Publications by authors named "Jia-Yuh Chen"

111 Publications

Neurodevelopment of preterm infants with glucose and sodium abnormalities.

Pediatr Neonatol 2021 Jul 17. Epub 2021 Jul 17.

Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address:

Background: Blood glucose and serum sodium abnormalities in very low birth weight infants may cause increased morbidity and mortality, but data regarding the long-term outcomes are limited. This study aimed to investigate the association between the peak and nadir blood glucose and serum sodium levels and neurodevelopmental outcomes in very low birth weight infants.

Methods: A single-center retrospective medical record of 284 infants with birth weight<1500 g born between February 1, 2011 and January 31, 2015 was reviewed. We analyzed the correlation between peak and nadir blood glucose and serum sodium levels during hospitalization and Bayley Scales of Infant and Toddler Development, third edition at 6, 12, and 24 months of corrected age.

Results: A total of 284 very low birth weight premature infants were eligible, and 223, 208, and 188 patients were assessed at 6, 12, and 24 months of corrected age, respectively. Multiple linear regression analysis with generalized estimating equations showed that the BSID-III cognitive scores were significantly lower in the peak serum sodium group when sodium was ≧150 mmol/L (95% confidence interval -11.681 to -0.822) than when sodium did not exceed 150 mmol/L.

Conclusion: A peak serum sodium of ≧150 mmol/L is associated with poor cognitive outcomes in very low birth weight infants. Further studies are necessary to determine if this association is causal or an expression of disease severity.
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http://dx.doi.org/10.1016/j.pedneo.2021.06.008DOI Listing
July 2021

Heat Shock Protein-70 Levels Are Associated With a State of Oxidative Damage in the Development of Bronchopulmonary Dysplasia.

Front Pediatr 2021 26;9:616452. Epub 2021 May 26.

Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan.

Heat shock protein-70 (Hsp-70) exhibits cytoprotective effects against oxidative stress-induced airway injury. This study aimed to examine Hsp-70 and 8-hydroxy-2'-deoxyguanosine (8-OHdG) from tracheal aspirates (TA) in very low-birth weight (VLBW) preterm infants to predict the development of bronchopulmonary dysplasia (BPD). This birth cohort study enrolled 109 VLBW preterm infants, including 32 infants who developed BPD. Hsp-70 and 8-OHdG concentrations from TA were measured by immunoassay. The apoptosis of TA epithelial cells obtained on Day 28 after birth was measured using annexin-V staining assay. Hsp-70 and 8-OHdG levels in TA fluid were persistently increased from Day 1 to Day 28 of life in the BPD group. Multiple linear regression analysis demonstrated that BPD was significantly associated with gestational age, respiratory distress syndrome, and TA Hsp-70 and 8-OHdG levels on post-natal Day 28. The TA Hsp-70 level positively correlated with TA 8-OHdG level on the Day 1 ( = 0.47) and Day 28 of life ( = 0.68). Incubation of recombinant Hsp-70 with primary epithelial cells derived from TA of patients decreased hydrogen peroxide-induced epithelial cell death. Hsp-70 levels are associated with a state of oxidative injury in the development of BPD.
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http://dx.doi.org/10.3389/fped.2021.616452DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8187579PMC
May 2021

Outcomes following liver transplantation in young infants: Data from the SPLIT registry.

Am J Transplant 2021 03 5;21(3):1113-1127. Epub 2020 Sep 5.

Liver and Small Bowel Transplantation, Seattle Children's Hospital, Seattle, Washington, USA.

Liver transplantation (LT) in young patients is being performed with greater frequency. We hypothesized that objective analysis of pre-, intra-, and postoperative events would help understand contributors to successful outcomes and guide transplant decision processes. We queried SPLIT registry for pediatric transplants between 2011 and 2018. Outcomes were compared for age groups: 0-<3, 3-<6, 6-<12 months, and 1-<3 years (Groups A, B, C, D respectively) and by weight categories: <5, 5-10, >10 kg; 1033 patients were available for analysis. Cholestatic disease and fulminant failure were highest in group A and those <5 kg; and biliary atresia in group C (72.8%). Group A had significantly higher life support dependence (34.6%; P < .001), listing as United Network for Organ Sharing status 1a/1b (70.4%; P < .001), and shortest wait times (P < .001). The median (interquartile range) for international normalized ratio and bilirubin were highest in group A (3.0 [2.1-3.9] and 16.7 [6.8-29.7] mg/dL) and those <5 kg (2.6 [1.8-3.4] and 13.5 [3.0-28.4] mg/dL). A pediatric end -stage liver disease score ≥40, postoperative hospital stays, rejection, and nonanastomotic biliary strictures were highest in group A with lowest survival at 93.1%. Infants 0 to <3 months and those <5 kg need more intensive care with lower survival and higher complications. Importantly, potential LT before reaching status 1a/1b and aggressive postoperative management may positively influence their outcomes.
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http://dx.doi.org/10.1111/ajt.16236DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867666PMC
March 2021

Impact of Personal Protective Equipment on Pediatric Cardiopulmonary Resuscitation Performance: A Controlled Trial.

Pediatr Emerg Care 2020 Jun;36(6):267-273

Feinberg School of Medicine, Northwestern University, Chicago, IL.

Objectives: This study aimed to determine whether personal protective equipment (PPE) results in deterioration in chest compression (CC) quality and greater fatigue for administering health care providers (HCPs).

Methods: In this multicenter study, HCPs completed 2 sessions. In session 1 (baseline), HCPs wore normal attire; in session 2, HCPs donned full PPE. During each session, they performed 5 minutes of uninterrupted CCs on a child manikin. Chest compression rate, depth, and release velocity were reported in ten 30-second epochs. Change in CC parameters and self-reported fatigue were measured between the start and 2- and 5-minute epochs.

Results: We enrolled 108 HCPs (prehospital and in-hospital providers). The median CC rate did not change significantly between epochs 1 and 10 during baseline sessions. Median CC depth and release velocity decreased for 5 minutes with PPE. There were no significant differences in CC parameters between baseline and PPE sessions in any provider group. Median fatigue scores during baseline sessions were 2 (at start), 4 (at 2 minutes), and 6 (at 5 minutes). There was a significantly higher median fatigue score between 0 and 5 minutes in both study sessions and in all groups. Fatigue scores were significantly higher for providers wearing PPE compared with baseline specifically among prehospital providers.

Conclusions: During a clinically appropriate 2-minute period, neither CC quality nor self-reported fatigue worsened to a significant degree in providers wearing PPE. Our data suggest that Pediatric Basic Life Support recommendations for CC providers to switch every 2 minutes need not be altered with PPE use.
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http://dx.doi.org/10.1097/PEC.0000000000002109DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7274141PMC
June 2020

Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Procedures by Prehospital Providers.

