Ja-Liang Lin

Publications of Ja-Liang Lin

• Heart Rate-Corrected QT Interval Helps Predict Mortality after Intentional Organophosphate Poisoning.

  Authors: Shou-Hsuan Liu, Ja-Liang Lin, Cheng-Hao Weng, Huang-Yu Yang, Ching-Wei Hsu, Kuan-Hsing Chen, Wen-Hung Huang, Tzung-Hai Yen

  PloS one. 01/2012; 7(5):e36576.

  In this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTcIn this study, we investigated the outcomes for patients with intentional organophosphate poisoning. Previous reports indicate that in contrast to normal heart rate-corrected QT intervals (QTc), QTc prolongation might be indicative of a poor prognosis for patients exposed to organophosphates. We analyzed the records of 118 patients who were referred to Chang Gung Memorial Hospital for management of organophosphate poisoning between 2000 and 2011. Patients were grouped according to their initial QTc interval, i.e., normal (<0.44 s) or prolonged (>0.44 s). Demographic, clinical, laboratory, and mortality data were obtained for analysis. The incidence of hypotension in patients with prolonged QTc intervals was higher than that in the patients with normal QTc intervals (P = 0.019). By the end of the study, 18 of 118 (15.2%) patients had died, including 3 of 75 (4.0%) patients with normal QTc intervals and 15 of 43 (34.9%) patients with prolonged QTc intervals. Using multivariate-Cox-regression analysis, we found that hypotension (OR = 10.930, 95% CI = 2.961-40.345, P = 0.000), respiratory failure (OR = 4.867, 95% CI = 1.062-22.301, P = 0.042), coma (OR = 3.482, 95% CI = 1.184-10.238, P = 0.023), and QTc prolongation (OR = 7.459, 95% CI = 2.053-27.099, P = 0.002) were significant risk factors for mortality. Furthermore, it was revealed that non-survivors not only had longer QTc interval (503.00±41.56 versus 432.71±51.21 ms, P = 0.002), but also suffered higher incidences of hypotension (83.3 versus 12.0%, P = 0.000), shortness of breath (64 versus 94.4%, P = 0.010), bronchorrhea (55 versus 94.4%, P = 0.002), bronchospasm (50.0 versus 94.4%, P = 0.000), respiratory failure (94.4 versus 43.0%, P = 0.000) and coma (66.7 versus 11.0%, P = 0.000) than survivors. Finally, Kaplan-Meier analysis demonstrated that cumulative mortality was higher among patients with prolonged QTc intervals than among those with normal QTc intervals (Log-rank test, Chi-square test = 20.36, P<0.001). QTc interval helps predict mortality after intentional organophosphate poisoning.

• Immunoglobulin G levels can predict non-diabetic renal disease in patients with type 2 diabetes mellitus.

  Authors: Cheng-Hao Weng, Ching-Chih Hu, Chun-Chen Yu, Ja-Liang Lin, Chih-Wei Yang, Cheng-Chieh Hung, Ching-Wei Hsu, Tzung-Hai Yen

  Journal of diabetes. 12/2011; 4(1):37-40.

  Background:  Proteinuria in patients with diabetes mellitus (DM) is sometimes caused by glomerular diseases other than diabetic nephropathy. In patients with type 2 DM (T2DM), specific predictors forBackground:  Proteinuria in patients with diabetes mellitus (DM) is sometimes caused by glomerular diseases other than diabetic nephropathy. In patients with type 2 DM (T2DM), specific predictors for non-diabetic renal disease (NDRD) are needed in addition to the traditional indicators for renal biopsy. Methods:  From 1 January 2000 to 31 March 2011, we retrospectively enrolled 54 T2DM patients with proteinuria who had undergone renal biopsies into the present study. Associations between NDRD and 20 potential biomarkers, including serum levels of Igs and proteins associated with kidney function, and urinary protein and red blood cell levels, and hepatitis virus carrier status, were analyzed by multivariate logistic regression. Results:  Multivariate logistic regression showed that reduced serum IgG (odds ratio [OR] 0.997; P = 0.006; 95% confidence interval [CI] 0.94-0.998) and creatinine (Cr; OR 0.587; P = 0.014; 95% CI 0.348-0.897) were predictors of NDRD. The area under the receiver operating characteristic curve (AUC(ROC) ) confirmed the good discriminatory power of IgG (AUC(ROC) 0.857 ± 0.058; 95% CI 0.744-0.970; P < 0.001) and Cr (AUC(ROC) 0.838 ± 0.054; 95% CI 0.732-0.943; P < 0.001). The IgG level below which the risk for NDRD increased, as calculated by obtaining the best Youden index, was 919.5 mg/dL (sensitivity 91.7%; specificity 83.3%), and the corresponding Cr level was 4.1 mg/dL (sensitivity 58.3%; specificity 96.7%). Conclusion:  Serum IgG levels <919.5 mg/dL and serum Cr levels <4.1 mg/dL are associated with NDRD in T2DM patients.

