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ORIGINAL ARTICLES
Caregiver Burden for Patients with Dementia with or Without Hiring Foreign Health Aides: A Cross-Sectional Study in a Northern Taiwan Memory Clinic
Nian-Sheng Tzeng, Chiung-Wen Chang, Ju-Yueh Hsu, Yu-Ching Chou, Hsin-An Chang, Yu-Chen Kao
November-December 2015, 35(6):239-247
DOI:10.4103/1011-4564.172999  
Background: The aim of the present study was to determine the prevalence, profile, and severity of dementia and the relative impact of these factors on caregiver burden in a selected population of persons with dementia and their caregivers. Methods: A convenience sample of 100 outpatients and their family caregivers dyads who presented to a memory clinic in one medical center during one consecutive year were recruited. The diagnosis and severity of dementia were determined according to the Diagnostic and Statistical Manual of Mental Disorders, Version IV, Text Revision. The clinical dementia rating scale, mini-mental status examination, and Clinical Global Impression of severity were also administered. The caregiver strain index was used to assess caregiver burden. Results: Caregiver burden is related to the severity of dementia, impairment of cognitive function, and severity of neuropsychiatric symptoms. The caregivers who were younger, nonspousal family members, had a poor relationship with the dementia patient, and psychosomatic symptoms after caring for the patient, or provided longer hours of care-giving, experienced greater strains. Hiring foreign helpers was not associated with a lower caregiver burden. Conclusions: Greater caregiver burden is associated with several factors related to persons with dementia and their caregivers. A possible over-burden on caregivers should be of concern in Taiwan. Hiring foreign helpers was not associated with a lower caregiver burden.
  10 3,976 220
In vitro antibacterial and anticancer activity of copper oxide nanostructures in human breast cancer Michigan Cancer Foundation-7 cells
J Emima Jeronsia, DJ Vidhya Raj, L Allwin Joseph, K Rubini, S Jerome Das
July-August 2016, 36(4):145-151
DOI:10.4103/1011-4564.188899  
Objective: The use of nanoparticles (NPs) in cancer diagnosis and treatment is a rapidly developing area of nanotechnology. The main objective of this research work is to synthesize copper oxide (CuO) NPs and to investigate its vitro anticancer and antibacterial property. Methods: The CuO NPs were synthesized via a facile and cost-effective precipitation method using cupric acetate (monohydrate) (CuAc 2 .2H 2 O), sodium hydroxide, and glacial acetic acid. By varying the pH of the precursor solution, the morphology, particle size, and reaction rate of the NPs could be well tailored. The prepared CuO NPs were characterized by X-ray diffraction, ultraviolet-visible spectroscopy, Fourier transform infrared analysis, and scanning electron microscopy. Results: The results revealed a well crystalline structure with leaf-like morphology. By controlling the pH of the solution, particle size and morphology of the NPs are altered. The synthesized CuO NPs have been screened for its antibacterial potency against Gram-positive (Methicillin-resistant Staphylococcus aureus and Bacillus subtilis) and Gram-negative (Salmonella Paratyphi, Klebsiella pneumonia, and Enterobacter aerogenes) bacterial strains. The as-synthesized NPs were found to be remarkable in inhibiting pathogenic bacteria. The anticancer activity reveals the dose-dependent influence of CuO NPs against human breast cancer cell line Michigan Cancer Foundation-7 (MCF-7). Conclusions: The results suggested that CuO NPs have a wide range of antibacterial applications which can be used to control the spread and infection of a variety of bacterial strains. The CuO NPs showed promising anticancer activity against human breast cancer cell line (MCF-7). Overall, CuO NPs are an effective candidate for pharmaceutical, biomedical, and environmental applications.
  9 3,366 332
Analysis of anesthesia-controlled operating room time after propofol-based total intravenous anesthesia compared with desflurane anesthesia in gynecologic laparoscopic surgery: A retrospective study
Hou-Chuan Lai, Shun-Ming Chan, Bo-Feng Lin, Tso-Chou Lin, Go-Shine Huang, Zhi-Fu Wu
July-August 2015, 35(4):157-161
DOI:10.4103/1011-4564.163823  
Background: Anesthesia technique may contribute to the improvement of operation room (OR) efficiency by reducing anesthesia-controlled time (ACT). We compared the difference between propofol-based total intravenous anesthesia (TIVA) and desflurane (DES) anesthesia for gynecologic laparoscopic surgery undergoing general anesthesia. Materials and Methods: We performed a retrospective study using data collected in our hospital to compare the ACT of gynecologic laparoscopic surgery using either TIVA via target-controlled infusion (TCI) with propofol/fentanyl or DES/fentanyl-based anesthesia between January 2010 and December 2011. The various time intervals (waiting for anesthesia, operation time, anesthesia time, emergence time, exit from OR after extubation, total OR time and postanesthesia care unit stay time) and the incidence of prolonged extubation (≥15 min) were compared between the two anesthetic techniques. Results: We included data from 926 patients, with 377 patients receiving TIVA and 549 patients receiving DES. The only significant difference is emergence time, TIVA was faster than the DES group (7.3 ± 3.3 min vs. 8.3 ± 3.1 min; P < 0.001). The factors of prolonged extubation are DES anesthesia, body mass index, surgical time, and anesthesia time. Conclusion: In our hospital, propofol-based TIVA by TCI provide faster emergence compared with DES anesthesia in gynecologic laparoscopic surgery.
