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Chen SJ, Chang SS, Meng NH. Bicarotid trunk and severe kinking of right common carotid artery presenting with large intracranial hemorrhage. J Postgrad Med 2024; 70:123-124. [PMID: 38668633 DOI: 10.4103/jpgm.jpgm_891_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/19/2024] [Indexed: 05/22/2024] Open
Affiliation(s)
- S J Chen
- Department of Education, China Medical University Hospital, Taichung, Taiwan
| | - S S Chang
- Division of Cardiovascular Medicine, China Medical University Hospital, Taichung, Taiwan
| | - N H Meng
- Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan
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Cully G, Corcoran P, Gunnell D, Chang SS, McElroy B, O'Connell S, Arensman E, Perry IJ, Griffin E. Evaluation of a national clinical programme for the management of self-harm in hospital emergency departments: impact on patient outcomes and the provision of care. BMC Psychiatry 2023; 23:917. [PMID: 38062378 PMCID: PMC10701986 DOI: 10.1186/s12888-023-05340-4] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/02/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Emergency departments are important points of intervention, to reduce the risk of further self-harm and suicide. A national programme to standardise the management of people presenting to the emergency department with self-harm and suicidal ideation (NCPSHI) was introduced in Ireland in 2014. The aim of this study was to evaluate the impact of the NCPSHI on patient outcomes and provision of care. METHODS Data on self-harm presentations were obtained from the National Self-Harm Registry Ireland from 2012 to 2017. The impacts of the NCPSHI on study outcomes (3-month self-harm repetition, biopsychosocial assessment provision, admission, post-discharge referral, and self-discharge) were examined at an individual and aggregate (hospital) level, using a before and after study design and interrupted time series analyses, respectively. The 15 hospitals that implemented the programme by January 2015 (of a total of 24 between 2015 and 2017) were included in the analyses. RESULTS There were 31,970 self-harm presentations during the study period. In hospitals with no service for self-harm (n = 4), risk of patients not being assessed reduced from 31.8 to 24.7% following the introduction of the NCPSHI. Mental health referral in this hospital group increased from 42.2 to 59.0% and medical admission decreased from 27.5 to 24.3%. Signs of a reduction in self-harm repetition were observed for this hospital group, from 35.1 to 30.4% among individuals with a history of self-harm, but statistical evidence was weak. In hospitals with a pre-existing liaison psychiatry service (n = 7), risk of self-discharge was lower post-NCPSHI (17.8% vs. 14.8%). In hospitals with liaison nurse(s) pre-NCPSHI (n = 4), medical admission reduced (27.5% vs. 24.3%) and there was an increase in self-harm repetition (from 5.2 to 7.8%. for those without a self-harm history). CONCLUSION The NCPSHI was associated with improvements in the provision of care across hospital groups, particularly those with no prior service for self-harm, highlighting the need to consider pre-existing context in implementation planning. Our evaluation emphasises the need for proper resourcing to support the implementation of clinical guidelines on the provision of care for people presenting to hospital with self-harm.
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Affiliation(s)
- G Cully
- School of Public Health, University College Cork, Cork, Ireland.
- National Suicide Research Foundation, Cork, Ireland.
| | - P Corcoran
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - D Gunnell
- NIHR Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
| | - S S Chang
- Institute of Health Behaviors and Community Sciences, and Global Health Program, College of Public Health, National Taiwan University, Taipei City, Taiwan
| | - B McElroy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - S O'Connell
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
| | - E Arensman
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
- School of Applied Psychology, Australian Institute for Suicide Research and Prevention, Griffith University, Brisbane, QLD, Australia
| | - I J Perry
- School of Public Health, University College Cork, Cork, Ireland
| | - E Griffin
- School of Public Health, University College Cork, Cork, Ireland
- National Suicide Research Foundation, Cork, Ireland
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Yao J, Liu XM, Yuan F, Luo TY, Lu ZN, Yan YF, Chang SS, Song GY. [Safety and efficacy of transcatheter aortic valve replacement using the "All in One" single artery/vessel technique]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:990-994. [PMID: 37709717 DOI: 10.3760/cma.j.cn112148-20230807-00058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Objective: To explore the safety and efficacy of transcatheter aortic valve replacement (TAVR) using the "All in One" single-artery/vessel technique. Methods: This is a retrospective study. A total of 30 consecutive patients underwent TAVR using the single artery/vascular technique in Beijing Anzhen Hospital from August to December 2021 were included. Baseline clinical data, operative situation, postoperative outcomes, and incidence of adverse events during hospitalization and at one month post TAVR were analyzed. Results: Mean age was (72.6±9.7) years, 16 were male patients, STS score was (4.73±3.12)%. Four patients were diagnosed as isolated aortic regurgitation (all with tricuspid aortic valves), and 26 patients were diagnosed as aortic stenosis (AS), 10 of whom with tricuspid aortic valves and 16 of whom with bicuspid aortic valves. The single-vessel technique was applied in 3 aortic stenosis cases; the single-artery technique was applied in 27 cases. Echocardiography was performed immediately after procedure and results showed no or trace perivalvular leak in 27 cases and small perivalvular leak in 3 cases; the mean aortic transvalvular gradient of 26 AS patients decreased from (50.4±16.0) mmHg (1 mmHg=0.133 kPa) to (9.4±3.2) mmHg (P<0.001). The procedure time was (64.8±18.9) min. There were no intraoperative death, valve displacement, conversion to surgery, coronary artery occlusion in all 30 patients. There were no major cardiac adverse events such as myocardial infarction or stroke occurred during hospitalization or at follow-up. One-month follow-up echocardiography indicated prosthesis works well. The symptoms were significantly alleviated, and the Kansas City Cardiomyopathy Score (KCCQ score) of all patients increased from 48.1±18.4 to 73.5±17.6 (P<0.001). Conclusions: TAVR using the single artery/vessel technique is safe and feasible. This technique is related to reduced access complications and worthy of wide application.
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Affiliation(s)
- J Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - X M Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - F Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - T Y Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - Z N Lu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - Y F Yan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - S S Chang
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
| | - G Y Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Beijing Institute of Heart, Lung, and Blood Vessel Diseases, Capital Medical University, Beijing 100029, China
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Chang SS, Liu XM, Lu ZN, Yao J, Yin CQ, Wu WH, Yuan F, Luo TY, Jiang ZM, Song GY. [Feasibility study of using bridging temporary permanent pacemaker in patients with high-degree atrioventricular block after TAVR]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:648-655. [PMID: 37312484 DOI: 10.3760/cma.j.cn112148-20221116-00898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To determine the feasibility of using temporary permanent pacemaker (TPPM) in patients with high-degree atrioventricular block (AVB) after transcatheter aortic valve replacement (TAVR) as bridging strategy to reduce avoidable permanent pacemaker implantation. Methods: This is a prospective observational study. Consecutive patients undergoing TAVR at Beijing Anzhen Hospital and the First Affiliated Hospital of Zhengzhou University from August 2021 to February 2022 were screened. Patients with high-degree AVB and TPPM were included. Patients were followed up for 4 weeks with pacemaker interrogation at every week. The endpoint was the success rate of TPPM removal and free from permanent pacemaker at 1 month after TPPM. The criteria of removing TPPM was no indication of permanent pacing and no pacing signal in 12 lead electrocardiogram (EGG) and 24 hours dynamic EGG, meanwhile the last pacemaker interrogation indicated that ventricular pacing rate was 0. Routinely follow-up ECG was extended to 6 months after removal of TPPM. Results: Ten patients met the inclusion criteria for TPPM, aged (77.0±11.1) years, wirh 7 females. There were 7 patients with third-degree AVB, 1 patient with second-degree AVB, 2 patients with first degree AVB with PR interval>240 ms and LBBB with QRS duration>150 ms. TPPM were applied on the 10 patients for (35±7) days. Among 8 patients with high-degree AVB, 3 recovered to sinus rhythm, and 3 recovered to sinus rhythm with bundle branch block. The other 2 patients with persistent third-degree AVB received permanent pacemaker implantation. For the 2 patients with first-degree AVB and LBBB, PR interval shortened to within 200 ms. TPPM was successfully removed in 8 patients (8/10) at 1 month without permanent pacemaker implantation, of which 2 patients recovered within 24 hours after TAVR and 6 patients recovered 24 hours later after TAVR. No aggravation of conduction block or permanent pacemaker indication were observed in 8 patients during follow-up at 6 months. No procedure-related adverse events occurred in all patients. Conclusion: TPPM is reliable and safe to provide certain buffer time to distinguish whether a permanent pacemaker is necessary in patients with high-degree conduction block after TAVR.
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Affiliation(s)
- S S Chang
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - X M Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Z N Lu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - J Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - C Q Yin
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - W H Wu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - F Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - T Y Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - Z M Jiang
- Department of Cardiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450000, China
| | - G Y Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
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Chang SS, Wu JH, Cui J, Hua C, Xia SJ, He L, Li X, Ning M, Hu R, Du X, Dong JZ, Ma CS. [Analysis of dyslipidemia management status in atrial fibrillation patients with very high and high risk of atherosclerotic cardiovascular disease]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:642-647. [PMID: 37312483 DOI: 10.3760/cma.j.cn112148-20221020-00818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Objective: To analyze the status of statins use and low-density lipoprotein cholesterol (LDL-C) management in patients with atrial fibrillation (AF) and very high/high risk of atherosclerotic cardiovascular disease (ASCVD) from Chinese Atrial Fibrillation Registry (CAFR). Methods: A total of 9 119 patients with AF were recruited in CAFR between January 1, 2015 to December 31, 2018, patients at very high and high risk of ASCVD were included in this study. Demographics, medical history, cardiovascular risk factors, and laboratory test results were collected. In patients with very high-risk, a threshold of 1.8 mmol/L was used as LDL-C management target and in patients with high risk, a threshold of 2.6 mmol/L was used as LDL-C management target. Statins use and LDL-C compliance rate were analyzed, multiple regression analysis was performed to explore the influencing factors of statins use. Results: 3 833 patients were selected (1 912 (21.0%) in very high risk of ASCVD group and 1 921 (21.1%) in high risk of ASCVD group). The proportion of patients with very high and high risk of ASCVD taking statins was 60.2% (1 151/1 912) and 38.6% (741/1 921), respectively. Attainment rate of LDL-C management target in patients with very high and high risk were 26.7% (511/1 912) and 36.4% (700/1 921), respectively. Conclusion: The proportion of statins use and attainment rate of LDL-C management target are low in AF patients with very high and high risk of ASCVD in this cohort. The comprehensive management in AF patients should be further strengthened, especially the primary prevention of cardiovascular disease in AF patients with very high and high risk of ASCVD.
