Chang Gung medical journal最新文献

Background: Hemoglobin variability in hemodialysis patients treated with erythropoiesis-stimulating agents has been used to evaluate mortality and comorbidity. Different outcomes have been reported in American and European hemodialysis patients. There are, however, few studies of the effects of hemoglobin variability in peritoneal dialysis patients.

Methods: We investigated hemoglobin variability in 363 peritoneal dialysis patients over 2 years to evaluate mortality and the association with comorbidity, peritonitis, and hospitalization. The hemoglobin of all patients selected for the study had been monitored for at least 6 months (April 2008 to September 2008). We assessed hemoglobin variability as fluctuations from the target hemoglobin level (11-12.5 g/dL). We defined the following 6 patient groups on the basis of hemoglobin patterns: consistently low (< 11 g/dL), consistently target range (11-12.5 g/dL), consistently high (> 12.5 g/dL), low-amplitude fluctuation with low hemoglobin levels, low-amplitude fluctuation with high hemoglobin levels, and high amplitude fluctuation.

Results: Only 2% of patients maintained a stable hemoglobin level within the target range and 46.8% of patients exhibited consistently low hemoglobin levels. After 2 years of observation, there was no difference in mortality as assessed by Kaplan-Meier analysis. There were also no differences in peritonitis and hospitalization between the 6 groups. However, the length of hospital stay was longer in the high amplitude fluctuation group (p = 0.008).

Conclusion: Hemoglobin variability does not predict mortality in peritoneal dialysis patients.

Background: A fluctuating blood glucose level is one of the risks of chronic complications in diabetes. Previous studies indicated that hemoglobin A1c (HbA1c) values apparently improved after initiation of self-monitoring blood glucose (SMBG). The purpose of this study is to investigate the relationship between the frequency of SMBG, long-term fluctuatation of HbA1c, and risks of chronic complications in diabetes.

Methods: We enrolled 1052 patients with type 2 diabetes. The mean follow-up was 4.7 years. The HbA1c level and frequency of SMBG were recorded every 3 months. Non-mydriatic retinal photography, semiquantitative neuropathy assessment, the lipid profile, serum creatinine level, and urine protein were measured at the beginning of the study and then every year. The fluctuation in HbA1c throughout the period was expressed as the standard deviations (SDs) of all measurements of the HbA1c.

Results: The frequency of SMBG was significantly and negatively correlated with the SDs of the HbA1c (r = -0.553, p < 0.001) but not with the average HbA1c. After controlling for age, sex, body mass index, duration of diabetes and comorbidities (dyslipidemia and hypertension), the correlation was still apparent (r = -0.511, p = 0.008). Patients with progression of nephropathy, neuropathy, and retinopathy, exhibited greater fluctuation of HbA1cs (2.38 ± 0.99 vs. 0.93 ± 1.16, p-value 0.002; 0.97 ± 1.59 vs. 0.90 ± 0.56, p-value 0.04; 0.99 ± 1.33 vs. 0.90 ± 0.56, p-value 0.04, respectively) and less frequent SMBG (3.2 ± 2.6 vs. 4.3 ± 3.1, p-value 0.02; 3.2 ± 2.6 vs. 4.1 ± 3.9, p-value 0.05; 3.0 ± 3.1 vs. 4.2 ± 2.8, p-value 0.01, respectively) than patients without progression of these complications.

Conclusion: This study shows that frequent SMBG decreased the fluctuation of HbA1c and decreased microvascular complications. Decreasing fluctuation of HbA1c may play an important role in diabetes treatment.

The adhesion-class G protein-coupled receptors (adhesion-GPCRs) constitute the second largest GPCR sub-family in humans. Adhesion-GPCRs are defined by the chimeric structure of an unusually large extracellular cell-adhesion domain and a GPCR-like seven-pass transmembrane domain. Adhesion-GPCRs are hence expected to display both cellular adhesion and signaling functions in many biological systems. Adhesion-GPCRs are normally expressed in the central nervous, immune, and reproductive systems in a cell type- or tissue-restricted fashion. However, aberrant expression of distinct adhesion-GPCR molecules has been identified in various human cancers with some of the receptors closely associated with cancer development. Tumor-associated adhesion-GPCRs are thought to involve in tumorigenesis by affecting the growth of tumor cells, angiogenesis, tumor cell migration, invasion and metastasis either positively or negatively. Furthermore, some adhesion-GPCRs are considered potential biomarkers for specific types of cancers. In this review article, the expressional characteristics and functional role of cancer-associated adhesion-GPCRs are discussed in depth.

