Yen-Hung Lin

National Taiwan University Hospital, T’ai-pei, Taipei, Taiwan

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Publications (77)221.59 Total impact

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    ABSTRACT: Telehealth programs are a growing field in the care of patients. The evolution of information technology has resulted in telehealth becoming a fourth-generation synchronous program. However, long-term outcomes and cost-effectiveness analysis of fourth-generation telehealth programs have not been reported in patients with chronic cardiovascular diseases.
    Journal of Medical Internet Research 01/2014; 16(6):e145. · 3.77 Impact Factor
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    ABSTRACT: Objectives To develop algorithms of locating patients with primary aldosteronism (PA) using insurance reimbursement data and to validate the algorithms using medical charts. Study Design and Setting We extracted National Health Insurance (NHI) reimbursement data and medical charts in seven enrolled hospitals and analyzed diagnosis-related information for 1999–2010. The NHI codes PA as 255.1x, using the International Classification of Diseases, Ninth Revision, Clinical Modification. Confirmation of PA was based on suppression tests. Results We reviewed medical charts for 1,094 cases with at least one PA diagnosis. PA was confirmed for 563 cases. Compared with patients with essential hypertension, PA patients had higher systolic blood pressure, higher aldosterone, lower renin activity, and lower potassium level (all P-values <0.05). An algorithm based on PA diagnosis reported in at least one hospital stay or three outpatient visits had modest performance (sensitivity = 0.94 and specificity = 0.20). The best additional condition for the algorithm was use of mineralocorticoid receptor antagonist (MRA; sensitivity = 0.89 and specificity = 0.88). Conclusion Using information on PA diagnosis and MRA prescription reported in insurance claims data can precisely locate PA patients in high-risk groups. This algorithm can construct a reliable PA sample for conducting research in various fields, including epidemiology and clinical practice.
    Journal of Clinical Epidemiology. 01/2014;
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    ABSTRACT: Objective To investigate the association between aldosterone and cardiac diastolic dysfunction. Methods We prospectively enrolled 20 patients with primary aldosteronism (PA) and 22 patients with essential hypertension (EH). Plasma aldosterone concentration, plasma renin activity, and 24-hr urine aldosterone level were measured. Echocardiography, including tissue Doppler image recordings, was performed. Results PA patients had a significantly higher left ventricular (LV) mass index and worse LV diastolic function than those in EH patients. Among various measures of aldosterone, log-transformed 24-hr urine aldosterone level had the most consistent correlation with diastolic function. Conclusions Aldosterone is strongly associated with LV diastolic dysfunction. Twenty-four hour urine aldosterone is a good indicator to evaluate the impact of aldosterone on LV diastolic function.
    Clinical Biochemistry. 01/2014;
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    ABSTRACT: Objective. Primary aldosteronism (PA) is associated with inappropriate left ventricular hypertrophy (LVH) in relation to a given gender and body size. There is no ideal parameter to predict the presence of LVH or inappropriate LVH in patients with PA. We investigate the performance of 24-hour urinary aldosterone level, plasma renin activity and aldosterone-to-renin ratio on this task. Methods. We performed echocardiography in 106 patients with PA and 31 subjects with essential hypertension (EH) in a tertiary teaching hospital. Plasma renin activity, aldosterone concentration, and 24-hour urinary aldosterone level were measured. Results. Only 24-hour urinary aldosterone was correlated with left ventricular mass index (LVMI) and excess LVMI among these parameters. The multivariate analysis revealed the urinary aldosterone level as an independent predictor for LVMI and excess LVMI. Analyzing the ability of urinary aldosterone, plasma aldosterone concentration, and plasma aldosterone-to-renin ratio to identify the presence of LVH (ROC AUC = 0.701, 0.568, 0.656, resp.) and the presence of inappropriate LV mass index (defined as measured LVMI in predicting LVMI ratio >135%) (ROC area under curve = 0.61, 0.43, 0.493, resp.) revealed the better performance of 24-hour urinary aldosterone. Conclusions. In conclusion, 24-hour urinary aldosterone level performed better to predict the presence of LVH and inappropriate LVMI in patients with PA.