  6 2,521 155
Is weight control surgery associated with increased risk of newly onset psychiatric disorders? A population-based, matched cohort study in Taiwan
Wu-Chien Chien, Chi-Hsiang Chung, Fu-Huang Lin, Hsin-An Chang, Yu-Chen Kao, Nian-Sheng Tzeng
July-August 2017, 37(4):137-149
DOI:10.4103/jmedsci.jmedsci_94_16  
Background: Morbid obesity is associated with various diseases, and the weight control surgery (WCS) is one of the treatments for morbid obesity. However, the association between the WCS and psychiatric disorders has yet to be elucidated. This study aimed to investigate the association between the WCS and the risk of developing psychiatric disorders. Materials and Methods: A total of 53,052 enrolled participants with 13,263 patients who received WCS and 39,789 controls with matched for sex and age, between January 1 and December 31, 2000, were selected from the National Health Insurance Research Database of Taiwan. After adjusting for confounding factors, Cox proportional hazards analysis was used to compare the risk of developing psychiatric disorders during 10 years of follow-up. Results: Of the study patients, 1170 (8.82%) developed psychiatric disorders when compared to 3490 (8.77%) in the control group. Cox proportional hazards regression analysis revealed that the study patients were more likely to develop psychiatric disorders (hazard ratio [HR]: 2.952, 95% confidence interval [CI] = 2.756–3.163, P < 0.001). After adjusting for gender, age, monthly income, urbanization level, geographic region, and comorbidities, the adjusted HR was 2.901 (95% CI = 2.701–3.115, P < 0.001). Among these psychiatric disorders, depressive disorders, bipolar disorders, and sleep disorders are with significantly increased risk. Conclusions: Patients who received the WCS have a higher risk of developing psychiatric disorders, and the risk was increased in the durations of <1 year and 1–3 years, especially within the duration of 1 year. Regular psychiatric follow-up might be needed for those patients.
  5 1,092 119
Predicting poor outcome in patients with intentional carbon monoxide poisoning and acute respiratory failure: A retrospective study
Chih-Hao Shen, Jr-Yu Lin, Ke-Ting Pan, Yu-Ching Chou, Chung-Kan Peng, Kun-Lun Huang
May-June 2015, 35(3):105-110
DOI:10.4103/1011-4564.158673  
Purpose: Intentional carbon monoxide (CO) poisoning has become the commonly used method of suicide in some Asian countries. The objective of this study was to identify the predictors that impact the outcome of intentional CO-poisoned patients with acute respiratory failure. Materials and Methods: This is a retrospective observational study of 796 consecutive patients diagnosed with acute CO poisoning that presented to the emergency department (ED). Patients who were CO poisoned with intentional exposure and acute respiratory failure were enrolled and divided into two groups. The poor outcome group consisted of in-hospital death, the presence of persistent neurological sequelae, and the presence of delayed neurologic sequelae. The good outcome group consisted of other enrolled patients. Demographic and clinical data of the two groups were extracted for analysis. Results: A total of 148 patients were enrolled in this study. Of the eligible subjects, 67.6% (100) were identified with positive toxicology screening results. On arriving ED, parameters associated with patients with a poor outcome included hypotension, myocardial injury, prolonged lag times from the first ED arrival to initiation of hyperbaric oxygen therapy, higher white blood cell count, and higher serum levels of blood urea nitrogen, creatine kinase, and troponin-I (P < 0.05). Positive toxicology screening result did not relate to the outcome. Multivariate analysis showed that the myocardial injury was an independent factor for poor outcome (odds ratio, 2.750; 95% confidence interval, 1.168-6.474; P = 0.021). Conclusions: Myocardial injury is an independent predictor of in-hospital death and neurologic sequelae in patients with intentional CO poisoning and acute respiratory failure.
