Chia-Yi Christian Hospital Research Articles

Underestimated Rate of Status Epilepticus according to the Traditional Definition of Status Epilepticus.

Purpose. Status epilepticus (SE) is an important neurological emergency. Early diagnosis could improve outcomes. Traditionally, SE is defined as seizures lasting at least 30 min or repeated seizures over 30 min without recovery of consciousness. Some specialists argued that the duration of seizures qualifying as SE should be shorter and the operational definition of SE was suggested. It is unclear whether physicians follow the operational definition. The objective of this study was to investigate whether the incidence of SE was underestimated and to investigate the underestimate rate. Methods. This retrospective study evaluates the difference in diagnosis of SE between operational definition and traditional definition of status epilepticus. Between July 1, 2012, and June 30, 2014, patients discharged with ICD-9 codes for epilepsy (345.X) in Chia-Yi Christian Hospital were included in the study. A seizure lasting at least 30 min or repeated seizures over 30 min without recovery of consciousness were considered SE according to the traditional definition of SE (TDSE). A seizure lasting between 5 and 30 min was considered SE according to the operational definition of SE (ODSE); it was defined as underestimated status epilepticus (UESE). Results. During a 2-year period, there were 256 episodes of seizures requiring hospital admission. Among the 256 episodes, 99 episodes lasted longer than 5 min, out of which 61 (61.6%) episodes persisted over 30 min (TDSE) and 38 (38.4%) episodes continued between 5 and 30 min (UESE). In the 38 episodes of seizure lasting 5 to 30 minutes, only one episode was previously discharged as SE (ICD-9-CM 345.3). Conclusion. We underestimated 37.4% of SE. Continuing education regarding the diagnosis and treatment of epilepsy is important for physicians.

Clinical Significance of Survivin Expression in Patients with Urothelial Carcinoma

Background. Survivin is a member of the inhibitors of apoptosis protein family that plays an important role in carcinogenesis. Here, we examined the association between survivin expression and clinical outcome in urothelial carcinoma of the bladder (UCB). Methods. A total of 56 histopathologically confirmed UCB patients were recruited from the Department of Urology of Chiayi Christian Hospital from August 2007 to May 2009. Immunohistochemistry (IHC) was used to detect the survivin expression in tumor tissues. The –31 C/G polymorphism in survivin promoter region was determined by polymerase chain reaction-restricted fragment length polymorphism. Results. The frequency of high survivin expression was significantly higher in muscle-invasive tumors (66.6%) than in non-muscle-invasive tumors (34.2%) (P = 0.042) and in poorly differentiated (85.7%) tumors than in moderately differentiated tumors (30.8%) (P = 0.0014). The higher frequency of risk genotypes (C/C and C/G) was found in the median (72.7%) and high (68.0%) survivin expression groups. The multivariate analysis showed that a high survivin expression level was a potential predictive biomarker of poor overall survival (P = 0.02). Conclusion. Our results suggest that the high survivin expression was associated with tumor stage and grade and may present a predictive marker of overall survival in UCB.

Alcohol consumption is inversely associated with stage 3 chronic kidney disease in middle-aged Taiwanese men

BackgroundChronic kidney disease (CKD) is a major global public health burden, but there is limited understanding of the relationship of alcohol consumption with CKD.MethodsIn this cross-sectional multivariable study, all participants of a health check-up program in Ditmanson Medical Foundation Chia-Yi Christian Hospital in Taiwan from 2003 to 2009 (15 353 women and 11 900 men) were included for analysis. Estimated glomerular filtration rate was used to define CKD stage and history of alcohol consumption was obtained by self-reporting. Multivariable logistic regression analyses of gender-specific association of alcohol drinking with stage 3 CKD were conducted. A trend tests was conducted to check the dose–response relationship of alcohol consumption with renal disease. A sensitivity test was conducted to rule out the likelihood of reverse causality.ResultsThe prevalence of stage 3 CKD was lower in drinkers than non-drinkers (p < 0.001) and the percentage of drinkers with stage 3 CKD was less than that of non-drinkers. Multivariable analysis indicated that alcohol consumption was negatively associated with the presence of stage 3 CKD in men (adjusted odds ratio [aOR] for occasional drinking: 0.68, 95% CI: 0.59 ~ 0.78, p < 0.001; aOR for frequent drinking: 0.47, 95% CI: 0.35 ~ 0.63, p < 0.001). Advanced age, hypertension, anemia, BMI of at least 24, hyperuricemia, and proteinuria were also associated with stage 3 CKD in men. Trend tests indicated lower odds of having stage 3 CKD with increased alcohol consumption in both genders. Subgroup analyses and sensitivity tests also indicated the reverse association between alcohol consumption and stage 3 CKD in men regardless of age, diabetes status, and other risky behaviors.ConclusionsAlcohol consumption was inversely associated with stage 3 CKD in Taiwanese men. However, considering the potential of other health damage with alcohol consumption, the current results should be interpreted cautiously.

