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Wu FMW, Chen KW, Consigliere D, Chiong E. The show must go on: navigating through the urology residency exit examinations amidst COVID-19 in Singapore. Singapore Med J 2023:370788. [PMID: 36926739 DOI: 10.4103/singaporemedj.smj-2021-062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Fiona Mei Wen Wu
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - Kelven Weijing Chen
- Department of Urology, National University Hospital, National University Health System, Singapore
| | - David Consigliere
- Department of Urology, National University Hospital, National University Health System; Examinations Committee for Urology, Residency Advisory Committee (Urology), Joint Committee on Specialist Training, Ministry of Health, Singapore
| | - Edmund Chiong
- Department of Urology, National University Hospital, National University Health System; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore; Examinations Committee for Urology, Residency Advisory Committee (Urology), Joint Committee on Specialist Training, Ministry of Health, Singapore
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Chen KW, Pek G, Yufei Q, Toh PC, Kuek N, Lee JKC, Tan LGL, Tsang WC, Chiong E. Comparing outcomes of transperineal to transrectal prostate biopsies performed under local anaesthesia. BJUI Compass 2021; 3:197-204. [PMID: 35505694 PMCID: PMC9045583 DOI: 10.1002/bco2.112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/23/2021] [Indexed: 11/11/2022] Open
Abstract
Objectives Patients and methods Results Conclusion
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Affiliation(s)
| | - Gregory Pek
- Department of Urology National University Hospital Singapore
| | - Qiao Yufei
- Department of Urology National University Hospital Singapore
| | - Poh Choo Toh
- Department of Urology National University Hospital Singapore
| | - Nicholas Kuek
- Department of Urology National University Hospital Singapore
| | | | | | - Woon Chau Tsang
- Department of Urology National University Hospital Singapore
| | - Edmund Chiong
- Department of Urology National University Hospital Singapore
- Department of Surgery National University of Singapore Singapore
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Lee SH, Mahendran R, Tham SM, Thamboo TP, Chionh BJ, Lim YX, Tsang WC, Wu QH, Chia JY, Tay MHW, Goh BYS, Chen KW, Mallari JZ, Periaswami R, Raman L, Choo SN, Kioh DYQ, Chiong E, Esuvaranathan K, Chan ECY. Tryptophan-kynurenine ratio as a biomarker of bladder cancer. BJU Int 2020; 127:445-453. [PMID: 32794357 DOI: 10.1111/bju.15205] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To investigate plasma and urinary kynurenine (KYN)-tryptophan (TRP) ratios in bladder cancer, expression of indoleamine 2,3-dioxygenase 1 (IDO1) in relation to tryptophan 2,3-dioxygenase (TDO2) in bladder tumour, and the correlation of KYN-TRP ratio with bladder tumour burden. METHODS Metabotyping of the TRP-KYN metabolic axis was performed via a clinical case-control study. Expression of IDO1 and TDO2 was measured in human biopsied tissues. Correlational experiments between KYN-TRP ratio and bladder tumour were performed using a murine orthotopic prostate-specific antigen (PSA)-secreting MB49 bladder cancer model. RESULTS We established for the first time that plasma TRP level was significantly decreased, while both plasma and urinary KYN-TRP ratios were significantly higher in bladder cancer patients, and expression level of IDO1 but not TDO2 was increased in human bladder tumour. We reported the positive correlation between IDO1 expression, KYN-TRP ratio, normalized PSA to creatinine, and bladder tumour burden in the murine model. CONCLUSION Kynurenine-tryptophan ratio is a promising surveillance biomarker for bladder cancer, but would require further validation before clinical translation.
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Affiliation(s)
- Sze Han Lee
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Ratha Mahendran
- Department of Surgery, National University of Singapore, Singapore City, Singapore
| | - Sin Mun Tham
- Department of Surgery, National University of Singapore, Singapore City, Singapore
| | | | - Billy Jianhao Chionh
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Yi Xin Lim
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Woon Chau Tsang
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Qing Hui Wu
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Jun Yang Chia
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Melissa Hui Wen Tay
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Benjamin Yen Seow Goh
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Kelven Weijing Chen
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Jeane Zepeda Mallari
- Department of Pathology, National University Health System, Singapore City, Singapore
| | - Revathi Periaswami
- Department of Surgery, National University of Singapore, Singapore City, Singapore
| | - Lata Raman
- Department of Surgery, National University of Singapore, Singapore City, Singapore
| | - Shoa Nian Choo
- Department of Urology, National University Health System, Singapore City, Singapore
| | - Dorinda Yan Qin Kioh
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
| | - Edmund Chiong
- Department of Surgery, National University of Singapore, Singapore City, Singapore.,Department of Pathology, National University Health System, Singapore City, Singapore
| | - Kesavan Esuvaranathan
- Department of Surgery, National University of Singapore, Singapore City, Singapore.,Department of Pathology, National University Health System, Singapore City, Singapore
| | - Eric Chun Yong Chan
- Department of Pharmacy, National University of Singapore, Singapore City, Singapore
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Dun ZL, Trinh J, Li K, Lee M, Chen KW, Baumbach R, Hu YF, Wang YX, Choi ES, Shastry BS, Ramirez AP, Zhou HD. Magnetic Ground States of the Rare-Earth Tripod Kagome Lattice Mg_{2}RE_{3}Sb_{3}O_{14} (RE=Gd,Dy,Er). Phys Rev Lett 2016; 116:157201. [PMID: 27127982 DOI: 10.1103/physrevlett.116.157201] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Indexed: 06/05/2023]
Abstract
We present the structural and magnetic properties of a new compound family, Mg_{2}RE_{3}Sb_{3}O_{14} (RE=Gd,Dy,Er), with a hitherto unstudied frustrating lattice, the "tripod kagome" structure. Susceptibility (ac, dc) and specific heat exhibit features that are understood within a simple Luttinger-Tisza-type theory. For RE=Gd, we found long-ranged order (LRO) at 1.65 K, which is consistent with a 120° structure, demonstrating the importance of diople interactions for this 2D Heisenberg system. For RE=Dy, LRO at 0.37 K is related to the "kagome spin ice" physics for a 2D system. This result shows that the tripod kagome structure accelerates the transition to LRO predicted for the related pyrochlore systems. For RE=Er, two transitions, at 80 mK and 2.1 K are observed, suggesting the importance of quantum fluctuations for this putative XY system.
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Affiliation(s)
- Z L Dun
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996-1200, USA
| | - J Trinh
- Department of Physics, University of California, Santa Cruz, California 95064, USA
| | - K Li
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, People's Republic of China
- Center for High Pressure Science and Technology Advanced Research, Beijing 100094, People's Republic of China
| | - M Lee
- Department of Physics, Florida State University, Tallahassee, Florida 32306-3016, USA
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310-3706, USA
| | - K W Chen
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310-3706, USA
| | - R Baumbach
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310-3706, USA
| | - Y F Hu
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, People's Republic of China
| | - Y X Wang
- Beijing National Laboratory for Molecular Sciences, State Key Laboratory of Rare Earth Materials Chemistry and Applications, College of Chemistry and Molecular Engineering, Peking University, Beijing 100871, People's Republic of China
| | - E S Choi
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310-3706, USA
| | - B S Shastry
- Department of Physics, University of California, Santa Cruz, California 95064, USA
| | - A P Ramirez
- Department of Physics, University of California, Santa Cruz, California 95064, USA
| | - H D Zhou
- Department of Physics and Astronomy, University of Tennessee, Knoxville, Tennessee 37996-1200, USA
- National High Magnetic Field Laboratory, Florida State University, Tallahassee, Florida 32310-3706, USA
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Fu HCH, Lie CWH, Ng TP, Chen KW, Tse CY, Wong WH. Prospective study on the effects of orthotic treatment for medial knee osteoarthritis in Chinese patients: clinical outcome and gait analysis. Hong Kong Med J 2015; 21:98-106. [PMID: 25756275 DOI: 10.12809/hkmj144311] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of various orthotic treatments for patients with isolated medial compartment osteoarthritis. DESIGN Prospective cohort study with sequential interventions. SETTING University-affiliated hospital, Hong Kong. PATIENTS From December 2010 to November 2011, 10 patients with medial knee osteoarthritis were referred by orthopaedic surgeons for orthotic treatment. All patients were sequentially treated with flat insole, lateral-wedged insole, lateral-wedged insole with subtalar strap, lateral-wedged insole with arch support, valgus knee brace, and valgus knee brace with lateral-wedged insole with arch support for 4 weeks with no treatment break. Three-dimensional gait analysis and questionnaires were completed after each orthotic treatment. MAIN OUTCOME MEASURES The Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analogue scale scores, and peak and mean knee adduction moments. RESULTS Compared with pretreatment, the lateral-wedged insole, lateral-wedged insole with arch support, and valgus knee brace groups demonstrated significant reductions in WOMAC pain score (19.1%, P=0.04; 18.2%, P=0.04; and 20.4%, P=0.02, respectively). The lateral-wedged insole with arch support group showed the greatest reduction in visual analogue scale score compared with pretreatment at 24.1% (P=0.004). Addition of a subtalar strap to lateral-wedged insoles (lateral-wedged insole with subtalar strap) did not produce significant benefit when compared with the lateral-wedged insole alone. The valgus knee brace with lateral-wedged insole with arch support group demonstrated an additive effect with a statistically significant reduction in WOMAC total score (-26.7%, P=0.01). Compliance with treatment for the isolated insole groups were all over 90%, but compliance for the valgus knee brace-associated groups was only around 50%. Gait analysis indicated statistically significant reductions in peak and mean knee adduction moments in all orthotic groups when compared with a flat insole. CONCLUSIONS These results support the use of orthotic treatment for early medial compartment knee osteoarthritis.