    The Scientific World Journal 12/2013; 2013:294594. · 1.73 Impact Factor
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    ABSTRACT: In mice, a lack of cryptochrome results in up-regulation of aldosterone production due to high expression of the 3β-hydroxysteroid dehydrogenases (HSD3β) gene. The HSD3β pathway might play a pivotal role in aldosterone synthesis. This study aimed to determine the association of HSD3β and HSD3β2 gene variations with primary aldosteronism in a Taiwanese population. In this case-control cohort, 688 consecutive ethnically matched unrelated individuals including 362 primary aldosteronism and 326 essential hypertension cases were recruited. Nineteen tag single-nucleotide polymorphisms (SNPs) across HSD3β1, HSD3β2, and CYP11β2 were genotyped. Expression of HSD3β mRNA and immunohistochemical stain of HSD3β in the specimens of aldosterone-producing adenoma (APA) was compared with that in nonfunctional incidentaloma. The SNPs of rs12410453 A allele in HSD3β2 gene [odds ratio (OR) 1.92, 95% confidence interval (CI) 1.13-3.32, P=0.018] and rs6203 C allele in the HSD3β1 gene (OR 2.21, 95% CI 1.28-3.95, P=0.006) showed significant association with primary aldosteronism, with corresponding population attributable risk of 6.7 and 30.7%, respectively. Primary aldosteronism patients of non-CC in rs6203 and non-GA in rs12401453 had lower plasma aldosterone-to-renin ratio. A haplotype in a linkage disequilibrium block containing rs6203 associated significantly with serum potassium level (OR 1.24, 95% CI 1.02-1.24, P=0.026). The expressions of HSD3β1 mRNA, HSD3β2 mRNA and HSD3β protein were increased in APA, as compared to incidentaloma. Risk-conferring genetic variations in the HSD3β gene influenced susceptibility of primary aldosteronism. Concomitant presence of rs6203 CC and rs12410453 GA genotypes synergistically increased aldosterone-to-renin ratio.
    Journal of hypertension 07/2013; 31(7):1396-405; discussion 1405. · 4.02 Impact Factor
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    ABSTRACT: Historically, urinary aldosterone level measurement was a commonly employed confirmatory test to detect primary aldosteronism (PA). However, 24-h urine collection is inconvenient and cumbersome. We hypothesized that random urinary aldosterone measurements with correction for creatinine concentration might be comparable to 24-h urinary aldosterone levels (Uald-24 h) in the diagnosis of PA. The non-concurrent prospective study was conducted between June 2006 and March 2008 in patients admitted for confirmation of aldosteronism by salt loading test. A 24-h urine sample, which was collected during hospitalization on the day before saline infusion testing after restoration of serum hypokalemia, was collected from all subjects. Moreover, participants were asked to collect a first bladder voiding random urine sample during clinic visits. Uald-24 h and the random urinary aldosterone-to-creatinine ratio (UACR) were calculated accordingly. A total of 102 PA patients (71 patients diagnosed of aldosterone-producing adenoma, 31 with idiopathic hyperaldosteronism) and 65 patients with EH were enrolled. The receiver operating characteristic curve showed comparable areas under the curves of UACR and Uald-24 h. The Bland-Altman plot showed mean bias but no obvious heteroscedasticity between the two tests. When using random UACR >3.0 ng/mg creatinine as the cutoff value, we obtained a specificity of 90.6% to confirm PA from essential hypertension. Our study reinforce that the diagnostic accuracy of random UACR was comparable to that of Uald-24 h in PA patients. With the quickness and simplicity of the UACR method and its equivalence to Uald-24 h, this assay could be a good alternative diagnostic tool for PA confirmation.
    PLoS ONE 06/2013; 8(6):67417-. · 3.73 Impact Factor
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    ABSTRACT: Primary aldosteronism (PA) is the most common secondary form of arterial hypertension, with a particularly high prevalence among patients with resistant hypertension. Aldosterone has been found to be associated with cardiovascular toxicity. Prolonged aldosteronism leads to higher incidence of cardiac events, glomerular hyperfiltration, and potentially bone/metabolic sequels. The wider application of aldosterone/renin ratio as screening test has substantially contributed to increasing diagnosis of PA. Diagnosis of PA consists of two phases: screening and confirmatory testing. Adrenal imaging is often inaccurate for differentiation between an adenoma and hyperplasia, and adrenal venous sampling is essential for selecting the appropriate treatment modality. The etiologies of PA have two main subtypes: unilateral (aldosterone-producing adenoma) and bilateral (micro- or macronodular hyperplasia). Aldosterone-producing adenoma is typically managed with unilateral adrenalectomy, while bilateral adrenal hyperplasia is amenable to pharmacological approaches using mineralocorticoid antagonists. Short-term treatment outcome following surgery is determined by factors such as preoperative blood pressure level and hypertension duration, but evidence regarding long-term treatment outcome is still lacking. However, directed treatments comprising of unilateral adrenalectomy or mineralocorticoid antagonists still potentially reduce the toxicities of aldosterone. Utilizing a physician-centered approach, we intend to provide up-dated information on the etiology, diagnosis, and the management of PA.
