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SHORT COMMUNICATION
Assessment of nutritional status in the community and clinical settings
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava, Jegadeesh Ramasamy
September-October 2014, 34(5):211-213
DOI:10.4103/1011-4564.143648  
The nutritional status of an individual is usually a result of multiple factors that interact with each other at different levels. Recognizing the role of diet at the onset of many diseases and assessing the nutritional status of an individual, family and community are important for public health. The nutritional assessment is done to obtain information about the prevalence and geographic distribution of nutritional disorders within a community or a specified population group. It can also be used to identify high-risk groups and to assess the role of different epidemiological factors in nutritional deficiency. Assessment of the nutritional status aids assessing the prevalence of nutritional disorders, planning corrective measures, and evaluating the effectiveness of the implemented strategies simultaneously.
  12,442 689 -
CASE REPORTS
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.
  10,305 250 2
Frameless stereotactic deep brain stimulation for Parkinson's disease: A case report and technical note
Chun-Chieh Lin, Tung-Han Tsai, Yueh-Feng Sung, Da-Tong Ju, Yung-Hsiao Chiang, Yuan-Hao Chen
September-October 2014, 34(5):224-234
DOI:10.4103/1011-4564.143652  
Because deep brain stimulation (DBS) implantations and other stereotactic and functional surgical procedures require accurate, precise, and safe targeting of the brain structure, the technical aids for preoperative planning, intervention, and postoperative follow-up have become increasingly important. In this paper, we introduce a case of advanced Parkinson's disease with 10 years of medical control in which the patient received subthalamic nuclei (STN) DBS therapy through frameless surgery. A preliminary outcomes analysis is also provided. The STN DBS was implanted using a frameless stereotaxy protocol. After identifying the STN by microelectrode recording (MER), the DBS electrodes were implanted and connected to an implanted programmable generator. Programming started 1 month after the operation, and the patient was followed up on regularly and 12 months of post-STN DBS unified Parkinson's disease rating scale were recorded. After 12 months of follow-up, the patient who received the frameless surgery showed a significant improvement in clinical motor functions compared with his preoperative scores. The frameless system has the advantage of providing accuracy in postoperative lead position survey and target deviation measurements with comparison to the preoperative planning image. The outcomes of frameless DBS surgery are similar to those of frame-based surgery, with the advantages being that frameless surgery can reduce the patient's discomfort, shorten the operation and MER time, and decrease the MER trajectory number.
  7,292 224 -
ORIGINAL ARTICLES
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.
  5,009 216 1
REVIEW ARTICLE
Oncological emergencies for the internist
Umesh Das, KC Lakshmaiah, TM Suresh, K Govind Babu
January-February 2015, 35(1):1-10
DOI:10.4103/1011-4564.151283  
An oncologic emergency is defined as any acute, potentially life-threatening event, either directly or indirectly related to a patient's cancer (ca) or its treatment. It requires rapid intervention to avoid death or severe permanent damage. Most oncologic emergencies can be classified as metabolic, hematologic, structural, or side effects from chemotherapy agents. Tumor lysis syndrome is a metabolic emergency that presents as severe electrolyte abnormalities. The condition is treated with aggressive hydration, allopurinol or urate oxidase to lower uric acid levels. Hypercalcemia of malignancy is treated with aggressive rehydration, furosemide, and intravenous (IV) bisphosphonates. Syndrome of inappropriate antidiuretic hormone should be suspected if a patient with ca presents with normovolemic hyponatremia. This metabolic condition usually is treated with fluid restriction and furosemide. Febrile neutropenia is a hematologic emergency that usually requires inpatient therapy with broad-spectrum antibiotics, although outpatient therapy may be appropriate for low-risk patients. Hyperviscosity syndrome usually is associated with Waldenstrφm's macroglobulinemia, which is treated with plasmapheresis and chemotherapy. Structural oncologic emergencies are caused by direct compression of surrounding structures or by metastatic disease. Superior vena cava syndrome is the most common structural oncological emergency. Treatment options include chemotherapy, radiation, and IV stenting. Epidural spinal cord compression can be treated with dexamethasone, radiation, or surgery. Malignant pericardial effusion, which often is undiagnosed in ca patients, can be treated with pericardiocentesis or a pericardial window procedure.
  4,645 361 -
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.
