The Effect of Agomelatine in Behavioral and Psychological Symptoms of Dementia

Carol Sheei-Meei Wang(Carol Sheei-Meei Wang ),Kuo-Sheng Cheng(Kuo-Sheng Cheng),Chia-Hung Tang(Chia-Hung Tang),Ming-Chyi Pai(Ming-Chyi Pai),Pai-Lien Chen(Pai-Lien Chen),Pei-Fang Chien(Pei-Fang Chien) 대한정신약물학회 2022 CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE Vol.20 No.4

Objective: Moderate and severe behavioral and psychological symptoms of dementia (BPSD) often need medical treatment to improve symptoms. Agomelatine is a selective melatonergic (MT1/MT2) agonist that has normalizing effects on disturbed circadian rhythms and disrupted sleep−wake cycles. Its activity of 5HT-2C receptor antagonism is associated with lessening depression and anxiety and increasing slow-wave sleep. Based on past clinical records and current findings it suggests that agomelatine can improve BPSD for patients. This retrospective cohort study was designed to compare the BPSD before and after using agomelatine. Methods: Records of dementia cases who had ever received agomelatine treatment for BPSD in a general hospital setting during the past 2.5 years were identified and reviewed. Scores from before and after 3 months of treatment with agomelatine were collected for Neuropsychiatric Inventory (NPI), Brief Psychiatric Rating Scale (BPRS), and Clinical Global Impression (CGI) to compare and analyze the difference of psychological and behavioral symptoms pre- and post-agomelatine used. Results: Records of 144 cases of dementia with BPSD who had ever used agomelatine from January 2015 to June 2017 were collected. All of the 112 cases had BPRS and CGI scores, of which 75 cases had additional NPI scores. Among these 112 cases, the BPRS and CGI scores were significantly improved in all types of dementia. NPI scores indicated that the use of agomelatine alleviated obvious symptoms and decreased overall distress, especially in the depression/poor mood, anxiety, and sleep/night behavior. Conclusion: It is consistent with an effective result of agomelatine in improving BPSD.

Full Endoscopic Removal of Cervical Spinal Epidural Abscess: Case Report and Technical Note

Kai-Sheng Chang,Li-Wei Sun,Chun-Yuan Cheng,Shang-Wen Chang,Chien-Min Chen 대한척추신경외과학회 2020 Neurospine Vol.17 No.sup.

Spinal epidural abscess is a rare disease that is less likely to occur in the cervical region. When it occurs here, cervical spondylodiscitis can develop. Surgical treatment is recommended because of possible life-threatening septic and neurological complications. We present a case of an 81-year-old man who suffered from right side paralysis and was subsequently diagnosed with a C4 to C7 epidural abscess. We utilized full endoscopic surgery for patient management. The traditional surgical methods for treating cervical epidural abscesses may cause spinal instability. There has only been one previous case report on the endoscopic-assisted method. Minimal invasive surgery by a full endoscopic method can be done with a small incision and is associated with minimal blood loss and muscle damage. This is the first report on cervical epidural abscess drainage utilization a full endoscopic method. We recommend this alternative minimally invasive method to manage cervical epidural abscess.

Surgical Outcomes and Predictive Factors in Patients With Detrusor Underactivity Undergoing Bladder Outlet Obstruction Surgery

Ming-Syun Chuang,Yin-Chien Ou,Yu-Sheng Cheng,Kuan-Yu Wu,Chang-Te Wang,Yuan-Chi Huang,Yao-Lin Kao 대한배뇨장애요실금학회 2024 International Neurourology Journal Vol.28 No.1

