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REVIEW ARTICLES - CLINICAL
A review of ovary torsion
Ci Huang, Mun-Kun Hong, Dah-Ching Ding
July-September 2017, 29(3):143-147
DOI:10.4103/tcmj.tcmj_55_17  PMID:28974907
Ovarian torsion is a rare but emergency condition in women. Early diagnosis is necessary to preserve the function of the ovaries and tubes and prevent severe morbidity. Ovarian torsion refers to complete or partial rotation of the adnexal supporting organ with ischemia. It can affect females of all ages. Ovarian torsion occurs in around 2%–15% of patients who have surgical treatment of adnexal masses. The main risk in ovarian torsion is an ovarian mass. The most common symptom of ovarian torsion is acute onset of pelvic pain, followed by nausea and vomiting. Pelvic ultrasonography can provide information on ovarian cysts. Once ovarian torsion is suspected, surgery or detorsion is the mainstay of diagnosis and treatment.
  1,673 196 3
Current consensus and controversy on the treatment of male lower urinary tract symptoms/benign prostatic hyperplasia
Chun-Hou Liao, Hann-Chorng Kuo
January-March 2017, 29(1):1-5
DOI:10.4103/tcmj.tcmj_2_17  PMID:28757756
Lower urinary tract symptoms (LUTS) are highly prevalent in men and increase with age. Because LUTS are common among elderly men, they are usually considered synonymous with benign prostatic hyperplasia (BPH). Drugs should be the first-line treatment for BPH and surgical intervention should be performed only when there are complications or LUTS refractory to medical treatment. In addition to medical treatment, several minimally invasive therapies, such as thermal therapy, prostatic lift, laser evaporation, or laser enucleation techniques have been developed. Recent investigations have also revealed that bladder dysfunction such as detrusor overactivity and detrusor underactivity may also contribute to male LUTS. In the treatment of LUTS suggestive of BPH (LUTS/BPH), the following questions should be considered: Is there an obstruction? Are we treating BPH or LUTS? Can management targeting BPH reduce LUTS? Should patients with LUTS be treated before bladder outlet obstruction is confirmed? What is the role of transurethral resection of the prostate (TURP) nowadays? Will new techniques provide better outcomes than TURP? This article discusses the current consensus and controversies in the treatment of LUTS/BPH.
  1,489 241 -
Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention
Jia-Fong Jhang, Hann-Chorng Kuo
July-September 2017, 29(3):131-137
DOI:10.4103/tcmj.tcmj_53_17  PMID:28974905
Recurrent urinary tract infection (UTI) might be one of the most common problems in urological clinics. Recent research has revealed novel evidence about recurrent UTI and it should be considered a different disease from the first infection. The pathogenesis of recurrent UTI might include two mechanisms, bacterial factors and deficiencies in host defense. Bacterial survival in the urinary bladder after antibiotic treatment and progression to form intracellular bacterial communities might be the most important bacterial factors. In host defense deficiency, a defect in pathogen recognition and urothelial barrier function impairment play the most important roles. Immunodeficiency and urogenital tract anatomical abnormalities have been considered the essential risk factors for recurrent UTI. In healthy women, voiding dysfunction and behavioral factors also increase the risk of recurrent UTI. Sexual intercourse and estrogen deficiency in postmenopausal women might have the strongest association with recurrent UTI. Traditional lifestyle factors such as fluid intake and diet are not considered independent risk factors now. Serum and urine biomarkers to predict recurrent UTI from the first infection have also attracted a wide attention recently. Current clinical evidence suggests that serum macrophage colony-stimulating factor and urinary nerve growth factor have potential predictive value for recurrent UTI. Clinical trials have proven the efficacy of the oral immunoactive agent OM-89 for the prevention of UTI. Vaccines for recurrent UTI are recommended by the latest guidelines and are available on the market.
  1,335 290 -
Impact of vegan diets on gut microbiota: An update on the clinical implications
Ming-Wun Wong, Chih-Hsun Yi, Tso-Tsai Liu, Wei-Yi Lei, Jui-Sheng Hung, Chin-Lon Lin, Shinn-Zong Lin, Chien-Lin Chen
October-December 2018, 30(4):200-203
DOI:10.4103/tcmj.tcmj_21_18  PMID:30305781
Numerous studies indicate that microbiota plays an important role in human health. Diet is a factor related to microbiota which also influences human health. The relationships between diet, microbiota, and human health are complex. This review focuses on the current literature on vegan diets and their unique impact on gut microbiota. We also report on the health benefits of a vegan diet for metabolic syndrome, cardiovascular disease, and rheumatoid arthritis concerning relevant impacts from gut microbiota. Despite evidence supporting the clinical relevance of vegan gut microbiota to human health, the whole mechanism awaits further investigation.