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Affiliation(s)
- Henry C H Fu
- Department of Orthopaedics and Traumatology, Queen Mary Hospital, Pokfulam, Hong Kong
| | - Chester W H Lie
- Department of Orthopaedics and Traumatology, Kwong Wah Hospital, Yaumatei, Hong Kong
| | - T P Ng
- Private Practice, Hong Kong
| | - K W Chen
- Department of Prosthetics and Orthotics, Queen Mary Hospital, Pokfulam, Hong Kong
| | - C Y Tse
- Department of Prosthetics and Orthotics, Queen Mary Hospital, Pokfulam, Hong Kong
| | - W H Wong
- Department of Prosthetics and Orthotics, Queen Mary Hospital, Pokfulam, Hong Kong
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Zhang HT, Sun ZY, Zhu XY, Chen KW, Qian ZL, Yang HL. Kyphoplasty for the Treatment of Very Severe Osteoporotic Vertebral Compression Fracture. J Int Med Res 2012; 40:2394-400. [PMID: 23321197 DOI: 10.1177/030006051204000638] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: A retrospective evaluation of the clinical outcome and technical feasibility of kyphoplasty for the treatment of very severe osteoporotic vertebral compression fracture (vsOVCF). Methods: Patients with vsOVCF were treated with kyphoplasty and followed-up for 1 year. Vertebral body height variation, kyphotic angle, back pain (visual analogue scale [VAS]) and Oswestry disability index (ODI) were evaluated preoperatively, postoperatively, 1 month, 3 months and 1 year after treatment. Results: In total, 35 patients (49 vertebrae) were treated with kyphoplasty. There were no cases of spinal or extraspinal injury, infection, bleeding, pulmonary embolism, epidural cement leakage, stroke or cardiac arrest as a result of treatment. There were significant postoperative improvements in all outcome measures (vertebral body height variation, kyphotic angle, VAS and ODI); these improvements were maintained during the follow-up period. Conclusion: Kyphoplasty is an effective and minimally invasive procedure for the treatment of vsOVCF.
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Affiliation(s)
- HT Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - ZY Sun
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - XY Zhu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - KW Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - ZL Qian
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - HL Yang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
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Zhu LQ, Ding XY, Tao J, Wang JY, Zhang XJ, Wang XB, Hu Y, Li HF, Chen KW, Zhu GQ. Identification of target cells for Goose parvovirus infection in the immune system organs. Acta Virol 2010; 54:211-5. [PMID: 20822314 DOI: 10.4149/av_2010_03_211] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Target cells for Goose parvovirus (GPV) in natural infection are still unknown. In this study, immune system organs namely the spleen, bone marrow, thymus, bursa of Fabricius, and blood of experimentally GPV-infected goslings were examined by an immunoassay and flow cytometry for the presence of viral antigen and by a PCR for viral genome. The results indicated that the virus replicated in some cells of the spleen and bone marrow, but not in peripheral blood lymphocytes (PBLs). These data suggested that some cell populations in the spleen and bone marrow were targets for GPV infection. In addition, the immunoassay used for the detection of GPV was found comparable with a PCR in reliability and sensitivity.
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Affiliation(s)
- L Q Zhu
- College of Veterinary Medicine, Yangzhou University, Yangzhou, P. R. China
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Abstract
1. The objective of this study was to investigate the effect of ADSL gene, GARS-AIRS-GART gene and their combination genotype on inosine monophosphate content (IMP) in chicken. 2. The chicken breeds used for this study were Recessive White chicken (RW, Jiang-13 strain of white Plymouth Rock) and preserved population of 4 Chinese native chicken breeds, including Silkies, Baier, Tibetan and Xiaoshan. 3. The primers for exon 2 in ADSL gene and 5'UTR region in GARS-AIRS-GART gene were designed and the single nucleotide polymorphisms (SNPs) were detected by PCR-SSCP and DNA sequencing. 4. Two SNPs were detected, C/T substitution at position 3484 in exon 2 of ADSL gene, which was a silent mutation, and C/T point mutation at position -179 in 5'UTR region of GARS-AIRS-GART gene. In ADSL gene, individuals with TT genotype had significantly higher IMP content than CT and CC genotype individuals. No significant difference was observed between CT and CC genotypes. Similar results were obtained for GARS-AIRS-GART gene. The combination of genotypes ADSL and GARS-AIRS-GART genes also had a significant effect on IMP content. Individuals with TTTT genotype had the highest muscle IMP content, while individuals with CCCT genotype had the lowest. 4. We putatively drew the conclusion that the SNPs in these two genes, as well as the combination genotypes, could be used as potential molecular markers for meat quality in chicken.
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Affiliation(s)
- J T Shu
- Institute of Poultry Science, Chinese Academy of Agricultural Sciences, Yangzhou, 225009, Jiangsu, PR China
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Li HF, Han W, Zhu YF, Shu JT, Zhang XY, Chen KW. Analysis of genetic structure and relationship among nine indigenous Chinese chicken populations by the Structure program. J Genet 2009; 88:197-203. [PMID: 19700858 DOI: 10.1007/s12041-009-0028-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The multi-locus model-based clustering method Structure program was used to infer the genetic structure of nine indigenous Chinese chicken (Gallus gallus) populations based on 16 microsatellite markers. Twenty runs were carried out at each chosen value of predefined cluster numbers (K) under admixture model. The Structure program properly inferred the presence of genetic structure with 0.999 probabilities. The genetic structure not only indicated that the nine kinds of chicken populations were defined actually by their locations, phenotypes or culture, but also reflected the underlying genetic variations. At K = 2, nine chicken populations were divided into two main clusters, one light-body type, including Chahua chicken (CHA), Tibet chicken (TIB), Xianju chicken (XIA), Gushi chicken (GUS) and Baier chicken (BAI); and the other heavy-body type, including Beijing You chicken (YOU), Xiaoshan chicken (XIA), Luyuan chicken (LUY) and Dagu chicken (DAG). GUS and DAG were divided into independent clusters respectively when K equaled 4, 5, or 6. XIA and BIA chicken, XIA and LUY chicken, TIB and CHA chicken still clustered together when K equaled 6, 7, and 8, respectively. These clustering results were consistent with the breeding directions of the nine chicken populations. The Structure program also identified migrants or admixed individuals. The admixed individuals were distributed in all the nine chicken populations, while migrants were only distributed in TIB, XIA and LUY populations. These results indicated that the clustering analysis using the Structure program might provide an accurate representation of the genetic relationship among the breeds.
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Affiliation(s)
- H F Li
- Institute of Poultry Science, Chinese Academy of Agricultural Science, Yangzhou 225003, People's Republic of China.
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Chen KW, Yang HL, Lu J, Liu JY, Chen XQ. Prognostic factors of sacral chordoma after surgical therapy: a study of 36 patients. Spinal Cord 2009; 48:166-71. [DOI: 10.1038/sc.2009.95] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Affiliation(s)
- M J Liou
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, Linkou, Taiwan
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Chen KW, Juang JH, Lin JD. Extreme insulin resistance syndrome. Chang Gung Med J 2001; 24:640-5. [PMID: 11771187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Congenital extreme insulin resistance syndrome has rarely been reported in Taiwan. In 1982, a girl of a consanguineous marriage was noted to have increased body hair, an enlarged clitoris, and acanthosis nigricans at birth. Two months later, she received an operation for bilateral polycystic evaries. She was found to have diabetes at 8 years old and was treated with insulin. In March 1999, she was referred to our clinic with growth retardation and poor glycemic control. She had a characteristic face with a saddle nose, broad mouth, large low-set ears, absence of subcutaneous fat, and deformed nails. Although a very high dose of insulin (> 10 IU/kg/day) was used, her glycemic control was very poor (HbA1c 13.8%). Pediatricians should remain alert for the manifestations of extreme insulin resistance.
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Affiliation(s)
- K W Chen
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital, 5, Fu-Shin Street, Kweishan, Taoyuan, 333, Taiwan, R.O.C.
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Yin L, Pu Y, Liu TY, Tung YH, Chen KW, Lin P. Genetic polymorphisms of NAD(P)H quinone oxidoreductase, CYP1A1 and microsomal epoxide hydrolase and lung cancer risk in Nanjing, China. Lung Cancer 2001; 33:133-41. [PMID: 11551408 DOI: 10.1016/s0169-5002(01)00182-9] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Genetic variations in metabolic activation or detoxification enzymes have been thought to contribute to individual differences in lung cancer susceptibility. Genetic polymorphisms of NAD(P)H quinone oxidoreductase (NQO1), cytochrome P4501A1 (CYP1A1) and microsomal epoxide hydrolase (HYL1) have been associated with increased lung cancer risk in Asian populations. In the present study, the possibility of an association of NQO1, CYP1A1 and HYL1 genetic polymorphisms with lung cancer was examined among residents in Nanjing, China. A total of 84 lung cancer patients and 84 control subjects were matched by age, gender, occupation and smoking status. No significant association was observed for these genetic polymorphisms with the overall incidence of lung cancer. When the groups were stratified according to smoking status, we found that smokers carrying the HYL1*2 allele had a higher relative risk for lung cancer Odds ratio ((OR), 5.66; 95% confidence interval (95% CI), 1.71-18.68). The association was also found with squamous cell carcinoma (OR, 3.23; 95% CI, 1.00-10.38). Our results suggest that HYL1*2 polymorphism might be a risk factor for smoking-associated lung cancer in China.
