Publications by authors named "Tao-Hsin Tung"

157 Publications

Work Fatigue in a Hospital Setting: The Experience at Cheng Hsin General Hospital.

Healthcare (Basel) 2021 Jun 21;9(6). Epub 2021 Jun 21.

Department of Occupational Safety and Health, Cheng-Hsin General Hospital, Taipei 112, Taiwan.

We aimed to investigate fatigue and its related factors in a medical professional population aged ≥30 years, as appraised by the implementation of an employee health screening program at Cheng Hsin General Hospital in Taipei, Taiwan. The study participants included a total of 2132 (400 males and 1732 females) healthy medical professionals enrolled in a teaching hospital who underwent physical verification in 2019. Demographic characteristics and fatigue information were collected. The overall prevalence of personal- and work-related fatigue in this study population was 41.4% and 39.1%, respectively. The prevalence of a high risk of work- or personal-related fatigue proved to be substantially greater (-value for chi-square test <0.0001) than it was for a low or moderate risk of personal-related fatigue. Using multinominal logistic regression analysis, seniority and position were statistically significant in relation to a high risk of personal- and work-related fatigue. Personal- and work-related fatigue were found to be prevalent in physicians and nurses. Lower seniority was also related to severe personal- or work-related fatigue. Providing this population with controlled working environments and health improvements is important.
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http://dx.doi.org/10.3390/healthcare9060776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234159PMC
June 2021

Effect of Exercise-Based Cardiac Rehabilitation on Left Ventricular Function in Asian Patients with Acute Myocardial Infarction after Percutaneous Coronary Intervention: A Meta-Analysis of Randomized Controlled Trials.

Healthcare (Basel) 2021 Jun 21;9(6). Epub 2021 Jun 21.

Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, China.

(1) Background: The effects of exercise-based cardiac rehabilitation (CR) on left ventricular function in patients with acute myocardial infarction (AMI) after percutaneous coronary intervention (PCI) are important but poorly understood. (2) Purpose: To evaluate the effects of an exercise-based CR program (exercise training alone or combined with psychosocial or educational interventions) compared with usual care on left ventricular function in patients with AMI receiving PCI. (3) Data sources, study selection and data extraction: We searched PubMed, WEB OF SCIENCE, EMBASE, EBSCO, PsycINFO, LILACS and Cochrane Central Register of Controlled Trials databases (CENTRAL) up to 12th June 2021. Article selected were randomized controlled trials and published as a full-text article. Meta-analysis was conducted with the use of the software Review manager 5.4. (4) Data synthesis: Eight trials were included in the meta-analysis, of which three trials were rated as high risk of bias. A significant improvement was seen in the exercise-based CR group compared with the control group regarding left ventricular ejection fraction (LVEF) (std. mean difference = 1.33; 95% CI:0.43 to 2.23; 0.004), left ventricular end-diastolic dimension (LVEDD) (std. mean difference = -3.05; 95% CI: -6.00 to -0.09; = 0.04) and left ventricular end-systolic volume (LVESV) (std. mean difference = -0.40; 95% CI: -0.80 to -0.01; = 0.04). Although exercise-based CR had no statistical effect in decreasing left ventricular end-systolic dimension (LVESD) and left ventricular end-diastolic volume (LVEDV), it showed a favorable trend in relation to both. (5) Conclusions: Exercise-based CR has beneficial effects on LV function and remodeling in AMI patients treated by PCI.
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http://dx.doi.org/10.3390/healthcare9060774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8234138PMC
June 2021

The relationship between falling and fear of falling among community-dwelling elderly.

Medicine (Baltimore) 2021 Jul;100(26):e26492

Department of Ophthalmology, Taipei City Hospital.

Abstract: Researchers have repeatedly examined the relationship between a previous experience of a fall and subsequent fear of falling (FOF); however, few studies have investigated the effects of falling along various timelines among older adults. The objective of this study was to determine whether experiencing a fall in the previous month or the previous year led to FOF among the elderly.The National Health and Aging Trends Study (NHATS) in the U.S. collected information indicative of basic trends in the behavior of individuals aged 65 years and older. In the current study, we applied multiple logistic regression analysis of results from round 7 of the NHATS with the aim of identifying the risk factors associated with FOF among 5559 participants aged 65 years or older.FOF was reported by 48.8% of those who experienced a fall in the previous year and 46.8% experienced a fall in the previous month. The results of regression analysis revealed that after adjusting for sex, age, related chronic disease, activities of daily living, and instrumental activities of daily living, FOF was significantly associated with experiencing a fall during the previous month (OR = 2.29, 95% CI: 1.78-2.95) or during the previous year (OR = 2.60, 95% CI: 2.16-3.14).Our results indicate that experiences of falling during the previous month or the previous year were both significantly associated with a fear of falling, and caregivers should keep this in mind when dealing with community-living elderly individuals.
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http://dx.doi.org/10.1097/MD.0000000000026492DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8257838PMC
July 2021

Effects of Transapical Transcatheter Mitral Valve Implantation.

Front Cardiovasc Med 2021 11;8:633369. Epub 2021 Jun 11.

Heart Center, Cheng Hsin General Hospital, Taipei, Taiwan.

