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Search Results: 1 - 10 of 23972 matches for " Chin-Kuo Chang "
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Osteoradionecrosis of External Auditory Canal in Nasopharyngeal Carcinoma
Sheng-Po Hao,Ngan-Ming Tsang,Kai-Ping Chang,Chin-Kuo Chen
Chang Gung Medical Journal , 2007,
Abstract: Background: Osteoradionecrosis (ORN) is one of the most serious complications of radiotherapyof nasopharyngeal carcinoma (NPC). ORN rarely occurs in theexternal auditory canal.Methods: This is a retrospective review of 11 NPC patients who had ORN in the externalauditory canal. Exposed necrotic bone over the external auditory canalwas the diagnostic hallmark. Three patients wore hearing aids and 2 had hadprevious otological surgery. ORN was detected between 2 and 15 years afterradiation therapy (mean 8 years). The radiation dose ranged from 6480 to8460 rads in 8 patients.Results: The symptoms of external auditory canal ORN were crust (100%), otorrhea(91%), otalgia (91%), hearing impairment (73%), foul odor (45%) and retroauriculardischarging fistula (9%), all of which mimicked those of chronicotitis media. After treatment, the diagnoses of 2 patients were rectified toexternal auditory canal malignancy and external auditory canalcholesteatoma, and the other 9 (82%) patients’ diagnoses remained as ORN.After combined treatment with local cleansing, hyperbaric oxygen therapy,sequestrectomy and ear drops, resolution of symptoms was achieved in allthe patients. Three patients who underwent sequestrectomy were free of disease.Conclusions: External auditory canal ORN is rare in NPC patients. The clinical presentationmimics that of chronic otitis media and differentiation is difficult. Thedisease is prone to occur in patients who wear hearing aids or have had previoussurgery. A high index of suspicion is mandatory for early diagnosis.The disease may lead to disastrous complications and should never beneglected by clinicians.
Acute and Prolonged Adverse Effects of Temperature on Mortality from Cardiovascular Diseases
Yu-Kai Lin, Chin-Kuo Chang, Yu-Chun Wang, Tsung-Jung Ho
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0082678
Abstract: Background Cardiovascular diseases are the leading causes of death worldwide, especially for developed countries. Elevated mortality from cardiovascular diseases has been shown related to extreme temperature. We thus assessed the risk of mortality from cerebrovascular diseases, heart diseases, and ischemic heart disease (IHD) in relation to temperature profiles in four subtropical metropolitans (Taipei, Taichung, Tainan, and Kaohsiung) from 1994 to 2007 in Taiwan. Methods Distributed lag non-linear models were applied to estimate the cumulative relative risks (RRs) with confidence intervals of cause-specific mortality associated with daily temperature from lag 0 to 20 days, and specific effect of extreme temperature episodes with PM10, NOx, and O3, and other potential confounders controlled. Estimates for cause-specific mortalities were then pooled by random-effect meta-analysis. Results Comparing to centered temperature at 27°C, the cumulative 4-day (lag 0 to 3) risk of mortality was significantly elevated at 31°C for cerebrovascular diseases (RR = 1.14; 95% CI: 1.00, 1.31) and heart diseases (RR = 1.22; 95% CI: 1.02, 1.46) , but not for IHD (RR = 1.09; 95% CI: 0.99, 1.21). To the other extreme, at 15°C, the cumulative 21-day (lag 0 to 20) risk of mortality were also remarkably increased for cerebrovascular diseases, heart diseases, and IHD (RRs = 1.48 with 95% CI: 1.04, 2.12, 2.04 with 95% CI: 1.61, 2.58, and 1.62 with 95% CI: 1.30, 2.01, respectively). Mortality risks for cardiovascular diseases were generally highest on the present day (lag 0) of extreme heat. No particular finding was detected on prolonged extreme temperature event by pooling estimations for cause-specific mortality. Conclusions Low temperature was associated with greater risk of mortality from cardiovascular diseases in comparison with that of high temperature. Adverse effects of extreme temperatures are acute at the beginning of exposure.
