National Cheng-Kung University Hospital Research Articles

Abstract 1760: High expression of CASZ1 is associated with poor prognosis in ovarian cancer

Abstract Epithelial ovarian cancer (EOC) carries the highest mortality rate of all gynecologic malignancies. This high mortality rate is attributed to the fact that most cases of ovarian cancer are detected at late stages when metastases are already present. We previously demonstrated that castor zinc finger 1 (CASZ1) is up-regulated in EOC cells and promotes EOC cells metastasis. However, the relationship between the ovarian cancer patient’s prognosis and CASZ1 expression is not clear. In the present study, we examined CASZ1 and CA125 expressions in EOC using immunohistochemistry and correlated their expression levels with patient survival. From January 2008 to January 2012, 144 EOC patients who underwent staging or cytoreductive surgery at the National Cheng Kung University Hospital (NCKUH) were consecutively enrolled. Clinical and pathology information, including age, stage, cell type, chemo-response, and survival, was collected from medical charts. The staging met the criteria of the International Federation of Gynecology and Obstetrics Classification (FIGO). Histological classification was defined according to the classification standards of the World Health Organization. The overall survival (OS) was calculated from the date of diagnosis. Progression-free survival (PFS) was measured as the period from surgery to the date of confirmed recurrence or disease progression or to the date of the investigators’ last note of a disease-free status. CASZ1, CA125 expression was evaluated by TissueFaxs microscopy system using an image analysis program. Five fields of the tumor in each slide (corresponding to a mean of 10000 tumors cells per case) were photographed. Images were acquired from using fluorescence-activated cell sorting (FACS)-like tissue cytometry. The percentage of positive cells in each sample was further quantified using TissueQuest software (TissueGnostics, Vienna, Austria). The CASZ1 was significantly upregulated in advanced EOC tissues, compared with early stage tumors. High CASZ1 expression levels were significantly associated with worse EOC clinical characteristics. By univariate survival analysis, high CASZ1 levels significantly correlated with decreased overall survival, progression-free survival. In addition, patients with both high expression with CASZ1 and CA125 carried the worst prognosis. In conclusion, we demonstrate that high expression of CASZ1 levels correlates with an aggressive EOC phenotype and may contribute for poor prognosis in EOC patient. Determination of CASZ1 could be clinically useful in identifying high-risk EOC patients for a more aggressive adjuvant therapy. Citation Format: Yuan-Jhe Chuang, Yu-Ling Liang, Yuh-Ling Chen, Tse-Ming Hong, Keng-Fu Hsu. High expression of CASZ1 is associated with poor prognosis in ovarian cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 1760. doi:10.1158/1538-7445.AM2017-1760

Case Series and Literature Review: Fetal Bowel Dilatation and Its Clinical Significant

Ultrasound has limited accuracy for bowel evaluation even in a normal adult. Therefore, during prenatal diagnosis, accidental finding of fetal bowel dilatation is very challenging for obstetrician in identifying and explaining the exact lesions and its clinical significant correlations. Fetal bowel dilatation is an indirect sonographic sign or possible the only sign in predicting probable mechanical or functional bowel obstruction. We reviewed cases of fetus with dilated bowels noted during prenatal care in the past three years, from January 2015 until March 2017 in National Cheng Kung University Hospital (NCKUH) and College of Medicine, Tainan, Taiwan. A total number of 11010 cases visited NCKUH for prenatal ultrasound screening from January 2015 until March 2017. We identified a total number of 629(5.7%) cases with congenital fetal anomalies and 19(0.17%) cases with fetal bowel dilatation. Fetal with gastroschisis and omphalocele were not including in this study. Out of the 19 cases with fetal bowel dilatation, 6(31.6%) fetuses showed poor outcome after delivery. Despite lower rate of sensibility and specificity, ultrasound plays an important role in the management and diagnosis of fetal bowel dilatation. It offers an opportunity for parental counseling and for choosing patients who need transfer to a specialized center which is of upmost importance as it allows prompt treatment and reduces the risk of complications.