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Affiliation(s)
- S S Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - J H Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - J Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - C Hua
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - S J Xia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - L He
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - X Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - M Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - R Hu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - X Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - J Z Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
| | - C S Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Centre for Cardiovascular Diseases, Beijing 100029, China
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Liao XS, Chen W, Jiang HF, Zhou J, Wei ZR, Chang SS, Zhang F, Nie KY. [Clinical effects of superficial temporal artery lobulated perforator flaps in repairing skin and soft tissue defects after temporal tumor resection]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:534-539. [PMID: 37805768 DOI: 10.3760/cma.j.cn501225-20220816-00347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To explore the feasibility and clinical effects of using superficial temporal artery lobulated perforator flaps in repairing skin and soft tissue defects after tumor resection in the temporal region. Methods: A retrospective observational study method was used. From March 2017 to October 2022, ten patients with temporal skin tumors were admitted to the Affiliated Hospital of Zunyi Medical University, including six women and four men, with age ranging from 42 to 87 years. Among them, three patients had squamous cell carcinoma and seven patients had basal cell carcinoma, with disease duration ranging from 6 months to 5 years. All temporal tumors underwent expanded resection, leaving wound areas of 5.4 cm×4.2 cm to 7.0 cm×4.0 cm after tumor resection. Superficial temporal artery frontal branch flaps with areas of 5.5 cm×1.2 cm to 7.0 cm×1.5 cm, superficial temporal artery descending branch flaps with areas of 4.2 cm×3.5 cm to 5.0 cm×4.0 cm, and superficial temporal artery parietal branch flaps with areas of 4.2 cm×1.0 cm to 5.0 cm×1.0 cm were designed to repair the wounds and reconstruct the hairline. The donor areas of the flaps were closed and sutured directly. The survival of the flaps was observed on 3 to 5 days after surgery, and the healing of wounds on the donor and recipient sites was observed when the stitches were removed on 5 to 7 days after surgery. During follow-up after surgery, the appearance of the temporal area, scar hyperplasia, hairline reconstruction, and tumor recurrence were observed in the temporal region on the affected side. Results: All the flaps survived well on 3 to 5 days after surgery, and all the donor and recipient site wounds healed well on 5 to 7 days after surgery. During follow-up of 3 to 6 months after surgery, the surgical incisions were concealed; the flaps were not swollen, with a consistent color to the surrounding skin; there were no obvious hypertrophic scars; the reconstructed hairline on the affected side was not significantly different from that of the healthy side; there was no tumor recurrence in the local area. Conclusions: For large areas of skin and soft tissue defects in the temporal region, the use of superficial temporal artery lobulated perforator flaps can repair the wounds in different regions and suture the donor sites in the primary stage simultaneously. The surgical operation is simple, and the facial appearance conforms to the aesthetic requirement after surgery with no tumor recurrence in the local area but a good repair effect. This method is particularly suitable for repairing large areas of skin and soft tissue defects in the temporal region in elderly patients.
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Affiliation(s)
- X S Liao
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - W Chen
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - H F Jiang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - J Zhou
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - Z R Wei
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - S S Chang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - F Zhang
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - K Y Nie
- Department of Burns and Plastic Surgery, Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
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Chen W, Chang SS, Zhou J, Zhang F, Yang CL, Nie KY, Deng CL, Wei ZR. [Clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer]. Zhonghua Shao Shang Yu Chuang Mian Xiu Fu Za Zhi 2023; 39:319-324. [PMID: 37805733 DOI: 10.3760/cma.j.cn501225-20220628-00267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 10/09/2023]
Abstract
Objective: To investigate the clinical effects of antibiotic bone cement combined with free anterolateral thigh flap in sequential treatment of diabetic foot ulcer (DFU) wounds. Methods: A retrospective observational study was conducted. From August 2018 to August 2021, 15 patients with DFU who met the inclusion criteria were admitted to the Affiliated Hospital of Zunyi Medical University, including 12 males and 3 females, aged 42-65 years, with a history of type 2 diabetes for 5-19 years. All the wounds of patients were complicated with local bone, muscle, or tendon defects or exposure. The wounds were covered with antibiotic bone cement after debridement in stage Ⅰ+free anterolateral thigh chimeric perforator flap (perforator flap+muscle flap) or simple free anterolateral thigh flap grafting in stage Ⅱ. The defect area of the wound after bone cement removal and debridement was 9.0 cm×5.0 cm-20.0 cm×7.0 cm, the incision area of the flap was 10.0 cm×5.0 cm-22.0 cm×7.0 cm, and the incision area of the muscle flap was 5.0 cm×3.0 cm-8.0 cm×4.0 cm. The donor sites of flaps were sutured directly. During follow-up, the situations of donor site healing and flap survival were observed. At the last follow-up, the texture and shape of the flap, the presence of new ulcers on both limbs, and the walking ability of the patient were observed. Results: During the follow-up of 8 to 21 months after operation in stage Ⅱ, the donor sites healed well with only residual linear scar; flaps in 14 patients survived completely, and the flap in 1 patient developed partial necrosis at 3 weeks after stage Ⅱ surgery, which was healed after debridement and skin grafting. At the last follow-up, the flaps were good in texture and appearance, there were no new ulcers in the affected limb or opposite limb, and the patients had no obvious impairment in daily walking function. Conclusions: To repair DFU wounds with antibiotic bone cement combined with free anterolateral thigh flap can rapidly control the infection, achieving a high survival rate of flap after operation with no obvious impairment in daily walking function of patients.
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Affiliation(s)
- W Chen
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - S S Chang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - J Zhou
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - F Zhang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - C L Yang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - K Y Nie
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - C L Deng
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
| | - Z R Wei
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
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Liu XM, Yao J, Dong Z, Yin CQ, Wu WH, Yuan F, Luo TY, Chang SS, Yan YF, Pu JZ, Song GY. [Transcatheter aortic valve replacement via single-vessel approach technique:a case report]. Zhonghua Xin Xue Guan Bing Za Zhi 2023; 51:73-75. [PMID: 36655245 DOI: 10.3760/cma.j.cn112148-20221130-00947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- X M Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - J Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - Z Dong
- Integrated Traditional and Western Medicine Department of Cardiology, China-Japan Friendship Hospital, Beijing 100029, China
| | - C Q Yin
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - W H Wu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - F Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - T Y Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - S S Chang
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - Y F Yan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - J Z Pu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
| | - G Y Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center of Cardiovascular Diseases, Beijing 100029, China
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Li Q, Liu GS, Chang SS, Guo DP, Yang F. [Association among urinary polycyclic aromatic hydrocarbons metabolites, SAHH activity and H19 expression in coke oven workers]. Zhonghua Lao Dong Wei Sheng Zhi Ye Bing Za Zhi 2022; 40:801-806. [PMID: 36510712 DOI: 10.3760/cma.j.cn121094-20210910-00451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Objective: To investigate the relationship of polycyclic aromatic hydrocarbons (PAHs) exposure, S-adenosylhomocysteine hydrolase (SAHH) activity and long noncoding RNA H19 gene expression in the urine of coke oven workers. Methods: In September 2019, in a coking plant in Taiyuan City, 146 male workers who had worked in coke oven operations for one year were selected through a completely random sampling method, and their basic personal information was collected by questionnaire survey, and blood and urine samples were collected. The levels of 4 PAHs metabolites 2-hydroxfluorene (2-FLU), 2- hydroxynaphthalene (2-NAP), 9-hydroxyphenanthren (9-PHE), and 1-hydroxypyrene (1-OHP) in urine were detected by high performance liquid chromatography (HPLC) -fluorescence detection method. HPLC-UV detection method was used to detect the content of S-adenosylmethionine (SAM) and S-adenosylhomocysteine (SAH) in plasma, and the SAHH activity value was obtained by calculating the ratio. Reverse transcription PCR method was used to determine the H19 gene expression level. Urine levels of 2-FLU, 2-NAP, 9-PHE, and 1-OHP were divided into Q(1), Q(2), Q(3), and Q(4) groups according to quartiles (P(25), P(50), P(75)). Regression, trend test and restricted cubic splines were used to analyze the relationship among PAHs metabolites, SAHH activity, H19 gene expression and their dose-response. Results: The median age of coke oven workers was 39.60 years old, the median length of service was 20.38 years, and the urinary levels of 2-FLU, 2-NAP, 9- PHE, and 1-OHP were 0.29, 0.74, 0.09, and 0.06 μg/mmol Cr, respectively. The levels of 2-FLU, 2-NAP and 9-PHE in the urine of workers were significantly different between groups with different 1-OHP levels (P<0.05). After adjusting for age, length of service, smoking, drinking, and levels of 2-FLU, 2-NAP and 9-PHE, SAHH activity decreased with the increase of urinary 1-OHP level (OR=0.63, 95%CI: 0.41-0.98, P=0.038), showing a nonlinear relationship (P(nonlinear)= 0.030). H19 gene expression increased with the increase of urinary 1- OHP level (OR=1.51, 95%CI: 1.03-2.19, P=0.033), there was a linear relationship (P(trend)= 0.058). The relationship between the other three metabolites in urine and SAHH activity and H19 gene expression was not statistically significant (P>0.05) . Conclusion: Urinary 1-OHP level may be a risk factor for decreased SAHH activity and increased H19 gene expression in coke oven workers.
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Affiliation(s)
- Q Li
- Office of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
| | - G S Liu
- Office of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
| | - S S Chang
- Analysis & Inspection Center of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
| | - D P Guo
- Analysis & Inspection Center of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
| | - F Yang
- Scientific Research Center of Occupational Disease Prevention and Control, Corporation of Xishan Coal Electricity Group Co. Ltd., Taiyuan 030053, China
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Chang SS, Gao Y, Xia SJ, Du X, Dong JZ, Ma CS. [Association between duration of digoxin use and adverse outcomes among Chinese patients with atrial fibrillation]. Zhonghua Xin Xue Guan Bing Za Zhi 2020; 48:728-734. [PMID: 32957754 DOI: 10.3760/cma.j.cn112148-20200613-00482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: We aimed to explore the impact of digoxin use on outcomes in Chinese patients with atrial fibrillation (AF). Methods: We used the dataset from the Chinese Atrial Fibrillation Registry, a prospective, multicenter, hospital-based registry study. According to the inclusion and exclusion criteria, 10 472 eligible patients enrolled from August 2011 to December 2016 were included in this ancillary study. The patients were classified into three groups according to the status of digoxin use at study enrollment, patients already receiving digoxin before registry were represented as continuous group, patients initiated on digoxin for the first time were represented as newly group, and patients without digoxin prescription at enrollment were represented as control group. Patients were followed by telephone or outpatient service every 6 months. Kaplan-Meier survival analysis and Cox proportional hazards regression models were used to investigate the association of digoxin use with adverse outcomes (all-cause death, cardiovascular death and cardiovascular hospitalization). Results: In the overall study population, men accounted for 42.8%, and the average age was (66.9±11.8) years. There were 777(7.42%)patients in continuous group, 375 (3.58%) patients in newly group, and 9 320 (89.00%) patients in control group. Compared with the control group, the patients in the newly group and the continuous group were older, had faster heart rate, lower estimated glomerular filtration rate, higher proportion of persistent atrial fibrillation, heart failure, renal insufficiency, diabetes mellitus, ischemic stroke, coronary heart disease, vascular disease and bleeding history. At the same time, the patients in the newly group and the continuous group were treated more often with anticoagulants, antiplatelet drugs, ACE inhibitors or angiotensin receptor blockers, beta-receptor blockers while the proportion of antiarrhythmic drugs was lower as compared to control group (P<0.05). During a median follow-up of 36 months (interquartile range: 18-48 month), risk of all-cause mortality was significantly higher in newly group compared to control group (7.3% vs. 4.7%, P<0.05), the rates of all-cause mortality, cardiovascular death and cardiovascular hospitalization were all higher in continuous group than in control group (8.0% vs. 4.7%; 4.7% vs. 3.0%; 16.7% vs. 11.8%; P all<0.05). After adjustment for age, male, body mass index, blood pressure, heart rate, renal function, AF type, history of stroke, heart failure, diabetes, coronary artery disease and other drugs treatment, the association between newly group and adverse outcomes was not significant, however, digoxin use was associated with increased all-cause mortality (HR 1.26; 95%CI 1.04-1.56; P=0.019), cardiovascular death (HR 1.38; 95%CI 1.08-1.77, P =0.01), and cardiovascular hospitalization (HR 1.10; 95%CI 1.06-1.52, P=0.02) in continuous group. Conclusion: Continuous digoxin use is associated with a significant increase in adverse outcomes among Chinese patients with atrial fibrillation.
