Kaohsiung Veterans General Hospital Research Articles

Type 1 (IgG4‐related) autoimmune pancreatitis: Experiences in a medical center in southern Taiwan within the past 10 years

SummaryBackgroundsAutoimmune pancreatitis (AIP) is a relatively rare disease and has similar presentations to pancreatic cancer. There are limited reports about this disease in Taiwan.MethodsWe retrospectively reviewed 14 cases of type 1 AIP from March 2007 to March 2016 in Kaohsiung Veterans General Hospital. The diagnosis was made according to the international consensus diagnostic criteria (ICDC) for AIP.ResultsThere were 12 male and two female patients diagnosed with type 1 AIP, with a mean age of 63.6 (33 – 88) years. The rates of DM and HTN were 28.5% and 35.7%, respectively. The clinical presentations were mainly weight loss, epigastric pain, and obstructive jaundice. Most patients didn't have the habits of cigarette smoking or drinking alcohol. Minority of these patients had leukocytosis but the majority of them had anemia. All patients had a normal range of platelet count. Most patients had elevation of alanine transaminase, alkaline phosphatase or lipase. Serum immunoglobulin G (IgG) or IgG4 tests were done in most cases, and high‐up levels were seen in most of them. Six of them had an upraised CA 19‐9. All patients had a normal range of coagulation profiles (prothrombin time and activated partial thromboplastin time). Diffuse or focal swellings of the pancreas were observed from CT or MRI among different patients. Six of them had pathology evidence. Three of them received Whipple's operation. Seven of them underwent ERCP. Four of them received PTCD. Two of them received PTGBD. Corticosteroids were prescribed to all patients after the diagnosis of AIP except of that one lost to follow‐up. There were eight patients taking steroid only and five taking steroid in combination with another immunomodulator.ConclusionsType 1 AIP has several common features with pancreatic cancer so accurate diagnosis is important to avoid unnecessary operation. The diagnosis involves clinician's alertness and several diagnostic modalities, including serology, radiology and pathology. Though steroid is effective for type 1 AIP, the relapse rate is high. longterm follow‐up is required. Several clinical features in this study are different from those in other reports and further study is still required for investigation.Copyright © 2017, The Gastroenterological Society of Taiwan, The Digestive Endoscopy Society of Taiwan and Taiwan Association for the Study of the Liver.

Efficacy and safety of switching from nevirapine immediate-release twice daily to nevirapine extended-release once daily in virologically suppressed HIV-infected patients: a retrospective cohort study in Taiwan

BackgroundWhether the non-inferior efficacy and safety results of switching virologically suppressed HIV-1-infected patients from nevirapine immediate-release (NVP-IR) to NVP extended-release (NVP-XR) demonstrated in the TRANxITION study conducted in Europe and North America are also applicable to virologically suppressed HIV-infected Taiwanese patients remains unknown. We evaluated the comparative safety and efficacy of continuing NVP-IR versus switching to NVP-XR in virologically suppressed HIV-infected Taiwanese adults receiving combined antiretroviral therapy (cART) regimens.MethodsWe conducted a retrospective cohort study at Kaohsiung Veterans General Hospital from April 1, 2013, to March 31, 2015. Eighty-four virologically suppressed HIV-infected adults receiving NVP-IR cART were split into two groups: those continuing with NVP-IR (n = 49) and those being switched to NVP-XR (n = 35). Demographic characteristics, clinical variables, and laboratory findings were compared. Therapeutic drug monitoring of steady-state plasma NVP concentrations and genotype analysis of CYP2B6 516 were also performed in 22 participants. The primary endpoint was continued virological suppression at the end of the study. Secondary endpoints were time to loss of virological response and adverse events.ResultsDuring a mean follow-up of 18.4 months, the NVP-XR group demonstrated similar success at maintaining virological response compared with the NVP-IR group (82.9% vs. 85.7%; P = 0.72). Cox regression analysis indicated that there were no significant differences between NVP regimens for time to loss of virological response (hazard ratio: 0.940; P = 0.754). Furthermore, there were no significant differences in adverse events between these two groups. In the 22 participants, there was a non-significantly lower level of steady-state plasma NVP concentrations in the NVP-XR group than in NVP-IR recipients (5145.0 ng/mL vs. 6775.0 ng/mL; P = 0.267). The prevalence of CYP2B6 516 GT was 86.6%, and there was no significant difference in the distribution of CYP2B6 516 between these two groups.ConclusionsWe found that switching from NVP-IR to NVP-XR appeared to have similar safety and efficacy compared with continuing NVP-IR among virologically suppressed, HIV-infected Taiwanese patients. Our finding of higher Ctrough levels in both groups compared with other studies conducted in Caucasian populations and the high prevalence of CYP2B6 516 GT requires further investigation in a larger Taiwanese cohort.

