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Chen YT, Nyam TTE, Tsai LC, Chang CH, Su CL, Ho CH, Chio CC, Gean PW, Kuo JR. Pretreatment with Lovastatin Improves Depression-Like Behavior After Traumatic Brain Injury Through Activation of the AMPK Pathway. World Neurosurg 2023; 180:e350-e363. [PMID: 37757945 DOI: 10.1016/j.wneu.2023.09.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023]
Abstract
BACKGROUND The beneficial effect of pretreatment with statins on traumatic brain injury (TBI)-induced depression and anxiety and its mechanism of action remain unclear. In this study, we combined epidemiological and experimental animal data to clarify this issue. METHODS We used the Taiwan National Health Insurance database to identify patients who were diagnosed with TBI from 2000 to 2013 and compared patients with and without statin treatment matched by age, sex, and underlying comorbidities in a 1:1 ratio. The risk of developing depression and/or anxiety was compared between patients with and without a statin using Cox proportional hazards regression. We also used a rat model to assess the effect of lovastatin pretreatment on neurobehavioral and neuropathological changes following TBI. RESULTS The risk of developing depression was lower in the 41,803 patients in the statin cohort than nonstatin cohort (adjusted hazard ratio, 0.91 [95% confidence interval, 0.83-0.99]). In animal models, the lovastatin group had significantly reduced infarct volume, decreased immobility time and latency to eat, a reduced number of Fluoro- Jade-positive cells and levels of glial fibrillary acidic protein and tumor necrosis factor-alpha, and increased adenosine monophosphate -activated protein kinase (AMPK) and its upstream kinase liver kinase B1 in the hippocampal dentate gyrus. These effects were blocked in AMPK inhibitor-pretreated TBI rats. CONCLUSIONS Our epidemiological data showed that a decreased risk of depression was associated with statin pretreatment, which was supported by an animal study. The underlying mechanism for this appears to involve AMPK activation in the statin pretreatment-induced alleviation of TBI.
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Affiliation(s)
- Yu-Ting Chen
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
| | | | - Li-Chen Tsai
- Department of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chih-Hua Chang
- Department of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chun-Lin Su
- Department of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Po-Wu Gean
- Department of Pharmacology, College of Medicine, National Cheng-Kung University, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Post-Baccalaureate Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan.
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Guo NW, Chou W, Kuo JR, Liao YC, Chuang MT, Su BY. The executive functions among patients with an initial Glasgow coma scale score of 15. Appl Neuropsychol Adult 2023:1-9. [PMID: 37878502 DOI: 10.1080/23279095.2023.2266080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2023]
Abstract
Executive functions (EF) were the critical neuropsychological functions linked to long-term adaptation. Given the heterogeneous prognosis trajectories of mild traumatic brain jury (mTBI), the mildest TBI may not always be benign in the chronic stage. The present study explored the long-term EF in patients with chronic complicated mTBI and a Glasgow Coma Scale (GCS) score of 15. Fifty patients with complicated mTBI and GCS scores of 15 and 35 control participants were recruited in this study. Medical records were retrospectively analyzed, and neuropsychological assessments and subjective measures examined the neuropsychological functions. Compared with healthy controls, complicated mTBI patients with a GCS score of 15 performed significantly worse on most EF assessments, including longer reaction time (RT) and poor cognitive flexibility and abstract reasoning performances. Patients also reported more EF problems and lower quality of life (QoL) than healthy controls. Females and those with subdural hematoma (SDH) had significantly longer reaction times (RT) on executive attention tests. This study found that complicated mTBI with a GCS score of 15 had incomplete recovery of EF, even in the chronic stage. We suggest that early neuropsychological assessment and rehabilitation should be arranged for such patients.
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Affiliation(s)
- Nai-Wen Guo
- Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Willy Chou
- Department of Physical Medicine and Rehabilitation, Chi-Mei Medical Center, Chiali, Taiwan
- Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Post-Baccalaureate Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Yu-Chi Liao
- Department of Psychology, College of Medical and Health Science, Asia University, Taichung, Taiwan
| | - Ming-Tsung Chuang
- Department of Diagnostic Radiology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Bei-Yi Su
- Department of Psychology, Chung Shan Medical University, Taichung, Taiwan
- Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung, Taiwan
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Kuo JR, Su BY. Neuropsychological Impairments in Patients With Post-traumatic Epilepsy: A Scoping Review. World Neurosurg 2023; 176:85-97. [PMID: 37127179 DOI: 10.1016/j.wneu.2023.04.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 04/24/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVES To date, the research on the prognosis of the neuropsychological function of patients with post-traumatic seizure (PTE) is sparse. This study aimed to systematically map the literature's extent, range, and characteristics regarding PTE and neuropsychological impairments. METHODS A systematic literature search was conducted in CINAHL, Cochrane, Embase, Medline, PubMed, Scopus, Web of Science, and ScienceDirect databases. The search terms were related to PTE and neuropsychological impairments. RESULTS This scoping review included seven studies, two of which examined the impact of PTE on neuropsychological outcomes. Among the three studies that used neuropsychological assessments, attention/concentration, and memory were the most frequently assessed domains. Only one study reported a significant difference between PTE and non-PTE patients. The cognitive rating scale findings in the other four studies were similar, indicating that patients with PTE performed worse than those without PTE. CONCLUSIONS The results of this review suggest that patients with PTE may have neuropsychological function impairments. More attention needs to be paid to older patients and those with higher brain injury and seizure severity. Additional investigation is necessary to determine the clinical characteristics of TBI and PTE and elucidate the relations between PTE and specific neuropsychological domains.
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Affiliation(s)
- Jinn-Rung Kuo
- Department of Neurosurgery, Medical Research, Chi Mei Medical Center, Tainan, Taiwan; Department of Post-Baccalaureate Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Bei-Yi Su
- Department of Psychology, Chung-Shan Medical University, Taichung, Taiwan; Clinical Psychological Room, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Chen HT, Hung KC, Hsu YC, Kuo JR, Chang YJ, Chen IW, Sun CK. Efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy: a meta-analysis of randomized controlled studies. Front Med (Lausanne) 2023; 10:1114485. [PMID: 37332744 PMCID: PMC10272834 DOI: 10.3389/fmed.2023.1114485] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 05/15/2023] [Indexed: 06/20/2023] Open
Abstract
Background This meta-analysis aimed at investigating the efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy (ESWL). Methods Randomized controlled trials comparing the efficacy of acupuncture with conventional treatments were retrieved from major electronic databases (e.g., MEDLINE, EMBASE, and Cochrane Library) until August 28, 2022. The primary outcome was the response rate (i.e., rate of pain relief), while secondary outcomes included stone-free rate, satisfaction rate, duration of ESWL, peri-/post-procedural pain score, and risk of adverse events. Results Thirteen eligible studies involving 1,220 participants published between 1993 and 2022 were analyzed. Pooled results indicated that acupuncture had a better response rate compared to conventional treatments (RR = 1.17, 95% CI: 1.06-1.3, p = 0.003, seven trials, n = 832). Despite no difference in ESWL duration (MD = 0.02 min, 95% CI: -1.53 to 1.57, p = 0.98, three trials, n = 141), stone-free rate (RR = 1.11, 95% CI: 1-1.25, p = 0.06, six trials, n = 498), and satisfaction rate (RR = 1.51, 95% CI: 0.92-2.47, p = 0.1, three trials, n = 334) between the two groups, the acupuncture group had a lower risk of adverse events (RR = 0.51, 95% CI: 0.33-0.79, p = 0.003, five trials, n = 327), peri- (MD = -1.91 points, 94% CI: -3.53 to -0.28, p = 0.02, four trials, n = 258 patient) and post-procedural (MD = -1.07, 95% CI: -1.77 to -0.36, p = 0.003, four trials, n = 335) pain score. Conclusion The results of this meta-analysis showed that the use of acupuncture in patients receiving ESWL was associated with a higher pain relief rate and a lower risk of adverse events, suggesting feasibility of its use in this clinical setting. Systematic review registration https://www.crd.york.ac.uk/prospero/, identifier: CRD42022356327.
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Affiliation(s)
- Hsiao-Tien Chen
- Department of Chinese Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Yao-Chin Hsu
- Department of Chinese Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Tainan, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan, Taiwan
| | - Ying-Jen Chang
- Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
- Department of Recreation and Health-Care Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, I-Shou University, Kaohsiung City, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung City, Taiwan
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Yang KS, Chen CW, Yau RB, Liang HC, Ko CC, Kuo JR, Chio CC, Lim SW. A novel surgical technique in transforaminal lumbar interbody fusion by the bone graft delivery device: evaluation of therapeutic effect in patients with minimally invasive spine surgery. BMC Surg 2022; 22:366. [PMID: 36289500 PMCID: PMC9597986 DOI: 10.1186/s12893-022-01773-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 08/17/2022] [Indexed: 11/28/2022] Open
Abstract
Background Transforaminal Lumbar Interbody Fusion (TLIF) is commonly associated with higher complications and longer operative time. This study aims to evaluate the effectiveness, safety, and usability of a novel minimally invasive surgery (MIS) bone graft delivery device.
Methods 73 consecutive patients with lumbar spondylosis, degenerative disc disease, spondylolisthesis, scoliosis or trauma were enrolled in this randomized controlled trial. Group 1 comprised 39 patients treated with the novel MIS bone graft delivery device. Group 2 consisted of 34 patients treated with the conventional system. The primary objective of the study was the assessment of the amount of bone graft delivery using the device. The secondary objectives were the effect of the device on operative time, pain relief, disability improvement, and bone fusion grade. Results Bone delivery amount was significantly higher in the MIS device group (6.7 ± 2.9 mL) compared to the conventional group (2.3 ± 0.5 mL), p < 0.001. Regarding the operation time, the MIS device group was associated significantly lower duration than the conventional group (p < 0.001). After a 3-month follow-up, 39.5% of the patients in the MIS device group and 3.5% of the patients in the conventional group were observed to achieve grade I fusion (complete fusion). There was a significant difference in fusion success rates (p < 0.01). Conclusion The novel MIS bone graft delivery device was associated with successful bone delivery. Our MIS device provides promising modality with less operative time and higher bone fusion rates than conventional modalities. Trial Registration This trial was retrospectively registered on ClinicalTrials.gov (Registration date: 11/19/2021; Registration number: NCT05190055). Supplementary Information The online version contains supplementary material available at 10.1186/s12893-022-01773-y.