  1,430 181 -
Current consensus and controversy on the diagnosis of male lower urinary tract symptoms/benign prostatic hyperplasia
Cheng-Ling Lee, Hann-Chorng Kuo
January-March 2017, 29(1):6-11
DOI:10.4103/tcmj.tcmj_3_17  PMID:28757757
Traditionally, male lower urinary tract symptoms (LUTS) have been considered a synonym for benign prostate hyperplasia (BPH) because most male LUTS develops in aging men. Medical treatment should be the first-line treatment for BPH and surgical intervention should be performed when there are complications or LUTS refractory to medical treatment. Recent investigations have revealed that bladder dysfunction and bladder outlet dysfunction contribute equally to male LUTS. In the diagnosis of LUTS suggestive of BPH (LUTS/BPH), the following questions should be considered: Is there an obstruction? Are the LUTS caused by an enlarged prostate? What are the appropriate tools to diagnose an obstructive BPH? Should patients with LUTS be treated before bladder outlet obstruction is confirmed? This article discusses the current consensus and controversies in the diagnosis of LUTS/BPH.
  1,262 164 -
ORIGINAL ARTICLES - CLINICAL RESEARCH
Vegetarian diet, food substitution, and nonalcoholic fatty liver
Tina H Chiu, Ming-Nan Lin, Wen-Harn Pan, Yen-Ching Chen, Chin-Lon Lin
April-June 2018, 30(2):102-109
DOI:10.4103/tcmj.tcmj_109_17  PMID:29875591
Objectives: Vegetarian diets have been shown to improve insulin resistance and reduce body weight, but the effects on nonalcoholic fatty liver require further confirmation. We aim to investigate the association between vegetarian diets, major food groups, and nonalcoholic fatty liver, and to compare the degree of liver fibrosis between vegetarians and nonvegetarians in those with fatty liver. Materials and Methods: We analyzed cross-sectional data from the Tzu Chi Health Study which included 2127 nonvegetarians and 1273 vegetarians who did not smoke or habitually drink alcohol and had no hepatitis B or hepatitis C. Fatty liver and liver fibrosis were determined using ultrasonography and the nonalcoholic fatty liver disease fibrosis score, respectively. Diet was assessed through a validated food frequency questionnaire. Results: Vegetarian diets were associated with lower odds of fatty liver (odds ratio = 0.79, 95% confidence interval: 0.68–0.91) after adjusting for age, gender, education, history of smoking and alcohol drinking. Adjustment for body mass index (BMI) attenuated the protective association. Vegetarians had less severe fibrosis than nonvegetarians. Replacing a serving of soy with a serving of meat or fish was associated with 12%–13% increased risk, and replacing a serving of whole grains with a serving of refined grains, fruits, and fruit juice was associated with 3%–12% increased the risk of fatty liver. Conclusion: Vegetarian diets, replacing meat and fish with soy, and replacing refined carbohydrates with whole grains, may be inversely associated with nonalcoholic fatty liver related to BMI.
  1,127 109 -
Comparison of Apgar scores in breech presentations between vaginal and cesarean delivery
Jonny Karunia Fajar, Mohd Andalas, Harapan Harapan
January-March 2017, 29(1):24-29
DOI:10.4103/tcmj.tcmj_5_17  PMID:28757760
Objective: The mode of delivery in breech presentation (BP) is controversial. Several studies have reported the advantages and disadvantages of delivery mode in BP. The aim of this study was to compare the Apgar scores in BPs between vaginal and cesarean delivery. Materials and Methods: A retrospective study was conducted at Dr.Zainoel Abidin General Hospital from January 2010 to December 2012. Data on the mode of delivery and Apgar scores at 1 and 5min for infants with a BP were extracted from the medical records. Logistic regression was employed to assess the correlation between mode of delivery and Apgar scores. In addition, a meta-analysis was conducted to summarize findings from other regions. Results: A total of 205(3.9%) BPs among 5252 deliveries between January 2010 and December 2012 were analyzed for this study. There were 26% (52cases) vaginal and 74% (153cases) cesarean deliveries. The mode of delivery for BP had a significant association with Apgar score at 1min (odds ratio [OR] 95% confidence interval [CI] = 6.462 [2.476–16.870], P=0.0001) and 5min (OR 95% CI =7.727 [1.416–42.175], P=0.018). Our meta-analysis showed that the delivery mode had a significant association with Apgar score in BP (OR: 3.69; 95% CI: 2.18–6.26, P=0.0001). Conclusions: There was a significant association between Apgar scores in BPs and mode of delivery. Our results suggest better outcomes for cesarean than vaginal delivery in BPs.