Purpose: This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes.Methods: We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery.Results: The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor.Conclusions: In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention. Purpose: This study was conducted to evaluate the efficacy of bladder outlet surgery in patients with detrusor underactivity (DU) and to identify factors associated with successful outcomes. Methods: We conducted a retrospective review of men diagnosed with DU in urodynamic studies who underwent bladder outlet surgery for lower urinary tract symptoms between May 2018 and April 2023. The International Prostate Symptom Score (IPSS) questionnaire, uroflowmetry (UFM), and multichannel urodynamic studies were administered. Successful treatment outcomes were defined as either an IPSS improvement of at least 50% or the regaining of spontaneous voiding in patients urethral catheterization prior to surgery. Results: The study included 93 male patients. Men diagnosed with significant or equivocal bladder outlet obstruction (BOO) experienced significant postoperative improvements in IPSS (from 20.6 to 6.0 and from 17.4 to 6.5, respectively), maximum urine flow rate (from 5.0 mL/sec to 14.4 mL/sec and from 8.8 mL/sec to 12.2 mL/sec, respectively) and voiding efficiency (from 48.8% to 86.0% and from 61.2% to 85.1%, respectively). However, in the group without obstruction, the improvements in IPSS and UFM results were not significant. The presence of detrusor overactivity (odds ratio [OR], 3.152; P=0.025) and preoperative urinary catheterization (OR, 2.756; P=0.040) were associated with favorable treatment outcomes. Conversely, an unobstructed bladder outlet was identified as a negative prognostic factor. Conclusions: In men with DU accompanied by equivocal or significant BOO, surgical intervention to alleviate the obstruction may enhance the IPSS, quality of life, and UFM results. However, those with DU and an unobstructed bladder outlet face a comparatively high risk of treatment failure. Preoperative detrusor overactivity and urinary catheterization are associated with more favorable surgical outcomes. Consequently, active deobstructive surgery should be considered for patients with DU who are experiencing urinary retention.

Development of human IgE biosensor using Sezawa-mode SAW devices

Ying-Chung Chen,Wei-Tsai Chang,Chien-Chuan Cheng,Jing-Yi Shen,Kuo-Sheng Kao 한국물리학회 2014 Current Applied Physics Vol.14 No.4

This paper reports Sezawa-mode surface acoustic wave (SAW) devices with via-isolated cavity to construct the allergy biosensor. To fabricate Sezawa-mode SAW devices, the RF magnetron sputtering method for the growth of piezoelectric ZnO thin films are adopted and influences of the sputtering parameters are investigated. The optimal substrate temperature of 300 C, RF power of 120 W and sputtering pressure of 2 Pa were used to deposit piezoelectric ZnO films with a smooth surface, uniform grain size and strongly c-axis-orientated crystallization. A back-etched SAW resonator is used in this study. The wet etching of (100)-oriented silicon wafers is used to form a back-side cavity which is critical to the formation of a hopper cavity for holding bio-analytes. The remaining membrane structure silicon thickness was 25 mm. In this report, the chrome (Cr, 12 nm)/gold (Au, 66 nm) layer was initially deposited onto the sensing area of SAW devices as the binding layer for biochemical sensor. The resonance frequency of the Sezawa-mode SAW device is 1.497 GHz. The maximum sensitivity of the Sezawa-mode is calculated to be 4.44 106 cm2/g for human immunoglobulin-E (IgE) detection. The stability for human IgE detection is calculated to be 80% and the variation of the stability 3% was obtained after several tests.

ORiginal Article : Association between IPTA Gene Polymorphisms and Hematological Abnormalities in Hepatitis C Virus-Infected Patients Receiving Combination Therapy

( Jow Jyh Hwang ),( Ching Chu Lo ),( Chien Hung Lin ),( Hsu Sheng Cheng ),( I Wen Hung ),( Wan Ju Tsai ),( Chien Hui Hung ) The Editorial Office of Gut and Liver 2015 Gut and Liver Vol.9 No.2

Background/Aims: Hematological abnormalities during hepatitis C virus (HCV) combination therapy with pegylated interferon α and ribavirin often necessitate dose reduction. Variants of the ITPA gene have been reported to protect against anemia during the early stages of HCV combination treatments but have also been associated with larger decreases in platelet counts. We aimed to identify the association between specific ITPA gene polymorphisms and hematological abnormalities in patients undergoing HCV combination therapy. Methods: In this retrospective study, 175 patients treated with HCV combination therapy were enrolled at St. Martin De Porres Hospital in Taiwan between 2006 and 2012. Two single nucleotide polymorphisms (SNP) within or adjacent to the ITPA gene (rs1127354, rs6051702) were genotyped. We investigated the effect of ITPA gene variants on hematological abnormalities during the therapy. Results: The ITPA rs1127354 minor variants were significantly associated with protection against anemia at week 4 (p=1.86×10-6) and with more severe decreases in platelet counts during HCV combination therapy. SNP rs6051702 was not associated with the hemoglobin decline to >3 g/dL at week 4 in our study (p=0.055). Conclusions: The ITPA SNP rs1127354 is a useful predictor of ribavirin-induced anemia in Taiwanese patients and may be related to more severe decreases in platelet counts during the early stage of HCV combination therapy. (Gut Liver, 2015;9:214-223)

Poster Session : PS 0589 ; Psychiatry ; Holistic Care Unit Improves Access Block in Emergency Department in Taiwan