    Annals of medicine 05/2013; · 3.52 Impact Factor
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    ABSTRACT: Multidetector-row computed tomography (MDCT) has become one of the major tools in diagnosing and evaluating patients with coronary artery disease in recent years. In selected patients, MDCT has been shown to provide more reliable accuracy in detection of stent patency than invasive coronary angiography. Chiou et al reported a delicate infarcted myocardium at-risk score. According to their results, the MDCT-based myocardium at-risk score had a good correlation with the thallium 201 ST-segment elevation myocardial infarction-based summed difference score (r = 0.841, P < 0.001). They claimed that dual-phase MDCT is useful in detecting different patterns of obstructive lesions and the extent of myocardium at risk. In this commentary, we discuss the current status of the clinical application of MDCT in patients with myocardial infarction in relation to evaluating the myocardial perfusion defect, detecting reversible myocardial ischemia, assessing myocardial viability, estimating target lesion restenosis, and calculating of fractional flow reserve from MDCT.
    World journal of cardiology. 04/2013; 5(4):115-118.
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    ABSTRACT: OBJECTIVE: The objective of this article is to measure serum dehydroepiandrosterone sulfate (DHEA-S) concentration in both genders with primary aldosteronism (PA). MATERIALS AND METHODS: The study enrolled 78 subjects with normal controls, 46 subjects with essential hypertension and 85 subjects with PA from October 2007 to June 2011. Subjects with PA were divided into three subtype groups: aldosterone-producing adenoma (APA), bilateral idiopathic hyperplasia (IHA) and PA with negative imaging findings. RESULTS: Women with PA (n = 49) had lower serum DHEA-S levels compared with normal controls and subjects with essential hypertension (p < 0.01). In subtype analysis, only female APAs had lower serum DHEA-S levels (p < 0.01 compared with normal controls, p < 0.01 compared with subjects with essential hypertension). In APA, a significant correlation between tumor size and serum DHEA-S was found in women (p < 0.01). CONCLUSION: Our data suggested that serum DHEA-S levels are lower in women with PA. In subtype groups, only women with APA had lower serum DHEA-S. There was no significant difference between subjects with bilateral essential hyperplasia, PA with negative imaging findings, normal controls and subjects with essential hypertension in both genders. The serum DHEA-S level is negatively correlated with the size of APA.
    Journal of Renin-Angiotensin-Aldosterone System 04/2013; · 2.29 Impact Factor
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    ABSTRACT: OBJECTIVE: To investigate the influence of aldosterone on myocardial fibrosis and cardiac structure and function in patients with rimary aldosteronism (PA) and essential hypertension (EH). METHODS: We prospectively enrolled 20 patients with PA and 22 patients with EH. Plasma carboxy-terminal propeptide of type I procollagen (PICP) level, aldosterone concentration (PAC), plasma renin activity (PRA), and 24-h urine aldosterone were measured. Echocardiography, including tissue Doppler image (TDI) recordings, was performed. RESULTS: PA patients had a significantly higher left ventricular mass index (LVMI), lower e' value, and higher E/e' value than those in EH patients. The plasma PICP levels were higher in PA patients than in EH patients (108±33 to 89±29μg/L, p=0.043). Plasma PICP levels were significantly correlated with various measures of aldosterone in PA patients including log-transformed 24-h urine aldosterone, log-transformed PAC, and log-transformed ARR. In contrast, no correlation was found in EH patients. CONCLUSIONS: PICP levels were higher in patients with PA than in those with EH. This finding implies that myocardial fibrosis is more severe in patients with PA. The influence of aldosterone on myocardial fibrosis is more significant in PA patients than in EH patients.