• Food safety involving ingestion of foods and beverages prepared with phthalate-plasticizer-containing clouding agents.

  Authors: Tzung-Hai Yen, Dan-Tzu Lin-Tan, Ja-Liang Lin

  Journal of the Formosan Medical Association = Taiwan yi zhi. 11/2011; 110(11):671-84.

  In May 2011, the illegal use of the phthalate plasticizer di(2-ethylhexyl) phthalate in clouding agents for use in foods and beverages was reported in Taiwan. This food scandal has caused shock andIn May 2011, the illegal use of the phthalate plasticizer di(2-ethylhexyl) phthalate in clouding agents for use in foods and beverages was reported in Taiwan. This food scandal has caused shock and panic among the majority of Taiwanese people and has attracted international attention. Phthalate exposure is assessed by ambient monitoring or human biomonitoring. Ambient monitoring relies on measuring chemicals in environmental media, foodstuff and consumer products. Human biomonitoring determines body burden by measuring the chemicals, their metabolites or specific reaction products in human specimens. In mammalian development, the fetus is set to develop into a female. Because the female phenotype is the default, impairment of testosterone production or action before the late phase may lead to feminizing characteristics. Phthalates disrupt the development of androgen-dependent structures by inhibiting fetal testicular testosterone biosynthesis. The spectrum of effects obtained following perinatal exposure of male rats to phthalates has remarkable similarities with the human testicular dysgenesis syndrome. Epidemiological studies have suggested associations between phthalate exposure and shorter gestational age, shorter anogenital distance, shorter penis, incomplete testicular descent, sex hormone alteration, precocious puberty, pubertal gynecomastia, premature thelarche, rhinitis, eczema, asthma, low birth weight, attention deficit hyperactivity disorder, low intelligence quotient, thyroid hormone alteration, and hypospadias in infants and children. Furthermore, many studies have suggested associations between phthalate exposure and increased sperm DNA damage, decreased proportion of sperm with normal morphology, decreased sperm concentration, decreased sperm morphology, sex hormone alteration, decreased pulmonary function, endometriosis, uterine leiomyomas, breast cancer, obesity, hyperprolactinemia, and thyroid hormone alteration in adults. Finally, the number of phthalate-related scientific publications from Taiwan has increased greatly over the past 5 years, which may reflect the health effects from the illegal addition of phthalate plasticizer to clouding agent in foodstuff over the past two decades.

• Hyperacute rejection from a donor who died of carbamate intoxication-a case report.

  Authors: Yi-Hsin Chan, Kuo-Ping Liew, Charles Chien-Feng Sun, Chuen Hsueh, Bing-Chin Li, Feng-Chun Tsai, Ja-Liang Lin, Pao-Hsien Chu

  The American journal of emergency medicine. 10/2011;

• Outcome of patients with lithium poisoning at a far-east poison center.

  Authors: Yen-Ching Lee, Ja-Liang Lin, Shen-Yang Lee, Ching-Wei Hsu, Cheng-Hao Weng, Yu-Hui Chen, Chih-Wei Yang, Tzung-Hai Yen

  Human & experimental toxicology. 07/2011; 30(7):528-34.