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Affiliation(s)
- Kai-shun Yang
- grid.440682.c0000 0001 1866 919XDepartment of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan China
| | - Chih-Wei Chen
- grid.413876.f0000 0004 0572 9255Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan City, 710 Taiwan ,grid.411315.30000 0004 0634 2255Department of Occupational Safety and Health/Institute of Industrial Safety and Disaster Prevention, College of Sustainable Environment, Chia Nan University of Pharmacy and Science, Tainan City, 717 Taiwan
| | - Ru-Bin Yau
- grid.440682.c0000 0001 1866 919XDepartment of Spinal Surgery, First Affiliated Hospital of Dali University, Dali, Yunnan China
| | - Huang-Chien Liang
- grid.440372.60000 0004 1798 0973Department of Materials Engineering, Ming Chi University of Technology, New Taipei City, Taiwan
| | - Ching-Chung Ko
- grid.413876.f0000 0004 0572 9255Department of Medical Imaging, Chi-Mei Medical Center, Tainan City, Taiwan ,grid.411315.30000 0004 0634 2255Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan City, Taiwan
| | - Jinn-Rung Kuo
- grid.413876.f0000 0004 0572 9255Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan City, 710 Taiwan ,grid.413876.f0000 0004 0572 9255Department of Medical Research, Chi-Mei Medical Center, Tainan City, Taiwan
| | - Chung-Ching Chio
- grid.413876.f0000 0004 0572 9255Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan City, 710 Taiwan
| | - Sher-Wei Lim
- grid.413876.f0000 0004 0572 9255Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan City, 710 Taiwan ,grid.452538.d0000 0004 0639 3335Department of Nursing, Min-Hwei College of Health Care Management, Tainan City, Taiwan
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Hung KC, Huang YT, Kuo JR, Hsu CW, Yew M, Chen JY, Lin MC, Chen IW, Sun CK. Elevated Surgical Pleth Index at the End of Surgery Is Associated with Postoperative Moderate-to-Severe Pain: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2022; 12:diagnostics12092167. [PMID: 36140567 PMCID: PMC9498235 DOI: 10.3390/diagnostics12092167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Despite acceptance of the surgical pleth index (SPI) for monitoring the intraoperative balance between noxious stimulation and anti-nociception under general anesthesia, its efficacy for predicting postoperative moderate-to-severe pain remains unclear. We searched electronic databases (e.g., Google Scholar, MEDLINE, Cochrane Library, and EMBASE) to identify articles focusing on associations of SPI at the end of surgery with immediate moderate-to-severe pain in the postanesthesia care unit from inception to 7 July 2022. A total of six observational studies involving 756 adults published between 2016 and 2020 were eligible for quantitative syntheses. Pooled results revealed higher values of SPI in patients with moderate-to-severe pain than those without (mean difference: 7.82, 95% CI: 3.69 to 11.95, p = 0.002, I2 = 46%). In addition, an elevated SPI at the end of surgery was able to predict moderate-to-severe pain with a sensitivity of 0.71 (95% confidence interval (CI): 0.65–0.77; I2 = 29.01%) and a specificity of 0.58 (95% CI: 0.39–0.74; I2 = 79.31%). The overall accuracy based on the summary receiver operating characteristic (sROC) curve was 0.72. In conclusion, this meta-analysis highlighted the feasibility of the surgical pleth index to predict postoperative moderate-to-severe pain immediately after surgery. Our results from a limited number of studies warrant further investigations for verification.
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Affiliation(s)
- Kuo-Chuan Hung
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
- Department of Hospital and Health Care Administration, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan City 71710, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan City 70101, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Tainan City 71004, Taiwan
- Department of Medical Research, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Chih-Wei Hsu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City 83301, Taiwan
| | - Ming Yew
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Jen-Yin Chen
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - Ming-Chung Lin
- Department of Anesthesiology, Chi Mei Medical Center, Tainan City 71004, Taiwan
| | - I-Wen Chen
- Department of Anesthesiology, Chi Mei Medical Center, Liouying, Tainan City 73657, Taiwan
- Correspondence: (I.-W.C.); (C.-K.S.)
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Hospital, Kaohsiung City 82445, Taiwan
- College of Medicine, I-Shou University, Kaohsiung City 84001, Taiwan
- Correspondence: (I.-W.C.); (C.-K.S.)
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Tu KC, Eric Nyam TT, Wang CC, Chen NC, Chen KT, Chen CJ, Liu CF, Kuo JR. A Computer-Assisted System for Early Mortality Risk Prediction in Patients with Traumatic Brain Injury Using Artificial Intelligence Algorithms in Emergency Room Triage. Brain Sci 2022; 12:brainsci12050612. [PMID: 35624999 PMCID: PMC9138998 DOI: 10.3390/brainsci12050612] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 05/05/2022] [Indexed: 01/27/2023] Open
Abstract
Traumatic brain injury (TBI) remains a critical public health challenge. Although studies have found several prognostic factors for TBI, a useful early predictive tool for mortality has yet to be developed in the triage of the emergency room. This study aimed to use machine learning algorithms of artificial intelligence (AI) to develop predictive models for TBI patients in the emergency room triage. We retrospectively enrolled 18,249 adult TBI patients in the electronic medical records of three hospitals of Chi Mei Medical Group from January 2010 to December 2019, and undertook the 12 potentially predictive feature variables for predicting mortality during hospitalization. Six machine learning algorithms including logistical regression (LR) random forest (RF), support vector machines (SVM), LightGBM, XGBoost, and multilayer perceptron (MLP) were used to build the predictive model. The results showed that all six predictive models had high AUC from 0.851 to 0.925. Among these models, the LR-based model was the best model for mortality risk prediction with the highest AUC of 0.925; thus, we integrated the best model into the existed hospital information system for assisting clinical decision-making. These results revealed that the LR-based model was the best model to predict the mortality risk in patients with TBI in the emergency room. Since the developed prediction system can easily obtain the 12 feature variables during the initial triage, it can provide quick and early mortality prediction to clinicians for guiding deciding further treatment as well as helping explain the patient’s condition to family members.
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Affiliation(s)
- Kuan-Chi Tu
- Department of Neurosurgery, Chi Mei Medical Center, Tainan 710402, Taiwan; (K.-C.T.); (T.-T.E.N.); (C.-C.W.)
| | - Tee-Tau Eric Nyam
- Department of Neurosurgery, Chi Mei Medical Center, Tainan 710402, Taiwan; (K.-C.T.); (T.-T.E.N.); (C.-C.W.)
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi Mei Medical Center, Tainan 710402, Taiwan; (K.-C.T.); (T.-T.E.N.); (C.-C.W.)
- Center for General Education, Southern Taiwan University of Science and Technology, Tainan 710402, Taiwan
| | - Nai-Ching Chen
- Department of Nursing, Chi Mei Medical Center, Tainan 710402, Taiwan;
| | - Kuo-Tai Chen
- Department of Emergency, Chi Mei Medical Center, Tainan 710402, Taiwan;
| | - Chia-Jung Chen
- Department of Information Systems, Chi Mei Medical Center, Tainan 710402, Taiwan;
| | - Chung-Feng Liu
- Department of Medical Research, Chi Mei Medical Center, Tainan 710402, Taiwan;
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Tainan 710402, Taiwan; (K.-C.T.); (T.-T.E.N.); (C.-C.W.)
- Center for General Education, Southern Taiwan University of Science and Technology, Tainan 710402, Taiwan
- Correspondence: ; Tel.: +886-6-281-2811-57423
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Lu CC, Nyam TTE, Ho CH, Kuo JR, Chio CC, Wang JJ, Wang CC. New diagnosis of cancer in mild and moderate/severe traumatic brain injury patients in a 12-year population-based study. BMC Cancer 2022; 22:291. [PMID: 35303821 PMCID: PMC8933911 DOI: 10.1186/s12885-022-09416-4] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background Traumatic brain injury (TBI) has been reported as a risk factor for brain cancer development. However, the magnitude of the impact of TBI on systemic cancer development has not been clarified. Methods A retrospective longitudinal cohort study was conducted using the Taiwan Longitudinal Health Insurance Database between January 2000 and December 2011. A total of 35,306 patients were initially enrolled, and 14,795 patients with mild TBI and 14,795 patients with moderate/severe TBI were matched using the National Health Insurance Research Database in Taiwan. The Cox proportional hazard regression model was used to estimate the hazard ratio (HR) of TBI adjusted for potential confounding factors. Results After matching, the results showed that patients with moderate/severe TBI had a high mortality rate (17.7% vs. 10.4%) and shorter time interval from TBI to death (mean 3.6 years vs. 5.8 years). No differences were observed in cancer incidence (4.1% vs. 4.1%) or risk factors for mortality between mild and moderate/severe TBI patients. However, patients aged between 46 and 55 years, female patients, and patients with pre-existing renal disease had a significant higher cancer incidence risk in moderate/severe TBI compared with mild TBI patients. The top 15 most common cancers showed that mild TBI patients had a higher percentage of head and neck cancer. The overall mortality rate in all TBI patients diagnosed with cancer was about 50%, and the cancer-specific mortality is approximately 85% in death of TBI patients with cancer. Conclusions We concluded that the incidence risk of a new cancer diagnosis and mortality risk of TBI patients with cancer between the mild TBI and moderate/severe TBI patients were not significantly different. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09416-4.
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Affiliation(s)
- Chung-Che Lu
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang, Tainan, Taiwan
| | - Tee-Tau Eric Nyam
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang, Tainan, Taiwan.,Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.,Department of Information Management, Southern Taiwan University of Science and Technology, Tainan, Taiwan.,Cancer Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan
| | - Jinn-Rung Kuo
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang, Tainan, Taiwan.,Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang, Tainan, Taiwan
| | - Jhi-Joung Wang
- Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Che-Chuan Wang
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang, Tainan, Taiwan. .,Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan. .,Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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Lim SW, Su HC, Nyam TTE, Chio CC, Kuo JR, Wang CC. Ceftriaxone therapy attenuates brain trauma in rats by affecting glutamate transporters and neuroinflammation and not by its antibacterial effects. BMC Neurosci 2021; 22:54. [PMID: 34521349 PMCID: PMC8439027 DOI: 10.1186/s12868-021-00659-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/04/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Ceftriaxone is a β-lactam antibiotic used to treat central nervous system infections. Whether the neuroprotective effects of ceftriaxone after TBI are mediated by attenuating neuroinflammation but not its antibacterial actions is not well established. METHODS Anesthetized male Sprague-Dawley rats were divided into sham-operated, TBI + vehicle, and TBI + ceftriaxone groups. Ceftriaxone was intraperitoneally injected at 0, 24, and 48 h with 50 or 250 mg/kg/day after TBI. During the first 120 min after TBI, we continuously measured heart rate, arterial pressure, intracranial pressure (ICP), and cerebral perfusion pressure. The infarct volume was measured by TTC staining. Motor function was measured using the inclined plane. Glutamate transporter 1 (GLT-1), neuronal apoptosis and TNF-α expression in the perilesioned cortex were investigated using an immunofluorescence assay. Bacterial evaluation was performed by Brown and Brenn's Gram staining. These parameters above were measured at 72 h after TBI. RESULTS Compared with the TBI + vehicle group, the TBI + ceftriaxone 250 mg/kg group showed significantly lower ICP, improved motor dysfunction, reduced body weight loss, decreased infarct volume and neuronal apoptosis, decreased TBI-induced microglial activation and TNF-α expression in microglia, and increased GLT-1 expression in neurons and microglia. However, the grades of histopathological changes of antibacterial effects are zero. CONCLUSIONS The intraperitoneal injection of ceftriaxone with 250 mg/kg/day for three days may attenuate TBI by increasing GLT-1 expression and reducing neuroinflammation and neuronal apoptosis, thereby resulting in an improvement in functional outcomes, and this neuroprotective effect is not related to its antibacterial effects.
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Affiliation(s)
- Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Hui-Chen Su
- Departments of Pharmacy, Chi-Mei Medical Center, Tainan, Taiwan
| | - Tee-Tau Eric Nyam
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Chung-Ching Chio
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan.,Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Che-Chuan Wang
- Departments of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan. .,Departments of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan. .,Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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Wang CC, Hsieh PW, Kuo JR, Wang SJ. Rosmarinic Acid, a Bioactive Phenolic Compound, Inhibits Glutamate Release from Rat Cerebrocortical Synaptosomes through GABA A Receptor Activation. Biomolecules 2021; 11:1029. [PMID: 34356653 PMCID: PMC8301814 DOI: 10.3390/biom11071029] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 07/13/2021] [Accepted: 07/13/2021] [Indexed: 12/15/2022] Open
Abstract
Rosmarinic acid, a major component of rosemary, is a polyphenolic compound with potential neuroprotective effects. Asreducing the synaptic release of glutamate is crucial to achieving neuroprotectant's pharmacotherapeutic effects, the effect of rosmarinic acid on glutamate release was investigated in rat cerebrocortical nerve terminals (synaptosomes). Rosmarinic acid depressed the 4-aminopyridine (4-AP)-induced glutamate release in a concentration-dependent manner. The removal of extracellular calcium and the blockade of vesicular transporters prevented the inhibition of glutamate release by rosmarinic acid. Rosmarinic acid reduced 4-AP-induced intrasynaptosomal Ca2+ elevation. The inhibition of N-, P/Q-type Ca2+ channels and the calcium/calmodulin-dependent kinase II (CaMKII) prevented rosmarinic acid from having effects on glutamate release. Rosmarinic acid also reduced the 4-AP-induced activation of CaMKII and the subsequent phosphorylation of synapsin I, the main presynaptic target of CaMKII. In addition, immunocytochemistry confirmed the presence of GABAA receptors. GABAA receptor agonist and antagonist blocked the inhibitory effect of rosmarinic acid on 4-AP-evoked glutamate release. Docking data also revealed that rosmarinic acid formed a hydrogen bond with the amino acid residues of GABAA receptor. These results suggested that rosmarinic acid activates GABAA receptors in cerebrocortical synaptosomes to decrease Ca2+ influx and CaMKII/synapsin I pathway to inhibit the evoked glutamate release.