Abstract P2-12-16: Current trend and indications of endoscopy-assisted breast surgery for breast cancer: Experience from Taiwan endoscopic breast surgery cooperative group

Abstract Background: Endoscopy-assisted breast surgery (EABS) performed through minimal axillary and/or periareolar incisions is a possible alternative to conventional surgery for certain patients with breast cancer. In this study, we report the early results of an EABS program in Taiwan. Methods: The medical records of patients who underwent EABS for breast cancer during the period May 2009 to December 2014 were collected from the Taiwan Endoscopic Breast Surgery Cooperative Group database. The Taiwan Endoscopic Breast Surgery Cooperative Group (T-EBSCG) was established to monitor the effectiveness of and clinical outcome associated with EABS in Taiwan. The T-EBSCG comprises members from three major endoscopic breast surgery centers, namely Changhua Christian Hospital, National Cheng-Kung University Hospital,and Taipei Medical University Hospital in Taiwan. Data on clinicopathologic characteristics, type of surgery, method of breast reconstruction, complications and recurrence were analyzed to determine the effectiveness and oncologic safety of EABS in Taiwan. Results: A total of 315 EABS procedures were performed in 292 patients with breast cancer, including 23 (7.8%) patients with bilateral disease. The mean tumor size of these 315 EABS was 2.2 ± 1.8 cm, and 44(13.9%) of them were multifocal/multicentric breast cancer. Lymph node metastasis was found during 23.3% of the procedures. The stage distribution of them were stage II cancer (n=103, 34.4%), followed by stage I cancer (n=92, 30.7%), ductal carcinoma in situ (stage 0) (n=86, 28.7%), and stage III breast cancer (n=19, 6.3%). The number of breast cancer patients who underwent EABS increased initially from 2009 to 2012 and then stabilized during the period 2012-2014. The most commonly performed EABS was endoscopy-assisted total mastectomy (EATM) (85.4%) followed by endoscopy-assisted partial mastectomy (EAPM) (14.6%). Of the 269 patients who underwent EATM, 198 (73.6%) received immediate breast reconstruction. The majority (72.2%) of them received implant-based (cohesive Gel implant or tissue expander) reconstruction and the remaining 27.8% received autologous pedicled TRAM flap for breast reconstruction. Endoscopic assisted nipple sparing mastectomy with Gel implant reconstruction was the most frequently performed EABS now. During the six-year study period, there was an increasing trend toward more frequently use of EABS in the management of breast cancer when total mastectomy was indicated (EATM) than breast conserving surgery (EPM). Overall, the rate of complications associated with EABS was 15.2% and all were minor and wound-related. There were no major or life threatening complications. The positive surgical margin rate was 1.9%. During a median follow-up of 26.8 months (range, 3.3-68.6 months), there were 3 (1%) cases of local recurrence (1 ipsilateral breast recurrence, 1 axillary local recurrence, and 1 core needle biopsy tract recurrences), 1 (0.3%) case of distant metastasis, and 1 death. Conclusion: The EABS program in Taiwan showed that EABS is a safe procedure and results in acceptable cosmetic outcome, these findings could help to promote this under-used surgical technique in the field of breast cancer. Citation Format: Lai H-W, Kuo Y-L, Hung C-S, Chen S-T, Chen D-R. Current trend and indications of endoscopy-assisted breast surgery for breast cancer: Experience from Taiwan endoscopic breast surgery cooperative group. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-12-16.

Acquisition of skills in digital rectal examination through supervised patient examination with real-time feedback in transrectal sonography room

ObjectiveTo assess the acquisition digital rectal examination (DRE) skills by medical students through an alternative teaching method. Materials and methodsMedical students at the National Cheng-Kung University Hospital, Tainan, Taiwan in 2009 were assigned to receive training through supervised rectal examination (DRE) with real-time feedback in a transrectal sonography room during their standard urologic rotation. Students completed a questionnaire (before and after the training) regarding their experiences in performing DRE to assess their confidence levels. Direct observation of practical skills (DOPS) was used to assess the students' competence in performing DRE at the end of urologic rotation. ResultsA total of 75 students received the questionnaire, of which 72 (96%) responded. On average, every student had an experience of 6.6 supervised patient examinations with real-time feedback in a transrectal sonography room. Following the training, students were more confident in their ability to give an opinion based on their findings related to DRE. The overall rate of the students' ability to interpret the DRE findings after urologic rotation improved from 69% to 100% for identification of the prostate, from 14% to 60% for assessment of prostate size, from 32% to 95% to describe prostate consistency accurately, and from 9.8% to 64% to identify overt prostate cancer from benign prostate hyperplasia. All students met expectations or were above expectations according to the grading scale of performing DOPS. ConclusionStudents' skills and confidence with regard to performing DRE were improved significantly through supervised examination with real-time feedback in a transrectal sonography room.