  Lithium is a popular medication for bipolar disorder, but very little work has been done to study Asian patients with lithium poisoning. A total of 21 out of 7140 poisoned patients were referred forLithium is a popular medication for bipolar disorder, but very little work has been done to study Asian patients with lithium poisoning. A total of 21 out of 7140 poisoned patients were referred for management of lithium poisoning between 2000 and 2009. Patients were stratified according to blood lithium level, that is mild-to-moderate (<2.5 mEq/L) or severe (≥2.5 mEq/L) poisoning. Demographic, clinical, and laboratory data were obtained for analysis. Mortality rates were also analyzed. There were no significant differences between both groups for the baseline variables such as poisoning patterns, age, sex, smoking habit, alcohol consumption, or medical history of diabetes mellitus or hypertension (p > 0.05). Patients with severe poisoning had a greater distribution of severe neurological symptoms (mild/moderate/ severe: 11.1%/44.4%/44.4% versus 58.35%/16.65%/8.3%, p < 0.05), cardiovascular symptoms (66.6% versus 16.6%, p < 0.05), and renal impairment (urea nitrogen/creatinine: 27.1 ± 17.8/ 1.9 ± 1.3 mg/dL versus 14.1 ± 7.1/ 1.3 ± 0.6 mg/dL, p < 0.05) than patients with mild-to-moderate poisoning. Most patients were treated with saline diuresis (9 patients [100%] with severe poisoning versus 9 patients [75.0%] with mild-to-moderate poisoning, p > 0.05). Hemodialysis was initiated in 2 (22.2%) of 9 and 1 (8.3%) of 12 patients with severe and mild-to-moderate poisoning, respectively (p > 0.05). The treatment was successful and all patients recovered without chronic sequelae. Thus, these favorable outcomes were comparable to the data from other international Poison Centers. Given the excellent outcomes of detoxification protocols, patients undergoing lithium therapy must be closely monitored for its toxicity and treated immediately in case of poisoning.

• Association of blood lead levels with mortality in patients on maintenance hemodialysis.

  Authors: Ja-Liang Lin, Dan-Tzu Lin-Tan, Ching-Wei Hsu, Tzung-Hai Yen, Kuan-Hsing Chen, Hsiang-Hao Hsu, Tai-Chin Ho, Kuang-Hong Hsu

  The American journal of medicine. 04/2011; 124(4):350-8.

  The association between blood lead levels and mortality in patients on maintenance hemodialysis remains unclear. A cross-sectional and 18-month prospective study included 927 patients on maintenanceThe association between blood lead levels and mortality in patients on maintenance hemodialysis remains unclear. A cross-sectional and 18-month prospective study included 927 patients on maintenance hemodialysis. Baseline variables and blood lead levels were measured before hemodialysis and categorized as 3 equal groups: high (>12.64 μg/dL), middle (8.51-12.64 μg/dL), and low (<8.51 μg/dL). Mortality and cause of death were recoded for longitudinal analyses. At baseline, after related variables were adjusted, logarithmic transformation of blood lead level was negatively related to log ferritin and positively related to the vintage of hemodialysis and the percentage of urban area patients. By the end of the follow-up, 59 patients had died. Kaplan-Meier survival analysis showed that the high blood lead level group had greater mortality than the low blood lead level group (log-rank test, P<.001). After adjustment for potential variables, Cox multivariate analysis demonstrated that by using the low blood lead level as the reference, high blood lead levels were associated with increased hazard ratios (HRs) for all-cause (HR 4.70; 95% confidence interval [CI], 1.92-11.49; P=.003), cardiovascular-cause (HR 9.71; 95% CI, 2.11-23.26; P=.005), and infection-cause (HR 5.35; 95% CI, 1.38-20.83; P=.046) 18-month mortality in patients on maintenance hemodialysis. Moreover, there was a significant trend (P=.032) of HRs for all-cause mortality among the 3 study groups. High blood lead level is associated with increased HRs for all-cause, cardiovascular-cause, and infection-cause 18-month mortality in patients on maintenance hemodialysis.

• Chronic renal failure induced by lead.

  Authors: Tzung-Hai Yen, Dan-Tzu Lin-Tan, Ja-Liang Lin

  Kidney international. 03/2011; 79(6):688; author reply 688-9.

• Human poisoning with spinosad and flonicamid insecticides.

  Authors: Ting-Yi Su, Ja-Liang Lin, Dan-Tzu Lin-Tan, Hsin-Hui Tseng, Tzung-Hai Yen

  Human & experimental toxicology. 03/2011; 30(11):1878-81.

  This report describes the first known case in the literature of acute exposure to a mixture of spinosad and flonicamid that resulted in a substantial clinical toxicities. An 80-year-old depressedThis report describes the first known case in the literature of acute exposure to a mixture of spinosad and flonicamid that resulted in a substantial clinical toxicities. An 80-year-old depressed female attempted suicide by drinking a mixture of 80-mL Conserve (Dow AgroSciences, Taipei, Taiwan) and 2-3 gram powder of flonicamid (Ishihara Sangyo Kaisha, Taipei, Taiwan). Spinosad was the main compound ingested. The clinical manifestations were mostly neurological, i.e. consciousness disturbance, shock, respiratory failure, pneumonitis and urinary retention. Endoscopic examination found grade 2a corrosive esophageal injury. After resuscitation, detoxification procedures and intensive care, the patient recovered fully without leaving any chronic sequels. An emerging question arising from this report is, why are the clinical symptoms so severe, given that both compounds were claimed safe in laboratory animals? The answer is unclear. One possible explanation is, the amount of spinosad ingested was far beyond the physiological safety dose that can be handled by human body. Other potential contributors to the clinical toxicities in this patient are the solvent compositions that were found in the Conserve insecticide formulation.

