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Chen YC, Malfertheiner P, Yu HT, Kuo CL, Chang YY, Meng FT, Wu YX, Hsiao JL, Chen MJ, Lin KP, Wu CY, Lin JT, O'Morain C, Megraud F, Lee WC, El-Omar EM, Wu MS, Liou JM. Global Prevalence of Helicobacter pylori Infection and Incidence of Gastric Cancer Between 1980 and 2022. Gastroenterology 2024; 166:605-619. [PMID: 38176660 DOI: 10.1053/j.gastro.2023.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/29/2023] [Accepted: 12/21/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND & AIMS We aimed to assess the secular trend of the global prevalence of Helicobacter pylori (H pylori) infection in adults and children/adolescents and to show its relation to that of gastric cancer incidence. METHODS We performed a systematic review and meta-analysis to calculate overall prevalence, adjusted by multivariate meta-regression analysis. The incidence rates of gastric cancer were derived from the Global Burden of Disease Study and Cancer Incidence in Five Continents. RESULTS Of the 16,976 articles screened, 1748 articles from 111 countries were eligible for analysis. The crude global prevalence of H pylori has reduced from 52.6% (95% confidence interval [CI], 49.6%-55.6%) before 1990 to 43.9% (95% CI, 42.3%-45.5%) in adults during 2015 through 2022, but was as still as high as 35.1% (95% CI, 30.5%-40.1%) in children and adolescents during 2015 through 2022. Secular trend and multivariate regression analyses showed that the global prevalence of H pylori has declined by 15.9% (95% CI, -20.5% to -11.3%) over the last 3 decades in adults, but not in children and adolescents. Significant reduction of H pylori prevalence was observed in adults in the Western Pacific, Southeast Asian, and African regions. However, H pylori prevalence was not significantly reduced in children and adolescents in any World Health Organization regions. The incidence of gastric cancer has decreased globally and in various countries where the prevalence of H pylori infection has declined. CONCLUSIONS The global prevalence of H pylori infection has declined during the last 3 decades in adults, but not in children and adolescents. The results raised the hypothesis that the public health drive to reduce the prevalence of H pylori as a strategy to reduce the incidence of gastric cancer in the population should be confirmed in large-scale clinical trials.
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Affiliation(s)
- Yi-Chu Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Peter Malfertheiner
- Medical Department II, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany; Medical Department Klinik of Gastroenterology, Hepatology and Infectiology, Otto-von-Guericke Universität, Magdeburg, Germany
| | - Hao-Ting Yu
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chih-Lin Kuo
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yung-Yueh Chang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Fan-Tsui Meng
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yu-Xuan Wu
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Juo-Lun Hsiao
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, Taiwan
| | - Mei-Jyh Chen
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Kun-Pei Lin
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chun-Ying Wu
- Institute of Biomedical Informatics, School of Medicine, National YangMing Chiao Tung University, Taipei, Taiwan; Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jaw-Town Lin
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, E-DA Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Colm O'Morain
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Francis Megraud
- INSERM U1312 BoRdeaux Institute of onCology (BRIC), University of Bordeaux, Bordeaux, France
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Emad M El-Omar
- UNSW Microbiome Research Centre, St George and Sutherland Clinical Campuses, School of Clinical Medicine, Faculty of Medicine and Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Ming-Shiang Wu
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jyh-Ming Liou
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Cancer Centre, Taipei, Taiwan.
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Wu NM, Chiang C, Lin KP, Chen YM, Yang WS. Muscle strength in ostensibly healthy non-diabetic subjects. J Formos Med Assoc 2023:S0929-6646(23)00444-8. [PMID: 37978027 DOI: 10.1016/j.jfma.2023.10.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 10/07/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023] Open
Abstract
BACKGROUND/PURPOSE Sarcopenia and decreased muscle strength (dynapenia) are emerging health issues. However, the study exploring muscle strength changes of both upper and lower limbs at the same time among all age groups is rare. This study aims to investigate the muscle strength and to establish a muscle strength norm of an ostensibly healthy non-diabetic Asian population. METHODS From 2018 June to 2020 March, subjects (aged from 20 to <80 years old) undergoing health checkup in Good Liver Medical Examination Center and National Taiwan University Hospital Geriatrics and Gerontology Department were enrolled. A battery of muscle power examinations including handgrip strength (HGS), five times sit-to-stand test (5TSTS), and one-leg standing test (OLST) were performed. RESULTS A total of 183 participants was enrolled, consisting of 92 females and 91 males. The finding shows the strongest HGS, best 5TSTS, and the longest OLST of both genders appeared in the 20-29-year-old group. Age, gender, and palm length are significantly related to HGS, whereas age is the only factor affecting 5TSTS and OLST. It revealed a progressive decline during ageing process, especially after age 60. Finally, Z-score and T-score norms of these were established. CONCLUSION These data will be useful as normal controls for muscle strength of specific disease groups. The application of the cutoffs from these data and their comparisons with the recommended cutoffs from various guidelines worth further exploration.
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Affiliation(s)
- Ney-Min Wu
- Good Liver Medical Examination Center, Good Liver Medical Foundation, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chieh Chiang
- Department of Mathematics, Tamkang University, New Taipei City, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Ming Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Division of Nephrology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Wei-Shiung Yang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Division of Endocrinology and Metabolism, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
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Tsai YC, Chen YM, Wen CJ, Wu MC, Chou YC, Chen JH, Lin KP, Chan DC, Lu FP. Multimorbidity and prior falls correlate with risk of 30-day hospital readmission in aged 80+: A prospective cohort study. J Formos Med Assoc 2023; 122:1111-1116. [PMID: 36990860 DOI: 10.1016/j.jfma.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 02/16/2023] [Accepted: 03/07/2023] [Indexed: 03/28/2023] Open
Abstract
BACKGROUND/PURPOSE Thirty-day hospital readmission rate significantly raised with advanced age. The performance of existing predictive models for readmission risk remained uncertain in the oldest population. We aimed to examine the effect of geriatric conditions and multimorbidity on readmission risk among older adults aged 80 and over. METHODS This prospective cohort study enrolled patients aged 80 and older discharged from a geriatric ward at a tertiary hospital, with phone follow-up for 12 months. Demographics, multimorbidity, and geriatric conditions were assessed before hospital discharge. Logistic regression models were conducted to analyse risk factors for 30-day readmission. RESULTS Patients readmitted had higher Charlson comorbidity index scores, and were more likely to have falls, frailty, and longer hospital stay, compared to those without 30-day readmission. Multivariate analysis revealed that higher Charlson comorbidity index score was associated with readmission risk. Older patients with a fall history within 12 months had a near 4-fold increase in readmission risk. Severe frailty status before index admission was associated with a higher 30-day readmission risk. Functional status at discharge was not associated with readmission risk. CONCLUSION In addition to multimorbidity, history of falls and frailty were associated with higher hospital readmission risk in the oldest.
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Affiliation(s)
- Yu-Chieh Tsai
- Department of Emergency Medicine, National Taiwan University Hospital Hsin-Chu Branch, Hsin-Chu, Taiwan
| | - Yung-Ming Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chiung-Jung Wen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meng-Chen Wu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Chou
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Feng-Ping Lu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
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Lin CY, Lin KP, Hsueh MC, Liao Y. Associations of accelerometer-measured sedentary behavior and physical activity with sleep in older adults. J Formos Med Assoc 2023:S0929-6646(23)00296-6. [PMID: 37586972 DOI: 10.1016/j.jfma.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 07/03/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Few studies have examined the non-linear relationships of objectively-measured sedentary behavior and physical activity with insomnia symptoms in older adults. We investigated such relationships of sedentary and physically-active behaviors with total sleep time and nocturnal wakefulness. METHODS We recruited adults aged 60 years and above who have received health check-ups or been to geriatric outpatient services from a hospital setting. Sedentary and physically-active behaviors, total sleep time, and wakefulness time after sleep onset were measured by Actigraphy, and their relationships were estimated using generalized additive models. RESULTS The 157 older adults receiving health-related services slept 7.5 h (20.8 min awake) on average per day. Total sleep time was negatively associated with sedentary and physically-active behaviors. By contrast, a U-shape relationship was found between sedentary behavior and wakefulness time after sleep onset, with a turning point at a daily sedentary time of 10.9 h. CONCLUSION Longer high-intensity physical activity time was related to a shorter wakefulness time after sleep onset. By contrast, daily sedentary time longer than 10.9 h was related to shorter total sleep time but more nocturnal wakefulness time. Future nonpharmacological strategies for sleep improvement should consider the sedentary threshold.
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Affiliation(s)
- Chien-Yu Lin
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
| | - Ming-Chun Hsueh
- Graduate Institute of Sport Pedagogy, University of Taipei, Taipei, Taiwan
| | - Yung Liao
- Faculty of Sport Sciences, Waseda University, Tokorozawa, Japan; Graduate Institute of Sport, Leisure and Hospitality Management, College of Sports and Recreation, National Taiwan Normal University, Taipei, Taiwan
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Lin KP, Li HY, Chen JH, Lu FP, Wen CJ, Chou YC, Wu MC, Derrick Chan DC, Chen YM. Prediction of adverse health outcomes using an electronic frailty index among nonfrail and prefrail community elders. BMC Geriatr 2023; 23:474. [PMID: 37550602 PMCID: PMC10408173 DOI: 10.1186/s12877-023-04160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 07/09/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Early recognition of older people at risk of undesirable clinical outcomes is vital in preventing future disabling conditions. Here, we report the prognostic performance of an electronic frailty index (eFI) in comparison with traditional tools among nonfrail and prefrail community-dwelling older adults. The study is to investigate the predictive utility of a deficit-accumulation eFI in community elders without overt frailty. METHODS Participants aged 65-80 years with a Clinical Frailty Scale of 1-3 points were recruited and followed for 2 years. The eFI score and Fried's frailty scale were determined by using a semiautomated platform of self-reported questionnaires and objective measurements which yielded cumulative deficits and physical phenotypes from 80 items of risk variables. Kaplan-Meier method and Cox proportional hazards regression were used to analyze the severity of frailty in relation to adverse outcomes of falls, emergency room (ER) visits and hospitalizations during 2 years' follow-up. RESULTS A total of 427 older adults were evaluated and dichotomized by the median FI score. Two hundred and sixty (60.9%) and 167 (39.1%) elders were stratified into the low- (eFI ≤ 0.075) and the high-risk (eFI > 0.075) groups, respectively. During the follow-up, 77 (47.0%) individuals developed adverse events in the high-risk group, compared with 79 (30.5%) in the low-risk group (x2, p = 0.0006). In multivariable models adjusted for age and sex, the increased risk of all three events combined in the high- vs. low-risk group remained significant (adjusted hazard ratio (aHR) = 3.08, 95% confidence interval (CI): 1.87-5.07). For individual adverse event, the aHRs were 2.20 (CI: 1.44-3.36) for falls; 1.67 (CI: 1.03-2.70) for ER visits; and 2.84 (CI: 1.73-4.67) for hospitalizations. Compared with the traditional tools, the eFI stratification (high- vs. low-risk) showed better predictive performance than either CFS rating (managing well vs. fit to very fit; not discriminative in hospitalizations) or Fried's scale (prefrail to frail vs. nonfrail; not discriminative in ER visits). CONCLUSION The eFI system is a useful frailty tool which effectively predicts the risk of adverse healthcare outcomes in nonfrail and/or prefrail older adults over a period of 2 years.