  1,052 137 3
Increased prevalence of obstructive sleep apnea in patients with pectus excavatum: A pilot study
Yeung-Leung Cheng, I-Shiang Tzeng, Mei-Chen Yang
October-December 2018, 30(4):233-237
DOI:10.4103/tcmj.tcmj_115_17  PMID:30305787
Objective: Laryngomalacia is the most common congenital laryngeal anomaly and is associated with pectus excavatum (PE). Patients with laryngomalacia and patients with obstructive sleep apnea (OSA) both experience upper airway obstruction, and patients with laryngomalacia had been found to have a higher prevalence of PE. However, no studies have established the prevalence of OSA in patients with PE. We conducted this pilot study to evaluate the prevalence of OSA in patients with PE. Materials and Methods: A total of 42 patients ≥20 years old with PE who were admitted for Nuss surgery to correct PE in Taipei Tzu Chi Hospital between October 2015 and September 2016 were invited to participate in the study; 31 of the 42 patients agreed. All 31 patients completed an Epworth sleepiness scale questionnaire to evaluate excessive daytime sleepiness (EDS) and underwent overnight polysomnography to evaluate OSA before Nuss surgery. Results: The prevalence of snoring in the study participants was 100%. Ten of 31 patients (32.3%) reported EDS. The overall prevalence of OSA with an apnea/hypopnea index ≥5/h was 25.8%, and all patients with OSA were men. Conclusions: The prevalence of OSA in patients with PE seemed to be higher than that previously reported in the general population, implying that OSA might be a potential etiology or, at least, an aggravating factor for the development or progression of PE or might be responsible for the postoperative recurrence of PE in some patients. Further studies are needed to clarify this relationship.
  1,103 52 -
CASE REPORTS
Tension wiring to increase stability of conventional plating for proximal humeral fractures: An alternative to a locking plate
Kai-Lan Hsu, Ta-Wei Tai, Wei-Ren Su, Chii-Jeng Lin, Pei-Yuan Lee
January-March 2017, 29(1):37-40
DOI:10.4103/tcmj.tcmj_6_17  PMID:28757762
Fixation of comminuted or osteoporotic fractures in the proximal humerus is a challenge for orthopedic surgeons. In the past two decades, locking plates have been used for proximal humeral fracture fixation. However, complications such as loss of reduction have been reported, and the implants are not always available in some regions. Therefore, we describe an alternative procedure involving fixation with a nonlocking cloverleaf plate augmented with tension wiring to provide adequate stability and prevent loss of reduction.
  983 138 -
Immune reconstitution inflammatory syndrome-associated disseminated Kaposi's sarcoma in a patient infected with human immunodeficiency virus: Report of an autopsy case
Chiu-Hsuan Cheng, Yung-Hsiang Hsu
January-March 2017, 29(1):41-45
DOI:10.4103/tcmj.tcmj_9_17  PMID:28757763
Immune reconstitution inflammatory syndrome is a collection of inflammatory disorders associated with paradoxical worsening of preexisting infectious processes following the initiation of highly active antiretroviral therapy (HAART) in individuals infected with human immunodeficiency virus (HIV). It involves a wide range of pathogens, neoplasms such as Kaposi's sarcoma (KS) and some autoimmune diseases. We describe an autopsy report of a 40-year-old man infected with HIV. He experienced a rapid dissemination of KS resulting in death within 6months after starting HAART. His serum viral load had significantly decreased 4 log10 within 32days and his CD4+ T-cell count increased 4-fold. He presented with multiple skin lesions over the chin and anterior neck, which rapidly spread over the trunk, 4 extremities, perianal region, and penis. Finally, he developed acute dyspnea and a plain chest radiograph showed bilateral pulmonary infiltrations. Despite treatment, he died of acute respiratory failure. At autopsy, multiple KS lesions were noted in the bilateral lungs, liver, kidneys, and gastrointestinal tract. Increased inflammatory cytokines during immune reconstruction from HAART-reactive human herpes virus type-8 infection, linked to the tumorigenesis of KS, finally led to rapid dissemination and death.