• Blood cadmium level's association with 18-month mortality in diabetic patients with maintenance haemodialysis.

  Authors: Tzung-Hai Yen, Ja-Liang Lin, Dan-Tzu Lin-Tan, Ching-Wei Hsu, Kuan-Hsing Chen, Hsiang-Hao Hsu

  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 03/2011; 26(3):998-1005.

  Cadmium exposure is related to severity of diabetes and diabetes-related organ damage in diabetic patients. Elevated blood cadmium levels (BCLs) are well known in maintenance haemodialysis (MHD)Cadmium exposure is related to severity of diabetes and diabetes-related organ damage in diabetic patients. Elevated blood cadmium levels (BCLs) are well known in maintenance haemodialysis (MHD) patients but the clinical significance in diabetic MHD patients remains unknown. A total of 212 diabetic MHD patients were enrolled in this 18-month prospective study and were categorized into three equal groups according to the basal BCL: high (> 0.889 μg/L; n = 71), middle (0.373-0.889 μg/L; n = 70) and low (< 0.373 μg/L; n = 71) BCL groups. The mortality and cause of death were recorded and analysed longitudinally. Patients with high BCL had trends of higher white blood cell counts, glycosylated haemoglobin, phosphate and blood lead levels than other group patients. At the end of the follow-up, 31 patients had died. Kaplan-Meier analysis showed that the high BCL group patients had a higher mortality than other group patients (log-rank test, P = 0.036). Cox multivariate analysis demonstrated that logarithmic BCL was associated with increased hazard ratios (HR) for the all-cause mortality (HR = 2.336, 95% confidence intervals [CI] = 1.099-4.964, P = 0.027) in diabetic MHD patients. Similarly, if the low BCL group was the reference, the high BCL was associated with increased HR for all-cause mortality (HR = 2.865, 95% CI = 1.117-7.353, P = 0.043) in these patients. The study results first demonstrated that BCL is associated with increased HR for 18-month all-cause mortality in diabetic MHD patients. Avoiding smoking and high cadmium-containing food may be important in these patients.

• Association of severity of conjunctival and corneal calcification with all-cause 1-year mortality in maintenance haemodialysis patients.

  Authors: Ching-Hsi Hsiao, Anning Chao, Sung-Yu Chu, Ken-Kuo Lin, Ling Yeung, Dan-Tzu Lin-Tan, Ja-Liang Lin

  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 03/2011; 26(3):1016-23.

  Conjunctival and corneal calcification (CCC) is the most common form of metastatic calcification in patients with chronic renal failure. The aim of this study is to investigate if severity of CCCConjunctival and corneal calcification (CCC) is the most common form of metastatic calcification in patients with chronic renal failure. The aim of this study is to investigate if severity of CCC correlates with vascular calcification and mortality in maintenance haemodialysis (MHD) patients. One hundred and nine MHD patients were recruited. CCC was evaluated by external eye photographs, and was graded and scored according to modified Porter and Crombie classification system described by Tokuyama et al. Chest X-ray examination was used to evaluate aortic arch calcification. Geographic, haematological, biochemical and dialysis-related data were obtained. The patients were analysed for traditional and non-traditional risk factors for cardiovascular disease stratified by severity of CCC. All patients were followed up for 1 year to investigate the risks for mortality. Forty-three, 35 and 31 patients had mild (scores ≤ 4), moderate and severe (scores ≥ 9) CCC at baseline, respectively. With trend estimation, patients with severe CCC had a significantly higher percentage of severe aortic arch calcification. Multiple linear regression analysis showed that hypertension, haemodialysis duration and corrected calcium level were associated with scores of CCC in MHD patients. Moreover, age, corrected calcium-phosphate level, and moderate and severe CCC were associated with grades of aortic arch calcification. At 1-year follow-up, 11 of 109 (10.1%) patients had died. Multivariate Cox proportional hazards model showed that age, corrected calcium and severe CCC were significant risk factors for all-cause 1-year mortality in MHD patients. Each increment of one score of CCC is associated with a 26.4% increased risk for all-cause mortality. Severity of CCC, which is easily obtained at bedside, acts as an independent predictor for all-cause 1-year mortality in MHD patients.