Disaster Med Public Health Prep 2020 May 11:1-8. Epub 2020 May 11.

Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

Background: Personal protective equipment (PPE) is worn by prehospital providers (PHPs) for protection from hazardous exposures. Evidence regarding the ability of PHPs to perform resuscitation procedures has been described in adult but not pediatric models. This study examined the effects of PPE on the ability of PHPs to perform resuscitation procedures on pediatric patients.

Methods: This prospective study was conducted at a US simulation center. Paramedics wore normal attire at the baseline session and donned full Level B PPE for the second session. During each session, they performed timed sets of psychomotor tasks simulating clinical care of a critically ill pediatric patient. The difference in time to completion between baseline and PPE sessions per task was examined using Wilcoxon signed-rank tests.

Results: A total of 50 paramedics completed both sessions. Median times for task completion at the PPE sessions increased significantly from baseline for several procedures: tracheal intubation (+4.5 s; P = 0.01), automated external defibrillator (AED) placement (+9.5 s; P = 0.01), intraosseous line insertion (+7 s; P < 0.0001), tourniquet (+8.5 s; P < 0.0001), intramuscular injection (+21-23 s, P < 0.0001), and pulse oximetry (+4 s; P < 0.0001). There was no significant increase in completion time for bag-mask ventilation or autoinjector use.

Conclusions: PPE did not have a significant impact on PHPs performing critical tasks while caring for a pediatric patient with a highly infectious or chemical exposure. This information may guide PHPs faced with the situation of resuscitating children while wearing Level B PPE.
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http://dx.doi.org/10.1017/dmp.2020.128DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7385319PMC
May 2020

The Risk of Developing Constipation After Neonatal Necrotizing Enterocolitis.

Front Pediatr 2020 3;8:120. Epub 2020 Apr 3.

Department of Pediatrics, School of Medicine, Chung Shan Medical University, Taichung, Taiwan.

Neonatal necrotizing enterocolitis (NEC) is a complex and lethal inflammatory bowel necrosis that primarily affects premature infants. Gut dysbiosis has been implicated in the pathogenesis of NEC. We aim to assess the association between NEC and two other diseases in children, including allergic diseases and constipation, considered to be associated with the alterations in gut microbiota composition. This retrospective population-based cohort study was conducted using the Taiwan Birth Registration Database, Birth Certificate Application, and National Health Insurance Research Database to inter-link the medical claims of neonates and their mothers. A total of 2,650,634 delivery events were retrieved from 2005 to 2015. We identified a NEC cohort and selected a comparison cohort according to propensity score matching (1:1). Cox proportional hazard regression models were used to determine possible associations of predictors and to obtain adjusted hazard ratios (aHRs). A total of 1,145 subjects in the NEC cohort and 1,145 subjects in the matched cohort were analyzed during the observation period. No significant difference was observed in the incidence of allergic diseases between the two groups. NEC patients had a significant 30.7% increased risk of developing constipation (aHR = 1.307; 95% CI 1.089-1.568). The cumulative incidence of constipation was significantly higher in the NEC cohort than in the matched cohort by the end of follow-up (log-rank test = 0.003). Infants with NEC have a significantly higher incidence rate of developing constipation and FTT but no increased risk of allergic diseases.
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http://dx.doi.org/10.3389/fped.2020.00120DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7147349PMC
April 2020

Impact of Personal Protective Equipment on the Performance of Emergency Pediatric Tasks.

Pediatr Emerg Care 2020 Feb 24. Epub 2020 Feb 24.

Department of Pediatrics, Perelman School of Medicine of the University of Pennsylvania, Philadelphia, PA.

Objectives: Personal protective equipment (PPE) is worn by health care providers (HCPs) to protect against hazardous exposures. Studies of HCPs performing critical resuscitation tasks in PPE have yielded mixed results and have not evaluated performance in care of children. We evaluated the impacts of PPE on timeliness or success of emergency procedures performed by pediatric HCPs.

Methods: This prospective study was conducted at 2 tertiary children's hospitals. For session 1, HCPs (medical doctors and registered nurses) wore normal attire; for session 2, they wore full-shroud PPE garb with 2 glove types: Ebola level or chemical. During each session, they performed clinical tasks on a patient simulator: intubation, bag-valve mask ventilation, venous catheter (IV) placement, push-pull fluid bolus, and defibrillation. Differences in completion time per task were compared.

Results: There were no significant differences in medical doctor completion time across sessions. For registered nurses, there was a significant difference between baseline and PPE sessions for both defibrillation and IV placement tasks. Registered nurses were faster to defibrillate in Ebola PPE and slower when wearing chemical PPE (median difference, -3.5 vs 2 seconds, respectively; P < 0.01). Registered nurse IV placement took longer in Ebola and chemical PPE (5.5 vs 42 seconds, respectively; P < 0.01). After the PPE session, participants were significantly less likely to indicate that full-body PPE interfered with procedures, was claustrophobic, or slowed them down.

Conclusions: Personal protective equipment did not affect procedure timeliness or success on a simulated child, with the exception of IV placement. Further study is needed to investigate PPE's impact on procedures performed in a clinical care context.
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http://dx.doi.org/10.1097/PEC.0000000000002028DOI Listing
February 2020

Validation and human factor analysis study of an infant weight estimation device.

BMC Pediatr 2020 01 22;20(1):30. Epub 2020 Jan 22.

Duke Clinical Research Institute, Durham, NC, USA.

Background: Weight is critical for the medical management of infants; however, scales can be unavailable or inaccessible in some practice settings. We recently developed and validated a robust infant weight estimation method based on chest circumference (CC) and head circumference (HC). This study was designed to determine the human factors (HF) experience with, and predictive performance of, an infant weight estimation device that implements this method.

Methods: Prospective, multi-center, observational, masked study of 486 preterm and term infants (0-90 days) assessed by 15 raters. Raters measured the infant using calibrated scales/measures and masked versions of the device. Raters also evaluated critical tasks associated with device use. Mean error (ME) and mean percentage error (MPE) were used to assess predictive performance.

Result: Among 486 infants enrolled (36.8 ± 4.0 weeks gestational age, 31.5 ± 28.6 days postnatal age), predicted weight correlated highly with actual weight (r = 0.97, ME: - 69 ± 257 g, MPE: - 1.3 ± 6.9%). Predicted weight was within 10 and 15% of actual weight in 86 and 99%, of infants. HF errors were low, 0.1-0.8% depending on task. In all cases raters were confident or very confident in their measurements.

