68 results on '"Ying-Jen Chang"'
Search Results
2. Systemic immune–inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis
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Yu-Chou Chen, Chien-Cheng Liu, Hui-Chen Hsu, Kuo-Chuan Hung, Ying-Jen Chang, Chun-Ning Ho, Chung-Hsi Hsing, and Ching-Yi Yiu
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postoperative atrial fibrillation ,systemic immune-inflammation index ,cardiac surgery ,inflammation ,cardiopulmonary bypass ,Diseases of the circulatory (Cardiovascular) system ,RC666-701 - Abstract
BackgroundPostoperative atrial fibrillation (POAF) is a frequent complication that may increase morbidity and mortality risk following cardiac surgery. The systemic immune–inflammation index (SII) is an emerging biomarker that provides an integrated measure of inflammation by incorporating neutrophil, lymphocyte, and platelet counts. Recent studies have reported associations between elevated SII and increased POAF risk; however, significant heterogeneity exists regarding its predictive efficacy. This meta-analysis aimed to assess SII's diagnostic efficacy for predicting POAF risk.MethodsTo synthesize existing evidence on the ability of perioperative SII for predicting POAF in patients undergoing cardiac surgery, a systematic review and meta-analysis was conducted. In August 2023, a comprehensive literature search was performed to identify relevant studies reporting SII cutoff values with corresponding sensitivity and specificity. The primary aim was to evaluate SII's diagnostic utility for predicting POAF, whereas secondary outcomes included the pooled incidence of POAF and the relationship between the SII and POAF.ResultsEight studies published between 2021 and 2023 with 3,245 patients were included. Six studies involved coronary artery bypass grafting (CABG) surgery; one encompassed various cardiac procedures, and another focused solely on mitral valve surgery. The pooled incidence of POAF was 23.6% [95% confidence interval (CI), 18.7%–29.2%]. Elevated SII significantly increased the odds of POAF by 3.24-fold (odds ratio, 3.24; 95% CI, 1.6–6.55; p = 0.001). SII's pooled sensitivity and specificity for predicting POAF were 0.80 (95% CI, 0.68–0.89) and 0.53 (95% CI, 0.23–0.8), respectively. The SII had moderate predictive accuracy based on a hierarchical summary receiver operating characteristic (HSROC) area under the curve of 0.78 (95% CI, 0.74–0.81). Subgroup analyses, whether focusing on CABG alone or CABG with cardiopulmonary bypass (CPB), both indicated an area under the HSROC curve of 0.78 (95% CI, 0.74–0.81).ConclusionElevated SII is significantly correlated with an increased POAF risk following cardiac surgery, highlighting its utility as a predictive biomarker. Considering its moderate diagnostic accuracy, further research is essential for clarifying SII's clinical effectiveness, either as an independent predictor or combined with other risk factors, for stratifying patients at high POAF risk.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/, identifier [CRD42023456128].
