Publications by authors named "Chia-Hui Wang"

38 Publications

Natal origin and migration pathways of Mekong catfish (Pangasius krempfi) using strontium isotopes and trace element concentrations in environmental water and otoliths.

PLoS One 2021 10;16(6):e0252769. Epub 2021 Jun 10.

IRD, MARBEC (Univ Montpellier, Ifremer, CNRS, IRD), Montpellier, France.

To improve our knowledge of the migration pathway of a highly threatened fish species along the Mekong River, strontium isotope ratios (87Sr/86Sr) and 18 trace element concentrations were measured in the water and in the otoliths of an anadromous catfish, Pangasius krempfi, to infer its natal origin and potential migration pathways. Water was sampled at 18 locations along the mainstream, tributaries and distributaries of the Mekong River. To check for accuracy and precision, measurements of the 87Sr/86Sr ratios and trace element concentrations were then compared in two laboratories that use different analytical methods. Differences in trace element concentrations between locations were not significant and could not, therefore, be used to discriminate between migration pathways. However, the Mekong mainstream, tributaries and distributaries could all be discriminated using Sr isotopes. The 87Sr/86Sr profiles recorded in P. krempfi otoliths showed that there were three contingents with obligate freshwater hatching and variable spawning sites along the Mekong mainstream, from Phnom Penh (Cambodia) to Nong Khai (Thailand) or further. After hatching, the fish migrated more or less rapidly to the Mekong Delta and then settled for most of their lifetime in brackish water. Spawning habitats and migration routes may be threatened by habitat shifts and the increasing number of hydropower dams along the river, especially the contingents born above Khone Falls (Laos). The conservation of P. krempfi, as well as other migratory fish in the Mekong River, requires agreements, common actions and management by all countries along the Mekong River. This study highlighted the importance of using both Sr/Ca and 87Sr/86Sr ratios to understand life history of anadromous fishes as the 87Sr/86Sr ratio in the water was shown to be less effective than the Sr/Ca ratio in identifying movements between different saline areas.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0252769PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191956PMC
June 2021

Increased Risk of Injury Following a Diagnosis of Vertigo: A Population-based Study.

Laryngoscope 2021 07 18;131(7):1633-1638. Epub 2021 Mar 18.

Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan.

Background: This study aimed to evaluate whether peripheral vestibular disorders (PVD) are associated with subsequent injury.

Methods: Data for this follow-up study were retrieved from the Taiwan's National Health Insurance (NHI) Dataset. A total of 251,355 patients with newly diagnosed PVD during January 2015 to December 2016 was identified as the study cohort, the diagnosis date being their index date. Comparison patients were identified by propensity score-matching (one per case, n = 251,355 controls) from the remaining NHI beneficiaries in 2015 with their index date being the date of their first health service claim in 2015. We tracked each subject's claims history for 1 year from the index date to identify those who suffered an injury. Cox proportional hazards regressions were performed to calculate the injury hazard ratio of cases versus controls.

Results: The incidence of injury during 1-year follow-up was 128.6 (95% CI = 127.6-129.5) per 1,000 person-years, 158.2 (95% CI = 156.8-159.6) and 97.5 (95% CI = 96.3-98.7) among the study and comparison cohorts, respectively. After adjusting for demographic variables, the hazard ratio (HR) for injury during 1-year was 1.663 (95% CI: 1.636-1.690) for cases relative to controls.

Conclusions: Patients with PVD were at a higher risk for a wide range of injuries, most of all, joint dislocation and sprain.

Level Of Evidence: 3 Laryngoscope, 131:1633-1638, 2021.
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http://dx.doi.org/10.1002/lary.29519DOI Listing
July 2021

Protection procedures and preventions against the spread of coronavirus disease 2019 in healthcare settings for nursing personnel: Lessons from Taiwan.

Aust Crit Care 2021 Mar 16;34(2):182-190. Epub 2020 Oct 16.

School of Nursing, College of Nursing, Taipei Medical University, No. 250 Wu-Hsing Street, Taipei, Taiwan; Department of Nursing, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Rd., Zhonghe District, New Taipei City, Taiwan; Center for Nursing and Healthcare Research in Clinical Practice Application, Wan Fang Hospital, Taipei Medical University, No. 111, Section 3, Xing-Long Road, Taipei, Taiwan; Psychiatric Research Center, Taipei Medical University Hospital, No. 252, Wuxing St, Xinyi District, Taipei, Taiwan. Electronic address:

Background: Since coronavirus disease 2019 was first discovered, at the time of writing this article, the number of people infected globally has exceeded 1 million. Its high transmission rate has resulted in nosocomial infections in healthcare facilities all over the world. Nursing personnel account for nearly 50% of the global health workforce and are the primary provider of direct care in hospitals and long-term care facilities. Nurses stand on the front line against the spread of this pandemic, and proper protection procedures are vital.

Objectives: The present study aims to share the procedures and measures used by Taiwan nursing personnel to help reduce global transmission.

Review Methods: Compared with other regions, where large-scale epidemics have overwhelmed the health systems, Taiwan has maintained the number of confirmed cases within a manageable scope. A review of various national and international policies and guidelines was carried out to present proper procedures and preventions for nursing personnel in healthcare settings.

Results: This study shows how Taiwan's health system rapidly identified suspected cases as well as the prevention policies and strategies, key protection points for nursing personnel in implementing high-risk nursing tasks, and lessons from a nursing perspective.

Conclusions: Various world media have affirmed the rapid response and effective epidemic prevention strategies of Taiwan's health system. Educating nurses on procedures for infection control, reporting cases, and implementing protective measures to prevent nosocomial infections are critical to prevent further outbreaks.
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http://dx.doi.org/10.1016/j.aucc.2020.10.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566791PMC
March 2021

Visual Guidance and Egg Collection Scheme for a Smart Poultry Robot for Free-Range Farms.