Conclusion: The device was statistically equivalent to the method on which it was based and approximated weight with acceptable variance from the true weight. HF data suggest the device is easy to use. This device can be used to estimate weight in infants when calibrated scales are impractical or unavailable.
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http://dx.doi.org/10.1186/s12887-020-1933-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6977278PMC
January 2020

Effects of fish oil-containing lipid emulsions on retinopathy of prematurity in very low birth weight infants.

Pediatr Neonatol 2020 04 30;61(2):224-230. Epub 2019 Nov 30.

Department of Neonatology, Changhua Christian Children's Hospital, Changhua, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Kaohsiung Medical University, Taiwan. Electronic address:

Background: The aim of the study was to assess the impact of different types of parenteral emulsions on retinopathy of prematurity (ROP) in very low birth weight (VLBW, birth body weight < 1500 g) infants by comparing fish oil-containing and soy-based parenteral emulsions.

Methods: Data of preterm infants with body weights below 1500 gm at birth and receiving total parenteral nutrition (TPN) for a minimum of 7 days during the period between January 2009 and November 2017 were analyzed in this retrospective study. We compared clinical outcomes in two epochs using different lipid emulsions: epoch 1 (soybean-based lipid emulsions, January 2009-February 2014) versus epoch 2 (fish oil-containing lipid emulsions, January 2015-November 2017). The primary outcomes measured were the incidence of ROP and the number of ROP cases requiring bevacizumab therapy.

Results: A total of 396 infants were enrolled in this study (203 in epoch 1 and 193 in epoch 2). A lower incidence of any stage ROP (24.1 vs. 11.4%, p < 0.001) and lower requirement of bevacizumab therapy (12.8 vs. 5.2%, p = 0.001) were observed in epoch 2. Gestational age, glutamic-pyruvic transaminase, total bilirubin, and alkaline phosphatase levels, and type of lipid emulsion in TPN were associated with higher ROP incidence. Multivariate logistic regression analysis revealed that parenteral nutrition in the form of lipid emulsions containing fish oil was associated with a lower risk of development of ROP [Odds Ratio: 0.178, 95% confidence interval (CI): 0.095-0.330, p < 0.001].

Conclusions: Compared with soybean-based lipid solutions, the use of fish oil-containing lipid solutions may be associated with a lower incidence of ROP and decreased need for bevacizumab treatment in preterm infants.
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http://dx.doi.org/10.1016/j.pedneo.2019.11.010DOI Listing
April 2020

Minimally invasive surfactant therapy versus intubation for surfactant administration in very low birth weight infants with respiratory distress syndrome.

Pediatr Neonatol 2020 04 13;61(2):210-215. Epub 2019 Nov 13.

Division of Neonatology, Department of Pediatrics, Changhua Christian Children's Hospital, Changhua City, Taiwan; Institute of Medicine, Chung-Shan Medical University, Taichung, Taiwan. Electronic address:

Background: Minimally invasive surfactant therapy (MIST) is a new mode of surfactant administration without intubation to spontaneously breathing preterm infants with respiratory distress syndrome (RDS). The aims of this study were to assess the feasibility, efficacy and safety of using MIST to give surfactant for very low birth weight (VLBW) infants with RDS.

Methods: In total, 53 VLBW infants who were born before 32 gestational weeks with spontaneous breathing, respiratory distress, and requiring surfactant therapy were divided into two groups. The infants in group A (n = 29) were intubated and received surfactant replacement therapy via endotracheal tube, followed by mechanical ventilation (MV). The infants in group B (n = 24) received tracheal instillation of surfactant via a semirigid vascular catheter during spontaneous breathing under nasal continuous positive airway pressure (nCPAP). After surfactant instillation, the infants in group B were still placed on nCPAP.

Results: Our data showed that infants in group B (MIST group) had significantly lower rate (P < 0.05) of composite outcome of death or bronchopulmonary dysplasia (BPD), duration of intermittent positive airway pressure ventilation (IPPV) or MV, drug treatment of patent ductus arteriosus (PDA), and surgical ligation of PDA than group A.

Conclusion: MIST is feasible, safe and it may reduce the composite outcome of death or BPD for VLBW infants with RDS requiring surfactant replacement therapy.
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http://dx.doi.org/10.1016/j.pedneo.2019.11.002DOI Listing
April 2020

Effect of high-frequency oscillatory ventilation combined with volume guarantee on preterm infants with hypoxic respiratory failure.

J Chin Med Assoc 2019 Nov;82(11):861-864

Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC.

Background: The aim of this study was to assess the effect of volume guarantee (VG) on high-frequency oscillatory ventilation (HFOV) compared with HFOV alone in preterm infants with hypoxic respiratory failure (HRF).

Methods: Fifty-two preterm infants with HRF refractory to conventional mechanical ventilation (CMV) were enrolled in this study. Between June 2012 and February 2016, HFOV alone was used as rescue therapy when CMV failed for 34 infants, whereas HFOV combined with VG was used as rescue therapy for the other 18 infants between March 2016 and December 2017.

Results: HFOV combined with VG resulted in a reduction in the combined outcome of death or bronchopulmonary dysplasia (BPD) (p = 0.017) and also a reduction in episodes of hypercarbia (p = 0.010) compared with HFOV alone.

Conclusion: In this study, the preterm infants with HRF ventilated using HFOV combined with VG had a reduced combined outcome of death or BPD and hypercarbia compared with those who received HFOV alone.
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http://dx.doi.org/10.1097/JCMA.0000000000000146DOI Listing
November 2019

Birth defects in Taiwan: A 10-year nationwide population-based, cohort study.

J Formos Med Assoc 2020 Jan 30;119(1 Pt 3):553-559. Epub 2019 Aug 30.

Division of Neonatology, Changhua Christian Children's Hospital, Changhua City, Taiwan; Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan. Electronic address:

Background/purpose: Birth defects (BDs) are main causes of mortality and disability in infants and children. The aims of this study were to analyze the prevalence, types and risk factors of BDs in Taiwan.

Methods: Data of all births (including live and stillbirths), types, characteristics, and associated risk factors of BDs were obtained from the National Birth Registry and National Health Insurance Research Data base in Taiwan between 2005 and 2014. Birth defects were coded according to International Classification of Diseases 9th Revision-Clinical Modification codes 740-759.

Results: A total of 55,299 infants were diagnosed as having BDs among 2,033,004 births. The prevalence of BDs was 271.66 per 10,000 births. The prevalence of BDs did not change significantly between 2005 and 2014, there was a higher birth rate and lower BDs in 2012 (year of dragon) in Taiwan. The most common type of BDs was cardiovascular abnormalities, and ventricular septal defect was the most common disease. Extreme maternal age (<18 years or ≧30 years), preterm, and low birth weight were associated with BDs. Maternal diseases associated with BDs included hypertension, cardiovascular diseases, renal diseases, genitourinary infections, anemia, mental disorders, and diabetes mellitus.