  4,101 202 1
ORIGINAL ARTICLES
Ten-year experience of superior gluteal artery perforator flap for reconstruction of sacral defects in Tri-Service General Hospital
Chin-Ta Lin, Nian-Tzyy Dai, Shun-Cheng Chang, Shyi-Gen Chen, Tim-Mo Chen, Hsian-Jenn Wang, Yuan-Sheng Tzeng
March-April 2014, 34(2):66-71
DOI:10.4103/1011-4564.131895  
Background: Despite advances in reconstruction techniques, sacral sores continue to present a challenge to the plastic surgeon. The superior gluteal artery perforator (SGAP) flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. However, the dissection of the perforator is tedious and carries a risk of compromising the perforator vessels. Patients and Methods: During the period between April 2003 and March 2013, 30 patients presented to our section with sacral wounds causing by pressure sores or infected pilonidal cysts. Of a total of 30 patients, 13 were female and 17 were male. Their ages ranged from 22 to 92 years old (mean 79.8 years old). Surgical intervention was performed electively with immediate or delayed reconstruction using a SGAP flap. The characteristics of patients' age, and sex, and cause of sacral defect, co-morbidities, wound culture, flap size, perforator number, hospital stay, and outcome were reviewed. Results: For all operations, the length of the pedicle dissection will not exceed 1 cm because of the vascular anatomy of the SGAP, which lies adjacent to the sacral region. Due to short pedicle dissection, all SGAP flap were elevated around an hour. All flaps survived except two, which had partial flap necrosis and were finally treated by contralateral V-Y advancement flaps coverage. The mean follow-up period was 14.8 months (range 3-24). No flap surgery-related mortality was found. Conclusion: Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Our study shows that deep pedicle dissection is unnecessary when the surgery involves an accurate indicating perforator, adequate flap size design, and correct selection of flap utilization between tunnel and rotation. The advantages of this modification include a faster operation, less bleeding, and less trauma of the pedicle, which make the SGAP flaps an alternative choice for sacral sores coverage.
  3,942 315 -
Evaluation of stroke risk associated with the use of typical or atypical antipsychotics among patients with cardiovascular diseases
Meng-Ting Wang, Min-Fang Li, Che-Li Chu, Chin-Bin Yeh, Cheng-Liang Tsai, Jun-Ting Liou
January-February 2015, 35(1):11-18
DOI:10.4103/1011-4564.151284  
Background: Concerns regarding stroke safety associated with the use of atypical antipsychotics among dementia patients have been raised. Although observational studies have found conflicting associations of stroke risk with the use of typical or atypical antipsychotics among the elderly with or without dementia, patients with cardiovascular diseases (CVDs), a high-risk for the stroke population, have not been examined. Little evidence has been provided regarding comparison of the stroke risk between the two antipsychotic classes. This study aimed to evaluate the comparative stroke risk with atypical versus typical antipsychotic use among CVD patients. Materials and Methods: We conducted a population-based nested case-control study analyzing the Taiwan National Health Insurance Research Database from January 1, 1996 to December 31, 2007. A total of 7,460 CVD patients was followed-up, among which 580 hospitalized cases with stroke were identified and matched to 5,398 randomly selected controls. Conditional logistic regressions were employed to quantify the difference in stroke risk associated with atypical versus typical antipsychotics. Results: Any use and current use of atypical antipsychotics were associated with a 1.67-fold (95% confidence interval [CI], 1.21-2.30) and a 2.30-fold (95% CI, 1.56-3.40) increased risk of stroke relative to any typical antipsychotic use, respectively. The stroke risk associated with current use of atypical antipsychotics persisted even compared with current use of typical antipsychotics (adjusted odds ratio, 1.53; 95% CI, 1.02-2.33). Conclusions: Use of atypical antipsychotics is associated with an increased risk of stroke requiring hospitalization compared to typical antipsychotic use among CVD patients. Healthcare professionals should take this risk into account when choosing between typical and atypical antipsychotic treatments among CVD patients.
