162 results on '"Chia-Der Lin"'
Search Results
2. Increased risk of hearing loss associated with MT-RNR1 gene mutations: a real-world investigation among Han Taiwanese Population
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Hou-Kuang Chen, Yow-Wen Hsieh, Hsing-Yu Hsu, Ting-Yuan Liu, Yu-Ting Zhang, Chia-Der Lin, and Fuu-Jen Tsai
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Mitochondrial DNA ,Mitochondrial 12S rRNA (MT-RNR1) ,Sensorineural hearing loss (SNHL) ,Internal medicine ,RC31-1245 ,Genetics ,QH426-470 - Abstract
Abstract Background Previous studies have implicated inherited mutations in mitochondrial DNA (mtDNA) in sensorineural hearing loss (SNHL). However, the definitive association between mitochondrial 12S rRNA (MT-RNR1) variants and hearing loss in the population has not been well established, particularly in Asia. The objective of this retrospective cohort study was to assess the association between MT-RNR1 variants and the risk of SNHL in patients in Taiwan. Methods The cohort included 306,068 participants from Taiwan between January 2003 and December 2020. Participants were classified based on genetic variants, particularly mitochondrial mutations (rs267606618, rs267606619, rs267606617). MT-RNR1 variant cases were matched 1:10 with non-mutant patients by age, gender, and visit year, excluding those with pre-existing hearing loss. The primary endpoint was SNHL, identified using specific ICD-TM codes with a 90% positive predictive value. Medication exposure history was determined via self-report or electronic medical records in the hospital. Cox proportional hazard regression models were used to assess the association between MT-RNR1 variants and hearing loss, adjusting for various covariates. Kaplan-Meier survival curves and log-rank tests compared hearing loss incidence between groups. Results The mean age of the mtDNA variants group is 32.4 years, with a standard deviation of 19.2 years. The incidence density of hearing loss for the mutation group was 36.42 per 10,000 person-years (95% Confidence Interval [CI], 27.21–47.73), which was higher than the 23.77per 10,000 person-years (95% CI, 21.32–26.42) in the wild-type group (p = 0.0036). Additionally, diabetes mellitus was associated with an increased risk of developing SNHL in individuals with MT-RNR1 variants (adjusted hazard ratio = 1.76 [95% CI, 1.00-3.09], p
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- 2024
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3. Effects of grit on medical students’ wellbeing during clerkships: a longitudinal observational cohort study
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Yung Kai Lin, Chia-Der Lin, Der-Yuan Chen, and Blossom Yen-Ju Lin
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perseverance ,grit ,workplace wellbeing ,burnout ,compassion satisfaction ,medical student ,Medicine (General) ,R5-920 - Abstract
IntroductionIn medical education, the clerkship phase is a demanding period during which medical students learn to navigate the responsibilities of medical school and clinical medicine. Grit, a personal quality regarded as a non-cognitive trait, refers to perseverance and passion; specifically, it represents the ability to endure hardship and work industriously toward a goal. Most studies analysed grit as a single concept and few studies have investigated the effect of grit on the well-being of medical students through the whole-specialty training (i.e. surgical and non-surgical specialty rotations) required in clinical clerkships. Therefore, this study investigated whether associations exist between medical students’ grit, measured by the two subconstructs of perseverance and passion, and their well-being during clerkships in surgical and non-surgical specialty units.MethodsThis one-year prospective web-based questionnaire study enrolled fifth-year medical students at a tertiary medical centre in central Taiwan between September 2017 and July 2018 in their first-year clerkship. The students’ sex, age, and grit were measured at the start of their clerkship. Routine surveys were conducted over one year to assess burnout and compassion satisfaction for students’ well-being, and the training specialty characteristics of the surgical and non-surgical specialty departments were recorded. This study included 92 medical students and 1,055 survey responses from individual specialty rotations. Descriptive, univariate and multivariate analyses were performed.ResultsOur results revealed that medical students’ perseverance, as part of grit, was related to lower burnout and higher compassion satisfaction during clerkships, but not the subconstruct of passion. Moreover, the positive trait of perseverance measured in our study had greater explanatory power for compassion satisfaction than for burnout. Furthermore, the results revealed that older medical students suffered from less burnout than their younger counterparts, and that male medical students expressed higher compassion satisfaction than their female counterparts.DiscussionPerseverance, as a subconstruct of grit, is a positive personal quality for medical students’ clerkships, and methods driving the cultivation of perseverance in medical education should be considered. In addition, even though positive traits such as perseverance equipped medical students for compassion satisfaction, additional factors attributed to medical students’ burnout must be identified.
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- 2024
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4. Clinical feature‐based diagnosis criteria of eosinophil and non‐eosinophil chronic rhinosinusitis in Taiwan
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Jia‐Hung Ma, Bing‐Han Hsieh, Shuang‐Shuang Huang, Yu‐Ting Li, Yung‐An Tsou, Chia‐Der Lin, Chih‐Jaan Tai, and Liang‐Chun Shih
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chronic rhinosinusitis ,eosinophil ,nasal polyps ,non‐eosinophil ,Otorhinolaryngology ,RF1-547 ,Surgery ,RD1-811 - Abstract
Abstract Background The prevalence of eosinophilic chronic rhinosinusitis (ECRS) has increased in Taiwan with a higher recurrence rate of nasal polyps after surgery. Therefore, we aimed to formulate the pre‐operative diagnostic criteria for patients with ECRS in Taiwan. Methods This case–control study included patients diagnosed with CRS with nasal polyps (CRSwNP) who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. The patients were classified into ECRS and non‐eosinophilic CRS (NECRS) groups based on their histopathology. Demographic data, symptom severity scores, and computed tomography findings of the two groups were analyzed. We utilized receiver operating characteristic curve (ROC) analysis to evaluate parameters that could predict the diagnosis of ECRS. Results Total 408 CRSwNP patients were enrolled (ECRS group: 163; NECRS group: 245). ECRS group was strongly associated with asthma (6.1% vs. 2.0%, p = .03), higher blood eosinophil counts (4.3% vs. 2.7%, p 45, 2 points), serum eosinophil count percentage (>4%, 4 points), asthma (4 points), total serum IgE (>140 IU/mL, 4 points), Lund–Mackay score (>9.5, 4 points), and ethmoid‐to‐maxillary opacification ratio on CT (>1.5, 5 points). The cutoff score was 14 points (sensitivity, 70.2%; specificity, 93.3%). Conclusions Clinical‐feature‐based criteria may predict the diagnosis of ECRS before FESS in Taiwan. Level of Evidence Level 3.
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- 2023
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5. Primary versus salvage intratympanic steroid treatment for idiopathic sudden sensorineural hearing loss
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Wei‐Che Lan, Chia‐Der Lin, Yung‐An Tsou, Liang‐Chun Shih, Yu Aoh, Chien‐Chi Lu, Hsiu‐San Hsu, Chun‐Yu Lai, and Ching‐Yuan Wang
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intratympanic ,salvage treatment ,sensorineural hearing loss ,steroid injection ,sudden hearing loss ,Otorhinolaryngology ,RF1-547 ,Surgery ,RD1-811 - Abstract
Abstract Objective The objective of this research is to compare primary and salvage intratympanic (IT) steroid treatments in terms of hearing outcomes in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Methods The patients were randomized into two (primary and salvage) groups. Both groups received systemic steroid treatment for 2 weeks. The primary group also received IT dexamethasone injection three times during the treatment period, whereas the salvage group received IT dexamethasone injection only if no or slight recovery was noted at the 2‐week follow‐up. If needed, salvage steroid injection was administered three times during the following 2 weeks. Hearing recovery was analyzed according to the modified American Academy of Otolaryngology‐Head and Neck Surgery criteria. Results The degrees of hearing improvement at the 3‐month follow‐up were similar in the two groups. Compared with baseline, the pure‐tone average values and speech discrimination scores improved by 38.45 ± 21.95 dB HL and 34.32% ± 30.55%, respectively, in the primary group and 36.80 ± 22.33 dB HL and 31.87% ± 27.88%, respectively, in the salvage group (p = .762 and .659, respectively). In addition, the complete or partial hearing recovery rates were also similar in the primary and salvage groups (67.7% vs. 73.3%, respectively; p = .780). In the salvage group, 18 patients required no IT steroid injection because they recovered after systemic steroid treatment. Conclusion Primary and salvage IT steroid treatments for ISSNHL led to similar outcomes. In summary, salvage IT steroid injection is recommended for patients with ISSNHL patients to prevent unnecessary IT injection. Level of evidence 2.
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- 2023
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6. Clinical Outcomes of Severe Rhinosinusitis Complicated with Cavernous Sinus Syndrome
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Jin-Yi Lin, Chien-Lin Liu, Zheng-Yan Dai, Yu-Ting Li, Yung-An Tsou, Chia-Der Lin, Chih-Jaan Tai, and Liang-Chun Shih
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rhinosinusitis ,sphenoiditis ,cavernous sinus syndrome ,cavernous sinus thrombosis ,septic cavernous sinus thrombosis ,fungal infection ,Medicine - Abstract
Background: Various diseases involving the cavernous sinus can cause a condition called cavernous sinus syndrome (CSS), which is characterized by ophthalmoplegia or sensory deficits over the face resulting from the compression effect of internal structure. While tumor compression is the most reported cause of CSS, statistical data on CSS caused by infections are limited. Its risk factors, treatment methods, and clinical outcomes are not well-documented. Methods: In this retrospective study, we reviewed the data of patients admitted to a tertiary medical center from 2015 to 2022 with a diagnosis of acute and chronic sinusitis and at least one diagnostic code for CSS symptoms. We manually reviewed whether patients were involved in two or more of the following cranial nerves (CN): CN III, CN IV, CN V, or CN VI, or at least one of these nerves with a neuroimaging-confirmed lesion in the cavernous sinus. Results: Nine patients were diagnosed with rhinosinusitis-related CSS. The most common comorbidity was type 2 diabetes, and the most common clinical manifestations were diplopia and blurred vision. The sphenoid sinus was the most affected sinus. One patient expired due to a severe brain abscess infection without surgery. The remaining patients underwent functional endoscopic sinus surgery, and 50% of the pathology reports indicated fungal infections. Staphylococcus spp. was the most cultured bacteria, and Amoxycillin/Clavulanate was the most used antibiotic. Only four patients had total recovery during the follow-up one year later. Conclusions: CSS is a rare but serious complication of rhinosinusitis. Patients with diabetes and the elderly may be at a higher risk for this complication. Even after treatment, some patients may still have neurological symptoms.
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- 2024
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7. Mycobacterial Infection in Recalcitrant Otomastoiditis: A Case Series and Literature Review
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Tammy Tsai, Wei-Che Lan, Jit-Swen Mao, Yu-Chien Lee, Yung-An Tsou, Chia-Der Lin, Liang-Chun Shih, and Ching-Yuan Wang
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mycobacterial infections ,middle ear ,otitis media ,clinical practice guidelines ,retrospective study ,literature review ,Medicine - Abstract
Otomastoiditis caused by mycobacterial infections is uncommon and recalcitrant. Its clinical presentations, sometimes similar to those of common chronic suppurative otitis media, make diagnosis difficult. This retrospective study analyzed the clinical features, treatment course, and therapeutic outcomes of patients with mycobacterial otomastoiditis. The cases of six patients diagnosed with mycobacterial otomastoiditis or suspected mycobacterial infection between January 2007 and January 2019 in a single tertiary medical center in Taiwan were investigated. Information about predisposing factors, clinical features, culture reports, histopathology, treatment course, and outcomes were collected and analyzed. Relevant literature available in English was also reviewed. One patient was infected with tuberculous mycobacteria, two with suspected tuberculous mycobacteria, and three with nontuberculous mycobacteria. All six patients responded poorly to empiric antibiotic therapy, and diagnosis was not possible at their previous clinics. Five patients underwent tympanomastoidectomies; one was administered antimycobacterial medication without undergoing surgery. Mycobacterial infection was confirmed from a tissue culture or from the histopathology of the specimen, but in two patients, no definitive evidence of tuberculosis was found. Antimycobacterial medication was administered based on clinical suspicion, and improvement was noted. With appropriate therapy, all patients recovered, and no sequelae were observed after treatment. If empiric antibiotic therapy cannot achieve acceptable results, atypical infections, such as mycobacteria, should be considered. Antimycobacterial medication could be administered under clinical suspicion, serving as a diagnosis ex juvantibus. Surgical intervention might help reduce the bacterial load and obtain specimens for accurate diagnosis, but this may be unnecessary if appropriate antimycobacterial medication results in improvement. Early diagnosis and treatment can prevent complications in patients with recalcitrant otomastoiditis.