( Meng Chieh Wu ),( Hsin Kai Huang ),( Chun Cheng Zhang ),( Li Sheng Chang ),( Yung Ze Cheng ),( Chien Chin Hsu ),( Kao Chang Lin ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Background: Emergency department (ED) overcrowding is a problem in many countries including Taiwan. Access block refers to a situation where patients in the emergency department requiring inpatient care are unable to gain access to appropriate hospital beds within a reasonable time frame (more than 8 hours total time in the emergency department). Access block is one major reason of ED overcrowding. Methods: A new holistic care unit was established in our medical center in Taiwan in July 2012, with the attending physicians including internal medicine physicians and a neurologist. The patients who required hospitalized treatment were referred to internal medicine physicians in the emergency department. The new department was comprised of seven experienced medical attending physician to take care of the patients directly, with 8-hour duty work shifts within 24 hours, in collaboration with emergency physicians, radiologists, nurses, social workers and case managers to form a team. This team had similar three-shift work duty, education and training programs, and they shared medical devices and resources. If beds in the intensive care unit or ward are not available immediately, procedures and treatment can be performed in the holistic care unit. The pediatric patients were excluded from this study. Results: In total, 26,623 patients were admitting to ward from our emergency department from August 2011 to July 2012, and 23,790 patients from August 2012 to July 2013. The rate of access block decreased from 55.29% to 50.01% ( p < 0.01) after holistic care unit was established. The mean time of ED length of stay was also improved from 18.04 hours to 15.43 hours ( p < 0.01). Conclusions: The newly established holistic care unit in our hospital improved the quality of medical care, not only physiologically but also psychologically.

Penetration Processes of Soft Solid Materials by Needle-Free Micro-Injections

( Muh Rong Wang ),( Chun Hsien Chiu ),( Chien Chih Huang ),( Li Jay Cheng ),( Yang Sheng Huang ),( Min Chen ) 한국액체미립화학회 2010 한국액체미립화학회 학술강연회 논문집 Vol.2010 No.-

Penetration characteristics of the single pulse micro-jets into the soft solid materials of gelatin gels and porcine colons are investigated in this paper. The images of penetration processes were taken by IDT high-speed digital camera at the sampling rate of 2500 frames per second. The evolution of the penetration process, penetration depth, volume of infection and penetration rate is investigated. Gelatin gel is a good model material for the observation of the penetration processes because of the translucent property. In vitro penetrations of porcine colons were also tested for the prior study of endoscopic needle-free injection. The penetration test was performed under the single-pulsed mode at injection time of 0.1, 0.25 and 0.5 seconds. The injection pressure was in the range of 50 to 125 bar. The diameter of the injectors, do, is 250 and 300 m. According to the high-speed photos of the gel penetration, the injection processes can be described as four steps: 1. Initial compression period: the elastic compression of the soft solid material at the penetration site and the neighborhood. 2. Material failure period: the jet penetrates inside the gelatin gel including the initial surface crack and growth of the injected volume. 3. Elastic rebounding period: It takes place when the injection is stopped. The injected water starts to be squeezed out of the gelatin gel under the compression of the gelatin gel during the elastic relaxation processes until the final penetration depth and width. 4. Final stable period: the penetration depth and width inside the gelatin gel are fixed afterward. Furthermore, the injection tests on the porcine colon show the penetration into submucosal layer is possible under the injection pressure less than 60 bar with the orifice of 300 m and injection time of 0.1 sec. The injection power is 16 W under this condition. However, higher injection power is needed for the punch through injection of porcine colon. The failure stress of the porcine colon is 1.077 0.333 MPa by the deep penetration test.

Hypoglycemia Revisited in the Acute Care Setting

Shih-Hung Tsai,Der-Ming Chu,Yen-Yue Lin,Chin-Wang Hsu,Chien-Sheng Cheng 연세대학교의과대학 2011 Yonsei medical journal Vol.52 No.6

Hypoglycemia is a common finding in both daily clinical practice and acute care settings. The causes of severe hypoglycemia (SH) are multi-factorial and the major etiologies are iatrogenic, infectious diseases with sepsis and tumor or autoimmune diseases. With the advent of aggressive lowering of HbA1c values to achieve optimal glycemic control, patients are at increased risk of hypoglycemic episodes. Iatrogenic hypoglycemia can cause recurrent morbidity, sometime irreversible neurologic complications and even death, and further preclude maintenance of euglycemia over a lifetime of diabetes. Recent studies have shown that hypoglycemia is associated with adverse outcomes in many acute illnesses. In addition, hypoglycemia is associated with increased mortality among elderly and non-diabetic hospitalized patients. Clinicians should have high clinical suspicion of subtle symptoms of hypoglycemia and provide prompt treatment. Clinicians should know that hypoglycemia is associated with considerable adverse outcomes in many acute critical illnesses. In order to reduce hypoglycemia-associated morbidity and mortality, timely health education programs and close monitoring should be applied to those diabetic patients presenting to the Emergency Department with SH. ED disposition strategies should be further validated and justified to achieve balance between the benefits of euglycemia and the risks of SH. We discuss relevant issues regarding hypoglycemia in emergency and critical care settings.