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Affiliation(s)
- L Yin
- School of Public Health, Southeast University, Nanjing, PR China
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Fujimoto WY, Bergstrom RW, Boyko EJ, Chen KW, Kahn SE, Leonetti DL, McNeely MJ, Newell LL, Shofer JB, Tsunehara CH, Wahl PW. Preventing diabetes--applying pathophysiological and epidemiological evidence. Br J Nutr 2000; 84 Suppl 2:S173-6. [PMID: 11242464 DOI: 10.1079/096582197388635] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This is a review of research carried out in Japanese Americans that points towards possible approaches to prevention of type 2 diabetes mellitus. The natural history of type 2 diabetes usually includes both insulin resistance and beta-cell dysfunction. Insulin secretion may compensate for insulin resistance. Alternatively, enhanced insulin sensitivity may mask an insulin secretory defect. Epidemiological data support the view that in the vast majority of cases of type 2 diabetes, insulin resistance is essential to the pathogenesis of hyperglycemia. Increased diabetes prevalence as ethnic groups migrate to more urban or westernized regions has been attributed to increased occurrence of insulin resistance. Research among Japanese Americans in Seattle, Washington, showed a higher prevalence of type 2 diabetes than in Japan, which suggested that factors associated with 'westernization' might be playing a role in bringing out underlying susceptibility to diabetes. Our research has shown that these impressions were correct and that the abnormalities that characterize the metabolic syndrome play a significant role. Due to increased intra-abdominal fat deposition, Japanese Americans were likely to be 'metabolically obese' despite relatively normal BMI. A diet higher in animal fat and lower levels of physical activity were risk factors leading to increased intra-abdominal fat deposition, insulin resistance, and diabetes. Information from epidemiological studies such as these may be used to determine whether diabetes may be prevented through changes in lifestyle or application of specific therapies targeted towards identified metabolic abnormalities.
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Affiliation(s)
- W Y Fujimoto
- Department of Medicine, University of Washington, Seattle, Washington 98195-6426, USA.
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Lee HL, Chen KW, Chi CH, Huang JJ, Tsai LM. Clinical presentations and prognostic factors of a glyphosate-surfactant herbicide intoxication: a review of 131 cases. Acad Emerg Med 2000; 7:906-10. [PMID: 10958131 DOI: 10.1111/j.1553-2712.2000.tb02069.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Suicide attempts with agricultural chemicals are common in southern Taiwan. Among them, glyphosate-surfactant herbicide (GlySH) intoxication has been encountered with increasing frequency. Although a number of reports have described the clinical course and outcomes following ingestion, predictors of serious complications and mortality have not been elucidated. The purpose of this study was to define predictors of serious complications and probable mortality. METHODS This was a retrospective study of 131 GlySH-intoxicated patients treated at the National Cheng Kung University Hospital from 1988 to 1995. Medical charts were reviewed and clinical and laboratory variables were abstracted, looking for predictors of mortality. RESULTS The most common symptoms included sore throat (79.5%), and nausea with or without vomiting (73.8%). The most common laboratory findings were leukocytosis (68.0%), low serum bicarbonate (48.1%), and acidosis (35.8%). Overall, 11 of 131 patients (8.4%) died; the mean +/- SEM time to death was 2.8 +/- 0.8 days after presentation. When comparing the clinical and laboratory characteristics among the survivor and fatality groups, significant differences were identified. Respiratory distress, pulmonary edema, respiratory distress necessitating intubation, shock (systolic blood pressure less than 90 mm Hg), altered consciousness, abnormal chest x-ray, renal failure necessitating hemodialysis, larger amount of ingestion (>200 mL), and hyperkalemia were predictors highly associated with poor outcomes and mortality. Using multiple logistic regression, three predictors were identified, which may predict mortality in severely intoxicated patients. CONCLUSIONS In managing patients who have larger amount of GlySH ingestion, airway protection, early detection of pulmonary edema, and prevention of further pulmonary damage and renal damage appear to be of critical importance.
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Affiliation(s)
- H L Lee
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
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Abstract
BACKGROUND Several experimental and clinical reports concerning endoscopic parathyroid surgery have appeared. However, reports concerning minimally invasive surgery for thyroid remains rare. Herein we present a new method, called video-assisted endoscopic thyroidectomy (VAET), for the management of various benign thyroid diseases. METHODS In all, 16 consecutive patients who underwent VAET for benign thyroid diseases were retrospectively studied. The study group included nodular hyperplasia in 8 patients, follicular adenoma in 6, and Hurthle's tumor and simple cyst in 1 each. A 2 to 3 cm transverse incision was made on the suprasternal notch. The wound was deepened to expose the underlying trachea from which the plane of the thyroid fascia was accessed directly, and the working space was established with lifting method using conventional instrument. All surgical procedures could be manipulated and monitored under laparoscopy without gas insufflation. The ultrasonically activated scalpel was the principal instrument used for VAET. RESULTS All 16 patients underwent VAET successfully without conversion to open thyroidectomy. The surgical procedures included lobectomy in 13 and extirpation in 3. The operation time ranged from 28 minutes to 5 hours (mean 1 hour, 42 minutes). For the 5 most recent cases, lobectomy took an average of 2 hours, whereas extirpation less than 40 minutes. The tumor size ranged from 3.5 cm to 8.0 cm (mean 5.8 cm). There were no surgical complications. All patients but 1 were discharged on postoperative day 2. During follow-up, all patients demonstrated euthyroid function and satisfactory cosmetic results. CONCLUSIONS VAET emerges as a promising minimally invasive surgical technique replacing conventional thyroidectomy for benign thyroid diseases in selected cases, with the advantage of satisfactory cosmetic results.
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Affiliation(s)
- T S Yeh
- Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Taipei, Taiwan
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17
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Abstract
The purpose of this study was to compare the morphological changes after Nd-YAG and CO2 laser irradiation on dentin surfaces with or without the smear layer. Eighty-one 3-mm-thick dentin specimens collected from the middle third of molar crowns were used. The dentin surfaces were ground to #320, #400, and #600 grit in series to create a smear layer. Half of the specimens were treated with 14% EDTA for 2 min to remove the smear layers. The lasers were applied on each specimen perpendicularly with 1-mm focus distance to the dentin surface for 4 s. The parameters for the Nd-YAG laser were 50 mJ, 100 mJ, and 150 mJ at 10 pps, 20 pps, and 30 pps, and for the CO2 laser were 2 W, 3 W, and 4 W at 5 ms x 20 pps, 10 ms x 10 pps, 20 ms x 20 pps, 50 ms x 2 pps, 100 ms x 2 pps, and 200 ms x 2 pps. The results showed that the Nd-YAG laser caused crater and melting of the dentin surface, especially in dentin specimens with smear layers. The CO2 laser produced extensive cracking lines on dentin surfaces with a smear layer, whereas surface erosion and crater formation were found on specimens without a smear layer. In conclusion, both the laser types and smear layer have a significant influence on the morphological changes of dentin surfaces irradiated by lasers.
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Affiliation(s)
- W H Lan
- Graduate Institute of Dental Sciences, College of Medicine, National Taiwan University, Taipei, Taiwan, Republic of China
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18
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Chou SC, Chen KW, Huang CC, Lin KD, Hwang JS, Lin JD. The effects of glurenorm on plasma glucose and lipids in patients with type 2 diabetes mellitus. Chang Gung Med J 2000; 23:480-4. [PMID: 11039250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
BACKGROUND The effects of sulfonylureas on plasma glucose, lipids, and macrovascular complications are of interest. This study was designed to investigate the effects of glurenorm on plasma glucose and lipids in patients with type 2 diabetes mellitus. METHODS Nineteen patients, 15 men and 4 women, with an age range of 38-69 years, and with type 2 diabetes mellitus, were studied. Plasma glucose, glycated hemoglobin, and lipids were compared before and 3 months after glurenorm treatment. RESULTS Fasting and postprandial plasma glucose, and HbA1c significantly improved after 3 months of glurenorm treatment. The mean (+/- SD) triglyceride level of 10 patients with mild to moderate hypertriglyceridemia decreased from 279 +/- 66 to 219 +/- 100 mg/dl (p = 0.054). The total cholesterol, low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) of 14 hypercholesterolemic patients did not change significantly. Their mean body weight increased significantly from 65.7 +/- 9.6 to 67.2 +/- 9.9 kg (p = 0.002). CONCLUSION Glurenorm was effective for glycemic control but caused weight gain in type 2 diabetic patients. Triglycerides in hypertriglyceridemic patients, and total cholesterol, LDL-C, and HDL-C in hypercholesterolemic patients did not improve after glurenorm treatment.