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Affiliation(s)
- Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Hsin-Yi Li
- School of Occupational Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Feng-Ping Lu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Chiung-Jung Wen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Chou
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Meng-Chen Wu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yung-Ming Chen
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
- Medical Department, National Taiwan University Hospital Bei-Hu Branch, No. 87, Neijiang St., Taipei, 108, Taiwan.
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Chang WN, Tzeng PL, Huang WJ, Lin YH, Lin KP, Wen CJ, Chou YC, Liao Y, Hsueh MC, Chan DC. Objective assessment of the association between frailty and sedentary behavior in older adults: a cross-sectional study. Eur Rev Aging Phys Act 2023; 20:14. [PMID: 37550620 PMCID: PMC10405382 DOI: 10.1186/s11556-023-00324-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 07/27/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Given the inconsistent findings of the association between frailty and sedentary behavior in older adults, this cross-sectional study investigated the aforementioned association using four different frailty criteria and two sedentary behavior indices in older adults. METHODS Data from older adults (age ≥ 65 y) who participated in health examinations or attended outpatient integrated clinics at a medical center in Taipei, Taiwan, were collected. Frailty was measured using the modified Fried Frailty Phenotype (mFFP), Clinical Frailty Scale in Chinese Translation (CFS-C), Study of Osteoporotic Fractures (SOF) index, and Clinical Frailty-Deficit Count (CF-DC) index; sedentary behavior was assessed with a waist-worn accelerometer. Adjusted linear regression ascertained the association between frailty and both sedentary behavior outcomes. RESULTS Among the 214 participants (mean age 80.82 ± 7.14 y), 116 were women. The average total sedentary time and number of sedentary bouts were 609.74 ± 79.29 min and 5.51 ± 2.09 times per day, respectively. Frail participants had a longer total sedentary time (odds ratio [OR]: 30.13, P = .01 and 39.43, P < .001) and more sedentary bouts (OR: 3.50 and 5.86, both P < .001) on mFFP and CFS-C assessments, respectively. The SOF index revealed more sedentary bouts among frail than in robust participants (OR: 2.06, P = .009), without a significant difference in the total sedentary time. Frail participants defined by the CF-DC index were more likely to have frequent sedentary bouts (OR: 2.03, P = .016), but did not have a longer total sedentary time. CONCLUSIONS Regardless of the frailty criteria adopted, frailty was positively associated with the number of sedentary bouts per day in older adults. A significant correlation between frailty and total sedentary time was detected only with mFFP and CFS-C indices. Further research may target decreasing the sedentary bouts in older adults as a strategy to improve frailty.
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Affiliation(s)
- Wen-Ning Chang
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
| | - Pei-Lin Tzeng
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
- Department of Health Promotion and Health Education, National Taiwan Normal University, No 162, Section 1, Heping E. Rd, Taipei, 106209, Taiwan
| | - Wei-Jia Huang
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
| | - Yu-Hung Lin
- Department of Health Promotion and Health Education, National Taiwan Normal University, No 162, Section 1, Heping E. Rd, Taipei, 106209, Taiwan
- National Taiwan University Hospital, Bei-Hu Branch, No. 87 Neijiang Street, Taipei, 108206, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
| | - Chiung-Jung Wen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
| | - Yi-Chun Chou
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
- Department of Family Medicine, College of Medicine, National Taiwan University, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan
| | - Yung Liao
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, No. 162, Section 1, Heping E. Rd, Taipei, 106209, Taiwan
| | - Ming-Chun Hsueh
- Graduate Institute of Sport Pedagogy, University of Taipei, No. 101, Sec. 2, Zhongcheng Rd, Taipei, 111036, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, No. 7, Chungshan S. Rd, Taipei, 100225, Taiwan.
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Lai TF, Liao Y, Hsueh MC, Lin KP, Chan DC, Chen YM, Wen CJ. Effect of isotemporal substitution of sedentary behavior with different intensities of physical activity on the muscle function of older adults in the context of a medical center. BMC Geriatr 2023; 23:130. [PMID: 36882730 PMCID: PMC9993594 DOI: 10.1186/s12877-023-03819-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND Engaging in physical activity and reducing sedentary time in daily life may enable older individuals to maintain muscle mass. This study aimed to investigate the effects of replacing sedentary behavior with light physical activity (LPA) or moderate-to-vigorous physical activity (MVPA) on the muscle function of older adults at a medical center in Taiwan. METHODS We recruited 141 older adults (51.1% men; 81.1 ± 6.9 years old) and asked them to wear a triaxial accelerometer on the waist to measure their sedentary behavior and physical activity. Functional performance was assessed based on handgrip strength, Timed Up and Go (TUG) test, gait speed, and five-times-sit-to-stand test (5XSST). Isotemporal substitution analysis was performed to examine the effect of substituting 60 min of sedentary time with 60 min of LPA, MVPA, and combined LPA and MVPA in different proportions. RESULTS Reallocating 60 min of sedentary behavior per day to LPA was associated with better handgrip strength (Beta [B] = 1.587, 95% confidence interval [CI] = 0.706, 2.468), TUG test findings (B = -1.415, 95% CI = -2.186, -0.643), and gait speed (B = 0.042, 95% CI = 0.007, 0.078). Reallocating 60 min of sedentary behavior per day to MVPA was associated with better gait speed (B = 0.105, 95% CI = 0.018, 0.193) and 5XSST findings (B = -0.060, 95% CI = -0.117, -0.003). In addition, each 5-min increment in MVPA in the total physical activity replacing 60 min of sedentary behavior per day resulted in greater gait speed. Replacing 60 min of sedentary behavior with 30-min of LPA and 30-min of MVPA per day significantly decreased the 5XSST test time. CONCLUSION Our study indicates that introducing LPA and a combination of LPA and MVPA to specifically replace sedentary behavior may help maintain muscle function in older adults.
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Affiliation(s)
- Ting-Fu Lai
- Department of Health Promotion and Health Education, National Taiwan Normal University, 162, Heping East Road Section 1, Taipei 106, Taipei, Taiwan
| | - Yung Liao
- Graduate Institute of Sport, Leisure and Hospitality Management, National Taiwan Normal University, General Building 6F.,129-1, Heping East Road Section 1, Taipei City 106, Taipei, Taiwan.,Graduate School of Sport Sciences, Waseda University, 2-579-15 Mikajima, 359-1192, Tokorozawa City, Japan
| | - Ming-Chun Hsueh
- Graduate Institute of Sport Pedagogy, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd., Shilin Dist, 11153, Taipei, Taiwan.,Master's Program of Transition and Leisure Education for Individuals with Disabilities, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd., Shilin Dist. 11153, Taipei, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, 100, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, 100, Taipei, Taiwan
| | - Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, 100, Taipei, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, 100, Taipei, Taiwan
| | - Yung-Ming Chen
- Department of Internal Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, 100, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Chiung-Jung Wen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, 100, Taipei, Taiwan. .,Department of Family Medicine, College of Medicine, National Taiwan University, No.1 Jen Ai Road Section 1, 100, Taipei, Taiwan.
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Chen MJ, Bair MJ, Chen PY, Lee JY, Yang TH, Fang YJ, Chen CC, Chang AT, Hsiao WD, Yu JJ, Kuo CC, Chiu MC, Lin KP, Tsai MH, Hsu YC, Chou CK, Chen CY, Lin JT, Lee YC, Wu MS, Liou JM. Declining trends of prevalence of Helicobacter pylori infection and incidence of gastric cancer in Taiwan: An updated cross-sectional survey and meta-analysis. Helicobacter 2022; 27:e12914. [PMID: 35848363 DOI: 10.1111/hel.12914] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 06/25/2022] [Accepted: 06/27/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND We aimed to assess the latest prevalence and secular trend of Helicobacter pylori infection and its association with the incidence and mortality of gastric cancer in Taiwan. MATERIALS AND METHODS Adults naive to H. pylori eradication received 13 C-urea breath test (13 C-UBT), H. pylori stool antigen test, and serology test during 2019-2020 in this prospective screening program. Children and adolescent aged between 7 and 19 years received 13 C-UBT for H. pylori screening. We also conducted a systematic review and meta-analysis to assess the secular trend of prevalence of H. pylori from 1990 to 2020 in Taiwan. The secular trends of age-standardized incidence and mortality of gastric cancer were obtained from the Taiwan Cancer Registry. RESULTS A total of 1494 participants were enrolled, including 294 children or adolescents and 1200 adults. The overall prevalence of active H. pylori infection by 13 C-UBT was 26.6% (397/1494), which was 30.8% in adults and 9.5% in adolescents/children. The age-standardized prevalence of active H. pylori infection was 32.3% in adults after adjustment of the population structure in Taiwan. Of the 29 studies including 38,597 subjects eligible for the meta-analysis, the pooled prevalence of H. pylori infection decreased from 63.8% (95% CI: 55.9%-71%) in 1990-2000 to 28.2% (95% CI:21.8%-35.6%) in 2016-2020. The age-standardized incidence and mortality of gastric cancer have also declined from 15.2 to 10.75 per 100,000, respectively, in 1999 to 9.29 and 5.4 per 100,000, respectively, in 2019. CONCLUSIONS The prevalence of H. pylori infection has declined in Taiwan, which correlates with the declining trends of age-standardized incidence and mortality of gastric cancer in Taiwan.