In this study, transapical transcatheter mitral valve-in-valve implantation (TAMVI) was compared with surgical redo mitral valve replacement (SRMVR) in terms of clinical outcomes. We retrospectively identified patients with degenerated mitral bioprosthesis or failed annuloplasty rings who underwent redo SRMVR or TAMVI at our medical center. Clinical outcomes were based on echocardiography results. We retrospectively identified patients with symptomatic mitral bioprosthetic valve dysfunction ( = 58) and failed annuloplasty rings ( = 14) who underwent redo SRMVR ( = 36) or TAMVI ( = 36). The Society of Thoracic Surgeons Predicted Risk of Mortality scores were higher in the TAMVI group (median: 9.52) than in the SRMVR group (median: 5.59) (-value = 0.02). TAMVI patients were more severe in New York Heart Association (-value = 0.04). The total procedure time (skin to skin) and length of stay after procedures were significantly shorter in the TAMVI group, and no significant difference in mortality was noted after adjustment for confounding factors (-value = 0.11). The overall mean mitral valve pressure gradient was lower in the TAMVI group than in the SRMVR group at 24 months ( < 0.01). Both groups presented a decrease in the severity of mitral and tricuspid regurgitation at 3-24 months. In conclusion, the statistical analysis is still not robust enough to make a claim that TAMVI is an appropriate alternative. The outcome of the patient appears only to be related to the patient's pre-operative STS score. Additional multi-center, longitudinal studies are warranted to adequately assess the effect of TAMVI.
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http://dx.doi.org/10.3389/fcvm.2021.633369DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8225931PMC
June 2021

Personality types of patients with glaucoma: A systematic review of observational studies.

Medicine (Baltimore) 2021 Jun;100(23):e25914

Department of Ophthalmology, Maoming People's Hospital, Maoming, Guangdong Province, China.

Objectives: To synthesize recent empirical research on the association between personality and glaucoma among this sub-population.

Methods: PubMed/MEDLINE, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, Scopus and ScienceDirect databases were searched to identify eligible studies published between January 1950 and March 2019 in any language. The quality of included observational studies was assessed using an 11-item checklist which was recommended by Agency for Healthcare Research and Quality (AHRQ). After using the checklist, 12 papers are included into the systematic review.

Results: There are some differences on the studies about the negative personality of glaucoma patients. In spite of these differences, most included studies significantly showed that glaucoma patients tend to or do have some specific personality.

Conclusion: The extant research could demonstrate that glaucoma patients tend to have some negative personality in some extent. Future studies are needed to provide more convincing support to personality of glaucoma patients.
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http://dx.doi.org/10.1097/MD.0000000000025914DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8202580PMC
June 2021

The Relationship Between Fragility Fractures and Pain Experience: A Systematic Review.

Front Med (Lausanne) 2021 24;8:609318. Epub 2021 May 24.

Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, China.

This systematic review is conducted to explore the relationship between fragility fractures and pain experience. We searched for relevant studies on Pubmed, Embase, Web of Science, and the Cochrane library without restrictions on language from inception until February 4th, 2021. The risk of bias and methodological quality was evaluated using the Newcastle-Ottawa Scale and ROBINS-I tool. Twenty-one studies were included in this systematic review. The so-called study reported participants with continuous post-fracture pain. The included studies showed that post- fractured pain can decrease with time, however, the continual pain can last at least 1 year even longer, and some participants would need to self-manage pain. Moreover, the limited range of motion was considered as a factor that might distress the normal development of daily activities. The current evidence could not fully support that pain continues to influence patients' lives after a fragility fracture. However, it still showed the pain might come with fracture. The findings also could be useful to help health care providers better recognize and manage this clinical consequence of fractures. Nonetheless, future large-scale longitudinal studies will be required to evaluate the long-term effects of pain in fragility fractures.
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http://dx.doi.org/10.3389/fmed.2021.609318DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8180595PMC
May 2021

Sarcopenia among the Elderly Population: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Healthcare (Basel) 2021 May 31;9(6). Epub 2021 May 31.

Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, China.

This systematic review and meta-analysis was conducted to explore the effect of protein intake on the prevention and improvement of sarcopenia. We searched the Cochrane Library, PubMed, and EMBASE from inception to 20 May 2021. Two authors independently selected studies, assessed the quality of included studies, and extracted data. Any disagreement was resolved by discussion with a third author. There were 12 studies that met the selection criteria among 53 eligible publications. The results of the study show that the protein intake has no significant effect on the physical performance-4 m gait speed, chair rise test, short physical performance battery, muscle mass-skeletal muscle mass index, and muscle strength-hand grip strength. Protein supplementation had no significant effect on 4 m gait speed and on improving skeletal muscle mass index, hand grip strength, chair rise test, and short physical performance battery. Additional randomized controlled trials are warranted to adequately assess the effect of protein supplementation on elderly sarcopenia.
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http://dx.doi.org/10.3390/healthcare9060650DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8228648PMC
May 2021

Safety of an inactivated SARS-CoV-2 vaccine among healthcare workers in China.

Expert Rev Vaccines 2021 May 13:1-8. Epub 2021 May 13.

Department of Orthopedics, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai, Zhejiang, China.

: Although the inactivated SARS-CoV-2 vaccine (CoronaVac) has undergone preclinical tests and clinical trials evaluating its efficacy and safety, few data have been reported in the post-licensure real-world setting. We aimed to assess the safety of the vaccine among healthcare workers.: A self-administered online survey on monitoring adverse reactions post vaccination was conducted among the staff who worked at and were vaccinated in a tertiary hospital in Taizhou, China, from February 24 to 7 March 2021. A total of 1526 subjects responded to the questionnaire when they received an e-mail or an e-poster on WeChat.: The incidences of overall adverse reactions after the first and second injections were 15.6% (238/1526) and 14.6% (204/1397), respectively. The most common adverse reaction was localized pain at the injection site, with an incidence of 9.6% and 10.7% after each dose, accounting for 61.8% and 73.0% of adverse reactions, respectively. Fatigue, muscle pain, and headache were the most common systemic adverse reactions.: These findings implied that the inactivated CoronaVac vaccine has an acceptable safety profile among healthcare workers due to the low incidence of self-reported adverse reactions. This may boost public confidence in nationwide mass vaccination campaigns.
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http://dx.doi.org/10.1080/14760584.2021.1925112DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8127168PMC
May 2021

Clinical Effects of Baduanjin Qigong Exercise on Cancer Patients: A Systematic Review and Meta-Analysis on Randomized Controlled Trials.

Evid Based Complement Alternat Med 2021 8;2021:6651238. Epub 2021 Apr 8.

Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang, China.