The Effect of Heart Rate Variability on Exercise Training Post-Cardiac Surgery

Purpose: the purpose of this study was to investigate heart rate variability on exercise training post-cardiac surgery. Method: the data collection was from the Chia-yi Christian Hospital Cardiac Surgery implementation of beating heart coronary artery bypass surgery and valve replacement patients. There were a total of 10 patients included in this study. Cardiac patients after discharge from hospital were the participation of exercise training groups (n=5), and no receiving cardiopulmonary physical therapy of patients was the home-based group (n=5). Statistics: Data analysis was conducted using the SPSS statistical software for Windows 20.0. Analysis of covariance (ANCOVA) was used as the statistical method at a significance level (α) of .05. Through statistical analysis and comparison, the results were obtained as below: In HRV time domain portion, SDNN, CV%, results were significant difference. In frequency domain portion, indices such as LF and VHF, results were significant difference. Conclusion: According to the experimental results, the heart rate variability on exercise training better than patients did not participate in sports training after cardiac surgery patient.

&amp;lt;i&amp;gt;Survivin&amp;lt;/i&amp;gt; promoter rs9904341 polymorphism is associated with tumor stage and grade in patients with bladder cancer

Survivin is an inhibitor of apoptosis protein and also plays a important role in the development of several malignancies. To investigate the association between survivin promoter –31 G/C (rs9904341) polymorphism and bladder cancer (BC) risk. A total of 200 pathologically confirmed BC cases and 200 unrelated cancer-free controls were recruited in Chiayi Christian Hospital from August 2002 to May 2009. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) method was used to determine the –31 G/C polymorphism at survivin promoter region. There was a significant difference in the frequency distribution of survivin promoter –31 G/C polymorphism in BC cases as compared to controls. Among BC cases, individuals with the C/C genotype of survivin promoter have a significantly higher prevalence of invasive (T2-T4) or high-grade (G2-G3) tumors as compared to those who carried the G/G genotype. In conclusion, our findings suggest that the survivin promoter –31 G/C polymorphism was not only associated with clinical stage and pathological grade but also involved in the development of bladder cancer.

The effectiveness of acupuncture on improving the blood flow rate and accelerating the recovery of neurological symptoms in stroke patients

1Ditmanson Medical Foundation Chia-Yi Christian Hospital; Graduate student, School of Nursing, Kaohsiung Medical University, Taiwan, 2School of Nursing, Kaohsiung Medical University, Kaohsiung, Taiwan

Successful thrombolytic therapy in a patient with infective endocarditis-related stroke

Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan Division of Cardiology, Department of Internal Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan

Abstract 4500: Clinical significance of survivin expression in urothelial carcinoma of the bladder