Sensors (Basel) 2020 Nov 19;20(22). Epub 2020 Nov 19.

Department of Biomechatronics Engineering, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan.

Free-range chicken farming allows egg-laying hens to move freely through their environment and perform their natural behavior, including laying her eggs. However, it takes time to gather these eggs manually, giving rise to high labor costs. This study proposes a smart mobile robot for poultry farms that can recognize eggs of two different colors on free-range farms. The robot can also pick up and sort eggs without damaging them. An egg feature extraction method with automatic thresholding is employed to detect both white and brown eggs, and a behavior-based navigation method is applied to allow the robot to reach the eggs while avoiding obstacles. The robot can move towards the position of each egg via visual tracking. Once the egg is within the collection area of the robot, it is gathered, sorted and stored in the tank inside the robot. Experiments are carried out in an outdoor field of size 5 m × 5 m under different climatic conditions, and the results showed that the average egg recognition rate is between 94.7% and 97.6%. The proposed mobile poultry robot is low in production cost and simple in operation. It can provide chicken farmers with automatic egg gathering on free-range farms.
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http://dx.doi.org/10.3390/s20226624DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7699349PMC
November 2020

Preventing Alveolar Osteitis After Molar Extraction Using Chlorhexidine Rinse and Gel: A Meta-Analysis of Randomized Controlled Trials.

J Nurs Res 2020 Sep 21;29(1):e137. Epub 2020 Sep 21.

PhD, Joint Appointment Medical Researcher, Center for Evidence-Based Health Care and Shared Decision Making Resource Center, Department of Medical Research, and Department of Dentistry, Taipei Medical University Shuang Ho Hospital; Researcher, Cochrane Taiwan, Taipei Medical University; and Assistant Professor, Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan, ROC.

Background: Alveolar osteitis (AO) may occur after molar extraction. Chlorhexidine (CHX) rinse and CHX gel are widely used to prevent AO. Although previous meta-analyses support the effectiveness of both CHX rinse and CHX gel in preventing AO, important issues regarding these two formulations have not been addressed adequately in the literature.

Purpose: A systematic review and meta-analysis of randomized controlled trials was conducted to determine the effectiveness of CHX rinse and CHX gel in preventing AO.

Methods: PubMed, EMBASE, SCOPUS, and Cochrane databases were searched for randomized controlled trials published before June 2018. The risk ratio (RR) was used to estimate the pooled effect of AO incidence using a random-effect model.

Results: The RRs of AO in patients treated with 0.12% CHX rinse (RR = 0.54, 95% CI [0.41, 0.72]) and 0.2% CHX rinse (RR = 0.84, 95% CI [0.52, 1.35]) were significantly lower than in those treated with the control. Moreover, a significantly lower RR was identified in patients treated with 0.2% CHX gel (RR = 0.47, 95% CI [0.34, 0.64]) than in those treated with the control. When CHX products of different concentrations were grouped together, patients treated with CHX rinse showed an RR of AO of 0.61 (95% CI [0.48, 0.78]) and those treated with CHX gel showed an RR of AO of 0.44 (95% CI [0.43, 0.65]). On the other hand, a meta-analysis of three trials that compared CHX rinse and CHX gel directly showed a significantly lower RR of AO in patients treated with CHX rinse than in those treated with CHX gel (RR = 0.56, 95% CI [0.34, 0.96]).

Conclusions/implications For Practice: The results support the effectiveness of both CHX rinse and gel in reducing the risk of AO after molar extraction. Each formulation provides unique benefits in terms of ease of application and cost. On the basis of the results of this study, the authors recommend that CHX gel be used immediately after molar extraction because of the convenience and cost-effectiveness of this treatment and that CHX rinse be used by the patient after discharge at home in combination with appropriate health education and case management.
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http://dx.doi.org/10.1097/jnr.0000000000000401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808365PMC
September 2020

Nurses' Late-Life Depression Knowledge and Attitudes Toward Depression: A Cross-Sectional Study.

Inquiry 2020 Jan-Dec;57:46958020945179

School of Nursing, College of Nursing, Taipei Medical University, Taiwan.

Depression in older population is more common now. Due to increasing numbers of older patients in hospitals, nurses have more opportunities to care for these patients. Therefore, nurses should have correct knowledge of late-life depression and more favorable attitudes about depression. The study aimed to understand hospital nurses' knowledge level of late-life depression and attitudes about depression. A cross-sectional research design was used. A convenience sample of 307 nurses from 3 hospitals in Taiwan was recruited. Nurses scored 55.15% in the Late-Life Depression Quiz. The average score of the Revised Depression Attitude Questionnaire was 71.76 (SD = 6.13). The study also found that hospital nurses had more favorable attitudes about depression when their late-life depression knowledge was higher; their interest level in providing care for older patients with depression was greater; they had ever taken care of older patients with depressive symptoms or depression; they had never received in-service training on depression in the past year; and they had ever attended lectures about depression in school. Hospital nurses' knowledge about late-life depression was limited, and they had neutral to slightly favorable attitudes about depression in Taiwan. It is suggested to carefully examine and evaluate in-service training related to depression for nurses in hospitals. In addition, developing appropriate interventions to increase hospital nurses' knowledge level of late-life depression and attitudes toward depression is recommended.
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http://dx.doi.org/10.1177/0046958020945179DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7391434PMC
July 2020

Efficacy of Pulsed Radiofrequency in Herpetic Neuralgia: A Meta-Analysis of Randomized Controlled Trials.

Clin J Pain 2020 11;36(11):887-895

Department of Surgery, Division of General Surgery, School of Medicine, College of Medicine.

Objectives: Herpes zoster and postherpetic neuralgia (PHN) are often refractory to current standard treatments and can reduce patients' quality of life (QoL). Pulsed radiofrequency (PRF) effectively controls intractable neurological pain. The aim of the study was to conduct a systematic review and meta-analysis to evaluate the efficacy of PRF in PHN management.