317P - Endoscopic Assisted Mastectomy with Immediate Reconstruction in Treatment of Early Breast Cancer-Experience from Taiwan

ABSTRACT Aim: Endoscopic assisted breast surgery (EABS), performed through minimal axillary and/or peri-areolar incisions, could be another option for the management breast cancer. In this study, we report our preliminary results of EABS in the National Cheng-Kung University Hospital (NCKUH), Taipei Medical University Hospital (TMUH) and Changhua Christian Hospital (CCH), Taiwan. Methods: Patients with breast cancer managed by EABS were search from 3 medical centers database. The patients' clinicopathologic characteristics, type of surgery, method of breast reconstruction, complication and recurrence were recorded. (IRB Nr 121229) Results: A total of 220 patients with breast cancer undergone EABS from the above three endoscopic breast surgery centers in Taiwan. All of them were female, and the mean age at diagnosis was 49.5 ± 10.1 years old (range 26 to 80 year). Among these 220 patients, 36(16.4%) underwent endoscopic assisted partial mastectomy (EAPM), and 184 received endoscopic assisted total mastectomy (EATM). In the 184 EATM patients, 46 (25%) received endoscopic assisted skin sparing mastectomy (E-SSM), and 138 (75%) underwent endoscopic assisted nipple sparing mastectomy (E-NSM). The mean pathologic tumor size of these 220 patients was 2.1 ± 1.6 cm (0.1 to 8.5 cm). Lymph node metastasis was found in 33 (15%) patients, 17 patients with lymph node 1-3 positive, and 16 patient with 4-9 lymph nodes metastasis. The post operative stage distribution were 70 (31.8%) ductal carcinoma in situ (DCIS), 75 (34.1%) stage 1, 36(16.4%) stage 2a, 26(11.8%) stage 2b, and 13 (5.9%) stage 3a.Among the 184 EATM patients, 147 (79.9%) received immediate breast reconstruction. Most (57.3%) of them received Gel implant reconstruction, and 42.7% received breast reconstruction with autologous pedicled transverse abdominal myocutaneous (TRAM) flap. Complications (9.6%) follow EABS were all minor, and most of them were wound related. The cosmetic result was scored by surgeons and patients. Conclusions: Endoscopic assisted breast surgery is a safe and highly acceptable operation for the management of Taiwanese women with early stage breast cancer. Disclosure: All authors have declared no conflicts of interest.

Femoral Narrow Neck Geometry and Strength Indices Assessed by Dual-Energy X-Ray Absorptiometry in Postmenopausal Women With Osteoporotic Vertebral Fracture

1.01-1.38, p50.032) or categorical FRAX without BMD for hip 1.5% (OR: 4.35, 95%CI: 1.39-13.63, p50.012) were independently associated with the incidence of falls. In women, only the fall history (OR: 2.40, CI95%: 1.21-4.74, p50.012) was positively associated with the incidence of falls. Conclusion: The incidence of falls is compatibly high in middle-aged and old people in Taiwan. The FRAX without BMD can be used to predict the incidence of falls in middle-aged and old people, especially in males. Acknowledgement: We sincerely thank the Bureau of Health Promotion-Department of Health R.O.C (Taiwan) as well as NCKUH for the financial support and data authorization (Grant Number: DOH98-HP-A9802-6 and NCKUH10102043). We also sincerely thank the staff working at the health promotion center of the Dou-Liou branch of National Cheng-Kung University Hospital for administrative assistance. Disclosure of Interest: None Declared