  4 2,545 187
HIV/AIDS-related stigma and discrimination among health-care providers in a tertiary health facility
Pauline Justin S Doka, Mela Danjin, Iliya Sarki Dongs
March-April 2017, 37(2):44-49
DOI:10.4103/jmedsci.jmedsci_99_16  
Aim: This study was aimed at assessing dispositions, attitudes, and behavioral tendencies for HIV/AIDS-related stigma and discrimination among health-care providers in Specialist Hospital Gombe, Northern Nigeria. Materials and Methods: Out of a total of 397 health personnel of the hospital, a sample of 201 health-care providers of various professional backgrounds was drawn using quota sampling technique. A descriptive exploratory survey method was adopted. Using a structured questionnaire, relevant data were collected from the subjects. Reliability test on key segments of the instrument yielded alpha Cronbach's internal consistency test values of not <7.0. The significance level for findings was set at 0.05. Results: The subjects were aged between 18 and 59 years with a mean of 39.11 ± 10.60 years. There were more females (123, 61.2%) than males (78, 38.8%), and majority (113, 56.2%) of them were diploma certificate holders, whereas a good number (62, 30.8%) had degree education. Seventy-two (35.8%) of them opined that “A person who contract HIV should be ashamed” and another 31 (15.4%) of them believe that such a person should be rejected. Although this tendency appeared to be more among doctors (31, 15.4%) and laboratory workers (4, 25.0%) than others, this was not statistically significant (P > 0.05). If given the choice, 34 (16.9%) of the personnel would not treat a patient with HIV. Conclusion: A prevalence rate of HIV/AIDS-related stigma of 15.4% among the health personnel is quite worrisome. Stigma reduction seminars and workshops would go a long way toward mitigating this trend.
  4 2,660 258
CASE REPORTS
Sorafenib-induced acute pancreatitis
Han-En Wang, Chun-Ting Chen, Hsin-Hung Huang
May-June 2014, 34(3):126-128
DOI:10.4103/1011-4564.134392  
Sorafenib was approved in 2005 for the treatment of metastatic renal cell carcinoma and advanced hepatocellular carcinoma (HCC). Acute pancreatitis is a side-effect of sorafenib usage. We present a patient with advanced HCC who presented with acute Grade D pancreatitis caused by sorafenib administration. Following the discontinuation of sorafenib, fasting, and fluid replacement, the patient's clinical manifestation of Grade D pancreatitis subsided in a short time. One month after discharge, she resumed sorafenib treatment (200 mg/day) due to disease progression. Based on this experience, resumption of sorafenib treatment appears to be safe.
  3 1,800 116
Pulsed radiofrequency therapy for relieving neuropathic bone pain in cancer patients
Wei-Li Lin, Bo-Feng Lin, Chen-Hwan Cherng, Billy K Huh, Hsin-I Ma, Shinn-Long Lin, Chih-Shung Wong, Chun-Chang Yeh
March-April 2014, 34(2):84-87
DOI:10.4103/1011-4564.131903  
Metastatic bone pain is among the most commonly reported pain conditions in cancer patients and pharmacological therapy frequently fails to provide satisfactory pain relief. Pulsed radiofrequency (PRF) is a minimally invasive procedure and may be an effective alternative. However, there is little published data evaluating PRF treatment of metastatic pain. PRF therapy of select lumbar dorsal root ganglia was performed on two patients suffering from uncontrolled metastatic lumbar bone pain. After PRF therapy, the patients reported markedly improved back pain, and the effect lasted for months until they deceased. No complications or adverse events were noted from this minimally invasive procedure. PRF may be considered a potential intervention in treating certain neuropathic cancer pain conditions.
  3 11,026 312
ORIGINAL ARTICLES
Increased risk of stroke in patients with atopic dermatitis: A population-based, longitudinal study in Taiwan
Yueh-Feng Sung, Chun-Chieh Lin, Jiu-Haw Yin, Chung-Hsing Chou, Chi-Hsiang Chung, Fu-Chi Yang, Chia-Kuang Tsai, Chia-Lin Tsai, Guan-Yu Lin, Yu-Kai Lin, Wu-Chien Chien, Jiunn-Tay Lee
January-February 2017, 37(1):12-18
DOI:10.4103/1011-4564.200737  
Background: Chronic inflammation has been linked to stroke, but it is not known whether atopic dermatitis (AD), a chronically inflammatory skin disease, is related to stroke. The aim of this study was to investigate the association of AD and stroke. Materials and Methods: In this population-based, cohort study, data were collected from a Longitudinal Health Insurance Database released from the National Health Research Institute in Taiwan in 2011. All patients with AD between 2000 and 2006 without prior stroke were included and an age- and gender-matched cohort without prior stroke, 4-fold of the AD sample size, was served as the control group. The two cohorts were followed until the end of 2010 for stroke incidence. Cox's proportional hazards regressions were used to assess the difference in stroke risk between groups. Results: During the follow-up period of 4–11 years, 471 (incidence: 4.46/1,000 person-years) and 1497 (incidence: 3.56/1,000 person-years) stroke incidents were noted in the study and control cohort, respectively. The patients with AD had an increased incidence of ischemic stroke (adjusted hazard ratio [HR]: 1.21; 95% confidence interval [CI]: 1.08–1.36) but not hemorrhagic stroke (adjusted HR: 0.97; 95% CI: 0.74–1.29). The severity of AD was significantly correlated with the risk of ischemic stroke. Conclusions: These results suggest that AD is independently associated with ischemic stroke but not with hemorrhagic stroke. The risk of ischemic stroke is correlated significantly with the severity of AD. Further research is necessary to explore the underlying mechanism.
