in 251 (68.4%) cases. Compared with callers with ECCS 1, callers with ECCS 2 and 3 were more likely to give unambiguous responses about the patient’s breathing status (adjusted OR (AOR)=2.6, 95% CI 1.1 to 6.4), leading to a significantly higher rate of OHCA recognition (AOR=2.3, 95% CI 1.1 to 5.0). Thirty-one callers were rated uncooperative (ECCS 4–5) but had shorter median times to OHCA recognition and chest compression (29 and 122 s, respectively) compared with the cooperative caller group (38 and 170 s, respectively). Nevertheless, those with ECCS 4–5 had a significantly lower DA-CPR delivery rate (54.2% vs 85.9%) due to ‘caller refused’ or ‘overly distraught’ factors.ConclusionsThe caller’s high emotional state is not a barrier to OHCA recognition by dispatchers but may prevent delivery of DA-CPR instruction. However, DA-CPR instruction followed by first chest compression is possible despite the caller’s emotional state if dispatchers are able to skilfully reassure the emotional callers.
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17
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Abstract
Effectiveness of bystander cardiopulmonary resuscitation (CPR) is known to provide emergency medical services which reduce the number of deaths in patients with out-of-hospital cardiac arrest. The survival at these patients is affected by the training level of the bystander, but the best format of CPR training is unclear. In this pilot study, we aimed to examine whether the sequence of CPR instruction improves learning retention on the course materials.A total of 95 participants were recruited and divided into 2 groups; Group 1: 49 participants were taught firstly how to recognize a cardiac arrest and activate the emergency response system, and Group 2: 46 participants were taught chest compression first. The performance of participants was observed and evaluated, the results from 1 pre-test and 2 post-tests between 2 groups were then compared.There was a significantly better improvement of participants in Group 2 regarding the recognition of a cardiac arrest and the activation of the emergency response system than of those in Group 1. At the post-test, participants in Group 2 had an improvement in chest compression compared to those in Group 1, but the difference was not statistically significant.Our study had revealed that teaching CPR first in a standardized public education program had improved the ability of participants to recognize cardiac arrest and to activate the emergency response system.
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Affiliation(s)
- Shou-Chien Hsu
- Department of Emergency Medicine, Camillians Saint Mary's Hospital Luodong
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linko
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linko
- Department of Emergency Medicine, Tao-Yuan General Hospital
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine
- Department of Emergency Medicine, Prehospital Care Division, Tao-Yuan General Hospital
- Faculty of Medicine, National Yang-Ming University
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linko
- Department of Emergency Medicine, Ton-Yen General Hospital, Taiwan
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linko
- Department of Emergency Medicine, Tao-Yuan General Hospital
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18
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Ng CJ, You SH, Wu IL, Weng YM, Chaou CH, Chien CY, Seak CJ. Introduction of a mass burn casualty triage system in a hospital during a powder explosion disaster: a retrospective cohort study. World J Emerg Surg 2018; 13:38. [PMID: 30181768 PMCID: PMC6114838 DOI: 10.1186/s13017-018-0199-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/09/2018] [Indexed: 11/10/2022] Open
Abstract
Background The triage system used during an actual mass burn casualty (MBC) incident is a major focus of concern. This study introduces a MBC triage system that was used by a burn center during an actual MBC incident following a powder explosion in New Taipei City, Taiwan. Methods This study retrospectively analyzed data from patients who were sent to the study hospital during a MBC incident. The patient list was retrieved from a national online management system. A MBC triage system was developed at the study hospital using the following modifiers: consciousness, breathing, and burn size. Medical records were retrieved from electronic records for analysis. Patient outcomes consisted of emergency department (ED) disposition and intervention. Results The patient population was predominantly female (56.3%), with an average age of 24.9 years. Mean burn sizes relative to the TBSA of triage level I, II, and III patients were 57.9%, 40.5%, and 8.7%, respectively. ICU length of stay differed markedly according to triage level (mean days for levels I vs II vs III: 57.9 vs 39.9 vs 2.5 days; p < 0.001). Triage system levels I and II indicate ICU admission with a sensitivity of 93.9% (95%CI 80.4-98.3%) and a specificity of 86.7% (62.1-96.3%).Overall, 3 (6.3%) patients were under-triaged. Two (4.2%) patients were over-triaged. Sixteen (48.5%) and 21 (63.6%) patients of triage levels I and II received endotracheal intubation and central venous catheterization, respectively. Sorting of the study population with simple triage and rapid treatment (START) showed great sensitivity (100.0%) but poor specificity (53.3%). The Taiwan Triage and Acuity Scale (TTAS) presented 87.9% sensitivity and 93.9% specificity. Conclusions The current MBC triage algorithm served as a good indicator of ED disposition but might have raised excessive immediate attention and had the potential to exhaust the available resources. These findings add to our knowledge of the MBC triage system and should help future researchers in adjusting the triage criteria to fit actual disasters.
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Affiliation(s)
- Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
| | - Shih-Hao You
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
| | - I-Lin Wu
- Department of Emergency, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
- Department of Emergency Medicine, Prehospital Care Division, Taoyuan General Hospital, Ministry of Health and Welfare, No. 1492 Zhongshan Rd., Taoyuan Dist, Taoyuan City, 330 Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Hsinchu County Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University, Linko, Taiwan
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Weng YM, Ng CJ, Seak CJ, Chien CY, Chen KF, Lin JR, Chang CJ. One-year survival rate and healthcare costs after cardiac arrest in Taiwan, 2006-2012. PLoS One 2018; 13:e0196687. [PMID: 29715272 PMCID: PMC5929539 DOI: 10.1371/journal.pone.0196687] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 04/17/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The annual increase in costs and the quality of life of survivors of cardiac arrest are major concerns. This study used National Health Insurance Research Database (NHIRD) of Taiwan to evaluate the 1-year survival rate and the annual healthcare costs of survivors after cardiac arrest. METHODS This retrospective, fixed-cohort study conducted from 2006 to 2012, involved 2 million individuals randomly selected from the NHIRD of Taiwan. Adult patients at least 18 years old who were diagnosed with cardiac arrest were enrolled. Survival was followed up for 1 year. RESULTS In total, 2,256 patients were enrolled. The survivor cohort accounted for 4% (89/2256) of the study population. There were no significant differences in the demographic characteristics of the survival and non-survival cohorts, with the exceptions of gender (male: survival vs. non-survival, 50.6% vs. 64.5%, p = 0.007), diabetes mellitus (49.4% vs. 35.8%, p = 0.009), and acute coronary syndrome (44.9% vs. 31.9%, p = 0.010). Only 38 (1.7%) patients survived for > 1 year. The mean re-admission to hospital during the 1-year follow up was 73.5 (SD: 110.2) days. The mean healthcare cost during the 1-year follow up was $12,953. Factors associated with total healthcare costs during the 1-year follow up were as follows: city or county of residence, being widowed, and Chronic Obstructive Pulmonary Disease (city or county of residence, β: -23,604, p < 0.001; being widowed, β: 25,588, p = 0.049; COPD, β: 14,438, p = 0.024). CONCLUSIONS There was a great burden of the annual healthcare costs of survivors of cardiac arrest. Socioeconomic status and comorbidity were major confounders of costs. The outcome measures of cardiac arrest should extend beyond the death, and encompass destitution. These findings add to our knowledge of the health economics and indicate future research about healthcare of cardiac arrest survivors.