Human sex ratio at amniocentesis and at birth in Taiwan

ObjectivesAn increase in the proportion of male-to-female live births has raised concerns in Taiwan. Disclosure of fetal sex during prenatal screening is not allowed by the Taiwan government. Fetal sex annotation in clinical genetic reports is also prohibited. This study tested the hypothesis that the male-to-female sex ratio at amniocentesis should be lower than the sex ratio at birth, if a certain percentage of female fetuses are being selectively aborted after amniocentesis. Therefore, we examined the differences between fetal sex ratio at amniocentesis at a tertiary medical center in southern Taiwan and the nationwide sex ratio at birth in Taiwan from 1992 to 2011. Materials and MethodsData of normal male and female karyotypes during the study period were collected from the cytogenetic laboratory of the National Cheng Kung University Hospital (NCKUH) in southern Taiwan. Data of sex ratio at birth nationwide in Taiwan were obtained from the Department of Statistics, Ministry of the Interior, Taiwan. We calculated 95% binominal confidence intervals for the sex ratios and differences between fetal sex ratio at amniocentesis, and nationwide sex ratio at birth were tested by the χ2 test and Bonferroni correction. ResultsThe nationwide sex ratio at birth ranged from 1.07 to 1.11 during the period from 1992 to 2011 in Taiwan, with the highest in 2004 and the lowest in 1993. The fetal sex ratio at amniocentesis at NCKUH ranged more widely (0.82–1.28), with the lowest in 1993 and the highest in 2007. After regression analysis, both trends of sex ratio at amniocentesis during midtrimester and at birth were not significantly increased by years. Furthermore, the sex distribution at amniocentesis during midtrimester did not differ significantly from the nationwide sex ratio at birth (1.113 vs. 1.092, p = 0.151). ConclusionsThe results showed that sex ratio was already skewed toward male at midtrimester. Our data imply that artificial sex selection, if it were present, might have already emerged prior to the timing of amniocentesis. However, more large nationwide studies on sex ratios in Taiwan are warranted.

Optimal dose for stroke thrombolysis in Asians: low dose may have similar safety and efficacy as standard dose

Although intravenous tissue-type plasminogen activator (t-PA) at a standard dose of 0.9 mg kg(-1) is effective for patients with acute ischemic stroke, concerns have been raised regarding Asians. To compare the safety and efficacy between low and standard doses for stroke thrombolysis. Consecutive patients receiving t-PA treatment were recruited according to the prespecified dosing policy from two medical centers in Taiwan: low dose (0.7 mg kg(-1) ) at National Cheng Kung University Hospital (NCKUH) from August 2006 to June 2009, or standard dose (0.9 mg kg(-1) ) at NCKUH from July 2009 to December 2010 and at Changhua Christian Hospital from May 2008 to December 2010. The primary safety outcome was the occurrence of symptomatic intracerebral hemorrhage (SICH). The secondary efficacy outcome was the proportion of patients with a modified Rankin Scale (mRS) grade of ≤ 1 at 3 months. From August 2006 to December 2010, 261 patients were recruited, of whom 105 and 156 received low and standard doses, respectively. The occurrence of SICH was non-significantly lower in the standard-dose group than in the low-dose group (2.6% vs. 4.8%, respectively; P = 0.34). The favorable outcome of mRS grade of ≤ 1 at 3 months was similar (38.4% and 41.1%, respectively; P = 0.676). A review of other case series of low vs. standard doses in Asians also showed similar safety and efficacy. Our study, as well as other case series on Asians, revealed that standard-dose thrombolysis for acute ischemic stroke in an Asian population carries no increased risk of symptomatic intracerebral hemorrhage when compared with the low dose.

Abstract P4-07-10: Prognostic Significance of Triple Negative Breast Cancer at Tumor Size 1 Cm and Smaller

Abstract Triple negative breast cancer (TNBC) is an independent biomarker of poor prognosis, and associated with a higher predilection for visceral metastasis and early recurrence. However, the prognostic significance of TNBC with a tumor size ≥1 cm is unclear. Patients with primary operable breast cancer with a tumor size ≥1cm were retrospectively collected at Changhua Christian Hospital and National Cheng-Kung University Hospital in Taiwan. Tumors negative for ER, PR, and HER-2, determined by immunohistochemical stain, were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS). From 1995 to 2006, a total of 377 (13%) patients with tumor size ≥1 cm were enrolled from 2835 primary breast cancer patients. The mean age at diagnosis and follow-up time were 50.86 and 4.04 ± 2.83 years, separately. Compared with non-TNBC patients, TNBC with a tumor size ≥1 cm as a whole or in lymph node-positive subgroup was not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS than the non-TNBC group. In multivariate Cox regression hazard analysis, lymph node invasion was the most important cause (hazard ratio: 19.89, 95% CI: 2.18-181.89, P=0.0081) of cancer-specific death. Fig. (a) Disease-free survival (DFS) of TNBC patients versus non-TNBC patients with tumor ≥1 cm. (b) Cancer-specific survival (CSS) of TNBC patients versus non-TNBC patients with tumor ≥1 cm. (c) CSS in node-positive patients with a TNBC versus non-TNBC phenotype. (d) CSS in node-negative patients with TNBC versus non-TNBC. (e) DFS in patients with HR+/ERBB2-, ERBB2+, and TNBC. (f) CSS in patients of HR+/ERBB2- , ERBB2+, and TNBC. (g) CSS in node-positive patients with HR+/ERBB2-, ERBB2+, and TNBC. (h) CSS in node-negative patients with HR+/ERBB2- , ERBB2+, and TNBC. TNBC is very likely an independent risk factor for CSS in small (≥1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P4-07-10.