  3,288 264 1
A comparative study evaluating the clinical efficacy of skin tapes versus silicone gel for the treatment of posttrauma scar in the rabbit model
Chih-Chien Wang, Juin-Hong Cherng, Shyi-Gen Chen, Tsai-Wang Huang, Leou-Chyr Lin, Ru-Yu Pan, Yi-Hsin Chan, Chih-Hsin Wang
September-October 2014, 34(5):195-200
DOI:10.4103/1011-4564.143641  
Background: Skin tape and silicone gel are two common over-the-counter preparations used to enhance the cosmesis of keloids and hypertrophic scars of posttrauma wounds. This animal study was performed to determine the clinical efficacy of skin tape versus silicone gel in subjects with scars. Materials and Methods: Three New Zealand rabbits that received total 12 incision wounds which two incision wounds on one ear side and subsequent primary suturing were studied. Stitches were removed after 1 week. Silicone gel was applied right upper side of the rabbit's ear directly on surgical incision wounds, and skin tapes were also applied left upper side of the rabbit's ear directly on another surgical incision wounds after 1 week of surgery. The lower incisions in both ears were covered with sterilized gauze and served as controls. We compared two experimental groups at binaural with using Vancouver Scar Scale, Manchester Scar Scale, and The Stony Brook Scar Evaluation Scale. These are widely used in clinical practice and research to document change in scar appearance. Results: We describe a rabbit model for incisional wounds and scarring outcome measures. The results of scar measuring devices demonstrated that skin tape reduced scar formation as well as silicone gel. Conclusions: The results of cosmetic demonstrated that skin tape reduced scar formation as well as silicone gel. However, the economical and effective materials were the important subject that suffices for clinical requirement. The application of these scar prevention devices to reduce scar formation after surgical incision is worthy of future investigation. Moreover, skin tape may represent a low-cost alternative and low scar formation for closure of surgical incisions.
  3,286 178 -
CASE REPORTS
Bipedicled flap reconstruction of soft tissue defect with Achilles tendon exposure
Chin-Ta Lin, Chi-Yu Chen, Shun-Cheng Chang
May-June 2014, 34(3):129-132
DOI:10.4103/1011-4564.134396  
Soft tissue defects exposing the Achilles tendon are common in patients who have undergone trauma or in those with pressure ulcers associated with vascular diseases. Here, we present our recent experience of using a bipedicled fasciocutaneous flap to resurface the complex soft tissue defect and provide a gliding surface for the exposed Achilles tendon. The donor-sites were covered with split-thickness skin grafts and healed well without complications. The bipedicled fasciocutaneous flap survived completely, and the wound healed satisfactorily at 2 months follow-up. The bipedicled fasciocutaneous flap is a reliable flap for coverage of defects overlying the Achilles tendon, especially in patients with vascular problems and/or advanced age. The ease of handling, short operative time, and early recovery of mobilization function are of great benefit to patients. This method can be a valuable alternative for defect reconstructions overlying the Achilles tendon, with satisfactory results both functionally and cosmetically.
  3,125 193 -
An isolated chest wall metastasis from cervical squamous cell carcinoma after 19 years of disease-free survival and no local recurrence: A case report and review of literature
Ying-Yi Chen, Chih-Hsin Wang, Wen-Chuan Tsai, Mu-Hsien Yu, Shih-Chun Lee, Hung Chang, Tsai-Wang Huang
November-December 2014, 34(6):272-276
DOI:10.4103/1011-4564.147272  
Chest wall tumors can arise from a wide variety of benign and malignant etiologies, and therefore it can be challenging for clinicians to diagnose and manage them. Isolated metastatic squamous cell carcinoma from cervical cancer is extremely rare. We report a metastatic chest wall tumor from cervical cancer arising after 19 years of disease-free survival. Wide resection of the metastatic chest wall tumor, followed by a polypropylene mesh and free flap reconstruction with adequate coverage was successful. The patient continues to be a disease-free at 2 years.
  3,083 107 -
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.