Materials And Methods: We searched PubMed, Embase, and Cochrane Library for randomized controlled trials (RCTs) published up to October 2019. The primary outcomes were pain levels and rescue analgesia at different postintervention time intervals. The secondary outcomes were QoL and sleep quality.

Results: We reviewed 6 RCTs involving 420 patients. The meta-analysis revealed that the PRF group exhibited significantly lower pain scores in PHN than did the control group at 2 to 3 days (weighted mean differences [WMD]=-2.82; 95% confidence interval [CI]: -5.08 to -0.55), 1 week (WMD=-2.95; 95% CI: -4.53 to -1.37), 2 weeks (WMD=-3.17; 95% CI: -4.11 to -2.23), 4 weeks (WMD=-2.59; 95% CI: -3.40 to -1.79), 8 weeks (WMD=-3.02; 95% CI: -4.17 to -1.88), and 6 months (WMD=-1.94; 95% CI: -2.85 to -1.03). After intervention, QoL was significantly higher in the PRF group than in the control group. No major complications were reported.

Discussion: PRF safely and effectively reduced pain scores and improved QoL in patients with herpes zoster in the cervical to lumbosacral areas. PRF could be considered during refractory PHN treatment. Future studies require standardized PRF settings and outcome assessment tools, including physical and emotional function assessments.
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http://dx.doi.org/10.1097/AJP.0000000000000867DOI Listing
November 2020

Mediating effects of shoulder-arm exercise on the postoperative severity of symptoms and quality of life of women with breast cancer.

BMC Womens Health 2020 05 11;20(1):101. Epub 2020 May 11.

School of Nursing, College of Nursing, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan.

Background: The postoperative severity of symptoms among women with breast cancer affects their quality of life (QoL). Although it is recommended that performing shoulder-arm exercise 30 min/day can alleviate symptoms and improve the QoL, there is little research on the mediating effects of performing shoulder-arm exercise 30 min/day on the postoperative severity of symptoms and QoL among patients with breast cancer.

Methods: A cross-sectional study was conducted 2 ~ 4 months after surgery on women diagnosed with breast cancer but with no distant metastasis and who had undergone breast cancer surgery for the first time. A structured questionnaire was employed which included a severity of symptoms scale, performing shoulder-arm exercise for 30 min/day, a QoL scale, demographic characteristics, and medical status.

Results: In total, 117 women with breast cancer completed the survey. The severity of symptoms and performing shoulder-arm exercise 30 min/day separately affected the QoL (B = -0.447, standard error (SE) = 0.050, p < 0.001; B = 15.666, SE = 4.542, p = 0.001, respectively). In model 3, performing shoulder-arm exercise for 30 min/day played a partial mediating role in the relationship of the severity of symptoms and QoL (R = 0.51, F = 5.41, p < 0.001).

Conclusions: During 2 ~ 4 months after surgery, regular shoulder-arm exercise for 30 min/day could decrease the effect of the severity of symptoms on the QoL among women with breast cancer. Clinical healthcare providers may inform and educate patients as to the benefits of regular shoulder-arm exercise for 30 min/day.
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http://dx.doi.org/10.1186/s12905-020-00968-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7216339PMC
May 2020

Impact of window views on recovery-an example of post-cesarean section women.

Int J Qual Health Care 2019 Dec;31(10):798-803

School of Architecture, University of Illinois at Urbana-Champaign, 611 Lorado Taft Drive, Champaign, Illinois, USA.

Objective: The objective of this study was to examine the impact of urban landscape from window views on quality of care for women who underwent Cesarean Section (C-section) in Taiwan.

Design: The participants were randomly assigned into 46 different hospital rooms to see the effects of various window views and daylight exposure on women's recovery from post C-section care.

Setting: We carried out this study in the obstetrics departments of three tertiary hospitals located in two major cities of Taiwan: Taipei City and New Taipei City.

Participants: A total of 296 women who underwent C-sections and used patient-controlled analgesic (PCA) for pain control after their surgery during the 10-month data collection period were recruited for this study.

Intervention: The 46 different patient rooms provided diverse window views and different daylight exposure for the participants.

Main Outcome Measures: Recovery for the women who underwent C-sections in this study was defined as PCA usage and perceived pain measured by Brief Pain Inventory (BFI).

Results: Higher satisfaction of window view significantly decreased analgesic usage (P = 0.057), reduced the scores of overall perceived pain (P = 0.046), pain severity (P = 0.004), and 'pain's interference with relations with others, enjoyment of life, and mood (REM).' (P = 0.095).

Conclusions: To maximize benefit and well-being of patients recovering from surgery, health care architects should design patient rooms to create maximum satisfaction with visual impacts and optimize window views. By doing so, it may decrease the use of pain medication and substantially reduce healthcare costs.
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http://dx.doi.org/10.1093/intqhc/mzz046DOI Listing
December 2019

Mental disorders and medical comorbidities: Association rule mining approach.

Perspect Psychiatr Care 2019 Jul 7;55(3):517-526. Epub 2019 Feb 7.

Department of Nursing, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.

Purpose: This study explored the medical comorbidities of mental disorders using association rule mining.

Design And Methods: Patients diagnosed with mental disorders between 2002 and 2010 were identified. An equal number of nonmental disorder subjects were randomly selected and matched with case group by age and gender.

Findings: Sleep disorders and digestive diseases were frequent comorbidities among mental disorders. The specific medical comorbidities were diabetes mellitus, chronic liver disease, extrapyramidal diseases, disorders of stomach function, general symptoms, sleep disturbance, and family circumstances.

Practice Implications: The results suggest that education of professional knowledge of comorbid conditions should be provided to nurses for caring patients with mental illnesses.
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http://dx.doi.org/10.1111/ppc.12362DOI Listing
July 2019

[An Experience Applying Life Review and Resilience to a Geriatric Patient With Functional Limitations and Depression].