Isolation of dengue virus from the upper respiratory tract of four patients with dengue fever.

BackgroundDengue fever is an important arboviral disease. The clinical manifestations vary from a mild non-specific febrile syndrome to severe life-threatening illness. The virus can usually be detected in the blood during the early stages of the disease. Dengue virus has also been found in isolated cases in the cerebrospinal fluid, urine, nasopharyngeal sections and saliva. In this report, we describe the isolation of dengue virus from the upper respiratory tract of four confirmed cases of dengue.MethodsWe reviewed all laboratory reports of the isolation of dengue virus from respiratory specimens at the clinical microbiology laboratory of the Kaohsiung Veterans General Hospital during 2007 to 2015. We then examined the medical records of the cases from whom the virus was isolated to determine their demographic characteristics, family contacts, clinical signs and symptoms, course of illness and laboratory findings.ResultsDengue virus was identified in four patients from a nasopharyngeal or throat culture. Two were classified as group A dengue (dengue without warning signs), one as group B (dengue with warning signs) and one as group C (severe dengue). All had respiratory symptoms. Half had family members with similar respiratory symptoms during the period of their illnesses. All of the patients recovered uneventfully.ConclusionsThe isolation of dengue virus from respiratory specimens of patients with cough, rhinorrhea and nasal congestion, although rare, raises the possibility that the virus is capable of transmission by the aerosol route among close contacts. This concept is supported by studies that show that the virus can replicate in cultures of respiratory epithelium and can be transmitted through mucocutaneous exposure to blood from infected patients. However, current evidence is insufficient to prove the hypothesis of transmission through the respiratory route. Further studies will be needed to determine the frequency of respiratory colonization, viable virus titers in respiratory secretions and molecular genetic evidence of transmission among close contacts.

Tumor Size Has a Time-Varying Effect on Recurrence in Cervical Cancer.

This study analyzed the risk factors for their possible association with overall survival and progression-free survival in cervical cancer, with a flexible model that allowed time-varying effects. Information about patients with cervical cancer from 2002 to 2012 was collected in the Kaohsiung Veterans General Hospital. All available biological and clinicopathologic factors were tested for the assumption of the Cox proportional hazard model, that is, whether they had time-varying effect on survival. The factors were also analyzed in univariate and multivariate statistics to identify independent risk factors. The multivariate analysis was performed with an extended Cox model so that those factors that failed the assumption test were allowed to vary with time. Approximately 797 patients were included in the final analysis. Most factors tested passed the Cox assumption test, except tumor size and body mass index in the event of recurrence and preoperative CA125 values in the event of death (P < 0.05). Univariate and multivariate analysis identified tumor size, stage, and lymph nodal metastasis as independent significant risk factors for both recurrence and death (P < 0.05), with tumor size being a time-varying factor for recurrence. Patients with larger tumor size, higher FIGO stage, and lymph nodal metastasis are faced with higher risk of recurrence and death. A larger tumor size poses increasingly higher risk for recurrence initially, and its importance declines as the patient survives longer without disease progression. These findings may be helpful to gynecologists when assessing tumor risk of patients with cervical cancer and in patient consultation.