Objective: Baduanjin is a traditional Chinese Qigong exercise for health improvement. However, a few studies were examining the association between Baduanjin Qigong exercise and cancer patients. This study is conducted to explore the clinical effects of the Baduanjin Qigong exercise among cancer patients.

Methods: We conducted a systematic review and meta-analysis using randomized controlled trials to assess the effects of the Baduanjin Qigong exercise on cancer patients. We searched Cochrane Library, PubMed, Embase, and Airiti Library for all relevant studies from inception through December 31, 2020, without language limitations. Two authors independently screened selected studies, assessed the quality of included studies, and extracted information. Any disagreement was discussed with a third senior author. Summary estimates were obtained using meta-analysis with the random effects model.

Results: Among the fourteen articles involved in the systematic review, ten studies were included in the meta-analysis. Cancer patients with moderate-severe cancer-related fatigue were significantly less in the Baduanjin group compared with the control group (odds ratio = 0.27; 95% confidence interval (CI) [0.17, 0.42]). Three studies used the questionnaire of Functional Assessment of Cancer Therapy-Breast Cancer (FACT-B) in the assessment of quality of life, and two used the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). For FACT-B, the Baduanjin group scored significantly higher than the control group (mean difference = 11.04, 95% CI [9.56, 12.53]). For EORTC QLQ-C30, the Baduanjin group scored significantly higher than the control group (mean difference = 10.57, 95% CI [7.82, 13.32]). The Pittsburgh Sleep Quality Index (PSQI) score for sleep quality of the Baduanjin group is significantly lower than the control group (mean difference = -2.89, 95% CI [-3.48, -2.30]).

Conclusion: In conclusion, we found the Baduanjin exercise had positive clinical effects on cancer patients. This meta-analysis not only supported that the Baduanjin exercise can alleviate the degree of cancer-related fatigue in patients but also improved their quality of life and sleep quality. Further long-term follow-up randomized controlled trials are warranted.
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http://dx.doi.org/10.1155/2021/6651238DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8049783PMC
April 2021

Predicting mortality in acute ischaemic stroke treated with mechanical thrombectomy: analysis of a multicentre prospective registry.

BMJ Open 2021 04 1;11(4):e043415. Epub 2021 Apr 1.

Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, China

Objectives: We aimed to determine predictors of mortality within 90 days and develop a simple score for patients with mechanical thrombectomy (MT).

Design: Analysis of a multicentre prospective registry.

Setting: In six participating centres, patients who had an acute ischaemic stroke (AIS) treated by MT between March 2017 and May 2018 were documented prospectively.

Participants: 224 patients with AIS were treated by MT.

Results: Of 224 patients, 49 (21.9%) patients died, and 87 (38.8%) were independent. Variables associated with 90-day mortality were age, previous stroke, admission National Institutes of Health Stroke Scale (NIHSS), fasting blood glucose and occlusion site. Logistic regression identified four variables independently associated with 90-day mortality: age ≥80 years (OR 3.26, 95% CI 1.45 to 7.33), previous stroke (OR 2.33, 95% CI 1.04 to 5.21), admission NIHSS ≥18 (OR 2.37, 95% CI 1.13 to 4.99) and internal carotid artery or basilar artery occlusion (OR 2.92, 95% CI 1.34 to 6.40). Using these data, we developed predicting 90-day mortality of AIS with MT (PRACTICE) score ranging from 0 to 6 points. The receiver operator curve analysis found that PRACTICE score (area under the curve (AUC)=0.744, 95% CI 0.669 to 0.820) was numerically better than iScore (AUC=0.661, 95% CI 0.577 to 0.745) and Predicting Early Mortality of Ischemic Stroke score (AUC=0.638, 95% CI 0.551 to 0.725) for predicting 90-day mortality.

Conclusions: We developed a simple score to estimate the 90-day mortality of patients who had an AIS treated with MT. But the score needs to be prospectively validated.

Trial Registration Number: Chinese Clinical Trial Registry (ChiCTR-OOC-17013052).
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http://dx.doi.org/10.1136/bmjopen-2020-043415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021751PMC
April 2021

Effect of adalimumab interventions on general infection among adults: a systematic review and meta-analysis of randomized controlled trials.

Expert Rev Anti Infect Ther 2021 Apr 13:1-17. Epub 2021 Apr 13.

Evidence-based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai, Zhejiang China.

Background: This study assessed the safety of adalimumab in different dosages and durations of treatment.

Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to explore the infection risk in people who received adalimumab. We searched the Cochrane Library, PubMed, and EMBASE from inception to December 8, 2020. Summary estimates were obtained  using meta-analysis with a random-effects model.

Results: Twenty-one RCTs, considered to be of high quality, were analyzed. We found that there was a risk of infection (RR: 1.10, 95% CI: 1.02-1.18). In the stratified analysis, we found an increase in infection among those that received normal dosage (RR: 1.13, 95% CI: 1.04-1.23), and in patients with psoriasis (RR: 1.13, 95% CI: 1.00-1.35) and rheumatoid arthritis (RR: 1.23, 95% CI: 1.06-1.41), but not in those that received high doses and other criteria. In the meta-regressions, intervention duration was not related to changes in incidence risk.

Conclusions: Trials that have a longer treatment duration and higher doses are needed to clarify whether patients that received adalimumab had an elevated risk of general infection.
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http://dx.doi.org/10.1080/14787210.2021.1902804DOI Listing
April 2021

Effect of Postoperative Adverse Events on Hospitalization Expenditures and Length of Stay Among Surgery Patients in Taiwan: A Nationwide Population-Based Case-Control Study.

Front Med (Lausanne) 2021 10;8:599843. Epub 2021 Feb 10.

Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, Shenzhen, China.

