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  Citation statistics : Table of Contents
   2017| October-December  | Volume 29 | Issue 4  
    Online since December 4, 2017

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The association of serum leptin levels with metabolic diseases
Jen-Pi Tsai
October-December 2017, 29(4):192-196
DOI:10.4103/tcmj.tcmj_123_17  PMID:29296046
Leptin is a 167-amino-acid protein released by white adipose tissue and encoded by the obese gene. It has a role as a negative regulator of appetite control through sending a satiety signal to act on receptors within the hypothalamus. At normal levels, leptin can exert its effects on weight regulation according to white fat mass, induce sodium excretion, maintain vascular tone, and repair the myocardium. Beyond these effects, elevated serum leptin levels have been implicated in the pathogenesis of metabolic syndrome, diabetes mellitus, hypertension, and multiple cardiovascular diseases. In addition, hyperleptinemia had been reported to contribute to renal diseases through multiple mechanisms resulting in glomerulopathy presenting with a decreased glomerular filtration rate, increased albuminuria, and related clinical symptoms, which are pathophysiological features of chronic kidney disease. Because these cardiovascular and metabolic disorders are great challenges for physicians, understanding the related pathophysiological association with leptin might become a valuable aid in handling patients in daily clinical practice. This review will discuss the roles of leptin in the regulation of biological functions of multiple organs beyond the maintenance of feeding and metabolism.
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Effects of continuous positive airway pressure on anxiety, depression, and major cardiac and cerebro-vascular events in obstructive sleep apnea patients with and without coronary artery disease
Ming-Chung Lee, Yu-Chih Shen, Ji-Hung Wang, Yu-Ying Li, Tzu-Hsien Li, En-Ting Chang, Hsiu-Mei Wang
October-December 2017, 29(4):218-222
DOI:10.4103/tcmj.tcmj_128_17  PMID:29296051
Objective: Obstructive sleep apnea (OSA) is associated with bad cardiovascular outcomes and a high prevalence of anxiety and depression. This study investigated the effects of continuous positive airway pressure (CPAP) on the severity of anxiety and depression in OSA patients with or without coronary artery disease (CAD) and on the rate of cardio- and cerebro-vascular events in those with OSA and CAD. Materials and Methods: This prospective study included patients with moderate-to-severe OSA, with or without a recent diagnosis of CAD; all were started on CPAP therapy. Patients completed the Chinese versions of the Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) at baseline and after 6-month follow-up. The occurrence of major adverse cardiac and cerebrovascular events (MACCE) was assessed every 3 months up to 1 year. Results: BAI scores decreased from 8.5 ± 8.4 at baseline to 5.4 ± 6.9 at 6 months in CPAP-compliant OSA patients without CAD (P < 0.05). BAI scores also decreased from 20.7 ± 14.9 to 16.1 ± 14.5 in CPAP-compliant OSA patients with CAD. BDI-II scores decreased in CPAP-compliant OSA patients without CAD (from 11.1 ± 10.7 at baseline to 6.6 ± 9.5 at 6 months) and in CPAP-compliant OSA patients with CAD (from 20.4 ± 14.3 to 15.9 ± 7.3). In addition, there was a large effect size (ES) of BAI and BDI in 6-month CPAP treatment of OSA patients with CAD and a large ES in those with OSA under CPAP treatment. In OSA patients with CAD, the occurrence of MACCE was significantly lower in CPAP-compliant patients than that in CPAP noncompliant patients (11% in CPAP compliant and 50% in noncompliant; P < 0.05). Conclusions: CPAP improved anxiety and depression in OSA patients regardless of CAD. In OSA patients with CAD, CPAP-compliant patients had a lower 1-year rate of MACCE than CPAP-noncompliant patients.