Abstract 3822: Targeting TPX2 arrested cell cycle progression, raised multinuclearity, ploidy, and suppresses tumorigenicity in hepatocellular carcinoma cells

Abstract Background: Hepatocellular carcinoma (HCC) remains one of the most difficult cancers to treat, with chemotherapies being relatively ineffective. Therefore, a better knowledge of molecular hepatocarcinogenesis will provide the opportunity for designed targeted therapy. TPX2 (targeting protein for Xklp2) are overexpressed as a consequence of oncogenic alterations, and they are likely to alter the proper regulation of chromosome segregation in cancer cells. Attacking the machinery that is responsible for mitotic genes involved chromosome instability in cancer cell is one of the most successful strategies of clinical therapy. For this reason, we consider that the targeting TPX2 of investigation in chromosome segregation and its consequential events could provide the novel therapeutic strategies for cancer. Methods: In human tissue approving, IHC stain addressed the molecular significant of TPX2 in HCC tissue microarray. RNAi was used to knockdown TPX2 protein expression. Clonogenic assay, immunostaining, double thymidine block, image-cytometry analysis, and xenografts mouse model were analyzed its role in tumor cell growth, multinuclearity, ploidy, cell cycle progression and tumorigenicity. RT-PCR, Western blotting were used to analyze anti-cancer mechanism in TPX2 targeting. Results: In this study, TPX2 protein up-expression was present in 16 (42%) of 38 primary HCCs, and associated with high stage, distant metastatic HCCs and poor prognosis (lower 5-year survival). Knockdown of TPX2 inhibited cancer cells growth and result in down-regulation of cyclin A, cyclin E and CDK2 proteins. Targeting TPX2 caused in tested liver cancer cell lines a rising impaired chromosomal instability resulting in multinuclearity and increased poly-ploidy content fraction cells. An image-cytometry analysis revealed a cell cycle progression arrest after TPX2 inhibition. Correlation between down-regulation protein level of genes related to chromosomal segregation such as securin, seprase, Aurora A, Aurora B, cyclin B1 and cyclin B2 and cell ploidy increasing, indicating mitotic phase progression failure and loss the balance of genomic instability. In vitro tumor spheroids assay and in vivo xenografts mouse model showed a therapeutic opportunity in our findings. Conclusion: Our findings suggest that targeting TPX2 deregulates chromosome segregation genes, thereby arrested cell cycle progression, raised multinuclearity, ploidy, and suppresses tumorigenicity in liver cancer cells and suggesting TPX2 as a potential therapeutic target for HCC. Grants support: This work was supported by the grants from Ministry of Science and Technology, Taiwan (MOST103-2320-B-075B-001-MY3 to Hung-Wei Pan), Kaohsiung Veterans General Hospital Research Program, Taiwan (VGHKS103-G01-4, VGHKS104-G01-1 to Hung-Wei Pan, VGHKS103-040 to Chao-Wen Hsu) Citation Format: Hung-Wei Pan, Chao-Wen Hsu, Yu-Chia Chen, Tony Wu. Targeting TPX2 arrested cell cycle progression, raised multinuclearity, ploidy, and suppresses tumorigenicity in hepatocellular carcinoma cells. [abstract]. In: Proceedings of the 107th Annual Meeting of the American Association for Cancer Research; 2016 Apr 16-20; New Orleans, LA. Philadelphia (PA): AACR; Cancer Res 2016;76(14 Suppl):Abstract nr 3822.

Potential Role of Vegetarianism on Nutritional and Cardiovascular Status in Taiwanese Dialysis Patients: A Case-Control Study.

Background & ObjectivesCardiovascular disease remains the most common cause of death for patients on chronic dialysis. End stage renal disease patients undergoing dialysis imposed to reduce phosphorus intake, which likely contributes to development of vegetarian diet behaviors. Vegetarian diets are often lower in protein content, in contradiction to the recommendation that a high protein diet is followed by patients undergoing dialysis. The purpose of the study was to investigate the effects of a vegetarian diet on the nutritional and cardiovascular status of dialysis patients.Design, Setting, Participants, MeasurementsA study of 21 vegetarian dialysis patients and 42 age- and sex-matched non-vegetarian dialysis patients selected as controls was conducted in the Kaohsiung Veterans General Hospital. Brachial-ankle pulse wave velocity and biochemistry data including total homocysteine levels, serum lipid profiles, high-sensitivity C-reactive protein, vitamin D levels, albumin, and normalized protein catabolic rate were measured.ResultsCompared with the non-vegetarian control group, vegetarian subjects had lower body weight, body mass index, serum phosphate, blood urea nitrogen, serum creatinine, vitamin D, uric acid, albumin, and normalized protein catabolic rate (p < 0.05). The vegetarian group showed higher brachial-ankle pulse wave velocity than the non-vegetarian group (1926.95 ± 456.45 and 1684.82 ± 309.55 cm/sec, respectively, p < 0.05). After adjustment for age, albumin, pre-dialysis systolic blood pressure, and duration of dialysis, vegetarian diet remained an independent risk factor for brachial-ankle pulse wave velocity.ConclusionsThe present study revealed that patients on dialysis who follow vegetarian diets may experience subclinical protein malnutrition and vitamin D deficiency that could offset the beneficial cardiovascular effects of vegetarianism.