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Affiliation(s)
- Mei-Jyh Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Integrated Diagnostics and Therapeutics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Jong Bair
- Division of Gastroenterology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan.,Mackay Medical College, New Taipei City, Taiwan
| | - Po-Yueh Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Ji-Yuh Lee
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin, Taiwan
| | - Tsung-Hua Yang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin, Taiwan
| | - Yu-Jen Fang
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin, Taiwan
| | - Chieh-Chang Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - An-Ti Chang
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Wang-De Hsiao
- Division of Hepatogastroenterology, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Jian-Jyun Yu
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin, Taiwan
| | - Chia-Chi Kuo
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin, Taiwan
| | - Min-Chin Chiu
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin, Taiwan
| | - Kun-Pei Lin
- Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Min-Horn Tsai
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Hsin-Chu, Taiwan
| | - Yao-Chun Hsu
- Department of Internal Medicine, E-DA Hospital and I-Shou University, Kaohsiung, Taiwan
| | - Chu-Kuang Chou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Chi-Yi Chen
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Jaw-Town Lin
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Digestive Medicine Center, China Medical University Hospital, Taichung, Taiwan
| | - Yi-Chia Lee
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Ming-Shiang Wu
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Jyh-Ming Liou
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
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9
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Chou YC, Tsou HH, Chan DCD, Wen CJ, Lu FP, Lin KP, Wu MC, Chen YM, Chen JH. Validation of clinical frailty scale in Chinese translation. BMC Geriatr 2022; 22:604. [PMID: 35858829 PMCID: PMC9298166 DOI: 10.1186/s12877-022-03287-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 07/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Identification of frailty is crucial to guide patient care for the elderly. The Clinical Frailty Scale (CFS) is a reliable, synthesis and clinical judgment-based tool. However, a validated Chinese version of CFS (CFS-C) is lacking. The aim of this study is to describe the translation process of CFS into traditional Chinese and to evaluate its reliability and validity in a geriatric study population in Taiwan. METHODS This cross-sectional study recruited 221 geriatric outpatients aged 65 years or older at a medical center in Taipei, Taiwan. The Chinese version of CFS was produced following Brislin's translation model. Weighted kappa for agreement and Kendall's tau for correlation were used to assess inter-rater reliability (a subgroup of 52 outpatients) between geriatricians and one research assistant, and validity tests (221 outpatients) by comparing CFS-C with Fried frailty phenotype and Frailty Index based on Comprehensive Geriatric Assessment (FI-CGA). Correlation between CFS-C and other geriatric conditions were also assessed. RESULTS The inter-rater reliability revealed moderate agreement (weighted kappa = 0.60) and strong correlation (Kendall's tau = 0.67). For criterion validity, CFS-C categorisation showed fair agreement (weighted kappa = 0.37) and significant correlation (Kendall's tau = 0.46) with Fried frailty phenotype, and higher agreement (weighted kappa = 0.51) and correlation (Kendall's tau = 0.63) with FI-CGA categorisation. CFS-C was significantly correlated with various geriatric assessments, including functional disability, physical performance, hand grip, comorbidity, cognition, depression, and nutrition status. No significant correlation was found between CFS-C and appendicular muscle mass. CONCLUSIONS The CFS-C demonstrated acceptable validity and reliability in Chinese older adults in Taiwan. Development of CFS-C enhanced consistency and accuracy of frailty assessment, both in research and clinical practice.
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Affiliation(s)
- Yi-Chun Chou
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Hsiao-Hui Tsou
- Institute of Population Health Sciences, National Health Research Institutes, 35 Keyan Road, Zhunan, Miaoli County, 350, Taiwan
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Chiung-Jung Wen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Family Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Feng-Ping Lu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan
| | - Meng-Chen Wu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan.,Department of Neurology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan
| | - Yung-Ming Chen
- Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan.,Superintendent Office, National Taiwan University Hospital Bei-Hu Branch, No. 87, Neijiang Street, Taipei, 108, Taiwan
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, No.7, Chung Shan South Road, Taipei, 100, Taiwan. .,Department of Internal Medicine, College of Medicine, National Taiwan University, No.1, Jen Ai Road Section 1, Taipei, 100, Taiwan.
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10
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Tzeng PL, Lin CY, Lai TF, Huang WC, Pien E, Hsueh MC, Lin KP, Park JH, Liao Y. Daily lifestyle behaviors and risks of sarcopenia among older adults. Arch Public Health 2020; 78:113. [PMID: 33292561 PMCID: PMC7653864 DOI: 10.1186/s13690-020-00498-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 10/30/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Lifestyle behaviors are modifiable factors that can provide information for designing intervention strategies for sarcopenia. The present study aimed to identify the relationships between a range of daily lifestyle behaviors and sarcopenia risks among older adults. METHODS A nationwide telephone-based survey targeting older adults (≥65 years) was performed in Taiwan. Data based on self-reported daily lifestyle behaviors (food selection, physical activity, sitting time, and sleep duration), the presence or absence of sarcopenia (measured by SARC-F), and personal characteristics were obtained. Binary logistic regression models were applied. RESULTS A total of 1068 older adults participated in this survey. In the adjusted model, older adults who selected unbalanced foods (odds ratio [OR] = 1.93, 95% confidence interval [CI] = 1.12-3.34), engaged in insufficient physical activity (OR = 5.14, 95% CI = 3.04-8.70), and sat for longer periods of time (OR = 1.98, 95% CI = 1.09-3.59) were more likely to have higher risks of sarcopenia. No significant association was observed for sleep duration. CONCLUSIONS The results of this study highlight that, among health behaviors, an unbalanced food selection (six nutrients), not meeting physical activity recommendations (150 min/week), and a higher sitting time (≥7 h/day) were risk factors for sarcopenia among older adults. Intervention programs for sarcopenia prevention in older adults should focus on promoting balanced food selection, sufficient physical activity, and reduced sitting time.
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Affiliation(s)
- Pei-Lin Tzeng
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Chien-Yu Lin
- Graduate School of Sport Sciences, Waseda University, Tokorozawa City, Japan
| | - Ting-Fu Lai
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Wan-Chi Huang
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Evonne Pien
- Department of Psychology, University of California, San Diego, USA
| | - Ming-Chun Hsueh
- Graduate Institute of Sport Pedagogy, University of Taipei, Taipei, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jong-Hwan Park
- Health Convergence Medicine Laboratory, Biomedical Research Institute, Pusan National University Hospital, Busan, South Korea
| | - Yung Liao
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
- Faculty of Sport Sciences, Waseda University, Tokorozawa City, Japan
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11
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Lin KP, Chen JH, Lu FP, Wen CJ, Chan DCD. The impact of early comprehensive geriatric screening on the readmission rate in an acute geriatric ward: a quasi-experimental study. BMC Geriatr 2019; 19:285. [PMID: 31651249 PMCID: PMC6813968 DOI: 10.1186/s12877-019-1312-y] [Citation(s) in RCA: 3] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 10/10/2019] [Indexed: 12/11/2022] Open
Abstract
Background Unplanned readmission is an important healthcare quality issue. We studied the effect of a comprehensive geriatric screen (CGS) in the early admission course followed by a comprehensive geriatric assessment on readmission rates in elderly patients. Methods This quasi-experimental study with a historical comparison group was conducted in the geriatric ward of a referral centre in northern Taiwan. Older adults (aged > = 65 y/o) admitted from June 2013 to December 2013 were recruited for the geriatric screen group (N = 377). Patients admitted to the same ward from July 2011 to June 2012 were selected for the historical group (N = 380). The CGS was administered within the first 48 h after admission and was followed by a comprehensive geriatric assessment (CGA). Confounding risk factors included age, gender, Charlson comorbidity index, Barthel index score and medical utilization (length of stay and number of admissions), which were controlled using logistic regression models. We also developed a scoring system to identify the group that would potentially benefit the most from the early CGS. Results The 30-day readmission rate was significantly lower in the early CGS group than in the historical comparison group (11.4% vs 16.9%, p = 0.03). After adjusting for confounding variables, the hazard ratio of the early CGS group was 0.64 (95% CI 0.43–0.95). After scoring the potential benefit to the patients in the early CGS group, the log rank test showed a significant difference (p = 0.001 in the high-potential group and p = 0.98 in the low-potential group). Conclusion An early CGS followed by a CGA may significantly reduce the 30-day readmission rate of elderly patients.
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Affiliation(s)
- Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Feng-Ping Lu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chiung-Jung Wen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan.,Department of Family Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Ding-Cheng Derrick Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan. .,Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan. .,National Taiwan University Hospital Chu-Tung Branch, No. 1, Changde St., Taipei, 100, Taiwan.
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12
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Chao CT, Chen YM, Ho FH, Lin KP, Chen JH, Yen CJ. 10-Year Renal Function Trajectories in Community-Dwelling Older Adults: Exploring the Risk Factors for Different Patterns. J Clin Med 2018; 7:jcm7100373. [PMID: 30347853 PMCID: PMC6210637 DOI: 10.3390/jcm7100373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Revised: 10/15/2018] [Accepted: 10/19/2018] [Indexed: 12/16/2022] Open
Abstract
Longitudinal changes of renal function help inform patients’ clinical courses and improve risk stratification. Rare studies address risk factors predicting changes in estimated glomerular filtration rate (eGFR) over time in older adults, particularly of Chinese ethnicity. We identified prospectively enrolled community-dwelling older adults (≥65 years) receiving annual health examinations between 2005 and 2015 with serum creatinine available continuously in a single institute, and used linear regression to derive individual’s annual eGFR changes, followed by multivariate logistic regression analyses to identify features associated with different eGFR change patterns. Among 500 elderly (71.3 ± 4.2 years), their mean annual eGFR changes were 0.84 ± 1.67 mL/min/1.73 m2/year, with 136 (27.2%) and 238 (47.6%) classified as having downward (annual eGFR change <0 mL/min/1.73 m2/year) and upward eGFR (≥1 mL/min/1.73 m2/year) trajectories, respectively. Multivariate logistic regression showed that higher age (odds ratio (OR) 1.08), worse renal function (OR 13.2), and more severe proteinuria (OR 9.86) or hematuria (OR 3.39) were predictive of a declining eGFR while greater waist circumference (OR 1.06) and higher leukocyte counts (OR 1.21) were predictive of an uprising 10-year eGFR. These findings elucidate important features associated with geriatric renal function variations, which are expected to improve their renal care.
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Affiliation(s)
- Chia-Ter Chao
- Department of Medicine, National Taiwan University Hospital BeiHu Branch, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
- Geriatric and Community Medicine Research Center, National Taiwan University Hospital BeiHu Branch, Taipei 10617, Taiwan.
| | - Yung-Ming Chen
- Department of Internal Medicine; National Taiwan University, Taipei 10617, Taiwan.
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Fu-Hui Ho
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Jen-Hau Chen
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei 10617, Taiwan.
| | - Chung-Jen Yen
- Department of Internal Medicine; National Taiwan University, Taipei 10617, Taiwan.