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- 2023
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8. Medical students’ preclinical service-learning experience and its effects on empathy in clinical training
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Yi-Sheng Yang, Pei-Chin Liu, Yung Kai Lin, Chia-Der Lin, Der-Yuan Chen, and Blossom Yen-Ju Lin
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Service learning ,Curriculum-based service team ,Extracurricular service team ,Empathy ,Clinical training ,Clerkships ,Special aspects of education ,LC8-6691 ,Medicine - Abstract
Abstract Background Service learning (SL) is an educational methodology presumed to help medical students be more empathetic and compassionate. We longitudinally investigated the level of empathy in medical students and how preclinical SL experience was related to their level of empathy in their clinical clerkships. Methods Our cohort comprised fifth-year medical students engaged in clerkships as part of a 7-year medical programme at one medical school in Taiwan. Surveys were conducted at the beginning of the clerkship in September 2015 (T1) to collect data on the medical students’ preclinical SL experience in curriculum-based service teams (CBSTs) and extracurricular service teams (ECSTs) and their SL self-efficacy, demographic characteristics, and empathy level. Subsequently, three follow-up surveys were conducted once every 3 months to determine the empathy level of the students during their clinical clerkships (T2–T4). Seventy students who returned the written informed consent and completed the baseline (T1) and two or more follow-up surveys (T2–T4) were included in our analysis with the response rate of 34%. In total, 247 responses across the 1-year clerkship were analysed. Descriptive statistics, paired t tests, and generalised estimating equations were employed. Results Our study revealed that changes in empathy level in the dimensions of perspective taking, compassionate care, and standing in patients’ shoes in their clinical clerkships. Relative to that at T1, their empathy decreased in perspective taking and compassionate care at T2–T4 but increased in standing in patients’ shoes at T3. Additionally, our study verified the positive effect of medical students’ preclinical SL experience in CBSTs and ECSTs on empathy in terms of compassionate care and perspective taking, respectively, but not on that of standing in patients’ shoes. Conclusions Separate investigations into subconstructs of empathy, such as perspective taking, compassionate care, and standing in patients’ shoes, in medical students may be necessary for exploring the various driving forces or barriers to developing empathy in medical students. Moreover, SL experience through both CBSTs and ECSTs at medical academies may have positive effects on medical students’ empathy in their clinical clerkships and should be promoted at medical schools.
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- 2021
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9. ACE2 localizes to the respiratory cilia and is not increased by ACE inhibitors or ARBs
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Ivan T. Lee, Tsuguhisa Nakayama, Chien-Ting Wu, Yury Goltsev, Sizun Jiang, Phillip A. Gall, Chun-Kang Liao, Liang-Chun Shih, Christian M. Schürch, David R. McIlwain, Pauline Chu, Nicole A. Borchard, David Zarabanda, Sachi S. Dholakia, Angela Yang, Dayoung Kim, Han Chen, Tomoharu Kanie, Chia-Der Lin, Ming-Hsui Tsai, Katie M. Phillips, Raymond Kim, Jonathan B. Overdevest, Matthew A. Tyler, Carol H. Yan, Chih-Feng Lin, Yi-Tsen Lin, Da-Tian Bau, Gregory J. Tsay, Zara M. Patel, Yung-An Tsou, Alexandar Tzankov, Matthias S. Matter, Chih-Jaan Tai, Te-Huei Yeh, Peter H. Hwang, Garry P. Nolan, Jayakar V. Nayak, and Peter K. Jackson
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Science - Abstract
Understanding how SARS-CoV-2 gains initial entry into the human body is a key step towards the development of prophylaxes and therapeutics for COVID-19. Here, the authors show that ACE2, the receptor for SARS-CoV-2, is abundantly expressed in the motile cilia of the human nasal and respiratory tract and is not affected by the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers.
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- 2020
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10. Neurofibromatosis type 2 initially presenting as a preauricular mass: a case report
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Wei-Che Lan, Yu Aoh, Rui-Yun Chen, Hui-Chi Tien, and Chia-Der Lin
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Neurofibromatosis type 2 (NF2) ,Schwannoma ,Atypical presentation ,Preauricular mass ,Case report ,Surgery ,RD1-811 - Abstract
Abstract Neurofibromatosis type 2 (NF2) is a rare genetic disease involving multiple tumors of the central and peripheral nervous systems. Most patients with NF2 have bilateral vestibular schwannomas; nonvestibular schwannomas may also develop. While the majority of patients may present with hearing impairment, tinnitus, dizziness and balance disorders, some may present with cutaneous manifestations. We describe the case of a 20-year-old man who initially presented with a solitary subcutaneous painless nodule in the left preauricular area without any other symptoms. He received excisional biopsy for the preauricular mass and the pathologic diagnosis was schwannoma. Magnetic resonance imaging of brain and neck revealed multiple mass lesions over the bilateral cerebellopontine angle cisterns, extending to the bilateral internal auditory canals, bilateral cervical neuroforamens, cervical and upper thoracic spinal canals, and left posterior neck. The patient was diagnosed with NF2 according to the clinical criteria. He underwent gamma knife stereotactic radiosurgery for bilateral vestibular schwannomas and is now under regular monitoring. Conclusion NF2 patients may present with an isolated solitary cutaneous schwannoma with no other associated clinical findings. Further assessment is thus warranted in young patients presenting with a peripheral schwannoma despite absence of other clinical findings.
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- 2020
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11. Medical students’ resilience: a protective role on stress and quality of life in clerkship
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Yung Kai Lin, Chia-Der Lin, Blossom Yen-Ju Lin, and Der-Yuan Chen
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Workplace stress ,Physical demands ,Psychological demands ,Resilience ,Burnout ,Compassion satisfaction ,Special aspects of education ,LC8-6691 ,Medicine - Abstract
Abstract Background Resilience refers to the ability to be flexible and adaptive in response to challenges. Medical students in clerkship who are transitioning from medical studies to clinical practice face a variety of workplace demands that can lead to negative learning experiences and poor quality of life. This study explored whether medical students’ resilience plays a protective role against the stresses incurred during workplace training and on their professional quality of life during clerkships. Methods This was a 1-year prospective web-based questionnaire study comprising one cohort of medical students in their fifth year who were working as clerks as part of their 6-year medical education programme at one medical school in Taiwan between September 2017 and July 2018. Web-based, validated, structured, self-administered questionnaires were used to measure the students’ resilience at the beginning of the clerkship and their perceived training stress (i.e. physical and psychological demands) and professional quality of life (i.e. burnout and compassion satisfaction) at each specialty rotation. Ninety-three medical students who responded to our specialty rotation surveys at least three times in the clerkship were included and hierarchical regressions were performed. Results This study verified the negative effects of medical students’ perceived training stress on burnout and compassion satisfaction. However, although the buffering (protective) effects of resilience were observed for physical demands (one key risk factor related to medical students’ professional quality of life), this was not the case for psychological demands (another key risk factor). In addition, through the changes in R square (∆R2) values of the hierarchical regression building, our study found that medical students’ perceived training stresses played a critical role on explaining their burnout but their resilience on their compassion satisfaction. Conclusions Medical students’ resilience demonstrated a buffering effect on the negative relationship between physical demands and professional quality of life during clerkships. Moreover, different mechanisms (predictive paths) leading to medical students’ professional quality of life such as burnout and compassion satisfaction warrant additional studies.
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- 2019
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12. Increased Incidence of Tinnitus Following a Hyperthyroidism Diagnosis: A Population-Based Longitudinal Study
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Tang-Chuan Wang, Chien-Jen Chiu, Pei-Chun Chen, Ta-Yuan Chang, Richard S. Tyler, Eveling Rojas-Roncancio, Claudia Barros Coelho, Patricia C. Mancini, Cheng-Li Lin, Chia-Der Lin, and Ming-Hsui Tsai
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hyperthyroidism ,incidence ,risk factors ,tinnitus ,cohort study ,national health insurance research database ,Diseases of the endocrine glands. Clinical endocrinology ,RC648-665 - Abstract
BackgroundAn association between thyroid disease and tinnitus has been described previously but further longitudinal, population-based studies are limited.ObjectiveTo investigate the incidence of tinnitus in patients with hyperthyroidism in a national sample, and to identify risk level and associated factors for tinnitus in hyperthyroidism patients.DesignRetrospective cohort study. Patient data were collected from the Longitudinal Health Insurance Database (LHID 2000), which includes national claims data of patient expenditures for admissions or ambulatory care from 1996 to 2011.SettingTaiwan hospitals and clinics providing healthcare nationwide.ParticipantsPatients aged 20 years and older with newly diagnosed hyperthyroidism (ICD-9-CM code 242) between 2000-2010 were selected as the study cohort. Hyperthyroidism patient cohort were identified from the LHID2000. Those with tinnitus history (ICD-9-CM code 388.3) before the index date (first hyperthyroidism diagnosis), younger than 20 years, and with incomplete demographic data were excluded. The non-hyperthyroidism cohort included patients with no history of hyperthyroidism and no documented tinnitus.Main Outcomes and MeasuresIncidence of tinnitus was the primary outcome. Baseline demographic factors and comorbidities possibly associated with tinnitus, including age, sex, and comorbidities of hearing loss, vertigo, insomnia and anxiety, were retrieved from the LHID 2000. Patients were followed until end of 2011.ResultsDuring the study period, 780 (4.9%) hyperthyroidism patients and 2007 (3.2%) non-hyperthyroidism controls developed tinnitus. Incidence rate of tinnitus in the hyperthyroidism cohort was significantly higher in hyperthyroidism cohort (7.86 vs. 5.05 per 1000 person-years) than that in non-hyperthyroidism cohort. A higher proportion of patients with hyperthyroidism had comorbid insomnia (45.1% vs. 30.9%) and anxiety (14.0% vs. 5.73%) than those without hyperthyroidism. After adjusting for age, gender and comorbidities (vertigo, insomnia, anxiety, hearing loss), hyperthyroidism patients had 1.38-fold higher risk of tinnitus (95% CI = 1.27-1.50) than those without hyperthyroidism.ConclusionsThis large population-based study suggests patients with diagnosed hyperthyroidism was more prone to develop tinnitus. Our findings suggest evaluation for comorbid vertigo, insomnia, anxiety and/or hearing loss may identify patients who are at high risk of developing tinnitus in patients with hyperthyroidism.
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- 2021
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13. Long-term follow-up of applying autologous bone grafts for reconstructing tympanomastoid defects in functional cholesteatoma surgery
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Wei-Che Lan, Ching-Yuan Wang, Ming-Hsui Tsai, and Chia-Der Lin
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Cholesteatoma ,Surgery ,Hearing ,Prognosis ,Long-term ,Medicine ,Biology (General) ,QH301-705.5 - Abstract
Objectives This study investigated the long-term surgical outcomes of functional cholesteatoma surgery with canal wall reconstruction using autologous bone grafts as the primary material in patients with acquired cholesteatoma. Subjects and Methods Medical charts were retrospectively reviewed for all patients admitted to one institution for surgical intervention between 2010 and 2018. We analyzed 66 patients (66 ears) who underwent functional tympanomastoidectomy involving the use of autologous bone grafts for canal wall defect reconstruction. Surgical outcomes were evaluated by comparing preoperative audiometric results with follow-up data (at least 36 months after surgery). Logistic regression analyses were performed to determine prognostic factors related to long-term hearing success. These factors included classification and stage of cholesteatoma, stapes condition, ossicular chain damage, active infection of the middle ear, state of the contralateral ear, preoperative hearing thresholds, gender, and age. Results The mean follow-up period was 49.2 months. The recidivism rate was 6% (four of 66 ears). The pure-tone average significantly improved from 50.78 ± 19.98 to 40.81 ± 21.22 dB hearing level (HL; p
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- 2021
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14. Relationship between medical students’ negative perceptions of colleagues’ work–life and burn-out during clerkships: a longitudinal observational cohort study
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Der-Yuan Chen, Yung Kai Lin, Blossom Yen-Ju Lin, and Chia-Der Lin
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Medicine - Published
- 2021
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15. The Changes in the Severity of Deep Neck Infection Post-UPPP and Tonsillectomy in Patients with OSAS
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Pin-Ching Hu, Liang-Chun Shih, Wen-Dien Chang, Jung-Nien Lai, Pei-Shao Liao, Chih-Jaan Tai, Chia-Der Lin, Hei-Tung Yip, Te-Chun Shen, and Yung-An Tsou
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deep neck infection ,uvulopalatopharyngoplasty ,obstructive sleep apnea syndrome ,National Health Insurance Research Database ,Science - Abstract
The main aim of this study is to compare the incidence rate and severity of deep neck infection (DNI) in patients post-UPPP+ T (uvulopalatopharyngoplasty plus tonsillectomy) and without UPPP+ T. We utilized the data derived from the Longitudinal Health Insurance Database (LHID) of the National Health Insurance Research Database (NHIRD) in Taiwan from 1 January 2000 to 31 December 2012. Patients who had undergone combined UPPP and tonsillectomy were selected using National Health Insurance (NHI) surgical order. Patients with DNI were selected using International Classification of Diseases (ICD-9-CM) code. A logistic regression model was applied for risk analysis. There were 1574 patients in the UPPP+ T cohort, and 6,296 patients who did not undergo combined UPPP and tonsillectomy for the control group. Our analysis showed that patients with an obstructive sleep apnea syndrome (OSAS) history constitute 76.1% (n = 1198) of the UPPP+ T cohort. Compared to the control group, there was no significantly increased incidence rate of DNI after UPPP+ T within 1–60 months. Patients undergoing combined UPPP and tonsillectomy had a lower intubation rate for DNI, with an adjusted odds ratio of 0.47 (95% CI = 0.32–0.69). The combined UPPP and tonsillectomy does not increase the risk of DNI within 1–60 months. Furthermore, combined UPPP and tonsillectomy can reduce the severity for DNI by decreasing the intubation rate and length of hospitalization.