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Affiliation(s)
- Yi-Ming Weng
- Department of Emergency Medicine, Prehospital Care Division, Tao-Yuan General Hospital, Tao-Yuan, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei City, Hsinchu county, Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Jr-Rung Lin
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Department of Anesthesiology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Chee-Jen Chang
- Clinical Informatics and Medical Statistics Research Center and Graduate Institute of Clinical Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Research Services Center for Health Information, Chang Gung University, Tao-Yuan, Taiwan
- Department of Cardiovascular Medicine, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
- * E-mail:
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Lo HY, Chen LLC, Su DH, Chen CH, Hsu TY, Wang SH, Weng YM, Chan CW, Wu SH, Chen HC, Chiu TF. Three-Minute Step Test for Predicting Acute Mountain Sickness: A Post Hoc Analysis of Rhodiola Crenulata Extract for Prevention of Acute Mountain Sickness, a Randomized, Double-Blind, Placebo-Controlled, Crossover Trial. J Acute Med 2018; 8:22-29. [PMID: 32995198 DOI: 10.6705/j.jacme.201803_8(1).0004] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background Acute mountain sickness (AMS) often occurs in individuals who rapidly travel above 2,500 m. As the convenience of traveling and the development of mountain sports increase, AMS will become an increasingly important public health problem. However, no method to effectively predict AMS before it occurs is currently available. Methods This post hoc study investigated whether the 3-Minute Step Test (3MST), which evaluates physical fitness, is predictive of AMS development. The data collected in "Rhodiola crenulata extract for prevention of AMS: a randomized, double-blind, placebo-controlled, crossover trial" was used in the analysis. This study collected 204 observations of 102 participants who made two ascents of Hehuan Mountain (3,100 m) by bus within a 3-month period. Participants completed the 3MST at 250 m (before ascent) and 3,100 m (on Hehuan Mountain). The presence of AMS was accessed using the Lake Louise scoring system. Results AMS was identified in 124 observations (60.78%). In the univariate analysis, the pre-departure 3MST score (at 250 m) was not significantly associated with AMS (p = 0.498), but the 3MST score measured at 3,100 m, ascent number, pulse rate at 3,100 m, and saturation of peripheral oxygen (SpO2) measured at 3,100 m were significantly correlated with the occurrence of AMS (p = 0.002, 0.039, 0.005, < 0.001, respectively). In a further multivariate analysis, only SpO2 measured at 3,100 m had a significant association with AMS (p = 0.016 and 0.006, respectively). The trend analysis showed that for every 1-point increase in the 3MST score at 3,100 m, the AMS decreased by 4% (adjusted odds ratio [AOR] = 0.96, 95% confidence interval [CI] = 0.92-1.01). Conclusion The 3MST score cannot be a predictor of AMS, but it may have a potential role in predicting ascent safety in high-altitude areas.
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Affiliation(s)
- Hsiang Yun Lo
- New Taipei City Hospital Department of Emergency Medicine New Taipei City Taiwan.,Linkou Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Lisa Li-Chuan Chen
- Landseed Hospital Research Center, Department of Community Medicine Taoyuan Taiwan
| | - Deng-Huang Su
- National Taiwan University Division of Biostatistics, Institute of Epidemiology and Preventive Medicine, College of Public Health Taipei Taiwan
| | | | - Tai-Yi Hsu
- China Medical University Hospital Department of Emergency Medicine Taichung Taiwan
| | - Shih-Hao Wang
- Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation Department of Emergency Medicine Chiayi Taiwan.,Chiayi Chang Gung Memorial Hospital Department of Physical Medicine and Rehabilitation Chiayi Taiwan
| | - Yi-Ming Weng
- Linkou Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan.,Ministry of Health and Welfare Department of Emergency Medicine, Taoyuan General Hospital Taoyuan Taiwan
| | - Cheng-Wei Chan
- Linkou Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan.,Ministry of Health and Welfare Department of Emergency Medicine, Chang-Hua Hospital Changhua Taiwan
| | - Shih-Hao Wu
- Linkou Chang Gung Memorial Hospital Department of Emergency Medicine Taoyuan Taiwan
| | - Hang-Cheng Chen
- China Medical University Hospital Department of Emergency Medicine Taichung Taiwan
| | - Te-Fa Chiu
- China Medical University Hospital Department of Emergency Medicine Taichung Taiwan
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Tsai LH, Chen CB, Liu PH, Chaou CH, Huang CH, Kuo CW, Lin CC, Wang KC, Weng YM, Chien CY. Significance of blood pH value and automated external defibrillator shock in determining the outcomes of out-of-hospital cardiac arrest patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917749480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: The prognosis of out-of-hospital cardiac arrest is generally poor. It is known that the survival of out-of-hospital cardiac arrest patients depends on treatments delivered in a very short time frame. Identifying outcome-associated factors may provide valuable information for decision-making in clinical practices. Aim: The objective of the present study was to assess the associations between various factors (e.g. serum biomarker levels and prehospital factors) and outcomes in adult, non-traumatic out-of-hospital cardiac arrest patients. Methods: Data from 386 consecutive out-of-hospital cardiac arrest patients treated from January 2012 to December 2015 at Taoyuan Chang Gung Memorial Hospital (Taiwan, ROC) were collected. While performing cardiopulmonary resuscitation in the emergency room, the levels of creatinine, aspartate aminotransferase, sodium, potassium, troponin-I, hydrogen bicarbonate and haemoglobin were determined, blood pH and pCO2 were measured and the white blood cell count was calculated. The response time and scene time interval were also recorded. Results: Here we found that out-of-hospital cardiac arrest patients with blood pH values of <7.34 had a lower chance of survival to 24 h (Odds Ratio (OR) = 2.77), survival to discharge (OR = 7.06) and a good neurological outcome (OR = 64.59). Moreover, patients without an automated external defibrillator shock had a lower chance of being discharged (OR = 4.27) and enjoying good neurological outcomes (OR = 25.09). Conclusion: Our data suggest that the blood pH and an automated external defibrillator shockable rhythm are two easily measurable factors strongly associated with the outcomes of out-of-hospital cardiac arrest patients.
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Affiliation(s)
- Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Chen-Bin Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
| | - Kuo-Cheng Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Linkou, Taiwan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Emergency Medicine, Ton-Yen General Hospital, Zhubei, Taiwan
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22
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Fan HJ, You SH, Huang CH, Seak CJ, Ng CJ, Li WC, Lin CC, Weng YM. Effectiveness of hands-on cardiopulmonary resuscitation practice with self-debriefing for healthcare providers: A simulation-based controlled trial. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917735086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: The psychomotor skill of cardiopulmonary resuscitation emphasized the importance of high-quality chest compression. This investigation examined the effect of self-debriefing and the different materials of debriefing during hands-on cardiopulmonary resuscitation practice for healthcare providers. Methods: This was a randomized controlled trial of a cardiopulmonary resuscitation training program involving emergency medical technicians in northern Taiwan. Participants were blinded to the study purpose and were allocated randomly using the black envelope method. All participants completed a 2-min pre-test of hands-only cardiopulmonary resuscitation using a manikin. Those who were allocated to the control group received self-debriefing with knowledge of pre-test result. Those who were allocated to the experimental group received self-debriefing with an additional biomechanical information of performance of chest compression. A post-test was performed 30 min after the pre-test. Results: A total of 88 participants were enrolled with 44 in each group. There was significant difference of cardiopulmonary resuscitation quality after self-debriefing among all participants (pre- vs post-test adequate rate, 54.7% vs 67.5%, p = 0.028; adequate depth, 41.2% vs 69.5%, p < 0.001; full recoil, 35.9% vs 54.5%, p = 0.001). The analysis of effects of self-debriefing with additional knowledge of performance revealed no significant difference in any of the measurements (improvement in adequate rate, 11.3% vs 14.2%, p = 0.767; adequate depth, 29.6% vs 27.0%, p = 0.784; full recoil, 23.0% vs 14.1%, p = 0.275). Conclusion: Self-debriefing improved hands-only cardiopulmonary resuscitation quality whether or not biomechanical information of performance of chest compression was given.