Abstract Objective: Survivin is one of the inhibitors of apoptosis protein family and plays an important role in carcinogenesis. Survivin also has been reported to be related with poor clinical outcome in various malignancies. The aim of this study is to examine the association between survivin expression and clinical outcome in urothelial carcinoma of the bladder. Materials and methods: A total of 56 histopathologically confirmed urothelial carcinoma of bladder (UCB) patients were recruited from the Department of Urology of Chiayi Christian Hospital and Chi-Mei Medical Center from August 2006 to May 2007. Immunohistochemistry (IHC) analysis was performed to determine the expression level of survivin in tumor and adjacent normal tissues. One normal human urothelial cell: HUC4449 and nine urothelial carcinoma cell lines which are TSGH8301, 5637, BFTC905, BFTC909, HT1376, TCC SUP, J82, T24 and HT1197 for survivin mRNA analysis by quantitative real-time PCR. The –31 C/G polymorphism in survivin gene was determined using PCR-RFLP method. The effects of a higher expression level of survivin on disease-free survival (DFS) and overall survival (OS) were estimated using Cox proportional hazard models. Results: The frequency of low, moderate and higher expression of survivin in tumor tissues of UCB were 16.1%, 39.3% and 44.6%, respectively. The frequency of high expression of survivin was significantly higher in muscle-invasive tumors (66.6%) than in non-muscle invasive tumors (34.2%) (P=0.042). The frequency of high expression of survivin was significantly higher in poor-differentiated (85.7%) than in moderate- differentiated tumors (30.8%) (P= 0.0014). The survivin mRNA expression (Log2 fold change were 3.41∼5.30) in various grade (G2-G4) urothelium carcinoma cell lines were all higher than normal human urothelial cell. Moreover, the higher frequency of risk genotypes (C/C+C/G) was observed in median and high survivn expression groups. In a multivariate analysis, high survivin expression was predictive of inferior OS (HR= 12.3, P=0.02). Conclusion: These findings suggest that the high expression of survivin is not only associated with tumor stage and grade of tumors but also may be predictive of inferior overall survival of urothelail carcinoma of the bladder. Keywords: survivin; bladder; urothelial carcinoma; immunohistochemistry, disease-free survival; overall survival Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 4500. doi:1538-7445.AM2012-4500

Laparoscopic Roux-en-Y gastric bypass in a morbidly obese patient with renal transplant: A case report

Renal transplant is the only curative treatment for end-stage renal disease. As diabetes and obesity are the major causes of graft failure and post-transplant complication, it is important to manage obesity in patients with renal transplant. Herein, we report a case of a morbidly obese renal-transplant patient with poorly controlled diabetes who received bariatric surgery. A 34-year-old obese Taiwanese man with type 2 diabetes had end-stage renal disease that had progressed since 2008, when he had commenced hemodialysis (January 2008) and had a renal transplant (July 2008). Because of persistent obesity and poorly controlled diabetes, he received LRYGB at Chiayi Christian hospital on 18 August 2010. In the month that followed, he lost 10 kg. His serum creatinine decreased to 1.11 mg/dL (1.4 mg/dL, preoperative) and his hemoglobin A1c decreased to 8.5% (10.4%, preoperative). These results indicate that, in obese renal transplant patients, LRYGB may be employed to treat obesity, control diabetes and stabilize or improve the renal function.

Aripiprazole-Associated Leukopenia With Coadministration of Fluoxetine

1Psychiatry Department Chiayi Christian Hospital Chiayi, Taiwan 2Psychiatry Department Armed Forces Beitou Hospital Taipei, Taiwan [email protected]

Prognostic relevance of preoperative circulating CD8-positive lymphocytes in the urinary bladder recurrence of urothelial carcinoma

ObjectiveTumor-infiltrate lymphocytes (TIL) have been associated with favorable outcomes in various tumors including urothelial carcinoma (UC). There is little literature about peripheral blood lymphocytes (PBL). Our objective is to investigate the clinical significance and relevance of PBL on the outcomes of UC patients. Materials and methodsNinety UC treated patients at Chia-Yi Christian hospital were enrolled. Preoperative PBLs were collected and analyzed for the percentage of each subpopulation of lymphocyte using flow cytometry. The prognostic values were calculated by using Kaplan-Meier curve and Cox progression model for univariate and multivariate analyses, respectively. Furthermore, available tumor specimens from 27 patients were further analyzed for number of CD8+ tumor infiltrating lymphocytes (TIL) using immunohistochemistry. The correlation between percentage of CD8+ PBL and number of CD8+ TIL was analyzed using a linear regression model. ResultsThe log-rank test showed that tumor location (urinary bladder vs. upper urinary tract), enrolled status (primary or recurrent), and CD8+ PBL were significant prognostic indicators of recurrence (P values, 0.043, 0.039, and 0.018, respectively). Cox analyses showed that CD8+ PBL was the sole independent prognostic indicator for recurrence-free survival (P = 0.048). The results using a linear regression analysis showed there was a reverse correlation between CD8+ TIL and PBL (r2 = 0.635, P < 0.0001). ConclusionsIn our investigation, preoperative CD8+ PBL was an independent predictor for bladder recurrence. The percentages of CD8+ PBL were reversely correlated with the number of TIL. Such findings may benefit in the decision for subsequent intravesical therapy after surgery.