Background: Salivary gland masses constitute a diagnostic challenge in daily clinical practice and tissue sampling is required to establish a diagnosis. We aimed to evaluate the efficacy of ultrasonography-guided fine needle aspiration biopsy (UGFNAB) in the diagnosis of salivary gland lesions.

Methods: From January 2007 to September 2010, a total of 158 patients who underwent both UGFNAB and surgical excision for salivary gland mass lesions were included in this study. Patients with insufficient sampling or inconclusive cytology diagnosis were excluded from the analysis of diagnostic accuracy of UGFNAB.

Results: UGFNAB yielded sufficient sampling for analysis in 137 patients, leading to a diagnostic yield of 86.7%. Among these 137 patients, 24 patients were confirmed to have malignant tumors. The sensitivity, specificity and accuracy of UGFNAB for malignancy were 66.7%, 98.2%, and 92.7%, respectively. No UGFNAB-related complications were encountered.

Conclusions: UGFNAB of salivary gland masses is a safe technique that offers high specificity and accuracy but moderate diagnostic yield and sensitivity.

Background: Hepatic hemangiomas are the most common benign hepatic tumors, and they are usually asymptomatic with normal liver function. When hepatic hemangiomas reach 4 cm, we define them as giant hemangiomas. Treatment options for giant hemangiomas are observation, surgical resection, and transcatheter arterial embolization. The aim of this study was to identify the risk factors for surgical complications.

Methods: In this study, the records of 61 patients with giant hepatic hemangiomas treated with surgical resection at Chang Gung Memorial Hospital, Linkou were retrospectively reviewed. Data on clinical variables including symptoms, the size, number, and location of the tumors, preoperative liver function tests, operative method, operation time, and operative blood loss were collected and analyzed.

Results: There were 8 patients (13.1%, 95% confidence interval 5.8% to 24.2%) with complications after resection or enucleation. Postoperative complications were associated with large tumor size (p = 0.021) and tumors that were symptomatic (p = 0.017). In addition, complications were associated with greater use of intraoperative inflow control (p = 0.053), longer operative time (p = 0.001), and greater intraoperative blood loss (p = 0.022). Most complications could be treated conservatively, but invasive interventions such as endoscopic retrograde cholangiopancreatography and percutaneous transhepatic cholangial drainage were required for management of grade III complications.

Conclusions: Most giant hepatic hemangiomas can be treated with enucleation or resection. Important factors associated with complications were large tumor size, the presence of symptoms, surgical bleeding, and prolonged surgery. Most complications were grade I and could be treated conservatively. Both resection and enucleation were relatively safe with an acceptable complication rate (13.1%) and no mortality in our study.

Background: Recently, tissue engineering has been introduced as a regenerative treatment for bone defects. There is some evidence showing bone regeneration from mesenchymal stem cells (MSC) loaded on hydroxyapatite β-tricalcium phosphate (HA/TCP) as a scaffold in large defects. This study aimed to compare the quality and quantity of regenerated bone using Bio-Oss, HA/TCP and MSC loaded HA/TCP scaffolds.

Methods: Mesenchymal stem cells were aspirated from iliac crest bone marrow after extracting the first, second and third premolars and the first molar in five mature hybrid dogs. The cells were cultured and their osteogenic differentiation potential was evaluated after the third cell passage using Alizarin red staining in experimental conditions. The HA/TCP scaffold (3 × 3 × 3 mm) was loaded with undifferentiated mesenchymal stem cells. Bilateral bone defects were then prepared in the jaws using trephine burs. The defects were randomly filled with HA/TCP, Bio-Oss, or HA/TCP + MSCs. One defect served as a control and was left as an empty cavity. All defects except the control defect were covered with an absorbable membrane. Histological and histomorphometric evaluations were conducted after 6 weeks and data were subjected to analysis of variance (ANOVA) (p < 0.05).

Results: The empty cavity demonstrated more bone formation (60.80%) than the HA/TCP (44.93%) and Bio-Oss (40.60%) (p < 0.05) groups. However, the difference from the HA/TCP + MSCs group was not significant (46.38%) (p > 0.05).

Conclusion: An MSC-loaded HA/TCP scaffold is a more effective alternative than Bio-OSS or HA/TCP in inducing bone regeneration.

Background: The two-incision technique and the modified Watson-Jones technique use muscular intervals and avoid muscle cutting in total hip arthroplasty (THA). However these two techniques have not been compared.