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Affiliation(s)
- S C Chou
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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19
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Huang JJ, Huang CJ, Ruaan MK, Chen KW, Yen TS, Sheu BS. Diagnostic efficacy of (13)C-urea breath test for Helicobacter pylori infection in hemodialysis patients. Am J Kidney Dis 2000; 36:124-9. [PMID: 10873881 DOI: 10.1053/ajkd.2000.8284] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The noninvasive urea breath test (UBT) avoids the discomforts and risks of invasive endoscopic methods of Helicobacter pylori detection. This study investigated the diagnostic efficacy of carbon 13 ((13)C)-labeled UBT for H pylori detection in 70 patients with end-stage renal disease (ESRD) undergoing hemodialysis (HD) and 70 dyspeptic controls without renal impairment. With H pylori infection defined as a positive result on either histological examination or culture of gastric biopsy specimen, we evaluated the reliability of the (13)C-UBT in detecting H pylori infection in both groups. To ascertain whether HD therapy affects the diagnostic efficacy of the UBT, the test was performed twice in patients with ESRD (before and after HD) at least 72 hours apart. In each UBT session, the baseline, 10-minute, and 15-minute (Delta15) gas samples were obtained to analyze excess (13)CO(2)/(12)CO(2) ratio (ECR). Histological stain and/or culture studies found that 33 of the patients with ESRD (47. 1%) and 42 of the control patients (60%) had H pylori infection. (13)C-UBT for H pylori detection in patients with ESRD was found to be only 93.8% sensitive and 85.3% specific. These results were achieved by gas sampling (Delta15) after HD therapy with a cutoff ECR value greater than 5. Conversely, the UBT in the control group achieved the greatest diagnostic efficacy (sensitivity, 97.6%; specificity, 96.4%) with a comparatively lower ECR cutoff value of 4. We conclude that the diagnostic accuracy for H pylori detection in patients with ESRD could be improved by performing (13)C-UBT (Delta15) after HD therapy and assessing the UBT with a cutoff ECR value greater than 5. However, the diagnostic efficacy of the UBT for patients with ESRD remained less accurate than that for dyspeptic patients without renal impairment.
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Affiliation(s)
- J J Huang
- Department of Internal Medicine, Division of Nephrology, National Cheng Kung University Hospital, Tainan, Taiwan
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20
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Lin P, Wang SL, Wang HJ, Chen KW, Lee HS, Tsai KJ, Chen CY, Lee H. Association of CYP1A1 and microsomal epoxide hydrolase polymorphisms with lung squamous cell carcinoma. Br J Cancer 2000; 82:852-7. [PMID: 10732758 PMCID: PMC2374384 DOI: 10.1054/bjoc.1999.1011] [Citation(s) in RCA: 46] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Lung cancer is the leading cause of death among cancers in Taiwan. Although the etiology of lung cancer has yet to be defined, genetic variability in activities of metabolic enzymes has been correlated with lung cancer. In the present study, the possibility of association of CYP1A1 and microsomal epoxide hydrolase (HYL1) genetic polymorphisms with lung cancer was examined among 132 lung cancer patients and 259 controls in Taiwan. No significant association was observed for either CYP1A1 or HYL1 polymorphism alone and the overall incidence of lung cancer after adjusting for age, gender and smoking status. When cases were stratified according to histological type, there was significant association between CYP1A1*2A homozygote and squamous cell carcinoma (SCC) (odds ratio (OR) 2.86; 95% confidence interval (CI) 1.33-6.12). Similarly, the proportion of HYL1 genotypes corresponding to high or normal enzyme activities was higher in SCC than in controls (OR 1.96; 95% CI 1.04-3.70). A combination of susceptible CYP1A1 and HYL1 genotypes was found to be highly associated with lung cancer, especially with SCC (OR 6.76; 95% CI 2.29-19.10). Our results suggest that the combination of CYP1A1 and HYL1 polymorphisms is an important risk factor for lung SCC.
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Affiliation(s)
- P Lin
- Institute of Toxicology, Chung-Shan Medical and Dental College, Taiwan, Republic of China
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21
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Wang JY, Gong YC, Chen GH, Chen KW. [Studies of the correlations between DNA fingerprints and meat production traits in chickens]. Yi Chuan Xue Bao 1999; 26:324-8. [PMID: 10593020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
This study revealed correlations between DNA fingerprints (DFPs) and slaughter traits of SR92A male x Xiaoshan female hybrids with EAV (endogenous avian retroviral element) as the probe. In the DFP patterns, the band J with molecular weight of about 4 kilobasepairs correlated significantly with alive weight, dressing weight, semi-eviscerated weight, talon weight, breast muscle weight, head weight and thigh weight. The mean alive weight, dressing weight, semi-eviscerated weight and breast muscle weight are 280 g (28.57%), 225 g (28.87%), 216 g (28.76%) and 16.71 g (54.00%) higher respectively in individuals without band J than in those with band J. With the following formula: delta W = (XJ(-) - XJ+) x N x FJ+, it was estimated that an addition of 165.2 kilograms of alive weight can be achieved in a hybrid population with size of 1,000 chickens established by selecting parents without band J.
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Affiliation(s)
- J Y Wang
- Animal Science and Veterinary Medicien College Yangzhou University, Yangzhou
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22
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Lin JD, Huang MJ, Juang JH, Chao TC, Huang BY, Chen KW, Chen JY, Li KL, Chen JF, Ho YS. Factors related to the survival of papillary and follicular thyroid carcinoma patients with distant metastases. Thyroid 1999; 9:1227-35. [PMID: 10646663 DOI: 10.1089/thy.1999.9.1227] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is limited clinical information comparing presentations and results of treatment of papillary and follicular thyroid carcinoma patients with distant metastases. We retrospectively analyzed data of 1,257 thyroid cancer patients who received their treatment and follow-up at Chang Gung Memorial Hospital. We found 992 patients with papillary carcinoma and 205 patients with follicular thyroid carcinoma. Of these, 68 patients with papillary thyroid carcinoma (6.9%) had distant metastases at the time of diagnosis or during the follow-up period. Of the follicular thyroid carcinoma patients, 69 (33.7%) had distant metastases. Of the 68 patients with papillary carcinoma, only 33 were categorized as stage IV at the time of diagnosis. Nine of the patients were categorized as clinical stage I carcinoma, 10 as stage II, and 16 as stage III. Sixteen patients (23.5%) died during the study period, all but 2 of thyroid cancer. Twelve of the 68 patients were disease-free after treatment. Of the 69 patients with follicular thyroid carcinoma, 58 were categorized as stage IV at the time of diagnosis. Six of the patients were categorized as clinical stage I carcinoma, 2 as stage II, and 3 as stage III at the time of diagnosis; all of these patients deteriorated to stage IV during the follow-up period. Of the 42 patients with follicular thyroid carcinoma involving bone, 24 presented with bone metastases during the initial diagnosis. After treatment, 25 of 69 patients with follicular carcinoma died of follicular carcinoma. Only 3 patients were disease-free after the treatment. In patients with follicular carcinoma, only tumor size was an important prognostic factor. In this study, 8 patients categorized as clinical stages I to III at the time of operation had thyroglobulin (Tg) levels less than 5 ng/mL and developed distant metastases during the follow-up period. In conclusion, at diagnosis a large group of Asian patients with metastatic well-differentiated thyroid cancer was more likely to have follicular than papillary histology, and that, as expected, metastases from follicular cancer were present earlier and more frequently, were more likely to involve bone, were more likely to be associated with mortality, and were linked to tumor size but not gender. Also unlike some other reports, treatment producing a low Tg did not always produce a good outcome. More aggressive surgical procedures may be able to improve outcomes.
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MESH Headings
- Adenocarcinoma, Follicular/blood
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/mortality
- Adenocarcinoma, Follicular/secondary
- Adult
- Bone Neoplasms/diagnosis
- Bone Neoplasms/secondary
- Carcinoma, Papillary/blood
- Carcinoma, Papillary/diagnosis
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/pathology
- Carcinoma, Papillary/secondary
- Female
- Follow-Up Studies
- Humans
- Magnetic Resonance Imaging
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Retrospective Studies
- Thyroglobulin/blood
- Thyroid Neoplasms/blood
- Thyroid Neoplasms/mortality
- Thyroid Neoplasms/pathology
- Tomography, X-Ray Computed
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Affiliation(s)
- J D Lin
- Department of Internal Medicine, Chang Gung Memorial Hospital, Chang Gung University, Taiwan, ROC.