  993 108 1
ORIGINAL ARTICLES - CLINICAL RESEARCH
Sensorineural hearing loss in patients with chronic renal failure on hemodialysis in Basrah, Iraq
Haider K Saeed, Ahmed M Al-Abbasi, Shukryia K Al-Maliki, Jasim N Al-Asadi
October-December 2018, 30(4):216-220
DOI:10.4103/tcmj.tcmj_149_17  PMID:30305784
Objectives: The objective of this study is to determine the effect of hemodialysis on the hearing threshold in patients with chronic renal failure (CRF). Materials and Methods: Fifty-nine patients with CRF on regular hemodialysis were followed up for 1 year with a pure-tone audiometric examination every 6 months. Results: The mean age of the patients was 41.8 ± 9.2 years (range: 17–50 years). At the beginning of the study, 39 patients (66.1%) had sensorineural hearing loss (SNHL). During the 12-month follow-up, 6 more patients developed SNHL giving a point prevalence rate of 76.3% at the end of the study. The hearing loss was more evident in the higher frequencies. Of the studied patients, 64.4% showed deterioration of the hearing threshold. The mean hearing threshold at the beginning of the study was 29.2 ± 21.1 dB versus 36.9 ± 17.3 dB at the end of the study (P < 0.001). No significant relation was found between age, sex, serum electrolytes, blood urea, and duration of CRF and hearing loss. Multivariate analysis showed that the duration of hemodialysis was the only significant independent predictor of SNHL. Conclusion: SNHL is common in patients with CRF on hemodialysis. It was mild to moderate in the majority of patients. Hearing impairment was most obvious at the high frequencies. Most of the patients showed further deterioration in the hearing threshold with the duration of dialysis.
  1,007 85 -
REVIEW ARTICLES - CLINICAL
Treatment of acute bipolar depression
Yu-Chih Shen
July-September 2018, 30(3):141-147
DOI:10.4103/tcmj.tcmj_71_18  PMID:30069121
Depression is the predominant pole of disability in bipolar disorder and compared with mania/hypomania, has less systematic research guiding the development of treatment especially in its acute phase (acute bipolar depression). The deficiency in the management of the acute bipolar depression largely reflects the natural divergence of opinion resulting from significant knowledge gaps. At present, there are only 3 approved drug treatments for acute bipolar depression: olanzapine/fluoxetine combination, quetiapine (immediate or extended release), and lurasidone (monotherapy or adjunctive to lithium or valproate). Nonapproved agents and nonpharmacologic treatment such as lamotrigine, antidepressants, modafinil, pramipexole, ketamine, and electroconvulsive therapy are often prescribed to treat acute bipolar depression. This article discusses the challenges of diagnosing bipolar depression, and reviews above treatment options for acute bipolar depression.
  935 143 -
ORIGINAL ARTICLES - CLINICAL RESEARCH
Prevalence, risk factors, and antimalarial resistance patterns of falciparum plasmodiasis among pregnant women in Kaduna metropolis, Nigeria
Maryam Muhammad Aliyu, Idris Abdullahi Nasir, Yahaya Abdullahi Umar, Anthony Philip Vanstawa, Jessy Thomas Medugu, Anthony Uchenna Emeribe, Dele Ohinoyi Amadu
April-June 2017, 29(2):98-103
DOI:10.4103/tcmj.tcmj_22_17  PMID:28757774
Objective: Pregnant women infected with malaria represent a significant obstetric problem, especially in the face of antimalarial resistance. This cross-sectional study investigated the prevalence of malaria parasitemia, associated risk factors as well as the antimalarial resistance pattern of Plasmodium isolates from pregnant women attending four selected secondary health facilities in Kaduna State, Nigeria. Materials and Methods: Blood samples were collected from 353 pregnant women attending selected hospitals. Malaria microscopy and parasite density count were conducted based on standard protocols. Antimalarial susceptibility test (using chloroquine, artesunate, artether, and sulfadoxine-pyrimethamine), and hemoglobin concentrations were determined using schizont maturation assay and methemoglobin method, respectively. Multiple-drug resistance (MDR) was defined by resistance against ≥3 antimalarial drugs. Results: The overall prevalence of plasmodiasis was 22.4%. Out of those infected, 5.2% was found to be anemic. Malaria parasitemia was significantly associated with parity, residential area, age of women, and use of preventive measures against malaria (P < 0.05) but not with hemoglobin concentration, occupation, and trimester of pregnancy (P > 0.05). Malaria parasites from the pregnant women exhibited the highest resistance against chloroquine, 75 (94.9%) followed Artemether, 30 (37.9%) then sulfadoxine-pyrimethamine, 29 (36.7%) and least resistant to artesunate, 28 (35.4%). The prevalence of MDR was 40.5% (32/79). Conclusion: The prevalence of malaria was relatively high due to inadequate and/or ineffective preventive measures adopted by pregnant women. More so, significant isolates of Plasmodium falciparum exhibited MDR against antimalarial agents tested.