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13
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Abstract
Bajiaolian ( Dysosma pleianthum), one species in the Mayapple family, has been widely used as a general remedy and for the treatment of snake bite, weakness, condyloma accuminata, lymphadenopathy and tumours in China for thousands of years. However, the textbooks of traditional Chinese medicine mention little about the toxicity of Bajiaolian. Within 1 year, the authors saw five people who manifested nausea, vomiting, diarrhoea, abdominal pain, thrombocytopenia, leucopenia, abnormal liver function tests, sensory ataxia, altered consciousness and persistant peripheral tingling or numbness after drinking infusions made with Bajiaolian. The herb was recommended by either traditional Chinese medical doctors or herbal pharmacies for postpartum recovery and treatment of a neck mass, hepatoma, lumbago and dysmenorrhoea. Podophyllotoxin is one of the main ingredients of the Bajiaolian root. The clinical manifestations observed in our patients were consistent with podophyllum intoxication. Podophyllotoxin intoxication usually results from the accidental ingestion or topical application of podophyllum resin. However, these cases of Bajiaolian intoxication were iatrogenic and results from 'therapeutic doses' of Bajiaolian cited in the textbooks of traditional Chinese medicine.
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Affiliation(s)
- W F Kao
- Department of Emergency Medicine, Veterans General Hospital, Taipei, Taiwan
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14
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Chan DC, McCloskey EV, Chang CB, Lin KP, Lim LC, Tsai KS, Yang RS. Establishing and evaluating FRAX ® probability thresholds in Taiwan. J Formos Med Assoc 2016; 116:161-168. [PMID: 27117886 DOI: 10.1016/j.jfma.2016.03.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2015] [Revised: 03/19/2016] [Accepted: 03/21/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/PURPOSE The Taiwanese FRAX® calculator was launched in 2010. However, cost-effectiveness thresholds for the prescription of antiosteoporosis medications were not established. This study aims to establish and evaluate FRAX®-based probability thresholds in Taiwan. METHODS Using previous data from Taiwan and literature, we determined cost-effectiveness thresholds for prevention of osteoporotic fractures by alendronate with a Markov model, as well as using two other translational approaches. Sensitivity analysis was applied using different alendronate prices. A clinical sample was used to test these Taiwan-specific thresholds by determining the percentages of high-risk patients who would be qualified for current National Health Insurance reimbursement. RESULTS With the Markov model, the intervention threshold for hip fracture was 7% for women and 6% for men; for major osteoporotic fracture, it was 15% for women and 12.5% for men. Both translational approach models were cost effective only for certain age groups. However, if branded alendronate was reimbursed at 60% of the current price, they became cost effective in almost all age groups. This clinical screening study showed that the National Health Insurance Administration model identified the highest proportion (44%) of patients qualified for National Health Insurance reimbursements, followed by the Markov model (30%), and the United States model (22%). CONCLUSION Three FRAX®-based models of alendronate use were established in Taiwan to help optimize treatment strategies. The government is encouraged to incorporate FRAX®-based approaches into the reimbursement policy for antiosteoporosis medicines.
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Affiliation(s)
- Ding-Cheng Chan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Superintendent's Office, National Taiwan University Hospital Chu-Tong Branch, Hsinchu City, Taiwan
| | - Eugene V McCloskey
- Metabolic Bone Centre, Northern General Hospital, Sheffield, United Kingdom
| | - Chirn-Bin Chang
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital Chu-Tong Branch, Hsinchu County, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Lay Chin Lim
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan
| | - Keh-Sung Tsai
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Laboratory Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Rong-Sen Yang
- Department of Orthopedics, National Taiwan University Hospital, Taipei, Taiwan.
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15
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Abstract
Recognizing potentially avoidable hospital readmission and admissions are important health care quality issues. We develop prediction models for inpatient readmission and outpatient admission to hospitals for older adults In the retrospective cohort study with 2 million sampling file of the National Health Insurance Research Database in Taiwan, older adults (aged ≥65 y/o) with a first admission in 2008 were enrolled in the inpatient cohort (N = 39,156). The outpatient cohort included subjects who had ≥1 outpatient visit in 2008 (N = 178,286). Each cohort was split into derivation (3/4) and validation (1/4) data set. Primary outcome of the inpatient cohort: 30-day readmission from the date of discharge. The outpatient cohort included hospital admissions within the 1-year follow-up period. Candidate risk factors include demographics, comorbidities, and previous health care utilizations. Series of logistic regression models were applied with area under the receiver operating curves (AUCs) to identify the best model. Roughly 1 of 7 (14.6%) of the inpatients was readmitted within 30 days, and 1 of 5 (19.1%) of the outpatient cohort was admitted within 1 year. Age, education, use of home health care, and selected comorbidities (e.g., cancer with metastasis) were included in the final model. The AUC of the inpatient readmission model was 0.655 (95% confidence interval [CI] 0.646-0.664) and outpatient admission model was 0.642 (95% CI 0.639-0.646). Predictive performance was maintained in both validation data sets. The goodness-to-fit model demonstrated good calibration in both groups. We developed and validated practical clinical prediction models for inpatient readmission and outpatient admissions for general older adults with indicators easily obtained from an administrative data set.
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Affiliation(s)
- Kun-Pei Lin
- From the Department of Geriatrics and Gerontology (K-PL, H-CM, D-CC); Department of Internal Medicine (K-PL, D-CC), National Taiwan University Hospital; Institute of Epidemiology and Preventive Medicine (P-CC), College of Public Health, National Taiwan University; Clinical Informatics and Medical Statistics Research Center (P-CC); Department of Neurology (P-CC), Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Chiayi, Taiwan; Chang-Gung University; National Taiwan University Health Data Research Center (L-YH); and National Taiwan University Hospital Chu-Tung Branch (D-CC), Chu-Tung, Taiwan
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16
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Lin KP, Chou YC, Chen JH, Chen CD, Yang SY, Chen TF, Sun Y, Wen LL, Yip PK, Chu YM, Chen YC. Religious affiliation and the risk of dementia in Taiwanese elderly. Arch Gerontol Geriatr 2015; 60:501-6. [PMID: 25631324 DOI: 10.1016/j.archger.2015.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/08/2015] [Accepted: 01/09/2015] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Religious affiliations vary across ethnic groups because of different cultural backgrounds. Some studies have explored the association between religious affiliation and cognitive decline. Only a small portion of patients with cognitive decline progress to dementia. However, the association between religious affiliation and dementia risk remains unclear. METHODS In this case-control study, we recruited 280 patients with Alzheimer's disease (AD) and 138 with vascular dementia (VaD) (both aged ≥60 years) from three teaching hospitals in northern Taiwan between 2007 and 2010. Age-matched healthy controls (n=466) were recruited from an elderly health checkup program and from volunteers visiting the hospital during the same period. Three religious affiliations-Taoism, Buddhism, and Christianity-were evaluated. The study also assessed the effect of important factors such as gender or leisure activities on the association of religious affiliation with dementia risk. RESULTS Participants with Christianity affiliation showed decreased AD risk (adjusted odds ratio [AOR]=0.46, 95% confidence interval [CI]=0.25-0.87) compared with those without any religious affiliation. Moreover, this effect was stronger in women (AOR=0.38, 95% CI=0.15-0.92) and in participants who exercised regularly (>3 times/week; AOR=0.33, 95% CI=0.14-0.77). No significant association was observed among participants with Taoism and Buddhism affiliations. Affiliation to none of the religions was associated with VaD risk. CONCLUSIONS Thus, Chinese participants having Christianity affiliation showed decreased AD risk. Moreover, the protective effect was more evident in women and in participants who exercised regularly.
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Affiliation(s)
- Kun-Pei Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yi-Chun Chou
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Jen-Hau Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Chi-Dan Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Sheng-Ying Yang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Ta-Fu Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, Taipei, Taiwan
| | - Li-Li Wen
- Department of Laboratory Medicine, En Chu Kong Hospital, Taipei, Taiwan
| | - Ping-Keung Yip
- School of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan; Center of Neurological Medicine, Cardinal Tien's Hospital, Taipei, Taiwan
| | - Yi-Min Chu
- Department of Laboratory Medicine, Cardinal Tien's Hospital, Taipei, Taiwan
| | - Yen-Ching Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Department of Public Health, Environment and Human Health, College of Public Health, National Taiwan University, Taipei, Taiwan; Research Center for Genes, Environment and Human Health, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Lin KP, Chen SY, Lai LC, Huang YL, Chen JH, Chen TF, Sun Y, Wen LL, Yip PK, Chu YM, Chen WJ, Chen YC. Genetic polymorphisms of a novel vascular susceptibility gene, Ninjurin2 (NINJ2), are associated with a decreased risk of Alzheimer's disease. PLoS One 2011; 6:e20573. [PMID: 21674003 PMCID: PMC3108950 DOI: 10.1371/journal.pone.0020573] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2011] [Accepted: 05/04/2011] [Indexed: 11/30/2022] Open
Abstract
Background Accumulated evidences have shown that vascular risk factors, e.g., hypertension, diabetes mellitus and hyperlipidemia, may be related to the risk of dementia. This study investigated the association between genetic polymorphisms of a vascular susceptibility gene, Ninjurin2 (NINJ2), and the risk of dementia, which has not been explored previously. Methods A total of 275 Alzheimer's disease (AD) patients and 119 vascular dementia (VaD) patients aged 50 or older were recruited from three teaching hospitals from 2007 to 2010. Healthy controls (n = 423) with the same age of cases were recruited from the health checkup and volunteers worked at the hospital during the same time period. Five common (frequency >5%) haplotype-tagging single nucleotide polymorphisms (htSNPs) in NINJ2 were genotyped to test for the association between sequence variants of NINJ2 and dementia risk, and how vascular risk factors modify this association. Results Homozygosity of two NINJ2 SNPs was significantly associated with a decreased risk of AD [rs11833579: adjusted odds ratio (AOR) = 0.43; 95% confidence interval (CI) = 0.23–0.80; rs12425791: AOR = 0.33, 95% CI = 0.12–0.96]. Five common haplotypes (cumulative frequency = 97%) were identified. The global test for the association between NINJ2 haplotypes and AD was significant (p = 0.03). Haplotype CAGGA was significantly associated with a decreased risk of AD (AOR = 0.32, 95% CI = 0.11–0.94). No associations were observed for VaD. Conclusion Inherited polymorphisms of the vascular susceptibility gene NINJ2 were associated with AD risk.