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Fujimoto WY, Bergstrom RW, Boyko EJ, Chen KW, Leonetti DL, Newell-Morris L, Shofer JB, Wahl PW. Visceral adiposity and incident coronary heart disease in Japanese-American men. The 10-year follow-up results of the Seattle Japanese-American Community Diabetes Study. Diabetes Care 1999; 22:1808-12. [PMID: 10546012 DOI: 10.2337/diacare.22.11.1808] [Citation(s) in RCA: 237] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify risk factors for incident coronary heart disease (CHD). RESEARCH DESIGN AND METHODS A total of 175 Japanese-American men without CHD were followed for up to 10 years. Baseline variables were blood pressure, weight, BMI, fat areas by computed tomography, skinfold thicknesses, abdominal circumference, plasma insulin, C-peptide, cholesterol, LDL cholesterol, HDL cholesterol, HDL2 cholesterol, and HDL3 cholesterol, triglycerides, apoproteins A1 and B, and diagnosis of diabetes and hypertension. CHD was diagnosed by electrocardiogram and clinical events. Logistic regression was used to estimate odds ratio. RESULTS There were 50 incident cases of CHD. Using univariate logistic regression analysis, significant risk factors were intra-abdominal fat (P = 0.0090), fasting glucose (P = 0.0002), 2-h glucose (P = 0.0008), fasting HDL cholesterol (P = 0.0086), fasting HDL2 cholesterol (P = 0.030), fasting HDL3 cholesterol (P = 0.018), fasting triglycerides (P = 0.013), systolic (P = 0.0007) and diastolic blood pressure (P = 0.0002), and presence of diabetes (P = 0.0023). Multiple logistic regression models adjusted for BMI and age showed that intra-abdominal fat accounted for the effects of HDL cholesterol or triglycerides. In a multiple logistic regression model that included intra-abdominal fat, all systolic blood pressure and fasting glucose were significant. Substituting diastolic blood pressure for systolic blood pressure and 2-h glucose or diabetes status for fasting glucose produced similar results. CONCLUSIONS Visceral adiposity, blood pressure, and plasma glucose are important independent risk factors for incident CHD in this population of diabetic and nondiabetic Japanese-American men.
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Affiliation(s)
- W Y Fujimoto
- Department of Medicine, University of Washington, Seattle 98195, USA.
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24
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Abstract
Cytochrome P4502E1 (CYP2E1) is involved in metabolic activation of carcinogenic nitrosamines, benzene and low molecular weight halogenated hydrocarbons. In this study, we assessed the association between CYP2E1 RsaI and DraI genetic polymorphisms and lung cancer in a Taiwanese population. The RsaI genotype distribution was significantly different between 119 lung cancer patients and 231 non-cancer controls. The homozygote variants of RsaI genotypes were more common in controls (6.9%) than in lung cancer patients (0.8%). The estimated odds ratio (OR) was 0.11 (95% confidence interval (CI), 0.01-0.87). After adjusting for age, sex, and smoking status, the OR was 0.12 (95%, CI, 0.02-0.95). This is the first observation of a positive association between this locus and lung cancer in an Asian population. No significant differences in CYP2E1 DraI genotype distributions were found between cases and controls. The results of this study indicate that CYP2E1 RsaI polymorphism, but not DraI polymorphism, may contribute to the development of lung cancer in Taiwan.
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Affiliation(s)
- S L Wang
- Departnent of Public Health, Chung-Shan Medical and Dental College, Taichung, Taiwan, ROC
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25
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Abstract
A stability study is usually conducted to ensure that a drug product can meet the approved specifications prior to its expiration dating period (shelf life). Several approaches for determination of drug shelf life assuming random batches have been proposed. In this paper, we examine sampling distributions of the estimated shelf lives proposed by Shao and Chow (1994, Biometrics 50, 753-763). An application to some stability data from the pharmaceutical industry is presented.
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Affiliation(s)
- Y Sun
- Department of Mathematics, University of North Carolina, Charlotte 28223, USA.
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26
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Chung MH, Chen KW, Chen JF, Lu WT, Sun JH, Lin JD. Identification of familial hypercholesterolemia in Taiwan: report of eleven cases. Changgeng Yi Xue Za Zhi 1999; 22:460-7. [PMID: 10584419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Familial hypercholesterolemia is associated with a very high risk of premature coronary heart disease. In order to identify cases of familial hypercholesterolemia in Taiwan, we screened the hyperlipidemic patients in our metabolic clinics. METHODS Hyperlipidemic patients were screened in the metabolic outpatient department and the cases which fulfilled the clinical criteria of definitive or possible familial hypercholesterolemia were further analyzed. Their clinical characteristics, including age, gender, physical findings, past history of coronary heart disease or cerebrovascular accident (CVA), family history, and lipid profiles before and after medical treatment, were reviewed. RESULTS Eight women and 3 men fulfilled the diagnostic criteria. The mean age at diagnosis was 51.1 +/- 11.9 years old. Tendon xanthomas were found in 5 patients with definitive familial hypercholesterolemia. Coronary heart disease was confirmed in one patient and old CVA was noted in another 2 patients. The mean total cholesterol level was 390.3 +/- 88.9 mg/dl and the mean low density lipoprotein-cholesterol (LDL-cholesterol) level was 309.6 +/- 89.9 mg/dl before treatment. After a mean treatment duration of 45.2 months, the mean total cholesterol level and LDL-cholesterol level were 326.8 +/- 87.8 mg/dl and 249.1 +/- 91.1 mg/dl, respectively. CONCLUSION Clinically diagnosed familial hypercholesterolemia indeed exists in Taiwan. As compared to other reports, the mean age at diagnosis in our series was older and the majority of patients were women. Most patients were not vigorously treated and the family members were not thoroughly screened. Adequate treatment of patients with familial hypercholesterolemia in clinical practice and screening their family members are crucial in preventing new or recurrent coronary heart disease.
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Affiliation(s)
- M H Chung
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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27
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Abstract
Hypotension is one of the most important predictors of mortality in sodium monofluoroacetate (SMFA) intoxication. This paper reports the hemodynamic response in one fatal and another survival case of SMFA intoxication. Despite correction of hypovolemia and with inotropic support, the patients remained in shock. Hemodynamic observations have provided evidence that shock after SMFA intoxication is due to diminished systemic vascular resistance and increased cardiac output. This is the first report in which such an invasive hemodynamic investigation has been recorded in a clinical case of SMFA intoxication.
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Affiliation(s)
- C H Chi
- Department of Emergency Medicine, National Cheng-Kung University Medical College and Hospital, Tainan City, Taiwan
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28
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Chang TL, Chen KW, Lee YD, Fan K. Determination of benzodiazepines in clinical serum samples: comparative evaluation of REMEDi system, aca analyzer, and conventional HPLC performance. J Clin Lab Anal 1999; 13:106-11. [PMID: 10323474 PMCID: PMC6807818] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
Emergency toxicology or drug screening in clinical settings requires rapid qualitative and quantitative analysis with acceptable levels of sensitivity and specificity. The aim of this study was to comparatively evaluate the performance of the multi-column HPLC-based REMEDi drug profiling system (Bio-Rad), the aca analyzer (Du Pont), and the bench standard conventional HPLC method in the identification of 12 clinically important benzodiazepines. In this study, the presence of benzodiazepines in 133 patients' serum samples were qualitatively and comparatively analyzed by these three procedures. Among these methods, 120 of 133 samples were identified as benzodiazepine-positive by conventional HPLC (90%); 127 by aca analyzer (95%); and 84 by REMEDi (63%). Detection sensitivity of REMEDi for most of the benzodiazepines was found satisfactory when concentrations were greater than 1.0 microg/mL. When benzodiazepine concentrations were in the ranges of 0.3-1.0 microg/mL, detection sensitivity became varied among the benzodiazepine family of drugs by REMEDi method. REMEDi procedure should not be considered as the method of choice for detection of benzodiazepines if expected concentration levels are below 0.3 microg/mL, with the exception of bromazepam. Conventional HPLC displayed the highest sensitivity and specificity for the detection of benzodiazepines. In our studies, 36 REMEDi-negative samples were positive by HPLC, although in 16 of the 36 REMEDi negative samples (13.3%), the presence of benzodiazepines was detected but only listed as candidates without positive identification of the individual compounds by REMEDi. In our series, however, there were no false positives by the REMEDi method whereas aca procedure showed 13 false positive results (9%) and 6 cases of false negative (4%). Our data indicate that the REMEDi procedure can be used on serum samples for rapid qualitative screening of clinically important high levels of benzodiazepines with high specificity. However, due to the relatively low sensitivity of REMEDi in samples with low benzodiazepine levels and relatively low specificity by aca, all samples should be further confirmed by conventional HPLC procedure.
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Affiliation(s)
- T L Chang
- Department of Pathology, National Cheng Kung University Hospital, Tainan, Taiwan, ROC.
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29
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Jeng JH, Chen KW, Lin CP, Chou HG, Lan WH. Ultrastructural changes of the tooth root surface by Nd:YAG laser irradiation followed by citric acid and tetracycline. J Formos Med Assoc 1999; 98:242-7. [PMID: 10389367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023] Open
Abstract
The neodymium:yttrium-aluminum-garnet (Nd:YAG) laser has been used for treatment of dentinal hypersensitivity, eradicating periodontal pathogens, and facilitating calculus removal. However, Nd:YAG laser irradiation exerts potentially harmful effects on the tooth root surface. The purpose of this study was to examine the ultrastructural changes of the tooth root surface caused by Nd:YAG laser irradiation, and to determine whether chemical and mechanical preparations can correct these ultrastructural changes. Eighteen tooth specimens (3 x 3 x 0.5 mm) with healthy root surfaces were prepared and irradiated with an Nd:YAG laser at various power densities. Root surfaces were irradiated at 100 mJ at 20 pulses per second (pps) for 2 seconds followed by the application of citric acid (pH 1.2) or tetracycline solution (100 mg/mL) for 3 and 5 minutes, respectively, or ultrasonic scaling for 5 strokes of 3 seconds per stroke. As observed with low-vacuum scanning electron microscopy, (Wet-SEM), Nd:YAG laser irradiation at 70 to 100 mJ, 20 pps for 2 seconds caused surface cratering, areas of porosity, pitting, fissures, and lava-like structures in an area 140 to 280 microns in diameter. Irradiation of 50 mJ, 20 pps for 2 seconds, led to only mild surface charring. No evidence of morphologic changes was found when root surfaces were irradiated with the Nd:YAG laser at 20 mJ, 20 pps for 2 seconds or at 50 mJ, 10 pps for 8 seconds. The laser-induced lava-like structures were partially detached by citric acid (pH 1.2) etching and ultrasonic scaling, but not by tetracycline (100 mg/mL). These results indicate that chemical and mechanical preparations can be used effectively in conjunction with Nd:YAG laser irradiation for root surface preparation during both nonsurgical and surgical periodontal treatments.