Synchronous endometrial and gastric metastases of invasive lobular breast carcinomas

a Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan b Division of Colorectal Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan c Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan d Division of General Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan e Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan f Division of Hematology and Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

Evaluating the effect of three teaching strategies on student nurses' moral sensitivity.

The Taiwan Nursing Accreditation Council has proposed eight core professional nursing qualities including ethical literacy. Consequently, nursing ethics education is a required course for student nurses. These courses are intended to improve the ethical literacy. Moral sensitivity is the cornerstone of ethical literacy, and learning moral sensitivity is the initial step towards developing ethical literacy. To explore the effect of nursing ethics educational interventions based on multiple teaching strategies on student nurses moral sensitivity. Based on the visual, auditory and kinaesthetic model, three strategies were developed for determining the programme components and corresponding learning styles. This was a quasi-experimental study. A total of 234 junior-college student nurses participated in this study. All participants were aged 18-19 years. Ethical considerations: The study protocol was approved by the institutional review boards of Kaohsiung Veterans General Hospital. Only the participants who signed an informed consent form took part in the study. The participants were permitted to withdraw from the study at any point if they wished to do so without affecting their academic score. The scores of Modified Moral Sensitivity Questionnaire for Student Nurses were significantly improved after the intervention of integrating multiple teaching strategies ( p = .042). Significant relationships were observed between the satisfaction scores of two teaching strategies and moral sensitivity. The results indicated that using multiple teaching strategies is effective for promoting nursing ethics learning. This strategy was consistent with the student nurses' preferred learning style and was used to correct their erroneous ethical conceptions, assisting in developing their ethical knowledge.

Clinical roles of breast 3T MRI, FDG PET/CT, and breast ultrasound for asymptomatic women with an abnormal screening mammogram

BackgroundMagnetic resonance imaging (MRI) and fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) show promise for molecular cancer imaging. We evaluated 3T MRI, FDG PET/CT, and ultrasound images for asymptomatic women with an abnormal screening mammogram. MethodsThe Institutional Review Board of Kaohsiung Veterans General Hospital (Kaohsiung, Taiwan) approved the study. Patients provided written informed consent. A total of 11,865 screening mammograms of 118,65 women were performed at our facility between January 2011 and December 2012. Fifty-three asymptomatic women (mean age, 53.3 years) whose screening mammograms had a Breast Imaging Reporting and Data System (BI-RADS) category of 4 or 5 were ultimately enrolled in this study. Breast 3T MRI, FDG PET/CT, and breast ultrasound were performed before biopsy. All imaging modalities were compared by lesion-by-lesion analyses. ResultsFifty-nine breast lesions (28 malignant and 31 benign lesions) from 53 women were analyzed. The sensitivity, specificity, and accuracy for 28 breast cancers were 96%, 77%, and 86%, respectively, for breast 3T MRI; 50%, 100%, and 76%, respectively, for FDG PET,CT; and 61%, 87%, and 74%, respectively, for breast ultrasound. One 0.8-cm invasive breast cancer was missed by the screening mammogram, but detected by breast 3T MRI and FDG PET/CT. The sensitivity for detecting breast cancer was significantly higher with MRI than with PET/CT or ultrasound (for all, p < 0.01). The specificity for detecting breast cancer was significantly higher for PET/CT than for breast MRI (p = 0.02). The sensitivity exhibited by 3T breast MRI and FDG PET/CT for 16 noninvasive breast cancers was 94% and 25%, respectively. ConclusionOn screening mammograms, breast 3T MRI showed higher sensitivity but less specificity than FDG PET/CT for detecting asymptomatic breast cancers.