Hu Li Za Zhi 2019 Feb;66(1):115-122

PhD, RN, Professor, School of Gerontology and Health Management, Taipei Medical University, and Nursing Consultant, Department of Nursing, Taipei Medical University- Shuang Ho Hospital, Ministry of Health and Welfare, Taiwan, ROC.

Negative self-values and attitudes during the process of adapting to disease tend to engender depression in the elderly. This case study describes a nursing experience with an elderly patient with depression related to a decline in activity and family role changes related to unexpected spinal infection. The nursing care in this study was provided between February 28th and April 25th, 2017. A comprehensive geriatric assessment was employed, with results showing that the patient was affected by negative self-identity and attitudes. The geriatric depression scale showed moderate depression. Life review strategy was employed in the interview to impart a positive influence on a different life stage and a resilience model was used to interpret the interview transcript. The protective factors were identified and used to develop an individualized nursing intervention that included promoting the support of the husband in order to enhance positive attitude, promoting interactions with the grandchildren in order to increase feelings of independence. Finally, the patient became cognizant of family support and expressed positive words and self-values, which improved depression symptoms. This case report provides a valuable nursing care experience as a reference for similar cases in the future.
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http://dx.doi.org/10.6224/JN.201902_66(1).14DOI Listing
February 2019

Labour pain control by aromatherapy: A meta-analysis of randomised controlled trials.

Women Birth 2019 Aug 19;32(4):327-335. Epub 2018 Oct 19.

Center for Evidence-Based Health Care, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, Zhonghe District, New Taipei City, Taiwan; Shared Decision Making Resource Center, Department of Medical Research, Shuang Ho Hospital, Taipei Medical University, Zhonghe District, New Taipei City, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: Aromatherapy is a treatment method that applies fragrant extracts from herbal plants, existed long ago in medical history as a major treatment approach and now used as an auxiliary treatment and sometimes a major treatment for pain and stress management, including those that occur in labour.

Aim: We aimed to conduct a meta-analysis of randomised controlled trials of the effectiveness of aromatherapy on labour pain and duration reduction.

Methods: We searched the Pubmed, EMBASE, Cochrane Central Register of Controlled Trials, Google Scholar and Clinicaltrials.gov for randomised controlled trials investigating the effectiveness of aromatherapy on labour pain and duration.

Results: A total of 17 trials with low-risk labouring women were included for meta-analysis using the Review Manager 5.3. Meta-analyses showed that aromatherapy reduced labour pain in the transition phase and the duration of active phase and third stage labour; a trend toward shortened duration was observed in the second stage. Also, aromatherapy had no influences on emergency caesarean section, membrane rupture, and spontaneous labour onset.

Conclusion: Our findings suggest that aromatherapy is effective in reducing labour pain and duration, and generally safe to the mothers. However, due to the heterogeneity across trials in some of the outcomes, further trials with device-based pain measurements, larger sample size, and more stringent design, should be conducted before strong recommendation.
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http://dx.doi.org/10.1016/j.wombi.2018.09.010DOI Listing
August 2019

Antiseptic Effect of Conventional Povidone-Iodine Scrub, Chlorhexidine Scrub, and Waterless Hand Rub in a Surgical Room: A Randomized Controlled Trial.

Infect Control Hosp Epidemiol 2017 04 20;38(4):417-422. Epub 2016 Dec 20.

4Center for Evidence-Based Health Care,Shuang Ho Hospital,Taipei Medical University,New Taipei City,Taiwan.

OBJECTIVE Effective perioperative hand antisepsis is crucial for the safety of patients and medical staff in surgical rooms. The antimicrobial effectiveness of different antiseptic methods, including conventional hand scrubs and waterless hand rubs, has not been well evaluated. DESIGN, SETTING, AND PARTICIPANTS A randomized controlled trial was conducted to investigate the effectiveness of the 3 antiseptic methods among surgical staff of Taipei Medical University-Shuang Ho Hospital. For each method used, a group of 80 participants was enrolled. INTERVENTION Surgical hand cleansing with conventional 10% povidone-iodine scrub, conventional 4% chlorhexidine scrub, or waterless hand rub (1% chlorhexidine gluconate and 61% ethyl alcohol). RESULTS Colony-forming unit (CFU) counts were collected using the hand imprinting method before and after disinfection and after surgery. After surgical hand disinfection, the mean CFU counts of the conventional chlorhexidine (0.5±0.2, P<0.01) and waterless hand rub groups (1.4±0.7, P<0.05) were significantly lower than that of the conventional povidone group (4.3±1.3). No significant difference was observed in the mean CFU count among the groups after surgery. Similar results were obtained when preexisting differences before disinfection were considered in the analysis of covariance. Furthermore, multivariate regression indicated that the antiseptic method (P=.0036), but not other variables, predicted the mean CFU count. CONCLUSIONS Conventional chlorhexidine scrub and waterless hand rub were superior to a conventional povidone-iodine product in bacterial inhibition. We recommend using conventional chlorhexidine scrub as a standard method for perioperative hand antisepsis. Waterless hand rub may be used if the higher cost is affordable. Infect Control Hosp Epidemiol 2017;38:417-422.
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http://dx.doi.org/10.1017/ice.2016.296DOI Listing
April 2017

Normal saline instillation before suctioning: A meta-analysis of randomized controlled trials.

Aust Crit Care 2017 Sep 18;30(5):260-265. Epub 2016 Nov 18.

Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taiwan; Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan. Electronic address:

Background: For airway management of intensive care unit (ICU) patients who are intubated, a 5-10-mL bolus of sterile normal saline (NS) solution is commonly instilled into an endotracheal or tracheostomy tube before suctioning. However, NS instillation has been associated with adverse events such as dyspnea, increasing heart rate, decreasing of oxygenation, blood pressure, and other vital parameters.