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Leptin as an independent marker of metabolic syndrome
Beuy Joob, Viroj Wiwanitkit
October-December 2017, 29(4):237-237
DOI:10.4103/tcmj.tcmj_48_17  PMID:29296056
  1 1,112 115
Author Index
October-December 2017, 29(4):0-0
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Nonfatal pulmonary embolism associated with the use of compression stockings in the lithotomy position after spinal anesthesia
I-Wen Chen, Cheuk-Kwan Sun, Jen-Yin Chen, Chien-Ming Lin, Kuo-Chuan Hung
October-December 2017, 29(4):228-231
DOI:10.4103/tcmj.tcmj_81_17  PMID:29296053
A 73-year-old male (height, 156 cm; body weight, 51 kg), without a history of cardiovascular disease or thromboembolic events, was scheduled for transurethral resection of the prostate under spinal anesthesia. Spinal anesthesia was administered with hyperbaric bupivacaine, resulting in an upper anesthetic level of T6. Before surgery, compression stockings were applied to both lower limbs, and the patient was placed in the lithotomy position. Approximately 15 min later, he complained of intolerable chest tightness, followed by tachycardia (heart rate, 110 beats/min) and desaturation (oxygen saturation [SaO2], 90%). Tracheal intubation was performed immediately. The decrease in end-tidal partial pressure of carbon dioxide (EtCO2) with an increase in the arterial carbon dioxide partial pressure-EtCO2gradient (16 mmHg) suggested pulmonary embolism (PE), which may have been induced by leg manipulation. The patient developed transient hypotension after tracheal intubation; however, his hemodynamic profile stabilized after inotropes administration. Subsequent tests showed normal cardiac enzyme levels; however, his D-dimer levels increased significantly. Imaging confirmed deep vein thrombosis (DVT) and PE. Anticoagulation with warfarin was administered, and he was discharged on the postoperative day 11 without complications. In conclusion, DVT is often a cause of PE. Preoperative identification of DVT risk factors and respiratory symptoms as well as intraoperative monitoring of arterial SaO2are vital for timely diagnosis of PE, especially in patients receiving intraoperative lower limb manipulation.
  - 1,508 147
Fine-needle aspiration cytology of a cesarean scar endometriosis
Jitendra Singh Nigam, Anita Omhare, Ankit Sharma
October-December 2017, 29(4):232-234
DOI:10.4103/tcmj.tcmj_37_17  PMID:29296054
Endometriosis is the presence of functioning endometrium outside the basement membrane of the uterine endometrium. It affects women of reproductive age and usually presents as a painful nodule over a period of 3 months to 10 years after surgery. Extrapelvic endometriosis is uncommon and more difficult to diagnose due to its variable presentation and is often confused with other surgical conditions. Fine-needle aspiration cytology (FNAC) is a rapid, cost-effective, and accurate diagnostic tool when making this diagnosis. Wide excision is the treatment of choice for scar endometriosis as well as for recurrent lesions. We present a case of scar endometriosis in a 30-year-old female who had undergone a cesarean section 2 years previously and was diagnosed by FNAC. A later histopathological examination confirmed the cytological diagnosis of scar endometriosis.