Efficacy and Safety of Dexamethasone Intravitreal Implant for Treatment of Refractory Macular Edema Secondary to Retinal Vein Occlusion in Taiwan.

To evaluate the long-term efficacy and safety of slow-release dexamethasone intravitreal implant (DEX implant) in patients with refractory macular edema (ME) secondary to retinal vein occlusion (RVO) in Taiwan. We conducted a retrospective chart review of patients with a diagnosis of ME secondary to RVO who received the DEX implant at Kaohsiung Veterans General Hospital from October 2010 to February 2014. A total of 28 patients with an average age of 60.7 ± 11.1 years were examined. Of these patients, 17 were diagnosed with branch RVO (BRVO) and 11 were diagnosed with central RVO (CRVO). The mean maximal change in vision from the baseline after the final injection was an improvement of 1.7 ± 2.8 lines (equivalent to 8.5 ETDRS letters; p<0.0001). The response to the first injection was similar across both BRVO and CRVO groups, but patients with BRVO showed a more favorable response than those with CRVO after the second injection. The response in patients who had refractory ME after at least 3 previous interventions was similar to the whole group. Three patients (10.7%) had elevated intraocular pressure (IOP) that was well controlled by IOP-lowering medications. None of these patients required laser or glaucoma surgery. Five patients (17.9%) exhibited cataract progression during the observation period. The DEX implant is an effective and safe treatment for ME, secondary to RVO, including refractory ME.

Prevention of acute exacerbation of chronic hepatitis B infection in cancer patients receiving chemotherapy in a hepatitis B virus endemic area.

Reactivation of hepatitis B viral (HBV) infection in cancer patients undergoing chemotherapy may cause interruption of chemotherapy and lead to liver failure and death. In our institute, a computerized order entry-based alert system was introduced in September 2011 to remind healthcare providers of HBV testing when prescribing chemotherapy. Since August 2012, an order entry-based therapeutic control system has been applied to ensure HBV prophylaxis during chemotherapy. This retrospective cohort study included cancer patients receiving chemotherapy in the Kaohsiung Veterans General Hospital from November 2009 to June 2013. The prechemotherapy HBV screening rate, HBV prophylactic rate, and severe HBV acute exacerbation rate were compared between stages with different order systems. Newly diagnosed cancer patients (n = 2512) were included. The HBV testing rate in the screening reminder stage was higher than that in the educational stage (93.5% versus 40.2%, P < 0.001), whereas the adequate HBV prophylactic rates in the two order entry-based stages were comparable (41.1% versus 39.2%). Patients in the order entry-based therapeutic control stage had a higher HBV screening rate (99.3% versus 40.2%, P < 0.001) and a higher HBV prophylactic rate (95.8% versus 39.2%, P < 0.001) than those in the educational stage. Additionally, the severe HBV acute exacerbation rate in the therapeutic control stage was lower than those in the educational and screening reminder stages (0% versus 1.2% and 1.2%, respectively; both P < 0.01). A computerized order entry-based therapeutic control system can provide excellent prechemotherapy HBV screening for cancer patients undergoing chemotherapy and can effectively prevent severe acute exacerbation of HBV infection in hospitals among HBV endemic areas.

Synchronous ipsilateral renal cell carcinoma and urothelial carcinoma of kidney or ureter: Cases report and literature review

Synchronous ipsilateral renal cell carcinoma and urothelial carcinoma of kidney or ureter: Cases report and literature review

Effects of dehydroepiandrosterone supplementation on women with poor ovarian response: A preliminary report and review