Objective: To conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the necessity of NS instillation before suctioning in ICU patients.

Data Sources: The PubMed, Embase, Cochrane Library, and Scopus databases and the ClinicalTrials.gov registry were searched for studies published before May 2016.

Review Methods: RCTs evaluating the outcome of NS instillation before suctioning in ICU patients undergoing endotracheal intubation or tracheostomy were included. Individual effect sizes were standardised, and a meta-analysis was conducted to calculate the pooled effect size by using a random-effect model. The primary outcome was the oxygen saturation immediately and 2 and 5min after suctioning. The secondary outcomes were the heart rate and blood pressure after suctioning.

Results: We reviewed 5 RCTs including 337 patients. Oxygen saturation was significantly higher in the non-NS group than in the NS group 5min after suctioning. The pooled mean difference in oxygen saturation was -1.14 (95% confidence interval: -2.25 to -0.03). The heart rate and blood pressure did not differ significantly between the non-NS and NS groups.

Conclusion: NS instillation before suctioning does not benefit patients undergoing endotracheal intubation or tracheostomy. Moreover, it reduces oxygen saturation 5min after suction. However, our reviewed studies had a low methodological quality. Thus, additional studies involving large-scale RCTs are warranted.
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http://dx.doi.org/10.1016/j.aucc.2016.11.001DOI Listing
September 2017

Text Mining of Journal Articles for Sleep Disorder Terminologies.

PLoS One 2016 20;11(5):e0156031. Epub 2016 May 20.

School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan.

Objective: Research on publication trends in journal articles on sleep disorders (SDs) and the associated methodologies by using text mining has been limited. The present study involved text mining for terms to determine the publication trends in sleep-related journal articles published during 2000-2013 and to identify associations between SD and methodology terms as well as conducting statistical analyses of the text mining findings.

Methods: SD and methodology terms were extracted from 3,720 sleep-related journal articles in the PubMed database by using MetaMap. The extracted data set was analyzed using hierarchical cluster analyses and adjusted logistic regression models to investigate publication trends and associations between SD and methodology terms.

Results: MetaMap had a text mining precision, recall, and false positive rate of 0.70, 0.77, and 11.51%, respectively. The most common SD term was breathing-related sleep disorder, whereas narcolepsy was the least common. Cluster analyses showed similar methodology clusters for each SD term, except narcolepsy. The logistic regression models showed an increasing prevalence of insomnia, parasomnia, and other sleep disorders but a decreasing prevalence of breathing-related sleep disorder during 2000-2013. Different SD terms were positively associated with different methodology terms regarding research design terms, measure terms, and analysis terms.

Conclusion: Insomnia-, parasomnia-, and other sleep disorder-related articles showed an increasing publication trend, whereas those related to breathing-related sleep disorder showed a decreasing trend. Furthermore, experimental studies more commonly focused on hypersomnia and other SDs and less commonly on insomnia, breathing-related sleep disorder, narcolepsy, and parasomnia. Thus, text mining may facilitate the exploration of the publication trends in SDs and the associated methodologies.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0156031PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4874549PMC
July 2017

The complete mitochondrial genome of the cryptic "lineage A" big-fin reef squid, Sepioteuthis lessoniana (Cephalopoda: Loliginidae) in Indo-West Pacific.

Mitochondrial DNA A DNA Mapp Seq Anal 2016 07 27;27(4):2433-4. Epub 2015 May 27.

c Department of Environmental Biology and Fisheries Science , National Taiwan Ocean University , Keelung , Taiwan , and.

In this study, the complete mitogenome sequence of the cryptic "lineage A" big-fin reef squid, Sepioteuthis lessoniana (Cephalopoda: Loliginidae) has been sequenced by the next-generation sequencing method. The assembled mitogenome consists of 16,605 bp, which includes 13 protein-coding genes, 22 transfer RNAs, and 2 ribosomal RNAs genes. The overall base composition of "lineage A" S. lessoniana is 37.5% for A, 17.4% for C, 9.1% for G, and 35.9% for T and shows 87% identities to "lineage C" S. lessoniana. It is also noticed by its high T + A content (73.4%), two non-coding regions with TA tandem repeats. The complete mitogenome of the cryptic "lineage A" S. lessoniana provides essential and important DNA molecular data for further phylogeography and evolutionary analysis for big-fin reef squid species complex.
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http://dx.doi.org/10.3109/19401736.2015.1030630DOI Listing
July 2016

Akt suppresses DLK for maintaining self-renewal of mouse embryonic stem cells.

Cell Cycle 2015 ;14(8):1207-17

a Graduate Institute of Life Sciences; National Defense Medical Center ; Taipei , Taiwan.

Mouse embryonic stem cells (ES cells) can proliferate indefinitely. To identify potential signals involved in suppression of self-renewal, we previously screened a kinase/phosphatase expression library in ES cells, and observed that inhibition of Dual Leucine zipper-bearing Kinase (DLK) increased relative cell numbers. DLK protein was detected in both the pluripotent and differentiated states of mouse ES cells while DLK kinase activity increased upon differentiation. Overexpression of DLK in mouse ES cells displayed reductions in relative cell/colony numbers and Nanog expression, suggesting a suppressive role of DLK in self-renewal. By examining protein sequences of DLK, we identified 2 putative Akt phosphorylation sites at S584 and T659. Blocking PI3K/Akt signaling with LY-294002 enhanced DLK kinase activity dramatically. We found that Akt interacts with and phosphorylates DLK. Mutations of DLK amino acid residues at putative Akt phosphorylation sites (S584A, T659A, or S584A and T659A) diminished the level of DLK phosphorylation. While the mutated DLKs (S584A, T659A, or S584A and T659A) were expressed, a further reduction in cell/colony numbers and Nanog expression appeared in mouse ES cells. In addition, these mutant DLKs (S584A, T659A, or S584A and T659A) exhibited more robust kinase activity and cell death compared to wild type DLK or green fluorescence (GFP) controls. In summary, our results show that DLK functions to suppress self-renewal of mouse ES cells and is restrained by Akt phosphorylation.
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http://dx.doi.org/10.1080/15384101.2015.1014144DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4614864PMC
January 2016

Impact of windows and daylight exposure on overall health and sleep quality of office workers: a case-control pilot study.