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Affiliation(s)
- Che-Chuan Wang
- Chi Mei Medical Center, Department of Neurosurgery, Tainan 71004, Taiwan; (C.-C.W.); (J.-R.K.)
- Biotechnology, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan
| | - Pei-Wen Hsieh
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan;
- Graduate Institute of Natural Products, School of Traditional Chinese Medicine, and Graduate Institute of Biomedical Sciences, College of Medicine, Chang Gung University, Taoyuan 33303, Taiwan
- Department of Anesthesiology, Chang Gung Memorial Hospital, Taoyuan 33303, Taiwan
| | - Jinn-Rung Kuo
- Chi Mei Medical Center, Department of Neurosurgery, Tainan 71004, Taiwan; (C.-C.W.); (J.-R.K.)
- Biotechnology, Southern Taiwan University of Science and Technology, Tainan 71005, Taiwan
| | - Su-Jane Wang
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan 33303, Taiwan;
- School of Medicine, Fu Jen Catholic University, New Taipei City 24205, Taiwan
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11
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Lu CC, Nyam TTE, Kuo JR, Lee YL, Chio CC, Wang CC. The neuroprotective effects of AMN082 on neuronal apoptosis in rats after traumatic brain injury. BMC Neurosci 2021; 22:44. [PMID: 34171999 PMCID: PMC8228939 DOI: 10.1186/s12868-021-00649-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 06/10/2021] [Indexed: 11/10/2022] Open
Abstract
Background The aim of this study was to investigate whether AMN082 exerts its neuroprotective effect by attenuating glutamate receptor-associated neuronal apoptosis and improving functional outcomes after traumatic brain injury (TBI). Methods Anesthetized male Sprague–Dawley rats were divided into the sham-operated, TBI + vehicle, and TBI + AMN082 groups. AMN082 (10 mg/kg) was intraperitoneally injected 0, 24, or 48 h after TBI. In the 120 min after TBI, heart rate, mean arterial pressure, intracranial pressure (ICP), and cerebral perfusion pressure (CPP) were continuously measured. Motor function, the infarct volume, neuronal nitrosative stress-associated apoptosis, and N-methyl-d-aspartate receptor 2A (NR2A) and NR2B expression in the pericontusional cortex were measured on the 3rd day after TBI. Results The results showed that the AMN082-treated group had a lower ICP and higher CPP after TBI. TBI-induced motor deficits, the increase in infarct volume, neuronal apoptosis, and 3-nitrotyrosine and inducible nitric oxide synthase expression in the pericontusional cortex were significantly improved by AMN082 therapy. Simultaneously, AMN082 increased NR2A and NR2B expression in neuronal cells. Conclusions We concluded that intraperitoneal injection of AMN082 for 3 days may ameliorate TBI by attenuating glutamate receptor-associated nitrosative stress and neuronal apoptosis in the pericontusional cortex. We suggest that AMN082 administration in the acute stage may be a promising strategy for TBI.
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Affiliation(s)
- Chung-Che Lu
- Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Tee-Tau Eric Nyam
- Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan.,Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yao-Lin Lee
- Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, 901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan. .,Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan. .,Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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12
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Huang YK, Lin CK, Wang CC, Kuo JR, Lai CF, Chen CW, Lin BS. A novel wireless optical technique for quantitative evaluation of cerebral perfusion pressure in a fluid percussion animal model of traumatic brain injury. Quant Imaging Med Surg 2021; 11:2388-2396. [PMID: 34079709 DOI: 10.21037/qims-20-777] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background Cerebral perfusion pressure (CPP) calculated by mean arterial pressure (MAP) minus intracranial pressure (ICP) is related to blood flow into the brain and reflects cerebral ischemia and oxygenation indirectly. Near-infrared spectroscopy (NIRS) can assess cerebral ischemia and hypoxia non-invasively and has been widely used in neuroscience. However, the correlation between CPP and NIRS, and its potential application in traumatic brain injury, has seldom been investigated. Methods We used a novel wireless NIRS system and commercial ICP and MAP devices to assess the trauma to rat brains using different impact intensity. The relationship between CPP and NIRS parameters with increasing impact strength were investigated. Results The results showed that changes in CPP (∆CPP), oxy-hemoglobin {∆[HbO2]}, total-hemoglobin {∆[HbT]}, and deoxy-hemoglobin were inversely proportional to the increase in impact intensity, and the correlations between ∆CPP, NIRS parameters {∆[HbO2], and ∆[HbT]} were significant. Conclusions The NIRS system can assess cerebral ischemia and oxygenation non-invasively and changes of HbO2 and HbT may be used as reference parameters to assess the level of CPP in an animal model of traumatic brain injury.
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Affiliation(s)
- Yao-Kuang Huang
- Division of Cardiovascular Surgery and Radiology, Chiayi Chang Gung Memorial Hospital, Putz, Chiayi.,College of Medicine, Chang Gung University, Taoyuan
| | - Chin-Kuo Lin
- College of Medicine, Chang Gung University, Taoyuan.,Division of Pulmonary Infection and Critical Care, Department of Pulmonary and Critical Care Medicine, Chiayi Chang Gung Memorial Hospital, Putz, Chiayi
| | - Che-Chuan Wang
- Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan
| | - Jinn-Rung Kuo
- Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan
| | - Chien-Fu Lai
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan
| | - Chien-Wei Chen
- Division of Cardiovascular Surgery and Radiology, Chiayi Chang Gung Memorial Hospital, Putz, Chiayi.,College of Medicine, Chang Gung University, Taoyuan
| | - Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Yang Ming Chiao Tung University, Tainan
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13
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Huang S, Tseng WH, Liu CL, Kuo JR, Hun SH, Chen CH, Su CC, Wang JC, Lee KH, Hsieh KL, Chiu A. Comparison of trimodal therapy versus radical cystectomy for each stage of muscle-invasive bladder cancer. Urol Sci 2021. [DOI: 10.4103/uros.uros_8_21] [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: 11/04/2022] Open
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14
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Zheng HX, Eric Nyam TT, Liu CA, Lee YL, Kuo JR, Sung KC. Spontaneous Spinal Epidural Hematoma After Normal Spontaneous Delivery with Epidural Analgesia: Case Report and Literature Review. World Neurosurg 2020; 137:214-217. [PMID: 32058108 DOI: 10.1016/j.wneu.2020.01.240] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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: 12/07/2019] [Revised: 01/30/2020] [Accepted: 01/31/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND Pregnancy is a known risk factor for spontaneous spinal epidural hematoma. During cesarean section or vaginal delivery, the unstable hemodynamic status that may occur owing to fluctuation of intra-abdominal pressure increases the possibility of spontaneous spinal epidural hematoma. During labor and the postpartum period, neurologic symptoms may be masked by labor pain or anesthesia block, which makes early diagnosis difficult, especially in the obstetric clinic without a neurologist or neurosurgeon. CASE DESCRIPTION A 28-year-old woman who had a normal spontaneous delivery under epidural anesthesia developed bilateral lower limb flaccid paralysis and loss of sensation 12.5 hours after delivery. Magnetic resonance imaging showed a 5.2 × 0.9 × 2 cm spinal epidural hematoma with severe spinal cord stenosis at the T2-T5 level with no evidence of a vascular anomaly. After emergent evacuation of the spinal epidural hematoma, lower limb muscle power improved from 0/5 to 1/5, and sensation gradually returned to bilateral lower limbs 22 days postoperatively. Deep vein thrombosis developed at 35 days postoperatively, and an inferior vena cava filter was implanted with urokinase infusion for thrombolytic therapy. She was discharged on day 52 after admission, and lower limb muscle power returned to normal after 3 months. CONCLUSIONS Clinicians should observe postpartum women for signs of myelopathy or back tenderness and closely monitor neurologic function until anesthesia has run its course. A prompt diagnosis can enable prompt intervention.
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Affiliation(s)
- Hong-Xiang Zheng
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | | | - Che-An Liu
- Jin-Sin Women and Children's Hospital, Tainan, Taiwan
| | - Yao-Lin Lee
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Kuan-Chin Sung
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
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15
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Lee YL, Lim SW, Zheng HX, Chang WT, Nyam TTE, Chio CC, Kuo JR, Wang CC. The Short-Term Effects of Isolated Traumatic Brain Injury on the Heart in Experimental Healthy Rats. Neurocrit Care 2020; 33:438-448. [PMID: 31907801 DOI: 10.1007/s12028-019-00902-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND To date, cardiac dysfunction after traumatic brain injury (TBI) has not been consistent. In this study, we hypothesized that TBI may play a role in the development of new-onset cardiac dysfunction in healthy experimental rats. MATERIALS AND METHODS Anesthetized healthy male Sprague-Dawley rats were divided into two groups: a sham-operated control group and a TBI group. The brain was injured with 2.4 atm percussion via a fluid percussion injury model. During the 120 min after TBI, we continuously measured brain parameters, including intracranial pressure (ICP) and cerebral perfusion pressure (CPP), and cardiac parameters, such as heart rate (HR), inter-ventricular septum dimension (IVSD), left ventricular internal dimension diastole (LVIDd), end-diastolic volume (EDV), ejection fraction (EF), fractional shortening (FS), and LV mass diastole (LVd mass) by cardiac echo. On days 1, 3, 7, and 14 after TBI, the brain damage volume was evaluated with triphenyltetrazolium chloride; the physiological parameters of the heart, including HR, IVSd, LVIDd, EDV, EF, FS, and LVd mass, were evaluated with cardiac echo; the morphology of cardiomyocytes was examined by hematoxylin and eosin (HE) and Masson trichrome staining; and the biomarkers of cardiac injury troponin I and B-type natriuretic peptide (BNP) were also examined. RESULTS Compared to sham-operated controls, the TBI groups had higher ICP, lower CPP, and higher brain neuronal apoptosis and infarction contusion volume. The impact of TBI on heart function showed hyperdynamic response trends in IVSd, LVIDd, EDV, EF, FS, and LVd mass within 30 min after TBI; however, EF and FS exhibited eventual decreasing trends. Simultaneously, the values of the biomarkers troponin I and BNP were within normal limits, and HE and Mass trichrome staining revealed no significant differences between the sham-operated control group and the TBI group. CONCLUSIONS Our results suggest that TBI due to 2.4 atm fluid percussion injury in healthy experimental rats may cause significant damage to the brain and affect the heart function as investigated by cardiac echo but not as investigated by HE and Masson trichrome stainings or troponin I and BNP evaluation.