  964 93 -
Treating intracranial dural arteriovenous fistulas with gamma knife radiosurgery: Asingle-center experience
Guan-Chyuan Wang, Kuan-Pin Chen, Tsung-Lang Chiu, Chain-Fa Su
January-March 2017, 29(1):18-23
DOI:10.4103/tcmj.tcmj_4_17  PMID:28757759
Objective: We evaluated the effectiveness and safety of gamma knife radiosurgery (GKRS) for the treatment of intracranial dural arteriovenous fistulas (dural AVFs) over the past 10years. Materials and Methods: The records of 21patients diagnosed with dural AVFs between 2004 and 2014 and treated with GKRS were reviewed retrospectively. Complete obliteration (CO) was defined as total symptom relief plus confirmation through magnetic resonance imaging or conventional angiography. Results: The median follow-up was 70.5months (range 3–136months). Five patients underwent embolization (2 after GKRS). One patient underwent GKRS twice. The CO rate was 47%, and partial to CO rate was 88%. The complete symptom resolution rate was 77%, and all patients achieved partial to complete symptom resolution. The CO rates for Borden TypeI and TypeII/III dural AVFs were 66.7% and 25% (P=0.153), respectively, and complete symptom-free rates were 76.9% and 75.0% (P=1.000%), respectively. The median duration between initial GKRS and complete symptom resolution was 14.3months. The median treatment to image-free durations for Borden TypeI and TypeII/III dural AVFs were 25.9 and 60.4months (P=0.028), respectively, and treatment to symptom-free durations were 10.6 and 36.7months (P=0.103), respectively. One patient had a recurrent hemorrhage. Two patients experienced brain edema after stereotactic radiosurgery and one patient experienced cystic formation after GKRS. The morbidity rate was 19% (four patients) and there was no mortality. Conclusion: Treatment with GKRS for dural AVFs offers a favorable rate of obliteration. Patients with dural AVFs that are refractory or not amenable to endovascular or surgical therapy may be safely and effectively treated using GKRS.
  925 122 -
REVIEW ARTICLES - CLINICAL
The borderland between normal aging and dementia
Raymond Y Lo
April-June 2017, 29(2):65-71
DOI:DOI: 10.4103/tcmj.tcmj_18_17  
Alzheimer's disease (AD) has become a global health issue as the population ages. There is no effective treatment to protect against its occurrence or progression. Some argue that the lack of treatment response is due to delays in diagnosis. By the time a diagnosis of AD is made, neurodegenerative changes are at the stage where very few neurons can be salvaged by medication. The AD research community has developed the idea of mild cognitive impairment (MCI) in an attempt to find predementia patients who might benefit from potentially therapeutic drugs that have proven ineffective in the past. However, MCI is heterogeneous in terms of its underlying pathology and practicality for predicting dementia. This article first reviews the conceptual evolution of MCI as the borderland between normal aging and dementia, and then proposes that built environment and sociocultural context are two key elements in formulating a diagnosis of dementia. Dementia is more than a biomedical term. Cognitive impairment is considered a dynamic outcome of how an individual interacts with cognitive challenges. To focus on amyloid deposition as a single etiology for AD does not adequately capture the social implications and geriatric aspects of dementia. Moreover, MCI is nosologically questionable. Unlike a diagnosis of AD, for which a prototype has been well established, MCI is defined by operational criteria and there are no cases seen as typical MCI. Biofluid and imaging markers are under active development for early detection of amyloid deposition and neurofibrillary tangles in the brain, whereas vascular risks, chronic medical diseases, and polypharmacy continue to add to the complexity of dementia in old age. The paradigm of dementia care policy may shift to early diagnosis of AD pathology and comprehensive care for chronic diseases in the elderly population.