J Clin Sleep Med 2014 Jun 15;10(6):603-11. Epub 2014 Jun 15.

Department of Neurology, Northwestern University, Chicago, IL.

Study Objective: This research examined the impact of daylight exposure on the health of office workers from the perspective of subjective well-being and sleep quality as well as actigraphy measures of light exposure, activity, and sleep-wake patterns.

Methods: Participants (N = 49) included 27 workers working in windowless environments and 22 comparable workers in workplaces with significantly more daylight. Windowless environment is defined as one without any windows or one where workstations were far away from windows and without any exposure to daylight. Well-being of the office workers was measured by Short Form-36 (SF-36), while sleep quality was measured by Pittsburgh Sleep Quality Index (PSQI). In addition, a subset of participants (N = 21; 10 workers in windowless environments and 11 workers in workplaces with windows) had actigraphy recordings to measure light exposure, activity, and sleep-wake patterns.

Results: Workers in windowless environments reported poorer scores than their counterparts on two SF-36 dimensions--role limitation due to physical problems and vitality--as well as poorer overall sleep quality from the global PSQI score and the sleep disturbances component of the PSQI. Compared to the group without windows, workers with windows at the workplace had more light exposure during the workweek, a trend toward more physical activity, and longer sleep duration as measured by actigraphy.

Conclusions: We suggest that architectural design of office environments should place more emphasis on sufficient daylight exposure of the workers in order to promote office workers' health and well-being.
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http://dx.doi.org/10.5664/jcsm.3780DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4031400PMC
June 2014

Endocytotic routes of cobra cardiotoxins depend on spatial distribution of positively charged and hydrophobic domains to target distinct types of sulfated glycoconjugates on cell surface.

J Biol Chem 2014 Jul 4;289(29):20170-81. Epub 2014 Jun 4.

the Department of Life Sciences and Institute of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu, 30013, Taiwan,

Cobra cardiotoxins (CTX) are a family of three-fingered basic polypeptides known to interact with diverse targets such as heparan sulfates, sulfatides, and integrins on cell surfaces. After CTX bind to the membrane surface, they are internalized to intracellular space and exert their cytotoxicity via an unknown mechanism. By the combined in vitro kinetic binding, three-dimensional x-ray structure determination, and cell biology studies on the naturally abundant CTX homologues from the Taiwanese cobra, we showed that slight variations on the spatial distribution of positively charged or hydrophobic domains among CTX A2, A3, and A4 could lead to significant changes in their endocytotic pathways and action mechanisms via distinct sulfated glycoconjugate-mediated processes. The intracellular locations of these structurally similar CTX after internalization are shown to vary between the mitochondria and lysosomes via either dynamin2-dependent or -independent processes with distinct membrane cholesterol sensitivity. Evidence is presented to suggest that the shifting between the sulfated glycoconjugates as distinct targets of CTX A2, A3, and A4 might play roles in the co-evolutionary arms race between venomous snake toxins to cope with different membrane repair mechanisms at the cellular levels. The sensitivity of endocytotic routes to the spatial distribution of positively charged or hydrophobic domains may provide an explanation for the diverse endocytosis pathways of other cell-penetrating basic polypeptides.
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http://dx.doi.org/10.1074/jbc.M114.557157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4106332PMC
July 2014

Effects of endurance exercise training on risk components for metabolic syndrome, interleukin-6, and the exercise capacity of postmenopausal women.

Geriatr Nurs 2014 May-Jun;35(3):212-8. Epub 2014 Mar 26.

Department of Laboratory Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan, R.O.C.

We conducted this study to investigate how an exercise program affects the risk components of metabolic syndrome (MS), serum interleukin (IL)-6 levels, and exercise capacity in postmenopausal women. A randomized clinical trial design was used. Women in an exercise group participated in a treadmill-exercise program for 12 weeks, whereas women in a control group maintained their customary lifestyle. Data on variables were collected at baseline and after 12 weeks of the study, which was completed by 46 women (mean age, 56.0 ± 7.0 y). Our results indicate endurance exercise exerted significant beneficial effects on waist circumference, serum high-density lipoprotein cholesterol (HDL-C) and IL-6 levels, and exercise capacity (all P < 0.05). The beneficial effects on IL-6 and exercise capacity were correlated with improvements in HDL-C levels (r = -0.33, P = 0.03 and r = 0.31, P = 0.04, respectively). Our results suggest that health-care providers can incorporate an exercise program in treatments to improve the health of postmenopausal women.
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http://dx.doi.org/10.1016/j.gerinurse.2014.02.001DOI Listing
August 2015

Array-based high-throughput screening in mouse embryonic stem cells with shRNAs.

Curr Protoc Stem Cell Biol 2013 Sep 20;26:5C.3.1-5C.3.19. Epub 2013 Sep 20.

Genomics Research Center, Academia Sinica, Taipei, Taiwan.