• High incidence and recurrence of transitional cell carcinoma in Taiwanese patients with end-stage renal disease.

  Authors: Tsung-Yang Wang, Chia-Jung Hu, Chin-Wei Kuo, Yu Chen, Ja-Liang Lin, Chih-Wei Yang, Tzung-Hai Yen

  Nephrology (Carlton, Vic.). 02/2011; 16(2):225-31.

  Aim: This study examines the epidemiology of transitional cell carcinoma (TCC) in end-stage renal disease (ESRD) population from Taiwan, the area with the highest incidence and prevalence of ESRD. AAim: This study examines the epidemiology of transitional cell carcinoma (TCC) in end-stage renal disease (ESRD) population from Taiwan, the area with the highest incidence and prevalence of ESRD. A total of 98 out of 10,890 ESRD patients were referred for management of TCC between 2000 and 2008. Demographic, clinical and laboratory data were collected and patient mortality and tumour recurrence rates were analyzed. TCC patients were aged 61.4 ± 10.2 years and 66.3% were female. The average time from initiation of dialysis to tumour detection was 51.2 ± 36.4 months. Hypertensive nephrosclerosis, diabetes mellitus, chronic glomerulonephritis and unknown aetiology accounted for 25.5%, 20.4%, 22.4% and 31.6% of the causes of renal failure, respectively. The aetiology of renal failure for the 31.6% of patients was unclear, but chronic tubulointerstitial nephritis following long-term consumption of Chinese herbs (19.4%) or analgesic compounds (3.1%) was considered in some patients. Almost all (98.0%) patients presented with gross haematuria. Most TCC were in early stage (stage 0, 3.1%; stage I, 56.1%) during diagnosis. At the end of this study, 17 of 98 (17.3%) patients died. Multivariate Cox regression analysis found that age (odds ratio =1.140, 95% confidence interval = 1.049-1.239, P = 0.002) and tumour pain (odds ratio = 0.234, 95% confidence interval = 0.057-0.961, P = 0.044) were significant risk factors for all-cause mortality. Furthermore, 35.7% of TCC recurred during follow up. The 5 year patient and tumour-free survival rates were 72.4% and 14.4%, respectively. The data shows that Taiwanese patients with ESRD had high incidence (0.9%) and recurrence (35.7%) of TCC.

• Cardiothoracic ratio association with mortality in patients on maintenance peritoneal dialysis.

  Authors: Kuan-Hsing Chen, Cheng-Chieh Hung, Dan-Tzu Lin-Tan, Wen-Hung Huang, Ching-Wei Hsu, Shu-Man Weng, Ja-Liang Lin

  Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 02/2011; 15(1):81-8.

  The cardiothoracic ratio (CTR) indicates the left ventricular size; however, the significance of the CTR in patients on maintenance peritoneal dialysis (PD) remains unclear. In this study, 335 PDThe cardiothoracic ratio (CTR) indicates the left ventricular size; however, the significance of the CTR in patients on maintenance peritoneal dialysis (PD) remains unclear. In this study, 335 PD patients were enrolled and demographic, biochemical, co-morbidity, and dialysis-related data were obtained. The factors determining CTR were further analyzed. All patients were followed up for two years to investigate the mortality risks. We defined a normal CTR as less than the mean CTR value, mild cardiomegaly as a CTR between the mean and mean + 1 SD, and moderate-to-severe cardiomegaly as more than the mean CTR + 1 SD. Among the 335 patients, 163 patients were classified as having a normal CTR (<49.2%), 112 patients as having mild cardiomegaly (CTR 49.2-55.7%), and 60 patients as having moderate-to-severe cardiomegaly (CTR > 55.7%). χ(2) -analysis showed that the incidences of malnutrition and anemia were significantly higher in patients with severe cardiomegaly than in patients of the other groups. The CTR was positively correlated with age, but negatively correlated with albumin and hemoglobin levels. Twenty-six patients (7.7%) had died by the end of the study. Cox multivariate analysis revealed that the CTR significantly predicts all-cause two-year mortality in PD patients on maintenance PD; therefore, the CTR correlates with the nutritional and anemic status of PD patients and is a reliable predictor for all-cause two-year mortality. The analytical results of this study support continued efforts to reduce the CTR and treat underlying causes in patients with cardiomegaly.