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- 2022
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16. Increased Incidence of Dysmenorrhea in Women Exposed to Higher Concentrations of NO, NO2, NOx, CO, and PM2.5: A Nationwide Population-Based Study
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Shih-Yi Lin, Yu-Cih Yang, Cheng-Chieh Lin, Cherry Yin-Yi Chang, Wu-Huei Hsu, I-Kuan Wang, Chia-Der Lin, Chung-Y. Hsu, and Chia-Hung Kao
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air pollution ,dysmenorrhea ,Taiwan air quality monitoring database ,national health insurance research database ,NOX ,CO ,Public aspects of medicine ,RA1-1270 - Abstract
Background: Air pollution is speculated to affect the reproductive health of women. However, a longitudinal association between exposure to air pollution and dysmenorrhea has not been identified, which this study aimed to examine this point.Methods: Two nationwide databases, namely the Taiwan Air Quality Monitoring database and the Taiwan National Health Research Institutes database were linked. Women with a history of dysmenorrhea (International Classification of Disease, Ninth Revision, Clinical Modification code 625.3) before 2000 were excluded. All participants were followed from January 1, 2000 until the diagnosis of dysmenorrhea, withdrawal from National Health Insurance, or December 31, 2013. Furthermore, air pollutants were categorized into quartiles with three cut-off points (25th, 50th, and 75th percentiles). The Cox regression model was used to calculate the hazard ratios of dysmenorrhea.Results: This study enrolled 296,078 women. The mean concentrations of yearly air pollutants were 28.2 (±12.6) ppb for nitric oxides (NOx), 8.91 (±7.93) ppb for nitric oxide (NO), 19.3 (±5.49) ppb for nitrogen dioxide (NO2), 0.54 (±0.18) ppm for carbon monoxide (CO), and 31.8 (±6.80) μg/m3 for PM2.5. In total, 12,514 individuals developed dysmenorrhea during the 12-year follow-up. Relative to women exposed to Q1 concentrations of NOx, women exposed to Q4 concentrations exhibited a significantly higher dysmenorrhea risk [adjusted hazard ratio (aHR)= 27.9, 95% confidence interval (CI) = 21.6–31.3]; similarly higher risk was found for exposure to NO (aHR = 16.7, 95% CI = 15.4–18.4) and NO2 (aHR = 33.1, 95% CI = 30.9–37.4). For CO, the relative dysmenorrhea risk in women with Q4 level exposure was 28.7 (95% CI = 25.4–33.6). For PM2.5, women at the Q4 exposure level were 27.6 times (95% CI = 23.1–29.1) more likely to develop dysmenorrhea than those at the Q1 exposure level.Conclusion: Our results showed that women would have higher dysmenorrhea incidences while exposure to high concentrations of NO, NO2, NOx, CO, and PM2.5.
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- 2021
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17. Campylobacter jejuni Cytolethal Distending Toxin C Exploits Lipid Rafts to Mitigate Helicobacter pylori-Induced Pathogenesis
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Jia-Yin Yeh, Hwai-Jeng Lin, Chia-Jung Kuo, Chun-Lung Feng, Chia-Huei Chou, Chia-Der Lin, Hui-Yu Wu, Chen-Yi Li, Cheng-Hsun Chiu, and Chih-Ho Lai
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Helicobacter pylori ,cytolethal distending toxin ,lipid rafts ,cytotoxin-associated gene A ,vacuolating cytotoxin A ,Biology (General) ,QH301-705.5 - Abstract
Helicobacter pylori infection is associated with several gastrointestinal diseases, including gastritis, peptic ulcer, and gastrointestinal adenocarcinoma. Two major cytotoxins, vacuolating cytotoxin A (VacA) and cytotoxin-associated gene A (CagA), interact closely with lipid rafts, contributing to H. pylori-associated disease progression. The Campylobacter jejuni cytolethal distending toxin consists of three subunits: CdtA, CdtB, and CdtC. Among them, CdtA and CdtC bind to membrane lipid rafts, which is crucial for CdtB entry into cells. In this study, we employed recombinant CdtC (rCdtC) to antagonize the functions of H. pylori cytotoxin in cells. Our results showed that rCdtC alleviates cell vacuolation induced by H. pylori VacA. Furthermore, rCdtC reduces H. pylori CagA translocation, which decreases nuclear factor kappa-B activation and interleukin-8 production, resulting in the mitigation of gastric epithelial cell inflammation. These results reveal that CdtC hijacks cholesterol to compete for H. pylori cytotoxin actions via lipid rafts, ameliorating H. pylori-induced pathogenesis.
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- 2021
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18. Fine Particulate Matter Exposure Alters Pulmonary Microbiota Composition and Aggravates Pneumococcus-Induced Lung Pathogenesis
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Yu-Wen Chen, Shiao-Wen Li, Chia-Der Lin, Mei-Zi Huang, Hwai-Jeng Lin, Chia-Yin Chin, Yi-Ru Lai, Cheng-Hsun Chiu, Chia-Yu Yang, and Chih-Ho Lai
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PM2.5 ,pulmonary inflammation ,microbiota ,pneumococcus ,pathogenesis ,Biology (General) ,QH301-705.5 - Abstract
Exposure to fine particulate matter (PM) with aerodynamic diameter ≤2.5 μm (PM2.5) is closely correlated with respiratory diseases. Microbiota plays a key role in maintaining body homeostasis including regulation of host immune status and metabolism. As reported recently, PM2.5 exposure causes microbiota dysbiosis and thus promotes disease progression. However, whether PM2.5 alters pulmonary microbiota distribution and aggravates bacteria-induced pathogenesis remains unknown. In this study, we used mouse experimental models of PM2.5 exposure combined with Streptococcus pneumonia infection. We characterized the airway microbiota of bronchoalveolar lavage fluid (BALF) by sequencing the 16S rRNA V3–V4 amplicon on the Illumina MiSeq platform, followed by a combination of bioinformatics and statistical analyses. Shannon-diversity index, observed ASVs, and Fisher’s diversity index indicated that microbiota richness was significantly decreased in the mice treated with either PM2.5 or pneumococcus when compared with the control group. The genera Streptococcus, Prevotella, Leptotrichia, and Granulicatella were remarkably increased in mice exposed to PM2.5 combined with pneumococcal infection as compared to mice with pneumococcal infection alone. Histopathological examination exhibited that a more pronounced inflammation was present in lungs of mice treated with PM2.5 and pneumococcus than that in mouse groups exposed to either PM2.5 or pneumococcal infection alone. Our results demonstrate that PM2.5 alters the microbiota composition, thereby enhancing susceptibility to pneumococcal infection and exacerbating lung pathogenesis.
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- 2020
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19. Complications of Outpatient and Inpatient Renal Biopsy: A Systematic Review and Meta-Analysis
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Shih-Yi Lin, Cherry Yin-Yi Chang, Cheng-Chieh Lin, Wu-Huei Hsu, I.-Wen Liu, Chia-Der Lin, and Chia-Hung Kao
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outpatient ,inpatient ,renal biopsies ,systematic review ,Medicine (General) ,R5-920 - Abstract
Background: The evidence indicates that the optimal observation period following renal biopsy ranges between 6 and 8 h. This systematic review and meta-analysis explored whether differences exist in the complication rates of renal biopsies performed in outpatient and inpatient settings. Methods: We searched the MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 1985 to February 2020. Two reviewers independently selected studies evaluating the bleeding risk from renal biopsies performed in outpatient and inpatient settings and reviewed their full texts. The primary and secondary outcomes were risks of bleeding and major events (including mortality) following the procedure, respectively. Subgroup analysis was conducted according to the original study design (i.e., prospective or retrospective). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effect meta-analysis. Heterogeneity was assessed using the I2 test. Results: Data from all 10 eligible studies, which included a total of 1801 patients and 203 bleeding events, were included for analysis. Renal biopsies in outpatient settings were not associated with a higher bleeding risk than those in inpatient settings (OR = 0.81; 95% CI, 0.59–1.11; I2 = 0%). The risk of major events was also comparable across both groups (OR = 0.45; 95% CI, 0.16–1.29; I2 = 4%). Conclusions: Similar rates of bleeding and major events following renal biopsy in outpatient and inpatient settings were observed.
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- 2021
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20. Metformin Increases Survival in Hypopharyngeal Cancer Patients with Diabetes Mellitus: Retrospective Cohort Study and Cell-Based Analysis
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Yung-An Tsou, Wei-Chao Chang, Chia-Der Lin, Ro-Lin Chang, Ming-Hsui Tsai, Liang-Chun Shih, Theresa Staniczek, Tsu-Fang Wu, Hui-Ying Hsu, Wen-Dien Chang, Chih-Ho Lai, and Chuan-Mu Chen
- Subjects
hypopharyngeal squamous cell carcinoma ,metformin ,drug repositioning ,anticancer ,mortality ,autophagy ,Medicine ,Pharmacy and materia medica ,RS1-441 - Abstract
Hypopharyngeal squamous cell carcinoma (HSCC) is usually diagnosed at an advanced stage, leading to a poor prognosis. Even after improvement of surgical techniques, chemotherapy, and radiation technology, the survival rate of HSCC remains poor. Metformin, which is commonly used for type 2 diabetes mellitus (DM), has been suggested to reduce the risk of various cancer types. However, only a few clinical studies mentioned the relationship between metformin use and HSCC. Hence, the aim of this study was to elucidate the specific effect and mechanism of action of metformin in hypopharyngeal cancer. We first assessed whether metformin use has an effect on hypopharyngeal cancer patients with DM by conducting a retrospective cohort study. Our results showed that DM hypopharyngeal cancer patients who used metformin exhibited significantly better overall survival rates than that without metformin treatment. The cell-based analysis further indicated that metformin treatment regulated p38/JNK pathway to reduce Cyclin D1 and Bcl-2 expressions. In addition, metformin activated the pathways of AMPKα and MEK/ERK to phosphorylate p27(Thr198) and reduce mTOR phosphorylation in cells. These actions direct cells toward G1 cell cycle arrest, apoptosis, and autophagy. Our results, through combining a clinical cohort analysis with an in vitro study, demonstrate that metformin can be used for drug repositioning in the treatment of DM patients with hypopharyngeal cancer.
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- 2021
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21. Noise Induced Hearing Loss and Tinnitus—New Research Developments and Remaining Gaps in Disease Assessment, Treatment, and Prevention
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Tang-Chuan Wang, Ta-Yuan Chang, Richard Tyler, Ying-Ju Lin, Wen-Miin Liang, Yio-Wha Shau, Wei-Yong Lin, Yi-Wen Chen, Chia-Der Lin, and Ming-Hsui Tsai
- Subjects
central auditory system ,cochlear damage ,deafferentation ,hidden hearing loss ,maladaptive plasticity ,neural plasticity ,Neurosciences. Biological psychiatry. Neuropsychiatry ,RC321-571 - Abstract
Long-term noise exposure often results in noise induced hearing loss (NIHL). Tinnitus, the generation of phantom sounds, can also result from noise exposure, although understanding of its underlying mechanisms are limited. Recent studies, however, are shedding light on the neural processes involved in NIHL and tinnitus, leading to potential new and innovative treatments. This review focuses on the assessment of NIHL, available treatments, and development of new pharmacologic and non-pharmacologic treatments based on recent studies of central auditory plasticity and adaptive changes in hearing. We discuss the mechanisms and maladaptive plasticity of NIHL, neuronal aspects of tinnitus triggers, and mechanisms such as tinnitus-associated neural changes at the cochlear nucleus underlying the generation of tinnitus after noise-induced deafferentation. We include observations from recent studies, including our own studies on associated risks and emerging treatments for tinnitus. Increasing knowledge of neural plasticity and adaptive changes in the central auditory system suggest that NIHL is preventable and transient abnormalities may be reversable, although ongoing research in assessment and early detection of hearing difficulties is still urgently needed. Since no treatment can yet reverse noise-related damage completely, preventative strategies and increased awareness of hearing health are essential.
