Journal of the Formosan Medical Association (J FORMOS MED ASSOC)

Publications in this journal

• Article: Cefepime-induced nonconvulsive status epilepticus as a cause of confusion in an elderly patient: A case report.

  Yuh-Ming Chang
  Journal of the Formosan Medical Association 06/2013;
• Article: Withdrawal from long-term hemodialysis in patients with end-stage renal disease in Taiwan.

  Chun-Fu Lai, Hung-Bin Tsai, Su-Hsuan Hsu, Chih-Kang Chiang, Jenq-Wen Huang, Sheng-Jean Huang
  [show abstract] [hide abstract]
  ABSTRACT: Withdrawal from dialysis is ethically appropriate for some patients with multiple comorbidities and a shortened life expectancy. Taiwan has the highest prevalence of dialysis patients in the world, and the National Health Insurance (NHI) program offers renal replacement therapy free of charge. In this review, we discuss its current status and many background issues related to withdrawing dialysis from patients with advanced renal failure in Taiwan. Compared with dialysis therapy, the medical resources for hospice care are relatively sparse. Since the announcement of the Statute for Palliative Care in 2000, there has been a gradual improvement in the laws and health polices supporting dialysis withdrawal. Culture and social customs also have a significant impact on the practice of hospice care. Based on current evidence and in accordance with the local environment, we propose recommendations for the clinical practice of dialysis withdrawal and hospice care. There remains a need to expand upon the community-based hospice care and home care systems to better serve patients. In conclusion, there are cross-cultural differences relating to dialysis withdrawal between Taiwan and Western countries. Our experience and clinical recommendations may be helpful for the countries with NHI systems or for the Eastern countries.
  Journal of the Formosan Medical Association 06/2013;
• Article: R1933X mutation in the MYH9 gene in May-Hegglin anomaly mimicking idiopathic thrombocytopenic purpura.

  Chih-Chien Sung, Shih-Hua Lin, Tai-Kuang Chao, Yeu-Chin Chen
  [show abstract] [hide abstract]
  ABSTRACT: May-Hegglin anomaly (MHA) is a rare autosomal dominant disorder characterized by the triad of thrombocytopenia, giant platelets, and inclusion bodies in leukocytes. Recent evidence links MHA to mutations in the MYH9 gene. MHA has not been reported in Taiwan before. We report a 25-year-old Taiwanese man who presented with prolonged bleeding after dental extraction. Examination of peripheral blood smear revealed thrombocytopenia (platelet = 35,000/μL), giant platelets, and Döhle-like cytoplasmic inclusions in neutrophils. A strong family history of thrombocytopenia favored hereditary macrothrombocytopenia over idiopathic thrombocytopenic purpura (ITP). Electron microscopy revealed a spindle shape and parallel order of filaments in the inclusions, consistent with the diagnosis of MHA. We performed mutational analysis using polymerase chain reaction followed by direct sequence of the MYH9 gene for the patient, his maternal uncle and cousin, and all showed the same heterozygous R1933X mutation in exon 40. MHA should be considered when a young patient has thrombocytopenia, frequently misdiagnosed as ITP. Morphological examination of peripheral blood smear, family history tracing and genetic studies are required to make an accurate diagnosis and avoid unnecessary and even harmful therapies such as corticosteroids and splenectomy.
  Journal of the Formosan Medical Association 06/2013;
• Article: Is avian influenza A (H7N9) virus staggering its way to humans?