Conclusion: The prevalence of BDs was 271.66 per 10,000 births. The most common types of BDs were cardiovascular abnormalities. If we can reduce maternal chronic diseases, we will decrease the prevalence of BDs.
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http://dx.doi.org/10.1016/j.jfma.2019.08.006DOI Listing
January 2020

Volume-targeted versus pressure-limited ventilation for preterm infants.

J Chin Med Assoc 2019 Oct;82(10):791-794

Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan, ROC.

Background: To compare the effects of volume-targeted ventilation (VTV) with pressure-limited ventilation (PLV) in preterm infants.

Methods: A total of 100 preterm infants who required mechanical ventilation during the two study periods were investigated. PLV was used for 50 preterm infants during period 1 and VTV was used for 50 preterm infants during period 2. Clinical outcomes including mortality rate, duration of mechanical ventilation, air leak syndrome, hypocarbia, hypercarbia, hypoxemia, combined outcome of death or bronchopulmonary dysplasia (BPD), intraventricular hemorrhage, and retinopathy of prematurity were evaluated.

Results: There was no significant difference (p > 0.05) in the duration of mechanical ventilation, air leak syndrome, hypocarbia, hypoxemia, or BPD between the two study groups. The mortality rate, hypercarbia, and combined outcome of death or BPD were significantly lower (p < 0.05) in the VTV group compared with the PLV group.

Conclusion: Preterm infants using VTV had a lower mortality rate, less hypercarbia, and a significant decrease in the combined outcome of death or BPD.
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http://dx.doi.org/10.1097/JCMA.0000000000000111DOI Listing
October 2019

Nebulized salbutamol diminish the blood glucose fluctuation in the treatment of non-oliguric hyperkalemia of premature infants.

J Chin Med Assoc 2019 Jan;82(1):55-59

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC.

Background: Hyperkalemia is a risky and potentially life-threatening condition in pre-term infants. Glucose-insulin infusion has been considered a major therapeutic way for non-oligouric hyperkalemia but affects the stability of blood sugar level. We aimed to evaluate the effectiveness of salbutamol nebulization compared to glucose-insulin infusion for the treatment of non-oliguric hyperkalemia in premature infants.

Methods: Forty premature infants (gestation age ≤36 weeks) with non-oliguric hyperkalemia (central serum potassium level greater than 6.0 mmol/L) within 72 h of birth were enrolled in this study. These infants were randomly assigned into two groups. One group received a regular insulin bolus with glucose infusion (Group A; n = 20), and the other received salbutamol (Ventolin) by nebulization (Group B; n = 20). Potassium level, blood sugar, heart rate, and blood pressure were recorded for each group before treatment and at 3, 12, 24, 48, and 72 h post-treatment.

Results: The serum potassium levels were reduced after treatment in both groups. No significant changes in heart rate or blood pressure were observed in either group. The fluctuation in glucose levels was gentler in the salbutamol-treated group than in the glucose-insulin infusion group.

Conclusion: Salbutamol nebulization is not only as effective as glucose-insulin infusion for treating non-oliguric hyperkalemia in premature infants but can avoid potential side effects such as vigorous blood glucose fluctuations.
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http://dx.doi.org/10.1016/j.jcma.2018.04.002DOI Listing
January 2019

Intravenous fish oil containing lipid emulsion attenuates inflammatory cytokines and the development of bronchopulmonary dysplasia in very premature infants: A double-blind, randomized controlled trial.

Clin Nutr 2019 06 18;38(3):1045-1052. Epub 2018 Jun 18.

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Pediatrics, Changhua Christian Children's Hospital, Changhua, Taiwan; School of Medicine, Kaohsiung Medical University, Taiwan. Electronic address:

Background & Aims: Preterm infants have lower levels of long-chain polyunsaturated fatty acids (LCPUFAs). Supplementing very premature infants with intravenous lipid emulsions that fish oil, which is rich in n-3 LC-PUFAs, may decrease bronchopulmonary dysplasia (BPD) by modulating inflammation and neonatal immune function.

Methods: Sixty very low birth weight (VLBW) premature infants requiring ventilator support were randomized in a double-blind manner to 2 groups and received total parenteral nutrition with fish oil containing LE (intervention group, n = 30) or soybean oil containing LE (control group, n = 30) for 7 days. Blood samples and bronchoalveolar lavage fluid (BALF) were obtained for assay on day 1 and 7 days after LE. The primary outcome was to compare the levels of interleukin (IL)-1β and IL-6 in serum and BALF. Secondary outcomes were to compare mortality and co-morbidities.

Results: The levels of IL-1β and IL-6 in serum and BALF were significantly lower in the intervention group at day 8 (p < 0.05). The incidence of BPD in the intervention group compared to the control group was 13.3% versus 36.7% (p = 0.04; odds ratio [OR], 0.36; 95% confidence interval [CI], 0.21-0.86). The duration of ventilator support and oxygen use was significantly less in the intervention group than in the control group (p < 0.05). The level of alanine aminotransferase was significantly lower in the intervention group on day 8 (p = 0.031).

Conclusions: In very premature infants, early administration of fish oil containing LE significantly decreased IL-1β and IL-6 levels in serum and BALF and was associated with shorter duration of ventilator support and less bronchopulmonary dysplasia (BPD).

Trial Registration Number: ISRCTN 11427103.
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http://dx.doi.org/10.1016/j.clnu.2018.06.929DOI Listing
June 2019

The value of real-time continuous glucose monitoring in premature infants of diabetic mothers.

PLoS One 2017 16;12(10):e0186486. Epub 2017 Oct 16.

Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan.

To determine the feasibility of using a real-time continuous glucose monitoring system (RTGMS) in intensive care units, our study focus on preterm infants with diabetic mothers owing to their high risk of blood sugar abnormalities. Thirty preterm babies (M = 15 and F = 15; ≤ 36 week gestation age) were studied from within 72 hours of delivery. These babies were admitted to the newborn intensive care and were further categorized into groups based on whether their mothers with or without diabetic mellitus. Blood sugar levels were monitored by both RTGMS and the traditional intermittent arterial line (A-Line) glucose method. Continuous glucose monitoring were well tolerated in 30 infants. There were good consistency between RTGMS and A-Line glucose concentration measurements. Of the preterm infants, 33.33% experienced abnormal glucose levels (hypoglycemia or hyperglycemia) between the checkpoint intervals of the intermittent A-Line blood sugar measurements. RTGM showed advantages with regards to reduced pain, greater comfort, the provision of real-time information, high sensitivity (94.59%) and specificity (97.87%) in discovering abnormalities of blood sugar, which are especially valuable for premature infants of diabetic mothers. RTGMS is comparable to A-line measurement for identifying fluctuations in blood glucose in premature infants. RTGMS detects more episodes of abnormal glucose concentration than intermittent A-line blood glucose measurement. High risk infants, especially premature infants with diabetic mothers, should receive more intensive blood sugar level checks by using continuous RTGMS.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0186486PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643124PMC
November 2017

Use of prescribed opioids before and after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.