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Affiliation(s)
- Hsuan-Jui Fan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Shih-Hao You
- Department of Emergency Medicine, Saint Mary’s Hospital Luodong, Luodong, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Division of Prehospital Care, Tao Yuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wen-Cheng Li
- Department of Occupation Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
- Department of Emergency Medicine, Chang Gung Hospital, Xiamen, China
| | | | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
- College of Medicine, Chang Gung University, Linkou, Taiwan
- Department of Emergency Medicine, Division of Prehospital Care, Tao Yuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
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23
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Huang CH, Fan HJ, Chien CY, Seak CJ, Kuo CW, Ng CJ, Li WC, Weng YM. Validation of a Dispatch Protocol with Continuous Quality Control for Cardiac Arrest: A Before-and-After Study at a City Fire Department-Based Dispatch Center. J Emerg Med 2017; 53:697-707. [DOI: 10.1016/j.jemermed.2017.06.028] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/14/2017] [Accepted: 06/28/2017] [Indexed: 11/25/2022]
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Hung SK, Ng CJ, Kuo CF, Goh ZNL, Huang LH, Li CH, Chan YL, Weng YM, Seak JCY, Seak CK, Seak CJ. Comparison of the Mortality in Emergency Department Sepsis Score, Modified Early Warning Score, Rapid Emergency Medicine Score and Rapid Acute Physiology Score for predicting the outcomes of adult splenic abscess patients in the emergency department. PLoS One 2017; 12:e0187495. [PMID: 29091954 PMCID: PMC5665602 DOI: 10.1371/journal.pone.0187495] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [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: 02/13/2017] [Accepted: 10/21/2017] [Indexed: 11/23/2022] Open
Abstract
Background Splenic abscess is rare but has mortality rates as high as 14% even with recent improvements in management. Early and appropriate intervention may improve patient outcomes, yet at present there is no identified method that can predict mortality risk rapidly and accurately for emergency physicians, surgeons, and intensivists to decide on the ideal course of action. Objective This study aims to evaluate the performance of Mortality in Emergency Department Sepsis Score (MEDS), Modified Early Warning Score (MEWS), Rapid Emergency Medicine Score (REMS) and Rapid Acute Physiology Score (RAPS) for predicting the mortality risk of adult splenic abscess patients. This will expedite decision making in the emergency department (ED) to increase survival rates and help avoid unnecessary splenectomies. Methods Data of 114 adult patients admitted to the EDs of 4 research and training hospitals who had undergone an abdominal contrast CT scan and diagnosed with splenic abscess between Jan 2000 and April 2015 were analyzed. The MEDS, MEWS, REMS, and RAPS and their corresponding mortality risks were calculated, with their abilities to predict patient mortality assessed through receiver operating characteristic curve analysis and calibration analysis. Results MEDS was found to be the best performing scoring system across all indicators, with sensitivity, specificity, and accuracy of 92.86%, 88.00%, and 88.60% respectively; its area under curve for AUROC analysis was 0.92. With a cutoff value of 8, negative predictive value of MEDS was 98.88%. Conclusion Our series is the largest multicenter study in adult ED patients with splenic abscess. The results from the present study show that MEDS is superior to MEWS, REMS and RAPS in predicting mortality, thus allowing earlier detection of critically ill adult ED splenic abscess patients. Therefore, we recommend that MEDS be used for predicting severity of illness and risk stratification in these patients.
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Affiliation(s)
- Shang-Kai Hung
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chang-Fu Kuo
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | | | - Lu-Hsiang Huang
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Chih-Huang Li
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ling Chan
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | | | - Chen-Ken Seak
- Sarawak General Hospital, Kuching, Sarawak, Malaysia
| | - Chen-June Seak
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.,College of Medicine, Chang Gung University, Taoyuan, Taiwan.,Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
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Han KW, Chen SY, Weng YM, Ng CJ, Chiu TF, Hsieh IC, Chen JC. Validation of different score systems in predicting cardiac arrest occurrence of ST-elevation myocardial infarction. HONG KONG J EMERG ME 2017. [DOI: 10.1177/1024907917724729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Introduction: Patients with ST-elevation myocardial infarction are at risk of developing cardiac arrest. A validated tool for predicting cardiac arrest would help physicians recognize these high-risk patients earlier. This study assessed the usefulness of various score systems in predicting cardiac arrest in patients hospitalized for ST-elevation myocardial infarction. Methods: Patients’ data were retrieved from the hospital’s ST-elevation myocardial infarction registry records. Patients aged 18 years or older seen at the emergency department with a diagnosis of ST-elevation myocardial infarction between 1 July 2013 and 30 June 2014 were enrolled. The Thrombolysis in Myocardial Infarction score, the 6-month Global Registry of Acute Coronary Event risk score, CHADS2 score, and HEART score were calculated and compared. Results: A total of 249 patients were recruited. The Thrombolysis in Myocardial Infarction score, 6-month Global Registry of Acute Coronary Event risk score, CHADS2 score, and HEART scores were calculated. In total, 41 (16.5%) patients had cardiac arrest at emergency department or during hospitalization and 12 (29.3%) of them survived. The 6-month Global Registry of Acute Coronary Event risk score had the biggest area under the receiver-operating characteristic curve (0.72). Conclusion: The 6-month Global Registry of Acute Coronary Event risk score is more useful in predicting cardiac arrest in patients hospitalized for ST-elevation myocardial infarction than the other three scores. It is recommended that the 6-month Global Registry of Acute Coronary Event risk score be calculated for identifying emergency department patients hospitalized for ST-elevation myocardial infarction who are at risk of cardiac arrest during their hospital stay.
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Affiliation(s)
- Ko-Wen Han
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Chang Hsieh
- Department of Cardiology, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Tsai LH, Huang CH, Su YC, Weng YM, Chaou CH, Li WC, Kuo CW, Ng CJ. Comparison of prehospital triage and five-level triage system at the emergency department. Emerg Med J 2017; 34:720-725. [PMID: 28720720 DOI: 10.1136/emermed-2015-205304] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 08/23/2015] [Revised: 04/21/2017] [Accepted: 05/04/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE There is lack of scientific evidence regarding the effectiveness of prehospital triage systems. This study compared the two-level Taiwan Prehospital Triage System (TPTS) with the five-level Taiwan Triage and Acuity Scale (TTAS) at ED arrival regarding the prediction of patient outcomes and the utilisation of medical resources. DESIGN This was a retrospective cohort study. Adult patients transported via the emergency medical service (EMS), who arrived at the ED of a medical centre in northern Taiwan during the study period were enrolled. TTAS acuity levels 1-2 were considered comparable to the designation of 'emergent' by the prehospital TPTS system. The outcomes were analysed by comparing TPTS and TTAS by acuity levels. RESULTS Among 4430 enrolled patients, 25.2% and 74.8% were classified as emergent and non-emergent by TPTS; 44.1% and 55.9% were classified as levels 1-2 and levels 3-5 by TTAS. Of the TPTS emergent patients, 15.2% were classified as TTAS levels 3-5, whereas 30.4% of TPTS non-emergent transports were classified as TTAS levels 1-2 at the ED. TTAS levels 1-2 showed better predictability than TPTS emergent level for hospitalisation rate with a sensitivity of 70.3% (95% CI 68.3% to 72.2%) versus 41.1% (95% CI 39.0% to 43.2%), and a negative predictive value of 74.8% (95% CI 73.4% to 76.0%) versus 62.6% (95% CI 61.7% to 63.5%). CONCLUSION The current prehospital triage system is insufficient and inappropriate in classifying patients transported to the ED. The present study offers supporting evidence for the introduction of a five-level triage system to prehospital EMS systems.
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Affiliation(s)
- Li-Heng Tsai
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.,Department of Emergency Medicine, Taoyuan General Hospital, Taoyuan, Taiwan
| | - Yi-Chia Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Chung-Hsien Chaou
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Wen-Cheng Li
- Department of Occupation Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou, Taiwan
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Chen CY, Weng YM, Chen JC. Pneumocystis Pneumonia Infection in a Survivor of Paraquat Intoxication. J Acute Med 2017; 7:75-78. [PMID: 32995175 PMCID: PMC7517916 DOI: 10.6705/j.jacme.2017.0702.005] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 09/12/2016] [Accepted: 10/03/2016] [Indexed: 06/11/2023]
Abstract
Patients who survived recent paraquat intoxication might be treated with glucocorticoid andcyclophosphamide to avoid further lung fi brosis. Such patients might be susceptible to opportunistic infections. Pneumocystis pneumonia (PCP) is an important opportunistic lung infection in hematologic malignancy patients on chemotherapy. We report a patient who recently survived paraquat intoxication and presented with acute respiratory insuffi ciency post glucocorticoid and cyclosporine treatment. A fulminant clinical course, and a clear medical history of immunocompromised state draw physician's attention to the possible opportunistic lung infection. PCP infection was confi rmed by a PCP deoxyribonucleic acid test. The symptoms improved markedly after appropriate antibiotics treatment. This report suggests that clinicians should consider PCP infection in patients who develop secondary pneumonia after paraquat intoxication. PCP treatment as part of empirical antibiotics should be added, especially in such patients presented with rapidly progressive course.