• Impaired fasting glucose association with mortality in nondiabetic patients on maintenance peritoneal dialysis.

  Authors: Kuan-Hsing Chen, Ja-Liang Lin, Cheng-Chieh Hung, Dan-Tzu Lin-Tan, Shu-Man Weng, Tzung-Hai Yen, Ching-Wei Hsu, Chih-Wei Yang

  The American journal of the medical sciences. 02/2011; 341(4):312-7.

  The aim of this study was to investigate clinical significance of impaired fasting glucose (IFG) in nondiabetic patients on maintenance peritoneal dialysis (PD). In total, 362 maintenance PD patientsThe aim of this study was to investigate clinical significance of impaired fasting glucose (IFG) in nondiabetic patients on maintenance peritoneal dialysis (PD). In total, 362 maintenance PD patients were enrolled and followed up for 2-years. According to 1997 definitions, patients were divided into 3 groups: diabetic (n = 85), nondiabetic with IFG (n = 62) and nondiabetic with normal fasting glucose levels (n = 215). After basal data were collected for cross-sectional analyses, mortality and cause of death were recorded for longitudinal analyses. After adjusting for related variables by multivariate logistic regression analysis, IFG was found to be positively associated with age but negatively associated with normalized protein nitrogen appearance and transferrin saturation in nondiabetic maintenance PD patients. Thirty nondiabetic patients had died after the 2-year follow-up. Cox multivariate analysis showed that age (hazard ratio: 1.037; 95% confidence interval: 1.002-1.073; P = 0.036) and presence of IFG (hazard ratio: 2.719; 95% confidence interval: 1.082-6.833; P = 0.033) were significant risk factors for all-cause 2-year mortality in nondiabetic maintenance PD patients. IFG, a preventable and treatable condition, was associated with all-cause 2-year mortality in nondiabetic maintenance PD patients.

• Improved survival in severe paraquat poisoning with repeated pulse therapy of cyclophosphamide and steroids.

  Authors: Ja-Liang Lin, Dan-Tzu Lin-Tan, Kuan-Hsing Chen, Wen-Hung Huang, Ching-Wei Hsu, Hsiang-Hao Hsu, Tzung-Hai Yen

  Intensive care medicine. 02/2011; 37(6):1006-13.

  To clarify the efficacy of repeated methylprednisolone (MP) and cyclophosphamide (CP) pulse therapy and daily dexamethasone (DEX) therapy in patients with severe paraquat (PQ) poisoning. A total ofTo clarify the efficacy of repeated methylprednisolone (MP) and cyclophosphamide (CP) pulse therapy and daily dexamethasone (DEX) therapy in patients with severe paraquat (PQ) poisoning. A total of 111 patients with severe PQ poisoning and dark-blue color in urine tests within 24 h of intoxication were included prospectively. The control group consisted of 52 patients who were admitted between 1998 and 2001 and who received high doses of CP (2 mg/kg per day) and DEX (5 mg every 6 h) for 14 days. The study group consisted of 59 patients who were admitted from 2002 to 2007 and who received initial MP (1 g) for 3 days and CP (15 mg/kg per day) for 2 days, followed by DEX (5 mg every 6 h) until a PaO(2) of >80 mmHg had been achieved, or treated with repeated 1 g MP for 3 days and 1 g CP for 1 day if the PaO(2) was <60 mmHg. There were no differences between the two groups with regard to baseline data and plasma PQ levels. The study group patients had a lower mortality rate (39/59, 66%) than the control group patients (48/52, 92%; P=0.003, log-rank test). Multivariate Cox regression analysis revealed that the repeated pulse therapy was correlated with decreased hazard ratios (HR) for all-cause mortality (HR=0.50, 95% CI 0.31-0.80; P=0.004) and death from lung fibrosis-related hypoxemia (HR=0.10, 95% CI 0.04-0.25; P<0.001) in severely PQ-intoxicated patients. Repeated pulses of CP and MP, rather than high doses of CP and DEX, may result in a lower mortality rate in patients with severe PQ poisoning.

• Respiratory failure and coma in an international traveler.

  Authors: Chun-Wei Chang, Ja-Liang Lin, Cheng-Hao Weng, Tzung-Hai Yen

  Internal medicine (Tokyo, Japan). 01/2011; 50(21):2691.