  3 1,564 125
REVIEW ARTICLE
Marine pharmacology: Potential, challenges, and future in India
Hemant R Kanase, Kritarth Naman M. Singh
March-April 2018, 38(2):49-53
DOI:10.4103/jmedsci.jmedsci_126_17  
More than 50% of the marketed drugs today are derived from natural sources. There are various cancers and diseases which cannot be managed well with the current available drugs. It is, therefore, important to identify new sources of drugs for the future. The biological diversity offered by the oceans shows promise in expressing some lead compounds for diseases which show a dearth of drug options for management. A handful of marine products have been approved by the United States – Food and Drug Administration (US-FDA) because of the involvement of academia and the pharmaceutical industry. However, there are many challenges involved which deter a better and faster process for drug development from marine sources. The current scenario in India is in a nascent phase, but steps are being taken in the right direction to develop a potential source of new drugs. In this review article, we try to give an overview over the history and impending potential of marine pharmacology, with an overlook on the current approved marine-sourced drugs by the US-FDA. We also take a brief look over the challenges involved in the field of marine pharmacology, its current progress in India and possible future scope.
  3 2,819 369
CASE REPORTS
Intestinal perforation complicating type II enteropathy-associated T-cell lymphoma
Fu-Chiang Yeh, Hong-Wei Gao, Sheng-Der Hsu, Jia-Hong Chen, Woei-Yau Kao
May-June 2014, 34(3):140-144
DOI:10.4103/1011-4564.134416  
Type II enteropathy-associated T-cell lymphoma (Type II EATL) is only rarely reported in Asia, especially in Taiwan and is known to be associated with a high bowel perforation rate. We described a case of Type II EATL with fatal perforation of the small intestine during his first cycle of chemotherapy. Conventional treatment for enteropathy-associated T-cell lymphoma consists of combination chemotherapy used for aggressive T-cell lymphoma (e.g., cyclophosphamide, adriamycin, vincristine, prednisone). Perforation of intestine often occurs at the time of diagnosis or in the early days of the first cycle of chemotherapy in these patients. To rescue and treat patient promptly, intestinal perforation should always be kept in mind as a differential diagnosis of acute abdominal pain in these patients. This case report highlights the potential pitfall in managing patients with gastrointestinal lymphoma and the need for maintaining a low threshold for prechemotherapy surgical intervention in patients diagnosed with type II EATL.
  2 2,580 109
Endocrine carcinoma of the pancreatic tail exhibiting gastric variceal bleeding
Si-Yuan Wu, Yuan-Min Chang, Jyh-Cherng Yu, De-Chuan Chan, Chung-Hsien Li, Gu-Jiun Lin, Shing-Hwa Huang
September-October 2014, 34(5):217-219
DOI:10.4103/1011-4564.143650  
Nonfunctional endocrine carcinoma of the pancreas is uncommon. Without excess hormone secretion, it is clinically silent until the enlarging or metastatic tumor causes compressive symptoms. Epigastric pain, dyspepsia, jaundice, and abdominal mass are the usual symptoms, whereas upper gastrointestinal (GI) bleeding is rare. Here, we describe the case of a 24-year-old man with the chief complaint of hematemesis. Upper GI panendoscopy revealed isolated gastric varices at the fundus and upper body. Ultrasonography and computed tomography showed a tumor mass at the pancreatic tail causing a splenic vein obstruction, engorged vessels near the fundus of the stomach, and splenomegaly. After distal pancreatectomy and splenectomy, the bleeding did not recur. The final pathologic diagnosis was endocrine carcinoma of the pancreas. Gastric variceal bleeding is a possible manifestation of nonfunctional endocrine carcinoma of the pancreas if the splenic vein is affected by a tumor. In non-cirrhotic patients with isolated gastric variceal bleeding, the differential diagnosis should include pancreatic disorders.
  2 1,683 89
A case of primary hemangiopericytoma of liver
Jayabal Pandiaraja, Viswanathan Subramanian
July-August 2015, 35(4):169-172
DOI:10.4103/1011-4564.163825  
Background: Hemangiopericytoma is a vascular tumor arises from pericyte of Zimmermann. Hemangiopericytoma arises from varies the location, but most commonly reported in extremities, retroperitoneum, head and neck, spine and cranium. However, intra-abdominal hemangiopericytoma is very rare. There are varies case report of intra-abdominal hemangiopericytoma including liver, spleen, pelvic cavity, and omentum; but primary hemangiopericytoma of the liver is very rare. Case Report: This is a case report of 49-year-old male presenting with abdominal pain for 2 months duration. No other positive history. During evaluation of the patient found to be having a mass lesion in the liver adjacent to caudate lobe, which compresses inferior vena cava. It found to be a primary hepatic hemangiopericytoma of the liver.