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Affiliation(s)
- S S Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - Y Gao
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - S J Xia
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - X Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - J Z Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
| | - C S Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, National Clinical Research Center for Cardiovascular Diseases, Beijing 100029, China
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Yang ZY, Wang H, He Y, Li L, Chang SS, Cui J, Liu T, Lyu J, Du X, Ma CS, Dong JZ. [Value of left ventricular myocardial strain derived from cardiac magnetic resonance tissue tracking on differentiating constrictive pericarditis from restrictive cardiomyopathy]. Zhonghua Xin Xue Guan Bing Za Zhi 2020; 48:386-392. [PMID: 32450655 DOI: 10.3760/cma.j.cn112148-20190906-00549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Objective: To compare left ventricular myocardial mechanics detected by cardiac magnetic resonance tissue tracking(CMR-TT) between patients with constrictive pericarditis(CP) and restrictive cardiomyopathy(RCM),and see if those can be used to differentiate CP from RCM patients. Methods: A total of 23 patients with CP, 20 patients with RCM, who hospitalized in Beijing Anzhen Hospital from January 2014 to April 2019 were included in this study and 25 healthy subjects served as control group, all subjects underwent cardiac magnetic resonance examination. Myocardial mechanics were evaluated by 2-dimensional(2D) and 3-dimensional(3D) CMR-TT in terms of global longitudinal strain(GLS), circumferential strain(GCS), radial strain(GRS) and the lateral wall strain to septal wall strain ratio(lateral/septal ratio) of basal, mid-cavity and apical. The diagnostic area under the receiver operating characteristic curve (ROC) was evaluated for differentiating CP from RCM. Results: Age, sex and heart rate were similar between CP and RCM patients(all P>0.05). 2D-GLS, 3D-GLS, GCS and GRS in CP and RCM groups were significantly lower than those in normal control group(all P<0.05).3D-GLS value was significantly lower in RCM patients than in CP patients(P<0.05), the area under the curve (AUC)=0.787(sensitivity 80%, specificity 78%). 3D-GCS was significantly lower in CP group than in RCM group(P<0.05), the AUC=0.737(sensitivity 80%, specificity 65%). However, there was no significant difference between CP and RCM in 3D-GRS(P>0.05). Compared with RCM, the circumferential and radial lateral/septal ratios of the basal were significantly lower in CP group than in RCM group(both P<0.05), AUC=0.737(sensitivity 70%, specificity 83%) and 0.737 (sensitivity 60%, specificity 87%), respectively. The left ventricular myocardial mechanics strain curve of the CP,RCM and normal control were different. The CP patients presented as " rapidly down-a platform" form, the RCM presented as "slowly down" form, and normal control presented as "rapidly down" form. Conclusion: Evaluating the differences in the diastolic process of left ventricular myocardium and left ventricular myocardial mechanics strain curve is helpful to differentiate CP from RCM patients.
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Affiliation(s)
- Z Y Yang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - H Wang
- Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - Y He
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing 100050, China
| | - L Li
- Department of Cardiology, First Affiliated Hospital, Zhengzhou University, Zhengzhou 450052, China
| | - S S Chang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - J Cui
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - T Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - J Lyu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - X Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - C S Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
| | - J Z Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China
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Liu HF, Ku CH, Chang SS, Chang CM, Wang IK, Yang HY, Weng CH, Huang WH, Hsu CW, Yen TH. Outcome of patients with chlorpyrifos intoxication. Hum Exp Toxicol 2020; 39:1291-1300. [PMID: 32336155 DOI: 10.1177/0960327120920911] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
INTRODUCTION There is a paucity of literature analyzing outcome of chlorpyrifos intoxication. METHODS A total of 40 patients with chlorpyrifos intoxication were seen at Chang Gung Memorial Hospital between 2008 and 2017. Patients were stratified into two subgroups according to their prognosis, as good (n = 12) or poor (n = 28). Good prognosis group were defined as patients who survived without serious complications, and poor prognosis group included patients who died and survived after development of severe complications. Demographic, clinical, laboratory, and mortality data were obtained for analysis. RESULTS Patients aged 53.8 ± 16.3 years and most were male (80.0%). All patients (100.0%) developed acute cholinergic crisis such as emesis (45.0%), respiratory failure (42.5%), tachycardia (30.0%), kidney injury (22.5%), and seizure (7.5%). Intermediate syndrome developed in 12.5% of patients, but none had delayed neuropathy (0%). The poor prognosis group suffered higher incidences of respiratory failure (p = 0.011), kidney injury (p = 0.026), and prolonged corrected QT interval (p = 0.000), and they had higher blood urea nitrogen level (p = 0.041), lower Glasgow coma scale score (p = 0.011), and lower monocyte count (p = 0.023) than good prognosis group. All patients were treated with atropine and pralidoxime therapy, but six patients (15.0%) still died of intoxication. In a multivariate logistic regression model, blood urea nitrogen was a significant risk factor for poor prognosis (odds ratio: 1.375, 95% confidence interval: 1.001-1.889, p = 0.049). Nevertheless, no mortality risk factor could be identified. CONCLUSION The mortality rate of patients with chlorpyrifos intoxication was 15.0%. Furthermore, acute cholinergic crisis, intermediate syndrome, and delayed neuropathy developed in 100.0%, 12.5%, and 0% of patients, respectively.
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Affiliation(s)
- H-F Liu
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - C-H Ku
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - S-S Chang
- Institute of Health Behaviors and Community Sciences, Department of Public Health, College of Public Health, National Taiwan University, Taipei
| | - C-M Chang
- Division of Rehabilitation and Community Psychiatry, Department of Psychiatry, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - I-K Wang
- Department of Nephrology, China Medical University Hospital and College of Medicine, China Medical University, Taichung
| | - H-Y Yang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - C-H Weng
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - W-H Huang
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - C-W Hsu
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
| | - T-H Yen
- Department of Nephrology, Clinical Poison Center, Kidney Research Center, Center for Tissue Engineering, Chang Gung Memorial Hospital and College of Medicine, Chang Gung University, Linkou
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Chang SS, He CN, Tang XJ, Zhang ZY, Wei ZR, Wang DL, Li H, Gong FY, Chen W. [Effect of perforator flap of the proper digital artery of the ulnar or radial side of finger in the treatment of webbed scar contracture of the same finger in child]. Zhonghua Shao Shang Za Zhi 2019; 35:356-361. [PMID: 31154733 DOI: 10.3760/cma.j.issn.1009-2587.2019.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the effect of the perforator flap of the proper digital artery on the ulnar or radial side of the finger in the treatment of webbed scar contracture of the same finger in child. Methods: From January 2012 to January 2016, 26 children who were treated with dressing change after burn of finger and then had webbed scar contracture along with growth and development were hospitalized in our unit, involving a total of 50 fingers. There were 14 males and 12 females among the children aged from 2 to 14 years. After the scar was dissected and released, the wound area ranged from 1.6 cm×1.0 cm to 5.0 cm×2.6 cm. The perforator flap of the proper digital artery of the ulnar or radial side of the same finger was used to repair the wound. The flap area ranged from 1.8 cm×1.0 cm to 4.6 cm×1.8 cm. The donor sites were sutured directly. The residual wounds in donor and recipient sites were repaired by full-thickness skin graft collected from inguinal area/adjacent area or adjacent perforator flap. The postoperative development and function of the fingers were followed up and observed. The range of motion of the fingers was evaluated according to the Chinese Medical Association Hand Surgery Society's upper limb functional evaluation trial standard, the Kantor Scar Cosmesis Assessment and Rating Scale was used to score the scar of finger, and the latest data were recorded. Results: The flaps and skin grafts survived successfully after operation. The patients were followed up for 6 to 24 months. The perforator flaps of the proper digital artery on the ulnar or radial side of the finger survived well at the latest follow-up, with good color and texture and a two-point discrimination distance of 9 to 12 mm. There was no contracture of the fingers, a little pigmentation in the skin graft area, no flexion deformity of the fingers, no lateral bending of the fingers to the flap-harvesting side, and no scar contracture at the webs of the fingers. Compared with that of healthy side, the development of finger was not obviously abnormal. The range of motion of the fingers was excellent in 38 fingers and good in 12 fingers, and the scar score of the fingers was 2-3 points in 31 fingers, 4-7 points in 15 fingers, and 8-10 points in 4 fingers. Conclusions: The efficacy of perforator flap of the proper digital artery of the ulnar or radial side of finger in the treatment of the webbed scar contracture of the same finger in child is reliable, with high postoperative survival rate of the flap, better color and texture, and fewer complications, which can avoid the risk of re-contracture of the finger in a short period after operation, and does not affect the growth and development of the finger.
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Affiliation(s)
- S S Chang
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical University, Zunyi 563003, China
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Jin WH, Chang SS, Wei ZR, Li H, Zhou J, Chen W, Sun GF, Tang XJ, Wang B. [Clinical effects of heel lateral flap in repair of skin and soft tissue defects at posterior heel region]. Zhonghua Shao Shang Za Zhi 2019; 35:218-220. [PMID: 30897869 DOI: 10.3760/cma.j.issn.1009-2587.2019.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To explore the clinical effects of heel lateral flap in repair of skin and soft tissue defects at posterior heel region. Methods: From September 2007 to April 2016, 24 patients (17 males and 7 females, aged 16-70 years) with skin and soft tissue defects at posterior heel region were admitted to our department. The size of skin and soft tissue defects after debridement ranged from 3.0 cm×2.0 cm to 5.0 cm×4.0 cm. The defects were repaired with heel lateral flaps, with size ranging from 3.5 cm×2.5 cm to 6.0 cm×5.0 cm. The flaps were transferred to the donor sites through the loose subcutaneous tunnel. The donor site was repaired by full-thickness skin graft collected from inguinal region. The survival of flaps and the follow-up of patients were observed. Results: All flaps of 24 patients survived successfully. The recipient sites and donor sites were all healed. The patients all had follow-up of 6 to 24 months. At the last follow-up, the flaps were in good shape, with nearly normal color and soft texture. There were 6 cases of grade S3 sensation and 16 cases of grade S3(+) sensation. The distance of two-point discrimination of flaps ranged from 6 to 11 mm. The lateral foot skin grafts healed well, and the skin of the lateral foot was numb in the range of 4.0 cm×2.0 cm to 9.0 cm×3.0 cm. Conclusions: Heel lateral flap can not only repair the skin and soft tissue defects in the posterior region, but also reconstruct the sensory function of the posterior region. It is an ideal method to repair the skin and soft tissue defects in the posterior region.
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Affiliation(s)
- W H Jin
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi 563003, China
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Zhou J, Wei ZR, Sun GF, Jin WH, Chang SS, Li H, Nie KY, Tang XJ, Gong FY. [Effects of free mini-flap on tibial side of third toe on repairing skin and soft tissue defect of finger pulp at the end of finger]. Zhonghua Shao Shang Za Zhi 2019; 35:205-208. [PMID: 30897867 DOI: 10.3760/cma.j.issn.1009-2587.2019.03.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effects of free mini-flap on tibial side of third toe on repairing skin and soft tissue defect of finger pulp at the end of finger. Methods: From August 2013 to May 2017, 18 patients with skin and soft tissue defect of finger pulp at the end of finger were admitted to our unit, with 12 men and 6 women aged 16 to 54 years. As the skin and soft tissue defect sites, there were 3 cases of thumb, 8 cases of index finger, 4 cases of middle finger, and 3 cases of ring finger. The area of defects ranged from 2.0 cm×1.4 cm to 3.5 cm×2.4 cm. Free mini-flaps on tibial side of third toes were designed according to area and shape of defects, and the length and width of flaps were 0.1 to 0.2 cm longer than the length and width of the defects, respectively. The area of flaps ranged from 2.1 cm×1.5 cm to 3.7 cm×2.6 cm. The end-to-end anastomosis of subcutaneous veins of flaps and superficial veins of the finger-palm side or superficial dorsal digital vein, the end-to-end tension-free anastomosis of the base metatarsal arteries on tibial side of third toe and proper digital arteries of recipient finger were performed. Besides, anastomosis of base metatarsal nerve on tibial side of third toe and proper digital nerve of recipient finger was performed. The donor sites on feet were sutured directly or repaired with full-thickness skin grafts on medial upper leg of the same side. The survival of flaps after operation and the follow-up of patients were observed. Results: All flaps survived well, with good blood supply. Among the 18 patients, 2 patients lost to follow-up, and 16 patients were followed up for 4 to 36 months. The shape and texture of flaps were good. After reconstruction, finger pulps at the end of finger were plump, with fingerprint. Function of the finger restored well, and the two-point discriminatory distances of flaps were 5 to 10 mm. The donor sites on feet of 14 patients healed after the operation, the other 2 patients had necrosis on edge and central area of skin grafts, and the necrotic area healed after dressing change. The skin graft areas on feet were wear-resistant, with slight damage to donor sites and did not influence shoes wearing and walking. Besides, patients did not feel uncomfortable. Conclusions: Skin and soft tissue defects of finger pulp at the end of finger repaired by free mini-flaps on tibial side of third toe are with good shape and slight damage to donor sites, and the operation is simple. It is worthy of popularization and application in clinic.