Functional Status and All-Cause Mortality in Serious Mental Illness
Richard D. Hayes, Chin-Kuo Chang, Andrea C. Fernandes, Aysha Begum, David To, Matthew Broadbent, Matthew Hotopf, Robert Stewart
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0044613
Abstract: Background Serious mental illness can affect many aspects of an individual’s ability to function in daily life. The aim of this investigation was to determine if the environmental and functional status of people with serious mental illness contribute to the high mortality risk observed in this patient group. Methods We identified cases of schizophrenia, schizoaffective and bipolar disorder aged ≥15 years in a large secondary mental healthcare case register linked to national mortality tracing. We modelled the effect of activities of daily living (ADLs), living conditions, occupational and recreational activities and relationship factors (Health of the Nation Outcome Scale [HoNOS] subscales) on all-cause mortality over a 4-year observation period (2007–10) using Cox regression. Results We identified 6,880 SMI cases (242 deaths) in the observation period. ADL impairment was associated with an increased risk of all-cause mortality (adjusted HR 1.9; 95% CI 1.3–2.8; p = 0.001, p for trend across ADL categories = 0.001) after controlling for a broad range of covariates (including demographic factors, physical health, mental health symptoms and behaviours, socio-economic status and mental health service contact). No associations were found for the other three exposures. Stratification by age indicated that ADLs were most strongly associated with mortality in the youngest (15 to <35 years) and oldest (≥55 years) groups. Conclusions Functional impairment in people with serious mental illness diagnoses is a marker of increased mortality risk, possibly in younger age groups as a marker of negative symptomatology.
All-cause mortality among people with serious mental illness (SMI), substance use disorders, and depressive disorders in southeast London: a cohort study
Chin-Kuo Chang, Richard D Hayes, Matthew Broadbent, Andrea C Fernandes, William Lee, Matthew Hotopf, Robert Stewart
BMC Psychiatry , 2010, DOI: 10.1186/1471-244x-10-77
Abstract: A case register was developed at the South London and Maudsley National Health Services Foundation Trust (NHS SLAM), accessing full electronic clinical records on over 150,000 mental health service users as a well-defined cohort since 2006. The Case Register Interactive Search (CRIS) system enabled searching and retrieval of anonymised information since 2008. Deaths were identified by regular national tracing returns after 2006. Standardized mortality ratios (SMRs) were calculated for the period 2007 to 2009 using SLAM records for this period and the expected number of deaths from age-specific mortality statistics for the England and Wales population in 2008. Data were stratified by gender, ethnicity, and specific mental disorders.A total of 31,719 cases, aged 15 years old or more, active between 2007-2009 and with mental disorders of interest prior to 2009 were detected in the SLAM case register. SMRs were 2.15 (95% CI: 1.95-2.36) for all SMI with genders combined, 1.89 (1.64-2.17) for women and 2.47 (2.17-2.80) for men. In addition, highest mortality risk was found for substance use disorders (SMR = 4.17; 95% CI: 3.75-4.64). Age- and gender-standardised mortality ratios by ethnic group revealed huge fluctuations, and SMRs for all disorders diminished in strength with age. The main limitation was the setting of secondary mental health care provider in SLAM.Substantially higher mortality persists in people with serious mental illness, substance use disorders and depressive disorders. Furthermore, mortality risk differs substantially with age, diagnosis, gender and ethnicity. Further research into specific risk groups is required.The potential impact of mental disorders on mortality has been increasingly recognised in recent years. People with serious mental illnesses (SMI, including schizophrenia, schizoaffective disorder, bipolar disorder, and depressive psychosis) live with health disparities, not only resulting from social dysfunction, stigma, and direct conseque
Life Expectancy at Birth for People with Serious Mental Illness and Other Major Disorders from a Secondary Mental Health Care Case Register in London
Chin-Kuo Chang,Richard D. Hayes,Gayan Perera,Mathew T. M. Broadbent,Andrea C. Fernandes,William E. Lee,Mathew Hotopf,Robert Stewart
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0019590
Abstract: Despite improving healthcare, the gap in mortality between people with serious mental illness (SMI) and general population persists, especially for younger age groups. The electronic database from a large and comprehensive secondary mental healthcare provider in London was utilized to assess the impact of SMI diagnoses on life expectancy at birth.