  Guang-Wu Chen, Michael M C Lai, Suh-Chin Wu, Shih-Cheng Chang, Li-Min Huang, Shin-Ru Shih
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND/PURPOSE: Human infections by a new avian influenza A (H7N9) virus have been reported. As of April 23, 2013, there were 108 confirmed cases including 22 deaths in China. MATERIALS AND METHODS: Influenza protein sequences were downloaded from the Influenza Virus Resource and GISAID EpiFlu databases. Pairwise nucleotide identities were computed for assessing the evolutionary distance of H7N9 to other known avian and human viruses, and multiple sequence alignments with their position-specific entropy values were used in discussing how mutations on species-associated signature positions were introduced in the new H7N9 which may steer its way to human infection. RESULTS: This report analyzed the genomic characteristics of this new H7N9 virus. Nucleotide sequence analysis clearly reveals its origin from avian viruses. In this article, we particularly focus on its internal genes that are found to derive from H9N2-another subtype of avian influenza A virus which has been circulating in birds for years. Amino acid sequences at species-specific genomic positions were examined. Although the new virus contains mostly avian-like residues at these signature positions, it does contain several human-like signatures. For instance, at the position 627 of PB2, the new virus has human-characteristic K instead of avian-characteristic E; in addition, PB2-627K, PA-100A, PA-356R, and PA-409N are also human-like signatures in the new H7N9 virus. CONCLUSION: The new H7N9 is an avian influenza A virus; however, it does harbor several human virus-like signatures, which raises great concern that it may have a higher probability to cross species barriers and infect humans.
  Journal of the Formosan Medical Association 06/2013;
• Article: Subsequent Epstein-Barr virus-associated gastric carcinoma shortly after chemotherapy for colonic cancer.

  Wen-Chih Huang, Chien-Chen Tsai
  Journal of the Formosan Medical Association 06/2013;
• Article: Distribution of airborne microbes and antibiotic susceptibility pattern of bacteria during Gwalior trade fair, Central India.

  Jayprakash Yadav, Awanish Kumar, Pawan Mahor, Ajay Kumar Goel, Hotam Singh Chaudhary, Pramod Kumar Yadava, Hariom Yadav, Pramod Kumar
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND/PURPOSE: Research into the distribution of bioaerosols during events associated with huge groups of people is lacking, especially in developing countries. The purpose of this study was to understand the distribution pattern of bioaerosols during an annual trade fair in the historical city of Gwalior, central India, a very important historical fair that was started by the King of Gwalior Maharaja Madho Rao in 1905. METHODS: Air samples were collected from six different sites at the fair ground and three different sites in a residential area before/during/after the fair using an impactor sampler on microbial content test agar and rose bengal agar for total bacteria and fungi, respectively. The representative strains of bacteria and fungi were further identified and selected bacterial strains were subjected to antibiotic susceptibility testing according to US Clinical and Laboratory Standards Institute (CLSI) guidelines. RESULTS: The bacterial bioaerosol count [colony-forming units (CFU)/m(3)] at fair sites was found to be 9.0 × 10(3), 4.0 × 10(4), and 1.0 × 10(4) before the start of the fair, during the fair, and after the fair, respectively. The fungal bioaerosol count at fair sites was 2.6 × 10(3) CFU/m(3), 6.3 × 10(3) CFU/m(3), and 1.7 × 10(3) CFU/m(3) before the fair, during the fair, and after the fair, respectively. Bacterial/fungal bioaerosols during-fair were increased significantly from the bacterial/fungal bioaerosols of the before-fair period (p < 0.05); they were also significantly higher than the bacterial/fungal bioaerosols at non-fair sites during the event (p < 0.0001). The proportion of antibiotic-resistant bacteria over the fair ground was significantly increased during-fair and was still higher in the after-fair period. Methicillin-resistant staphylococci (MRS) were also reported at the fair ground. CONCLUSION: The study indicates significantly higher bacterial and fungal bioaerosols during the fair event. Therefore, further research is needed to explore the health aspects and guidelines to control microbial load during such types of events.
  Journal of the Formosan Medical Association 06/2013;
• Article: Treatment of neuropathic pain in acute intermittent porphyria with gabapentin.

  Ting-Chun Lin, Shiao-Lin Lai, Shih-Pin Hsu, Long-Sun Ro
  Journal of the Formosan Medical Association 06/2013;
• Article: Vertical transmission of Neisseria gonorrhoeae to a female premature neonate with congenital pneumonia.