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- 2024
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3. Incidence change of postoperative delirium after implementation of processed electroencephalography monitoring during surgery: a retrospective evaluation study
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Yi-Chen Chen, I-Yin Hung, Kuo-Chuan Hung, Ying-Jen Chang, Chin-Chen Chu, Jen-Yin Chen, Chung-Han Ho, and Chia-Hung Yu
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Postoperative delirium ,Processed electroencephalography ,General anesthesia ,Intravenous patient-controlled analgesia ,Anesthesiology ,RD78.3-87.3 - Abstract
Abstract Background Postoperative delirium (POD) is a common complication in the elderly, which is associated with poor outcomes after surgery. Recognized as predisposing factors for POD, anesthetic exposure and burst suppression during general anesthesia can be minimized with intraoperative processed electroencephalography (pEEG) monitoring. In this study, we aimed to evaluate whether implementation of intraoperative pEEG-guided anesthesia is associated with incidence change of POD. Methods In this retrospective evaluation study, we analyzed intravenous patient-controlled analgesia (IVPCA) dataset from 2013 to 2017. There were 7425 patients using IVPCA after a noncardiac procedure under general anesthesia. Patients incapable of operating the device independently, such as cognitive dysfunction or prolonged sedation, were declined and not involved in the dataset. After excluding patients who opted out within three days (N = 110) and those with missing data (N = 24), 7318 eligible participants were enrolled. Intraoperative pEEG has been implemented since July 2015. Participants having surgery after this time point had intraoperative pEEG applied before induction until full recovery. All related staff had been trained in the application of pEEG-guided anesthesia and the assessment of POD. Patients were screened twice daily for POD within 3 days after surgery by staff in the pain management team. In the first part of this study, we compared the incidence of POD and its trend from 2013 January–2015 July with 2015 July–2017 December. In the second part, we estimated odds ratios of risk factors for POD using multivariable logistic regression in case-control setting. Results The incidence of POD decreased from 1.18 to 0.41% after the administration of intraoperative pEEG. For the age group ≧ 75 years, POD incidence decreased from 5.1 to 1.56%. Further analysis showed that patients with pEEG-guided anesthesia were associated with a lower odd of POD (aOR 0.33; 95% CI 0.18–0.60) than those without after adjusting for other covariates. Conclusions Implementation of intraoperative pEEG was associated with a lower incidence of POD within 3 days after surgery, particularly in the elderly. Intraoperative pEEG might be reasonably considered as part of the strategy to prevent POD in the elder population. Trial registration Not applicable.
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- 2023
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4. Association of prognostic nutritional index with long-term mortality in patients receiving percutaneous coronary intervention for acute coronary syndrome: a meta-analysis
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Wei-Ting Chang, Cheuk-Kwan Sun, Jheng-Yan Wu, Chia-Hung Yu, Ying-Jen Chang, Ming-Chung Lin, Kuo-Mao Lan, I-Wen Chen, and Kuo-Chuan Hung
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Medicine ,Science - Abstract
Abstract The predictive value of the prognostic nutritional index (PNI) for the long-term prognosis of patients with acute coronary syndrome (ACS) remains uncertain. Medline, Embase, Cochrane Library, and Google Scholar were searched from inception until January 2023 to study the relationship between all-cause mortality risk and PNI in patients receiving percutaneous coronary intervention for ACS (i.e., primary outcome). Thirteen observational studies were included in this meta-analysis. Analysis of seven studies using PNI as a categorical variable showed a pooled hazard ratio (HR) of all-cause mortality of 2.97 (95% CI 1.65 to 5.34, p = 0.0003, I2 = 89%, n = 11,245) for patients with a low PNI. The meta-analysis also showed a higher risk of major adverse cardiovascular events (MACEs) in patients with a low PNI (HR 2.04; 95% CI 1.59 to 2.61; p
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- 2023
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5. Association of vitamin D deficiency with post-stroke depression: a retrospective cohort study from the TriNetX US collaborative networks
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Chun-Ning Ho, Cheuk-Kwan Sun, Jheng-Yan Wu, Jen-Yin Chen, Ying-Jen Chang, I-Wen Chen, and Kuo-Chuan Hung
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post-stroke depression ,vitamin D deficiency ,propensity score matching ,stroke ,vitamin D ,Nutrition. Foods and food supply ,TX341-641 - Abstract
BackgroundPost-stroke depression (PSD) affects up to one-third of patients who survive stroke. This matched cohort study aimed to investigate the relationship between vitamin D deficiency (VDD) and PSD using a global health research network.MethodsAdult patients with first-ever stroke were eligible for inclusion if their circulating vitamin D levels were available within 3 months before the onset of stroke. Patients were subdivided into those with VDD [VDD group, 25(OH) D
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- 2023
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6. The impact of esophageal device insertion on cuff pressure of endotracheal tube: a literature review and meta-analysis
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Kuo-Chuan Hung, Ying-Jen Chang, Yang-Pei Chang, Chun-Ning Ho, Kuo-Mao Lan, Jen-Yin Chen, Li-Kai Wang, Ping-Wen Huang, and Cheuk-Kwan Sun
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Medicine ,Science - Abstract
Abstract The impact of intraoperative esophageal device insertion (EDI) on endotracheal tube (ET) cuff inflation pressure remains unclear. Electronic databases including Medline, Embase, Google scholar, Web of Science™ and Cochrane Central Register of Controlled Trials were searched for studies involving EDI after placement of ETs from inception to July 7, 2022. The primary outcome was risk of high cuff pressure, while the secondary outcomes were increases in cuff pressure following EDI. Difference between adults and children was investigated with subgroup analysis. There were ten eligible studies (observation study, n = 9, randomized controlled study, n = 1) involving a total of 468 participants. EDI notably increased the risk of high cuff pressure (n = 7, risk ratio: 12.82, 95% confidence interval: 4.9 to 33.52, subgroup analysis: p = 0.008). There were significant elevations in cuff pressure in adults and children both during (13.42 and 7.88 cmH2O, respectively, subgroup analysis: p = 0.15) and after (10.09 and 3.99 cmH2O, respectively, subgroup analysis: p = 0.0003) EDI. Our results revealed an over 12-fold increase in the risk of high endotracheal tube cuff pressure in patients, especially adults, receiving EDI under endotracheal anesthesia. There were significant increases in both adults and children despite a higher increase in the former after device insertion.