• Massive brain calcifications associated with vitamin D deficiency.

  Authors: Sheng-Wen Ko, Ja-Liang Lin, Huan-Yu Yang, Tzung-Hai Yen

  Internal medicine (Tokyo, Japan). 01/2011; 50(21):2693.

• White blood cell count predicts all-cause, cardiovascular disease-cause and infection-cause one-year mortality of maintenance hemodialysis patients.

  Authors: Ching-Wei Hsu, Ja-Liang Lin, Dan-Tzu Lin-Tan, Tzung-Hai Yen, Kuan-Hsing Chen

  Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 12/2010; 14(6):552-9.

  Elevated white blood cell (WBC) counts predict coronary heart disease and all-cause mortality in the general population. Chronic inflammation and malnutrition are associated with increased risk ofElevated white blood cell (WBC) counts predict coronary heart disease and all-cause mortality in the general population. Chronic inflammation and malnutrition are associated with increased risk of cardiovascular death in individuals with chronic kidney disease. In this study, we investigated the association between WBC count with inflammation, malnutrition, and mortality in maintenance hemodialysis (MHD) patients. A total of 959 MHD patients were stratified into four equal sized groups based on WBC count. Demographic, hematological, nutritional and inflammatory markers, and biochemical and dialysis-related data were obtained for cross-sectional analysis. All patients were followed for one year to investigate the risks for mortality. The mean WBC count was 6.4 ± 1.8 × 10(3)/µL (range: 2.3-16.3 × 10(3)/µL). Stepwise multiple linear regression analysis indicated a positive correlation between WBC count and inflammation (high-sensitivity C-reactive protein > 3 mg/L). Forty-five patients (4.7%) died within the 1-year study period. Cox multivariate regression analysis demonstrated that total WBC count significantly predicts 1-year mortality due to all-cause (hazard ratio (HR): 1.228, 95% confidence interval (CI): 1.095-1.378; P < 0.001), due to cardiovascular disease (HR: 1.242, 95% CI: 1.046-1.475; P = 0.013) and due to infection (HR: 1.252, 95% CI: 1.066-1.470; P = 0.006). These findings suggest that total WBC count should be measured in future studies that evaluate the clinical outcome of MHD patients and that dialysis patients with elevated WBC counts require further medical attention to reduce risks of mortality.

• Glycated hemoglobin predicts mortality in nondiabetic patients receiving chronic peritoneal dialysis.

  Authors: Kuan-Hsing Chen, Ja-Liang Lin, Dan-Tzu Lin-Tan, Ching-Wei Hsu, Wen-Hung Huang, Tzung-Hai Yen, Shu-Man Weng, Cheng-Chieh Hung

  American journal of nephrology. 11/2010; 32(6):567-74.

  patients with chronic peritoneal dialysis (CPD) use glucose-based dialysate to maintain their life; however, whether the glycemic status influences outcome of these patients without diabetes remainspatients with chronic peritoneal dialysis (CPD) use glucose-based dialysate to maintain their life; however, whether the glycemic status influences outcome of these patients without diabetes remains unknown. we conducted a cross-sectional and 18-month prospective study, and 269 nondiabetic patients with CPD were enrolled in a medical center. Glycated hemoglobin (HbA1c) levels were measured at baseline and categorized in tertiles of HbA1c: high (>5.4%), middle (5.1-5.4%) and low normal (<5.1%). Mortality and cause of death were recorded for longitudinal analyses. the study results showed high HbA1c group patients had a trend of being older and having higher body mass index (BMI) than other group patients. Stepwise multiple linear regression analysis showed HbA1c was positively related to age, BMI and the peritoneal solute transport rate. After 18 months of follow-up, Cox multivariate analysis showed that HbA1c (HR: 4.114; 95% CI: 1.426-11.872; p = 0.009) was the significant risk factor for all-cause mortality after relating variables were adjusted. Moreover, high HbA1c (HR: 3.892; 95% CI: 1.273-11.959; p = 0.026) and low HbA1c (HR: 1.179; 95% CI: 1.160-1.198; p = 0.039), with middle HbA1c group as the reference, also significantly predicted for mortality in these patients. HbA1c levels, or presence of low or high HbA1c, are associated with 18-month all-cause mortality in nondiabetic patients with CPD.

• Association between body mass and mortality in maintenance hemodialysis patients.

