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   2017| July-August  | Volume 37 | Issue 4  
    Online since August 23, 2017

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Overview of clinical trials for dry age-related macular degeneration
Wen-Sheng Cheng, Da-Wen Lu, Chiao-Hsi Chiang, Charn-Jung Chang
July-August 2017, 37(4):121-129
The overall goal of treating age-related macular degeneration (AMD) is to target the underlying cause of the disease and prevent, or at least slow down, the loss of vision, which requires the preservation of the choroid, retinal pigment epithelium (RPE), and photoreceptors. At present, there is no proven drug treatment for dry AMD; however, the cessation of smoking and treatments based on the age-related eye diseases study vitamin formula combined with a healthy diet are considered the only options for slowing disease progression. A number of pharmaceutical agents are currently under evaluation for the treatment of dry AMD using strategies such as reduction RPE and photoreceptor loss, neuroprotection, visual cycle modulators, suppression of inflammation, prevention of oxidative damage, and choroidal perfusion enhancers. The hope is that some of these therapies will achieve significant improvement to current management and prevent future loss of vision in this devastating eye condition.
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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
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.
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Effects of isolation rearing and early antipsychotic intervention on oxidative stress-induced apoptosis and brain-derived neurotrophic factor in hippocampus in a rat model of schizophrenia
Szu-Nian Yang, Yu-Yin Yang, Fang-Jung Wan, Chuen-Lin Huang, Yia-Ping Liu
July-August 2017, 37(4):155-162
Background: Oxidative stress-induced neuronal dysfunction has been considered an essential factor for the development of schizophrenia. However, a longitudinal and causal relation between the impacts of developmental stress and oxidative stress remains unsolved. The present study aimed to examine whether the oxidative stress-relevant dysfunctions of the apoptotic index can be induced in rats of isolation rearing (IR, a rodent model of schizophrenia) and to see if the intervention of antipsychotics can reverse these dysfunctions. Materials and Methods: Pharmacological manipulation (risperidone [RIS] [1 mg/kg/day], olanzapine [OLA] [2.5 mg/kg/day], or saline [SAL] vehicle) was introduced 4 weeks (adolescence) or 8 weeks (young adulthood) after IR (i.e., rats were 7- or 11-week-old). The regime of RIS, OLA, or SAL was continued for 9 weeks. Locomotor activity was employed to validate the IR effect. Rats' hippocampus immediately after sacrifice was removed to measure messenger RNA expression of Bax, Bcl-2, brain-derived neurotrophic factor (BDNF) and the plasma level of nitric oxide (NO). Results: The results showed: (i) IR rats were more hyperactive. (ii) RIS may exert anti-apoptotic effects on IR rats, particularly at their adolescent age (as indexed by increased Bcl-2 and decreased Bax/Bcl-2 ratio). (iii) The therapeutic potential of RIS can be also observed in the change of BDNF in an age-independent manner, in which RIS effectively increased the BDNF level in IR but not social (SOC) rats. (iv) Plasma NO was not altered. Conclusion: The study results support the utility of the IR paradigm in exploring mental disorders with neurodevelopmental origin in which early pharmacological intervention may provide a therapeutic benefit in the overloaded oxidative stress and the dysfunction of BDNF.
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Skin cancer and soft-tissue sarcoma prevalence and incidence rate among the population of Karbala, Iraq, 2008–2015
Ali Abdul Hussein S. AL-Janabi
July-August 2017, 37(4):130-136
Background: There is no restricted area free from cancer. Skin cancer and soft-tissue sarcoma (STS) are among many types of cancer that can develop among any population worldwide. Thus, it is important to follow-up these malignant diseases in Iraq cities for information about the epidemiological pattern of such types of cancer. Methods: Incidence rate, prevalence, and age-specific rate (ASR) for skin and STS were determined. The data about 143 positive cases of skin cancer and 38 patients with STS in Karbala, a city in Iraq, were collected for the past 8 years (2008-2015). Results: The prevalence and incidence rate were found higher for STS than for skin cancer, especially in males. In males with skin cancer, the ASR was greater than 10 per 100,000 of the population for the age range 50–85 years, whereas in females, it was for 40–85 + years over the period considered. Meanwhile, in males with STS, a higher ASR was shown for age range 55–85+ years, whereas it was for 65–74 years in females. Conclusion: The STS showed a higher prevalence and incidence rate than that skin cancer, especially in older males. Both types of malignant disease are considered among more serious types of cancer among the population of Karbala and people are under the progressive risk of such type of cancers.