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- 2020
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22. Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study
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Shih-Yi Lin, Cheng-Li Lin, Cheng-Chieh Lin, Wu-Huei Hsu, Chia-Der Lin, I.-Kuan Wang, Chung-Y. Hsu, and Chia-Hung Kao
- Subjects
angiotensin-converting enzyme inhibitors (aceis) ,lung cancer ,air pollutant ,Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,RC254-282 - Abstract
Background: Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking. Methods: The ACEI cohort comprised 22,384 patients aged ≥ 18 years with a first prescription of ACEI. The comparison angiotensin receptor blocker (ARB) cohort consisted of age-, sex- and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model. Results: The overall incidence rates of lung cancer in the ACEI and ARB cohorts were 16.6 and 12.2 per 10,000 person-years, respectively. The ACEI cohort had a significantly higher risk of lung cancer than the ARB cohort (adjusted hazard ratio [aHR]. = 1.36; 95% confidence interval [CI]. = 1.11−1.67). Duration−response and dose−response analyses revealed that compared with patients who did not receive ACEIs, patients who received ACEIs for more than 45 days per year (aHR = 1.87; 95% CI = 1.48−2.36) and patients who received more than 540 defined daily doses of ACEIs per year (aHR =1.80; 95% CI = 1.43−-2.27) had a significantly higher risk of lung cancer. The cumulative incidence of lung cancer was also significantly higher in the ACEI cohort than in the ARB cohort (log-rank test, p = 0.002). Conclusions: ACEI use is associated with an increased risk of lung cancer compared with ARB use. Patients using ARBs have a significantly lower risk of lung cancer than non-ARB users.
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- 2020
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23. Long-Term Surveillance of Antibiotic Prescriptions and the Prevalence of Antimicrobial Resistance in Non-Fermenting Gram-Negative Bacilli
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Chia-Huei Chou, Yi-Ru Lai, Chih-Yu Chi, Mao-Wang Ho, Chao-Ling Chen, Wei-Chih Liao, Cheng-Mao Ho, Yu-An Chen, Chih-Yu Chen, Yu-Tzu Lin, Chia-Der Lin, and Chih-Ho Lai
- Subjects
antimicrobial prescription ,antimicrobial resistance ,acinetobacter calcoaceticus-acinetobacter baumannii complex ,pseudomonas aeruginosa ,Biology (General) ,QH301-705.5 - Abstract
The increasing emergence of multidrug-resistant (MDR) bacteria has been recognized as a public health threat worldwide. Hospitalized patients and outpatients are commonly infected by non-fermenting Gram-negative bacilli (NFGNB), particularly the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB) and Pseudomonas aeruginosa. Antimicrobial agents are critical for treating the nosocomial infections caused by NFGNB. The aim of this study was to assess antimicrobial resistance and the use of antimicrobial agents. The bacterial isolates of 638,152 specimens from both inpatients and outpatients, retrieved from 2001 to 2008 at a medical center in central Taiwan, were examined for their susceptibility to various antimicrobial agents, including cefepime, imipenem, ciprofloxacin, gentamicin, amikacin, meropenem, and levofloxacin. Administrated prescriptions of the monitored antibiotics were analyzed using the Taiwan National Health Insurance Research Database (NHIRD). Our results show that the defined daily doses (DDDs) for cefepime, imipenem, and ciprofloxacin increased with time, and a trend toward reduced antimicrobial sensitivities of both ACB and P. aeruginosa was noticeable. In conclusion, the antimicrobial sensitivities of ACB and P. aeruginosa were reduced with the increased use of antibiotics. Continuous surveillance of antibiotic prescriptions and the prevalence of emerging resistance in nosocomial infections is warranted.
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- 2020
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24. Redesigning a clinical mentoring program for improved outcomes in the clinical training of clerks
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Chia-Der Lin, Blossom Yen-Ju Lin, Cheng-Chieh Lin, and Cheng-Chun Lee
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clinical mentoring ,clerks ,mentoring program ,mentor ,mentee ,medical student ,Taiwan ,longitudinal survey ,Special aspects of education ,LC8-6691 ,Medicine (General) ,R5-920 - Abstract
Introduction: Mentorship has been noted as critical to medical students adapting to clinical training in the medical workplace. A lack of infrastructure in a mentoring program might deter relationship building between mentors and mentees. This study assessed the effect of a redesigned clinical mentoring program from the perspective of clerks. The objective was to assess the benefits of the redesigned program and identify potential improvements. Methods: A redesigned clinical mentoring program was launched in a medical center according to previous theoretical and practical studies on clinical training workplaces, including the elements of mentor qualifications, positive and active enhancers for mentor–mentee relationship building, the timing of mentoring performance evaluation, and financial and professional incentives. A four-wave web survey was conducted, comprising one evaluation of the former mentoring program and three evaluations of the redesigned clinical mentoring program. Sixty-four fifth-year medical students in clerkships who responded to the first wave and to at least two of the three following waves were included in the study. A structured and validated questionnaire encompassing 15 items on mentor performance and the personal characteristics of the clerks was used. Mixed linear models were developed for repeated measurements and to adjust for personal characteristics. Results: The results revealed that the redesigned mentoring program improved the mentors’ performance over time for most evaluated items regarding professional development and personal support provided to the mentees. Conclusions: Our findings serve as an improved framework for the role of the institution and demonstrate how institutional policies, programs, and structures can shape a clinical mentoring program. We recommend the adoption of mentorship schemes for other cohorts of medical students and for different learning and training stages involved in becoming a physician.
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- 2015
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25. Cytolethal Distending Toxin Enhances Radiosensitivity in Prostate Cancer Cells by Regulating Autophagy
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Hwai-Jeng Lin, Hsin-Ho Liu, Chia-Der Lin, Min-Chuan Kao, Yu-An Chen, Chuan Chiang-Ni, Zhi-Pei Jiang, Mei-Zi Huang, Chun-Jung Lin, U-Ging Lo, Li-Chiung Lin, Cheng-Kuo Lai, Ho Lin, Jer-Tsong Hsieh, Cheng-Hsun Chiu, and Chih-Ho Lai
- Subjects
Campylobacter jejuni ,cytolethal distending toxin ,cell cycle ,autophagy ,radioresistance ,Microbiology ,QR1-502 - Abstract
Cytolethal distending toxin (CDT) produced by Campylobacter jejuni contains three subunits: CdtA, CdtB, and CdtC. Among these three toxin subunits, CdtB is the toxic moiety of CDT with DNase I activity, resulting in DNA double-strand breaks (DSB) and, consequently, cell cycle arrest at the G2/M stage and apoptosis. Radiation therapy is an effective modality for the treatment of localized prostate cancer (PCa). However, patients often develop radioresistance. Owing to its particular biochemical properties, we previously employed CdtB as a therapeutic agent for sensitizing radioresistant PCa cells to ionizing radiation (IR). In this study, we further demonstrated that CDT suppresses the IR-induced autophagy pathway in PCa cells by attenuating c-Myc expression and therefore sensitizes PCa cells to radiation. We further showed that CDT prevents the formation of autophagosomes via decreased high-mobility group box 1 (HMGB1) expression and the inhibition of acidic vesicular organelle (AVO) formation, which are associated with enhanced radiosensitivity in PCa cells. The results of this study reveal the detailed mechanism of CDT for the treatment of radioresistant PCa.
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- 2017
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26. A web-based audiometry database system
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Chung-Hui Yeh, Sung-Tai Wei, Tsung-Wen Chen, Ching-Yuang Wang, Ming-Hsui Tsai, and Chia-Der Lin
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audiometry ,database system ,pure tone audiometry ,Medicine (General) ,R5-920 - Abstract
To establish a real-time, web-based, customized audiometry database system, we worked in cooperation with the departments of medical records, information technology, and otorhinolaryngology at our hospital. This system includes an audiometry data entry system, retrieval and display system, patient information incorporation system, audiometry data transmission program, and audiometry data integration. Compared with commercial audiometry systems and traditional hand-drawn audiometry data, this web-based system saves time and money and is convenient for statistics research.
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- 2014
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27. Increased Acquired Cholesteatoma Risk in Patients with Osteoporosis: A Retrospective Cohort Study.
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Tang-Chuan Wang, Che-Chen Lin, Chia-Der Lin, Hsiung-Kwang Chung, Ching-Yuang Wang, Ming-Hsui Tsai, and Chia-Hung Kao
- Subjects
Medicine ,Science - Abstract
Clinically, we found the increased incidence of acquired colesteatoma in the patients with osteoporosis. In this study, we used a retrospective cohort to examine this association and to investigate the possible mechanism.We conducted a population-based retrospective cohort study by using the National Health Insurance Research Database (NHIRD). We identified an osteoporosis cohort comprising 37 124 patients newly diagnosed with osteoporosis aged 20 years or older. Patients in the comparison cohort had no history of osteoporosis and were frequency matched with the patients in the osteoporosis cohort according to sex, age, and index year.The acquired cholesteatoma incidence rates for the osteoporosis and comparison cohorts were 1.12 and 0.83 per 1000 person-years, respectively. After we adjusted for confounding factors, the osteoporosis cohort exhibited a 1.32-fold increased acquired cholesteatoma risk relative to the comparison cohort (hazard ratio [HR] = 1.32, 95% confidence interval [CI] = 1.11-1.57). In addition, patients with no history of otitis media (HR = 1.33, 95% CI = 1.11-1.59), cancer (HR = 1.34, 95% CI = 1.12-1.60), or COPD (HR = 1.26, 95% CI = 1.05-1.52) in the osteoporosis cohort exhibited an increased risk of subsequent acquired cholesteatoma relative to those in the comparison cohort.Our cohort study indicated that patients with osteoporosis had a 1.31-fold increased acquired cholesteatoma risk relative to the comparison cohort. This risk was further increased in patients with comorbid otitis media. Hence, we recommend that otolaryngologists evaluate the condition of the middle ear of patients with osteoporosis.
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- 2015
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28. Interleukin-13 Inhibits Lipopolysaccharide-Induced BPIFA1 Expression in Nasal Epithelial Cells.
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Yung-An Tsou, Chia-Der Lin, Hui-Chen Chen, Hui-Ying Hsu, Lii-Tzu Wu, Chuan Chiang-Ni, Chih-Jung Chen, Tsu-Fang Wu, Min-Chuan Kao, Yu-An Chen, Ming-Te Peng, Ming-Hsui Tsai, Chuan-Mu Chen, and Chih-Ho Lai
- Subjects
Medicine ,Science - Abstract
Short palate, lung, and nasal epithelium clone 1 (SPLUNC1) protein is expressed in human nasopharyngeal and respiratory epithelium and has demonstrated antimicrobial activity. SPLUNC1 is now referred to as bactericidal/permeability-increasing fold containing family A, member 1 (BPIFA1). Reduced BPIFA1 expression is associated with bacterial colonization in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Interleukin 13 (IL-13), predominately secreted by T helper 2 (TH2) cells, has been found to contribute to airway allergies and suppress BPIFA1 expression in nasal epithelial cells. However, the molecular mechanism of IL-13 perturbation of bacterial infection and BPIFA1 expression in host airways remains unclear. In this study, we found that lipopolysaccharide (LPS)-induced BPIFA1 expression in nasal epithelial cells was mediated through the JNK/c-Jun signaling pathway and AP-1 activation. We further demonstrated that IL-13 downregulated the LPS-induced activation of phosphorylated JNK and c-Jun, followed by attenuation of BPIFA1 expression. Moreover, the immunohistochemical analysis showed that IL-13 prominently suppressed BPIFA1 expression in eosinophilic CRSwNP patients with bacterial infection. Taken together, these results suggest that IL-13 plays a critical role in attenuation of bacteria-induced BPIFA1 expression that may result in eosinophilic CRSwNP.
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- 2015
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29. Adult-onset congenital cholesteatoma in the hypotympanum initially presenting as Bell’s palsy: A case report.