The current study sought to determine the incidence of postoperative adverse events (AEs) based on data from the 2006 Taiwan National Health Insurance Research Database (NHIRD). This retrospective case-control study included patients who experienced postoperative AEs in 387 hospitals throughout Taiwan in 2006. The independent variable was the presence or absence of 10 possible postoperative AEs, as identified by patient safety indicators (PSIs). A total of 17,517 postoperative AEs were identified during the study year. PSI incidence ranged from 0.1/1,000 admissions (obstetric trauma-cesarean section) to 132.6/1,000 admissions (obstetric trauma with instrument). Length of stay (LOS) associated with postoperative AEs ranged from 0.10 days (obstetric trauma with instrument) to 14.06 days (postoperative respiratory failure). Total hospitalization expenditures (THEs) ranged from 363.7 New Taiwan Dollars (obstetric trauma without instrument) to 263,732 NTD (postoperative respiratory failure). Compared to patients without AEs, we determined that the THEs were 2.13 times in cases of postoperative AE and LOS was 1.72 times higher. AEs that occur during hospitalization have a major impact on THEs and LOS.
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http://dx.doi.org/10.3389/fmed.2021.599843DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7902791PMC
February 2021

The association between maternal exposure to outdoor air pollutants, inflammatory response, and birth weight in healthy women.

Environ Res 2021 05 25;196:110921. Epub 2021 Feb 25.

Department of Obstetrics and Gynecology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Department of Respiratory Therapy, College of Medicine, Chang Gung University, Taoyuan, Taiwan; Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi, Taiwan; Center for Environmental Sustainability and Human Health, Ming Chi University of Technology, Taishan, New Taipei, Taiwan. Electronic address:

Increased maternal inflammatory response has been noted in women with pregnancies complicated by preterm birth and small-for-gestational age infants. However, the association between gestational exposure to air pollutants, maternal inflammatory response, and fetal growth remains unclear. In this study, we aimed to investigate the association between exposure to air pollutants during pregnancy and the concentration of inflammatory indicators in maternal and fetal circulations, as well as fetal growth. We recruited 108 healthy pregnant women living in northern (n = 55) and southern (n = 53) areas of Taiwan and prospectively collected information of exposure to outdoor air pollutants throughout gestation. Maternal blood from each trimester and umbilical cord blood after delivery were collected and analyzed for inflammatory indicators including high sensitivity C-reactive protein (hs-CRP), interleukin-1β (IL-1β), and tumor necrosis factor (TNF)-α. Our results showed that exposure to particulate matter less than or equal to 10 μm (PM) and ozone (O) during the first trimester had a direct effect on reduction of birth weight, but the direct effect of PM mediated by hs-CRP and the direct effect of O mediated by TNF-α on fetal birth weight were not significant. Exposure to PM and PM during the second and third trimesters also directly affected birth weight. Furthermore, exposure to sulfur dioxide (SO) caused changes in the concentrations of TNF-α in maternal blood during the second trimester, which subsequently resulted in reduced fetal weight. Together, these results indicate that exposure to air pollutants may cause both direct and indirect effects on the reduction of fetal weight.
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http://dx.doi.org/10.1016/j.envres.2021.110921DOI Listing
May 2021

Evidence-searching capability among health care professionals: a comparative study.

BMC Med Educ 2021 Feb 25;21(1):134. Epub 2021 Feb 25.

Department of Dermatology, Chang Gung Memorial Hospital, Linkou, 5, Fuxing St, Guishan Dist, 33305, Taoyuan, Taiwan.

Background: Evidence-based practice is among core competencies of health care professionals (HCPs). However, the levels of evidence-searching capability may differ among various disciplines of HCPs as they receive different education and trainings for various durations in medical schools and teaching hospitals.

Methods: This study aimed to compare the evidence-searching capability among different disciplines of HCPs and identify which aspects need to be reinforced. From a teaching hospital, we recruited 80 HCPs of various disciplines and compared their evidence-searching capability by using a validated scale. To examine if sex and education levels affect evidence-searching capability, we performed a multiple linear regression analysis with collinearity diagnostics.

Results: Physicians and pharmacists performed significantly better than other disciplines in the seven formative assessment items and the summative item (all P < 0.05). No collinearity was detected between discipline and age nor level of education. Except for the 2nd formative assessment item (correlation coefficient 0.24 ± 0.12, P = 0.04), participant's levels of education did not affect evidence-searching capability. Age was associated with lower evidence-searching capability in five formative and the summative assessment items.

Conclusions: We found a better evidence-searching capability among physicians and pharmacists than other HCPs who may require more training on evidence-searching skills. Also, evidence-searching skills training should be provided to HCPs irrespective of age and education levels.
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http://dx.doi.org/10.1186/s12909-021-02565-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7908732PMC
February 2021

Care needs, social support and meaning in life in patients after acute heart failure hospitalisation: a longitudinal study.

Eur J Cardiovasc Nurs 2021 02;20(2):106–114

School of Nursing, National Yang-Ming University, Taiwan.

Background: Meaning in life serves as a protective mechanism for coping with persistent, often distressful symptoms in patients with heart failure. However, meaning in life and its associated factors are not adequately explored in patients after acute hospitalisation for heart failure.

Aims: To explore the associated factors of meaning in life in patients with heart failure from acute hospitalisation to 3 months post-discharge.

Methods: A total of 103 hospitalised patients with heart failure in Northern Taiwan were recruited using a longitudinal study design and interviewed with structured questionnaires including meaning in life, symptom distress, care needs, and social support at hospitalisation, 1 month and 3 months post-discharge.

Results: A total of 83 patients completed the 3 months follow-up. The presence of meaning in life significantly increased from hospitalisation to 3 months post-discharge. Decreases in care needs (B=-0.10, P=0.020) and social support (B=-0.18, P=0.016) from hospitalisation to 3 months post-discharge were significantly associated with an increase in the presence of meaning in life, while a decrease in social support was associated with an increase in the search for meaning in life (B=-0.17, P=0.034).

Conclusion: Care needs and social support were pivotal factors for developing meaning in life for patients with heart failure. Assessments of care needs and social support might help strengthen their meaning in life.
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http://dx.doi.org/10.1177/1474515120945478DOI Listing
February 2021

Evolution of impedance values in cochlear implant patients after early switch-on.