Elucidating the role of ApxI in hemolysis and cellular damage by using a novel apxIA mutant of Actinobacillus pleuropneumoniae serotype 10

Nai-Yun Chang,Zeng-Weng Chen,Ter-Hsin Chen,Jiunn-Wang Liao,Cheng-Chung Lin,Maw-Sheng Chien,Wei-Cheng Lee,Jiunn-Horng Lin,Shih-Ling Hsuan 대한수의학회 2014 Journal of Veterinary Science Vol.15 No.1

Exotoxins produced by Actinobacillus (A.) pleuropneumoniae(Apx) play major roles in the pathogenesis of pleuropneumoniain swine. This study investigated the role of ApxI in hemolysisand cellular damage using a novel apxIA mutant, ApxIA336,which was developed from the parental strain A. pleuropneumoniae serotype 10 that produces only ApxI in vitro. The genotype of ApxIA336 was confirmed by PCR, Southernblotting, and gene sequencing. Exotoxin preparation derivedfrom ApxIA336 was analyzed for its bioactivity towardsporcine erythrocytes and alveolar macrophages. Analysisresults indicated that ApxIA336 contained a kanamycinresistantcassette inserted immediately after 1005 bp of theapxIA gene. Phenotype analysis of ApxIA336 revealed nodifference in the growth rate as compared to the parentalstrain. Meanwhile, ApxI production was abolished in thebacterial culture supernatant, i.e. exotoxin preparation. Theinability of ApxIA336 to produce ApxI corresponded to the lossof hemolytic and cytotoxic bioactivity in exotoxin preparation,as demonstrated by hemolysis, lactate dehydrogenase release,mitochondrial activity, and apoptosis assays. Additionally, thevirulence of ApxIA336 appeared to be attenuated by 15-fold inBALB/c mice. Collectively, ApxI, but not other components inthe exotoxin preparation of A. pleuropneumoniae serotype 10,was responsible for the hemolytic and cytotoxic effects onporcine erythrocytes and alveolar macrophages.

Diverse genetic spectrum among patients who met the criteria of hereditary breast, ovarian and pancreatic cancer syndrome

Po-Han Lin,Yun-Wen Tien,Wen-Fang Cheng,Ying-Cheng Chiang,Chien-Huei Wu,Karen Yang,Chiun-Sheng Huang 대한부인종양학회 2023 Journal of Gynecologic Oncology Vol.34 No.5

Objective: Genetic high-risk assessment combines hereditary breast, ovarian and pancreatic cancer into one syndrome. However, there is a lack of data for comparing the germline mutational spectrum of the cancer predisposing genes between these three cancers. Methods: Patients who met the criteria of the hereditary breast, ovarian and pancreatic cancer were enrolled and received multi-gene sequencing. Results: We enrolled 730 probands: 418 developed breast cancer, 185 had ovarian cancer, and 145 had pancreatic cancer. Out of the 18 patients who had two types of cancer, 16 had breast and ovarian cancer and 2 had breast and pancreatic cancer. A total of 167 (22.9%) patients had 170 mutations. Mutation frequency in breast, ovarian and pancreatic cancer was 22.3%, 33.5% and 17.2%, respectively. The mutation rate was significantly higher in patients with double cancers than those with a single cancer (p<0.001). BRCA1 and BRCA2 were the most dominant genes associated with hereditary breast and ovarian cancer, whereas ATM was the most prevalent gene related to hereditary pancreatic cancer. Genes of hereditary colon cancer such as lynch syndrome were presented in a part of patients with pancreatic or ovarian cancer but seldom in those with breast cancer. Families with a history of both ovarian and breast cancer were associated with a higher mutation rate than those with other histories. Conclusion: The mutation spectrum varies across the three cancer types and family histories. Our analysis provides guidance for physicians, counsellors, and counselees on the offer and uptake of genetic counseling.