Association Between Survivin Gene Promoter −31 C/G Polymorphism and Urothelial Carcinoma Risk in Taiwanese Population

To investigate the association between survivin gene promoter -31 C/G polymorphism and urothelial carcinoma (UC) risk in a Taiwanese population. A total of 190 patients with pathologically confirmed UC and 210 unrelated controls without cancer were recruited at Chiayi Christian Hospital from August 2002 to May 2007. The -31 C/G polymorphism in the survivin gene promoter was determined using polymerase chain reaction-restriction fragment length polymorphism analysis. Compared with study subjects carrying the G/G genotype, significantly increased UC risks were found for individuals carrying the C/G genotype (odds ratio 2.8; 95% confidence interval [CI] 1.7-4.6) and those with the C/C genotype (odds ratio 4.0; 95% CI 2.3-7.2). Those carrying the C/C or C/G genotype had a significantly increased UC risk of 3.2 (95% CI 1.9-5.2) compared with those with the G/G genotype. Among heavy smokers (> or = 30 pack-years), we found a significantly increased UC risk of 3.8 (95% CI 1.3-11.3) for individuals with the C/C or C/G genotype compared with those with the G/G genotype. Furthermore, patients with UC carrying the C/C genotype had a significantly greater prevalence of muscle-invasive (Stage T2-T4), high-grade (G3), or invasive, high-grade tumor compared with those carrying the G/G genotype. These findings suggest that the -31 C/G polymorphism of the survivin gene promoter is associated with both the clinical tumor stage and the pathologic tumor grade and might be involved in the development of UC.

The Effect of T'ai Chi Exercise on Autonomic Nervous Function of Patients with Coronary Artery Disease

The objective of this study was to evaluate the effect of t'ai chi (TC) on heart rate variability (HRV) from baseline to 9 months in patients with coronary artery disease (CAD). A comparative trial was undertaken comparing the acute and long-term effect of TC on HRV in patients with CAD. Sixty-one (61) subjects with CAD undergoing percutaneous intervention or coronary bypass grafting for a period of more than 1 month were recruited from the clinics of cardiology and cardiovascular surgery at Chia-Yi Christian Hospital, Taiwan. The experimental group (n = 22) practiced weekly 90-minute Yang's style TC for 9 months and the control group (n = 39) continued their normal daily physical activity. HRV was recorded at baseline, 3 months, 6 months, and 9 months in the control group. Resting HRV was recorded before TC exercise and recovery HRV was recorded 30 minutes post TC at the same four time points in the experimental group. The change in the normalized low-frequency power, normalized high-frequency power, and the low-/high-frequency power ratio between resting and post-TC was significantly different at 9 months when compared with those at baseline, 3, and 6 months. The mean difference in normalized low-frequency power and the low/high-frequency power ratio changed from positive values at baseline, 3, and 6 months to negative values at 9 months. However, there were no significant differences in resting HRV between the patients in TC and control groups in either time domain or frequency domain HRV indices. The change in heart rate and HRV between resting and post-TC suggested that TC exercise could enhance vagal modulation. The potential beneficial effect of long-term regular TC exercise in patients with CAD merits further investigation.

Innovative Metal Dilators for Percutaneous Nephrostomy Tract: Report on 546 Cases