Prognostic significance of triple negative breast cancer at tumor size 1 cm and smaller

AimsThe purpose of this study was to clarify the prognostic significance of triple-negative breast cancer (TNBC) with a tumor size ≤ 1 cm. Materials and methodsPatients with primary operable breast cancer with a tumor size ≤ 1 cm were enrolled at Changhua Christian Hospital and National Cheng-Kung University Hospital. Tumors negative for ER, PR, and HER-2 were classified as TNBCs and compared with tumors with any receptor positivity (non-TNBC) for disease-free survival (DFS) and cancer-specific survival (CSS). ResultsFrom 1995 to 2006, a total of 377 patients with tumor size ≤ 1 cm were enrolled. Compared with non-TNBC patients, TNBC patients with a tumor size ≤ 1 cm as a whole or in a lymph node-positive subgroup were not associated with a poorer 5-year DFS and CSS. In lymph node-negative patients (pT1a-bN0M0), TNBC was associated with a poorer 5-year CSS but not DFS. Compared with the hormone receptor-positive, HER-2-negative subgroup, TNBC was associated with poorer DFS and CSS. In the multivariate Cox regression hazard analysis, lymph node invasion was the most important cause of disease recurrence and cancer-specific death. ConclusionTNBC is very likely an independent risk factor in small (≤1 cm) node-negative invasive breast cancer. With tumors 1 cm and smaller, lymph node invasion was the single most important prognostic factor.

Modeling short-term antidepressant responsiveness with artificial neural networks

correspondence: Po see chen Department of Psychiatry, hospital and college of Medicine, national cheng Kung University, Tainan, Taiwan Tel + 886 6-235-3535 ext 5190 Fax + 886 6-275-9259 email chenps@mail.ncku.edu.tw Abstract: Due to the varying nature of patient response to different types and even dosages of the same antidepressant, doctors currently prescribe antidepressants on a trial and error basis. Therefore, it is highly desirable, both clinically and economically, to establish tools that distinguish responders from non-responders and to predict possible outcomes of the antidepressant treatments. The overall effectiveness of treatment using antidepressants may thus be optimized. Common genetic polymorphisms, such as single nucleotide polymorphisms (SNPs) can be used in clinical association studies to determine the contribution of genes to drug efficacy. In this work we developed a prediction model resulting from the analysis of clinical factors such as SNPs, age, baseline Hamilton Rating Scale for Depression (HAM-D) score, antidepressant groups, and gender of depression patients. We used it to predict the responsiveness of antidepressant treatment. By using candidate genes reported in the literature, we selected four SNPs that were strongly relevant to antidepressant efficacy. Our study population consisted of Taiwanese patients with major depression recruited from the National Cheng Kung University Hospital. The genotyping data was generated in the high-throughput genomics lab of Vita Genomics, Inc. With the wrapper-based feature selection approach, we employed multilayer feedforward neural network (MFNN) and logistic regression as a basis for comparisons. Our data revealed that the MFNN models were superior to the logistic regression model. The MFNN approach provides an efficient way to develop a tool for distinguishing responders from nonresponders prior to treatments. Our preliminary results showed that the MFNN algorithm is effective for deriving models for pharmacogenomics studies and for providing the link from clinical factors such as SNPs to the responsiveness of antidepressants in clinical association studies.