ObjectiveTo investigate the effect of dehydroepiandrosterone (DHEA) supplementation on women with poor ovarian response (POR). Materials and methodsWomen with POR treated with flexible daily gonadotropin-releasing hormone antagonist in vitro fertilization (IVF) cycles at The Reproductive Center in Kaohsiung Veterans General Hospital between January 2013 and October 2013, were enrolled for this prospective study. When patients failed to become pregnant during the first IVF cycle, they were treated with DHEA supplementation (30 mg, 3 times a day, orally) for 3 months (mean 12.2 weeks) before the next IVF cycle. Parameters of biochemical, ultrasound and treatment outcomes were compared before and after DHEA supplementation. ResultsTen patients with a mean age of 36.6 ± 4.2 years were identified. After DHEA treatment, there was a significant increase in antral follicle count, from 2.8 ± 1.0 to 4.1 ± 1.2 (p < 0.05), and anti-Müllerian hormone, from 0.4 ± 0.2 ng/mL to 0.84 ± 0.2 ng/mL (p < 0.001). A significant decrease of Day 3 follicle-stimulating hormone and estradiol, from 14.4 ± 1.7 mIU/mL to 10.1 ± 0.7 mIU/mL and from 51.2 ± 6.3 pg/mL to 35.2 ± 4.2 pg/mL, respectively (both p < 0.001), was noted. Increased numbers of retrieved oocytes (from 2.4 ± 1.1 to 4.2 ± 1.2; p < 0.01), fertilized oocytes (from 1.7 ± 0.5 to 3.8 ± 1.1; p < 0.001), Day 3 embryos (from 1.7 ± 0.5 to 3.7 ± 1.1; p < 0.001) and transferred embryos (from 1.7 ± 0.8 to 2.8 ± 0.8; p < 0.01) were also seen in these women with POR after DHEA treatment. Three women became pregnant after DHEA treatment. ConclusionThe potential benefits of DHEA supplementation in women with POR were suggested by the biochemical parameters and IVF outcomes.

A Novel Hemoglobin Variant Found on the α1 Chain: Hb KSVGH (HBA1: p.Lys57_Gly58insSerHisGlySerAlaGlnValLys)

Glycosylated hemoglobin (Hb A1C) is a crucial indicator for the long-term control and the diagnosis of diabetes. However, the presence of hemoglobin (Hb) variants may affect the measured value of Hb A1C and result in an abnormal graph trend and inconsistency between the clinical blood sugar test and Hb A1C values. In this study, laboratory data of 41,267 patients with diabetes were collected. The Hb A1C levels and the graph results were examined. We identified 74 cases containing abnormal Hb A1C graph trends. The conducted blood cell counts and capillary Hb electrophoresis were used to analyze Hb variants. We also determined gene variation for the Hb variants by a sequence approach. Fifteen different types of Hb variants were identified in this study. Among these, we found a novel variant in which the α1 subunit of Hb showed an insertion of 24 nucleotides (nts) between the 56th and 57th residues. We named this novel variant Hb Kaohsiung Veterans General Hospital (Hb KSVGH) (HBA1: p.Lys57_Gly58insSerHisGlySerAlaGlnValLys).

Key Factors in Hospital Crisis Response-An Example of Violence in Emergency Medicine

The medical personnel has to particularly pay attention to the treatment processes, including medication, attitudes, and interaction, as a lot of violence in emergency medicine shows no absolute relationship with medical profession. However, finding out the sign of violence in emergency medicine in advance to further reduce the occurrence of violence in emergency medicine is a favorable approach. The nurses, doctors, and the public in emergency rooms of Kaohsiung Veterans General Hospital are investigated in this study. Total 300 copies of questionnaires are distributed, and 176 valid copies are retrieved, with the retrieval rate 59y. The research results show the top five indicators, among 12 evaluation indicators, appear Judgment Competence, Afterward Disposal, Potential Crisis, Decisive Management, and Command and Dispatch. Some suggestions are proposed in the conclusion in this study, expecting to assist in the worry of violence in emergency medicine in hospitals.

Gene expression of cumulus cells in women with poor ovarian response after dehydroepiandrosterone supplementation