Objectives A retrospective study was conducted to evaluate the efficacy and safety of creating a percutaneous nephrostomy tract for stone removal with innovative metal dilators. Methods A total of 546 percutaneous nephrolithotomies was performed at Chiayi Christian Hospital from January 2001 to December 2005. Innovative metal dilators were used to create 546 percutaneous nephrostomy tracts in 520 patients. Several patients had multiple percutaneous nephrostomy tracts. Patient age, stone burden, operative time, stone-free rate, postoperative hospital day, postoperative urinary tract infection rate, and blood transfusion rate were recorded using retrospective chart review. Results The dilation time was less than 15 minutes. The average patient age was 53.7 ± 13.1 years, and the average stone size was 3.5 ± 2.0 cm. The average operative time was 100 ± 45 minutes. The average postoperative hospital stay was 4.4 ± 2.6 days. The overall stone-free rate was 84.4% (461 of 546). The stone-free rate was 99% (142 of 143) for upper ureteral stones, 87% (268 of 305) for renal stones, and 52% (51 of 98) for complete staghorn stones. The blood transfusion rate was 2.5% (14 of 546). The postoperative urinary tract infection rate was 8.6% (47 of 546). Of the 520 patients, 6 had pleural effusion and 1 had pneumothorax. Conclusions Our innovative metal dilators saved time, resulted in less bleeding, and successfully provided one-stage tract creation in 520 patients. The dilation system also allowed the use of a ureteroscope to check the entrance tract to reduce complications.

Electrocauterization of bleeding points for percutaneous nephrolithotomy

Objectives To perform a retrospective study to assess the efficacy and safety of electrocauterization of bleeding points after stone extraction using the data from 249 percutaneous nephrolithotomies. Methods A total of 341 percutaneous nephrolithotomies in 324 patients were performed at the Chiayi Christian Hospital from July 2000 to July 2003. Electrocauterization of bleeding points with an elongated electrode probe was performed in 249 patients. The age, height, weight, preoperative hemoglobin level, stone burden, operating time, stone free rate, length of postoperative hospital stay, postoperative urinary tract infection rate, and blood transfusion rate were recorded by retrospective chart review. Results No statistically significant differences in age, height, weight, stone burden, operating time, stone free rate, or length of postoperative hospital stay were found between patients with or without electrocauterization. No increase occurred in the postoperative urinary tract infection rate in patients who received electrocauterization, and these patients had a statistically significant decrease in the transfusion rate. No nephrostomy tube was inserted at the completion of surgery in 84 (33.7%) of the 249 operations in which electrocauterization was performed. Conclusions Electrocauterization of the bleeding points at the end of percutaneous renal surgery decreases the blood transfusion rate without causing an increase in morbidity. This procedure is safe and effective and may make more patients suitable for tubeless modification.

Investigating Bacillary Dysentery Outbreaks in Dabang and Shanmei Villages of Alishan Township, Chiayi County

The Saint Martin Hospital of Chiayi county reported on 9 April 2001 a bacillary dysentery case of a 66-year old female in Tefuyeh Tribe of Dabang Village, Alishan Township. As there had never been such cases in the last ten some years, a large-scale epidemiological investigation was conducted. The investigation took primarily the forms of case interviews, survey of the residents, review of medical records of all medical care institutions in Alishan Township, and review of student school attendance, and healthcare records at schools. Surveillance stations for diarrhea patients were set up at the same time at the Alishan Health Station, medical units of the Saint Martin Hospital, the Chiayi Christian Hospital, the Wang FF Clinic, the Wang CL clinic, the Dabang Primary School, the Sanmei Primary School, and the Dabang and Sanmei nurseries. Any individuals with two or more diarrhea in a day should be reported immediately and their rectal specimens collected for laboratory testing. These measures were taken to detect suspected cases. The epidemiological survey described the date of onset of each case, their distribution and their personal and geographic relationship to disclose the possible causes of infection and route of transmission. Between the first confirmed case in Dabang on 9 April till 7 June, 82 cases had been identified (10 confirmed cases, one asymtomatic positive case, and 34 suspects in Dabang, and 14 confirmed cases and 23 suspects in Shanmei). The first case in Dabang became ill on 31 March. The first case in Shanmei became ill on 22 April and her grandmother is a sister of the first case of Dabang. She had visited the case in Dabang. As all cases were related through personal contacts, time of onset and geographically, it was decided that the present bacillary dysentery outbreaks were brought about by person-to-person contacts. It was, however, not possible to decide when and where the outbreaks broke out. By the medical records of the residents, bacillary dysentery did occur in the past, but was in most cases treated as gastrointestinal infections. The outbreaks concluded on 24 May when the last case was detected. A special feature of this investigation was that all cases were, with the exception of the first case which was reported by the hospital, identified by the health and medical care institutions at all levels through surveillance, symptom reporting, and immediate investigation. Control measures taken at the same time effectively prevented the spread of the infection to other parts of Alishan Township.