High-throughput short-hairpin RNA (shRNA) lentivirus screening is a powerful tool for identifying multiple functional regulators in embryonic stem cells (ESCs). shRNA libraries can efficiently down-regulate target genes persistently with high efficiency. The concurrent measurement of relative cell number by alamarBlue (AB) assay and undifferentiated ESC markers via an alkaline phosphatase (ALP) activity assay in the same cell culture well provides an efficient and economical way to pinpoint factors crucial for ESC pluripotency and/or expansion. Most of the renewal pathways affect ALP activity. Thus, multiple positive and negative regulators can be identified by this method. In addition, morphological changes and/or the expression levels of specific pluripotency or differentiation markers examined by immunofluorescence can be used as secondary screens for target-gene selection. In summary, we describe an efficient way to identify multiple regulators of ESC renewal using shRNAs. Curr. Protoc.
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http://dx.doi.org/10.1002/9780470151808.sc05c03s26DOI Listing
September 2013

MicroRNA miR-24 enhances tumor invasion and metastasis by targeting PTPN9 and PTPRF to promote EGF signaling.

J Cell Sci 2013 Mar 15;126(Pt 6):1440-53. Epub 2013 Feb 15.

Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, M4N 3M5, Canada.

MicroRNAs are known to play regulatory roles in gene expression associated with cancer development. We analyzed levels of the microRNA miR-24 in patients with breast carcinoma and found that miR-24 was higher in breast carcinoma samples than in benign breast tissues. We generated constructs expressing miR-24 and studied its functions using both in vitro and in vivo techniques. We found that the ectopic expression of miR-24 promoted breast cancer cell invasion and migration. In vivo experiments in mice indicated that the expression of miR-24 enhanced tumor growth, invasion into local tissues, metastasis to lung tissues and decreased overall mouse survival. In the miR-24-expressing cells and tumors, EGFR was highly phosphorylated, whereas expression of the phosphatases tyrosine-protein phosphatase non-receptor type 9 (PTPN9) and receptor-type tyrosine-protein phosphatase F (PTPRF) were repressed. We confirmed that miR-24 could directly target both PTPN9 and PTPRF. Consistent with this, we found that the levels of phosphorylated epidermal growth factor receptor (pEGFR) were higher whereas the levels of PTPN9 and PTPRF were lower in the patients with metastatic breast carcinoma. Ectopic expression of PTPN9 and PTPRF decreased pEGFR levels, cell invasion, migration and tumor metastasis. Furthermore, we found that MMP2, MMP11, pErk, and ADAM15 were upregulated, whereas TIMP2 was downregulated; all of which supported the roles of miR-24 in tumor invasion and metastasis. Our results suggest that miR-24 plays a key role in breast cancer invasion and metastasis. miR-24 could potentially be a target for cancer intervention.
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http://dx.doi.org/10.1242/jcs.118299DOI Listing
March 2013

A shRNA functional screen reveals Nme6 and Nme7 are crucial for embryonic stem cell renewal.

Stem Cells 2012 Oct;30(10):2199-211

Genomics Research Center, Academia Sinica, Taipei, Taiwan.

In contrast to the somatic cells, embryonic stem cells (ESCs) are characterized by its immortalization ability, pluripotency, and oncogenicity. Revealing the underlying mechanism of ESC characteristics is important for the application of ESCs in clinical medicine. We performed systematic functional screen in mouse ESCs with 4,801 shRNAs that target 929 kinases and phosphatases. One hundred and thirty-two candidate genes that regulate both ESC expansion and stem cell marker expression were identified. Twenty-seven out of the 132 genes were regarded as most important since knockdown of each gene induces morphological changes from undifferentiated to differentiated state. Among the 27 genes, we chose nonmetastatic cell 6 (Nme6, also named as Nm23-H6) and nonmetastatic cell 7 (Nme7, also designated as Nm23-H7) to study first. Nme6 and Nme7 both belong to the members of nucleoside diphosphate kinase family. We demonstrate that Nme6 and Nme7 are important for the regulation of Oct4, Nanog, Klf4, c-Myc, telomerase, Dnmt3B, Sox2, and ERas expression. Either knockdown of Nme6 or Nme7 reduces the formation of embryoid body (EB) and teratoma. The overexpression of either Nme6 or Nme7 can rescue the stem cell marker expression and the EB formation in the absence of leukemia inhibiting factor. This implies the importance of Nme6 and Nme7 in ESC renewal. This finding not only pinpoints Nme6 or Nme7 can regulate several critical regulators in ESC renewal but also increases our understanding of the ESC renewal and oncogenesis.
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http://dx.doi.org/10.1002/stem.1203DOI Listing
October 2012

A non-coding transcript of nephronectin promotes osteoblast differentiation by modulating microRNA functions.

FEBS Lett 2011 Aug 23;585(16):2610-6. Epub 2011 Jul 23.

Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.

We investigated the roles of the non-coding transcripts and found that expression of a fragment containing the 3'-untranslated region (3'-UTR) of nephronectin in osteoblast progenitor cells MC3T3-E1 promoted cell differentiation dramatically. We hypothesized that the ectopically expressed 3'-UTR binds microRNAs and modulates their functions. β-Catenin and GSK3β were up-regulated in the 3'-UTR-transfected cells, contributing to the increased cell differentiation, through reduction of EGFR and ERK phosphorylation. Activator of GSK3β promoted differentiation, while inhibitor of GSK3β blocked differentiation. Our results indicate that the non-coding transcripts are important in regulating cell activities and may have potential application for modulating endogenous microRNA functions.
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http://dx.doi.org/10.1016/j.febslet.2011.07.016DOI Listing
August 2011

Origin of the mass mortality of the flathead grey mullet (Mugil cephalus) in the Tanshui River, northern Taiwan, as indicated by otolith elemental signatures.

Mar Pollut Bull 2011 Aug 8;62(8):1809-13. Epub 2011 Jun 8.

Department of Environmental Biology and Fisheries Science, National Taiwan Ocean University, Keelung 104, Taiwan, ROC.