  Jui-Hsing Chang, Yen-Lin Huang, Chun-Chen Chen, Shu-Ying Li
  Journal of the Formosan Medical Association 05/2013;
• Article: Prevention of necrotizing enterocolitis in preterm very low birth weight infants: Is it feasible?

  Hsiang-Yu Lin, Jui Hsing Chang, Mei-Yung Chung, Hung-Chih Lin
  [show abstract] [hide abstract]
  ABSTRACT: Necrotizing enterocolitis (NEC) is still one of the most catastrophic intestinal emergencies in preterm very low-birth weight infants. Primary prevention of NEC should be the priority, since NEC frequently progresses from nonspecific signs, to extensive necrosis within a matter of hours with medical or surgical treatment, making successful treatment and secondary prevention difficult to achieve. Currently available strategies for primary prevention of NEC include antenatal glucocorticosteroids, breast milk feeding, cautious feeding strategy, fluid restriction and probiotics. Nonetheless, based on current research evidence, mixed flora probiotics, and/or breast milk feeding, would appear to be the most effective feasible methods in the prevention of NEC at present.
  Journal of the Formosan Medical Association 05/2013;
• Article: 3M Cavilon No-Sting Barrier Film or topical corticosteroid (mometasone furoate) for protection against radiation dermatitis: A clinical trial.

  Su-Zun Shaw, Hsin-Hua Nien, Ching-Jung Wu, Louis Tak Lui, Jui-Fen Su, Chin-Hsin Lang
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND/PURPOSE: Evidence on the prevention of radiation dermatitis is lacking. The aim of this study was to investigate the effect of 3M Cavilon No Sting Barrier Film and topical corticosteroids on irradiated skin. METHODS: Thirty-nine postoperative breast cancer patients were randomized into three groups for intraindividual comparison (skin to be irradiated was divided into 2 parts): (1) 3M No Sting Barrier Film versus no treatment; (2) corticosteroid versus no treatment; and (3) corticosteroid versus 3M No Sting Barrier Film. The primary end points monitored were the time to first occurrence of grade 1 pruritus, pain score of 3 and grade 2 radiation dermatitis. The secondary end points studied were the incidence of grade 3 radiation dermatitis and total pain scores. Data analysis was done using the SPSS software version 10. RESULTS: Skin given the 3M barrier film experienced a later occurrence of pruritus compared to both corticosteroids and untreated, although this was statistically insignificant. Corticosteroids delayed the time to occurrence of grade 2 dermatitis compared to both untreated skin and 3M barrier film, (mean day of onset = corticosteroid: 52 vs. untreated: 43, p = 0.092; corticosteroid: 53.4 vs. 3M barrier film: 44.5, p = 0.002, t test). Skin given corticosteroids had the lowest incidence of grade 3 dermatitis among all three conditions, although the differences were statistically insignificant. No statistically significant differences were noted in total pain scores. CONCLUSION: The 3M barrier film may be helpful against dermatitis associated pruritus. Corticosteroids may delay the time of onset of severe skin reactions and also reduce the incidence of severe radiation dermatitis.
  Journal of the Formosan Medical Association 05/2013;
• Article: Tailor-made circulatory management based on the stress-velocity relationship in preterm infants.