  - 1,645 131
Contents Index

October-December 2017, 29(4):0-0
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May–Thurner syndrome caused by a huge uterine myoma
Shun-Chung Chang, Ming-Jen Tsai, Chi-Feng Hsu
October-December 2017, 29(4):235-236
DOI:10.4103/tcmj.tcmj_126_17  PMID:29296055
  - 1,182 128
Deduced probable human leukocyte antigen haplotypes associated with HLA-A*11:256Q and HLA-A*02:621 identified by case analyses of Taiwanese individuals
Kuo-Liang Yang, Zheng-Zhong Zheng
October-December 2017, 29(4):197-200
DOI:10.4103/tcmj.tcmj_124_17  PMID:29296047
Objective: HLA-A*11:256Q and HLA-A*02:621 are two low-frequency HLA-A alleles. The aim here is to report the ethnicity of A*11:256Q and A*02:621 and associated human leukocyte antigen (HLA) haplotypes among Taiwanese individuals. Materials and Methods: HLA data from randomized Taiwanese registered in the Tzu Chi Stem Cells Centre and China Shanghai Tissuebank Diagnostics were analyzed. HLA typing of the donors was carried out using a sequence-based typing method to confirm the two low-incidence alleles. Polymerase chain reaction was performed to amplify exons 2 and 3 of the HLA-A and HLA-B loci and exon 2 of the HLA-DRB1 locus using group-specific primer sets. The amplicons were sequenced in both directions using BigDye Terminator Cycle Sequencing Ready Reaction kits and the manufacturer's protocols. Exon 1 and exons 4-8 of the A*11:256Q allele were also sequenced and analyzed. Results: The Taiwanese ethnicity for both A*11:256Q and A*02:621 alleles was confirmed in this study. Further, the DNA sequence of A* 11:256Q was confirmed to be identical to A*11:02:01from exon 1 to exon 8 except for the residues from 409 to 417 where a segment of nine nucleotides (TACCGGCAG) is deleted in A*11:256Q. The HLA haplotype associated with A*11:256Q was deduced as A*11:256Q-B*27-DRB1*12. In exons 2 and 3, the DNA sequence of A*02:621 is identical to A*02:01:01:01 except at residue 169 where T of A*02:01:01:01 is replaced by C in A*02:621 (at codon 33; TTC->CTC). The HLA haplotype in association with A*02:621 was deduced as A*02:621-B*15:18-DRB1*12:02. Conclusion: The information on the ethnicity of the A*11:256Q and A*02:621 alleles and the deduced probable HLA haplotypes associated with the two low-incidence alleles reported here are valuable to HLA testing laboratories for reference purposes. In addition, they can be used by stem cell transplantation donor search coordinators to aid in finding compatible donors in unrelated bone marrow donor registries when a patient carries these uncommon HLA alleles.
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Long-term risk of dementia following acute kidney injury: A population-based study
Chih-Chin Kao, Che-Hsiung Wu, Chun-Fu Lai, Tao-Min Huang, Hsi-Hsien Chen, Vin-Cent Wu, Likwang Chen, Mai-Szu Wu, Kwan-Dun Wu,
October-December 2017, 29(4):201-207
DOI:10.4103/tcmj.tcmj_40_17  PMID:29296048
Objective: Adverse neurological effects may be common following acute kidney injury (AKI). The purpose of our study was to investigate the long-term risk of dementia following AKI and temporary dialysis during hospitalization. Materials and Methods: The study was based on data from the National Health Insurance Research Database of Taiwan. Patients 18-year-old and older who were withdrawn from temporary dialysis because of AKI and survived for at least 90 days following discharge were included in our acute-dialysis-recovery group. Patients without AKI and dialysis were the control group. A Cox proportional-hazards regression model was applied to determine the risk of dementia. Results: Of 2905 acute-dialysis patients, 689 (23.7%) survived for at least 90 days following recovery from acute dialysis. The Cox proportional-hazards regression model showed that the acute-dialysis-recovery group had an increased long-term risk of dementia (hazard ratio [HR], 2.01; P = 0.01) compared with the control group. The conditional effects plot showed that the risk of dementia was amplified in patients who were older than 58 years. The development of dementia following recovery from acute dialysis was associated with an increase in all-cause mortality (HR, 2.38; P < 0.001). Conclusions: Patients with acute dialysis have a greater risk for the subsequent development of dementia after recovery than patients without AKI and dialysis, and patients who develop dementia after recovery from temporary dialysis are at increased risk for mortality.