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Affiliation(s)
- Yao-Lin Lee
- Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chia-li, Tainan, Taiwan.,Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Hong-Xiang Zheng
- Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Wei-Ting Chang
- Department of Cardiology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Tee-Tau Eric Nyam
- Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan. .,Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang City, Tainan, Taiwan. .,Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan. .,Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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Kuo JR, Zheng HX, Lee YL, Wang CC. Utilization of the 3-D image and printed model as a surgical plan: An experience of a multi-level cervical spine fracture. Formos J Surg 2020. [DOI: 10.4103/fjs.fjs_80_19] [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: 11/04/2022] Open
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Chong AJ, Wee HY, Chang CH, Chio CC, Kuo JR, Lim SW. Effects of a High-Fat Diet on Neuroinflammation and Apoptosis in Acute Stage After Moderate Traumatic Brain Injury in Rats. Neurocrit Care 2019; 33:230-240. [DOI: 10.1007/s12028-019-00891-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Chong AJ, Lim SW, Lee YL, Chio CC, Chang CH, Kuo JR, Wang CC. The Neuroprotective Effects of Simvastatin on High Cholesterol Following Traumatic Brain Injury in Rats. World Neurosurg 2019; 132:e99-e108. [PMID: 31518751 DOI: 10.1016/j.wneu.2019.08.250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 08/29/2019] [Accepted: 08/30/2019] [Indexed: 11/16/2022]
Abstract
BACKGROUND High cholesterol has been correlated with a greater risk of cerebrovascular diseases. Whether pre-existing high cholesterol exacerbates traumatic brain injury (TBI), and whether treatment with the cholesterol-lowering agent simvastatin has neuroprotective effects, especially anti-neuroinflammatory effects, after TBI are not well investigated. METHODS Five-week-old male Sprague-Dawley rats were fed a high-fat diet for 8 weeks to induce hypercholesterolemia. Anesthetized male Sprague-Dawley rats were divided into 5 groups, including the sham-operated control, TBI control, and TBI with simvastatin treatment (4 mg/kg, 10 mg/kg, or 20 mg/kg) groups. Simvastatin was intraperitoneally injected at 0, 24, and 48 hours after TBI. Motor function was measured using an inclined plane. Neuronal apoptosis (maker Neu-N, terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling), tumor necrosis factor-α expression in microglia (marker OX42) and astrocytes (marker glial fibrillary acidic protein), and Tumor necrosis factor-alpha receptor (TNFR) 1 and TNFR2 expression in neurons in the ischemic cortex were investigated using an immunofluorescence assay. All of the parameters were measured on the third day after TBI. RESULTS TBI significantly increased the serum levels of cholesterol. The TBI-induced motor deficit was significantly attenuated by 4, 10, and 20 mg/kg simvastatin therapy on the third day after TBI. TBI-induced neuronal TNFR1 activation and apoptosis, as well as tumor necrosis factor-α expression in astrocytes in the ischemic cortex, were significantly attenuated by simvastatin, particularly when 20 mg/kg was administered. Simultaneously, the serum cholesterol remained high despite simvastatin treatment. CONCLUSIONS The neuroprotection effects of simvastatin on the pre-existing hypercholesterolemia during TBI in rats may be related to its anti-neuroinflammatory effects but not to its cholesterol-lowing effects.
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Affiliation(s)
- Arng Jack Chong
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yao-Lin Lee
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Hung Chang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research Chi-Mei Medical Center, Tainan, Taiwan.
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Medical Research Chi-Mei Medical Center, Tainan, Taiwan
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Lee YL, Kuo JR. Postobliteration Arteriovenous Malformation Mimicking Malignant Change 30 Years After X-Knife Treatment—Case Report and Review of Literature. World Neurosurg 2019; 128:169-173. [DOI: 10.1016/j.wneu.2019.04.263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Revised: 04/29/2019] [Accepted: 04/30/2019] [Indexed: 10/26/2022]
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Eric Nyam TT, Ho CH, Chio CC, Lim SW, Wang JJ, Chang CH, Kuo JR, Wang CC. Traumatic Brain Injury Increases the Risk of Major Adverse Cardiovascular and Cerebrovascular Events: A 13-Year, Population-Based Study. World Neurosurg 2018; 122:e740-e753. [PMID: 30391613 DOI: 10.1016/j.wneu.2018.10.130] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/18/2018] [Accepted: 10/20/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Previous studies have indicated traumatic brain injury (TBI) as a risk factor for stroke and myocardial injury. Whether TBI increases new onset of major adverse cardiovascular and cerebrovascular events (MACCE) is not well established. METHODS Patients with a diagnosis of TBI from 2000 to 2012 were 1:2 age-, sex-, and age-adjusted comorbidities matched with normal population cohorts. The MACCE, which included coronary artery disease, heart failure and arrhythmia, ischemic and hemorrhagic stroke, and death, was defined as one inpatient admission with MACCE diagnosis. The maximum follow-up duration to MACCE after the initial TBI diagnosis was 5 years. The baseline comorbidities before TBI, including hypertension, diabetes mellitus, renal disease, and liver disease, also were considered to estimate the risk of MACCE. RESULTS In total, 16,211 patients with TBI and 32,422 people from the control group were enrolled in the current study. Our results showed that patients with TBI had a 2.77-fold risk of MACCE, 1.72-fold risk of cardiovascular disease, 2.10-fold risk of ischemic stroke, 6.02-fold risk of hemorrhagic stroke, and 3.13-fold risk of mortality compared with the control group (all P < 0.0001) after adjusting the confounding factors. In addition, the trend of cumulated incidence risk among MACCE, cardiovascular disease, ischemic and hemorrhagic stroke, and mortality presented the greatest incidence within the first year after diagnosis and persisted during the 5 years of follow-up. CONCLUSIONS Our results showed that patients with TBI have a significantly greater risk of MACCE than the control group. We hope this information will remind critical-care physicians and neurosurgeons to keep in mind the long-term effects of TBI on MACCE.
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Affiliation(s)
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ching-Hung Chang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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Eric Nyam TT, Lim SW, Ho CH, Liao JC, Wang JJ, Chio CC, Kuo JR, Wang CC. In-Hospital Mortality After Spinal Surgery in Hemodialysis Patients: An 11-Year Population-Based Study. World Neurosurg 2018; 122:e667-e675. [PMID: 31108081 DOI: 10.1016/j.wneu.2018.10.119] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Revised: 10/17/2018] [Accepted: 10/19/2018] [Indexed: 01/25/2023]
Abstract
BACKGROUND Patients with end-stage renal disease (ESRD) are at an increased risk of surgical mortality. We aimed to investigate the factors associated with in-hospital mortality in patients with ESRD who underwent spinal surgery, which remains to be determined. MATERIAL AND METHODS An age- and sex-matched cohort study was conducted using the Taiwan Longitudinal Health Insurance Database between January 2000 and December 2012. Kaplan-Meier curves were plotted with log-rank test to compare the differences between these 2 groups. The Cox proportional hazard model was used to estimate the hazard ratio of in-hospital mortality adjusted with potential confounding. RESULTS In total, 4109 participants with pre-existing ESRD and 8218 patients without ESRD were included. The in-hospital mortality in ESRD (10.17%) was greater than without ESRD (1.39%). Spinal surgery patients with pre-existing ESRD had a 6.78-fold increase in-hospital mortality risk compared with those without ESRD. Spinal surgery patients with ESRD of any age, male or female, and comorbidities experienced a greater incidence of hospital mortality. In patients with ESRD, operations on spinal cords and spinal canal structures had the greatest hospital mortality (14.87%) compared with spinal fusion (3.46%) or excision or destruction of intervertebral disc (3.01%). Kaplan-Meier survival curves showed that patients with ESRD experienced greater hospital mortality than patients without ESRD in all 3 spinal surgery methods (log rank P < 0.0001). CONCLUSIONS Spinal surgery patients with ESRD have greater in-hospital mortality than patients without ESRD. Age, sex, history of comorbidities, and types of surgical methods were associated with greater in-hospital mortality among patients with ESRD.
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Affiliation(s)
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jen-Chieh Liao
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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Wee HY, Ho CH, Chang CH, Chio CC, Wang JJ, Wang CC, Kuo JR. Probability of New-Onset Cancer Between Patients with Traumatic Brain Injury and a Comparison General Population Cohort. World Neurosurg 2018; 121:e817-e826. [PMID: 30312818 DOI: 10.1016/j.wneu.2018.09.229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 09/26/2018] [Accepted: 09/28/2018] [Indexed: 01/28/2023]
Abstract
BACKGROUND Traumatic brain injury (TBI) has been reported as a risk factor for the development of brain tumors. However, whether TBI affects systemic cancer remains to be determined. We investigated the incidence and factors associated with cancer development in patients with TBI. METHODS A propensity score (age, gender, and comorbidity)-matched longitudinal cohort study of 34,556 patients with pre-existing TBI and 69,112 patients without TBI from January 2000 to December 2015 was presented using the Taiwan's National Health Insurance Research Database. The Cox proportional hazard regression model was used to estimate the hazard ratio of developing cancer adjusted by the potential confounding factors. The stratified analysis of age, gender, and comorbidities for each cancer type was evaluated using forest plot analysis. RESULTS The cancer incidence rate in the patients with TBI (4.38%) was greater than that in patients without TBI (3.88%). The interval to cancer development in those with TBI (5.65 ± 3.58 years) was shorter than that in those without TBI (6.02 ± 3.65 years). The cancer risk in those with TBI was increased 1.27-fold compared with that in the general population. Of the patients with TBI, age <55 years and male gender indicated a greater incidence of cancer than that of the general population. The patients with TBI had greater cancer frequencies in the head and neck structures compared with those in the general population. CONCLUSIONS TBI is a risk factor for cancer development, especially in males and those aged <55 years. We hope this information will remind physicians to consider the long-term effects of TBI on cancer development.
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Affiliation(s)
- Hsiao-Yue Wee
- Department of Neurosurgery, Liouying Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ching-Hung Chang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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Tseng WH, Tian YF, Liao ACH, Chen MJ, Ho HY, Kuo JR, Huang SK. Successful reuse of a transplanted kidney 9 years after initial transplantation: 4-year follow-up. BMC Nephrol 2018; 19:234. [PMID: 30223782 PMCID: PMC6142365 DOI: 10.1186/s12882-018-1040-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 09/10/2018] [Indexed: 11/10/2022] Open
Abstract
Background Kidney transplantation is the preferred renal replacement therapy for patients with end-stage renal disease, but the waiting list for kidneys continues to grow because of a shortage of donor organs. The reuse of transplanted kidneys would seem to be a good approach to expand the pool of available organs. Here, we describe the reuse of a kidney 9 years after the initial transplantation. At 4-year follow-up, the second recipient is showing good renal function. Case presentation In 2005, a kidney was transplanted from a 40-year-old man, who suffered brain death due to an intracranial hemorrhage, into a 45-year-old man. Nine years later, the recipient suffered a ruptured cerebral aneurysm, resulting in brain death. The kidney was re-transplanted into a 40-year-old man with diabetic nephropathy who had received hemodialysis for 5 years. During 4 years of follow-up, the graft has functioned well. Conclusions This case demonstrates the successful regrafting of a transplanted kidney. We believe this is the longest period for reuse of kidney after initial transplantation. The outcome suggests that a well-functioning transplanted kidney can be reused years after transplantation.