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Affiliation(s)
- Chih-Yu Chen
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Emergency Medicine Linko Taiwan
| | - Yi-Ming Weng
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Emergency Medicine Linko Taiwan
| | - Jih-Chang Chen
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine Department of Emergency Medicine Linko Taiwan
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Tsai SL, Chaou CH, Huang CH, Tzeng IS, Kuo CW, Weng YM, Chien CY. Features of hospital and emergency medical service in out-of-hospital cardiac arrest patients with shockable rhythm. Am J Emerg Med 2017; 35:1222-1227. [PMID: 28341188 DOI: 10.1016/j.ajem.2017.03.032] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 03/07/2017] [Accepted: 03/15/2017] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Predicting the outcome of out-of-hospital cardiac arrest (OHCA) patients is crucial. We examined hospital characteristics and parameters of emergency medical service (including scene time interval and direct ambulance delivery to intensive heart hospitals) as survival or outcome predictors. STUDY DESIGN Data from 546 consecutive OHCA shockable patients treated between January 2012 and December 2015 in Taoyuan City (Taiwan, ROC) were collected. In addition to demographic data, location of arrest, initial rhythm, availability of a hospital with or without 24/7 percutaneous coronary intervention (PCI), emergency medical service (EMS) time, provision of cardiopulmonary resuscitation by a bystander, presence of a witness at collapse, and level of life support were analysed. RESULTS Multivariate analysis showed that hospitalisation with immediate PCI availability was an independent predictor (OR: 4.32; 95% CI: 1.27-14.70) solely for the outcome of survival until discharge. The presence of a witness while collapsing (OR: 3.52; 95% CI: 1.03-11.98), EMS response time (OR: 0.83; 95% CI: 0.70-0.98), and scene time interval (STI; OR: 0.89; 95% CI: 0.81-0.99) were valuable for predicting the neurological outcome. CONCLUSIONS Direct ambulance delivery to intensive heart hospitals that had 24/7 PCI availability was associated with a higher probability of surviving until discharge in OHCA patients with shockable rhythms. Similarly, a witnessed collapse was correlated with being discharged alive from hospital and recovering with good cerebral performance. In addition, longer response time and scene time interval indicated poorer survival and neurological outcome.
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Affiliation(s)
- Shang-Li Tsai
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Chung-Hsien Chaou
- Chang Gung University College of Medicine, 259 Wen-Hwa 1st Road, Guishan District, Taoyuan 333, Taiwan; Department of Emergency Medicine and Medical Education, Taipei Chang Gung Memorial Hospital, 199 Tunghwa Road, Taipei 105, Taiwan
| | - Chien-Hsiung Huang
- Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Anle District, Keelung 204, Taiwan
| | - I-Shiang Tzeng
- Institute of Epidemiology and Preventive Medicine, National Taiwan University, Room 501, 17 Xu-Zhou Road, Taipei 100, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Linkou Chang Gung Memorial Hospital, 5 Fuxing Street, Guishan District, Taoyuan 333, Taiwan; Department of Emergency Medicine, Keelung Chang Gung Memorial Hospital, 222 Maijin Rd, Anle District, Keelung 204, Taiwan.
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Wang KC, Liu PH, Yu KH, Weng YM, Ng CJ, Chiu TF, Chen SY. Is initial C-reactive protein level associated with corticosteroid use in lupus erythematosus patients during a bacterial infection episode? Immunol Lett 2017; 185:84-89. [PMID: 28286229 DOI: 10.1016/j.imlet.2017.03.008] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Accepted: 03/08/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE C-reactive protein (CRP), a marker for inflammation, indicates bacterial infection in systemic lupus erythematosus (SLE) when markedly elevated. Our study investigated the association of regular corticosteroid or immunosuppressant use with initial CRP level in febrile SLE patients with bacterial infection. METHODS This retrospective cohort study included adult SLE patients (18 years of age or older) who presented with fever at the emergency department from January 2008 to December 2012. Data were retrieved from our institutional database. RESULTS CRP levels in the total 193 patient database were significantly increased in the bacterial infection group compared to the no infection and non-bacterial infection groups. Seventy-eight (86.7%) of the 90 patients in the bacterial infection group took regular corticosteroids (mean equivalent dose of prednisolone 0.33±0.26mg/kg/day) and 55 (61.1%) used immunosuppressants. Mean CRP level in the bacterial infection group was 97.8mg/L. CRP level was lower in patients using corticosteroids, but the difference between users and nonusers of corticosteroids was not statistically significant (p=0.367). The difference in CRP level between immunosuppressant and non-immunosuppressant users was also not significant (p=0.599). The Spearman test found no correlation between corticosteroid dosage and CRP level (p=0.911). CONCLUSION Initial CRP level was not significantly associated with regular corticosteroid or immunosuppressant use in SLEs patients during a bacterial infection episode, and CRP level was not dose-dependently related to daily corticosteroid use. An elevated CRP level might be an appropriate marker for bacterial infection at the emergency department for febrile SLE patients.
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Affiliation(s)
- Kuo-Cheng Wang
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Peng-Huei Liu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Kuang-Hui Yu
- Division of Rheumatology, Allergy and Immunology, Chang Gung Memorial Hospital, Linko, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan.
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Tzeng IS, Liu SH, Chiou YT, Huang CH, Lee CJ, Chien CY, Hsu SC, Weng YM, Chen KF, Chen JC. Predicting emergency departments visit rates from septicemia in Taiwan using an age-period-cohort model, 1998 to 2012. Medicine (Baltimore) 2016; 95:e5598. [PMID: 27977595 PMCID: PMC5268041 DOI: 10.1097/md.0000000000005598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [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: 12/31/2022] Open
Abstract
The aim of this study was to determine the age-period-cohort (APC) effects on the rate of infection-related emergency department (ED) visits from septicemia for predicting the same in recent periods.In our study, we investigated the longitudinal trends in septicemia-related visit rates. Using an APC model to decompose the septicemia visit rates into the effects of age, time period, and cohort, and examine whether their effects varied by sex.The septicemia ED visit rate was classified as the International Classification of Disease Code 038 by primary and secondary diagnosis between 1998 and 2012.In both males and females, the visit rate of septicemia showed an increase from 2003 through 2012. An increase in septicemia visit rate after 2003 was observed in all age groups. An APC model indicated a reversal increasing period effect, which increased prominently from 2003 to 2012 in both males and females. The age effect showed an increasing trend. The cohort effect tended to show a slight oscillation from 1913 to 1988. With reference to the prediction of the logarithms of the age-specific 5-year visit rates, we observed that the younger cohorts exhibited a slightly increasing trend, as compared to the older cohorts.The period effect can explain the increase in septicemia visit rates, suggesting the role of screening for septicemia. Furthermore, it is well known that aging is a relevant risk variable for infectious diseases. The present study concludes that the aged population exhibited a strong increasing future trend for septicemia-related ED visit rates.