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Affiliation(s)
- J Zhou
- Department of Burns and Plastic Surgery, the Affiliated Hospital of Zunyi Medical College, Zunyi 563003, China
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Ma CH, Chang SS, Tsai HJ, Gau SSF, Chen IM, Liao SC, Chien YL, Hsieh MH, Wu CS. Comparative effect of antipsychotics on risk of self-harm among patients with schizophrenia. Acta Psychiatr Scand 2018; 137:296-305. [PMID: 29430641 DOI: 10.1111/acps.12857] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To investigate the association of different antipsychotic treatments with hospitalization due to self-harm among patients with schizophrenia. METHOD This retrospective cohort study was based on Taiwan's universal health insurance database. Patients aged 15-45 years with a newly diagnosed schizophrenic disorder in 2001-2012 were included. The study outcome was the first hospitalization due to self-harm or undetermined injury after the diagnosis of schizophrenic disorders. The exposure status of antipsychotics was modeled as a time-dependent variable. The analyses were stratified by antipsychotic dosage based on defined daily dose (DDD). RESULTS Among 70 380 patients with a follow-up of 500 355 person-years, 2272 self-harm hospitalization episodes were identified. Compared with none or former use, current use of several second-generation antipsychotics with a dose of one DDD or above, including amisulpride, aripiprazole, clozapine, risperidone, and sulpiride, was associated with decreased risk of self-harm hospitalization, with clozapine showing the strongest effect (adjusted rate ratio = 0.26, 95% confidence interval 0.15-0.47). CONCLUSION The protective effect on self-harm may vary across different antipsychotics. Further studies are needed to replicate the findings.
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Affiliation(s)
- C-H Ma
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - S-S Chang
- Department of Public Health, Institute of Health Behaviors and Community Sciences, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - H-J Tsai
- Division of Biostatistics and Bioinformatics, Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - S S-F Gau
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - I-M Chen
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - S-C Liao
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Y-L Chien
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - M H Hsieh
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - C-S Wu
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
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Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Erratum to: Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1763. [PMID: 28233021 DOI: 10.1007/s00198-017-3938-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City 100, Taiwan.
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Lee SH, Hsu WT, Lai CC, Esmaily-Fard A, Tsai YW, Chiu CC, Wang J, Chang SS, Lee CC. Use of antipsychotics increases the risk of fracture: a systematic review and meta-analysis. Osteoporos Int 2017; 28:1167-1178. [PMID: 28083669 DOI: 10.1007/s00198-016-3881-3] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 01/19/2023]
Abstract
UNLABELLED Our systematic review and meta-analysis of observational studies indicated that the use of antipsychotics was associated with a nearly 1.5-fold increase in the risk of fracture. First-generation antipsychotics (FGAs) appeared to carry a higher risk of fracture than second-generation antipsychotics (SGAs). INTRODUCTION The risk of fractures associated with the use of antipsychotic medications has inconsistent evidence between different drug classes. A systematic review and meta-analysis was conducted to evaluate whether there is an association between the use of antipsychotic drugs and fractures. METHODS Searches were conducted through the PubMed and EMBASE databases to identify observational studies that had reported a quantitative estimate of the association between use of antipsychotics and fractures. The summary risk was derived from random effects meta-analysis. RESULTS The search yielded 19 observational studies (n = 544,811 participants) with 80,835 fracture cases. Compared with nonuse, use of FGAs was associated with a significantly higher risk for hip fractures (OR 1.67, 95% CI, 1.45-1.93), and use of second generation antipsychotics (SGAs) was associated with an attenuated but still significant risk for hip fractures (OR 1.33, 95% CI, 1.11-1.58). The risk of fractures associated with individual classes of antipsychotic users was heterogeneous, and odds ratios ranged from 1.24 to 2.01. Chlorpromazine was associated with the highest risk (OR 2.01, 95% CI 1.43-2.83), while Risperidone was associated with the lowest risk of fracture (OR 1.24, 95% CI 0.95-1.83). CONCLUSIONS FGA users were at a higher risk of hip fracture than SGA users. Both FGAs and SGAs were associated with an increased risk of fractures, especially among the older population. Therefore, the benefit of the off-label use of antipsychotics in elderly patients should be weighed against any risks for fracture.
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Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
| | - W-T Hsu
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan
| | - C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - A Esmaily-Fard
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital, University College of Medicine, Taoyuan, Taiwan
| | - C-C Chiu
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
| | - J Wang
- University of Nevada School of Medicine, Las Vegas, Nevada, USA
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, No.5. Fu-Hsing street, Kuei Shan Hsiang, Taoyuan, Hsien, Taiwan.
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan.
| | - C C Lee
- Health Economics and Outcome Research Group, Department of Emergency Medicine, National Taiwan University Hospital, No.7, Chung Shan S. Rd., Zhongzheng Dist., Taipei City, 100, Taiwan.
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Wu CS, Liao SC, Tsai YT, Chang SS, Tsai HJ. Comparative risk of self-harm hospitalization amongst depressive disorder patients using different antidepressants: a population-based cohort study in Taiwan. Psychol Med 2017; 47:81-92. [PMID: 27659718 DOI: 10.1017/s0033291716002257] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The aim of the study was to evaluate the comparative risk of self-harm associated with the use of different antidepressants. METHOD A cohort study was conducted using data from Taiwan's National Health Insurance Research Database from 2001 to 2012. A total of 751 606 new antidepressant users with depressive disorders were included. The study outcome was hospitalization due to self-harm (International Classification of Diseases, Ninth Revision, Clinical Modification codes: E950-E958 and E980-E988). Cox proportional hazards models with stratification of the propensity score deciles were used to estimate the hazard ratios of self-harm hospitalization during the first year following the initiation of antidepressant treatment. RESULTS There were 1038 hospitalization episodes due to self-harm that occurred during the follow-up of 149 796 person-years, with an overall incidence rate of 6.9 [95% confidence interval (CI) 6.5-7.4] per 1000. Compared with fluoxetine, the risk of self-harm hospitalization was higher for maprotiline [adjusted hazard ratio (aHR) = 3.00, 95% CI 1.40-6.45], milnacipran (aHR = 2.34, 95% CI 1.24-4.43) and mirtazapine (aHR = 1.40, 95% CI 1.06-1.86), lower for bupropion (aHR = 0.51, 95% CI 0.30-0.86), and similar level of risk was found for other selective serotonin reuptake inhibitors (citalopram, escitalopram, fluvoxamine, paroxetine and sertraline). CONCLUSIONS The risk of self-harm may vary across different antidepressant drugs. It would be of importance to conduct further research to investigate the influence of antidepressant use on self-harm behaviors.
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Affiliation(s)
- C-S Wu
- Department of Psychiatry,National Taiwan University Hospital and College of Medicine, National Taiwan University,Taipei,Taiwan
| | - S-C Liao
- Department of Psychiatry,National Taiwan University Hospital and College of Medicine, National Taiwan University,Taipei,Taiwan
| | - Y-T Tsai
- Division of Biostatistics and Bioinformatics,Institute of Population Health Sciences, National Health Research Institutes,Zhunan,Taiwan
| | - S-S Chang
- Institute of Health Behaviors and Community Sciences and Department of Public Health,College of Public Health,National Taiwan University,Taipei,Taiwan
| | - H-J Tsai
- Division of Biostatistics and Bioinformatics,Institute of Population Health Sciences, National Health Research Institutes,Zhunan,Taiwan
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20
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Jing R, Guo XY, Xia SJ, Chang SS, Li JY, Lu SX, Du X, Dong JZ, Ma CS. [Situation of long-term use of oral anticoagulation among atrial fibrillation patients with stroke in different level hospital]. Zhonghua Yi Xue Za Zhi 2016; 96:2049-53. [PMID: 27468615 DOI: 10.3760/cma.j.issn.0376-2491.2016.26.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To investigate the current situation, time trends and factors associated with long-term use of oral anticoagulation (OAC) among atrial fibrillation (AF) patients with ischemic stroke. METHODS We used the dataset from the CAFR (Chinese Atrial Fibrillation Registry), a prospective, multicenter, hospital-based registry study involving 20 tertiary and 12 nontertiary hospitals in Beijing. In brief, 380 consecutive AF patients with following ischemic stroke were enrolled from 2003 to 2014.Patients with valvular AF, radiofrequency catheter ablation history or contraindications of OAC were excluded. We divided the patients into two groups according to hospital level, and investigated the rate of OAC use and its change over time in patients who had indication, the factors including patient characteristics and hospital level associated with OAC use were also analyzed. RESULTS Overall oral anticoagulation use rate was 27.71%, which dropped to 22.11% and 15.26% at 6 months and 12 months, respectively.A total of 298 participates were enrolled from tertiary hospitals (78.42%), and 82 were enrolled from nontertiary hospitals. The status of OAC use in tertiary hospitals was better than nontertiary hospitals (32.66% vs 7.32%, P<0.001). Multivariable analysis showed better oral anticoagulation use was independently associated with higher-level hospitals (odds ratio 1.785, 95% confidence interval 1.026-3.106, P=0.040), and history of heart failure (odds ratio 2.247, 95% confidence interval 1.235-4.090, P=0.008). CONCLUSIONS These data indicates oral anticoagulation use has improved in atrial fibrillation patients with stroke in Beijing. The use of anticoagulation among the patients from tertiary hospitals is significantly better than those from nontertiary hospitals, and the history of heart failure may have effect on the use of oral anticoagulation.
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Affiliation(s)
- R Jing
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing 100029, China
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21
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Abstract
OBJECTIVE To examine the association between corticosteroid use and risk of active tuberculosis (TB) disease. METHODS We conducted a population-based nested case-control study based on Taiwan's National Health Insurance Research Database between January 1999 and December 2011. Each case of incident active TB was matched to 100 controls using a risk-set sampling scheme. RESULTS From a participant cohort of 1 million, 6229 cases of new active TB and 622,900 controls were identified. Current, recent, past, ever and chronic use of corticosteroids were associated with an increased risk of developing incident active TB, with adjusted rate ratios of respectively 2.76 (95%CI 2.44-3.11), 1.99 (95%CI 1.73-2.31), 1.17 (95%CI 1.06-1.29), 1.60 (95%CI 1.49-1.72), and 1.58 (95%CI 1.43-1.75). For subgroup analysis, the increased risk of TB in chronic corticosteroids users was substantially higher in subjects aged ≤70 years and female subjects. CONCLUSION In this relatively high TB prevalence setting, we found that use of corticosteroids was associated with an increased risk of TB. Current use of corticosteroids was associated with the highest risk of TB.