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Pei-Shao Liao, Wei-Che Lan, Ching-Yuan Wang, Chia-Der Lin, and Yu Aoh
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- 2024
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30. A comparison of central compartment atopic disease and lateral dominant nasal polyps
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Liang‐Chun Shih, Bing‐Han Hsieh, Jia‐Hung Ma, Shuang‐Shuang Huang, Yung‐An Tsou, Chia‐Der Lin, Kuang‐Hua Huang, and Chih‐Jaan Tai
- Subjects
Nasal Polyps ,Otorhinolaryngology ,Case-Control Studies ,Chronic Disease ,Eosinophilia ,Humans ,Immunology and Allergy ,Endoscopy ,Sinusitis ,Rhinitis, Allergic ,Asthma ,Rhinitis - Abstract
The characteristics and surgical outcomes of central compartment atopic disease (CCAD) vary by region and race. Therefore, we aimed to identify the risk factors, symptom severity, and prognosis of CCAD in the Asian population.This case-control study recruited patients diagnosed with chronic rhinosinusitis with nasal polyps who underwent functional endoscopic sinus surgery (FESS) at a tertiary hospital in Taiwan. Patients were classified into CCAD and lateral-dominant nasal polyp (LDNP) groups based on endoscopic and computed tomography imaging findings. The demographic data, symptom severity scores, and surgical outcomes of the 2 groups were analyzed.Our study included 442 patients (CCAD group: n = 51; LDNP group: n = 391). We found that CCAD was strongly related to both asthma (9.8% vs 3.5%, p = 0.04) and allergic rhinitis symptoms (43.3% vs 26.6%, p = 0.01). Higher eosinophil counts were detected in blood serum (5.8% vs 2.8%, p0.01) and histopathologic profiles (57.0 vs 17.3, p0.01) among patients with CCAD. Improvements in 22-item Sino-Nasal Outcome Test (SNOT-22) score and mucociliary clearance time (MCT) after surgical intervention revealed that the CCAD group had a better response to FESS (SNOT-22 score: -31.82 vs -22.66, p0.01; MCT: -233.06 vs -191.93 seconds, p = 0.03). The revision FESS rate was not different between the 2 groups.Polyps originating from the central compartment were found to be related to asthma and allergic rhinitis in Taiwanese patients. A higher eosinophil count was suggested in both serum and local nasal tissue from patients with CCAD. FESS serves as an effective treatment for symptom relief in patients with CCAD.
- Published
- 2022
31. Effect of Electroacupuncture on Noise-Induced Hearing Loss in Rats
- Author
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Ching Liang Hsieh, Chia-Hao Chang, and Chia-Der Lin
- Subjects
medicine.medical_specialty ,Article Subject ,business.industry ,Electroacupuncture ,Hearing loss ,medicine.medical_treatment ,Audiology ,medicine.disease ,Other systems of medicine ,Noise ,medicine.anatomical_structure ,Complementary and alternative medicine ,otorhinolaryngologic diseases ,Acupuncture ,medicine ,medicine.symptom ,business ,RZ201-999 ,Tinnitus ,Cochlea ,Noise-induced hearing loss ,Spiral ganglion ,Research Article - Abstract
Acupuncture has long been used to relieve some inner ear diseases such as deafness and tinnitus. The present study examined the effect of electroacupuncture (EA) on noise-induced hearing loss (NIHL) in animals. A NIHL rat model was established. Electroacupuncture pretreatment at 2 Hz or posttreatment at the right Zhongzhu (TE3) acupoint was applied for 1 hour. Auditory thresholds were measured using auditory brainstem responses (ABRs), and histopathology of the cochlea was examined. The results indicated that the baseline auditory threshold of ABR was not significantly different between the control (no noise), EA-only (only EA without noise), noise (noise exposure only), pre-EA (pretreating EA then noise), and post-EA (noise exposure then posttreating with EA) groups. Significant auditory threshold shifts were found in the noise, pre-EA, and post-EA groups in the immediate period after noise exposure, whereas auditory recovery was better in the pre-EA and post-EA groups than that in the noise group at the three days, one week (W1), two weeks (W2), three weeks (W3), and four weeks(W4) after noise stimulation. Histopathological examination revealed greater loss of the density of spiral ganglion neurons in the noise group than in the control group at W1 and W2. Although significant loss of spiral ganglion loss happened in pre-EA and post-EA groups, such loss was less than the loss of the noise group, especially W1. These results indicate that either pretreatment or posttreatment with EA may facilitate auditory recovery after NIHL. The detailed mechanism through which EA alleviates NIHL requires further study.
- Published
- 2021
32. Electroacupuncture Promotes Neuroplasticity of Central Auditory Pathway: An Auditory Evoked Potentials Study
- Author
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Chia-Hao Chang, Chia-Der Lin, and Ching-Liang Hsieh
- Subjects
Article Subject ,Complementary and alternative medicine - Abstract
Our previous studies found that electroacupuncture at the right Zhongzhu acupoint (TE3) can enhance auditory recovery in rats with noise-induced hearing loss. Here, we investigated the changes in auditory brainstem response (ABR) and long late latency (LLR) evoked potential to explain the mechanisms of electroacupuncture at TE3. The auditory evoked potentials were recorded, including ABR and LLR, at baseline and on day 3 (D3), D5, and D8 after baseline. The 2-Hz electroacupuncture at the right TE3 was applied on D3, D4, and D5 in the electroacupuncture group but not in the control group. In ABR, compared with the control group, the latency shift of waves I (0.298 ± 0.033 vs −0.045 ± 0.057 ms), III (0.718 ± 0.038 vs −0.163 ± 0.130 ms), and V (1.160 ± 0.082 vs −0.207 ± 0.138 ms) on D3 (all p < 0.01 ) and of wave V (0.616 ± 0.433 vs −0.352 ± 0.209 ms, p < 0.05 ) on D5 was greater in the electroacupuncture group than that in the control group. Moreover, the interpeak latency shift of I–III (0.420 ± 0.041 vs −0.118 ± 0.177 ms) and I–V (0.863 ± 0.088 vs −0.162 ± 0.156 ms) on D3 (both p < 0.05 ) and of III–V (0.342 ± 0.193 vs −0.190 ± 0.110 ms) and I–V (0.540 ± 0.352 vs −0.343 ± 0.184 ms) on D5 (both p < 0.05 ) was greater in the electroacupuncture group than that in the control group. In LLR, the latency shift of P0 was greater in the electroacupuncture group than in the control group on D3 (3.956 ± 2.975 vs −1.178 ± 1.358 ms, p < 0.01 ) and D5 (2.200 ± 1.889 vs −0.311 ± 1.078 ms, p < 0.05 ). These findings indicate that electroacupuncture at the right TE3 can modulate the neuroplasticity of the central auditory pathway, including the brain stem and the primary and secondary auditory cortex.
- Published
- 2022
33. Association between angiotensin receptor blockers and suicide: nationwide population-based propensity score matching study
- Author
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Cheng-Li Lin, Chung Y. Hsu, Shih-Yi Lin, I-Kuan Wang, Wu-Huei Hsu, Chia-Hung Kao, Cheng-Chieh Lin, Chia-Der Lin, and Ming-Han Hsieh
- Subjects
medicine.medical_specialty ,Angiotensin-Converting Enzyme Inhibitors ,urologic and male genital diseases ,Cohort Studies ,Angiotensin Receptor Antagonists ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Cumulative incidence ,cardiovascular diseases ,Medical prescription ,Propensity Score ,Survival analysis ,Retrospective Studies ,Suicide attempt ,business.industry ,medicine.disease ,female genital diseases and pregnancy complications ,030227 psychiatry ,Psychiatry and Mental health ,Clinical Psychology ,Mood disorders ,Propensity score matching ,Cohort ,Anxiety ,medicine.symptom ,business ,hormones, hormone substitutes, and hormone antagonists ,030217 neurology & neurosurgery - Abstract
Background Angiotensin receptor blockers (ARBs) have been reported to ameliorate anxiety and mood disorders in animal models. Cohort links between ARB use and suicide risk in humans require clarification. Methods Data were obtained from the National Health Insurance Research Database. Patients diagnosed as having hypertension according to the criteria of the International Classification of Diseases, Ninth Revision, Clinical Modification (401-405) from January 1, 2000 to December 31, 2012 were enrolled as the target population. We defined enrollees who had received ARB prescriptions for at least 28 days as ARB users. Those who had never taken ARB prior or during the study period were defined as ARB nonusers and were propensity score–matched with ARB users. The end outcome was confirmation of a suicide attempt. Results After propensity score matching was conducted, 40,976 ARB users and 40,976 nonusers were selected as the matched cohorts. The overall incidence rate of suicide attempt was significantly lower in ARB users than in nonusers (0.51 vs. 1.07 per 10,000 person-years; adjusted hazard ratio = 0.48, 95% confidence interval = 0.26–0.87). A Kaplan–Meier survival analysis with a log-rank test revealed a lower cumulative incidence of suicide attempt in ARB users than in nonusers (p Conclusions ARB use was not associated with an increased risk for suicide compared with non-ARB use.
- Published
- 2020
34. Chronic rhinosinusitis and premorbid autoimmune diseases: a population-based case–control study
- Author
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Te Chun Shen, Ivan T. Lee, Cheng-Li Lin, Ming Hsui Tsai, Da Tian Bau, Yung An Tsou, Gregory J. Tsay, Liang Chun Shih, Hua-Hsin Hsieh, Chia-Der Lin, and Chih Jaan Tai
- Subjects
Adult ,Male ,medicine.medical_specialty ,Population ,lcsh:Medicine ,Diseases ,Subgroup analysis ,Article ,Autoimmune Diseases ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Rheumatology ,Sicca syndrome ,Internal medicine ,otorhinolaryngologic diseases ,Humans ,Medicine ,030212 general & internal medicine ,Sinusitis ,education ,lcsh:Science ,Retrospective Studies ,Ankylosing spondylitis ,education.field_of_study ,Multidisciplinary ,business.industry ,lcsh:R ,Health care ,Case-control study ,Retrospective cohort study ,Odds ratio ,Middle Aged ,medicine.disease ,Risk factors ,030228 respiratory system ,Case-Control Studies ,Population Surveillance ,Rheumatoid arthritis ,Chronic Disease ,Female ,lcsh:Q ,business - Abstract
Evidence shows that chronic rhinosinusitis (CRS) is associated with prior presence of autoimmune diseases; however, large-scale population-based studies in the literature are limited. We conducted a population-based case–control study investigating the association between CRS and premorbid autoimmune diseases by using the National Health Insurance Research Database in Taiwan. The CRS group included adult patients newly diagnosed with CRS between 2001 and 2013. The date of diagnosis was defined as the index date. The comparison group included individuals without CRS, with 1:4 frequency matching for gender, age, and index year. Premorbid diseases were forward traced to 1996. Univariate and multivariate logistic regression was performed to estimate odds ratios (ORs) and 95% confidence intervals. The CRS group consisted of 30,611 patients, and the comparison group consisted of 122,444 individuals. Patients with CRS had a higher significant association with premorbid autoimmune diseases (adjusted OR 1.39 [1.28–1.50]). Specifically, patients with CRS had a higher significant association with ankylosing spondylitis, polymyositis, psoriasis, rheumatoid arthritis, sicca syndrome, and systemic lupus erythematosus (adjusted OR 1.49 [1.34–1.67], 3.47 [1.12–10.8], 1.22 [1.04–1.43], 1.60 [1.31–1.96], 2.10 [1.63–2.72], and 1.69 [1.26–2.25]). In subgroup analysis, CRS with and without nasal polyps demonstrated a significant association with premorbid autoimmune diseases (adjusted OR 1.34 [1.14–1.58] and 1.50 [1.38–1.62]). In addition, CRS with fungal and non-fungal infections also demonstrated a significant association with premorbid autoimmune diseases (adjusted OR 2.02 [1.72–2.49] and 1.39 [1.28–1.51]). In conclusion, a significant association between CRS and premorbid autoimmune diseases has been identified. These underlying mechanisms need further investigation.
- Published
- 2020
35. Separating the Novel Speech Sound Perception of Lexical Tone Chimeras From Their Auditory Signal Manipulations: Behavioral and Electroencephalographic Evidence
- Author
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Chia-Der Lin, Fuh-Cherng Jeng, and Breanna N. Hart
- Subjects
Auditory perception ,Speech sound ,Chimera ,Speech recognition ,media_common.quotation_subject ,Novelty ,Auditory signal ,Experimental and Cognitive Psychology ,Electroencephalography ,Frequency following response ,Sensory Systems ,Tone (musical instrument) ,Phonetics ,Perception ,Speech Perception ,Humans ,Normal speech ,Psychology ,Pitch Perception ,media_common - Abstract
Previous research has shown the novelty of lexical-tone chimeras (artificially constructed speech sounds created by combining normal speech sounds of a given language) to native speakers of the language from which the chimera components were drawn. However, the source of such novelty remains unclear. Our goal in this study was to separate the effects of chimeric tonal novelty in Mandarin speech from the effects of auditory signal manipulations. We recruited 20 native speakers of Mandarin and constructed two sets of lexical-tone chimeras by interchanging the envelopes and fine structures of both a falling/yi4/and a rising/yi2/Mandarin tone through 1, 2, 3, 4, 6, 8, 16, 32, and 64 auditory filter banks. We conducted pitch-perception ability tasks via a two-alternative, forced-choice paradigm to produce behavioral (versus physiological) pitch perception data. We also obtained electroencephalographic measurements through the scalp-recorded frequency-following response (FFR). Analyses of variances and post hoc Greenhouse-Geisser procedures revealed that the differences observed in the participants’ reaction times and FFR measurements were attributable primarily to chimeric novelty rather than signal manipulation effects. These findings can be useful in assessing neuroplasticity and developing speech-processing strategies.