  2 1,761 128
ORIGINAL ARTICLES
Duodenogastric reflux: Proposed new endoscopic classification in symptomatic patients
Wei-Kuo Chang, Chih-Kung Lin, De-Chuan Chuan, You-Chen Chao
January-February 2016, 36(1):1-5
DOI:10.4103/1011-4564.177165  
Background: Duodenal contents reflux through the pylorus into the stomach can cause chronic gastritis and gastric cancer. This study aims to propose a new classification of endoscopic findings of duodenogastric reflux (DGR) in symptomatic patients. Patients and Methods: Eighty-eight patients with symptoms of DGR were included. Endoscopic findings, Helicobacter pylori, and mucosa pathological were recorded. Hepatobiliary scintigraphy was performed to quantify the DGR. Results: Among the 88 patients, 41 patients had normal mucosa (control group), 36 patients had bile lake (BL) (Group A), and 11 patients had bile stain (BS) (Group B). Group A significantly increases in postprandial DGR at 50 and 60 min. Group B significantly increases in fasting DGR at 50 and 60 min and postprandial DGR at 30, 40, 50, and 60 min. Group A and Group B had significant high intestine metaplasia and mucosal inflammation score than those in control group. Group B had a significantly higher incidence of gastric polyp than those patients in Group A and control group. Conclusions: Endoscopic findings of BS increased both fasting and postprandial DGR. BL had significant increased postprandial DGR. DGR increased the intestine metaplasia, mucosal inflammation, and gastric polyp in the stomach.
  2 2,788 213
Cognitive function, depressive symptoms, function level, and quality of life in mild dementia and amnestic-mild cognitive impairment
Shu Ping Chuang, Jo Yung Wei Wu, Chien Shu Wang, Li Hsiang Pan
January-February 2016, 36(1):14-21
DOI:10.4103/1011-4564.177171  
Objective: The present study aimed to investigate the relationship among neurocognitive variables, depressive symptoms, functional activities, and the quality of life (QoL) in patients with mild dementia and single-domain amnestic mild cognitive impairment (a-MCI). Materials and Methods: Thirty-seven mild dementia patients and thirty a-MCI participants were recruited. All subjects participated in a series of neuropsychological measures (Cognitive Abilities Screening Instrument, family pictures, and digit span), geriatric depression scale-15 (GDS-15), activities of daily living (ADL), The Lawton instrumental ADL scale (IADL) and QoL-Alzheimer's disease. Results: Multiple regression analysis revealed that only depressive symptoms was a predictor for the QoL in mild dementia (β = −0.56, P < 0.001). In contrast, all variables were not associated with the QoL in a-MCI. Mildly demented people scored significantly lower on most aspects of cognitive functioning and reported poorer performances on IADL than a-MCI. There were no significant differences on GDS, ADL, and QoL between the two groups. Conclusion: Findings indicated that depressive symptoms contributed to the QoL in mild dementia. Interventions targeting depressive symptoms in mild dementia may improve their QoL during their early stages of dementia.
  2 3,254 227
Phosphodiesterase 4B is essential for lipopolysaccharide-induced CC chemokine ligand 3 production in mouse macrophages
Ciou-Rong Lai, Huan-Chu Lo, Yi-Ling Chen, Jing-Xing Yang, Shiau-Li Ding, Hsian-He Hsu, Marco Conti, Chin-Pyng Wu, SL Catherine Jin
May-June 2015, 35(3):111-119
DOI:10.4103/1011-4564.158674  
Background: Phosphodiesterase 4 (PDE4) inhibitors negatively modulate many inflammatory responses, and some of these pharmacological effects are mediated by inhibition of PDE4B in inflammatory cells. While inactivation of PDE4B, but not other PDE4 isotypes, is known to inhibit lipopolysaccharide (LPS)-induced tumor necrosis factor-α (TNF-α) production in macrophages, a cell type critical in mediating innate immunity, the impact of PDE4B on many other inflammatory responses in these cells remains largely unknown. Materials and Methods: To investigate whether PDE4B regulates additional inflammatory mediators other than TNF-α, in this study we initially used two-dimensional gel electrophoresis approach to screen the secreted proteins that are modulated by the PDE4 inhibitor rolipram in LPS-stimulated Raw 264.7 macrophages. Results: Three proteins were identified, of which the proinflammatory chemokine CC chemokine ligand 3 (CCL3) and cytokine TNF-α were downregulated and the antiinflammatory cytokine interleukin-1 receptor antagonist was upregulated. Further analysis on CCL3 production in mouse peritoneal macrophages revealed that the reduced CCL3 secretion was associated with a substantial decrease in CCL3 mRNA accumulation. The inhibitory effect of rolipram on CCL3 production was mimicked by the protein kinase A activator 6-Bnz-cAMP, but not the exchange protein directly activated by cAMP activator 8-pCPT-2'-O-Me-cAMP. Analysis of PDE4-deficient macrophages showed that ablation of only PDE4B reproduced the rolipram effect on CCL3 production. Moreover, PDE4 inhibitor potentially attenuates T-cell migration to CCL3 in inflammatory sites. Conclusions: These findings suggest that PDE4B may regulate the production of diverse inflammatory mediators in LPS-stimulated macrophages, and an inhibitor with PDE4B selectivity should retain the anti-inflammatory effects of nonselective PDE4 inhibitors in endotoxin-induced inflammatory conditions.