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Affiliation(s)
- I-Shiang Tzeng
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei
| | - Su-Hsun Liu
- College of Medicine, Chang Gung University, Taoyuan
- Department of Family Medicine, Chang Gung Memorial Hospital, Linkou
| | - Yu Ting Chiou
- New Taipei City Limited Liability Indigenous People of Labor Cooperation
| | | | - Cheng-Jung Lee
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei
| | - Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou
| | - Shou-Chien Hsu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University, Taoyuan
- Community Medicine Research Center, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jih-Chang Chen
- College of Medicine, Chang Gung University, Taoyuan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou
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Chen SY, Chaou CH, Ng CJ, Cheng MH, Hsiau YW, Kang SC, Hsu CP, Weng YM, Chen JC. Factors associated with ED length of stay during a mass casualty incident. Am J Emerg Med 2016; 34:1462-6. [DOI: 10.1016/j.ajem.2016.04.056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 04/15/2016] [Accepted: 04/20/2016] [Indexed: 11/30/2022] Open
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Lee YY, Yang CK, Weng YM, Chuang CH, Yu W, Chen JC, Li WC. All Components of Metabolic Syndrome Are Associated with Microalbuminuria in a Chinese Population. PLoS One 2016; 11:e0157303. [PMID: 27327443 PMCID: PMC4915633 DOI: 10.1371/journal.pone.0157303] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 05/30/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND AIM Albuminuria is a well-known predictor of poor renal and cardiovascular outcomes and associated with increased risk of all-cause mortality. The study aimed to evaluate the associations between metabolic characteristics and the presence of albuminuria. METHODS This cross-sectional study included 18,384 adult Chinese who participated in health examinations during 2013-2014. Differences in clinical characteristics were compared for microalbuminuria (MAU) and albuminuria, and between genders. Potential risk factors associated with the risk of developing MAU and albuminuria were analyzed using univariate logistic regression. Multiple logistic regression was applied to further identify the independent associations between different levels of risk factors and the presence of MAU and albuminuria. The area under the ROC curve (AUC) was used to determine the discriminatory ability of metabolic risk factors in detecting albuminuria. RESULTS There were significant gender differences in clinical characteristics according to albuminuria status. Risk for the presence of albuminuria was significantly associated with age, male gender, waist circumference (WC), waist-to-height ratio (WHtR), hypertension, fasting plasma glucose (FPG), and triglycerides to high-density lipoprotein cholesterol ratio (TG/HDL-C) in univariate logistic regression. Multiple logistic regression analysis indicated that the factors significantly associated with the presence of MAU were WC > 90cm, WHtR at 0.6-0.7, hypertension, FPG > 6.1 mmole/L, and TG/HDL-C ratio > 1.6. The optimal cutoffs for risk factors of metabolic syndrome (MetS) to predict albuminuria in males and females were: WC, 90.8 vs. 80.0 cm; WHtR, 0.53 vs. 0.52; MAP, 97.9 vs. 91.9 mmHg; FPG, 5.40 vs. 5.28 mmole/L; and TG/HDL-C, 1.13 vs. 1.08. CONCLUSION MetS and all its components were associated with the presence of MAU in a health check-up population in China. Gender specific and optimal cutoffs for MetS components associated with the presence of MAU were determined.
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Affiliation(s)
- Yi-Yen Lee
- Division of Pediatric Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chih-Kai Yang
- Department of Emergency Medicine, Xiamen Chang-Gung Hospital, Xiamen, China
| | - Yi-Ming Weng
- Department of Emergency Medicine, Xiamen Chang-Gung Hospital, Xiamen, China
- Department of Emergency Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Chung-Hsun Chuang
- Department of Emergency Medicine, Xiamen Chang-Gung Hospital, Xiamen, China
- Department of Emergency Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wei Yu
- Department of Health Management, Xiamen Chang-Gung Hospital, Xiamen, China
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan
| | - Wen-Cheng Li
- Department of Emergency Medicine, Xiamen Chang-Gung Hospital, Xiamen, China
- Department of Emergency Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
- * E-mail:
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Weng YM, Yeh WB, Yang MM. A new species of alpine Apenetretus Kurnakov from Taiwan: evidences from DNA barcodes and morphological characteristics (Coleoptera, Carabidae, Patrobini). Zookeys 2016:121-34. [PMID: 27199599 PMCID: PMC4857027 DOI: 10.3897/zookeys.584.6320] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Accepted: 03/15/2016] [Indexed: 11/21/2022] Open
Abstract
There are three isolated mountain ranges in Taiwan including Hsueshan Range, Central Mountain Range, and Yushan Range. The rise of these mountains has resulted in the isolation of some species and caused allopatric distribution resulting in divergence and speciation events of high mountain carabids, especially the flightless carabids such as Epaphiopsis, Apenetretus, and partial Nebria. Genus Apenetretus Kurnakov (1960) is typically distributed in high mountain areas of Taiwan. Three of the currently known Apenetretus species have been described from different mountain ranges. These species include Apenetretusyushanensis Habu, Apenetretusnanhutanus Habu, and Apenetretussmetanai Zamotajlov and Sciaky. In this study, a new species is described from Hsueshan, a mountain separated from the ranges of the previous known species, Apenetretushsueshanensissp. n. A key to the Taiwanese Apenetretus is included. A reconstructed phylogeny of the Taiwanese Apenetretus is introduced with the use of mitochondrial cytochrome c oxidase subunit I (COI) gene. Molecular data and geographical distribution of Apenetretus support the morphological characteristics observed among those mountain-isolated species and confirms the new species as being distinctly different. Moreover, lineage calibration suggests that the southern Apenetretusyushanensis is the most distant one compared to the other three northern Apenetretus at ca. 1.81 million years ago (mya), while the divergence time of Apenetretushsueshanensis to its sister group was dated to 0.94 mya.
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Affiliation(s)
- Yi-Ming Weng
- Department of Entomology, National Chung Hsing University, No. 250 Kuo-Kuang Road, Taichung, Taiwan 402, R.O.C.; Master Program for Plant Medicine, National Taiwan University, No.1, Sec. 4, Roosevelt Rd., Taipei, Taiwan, 106, R.O.C
| | - Wen-Bin Yeh
- Department of Entomology, National Chung Hsing University, No. 250 Kuo-Kuang Road, Taichung, Taiwan 402, R.O.C
| | - Man-Miao Yang
- Department of Entomology, National Chung Hsing University, No. 250 Kuo-Kuang Road, Taichung, Taiwan 402, R.O.C
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Weng YM, Yang MM, Yeh WB. A comparative phylogeographic study reveals discordant evolutionary histories of alpine ground beetles (Coleoptera, Carabidae). Ecol Evol 2016; 6:2061-73. [PMID: 27066226 PMCID: PMC4768753 DOI: 10.1002/ece3.2006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 01/03/2016] [Accepted: 01/18/2016] [Indexed: 11/10/2022] Open
Abstract
Taiwan, an island with three major mountain ranges, provides an ideal topography to study mountain-island effect on organisms that would be diversified in the isolation areas. Glaciations, however, might drive these organisms to lower elevations, causing gene flow among previously isolated populations. Two hypotheses have been proposed to depict the possible refugia for alpine organisms during glaciations. Nunatak hypothesis suggests that alpine species might have stayed in situ in high mountain areas during glaciations. Massif de refuge, on the other hand, proposes that alpine species might have migrated to lower ice-free areas. By sampling five sympatric carabid species of Nebria and Leistus, and using two mitochondrial genes and two nuclear genes, we evaluated the mountain-island effect on alpine carabids and tested the two proposed hypotheses with comparative phylogeographic method. Results from the phylogenetic relationships, network analysis, lineage calibration, and genetic structure indicate that the deep divergence among populations in all L. smetanai, N. formosana, and N. niitakana was subjected to long-term isolation, a phenomenon in agreement with the nunatak hypothesis. However, genetic admixture among populations of N. uenoiana and some populations of L. nokoensis complex suggests that gene flow occurred during glaciations, as a massif de refuge depicts. The speciation event in N. niitakana is estimated to have occurred before 1.89 million years ago (Mya), while differentiation among isolated populations in N. niitakana, N. formosana, L. smetanai, and L. nokoensis complex might have taken place during 0.65-1.65 Mya. While each of the alpine carabids arriving in Taiwan during different glaciation events acquired its evolutionary history, all of them had confronted the existing mountain ranges.
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Affiliation(s)
- Yi-Ming Weng
- Department of Entomology National Chung Hsing University 250 Kuo-Kuang Rd South District Taichung Taiwan 40227
| | - Man-Miao Yang
- Department of Entomology National Chung Hsing University 250 Kuo-Kuang Rd South District Taichung Taiwan 40227
| | - Wen-Bin Yeh
- Department of Entomology National Chung Hsing University 250 Kuo-Kuang Rd South District Taichung Taiwan 40227
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Chan CW, Lin YC, Chiu YH, Weng YM, Li WC, Lin YJ, Wang SH, Hsu TY, Huang KF, Chiu TF. Incidence and risk factors associated with acute mountain sickness in children trekking on Jade Mountain, Taiwan. J Travel Med 2016; 23:tav008. [PMID: 26782126 DOI: 10.1093/jtm/tav008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2015] [Indexed: 11/13/2022]
Abstract
BACKGROUND Acute mountain sickness (AMS) is a pathophysiological symptom complex that occurs in high-altitude areas. The incidence of AMS on Jade Mountain, the highest peak in Taiwan (3952 m), has been reported to be ∼36%. There is a lack of data in children trekking at altitude in Taiwan. The purpose of this study was to determine the incidence, risk factors and symptoms of AMS in children trekking on Jade Mountain, Taiwan. METHODS This prospective cohort study included a total of 96 healthy non-acclimatized children aged 11-12 years who trekked from an elevation of 2600-3952 m in 3 days. The Lake Louise AMS score was used to record symptoms associated with AMS. RESULTS AMS were reported in 59% of children trekking on Jade Mountain over a 3 day period. AMS incidence increased significantly with increasing altitude. The most common AMS symptom was headache, followed by fatigue or weakness, difficulty sleeping, dizziness or lightheadedness and gastrointestinal symptoms. Children who had experienced upper respiratory infection (URI) within the 7 days before their trek tended to have a greater risk for development of AMS. AMS incidence did not significantly differ according to gender, recent acute gastroenteritis, menstruation and body mass index. CONCLUSIONS The incidence of AMS in children trekking on Jade Mountain is greater than that observed in adults, and was associated with altitude and recent URI.