ObjectiveOur previous study showed the potential benefits of dehydroepiandrosterone (DHEA) supplementation in women with a poor ovarian response (POR). Because the connection between cumulus cells (CCs) and oocytes is a key step for oocyte maturation, we supposed that altered gene expression of CCs in women with POR after DHEA supplementation might favor oocyte maturation. Materials and methodsWomen with POR treated with flexible daily gonadotropin-releasing hormone antagonist in vitro fertilization (IVF) cycles at The Reproductive Center in Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan between January 2013 and October 2013 were enrolled for this prospective study. CCs were isolated during IVF before and after DHEA (CPH-Formulation, Oakdale, CA, USA) supplementation. Nine genes of isolated CCs, including hyaluronan synthase (HAS2), versican (VCAN), thrombospondin 1 (THBS1), runt-related transcription factor 2 (RUNX2), chromobox homolog 3 (CBX3), tripartite motif-containing 28 (TRIM28), B-cell lymphoma 2 (BCL2), BCL2-associated X protein (BAX), and ankyrin repeat domain 57 (ANKRD57), were compared. ResultsThere was a significant difference in the expression of genes in women with POR before and after DHEA supplementation (all p < 0.05). All genes related to extracellular matrix (ECM) formation, including HAS2, VCAN, and THBS1, were upregulated. By contrast, all genes involving cell development, differentiation, and apoptosis regulation were downregulated. Unknown function gene ANKRD57 was also downregulated after DHEA supplementation. Although expressions of both BCL2 and BAX were decreased in women with POR after DHEA supplementation compared to those before treatment, the ratio of BCL2 and BAX was significantly increased in women with POR after DHEA supplementation, suggesting that DHEA supplementation might activate the antiapoptosis process of CCs, which might be beneficial to the improvement of ovarian function in women with POR. ConclusionThe study showed that DHEA therapy positively affected the gene expression of CCs in women with POR, and provided evidence to support the positive effect of DHEA supplementation on women with POR.

PO-0140 Whether Antimicrobial Therapy Affect Fecal Excretion Time In Paediatric Patients Of Nontyphoid Salmonellosis With Different Severity

<h3>Objective</h3> To investigate whether the administration of antibiotics affect faecal excretion time in paediatric salmonellosis with different severity. <h3>Methods</h3> Children with nontyphoid salmonellosis admitted to Kaohsiung Veterans General Hospital, Taiwan who consented to receive consecutive stool cultures every 4–7 days till two consecutive negative results between 2005 and 2013 were enrolled. Faecal excretion time was defined as the timeframe of the first positive stool culture and the first of two consecutive negative results. The Severity Score was used to stratify the patients as the severe, moderate and mild group according to their fever days before admission, band cells in peripheral blood and C-reactive protein. Patients were classified into no antibiotics (mild disease without antibiotic), concordant (severe patients receiving antibiotics active <i>in vitro</i>) and inappropriate therapy group (mild patients receiving antibiotics or severe patients receiving antibiotics resistant <i>in vitro</i>). <h3>Results</h3> 53 patients were enrolled. Compared with no antibiotic group (n = 28), the concordant group (n = 11) had comparable faecal excretion time (12.36 vs 9.79 days), fever days after admission and hospital stay (2.45 vs 2.25; 6.45 vs 6.39 days). The inappropriate group (n = 14) had significantly longer faecal excretion time (24.50 vs 9.79 days), hospital stay (8.50 vs 6.39 days) and higher platelet count (333.43 vs 269.82 × 1,000/mm3) than no antibiotics group. With further multiple regression analysis, only inappropriate antibiotic use affected significantly (p = 0.008) on faecal excretion time. <h3>Conclusions</h3> Antibiotics used in severe children with salmonellosis didn’t prolong faecal excretion time, but inadequate use of antibiotics prolonged faecal excretion time in Salmonellosis.

P468: Interrelationship of delirium and cognitive impairment on adverse functional outcomes of older patients receiving orthopedic surgery: a prospective cohort study