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Affiliation(s)
- Kun-Pei Lin
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shih-Yuan Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Liang-Chuan Lai
- Graduate Institute of Physiology, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ling Huang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Jen-Hau Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
| | - Ta-Fu Chen
- Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu Sun
- Department of Neurology, En Chu Kong Hospital, Taipei, Taiwan
| | - Li-Li Wen
- Department of Laboratory Medicine, En Chu Kong Hospital, Taipei, Taiwan
| | - Ping-Keung Yip
- Center of Neurological Medicine, Cardinal Tien's Hospital, Taipei, Taiwan
| | - Yi-Min Chu
- Department of Laboratory Medicine, Cardinal Tien's Hospital, Taipei, Taiwan
| | - Wei J. Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Research Center for Genes, Environment, and Human Health, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Yen-Ching Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
- Department of Public Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- Research Center for Genes, Environment, and Human Health, College of Public Health, National Taiwan University, Taipei, Taiwan
- * E-mail:
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Lin KP, Sheng WH, Wang CP, Chang YL, Chang SC. Resolution of secondary pulmonary alveolar proteinosis following treatment of rhinocerebral aspergillosis. Int J Infect Dis 2010; 14 Suppl 3:e246-9. [PMID: 20117952 DOI: 10.1016/j.ijid.2009.10.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2009] [Revised: 08/27/2009] [Accepted: 10/27/2009] [Indexed: 10/19/2022] Open
Abstract
Pulmonary alveolar proteinosis can be secondary to inhaled dust exposure, malignancy, and chronic pulmonary infections. However, pulmonary alveolar proteinosis secondary to extrapulmonary aspergillosis has never been reported. We report herein a case of pulmonary alveolar proteinosis secondary to invasive rhinocerebral aspergillosis. Neither immune modulators nor whole lung lavage was applied during the treatment course. The severe respiratory distress subsided, hypoxia resolved, and radiological infiltrates improved following the successful treatment of invasive rhinocerebral aspergillosis alone.
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Affiliation(s)
- Kun-Pei Lin
- Department of Internal Medicine, National Taiwan University Hospital, 7 Chung-Shan South Road, Taipei 100, Taiwan
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19
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Abstract
Background Observational studies suggested an association between diabetes and the risk of various geriatric conditions (i.e., cognitive impairment, dementia, depression, mobility impairment, disability, falls, and urinary incontinence). However, the magnitude and impact of diabetes on older adults have not been reviewed. Methodology/Principal Findings MEDLINE and PSYCINFO databases were searched through November 2007 for published studies, supplemented by manual searches of bibliographies of key articles. Population-based, prospective cohort studies that reported risk of geriatric outcomes in relation to diabetes status at baseline were selected. Two authors independently extracted the data, including study population and follow-up duration, ascertainment of diabetes status at baseline, outcomes of interest and their ascertainment, adjusted covariates, measures of association, and brief results. Fifteen studies examined the association of DM with cognitive dysfunction. DM was associated with a faster decline in cognitive function among older adults. The pooled adjusted risk ratio (RR) for all dementia when persons with DM were compared to those without was 1.47 (95% CI, 1.25 to 1.73). Summary RRs for Alzheimer's disease and vascular dementia comparing persons with DM to those without were 1.39 (CI, 1.16 to 1.66) and 2.38 (CI, 1.79 to 3.18), respectively. Four of 5 studies found significant association of DM with faster mobility decline and incident disability. Two studies examined the association of diabetes with falls in older women. Both found statistically significant associations. Insulin users had higher RR for recurrent falls. One study for urinary incontinence in older women found statistically significant associations. Two studies for depression did not suggest that DM was an independent predictor of incident depression. Conclusions/Significance Current evidence supports that DM is associated with increased risk for selected geriatric conditions. Clinicians should increase their awareness and provide appropriate care. Future research is required to elucidate the underlying pathological pathway.
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Affiliation(s)
- Feng-Ping Lu
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Kun-Pei Lin
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Institute of Epidemiology, College of Public Health, National Taiwan University, Taipei, Taiwan
| | - Hsu-Ko Kuo
- Department of Geriatrics and Gerontology, National Taiwan University Hospital, Taipei, Taiwan
- Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
- Division of Gerontology Research, National Health Research Institutes, Taipei, Taiwan
- * E-mail:
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Lee YC, Chang MH, Lin KP, Soong BW. Gene symbol: MPZ. Disease: Charcot-Marie-Tooth disease type 1B. Hum Genet 2005; 118:547-8. [PMID: 16521307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Affiliation(s)
- Y C Lee
- Section of Neurology, Taichung Veterans General Hospital, Taichung, Taiwan 00407 (ROC)
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Abstract
OBJECTIVES We can assess brain function by measuring the cortical relay time (CRT) of long latency reflex (LLR) of hand muscle. We would study if measurement of CRT of LLR can explore the brain involvement of adrenomyeloneuropathy (AMN). METHODS Two AMN patients were included in the study. Both of them had spastic gait and mild sensory deficits but normal mental function. The LLRs were provoked at the first dorsal interosseous muscle by electrical stimulation of the middle finger. We measured the latency of LLR and its CRT. RESULTS Delayed LLR and prolonged CRT were noted in AMN patients, even though the magnetic resonance imaging of brain did not show any significant abnormalities. CONCLUSIONS Measuring CRT of LLR reveals brain involvement of AMN patients, and it is an adjunct in the assessment of brain function though without specific anatomic diagnosis.
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Affiliation(s)
- K K Liao
- Neurology, Neurological Institute, Taipei Veterans General Hospital, Taiwan.
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Tsai DC, Lin PK, Lin KP, Kao KP, Liu JH. Optic neuropathy in a patient with chronic inflammatory demyelinating polyneuropathy. Eye (Lond) 2000; 14:911-2. [PMID: 11584858 DOI: 10.1038/eye.2000.252] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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23
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Yu HY, Wu ZA, Su MS, Yen DJ, Luk HR, Chao YC, Liao KK, Lin KP, Yu SM, Liu HC. Problem-based, small-group tutorial learning in clinical neurology for second-year medical students. Zhonghua Yi Xue Za Zhi (Taipei) 2000; 63:598-604. [PMID: 10969445] [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: 02/17/2023]
Abstract
BACKGROUND Problem-based learning (PBL) in small-group tutorials has been a trend in medical education. Chinese students are known to be reserved and passive; thus, they may not be adaptable to PBL. Neuroanatomy, important to clinical neurology, is difficult to learn. We incorporated clinical neurology with PBL, complementary to the traditional neuroanatomy curriculum, to evaluate the feasibility of PBL for Chinese students in Taiwan. METHODS Forty-two second-year medical students and seven tutors participated in the clinical neurology PBL small-group tutorials. Twelve case reports were discussed weekly beginning in February, 1999. Each case was designed to meet the progressive curriculum of the neuroanatomy course. The tutors evaluated the students by the degree of their preparation, participation, key-point comprehension and interaction. All tutors and students filled out questionnaires at the end of each session. RESULTS The majority of the students and tutors agreed that the case materials were clearly written. Ninety percent of the students agreed that the case materials matched the traditional content of neuroanatomy. Eighty-five percent of students and 71% of tutors were satisfied and found the class rewarding. Ninety-one percent of students and 74% of tutors were in favor of PBL being continued. CONCLUSIONS This preliminary PBL, small-group tutorial learning in clinical neurology showed satisfactory results and was, indeed, complementary to a traditional neuroanatomy course. The students, as early as during the second year of their medical school education, were able to learn through the PBL. More integration of basic and clinical sciences by PBL may be considered in future curricula designs.
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Affiliation(s)
- H Y Yu
- Neurological Institute, Taipei Veterans General Hospital, Taiwan, ROC
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Abstract
High spatial resolution results in very large digital mammogram file sizes. For telemammography, and picture archiving and communication systems, the large file issue introduces technical difficulties in image transmission, storage, and display. We propose extracting the breast region from the mammogram to reduce the image file size. The challenge is on how to faithfully extract breast regions from digital mammograms generated from different types of acquisition systems that contain various imaged compositions. We report an algorithm to automatically identify the orientation of breast region and extract the breast region from mammograms. Breast regions extracted from full-field digital mammograms reduce file sizes by three to five folds.
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Affiliation(s)
- S L Lou
- Laboratory for Radiological Informatics, Department of Radiology, University of California, San Francisco, 530 Parnassus Avenue, San Francisco, CA 94143-0628, USA.
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Huang CC, Wang ST, Chang YC, Lin KP, Wu PL. Measurement of the urinary lactate:creatinine ratio for the early identification of newborn infants at risk for hypoxic-ischemic encephalopathy. N Engl J Med 1999; 341:328-35. [PMID: 10423467 DOI: 10.1056/nejm199907293410504] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.8] [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: 11/19/2022]
Abstract
BACKGROUND Newborn infants with perinatal asphyxia are prone to the development of hypoxic-ischemic encephalopathy. There are no reliable methods for identifying infants at risk for this disorder. METHODS We measured the ratio of lactate to creatinine in urine by proton nuclear magnetic resonance spectroscopy within 6 hours and again 48 to 72 hours after birth in 58 normal infants and 40 infants with asphyxia. The results were correlated with the subsequent presence or absence of hypoxic-ischemic encephalopathy. RESULTS Hypoxic-ischemic encephalopathy did not develop in any of the normal newborns but did develop in 16 of the 40 newborns with asphyxia. Within six hours after birth, the mean (+/-SD) ratio of urinary lactate to creatinine was 16.75+/-27.38 in the infants who subsequently had hypoxic-ischemic encephalopathy, as compared with 0.09+/-0.02 in the normal infants (P<0.001) and 0.19+/-0.12 in the infants with asphyxia in whom hypoxic-ischemic encephalopathy did not develop (P<0.001). A ratio of 0.64 or higher within six hours after birth had a sensitivity of 94 percent and a specificity of 100 percent for predicting the development of hypoxic-ischemic encephalopathy. The sensitivity and specificity of measurements obtained 48 to 72 hours after birth were much lower. The mean ratio of urinary lactate to creatinine was significantly higher in the infants who had adverse outcomes at one year (25.36+/-32.02) than in the infants with favorable outcomes (0.63+/-1.50) (P<0.001). CONCLUSIONS Measurement of the urinary lactate: creatinine ratio soon after birth may help identify infants at high risk for hypoxic-ischemic encephalopathy.
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Affiliation(s)
- C C Huang
- Department of Pediatrics, National Cheng Kung University Medical Center, Tainan, Taiwan
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26
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Pong WF, Lin KP, Chang YK, Tsai MH, Hsieh HH, Pieh JY, Tseng PK, Lee JF, Hsu LS. Electronic structure of Ni3Al and Ni3Ga alloys. J Synchrotron Radiat 1999; 6:731-733. [PMID: 15263440 DOI: 10.1107/s0909049598016203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/1998] [Accepted: 12/01/1998] [Indexed: 05/24/2023]
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Chen JT, Chen CC, Lin KP, Wang SJ, Wu ZA, Liao KK. Botulism: heart rate variation, sympathetic skin responses, and plasma norepinephrine. Can J Neurol Sci 1999; 26:123-6. [PMID: 10352872] [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: 02/12/2023]
Abstract
BACKGROUND Botulism may involve the autonomic nervous system. METHODS We assessed the autonomic function of 6 botulism patients with heart rate variations, sympathetic skin responses, and plasma norepinephrine. RESULTS Two weeks after onset, all the patients had absent sympathetic skin response in the palm and sole. Compared with controls, the heart rate variation of botulism patients was significantly decreased at rest (3.1 +/- 1.2% vs. 20.9 +/- 2.0%, p = 0.0018) and during deep breathing (4.3 +/- 2.3% vs. 29.7 +/- 2.6%, p = 0.0018). The botulism patients had significantly lower plasma norepinephrine levels (supine 29.2 +/- 10.1 pg/ml vs. 257.5 +/- 65.8 pg/ml, p = 0.0018; standing 40.3 +/- 13.1 pg/ml vs. 498.5 +/- 85.6 pg/ml, p = 0.0018). The heart rate variation and sympathetic skin response was greatly improved 6 months after onset. CONCLUSIONS Heart rate variation, absence of sympathetic skin response, and low plasma norepinephrine are all manifestations of autonomic dysfunction in botulism patients.