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Combining two different chemotherapy agents with platinum analogs as induction and consolidation regimes in nonsmall cell lung carcinoma
Mohsin Khan, Shahid Ali Siddiqui
July-August 2017, 37(4):150-154
Background: There are limited data pertaining to the combined use of induction and consolidation chemotherapy with concurrent chemo-radiotherapy (RT) for treating nonsmall cell lung carcinoma (NSCLC). To find out an optimum/effective regime for treating NSCLC utilizing both induction and consolidation approach with concurrent chemo-RT is the primary aim of this study. Materials and Methods: We retrospectively analyzed 132 patients with NSCLC. Fifty-four patients treated with paclitaxel-carboplatin and 78 with gemcitabine-cisplatin combinations in induction and consolidation phases. Concurrent chemo-RT included 60–66 Gray (Gy) of RT with weekly cisplatin and was similar in both the arms. Results: After completion of the consolidation phase, we observed on overall response rate (ORR) of 42.7% in the paclitaxel-carboplatin arm and 42.3% in gemcitabine-cisplatin arm with 2 and 3 years' survival rates of 32% and 19% with paclitaxel-carboplatin and 38% and 24% with gemcitabine-cisplatin regimes. We also observed higher ORR for squamous cell histology treated with the gemcitabine-cisplatin combination. Conclusion: Although both paclitaxel-carboplatin and gemcitabine-cisplatin combinations are equally effective in treating NSCLC, gemcitabine-cisplatin provided slightly better response rates but with clinically more frequent and relevant toxicities.
  215 59 -
Radiotherapy inducing total knee prosthetic component loosening for recurrent pigmented villonodular synovitis following joint replacement
Ko-Ta Chen, Jan-Show Chu, Chian-Her Lee
July-August 2017, 37(4):168-171
Pigmented villonodular synovitis (PVNS) following total knee arthroplasty (TKA) is a rare condition. We reported a case of PVNS following TKA; initially, arthroscopic synovectomy was performed; however, recurrence of PVNS happened. We performed second arthroscopic synovectomy and moderate dose radiotherapy (total dose 44 cGy/22 fractions to posterior fossa, 36 cGy/18 fractions to knee) for the patient. Unfortunately, distal femur osteonecrosis with femoral and tibial component loosening happened 2 months after completing the radiotherapy procedure. Revision TKA with Legacy Constrained Condylar Knee was done. Radiotherapy is not recommended for recurrent PVNS after TKA.
  192 52 -
Blunt chest trauma with diaphragmatic laceration presenting as delayed hemothorax
Ao-Chi Lin, Cheng-Ken Tsai, Chien-Sung Tsai, Chih-Yuan Lin
July-August 2017, 37(4):175-177
We report a case of delayed hemothorax resulted from diaphragmatic laceration after blunt chest trauma and its successful treatment. Initial chest X-ray and initial computed tomography (CT) scan revealed no hemothorax in this 19-year-old male with a stable hemodynamic condition although there were multiple contusion wounds with ecchymoses over the right chest wall, shoulder, back and right upper quadrant of abdomen. In the following day, he experienced progressive dyspnea and conscious disturbance. Massive hemothorax was verified through repeated chest X-ray and CT scan. A laceration wound about 3 cm in length with continuous oozing at the dome of the right hemidiaphragm was noted in emergent thoracotomy. The laceration was repaired, and the patient had an uneventful recovery after the surgery. We proposed that traumatic diaphragmatic injury should be considered in any patient who has sustained blunt trauma to the lower chest and upper abdomen regions, watchful observation and high index of suspicion are necessary.
  185 41 -
Movement disorder and epilepsy in subependymal nodular heterotopia
Anurag Lohmror, Richa Choudhary
July-August 2017, 37(4):172-174
Subependymal nodular heterotopia is a cortical development malformation that is commonly associated with refractory epilepsy. Patients with heterotopia show a wide spectrum of clinical manifestations, from being asymptomatic to presenting with intractable seizures and intellectual impairment. We report a case of drug-resistant epilepsy with normal intelligence, having bilateral subependymal heterotopic nodules in the brain, presenting to us with a movement disorder in the form of myoclonus of bilateral lower limbs which is an unusual manifestation of gray matter heterotopias. Although rare, gray matter heterotopias may present as movement disorder and should be considered in differential diagnosis while workup of movement disorders.
  151 47 -
Improved diagnostic potential of polymerase chain reaction by amplification of multiple gene targets in osteoarticular tuberculosis
Gopinath Palanisamy, Sameer Aggarwal, Kusum Sharma, Balaji Saibaba, Mandeep Singh Dhillon
July-August 2017, 37(4):163-167
Purpose: Till date, a number of primers have been described for the diagnostic polymerase chain reaction (PCR) assays for tuberculosis (TB). However, most investigators have evaluated PCR's clinical utility using only one primer specific for Mycobacterium tuberculosis. The purpose of this study was to evaluate the efficacy of PCR tests targeting two different DNA sequences – insertion sequence 6110 (IS6110) and protein antigen b (Pab), in the same set of clinical samples from osteoarticular TB cases, and to evaluate if the sensitivity of the assay is improved. Materials and Methods: Twenty clinical samples obtained from osteoarticular TB cases were subjected to two different PCR assays - 123 base pair (bp) sequence coding for IS6110 and 419 bp sequence coding for Pab. Ten clinical samples from cases of proven septic arthritis were studied as controls. Results: The sensitivity of IS6110 PCR and Pab PCR were found to be 75% and 80%, respectively, and the specificity of both IS6110 PCR and Pab PCR was 100%. No significant difference was found between two PCR assays (P > 0.05). However, there were two cases which were negative by IS6110 PCR but were positive by Pab PCR. There was one case which was positive by IS6110 but was negative by Pab PCR. Seventeen out of 20 samples showed concordance between the results of two PCR tests, increasing the sensitivity to 85%. Conclusion: The diagnostic yield of the PCR test can be improved with the simultaneous amplification of two or more gene targets.
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