Surg Obes Relat Dis 2017 Aug 7;13(8):1337-1346. Epub 2017 Apr 7.

Neuropsychiatric Research Institute, Fargo, North Dakota; Department of Pharmaceutical Sciences, North Dakota State University, Fargo, North Dakota.

Background: Limited evidence suggests bariatric surgery may not reduce opioid analgesic use, despite improvements in pain.

Objective: To determine if use of prescribed opioid analgesics changes in the short and long term after bariatric surgery and to identify factors associated with continued and postsurgery initiated use.

Setting: Ten U.S. hospitals.

Methods: The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study. Assessments were conducted presurgery, 6 months postsurgery, and annually postsurgery for up to 7 years until January 2015. Opioid use was defined as self-reported daily, weekly, or "as needed" use of a prescribed medication classified as an opioid analgesic.

Results: Of 2258 participants with baseline data, 2218 completed follow-up assessment(s) (78.7% were female, median body mass index: 46; 70.6% underwent Roux-en-Y gastric bypass). Prevalence of opioid use decreased after surgery from 14.7% (95% CI: 13.3-16.2) at baseline to 12.9% (95% CI: 11.5-14.4) at month 6 but then increased to 20.3%, above baseline levels, as time progressed (95% CI: 18.2-22.5) at year 7. Among participants without baseline opioid use (n = 1892), opioid use prevalence increased from 5.8% (95% CI: 4.7-6.9) at month 6 to 14.2% (95% CI: 12.2-16.3) at year 7. Public versus private health insurance, more pain presurgery, undergoing subsequent surgeries, worsening or less improvement in pain, and starting or continuing nonopioid analgesics postsurgery were significantly associated with higher risk of postsurgery initiated opioid use.

Conclusion: After bariatric surgery, prevalence of prescribed opioid analgesic use initially decreased but then increased to surpass baseline prevalence, suggesting the need for alternative methods of pain management in this population.
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http://dx.doi.org/10.1016/j.soard.2017.04.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568488PMC
August 2017

Alcohol and other substance use after bariatric surgery: prospective evidence from a U.S. multicenter cohort study.

Surg Obes Relat Dis 2017 Aug 31;13(8):1392-1402. Epub 2017 Mar 31.

Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

Background: Empirical evidence suggests Roux-en-Y gastric bypass (RYGB) increases risk of developing alcohol use disorder (AUD). However, prospective assessment of substance use disorders (SUD) after bariatric surgery is limited.

Objective: To report SUD-related outcomes after RYGB and laparoscopic adjustable gastric banding (LAGB). To identify factors associated with incident SUD-related outcomes.

Setting: 10 U.S. hospitals METHODS: The Longitudinal Assessment of Bariatric Surgery-2 is a prospective cohort study. Participants self-reported past-year AUD symptoms (determined by the Alcohol Use Disorders Identification Test), illicit drug use (cocaine, hallucinogens, inhalants, phencyclidine, amphetamines, or marijuana), and SUD treatment (counseling or hospitalization for alcohol or drugs) presurgery and annually postsurgery for up to 7 years through January 2015.

Results: Of 2348 participants who underwent RYGB or LAGB, 2003 completed baseline and follow-up assessments (79.2% women, baseline median age: 47 years, median body mass index 45.6). The year-5 cumulative incidence of postsurgery onset AUD symptoms, illicit drug use, and SUD treatment were 20.8% (95% confidence interval (CI): 18.5-23.3), 7.5% (95% CI: 6.1-9.1), and 3.5% (95% CI: 2.6-4.8), respectively, post-RYGB, and 11.3% (95% CI: 8.5-14.9), 4.9% (95% CI: 3.1-7.6), and .9% (95% CI: .4-2.5) post-LAGB. Undergoing RYGB versus LAGB was associated with higher risk of incident AUD symptoms (adjusted hazard ratio or AHR = 2.08 [95% CI: 1.51-2.85]), illicit drug use (AHR = 1.76 [95% CI: 1.07-2.90]) and SUD treatment (AHR = 3.56 [95% CI: 1.26-10.07]).

Conclusions: Undergoing RYGB versus LAGB was associated with twice the risk of incident AUD symptoms. One-fifth of participants reported incident AUD symptoms within 5 years post-RYGB. AUD education, screening, evaluation, and treatment referral should be incorporated in pre- and postoperative care.
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http://dx.doi.org/10.1016/j.soard.2017.03.021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5568472PMC
August 2017

Prenatal cytogenetic diagnosis in Taiwan: a nationwide population-based study.

J Matern Fetal Neonatal Med 2017 Nov 24;30(21):2521-2528. Epub 2016 Nov 24.

b Department of Critical Care Medicine , Chung Shan Medical University Hospital , Taichung , Taiwan.

Purpose: The goal of this study was to gain a better understanding of the status of advanced maternal age among criteria for provision of amniocentesis in pregnant women in Taiwan.

Materials And Method: Data of 315 670 second-trimester amniocenteses from 28 national certified cytogenetics laboratories were retrospectively analyzed from the Prenatal Genetic Diagnosis Declaring and Database System of the Health Promotion Administration, Ministry of Health and Welfare in Taiwan between 2006 and 2013.

Results: The number of pregnant women undergoing amniocentesis in Taiwan between 2006 and 2013 increased, and the most common three indications for amniocentesis were advance maternal age (75.11%), abnormal second trimester maternal serum screening (13.22%) and abnormal sonographic finding (8.00%). Down syndrome was the most common autosomal abnormality identified (25.74%); Turner syndrome was the most common sex chromosome abnormality (7.04%). Of structural rearrangements, 26.93% were balanced translocations and 17.10% were unbalanced translocations. The greatest proportion of fetal chromosomal abnormalities was found in cases where parents were also affected (38.02%).

Conclusions: Clinical workers should provide detailed genetic diagnostic information to pregnant women, especially those with the common amniocentesis indications, which will enable them to determine a birth plan.
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http://dx.doi.org/10.1080/14767058.2016.1255191DOI Listing
November 2017

Pain and Physical Function Following Bariatric Surgery--Reply.

JAMA 2016 Aug;316(7):771

Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.

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http://dx.doi.org/10.1001/jama.2016.8593DOI Listing
August 2016

Change in Pain and Physical Function Following Bariatric Surgery for Severe Obesity.