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Affiliation(s)
- J T Chen
- Department of Neurology, Veterans General Hospital-Taipei, Taiwan, R.O.C
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Chang LB, Tsai CP, Liao KK, Kao KP, Yuan CL, Yen DJ, Lin KP. Use of botulinum toxin A in the treatment of hemifacial spasm and blepharospasm. Zhonghua Yi Xue Za Zhi (Taipei) 1999; 62:1-5. [PMID: 10063705] [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: 02/11/2023]
Abstract
BACKGROUND Hemifacial spasm and blepharospasm are both dystonic disorders. They may seriously affect individuals' lifestyle and social activities. In 1990, the Food and Drug Administration of the USA approved botulinum toxin A as a therapeutic agent in the treatment of hemifacial spasm and blepharospasm. We present a therapeutic review of botulinum toxin A in 80 patients in Taiwan. METHODS Fifty-eight patients with hemifacial spasm and 22 with blepharospasm. Botulinum toxin A was prepared and injected into the facial and eyelid muscles. Patients were monitored every two weeks and classified into four groups (excellent, moderate, mild and no improvement) according to the clinical improvement scale. Complications were also recorded. RESULTS A total of 86.2% of hemifacial spasm patients and 81.8% of blepharospasm patients had excellent improvement on the spasm intensity scale, while 6.8% of hemifacial spasm and 9.0% of blepharospasm patients had moderate improvement. The complication rate was low and included transient mild facial weakness (5%), ptosis (3.8%), eyelid swelling and/or ecchymosis (3.8%), nausea/vomiting (2.5%) and transient severe facial weakness (1.3%). CONCLUSION Botulinum toxin A is an excellent therapeutic agent to improve spasm intensity and has a low complication rate.
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Affiliation(s)
- L B Chang
- Section of Neurology, Cardinal Tien Hospital, Taipei, Taiwan, ROC
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Lin KP, Tsai CP, Yamawaki M, Ariga T, Yu RK. Heterogeneity of antibody specificity in Taiwanese patients with polyneuropathy and IgM paraproteinemia. J Biomed Sci 1998; 5:441-5. [PMID: 9845848 DOI: 10.1007/bf02255933] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
About half of the Caucasian patients with chronic polyneuropathy and IgM paraproteinemia show serum anti-myelin-associated glycoprotein (MAG) and anti-sulfoglucuronosyl glycosphingolipid (SGGLs) activities. These antibody activities have been demonstrated to react with a carbohydrate epitope known as the HNK-1 or sulfoglucuronic acid (SGA) epitope. However, in Asian populations the occurrence of serum anti-SGA activities has been reported to be relatively rare. We investigated 5 cases of chronic polyneuropathy with IgM paraproteinemia from Taiwan and found that 3 of them had high-titer serum anti-SGA (SGGL/MAG) antibody activities. The clinical symptoms of these 3 patients were consistent with sensory dominant polyneuropathy with a severer involvement of the lower limbs than of the upper limbs. Electromyography and nerve conduction studies revealed severe sensory nerve involvement (no response in 3 cases) and moderate slowing of motor conduction velocity (MCV) without conduction block. The decrease in MCV correlated well with anti-SGA antibody titer (less than 30 m/s with the titration of 1:12, 800, normal 55-60 m/s). Pathological findings showed active demyelinating polyneuropathy with myelin ovoid and myelinated fiber loss. Our data suggest that anti-SGGL antibody activities may not be very rare among Asian populations. Additionally, there seems an intriguing possibility that the titer of this antibody correlates with the severity of peripheral nerve involvement in patients of demyelinating polyneuropathy with IgM paraproteinemia.
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Affiliation(s)
- K P Lin
- Neurological Institute, Department of Neurology, Veterans' General Hospital, and Department of Neurology, National Yang Ming University, Faculty of Medicine, Taipei, Taiwan, ROC
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Liu YC, Wu ZA, Wang SJ, Shan DE, Lin KP. Transient syndrome of continuous muscle fiber activity associated with staphylococcal infection. Mov Disord 1998; 13:609-11. [PMID: 9613766 DOI: 10.1002/mds.870130343] [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: 11/08/2022] Open
Affiliation(s)
- Y C Liu
- Department of Neurology, Li-Shin Hospital, Ping-Chen, Tao-Yuan, Taiwan
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Soong BW, Lin KP. An electrophysiologic and pathologic study of peripheral nerves in individuals with Machado-Joseph disease. Zhonghua Yi Xue Za Zhi (Taipei) 1998; 61:181-187. [PMID: 9614775] [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: 05/22/2023]
Abstract
BACKGROUND Machado-Joseph disease (MJD) is characterized by cerebellar ataxia, pyramidal signs, progressive external ophthalmoplegia, and variable degrees of bulging eyes and dystonia. Electrophysiologic and histologic alterations of the peripheral nervous system in patients with MJD have rarely been reported. METHODS The peripheral nerves of four patients with MJD who were identified by polymerase chain reaction were subjected to electrophysiologic testing and histologic study. Correlation analyses were made between clinical parameters and the electrophysiologic as well as histologic changes. RESULTS Electrophysiologic studies demonstrated a marked reduction of sensory action potential, as well as a decrease in the compound motor action potential. Light microscopy of the sural nerves revealed marked loss of myelinated fibers, and morphometry studies showed a loss of large myelinated fibers. The severity of these pathologic changes was not related to the duration of the disease. CONCLUSIONS In MJD, the peripheral nervous system was frequently affected. These findings were similar to those seen in Friedreich's ataxia, suggesting a loss of sensory and motor fibers probably following a lesion of the dorsal root ganglion and the anterior horns in the spinal cord.
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Affiliation(s)
- B W Soong
- Department of Neurology, National Yang-Ming University School of Medicine, Taiwan, ROC
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Abstract
Jugular venous cannulation is generally safer than subclavian cannulation. The traumatic complications associated with jugular vein hemodialysis catheters are rare. A jugular vein, therefore, has become the preferred site for hemodialysis catheter insertion. We describe the first case of brachial plexus compression attributable to delayed recognition of a right subclavian pseudoaneurysm as a complication of jugular venous cannulation of hemodialysis catheter. We advocate that any neck swelling, new bruit, and the symptoms of brachial plexopathy after jugular venous cannulation warrant an intensive investigation to exclude arterial injury. Because delayed diagnosis may lead to a worsened prognosis in patients with brachial plexus palsy, physicians should exercise vigilance to detect and manage early the potentially serious and fatal complications of subclavian artery pseudoaneurysm and brachial nerve injury.
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Affiliation(s)
- D C Tarng
- Department of Medicine, Veterans General Hospital-Taipei, Taiwan.
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Abstract
BACKGROUND Machado-Joseph disease (MJD) is a dominantly inherited cerebellar ataxia associated with spasticity, ophthalmoplegia and dystonia. There has been no report of electrophysiological or histological alterations of the peripheral nervous system in patients with MJD. METHODS Four patients with MJD were identified by polymerase chain reaction. The peripheral nerves of these patients were subjected to electrophysiological testing and histological study. Correlation analyses were made between various clinical parameters and the electrophysiological and histological changes. RESULTS Electrophysiological studies demonstrated a marked reduction of sensory action potential, acute denervation changes on needle EMG, as well as mild decrease in the compound motor action potential. Light microscopy of the sural nerves revealed clear loss of myelinated fibers, and morphometry studies showed a loss of large myelinated fibers. Moreover, the severity of these pathological changes was found to be related to the CAG repeat length in the MJD gene. CONCLUSION Our findings indicated that the peripheral nervous system was frequently affected in patients with MJD. These findings were similar to those seen in Friedreich's ataxia, suggesting a loss of sensory and motor fibers probably following a lesion of the dorsal root ganglion and the anterior horns in the spinal cord. Furthermore, the number of CAG repeats seems to have an inverse relationship to the extent of pathological changes of the peripheral nerves.
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Affiliation(s)
- B W Soong
- Department of Neurology, National Yang-Ming University School of Medicine, Taipei, Taiwan, Republic of China
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Li X, Feng D, Lin KP, Huang SC. Estimation of myocardial glucose utilisation with PET using the left ventricular time-activity curve as a non-invasive input function. Med Biol Eng Comput 1998; 36:112-7. [PMID: 9614758 DOI: 10.1007/bf02522867] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The validation study is described of a new modelling method that has been developed, using tracer kinetic modelling with positron emission tomography (PET) to achieve non-invasive measurement of myocardial metabolic rate of glucose (MMRGlc). Eight data sets obtained from dynamic cardiac PET 2-[18F]fluoro-2-deoxy-D-glucose (FDG) studies on human subjects are employed, and the estimation of MMRGlc using both the new and traditional methods is compared. The results from all eight human FDG studies are consistent with those from previous computer simulations. With the new method, the estimated mean of K (a parameter directly proportional to MMRGlc) increases by about 8%, and that of k 4 (the rate constant of FDG dephosphorylation) decreases by about 48%. The approach should be more suitable for use in dynamic cardiac PET studies when non-invasive means are used to obtain the plasma time-activity curve from left-ventricle PET images.