  2 2,520 154
The impact of medical institutions on the treatment decisions and outcome of root-resected molars: A retrospective claims analysis from a representative database
Da-Yo Yuh, Fu-Gong Lin, Wen-Hui Fang, Wu-Chien Chien, Chi-Hsiang Chung, Lian-Ping Mau, E-Chin Shen, Earl Fu, Yi-Shing Shieh, Ren-Yeong Huang
January-February 2014, 34(1):1-8
DOI:10.4103/1011-4564.129380  
Background: This study analyzes the prognostic factors affecting the survival rate of root-resected molars by using a representative population-based dataset. Materials and Methods: A total of 635,216 eligible patients were enrolled from a representative cohort composed of one million of Taiwan's population. The tooth-related factors influencing the survival rates of root-resected teeth were examined on 516 molars, in 492 patients. Cox regression was performed to statistically analyze the factors. Results: The overall survival rate for the root-resected molars was 91.7%. Of the analyzed factors with respect to root-resection procedures, whether or not concomitant flap surgery was performed in the medical institutions, the dental arch and tooth location demonstrated a considerable influence on the treatment and decision-making. The main reasons and results of root-resected molars receiving root-resection therapy in hospitals were the periodontal-compromised conditions, whereas, the root-resected molars that received root-resection therapy in private practice clinics were caused by caries/endodontic reasons. After adjusting for other factors, in the outcome of root-resected molars, a higher risk of extraction occurrence was seen in hospitals than in private practice clinics (hazard ratio = 2.03; 95% CI = 1.04 to 3.98; P = 0.039). Conclusions: Of the analyzed prognostic factors, medical institutions significantly affect the treatment decision and survival of root-resected molars. Therefore, a comprehensive evaluation, risk assessment, and treatment plan should be executed before the root-resection procedure is performed.
  2 3,206 177
Topoisomerase I inhibitor suppress tumor growth in chemoresistant ovarian cancer-initiating cells
Yu-Chi Wang, Cheng-Chang Chang, Kai-Jo Chiang, Tai-Kuang Chao, Chia-Chun Wu, Ping-Ying Chang, Chang-Chieh Wu, Hung-Cheng Lai
March-April 2014, 34(2):72-76
DOI:10.4103/1011-4564.131897  
Background: To investigate the role of a topoisomerase I inhibitor (topotecan) in chemoresistant ovarian cancer-initiating cells. Materials and Methods: We isolated ovarian cancer-initiating cells (CP70 side-population cells) from the CP70 cell line using FACS Aria-based sorting and cultured them in suspension to form spheroids (CP70 side-population sphere [SPS]). Gene expression was assessed by microarray, to identify potentially effective chemotherapeutic drugs. An MTS assay was used to evaluate cell growth. Results: CP70 SPS cells showed significant resistance to the chemotherapeutic drugs cisplatin and paclitaxel. Microarray analysis demonstrated a high expression of topoisomerase-related genes in CP70 SPS cells. Topotecan inhibited ovarian cancer-initiating cells (CP70 SPS) in vitro more than it did their parental CP70 cells. This result was confirmed in tissues from human patients. Conclusions: Chemoresistant ovarian cancer-initiating cells exhibited high expression levels of topoisomerase, which could be an alternative target of adjuvant therapy for patients with chemoresistant ovarian cancer.
  2 2,099 151
Depression, anxiety, and heart rate variability: A case-control study in Taiwan
Li-Fen Chen, Chuan-Chia Chang, Nian-Sheng Tzeng, Terry B. J. Kuo, Yu-Chen Kao, San-Yuan Huang, Hsin-An Chang
January-February 2014, 34(1):9-18
DOI:10.4103/1011-4564.129383  
Objective: Decreased heart rate variability (HRV) has been reported in persons with major depressive disorder (MDD), but the results obtained are inconsistent. Little is known about the impact of comorbid anxiety disorders on HRV in MDD patients. Both issues necessitate further investigation. Materials and Methods: Forty-nine unmedicated, physically healthy, MDD patients without comorbidity, 21 MDD patients with comorbid generalized anxiety disorder (GAD), 24 MDD patients with comorbid panic disorder (PD), and 81 matched controls were recruited. The Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale are employed to assess the severity of depression and anxiety, respectively. The cardiac autonomic function was evaluated by measuring the HRV parameters. The frequency-domain indices of HRV were obtained. Results: MDD patients without comorbidity had lower high-frequency (HF)-HRV (which reflected vagal control of HRV) than controls. Any comorbid anxiety disorder (GAD or PD) was associated with significantly faster heart rates, relative to the controls, and caused greater reductions in HF-HRV among MDD patients. MDD participants with comorbid GAD displayed the greatest reductions in HF-HRV, relative to controls. Correlation analyses revealed that the severity of both depression and anxiety were significantly associated with the mean R wave to R wave (R-R) intervals, variance, low-frequency (LF)-HRV, and HF-HRV. Conclusion: The present results show decreased HRV in MDD patients, suggesting that reduction in HRV is a psychophysiological marker of MDD. MDD patients with comorbid GAD had the greatest reductions in HRV. Further investigation of the links between MDD and comorbid GAD, HRV, and cardiovascular disease is warranted.