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Affiliation(s)
- Cheng-Wei Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Taiwan Wilderness Medical Association, Taiwan
| | - Yin-Chou Lin
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Yu-Hui Chiu
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan, Department of Emergency, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan, Taiwan Wilderness Medical Association, Taiwan
| | - Wen-Cheng Li
- College of Medicine, Chang Gung University, Taoyuan, Taiwan, Department of Emergency Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Yu-Jr Lin
- Biostatistical Center for Clinical Research, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Shih-Hao Wang
- Taiwan Wilderness Medical Association, Taiwan, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chiayi, Taiwan, Altitude Research Center, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA,
| | - Tai-Yi Hsu
- Taiwan Wilderness Medical Association, Taiwan, Department of Emergency Medicine, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Kuo-Feng Huang
- Taiwan Wilderness Medical Association, Taiwan, Department of Emergency Medicine, Taiwan Adventist Hospital, Taipei, Taiwan and Department of Physical Education, National Taitung University, Taitung, Taiwan
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung Branch, Keelung, Taiwan, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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Chien CY, Su YC, Lin CC, Kuo CW, Lin SC, Weng YM. Is 15 minutes an appropriate resuscitation duration before termination of a traumatic cardiac arrest? A case-control study. Am J Emerg Med 2015; 34:505-9. [PMID: 26774992 DOI: 10.1016/j.ajem.2015.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND Previous guidelines suggest up to 15 minutes of cardiopulmonary resuscitation (CPR) accompanied by other resuscitative interventions before terminating resuscitation of a traumatic cardiac arrest. The current study evaluated the duration of CPR according to outcome using the model of a county-based emergency medical services (EMS) system in Taiwan. METHODS This study was performed as a prospectively defined retrospective review from EMS records and cardiac arrest registration between June 2011 and November 2012 in Taoyuan, Taiwan. RESULTS A total of 396 patients were enrolled. Among the blunt injuries, most incidents were traffic accidents (66.5%) followed by falls (31.5%). Bystander CPR was performed in 34 patients (8.6%). Of the patients, 18.4% were sent to intermediate to advanced level traumatic care hospitals. Although 4.8% of patients survived for 24 hours, only 2.3% survived to discharge, and 0.8% achieved cerebral performance category 1 or 2. Among all patients who developed return of spontaneous circulation (ROSC), 14.3% of ROSC was achieved within 15 minutes since CPR. Except for 1, most patients who developed ROSC over 24 hours but did not survive to discharge received CPR more than 15 minutes. Four of 6 patients who survived to discharge achieved ROSC after CPR for more than 15 minutes (16, 18, 22, and 24 minutes). Three patients discharged with cerebral performance category 1 or 2 received CPR for 6, 16, and 18 minutes, respectively. CONCLUSIONS Fifteen minutes of CPR before terminating resuscitation is inappropriate for patients undergoing traumatic cardiac arrsests, as longer duration resuscitation increases ROSC and survival.
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Affiliation(s)
- Cheng-Yu Chien
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taipei, Taiwan.
| | - Yi-Chia Su
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan.
| | - Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan.
| | - Shen-Che Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taipei, Taiwan.
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan.
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Lin CC, Kuo CW, Ng CJ, Li WC, Weng YM, Chen JC. Rescuer factors predict high-quality CPR--a manikin-based study of health care providers. Am J Emerg Med 2015; 34:20-4. [PMID: 26431945 DOI: 10.1016/j.ajem.2015.09.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 09/05/2015] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND In the provision of high-quality cardiopulmonary resuscitation (CPR) by health care providers, factors associated with high-quality CPR should be explored. METHODS This is a post hoc analysis using data from a manikin-based survey of CPR quality among volunteer emergency medical technicians (EMTs) from 2 county fire departments in northern Taiwan. RESULTS Among the 95 enrolled EMTs, 36 (37.9%) performed high-quality CPR on a manikin. The baseline characteristics that differed significantly between groups were board-certified EMT levels (P = .010), body mass index (BMI, P = .029), average exercise frequency (P = .001), and average exercise duration (P = .005). Average total exercise time per week, which uses frequency times exercise duration, was independently associated with high-quality CPR performance after adjusting for variables via logistic regression analysis (odds ratio, 1.004; P = .044). An index was developed (BMI × ExeTime) based on the product of BMI and average total exercise time per week. A comparison of the area under curve for the different indices showed that BMI × ExeTime was a significant predictor of high-quality CPR, with an area under curve of 0.718 (95% confidence interval, 0.613-0.824; P < .001; Fig. 2) and a cutoff value of 4136.7 kg·min/m(2) (sensitivity, 0.722; specificity, 0.678). CONCLUSIONS This study identified factors associated with the performance by health care providers of high-quality CPR, including BMI and exercise habits. To optimize CPR quality, a program of exercise frequency and duration adjusted according to individual's BMI should be considered in such populations.
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Affiliation(s)
- Chi-Chun Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Chan-Wei Kuo
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan; Department of Emergency Medicine, Xiamen Chang Gung Hospital, Xiamen, China
| | - Chip-Jin Ng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
| | - Wen-Cheng Li
- Department of Occupation Medicine Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Department of Emergency Medicine, Xiamen Chang Gung Hospital, Xiamen, China
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan; Department of Emergency Medicine, Xiamen Chang Gung Hospital, Xiamen, China.
| | - Jih-Chang Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linko, Taiwan
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Weng YM, Hsu TY, Chan CW, Chen JC. Rare cause of abdominal pain and shock: Rupture of a sinus of Valsalva aneurysm. J Acute Med 2015. [DOI: 10.1016/j.jacme.2015.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Wu SH, Lin YC, Weng YM, Chiu YH, Li WC, Wang SH, Chan CW, Chiu TF, Huang KF, Chen CH. The impact of physical fitness and body mass index in children on the development of acute mountain sickness: A prospective observational study. BMC Pediatr 2015; 15:55. [PMID: 25947200 PMCID: PMC4493965 DOI: 10.1186/s12887-015-0373-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Accepted: 04/29/2015] [Indexed: 12/03/2022] Open
Abstract
Background Acute mountain sickness (AMS) is commonly found among people traveling above 2500 m. We investigated whether the occurrence of AMS is related to differences in individual physical fitness and BMI in subjects 11–13 years of age. Methods This study was conducted at Xue Mountain, Taiwan (elevation of 3886 m) between June 13, 2011 and June 17, 2011. Subjects were asked to ascend from Taipei City (25 m) to the summit (3886 m) over 3 days and 2 nights. Gender, age, weight, height, and fitness index (determined using a 3-minute step test) were recorded at sea level before ascent. The Lake Louise AMS score was used to record symptoms and diagnose AMS. Results A total of 179 subjects (mean age: 11.8 years; 102 males, 77 females) were included in the analysis. A total of 44.7% of subjects were diagnosed with AMS. Male gender (p = 0.004) and elevated body mass index (BMI) (p < 0.001) were each associated with the development of AMS. However the physical fitness index was comparable in subjects with and without AMS (67.8 ± 10.1 vs. 68.0 ± 9.3, p = 0.9). Conclusions This study shows that both BMI and male gender were associated with the development of AMS in 11–13 year old children. Physical fitness was not associated with the occurrence of AMS. Electronic supplementary material The online version of this article (doi:10.1186/s12887-015-0373-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Shih-Hao Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Chang Gung University School of Medicine, Taoyuan, Taiwan.
| | - Yin-Chou Lin
- Chang Gung University School of Medicine, Taoyuan, Taiwan. .,Department of Physical and Rehabilitation Medicine, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan.