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Affiliation(s)
- Wen-Hsin Tseng
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Feng Tian
- Division of Transplantation Surgery, Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan. .,Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan.
| | - Alex Chien-Hwa Liao
- Division of Urology, Division of Transplantation Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Ming-Jenn Chen
- Division of Transplantation Surgery, Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Hsuan-Ying Ho
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Division of Neurosurgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan.,Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Steven K Huang
- Division of Urology, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
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Eric Nyam TT, Ho CH, Wang YL, Lim SW, Wang JJ, Chio CC, Kuo JR, Wang CC. The Risk of Traumatic Brain Injury Occurring Among Patients with Parkinson Disease: A 14-Year Population-Based Study. World Neurosurg 2018; 113:e328-e335. [DOI: 10.1016/j.wneu.2018.02.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 02/03/2018] [Accepted: 02/05/2018] [Indexed: 10/18/2022]
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Sun DP, Lee LH, Tian YF, Zheng HX, Kuo JR, Wang CC. How to Deal with the Empty Space After Organ Removal for Transplantation: A Single Medical Center Experience. World Neurosurg 2018; 115:e299-e304. [PMID: 29660548 DOI: 10.1016/j.wneu.2018.04.038] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 04/04/2018] [Accepted: 04/05/2018] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Dealing with the empty space after organ removal for transplantation has not been investigated. METHODS From January 28, 2005, to November 21, 2017, 111 organ donors were enrolled in this study. They were divided into 3 groups: no replacement, replaced with paper printed with organ graphics, or replaced with 3-dimensional (3D) printed simulated organs. The organs were removed at different periods. The donor's age, gender, etiology of admission, characteristics, clinical pictures, time interval between admission and date of donation, and time interval between donor coordinator consultations were evaluated. RESULTS A total of 82 men and 29 women with mean age of 43 ± 15.1 years were enrolled. Overall, 329 organs and 126 corneas were transplanted. The major causes of brain death were traumatic brain injury (44.1%) and cerebrovascular disease (32.4%). Twelve donors initially presented with out-of-hospital cardiac arrest. Ten patients with solid cancers and 3 with septic shock donated both of their corneas. The mean time interval between donor coordinator and social worker consultation to organ donation was 3 (2-5 days) (median [interquartile range]). Periods I and II averaged 7-8 donors per year. Fourteen donors and 41 organs were replaced with 3D-printed simulated organs at the families' request in 1 year. CONCLUSIONS This is the first study to provide a replacement method dealing with the empty space after organ removal. We used 3D-printed simulated organs in addition to providing grief assistance and spiritual support. It also has the potential effect of increasing the organ donation rate.
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Affiliation(s)
- Ding-Ping Sun
- Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; Department of Food Science and Technology and Biotechnology, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Ling-Hsien Lee
- Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Yu-Feng Tian
- Section of Transplantation Medicine, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; Department of Health and Nutrition, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hong-Xiang Zheng
- Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
| | - Che-Chuan Wang
- Division of General Surgery, Department of Surgery, Chi Mei Medical Center, Tainan, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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Lim SW, Nyam TT E, Hu CY, Chio CC, Wang CC, Kuo JR. Estrogen Receptor-α is Involved in Tamoxifen Neuroprotective Effects in a Traumatic Brain Injury Male Rat Model. World Neurosurg 2018; 112:e278-e287. [DOI: 10.1016/j.wneu.2018.01.036] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Accepted: 01/06/2018] [Indexed: 01/23/2023]
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Wang CC, Wee HY, Hu CY, Chio CC, Kuo JR. The Effects of Memantine on Glutamic Receptor-Associated Nitrosative Stress in a Traumatic Brain Injury Rat Model. World Neurosurg 2018; 112:e719-e731. [PMID: 29382619 DOI: 10.1016/j.wneu.2018.01.140] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The main aim of this study is to elucidate whether the neuroprotective effect of memantine, a noncompetitive N-methyl-d-aspartate receptor 2B (NR2B) antagonist, affects neuronal nitrosative stress, apoptosis, and NR2B expression and improves functional outcomes. METHODS Immediately after the onset of fluid percussion traumatic brain injury (TBI), anesthetized male Sprague-Dawley rats were divided into sham-operated, TBI + vehicle, and TBI + memantine groups. TBI rats were treated with a memantine intraperitoneal injection dose of 20 mg/kg intraperitoneally and then 1 mg/kg every 12 hours intraperitoneally for 6 doses. The motor function, proprioception, infarction volume, and neuronal apoptosis were then measured. Immunofluorescence was used to evaluate astrogliosis, microgliosis, nitrosative stress, and NR2A and NR2B expression in cortical cells. All the parameters were assessed 72 hours after TBI. RESULTS Compared with the sham-operated controls, the TBI-induced motor and proprioception deficits, and increased infraction volume after TBI were significantly attenuated by memantine therapy. The TBI-induced neuronal apoptosis, astrogliosis, and microgliosis, the numbers of neuronal NO synthase and 3-nitro-l-tyrosine expression in neurons, and inducible NO synthase expression in microglia and astrocyte cells in the ischemic cortex after TBI were significantly improved by memantine therapy. Simultaneously, without affecting the NR2A expression in neuronal cells, the NR2B expression significantly decreased after memantine therapy, as evaluated by an immunofluorescence stain. CONCLUSIONS Intraperitoneal injection of memantine in the acute stage may ameliorate TBI in rats by affecting NR2B expression and decreasing neuronal apoptosis and nitrosative stress in the injured cortex. These effects might represent 1 mechanism by which functional recovery occurred.
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Affiliation(s)
- Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Center for General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Hsiao-Yue Wee
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chiao-Ya Hu
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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Ho CH, Liang FW, Wang JJ, Chio CC, Kuo JR. Impact of grouping complications on mortality in traumatic brain injury: A nationwide population-based study. PLoS One 2018; 13:e0190683. [PMID: 29324771 PMCID: PMC5764255 DOI: 10.1371/journal.pone.0190683] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/19/2017] [Indexed: 11/19/2022] Open
Abstract
Traumatic brain injury (TBI) is an important health issue with high mortality. Various complications of physiological and cognitive impairment may result in disability or death after TBI. Grouping of these complications could be treated as integrated post-TBI syndromes. To improve risk estimation, grouping TBI complications should be investigated, to better predict TBI mortality. This study aimed to estimate mortality risk based on grouping of complications among TBI patients. Taiwan's National Health Insurance Research Database was used in this study. TBI was defined according to the International Classification of Diseases, Ninth Revision, Clinical Modification codes: 801-804 and 850-854. The association rule data mining method was used to analyze coexisting complications after TBI. The mortality risk of post-TBI complication sets with the potential risk factors was estimated using Cox regression. A total 139,254 TBI patients were enrolled in this study. Intracerebral hemorrhage was the most common complication among TBI patients. After frequent item set mining, the most common post-TBI grouping of complications comprised pneumonia caused by acute respiratory failure (ARF) and urinary tract infection, with mortality risk 1.55 (95% C.I.: 1.51-1.60), compared with those without the selected combinations. TBI patients with the combined combinations have high mortality risk, especially those aged <20 years with septicemia, pneumonia, and ARF (HR: 4.95, 95% C.I.: 3.55-6.88). We used post-TBI complication sets to estimate mortality risk among TBI patients. According to the combinations determined by mining, especially the combination of septicemia with pneumonia and ARF, TBI patients have a 1.73-fold increased mortality risk, after controlling for potential demographic and clinical confounders. TBI patients aged<20 years with each combination of complications also have increased mortality risk. These results could provide physicians and caregivers with important information to increase their awareness about sequences of clinical syndromes among TBI patients, to prevent possible deaths among these patients.
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Affiliation(s)
- Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Fu-Wen Liang
- National Cheng Kung University Research Center for Health Data and Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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Lim SW, Shiue YL, Liao JC, Wee HY, Wang CC, Chio CC, Chang CH, Hu CY, Kuo JR. Simvastatin Therapy in the Acute Stage of Traumatic Brain Injury Attenuates Brain Trauma-Induced Depression-Like Behavior in Rats by Reducing Neuroinflammation in the Hippocampus. Neurocrit Care 2017; 26:122-132. [PMID: 27406816 DOI: 10.1007/s12028-016-0290-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND The antidepressant-like effects of simvastatin on traumatic brain injury (TBI) remain unclear. The present study aimed to investigate the neuroprotective effects of simvastatin and determine whether simvastatin attenuates TBI-induced depression-like behavior and, more specifically, acts as an antineuroinflammatory. METHODS Anesthetized male Sprague-Dawley rats were divided into five groups: sham-operated controls, TBI controls, and TBI treatment with simvastatin 4, 10, or 20 mg/kg. Simvastatin was intraperitoneally injected 0, 24, and 48 h after TBI. The motor function was measured using an inclined plane, and depression-like behavior was evaluated using forced swimming tests. Neuronal apoptosis (markers: NeuN, TUNEL, caspase-3), microglia (marker: OX42) and astrocyte (marker: GFAP) activation, and TNF-α expression in the microglia and astrocytes of the hippocampal CA3 area were investigated using immunofluorescence assay. All parameters were measured on the 4th, 8th, and 15th day, or only on the 15th day after TBI. RESULTS TBI-induced depression-like behavior, which increased duration of immobility, was significantly attenuated by 20 mg simvastatin therapy on day 15 after TBI. TBI-induced neuronal apoptosis, microglia and astrocyte activation, and TNF-α expression in the microglia and astrocytes of the CA3 area of the hippocampus were significantly reduced by simvastatin treatment, particularly when 20 mg/kg was administered for 3 days. CONCLUSIONS Intraperitoneal injection of simvastatin attenuated TBI in rats during the acute stage by reducing neuronal apoptosis, microglia, and TNF-α expression, thereby resulting in a reduction of depressive-like behavior. Our results suggest that simvastatin may be a promising treatment for TBI-induced depression-like behavior.
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Affiliation(s)
- Sher-Wei Lim
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Jen-Chieh Liao
- Departments of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Hsiao-Yue Wee
- Department of Neurosurgery, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
| | - Che-Chuan Wang
- Departments of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
- Departments of Child Care, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Ching Chio
- Departments of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Hung Chang
- Departments of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chiao-Ya Hu
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Departments of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan.
- Departments of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
- Chi-Mei Medical Center, #901 Chung Hwa Road, Yung Kang, Tainan, Taiwan.
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Ao KH, Ho CH, Wang CC, Wang JJ, Chio CC, Kuo JR. The increased risk of stroke in early insomnia following traumatic brain injury: a population-based cohort study. Sleep Med 2017; 37:187-192. [DOI: 10.1016/j.sleep.2017.02.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/06/2017] [Accepted: 02/09/2017] [Indexed: 12/12/2022]
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Weng JY, Wang CC, Chen PJ, Lim SW, Kuo JR. The Application of a Three-Dimensional Printed Product to Fill the Space After Organ Removal. World Neurosurg 2017; 107:1045.e17-1045.e19. [PMID: 28826704 DOI: 10.1016/j.wneu.2017.07.149] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 12/27/2022]
Abstract
BACKGROUND Maintaining body integrity, especially in Asian societies, is an independent predictor of organ donation. CASE DESCRIPTION Herein, we report the case of an 18-year-old man who suffered a traumatic brain injury with ensuing brain death caused by a car accident. According to the family's wishes, we used a 3-dimensional printer to create simulated heart, kidneys, and liver to fill the spaces after the patient's organs were removed. This is the first case report to introduce this new clinical application of 3-dimensional printed products during transplantation surgery. CONCLUSIONS This new clinical application may have supportive psychological effects on the family and caregivers; however, given the varied responses to our procedure, this ethical issue is worth discussing.
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Affiliation(s)
- Jui-Yu Weng
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Che-Chuna Wang
- Department of General Education, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Pei-Jar Chen
- Department of Electrical Engineering, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan; Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan.