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Affiliation(s)
- J H Jeng
- Graduate Institute of Clinical Dental Science, College of Medicine, National Taiwan University, Taipei
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30
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Abstract
BACKGROUND Acute pesticide poisoning is a major cause of morbidity and mortality in Taiwan and herbicides are most frequently implicated. Imazapyr [2-(4-isopropyl-4-methyl-5-oxo-2 imidazoline-2-yl)nicotinic acid] is a new herbicide, recently registered in Taiwan under the tradename "Arsenal" (Imazapyr 23.1%, Cyanamid Taiwan Corporation, Taipei). Imazapyr is also marketed as Assault, Chopper, Contain, and Pivot. To the best of our knowledge, there is no information in the literature concerning acute toxicity in humans after ingestion of herbicides containing this compound. METHOD Six cases of acute poisoning with Arsenal occurred during the period 1993-1997 in a single hospital. Emergency room records and medical charts were reviewed. RESULTS Of 6 cases, 5 were suicide attempts and 1 was an act of violence inflicted on a child. Three of the 6 patients (50%) presented with severe symptoms, including impairment of consciousness and respiratory distress requiring intubation. Other presentations included metabolic acidosis (2), hypotension (2), leukocytosis (3), fever (2), mild elevation of hepatic transaminase and creatinine (2), unconjugated hyperbilirubinemia (2), oral ulceration (2), pharyngolaryngitis (2), and chemical burns of the cornea (1). All cases had copious vomiting after ingestion of Arsenal. No mortality occurred. CONCLUSION According to our observations, it appeared the toxic syndrome that results from a large quantity (> 100 mL) of Arsenal herbicide ingestion consists of hypotension, pulmonary dysfunction, oral mucosal and gastrointestinal irritation, and transient liver and renal dysfunction. However, the existence of a dose-response relationship, with increasing amounts of ingestion resulting in more severe symptoms, needs further observation and studies that include a larger series.
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Affiliation(s)
- H L Lee
- National Cheng Kung University Hospital, Tainan, Taiwan, ROC
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Jong IC, Huang JJ, Lan RR, Wang MC, Tseng CC, Chen KW. Emphysematous pyelonephritis in two diabetic patients with complete uterine prolapse and cystocele. Nephrol Dial Transplant 1998; 13:3214-7. [PMID: 9870495 DOI: 10.1093/ndt/13.12.3214] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- I C Jong
- Department of Internal Medicine, Chia-Yi Christian Hospital, Taiwan, Republic of China
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Hsiue TR, Guo YL, Chen KW, Chen CW, Lee CH, Chang HY. Dose-response relationship and irreversible obstructive ventilatory defect in patients with consumption of Sauropus androgynus. Chest 1998; 113:71-6. [PMID: 9440571 DOI: 10.1378/chest.113.1.71] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
STUDY OBJECTIVES To determine the dose-response aspect of pulmonary function impairment in patients with consumption of Sauropus androgynus for weight reduction. METHODS A questionnaire and pulmonary function tests were performed in 194 patients with a history of consumption of S androgynus with or without chest symptoms. Patients with obstructive ventilatory defect received follow-up spirometry 22 to 24 months after beginning consumption of the vegetable. RESULTS Data from 178 patients were analyzed. Patients generally consumed 150 g of S androgynus daily as raw juice (60.7%), sauteed (16.9%), mixed preparation (20.8%), or boiled (1.7%) for various periods of time. We divided patients into five groups according to the total dose consumed (group A, 0 to 1,799 g; group B, 1,800 to 3,599 g; group C, 3,600 to 5,399 g; group D, 5,400 to 7,199 g; and group E, > or =7,200 g). The frequency of obstructive ventilatory defect was higher in the high-dose group than in the low-dose group (A, 4/43=9.3%; B, 13/64=20.3%; C, 14/32=43.8%; D, 5/12=41.7%; and E, 13/27=48.1%; p < 0.01). In total, 49 patients (27.5%) had moderate to severe obstructive ventilatory defects without bronchodilator response. The FEV1 and FEV1 percent predicted in these 49 patients were 0.96+/-0.38 L (mean+/-SD) and 41.8+/-16.9%, respectively. Sixty-five percent of these 49 patients began to suffer from dyspnea in the third, fourth, or fifth month after taking the vegetable and no patient began to develop dyspnea later than 7 months after beginning consumption of the vegetable. Using stepwise multiple regression, we found that the FEV1 percent predicted was negatively associated with the total dose ingested (r=0.24, p < 0.01). Follow-up spirometry showed that the obstructive ventilatory defect was irreversible in all patients. CONCLUSIONS Consumption of S androgynus can result in moderate to severe obstructive ventilatory defect within 7 months, and the disorder was irreversible in the observation period for 22 months.
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Affiliation(s)
- T R Hsiue
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan.
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Chen KW, Chow SC, Li G. A note on sample size determination for bioequivalence studies with high-order crossover designs. J Pharmacokinet Biopharm 1997; 25:753-65. [PMID: 9697082 DOI: 10.1023/a:1025738019069] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Similar to Liu and Chow, approximate formulas for sample size determination are derived based on Schuirmann's two one-sided tests procedure for bioequivalence studies for the additive and the multiplicative models under various higher order crossover designs for comparing two formulations of a drug product. The higher order crossover designs under study include Balaam's design, the two-sequence dual design, and two four-period designs (with two and four sequences), which are commonly used for assessment of bioequivalence between formulations. The derived formulas are simple enough to be carried out with a pocket calculator. The number of subjects required for each of the four higher order designs are tabulated for selected powers and various parameter values.
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Affiliation(s)
- K W Chen
- Department of Medical Affairs, Pasteur Mérieux Connaught, Swiftwater, Pennsylvania 18370, USA
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Lu WT, Chen KW, Lin JD, Huang HS, Lee CR, Huang RS. Ketoacidosis with hyperglycemia in heavy drinkers: a report of 12 cases. Changgeng Yi Xue Za Zhi 1997; 20:34-8. [PMID: 9178591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Heavy alcohol intake (> 45 g daily) might be a cause of diabetes. The short-term risks of heavy alcohol intake include ketoacidosis, glucose intolerance and pancreatitis. Alcoholic ketoacidosis (AKA) in combination with hyperglycemia mimics diabetic ketoacidosis (DKA). We described the characteristics of heavy drinkers with ketoacidosis and hyperglycemia but without a prior history of diabetes. METHODS Twelve habitually heavy drinkers who had not been previously diagnosed as diabetes were identified by reviewing the records of diabetic patients admitted to Chang Gung Memorial Hospital from 1989 to 1992. All of them met DKA criteria. RESULTS Elevated glycohemoglobulin (HbAlc) level is an indicator for the diagnosis of diabetes. Among these 12 patients, 10 had elevated levels of HbAlc and 2 had normal HbAlc levels. Of these 2 patients, 1 had an elevated level of HbAlc 6 months later; the other who was a female who after observation, had normal levels of HbAlc and glucose for the follow-up of two years. CONCLUSION We found that most heavy drinkers with both ketoacidosis and hyperglycemia also had diabetes as indicated by high levels of HbAlc. The only female patient had normal HbAlc and was diagnosed as AKA rather than DKA.
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Affiliation(s)
- W T Lu
- Department of Internal Medicine, Chang Gung Memorial Hospital, Taipei, Taiwan, R.O.C
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Chen KW, Shin JS, Chi CH, Cheng L. Seizure: a rare and transient cause of portal venous gas. Am J Gastroenterol 1997; 92:351-2. [PMID: 9040225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Gas in the hepatic portal venous system has been noted to be a complication of a wide range of intra-abdominal catastrophes that involve damage to bowel mucosa. We describe a patient who, after a seizure, was found to have portal venous gas on sonography and CT. The search for other possible causes revealed negative results. This case demonstrates a rare cause of hepatic portal venous gas that is self-resolving and clinically benign.