  2 5,835 307
Epidemiologic and pathologic characteristics of basal cell carcinoma in northern Taiwan: Experience from a medical center
Yu-Wen Yeh, Sheng-Yi Chen, Bai-Yao Wu, Hong-Wei Gao, Chun-Yuan Liu, Wu-Chien Chien, Chien-Ping Chiang
May-June 2014, 34(3):98-103
DOI:10.4103/1011-4564.134272  
Background: The epidemiologic studies of basal cell carcinoma (BCC) in Taiwan are lacking. Aim: This study aimed to provide the epidemiologic and pathologic information of BCC among the northern Taiwanese population and try to identify the association of patient demographic characteristics with histopathological findings. Materials and Methods: We retrospectively analyzed 103 BCC cases diagnosed between December 1985 and December 2011 at the Tri-Service General Hospital, Taipei, Taiwan. The patients' age and sex, and anatomic distribution, subtype, depth, and pigmentation of the lesions were analyzed. Results: Of the patients, 59 were men and 44 were women (male-to-female ratio, 1.34). The overall mean age was 69.5 ± 12.91 years; with the mean age of the women lower than that of the men (66.9 vs. 71.4 years). The frequency of microscopic pigmentation in BCC was 52.4%. Nodular BCC was more inclined to develop microscopic pigmentation. The BCCs with depths greater than 3.3 mm tended to have no microscopic pigmentation. Superficial BCCs tended to involve the trunk and to occur in people younger than 60 years of age. Conclusions: This updated analysis study of BCC showed the mean age of BCC had a trend to increase in northern Taiwan. The male-to-female ratio in our study was slightly higher than those of other Asian countries. We suggest that excision of BCC without pigmentation could be deeper than pigmented BCC.
  2 3,246 240
Accuracy of spinal screw fixation using intraoperative O-arm navigation: Consecutive series of 118 screws
Shao-Wei Feng, Yun-Ju Yang, Chiao-Zhu Li, Meng-Chi Lin, Tzu-Tsao Chung, Yuan-Hao Chen
January-February 2016, 36(1):6-13
DOI:10.4103/1011-4564.177169  
Background: Imaging-guided surgery provides intraoperative realtime navigation for spinal surgery to prevent neurovascular injury. However, the initial experience of O-arm three-dimensional (3D) navigation is less clarified. The study aims to evaluate the accuracy of O-arm 3D navigation-assisted spinal implantation. Materials and Methods: Total 118 transpedicle/lateral mass screws in 17 consecutive patients performed through O-arm 3D computed tomography (CT) imaging navigation. Screws accuracy, Visual analogue scale (VAS), and operation time were assessed. O-arm 3D navigation included 96 pedicle screws and 22 lateral mass screws. Results: There accuracy rate of screw implantation was 96.6% (114/118) without breach (Grade 0), whereas 3.4% (4/118) breach between 2 and 4 mm (Grade 2). In the cervical spinal, 12 pedicle screws were placed in 4 patients; 16.7% (2/12) exhibited a Grade 2 breach in one patient, who developed a new neurological deficit and required revision. In the lumbosacral spine, 2.78% (2/72) exhibited a Grade 2 breach in 2 patients. The mean ± standard deviation VAS of the patients in postoperative and preoperative status was 1.47 ± 0.50 and 3.58 ± 1.00, respectively. The operation time was significantly longer in O-arm navigation than in C-arm guidance (426.5 ± 180.4 vs. 317.9 ± 133.6 min, P < 0.05). Conclusion: O-arm 3D navigation achieves a relatively high accuracy of pedicle and lateral mass screws implantation. The accumulation of experience for O-arm 3D CT during initial learning curve is still warranted to promote the accuracy of screws position and shorten operation time.