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Affiliation(s)
- C-C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - M-T G Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - S-H Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan, Taiwan
| | - S-S Chang
- Department of Family Medicine, Chang-Gung University Hospital, Linkou, Taiwan; Graduate Institute of Clinical Medicine, Chang-Gung University Hospital, Linkou, Taiwan
| | - C-C Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Emergency Medicine and General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
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22
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Chang SS, Bjørngaard JH, Tsai MK, Bjerkeset O, Wen CP, Yip PSF, Tsao CK, Gunnell D. Heart rate and suicide: findings from two cohorts of 533 000 Taiwanese and 75 000 Norwegian adults. Acta Psychiatr Scand 2016; 133:277-88. [PMID: 26493376 DOI: 10.1111/acps.12513] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/17/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To investigate the association of resting heart rate with suicide in two large cohorts. METHOD The MJ cohort (Taiwan) included 532 932 adults from a health check-up programme (1994-2008). The HUNT cohort (Norway) included 74 977 adults in the Nord-Trøndelag County study (1984-1986), followed up to 2004. In both cohorts heart rate was measured at baseline, and suicide was ascertained through linkage to cause-of-death registers. Risk of suicide was estimated using Cox proportional hazards models. RESULTS There were 569 and 188 suicides (average follow-up period of 8.1 and 16.9 years) in the MJ and HUNT cohorts respectively. Sex- and age-adjusted hazard ratio for every 10 beat increase in heart rate per minute was 1.08 (95% Confidence Interval 1.00-1.16) and 1.24 (1.12-1.38) in the MJ and HUNT cohorts, respectively. In the MJ cohort this association was confined to individuals with a history of heart diseases vs. those without such a history (P for interaction = 0.008). In the HUNT cohort the association did not differ by history of heart diseases and was robust to adjustment for health-related life style, medication use, and symptoms of anxiety and depression. CONCLUSION Elevated resting heart rate may be a marker of increased suicide risk.
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Affiliation(s)
- S-S Chang
- Institute of Health Behaviors and Community Sciences, and Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan.,Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - J H Bjørngaard
- Department of Public Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.,Forensic Department and Research Centre, Bröset St. Olav's University Hospital Trondheim, Trondheim, Norway
| | - M K Tsai
- China Medical University Hospital, Taichung, Taiwan.,Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - O Bjerkeset
- Faculty of Health Sciences, Nord-Trøndelag University College (HiNT), Levanger, Norway.,Institute of Neuromedicine, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
| | - C P Wen
- China Medical University Hospital, Taichung, Taiwan.,Institute of Population Health Science, National Health Research Institutes, Miaoli, Taiwan
| | - P S F Yip
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Hong Kong SAR, China.,Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong SAR, China
| | - C K Tsao
- MJ Health Management Institution, Taipei, Taiwan
| | - D Gunnell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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23
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Tsai YW, Lu MC, Lin YH, Lee YC, Li WC, Chen JY, Chang SS. Combined body mass index with high-sensitivity C-reactive protein as independent predictors for chronic kidney disease in a relatively healthy population in Taiwan. Eur J Clin Nutr 2016; 70:766-71. [PMID: 26979987 DOI: 10.1038/ejcn.2016.28] [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] [Received: 10/17/2015] [Revised: 02/02/2016] [Accepted: 02/03/2016] [Indexed: 12/20/2022]
Abstract
BACKGROUND/OBJECTIVES Obesity, a chronic inflammatory state, increases risk of cardiovascular disease and insulin resistance, which are the leading cause of end-stage renal disease (ESRD). We evaluated the relationship between body mass index (BMI) and high-sensitivity C-reactive protein (hsCRP) level and impaired kidney function to determine the predictive value of both markers for estimating chronic kidney disease (CKD) risk in a healthy adult population in Taiwan. SUBJECTS/METHODS In a retrospective cross-sectional study of 4100 subjects ⩾18 years, a multivariate logistic regression model was used to assess the relationship among BMI, high hsCRP levels and CKD. Receiver-operating characteristic curve and Youden index were developed to define the discrimination power of combining BMI with hsCRP for CKD prediction and to determine the best predictive index. RESULTS Overweight/obese subjects with high hsCRP levels had the highest odds ratio for CKD (P=0.048). In females, combining BMI with hsCRP for CKD prediction was superior to that of males (0.890 vs 0.623, respectively; both P<0.001). For females, the Youden index was 25.65 kg/m(2) for BMI and 1.04 μg/ml for hsCRP. CONCLUSIONS Overweight/obesity with higher hsCRP levels is associated with reduced renal function and increased risk for CKD. BMI and hsCRP levels can be used as surrogate markers for CKD risk, especially for females.
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Affiliation(s)
- Y-W Tsai
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - M-C Lu
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Y-H Lin
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Y-C Lee
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - W-C Li
- Department of Emergency Medicine, Chang Gung Memorial Hospital at Taipei, Taipei City, Taiwan
| | - J-Y Chen
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
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24
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Chang SS, Tsai HJ, Chang FY, Lee TS, Huang KC, Fang KY, Wallace RM, Inoue S, Fei CY. Government Response to the Discovery of a Rabies Virus Reservoir Species on a Previously Designated Rabies-Free Island, Taiwan, 1999-2014. Zoonoses Public Health 2015; 63:396-402. [PMID: 26542085 DOI: 10.1111/zph.12240] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Indexed: 11/28/2022]
Abstract
Taiwan had been considered rabies free since 1961. In 2013, Taiwan confirmed the detection of rabies virus in wild Taiwan ferret-badgers. Up to December 2014, there have been 423 rabies-confirmed ferret-badgers and three cases of spillover infection into non-reservoir hosts. Genetic analysis indicates that TFBV is distinct from all other known rabies virus variants. To date, ferret-badger rabies is known to occur only in China and Taiwan. The temporal dynamics of rabid ferret-badgers in Taiwan suggests that the epizootic appears to have subsided to enzootic levels as of December 2014. According to the current epidemiologic data, there is only one TFBV strain in Taiwan. TFBV is still sequestered to the mountainous regions. Humans are at risk mainly through exposure to the virus from infected domestic meso-carnivores, mainly dogs and cats. Dogs and cats should be vaccinated to establish an immunological barrier to stop the spread of the disease from mountainous regions to domestic meso-carnivores.
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Affiliation(s)
- S-S Chang
- Bureau of Animal and Plant Health Inspection and Quarantine, Council of Agriculture, Taipei, Taiwan
| | - H-J Tsai
- Animal Health Research Institute, Council of Agriculture, Taipei, Taiwan
| | - F-Y Chang
- Taiwan Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan
| | - T-S Lee
- Forestry Bureau, Council of Agriculture, Taipei, Taiwan
| | - K-C Huang
- Department of Animal Industry, Council of Agriculture, Taipei, Taiwan
| | - K-Y Fang
- Endemic Species Research Institute, Council of Agriculture, Taipei, Taiwan
| | - R M Wallace
- United States Centers for Disease Control and Prevention, CDC, Atlanta, GA, USA
| | - S Inoue
- National Institute of Infectious Diseases, Tokyo, Japan
| | - C-Y Fei
- School of Veterinary Medicine, National Taiwan University, Taipei, Taiwan
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25
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Chen CC, Cheng KW, Chang SS. Impact on population alcohol use of policy changes following WTO membership in Taiwan. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.132] [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: 11/14/2022] Open
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Abstract
BACKGROUND Schizophrenia patients have higher rates of minor physical anomalies (MPAs) than controls, particularly in the craniofacial region; this difference lends support to the neurodevelopmental model of schizophrenia. Whether MPAs are associated with treatment response in schizophrenia remains unknown. The aim of this case-control study was to investigate whether more MPAs and specific quantitative craniofacial features in patients with schizophrenia are associated with operationally defined treatment resistance. METHOD A comprehensive scale, consisting of both qualitatively measured MPAs and quantitative measurements of the head and face, was applied in 108 patients with treatment-resistant schizophrenia (TRS) and in 104 non-TRS patients. Treatment resistance was determined according to the criteria proposed by Conley & Kelly (2001; Biological Psychiatry 50, 898-911). RESULTS Our results revealed that patients with TRS had higher MPA scores in the mouth region than non-TRS patients, and the two groups also differed in four quantitative measurements (facial width, lower facial height, facial height, and length of the philtrum), after controlling for multiple comparisons using the false discovery rate. Among these dysmorphological measurements, three MPA item types (mouth MPA score, facial width, and lower facial height) and earlier disease onset were further demonstrated to have good discriminant validity in distinguishing TRS from non-TRS patients in a multivariable logistic regression analysis, with an area under the curve of 0.84 and a generalized R 2 of 0.32. CONCLUSIONS These findings suggest that certain MPAs and craniofacial features may serve as useful markers for identifying TRS at early stages of the illness.
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Affiliation(s)
- A-S Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
| | - S-S Chang
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, University of Hong Kong,Hong Kong Special Administrative Region,People's Republic of China
| | - S-H Lin
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University,Tainan,Taiwan
| | - Y-C Peng
- Department of General Psychiatry,Bali Psychiatric Center, Ministry of Health and Welfare,New Taipei City,Taiwan
| | - H-G Hwu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
| | - W J Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University,17 Xu-Zhou Road,Taipei 100,Taiwan
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Lee MTG, Lin HY, Lee SH, Lee SH, Chang SS, Chen SC, Lee CC. Risk of skin ulcerations associated with oral nicorandil therapy: a population-based study. Br J Dermatol 2015; 173:498-509. [PMID: 25939634 DOI: 10.1111/bjd.13884] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Although healthcare products regulatory agencies have issued warnings on risk of ulceration associated with the use of nicorandil, a population-based study has not been carried out. OBJECTIVES To determine the relationship between use of nicorandil and skin ulceration. METHODS We carried out a population-based study using a cohort of 1 million people assembled from Taiwan's national health insurance database. The association between nicorandil use and skin ulcers was estimated by a Cox proportional hazards regression model adjusting for a nicorandil-specific propensity score (PS) comprising of 86 potential predictors (c-statistic = 0·91). RESULTS The prospective cohort was longitudinally followed from January 2005 to December 2009, during which 1268 new users of nicorandil and 771 136 nonusers were identified. A higher frequency of skin ulcers (29 of 1268; 2·3%) was observed for users of nicorandil compared with nonusers (3231 of 771 136; 0·4%). Compared with nonusers, the crude hazard ratio (HR) associating nicorandil use with skin ulcers was 5·52 [95% confidence interval (CI) 3·82-7·95] and the PS-adjusted HR was 1·85 (95% CI 1·27-2·69). A risk period analysis showed that the risk of skin ulceration among users of nicorandil was greatest in the first year. Subgroup analysis found that the interaction term reached statistical significance (P < 0·05) for age and diabetes. CONCLUSIONS Use of nicorandil was found to be associated with an increased risk for skin ulceration, especially in the first year after incident exposure. We suggest that regulatory agencies re-evaluate the risk for skin ulceration associated with use of nicorandil.
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Affiliation(s)
- M-T G Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - H-Y Lin
- Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, Taipei, Taiwan.,Hsin-Yi Lin Dermatological Clinic, Taipei, Taiwan
| | - S-H Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.,College of Medicine, National Yang Ming University Hospital, Taipei, Taiwan
| | - S-S Chang
- Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, 333, Taiwan.,College of Medicine, Graduate Institute of Clinical Medical Sciences, Chang Gung University, Taoyuan, 333, Taiwan
| | - S-C Chen
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - C-C Lee
- Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, 640, Taiwan.,Department of General Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, 640, Taiwan
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28
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Gakis G, Morgan TM, Daneshmand S, Keegan KA, Todenhöfer T, Mischinger J, Schubert T, Zaid HB, Hrbacek J, Ali-El-Dein B, Clayman RH, Galland S, Olugbade K, Rink M, Fritsche HM, Burger M, Chang SS, Babjuk M, Thalmann GN, Stenzl A, Efstathiou JA. Impact of perioperative chemotherapy on survival in patients with advanced primary urethral cancer: results of the international collaboration on primary urethral carcinoma. Ann Oncol 2015; 26:1754-9. [PMID: 25969370 DOI: 10.1093/annonc/mdv230] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [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: 10/12/2014] [Accepted: 05/06/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To investigate the impact of perioperative chemo(radio)therapy in advanced primary urethral carcinoma (PUC). PATIENTS AND METHODS A series of 124 patients (86 men, 38 women) were diagnosed with and underwent surgery for PUC in 10 referral centers between 1993 and 2012. Kaplan-Meier analysis with log-rank testing was used to investigate the impact of perioperative chemo(radio)therapy on overall survival (OS). The median follow-up was 21 months (mean: 32 months; interquartile range: 5-48). RESULTS Neoadjuvant chemotherapy (NAC), neoadjuvant chemoradiotherapy (N-CRT) plus adjuvant chemotherapy (ACH), and ACH was delivered in 12 (31%), 6 (15%) and 21 (54%) of these patients, respectively. Receipt of NAC/N-CRT was associated with clinically node-positive disease (cN+; P = 0.033) and lower utilization of cystectomy at surgery (P = 0.015). The objective response rate to NAC and N-CRT was 25% and 33%, respectively. The 3-year OS for patients with objective response to neoadjuvant treatment (complete/partial response) was 100% and 58.3% for those with stable or progressive disease (P = 0.30). Of the 26 patients staged ≥cT3 and/or cN+ disease, 16 (62%) received perioperative chemo(radio)therapy and 10 upfront surgery without perioperative chemotherapy (38%). The 3-year OS for this locally advanced subset of patients (≥cT3 and/or cN+) who received NAC (N = 5), N-CRT (N = 3), surgery-only (N = 10) and surgery plus ACH (N = 8) was 100%, 100%, 50% and 20%, respectively (P = 0.016). Among these 26 patients, receipt of neoadjuvant treatment was significantly associated with improved 3-year relapse-free survival (RFS) (P = 0.022) and OS (P = 0.022). Proximal tumor location correlated with inferior 3-year RFS and OS (P = 0.056/0.005). CONCLUSION In this series, patients who received NAC/N-CRT for cT3 and/or cN+ PUC appeared to demonstrate improved survival compared with those who underwent upfront surgery with or without ACH.