Implementation of the Hospital Emergency Incident Command System during an outbreak of severe acute respiratory syndrome (SARS) at a hospital in Taiwan, ROC

We sought to describe the implementation of the Hospital Emergency Incident Command System (HEICS) at National Cheng Kung University Hospital (NCKUH) in Taiwan, ROC during the outbreak of severe acute respiratory syndrome (SARS) in early 2003. We administered a 14-question survey via structured interviews to individuals occupying activated HEICS leadership positions at NCKUH to identify the organization, structure, and function of the HEICS units and subunits they led and the job actions they performed from 25 March to 16 June 2003 Thirty-three of 38 persons (87%) occupying 39 of 44 (89%) activated HEICS leadership positions directly participated in the survey. The participants collectively reported: 1) the creation of four new HEICS unit leader positions and corresponding units during the outbreak, including the infection control officer (administrative section) and SARS assessment, isolation, and critical care unit leaders (operations section); 2) the creation of six new HEICS subunits, including functional areas for fever screening, SARS assessment, and resuscitation outside the hospital, and SARS patient care, SARS critical care, and employee isolation inside the hospital; and 3) the performance of new job actions related to infection control by all HEICS unit leaders. HEICS provides a flexible framework that seems to have assisted NCKUH in the organization of its emergency response to the SARS outbreak in Taiwan, ROC.

Impact of an outbreak of severe acute respiratory syndrome on a hospital in Taiwan, ROC

Study objective: To estimate the impact of the severe acute respiratory syndrome (SARS) outbreak in early 2003 on a tertiary care hospital in Taiwan, ROC. Methods: The study estimated the...

Genetic Polymorphism in p53 Codon 72 and Skin Cancer in Southwestern Taiwan

The Pro/Pro polymorphism of p53 codon 72 has been reported to be related to bladder and lung cancer, but its relationship with skin cancer is unclear. We assessed the hypothesis that there is a relationship between the p53 codon 72, Pro/Pro polymorphism, cumulative arsenic exposure, and the risk of skin cancer in a hospital-based case–control study in southwestern Taiwan. From 1996 to 1999, 93 newly-diagnosed skin cancer patients at the National Cheng-Kung University (NCKU) Hospital and 71 community controls matched on residence were recruited in southwestern Taiwan. The genotype of p53 codon 72 (Arg/Arg, Arg/Pro, or Pro/Pro) was determined for all subjects by polymerase chain reaction-restricted fragment length polymorphism (PCR-RFLP). A questionnaire was administered to each subject for collection of demographic information, personal habits, disease history, diet information, and other relevant questions. The Pro/Pro (homozygous) genotype was more frequent in skin cancer patients (cases, 20%; controls, 12%; P = 0.37). Subjects with the susceptible genotype Pro/Pro and heterozygous (intermediate) genotype Pro/Arg had 2.18 and 0.99 times risk of skin cancer than the wild type Arg/Arg (95% confidence interval, 0.74–4.38; 95% confidence interval, 0.44–2.21), respectively. Compared with subjects with 18.5<BMI<23, subjects with BMI>18.5 had 5.78 times risk of skin cancer (95% confidence interval, 1.06 to 31.36) after adjusting for other risk factors. There was no interaction between BMI and genotype, but the sample size was small. The risk of skin cancer did not significantly vary by tumor cell-type. The risk of skin cancer is increased in individuals with the Pro/Pro genotype. Larger, confirmatory studies are needed to clarify the role of constitutional polymorphisms in p53 and skin cancer risk.

Supernumerary intravagal parathyroid hyperplasia

Surgery 2002;131:359-61.

Emergency department-based telemedicine

Although many studies have been published concerning clinical telemedicine, little information is available about emergency department (ED)-based telemedicine programs. An ED-based telemedicine program was initiated in April 1996 involving the National Cheng Kung University Hospital (NCKUH) and the Provincial Peng-Hu Hospital (PPHH) under a pilot project supported by the Department of Health. This is the first telemedicine program for remote offshore island service in Taiwan. The program is synchronous in nature to the practice of telemedicine. The role of the emergency physician includes giving initial suggestions, arranging consultations, coordination, and the organization of other medical tasks, such as accompanying some of the transfers. During the 12-month period, this system was used in 275 consultations, including 24 specialty and/or subspecialty department/sections, and more than 100 members of the medical staff have participated in this project since. In a survey, 89.4% of physicians in the PPHH and 82.2% of the physicians in NCKUH rated the system as very comfortable to work with and satisfactory. According to these observations, an ED-based telemedicine program is a feasible method for carrying out remote consultations. Successful development of the partnership and program of telemedicine is based on the active participation and coordination of the medical personnel and technicians between the cooperating hospitals.