JAMA 2016 Apr;315(13):1362-71

National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland.

Importance: The variability and durability of improvements in pain and physical function following Roux-en-Y gastric bypass (RYGB) or laparoscopic adjustable gastric banding (LAGB) are not well described.

Objectives: To report changes in pain and physical function in the first 3 years following bariatric surgery, and to identify factors associated with improvement.

Design, Setting, And Participants: The Longitudinal Assessment of Bariatric Surgery-2 is an observational cohort study at 10 US hospitals. Adults with severe obesity undergoing bariatric surgery were recruited between February 2005 and February 2009. Research assessments were conducted prior to surgery and annually thereafter. Three-year follow-up through October 2012 is reported.

Exposures: Bariatric surgery as clinical care.

Main Outcomes And Measures: Primary outcomes were clinically meaningful presurgery to postsurgery improvements in pain and function using scores from the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) (ie, improvement of ≥5 points on the norm-based score [range, 0-100]) and 400-meter walk time (ie, improvement of ≥24 seconds) using established thresholds. The secondary outcome was clinically meaningful improvement using the Western Ontario McMaster Osteoarthritis Index (ie, improvement of ≥9.7 pain points and ≥9.3 function points on the transformed score [range, 0-100]).

Results: Of 2458 participants, 2221 completed baseline and follow-up assessments (1743 [78.5%] were women; median age was 47 years; median body mass index [BMI] was 45.9; 70.4% underwent RYGB; 25.0% underwent LAGB). At year 1, clinically meaningful improvements were shown in 57.6% (95% CI, 55.3%-59.9%) of participants for bodily pain, 76.5% (95% CI, 74.6%-78.5%) for physical function, and 59.5% (95% CI, 56.4%-62.7%) for walk time. Additionally, among participants with severe knee or disability (633), or hip pain or disability (500) at baseline, approximately three-fourths experienced joint-specific improvements in knee pain (77.1% [95% CI, 73.5%-80.7%]) and in hip function (79.2% [95% CI, 75.3%-83.1%]). Between year 1 and year 3, rates of improvement significantly decreased to 48.6% (95% CI, 46.0%-51.1%) for bodily pain and to 70.2% (95% CI, 67.8%-72.5%) for physical function, but improvement rates for walk time, knee and hip pain, and knee and hip function did not (P for all ≥.05). Younger age, male sex, higher income, lower BMI, and fewer depressive symptoms presurgery; no diabetes and no venous edema with ulcerations postsurgery (either no history or remission); and presurgery-to-postsurgery reductions in weight and depressive symptoms were associated with presurgery-to-postsurgery improvements in multiple outcomes at years 1, 2, and 3.

Conclusions And Relevance: Among a cohort of participants with severe obesity undergoing bariatric surgery, a large percentage experienced improvement, compared with baseline, in pain, physical function, and walk time over 3 years, but the percentage with improvement in pain and physical function decreased between year 1 and year 3.

Trial Registration: clinicaltrials.gov Identifier: NCT00465829.
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http://dx.doi.org/10.1001/jama.2016.3010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4856477PMC
April 2016

Mortality After Bereavement: The Role of Cardiovascular Disease and Depression.

Psychosom Med 2016 Jul-Aug;78(6):697-703

From the Departments of Psychiatry (Stahl, Schulz) and Biostatistics (Chen, Anderson) and University Center for Social and Urban Research (Stahl, Schulz), University of Pittsburgh, Pittsburgh, Pennsylvania; and Department of Biostatistics (Arnold), University of Washington, Seattle, Washington.

Objectives: Late-life bereavement is associated with an increased risk of mortality. This study assesses the associations among bereavement, cardiovascular disease (CVD), and depressive symptoms on mortality in older men and women.

Methods: We examined data from the Cardiovascular Health Study, a prospective population-based cohort study of older adults. We compared mortality in those who became bereaved from 1989 to 1999 (n = 593) to an age- and sex-matched sample of individuals who remained married (n = 593). Cox regression was used to examine the association between bereavement and 3-year all-cause mortality and whether or not the association differed by sex, presence of CVD, or postbereavement depressive symptoms.

Results: One hundred ninety-nine (16.8%) individuals died. There was no association of bereavement with mortality (hazard ratio [HR] = 0.98 [0.74-1.30]). However, there were significant interaction effects of bereavement with participant sex (p < .001) and CVD (p = .010). Bereavement decreased the risk of mortality in women (HR = 0.67 [0.46-0.97]) and increased the risk of mortality in men (HR = 1.77 [1.14-2.75]). Within sex, the association of bereavement with mortality differed according to CVD status. The reduced risk of mortality associated with bereavement in women was only observed in women with CVD, and the increased risk in men was only observed in men without CVD. High levels of depressive symptoms attenuated the relation between bereavement and mortality in men without CVD.

Conclusions: The relation between bereavement and mortality was different in men and women and varied by CVD status. Bereavement decreased mortality in women with CVD and increased mortality in men without CVD.
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http://dx.doi.org/10.1097/PSY.0000000000000317DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927386PMC
July 2017

Factors Associated with Post-Traumatic Symptoms in Mothers of Preterm Infants.

Arch Psychiatr Nurs 2016 Feb 28;30(1):96-101. Epub 2015 Aug 28.

Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan; Chang Gung University, Tao-Yuan, Taiwan. Electronic address:

Objectives: Symptoms of post-traumatic distress in mothers of preterm infants have been a subject of mental health research. The aim of this study was to assess the prevalence of and risk factors associated with such symptoms in mothers of preterm infants in Taiwan.

Methods: This was a cross-sectional study performed between January 1, 2010 and June 30, 2011. One hundred and two mothers of preterm infants born at less than 37 weeks gestation and with a subsequent neonatal intensive care unit (NICU) stay between 2005 and 2009 were recruited. Participants completed a demographic questionnaire, the Impact of Event Scale-Revised (IES-R), the Center for Epidemiologic Studies Depression Scale (CES-D) and the neuroticism subscale of the Maudsley Personality Inventory (MPI). The preterm infants' data were taken from medical records.

Results: The prevalence of symptoms of distress was 25.5% (26/102) in the participants. These symptoms were associated with previous miscarriages, preterm premature rupture of membranes, neurotic personality and depression.

Conclusions: The experience of preterm birth and NICU hospitalization can be traumatic to mothers. Early support for mothers during the preterm infants' NICU stay and transition to home care are recommended.
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http://dx.doi.org/10.1016/j.apnu.2015.08.019DOI Listing
February 2016

Objectively-measured sedentary time and cardiometabolic health in adults with severe obesity.

Prev Med 2016 Mar 24;84:12-8. Epub 2015 Dec 24.