  3,012 135 6
Antroquinonol, an active pure compound from Antrodia camphorate mycelium, modulates the development of atherosclerosis in a mouse carotid artery ligation model
Tsai-Jung Lin, Yun-Yi Lee, Bieng-Hsian Tzeng, Shih-Ping Yang, Cheng-Wen Ho, Dueng-Yuan Hueng, Jia-Ming Chang, Kun-Lun Huang, Fu-Gong Lin, Ann Chen, Yeukuang Hwu, Shuk-Man Ka
March-April 2014, 34(2):56-61
DOI:10.4103/1011-4564.131888  
Background: Antroquinonol (Antroq) is an active component of Antrodia camphorate. The present study was to validate the preventive effects of Antroq in an atherosclerosis model. Materials and Methods: We examined Antroq inhibitory effect on rat aortic smooth muscle cell proliferation and migration and evaluated its effect on neointima formation and inflammation in mouse carotid artery ligation (CAL). Results: Our data show that Antroq [1] inhibited the proliferation (Antroq [3.0 μg/ml] + PDGF 41.7 ± 7.3%, vehicle + PDGF 134.5 ± 7.3%) (p<0.005) and migration (6h: Antroq [3.0 μg/ml] + PDGF 0.9 ± 0.3%, vehicle + PDGF 25.0 ± 3.4%; 12h: Antroq [3.0 μg/ml] + PDGF 4.0 ± 1.6%, vehicle + PDGF 40.5 ± 2.2%; 24h: Antroq [3.0 μg/ml] + PDGF 14.2 ± 3.0%, vehicle + PDGF 59.8 ± 3.3%) (each, p<0.005) of the cultured smooth muscle cells, [2] prevented neointima formation and reduced N/M ratios in CAL mice (900 μm: Antroq + CAL 0.8 ± 0.3, CAL 3.5 ± 1.1; 800 μm: Antroq + CAL 0.6 ± 0.2, CAL 3.5 ± 0.7; 700 μm: Antroq + CAL 0.7 ± 0.2, CAL 3.8 ± 0.4; 600 μm: Antroq + CAL 0.9 ± 0.2, CAL 3.8 ± 0.9; 500 μm: Antroq + CAL 1.3 ± 0.4, CAL 3.9 ± 0.8; 400 μm: Antroq + CAL 1.5 ± 0.5, CAL 4.0 ± 1.0; 300 μm: Antroq + CAL 1.8 ± 0.6, CAL 3.5 ± 0.6; 200 μm: Antroq + CAL 2.3 ± 0.6, CAL 4.6 ± 1.1) (each, p<0.01), [3] and prevented inflammatory processes and matrix accumulation/fibrosis in the CAL mice. Conclusions: Our data may be useful in developing new and practical strategy for the prevention of atherosclerosis based on the pathogenesis of the disorder.
  2,766 248 -
Valproic acid exerts an anti-tumor effect on tongue cancer sas cells in vitro and in vivo
Gu-Jiun Lin, Shu-Sheng Kao Chen, Shing-Hwa Huang, I-Hsun Li, Li-Chen Yen, Jang-Yi Chen, Huey-Kang Sytwu, Yuan-Wu Chen
January-February 2015, 35(1):28-36
DOI:10.4103/1011-4564.151289  
Background: Valproic acid (VPA) is a drug approved by the Food and Drug Administration for epilepsy and bipolar disorders. It is also a known histone deacetylase inhibitor and has been evaluated as an anti-cancer agent. However, the in vitro and in vivo anti-tumor effect of VPA on human tongue cancer has not been evaluated. Materials and Methods: We tested VPA for its anti-tumor activity on the human tongue cancer (SAS) cell line in vitro and in vivo in a tumor xenograft model in mice. The effect of VPA on the cell cycle and apoptosis was examined. Results: Growth inhibition was noted when SAS, squamous cell carcinoma 25 and OECM-1 cells were treated with various doses of VPA for 24-72 h, and it was found that VPA treatment caused G1 arrest and apoptosis in SAS cells. VPA also inhibited the phosphorylation of Akt and ERK in SAS cells in vitro. Tumor growth inhibition was observed in NOD/SCID mice bearing xenografts of human tongue cancer that were treated with a VPA dose of 400 mg/kg/day. Conclusions: This study demonstrates that VPA can inhibit the growth of human tongue cancer cells in vitro and in vivo without causing any significant adverse effects.
  2,693 193 1
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.