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Affiliation(s)
- X Li
- Department of Computer Science, University of Sydney, NSW, Australia
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Wang SJ, Liu HC, Fuh JL, Liu CY, Lin KP, Chen HM, Lin CH, Wang PN, Hsu LC, Wang HC, Lin KN. Prevalence of headaches in a Chinese elderly population in Kinmen: age and gender effect and cross-cultural comparisons. Neurology 1997; 49:195-200. [PMID: 9222190 DOI: 10.1212/wnl.49.1.195] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.0] [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: 02/04/2023] Open
Abstract
OBJECTIVE To investigate the prevalence of headaches in a Chinese elderly population. BACKGROUND There are few headache surveys in the elderly. Previous studies have shown a low headache prevalence in Chinese. METHODS TARGET POPULATION eligible registered residents > or = 65 years old (N = 2,003) in two townships of Kinmen Island on August 1, 1993. All participants completed a headache questionnaire and underwent clinical evaluation and examination by a neurologist. Headache diagnoses were made according to the International Headache Society, 1988. RESULTS 1,533 persons (77%) participated in the study, of whom 584 (38%) had at least one episode of headache in the previous year. One-year prevalence of migraine was 3.0%, and tension-type headache, 35%. The prevalence of migraine, but not tension-type headaches, continued to decline with age in the elderly. Life-time prevalence of "incapacitating headache" was 10%, and that of migraine, 5.2%. Forty-two percent of migraineurs stopped having migraine before this survey. In comparison with "10 years ago" 8% participants felt their current headaches were worse, 25% better, and 67%, no change, with a net improvement of 17%. CONCLUSIONS We have reported the highest headache prevalence among different Chinese elderly populations, but these were still lower than those reported from Western series. More than half of the elderly life-time migraineurs still had attacks of migraine. Severe headaches, including migraine but not tension-type headaches, declined with age.
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Affiliation(s)
- S J Wang
- Neurological Institute, Veterans General Hospital-Taipei, Taiwan
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36
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Liu HC, Wang SJ, Fuh JL, Liu CY, Lin KP, Lin CH, Wang PN, Lin KN, Wang HC, Chen HM, Chang R, Larson EB, Wu GS, Chou P, Teng EL. The Kinmen Neurological Disorders Survey (KINDS): a study of a Chinese population. Neuroepidemiology 1997; 16:60-8. [PMID: 9057167 DOI: 10.1159/000109672] [Citation(s) in RCA: 22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
We conducted an epidemiological study of several neurological disorders among the Chinese aged 50 years or older on the islet of Kinmen. All participants were interviewed and examined by neurologists. From the targeted population of 5,061 individuals, 3,915 (77.4%) of them completed the evaluations. Among the 4,087 individuals with whom face-to-face contact was made, the refusal rate was 4.2%. The disorders of interest were dementia, Parkinson's disease, essential tremor, stroke, transient ischemic attacks, and migraine. Among the 3,915 participants, 366 cases were found with 1 or more of the surveyed neurological disorders on the prevalence day, August 1, 1993, yielding a prevalence of 93.5/1,000. The purpose of this study, the general methodology, and some overall findings are presented in this communication in order to provide a common background for detailed findings on each disorder to be reported separately.
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Affiliation(s)
- H C Liu
- Neurological Institute, Veterans General Hospital, Taipei, Taiwan, ROC
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Lin KP, Yeh TP, Wang S, Liao KK, Kao KP, Shan DE. Polyneuropathy associated with acute monoblastic leukemia: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1996; 58:435-8. [PMID: 9068211] [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
Polyneuropathy associated with acute myelocytic leukemia is rare. We report a woman aged 34 years with acute monoblastic leukemia and polyneuropathy in hematology remission. The clinical, electrophysiological and pathological findings revealed acute symmetrical sensorimotor axonal polyneuropathy that differs from previous reports of three cases.
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Affiliation(s)
- K P Lin
- Neurology, Neurological Institute, Veterans General Hospital-Taipei, Taiwan, R.O.C
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38
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Abstract
In this study, various image registration methods are investigated for their suitability for registration of L-6-[18F]-fluoro-DOPA (FDOPA) PET images. Five different optimization criteria including sum of absolute difference (SAD), mean square difference (MSD), cross-correlation coefficient (CC), standard deviation of pixel ratio (SDPR), and stochastic sign change (SSC) were implemented and Powell's algorithm was used to optimize the criteria. The optimization criteria were calculated either unidirectionally (i.e. only evaluating the criteria for comparing the resliced image 1 with the original image 2) or bidirectionally (i.e. averaging the criteria for comparing the resliced image 1 with the original image 2 and those for the sliced image 2 with the original image 1). Monkey FDOPA images taken at various known orientations were used to evaluate the accuracy of different methods. A set of human FDOPA dynamic images was used to investigate the ability of the methods for correcting subject movement. It was found that a large improvement in performance resulted when bidirectional rather than unidirectional criteria were used. Overall, the SAD, MSD and SDPR methods were found to be comparable in performance and were suitable for registering FDOPA images. The MSD method gave more adequate results for frame-to-frame image registration for correcting subject movement during a dynamic FDOPA study. The utility of the registration method is further demonstrated by registering FDOPA images in monkeys before and after amphetamine injection to reveal more clearly the changes in spatial distribution of FDOPA due to the drug intervention.
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Affiliation(s)
- K P Lin
- Department of Electrical Engineering, Chung-Yuan University, Chung-Li, Taiwan, Republic of China
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Chen HM, Tsai CP, Lin KP, Wang SJ, Wu ZA, Kao KP. Myasthenia gravis complicated with hyperthyroidism, thymoma and serological evidence of systemic lupus erythematosus: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1996; 58:62-5. [PMID: 8870331] [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: 02/02/2023]
Abstract
A 55-year-old woman with a several-decade history of thyroid goiter is presented here as a case of myasthenia gravis complicated with hyperthyroidism and thymoma with serological evidence of systemic lupus erythematous (SLE). She had had right eyelid ptosis since July 1992, with a positive tensilon test. The acetylcholine receptor antibody titer was 4.01 nmol/L. A thyroid function test revealed T3: 162 ngidl, T4: 14.98 micrograms/dl, TSH:0.09 microIU/ml and positive anti-microsomal antibody (1:400). An MRI of the chest showed a thymoma in the left thymus. Other autoantibody screenings include ANA (1:320, speckled pattern) and anti-ds DNA (+) suggesting a serological association with SLE. After three courses of plasmapheresis, she received an extended maximal thymomectomy and a subtotal thyroidectomy. She was then treated with prednisolone, Mestinon, Eltroxin and discharged without complications. The coexistence of myasthenia gravis, hyperthyroidism, thymoma and a serological evidence of SLE have not previously been documented in the literature.
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Affiliation(s)
- H M Chen
- Department of Neurology, Veterans Hospital-Chia Yi, Taiwan, R.O.C
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40
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Wang SJ, Fuh JL, Teng EL, Liu CY, Lin KP, Chen HM, Lin CH, Wang PN, Ting YC, Wang HC, Lin KN, Chou P, Larson EB, Liu HC. A door-to-door survey of Parkinson's disease in a Chinese population in Kinmen. Arch Neurol 1996; 53:66-71. [PMID: 8599561 DOI: 10.1001/archneur.1996.00550010084020] [Citation(s) in RCA: 52] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Most published studies have shown lower prevalence rates of Parkinson's disease (PD) in Asian and black African than in Western countries, leading to the hypothesis that Asians and blacks might be protected from PD. OBJECTIVE To investigate the prevalence of PD in a Chinese population. DESIGN Community-based survey. SETTING Registered residents 50 years of age or older (N = 5061) on the islet of Kinmen located off the southeastern coast of China [corrected]. METHOD Single-phase door-to-door survey by neurologists. All participants were administered a questionnaire and received motor examinations of the Unified Parkinson's Disease Rating Scale. RESULTS The participation rate was 96% (N = 3915) among 4158 contacted individuals. Twenty-three cases of PD were identified, including three cases with dementia. The crude prevalence rate of PD was 587 (95% confidence interval (CI), 373 to 884) per 100,000 persons 50 years of age or older. Assuming no case of PD among individuals under 50 years of age, the prevalence rate was 119 (95% CI, 80 to 169) per 100,000 for the total population. CONCLUSIONS The prevalence rates of PD in Kinmen were much higher than those reported from mainland China, but slightly lower than those reported from more developed countries. The present findings suggest that, instead of genetic factors, differences in case-ascertainment, life expectancy, and the length of survival with PD may be more important contributors to the variations in observed PD prevalence rates.
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Affiliation(s)
- S J Wang
- Neurological Institute, Veterans General Hospital-Taipei, Taiwan
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41
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Melega WP, Quintana J, Raleigh MJ, Stout DB, Yu DC, Lin KP, Huang SC, Phelps ME. 6-[18F]fluoro-L-DOPA-PET studies show partial reversibility of long-term effects of chronic amphetamine in monkeys. Synapse 1996; 22:63-9. [PMID: 8822479 DOI: 10.1002/(sici)1098-2396(199601)22:1<63::aid-syn7>3.0.co;2-g] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.2] [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: 02/02/2023]
Abstract
The acute and long-term effects of chronic amphetamine administration on the striatal dopamine system in monkeys were assessed with 6-[18F]fluoro-L-DOPA (FDOPA) and positron emission tomography (PET). Vervet monkeys (Cerecopithecus aethiops) were administered amphetamine doses, i.m., that increased from 4 mg/kg/d to 18 mg/kg/d over a 10 day period. Post-amphetamine FDOPA-PET scans at 1-2, 3-4, and 6 week time points in individual subjects showed persistent decrements in dopamine synthesis capacity as reflected by FDOPA influx rate constant (Ki) values being approximately 30% that of pre-drug assessment. In other animals that were administered the same drug regimen, biochemical analysis of striatal regions at 1-2 weeks post-drug indicated that dopamine concentrations were decreased by approximately 95% throughout caudate and putamen regions, while the homovanillic acid/dopamine level ratio was increased 3-10-fold. Post-drug FDOPA-PET Ki values remained consistently low up to 6 weeks; however, at the 5-6 month time point, relative increases in FDOPA-Ki values (approximately 53% of pre-drug values) were observed for all subjects, indicative of partial recovery of striatal dopamine synthesis capacity. These results demonstrate that FDOPA-PET can reveal temporal activity changes within the striatal dopamine system of individual subjects. The apparent, partial reversibility of amphetamine's neurotoxic effects suggests a plasticity of dopaminergic function that may include regeneration of dopaminergic terminals and compensatory increases in residual dopamine synthesis rates. The persistence of the partial decrement in dopamine synthesis capacity, however, may indicate a long term component of amphetamine's toxic effects.
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Affiliation(s)
- W P Melega
- Department of Molecular and Medical Pharmacology, UCLA School of Medicine 90095-1735
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Liu HC, Wang SJ, Lin KP, Lin KN, Fuh JL, Teng EL. Performance on a smell screening test (the MODSIT): a study of 510 predominantly illiterate Chinese subjects. Physiol Behav 1995; 58:1251-5. [PMID: 8623028 DOI: 10.1016/0031-9384(95)02042-x] [Citation(s) in RCA: 22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The 12-item Modular Smell Identification Test (MODSIT) was administered to 239 male and 271 female Chinese subjects whose age ranged from 50 to 92 years (68.3 +/- 10.9) and whose education ranged from 0 to 20 years (2.5 +/- 4.3). Every participant was examined by a physician and was found to be free of dementia, stroke, and Parkinson's disease. Different from the standard procedures, only one-third of each odor pad was used for each subject, the four odor choices were presented orally for the majority of subjects, and they were not forced to make a selection when they could not detect or identify the odor. The average level of performance was 46% correct. The score was negatively associated with age, positively associated with education and with performance on a dementia screening test, and corroborated with subjects' report of smell deterioration in recent years. Nonsmokers and women performed better than smokers and men. The 12-item MODSIT had an internal consistency reliability of 0.73 and a 7-month retest stability of 0.57 with different examiners. The MODSIT is satisfactory for group studies, even when administered with suboptimal procedures such as those used in the present study.