Methods: A prospective randomized study of clinical outcomes and patient preferences was performed in 20 patients who had a two-incision THA in one hip and a modified Watson-Jones THA in the other between January 2004 and August 2007. The 20 patients were randomized equally to the two-incision first or the modified Watson-Jones first group. After the second surgery, patients were asked about their preferences for one of the two techniques and clinical results were analyzed.

Results: After a minimal follow-up of 2 years, there were no differences in the hospital course, clinical results, functional outcomes, and radiographic results between techniques. However more patients (70%) preferred the two-incision side to the modified Watson-Jones side in the first 6 months regardless which procedure was performed first.

Conclusion: Given the similarity of these two techniques in cup implantation and with only a difference in femoral stem implantation, we think that the difference in patient preferences in the early postoperative period might be related to the surgical dissection and manipulation of the hip with the modified Watson-Jones technique.

Background: Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as those with life-threatening respiratory failure or post-cardiotomy cardiogenic shock. Patients on ECMO with acute renal failure have high mortality rates. This study identifies specific predictors of hospital mortality for patients receiving ECMO and continuous arteriovenous hemofiltration (CAVH).

Methods: This study reviewed the medical records of 123 critically ill patients on ECMO plus CAVH at a cardiovascular surgical intensive care unit (CVSICU) at a tertiary care university hospital between March 2003 and August 2010. Patient baseline, clinical, and laboratory data were collected retrospectively as survival predicators.

Results: The overall mortality rate was 85.4%. The most common conditions requiring ECMO plus CAVH were cardiogenic shock and oliguria. The Acute Physiology and Chronic Health Evaluation II (APACHE II) score and organ system failure (OSF) score both indicated good discriminative power (area under the receiver operating characteristic curve [AUROC] 0.812 ± 0.048 and 0.758 ± 0.057, respectively). Multiple logistic regression analysis indicated that age, mean arterial pressure, and OSF score on day 1 of ECMO plus CAVH were independent risk factors for hospital mortality. Cumulative survival rates at the 6-month follow-up differed significantly (p < 0.001) between those with an OSF score ≤ 4 vs. those with an OSF score > 4.

Conclusions: During ECMO plus CAVH support, both the OSF and APACHE II scores showed good discriminative power in predicting hospital mortality for these patients.

Background: Periventricular nodular heterotopia (PNH) is a rare congenital anomaly of the brain presenting as nodular heterotopia along the paraventricular region. Ten cases of PNH complicated by aortic aneurysm have been reported in the literature, and 9 of them also had symptoms of Ehlers-Danlos syndrome (EDS). This study investigated the association of PNH and cardiovascular anomalies in Asians.

Methods: Patients with a diagnosis of brain heterotopia on magnetic resonance imaging at Chang Gung Memorial Hospital between 1994 and 2010 were screened for both typical PNH and cardiovascular anomalies. The family members of the index cases were also evaluated.

Results: One family (5 patients) and a sporadic case were found to have both typical PNH and cardiovascular anomalies. Two of them had aortic root aneurysm, one had aortic regurgitation, and one had minor valvular disease. Two patients had a history of seizures, but none of them had EDS.

Conclusions: Clinical heterogeneity exists in the patients with PNH. Overlap in the symptoms of PNH, cardiovascular anomalies, aortic aneurysm, and EDS were reviewed. EDS is unusual in Asians with PNH. Aortic aneurysm and other valvular heart diseases are common cardiovascular anomalies in PNH patients.

Background: Tobacco use is known as a serious global public health problem, and is also an important risk factor for oral diseases. Saliva is the first biological medium encountered during inhalation of cigarette smoke. Therefore, the main aim of this study was to compare the levels of salivary antioxidants between healthy smoking and non-smoking men.

Methods: Unstimulated whole saliva samples were collected from 80 men. Forty subjects were smokers with a daily consumption of 20 cigarettes for at least 10 years and 40 subjects were non-smokers. The salivary levels of uric acid, superoxide dismutase, glutathione peroxidase, and peroxidase were measured and compared between studied groups.

Results: The mean levels of salivary superoxide dismutase, glutathione peroxidase, and peroxidase were significantly lower in smokers than non-smokers. There was no statistically significant difference in the salivary uric acid level between smokers and non-smokers.

Conclusions: Measurement of antioxidant agents in human saliva might be useful for estimating the level of oxidative stress caused by cigarette smoke.