  2,709 149 2
The serotonin transporter gene (triallelic 5-HTTLPR polymorphism) may associate with male depression in Han Chinese population
Pei-Shen Ho, Chih-Lun Chen, Chuan-Chia Chang, Hsin-An Chang, Yi-Wei Yeh, Chih-Sung Liang, Che-Hung Yen, Shin-Chang Kuo, Chun-Yen Chen, Chang-Chih Huang, Chun-Long Lin, Ru-Band Lu, Mei-Chen Shih, San-Yuan Huang
March-April 2016, 36(2):59-67
DOI:10.4103/1011-4564.181519  
Background: Pharmacological, neurobehavioral, and therapeutic evidence have implicated serotonin in the pathogenesis of depression. There are conflicting reports on the association of genetic variants of serotonin transporter gene (5-HTTLPR) with major depressive disorder. The 5-HTTLPR is thought to have three primary allelic variants (rs25531): LA, LG, and S. The present study examined whether major depression was associated with tri-allelic 5-HTTLPR polymorphisms in a Han Chinese population. Materials and Methods: Bi-allelic and tri-allelic 5-HTTLPR polymorphisms were assessed in 305 patients with major depressive disorder (MD) and 313 unrelated healthy control subjects. In addition, to reduce clinical heterogeneity, subtype analyses were performed for clinically important variables, including family history of major affective disorder, age at onset, and severity of MD. Results: The bi-allelic 5-HTTLPR polymorphism was not associated with MD and its clinical subgroups. However, the tri-allelic 5-HTTLPR polymorphism was associated with major depression and with specific subgroups. In particular, in male subjects, patients with a low expressing genotype (S'/S') were at higher risk for MD than those with high expressing genotypes (S'/L' and L'/L'). This positive association was only observed in the subgroups of late-onset and moderate severity MD. Conclusions: The present study suggests that the tri-allelic 5-HTTLPR polymorphism might be a risk factor for susceptibility to either MD or its clinical subtypes in the Han Chinese male population but not in the female population. However, these results should be validated in a larger patient population that includes different ethnic samples or subdiagnosis groups.
  2,747 94 1
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.
  2,580 209 1
CASE REPORTS
Preserve the lower limb in a patient with calcaneal osteomyelitis and severe occlusive peripheral vascular disease by partial calcanectomy
Chin-Ta Lin, Chi-Yu Chen, Shyi-Gen Chen, Tim-Mo Chen, Shun-Cheng Chang
March-April 2015, 35(2):74-78
DOI:10.4103/1011-4564.156016  
Heel ulcers in patients with severe peripheral artery occlusive disease represent a challenge to the treating physician. They become more difficult to treat with underlying medical comorbidities. We report a case of 76-year-old man with hypertension, diabetes mellitus, and end-stage renal disease in uremia status presented to our hospital with a 3-month history of a diabetic foot ulcer on his right heel. He was diagnosed with near total artery occlusion below the knee at the local hospital, and vascular reconstruction failed. After admission, surgical debridement was performed with subsequent partial calcanectomy facilitating wound closure without tension. After surgery, the foot was immobilized with a short-leg splint for 2 weeks. Thereafter, ankle immobilization was accomplished using a thermal protective plastic splint and cast shoes with a posterior window for wound care. The wound healed well with no recurrence during the 12-month follow-up period, and the patient may return to an ambulatory status, including a normal gait pattern. In this case, we demonstrate that the partial calcanectomy is practical for the treatment of plantar heel ulcers in a patient with severe comorbidities. With proper surgical planning and postoperative care, partial calcanectomy is a viable alternative to below-the-knee amputation and may better serve the patient who would otherwise be restricted to a sedentary lifestyle.
  2,597 133 -
ORIGINAL ARTICLES
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.
  2,440 199 1
CASE REPORTS
Chronological emergence of a class a carbapenemase-producing Enterobacter aerogenes in Taiwan
Zheng-Yi Huang, Jun-Ren Sun, Sheng-Ting Hsu, Ching-Mei Yu, Cherng-Lih Perng, Tzong-Shi Chiueh
January-February 2014, 34(1):44-48
DOI:10.4103/1011-4564.129394  
This study reports the case of a 77-year-old, long-term, bedridden patient, with a nosocomial wound infection caused by a multidrug-resistant strain of Enterobacter aerogenes (E. aerogense). The isolate produced an Ambler-class A carbapenemase, which was demonstrated by the Modified Hodge test (MHT) and a confirmatory inhibition test. However, no known carbapenemase genes were discovered in this isolate by polymerase chain reactions (PCRs) with specific primers. New carbapenemase or other resistant mechanisms could be explored from the isolate of carbapenem-resistant E. aerogense, according to the revised criteria (CLSI, 2012).
  2,470 154 -
ORIGINAL ARTICLES
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.