  897 131 -
ORIGINAL ARTICLES - CLINICAL RESEARCH
Vegetarian diet and blood pressure in a hospital-base study
Hao-Wen Liu, Jia-Sin Liu, Ko-Lin Kuo
July-September 2018, 30(3):176-180
DOI:10.4103/tcmj.tcmj_91_17  PMID:30069127
Objective: Previous studies have reported that a vegetarian diet may lower blood pressure (BP), but the effect of diet on BP in asymptomatic participants with proteinuria is unknown. We examined the association of diet and BP in individuals with or without proteinuria. Materials and Methods: This cross-sectional study analyzed data from participants who were more than 40 years old and received physical checkups at Taipei Tzu Chi Hospital from September 5, 2005, to December 31, 2016. Diets were assessed at baseline by a self-reported questionnaire and categorized as vegan, lacto-ovo vegetarian, or omnivore. There were 2818 (7.7%) vegans, 5616 (15.3%) lacto-ovo vegetarians, and 28,183 (77.0%) omnivores. The effect of different parameters on BP was determined using a multivariate multiple linear regression model with no intercept, with control for important characteristics and lifestyle confounders. Results: The vegan group had a lower mean systolic BP (−3.87 mmHg, P < 0.001) and diastolic BP (−2.48 mmHg, P < 0.001) than the omnivore group. Participants with proteinuria had a higher systolic BP (4.26 mmHg, P < 0.001) and diastolic BP (2.15 mmHg, P < 0.001) than those without proteinuria. Interaction analysis indicated that vegan participants with proteinuria had a lower systolic BP (−2.73 mmHg, P = 0.046) and diastolic BP (−2.54 mmHg, P = 0.013) than other participants with proteinuria. However, individuals in the lacto-ovo group with proteinuria had a BP similar to other participants with proteinuria. Conclusions: A vegan diet was associated with lower BP in asymptomatic participants with proteinuria. This diet could be a nonpharmacologic method to reduce BP.
  895 124 -
REVIEW ARTICLE - CLINICAL
Evidence-based review and appraisal of the use of droperidol in the emergency department
Pei-Chun Lai, Yen-Ta Huang
January-March 2018, 30(1):1-4
DOI:10.4103/tcmj.tcmj_195_17  PMID:29643708
Droperidol is a short-acting, potent dopamine D2 antagonist that can pass through the blood–brain barrier. A black box warning was issued for droperidol by the United States Food and Drug Administration in 2001 because of a risk of development of torsades de pointes induced by QT prolongation. Many experts feel that the incidence of arrhythmia is overestimated, and low-dose droperidol is almost always used by anesthesiologists for postoperative nausea and vomiting. In this review, we used evidence-based analysis to appraise high-quality studies with a low risk of bias published after 2001 on the use of droperidol in the emergency department (ED). Droperidol appears not only efficacious but also safe to treat patients with nausea/vomiting, acute psychosis, and migraine in the ED. For these conditions, droperidol may be an option for shared decision-making.
  878 110 -
REVIEW ARTICLES - CLINICAL
Alzheimer's disease and osteoporosis
Yu-Hung Chen, Raymond Y Lo
July-September 2017, 29(3):138-142
DOI:10.4103/tcmj.tcmj_54_17  PMID:28974906
Alzheimer's disease (AD) and osteoporosis are both common degenerative diseases in the elderly population. The incidence of both diseases increases with age and will be posing enormous societal burden worldwide. It may appear that AD and osteoporosis are two distinct diseases although many risk factors are shared. Previous observational studies have shown that patients with osteoporosis have higher risks of developing AD than those who do not have osteoporosis. Although osteoporosis, falls, and fractures are more often seen in patients with AD than other older adults, the association between these two diseases may be due to a pathophysiological link rather than one condition causing the other. Several in vitro and in vivo studies lend support to this notion. Patients with AD have excessive amyloid plaques in the brain, and the pathology may extend to peripheral organs and cause skeletal amyloid deposition, which would enhance receptor activator nuclear factor-kappa B ligand signaling and lead to greater osteoclast activities. Patients with osteoporosis may have Vitamin D deficiency or lower levels of Vitamin D binding protein, which protects against amyloid aggregation, thus linking Vitamin D deficiency and AD or osteoporosis and AD. Osteoporosis coexisting with AD provides a window to examine the amyloid hypothesis from peripheral tissues. Future studies are warranted to clarify the role of genetic background regarding Vitamin D levels, exposure to sunlight, estrogen replacement therapy, and physical activity in patients with both chronic diseases.