  Katsuaki Toyoshima, Motoyoshi Kawataki, Makiko Ohyama, Jun Shibasaki, Naoto Yamaguchi, Rikuo Hoshino, Yasufumi Itani, Makoto Nakazawa
  [show abstract] [hide abstract]
  ABSTRACT: Preterm infants frequently experience pulmonary hemorrhage or cerebral intraventricular hemorrhage after birth. The immature myocardium of the left ventricle faces a high afterload after the baby is separated from the placenta. However, the preterm left ventricle has limited ability to respond to such an increase in afterload. This results in depressed cardiac function and a deterioration in hemodynamics. We speculated that the perinatal deterioration in cardiac performance would be closely related to serious hemorrhages. To prove our hypothesis, we studied the interrelationship between the perinatal changes in cardiac performance and the incidences of intraventricular and pulmonary hemorrhage. We obtained the stress-velocity relationship (rate-corrected mean fiber shortening velocity and end-systolic wall stress relationship) by M-mode echocardiography and arterial blood pressure measurement. We found that the incidences of intraventricular and/or pulmonary hemorrhages were higher in infants with an excessive afterload, which resulted in a decrease in the function of the left ventricle. We suggest that careful attention to keep the afterload at an acceptable level by vasodilator therapy and sedation may reduce or prevent these serious complications. In this review, we will discuss our data along with related literature.
  Journal of the Formosan Medical Association 05/2013;
• Article: Prevalence and factors associated with baseline chronic kidney disease in China: A 10-year study of 785 upper urinary tract urothelial carcinoma patients.

  Gengyan Xiong, Xiaopeng Chen, Xuesong Li, Dong Fang, Luxia Zhang, Li Yang, Lei Zhang, Lin Yao, Zhisong He, Liqun Zhou
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND/PURPOSE: There is relatively little literature on prevalence of chronic kidney disease (CKD) prior to surgery in patients with upper urinary tract urothelial carcinoma (UTUC). We evaluated the prevalence and clinical associated factors of baseline CKD in patients with UTUC. MATERIALS AND METHODS: There were 785 patients with a pathologic diagnosis of UTUC from January 2002 to December 2011 who were analyzed in this study. Estimated glomerular filtration rate (eGFR) was calculated by re-expressed Modification of Diet in Renal Disease (MDRD) formulas for the Chinese population. A multivariate logistic regression was performed to evaluate the odds ratios (ORs) for CKD stage 3 or higher in UTUCs after data differences were tested. RESULTS: The prevalence of CKD in UTUCs presenting at our hospital was 58.6% and 70.8% in the group age 70 years and older. Older age [per year increased; OR = 1.050; 95% confidence interval (CI): 1.034-1.067], lower tumor stage (T stage; per stage increased; OR = 0.666; 95% CI: 0.544-0.816), higher tumor grade (per grade increased; OR = 1.392; 95% CI: 1.004-1.930) and the main tumor locating in the pelvis (ureter as reference; OR = 0.648; 95% CI: 0.475-0.885) were independently associated with decreased kidney function in the multivariate logistic regression. The use of serum creatinine (Scr) only to evaluate the renal function would ignore a large proportion of patients suffering from CKD stage 3 in UTUCs, especially in those older than 70 years (39.3% vs. 54.1%, p = 0.022). CONCLUSION: We demonstrated a high prevalence (58.6%) of CKD in patients with UTUC, particularly in the group older than 70 years (70.8%). Older age, lower T stage, higher tumor grade, and the main tumor locating in pelvis (ureter as reference) were independently associated with CKD in UTUCs.
  Journal of the Formosan Medical Association 05/2013;
• Article: Baicalin ameliorates neuropathic pain by suppressing HDAC1 expression in the spinal cord of spinal nerve ligation rats.