    Clinical biochemistry 01/2013; · 2.02 Impact Factor
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    ABSTRACT: Primary aldosteronism (PA), an underdiagnosed cause of hypertension, is associated with more significant cardiac remodeling and myocardial fibrosis than is essential hypertension (EH). The aim of this study was to validate myocardial fibrosis and to evaluate factors associated with the degree of myocardial fibrosis in patients with PA. We prospectively analyzed 62 patients with PA (including 46 patients with aldosterone-producing adenoma and 16 with bilateral hyperplasia) between October 2006 and October 2010, and we enrolled 17 patients with EH as the control group. Echocardiography, including ultrasonic tissue characterization using cyclic variation of integrated backscatter (CVIBS), was performed in individuals in both groups. Among patients with PA, the diastolic blood pressures and plasma aldosterone concentrations were significantly higher than those of patients with EH. Moreover, the serum potassium levels and the plasma renin activities were significantly lower in patients with EH. As observed by echocardiography, patients with PA had greater interventricular septal thickness, greater left ventricular posterior wall thickness, and higher left ventricular mass indexes than did patients with EH. Patients with PA had significantly lower CVIBS values than patients with EH (7.1 ± 2.2 vs. 8.7 ± 1.5 dB; p = .005). In a correlation study that corrected for various clinical parameters, only log-transformed plasma renin activity values correlated significantly with CVIBS values. Ultrasonic tissue characterization with CVIBS is a useful tool for determining the extent of myocardial fibrosis. Patients with PA exhibit a more severe degree of myocardial fibrosis, as detected by CVIBS, than do patients with EH. Moreover, the severity of fibrosis, as detected by CVIBS, correlates with log-transformed plasma renin activity values.
    Ultrasound in medicine & biology 01/2013; 39(1):54-61. · 2.46 Impact Factor
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    ABSTRACT: Telehealth based on advanced information technology is an emerging health care strategy for managing chronic diseases. However, the cost-effectiveness and clinical effect of synchronous telehealth services in older patients with cardiovascular diseases has not yet been studied. Since 2009, the Telehealth Center at the National Taiwan University Hospital has provided a range of telehealth services (led by a cardiologist and staffed by cardiovascular nursing specialists) for cardiovascular disease patients including (1) instant transmission of blood pressure, pulse rate, electrocardiography, oximetry, and glucometry for analysis, (2) mutual telephone communication and health promotion, and (3) continuous analytical and decision-making support. To evaluate the impact of a synchronous telehealth service on older patients with cardiovascular diseases. Between November 2009 and April 2010, patients with cardiovascular disease who received telehealth services at the National Taiwan University Hospital were recruited. We collected data on hospital visits and health expenditures for the 6-month period before and the 6-month period after the opening of the Telehealth Center to assess the clinical impact and cost-effectiveness of telehealth services on cardiovascular patients. A total of 141 consecutive cardiovascular disease patients were recruited, including 93 aged ≥65 years (senior group) and 48 aged <65 years (nonsenior group). The telehealth intervention significantly reduced the all-cause admission rate per month per person in the nonsenior group (pretelehealth: median 0.09, IQR 0-0.14; posttelehealth: median 0, IQR 0-0; P=.002) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.70, IQR 0-1.96; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 0.77, IQR 0.20-1.64; posttelehealth: mean 1.60, IQR 1.06-2.57; P=.002). In the senior group, the telehealth intervention also significantly reduced the all-cause admission rate per month per person (pretelehealth: median 0.10, IQR 0-0.18; posttelehealth: median 0, IQR 0-0; P<.001) and the duration (days per month per person) of all-cause hospital stay (pretelehealth: median 0.59, IQR 0-2.24; posttelehealth: median 0, IQR 0-0; P<.001) with increased all-cause outpatient visits per month per person (pretelehealth: median 1.40, IQR 0.52-2.63; posttelehealth: median 1.76, IQR 1.12-2.75; P=.02). In addition, telehealth intervention reduced the inpatient cost in the nonsenior group from $814.93 (SD 1000.40) to US $217.39 (SD 771.01, P=.001) and the total cost per month from US $954.78 (SD 998.70) to US $485.06 (SD 952.47, P<.001). In the senior group, the inpatient cost per month was reduced from US $768.27 (SD 1148.20) to US $301.14 (SD 926.92, P<.001) and the total cost per month from US $928.20 (SD 1194.11) to US $494.87 (SD 1047.08, P<.001). Synchronous telehealth intervention may reduce costs, decrease all-cause admission rates, and decrease durations of all-cause hospital stays in cardiovascular disease patients, regardless of age.