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Affiliation(s)
- G Gakis
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - T M Morgan
- Department of Urology, University of Michigan, Ann Arbor, USA
| | - S Daneshmand
- Institute of Urology, USC/Norris Comprehensive Cancer Center, Los Angeles
| | - K A Keegan
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - T Todenhöfer
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - J Mischinger
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - T Schubert
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - H B Zaid
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - J Hrbacek
- 2nd Medical School, Department of Urology, Charles University, Prague, Czech Republic
| | - B Ali-El-Dein
- Urology and Nephrology Center, Mansoura Clinic, Mansoura, Egypt
| | - R H Clayman
- Department of Radiooncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - S Galland
- Department of Radiooncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - K Olugbade
- Department of Urology, University of Michigan, Ann Arbor, USA
| | - M Rink
- Department of Urology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - H-M Fritsche
- Department of Urology, University Hospital Regensburg, Regensburg, Germany
| | - M Burger
- Department of Urology, University Hospital Regensburg, Regensburg, Germany
| | - S S Chang
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, USA
| | - M Babjuk
- 2nd Medical School, Department of Urology, Charles University, Prague, Czech Republic
| | - G N Thalmann
- Department of Urology, University Hospital Bern, Bern, Switzerland
| | - A Stenzl
- Department of Urology, University of Tuebingen, Tuebingen, Germany
| | - J A Efstathiou
- Department of Radiooncology, Massachusetts General Hospital, Harvard Medical School, Boston, USA
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Gunnell D, Coope C, Fearn V, Wells C, Chang SS, Hawton K, Kapur N. Suicide by gases in England and Wales 2001-2011: evidence of the emergence of new methods of suicide. J Affect Disord 2015; 170:190-5. [PMID: 25254616 DOI: 10.1016/j.jad.2014.08.055] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [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: 06/06/2014] [Revised: 08/29/2014] [Accepted: 08/31/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND Increases in suicide deaths by gassing, particularly carbon monoxide poisoning from burning barbecue charcoal, have occurred in many parts of East Asia and resulted in rises in overall suicide rates in some countries. Recent trends in gas poisoning suicides outside Asia have received little attention. METHODS We analysed suicides by gassing in England and Wales (2001-2011) using national suicide mortality data enhanced by free text searching of information sent by coroners to the Office for National Statistics (ONS). We conducted specific searches for suicides involving barbecue charcoal gas, helium, and hydrogen sulphide. We analysed coroners' records of eight people who used helium as a method of suicide, identified from systematic searches of the records of four coroners. RESULTS Gassing accounted for 5.2% of suicide deaths in England and Wales during 2001-2011. The number of gas suicides declined from 368 in 2001 to 174 by 2011 (a 53% reduction). The fall was due to a decline in deaths involving car exhaust and other sources of carbon monoxide. There was a rapid rise in deaths due to helium inhalation over the period, from five deaths in the two year period 2001-2002 to 89 in 2010-2011 (a 17-fold increase). There were small rises in deaths involving hydrogen sulphide (0 cases in 2001-2002 versus 14 cases in 2010-2011) and barbecue charcoal gas (1 case in 2001-2002 versus 11 cases in 2010-2011). Compared to individuals using other methods, those suicides adopting new types of gas for suicide were generally younger and from more affluent socioeconomic groups. The corones' records of four of the eight individuals dying by helium inhalation whose records were reviewed showed evidence of Internet involvement in their choice of method. LIMITATIONS We were not able to identify the source of carbon monoxide (car exhaust or barbecue charcoal) for over 50% of cases. CONCLUSION Increases in helium inhalation as a method of suicide have partially offset recent decreases in suicide by the use of car exhaust. Public health measures are urgently needed to prevent a potential epidemic rise in the use of helium similar to the recent rises in charcoal burning suicides in East Asia.
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Affiliation(s)
- D Gunnell
- School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, University of Bristol, Bristol BS8 2PS, United Kingdom.
| | - C Coope
- School of Social and Community Medicine, Canynge Hall, 39 Whatley Road, University of Bristol, Bristol BS8 2PS, United Kingdom
| | - V Fearn
- Office for National Statistics, Newport, Wales NP10 8XG, United Kingdom
| | - C Wells
- Office for National Statistics, Newport, Wales NP10 8XG, United Kingdom
| | - S-S Chang
- Hong Kong Jockey Club Centre for Suicide Research and Prevention, The University of Hong Kong, Pokfulam, Hong Kong, China; Department of Social Work and Social Administration, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - K Hawton
- Centre for Suicide Research, University of Oxford Department of Psychiatry, Warneford Hospital, Oxford OX3 7JX, United Kingdom
| | - N Kapur
- Centre for Suicide Prevention, University of Manchester, Manchester M13 9PL, United Kingdom
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Lui WH, Chou TC, Chang SS, Hung CJ, Lin YJ, Lee PC. Peliosis hepatis in a kidney transplant recipient with manifestation as massive ascites and liver dysfunction: case report. Transplant Proc 2014; 46:630-3. [PMID: 24656031 DOI: 10.1016/j.transproceed.2013.12.008] [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] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/29/2013] [Accepted: 12/10/2013] [Indexed: 02/07/2023]
Abstract
We report a case of 59-year-old woman who received a kidney transplant 7 years earlier without evidence of viral hepatitis history. She was asymptomatic initially and a newly developed nodule, ∼2.3 cm in size, was discovered in the right liver during routine sonographic examination. Computerized tomography-guided biopsy was inconclusive at that time. However, the lesion grew to 6.8 cm and bilobular multiple nodules developed with concomitant massive ascites and hyperbilirubinemia months later. Laparoscopy showed typical bluish-reddish-blackish nodules. Needle-biopsy histology showed severe sinusoid dilation and dropout of centrilobular hepatocytes consistent with peliosis hepatis. Reticulin staining also demonstrated disruption of sinusoidal reticulin fibers. We tried to withdraw possible offending drugs to anticipate regression of peliosis, but it failed and liver dysfunction progressed, leaving liver transplant as the last resort in such rare circumstances.
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Affiliation(s)
- W-H Lui
- Department of Surgery, National Cheng-Kung University, Tainan, Taiwan
| | - T-C Chou
- Department of Surgery, National Cheng-Kung University, Tainan, Taiwan
| | - S-S Chang
- Department of Surgery, National Cheng-Kung University, Tainan, Taiwan
| | - C-J Hung
- Department of Surgery, National Cheng-Kung University, Tainan, Taiwan
| | - Y-J Lin
- Department of Surgery, National Cheng-Kung University, Tainan, Taiwan
| | - P-C Lee
- Department of Surgery, National Cheng-Kung University, Tainan, Taiwan; Department of Surgery, Tainan Hospital, Tainan, Taiwan.
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Su H, Chang SS, Han CM, Wu KY, Li MC, Huang CY, Lee CL, Wu JY, Lee CC. Inflammatory markers in cord blood or maternal serum for early detection of neonatal sepsis-a systemic review and meta-analysis. J Perinatol 2014; 34:268-74. [PMID: 24457256 DOI: 10.1038/jp.2013.186] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2013] [Revised: 11/18/2013] [Accepted: 11/20/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To perform a quantitative review of the evidence on the diagnostic value of inflammatory markers in maternal serum or umbilical cord blood for the diagnosis of early-onset neonatal sepsis (EONS). STUDY DESIGN We searched multiple databases for studies published through March 2013 that evaluated the diagnostic performance of procalcitonin (PCT), C-reactive protein (CRP) and interleukin-6 (IL-6), and leukocyte count (white blood cell, WBC) in either umbilical cord blood or maternal serum for diagnosis of EONS. We summarized test performance characteristics with the use of forest plots, hierarchical summary receiver operating characteristic curves and bivariate random effects models. RESULT Our search identified 3874 citations, of which 15 studies evaluating 2178 episodes of suspected neonatal infection were included for analysis. IL-6 in cord blood with a pooled-positive likelihood ratio (LR+) of 9.47 (95% confidence interval: 3.86 to 23.3), PCT in cord blood with a LR+ of 5.72 (1.56 to 21.0) and IL-6 in maternal serum with a LR+ of 5.47 (2.10 to 14.2) can be qualified as a valid rule-in test. IL-6 in cord blood with a LR- of 0.10 (0.05 to 0.21) and PCT in cord blood with a LR- of 0.20 (0.12-0.37) can be qualified as a useful rule-out test. Either CRP or WBC was inadequate for diagnosis of EONS. CONCLUSION For cord blood sample, IL-6 or PCT can be used as reliable rule-in and rule-out tool. For maternal serum, only IL-6 appeared to be sufficient for rule-in diagnosis. An interventional study may be needed to answer whether the addition of these tests will improve the outcome of patients with EONS.
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Affiliation(s)
- H Su
- Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - S-S Chang
- 1] Department of Family Medicine, Chang Gung Memorial Hospital, Taoyuan, and Chang Gung University College of Medicine, Taoyuan, Taiwan [2] Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - C-M Han
- Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - K-Y Wu
- Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - M-C Li
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - C-Y Huang
- Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - C-L Lee
- Department of Obstetrics and Gynecology Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - J-Y Wu
- 1] Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, and Chang Gung University College of Medicine, Taoyuan, Taiwan [2] Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - C-C Lee
- 1] Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan [2] Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan
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Lee SH, Chang SS, Lee M, Chan RC, Lee CC. Risk of osteonecrosis in patients taking bisphosphonates for prevention of osteoporosis: a systematic review and meta-analysis. Osteoporos Int 2014; 25:1131-9. [PMID: 24343364 DOI: 10.1007/s00198-013-2575-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/07/2013] [Indexed: 11/27/2022]
Abstract
SUMMARY We aimed to systematically review observational studies evaluating use of bisphosphonates (BPs) and risk of osteonecrosis of jaw (ONJ) or other sites among non-cancer patients. INTRODUCTION PubMed, EMBASE, and Cochrane Library were screened from database inception to Dec 2012. METHODS Two reviewers independently identified cohort and case-control studies evaluating the use of oral or intravenous (IV) BPs and the risk of ONJ and extracted the characteristics of the studies and risk estimates. Pooled estimates of odds ratios and 95 % confidence intervals (CI) were derived by random effects meta-analysis. Subgroup analyses were carried according to patients' characteristics and route of BP use. RESULTS We identified 12 studies, including 2,652 cases and 1,571,997 controls. Use of BPs was associated with a significantly increased risk of ONJ or ON of other sites [odds ratio (OR) 2.32; 95 % CI 1.38-3.91; I (2) = 91 %]. The summary OR was 2.91 (95 % CI 1.62-5.22; I (2) = 85.9 %) for adjusted studies. Use of BPs were associated with higher risk on ONJ (OR 2.57; 95 % CI 1.37-4.84; I (2) = 92.2 %) than ON of other sites (OR 1.79; 95 % CI 0.71-4.47; I (2) = 83.3 %). Meta-regression analysis did not find design characteristics or outcome definitions to be significant sources of heterogeneity. CONCLUSION The available evidence suggests that use of BPs in cancer patients is associated with a substantial risk for ONJ. Patients receiving IV BP are at highest risk.