Introduction: Delirium, the acute deterioration of cognitive function and attention, is the most frequent mental disorder in elderly. Its correct diagnosis and adequate management are of crucial importance for the patient’s health and functional outcome. The aim was to highlight potential intervention points to offset the risk of incurring a hip fracture and delirium its attendant disability. Methods: We conducted a retrospective chart review study carried out in our Orthogeriatric Unit. A total of 542 consecutive hip fracture, we selected those with delirium during the admission. Underwent comprehensive geriatric assessment that evaluates co morbidities, medication use, ability to perform basic activities of daily living and instrumental activities of daily living, place of residence and family support. Results: We found 163 patients with delirium and hip fracture; the mean age of our cohort was 87.23±9.6 years (76–98 years). 46 (28%) patients were male. The mean duration of the hospital stay was 13.62±9.6 days (range 2–41 days). 42.3% of the patients with pre-existing neurological conditions. In 44 patients, we were able to identify possible precipitating cause of an acute confusional state. Anemia and hyponatremia were frequent factors associated with delirium. Surgical treatment was performed 90.18%. Conclusions: • Delirium is a very prevalent condition in patients with hip fracture. • Delirium may increase the complications after hip fracture. • Patients, in whom a cause was found out, had better prognosis in terms of lesser mortality and the duration of hospital stay. P468 Interrelationship of delirium and cognitive impairment on adverse functional outcomes of older patients receiving orthopedic surgery: a prospective cohort study M.Y. Chou, C.K. Liang, C.L. Chu, Y.T. Lin, T. Lu, C.J. Hsu, L.K. Chen Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Taipei Veterans General Hospital, Taipei, Taiwan

Ocular adnexal lymphoma: Five case reports and a literature review

This article reports the clinical course and treatment of ocular adnexal lymphoma based on a retrospective review of five cases with a histologically approved ocular adnexal lymphoma at Kaohsiung Veterans General Hospital over 10 years. Extranodal B-cell lymphoma in the orbit, lacrimal gland, eyelid, or conjunctiva was found in these patients. Four of them were female, and they were aged 45–64 years. All patients were also consulted with hematologists for possible systemic involvement and therapeutic plan. The patient with retrobulbar and orbital apex involvement received systemic chemotherapy. The patient with lacrimal gland involvement experienced tumor recurrence after local excision, and therefore received adjuvant radiotherapy. The remaining three patients had localized lymphoma on the eyelid or bulbar conjunctiva, and they all showed no recurrence after surgical excision. The incidence of ocular adnexal lymphoma has risen worldwide over the last few decades. Although most cases are confined to ocular adnexal, some may also be associated with disseminated lymphoma. Accurate diagnosis and staging is mandatory for appropriate treatment. Generally speaking, localized and low-grade ocular adnexal lymphoma involved eyelid or conjunctiva seem to have good outcome after surgical excision only. Systemic chemotherapy should be considered in patients with advanced disease or systemic manifestations, and radiotherapy also offers a good choice for lacrimal gland lymphoma.

Investigations of kanuka and manuka essential oils for in vitro treatment of disease and cellular inflammation caused by infectious microorganisms

Diseases caused by infectious and inflammatory microorganisms are among the most common and most severe nosocomial diseases worldwide. Therefore, developing effective agents for treating these illnesses is critical. In this study, essential oils from two tea tree species, kanuka (Kunzea ericoides) and manuka (Leptospermum scoparium), were evaluated for use in treating diseases and inflammation caused by microorganism infection. Isolates of clinically common bacteria and fungi were obtained from American Type Culture Collection and from Kaohsiung Veterans General Hospital. Minimum inhibitory concentrations for Trichosporon mucoides, Malassezia furfur, Candida albicans, and Candida tropicalis were determined by the broth microdilution method with Sabouraud dextrose broth. The antibacterial susceptibility of Staphylococcus aureus, Streptococcus sobrinus, Streptococcus mutans, and Escherichia coli were determined by the broth microdilution method. A human acute monocytic leukemia cell line (THP-1) was cultured to test the effects of the essential oils on the release of the two inflammatory cytokines, tumor necrosis factor-α and interleukin-4. Multiple analyses of microorganism growth confirmed that both essential oils significantly inhibited four fungi and the four bacteria. The potent fungicidal properties of the oils were confirmed by minimum inhibitory concentrations ranging from 0.78% to 3.13%. The oils also showed excellent bactericidal qualities with 100% inhibition of the examined bacteria. In THP-1 cells, both oils lowered tumor necrosis factor-α released after lipopolysaccharide stimulation. Finally, the antimicrobial and anti-inflammatory effects of the oils were obtained without adversely affecting the immune system. These results indicate that the potent antimicroorganism and anti-inflammation properties of kanuka and manuka essential oils make them strong candidates for use in treating infections and immune-related disease. The data confirm the potential use of kanuka and manuka extracts as pharmaceutical antibiotics, medical cosmetology agents, and food supplements.