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- 2021
36. Medical students’ preclinical service-learning experience and its effects on empathy in clinical training
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Der-Yuan Chen, Pei-Chin Liu, Yung Kai Lin, Blossom Yen-Ju Lin, Chia-Der Lin, and Yi-Sheng Yang
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Students, Medical ,020205 medical informatics ,media_common.quotation_subject ,education ,Service-learning ,Taiwan ,Empathy ,02 engineering and technology ,Education ,03 medical and health sciences ,0302 clinical medicine ,Informed consent ,Clinical training ,Service learning ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,030212 general & internal medicine ,Curriculum ,media_common ,Extracurricular service team ,Response rate (survey) ,Medical education ,Descriptive statistics ,LC8-6691 ,Research ,Clerkships ,Clinical Clerkship ,General Medicine ,Special aspects of education ,Perspective-taking ,Cohort ,Curriculum-based service team ,Medicine ,Psychology - Abstract
Background Service learning (SL) is an educational methodology presumed to help medical students be more empathetic and compassionate. We longitudinally investigated the level of empathy in medical students and how preclinical SL experience was related to their level of empathy in their clinical clerkships. Methods Our cohort comprised fifth-year medical students engaged in clerkships as part of a 7-year medical programme at one medical school in Taiwan. Surveys were conducted at the beginning of the clerkship in September 2015 (T1) to collect data on the medical students’ preclinical SL experience in curriculum-based service teams (CBSTs) and extracurricular service teams (ECSTs) and their SL self-efficacy, demographic characteristics, and empathy level. Subsequently, three follow-up surveys were conducted once every 3 months to determine the empathy level of the students during their clinical clerkships (T2–T4). Seventy students who returned the written informed consent and completed the baseline (T1) and two or more follow-up surveys (T2–T4) were included in our analysis with the response rate of 34%. In total, 247 responses across the 1-year clerkship were analysed. Descriptive statistics, paired t tests, and generalised estimating equations were employed. Results Our study revealed that changes in empathy level in the dimensions of perspective taking, compassionate care, and standing in patients’ shoes in their clinical clerkships. Relative to that at T1, their empathy decreased in perspective taking and compassionate care at T2–T4 but increased in standing in patients’ shoes at T3. Additionally, our study verified the positive effect of medical students’ preclinical SL experience in CBSTs and ECSTs on empathy in terms of compassionate care and perspective taking, respectively, but not on that of standing in patients’ shoes. Conclusions Separate investigations into subconstructs of empathy, such as perspective taking, compassionate care, and standing in patients’ shoes, in medical students may be necessary for exploring the various driving forces or barriers to developing empathy in medical students. Moreover, SL experience through both CBSTs and ECSTs at medical academies may have positive effects on medical students’ empathy in their clinical clerkships and should be promoted at medical schools.
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- 2021
37. Complications of Outpatient and Inpatient Renal Biopsy: A Systematic Review and Meta-Analysis
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Chia-Hung Kao, Shih-Yi Lin, I-Wen Liu, Cherry Yin-Yi Chang, Chia-Der Lin, Wu-Huei Hsu, and Cheng-Chieh Lin
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medicine.medical_specialty ,Clinical Biochemistry ,030232 urology & nephrology ,MEDLINE ,Subgroup analysis ,Review ,inpatient ,03 medical and health sciences ,0302 clinical medicine ,systematic review ,Internal medicine ,Medicine ,030212 general & internal medicine ,lcsh:R5-920 ,medicine.diagnostic_test ,business.industry ,Odds ratio ,Confidence interval ,Systematic review ,Meta-analysis ,outpatient ,renal biopsies ,Renal biopsy ,lcsh:Medicine (General) ,business ,Complication - Abstract
The evidence indicates that the optimal observation period following renal biopsy ranges between 6 and 8 h. This systematic review and meta-analysis explored whether differences exist in the complication rates of renal biopsies performed in outpatient and inpatient settings. Methods: We searched the MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews from 1985 to February 2020. Two reviewers independently selected studies evaluating the bleeding risk from renal biopsies performed in outpatient and inpatient settings and reviewed their full texts. The primary and secondary outcomes were risks of bleeding and major events (including mortality) following the procedure, respectively. Subgroup analysis was conducted according to the original study design (i.e., prospective or retrospective). Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using a random effect meta-analysis. Heterogeneity was assessed using the I2 test. Results:Data from all 10 eligible studies, which included a total of 1801 patients and 203 bleeding events, were included for analysis. Renal biopsies in outpatient settings were not associated with a higher bleeding risk than those in inpatient settings (OR = 0.81, 95% CI, 0.59–1.11, I2 = 0%). The risk of major events was also comparable across both groups (OR = 0.45, 95% CI, 0.16–1.29, I2 = 4 %). Conclusions:Similar rates of bleeding and major events following renal biopsy in outpatient and inpatient settings were observed.
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- 2021
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38. Efficacy and Safety of AM-111 in the Treatment of Acute Unilateral Sudden Deafness—A Double-blind, Randomized, Placebo-controlled Phase 3 Study
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Galina Jokovic, Nida Wright, Pavel Navratil, Hinrich Staecker, Chia-Der Lin, Thomas Meyer, Andrzej Krzyzaniak, Ventzislav Tzvetkov, S. A. Karpishchenko, and Andrea Kienle-Gogolok
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Adult ,Male ,medicine.medical_specialty ,Hearing loss ,Hearing Loss, Sensorineural ,Apoptosis ,Hearing Loss, Unilateral ,Placebo ,law.invention ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Randomized controlled trial ,law ,Internal medicine ,otorhinolaryngologic diseases ,medicine ,Humans ,Prospective Studies ,Rescue medication ,030223 otorhinolaryngology ,Adverse effect ,Prospective cohort study ,Aged ,Injection, Intratympanic ,Absolute threshold of hearing ,business.industry ,Sensorineural Hearing Loss & Tinnitus ,Hearing Loss, Sudden ,Middle Aged ,AM-111 ,Sensory Systems ,Clinical trial ,Treatment Outcome ,ISSNHL ,Otorhinolaryngology ,Peptide ,Brimapitide ,Female ,JNK ,Neurology (clinical) ,medicine.symptom ,Peptides ,business ,030217 neurology & neurosurgery ,Tinnitus - Abstract
Objective: To confirm the efficacy and safety of AM-111 (brimapitide), a cell-penetrating c-Jun N-terminal Kinase (JNK) inhibitor, in patients suffering from severe to profound acute unilateral idiopathic sudden sensorineural hearing loss (ISSNHL). Study design: Prospective, double-blind, randomized, placebo-controlled phase 3 study with follow-up visits on Days 3, 7, 28, and 91. Setting: Fifty-one European and Asian sites (tertiary referral centers, private ENT practices). Patients: Two hundred fifty-six patients aged 18 to 65 years presenting within 72 hours following ISSNHL onset with mean hearing loss ≥ 40 dB and mean threshold ≥ 60 dB at the 3 worst affected contiguous test frequencies. Interventions: Single-dose intratympanic injection of AM-111 (0.4 or 0.8 mg/ml) or placebo; oral prednisolone as reserve therapy if hearing improvement < 10 dB at Day 7. Main outcome measures: Hearing improvement to Day 28 was the primary efficacy endpoint; complete hearing recovery, frequency of reserve therapy used, complete tinnitus remission, improvement in word recognition were secondary endpoints. Safety was evaluated by the frequency of clinically relevant hearing deterioration and adverse events. Results: While the primary efficacy endpoint was not met in the overall study population, post-hoc analysis showed a clinically relevant and nominally significant treatment effect for AM-111 0.4 mg/ml in patients with profound ISSNHL. The study drug and the administration procedure were well tolerated. Conclusions: AM-111 provides effective otoprotection in case of profound ISSNHL. Activation of the JNK stress kinase, AM-111's pharmacologic target, seems to set in only following pronounced acute cochlear injury associated with large hearing threshold shifts.
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- 2019
39. Association between angiotensin-converting enzyme inhibitors or angiotensin receptor blockers and community-acquired pneumonia: A nationwide population propensity-score matching study
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Chih Yen Tu, Chia-Hui Chou, Shih-Yi Lin, Chih-Yu Chi, Wu-Huei Hsu, Chia-Hung Kao, Cheng-Li Lin, Cheng-Chieh Lin, Shih-Sheng Chang, Chung Y. Hsu, and Chia-Der Lin
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medicine.medical_specialty ,Population ,Pneumonia, Viral ,Angiotensin-Converting Enzyme Inhibitors ,urologic and male genital diseases ,Cohort Studies ,Angiotensin Receptor Antagonists ,Community-acquired pneumonia ,Internal medicine ,medicine ,Humans ,cardiovascular diseases ,education ,Retrospective Studies ,education.field_of_study ,business.industry ,Hazard ratio ,Retrospective cohort study ,General Medicine ,medicine.disease ,female genital diseases and pregnancy complications ,Viral pneumonia ,Cohort ,Propensity score matching ,business ,hormones, hormone substitutes, and hormone antagonists ,Cohort study - Abstract
Background Few large-scale cohort studies have investigated the association between community acquired pneumonia and the use of angiotensin-converting enzyme inhibitors (ACEIs) or angiotensin II receptor blockers (ARBs). We aimed to study whether using ACEIs or ARBs had protective effects for community acquired pneumonia. Methods This database cohort study was conducted retrospectively in Taiwan. The hypertensive patients were the target population of this study. Patients with ARB use were defined as our first study cohort. The second study cohort comprised patients who used ACEI. Propensity-score matching at 1:1 was used between ARB users and non-ARB users. We recruited 67 944 participants for the ARB study and 58 062 participants for the ACEI study. The same matching was also performed between ACEI users and non-ACEI users. Cox proportional hazard regression was used to analyze the risk of the outcome of viral pneumonia. Results The hazard ratio of community acquired pneumonia for ARB users relative to non-ARB users was 0.33. The hazard ratio of community acquired pneumonia was 0.71 times in ACEI users compared with ACEI nonusers. In stratification analysis, both ARB and ACEI both exhibited a protective effect for community acquired pneumonia in each age and sex group. In the analysis of the effects of therapy duration, patients using ARB for fewer than 100 days exhibited a greater reduction in the risk of community acquired pneumonia (adjusted HR = 0.58) compared with the non-ARB cohort. For the ACEI study, patients who used ACEI for 121 to 450 days were more likely to exhibit reduced risks of community acquired pneumonia (adjusted HR = 0.5). Conclusion Both ACEI and ARB uses were associated with decreased risk of community acquired pneumonia infection.
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- 2021
40. A novel diagnostic tool for hyaline vascular Castleman disease versus lymphoma based on contrast-enhanced computed tomography in neck mass.