PLoS One 2021 19;16(2):e0246545. Epub 2021 Feb 19.

Department of Otolaryngology, Cheng Hsin General Hospital, Taipei, Taiwan.

Cochlear implantation is currently the most effective treatment modality for severe to profound sensorineural hearing loss. Over the past few years, at the Department of Otolaryngology, Cheng Hsin General Hospital (Taipei, Taiwan), cochlear implant devices have been switched on within 24 hours of their implantation. Differences in impedance evolution after early switch-on for different devices have not been previously discussed. The present study aimed to investigate the impedance evolution of one device and the factors influencing this after early activation. Results are compared to published results of other devices. A total of 16 patients who received Advanced BionicsTM devices and had early activation within 24 hours of implantation, were included in the study. Impedance telemetry was recorded intraoperatively and postoperatively at 1 day, 1 week, 2 weeks, 4 weeks and 8 weeks. A stepwise increase was observed in the impedance evolution. To the best of our knowledge, the present study is the first to investigate the impedance evolution of the different devices after early switch-on within 24 hours of implantation and its influencing factors. Further research with a longitudinal design to compare the differences in electrode impedances between patients activated early versus those activated after a few weeks will be necessary for the disclosure of the underlying mechanisms.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0246545PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7894879PMC
February 2021

Insights from the comparisons of SARS-CoV and COVID-19 outbreaks: The evidence-based experience of epidemic prevention in China.

Medicine (Baltimore) 2021 Feb;100(6):e24650

Department of Medical Research and Education, Cheng-Hsin General Hospital, Taipei, Taiwan.

Abstract: Coronavirus disease 2019 (COVID-19) is one of infectious diseases caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). At the beginning of 2020, a sudden outbreak of novel pneumonia, originated from Wuhan, China, swiftly evolves to a worldwide pandemic, alike the severe acute respiratory syndrome (SARS) in 2003. However, Chinese-style innovation in response to the outbreak of COVID-19 helped China to reach a faster and more effective success in the containment of this epidemic. This review summarizes insights from the comparisons of severe acute respiratory syndrome coronavirus (SARS-CoV) and COVID-19 outbreaks on the basis of preventive strategies in China for this coronavirus pandemic.
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http://dx.doi.org/10.1097/MD.0000000000024650DOI Listing
February 2021

Clinical Knowledge Supported Acute Kidney Injury (AKI) Risk Assessment Model for Elderly Patients.

Int J Environ Res Public Health 2021 02 8;18(4). Epub 2021 Feb 8.

Evidence-Based Medicine Center, Taizhou Hospital of Zhejiang Province Affiliated to Wenzhou Medical University, Linhai 317000, China.

From the clinical viewpoint, the statistical approach is still the cornerstone for exploring many diseases. This study was conducted to explore the risk factors related to acute kidney injury (AKI) for elderly patients using the multiple criteria decision-making (MCDM) approach. Ten nephrologists from a teaching hospital in Taipei took part in forming the AKI risk assessment model. The key findings are: (1) Comorbidity and Laboratory Values would influence Comprehensive Geriatric Assessment; (2) Frailty is the highest influential AKI risk factor for elderly patients; and (3) Elderly patients could enhance their daily activities and nutrition to improve frailty and lower AKI risk. Furthermore, we illustrate how to apply MCDM methods to retrieve clinical experience from seasoned doctors, which may serve as a knowledge-based system to support clinical prognoses. In conclusion, this study has shed light on integrating multiple research approaches to assist medical decision-making in clinical practice.
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http://dx.doi.org/10.3390/ijerph18041607DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7915995PMC
February 2021

The occurrence of delayed neuropsychologic sequelae in acute carbon monoxide poisoning patients after treatment with hyperbaric or normobaric oxygen therapy.

Medicine (Baltimore) 2021 Jan;100(2):e24183

Institute for Hospital Management, Tsing Hua University, Shenzhen Campus, China.

Abstract: This study aimed at assessing which one of the 2 therapies is better for treating carbon monoxide (CO) poisoning from the perspective of reducing delayed neuropsychologic sequelae (DNS).We used Taiwan's National Health Insurance Research Database (NHIRD) to conduct a nationwide population-based cohort study to assess which therapy is better for CO poisoning patients. To accurately identify patients with DNS, the definition of DNS is included neurological sequelae, and cognitive and psychological sequele. The independent variable was therapy and the dependent variable was DNS occurred within 1 year after discharge from a medical institution. The control variables were age, gender, the severity of CO poisoning, and comorbidities present before CO poisoning admission.The risk of developing DNS in patients treated with Hyperbaric Oxygen (HBO) was 1.87-fold (P < .001) than normobaric oxygen (NBO) therapy. The severity of CO poisoning and comorbidities were also found to have significant influences on the risk of developing DNS.HBO may be a risk therapy for treating CO poisoning.
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http://dx.doi.org/10.1097/MD.0000000000024183DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7808522PMC
January 2021

Constructing a new health education model for patients with chronic hepatitis B.

Medicine (Baltimore) 2020 Dec;99(50):e23687

Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan, China.

To explore the effects of the project-achievement quality control circle in constructing a new health education model for patients with chronic hepatitis B.The quality control circle group was established and the theme of "constructing a new health education model for patients with chronic hepatitis B" was selected. The circle staff determined that this quality control circle was of project-achievement according to the quality control story judgment table, and then carry out activities in strict accordance with the 10 steps of project-achievement quality control circle, evaluate the tangible results and non-tangible results before and after the activity.After the implementation of the activity, the health education integrity of patients with chronic hepatitis B increased from 74.75 ± 11.00 to 95.00 ± 5.55 points (P < .001). The awareness of health education increased from 71.90 ± 13.48 to 95.60 ± 2.84 points (P < .001), the satisfaction rate of health education increased from 76.60 ± 8.71 points to 98.00 ± 2.03 points (P < .001), and the evaluation rate after health education increased from 10% to 100% (P < .001).The circle members have much more confidence in quality control circle activities, the use of techniques, and the knowledge related to scientific research.
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http://dx.doi.org/10.1097/MD.0000000000023687DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7738050PMC
December 2020

Characterizing spatiotemporal progression and prediction of infarct lesion volumes in experimental acute ischemia using quantitative perfusion and diffusion imaging.