  2,452 152 -
Analysis of risk factors in elderly patients with purple urine bag syndrome: A retrospective analysis in a medical center in northern Taiwan
Tao-Chun Peng, Chung-Ching Wang, James Yi-Hsin Chan, Shih-Ming Huang, Tung-Wei Kao, Yaw-Wen Chang, Wen-Hui Fang, Wei-Liang Chen
May-June 2014, 34(3):110-114
DOI:10.4103/1011-4564.134380  
Background: Purple urine bag syndrome (PUBS), an uncommon phenomenon that turns urine tubes or bags purple or blue, can be encountered in long-term-care facilities. A thorough literature review shows that East Asia has a high incidence of PUBS. It is important to recognize the clinical features and risk factors of this phenomenon. The aim of this study is to explore the characteristics of patients with PUBS and correlate the onset of PUBS symptoms with risk factors. Materials and Methods: We reported nine cases of clinically confirmed PUBS between January 2009 and June 2013. Pertinent clinical information was collected, including age, feeding type, renal function, type of Foley catheter, urine analysis, and bacteriological data. Results: All of patients with PUBS presented with stable vital signs without evidence of clinical infection, such as fever or chills. The mean age of the patients was 86.6 ± 10.1 years, with a preponderance of females (77%). Five PUBS patients (55%) had a history of chronic renal insufficiency. Six patients (66%) had constipation. A logistic regression univariate analysis demonstrated a statistically significant urine pH in patients with PUBS [odds ratio (OR), 3.078; P = 0.036]. Risk factors, such as gender, were found to be significant using logistic regression multivariate analysis (OR, 0.031; P = 0.021). During the follow-up, all of the patients had Foley catheters re-inserted, and all of the patients received health education. Conclusion: The incidence of PUBS in the elderly population is associated with asymptomatic bacteriuria, urine pH, and gender but not renal function, type of feeding, or type of Foley catheter used. To understand PUBS and maintain urological hygiene, it is important to educate families and health care workers about PUBS and to recognize that PUBS is not regarded as a symptom of severe disease.
  2,412 176 -
REVIEW ARTICLE
Age estimation: Current state and research challenges
Abhishek Singh Nayyar, B Anand Babu, B Krishnaveni, M Vaishnavi Devi, HC Gayitri
November-December 2016, 36(6):209-216
DOI:10.4103/1011-4564.196348  
There exist several methods and a fairly substantial literature on the field of age estimation. However, different methods are associated with varying degrees of uncertainty and precision, and this is not always well understood. From a statistical-methodological point of view, there are reasons to believe that a combination of different measurement methods and a more conscious use of the relevant statistical methodology may provide more reliable estimates and better quantification of associated levels of uncertainty. When the uncertainty is known, considering the acceptance level of the error rates, methods are to be found out to rectify it to the maximum possible extent to make it in acceptable limits with maximum validity as there are no methods, by which the age of an individual can be precisely estimated.
  2,336 239 -
ORIGINAL ARTICLES
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.
  2,374 171 1
Facial biometrics of Yorubas of Nigeria using Akinlolu-Raji image-processing algorithm
Adelaja Abdulazeez Akinlolu
March-April 2016, 36(2):39-45
DOI:10.4103/1011-4564.181520  
Background: Forensic anthropology deals with the establishment of human identity using genetics, biometrics, and face recognition technology. This study aims to compute facial biometrics of Yorubas of Osun State of Nigeria using a novel Akinlolu-Raji image-processing algorithm. Materials and Methods: Three hundred Yorubas of Osun State (150 males and 150 females, aged 15–33 years) were selected as subjects for the study with informed consents and when established as Yorubas by parents and grandparents. Height, body weight, and facial biometrics (evaluated on three-dimensional [3D] facial photographs) were measured on all subjects. The novel Akinlolu-Raji image-processing algorithm for forensic face recognition was developed using the modified row method of computer programming. Facial width, total face height, short forehead height, long forehead height, upper face height, nasal bridge length, nose height, morphological face height, and lower face height computed from readings of the Akinlolu-Raji image-processing algorithm were analyzed using z-test (P ≤ 0.05) of 2010 Microsoft Excel statistical software. Results: Statistical analyzes of facial measurements showed nonsignificant higher mean values (P > 0.05) in Yoruba males compared to females. Yoruba males and females have the leptoprosopic face type based on classifications of face types from facial indices. Conclusions: Akinlolu-Raji image-processing algorithm can be employed for computing anthropometric, forensic, diagnostic, or any other measurements on 2D and 3D images, and data computed from its readings can be converted to actual or life sizes as obtained in 1D measurements. Furthermore, Yoruba males and females have the leptoprosopic face type.
  2,446 96 -
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