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Affiliation(s)
- K W Chen
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, Republic of China
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Chen MW, Huang JJ, Sung JM, Wang MC, Chen KW, Chen FF. [Acute uremic pericarditis presented as cardiac tamponade with acute ischemic hepatitis: a case report]. Changgeng Yi Xue Za Zhi 1996; 19:392-6. [PMID: 9041774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Pericarditis is a frequent and serious complication of chronic uremia. The uremic pericarditis can get much improvement by aggressive heparin-free hemodialysis therapy. However, the presenting symptoms and signs are too nonspecific to identify at early stage. Cardiac tamponade is the late and fatal complication, and need the immediate & adequate management. A 35-year-old female patient suffered from nausea, vomiting and right upper quadrant dull pain in November 1993, and was admitted to a local hospital. Uremia (BUN: 210 mg/dl, serum Cr.: 13.2 mg/dl) and abnormal liver function (SGOT: 330 IU/L, SGPT: 449 IU/L) were found, then she received regular hemodialysis therapy. About 10 days later, acute exacerbation of liver function (SGOT: 2,488 IU/L, SGPT: 1,048 IU/L), consciousness disturbance and hypotension occurred during hemodialysis. She was referred to our ER immediately. At ER, she had been on comatous, shock state with pulseless electric activity. After resuscitation and serial evaluation, cardiac tamponade was diagnosed. Emergent pericardiocentesis and then bilateral partial pericardiectomy were done about 2 hours later. The pericardial effusion was bloody without evidence of malignancy, bacterial or TB infection. The pathology of pericardium revealed chronic inflammation only. HBsAg, Anti-HCV Ab, and anti-HAV IgM were undetectable. So the etiology of acute hepatitis was diagnosed as ischemic hepatitis. Her general condition and vital sign became stable thereafter. The liver function also improved rapidly. She was discharged one month later and received maintainance hemodialysis therapy and no evidence of recurrence till now.
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Affiliation(s)
- M W Chen
- Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan, R.O.C
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Chi CH, Tsai MC, Chen KW, Wu MH. [119 emergency medical transport of the elderly]. Kaohsiung J Med Sci 1996; 12:699-706. [PMID: 9011128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
A retrospective analysis of emergency ambulance transports in the EMS-Tainan was made to evaluate the utilization of emergency medical system by the elderly and to determine the factors that may influence these transports. The study group consisted of 4,090 emergency ambulance transports from 1/1/1195 to 30/4/1995. 1,017 patients (24%) were aged over 65. The main characteristics of these elderly patients were as follows: more non-trauma cases, higher severity of triage, and longer total transport time (23.0 +/- 0.5 vs. 18.9 +/- 0.2 minutes) were noted. In addition, 136 (13.4%) of the elderly patients were not received by the EMS network hospital. The most important factors that affect the total transport time in the elderly group were triage classification and trauma, which determined that speed of transport. In the elderly group, female patients tend to be older, of more severe triage classification, more nontrauma-related, have longer total transport time, and have less access to the EMS than male patient. Based on these results, we recommended make efficient transport in order to provide better emergency care for the elderly. A network linking the elder users with EMS dispatch center should improve the efficiency in fulfilling the EMS calls, and further investigation about the value of such a network is warranted. It is also important to establish a competent and countrywide database for EMS users and to pursue ongoing planning in order to evaluate and investigate the needs of EMS for elderly patients in the future.
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Affiliation(s)
- C H Chi
- Department of Emergency Medicine, National Cheng Kung University, Medical College Hospital, Tainan, Taiwan, Republic of China
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Chen CW, Hsiue TR, Chen KW, Chang HY, Chen CR, Yang BC. Increased IL-5 and IL-10 transcription in bronchial cells after Sauropus androgynus ingestion. J Formos Med Assoc 1996; 95:699-702. [PMID: 8918059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
An outbreak of rapidly progressive obstructive lung disease in Taiwan was noted in some patients regularly ingesting the vegetable Sauropus androgynus because of its perceived weight reducing properties. Bronchoalveolar lavage (BAL) prior to administration of medication was performed in two women who had regularly ingested this vegetable and had developed obstructive ventilatory defects. Both patients showed a significant increase in neutrophils and, to a lesser extent, of eosinophils in the lavage fluid as compared to two unrelated controls. Interleukin (IL)-1 beta, IL-2, IL-5, IL-10, interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha in cells recovered from BAL fluid were analyzed by reverse transcription-polymerase chain reaction (RT-PCR). Augmented expression of the IL-10 gene was detected in only two patients who had regularly ingested S. androgynus. Our results suggest that altered cytokine expression and infiltration of eosinophils and neutrophils may be involved in the pathology of obstructive lung disease caused by regular ingestion of S. androgynus.
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Affiliation(s)
- C W Chen
- Department of Internal Medicine, National Cheng Kung University Medical Center, Tainan, Taiwan, ROC
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Abstract
The diagnostic value of C-reactive protein (CRP) was established in 143 patients with acute abdominal pain, 67 men and 76 women with mean age of 48 +/- 20 years old. Clinical and laboratory variables were collected after the patients' arrival at the emergency department. The attending clinicians did not consider the CRP value during the study period and did not use it for their management. When patients were grouped by final disposition, which was according to severity, only CRP and leukocyte count were identified as significant quantitative variables by multivariate analysis. CRP can detect the serious conditions, ie, in 79% of the hospitalized group, although specificity was 64%, the total accuracy was 73%. When elevated CRP was combined with leukocytosis, the diagnostic value was much improved, with specificity of 89% and positive predictive value of 88%. The sensitivity was improved to 90% when elevated CRP or leukocytosis was used. It is thus concluded that CRP is a helpful quantitative variable for disposition decision-making in patients with acute abdominal pain.
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Affiliation(s)
- C H Chi
- Department of Emergency Medicine, National Cheng Kung University and Hospital, Tainan, Taiwan
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Abstract
We report the first prenatal diagnosis of a case of congenital mesoblastic nephroma complicated by hydrops fetalis. Congenital mesoblastic nephroma is generally thought to be a benign disease but when complicated by hydrops fetalis it may be a potentially lethal condition.
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Affiliation(s)
- Y C Liu
- Department of Obstetrics and Gynecology, Provincial Tao-Yuan Hospital, Taiwan, Republic of China
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41
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Chen KW, Lee CJ, Huang HS, Lin JD, Huang BY, Huang MJ. Identification of malnutrition-related diabetes mellitus among hospitalized patients in Taiwan. J Formos Med Assoc 1996; 95:76-8. [PMID: 8640103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
A retrospective review of 1,089 diabetes mellitus admitted to the metabolic ward of Chang Gung Memorial Hospital was performed to screen for malnutrition-related diabetes mellitus (MRDM). None of the patients fulfilled the MRDM criteria, although 20 patients with a body mass index < or = 15 kg/m2 were further analyzed. These patients presented with poor glycemic control and most had associated chronic diseases. C-peptide levels were < 0.8 ng/mL in 17 patients and undetectable in six patients. Two patients experienced diabetic ketoacidosis (DKA). Insulin treatment was required by 18 patients with a mean (+/- SD) dosage of 30 +/- 9 U/day. During follow-up of 14 of the patients for 9.8 +/- 4.3 months, HbA1c decreased significantly. Their mean body weight and body mass index increased significantly from 36.6 +/- 4.6 kg to 47.2 +/- 6.2 kg and 13.9 +/- 0.9 to 18.0 +/- 1.9 kg/m2, respectively. Careful attention should be paid to diabetic control and associated chronic illness in patients with severe undernutrition.
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Affiliation(s)
- K W Chen
- Department of Internal Medicine, Chang Gung Medical College and Memorial Hospital, Taipei, Taiwan, ROC
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Lin TJ, Lu CC, Chen KW, Deng JF. Outbreak of obstructive ventilatory impairment associated with consumption of Sauropus androgynus vegetable. J Toxicol Clin Toxicol 1996; 34:1-8. [PMID: 8632498 DOI: 10.3109/15563659609020224] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Forty four individuals, suffering from temporary insomnia and poor appetite followed by progressive difficulty breathing after four weeks or more ingestion of the Sauropus androgynus or Sabah vegetable, were reported to the National Poison Center of Taiwan by physicians between August 23, 1994 and August 25, 1995. OBJECTIVE A telephone questionnaire survey was designed and conducted to collect demographic data, information about use of the vegetable, past medical history and clinical presentation. Laboratory data were obtained from their physicians as available. RESULTS Forty one patients, predominantly women, 43 +/- 11 years old, were identified in our survey. They reported a variety of sources and preparation methods for the vegetable. Difficulty breathing, identified in 36 cases, was the clinical hallmark. Twenty people gave a history of dyspnea delayed until 44 +/- 40 days after discontinuing vegetable consumption. Laboratory evidence of obstructive ventilatory impairment (FEV1/FVC 56 +/- 12%, FEV1 31 +/- 6%, PaO2 71 +/- 15%) was observed in 12 cases tested. An open lung biopsy performed in a demonstration case disclosed bronchiolitis obliterans organizing pneumonia. CONCLUSION In this case series of 41 victims, we have identified a severe pulmonary effect and hypothesize that it is related to consumption of sauropus androgynus vegetable. Papaverine has been previously identified in this vegetable but is unlikely to be responsible for the full range of toxicity seen.