    Journal of Medical Internet Research 01/2013; 15(4):e87. · 3.77 Impact Factor
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    ABSTRACT: Non-alcoholic fatty liver disease (NAFLD) is associated with cardiovascular atherosclerosis independent of classical risk factors. This study investigated the influence of NAFLD on autonomic changes, which is currently unknown. Subjects without an overt history of cardiovascular disease were enrolled during health checkups. The subjects diagnosed for NAFLD using ultrasonography underwent 5-min heart rate variability (HRV) measurements that was analyzed using the following indices: (1) the time domain with the standard deviation of N-N (SDNN) intervals and root mean square of successive differences between adjacent N-N intervals (rMSSD); (2) the frequency domain with low frequency (LF) and high frequency (HF) components; and (3) symbolic dynamics analysis. Routine blood biochemistry data and serum leptin levels were analyzed. Homeostasis model assessment of insulin resistance (HOMA-IR) was measured. Of the 497 subjects (mean age, 46.2 years), 176 (35.4%) had NAFLD. The HRV indices (Ln SDNN, Ln rMSSD, Ln LF, and Ln HF) were significantly decreased in the NAFLD group (3.51 vs 3.62 ms, 3.06 vs 3.22 ms, 5.26 vs 5.49 ms(2), 4.49 vs 5.21 ms(2), respectively, all P<0.05). Ln SDNN was significantly lower in the NAFLD group after adjustment for age, sex, hypertension, dyslipidemia, metabolic syndrome, body mass index, smoking, estimated glomerular filtration rate, HOMA-IR, and leptin (P<0.05). In the symbolic dynamic analysis, 0 V percentage was significantly higher in the NAFLD group (33.8% vs 28.7%, P = 0.001) and significantly correlated with linear HRV indices (Ln SDNN, Ln rMSSD, and Ln HF). NAFLD is associated with decreased Ln SDNN and increased 0 V percentage. The former association was independent of conventional cardiovascular risk factors and serum biomarkers (insulin resistance and leptin). Further risk stratification of autonomic dysfunction with falls or cardiovascular diseases by these HRV parameters is required in patients with NAFLD.
    PLoS ONE 01/2013; 8(4):e61803. · 3.73 Impact Factor
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    ABSTRACT: Hypertension is a frequent early manifestation of autosomal dominant polycystic kidney disease (ADPKD). Several mechanisms can cause hypertension in ADPKD patients, although, primary aldosteronism (PA) as a possible manifestation of hypertension in ADPKD is extremely rare. We retrospectively reviewed the Taiwan Primary Aldosteronism Investigation (TAIPAI) database, which listed a total of 346 patients diagnosed with PA. Of these 346 patients, only three cases of concurrent PA and ADPKD were identified. These patients presented with hypertensive crisis and hypokalemia, and subsequent testing revealed aldosterone-producing adenomas (APAs) that were removed by laparoscopic adrenalectomy. Postoperatively, aldosterone-renin ratios (ARRs) and potassium levels normalized, and blood pressure improved. The diagnosis of PA in ADPKD is extremely challenging because multiple renal cysts can obscure the identification of adrenal adenomas, and ADPKD is associated with hypertension in almost all cases.(1) Because of frequent delays in the diagnosis of PA in ADPKD patients, future prospective studies to screen PA in hypertensive ADPKD patients may be necessary to evaluate the exact prevalence of coexistence of PA and ADPKD.
    Journal of Renin-Angiotensin-Aldosterone System 07/2012; · 2.29 Impact Factor
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    ABSTRACT: Primary aldosteronism is the most frequent cause of secondary hypertension and is associated with more prominent left ventricular hypertrophy and increased myocardial fibrosis. However, the reversibility of cardiac fibrosis is still unclear. Our objective was to investigate myocardial fibrosis in primary aldosteronism patients and its change after surgery. We prospectively analyzed 20 patients with aldosterone-producing adenoma (APA) who received adrenalectomy from December 2006 to October 2008 and 20 patients with essential hypertension were enrolled as the control group. Plasma carboxy-terminal propeptide of procollagen type I (PICP) determination and echocardiography including ultrasonic tissue characterization by cyclic variation of integrated backscatter (CVIBS) were performed in both groups and 1 year after operation in the APA group. APA patients had significantly higher SBP and DBP, higher plasma aldosterone concentration (PAC), higher aldosterone-renin ratio (ARR), lower serum potassium levels, and lower plasma renin activity (PRA) than patients with essential hypertension. In echocardiography, APA patients had a higher left ventricular mass index than essential hypertension patients. APA patients had significantly lower CVIBS (6.2 ± 1.5 vs. 8.7 ± 2.0 dB, P < 0.001) and higher plasma PICP levels (107 ± 27 vs. 85 ± 24 μg/l, P = 0.009) than essential hypertension patients. In the correlation study, CVIBS is correlated with log-transformed PRA and log-transformed ARR and PICP is correlated with log-transformed PRA, log-transformed PAC, and log-transformed ARR. One year after adrenalectomy, CVIBS increased significantly (6.2 ± 1.5 to 7.3 ± 1.7 dB, P = 0.033) and plasma PICP levels decreased (107 ± 27 vs. 84 ± 28 μg/l, P = 0.026). Increases in collagen content in the myocardium of APA patients may be reversed by adrenalectomy.