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Affiliation(s)
- H C Liu
- Neurological Institute, Veterans General Hospital-Taipei, Taiwan, Republic of China
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43
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Lin YY, Tsai CP, Ting YC, Lin KP, Liao KK, Kao KP, Wang SJ. Intravenous immunoglobulin infusion in multifocal demyelinating motor neuropathy: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1995; 56:66-9. [PMID: 7553414] [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: 01/25/2023]
Abstract
The following report is a case of multifocal demyelinating motor neuropathy (MMN) presenting as a gradual development of asymmetric motor weakness without sensory involvement. Electrophysiological studies showed mainly a conduction block with normal or slightly slow nerve conduction velocity. Cerebrospinal fluid (CSF) protein and serum protein electrophoresis were normal, but serum IgM anti-GM1 ganglioside antibody was elevated. The patient had a poor response to steroid, plasmapheresis and chemotherapy with cyclophosphamide, but significant improvement was noted after intravenous immunoglobulin (IVIG) infusion. MMN is a potentially treatable condition which clinically mimics a motor neuron disease; if treatment with steroid, plasmapheresis and cyclophosphamide have failed, IVIG may be effective.
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Affiliation(s)
- Y Y Lin
- Neurological Institute, Veterans General Hospital-Taipei, Taiwan, R.O.C
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45
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Lin KP, Huang SC, Choi Y, Brunken RC, Schelbert HR, Phelps ME. Correction of spillover radioactivities for estimation of the blood time-activity curve from the imaged LV chamber in cardiac dynamic FDG PET studies. Phys Med Biol 1995; 40:629-42. [PMID: 7610118 DOI: 10.1088/0031-9155/40/4/009] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.9] [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: 01/26/2023]
Abstract
In dynamic cardiac PET FDG studies for measurement of myocardial metabolic rate of glucose (MMRGlc), the plasma FDG time-activity curve (input function) is commonly obtained from the left ventricular (LV) region on the PET images. The input function is contaminated by spillover of radioactivity from the surrounding myocardium and this could cause significant error in the estimated MMRGlc. In this study, we determined the effect of myocardial to blood pool spillover on MMRGlc and developed a method to correct for this spillover of activity. The method is based on a reformulation of the FDG model equation in terms of the spillover contaminated input function that includes both the myocardium to blood pool and blood pool to myocardium spillover fractions as variable parameters (Fmb and Fbm). The reformulated model equation can be used to fit the global myocardial tissue activity curve to estimate Fmb and thus yields a spillover corrected input function. The MMRGlc estimate with the corrected input function was within 95% of the true value (compared to 85% using the uncorrected input function) in a set of computer simulation studies. Dynamic PET FDG data were obtained in eight human studies and blood samples were obtained during the study. As compared to the results with the uncorrected input function, the estimates of k4 by the new method were reduced by 69% into a range consistent with in vitro results. The method is effective in correcting Fmb spillover and leads to more accurate estimates of MMRGlc. The method also allows larger regions of interest (up to 150 mm2) to be drawn over the LV in dynamic PET images, thereby reducing the noise level in the input function.
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Affiliation(s)
- K P Lin
- Department of Electrical Engineering, Chung-Yuan University, Taiwan
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46
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Chang DB, Lin YY, Guo WY, Wang S, Tsai CP, Lin KP, Liao KK. Midbrain hemorrhage presenting as bilateral ptosis without hemiplegia: a case report. Zhonghua Yi Xue Za Zhi (Taipei) 1995; 55:185-188. [PMID: 7750061] [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: 05/22/2023]
Abstract
A 66-year-old man suddenly developed bilateral ptosis after awaking from a nap. He did not experience nausea, vomiting or headache. In the emergency room, high blood pressure was noted. On examination, his consciousness was clear. Ptosis was present bilaterally and worse on the right side. The pupils promptly constricted to light. He could fully adduct his eyes during conjugate gaze movements, but convergence was impaired in the right eye. There was no diplopia or nystagmus. The assessment of the motor and sensory systems revealed no significant findings. Computed tomographic scanning and magnetic resonance imaging of the brain showed a small hematoma in the midbrain. Six months later, ptosis improved; however, the convergence deficit remained.
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Affiliation(s)
- D B Chang
- Section of Neurology, Neurological Institute, Veterans General Hospital-Taipei, Taiwan, R.O.C
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47
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Tsai CP, Huang CI, Wang V, Lin KP, Liao KK, Yen DJ, Wu ZA. Evaluation of cervical radiculopathy by cervical root stimulation. Electromyogr Clin Neurophysiol 1994; 34:363-6. [PMID: 8001478] [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: 01/28/2023]
Abstract
For precise evaluation of cervical radiculopathy, cervical root stimulation (CRS), conventional electromyographic (EMG) studies, nerve conduction velocity (NCV) studies and F responses were done in 32 patients with clinical symptoms and signs of cervical radiculopathy. While performing CRS, a monopolar needle was inserted into the paraspinal muscles, and the compound muscle action potentials (CMAPs) in the biceps, triceps and abductor digiti minimi muscles were recorded. Conventional EMG was abnormal in 18 (56.2%), whereas CRS was abnormal in 25 (78.1%). Among the 25 patients with positive CRS tests, 13 received surgical decompression for cervical root compression caused either by a cervical disc or by foramen narrowing due to spondylosis. Only 10 out of 13 (76.9%) had abnormal conventional EMG findings. CRS provides a sensitive method for making a direct evaluation of proximal root conduction and is a good aid for pre-surgical evaluation of cervical radiculopathy.
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Affiliation(s)
- C P Tsai
- Neurological Institute Neurosurgery Department, Veterans General Hospital Taipei, Taiwan
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Wang SJ, Liao KK, Liou HH, Lee SS, Tsai CP, Lin KP, Kao KP, Wu ZA. Sympathetic skin response and R-R interval variation in chronic uremic patients. Muscle Nerve 1994; 17:411-8. [PMID: 8170487 DOI: 10.1002/mus.880170408] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [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: 01/29/2023]
Abstract
Sympathetic skin response (SSR) and R-R interval variation (RRIV) were studied in 36 chronic, nondiabetic uremics to compare with their nerve conduction studies (NCS) and clinical dysautonomia. Abnormal SSR was noted in 5 (13.9%) patients, abnormal RRIV in 14 (38.9%), and abnormal NCS in 26 (72.2%). The patients were classified into three groups: group (GP) 1: "normal," n = 21 (58.3%), normal RRIV and SSR; GP 2: "isolated parasympathetic dysfunction," n = 10 (27.8%), abnormal RRIV and normal SSR; and GP 3: "sympathetic sudomotor dysfunction," n = 5 (13.9%), abnormal SSR. A significant difference in age was found among the three groups (GP 3 > GP 2 > GP 1; P < 0.0001, ANOVA). After controlling the age factor, we still noted a tendency toward increasing NCS disturbances (distal latency and nerve conduction velocity of peroneal nerve; P < 0.05, multiple regression analysis) and frequencies of clinical autonomic symptoms (postural dizziness and impotence; P < 0.05, Mantel-Hanszel test) from GP 1 to GP 3. Patients with abnormal SSR (GP 3) displayed significantly higher frequencies of postural dizziness and impotence, indicating the relationship between an absence of SSR and clinical dysautonomia.
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Affiliation(s)
- S J Wang
- Neurological Institute, Veterans General Hospital-Taipei, Taiwan, ROC
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Wang SJ, Fuh JL, Liu CY, Lin KP, Chang R, Yih JS, Chou P, Lin KN, Teng EL, Larson EB. Parkinson's disease in Kin-Hu, Kinmen: a community survey by neurologists. Neuroepidemiology 1994; 13:69-74. [PMID: 8190209 DOI: 10.1159/000110361] [Citation(s) in RCA: 24] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
A door-to-door survey by neurologists in Kin-Hu township, Republic of China, of a sample of the Chinese population of 683 persons aged 50 years and over was performed in August, 1992. A total of 482 subjects (70.6%) completed the study. Kin-Hu, a township of Kinmen, is predominantly rural with agriculture as the main occupation. Six subjects (5 men, 1 woman) were diagnosed with Parkinson's disease (PD). Of these six, five were newly diagnosed; one of the five also had dementia. The crude prevalence rate per 1,000 persons over 50 years of age of PD in Kin-Hu was 6.2. The age-specific prevalence rates per 1,000 persons (95% confidence intervals) were 0 for age 50-59, 7.8 (0-22.9) for age 60-69, 17.5 (5.2-29.8) for age 70-79, and 25.4 (10.9-39.9) for age > or = 80. These rates are considerably higher than those reported in the People's Republic of China, and similar to rates found in Western countries. The higher prevalence of PD found in this pilot study suggests that environmental factors may be more important than racial factors in the pathogenesis of PD. If confirmed, the results suggest that epidemiologic studies looking for environmental risk factors might be of value.
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Affiliation(s)
- S J Wang
- Neurological Institute, Veterans General Hospital-Taipei, Taiwan, Republic of China
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Wang V, Liao KK, Ju TH, Lin KP, Wang SJ, Wu ZA. Myokymia and neuromyotonia of the tongue: a case report of complication of irradiation. Zhonghua Yi Xue Za Zhi (Taipei) 1993; 52:413-5. [PMID: 8299045] [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: 01/29/2023]
Abstract
A 51-year-old man has suffered from progressive dysarthria since 1989. He himself noted slight weakness and tightness of the tongue, so that he was unable to perform motor tasks in a normal fashion. He was diagnosed as having nasopharyngeal carcinoma and had irradiation 70 Gy in 32 divided doses in 1979. Neurological examination revealed left-sided tongue atrophy and myokymia sparing of facial muscles involvement. Electrical discharges of myokymia and neuromyotonia were observed in the tongue muscles, suggesting hypoglossal nerve lesion with hyperexcitability of the axon membrance. Computed tomogram of brain did not show any evidence of recurrence of tumor; indicating that irradiation was the pathologic basis. Our report revealed that myokymia and neuromyotonia of the tongue was an unusual complication of irradiation.
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Affiliation(s)
- V Wang
- Neurological Institute, Veterans General Hospital-Taipei, Taiwan, R.O.C
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