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Affiliation(s)
- T J Lin
- Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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Chi CH, Chen KW, Chan SH, Wu MH, Huang JJ. Clinical presentation and prognostic factors in sodium monofluoroacetate intoxication. J Toxicol Clin Toxicol 1996; 34:707-12. [PMID: 8941201 DOI: 10.3109/15563659609013833] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND The diagnosis of sodium monofluoroacetate intoxication in humans is usually based on a history of ingestion and clinical findings. Although several previous reports have described the clinical course and outcome of patients who ingested this drug, prognostic indicators of short-term survival are not available. METHODS A retrospective study of 38 consecutive cases of sodium monofluoroacetate poisoning at the National Cheng Kung. University Hospital, 1988-1993, to analyze the clinical findings and to predict mortality. RESULTS Seven of 38 patients (18%) died. The most common symptom was nausea or vomiting (74%). The most frequent ECG finding was nonspecific ST-T and T wave abnormalities (72%). Hypocalcemia (42%) and hypokalemia (65%) were the common electrolyte abnormalities. The clinical and laboratory characteristics were compared for the survival and mortality groups. Significant differences in hypotension, respiratory rate, pulse rate, creatinine, potassium, elevated alanine aminotransferase, pH, PCO2, APACHE II score, and subjective respiratory distress were noted. Discriminant analysis identified hypotension, increased serum creatinine, and decreased pH as the most important predictors of mortality, with sensitivity of 86% and specificity of 96%. CONCLUSIONS Hypotension and the early onset of metabolic acidosis and increased serum creatinine are associated with poor short-term survival. These prognostic variables can be useful in the care of patients with suspected sodium monofluoroacetate intoxication. It is suggested that all such patients should be observed intensively for at least 48 h.
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Affiliation(s)
- C H Chi
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
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Chi CH, Chen KW, Huang JJ, Chuang YC, Wu MH. Gas composition in Clostridium septicum gas gangrene. J Formos Med Assoc 1995; 94:757-9. [PMID: 8541740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Clostridial gas gangrene (myonecrosis) is a rare but catastrophic condition that usually occurs in patients with underlying diseases. This paper reports a fatal case of spontaneous clostridial gas gangrene in a 60-year-old female diabetic patient. The composition of gas samples from the patient's damaged muscle was analyzed. The results showed 5.9% hydrogen, 3.4% carbon dioxide, 74.5% nitrogen and 16.1% oxygen. This gas composition supports the belief that such gas production occurs via glucose fermentation. This is the first time such an analysis has been performed in a clinical case of spontaneous clostridial gas gangrene.
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Affiliation(s)
- C H Chi
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
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Chen KW, Boyko EJ, Bergstrom RW, Leonetti DL, Newell-Morris L, Wahl PW, Fujimoto WY. Earlier appearance of impaired insulin secretion than of visceral adiposity in the pathogenesis of NIDDM. 5-Year follow-up of initially nondiabetic Japanese-American men. Diabetes Care 1995; 18:747-53. [PMID: 7555498 DOI: 10.2337/diacare.18.6.747] [Citation(s) in RCA: 109] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE--To identify risk factors for development of non-insulin-dependent diabetes mellitus (NIDDM) during a 5-year longitudinal follow-up of second-generation Japanese-American (Nisei) men. RESEARCH DESIGN AND METHODS--For 5 years, 137 initially nondiabetic Nisei men were followed with 75-g oral glucose tolerance tests at the initial visit and at 2.5- and 5-year follow-up visits. Body fat distribution was assessed by computed tomography (CT) and body mass index (BMI) calculated at each visit. Fasting insulin and C-peptide, the increment of insulin and C-peptide at 30 min after the oral glucose load, intra-abdominal and total subcutaneous fat by CT, and BMI were compared between those who remained nondiabetic (non-DM) and those who had developed NIDDM at 2.5 years (DM-A) and 5 years (DM-B). RESULTS--At baseline, the DM-A group had significantly increased intra-abdominal fat, elevated fasting plasma C-peptide, and lower C-peptide response at 30 min after oral glucose. At the 2.5-year follow-up, this group had markedly increased fasting plasma insulin and decreased 30-min insulin and C-peptide response to oral glucose. The DM-B group also had significantly lower insulin response at 30 min after oral glucose at baseline but no significant difference in intra-abdominal fat or fasting plasma insulin and C-peptide levels. When this group developed NIDDM by 5-year follow-up, however, an increase of intra-abdominal fat was found superimposed on the pre-existing lower insulin response. Fasting plasma insulin and C-peptide remained low. CONCLUSION--In DM-A, lower 30-min insulin response to oral glucose (an indicator of beta-cell lesion) and increased intra-abdominal fat and fasting C-peptide (indicators of insulin resistance) were the risk factors related to the development of NIDDM. DM-B subjects had a lower 30-min insulin response to oral glucose at baseline and increased intra-abdominal fat at 5-years, when they were found to have NIDDM. Thus, both insulin resistance and impaired beta-cell function contribute to the development of NIDDM in Japanese-Americans, and impaired beta-cell function may be present earlier than visceral adiposity in some who subsequently develop NIDDM.
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Affiliation(s)
- K W Chen
- Department of Medicine, University of Washington, Seattle 98195, USA
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Sheu BS, Lin CY, Chen KW, Chi CH, Chou NH, Lin XZ. Severe hepatocellular damage induced by chlormezanone overdose. Am J Gastroenterol 1995; 90:833-5. [PMID: 7733102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chlormezanone is a widely prescribed muscle relaxant (1-3) whose pharmacology is well known (4-6), but the clinical effect of overdose still remains relatively obscure (1, 7, 8). We here report a recent case of a patient who had severe liver function impairment and other associated findings typical of chlormezanone overdose. The ingested dose (at least 12 g) is much larger than those of previous record (1, 2, 7, 8); thus, her critical presentation deserves to be reviewed.
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Affiliation(s)
- B S Sheu
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
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Abstract
Reports of food poisoning caused by pesticide-contaminated food are rare in the medical literature. In this paper, we report six patients who suffered food poisoning in two separate episodes in which the pesticide coumaphos was apparently misused as a food flavoring. These six patients presented not only the general manifestations of gastroenteritis, but also some unusual extraintestinal symptoms. These included cholinergic overactivity (miosis, urinary incontinence and hypersalivation) that led us to suspect organophosphate intoxication. This diagnosis was confirmed by serial changes in RBC cholinesterase and pseudocholinesterase activity, and by the presence of coumaphos in the contaminated food. Of the six patients, one was dead on arrival. Another patient developed progressive respiratory failure and required mechanical ventilation. The mortality rate among our cases was 16.7%. Since the coumaphos was apparently added to food during cooking, its toxic effects do not appear to be mitigated by heating. When food poisoning cases present with both gastroenteritis and unusual autonomic symptoms, the autonomic syndromes will aid in the diagnosis and management of these critically ill patients.
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Affiliation(s)
- T C Fang
- Department of Emergency Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, R.O.C
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Abstract
Emphysematous pyelonephritis (EPN) is an uncommon but necrotizing renal infection due to gas-forming coliform bacteria that usually occurs in patients with diabetes mellitus and/or obstructive uropathy. Bilateral EPN is rarely seen and recurrent infection in different kidneys has never been reported in the literature. Here we present a female diabetic patient who experienced two episodes of EPN in different kidneys within 2.5 years, resulting in death eventually. We discuss the pathogenesis, incompatibility between clinical features and radiological findings of EPN, and the principle of management for this life-threatening infection.
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Affiliation(s)
- J J Huang
- Department of Internal Medicine, National Cheng Kung University Hospital, Taiwan R.O.C
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Shin JS, Chen KW, Lin XZ, Lin CY, Chang TT, Yang CC. Active, bleeding marginal ulcer of Billroth II gastric resection: a clinical experience of 18 patients. Am J Gastroenterol 1994; 89:1831-5. [PMID: 7942677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES From July 1988 to April 1993, 18 patients with active, marginal ulcer bleeding were investigated for their clinical presentation, endoscopic findings, and successful rate of therapeutic endoscopy. METHODS Through endoscopic survey, data on the ulcer number, ulcer location, and prevalence rate of each major stigmata of recent hemorrhage were obtained. Therapeutic methods used include heater probe thermocoagulation and local injection with diluted epinephrine (0.01%) or 95% alcohol through the endoscope. RESULTS All patients were male with a mean age of 65.3 years. Tarry stool passage (15/18; 83.3%) was the most common clinical presentation. Fifteen patients (15/18; 83.3%) had single marginal ulcer. Ulcerations were located in the jejunal site (12/18; 66.6%) and gastro-jejunal anastomosis (5/18; 27.7%). There were two patients with spurting artery, six with nonbleeding visible vessel, two with blood clot adhesion, four with oozing, three with visible vessel-associated oozing and three, with blood clot adhesion accompanying oozing. The rate of therapeutic endoscopy to successfully stop bleeding or prevent rebleeding was 94.4% (17/18). Sixteen cases (16/17) received one session of endoscopic therapy, and one patient (1/17) accepted two sessions. One patient with multiple underlying diseases died of persistent bleeding after three sessions of therapy. No complication was found to be related to the endoscopic procedure. CONCLUSIONS Marginal ulcer bleeding exhibits the same endoscopic findings as peptic ulcer hemorrhage. Most marginal ulcers are single and located at the saddle area of the jejunal site. Endoscopy can be useful in diagnosing marginal ulcer, and it is safe and effective in managing active marginal ulcer bleeding.
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Affiliation(s)
- J S Shin
- Department of Internal Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, ROC
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