  - 1,754 194
Hysterectomy and ovarian cystectomy using natural orifice transluminal endoscopic surgery: An initial experience at Tzu Chi General Hospital
Dah-Ching Ding, Tang-Yuan Chu, Mun-Kun Hong
October-December 2017, 29(4):208-212
DOI:10.4103/tcmj.tcmj_127_17  PMID:29296049
Objectives: The objective of this study is to report our initial experience with patients undergoing transvaginal natural orifice transluminal endoscopic surgery (NOTES). Materials and Methods: From September 2016 to December 2016, patients who were not virgins and did not have pelvic inflammation or obliteration of the cul-de-sac who underwent NOTES hysterectomy or ovarian cystectomy (OC) were included in the study. Results: Transvaginal NOTES was performed smoothly in six patients, two patients (mean age 35 years, mean body mass index [BMI] 25) received an OC and four patients (mean age 49 years, mean BMI 27) underwent a hysterectomy. One patient with a hysterectomy received concurrent adhesiolysis. The mean surgical times were 74 and 75 min and blood loss was 50 and 87.5 ml in the OC and hysterectomy groups, respectively. One patient with a hysterectomy had a postoperative fever with 38°C last for 2 days. Pain scores were 0 at 48 h postoperatively in both groups. Conclusion: Transvaginal NOTES is a feasible and safe technique for hysterectomy and OC in our patients and those in previous reports. This procedure was minimally invasive with no scars on the abdomen as well as little pain.
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The Hospice Information System and its association with the congruence between the preferred and actual place of death
Huang-Ren Lin, Jen-Hung Wang, Jyh-Gang Hsieh, Ying-Wei Wang, Sheng-Lun Kao
October-December 2017, 29(4):213-217
DOI:10.4103/tcmj.tcmj_125_17  PMID:29296050
Objective: A Hospice Information System (HIS) developed in eastern Taiwan in 2012 aimed to improve the quality of hospice care through an integrated system that provided telemetry-based vital sign records, online 24/7 consultations, online video interviews, and online health educations. The purpose of this study was to explore the congruence between the preferred and actual place of death (POD) among patients who received HIS services. Materials and Methods: A retrospective study was performed from January 2012 to August 2016. Data from patients enrolled in the HIS who died during this period were included. Data on basic characteristics and the actual and preferred POD were obtained from the HIS database. The primary outcome was the congruence between the preferred and actual POD. Secondary outcomes were comparisons between patients who did and did not achieve their preferred POD. Further comparisons between patients who did and did not achieve home death were also performed. Results: In total, we enrolled 481 patients who received HIS services and died. Of them, 444 (92.3%) died at their preferred POD. Patients who preferred an inpatient hospice as their POD had higher achievement rate than those who wanted a home death. High-intensity HIS utilization was associated with a higher likelihood of home death than low-intensity HIS utilization. Patients living in areas distant from the medical center had lower achievement of home death than those living in local areas. Conclusions: This study suggested that patients enrolled in the HIS had high congruence between the actual and preferred POD.
  - 1,463 138
Analyzing the effectiveness of teaching and factors in clinical decision-making
Ming-Chen Hsieh, Ming-Shinn Lee, Tsung-Ying Chen, Tsuen-Chiuan Tsai, Yi-Fong Pai, Min-Muh Sheu
October-December 2017, 29(4):223-227
DOI:10.4103/tcmj.tcmj_34_17  PMID:29296052
Objective: The aim of this study is to prepare junior physicians, clinical education should focus on the teaching of clinical decision-making. This research is designed to explore teaching of clinical decision-making and to analyze the benefits of an “Analogy guide clinical decision-making” as a learning intervention for junior doctors. Materials and Methods: This study had a “quasi-experimental design” and was conducted in a medical center in eastern Taiwan. Participants and Program Description: Thirty junior doctors and three clinical teachers were involved in the study. The experimental group (15) received 1 h of instruction from the “Analogy guide for teaching clinical decision-making” every day for 3 months. Program Evaluation: A “Clinical decision-making self-evaluation form” was used as the assessment tool to evaluate participant learning efficiency before and after the teaching program. Semi-structured qualitative research interviews were also conducted. Results: We found using the analogy guide for teaching clinical decision-making could help enhance junior doctors' self-confidence. Important factors influencing clinical decision-making included workload, decision-making, and past experience. Conclusion: Clinical teaching using the analogy guide for clinical decision-making may be a helpful tool for training and can contribute to a more comprehensive understanding of decision-making.
  - 1,596 157
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.
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Subject Index

October-December 2017, 29(4):0-0
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