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Huan-Yu Lin, Pei-Shao Liao, Liang-Chun Shih, Chun-Hung Hua, Ming-Hsui Tsai, and Chia-Der Lin
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CASTLEMAN'S disease ,COMPUTED tomography ,VASCULAR diseases ,LYMPHOMAS ,DIAGNOSIS - Abstract
Background: Castleman disease and lymphoma each have a distinct treatment plan; however, they share the same features on contrast-enhanced computed tomography. Methods: To assess the quantitative outcomes of Castleman disease versus lymphoma using contrast-enhanced computed tomography based on Hounsfield units (HU). We retrospectively reviewed eight patients with unicentric Castleman disease and 30 patients with lymphoma based on pathological diagnosis at China Medical University Hospital between 2015 and 2020. Preoperative computed tomography with contrast scans was reviewed, and the HU of each tumor were measured. Results: This study included eight patients with unicentric Castleman disease (four men and four women; mean age, 33 years) and 25 patients with lymphoma (11 men and 14 women; mean age, 53 years). There was no significant difference in heterogeneity between the two diseases (0.161 ± 0.052 vs 0.239 ± 0.063, p = 0.22); however, enhancement in Castleman disease was higher than that in lymphoma (126.40 ± 31.90 vs 74.19 ± 7.11, p < 0.001), providing a very good diagnostic tool (cutoff point at 88.5-91.3, sensitivity 0.86/specificity 0.88). Furthermore, we found a highly linear relationship in Castleman disease, which was not noted in lymphoma. Conclusion: The value of HU provides a good diagnostic tool for the differential diagnosis of Castleman disease versus lymphoma in the neck lymph nodes. Considering the linear relationship in Castleman disease, an increasingly accurate differential diagnosis can be made. [ABSTRACT FROM AUTHOR]
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- 2022
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41. ACE2 localizes to the respiratory cilia and is not increased by ACE inhibitors or ARBs
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Angela Yang, Da Tian Bau, Yung An Tsou, Jayakar V. Nayak, Han Chen, David Zarabanda, Phillip A. Gall, Matthias S. Matter, Chih Feng Lin, Nicole A. Borchard, Yi Tsen Lin, Yury Goltsev, Garry P. Nolan, Sachi S. Dholakia, Katie M. Phillips, Tsuguhisa Nakayama, Chia-Der Lin, Jonathan B. Overdevest, Te-Huei Yeh, Matthew A. Tyler, Chien-Ting Wu, Alexandar Tzankov, Liang Chun Shih, Pauline Chu, Raymond Kim, Sizun Jiang, David R. McIlwain, Ivan T. Lee, Tomoharu Kanie, Christian M. Schürch, Peter K. Jackson, Zara M. Patel, Chun Kang Liao, Ming Hsui Tsai, Carol H. Yan, Dayoung Kim, Peter H. Hwang, Chih Jaan Tai, and Gregory J. Tsay
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0301 basic medicine ,viruses ,Respiratory System ,Gene Expression ,General Physics and Astronomy ,Angiotensin-Converting Enzyme Inhibitors ,medicine.disease_cause ,Pathogenesis ,0302 clinical medicine ,2.2 Factors relating to the physical environment ,2.1 Biological and endogenous factors ,Viral ,Aetiology ,Respiratory system ,lcsh:Science ,Lung ,Coronavirus ,Multidisciplinary ,Angiotensin Receptor Antagonists ,Cilium ,Smoking ,Age Factors ,respiratory system ,Infectious Diseases ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Angiotensin-converting enzyme 2 ,Pneumonia & Influenza ,Respiratory ,Motile cilium ,Goblet Cells ,Angiotensin-Converting Enzyme 2 ,Infection ,Coronavirus Infections ,hormones, hormone substitutes, and hormone antagonists ,Science ,Pneumonia, Viral ,Peptidyl-Dipeptidase A ,Article ,General Biochemistry, Genetics and Molecular Biology ,Vaccine Related ,03 medical and health sciences ,Sex Factors ,Clinical Research ,Biodefense ,medicine ,Humans ,Cilia ,Sinusitis ,Pandemics ,Respiratory tract diseases ,SARS-CoV-2 ,business.industry ,Prevention ,Endothelial Cells ,COVID-19 ,Pneumonia ,General Chemistry ,respiratory tract diseases ,Emerging Infectious Diseases ,Good Health and Well Being ,030104 developmental biology ,Viral infection ,Immunology ,lcsh:Q ,business - Abstract
The coronavirus SARS-CoV-2 is the causative agent of the ongoing severe acute respiratory disease pandemic COVID-19. Tissue and cellular tropism is one key to understanding the pathogenesis of SARS-CoV-2. We investigate the expression and subcellular localization of the SARS-CoV-2 receptor, angiotensin-converting enzyme 2 (ACE2), within the upper (nasal) and lower (pulmonary) respiratory tracts of human donors using a diverse panel of banked tissues. Here, we report our discovery that the ACE2 receptor protein robustly localizes within the motile cilia of airway epithelial cells, which likely represents the initial or early subcellular site of SARS-CoV-2 viral entry during host respiratory transmission. We further determine whether ciliary ACE2 expression in the upper airway is influenced by patient demographics, clinical characteristics, comorbidities, or medication use, and show the first mechanistic evidence that the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARBs) does not increase susceptibility to SARS-CoV-2 infection through enhancing the expression of ciliary ACE2 receptor. These findings are crucial to our understanding of the transmission of SARS-CoV-2 for prevention and control of this virulent pathogen., Understanding how SARS-CoV-2 gains initial entry into the human body is a key step towards the development of prophylaxes and therapeutics for COVID-19. Here, the authors show that ACE2, the receptor for SARS-CoV-2, is abundantly expressed in the motile cilia of the human nasal and respiratory tract and is not affected by the use of angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers.
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- 2020
42. Noise Induced Hearing Loss and Tinnitus—New Research Developments and Remaining Gaps in Disease Assessment, Treatment, and Prevention
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Wen-Miin Liang, Ming Hsui Tsai, Tang-Chuan Wang, Yi-Wen Chen, Chia-Der Lin, Wei-Yong Lin, Ta-Yuan Chang, Ying Ju Lin, Yio-Wha Shau, and Richard S. Tyler
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medicine.medical_specialty ,deafferentation ,Early detection ,Review ,Maladaptive plasticity ,Audiology ,lcsh:RC321-571 ,03 medical and health sciences ,0302 clinical medicine ,Noise exposure ,Neuroplasticity ,medicine ,otorhinolaryngologic diseases ,Auditory system ,tinnitus ,030223 otorhinolaryngology ,lcsh:Neurosciences. Biological psychiatry. Neuropsychiatry ,central auditory system ,cochlear damage ,business.industry ,General Neuroscience ,hidden hearing loss ,medicine.disease ,maladaptive plasticity ,medicine.anatomical_structure ,noise induced hearing loss ,Disease assessment ,medicine.symptom ,business ,030217 neurology & neurosurgery ,Tinnitus ,Noise-induced hearing loss ,neural plasticity - Abstract
Long-term noise exposure often results in noise induced hearing loss (NIHL). Tinnitus, the generation of phantom sounds, can also result from noise exposure, although understanding of its underlying mechanisms are limited. Recent studies, however, are shedding light on the neural processes involved in NIHL and tinnitus, leading to potential new and innovative treatments. This review focuses on the assessment of NIHL, available treatments, and development of new pharmacologic and non-pharmacologic treatments based on recent studies of central auditory plasticity and adaptive changes in hearing. We discuss the mechanisms and maladaptive plasticity of NIHL, neuronal aspects of tinnitus triggers, and mechanisms such as tinnitus-associated neural changes at the cochlear nucleus underlying the generation of tinnitus after noise-induced deafferentation. We include observations from recent studies, including our own studies on associated risks and emerging treatments for tinnitus. Increasing knowledge of neural plasticity and adaptive changes in the central auditory system suggest that NIHL is preventable and transient abnormalities may be reversable, although ongoing research in assessment and early detection of hearing difficulties is still urgently needed. Since no treatment can yet reverse noise-related damage completely, preventative strategies and increased awareness of hearing health are essential.
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- 2020
43. Robust ACE2 protein expression localizes to the motile cilia of the respiratory tract epithelia and is not increased by ACE inhibitors or angiotensin receptor blockers
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Chien-Ting Wu, David Zarabanda, David R. McIlwain, Angela Yang, Yury Goltsev, Te-Huei Yeh, Ivan T. Lee, Tsuguhisa Nakayama, Carol H. Yan, Chih Jaan Tai, Raymond Kim, Gregory J. Tsay, Chun-Kang Liao, Chia-Der Lin, Jayakar V. Nayak, Katie M. Phillips, Matthew A. Tyler, Garry P. Nolan, Ming Hsui Tsai, Sizun Jiang, Sachi S. Dholakia, Dayoung Kim, Tomoharu Kanie, Chih-Feng Lin, Christian M. Schürch, Liang-Chun Shih, Phillip A. Gall, Da Tian Bau, Yung An Tsou, Pauline Chu, Yi-Tsen Lin, Nicole A. Borchard, Jonathan B. Overdevest, Peter K. Jackson, Peter H. Hwang, and Zara M. Patel
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Cilium ,respiratory system ,Pharmacology ,Biology ,Subcellular localization ,medicine.anatomical_structure ,Viral entry ,Organelle ,medicine ,Motile cilium ,Respiratory system ,Receptor ,hormones, hormone substitutes, and hormone antagonists ,Respiratory tract - Abstract
We investigated the expression and subcellular localization of the SARS-CoV-2 receptor, angiotensin-converting enzyme 2 (ACE2), within the upper (nasal) and lower (pulmonary) respiratory tracts of healthy human donors. We detected ACE2 protein expression within the cilia organelle of ciliated airway epithelial cells, which likely represents the initial or early subcellular site of SARS-CoV-2 viral entry during respiratory transmission. We further determined whether ACE2 expression in the cilia of upper respiratory cells was influenced by patient demographics, clinical characteristics, co-morbidities, or medication use, and found no evidence that the use of angiotensin-converting enzyme inhibitors (ACEI) or angiotensin II receptor blockers (ARBs) increases ACE2 protein expression.
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- 2020
44. Long-Term Surveillance of Antibiotic Prescriptions and the Prevalence of Antimicrobial Resistance in Non-Fermenting Gram-Negative Bacilli
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Wei-Chih Liao, Yu-An Chen, Chih Ho Lai, Yu-Tzu Lin, Chia-Der Lin, Yi-Ru Lai, Mao-Wang Ho, Chih-Yu Chi, Chia-Huei Chou, Chao-Ling Chen, Chih-Yu Chen, and Cheng-Mao Ho
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0301 basic medicine ,Microbiology (medical) ,Imipenem ,medicine.medical_specialty ,antimicrobial prescription ,medicine.drug_class ,Cefepime ,030106 microbiology ,Antibiotics ,Microbiology ,Meropenem ,Article ,03 medical and health sciences ,0302 clinical medicine ,Antibiotic resistance ,Virology ,Internal medicine ,medicine ,030212 general & internal medicine ,antimicrobial resistance ,lcsh:QH301-705.5 ,Acinetobacter calcoaceticus-Acinetobacter baumannii complex ,business.industry ,Antimicrobial ,bacterial infections and mycoses ,Ciprofloxacin ,Pseudomonas aeruginosa ,lcsh:Biology (General) ,Amikacin ,business ,medicine.drug - Abstract
The increasing emergence of multidrug-resistant (MDR) bacteria has been recognized as a public health threat worldwide. Hospitalized patients and outpatients are commonly infected by non-fermenting Gram-negative bacilli (NFGNB), particularly the Acinetobacter calcoaceticus-Acinetobacter baumannii complex (ACB) and Pseudomonas aeruginosa. Antimicrobial agents are critical for treating the nosocomial infections caused by NFGNB. The aim of this study was to assess antimicrobial resistance and the use of antimicrobial agents. The bacterial isolates of 638,152 specimens from both inpatients and outpatients, retrieved from 2001 to 2008 at a medical center in central Taiwan, were examined for their susceptibility to various antimicrobial agents, including cefepime, imipenem, ciprofloxacin, gentamicin, amikacin, meropenem, and levofloxacin. Administrated prescriptions of the monitored antibiotics were analyzed using the Taiwan National Health Insurance Research Database (NHIRD). Our results show that the defined daily doses (DDDs) for cefepime, imipenem, and ciprofloxacin increased with time, and a trend toward reduced antimicrobial sensitivities of both ACB and P. aeruginosa was noticeable. In conclusion, the antimicrobial sensitivities of ACB and P. aeruginosa were reduced with the increased use of antibiotics. Continuous surveillance of antibiotic prescriptions and the prevalence of emerging resistance in nosocomial infections is warranted.
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- 2020
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45. Association between Angiotensin-Converting Enzyme Inhibitors and Lung Cancer—A Nationwide, Population-Based, Propensity Score-Matched Cohort Study
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Chung Y. Hsu, I.-Kuan Wang, Cheng-Chieh Lin, Shih-Yi Lin, Wu-Huei Hsu, Chia-Der Lin, Chia-Hung Kao, and Cheng-Li Lin
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Cancer Research ,medicine.medical_specialty ,030204 cardiovascular system & hematology ,Lower risk ,lcsh:RC254-282 ,Article ,angiotensin-converting enzyme inhibitors (aceis) ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Medicine ,Cumulative incidence ,cardiovascular diseases ,Lung cancer ,business.industry ,Proportional hazards model ,Incidence (epidemiology) ,Hazard ratio ,air pollutant ,medicine.disease ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Confidence interval ,lung cancer ,Oncology ,030220 oncology & carcinogenesis ,Cohort ,business - Abstract
Background: Direct evidence of lung cancer risk in Asian users of angiotensin-converting enzyme inhibitors (ACEIs) is lacking. Methods: The ACEI cohort comprised 22,384 patients aged &ge, 18 years with a first prescription of ACEI. The comparison angiotensin receptor blocker (ARB) cohort consisted of age-, sex- and comorbidity-matched patients at a ratio of 1:1. The primary outcome was the incidence of lung cancer, which was evaluated using a proportional hazard model. Results: The overall incidence rates of lung cancer in the ACEI and ARB cohorts were 16.6 and 12.2 per 10,000 person-years, respectively. The ACEI cohort had a significantly higher risk of lung cancer than the ARB cohort (adjusted hazard ratio [aHR]. = 1.36, 95% confidence interval [CI]. = 1.11&ndash, 1.67). Duration&ndash, response and dose&ndash, response analyses revealed that compared with patients who did not receive ACEIs, patients who received ACEIs for more than 45 days per year (aHR = 1.87, 95% CI = 1.48&ndash, 2.36) and patients who received more than 540 defined daily doses of ACEIs per year (aHR =1.80, 95% CI = 1.43&ndash, 2.27) had a significantly higher risk of lung cancer. The cumulative incidence of lung cancer was also significantly higher in the ACEI cohort than in the ARB cohort (log-rank test, p = 0.002). Conclusions: ACEI use is associated with an increased risk of lung cancer compared with ARB use. Patients using ARBs have a significantly lower risk of lung cancer than non-ARB users.