University of Pittsburgh, Graduate School of Public Health, Pittsburgh, PA, USA. Electronic address:

It is unknown whether sedentary behavior is independently associated with the cardiometabolic health of adults with severe obesity. Additionally, there is debate regarding how best to derive meaningful indices of sedentary time (ST) from activity monitor data. A convenience sample of adults with severe obesity (N=927; 79% female, median age 45y, median body mass index (BMI) 46kg/m(2)) completed a research assessment at one of ten US hospitals in 2006-2009 prior to bariatric surgery. Cardiometabolic health was assessed via physical measures, fasting blood samples and medication use. Indices of ST were derived from StepWatch™ activity monitor data with minimum bout durations of 1min, 10min and 30min. Cross-sectional associations were examined. Median (25th, 75th percentile) ST was 9.3h/d (8.1, 10.5) in ≥1min bouts, 6.5h/d (5.2, 8.0) in ≥10min bouts, or 3.2h/d (2.1, 4.5) in ≥30min bouts. Associations with ST were generally strongest with the ≥10min bout duration. Independent of moderate-to-vigorous intensity physical activity, BMI and other potential confounders, 1h/day ST in ≥10min bouts was associated with higher odds of diabetes by 15% (95%CI: 1.05-1.26), metabolic syndrome by 12% (95%CI: 1.01-1.24) and elevated blood pressure by 14% (95%CI: 1.02-1.26), and was associated with 1.4cm (95%CI: 0.9-1.9) larger waist circumference. Findings indicate the importance of considering ST as a distinct health risk among adults with severe obesity, and suggest a 10min minimum duration may be preferable to 1min or 30min for establishing ST from activity monitor data.
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http://dx.doi.org/10.1016/j.ypmed.2015.12.007DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4758881PMC
March 2016

Corrigendum to "Antimetastatic Potentials of Dioscorea nipponica on Melanoma In Vitro and In Vivo".

Evid Based Complement Alternat Med 2015 18;2015:760692. Epub 2015 Nov 18.

Clinical Laboratory, Chung Shan Medical University Hospital, No. 110, Section 1, Jianguo N. Road, Taichung 402, Taiwan ; Institute of Biochemistry and Biotechnology, Chung Shan Medical University, No. 110, Section 1, Jianguo N. Road, Taichung 402, Taiwan.

[This corrects the article DOI: 10.1155/2011/507920.].
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http://dx.doi.org/10.1155/2015/760692DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4667019PMC
December 2015

Psychiatric Disorders and Weight Change in a Prospective Study of Bariatric Surgery Patients: A 3-Year Follow-Up.

Psychosom Med 2016 04;78(3):373-81

From the Duquesne University School of Nursing (Kalarchian), Pittsburgh, Pennsylvania; Department of Epidemiology (King), Department of Biostatistics (Chen), University of Pittsburgh, Pittsburgh, Pennsylvania; Columbia University College of Physicians and Surgeons/New York State Psychiatric Institute (Devlin), New York, New York; Department of Psychiatry, University of Pittsburgh School of Medicine (Marcus), Pittsburgh, Pennsylvania; Sanford Health System and the University of North Dakota School of Medicine and Health Sciences (Garcia), Grand Forks, North Dakota; Division of Digestive Diseases and Nutrition, National Institute of Diabetes and Digestive and Kidney Diseases (Yanovski), Bethesda, Maryland; and Neuropsychiatric Research Institute and the University of North Dakota School of Medicine and Health Sciences (Mitchell), Grand Forks, North Dakota.

Objectives: To document changes in Axis I psychiatric disorders after bariatric surgery and examine their relationship with postsurgery weight loss.

Methods: As part of a three-site substudy of the Longitudinal Assessment of Bariatric Surgery Research Consortium, 199 patients completed the Structured Clinical Interview for DSM-IV before Roux-en-Y gastric bypass or laparoscopic adjustable gastric band. At 2 or 3 years after surgery, 165 (83%) patients completed a follow-up assessment (presurgery median body mass index = 44.8 kg/m, median age = 46 years, 92.7% white, 81.1% female). Linear-mixed modeling was used to test change in prevalence of psychiatric disorders over time, report remission and incidence, and examine associations between psychiatric disorders and weight loss.

Results: Compared with status presurgery, the prevalence of any Axis I psychiatric disorder was significantly lower at 2 and 3 years after surgery (30.2% versus 16.8% [p = .003] and 18.4% [p = .012], respectively). Adjusting for site, age, sex, race, presurgery body mass index, and surgical procedure, presurgery mood, anxiety, eating or substance use disorders (lifetime or current) were not related to weight change, nor were postsurgery mood or anxiety disorders (p for all > .05). However, having a postsurgery eating disorder was independently associated with less weight loss at 2 or 3 years (β = 6.7%, p = .035).

Conclusions: Bariatric surgery was associated with decreases in psychiatric disorders through 3 years after surgery. Postsurgical eating disorders were associated with less weight loss after surgery, adding to the literature suggesting that disordered eating after surgery is related to suboptimal weight loss.
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http://dx.doi.org/10.1097/PSY.0000000000000277DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5041300PMC
April 2016

Urinary Incontinence Before and After Bariatric Surgery.

JAMA Intern Med 2015 Aug;175(8):1378-87

Department of Medicine, University of California, San Francisco.

Importance: Among women and men with severe obesity, evidence for improvement in urinary incontinence beyond the first year after bariatric surgery-induced weight loss is lacking.

Objectives: To examine change in urinary incontinence before and after bariatric surgery and to identify factors associated with improvement and remission among women and men in the first 3 years after bariatric surgery.

Design, Setting, And Participants: The Longitudinal Assessment of Bariatric Surgery 2 is an observational cohort study at 10 US hospitals in 6 geographically diverse clinical centers. Participants were recruited between February 21, 2005, and February 17, 2009. Adults undergoing first-time bariatric surgical procedures as part of clinical care by participating surgeons between March 14, 2006, and April 24, 2009, were followed up for 3 years (through October 24, 2012).

Intervention: Participants undergoing bariatric surgery completed research assessments before the procedure and annually thereafter.

Main Outcomes And Measures: The frequency and type of urinary incontinence episodes in the past 3 months were assessed using a validated questionnaire. Prevalent urinary incontinence was defined as at least weekly urinary incontinence episodes, and remission was defined as change from prevalent urinary incontinence at baseline to less than weekly urinary incontinence episodes at follow-up.