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Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
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Lee SH, Chan RC, Wu JY, Chen HW, Chang SS, Lee CC. Diagnostic value of procalcitonin for bacterial infection in elderly patients - a systemic review and meta-analysis. Int J Clin Pract 2013; 67:1350-7. [PMID: 24246214 DOI: 10.1111/ijcp.12278] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 05/09/2013] [Accepted: 08/08/2013] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To summarise evidence for the diagnostic accuracy of procalcitonin (PCT) tests for identifying systemic bacterial infections in elderly patients. METHODS Major databases, including MEDLINE, EMBASE and the Cochrane Library, were searched for studies published from 1975 to March 2013 that evaluated PCT as a marker for diagnosing systemic bacterial infections in elderly patients and that provided sufficient data to construct two-by-two tables. RESULTS Four studies were available for quantitative meta-analysis. The area under a summary receiver operating characteristic curve was 0.89 (95% CI: 0.86-0.92). The overall sensitivity and specificity estimates for PCT tests were 0.83 (95% CI: 0.38-0.98) and 0.83 (95% CI: 0.60-0.94), respectively. These studies reported heterogeneous sensitivity estimates ranging from 0.24 to 0.96. The positive likelihood ratio for PCT (LR+ = 4.77; 95% CI: 2.49-9.13) was not sufficiently high for its use as a rule-in diagnostic tool, while its negative likelihood ratio was acceptably low for its use as a rule-out diagnostic tool (LR- = 0.20; 95% CI: 0.04-0.97). CONCLUSIONS Existing data suggest that PCT tests may add to the diagnosis of sepsis in elderly patients. We did not observe the performance of the PCT test in elderly patients inferior to adult patients. Given the imperfect accuracy, we do not recommend that the PCT test be used in isolation; instead, we suggest that it be interpreted in the context of clinical findings.
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Affiliation(s)
- S-H Lee
- Department of Rehabilitation and Physical Medicine, Taipei Veteran General Hospital, Taipei, Taiwan; Department of Medicine, College of Medicine, National Yang Ming University, Taipei, Taiwan
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Reeves A, Stuckler D, McKee M, Gunnell D, Chang SS, Basu S. OP67 Increase in State Suicide Rates in the USA During Economic Recession. Br J Soc Med 2013. [DOI: 10.1136/jech-2013-203126.67] [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: 11/03/2022]
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Chang SS, Shukla R, Polydorides AD, Vila PM, Lee M, Han H, Kedia P, Lewis J, Gonzalez S, Kim MK, Harpaz N, Godbold J, Richards-Kortum R, Anandasabapathy S. High resolution microendoscopy for classification of colorectal polyps. Endoscopy 2013; 45:553-9. [PMID: 23780842 DOI: 10.1055/s-0032-1326502] [Citation(s) in RCA: 21] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND STUDY AIMS It can be difficult to distinguish adenomas from benign polyps during routine colonoscopy. High resolution microendoscopy (HRME) is a novel method for imaging colorectal mucosa with subcellular detail. HRME criteria for the classification of colorectal neoplasia have not been previously described. Study goals were to develop criteria to characterize HRME images of colorectal mucosa (normal, hyperplastic polyps, adenomas, cancer) and to determine the accuracy and interobserver variability for the discrimination of neoplastic from non-neoplastic polyps when these criteria were applied by novice and expert microendoscopists. METHODS Two expert pathologists created consensus HRME image criteria using images from 68 patients with polyps who had undergone colonoscopy plus HRME. Using these criteria, HRME expert and novice microendoscopists were shown a set of training images and then tested to determine accuracy and interobserver variability. RESULTS Expert microendoscopists identified neoplasia with sensitivity, specificity, and accuracy of 67 % (95 % confidence interval [CI] 58 % - 75 %), 97 % (94 % - 100 %), and 87 %, respectively. Nonexperts achieved sensitivity, specificity, and accuracy of 73 % (66 % - 80 %), 91 % (80 % - 100 %), and 85 %, respectively. Overall, neoplasia were identified with sensitivity 70 % (65 % - 76 %), specificity 94 % (87 % - 100 %), and accuracy 85 %. Kappa values were: experts 0.86; nonexperts 0.72; and overall 0.78. CONCLUSIONS Using the new criteria, observers achieved high specificity and substantial interobserver agreement for distinguishing benign polyps from neoplasia. Increased expertise in HRME imaging improves accuracy. This low-cost microendoscopic platform may be an alternative to confocal microendoscopy in lower-resource or community-based settings.
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Affiliation(s)
- S S Chang
- Department of Internal Medicine, Mount Sinai Hospital, New York 10029, USA
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Affiliation(s)
- S S Chang
- Department of Urology, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021, USA
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Choi CW, Kim KH, Chang SS, Choi NJ. Soluble Non-ammonia Nitrogen in Ruminal and Omasal Digesta of Korean Native Steers Supplemented with Soluble Proteins. Asian-Australas J Anim Sci 2012; 25:1269-75. [PMID: 25049690 PMCID: PMC4092946 DOI: 10.5713/ajas.2012.12318] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 07/03/2012] [Accepted: 06/20/2012] [Indexed: 11/27/2022]
Abstract
An experiment was conducted to study the effect of soluble protein supplements on concentration of soluble non-ammonia nitrogen (SNAN) in the liquid phase of ruminal (RD) and omasal digesta (OD) of Korean native steers, and to investigate diurnal pattern in SNAN concentration in RD and OD. Three ruminally cannulated Korean native steers in a 3×3 Latin square design consumed a basal diet of rice straw and corn-based concentrate (control), and that supplemented (kg/d DM basis) with intact casein (0.24; IC) or acid hydrolyzed casein (0.46; AHC). Ruminal digesta was sampled using a vacuum pump, whereas OD was collected using an omasal sampling system at 2.0 h intervals after a morning feeding. The SNAN fractions (free amino acid (AA), peptide and soluble protein) in RD and OD were assessed using the ninhydrin assay. Concentrations of free AA and total SNAN in RD were significantly (p<0.05) lower than those in OD. Although free AA concentration was relatively high, mean peptide was quantitatively the most important fraction of total SNAN in both RD and OD, indicating that degradation of peptide to AA rather than hydrolysis of soluble protein to peptide or deamination may be the most limiting step in rumen proteolysis of Korean native steers. Diurnal variation in peptide concentration in OD for the soluble protein supplemented diets during the feeding cycle peaked 2 h post-feeding and decreased thereafter whereas that for the control was relatively constant during the entire feeding cycle. Diurnal variation in peptide concentration was rather similar between RD and OD.
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Affiliation(s)
- C W Choi
- National Institute of Animal Science, RDA, 441-706, Korea
| | - K H Kim
- National Institute of Animal Science, RDA, 441-706, Korea
| | - S S Chang
- National Institute of Animal Science, RDA, 441-706, Korea
| | - N J Choi
- Department of Animal Science, Chonbuk National University, Jeonju, 561-756, Korea
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Lee PC, Chang SS, Shieh SC, Wu ZC, Wang WM, Wang JD, Hung CJ, Lin YJ, Chou TC, Chan RH. Cyclosporine or tacrolimus: which is the better partner for myfortic or cellcept? Transplant Proc 2012; 44:137-9. [PMID: 22310598 DOI: 10.1016/j.transproceed.2011.12.023] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Mycophenolic acid (MPA) pharmacokinetics using the mycophenolate mofetil (CellCept) formulation are known to differ between patients receiving tacrolimus (FK) or cyclosporine (CyA), but only limited data exist concerning concomitant use of FK or CyA with enteric-coated mycophenolate sodium (EC-MPS; Myfortic). This retrospective study compared the drug interactions with the mycophenolic acid blood levels using different immunosuppressants and their relation to graft survival. PATIENTS AND METHODS We studied MPA levels in posttransplant sera from 298 renal transplant recipients. RESULTS Patients receiving immunosuppression with CyA + Myfortic showed 94% at 5- and 10-year graft survivals, which were better than CyA + CellCept (75%, 63%). This combination suppressed posttransplant human leukocyte antigen (HLA) antibody development significantly (P = .03) with higher MPA levels. CONCLUSION Patients immunosuppressed with CyA + Myfortic showed higher MPA levels and lower posttransplant HLA antibody development as well as the best graft survival. CyA + Myfortic or FK + Cellcept may be better combinations.
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Affiliation(s)
- P-C Lee
- Department of Surgery, National Cheng-Kung University Medical College and Hospital, Tainan, Taiwan.
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Abstract
BACKGROUND AND OBJECTIVES Deterioration in pulmonary function is associated with greater disability and mortality in older adults. Dietary antioxidants are implicated in lung health, but the relationship between major dietary antioxidants, such as serum carotenoids, and pulmonary function have not been well characterized. Serum carotenoids are considered the most reliable indicator of fruit and vegetable intake. SUBJECTS AND METHODS We examined the relationship between serum α-carotene, β-carotene, β-cryptoxanthin, lutein/zeaxanthin, and lycopene with pulmonary function (forced expiratory volume in one second [FEV1] and forced vital capacity [FVC]) in a population-based sample of 631 moderately to severely disabled community-dwelling older women (Women's Health and Aging Study I) in Baltimore, Maryland, USA. RESULTS Higher serum α-carotene and β-carotene concentrations were positively associated with both FEV1 and FVC, respectively (all P < 0.05), in separate multivariate linear regression models adjusting for age, race, education, cognition, anemia, inflammation, and chronic diseases. Total serum carotenoids were associated with FEV1 (P = 0.08) and FVC (P = 0.06), respectively, in similar models. No association was found between β-cryptoxanthin, lutein/zeaxanthin, and lycopene, and FEV1 or FVC. CONCLUSIONS Higher serum α-carotene and β-carotene concentrations, which reflect greater intake of orange and dark green leafy fruits and vegetables, were associated with better pulmonary function among older community-dwelling women.function may lead to food avoidance and to a higher incidence of digestive complaints.
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Affiliation(s)
- R D Semba
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Lee PC, Chen YL, Chou TC, Wang WM, Wang JD, Hung CJ, Chang SS, Lin YJ, Chan RH. The clinical significance of human leukocyte antigen antibody development in kidney transplantation. Transplant Proc 2012; 44:264-6. [PMID: 22310628 DOI: 10.1016/j.transproceed.2011.11.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND This retrospective study uses the LAT-M (One Lambda Inc., Calif) screen assay to reexamine the impacts (a), of pretransplant human leukocyte antigen (HLA) antibody on long-term graft survival; (b) posttransplant HLA antibody on long-term graft survival and (c) immunosuppressive regimen on posttransplant HLA antibody development. PATIENTS AND METHODS Pretransplant sera from 222 renal transplant recipients and posttransplant sera from 216 renal transplant recipients were studied for the impact of HLA antibody on long-term graft survival. RESULTS Among the patients who did not display pretransplant HLA antibodies, 85% enjoyed 5-year and 59% 10-year graft survival, whereas the patients who tested positive were 83% and 83% (P = .5596). Among the patients who did not show posttransplant HLA antibodies, 99% enjoyed 5-, 91% 10-, and 65% 15-year graft survival, whereas for the 44 patients who tested positive they were 59%, 44%, and 30%, respectively (P < .0001). Patients prescribed cyclosporine + myfortic (odds ratio 0.17, P = .05) or FK + Cellcept (odds ratio 0.36, P = .04) showed the lowest posttransplant HLA antibody development. CONCLUSION Both regimens improve graft survival.