  Authors: Tzung-Hai Yen, Ja-Liang Lin, Dan-Tzu Lin-Tan, Ching-Wei Hsu

  Therapeutic apheresis and dialysis : official peer-reviewed journal of the International Society for Apheresis, the Japanese Society for Apheresis, the Japanese Society for Dialysis Therapy. 08/2010; 14(4):400-8.

  A total of 959 Taiwanese patients undergoing maintenance hemodialysis-102 underweight (BMI < 18.5 kg/m(2)), 492 normal weight (BMI 18.5-22.9 kg/m(2)), 187 overweight (BMI 23.0-24.9 kg/m(2)), and 178A total of 959 Taiwanese patients undergoing maintenance hemodialysis-102 underweight (BMI < 18.5 kg/m(2)), 492 normal weight (BMI 18.5-22.9 kg/m(2)), 187 overweight (BMI 23.0-24.9 kg/m(2)), and 178 obese (BMI >or= 25 kg/m(2)) were recruited into this three-year, multicenter longitudinal study. It was found initially that the underweight group had more females, longer hemodialysis durations, less use of a biocompatible membrane (BCM) dialyzer, higher erythropoietin doses and Kt/V(urea), and lower white blood cell counts, hemoglobin, serum creatinine and phosphate, and high sensitivity C-reactive protein (hsCRP) than other groups (P < 0.001). Furthermore, a chi(2)-test demonstrated that underweight patients had poorer nutrition (P = 0.023), but less systemic inflammation (P < 0.001) than other groups. A stepwise multiple linear regression analysis established that age, sex, diabetes mellitus, hemodialysis duration, use of BCM dialyzer, Kt/V(urea), creatinine, high-density lipoprotein cholesterol, and hsCRP were significant risk factors associated with BMI (P < 0.001-0.002). After three years, 149 (15.5%) patients had died, including 22 of 102 (21.6%) underweight patients, 64 of 492 (13.0%) normal weight patients, 38 of 187 (20.3%) overweight patients, and 25 of 178 (15.5%) obese patients. The primary causes of mortality were cardiovascular (52.3%) and infection (39.6%). A multivariate Cox regression analysis revealed that age, diabetes mellitus, BMI, albumin, hsCRP, and cardiothoracic ratio were significant risk factors associated with all-cause mortality over three years (P < 0.001-0.022). Finally, Kaplan-Meier analysis confirmed that underweight patients suffer higher mortality than other groups (Log rank, P = 0.0392); therefore, the data have demonstrated a survival disadvantage of low BMI in Taiwanese patients undergoing maintenance hemodialysis.

• Spectrum of corrosive esophageal injury after intentional paraquat ingestion.

  Authors: Tzung-Hai Yen, Ja-Liang Lin, Dan-Tzu Lin-Tan, Ching-Wei Hsu, Cheng-Hao Weng, Yu-Hui Chen

  The American journal of emergency medicine. 07/2010; 28(6):728-33.

  This is an observational study that examines the clinical features, the degrees of esophageal injury, physiological markers, and clinical outcomes after paraquat ingestion and seeks to determine whatThis is an observational study that examines the clinical features, the degrees of esophageal injury, physiological markers, and clinical outcomes after paraquat ingestion and seeks to determine what association, if any, may exist between these findings. The study included 16 of 1410 paraquat subjects who underwent endoscopies at Chang Gung Memorial Hospital between 1980 and 2007. Corrosive esophageal injuries were classified as grade 1 in 8, 2a in 5, and 2b in 3 patients. No patients had grade 0, 3a, or 3b esophageal injuries. After paraquat ingestion, systemic toxicity occurred, with rapid development of hypoxia, hepatitis, and renal failure in many cases. Hypoxia occurred in 1 (12.5%), 5 (100%), and 3 (100%) patients with grades 1, 2a, and 2b esophageal injury, respectively. There were more hypoxic patients with grades 2a and 2b than those with grade 1 esophageal injury (P < .05). The nadir Pao(2) was lower in patients with grades 2a and 2b than those with grade 1 esophageal injury (P < .05). However, there were no significant differences in terms of acute hepatitis, peak serum alanine aminotransferase, acute renal failure, and peak serum creatinine between the 3 groups (P > .05). Kaplan-Meier analysis did not find any difference in survival between the groups (P > .05). Paraquat, a mild caustic agent, produces only grades 1, 2a, and 2b esophageal injury. Our findings showed a potential relationship between the degree of hypoxia, mortality, and degree of esophageal injury, although such a low number of study subjects limits the conclusions that can be made by this study.