Investigation of the Pathogenic Factors of Sauropus androgynus Poisoning

The purpose for this study is to investigate the dosage effects of Sauropus androgynus on pulmonary funcitions and to better understand the epidemiology of the Sauropus androgynus poisoning. The subjects studied were 278 Sauropus androgynus users who had sought for telephone counseling in 1994-1995 through the Taipei National Toxicology Counseling Center, the Taipei Verterans General Hospital, the Taichung Veterans General Hospital, the National Chengkung University Hospital, and the Department of Health. Every subject was interviewed with a structured questionnaire. The questionnaire was designed toobtain the following:demographic information of the users,history of Sauropusandrogynus consumption, health history, use of any weight-reducing drugns,clinical symptoms/signs(while using and ofter termination of use).findings of pulmonary function tests and high resolution CT scan. The results of this study indicated that the use of Sauropus androgynus induced primarily cardio-pulmonary problems such as: dyspnea, heart brun,coughing, and palpitation. Also,it was determined that the dosage of Sauropus androgynus was not associated with weight-reduction. Educational level and occupation did not affect the intake of Sauropus androgynus. In addition, this study found that the symptoms of poisoning can appear no matter whether thestem or the leaf is eaten;or the juice is frozen or filtered;or any additive is added;and the way it is processed. In conclusion ,the results noted. By adjusting for gender and body mass index(BMI) of the cases, the dosage of the vegetable was found to be significantly associated only with FEV and FAC, but not with FEV1/FVC,RV,DLco,and(all p values larger than 0.05).

Experimental assessment of the feasibility of integrating an endoscopic imaging system into an existing hospital information system.

The National Cheng Kung University (NCKU) Hospital operates a comprehensive integrated hospital information system. This was designed and installed as an integral component of the building of the hospital, which opened in 1988. The information system provides a service to all staff in the hospital, administrative and clinical, across the whole of the hospital. To make sure that the information is accessible, where and when it is needed, a comprehensive communications network consisting of both hardware and software mechanisms supports the information system. This paper explores the requirements for a computerised image system for endoscopy and assesses two approaches to the implementation of such a system, as a stand-alone system and as a subsystem of the NCKU hospital information system already in place. The latter would satisfy the original design specification of developing a single system to cover all aspects of hospital operation but places additional demands on the endoscopy systems designer to ensure integration. Both operational modes are set out in the paper and their implications assessed.

Age and Sex Effects on HbA1c: A study in a healthy Chinese population

To evaluate whether glycohemoglobin levels increase with age in both sexes and to determine the effect of BMI on this increment. A cross-sectional survey of 4,580 healthy Chinese men and women, aged 20-85 years, was performed. All subjects who did not have identifiable diseases and who were not on medication known to influence glucose tolerance were recruited from participants at the preventive services of the National Cheng-Kung University Hospital. As an indicator of plasma glucose levels, glycohemoglobin was measured. The subjects were classified according to their age and BMI for both men and women, and any relationships with glycohemoglobin levels were evaluated. In all the BMI groups divided into quartiles, glycohemoglobin levels increased with age. The largest elevation of glycohemoglobin was observed in the 45- to 54-year-old age-group, except in men with a BMI between the lowest and highest quartiles. The group with a BMI above the highest quartile had a higher glycohemoglobin than the group with a BMI below the lowest quartile in men aged < 54 years and women aged 35-64 years. Men had higher average glycohemoglobin levels than women < 55 years of age. The age factor itself may cause an elevation in glycohemoglobin independent of other age-related factors in Chinese men and women, and there is a sex difference with a lower average glycohemoglobin level in women before menopause. Furthermore, BMI, but not a family predisposition to diabetes or leisure-time physical activity, affects this age-dependent increase in glycohemoglobin levels.

Using hypermedia in computer-aided instruction

The previous article in this issue (see ibid., 1996) described the Discover distributed interactive visualization system, which has been running at National Cheng-Kung University Hospital since 1993. Shortly after Discover was implemented, we observed that physicians were having trouble understanding and navigating through Discover processes for image analysis and generation. To address this problem, we developed a computer aided instruction mechanism based on hypermedia technology-multimedia with hypertext navigation. Hints (Hypermedia Information Network System) is built around the concept of hypercontrol-the use of a multimedia document to control hardware or software systems. It is currently being used with Discover at the university hospital. Physicians use this hypermedia network system to learn the processes of the discover visualization system and to help them standardize the way they examine images.