Appl Radiat Isot 2021 Feb 19;168:109522. Epub 2020 Nov 19.

Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan, China; Taiwan association of health industry management and development, Taipei, Taiwan, China. Electronic address:

Purpose: This study was conducted to explore the diagnostic value of arterial spin labeling (ASL) combined with diffusion weighted imaging (DWI) in characterizing the spatiotemporal progression of infarct lesions in a rabbit middle cerebral artery occlusion (MCAO) model and predicting the acute cerebral infarction (ACI) volume.

Materials And Methods: Forty-two male rabbits (2.9 ± 0.2 kg body weight) were used in this experimental study. Animals were initially anesthetized by intravenous injection of uratan. There were seven experimental groups with six rabbits in each group. The apparent diffusion coefficient (ADC) and cerebral blood flow (CBF) thresholds were established in the control group (n = 6), which were sacrificed at 12 h, stained for infarct volume, and imaged at each time point.

Results: The normal ADC and CBF were estimated as 0.90 ± 0.03 × 10 mm/s and 0.68 ± 0.06 mL g min, respectively. The viability thresholds of ADC and CBF yielding the lesion volumes (LVs) at 3 h, which best approximated the 2,3,5-triphenyltetrazolium chloride (TTC) infarct volumes at 12 h, were 0.52 ± 0.02 × 10 mm/s (42.2 ± 3% reduction) and 0.33 ± 0.09 mL g min (51.0 ± 11% reduction), respectively. The temporal evolution of the ADC- and CBF-defined LVs showed a significant perfusion/diffusion mismatch up to 1 h (p = 0.001).

Conclusion: ADC values and ACI volumes were positively correlated, while CBF was negatively correlated, which is supposed to be a reference for predicting ACI volume.
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http://dx.doi.org/10.1016/j.apradiso.2020.109522DOI Listing
February 2021

Effects of antidiabetic drugs on psoriasis: A meta-analysis.

Eur J Clin Invest 2021 Feb 10;51(2):e13377. Epub 2020 Sep 10.

Hechi Third People's Hospital, Guangxi, China.

Background: Psoriasis, a chronic inflammatory skin disease, poses an elevated risk of developing diabetes mellitus.

Purpose: To investigate the effects of antidiabetic medications on psoriasis.

Data Sources, Study Selection And Data Extraction: We conducted a systemic review and meta-analysis and searched MEDLINE, EMBASE and CENTRAL for relevant randomized controlled trials. Our outcomes included 75% improvement in the psoriasis area and severity index from baseline (PASI 75), change in the psoriasis area and severity index (PASI) score, or change in the Dermatology Life Quality Index score under antidiabetic agents. Cochrane Collaboration's tool was used to evaluate the risk of bias of included studies. Subgroup analysis of different dosages of the antidiabetic agents was also performed.

Data Synthesis: We included 10 randomized controlled studies examining the effect of antidiabetic agents. Eight studies were rated high risk of bias. Pioglitazone demonstrated significant increase in PASI 75 (risk difference = 0.42; 95% CI: 0.18-0.65) and decrease in mean PASI (mean difference = -3.82; 95% CI: -6.05-1.ㄍ59). In subgroup analysis, 30 mg pioglitazone group demonstrated a significantly higher portion of PASI 75 than 15 mg pioglitazone group (P = .003).

Limitations: Some biases are reported high risk in involved articles. The main limitation of the study is in the inclusion of only glitazones. The lack of effect was seen for rosiglitazone and metformin. In the case of metformin, there was only one study available, which is also an important issue.

Conclusions: The current evidence demonstrates therapeutic efficacy of pioglitazone, which may be a treatment option in patients with psoriasis and diabetes mellitus.
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http://dx.doi.org/10.1111/eci.13377DOI Listing
February 2021

Topical Triamcinolone on "Sweet Spots" to Block Dynamic Pain after Tonsillectomy and Uvulo-Palato-Pharyngo-Plasty.

Ann Otol Rhinol Laryngol 2021 Apr 10;130(4):382-388. Epub 2020 Sep 10.

Department of Medical Research, China Medical University Hospital, China Medical University, Taichung.

Objectives: Severe pain on swallowing (or dynamic pain) has long been a problem in patients receiving tonsillectomy and uvulopalatopharyngoplasty for the treatment of obstructive sleep apnea syndrome and/or snoring. We have previously verified that dynamic pain after laser-assisted uvulopalatoplasty could immediately be mitigated by local treatments with topical triamcinolone on the "sweet spots" of the wounds. This study aimed to assess the efficacy of applying triamcinolone on "sweet spot" in surgical incisions instead of whole surgical wounds to alleviate dynamic pain of some oropharyngeal surgeries such as tonsillectomy and uvulopalatopharyngoplasty.

Methods: This study is a retrospective case series based on chart review of the participants. Forty-five subjects (31 males; 12~68 years, mean 34 years) with obstructive sleep apnea syndrome and/or snoring treated with tonsillectomy or uvulopalatopharyngoplasty were studied. Local treatments were done to sweet spots with triamcinolone on the 1st, 2nd, 3rd, and 7th days after the surgery. Evaluation of dynamic pain relief was performed by using a visual analogous scale.

Results: Sweet spots treatment led to instantaneous reduction of dynamic pain. The average improvement level was ≥72% ( ≤ .002). No gender effect was noted.