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Yu SC, Kuo JR, Shiue YL, Yu ZX, Ho CH, Wu CC, Wang JJ, Chu CC, Lim SW. One-Year Mortality of Patients with Chronic Kidney Disease After Spinal Cord Injury: A 14-Year Population-Based Study. World Neurosurg 2017; 105:462-469. [PMID: 28602927 DOI: 10.1016/j.wneu.2017.06.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/31/2017] [Accepted: 06/01/2017] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Chronic kidney disease (CKD) has become a global public health burden because of its increasing incidence, high risk of progression to end-stage renal disease (ESRD), and poor prognosis. We aimed to investigate the 1-year mortality of patients with spinal cord injury (SCI) with CKD and ESRD, and compare it with that of patients with SCI without CKD by reviewing a large Taiwanese population data set. METHODS In this 14-year retrospective cohort study, the study group (SCI with CKD group, n = 3315) and comparison group (SCI without CKD group, n = 6630) were matched at a 1:2 ratio with propensity score matching by age, sex, comorbidities, length of intensive care unit stay, and length of stay. The 1-year mortality and the relative risks of mortality were calculated. Mortality stratified by age, sex, and comorbidities was also analyzed. RESULTS The SCI with CKD group had a significantly shorter survival period (10.13 vs. 10.97 months), higher 1-year mortality (17.65% vs. 8.54%), and higher risk of mortality than did the comparison group (adjusted hazard ratio, 2.25). Furthermore, patients with CKD with ESRD had a 7.71-fold higher risk of mortality than did patients with SCI without CKD for ages <50 years. The presence of comorbidities was a risk factor for mortality among patients with SCI CKD or ESRD in contrast to patients with SCI without CKD. CONCLUSIONS Patients with SCI with CKD, especially those with ESRD, have a higher risk of mortality than do patients who do not have CKD. Therefore, patients with CKD should have carefully monitoring for the development of 1-year mortality after SCI, especially for ESRD.
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Affiliation(s)
- Shou-Chun Yu
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Medical Research, Chi Mei Medical Center, Chiali Branch, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, Chiali Branch, Tainan, Taiwan; Department of Medical Research, Chi Mei Medical Center, Chiali Branch, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Zong-Xing Yu
- Department of Orthopedics, Chi Mei Medical Center, Chiali Branch, Tainan, Taiwan; Department of Dental Laboratory Technology, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center, Chiali Branch, Tainan, Taiwan; Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chia-Chun Wu
- Department of Nephrology, Chi Mei Medical Center, Tainan, Taiwan; Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi Mei Medical Center, Chiali Branch, Tainan, Taiwan
| | - Chin-Chen Chu
- Department of Medical Research, Chi Mei Medical Center, Chiali Branch, Tainan, Taiwan; Department of Anesthesiology, Chi Mei Medical Center, Tainan, Taiwan
| | - Sher-Wei Lim
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Neurosurgery, Chi Mei Medical Center, Chiali Branch, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan.
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Lim SW, Ao KH, Ho CH, Tseng CJ, Wang JJ, Chio CC, Kuo JR. The Association Between Ventriculo-Peritoneal Shunt and Acute Appendicitis in Patients with Traumatic Brain Injury: A 14-Year, Population-Based Study. World Neurosurg 2017; 103:106-113. [PMID: 28377254 DOI: 10.1016/j.wneu.2017.03.122] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/23/2017] [Accepted: 03/25/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE The association between preexisting ventriculoperitoneal (VP) shunt and the risk of new-onset acute appendicitis in patients with traumatic brain injury (TBI) is not well established. The aim of the present study was to determine the relationships between VP shunt and acute appendicitis in patients with TBI. METHODS A longitudinal cohort study matched by a propensity score in patients with TBI with (4781 patients) or without (9562 patients) VP shunt was conducted using the National Health Insurance Research Database in Taiwan between January 1993 and December 2013. RESULTS The main outcome studied was diagnosis of acute appendicitis. The cumulative probability of acute appendicitis was not different between these 2 groups (P = 0.6244). A Cox model showed central nervous system (CNS) infection to be an independent predictor of acute appendicitis with an adjusted hazard ratio of 2.98. Patients with TBI with both a VP shunt and a CNS infection had a greater risk of developing new-onset acute appendicitis (hazard ratio 4.25; 95% confidence interval 1.84-9.81) compared patients with TBI without a VP shunt or CNS infection. CONCLUSIONS We concluded that VP shunt is not a risk factor in the development of appendicitis in patients with TBI. Patients with TBI with a shunt and a CNS infection may have a greater risk of developing acute appendicitis. Therefore, care in avoiding CNS infection is a key for the prevention acute appendicitis in this patient population.
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Affiliation(s)
- Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Hospital, Chiali, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Kam-Hou Ao
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Chien-Jen Tseng
- Department of General Surgery, Chi-Mei Hospital, Chiali, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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Su BY, Guo NW, Chen NC, Lin SS, Chuang MT, Liao YC, Kuo CM, Lin CW, Chou W, Kuo JR, Yen SY. Brain contusion as the main risk factor of memory or emotional complaints in chronic complicated mild traumatic brain injury. Brain Inj 2017; 31:601-606. [PMID: 28350185 DOI: 10.1080/02699052.2016.1267800] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the risk factors for memory or emotional complaints in patients with complicated mild traumatic brain injury (mTBI). METHODS Retrospective analysis of medical records was conducted by physicians in a teaching hospital in Southern Taiwan, and complicated mTBI had been identified by means of computed tomography. Psychological complaints, including problems with memory and emotions, were collected by structured telephone interviews, 10-15 minutes long, and were held with subjects who agreed to participate in our study. Among 327 patients who were injured for more than two years, 190 agreed to join this study (mean age: 41.6 years; male: 60.5%; stably employed: 50.0%). We used demographic data and neurological factors to predict memory or emotional complaints without muscle power or response speed (MEMR) complaints. RESULTS Only the presence or absence of cerebral contusions predicted memory or emotional complaints without MEMR complaints in different employed status, and the odds ratio was 4.82-13.50 times higher for those with cerebral contusions than for those without. CONCLUSIONS Cerebral contusions were the primary risk factor for MEMR complaints in chronic complicated mTBI. Early preventive psychological intervention might be necessary for patients with complicated mTBI and cerebral contusions.
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Affiliation(s)
- Bei-Yi Su
- a Institute of Allied Health Sciences , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Nai-Wen Guo
- a Institute of Allied Health Sciences , College of Medicine, National Cheng Kung University , Tainan , Taiwan.,b Institute of Behavioral Medicine , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Nan-Chun Chen
- b Institute of Behavioral Medicine , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Sheng-Sian Lin
- b Institute of Behavioral Medicine , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Ming-Tsung Chuang
- c Department of Diagnostic Radiology , National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Yu-Chi Liao
- a Institute of Allied Health Sciences , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Chia-Min Kuo
- b Institute of Behavioral Medicine , College of Medicine, National Cheng Kung University , Tainan , Taiwan
| | - Cheng-Wei Lin
- d Department of Orthopedics , National Cheng Kung University Hospital , Tainan , Taiwan
| | - Willy Chou
- e Department of Physical Medicine and Rehabilitation , Chi-Mei Medical Center , Tainan , Taiwan.,f Recreation Management Department , Chia-Nan University of Pharmacy and Science , Tainan , Taiwan
| | - Jinn-Rung Kuo
- g Department of Neurosurgery , Chi-Mei Medical Center , Tainan , Taiwan.,h Department of Biotechnology , Southern Taiwan University of Science and Technology , Tainan , Taiwan
| | - Shih-Yin Yen
- e Department of Physical Medicine and Rehabilitation , Chi-Mei Medical Center , Tainan , Taiwan
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Lim SW, Shiue YL, Ho CH, Yu SC, Kao PH, Wang JJ, Kuo JR. Anxiety and Depression in Patients with Traumatic Spinal Cord Injury: A Nationwide Population-Based Cohort Study. PLoS One 2017; 12:e0169623. [PMID: 28081205 PMCID: PMC5231351 DOI: 10.1371/journal.pone.0169623] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 12/20/2016] [Indexed: 12/25/2022] Open
Abstract
Background Traumatic spinal cord injury (tSCI) may involve new-onset anxiety and depression post-discharge. However, long-term population-based studies have lacked access to follow-up conditions in terms of new-onset anxiety and depression. The objective of this study was to estimate the long-term risk of new-onset anxiety and depression post-discharge. Methods The Longitudinal Health Insurance Database 2000 (LHID2000) from Taiwan’s National Health Insurance Research Database was used in this study. Individuals with tSCI were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnostic codes of 806 and 952 from 1999–2008. The comparison cohort (other health conditions group) was randomly selected from the LHID2000 and was 1:1 matched by age, sex, index year, and comorbidities to reduce the selection bias. All study participants were retrospectively followed for a maximum of 3 years until the end of follow-up, death, or new-onset anxiety (ICD-9-CM: 309.2–309.4) or depression (ICD-9-CM: 296.2, 296.5, 296.82, 300.4, 309.0–309.1, and 311). Persons who were issued a catastrophic illness card for tSCI were categorized as having a severe level of SCI (Injury Severity Score [ISS] ≥16). Poisson regression was used to estimate the incidence rate ratios of anxiety or depression between patients with tSCI and other health conditions. The relative risk of anxiety or depression was estimated using a Cox regression analysis, which was adjusted for potential confounding factors. Results Univariate analyses showed that the tSCI patients (n = 3556) had a 1.33 times greater incidence of new-onset anxiety or depression (95% confidence interval [CI]: 1.12–1.57) compared to the other health conditions group (n = 3556). After adjusting for potential risk factors, the tSCI patients had a significant 1.29-fold increased risk of anxiety or depression compared to the group with other health conditions (95% CI: 1.09–1.53). Individuals with tSCI, including patients who were under the age of 35, patients who were males, patients who had a low income, and patients without a Charlson Comorbidity Index score, all had a higher long-term risk of anxiety or depression than the other health conditions group (IRRs: 1.84, 1.63, 1.29, and 1.39, respectively). For all tSCI patients, those with an Injury Severity Score (ISS) ≥16 had an almost 2-fold higher risk of anxiety or depression (adjusted Hazard Ratio: 1.85; 95% CI: 1.17–2.92) compared to those with ISS <16. Conclusions Our findings indicated that tSCI patients have a high risk of anxiety or depression post-discharge, especially among the younger tSCI patients (age <50 years), compared with the other health conditions group. This information could help physicians understand the long-term risk of new-onset anxiety or depression in tSCI patients post-discharge.
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Affiliation(s)
- Sher-Wei Lim
- Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Pharmacy, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shou-Chun Yu
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
- Department of Medical Research, Chi-Mei Medical Center, Chiali, Tainan, Taiwan
| | - Pei-Hsin Kao
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- * E-mail:
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Lim SW, Sung KC, Shiue YL, Wang CC, Chio CC, Kuo JR. Hyperbaric Oxygen Effects on Depression-Like Behavior and Neuroinflammation in Traumatic Brain Injury Rats. World Neurosurg 2017; 100:128-137. [PMID: 28065873 DOI: 10.1016/j.wneu.2016.12.118] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Accepted: 12/27/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to determine whether hyperbaric oxygen (HBO) therapy causes attenuation of traumatic brain injury (TBI)-induced depression-like behavior and its associated anti-neuroinflammatory effects after fluid percussion injury. METHODS Anesthetized male Sprague-Dawley rats were divided into 3 groups: sham operation plus normobaric air (NBA) (21% oxygen at 1 absolute atmosphere [ATA]), TBI plus NBA, and TBI plus HBO (100% oxygen at 2.0 ATA). HBO was applied immediately for 60 min/d after TBI for 3 days. Depression-like behavior was tested by a forced swimming test, motor function was tested by an inclined plane test, and infarction volume was tested by triphenyltetrazolium chloride (TTC) staining on days 4, 8, and 15. Neuronal apoptosis (terminal deoxynucleotidyl transferase dUTP nick-end labeling assay), microglial (marker OX42) activation, and tumor necrosis factor (TNF)-α expression in microglia in the hippocampus CA3 were measured by immunofluorescence methods. RESULTS Compared with the TBI controls, without significant changes in TTC staining or in the motor function test, TBI-induced depression-like behavior was significantly attenuated by HBO therapy by day 15 after TBI. Simultaneously, TBI-induced neuronal apoptosis, microglial (marker OX42) activation, and TNF-α expression in the microglia in the hippocampus CA3 were significantly reduced by HBO. CONCLUSIONS Our results suggest that HBO treatment may ameliorate TBI-induced depression-like behavior in rats by attenuating neuroinflammation, representing one possible mechanism by which depression-like behavior recovery might occur. We also recommend HBO as a potential treatment for TBI-induced depression-like behavior if early intervention is possible.