Results: Of 2458 participants, 1987 (80.8%) completed baseline and follow-up assessments. At baseline, the median age was 47 years (age range, 18-78 years), the median body mass index was 46 kg/m2 (range, 34-94 kg/m2), and 1565 of 1987 (78.8%) were women. Urinary incontinence was more prevalent among women (49.3%; 95% CI, 46.9%-51.9%) than men (21.8%; 95% CI, 18.2%-26.1%) (P < .001). After a mean 1-year weight loss of 29.5% (95% CI, 29.0%-30.1%) in women and 27.0% (95% CI, 25.9%-28.6%) in men, year 1 urinary incontinence prevalence was significantly lower among women (18.3%; 95% CI, 16.4%-20.4%) and men (9.8%; 95% CI, 7.2%-13.4%) (P < .001 for all). The 3-year prevalence was higher than the 1-year prevalence for both sexes (24.8%; 95% CI, 21.8%-26.5% among women and 12.2%; 95% CI, 9.0%-16.4% among men) but was substantially lower than baseline (P < .001 for all). Weight loss was independently related to urinary incontinence remission (relative risk, 1.08; 95% CI, 1.06-1.10 in women and 1.07; 95% CI, 1.02-1.13 in men) per 5% weight loss, as were younger age and the absence of a severe walking limitation.

Conclusions And Relevance: Among women and men with severe obesity, bariatric surgery was associated with substantially reduced urinary incontinence over 3 years. Improvement in urinary incontinence may be an important benefit of bariatric surgery.
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http://dx.doi.org/10.1001/jamainternmed.2015.2609DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4529061PMC
August 2015

Objective assessment of changes in physical activity and sedentary behavior: Pre- through 3 years post-bariatric surgery.

Obesity (Silver Spring) 2015 Jun;23(6):1143-50

Department of General Surgery, Oregon Health and Science University, Portland, Oregon, USA.

Objective: To evaluate change in sedentary behavior (SB) and physical activity (PA) over 3 years following bariatric surgery.

Methods: A subset of participants in an observational study (n = 473 of 2,458; 79% female, median body mass index 45 kg m(-2) ) wore an activity monitor presurgery and at 1-3 annual postsurgery assessments.

Results: Over the first year, on average, sedentary time decreased from 573 (95% CI: 563-582) to 545 (95% CI: 534-555) min days(-1) and moderate- to vigorous-intensity PA (MVPA) increased from 77 (95% CI: 71-84) to 106 (95% CI: 98-116) min week(-1) , or 7 (95% CI: 5-10) to 24 (95% CI: 18-29) min week(-1) in MVPA bouts ≥10 min. There were no changes in these parameters from years 1 to 3 (P for all > 0.05). The percentage of participants achieving ≥150 min week(-1) of bout-related MVPA was not different at year 3 [6.5% (95% CI: 3.1-12.7)] vs. presurgery [3.4% (95% CI: 1.8-5.0); P = 0.45]. Most participants followed SB and PA trajectories that paralleled mean change and were consistent with their presurgery position in relation to the group.

Conclusions: On average, bariatric surgical patients make small reductions in SB and increases in PA during the first postsurgery year, which are maintained through 3 years. Still, postsurgery PA levels fall short of PA guidelines for general health or weight control.
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http://dx.doi.org/10.1002/oby.21106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4445467PMC
June 2015

Thyroid and growth hormone concentrations in 8-year-old children exposed in utero to dioxins and polychlorinated biphenyls.

J Toxicol Sci 2015 Jun;40(3):309-19

Department of Pediatrics, Chung Shan Medical University Hospital; 2. School of Medicine, Chung Shan Medical University, Taichung, Taiwan.

The objective of this study was to examine the effects of in utero exposure to polychlorinated biphenyls (PCBs) and dioxins (polychlorinated dibenzo-p-dioxins, dibenzofurans (PCDD/F) on thyroid and growth hormone concentrations and growth in 8-year-old children. A total of 56 children (23 boys, 33 girls) were included in the study. All were stratified into high and low PCDD/F + PCB exposure groups based on maternal median indicator PCB and PCDD/F + PCB concentrations during pregnancy. Height, weight, body mass index, and thyroid and growth hormone concentrations were assessed and compared among the different exposure groups. There were no significant effects of indicator PCB or PCDD/F + PCB exposure levels on growth (height, weight, and bone age) among 8-year-old boys or girls. Boys exposed to high PCDD/F + PCB levels had significantly higher thyroxine-binding globulin (TBG) concentrations than boys exposed to low levels (P = 0.027). Girls exposed to high PCB levels had significantly lower IGF-binding protein-3 (IGFBP-3) concentrations than girls exposed to low levels (P = 0.038). Low levels of in utero exposure to PCDD/F+PCB and high indicator PCB levels were significantly associated with reduced serum concentrations of IGFBP-3. High levels of in utero exposure to PCDD/F+PCB plus either high or low indicator PCB levels were significantly associated with increased serum concentrations of growth hormone, T3, T4, and TBG. These findings suggest that the level of in utero exposure to PCBs and dioxins may affect serum concentrations of growth hormone, thyroid hormones, TBG, and IGFBP-3 in 8-year-old children.
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http://dx.doi.org/10.2131/jts.40.309DOI Listing
June 2015

Addictive disorders after Roux-en-Y gastric bypass.

Surg Obes Relat Dis 2015 Jul-Aug;11(4):897-905. Epub 2014 Nov 13.

Pacific University, Hillsboro, Oregon.

Background: Recent literature suggests that some patients may develop addictive disorders after bariatric surgery, in particular after Roux-en-Y gastric bypass (RYGB). These may include traditional addictions and so called "behavioral addictions," although prevalence data on the latter have not been published. The objective of this study was to establish the prevalence of addictive behaviors in adults after RYGB.

Methods: Participants from a large observational study of bariatric surgery who had undergone RYGB were recruited to complete additional measures. Of 241 consented participants, 201 provided data (i.e., Structured Clinical Interview for DSM-IV Axis I [SCID], additional Impulsive Control Disorder Modules, and various self-report measures, including the Alcohol Use Disorder Identification Test [AUDIT]) to assess status before surgery and in the first 3 postoperative years.

Results: Based on the SCID, 16 (8.0%) developed alcohol use disorder [AUD] within 3 years post-RYGB, 7 (43.8%) of whom had no history of AUD. When both the SCID and AUDIT were used to identify AUD, the corresponding numbers/percentages were 32 (18.4%) and 13 (40.6%). Data on other behavioral addictive disorders indicated 19 (9.5%) had a postsurgery disorder, 6 (31.6%) of whom had no history.

Conclusion: These data add to a growing literature suggesting there is a substantial risk for the development of AUD after bariatric surgery. Understanding the risk for nondrug-related addictive disorders requires more data from larger studies before clear conclusions can be drawn.
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http://dx.doi.org/10.1016/j.soard.2014.10.026DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430439PMC
May 2016
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