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Chang Gung University School of Medicine, Taoyuan, Taiwan.
| | - Yu-Hui Chiu
- Department of Emergency Medicine, Mackay Memorial Hospital, Taipei, Taiwan. .,Institute of Environmental and Occupational Health Science, National Yang-Ming University, Taipei, Taiwan.
| | - Wen-Cheng Li
- Chang Gung University School of Medicine, Taoyuan, Taiwan. .,Department of Occupation Medicine, Chang-Gung Memorial Hospital at Keelung, Keelung, Taiwan. .,Department of Occupation Medicine, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
| | - Shih-Hao Wang
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital at Chiayi, Chiayi, Taiwan. .,Department of Emergency Medicine, National Yang-Ming University Hospital, Yilan, Taiwan. .,Altitude Research Center, Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. .,Taiwan Wilderness Medical Association, Taipei, Taiwan.
| | - Chang-Wei Chan
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Chang Gung University School of Medicine, Taoyuan, Taiwan.
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan. .,Chang Gung University School of Medicine, Taoyuan, Taiwan.
| | - Kuo-Feng Huang
- Department of Physical Education, National Taitung University, Taitung, Taiwan. .,Department of Emergency Medicine, Taiwan Adventist Hospital, Taipei, Taiwan.
| | - Chung-Hsien Chen
- Chang Gung University School of Medicine, Taoyuan, Taiwan. .,Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.
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Chen JY, Tsai YW, Chen SY, Ho CI, Weng YM, Hsiao CT, Li WC. The association of leptin and homocysteine with renal function impairment in a population of Taiwanese adults. Clin Nutr 2014; 34:943-50. [PMID: 25453393 DOI: 10.1016/j.clnu.2014.10.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [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: 03/22/2014] [Revised: 09/08/2014] [Accepted: 10/01/2014] [Indexed: 11/18/2022]
Abstract
BACKGROUND & AIMS Higher levels of leptin and homocysteine (Hcy) have been evaluated as risk factors of chronic kidney disease in patients and general population. The aim of this study was to examine gender differences in the associations of leptin and Hcy levels and renal function a representative healthy young population in Taiwan. METHODS The participants aged ≥18 years who underwent health examinations were included and categorized into three groups by gender-specific tertiles of leptin and Hcy levels. Estimated glomerular filtration rates (eGFR) were estimated according to the modified equation of Modification of Diet in Renal Disease (MDRD). RESULTS A higher mean Hcy level was found in male subjects than females. Mean values of metabolic syndrome risk factors significantly elevated with increasing leptin levels in both genders. Both male and female subjects with higher plasma Hcy levels were more likely to have a lower eGFR. Plasma Hcy levels were significantly negatively correlated with eGFR in linear regression models adjusted for age and smoking. The associations persisted even after mean arterial pressure and fasting plasma glucose were included for adjustments both genders. Plasma Hcy level was negatively associated eGFR and the association was more profound for females. CONCLUSIONS Leptin levels did not reveal strong or consistent evidence to support a significant association with eGFR. Hcy had a more decisive effect on renal function impairment than leptin and may be considered a more sensitive biomarker for Taiwanese adults.
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Affiliation(s)
- Jau-Yuan Chen
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Yi-Wen Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Shou-Yen Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Chih-I Ho
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taiwan
| | - Cheng-Ting Hsiao
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Chiayi, Taiwan; Chang Gung Institute of Technology, Chiayi Branch, Taiwan
| | - Wen-Cheng Li
- Department of Occupation Medicine, Chang-Gung Memorial Hospital at Chiayi, Taiwan.
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Tsai LH, Weng YM, Lin CC, Kuo CW, Chen JC. Risk screening for long QT prior to prescribing levofloxacin. Am J Emerg Med 2014; 32:1153.e1-3. [DOI: 10.1016/j.ajem.2014.02.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2014] [Accepted: 02/19/2014] [Indexed: 01/05/2023] Open
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Lin WL, Seak CJ, Wu JY, Weng YM, Chen HC. Risk factors for development of chronic kidney disease following renal infarction: retrospective evaluation of emergency room patients from a single center. PLoS One 2014; 9:e98880. [PMID: 24911965 PMCID: PMC4049636 DOI: 10.1371/journal.pone.0098880] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 05/08/2014] [Indexed: 12/16/2022] Open
Abstract
Background Previous studies have analyzed factors associated with renal infarction so that patients can be provided with earlier diagnosis and treatment. However, the factors associated with development of chronic kidney disease (CKD) following renal infarction are unknown. Methods We retrospectively reviewed the records of patients with a diagnosis of renal infarction based on enhanced computed tomography. All patients were admitted to a single emergency department in Taiwan from 1999 to 2008. Univariate and multivariate analysis were used to assess the effect of different factors on development of CKD based on estimates of the glomerular filtration rate (eGFR) at admission and at 3–12 months after discharge. Results Univariate analysis indicated significantly increased risk of CKD in patients older than 50 years, with symptoms for 24 h or less before admission, lower eGFR at admission, APACHE II score greater than 7, SOFA score greater than 1, ASA score greater than 2, and SAPS II score greater than 15. Multivariate analysis indicated that only SOFA score greater than 1 was significantly and independently associated with CKD at follow-up (p<0.001). Conclusions A total of 32.5% of patients admitted for renal infarction over a ten-year period developed CKD at 3–12 months after discharge. A SOFA score greater than 1 was significantly and independently associated with development of CKD in these patients.
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Affiliation(s)
- Wen-Ling Lin
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Jiunn-Yih Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Taoyuan, Taiwan, and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hang-Cheng Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan, and Chang Gung University College of Medicine, Taoyuan, Taiwan
- * E-mail:
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Hsu SC, Chen CY, Weng YM, Chen SY, Lin CC, Chen JC. Comparison of 3 scoring systems to predict mortality from unstable upper gastrointestinal bleeding in cirrhotic patients. Am J Emerg Med 2014; 32:417-20. [DOI: 10.1016/j.ajem.2014.01.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Revised: 01/09/2014] [Accepted: 01/11/2014] [Indexed: 12/14/2022] Open
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Weng YM, Chiu YH, Lynn JJ, Li WC, Wang SH, Kao WF, Hsu TY, Chiu TF, Lin YJ, Chan CW. Different duration of high-altitude pre-exposure associated with the incidence of acute mountain sickness on Jade Mountain. Am J Emerg Med 2013; 31:1113-7. [PMID: 23688567 DOI: 10.1016/j.ajem.2013.03.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2013] [Revised: 03/15/2013] [Accepted: 03/16/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The objective of this study is to determine the association between the duration of high-altitude (>3000 m) pre-exposure and acute mountain sickness (AMS) incidence. METHODS A prospective observational study was conducted on 2 random days each month from April 2007 to March 2008 at Paiyun Lodge (3402 m), Jade Mountain, Taiwan. Demographic data, prior AMS history, symptoms, and scores and the days and times of high-altitude pre-exposure within the preceding 2 months were obtained from lowland (<1500 m) trekkers. RESULTS Totally, 1010 questionnaires were analyzed; 106, 76, and 828 trekkers had pre-exposure lasting at least 3 days (group 1), less than 3 days (group 2), and 0 days (group 3), respectively. Acute mountain sickness incidence was significantly higher in groups 2 and 3 than in group 1 (21.70%, 35.53%, 37.08%, respectively; P = .008). Logistic regression analysis indicated a significantly lower AMS risk in group 1 (group 1, P = .004; odds ratio [OR], 0.479; 95% confidence interval [CI], 0.290-0.791; group 2, P = .226; OR, 0.725; 95% CI, 0.430-1.221). In group 1, 28 and 78 trekkers had single and intermittent multiple pre-exposure, respectively. There was no difference in the incidence or severity of AMS symptoms between single and intermittent multiple pre-exposure (AMS, P = .838; headache, P = .891; dizziness or lightheadedness, P = .414; fatigue and/or weakness, P = .957; gastrointestinal symptoms, P = .257; difficulty sleeping, P = .804; AMS score, P = .796). CONCLUSIONS High-altitude pre-exposure lasting at least 3 days within the preceding 2 months was associated with a significant lower AMS incidence during a subsequent ascent among Jade Mountain trekkers.