  Chen-Hwan Cherng, Kwong-Chiu Lee, Chih-Cheng Chien, Kuang-Yi Chou, Yu-Che Cheng, Shih-Tai Hsin, Sing-Ong Lee, Ching-Hui Shen, Ru-Yin Tsai, Chih-Shung Wong
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND/PURPOSE: In a recent study, we found that baicalin exhibited a potent analgesic effect on carrageenan-evoked thermal hyperalgesia. The underlining mechanisms may be associated with inhibition of inflammatory mediator overproduction, including proinflammatory cytokines, nitric oxide (NO), and prostaglandin E2 (PGE2). In the present study, we examined the effect of baicalin on the antinociceptive effect of morphine and histone deacetylase 1 (HDAC1) expression in the spinal cord dorsal horn in neuropathic pain rats. METHODS: Neuropathic pain was induced by tight ligation of the left L5 spinal nerve of the rats. An intrathecal catheter was implanted for drug administration. Nociception was assessed by using the plantar test with the Hargreaves radiant heat apparatus, and the von Frey test with the dynamic plantar anesthesiometer. Spinal cords were removed for histone acetyl-H3 and HDAC1 western blot analysis at the end of the nociceptive assessment. RESULTS: The results showed that hyperalgesia and allodynia were observed in the spinal nerve ligated (SNL) left hindlimb; it was companied by histone-H3 deacetylation and HDAC1 overexpression on the ipsilateral side of the spinal cord dorsal horn. Intrathecal injection of baicalin (10 μg) significantly attenuated the allodynia and hyperalgesia, and enhanced the antinociceptive effect of morphine (15 μg). Moreover, baicalin reversed the histone-H3 acetylation and suppressed HDAC1 expression on the ipsilateral side of the spinal cord dorsal horn of SNL rats. CONCLUSION: The present findings suggest that baicalin can ameliorate neuropathic pain by suppressing HDAC1 expression and preventing histone-H3 acetylation in the spinal cord dorsal horn of SNL rats.
  Journal of the Formosan Medical Association 05/2013;
• Article: Office-based narrow band imaging-guided flexible laryngoscopy tissue sampling: A cost-effectiveness analysis evaluating its impact on Taiwanese health insurance program.

  Tuan-Jen Fang, Hsueh-Yu Li, Chun-Ta Liao, Hui-Chen Chiang, I-How Chen
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND/PURPOSE: Narrow band imaging (NBI)-guided flexible laryngoscopy tissue sampling for laryngopharyngeal lesions is a novel technique. Patients underwent the procedure in an office-based setting without being sedated, which is different from the conventional technique performed using direct laryngoscopy. Although the feasibility and effects of this procedure were established, its financial impact on the institution and Taiwanese National Health Insurance program was not determined. MATERIALS AND METHODS: This is a retrospective case-control study. From May 2010 to April 2011, 20 consecutive patients who underwent NBI flexible laryngoscopy tissue sampling were recruited. During the same period, another 20 age-, gender-, and lesion-matched cases were enrolled in the control group. The courses for procedures and financial status were analyzed and compared between groups. RESULTS: Office-based NBI flexible laryngoscopy tissue sampling procedure took 27 minutes to be completed, while 191 minutes were required for the conventional technique. Average reimbursement for each case was New Taiwan Dollar (NT$)1264 for patients undergoing office-based NBI flexible laryngoscopy tissue sampling, while NT$10,913 for those undergoing conventional direct laryngoscopy in the operation room (p < 0.001). The institution suffered a loss of at least NT$690 when performing NBI flexible laryngoscopy tissue sampling. CONCLUSION: Office-based NBI flexible laryngoscopy tissue sampling is a cost-saving procedure for patients and the Taiwanese National Health Insurance program. It also saves the procedure time. However, the net financial loss for the institution and physician would limit its popularization unless reimbursement patterns are changed.
  Journal of the Formosan Medical Association 05/2013;
• Article: Prospect and vision of the Taiwan Ministry of Health and Welfare.

  Lee-Chin Chang, Peng-Xuan Wang, Ying-Yi Chen, Chung-Liang Shih
  Journal of the Formosan Medical Association 05/2013;
• Article: Sister Mary Joseph nodule associated with pancreatic adenocarcinoma.

  Chi-Hsuan Chiang, Ming-Hsien Lin
  Journal of the Formosan Medical Association 05/2013;
• Article: Seeking for a way to revive erythropoietin production in chronic kidney disease.

  Yu-Ting Chang, Szu-Yu Pan, Shuei-Liong Lin
  Journal of the Formosan Medical Association 05/2013;
• Article: Response to "Increase risks of upper tract urothelial carcinoma in male and female Chinese herbalists"

  Yann-Rong Su, Chung-Hsin Chen
  Journal of the Formosan Medical Association 05/2013;