Conclusion: Dynamic pain after tonsillectomy and uvulopalatopharyngoplasty could immediately be mitigated by local treatments upon sweet spots. Local treatments upon sweet spots were highly suggested to begin early post-operatively and be included in the take-home routines for patients receiving tonsillectomy and uvulopalatopharyngoplasty.
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http://dx.doi.org/10.1177/0003489420953602DOI Listing
April 2021

Recent pubertal timing trends in Northern Taiwanese children: Comparison with skeletal maturity.

J Chin Med Assoc 2020 Sep;83(9):870-875

Department of Pediatrics, Cheng Hsin General Hospital, Taipei, Taiwan, ROC.

Background: International studies have reported an early age of onset of puberty in girls and boys. However, the current situation of puberty onset in Taiwanese children is unknown. In this study, the timing of menarche and pubertal change in testicular volume (TV) in Taiwanese children was examined, and bone age (BA) was used as an internal somatic maturity scale and compared with the chronological age (CA) at pubertal timing.

Methods: Clinical data from October 1, 2010, to March 31, 2018, were retrospectively collected from a general hospital in Taipei. The data of patients who were diagnosed with endocrine/genetic disorders were excluded. Clinical data included CA, timing of menarche, and X-ray images of TV and BA. BA was determined by a senior pediatrician and a senior pediatric radiologist. The reliability and validity of BA readings were tested. Collected data were analyzed statistically.

Results: Overall, TV records of 241 boys and the menarche timing data of 98 girls were collected from 1823 children. CA for menarche was 11.35 ± 1.06 years (mean ± SD), and BA for menarche was 12.95 ± 0.80 years. CA and BA at TV = 15 mL in male puberty was 12.32 ± 1.22 and 13.46 ± 0.68 years, respectively. A stronger correlation was observed between TV and BA than between TV and CA during the pubertal period.

Conclusion: The secular trend of earlier puberty timing continues. The decline rate of menarche timing was approximately 0.43 years per decade in the past 30 years. Among boys, an advance of more than 1 year in pubertal timing age was observed over the past 20 years. BA and TV showed high correlation during puberty.
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http://dx.doi.org/10.1097/JCMA.0000000000000360DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7478199PMC
September 2020

Surgical results in acute type A aortic dissection with preoperative cardiopulmonary resuscitation: Survival and neurological outcome.

PLoS One 2020 24;15(8):e0237989. Epub 2020 Aug 24.

Department of Medicine, College of Medicine, Chang-Gung University, Taoyuan, Taiwan.

Background: Acute type A aortic dissection (ATAAD) is a life-threatening disease that requires emergent surgical intervention. This retrospective study aimed to clarify the individual characteristics, short-term and mid-term outcomes, and prognostic factors of patients who underwent surgical repair of ATAAD with preoperative cardiopulmonary resuscitation (CPR).

Methods: Between January 2007 and January 2020, 656 consecutive patients underwent ATAAD repair at our institution; 22 (3.4%) of these patients underwent CPR prior to surgery. Patients who underwent preoperative CPR were classified as the survivor group (n = 9) and non-survivor group (n = 13), according to whether they survived to hospital discharge. Clinical features, surgical information, and postoperative complications were analyzed and compared. Three-year cumulative survival rates and cerebral performance categories (CPC) scores are presented.

Results: In patients undergoing CPR prior to ATAAD surgery, the in-hospital mortality rate was 59.1%. A total of 72.7% of patients underwent concomitant surgical resuscitation procedures during CPR such as emergent subxiphoid pericardiotomy and/or emergent cardiopulmonary bypass. The survivor group had a higher rate of return of spontaneous heartbeat (ROSB) compared to the non-survivor group (100% versus 53.8%; P = 0.017). The 3-year cumulative survival rates were 35.1% (95% confidence interval [CI], 27.6%-42.6%) and 85.7% (95% CI, 81.9%-88.8%) for overall patients and for survivors, respectively. As for the neurological outcome, 77.8% (7/9) of patients had full cerebral performance (CPC-1) at the 3-month follow-up examination after discharge.

Conclusions: Patients with ATAAD undergoing preoperative CPR, especially those without ROSB after CPR, are at high risk for in-hospital mortality. However, the short-term and mid-term outcomes, including the cerebral performance after discharge and 3-year survival rate, are promising for patients who survived to discharge.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0237989PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7446916PMC
October 2020

Prevalence and associated factors of myopia among rural school students in Chia-Yi, Taiwan.

BMC Ophthalmol 2020 Aug 5;20(1):320. Epub 2020 Aug 5.

Department of Medical Research and Education, Cheng-Hsin General Hospital, Taipei, Taiwan.

Background: The prevalence of myopia has increased rapidly worldwide over the past few decades. The aim of this study was to evaluate the prevalence and associated risk factors for myopia in elementary and junior high school students in Chia-Yi, Taiwan.

Methods: We included 5417 students in total from Grade 1-6 (n = 4763) and Grade 7-9 (n = 654) from Chia Yi County in this population-based study. The students underwent noncycloplegic autorefractometry and an interview with a structured questionnaire.

Results: For this study population, the prevalence of myopia and high myopia was 42.0 and 2.0%, respectively, revealing a statistically significant increase with increasing age (p < 0.05). Junior high school students (aged 13-15) showed a greater prevalence of myopia than elementary school students (aged 7-12) (55.8% vs. 40.1%, respectively, p < 0.001). Multiple logistic regression analysis showed that associated factors of myopia were body height (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 1.05-1.06), body mass index (OR: 0.98, 95% CI: 0.96-1.00), and ocular alignment (horizontal heterophoria vs. orthophoria, OR: 2.37, 95% CI: 2.08-2.70; tropia vs. orthophoria, OR: 1.94, 95% CI: 1.50-2.52) for elementary school students, whereas in junior high school students, they included body height (OR: 1.02, 95% CI: 1.01-1.04) and ocular alignment (heterophoria vs. orthophoria, OR: 2.20, 95% CI: 1.56-3.10).