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Affiliation(s)
- Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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Pan MW, Chen SY, Chen CC, Chen WJ, Chang CJ, Lin CP, Weng YM, Chen YC. Implementation of multiple strategies for improved door-to-balloon time in patients with ST-segment elevation myocardial infarction. Heart Vessels 2013; 29:142-8. [PMID: 23508307 DOI: 10.1007/s00380-013-0336-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Accepted: 03/01/2013] [Indexed: 10/27/2022]
Abstract
Several strategies have been found to be associated with a significant reduction in door-to-balloon (D2B) time in the management of ST-segment elevation myocardial infarction (STEMI). The objective of this retrospective cohort study was to assess D2B time before and after specific hospital strategies, including a computerized provider order entry (CPOE), were implemented to reduce D2B time. Patients who presented to the emergency department within 12 h of STEMI were enrolled. Strategies adopted included: (1) electrocardiography during triage for patients with chest pain; (2) implementing a CPOE; (3) activating the catheterization laboratory by sending a cell phone notification via the computer system; (4) using an open real-time on-line STEMI registry; and (5) conducting a monthly meeting to review registration. A total of 134 patients were included in the study (preintervention, n = 69; postintervention, n = 65). Median D2B time improved from 83 to 63 min after the new strategies were implemented (P = 0.001). Median door-to-electrocardiogram (5-2 min) and door-to-laboratory time (60-41 min) also significantly improved (P < 0.001). The proportion of patients with a D2B time within 90 min increased from 59.4 % to 98.5 % (P < 0.001). In conclusion, our findings suggest that implementing specific strategies can substantially improve D2B time for patients with STEMI and increase the proportion of patients with D2B time less than 90 min.
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Affiliation(s)
- Ming-Wei Pan
- Department of Emergency Medicine, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No. 5 Fushing Street, Gueishan Shiang, Taoyuan, Taiwan
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Lynn JJ, Chen KF, Weng YM, Chiu TF. Risk factors associated with complications in patients with chemotherapy-induced febrile neutropenia in emergency department. Hematol Oncol 2013; 31:189-96. [DOI: 10.1002/hon.2040] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Revised: 10/16/2012] [Accepted: 12/05/2012] [Indexed: 11/08/2022]
Affiliation(s)
- Jiun-Jen Lynn
- Department of Emergency Medicine, Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Kuan-Fu Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Yi-Ming Weng
- Department of Emergency Medicine, Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Taoyuan Taiwan
| | - Te-Fa Chiu
- Department of Emergency Medicine, Chang Gung Memorial Hospital; Chang Gung University College of Medicine; Taoyuan Taiwan
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Lin WC, Weng YM, Chan YL, Chang H, Huang SL, Chen SY. Acute Myocardial Injury in a 45-year-old Female: Hypereosinophilic Syndrome. HONG KONG J EMERG ME 2013. [DOI: 10.1177/102490791302000111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Hypereosinophilic syndrome (HES) can cause eosinophilic infiltration in multiple organ systems resulting in organ damage. Among all, cardiac involvement is the major cause of morbidity and mortality. Early diagnosis and prompt treatment are important to improve the prognosis. We reported a 45-year-old woman with a history of eosinophilia presented with chest pain in our emergency department. Laboratory tests revealed marked eosinophilia and elevated cardiac markers. A neurological event, presenting as right-side limb weakness, supervened later. The diagnosis of HES was established, and prompt treatment with corticosteroids, hydroxyurea, and imatinib resolved the eosinophilia; further cardiac and neurological injury was thus prevented. This case reminds us to consider and, if applicable, to provide the appropriate management for HES in the context of making a differential diagnosis in clinical situations involving organ damage.
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Affiliation(s)
| | | | | | - H Chang
- Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Division of Hematology, Department of Internal Medicine, Tao-Yuan, Taiwan
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Lin CC, Yu JH, Lin CC, Li WC, Weng YM, Chen SY. Postintubation hemodynamic effects of intravenous lidocaine in severe traumatic brain injury. Am J Emerg Med 2012; 30:1782-7. [DOI: 10.1016/j.ajem.2012.02.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2012] [Revised: 02/20/2012] [Accepted: 02/21/2012] [Indexed: 10/28/2022] Open
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Yu JH, Weng YM, Chen KF, Chen SY, Lin CC. Triage vital signs predict in-hospital mortality among emergency department patients with acute poisoning: a case control study. BMC Health Serv Res 2012; 12:262-9. [PMID: 22900613 PMCID: PMC3459725 DOI: 10.1186/1472-6963-12-262] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [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: 02/25/2012] [Accepted: 08/15/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To document the relationship between triage vital signs and in-hospital mortality among emergency department (ED) patients with acute poisoning. METHODS Poisoning patients who admitted to our emergency department during the study period were enrolled. Patient's demographic data were collected and odds ratios (OR) of triage vital signs to in-hospital mortality were assessed. Receiver operating characteristic curve was used to determine the proper cut-off value of vital signs that predict in-hospital mortality. Logistic regression analysis was performed to test the association of in-hospital mortality and vital signs after adjusting for different variables. RESULTS 997 acute poisoning patients were enrolled, with 70 fatal cases (6.7%). A J-shaped relationship was found between triage vital signs and in-hospital mortality. ED triage vital signs exceed cut-off values independently predict in-hospital mortality after adjusting for variables were as follow: body temperature <36 or >37°C, p < 0.01, OR = 2.8; systolic blood pressure <100 or >150 mmHg, p < 0.01, OR: 2.5; heart rate <35 or >120 bpm, p < 0.01, OR: 3.1; respiratory rate <16 or >20 per minute, p = 0.38, OR: 1.4. CONCLUSIONS Triage vital signs could predict in-hospital mortality among ED patients with acute poisoning. A J-curve relationship was found between triage vital signs and in-hospital mortality. ED physicians should take note of the extreme initial vital signs in these patients.
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Affiliation(s)
- Jiun-Hao Yu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Linkou, No. 5, Fu-Hsing St., Kuei Shan Hsiang, Tao-yuan Hsien, Taiwan
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Chiu FH, Chuang CH, Li WC, Weng YM, Fann WC, Lo HY, Sun C, Wang SH. The association of leptin and C-reactive protein with the cardiovascular risk factors and metabolic syndrome score in Taiwanese adults. Cardiovasc Diabetol 2012; 11:40. [PMID: 22533665 PMCID: PMC3471043 DOI: 10.1186/1475-2840-11-40] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2011] [Accepted: 02/13/2012] [Indexed: 12/12/2022] Open
Abstract
Background Serum C-reactive protein (CRP) and leptin levels have been independently associated with the cardiovascular risk factors. The aim of the present study was to determine if their serum levels were associated with cardiovascular risk factors or metabolic syndrome as well as their correlation in the Taiwanese population. Methods This retrospective study included 999 subjects (> 18 y), who underwent a physical examination in Chang-Gung Memorial Hospital-Linkou and Chiayi in Taiwan. The associations between CRP and/or leptin levels and cardiovascular risk factors and metabolic syndrome were determined using independent two sample t-tests to detect gender differences and chi-square tests to evaluate differences in frequencies. To compare the means of the variables measured among the four groups (high and low leptin and high and low CRP), analysis of variance (ANOVA) was used. Results Both CRP and leptin levels were independently associated with several cardiovascular risk factors, including diabetes, hypercholesterolemia and metabolic syndrome in both men and women (P < 0.05). In addition, a positive correlation between leptin and CRP levels was observed in both genders. Both high-CRP and high-leptin were associated with high blood glucose, waist circumference and serum triglyceride. Whereas increased metabolic syndrome incidence was observed in males with elevated leptin regardless of CRP levels, females with elevated CRP or leptin had increased incidence of metabolic syndrome. Conclusion Both leptin and CRP levels were associated with cardiovascular risk factors as well as metabolic syndrome score in both men and women although gender-specific differences were observed. Thus, CRP and leptin may represent useful biomarkers for predicting the onset of cardiovascular disease or metabolic syndrome in Taiwanese adults. Trial registration IRB/CGMH 100-3514B
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Affiliation(s)
- Feng-Hsiang Chiu
- Department of Occupation Medicine, Chang-Gung Memorial Hospital, Keelung Branch, No, 222 Maijin Rd., Keelung, Taiwan
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