  803 180 -
REVIEW ARTICLE - BASIC
Salivary micro RNA as a potential biomarker in oral potentially malignant disorders: A systematic review
T N Uma Maheswari, Archana Venugopal, Nivedhita Malli Sureshbabu, Prathiba Ramani
April-June 2018, 30(2):55-60
DOI:10.4103/tcmj.tcmj_114_17  PMID:29875583
Oral potentially malignant disorders (OPMD) are oral mucosal disorders which have a high potential to turn into malignancy. A recent report suggests that 16%–62% of epithelial dysplasia cases of OPMD undergo malignant transformation, showing the need for early detection of malignancy in these disorders. Micro RNA (miRNA) plays an important role in cellular growth, differentiation, apoptosis, and immune response, and hence, deregulation of miRNA is considered a signature of oral carcinogenesis. A search was done using MeSH terms in the PubMed, ScienceDirect databases, hand search, and finally, six studies were included in this systematic review. A total of 167 patients with oral cancer, 78 with OPMDs, 147 healthy controls, and 20 disease controls were analyzed for the expression of salivary miRNAs. Quality assessment based on the Quality Assessment of Diagnostic Accuracy Studies 2 tool was used to obtain a risk of bias chart using Revman 5.3 software and it was proved that the study done by Zahran et al. in 2015 had a low risk of bias. The results of this study revealed upregulated miRNA 184 with an area under the curve (AUC) of 0.86 and miRNA 21 with an AUC of 0.73 and downregulated miRNA 145 with an AUC of 0.68, which proved that these miRNAs are significant in detecting early malignancy in OPMD and should be further analyzed in various populations. This systematic review explored the potential of expression of salivary miRNA in OPMD for future studies. This could pave the way to utilize saliva as a surrogate marker in diagnosing early malignant changes in OPMD.
  806 143 -
REVIEW ARTICLES - CLINICAL
Pathophysiology of benign prostate enlargement and lower urinary tract symptoms: Current concepts
Cheng-Ling Lee, Hann-Chorng Kuo
April-June 2017, 29(2):79-83
DOI:10.4103/tcmj.tcmj_20_17  PMID:28757771
Lower urinary tract symptoms (LUTS) are highly prevalent in the aging population, particularly in men. Historically, prostate enlargement was thought to be responsible for most cases of male LUTS. Several risk factors for the development of benign prostate enlargement/hyperplasia (BPE/BPH) have been identified, including age, genetics, hormones, growth factors, inflammation, and lifestyle factors. However, as our knowledge continues to evolve, male LUTS are no longer managed entirely in a prostate-centric fashion. In this article, we review current concepts in the epidemiology, etiology, and pathophysiology of BPE/BPH and male LUTS.
  807 118 -
Current pharmacological and surgical treatment of underactive bladder
Yuan-Hong Jiang, Cheng-Ling Lee, Jia-Fong Jhang, Hann-Chorng Kuo
October-December 2017, 29(4):187-191
DOI:10.4103/tcmj.tcmj_122_17  PMID:29296045
Underactive bladder (UAB) or detrusor underactivity (DU) is a common yet still poorly understood urological problem. In addition to true detrusor failure and neuropathy, the inhibitory effects of detrusor contraction by the striated urethral sphincter and the bladder neck through alpha-adrenergic activity may also play a role in the development of UAB or DU. Treatment of UAB or DU aims to reduce the postvoid residual (PVR) urine volume and increase voiding efficiency, either by spontaneous voiding or abdominal straining. Pharmacotherapy with parasympathomimetics or cholinesterase inhibitors might be tried, and benefits can be achieved in combination with alpha-blockers. Bladder outlet surgeries, including urethral onabotulinumtoxinA injection, transurethral incision of the bladder neck, and transurethral incision or resection of the prostate can effectively improve voiding efficiency and decrease the PVR in most patients with DU. The mechanisms have not been well elucidated. It is likely that ablation of the bladder neck or prostatic urethra might not only decrease bladder outlet resistance but also abolish the sympathetic hyperactivity which inhibits detrusor contractility in patients with idiopathic UAB or DU.