A massive fish kill of approximately 50 tons of flathead grey mullet (Mugil cephalus) occurred in August 2006 in the Tanshui River, northern Taiwan. To clarify the origin of these mullets, 42 individuals were randomly collected to determine their ages by reading otolith annuli and to measure the trace elements in the otolith. The total lengths of the fish averaged 32.7±4.4 cm, and most of the individuals were 2 years old, indicating that the mullets in the mass fish kill event were in the immature and growth stages. The Sr/Ca and Ba/Ca ratios of a subsample of 14 otoliths showed that half of the fish killed were estuarine residents, and the rest originated from marine and freshwater habitats. The multiple causes involved in this fish kill implied that additional unknown factors influenced the mullet populations on a large scale and induced them to move quickly and gather at this estuary.
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http://dx.doi.org/10.1016/j.marpolbul.2011.05.011DOI Listing
August 2011

Cell surface heparan sulfates mediate internalization of the PWWP/HATH domain of HDGF via macropinocytosis to fine-tune cell signalling processes involved in fibroblast cell migration.

Biochem J 2011 Jan;433(1):127-38

Department of Life Sciences and Institute of Bioinformatics and Structural Biology, National Tsing Hua University, Hsinchu, Taiwan.

HDGF (hepatoma-derived growth factor) stimulates cell proliferation by functioning on both sides of the plasma membrane as a ligand for membrane receptor binding to trigger cell signalling and as a stimulator for DNA synthesis in the nucleus. Although HDGF was initially identified as a secretory heparin-binding protein, the biological significance of its heparin-binding ability remains to be determined. In the present study we demonstrate that cells devoid of surface HS (heparan sulfate) were unable to internalize HDGF, HATH (N-terminal domain of HDGF consisting of amino acid residues 1-100, including the PWWP motif) and HATH(K96A) (single-site mutant form of HATH devoid of receptor binding activity), suggesting that the binding of HATH to surface HS is important for HDGF internalization. We further demonstrate that both HATH and HATH(K96A) could be internalized through macropinocytosis after binding to the cell surface HS. Interestingly, HS-mediated HATH(K96A) internalization is found to exhibit an inhibitory effect on cell migration and proliferation in contrast with that observed for HATH action on NIH 3T3 cells, suggesting that HDGF exploits the innate properties of both cell surface HS and membrane receptor via the HATH domain to affect related cell signalling processes. The present study indicates that MAPK (mitogen-activated protein kinase) signalling pathways could be affected by the HS-mediated HATH internalization to regulate cell migration in NIH 3T3 fibroblasts, as judged from the differential effect of HATH and HATH(K96A) treatment on the expression level of matrix metalloproteases.
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http://dx.doi.org/10.1042/BJ20100589DOI Listing
January 2011

MicroRNA miR-378 regulates nephronectin expression modulating osteoblast differentiation by targeting GalNT-7.

PLoS One 2009 Oct 21;4(10):e7535. Epub 2009 Oct 21.

Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.

MicroRNAs (miRNAs) are small fragments of single-stranded RNA containing 18-24 nucleotides, and are generated from endogenous transcripts. MicroRNAs function in post-transcriptional gene silencing by targeting the 3'-untranslated region (UTR) of mRNAs, resulting in translational repression. We have developed a system to study the role of miRNAs in cell differentiation. We have found that one of the miRNAs tested in our system (miR-378, also called miR-378*) plays a role in modulating nephronectin-mediated differentiation in the osteoblastic cell line, MC3T3-E1. Nephronectin is an extracellular matrix protein, and we have demonstrated that its over-expression enhanced osteoblast differentiation and bone nodule formation. Furthermore, we found that the nephronectin 3'-untranslated region (3'UTR) contains a binding site for miR-378. Stable transfection of MC3T3-E1 cells with miR-378 inhibited cell differentiation. MC3T3-E1 cells stably transfected with nephronectin exhibited higher rates of differentiation and nodule formation as compared with cells transfected with nephronectin containing the 3'UTR in the early stages of development, suggesting that endogenous miR-378 is present and active. However, in the later stages of MC3T3-E1 development, the differentiation rates were opposite, with higher rates of differentiation and nodule formation in the cells over-expressing the 3'UTR of nephronectin. This appeared to be the consequence of competition between nephronectin and UDP-N-acetyl-alpha-D-galactosamine:polypeptide N-acetylgalactosaminyltransferase 7 (GalNAc-T7 or GalNT7) for miR-378 binding, resulting in increased GalNT7 activity, which in turn lead to increased nephronectin glycosylation and product secretion, thereby resulting in a higher rate of osteoblast differentiation.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0007535PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2760121PMC
October 2009

MicroRNA miR-328 regulates zonation morphogenesis by targeting CD44 expression.

PLoS One 2008 Jun 18;3(6):e2420. Epub 2008 Jun 18.

Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada.

Morphogenesis is crucial to initiate physiological development and tumor invasion. Here we show that a microRNA controls zonation morphogenesis by targeting hyaluronan receptor CD44. We have developed a novel system to study microRNA functions by generating constructs expressing pre-miRNAs and mature miRNAs. Using this system, we have demonstrated that expression of miR-328 reduced cell adhesion, aggregation, and migration, and regulated formation of capillary structure. Protein analysis indicated that miR-328 repressed CD44 expression. Activities of luciferase constructs harboring the target site in CD44, but not the one containing mutation, were repressed by miR-328. Zonation morphogenesis appeared in cells transfected by miR-328: miR-328-transfected cells were present on the surface of zonating structures while the control cells stayed in the middle. MiR-328-mediated CD44 actions was validated by anti-CD44 antibody, hyaluronidase, CD44 siRNA, and CD44 expression constructs. In vivo experiments showed that CD44-silencing cells appeared as layers on the surfaces of nodules or zonating structures. Immuno-histochemistry also exhibited CD44-negative cells on the surface layers of normal rat livers and the internal zones of Portal veins. Our results demonstrate that miR-328 targets CD44, which is essential in regulating zonation morphogenesis: silencing of CD44 expression is essential in sealing the zonation structures to facilitate their extension and to inhibit complex expansion.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0002420PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2409976PMC
June 2008