Conclusions: This study provided epidemiological data on myopia in rural school students in Chia-Yi, Taiwan, and demonstrated the association between heterophoria and myopia. Correction of refractive errors in the students remained a challenge.
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http://dx.doi.org/10.1186/s12886-020-01590-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405435PMC
August 2020

A population-based study of the association between hemodialysis and cognitive impairment.

Asia Pac Psychiatry 2020 Dec 27;12(4):e12404. Epub 2020 Jul 27.

Department of Medical Research and Education, Cheng Hsin General Hospital, Taipei, Taiwan, China.

Introduction: End-stage renal disease is a serious public health issue. The objective of this retrospective cohort study was to assess the association between hemodialysis and cognitive impairment, while controlling for age, sex, residence, and comorbidities.

Methods: This study assesses the risk of cognitive impairment among a nationwide cohort of new hemodialysis patients derived from the NHIRD.

Results: A total of 4330 patients were assigned to the dialysis group and 17 320 patients were assigned to the control group. A total of 2103 of the patients developed cognitive impairment within 2 years after the date of dialysis initiation. Patients who developed cognitive impairment were older (69.85 ± 11.56) than their counterparts who did not develop cognitive impairment (58.58 ± 14.77; P < .001). The log-rank test of Kaplan-Meier analysis revealed a higher risk of cognitive impairment in the hemodialysis group than in the non-hemodialysis group (P < .001). The interval between dialysis initiation and the onset of cognitive impairment was 98.66 ± 46.39 months among non-dialysis subjects and 53.45 ± 41.90 months among dialysis subjects, and the between-group difference was significant (P < .001). The Cox Proportional Hazard Model revealed that after controlling for gender, age, residence, and comorbidities, hemodialysis was shown to have a significant impact on cognitive impairment (Hazard Ratio [HR]: 1.44; 95% confidence interval [CI]: 1.29-1.60). Furthermore, the risk of developing cognitive impairment increased with age (HR: 1.07; 95% CI: 1.06-1.08).

Discussion: Hemodialysis was associated with cognitive impairment. There was a significant association between age and cognitive impairment, regardless of the comorbidities prior to hemodialysis. There was no evidence of an association between comorbidities and cognitive impairment after beginning hemodialysis.
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http://dx.doi.org/10.1111/appy.12404DOI Listing
December 2020

The effects of psychotherapy for depressed or posttraumatic stress disorder women with childhood sexual abuse history: Meta-analysis of randomized controlled trials.

Medicine (Baltimore) 2020 Apr;99(17):e19776

Department of Public Health, Kaohsiung Medical University, Kaohsiung.

Background: Depression and posttraumatic stress disorder (PTSD) are the most common mental disorders of women suffered from childhood sexual abuse histories. It has been widely recognized that depression and PTSD may decrease patients' quality of life. The objective of this study is conducted to explore the effects of psychotherapy for depressed or PTSD women with childhood sexual abuse history.

Methods: We searched the PubMed and Cochrane Library from inception to June 30, 2019. The search strategy is (sexual assault OR sexual crime OR sexual abuse) AND (depression OR PTSD) AND (treatment OR intervention OR psychotherapy) with no restriction on language. Two authors independently selected the studies, assessed the quality of the included studies, and extracted data.

Results: Nine randomized control trials with 761 participants met the inclusion criteria. There were 340 participants in the psychotherapy group and 421 participants in the control group (usual treatment or waiting list). Compared to usual care, improvements were significantly greater in the psychotherapy group. The Beck depression inventory score for depression diagnosis of the psychotherapy group is lower from 4.27 to 8.96 (P < .05) than the control group. The client assessment protocols for PTSD, the diagnosis is also lower from 12.4 to 13.71 than the control group (P < .05).

Conclusion: The results suggested that psychotherapy is effective in reducing depressed or PTSD women with childhood sexual abuse. Further large-scale high-quality randomized controlled trials with long-term follow-up are warranted for confirming this finding.
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http://dx.doi.org/10.1097/MD.0000000000019776DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7220744PMC
April 2020

A Joint Evaluation of Neurohormone Vasopressin-Neurophysin II-Copeptin and Aortic Arch Calcification on Mortality Risks in Hemodialysis Patients.

Front Med (Lausanne) 2020 31;7:102. Epub 2020 Mar 31.

Department of Orthopaedic Surgery, School of Medicine, National Taiwan University, Taipei, Taiwan.

Systemic hypoperfusion is intricately involved in neurohormone secretion, vascular calcification (VC) related impaired vasodilation, and luminal stenosis. We aimed to conduct a joint evaluation of vasopressin-neurophysin II-copeptin peptide (VP) and advanced aortic arch calcification (AAC) on all-cause and cardiovascular (CV) mortality in maintenance hemodialysis (MHD) patients. Unadjusted and adjusted hazard ratios (aHRs) of mortality risks were analyzed for different groups of VP and AAC in 167 MHD patients. The modification effect between higher VP and advanced AAC on mortality risk was examined using an interaction product term. Interactions between VP and AAC with respect to all-cause and CV mortality were statistically significant. In multivariable analysis, higher VP predicted all-cause and CV mortality [aHR: 2.2 (95% confidence interval (CI): 1.1-4.5)] and 2.6 (95% CI: 1.1-4.6), respectively. Advanced AAC was associated with incremental risks of all-cause and CV mortality [aHR: 2.1 (95% CI: 1.1-4.0)and 2.5 (95% CI: 1.0-4.3), respectively]. Patients with combined higher VP (>101.5 ng/mL) and advanced AAC were at the greatest risk of all-cause and CV mortality [aHR: 4.7 (95% CI: 1.2-16.2)and 4.9 (95% CI: 1.1-18.9), respectively]. Combined VP and advanced AAC predict not only all-cause but also CV death in MHD patients, and a joint evaluation is more comprehensive than single marker. In light of hypoperfusion and ischemic events in vital organs, VP and AAC could act as more robust dual marker for prognostic assessment.
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http://dx.doi.org/10.3389/fmed.2020.00102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7136408PMC
March 2020
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