    Journal of hypertension 06/2012; 30(8):1606-13. · 4.02 Impact Factor
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    ABSTRACT: Eur J Clin Invest 2012; 42 (10): 1079-1086 ABSTRACT: Objectives  The goal of this study was designed to assess prognostic values of simultaneous measurement of adipocytokines in systolic heart failure (HF) patients. Methods  Patients with HF manifestations and left ventricular ejection fraction (LVEF) ≤ 50% were selected in this study. Gender, age, medications and serum biochemical data were recorded upon admissions. Adipocytokines including adiponectin, leptin, resistin, visfatin and retinol binding protein-4 were measured. Results  A total of 108 (83 males and 25 females) patients were enroled. The age was 62 ± 15 years and mean LVEF was 35%. Twenty patients died during 776 ± 323 days follow-up. In univariate analysis, mortality was found to be associated with the log-transformed values of serum resistin (β = 5·616, P = 0·04), log-transformed values of serum adiponectin (β = 4·377, P = 0·038), age (β = 1·071, P < 0·001), NTHA functional status (β = 3·752, P = 0·001) and body mass index (β = 0·858, P = 0·012). Patients with higher level of serum resistin were associated with higher mortality (P = 0·012). In multivariate analysis, mortality is associated with log-transformed values of serum resistin (β = 3·666, P = 0·045), age (β = 1·044, P = 0·017) and NTHA functional status (β = 2·541, P = 0·025). Conclusions  Serum resistin level was associated with higher mortality in systolic HF patients even after adjusting clinical parameters. Resistin may be an informative risk marker for systolic HF patients.
    European Journal of Clinical Investigation 05/2012; 42(10):1079-1086. · 3.37 Impact Factor
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    ABSTRACT: Adrenalectomy is the definite treatment for aldosterone-producing adenoma (APA). Percutaneous ethanol or acetic acid injection with computed tomography (CT) guidance has been described as a safe, noninvasive, and effective alternative treatment modality in patients with high surgical risk. We report on a man who was 49 years of age and presented with treatment-resistant hypertension and was later diagnosed with APA. CT-guided percutaneous ethanol injection (PEI) was performed for this high surgical risk patient. He had aldosteronism recurrence 4 years after the ethanol injection, so a second PEI was performed. The tumor size was reduced and his blood pressure was normalized. Therefore, we suggest that clinicians should closely check aldosterone to renin ration and potassium level if percutaneous chemical ablation is considered in functioning adrenal adenomas.
    Journal of the Formosan Medical Association 03/2012; 111(3):176-8. · 1.00 Impact Factor
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    ABSTRACT: To assess the degree of myocardial fibrosis in patients with primary aldosteronism (PA). Twenty-five patients with PA and 12 age-matched healthy volunteers underwent cine and late gadolinium enhancement (LGE) magnetic resonance imaging (MRI) on a 1.5 T MR system. From volume-time curves of cine MRI, the time for deceleration (Tdec) was determined to assess the left ventricle (LV) chamber stiffness. Based on phase-sensitive reconstructed LGE images, a fibrosis index called enhancement value (EV) was computed as the signal intensity change in the myocardium over blood before and after contrast. Both Tdec and EV were compared between patients and controls. The association between Tdec and EV was investigated. Patients showed a significantly higher EV (0.43 ± 0.05 vs. 0.36 ± 0.07; P = 0.002) and a significantly shorter Tdec (11.5 ± 3.5 %RR vs. 15.3 ± 2.4 %RR; P = 0.004) than controls. Significant correlations between EV and Tdec were observed in patients (r = -0.46, P = 0.018), in controls (r = -0.68, P = 0.015) and in all subjects (r = -0.63, P < 0.001). The fibrosis index is increased in patients with PA and the increase imposes an adverse effect on LV diastolic function.