  2 2,727 243
Determination of virulence factors and biofilm formation among isolates of vulvovaginal candidiasis
Tapan Majumdar, Jhinuk Basu Mullick, Raunak Bir, Jayanta Roy, Samir Kumar Sil
March-April 2016, 36(2):53-58
DOI:10.4103/1011-4564.181521  
Context: Under morphogenesis-inducing conditions, Candida spp. begins to undergo yeast-to-hypha switch. This shift from commensal to pathogenic state is dependent on several virulence factors. Aim: To find out whether the isolated Candida spp. were pathogens causing vulvovaginal candidiasis or mere bystanders. Settings and Design: Cross-sectional observational study conducted on 275 symptomatic hospital patients in Tripura between August 2012 and April 2015. Subjects and Methods: Discharge was collected from patients and identified by Grams staining and wet mount test. Culturing was done in Sabouraud dextrose agar followed by speciation. To test for virulence factors, assays for adherence, plasma coagulase, phospholipase, lipase, protease, hemolysin, and biofilm formation were carried out. Statistical Analysis Used: Significance between two groups was compared using one-way analysis of variance along with Tukey test, and Chi-square 2 × 2 contingency table at 95% confidence interval. Results: Fifty-six Candida spp. could be isolated in the study which was used for further virulence tests. One hundred percent of isolates expressed adherence. Among other virulence factors, maximum virulence 25 (45%) was shown through protease production. Hemolysin production and biofilm formation were the second most 22 (39%) expressed virulence factors. In a comparison of virulence factors between biofilm-forming isolates and planktonic cells, significant difference was seen for plasma coagulase and hemolysin production. Conclusions: All the isolates expressed one or more virulence factors. Adherence was expressed in all isolates but highest number was observed for Candida albicans. Furthermore, C. albicans strain number was highest for protease, hemolysin and coagulase expression and biofilm formation. Candida krusei isolates were the least in number for expressing any of the virulence factors. Significantly higher number of biofilm forming isolates produced hemolysin and coagulase in comparison to planktonic cells.
  2 2,188 231
Antimicrobial activities of cefoperazone-sulbactam in comparison to cefoperazone against clinical organisms from medical centers in Taiwan
Tsung-Ta Chiang, Hung-Jen Tang, Cheng-Hsun Chiu, Te-Li Chen, Mao-Wang Ho, Chen-Hsiang Lee, Wang-Huei Sheng, Ya-Sung Yang
November-December 2016, 36(6):229-233
DOI:10.4103/1011-4564.196365  
Background: The multidrug-resistant Gram-negative bacteria (MDRGNBs) have emerged as important pathogens recently. Cefoperazone-sulbactam is active against a great proportion of those MDRGNBs. However, the susceptibilities data of cefoperazone-sulbactam are lacking in Taiwan. Object: This study was conducted to evaluate the susceptibilities data of cefoperazone-sulbactam aganist commonly encountered clinical pathogens in Taiwan. Materials and Methods: 2272 isolates were collected from various clinical specimens from five centers in Taiwan in 2012. The agar dilution method was used to evaluate the susceptibility of the isolated pathogens to cefoperazone and cefoperazone-sulbactam. Result: cefoperazone-sulbactam showed better activity against various GNBs, including MDRGNBs and part of carbapenem-resistant isolates tested compared to cefoperazone alone. Conclusion: Cefoperazone-sulbactam is active against most commonly encountered clinical pathogens, including MDRGNBs and part of carbapenem-esistant A. baumannii complex. It can be a potentially therapeutic agent for treating infections caused by these pathogens in Taiwan.
  2 9,547 569
REVIEW ARTICLE
Epidemiology and genetics of osteoarthritis
Donald M Salter, Sui-Lung Su, Herng-Sheng Lee
November-December 2014, 34(6):252-259
DOI:10.4103/1011-4564.147251  
Osteoarthritis (OA) is becoming a significant problem worldwide. Pain and loss of joint function have a major impact on an individual's quality of life and through loss of time at work and increasing health care costs has a significant economic burden on society. OA is a complex disease with a number of known risk factors. There is variable involvement of the synovial joints in populations as a result of both environmental and genetic factors. Recent candidate gene studies and genome-wide association studies are beginning to identify known and previously unsuspected genes to be associated with the development of OA. These studies raise the exciting prospect of future stratification of patients into genetically identified sub-groups that may have specific targetable pathways for disease management.
  2 5,032 296
SHORT COMMUNICATION
A preliminary report for the touring base model evaluation of the children with developmental delay in Kinmen
Chin-Bin Yeh
January-February 2016, 36(1):35-38
DOI:10.4103/1011-4564.177177  
Background: The purpose of this study was to analyze the characteristics of the children with developmental delays (DDs) in Kinmen. The methods of evaluation for the children with DDs were also discussed as references for other rural areas in Taiwan. Materials and Methods: There were 73 children recruited into our study in 2003 while starting the project of early evaluation for children with DDs in Kinmen. All the children were classified into 6 functional delay groups: Cognitive, speech, motor, social/emotional, pervasive, and nonspecific DDs. Results: Speech DD (46.7%) was the most frequently seen in all types of DDs. The second was the motor DD type (34.7%). Both the cognitive and pervasive types were the third frequent types of DDs (25.3%). It was shown that the speech DD types were the most frequently seen both in Taiwan and Kinmen, but the motor DD type was more frequent in Kinmen than in Taiwan. Conclusions: Our findings suggested that there are various factors related to the types of DDs. This result of our study could provide the future directions of the early evaluation program for the children with DD in rural areas.
  2 1,273 73
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