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- 2020
46. Medical students’ resilience: a protective role on stress and quality of life in clerkship
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Der-Yuan Chen, Chia-Der Lin, Blossom Yen-Ju Lin, and Yung Kai Lin
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Adult ,Male ,Students, Medical ,020205 medical informatics ,media_common.quotation_subject ,education ,Specialty ,lcsh:Medicine ,Compassion ,02 engineering and technology ,Burnout ,Education ,03 medical and health sciences ,0302 clinical medicine ,Quality of life (healthcare) ,Surveys and Questionnaires ,0202 electrical engineering, electronic engineering, information engineering ,Humans ,Compassion satisfaction ,Clerkship ,Prospective Studies ,030212 general & internal medicine ,Burnout, Professional ,media_common ,lcsh:LC8-6691 ,Medical education ,Workplace stress ,Resilience ,lcsh:Special aspects of education ,lcsh:R ,Multilevel model ,Clinical Clerkship ,General Medicine ,Resilience, Psychological ,Medical students ,Physical demands ,Negative relationship ,Cohort ,Quality of Life ,Female ,Psychological resilience ,Psychology ,Psychological demands ,Research Article - Abstract
BackgroundResilience refers to the ability to be flexible and adaptive in response to challenges. Medical students in clerkship who are transitioning from medical studies to clinical practice face a variety of workplace demands that can lead to negative learning experiences and poor quality of life. This study explored whether medical students’ resilience plays a protective role against the stresses incurred during workplace training and on their professional quality of life during clerkships.MethodsThis was a 1-year prospective web-based questionnaire study comprising one cohort of medical students in their fifth year who were working as clerks as part of their 6-year medical education programme at one medical school in Taiwan between September 2017 and July 2018. Web-based, validated, structured, self-administered questionnaires were used to measure the students’ resilience at the beginning of the clerkship and their perceived training stress (i.e. physical and psychological demands) and professional quality of life (i.e. burnout and compassion satisfaction) at each specialty rotation. Ninety-three medical students who responded to our specialty rotation surveys at least three times in the clerkship were included and hierarchical regressions were performed.ResultsThis study verified the negative effects of medical students’ perceived training stress on burnout and compassion satisfaction. However, although the buffering (protective) effects of resilience were observed for physical demands (one key risk factor related to medical students’ professional quality of life), this was not the case for psychological demands (another key risk factor). In addition, through the changes in R square (∆R2) values of the hierarchical regression building, our study found that medical students’ perceived training stresses played a critical role on explaining their burnout but their resilience on their compassion satisfaction.ConclusionsMedical students’ resilience demonstrated a buffering effect on the negative relationship between physical demands and professional quality of life during clerkships. Moreover, different mechanisms (predictive paths) leading to medical students’ professional quality of life such as burnout and compassion satisfaction warrant additional studies.
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- 2019
47. Pentoxifylline versus Steroid Therapy for Idiopathic Sudden Sensorineural Hearing Loss with Diabetes
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Wei-Che Lan, Chia-Der Lin, and Ching-Yuan Wang
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Blood Glucose ,Male ,Phosphodiesterase Inhibitors ,Hearing loss ,Hearing Loss, Sensorineural ,Prednisolone ,Administration, Oral ,Blood sugar ,Dexamethasone ,Pentoxifylline ,Diabetes Complications ,03 medical and health sciences ,0302 clinical medicine ,Hearing ,Diabetes mellitus ,Diabetes Mellitus ,medicine ,Humans ,030212 general & internal medicine ,030223 otorhinolaryngology ,Glucocorticoids ,Aged ,Retrospective Studies ,medicine.diagnostic_test ,business.industry ,Retrospective cohort study ,General Medicine ,Hearing Loss, Sudden ,Middle Aged ,medicine.disease ,Treatment Outcome ,Steroid therapy ,Otorhinolaryngology ,Sudden sensorineural hearing loss ,Anesthesia ,Audiometry, Pure-Tone ,Administration, Intravenous ,Female ,Original Article ,medicine.symptom ,Audiometry ,business ,medicine.drug - Abstract
Objectives To compare the efficacy of pentoxifylline with that of conventional steroid therapy in diabetic patients with idiopathic sudden sensorineural hearing loss (ISSNHL) and to compare blood sugar levels during hospitalization. Materials and methods Medical charts were retrospectively reviewed for all diabetic patients admitted to one institution for ISSNHL between 2000 and 2015. We analyzed 298 cases; 50 patients received pulse steroid treatment (steroid group) and 248 received intravenous administration of pentoxifylline only (pentoxifylline group). Hearing change was evaluated by comparing the initial hearing tests with follow-up hearing tests for up to 3 months. Blood sugar levels were also compared between the 2 groups. Results At 3 months post-treatment, the degree of hearing recovery was similar between the 2 groups. The pure-tone average was improved from baseline by 17.9±21.2 dB in the steroid group and 18.9±20.7 dB in the pentoxifylline group (p=0.776); hearing recovery rates were also similar (40% vs 39.1%; p=0.826). During hospitalization, average fasting blood sugar levels were higher (203.9±92.0 vs 174.4±54.8 mg/dL; p=0.033) and acute hyperglycemia was more common (48.0% vs 33.1%; p=0.044) with steroid versus pentoxifylline treatment. Conclusion Hearing recovery rates did not significantly differ between steroid and pentoxifylline treatment in diabetic patients with ISSNHL, but pentoxifylline appeared to be associated with better blood sugar control.
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- 2018
48. Neurofibromatosis type 2 initially presenting as a preauricular mass: a case report
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Wei-Che Lan, Hui-Chi Tien, Rui-Yun Chen, Chia-Der Lin, and Yu Aoh
- Subjects
Male ,medicine.medical_specialty ,Neurofibromatosis 2 ,Schwannoma ,medicine.medical_treatment ,lcsh:Surgery ,Preauricular mass ,Case Report ,Radiosurgery ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,medicine ,Peripheral Schwannoma ,otorhinolaryngologic diseases ,Humans ,Neurofibromatosis type 2 ,030223 otorhinolaryngology ,Hearing Loss ,medicine.diagnostic_test ,Atypical presentation ,business.industry ,Magnetic resonance imaging ,lcsh:RD1-811 ,Cerebellopontine angle ,medicine.disease ,Magnetic Resonance Imaging ,Otorhinolaryngology ,030220 oncology & carcinogenesis ,Neurofibromatosis type 2 (NF2) ,Surgery ,Radiology ,medicine.symptom ,business ,Tinnitus ,Ear Auricle - Abstract
Abstract Neurofibromatosis type 2 (NF2) is a rare genetic disease involving multiple tumors of the central and peripheral nervous systems. Most patients with NF2 have bilateral vestibular schwannomas; nonvestibular schwannomas may also develop. While the majority of patients may present with hearing impairment, tinnitus, dizziness and balance disorders, some may present with cutaneous manifestations. We describe the case of a 20-year-old man who initially presented with a solitary subcutaneous painless nodule in the left preauricular area without any other symptoms. He received excisional biopsy for the preauricular mass and the pathologic diagnosis was schwannoma. Magnetic resonance imaging of brain and neck revealed multiple mass lesions over the bilateral cerebellopontine angle cisterns, extending to the bilateral internal auditory canals, bilateral cervical neuroforamens, cervical and upper thoracic spinal canals, and left posterior neck. The patient was diagnosed with NF2 according to the clinical criteria. He underwent gamma knife stereotactic radiosurgery for bilateral vestibular schwannomas and is now under regular monitoring. Conclusion NF2 patients may present with an isolated solitary cutaneous schwannoma with no other associated clinical findings. Further assessment is thus warranted in young patients presenting with a peripheral schwannoma despite absence of other clinical findings.
- Published
- 2019
49. Relationship between medical students’ negative perceptions of colleagues’ work–life and burn-out during clerkships: a longitudinal observational cohort study
- Author
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Blossom Yen-Ju Lin, Chia-Der Lin, Der-Yuan Chen, and Yung Kai Lin
- Subjects
medicine.medical_specialty ,Students, Medical ,health services administration & management ,media_common.quotation_subject ,education ,Emotional contagion ,Affect (psychology) ,Cohort Studies ,human resource management ,Informed consent ,Perception ,medicine ,Humans ,Prospective Studies ,Burnout, Professional ,media_common ,business.industry ,Clinical Clerkship ,General Medicine ,Medical Education and Training ,education & training (see medical education & training) ,Turnover ,Family medicine ,Human resource management ,Cohort ,Quality of Life ,Medicine ,business ,Education, Medical, Undergraduate ,Cohort study - Abstract
ObjectiveBecause work and educational environments are closely related and can affect each other, this study examined whether medical students’ negative perceptions of their colleagues’ work–life balance (NWLB) during their clinical rotations would be related to burn-out in clerkships and investigated the effect of students’ gender on this relationship.DesignA longitudinal, prospective 2-year cohort study conducted between September 2013 and April 2015.SettingMedical students from a university school of medicine in Taiwan.ParticipantsOne voluntary cohort of undergraduate medical students in clerkships was invited to participate. Among 190 medical students recruited in September 2013, a total of 124 students provided written informed consent. Participants were free to decide whether to complete each survey; therefore, varying numbers of responses were obtained during the study period. Those who responded to our survey for more than 6 months were included in our analyses. Overall, 2128 responses from 94 medical students were analysed, with each student providing an average of 23 responses for 2 years.Primary outcome measureBurn-out was measured using the Professional Quality of Life Scale.ResultsOur study found that a strong NWLB was related to high burn-out levels among medical students during their clerkships (p0.05). In addition, our study indicated that medical students living with a companion had decreased burn-out levels than did those living alone during their clerkships.ConclusionsThe significance of policies promoting employee work–life balance should be emphasised because of the potential for social contagion effects on medical students. Clerkship trainees might be vulnerable to such negative contagion effects during the transition to their early clinical workplace training and may, therefore, require advanced socialisation and mentoring.
- Published
- 2021
50. Effect of Transcranial Direct Current Stimulation in Patients With Tinnitus: A Meta-Analysis and Systematic Review
- Author
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Tang-Chuan Wang, Chia-Der Lin, Ta-Yuan Chang, Richard S. Tyler, Hsiung Kwang Chung, Jui-Cheng Chen, and Yung An Tsou
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Audiology ,Transcranial Direct Current Stimulation ,Loudness ,Tinnitus ,03 medical and health sciences ,0302 clinical medicine ,otorhinolaryngologic diseases ,medicine ,Humans ,In patient ,030223 otorhinolaryngology ,Clinical Trials as Topic ,Transcranial direct-current stimulation ,business.industry ,General Medicine ,Middle Aged ,External source ,Distress ,Otorhinolaryngology ,Patient Satisfaction ,Meta-analysis ,Female ,medicine.symptom ,business ,030217 neurology & neurosurgery - Abstract
Objectives: Subjective tinnitus is a phantom sensation experienced without any external source of sound that profoundly impacts the quality of life. Some investigations have claimed that transcranial direct current stimulation (tDCS) reduces tinnitus, but studies on tDCS have demonstrated variable results. This meta-analysis aimed to examine the effect of tDCS on patients with tinnitus. Methods: We searched for articles published through January 5, 2016, in Medline, Cochrane, EMBASE, and Google Scholar using the following keywords: tinnitus, transcranial direct current stimulation, and tDCS. The study outcomes were change in magnitude estimates of loudness (loudness), tinnitus-related distress (distress), and Tinnitus Handicap Inventory (THI). Results: Pooled results demonstrated that tDCS did not have a beneficial effect on loudness (pooled standardized difference in means = 0.674, 95% CI, –0.089 to 1.437, P = .083). Further, the pooled results demonstrated a greater reduction in distress for the tDCS group (pooled standardized difference in means = 0.634, 95% CI, 0.021-1.247, P = .043). Conclusions: We conclude that the pooled results demonstrated a greater reduction in distress for groups treated with tDCS as compared with those administered a sham treatment.
- Published
- 2017
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