  786 128 -
CASE REPORTS
Pulseless electrical activity in acute massive pulmonary embolism during thrombolytic therapy
Han-Hua Yu, Jing-Ren Jeng
January-March 2017, 29(1):50-54
DOI:10.4103/tcmj.tcmj_7_17  PMID:28757765
We report a case of acute pulmonary embolism with hemodynamic instability diagnosed by a computed tomography pulmonary angiogram. The patient developed pulseless electrical activity during systemic thrombolytic therapy with recombinant tissue plasminogen activator. Successful return of spontaneous circulation was achieved after immediate cardiopulmonary resuscitation with chest compressions for 6min. His electrocardiogram (ECG) on arrival in the emergency department displayed sinus tachycardia, an S wave in lead I, a Q wave in lead III, incomplete right bundle branch block (RBBB), T-wave inversion (TWI) in leads V1–V3, ST elevation in leads aVR and V1, and ST depression in leads I, II, III, aVF, and V4–V6. These characteristic ECG changes might have prognostic value for clinical deterioration. He recovered after treatment. After discharge, the ECG showed resolution of TWI in leads V1–V3 and incomplete RBBB, suggesting recovery from right ventricular dysfunction, which was confirmed by an echocardiogram on follow in the outpatient department.
  805 101 1
REVIEW ARTICLES - CLINICAL
Clinical manifestations and basic mechanisms of myocardial ischemia/reperfusion injury
Chiu-Fen Yang
October-December 2018, 30(4):209-215
DOI:10.4103/tcmj.tcmj_33_18  PMID:30305783
Acute myocardial ischemia/reperfusion (I/R) injury is a significant, unsolved clinical puzzle. In the disease context of acute myocardial infarction, reperfusion remains the only effective strategy to salvage ischemic myocardium, but it also causes additional damage. Myocardial I/R injury is composed of four types of damage, and these events attenuate the benefits of reperfusion therapy. Thus, inventing new strategies to conquer I/R injury is an unmet clinical need. A variety of pathological processes and mediators, including changes in the pH, generation of reactive oxygen radicals, and intracellular calcium overload, are proposed to be crucial in I/R-related cell injury. Among the intracellular events that occur during I/R, we stress the importance of protein phosphorylation signaling and elaborate its regulation. A variety of protein kinase pathways could be activated in I/R, including reperfusion injury salvage kinase and survivor-activating factor enhancement pathways, which are critical to cardiomyocyte survival. In addition to serine/threonine phosphorylation signaling, protein tyrosine phosphorylation is also critical in multiple cell functions and survival. However, the roles of protein kinases and phosphatases in I/R have not been extensively studied yet. By better understanding the mechanisms of I/R injury, we may have a better chance to develop new strategies for I/R injury and apply them in the clinical patient care.
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Medical leadership: An important and required competency for medical students
Tsung-Ying Chen
April-June 2018, 30(2):66-70
DOI:10.4103/tcmj.tcmj_26_18  PMID:29875585
Good medical leadership is the key to building high-quality healthcare. However, in the development of medical careers, the teaching of leadership has traditionally not equaled that of technical and academic competencies. As a result of changes in personal standards, the quality of medical leadership has led to variations between different organizations, as well as occasional catastrophic failure in the standard of care provided for patients. Leaders in the medical profession have called for reform in healthcare in response to challenges in the system and improvements in public health. Furthermore, there has been an increased drive to see leadership education for doctors starting earlier, and continuing throughout their careers so that they can take on more important leadership roles throughout the healthcare system. Being a physician requires not only management and leadership but also the need to transfer competencies to communication and critical thinking. These attributes can be obtained through experience in teamwork under the supervision of teaching staff. Therefore, medical students are expected to develop skills to deal with and resolve conflicts, learn to share leadership, prepare others to help and replace them, take mutual responsibility and discuss their performance.
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Recent research on the role of urodynamic study in the diagnosis and treatment of male lower urinary tract symptoms and urinary incontinence
Yuan-Hong Jiang, Hann-Chorng Kuo
April-June 2017, 29(2):72-78
DOI:10.4103/tcmj.tcmj_19_17  PMID:28757770
Although evidence shows that urodynamic study may not improve outcomes, it can be used to evaluate men with lower urinary tract symptoms (LUTSs) which have not been adequately delineated and treated. In young men with LUTS not responding to treatment based on clinical examination, or elderly men with LUTS and incontinence, a complete urodynamic evaluation is mandatory to understand the pathophysiology underlying LUTS, such as bladder outlet obstruction (BOO), detrusor overactivity, and detrusor underactivity. Preoperative urodynamic study-proven BOO is a predictor of a successful surgical outcome. An urodynamic study should be performed when patients with LUTS are planning to undergo surgical treatment for benign prostatic obstruction.
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