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Affiliation(s)
- Sher-Wei Lim
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan; Department of Neurosurgery, Chi-Mei Medical Center, Chiali, Tainan, Taiwan; Department of Nursing, Min-Hwei College of Health Care Management, Tainan, Taiwan
| | - Kuan-Chin Sung
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Yow-Ling Shiue
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung, Taiwan
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Child Care, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan.
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Kuo JR, Shang HS, Ho CT, Lai KG, Liu TZ, Chen YJ, Chiou JF. Cisplatin-induced regulation of signal transduction pathways and transcription factors in p53-mutated subclone variants of hepatoma cells: Potential application for therapeutic targeting. Oncol Lett 2016; 12:3723-3730. [PMID: 27895723 PMCID: PMC5104157 DOI: 10.3892/ol.2016.5181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 08/09/2016] [Indexed: 01/23/2023] Open
Abstract
Cisplatin is commonly recognized as a DNA-damaging drug; however, its versatile antitumor effects have been demonstrated to extend beyond this narrow functional attribute. The present study determined how cisplatin regulates alternative pathways and transcription factors to exert its additional antitumor actions. Cisplatin was observed to be able to trigger an endoplasmic reticulum stress response through aggravated nitrosative stress coupled to perturbed mitochondrial calcium (Ca2+) homeostasis, which substantially downregulated glucose-regulated protein (GRP) 78 expression by suppressing the cleavage of activating transcription factor (ATF) 6α (90 kDa) to its active 50 kDa subunit. Concomitantly, the ATF4-ATF3-C/emopamil binding protein homologous protein axis was activated by cisplatin, which triggered cellular glutathione (GSH) depletion by strongly inhibiting γ-glutamylcysteine synthetase heavy chain (γ-GCSh), a key enzyme in GSH biosynthesis. The present study also demonstrated that cisplatin substantially inhibited β-catenin, causing a marked downregulation of survivin and B-cell lymphoma (Bcl)-2. Taken together, the present results uncovered a novel mechanism of cisplatin that could simultaneously trigger the inhibition of three prominent antiapoptotic effector molecules (Bcl-2, survivin and GRP78) and effectively promote GSH depletion by inhibiting γ-GCSh. These newly discovered functional attributes of cisplatin can provide an avenue for novel combined therapeutic strategies to kill hepatocellular carcinoma cells effectively.
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Affiliation(s)
- Jinn-Rung Kuo
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan 71004, Taiwan, R.O.C.; Department of Medical Research, Chi-Mei Medical Center, Tainan 71004, Taiwan, R.O.C
| | - Hung-Sheng Shang
- Division of Clinical Pathology, Department of Pathology, National Defense Medical Center, Tri-Service General Hospital, Taipei 11490, Taiwan, R.O.C
| | - Chun-Te Ho
- Graduate Institute of Medical Sciences, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan, R.O.C
| | - Kun-Goung Lai
- Department of Radiation Oncology, Tungs' Taichung Metro Harbor Hospital, Taichung 43503, Taiwan, R.O.C
| | - Tsan-Zon Liu
- Translational Research Laboratory, Cancer Center, Taipei Medical University, Taipei 11031, Taiwan, R.O.C
| | - Yin-Ju Chen
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 11031, Taiwan, R.O.C.; Graduate Institute of Biomedical Materials and Tissue Engineering, College of Biomedical Engineering, Taipei Medical University, Taipei 11031, Taiwan, R.O.C.; Graduate Institute of Cancer Biology and Drug Discovery, College of Medical Science and Technology, Taipei Medical University, Taipei 11031, Taiwan, R.O.C
| | - Jeng-Fong Chiou
- Department of Radiation Oncology, Taipei Medical University Hospital, Taipei 11031, Taiwan, R.O.C.; Department of Radiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan, R.O.C
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Tang WC, Hsu YC, Wang CC, Hu CY, Chio CC, Kuo JR. Early electroacupuncture treatment ameliorates neuroinflammation in rats with traumatic brain injury. Altern Ther Health Med 2016; 16:470. [PMID: 27852302 PMCID: PMC5112630 DOI: 10.1186/s12906-016-1457-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 10/31/2016] [Indexed: 02/21/2023]
Abstract
Background Neuroinflammation is the leading cause of neurological sequelae after traumatic brain injury (TBI). The aim of the present study was to investigate whether the neuroprotective effects of electroacupuncture (EA) are mediated by anti-neuroinflammatory effects in a rat model of TBI. Methods Male Sprague-Dawley rats were randomly divided into three groups: sham-operated, TBI control, and EA-treated. The animals in the sham-operated group underwent a sham operation, those in the TBI control group were subjected to TBI, but not EA, and those in the EA group were treated with EA for 60 min immediately after TBI, daily for 3 consecutive days. EA was applied at the acupuncture points GV20, GV26, LI4, and KI1, using a dense-dispersed wave, at frequencies of 0.2 and 1 Hz, and an amplitude of 1 mA. Cell infarction volume (TTC stain), neuronal apoptosis (markers: TUNEL and Caspase-3), activation of microglia (marker: Iba1) and astrocytes (marker: GFAP), and tumor necrosis factor (TNF)-α expression in the microglia and astrocytes were evaluated by immunofluorescence. Functional outcomes were assessed using the inclined plane test. All tests were performed 72 h after TBI. Results We found that TBI-induced loss of grasp strength, infarction volume, neuronal apoptosis, microglial and astrocyte activation, and TNF-α expression in activated microglia and astrocytes were significantly attenuated by EA treatment. Conclusions Treatment of TBI in the acute stage with EA for 60 min daily for 3 days could ameliorate neuroinflammation. This may thus represent a mechanism by which functional recovery can occur after TBI.
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Liao JC, Ho CH, Chiu HY, Wang YL, Kuo LC, Liu C, Wang JJ, Lim SW, Kuo JR. Physiotherapists working in clinics have increased risk for new-onset spine disorders: a 12-year population-based study. Medicine (Baltimore) 2016; 95:e4405. [PMID: 27512853 PMCID: PMC4985308 DOI: 10.1097/md.0000000000004405] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 06/18/2016] [Accepted: 06/21/2016] [Indexed: 11/30/2022] Open
Abstract
Health care professionals are known to have a high risk for work-related musculoskeletal disorders. However, the information on the risk of new-onset spine-related musculoskeletal disorders (SRMDs) in health care professionals is insufficient. This study aimed to investigate new-onset spine disorder associations among physical, occupational, and pharmacy health care professionals working in different workplaces.Taiwan's National Health Insurance Research Database for registered medical personnel claims from 2000 to 2011 was analyzed. An age- and sex-matched longitudinal cohort study of 7448 subjects (1682 physiotherapists, 1682 occupational therapists [OTs], and 3724 pharmacists) with or without new-onset spine disorders was conducted. The hazard ratios for the development of new-onset spine disorders were estimated among these 3 groups.The overall percentage of new-onset SRMD for physiotherapists is 32.12. The median time from obtaining a registered license to developing SRMD is 1.94 years. The log-rank test showed that physiotherapists have the least possibility of having a SRMD-free rate (P < 0.0001). The Cox model showed that physiotherapists have a higher risk of new-onset SRMD (hazard ratio: 1.65, 95% confidence interval: 1.48-1.84, P < 0.0001) compared with OTs and pharmacists. Physiotherapists working in clinics have a 2.40-fold increased risk of developing SRMD (95% confidence interval: 1.97-2.92, P < 0.0001) relative to OTs and pharmacists.This may be the first study regarding new-onset SRMD in physiotherapists based on a powerful nationwide population-based database. We conclude that working in clinics is a potential risk for new-onset SRMD in physiotherapists. Therefore, we suggest that physiotherapists should pay more attention to this issue to prevent the development of spine disorders.
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Affiliation(s)
| | - Chung-Han Ho
- Department of Medical Research, Chi Mei Medical Center
- Department of Hospital and Health Care Administration
- Department of Pharmacy, Chia Nan University of Pharmacy and Science
| | - Haw-Yen Chiu
- Department of Plastic Surgery, Chi Mei Medical Center
| | - Yu-Lin Wang
- Department of Rehabilitation, Chi Mei Medical Center
| | - Li-Chieh Kuo
- Department of Occupational Therapy, National Cheng Kung University
| | - Cheng Liu
- Department of Plastic Surgery, Chi Mei Medical Center
| | | | - Sher-Wei Lim
- Department of Neurosurgery, Chi Mei Hospital, Chiali
- Department of Nursing, Min-Hwei College of Health Care Management, Tainan City
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung City
| | - Jinn-Rung Kuo
- Department of Neurosurgery
- Department of Medical Research, Chi Mei Medical Center
- Departments of Biotechnology, Southern Taiwan University of Science and Technology, Tainan City, Taiwan
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Wang CC, Wee HY, Chio CC, Hu CY, Kuo JR. Effects of tamoxifen on traumatic brain injury-induced depression in male rats. Formosan Journal of Surgery 2016. [DOI: 10.1016/j.fjs.2015.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Wee HY, Ho CH, Liang FW, Hsieh KY, Wang CC, Wang JJ, Chio CC, Chang CH, Kuo JR. Increased risk of new-onset depression in patients with traumatic brain injury and hyperlipidemia: the important role of statin medications. J Clin Psychiatry 2016; 77:505-11. [PMID: 27035519 DOI: 10.4088/jcp.14m09749] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 03/26/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Depression is a common complication after traumatic brain injury (TBI). This study aimed to evaluate the risk of hyperlipidemia for new-onset depression after TBI and the role of statin medications using a longitudinal population database. METHOD A matched longitudinal cohort study of 3,792 subjects (1,264 TBI patients [ICD-9-CM code: 801-804 and 850-854] with preexisting hyperlipidemia [ICD-9-CM code: 272.0, 272.1, 272.2, 272.4] and 2,528 age- and sex-matched TBI patients without hyperlipidemia) was conducted using the Taiwan Longitudinal Health Insurance Database from January 2001 to December 2008. The incidence and hazard ratios (HRs) for the development of new-onset depression (ICD-9-CM code: 296.2X-296.3X, 300.4, and 311.X) after TBI were compared between the 2 groups. RESULTS The incidence rate of depression in TBI with preexisting hyperlipidemia was 136.61 per 10,000 person-years. TBI patients with preexisting hyperlipidemia had a 1.72-fold increased incidence rate ratio compared with those without hyperlipidemia (P = .0056). A Cox model showed hyperlipidemia to be an independent predictor of depression (HR = 1.61; 95% CI, 1.03-2.53). TBI patients with hyperlipidemia who were not treated with statins experienced a 1.95-fold incidence risk ratio (P = .0017) and higher risk of new-onset depression (HR = 1.61; 95% CI, 1.03-2.53) compared to TBI patients without hyperlipidemia. CONCLUSIONS Preexisting hyperlipidemia could be an independent predictor of new-onset depression in TBI patients, and TBI patients with preexisting hyperlipidemia who were not treated with statins presented a higher risk of new-onset depression than TBI patients without hyperlipidemia. Our findings may provide some insight into the important role of statin medications in the development of new-onset depression in patients with traumatic brain injury.