Evaluation of Smoking Status Identification Using Electronic Health Records and Open-Text Information in a Large Mental Health Case Register
Chia-Yi Wu, Chin-Kuo Chang, Debbie Robson, Richard Jackson, Shaw-Ji Chen, Richard D. Hayes, Robert Stewart
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074262
Abstract: Background High smoking prevalence is a major public health concern for people with mental disorders. Improved monitoring could be facilitated through electronic health record (EHR) databases. We evaluated whether EHR information held in structured fields might be usefully supplemented by open-text information. The prevalence and correlates of EHR-derived current smoking in people with severe mental illness were also investigated. Methods All cases had been referred to a secondary mental health service between 2008-2011 and received a diagnosis of schizophreniform or bipolar disorder. The study focused on those aged over 15 years who had received active care from the mental health service for at least a year (N=1,555). The ‘CRIS-IE-Smoking’ application used General Architecture for Text Engineering (GATE) natural language processing software to extract smoking status information from open-text fields. A combination of CRIS-IE-Smoking with data from structured fields was evaluated for coverage and the prevalence and demographic correlates of current smoking were analysed. Results Proportions of patients with recorded smoking status increased from 11.6% to 64.0% through supplementing structured fields with CRIS-IE-Smoking data. The prevalence of current smoking was 59.6% in these 995 cases for whom this information was available. After adjustment, younger age (below 65 years), male sex, and non-cohabiting status were associated with current smoking status. Conclusions A natural language processing application substantially improved routine EHR data on smoking status above structured fields alone and could thus be helpful in improving monitoring of this lifestyle behaviour. However, limited information on smoking status remained a challenge.
Esophagogastroduodenoscopy with conscious sedation does not interfere with catheter-based 24-h pH monitoring
Yung-Kuan Tsou,Jau-Min Lien,Chin-Kuo Chen,Cheng-Hui Lin
World Journal of Gastroenterology , 2013, DOI: 10.3748/wjg.v19.i11.1805
Abstract: AIM: To investigate the impact of esophagogastroduodenoscopy with conscious sedation on the subsequent 24-h catheter-based pH monitoring. METHODS: Fifty patients with extra-esophageal symptoms of gastroesophageal reflux disease undergoing ambulatory dual-probe 24-h pH monitoring were enrolled from March 2010 to August 2011. All of the data were collected prospectively and analyzed retrospectively. Thirty-six patients (72%, group A) underwent pH monitoring shortly after esophagogastroduodenoscopy (EGD) with conscious sedation, and 14 patients (28%, group B) underwent pH monitoring without conscious sedation. The 24-h pH data from two time periods were analyzed: the first 4 h (Period I) and the remaining time of the study (Period II). RESULTS: The mean age of the patients was 49.6 ± 12.5 years; 20 patients (40%) were men. The baseline data, including age, sex, body mass index, reflux esophagitis, the Reflux Symptom Index, and the Reflux Findings Score, were comparable between the two groups. The percentage of total time with a pH < 4 and the frequency of acid reflux during Period I were not significantly different between the two groups, as measured using both pharyngeal (0.03% ± 0.10% vs 0.07% ± 0.16%, P = 0.32; and 0.07 ± 0.23 episodes/h vs 0.18 ± 0.47 episodes/h, P = 0.33, respectively) and esophageal probes (0.96% ± 1.89% vs 0.42% ± 0.81%, P = 0.59; and 0.74 ± 1.51 episodes/h vs 0.63 ± 0.97 episodes/h, P = 0.49, respectively). The percentage of total time with a pH < 4 and the frequency of acid reflux were also not significantly different between Periods I and II in group A patients, as measured using both pharyngeal (0.03% ± 0.10% vs 0.23% ± 0.85%, P = 0.21; and 0.07 ± 0.23 episodes/h vs 0.29 ± 0.98 episodes/h, P = 0.22, respectively) and esophageal probes (0.96% ± 1.89% vs 1.11% ± 2.57%, P = 0.55; and 0.74 ± 1.51 episodes/h vs 0.81 ± 1.76 episodes/h, P = 0.55, respectively). CONCLUSION: EGD with conscious sedation does not interfere with the results of subsequent 24-h pH monitoring in patients with extra-esophageal symptoms of gastroesophageal reflux disease.