    Journal of Magnetic Resonance Imaging 01/2012; 35(6):1349-55. · 2.57 Impact Factor
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    ABSTRACT: Patients with end-stage renal disease (ESRD) are at particular risk for methicillin-resistant Staphylococcus aureus (MRSA) infections, especially via nasal colonization of MRSA. Surveillance cultures are recommended to identify patients colonized by MRSA. Clinical data and screening cultures of S. aureus from the anterior nares of 541 patients on long-term dialysis in the hospitals were performed in March 2007. The follow-up survey was conducted 1 year later. A total of 32 (5.9%) of the 541 patients were positive nasal cultures for MRSA, while 89 (16.5%) were positive for methicillin-susceptible S. aureus (MSSA). In a multivariate analysis, risk factors for ESRD patients with MRSA colonization included congestive heart failure, nursing home admission, and nasogastric tube feeding in the last 3 months. Follow-up of the 32 MRSA colonized patients showed that one (3.1%) died due to MSSA and three (9.3%) died due from MRSA infection. We found that patients with ESRD and MRSA nasal colonization were associated with a history of congestive heart failure, nursing home admission, and nasogastric tube feeding in the last 3 months.
    Journal of the Formosan Medical Association 01/2012; 111(1):14-8. · 1.00 Impact Factor
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    ABSTRACT: A mobile ECG healthcare platform is developed. The wireless prototype, which consists of the single lead electrode, is developed with commercial discrete components and can demo a patient centric medical environment. The platform uses an Android phone as a gateway to transmit the recorded ECG data back to the cloud server: Bluetooth for ECG sensor to the Android phone, while 3G/WiFi for the Android phone to the cloud server. With wireless technology on the platform, patient can go outside for common life, instead of being tied at home or hospital. Another advantage to use an Android phone as a hub is its computing power. We can put several light-weighted monitoring functions in the phone to provide important services such as emergency alarm and location information. After the mobile hub, we transmit the data onto our cloud server. The server in the cloud can analyze recorded ECG signal in more details with accurate algorithms and advanced analysis. Therefore, cloud server plays an important role in the platform that let the whole system has diagnostic grade. The demonstration can show how the whole platform works. On one hand, an Android phone/ tablet will be used to monitor the ECG waveform in real time. In addition, the application on the Android device can provide some valuable services we mentioned above. On the other hand, a Windows laptop will be use to show the analyzed results of the cloud server. Further more, we also plan to demo the cloud server by using browsers (IE, Firefox, Chrome, Safari and Opera). This can reveal that, our platform can apply to every operation system (Windows, Linux, Mac OS, iOS and Android). Incidentally, the sensor and the application program are very low power. Hence users can monitor their ECG continuously for 24 hours by a wearable sensor (half of the credit card size) and their general Android phones.
    Biomedical Circuits and Systems Conference (BioCAS), 2012 IEEE; 01/2012

Publication Stats

541 Citations
221.59 Total Impact Points

Institutions

  • 2004–2014
    • National Taiwan University Hospital
      • Department of Internal Medicine
      T’ai-pei, Taipei, Taiwan
  • 2013
    • Taipei City Hospital
      T’ai-pei, Taipei, Taiwan
    • Far Eastern Memorial Hospital
      T’ai-pei, Taipei, Taiwan
  • 2010–2013
    • Buddhist Tzu Chi General Hospital
      T’ai-pei, Taipei, Taiwan
  • 2012
    • Fu Jen Catholic University
      T’ai-pei, Taipei, Taiwan
  • 2011
    • National Yang Ming University
      • Department of Internal Medicine
      T’ai-pei, Taipei, Taiwan
  • 2007–2011
    • Taipei Medical University
      • • Department of Internal Medicine
      • • Division of Cardiology
      T’ai-pei, Taipei, Taiwan
    • Yuan's General Hospital
      Kao-hsiung-shih, Kaohsiung, Taiwan
  • 2009
    • China Medical University Hospital
      臺中市, Taiwan, Taiwan
  • 2007–2008
    • National Taiwan University
      • College of Medicine
      T’ai-pei, Taipei, Taiwan