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Affiliation(s)
- Hsiao-Yue Wee
- Department of Neurosurgery, Chi-Mei Medical Center, Liouying, Tainan, Taiwan
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Cheng CY, Ho CH, Wang CC, Liang FW, Wang JJ, Chio CC, Chang CH, Kuo JR. One-Year Mortality after Traumatic Brain Injury in Liver Cirrhosis Patients--A Ten-Year Population-Based Study. Medicine (Baltimore) 2015; 94:e1468. [PMID: 26448001 PMCID: PMC4616736 DOI: 10.1097/md.0000000000001468] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 12/15/2022] Open
Abstract
This study investigated the 1-year mortality of patients who underwent brain surgery following traumatic brain injury (TBI) who also had alcoholic and/or nonalcoholic liver cirrhosis (LC) using a nationwide database in Taiwan. A longitudinal cohort study matched by propensity score with age, gender, length of ICU stay, HTN, DM, MI, stroke, HF, renal diseases, and year of TBI diagnosis in TBI patients with alcoholic and/or nonalcoholic LC and TBI patients without LC was conducted using the National Health Insurance Research Database in Taiwan between January 1997 and December 2007. The main outcome studied was 1-year mortality. In total, 7296 subjects (2432 TBI patients with LC and 4864 TBI patients without LC) were enrolled in this study. The main findings were (1) TBI patients with LC had a higher 1-year mortality (52.18% vs 30.61%) and a 1.75-fold increased risk of mortality (95% CI 1.61-1.90) compared with non-LC TBI patients, (2) renal diseases and HF are risk factors, but hypertension could be a protective factor in cirrhotic TBI patients, and (3) TBI patients with non-alcoholic LC and the coexistence of alcoholic and nonalcoholic LC had higher 1-year mortality compared with TBI patients with alcoholic cirrhosis. This study showed that patients with LC who have undergone brain surgery might have higher risk of 1-year mortality than those without LC. In addition, nonalcoholic and the coexistence of alcoholic and nonalcoholic LC show higher 1-year mortality risk than alcoholic in TBI patients with LC, especially in those with comorbidities of hypertension, diabetes mellitus, and stroke.
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Affiliation(s)
- Chieh-Yang Cheng
- From the Departments of Neurosurgery (C-YC, C-CW, C-CC, C-HC, J-RK); Medical Research, Chi-Mei Medical Center, Tainan, Taiwan (C-HH, J-JW, J-RK); Departments of Biotechnology (J-RK); ChildCare, Southern Taiwan University of Science and Technology, Tainan, Taiwan (C-CW); Departments of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan (F-WL); and Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan (C-HH)
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Abstract
Right lower quadrant pain after a lumbar discectomy is a rare condition. We report on a 29-year-old man who developed right lower quadrant pain 12 h after lumbar discectomy due to the formation and rupture of a right iliac artery pseudoaneurysm. The diagnostic laparoscopy was done under the impression of acute appendicitis but showed a retroperitoneal hematoma. An emergency abdominal computed tomography confirmed a right iliac artery pseudoaneurysm rupture. We performed a transarterial embolization with multiple metallic coils in the aneurysm cavity and connected the proximal and distal right internal iliac artery because his hemodynamics became progressively unstable. In this article, in addition to presenting the clinical course of an unusual case, we also wanted to emphasize that patients with right lower quadrant pain could be presenting an early sign of pseudoaneurysm formation and rupture after a lumbar discectomy.
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Affiliation(s)
- Hsiao-Yue Wee
- Department of Neurosurgery, Chi Mei Medical Center, Liouying, Taiwan
| | - Che-Chuan Wang
- Department of Neurosurgery, Chi Mei Medical Center, YongKang, Taiwan
| | - Jinn-Rung Kuo
- Department of Neurosurgery, Chi Mei Medical Center, YongKang, Taiwan ; Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
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Wu PJ, Chang MH, Huang CY, Wang YC, Kuo JR, Huang YJ, Lin BS. Near-infrared spectroscopy system for determining brain hemoglobin level. Annu Int Conf IEEE Eng Med Biol Soc 2015; 2013:2412-4. [PMID: 24110212 DOI: 10.1109/embc.2013.6610025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Traumatic brain injury (TBI) usually results from brain shaking or impact. It can affect the normal function of the brain and even cause people become disabled and death. However, there is lack of studies for the physiological changes of humans or animals under brain injury. In order to obtain the information of physiological state change, we designed and enforced a non-invasive, wireless multi-channel near-infrared spectroscopy (NIRS) for monitoring the concentration change of oxy-hemoglobin (HbO2), deoxy-hemoglobin (HbR) and total-hemoglobin (HbT) continuously during and after TBI. The experimental results indicated that the concentration change of HbO2 and HbT is significantly related to the impact strength and infarction volume. Thus, this system is easily used and stable for TBI study.
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Kuo JR, Lin SS, Liu J, Chen SH, Chio CC, Wang JJ, Liu JM. Deep brain light stimulation effects on glutamate and dopamine concentration. Biomed Opt Express 2015; 6:23-31. [PMID: 25657871 PMCID: PMC4317125 DOI: 10.1364/boe.6.000023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/12/2014] [Accepted: 11/14/2014] [Indexed: 06/04/2023]
Abstract
Compared to deep brain electrical stimulation, which has been applied to treating pathological brain diseases, little work has been done on the effect of deep brain light stimulation. A fiber-coupled laser stimulator at 840 nm wavelength and 130 Hz pulse repetition rate is developed in this work for deep brain light stimulation in a rat model. Concentration changes in glutamate and dopamine in the striatum are observed using a microdialysis probe when the subthalamic nucleus (STN) is stimulated at various optical power levels. Experimental results show that light stimulation causes the concentration of glutamate to decrease while that of dopamine is increased. This suggests that deep brain light stimulation of the STN is a promising therapeutic strategy for dopamine-related diseases such as Parkinson's disease. The stimulator developed for this work is useful for deep brain light stimulation in biomedical research.
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Affiliation(s)
- Jinn-Rung Kuo
- Departments of Neurosurgery, Chi-Mei Medical Center, Tainan,
Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan,
Taiwan
| | - Shih-Shian Lin
- Neurophotonics Laboratory, College of Photonics, National Chiao Tung University, Tainan,
Taiwan
| | - Janelle Liu
- Neuroscience Interdepartmental Program, University of California, Los Angeles, Los Angeles, CA,
USA
| | - Shih-How Chen
- Neurophotonics Laboratory, College of Photonics, National Chiao Tung University, Tainan,
Taiwan
| | - Chung-Chin Chio
- Departments of Neurosurgery, Chi-Mei Medical Center, Tainan,
Taiwan
| | - Jhi-Joung Wang
- Medical Research, Chi-Mei Medical Center, Tainan,
Taiwan
| | - Jia-Ming Liu
- Neurophotonics Laboratory, College of Photonics, National Chiao Tung University, Tainan,
Taiwan
- Department of Electrical Engineering, University of California, Los Angeles, Los Angeles, CA,
USA
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Wee HY, Kuo JR, Lee YL, Chen TJ, Lee YY. Low-grade astrocytoma presenting as brain stone. Formosan Journal of Surgery 2014. [DOI: 10.1016/j.fjs.2014.11.001] [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: 10/24/2022] Open
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Abstract
Near-infrared spectroscopy (NIRS) is a modern measuring technology in neuroscience. It can be used to noninvasively measure the relative concentrations of oxyhemoglobin (OxyHb) and deoxyhemoglobin (DeoHb), which can reflect information related to cerebral blood volume and cerebral oxygen saturation. Therefore, it has the potential for noninvasive monitoring of cerebral ischemia. However, there is still a lack of reliable physiological information on the relationship between the concentrations of OxyHb and DeoHb in cerebral blood and the exact hypoxic state of brain cells under cerebral ischemia. In this study, we describe a wireless multichannel NIRS system, which we designed to noninvasively monitor the relative concentrations of OxyHb and DeoHb in bilateral cerebral blood before, during, and after middle cerebral artery occlusion. By comparing the results with the lactate/pyruvate ratio measured by microdialysis, we investigated the correlation between the relative concentrations of OxyHb and DeoHb in cerebral blood and the hypoxic state of brain cells. The results showed that the relationship between the concentration changes of DeoHb in cerebral blood and the hypoxic state of brain cells was significant. Therefore, by monitoring the changes in concentrations of DeoHb, the wireless NIRS can be used to estimate the hypoxic state of brain cells indirectly.
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Ho CH, Hsieh KY, Liang FW, Li CJ, Wang JJ, Chio CC, Chang CH, Kuo JR. Pre-existing hyperlipidaemia increased the risk of new-onset anxiety disorders after traumatic brain injury: a 14-year population-based study. BMJ Open 2014; 4:e005269. [PMID: 25034630 PMCID: PMC4120375 DOI: 10.1136/bmjopen-2014-005269] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVES Anxiety disorders (ADs) are common after traumatic brain injury (TBI). However, the risk factors of new-onset ADs remain unclear. This study was aimed at evaluating the incidence and risk factors for new-onset ADs, including pre-existing hyperlipidaemia and three major comorbidities (diabetes mellitus, hypertension and cardiovascular disease), in patients with TBI. SETTING A matched cohort study was conducted using the Taiwan Longitudinal Health Insurance Database between January 1997 and December 2010. PARTICIPANTS A total of 3822 participants (1274 patients with TBI with hyperlipidaemia and 2548 age-matched and gender-matched patients with TBI without hyperlipidaemia). OUTCOME MEASURES The incidence and HRs for the development of new-onset ADs after TBI were compared between the two groups. RESULTS The overall incidence rate of new-onset ADs for patients with TBI with hyperlipidaemia is 142.03/10 000 person-years (PYs). Patients with TBI with hyperlipidaemia have a 1.60-fold incidence rate ratio (p<0.0001) and increased HR of ADs (1.58, 95% CI 1.24 to 2.02) compared with those without hyperlipidaemia. The incidence rates of ADs for males and females with hyperlipidaemia, respectively, were 142.12 and 292.32/10 000 PYs, which were higher than those without hyperlipidaemia (93.03 and 171.68/10 000 PYs, respectively). Stratified by age group, hyperlipidaemia is a risk factor of ADs for patients with TBI aged 65 years or younger. CONCLUSIONS Pre-existing hyperlipidaemia is an independent predictor of new-onset ADs in patients with TBI, even when controlling for other demographic and clinical variables. Female patients with pre-existing hyperlipidaemia had significantly higher risk of new-onset ADs than males, especially between the ages of 35 and 65 years.
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Affiliation(s)
- Chung-Han Ho
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kuang-Yang Hsieh
- Department of Psychiatry, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
| | - Fu-Wen Liang
- Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chia-Jung Li
- Department of Psychiatry, National Cheng-Kung University, Tainan, Taiwan
| | - Jhi-Joung Wang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chung-Ching Chio
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
| | - Chin-Hung Chang
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
| | - Jinn-Rung Kuo
- Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan
- Department of Biotechnology, Southern Taiwan University of Science and Technology, Tainan, Taiwan
- Department of Neurosurgery, Chi-Mei Medical Center, Tainan, Taiwan
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Tsai YT, Wang CC, Leung PO, Lin KC, Chio CC, Hu CY, Kuo JR. Extracellular signal–regulated kinase 1/2 is involved in a tamoxifen neuroprotective effect in a lateral fluid percussion injury rat model. J Surg Res 2014; 189:106-16. [DOI: 10.1016/j.jss.2014.02.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 12/20/2013] [Accepted: 02/11/2014] [Indexed: 12/13/2022]
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