Epidermal Growth Factor Receptor Mutations in Cells from Non-Small Cell Lung Cancer Malignant Pleural Effusions
Ming-Szu Hung,Chin-Kuo Lin,Shaw-Wei Leu,Mei-Yi Wu
Chang Gung Medical Journal , 2006,
Abstract: Background: The prevalence of epidermal growth factor receptor (EGFR) mutations innon-small cell lung cancer (NSCLC) patients is about 40~50% in Taiwan,and there are significant correlations between EGFR mutations and clinicalresponses after gefitinib treatment. For most patients with advanced disease,surgical intervention for tissue sampling is not feasible. We therefore conductedthis study to survey EGFR mutations in cells from NSCLC malignantpleural effusions and to evaluate the clinical significance.Methods: In the present study, malignant pleural effusion cells from 29 NSCLCpatients were studied for EGFR mutations. Exons 18, 19, 20, 21 of the EGFRgene were analyzed by polymerase chain reaction (PCR) and automatedsequencing. For 11 patients who had received gefitinib therapy, correlationsbetween gefitinib effect and EGFR mutations were also evaluated.Results: EGFR mutations were detected in 12 of 29 specimens (41%). In-frame deletionmutations in exon 19 (8 of 12 specimens, 67%) and missense mutationsin exon 21 (3 of 12 specimens, 25%) were the most frequent mutationsdetected. The frequency of EGFR mutations was significantly higher in gefitinibresponders (4/4) than non-responders (1/7) (p = 0.015).Conclusion: Our results suggest that detecting EGFR mutations in cells from malignantpleural effusions is a feasible adjunct method to finding the subgroup withfavorable response to gefitinib therapy among patients with advancedNSCLC.
The Natural Vibration Characteristics of Human Ossicles
Ching-Feng Chou,Jen-Fang Yu,Chin-Kuo Chen
Chang Gung Medical Journal , 2011,
Abstract: Background: Recently, a model of the ossicular chain for finite element analysis has beendeveloped. However, the natural vibration characteristics of human ossicleshave never been studied. Herein, we investigated the dynamic characteristicsof the coupling of in-vivo ossicles using finite element analysis.Methods: The geometry of the ossicular chain was obtained by high-resolution computedtomography of the temporal bone, and a 3D model of the ossicularchain was reconstructed by the medical imaging software, Amira . The filewas then imported into the finite element analysis software, ANSYS . Thenatural vibration characteristics of human ossicles were measured by finiteelement analysis.Results: The characteristic dimensions of the model were measured and comparedwith previously published data. The malleus resonated to sound stimuli at 3kHz and 4 kHz; the incus and stapes did not resonate to sound stimuli at anyfrequency. A coupling of the incus and malleus easily resonated to soundstimuli at 5 kHz. A coupling of the incus and stapes easily resonated tosound stimuli at 3 kHz. The coupling of the ossicular chain easily resonatedto sound stimuli at 5 kHz, 6 kHz and 8 kHz.Conclusion: The dynamic characteristics of the ossicular chain were analyzed by finiteelement analysis method. The characteristics of a free vibration model of theossicles could be determined, which would be helpful in evaluation and consultationfor ossicular prosthesis development.
Magnetic Resonance Imaging of the In-vivo Human Tympanic Membrane
Tung-Yu Lin,Jen-Fang Yu,Chin-Kuo Chen
Chang Gung Medical Journal , 2011,
Abstract: Background: To obtain magnetic resonance images of the in-vivo human tympanic membraneto avoid radiation exposure.Methods: Images of the in-vivo human tympanic membrane were obtained by magneticresonance imaging (MRI). The differences in resolution of the imagesobtained by multi slice single echo (MSSE) and 3-dimentional (3D) SNAPsequences were then compared.Results: The resolution of the 2D MR images acquired by MSSE sequences was higherthan that obtained by 3D SNAP. The voxel size of the MR images wassmaller than that with 3D SNAP because of the narrower slice thickness.Therefore, the spatial resolution of the 3D SNAP sequenced images was betterthan that of MSSE images. The scanning time for MSSE and 3D SNAPwere 12 minutes and 40 seconds and 1 minute and 42 seconds respectively.The signal-to-noise ratio (SNR) of MR images with 3D SNAP was 0.32decibels higher than that with MSSE.Conclusion: In this study, MR images of the in-vivo human tympanic membrane could beobtained with a 9-cm surface coil with MSSE and 3D SNAP sequences. Thespatial resolution of MR images acquired with 3D SNAP was better than thatwith MSSE. The scanning time with 3D SNAP was shorter than that withMSSE based on similar SNRs. The structure and geometry of the tympanicmembrane can be observed clearly, which would be helpful for diagnosis inclinics and can avoid radiation exposure.
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