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Affiliation(s)
- P-C Lee
- Department of Surgery, National Chang-Kung University Medical College and Hospital, 138, Sheng-Li Road Tainan 70144, Taiwan.
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Wang YC, Lo PH, Chang SS, Lin JJ, Wang HJ, Chang CP, Hsieh LC, Chen YP, Chen WK, Chen CH, Chang KC, Hung JS. Reduced door-to-balloon times in acute ST-elevation myocardial infarction patients undergoing primary percutaneous coronary intervention. Int J Clin Pract 2012; 66:69-76. [PMID: 22171906 DOI: 10.1111/j.1742-1241.2011.02775.x] [Citation(s) in RCA: 7] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Primary percutaneous coronary intervention (PCI) in patients with ST-elevation myocardial infarction (STEMI) significantly reduces mortality and morbidity, particularly when door-to-balloon (D2B) time is < 90 min. We sought to minimize preventable delays by instituting an on-site cardiology team-based approach in the emergency department (ED). METHODS The on-site group comprised 146 consecutive patients with STEMI undergoing primary PCI after implementation of the on-site strategy. This new patient care model was compared with the conventional care administered before instituting the on-site cardiology team-based strategy in ED, which included 90 patients (interim group) receiving primary PCI at a catheterization room in the same building as the ED, and 147 patients (pre-on-site group) undergoing primary PCI at a catheterization room two blocks away from the ED. RESULTS Median D2B time decreased from 107 min in the pre-on-site group to 72 min in the interim group, and to 47 min in the on-site group, respectively (p < 0.001). The percentage of D2B times < 90 min increased from 34% to 78% and 96%, respectively among the three groups (p < 0.001). Hospitalization costs were significantly reduced in the on-site and interim vs. pre-on-site groups ($5944, $5999, and $6581, respectively; p = 0.008). In-hospital mortality did not differ significantly among the three groups (4.8%, 2.2%, and 6.1%, respectively; p = 0.387). CONCLUSIONS Institution of an on-site cardiology team-based approach in the ED significantly reduces D2B time in STEMI patients eligible for primary PCI.
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Affiliation(s)
- Y-C Wang
- Division of Cardiology, Department of Medicine, China Medical University Hospital, Taichung, Taiwan
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Gunnell D, Wheeler B, Chang SS, Thomas B, Sterne JAC, Dorling D. Changes in the geography of suicide in young men: England and Wales 1981–2005. J Epidemiol Community Health 2010; 66:536-43. [DOI: 10.1136/jech.2009.104000] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Song MK, Jin GL, Ji BJ, Chang SS, Jeong J, Smith SB, Choi SH. Conjugated linoleic acids content in M.longissimus dorsi of Hanwoo steers fed a concentrate supplemented with soybean oil, sodium bicarbonate-based monensin, fish oil. Meat Sci 2010; 85:210-4. [PMID: 20374887 DOI: 10.1016/j.meatsci.2010.01.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Revised: 11/03/2009] [Accepted: 01/04/2010] [Indexed: 10/20/2022]
Abstract
We hypothesized that increasing ruminal pH would lead to enrichment of adipose tissue with conjugated linoleic acid (CLA). Twenty-four Korean native (Hanwoo) steers were used to investigate the additive effects of monensin (30ppm, SO-BM) and/or fish oil (0.7%, SO-BMF) in the diets along with soybean oil (7%) and sodium bicarbonate (0.5%, SO-B) on cis-9, trans-11 and trans-10, cis-12 CLAs in adipose tissue. The steers were assigned to randomly four groups of six animals each based on body weight. The control group (CON) was fed a commercial concentrate for the late fattening stage. Supplementation of oil and sodium bicarbonate reduced feed intake and daily gain, and fish oil further decreased feed intake (P<0.001) and daily gain (P<0.087) compared to steers fed other diets. Total CLA and CLA isomers in M.longissimus dorsi were not affected when steers were fed SO-B and SO-BM diets compared with those of steers fed CON and SO-BMF diets. However, total poly unsaturated fatty acids were higher (P=0.03) in steers fed SO than in CON steers.
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Affiliation(s)
- M K Song
- Department of Animal Science, Chungbuk National University, Cheong-Ju 361-763, Republic of Korea
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Lee PC, Ozawa M, Hung CJ, Lin YJ, Chang SS, Chou TC. Reappraisal of HLA antibody analysis and crossmatching in kidney transplantation. Transplant Proc 2009; 41:95-8. [PMID: 19249487 DOI: 10.1016/j.transproceed.2008.10.074] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Revised: 09/14/2008] [Accepted: 10/15/2008] [Indexed: 11/24/2022]
Abstract
Enzyme-linked immunosorbent assay (ELISA) and flow cytometric techniques have been introduced to overcome the limited sensitivity and specificity of the CDC assay. This retrospective study used lambda antigen tray-mixed screening and Luminex HLA class I and II specificity assays to re-examine: (1) the accuracy with which detection of HLA antibody and specificity by ELISA predicts pretransplantation National Institutes of Health (NIH)/Centers for Disease Control and Prevention (CDC) crossmatch; and (2) a comparison of Luminex and ELISA methods to detect HLA antibodies. Sera from 481 patients awaiting kidney transplantation were tested using the ELISA method lambda antigen tray-mixed and using NIH-CDC to determine how well HLA antibodies detected using ELISA predicted crossmatches using CDC. Pretransplantation sera from 48 patients with follow-up data were retested using both ELISA lambda antigen tray-mixed and Luminex to compare the efficacy of the 2 methods.
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Affiliation(s)
- P-C Lee
- Medical College, National Cheng Kung University, Tainan, Taiwan.
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Abstract
OBJECTIVE Preoperative reduction of isoagglutinins leads to successful ABO-incompatible (ABOi) renal transplantation. The strategy includes pretransplantation plasmapheresis, more potent immunosuppressive drugs, splenectomy, and anti-CD20 antibody. It has been reported that low isoagglutinin antibody titers posttransplant were observed among ABOi renal transplants with favorable outcome. The isoagglutinin titers may increase slightly when plasmapheresis is discontinued; however, it never returns to the pretreatment level under immunosuppressive therapy. This raises the question of what occurs to the isoagglutinin titer in ABO-compatible renal transplants under maintenance immunosuppressive pharmacotherapy. METHODS We analyzed 10 renal transplant recipients, including seven living and three cadaveric donors. Patients were treated with basiliximab (20 mg) intravenously on day 0 and day 4. Maintenance immunosuppressive therapy involved a calcineurin inhibitor, mycophenolate mofetil, and steroid. Anti-human globulin isoagglutinin titers were routinely examined 1 day before and day 0 and 1, 2, 3, 4, 8, 12, and 24 weeks posttransplant. No ALG or intravenous immunoglobulin or plasmapheresis treatment was provided in the follow-up period. RESULTS Our preliminary data showed nearly no influence on isoagglutinin titer levels in 6-month follow-up under maintenance immunosuppressive therapy. In addition, no significant difference in isoagglutinin titer was observed between tacrolimus and cyclosporine groups. CONCLUSION Maintenance immunosuppressive pharmacotherapy did not affect isoagglutinin titer levels in ABO-compatible kidney transplants. Further study is needed to investigate the mechanisms of persistent low-level isoagglutinin titers among successful ABOi renal transplantation patients.
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Affiliation(s)
- J-P Chuang
- Department of Surgery, Tainan Hospital, Taiwan
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Sheu BF, Lee CC, Young YR, Li LF, Chang SS. Delayed-onset bronchiolitis obliterans with organising pneumonia associated with massive acetic acid steam inhalation. Thorax 2008; 63:570. [PMID: 18511648 DOI: 10.1136/thx.2007.079665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- B-F Sheu
- Department of Emergency Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan
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Abstract
BACKGROUND Pyogenic sacroiliitis is a rare cause of hip pain and fever. We aim to report a series of 33 patients with pyogenic sacroiliitis and to investigate the differences among paediatric and adult cases. METHODS Clinical and laboratory data of 33 cases who were admitted to the emergency department with a confirmed discharge diagnosis of pyogenic sacroiliitis between 1996 and 2005 were assessed. All patients were divided into paediatric and adult groups by the age of 15 yr. The features of pyogenic sacroiliitis and clinical outcome were compared among the two groups. Several factors were analysed including gender, age, clinical signs and symptoms, laboratory tests, radiological examinations and scintigraphy. RESULTS Among the all included patients, females were attacked more frequently than males (3: 1). One-third of patients had concurrent infections, of which urinary tract infections were the most common (41.6%). Compared with adult patients, paediatric patients tend to have fewer comorbid immunocompromized conditions, fewer concurrent infections, more equality in gender distribution and more presentations of weight bearing difficulty. Staphylococcus aureus was the main blood culture isolate from paediatric patients (80%), but only accounted for half of those from adult patients. Group B streptococcus and Salmonella spp. were not uncommon in the adult patients. Scintigraphic bone scan has the highest sensitivity (93.3%) and remains the image modality of choice. When local abscess formation is suspected, computed tomography or magnetic resonance imaging may be the preferred method used for examination. CONCLUSION This case series should alert the physicians to the possibility of pyogenic sacroiliitis and the difference between paediatric and adult patients.
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Affiliation(s)
- M-S Wu
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chang Gung University, College of Medicine, Taipei, Taiwan
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Abstract
AIM To evaluate the applicability of filtration membranes for detecting Alicyclobacillus spp. spores in apple juice. METHODS AND RESULTS Ten types of nitrocellulose membrane filters from five manufacturers were used to collect and enumerate five Alicyclobacillus spore isolates and results were compared to conventional K agar plating. Spore recovery differed among filters with an average recovery rate of 126.2%. Recovery levels also differed among spore isolates. Although significant difference (P < 0.05) in spore sizes existed, no correlation could be determined between spore size and membrane filter recovery rate. CONCLUSIONS Recovery of spores using membrane filtration is dependent on the manufacturer and filter pore size. Correlations between spore recovery rate and spore size could not be determined. SIGNIFICANCE AND IMPACT OF THE STUDY Low numbers of Alicyclobacillus spores in juice can be effectively detected using membrane filtration although recovery rate differences exist among different manufacturers. Use of membrane filtration is a simple, fast alternative to the week-long enrichment procedures currently employed in most quality assurance tests.
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Affiliation(s)
- S-Y Lee
- Department of Food Science and Nutrition, Chung-Ang University, Korea
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Tsai CL, Pan KM, Huang KS, Chang SS. THE SURFACE EMG ACTIVITY OF THE LOWER EXTREMITIES IN BADMINTON FOOTWORK. J Biomech 2007. [DOI: 10.1016/s0021-9290(07)70745-5] [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: 10/22/2022]
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Fowke JH, Motley SS, Cookson MS, Concepcion R, Chang SS, Wills ML, Smith JA. The association between body size, prostate volume and prostate-specific antigen. Prostate Cancer Prostatic Dis 2006; 10:137-42. [PMID: 17179979 DOI: 10.1038/sj.pcan.4500924] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Increasing prostate volume contributes to urinary tract symptoms and may obscure prostate cancer detection. We investigated the association between obesity and prostate volume, prostate-specific antigen (PSA) and PSA density among 753 men referred for prostate biopsy. Among men with a negative biopsy, prostate volume significantly increased approximately 25% from the lowest to highest body mass index (BMI), waist or hip circumference or height categories. PSA was 0.7 ng/ml lower with a high waist-to-hip ratio. These associations were less consistent among subjects diagnosed with high-grade prostatic intraepithelial neoplasia or cancer. Our data suggest that obesity and height are independently associated with prostate volume..
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Affiliation(s)
- J H Fowke
- Vanderbilt Epidemiology Center, Division of Internal Medicine and Public Health, Vanderbilt University Medical Center, Nashville, TN 37232-8300, USA.
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