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- 2022
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7. Efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy: a meta-analysis of randomized controlled studies
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Hsiao-Tien Chen, Kuo-Chuan Hung, Yao-Chin Hsu, Jinn-Rung Kuo, Ying-Jen Chang, I-Wen Chen, and Cheuk-Kwan Sun
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acupuncture ,extracorporeal shock wave lithotripsy ,meta-analysis ,pain ,urolithiasis ,Medicine (General) ,R5-920 - Abstract
BackgroundThis meta-analysis aimed at investigating the efficacy of acupuncture for pain relief in patients receiving extracorporeal shock wave lithotripsy (ESWL).MethodsRandomized controlled trials comparing the efficacy of acupuncture with conventional treatments were retrieved from major electronic databases (e.g., MEDLINE, EMBASE, and Cochrane Library) until August 28, 2022. The primary outcome was the response rate (i.e., rate of pain relief), while secondary outcomes included stone-free rate, satisfaction rate, duration of ESWL, peri-/post-procedural pain score, and risk of adverse events.ResultsThirteen eligible studies involving 1,220 participants published between 1993 and 2022 were analyzed. Pooled results indicated that acupuncture had a better response rate compared to conventional treatments (RR = 1.17, 95% CI: 1.06–1.3, p = 0.003, seven trials, n = 832). Despite no difference in ESWL duration (MD = 0.02 min, 95% CI: −1.53 to 1.57, p = 0.98, three trials, n = 141), stone-free rate (RR = 1.11, 95% CI: 1–1.25, p = 0.06, six trials, n = 498), and satisfaction rate (RR = 1.51, 95% CI: 0.92–2.47, p = 0.1, three trials, n = 334) between the two groups, the acupuncture group had a lower risk of adverse events (RR = 0.51, 95% CI: 0.33–0.79, p = 0.003, five trials, n = 327), peri- (MD = −1.91 points, 94% CI: −3.53 to −0.28, p = 0.02, four trials, n = 258 patient) and post-procedural (MD = −1.07, 95% CI: −1.77 to −0.36, p = 0.003, four trials, n = 335) pain score.ConclusionThe results of this meta-analysis showed that the use of acupuncture in patients receiving ESWL was associated with a higher pain relief rate and a lower risk of adverse events, suggesting feasibility of its use in this clinical setting.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier: CRD42022356327.
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- 2023
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8. Impact of intravenous vitamin C as a monotherapy on mortality risk in critically ill patients: A meta-analysis of randomized controlled trials with trial sequential analysis
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Kuo-Chuan Hung, Min-Hsiang Chuang, Jen-Yin Chen, Chih-Wei Hsu, Chong-Chi Chiu, Ying-Jen Chang, Chia-Wei Lee, I-Wen Chen, and Cheuk-Kwan Sun
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vitamin C ,sepsis ,septic shock ,critically illness ,mortality ,Nutrition. Foods and food supply ,TX341-641 - Abstract
BackgroundThis meta-analysis aimed at investigating the pooled evidence regarding the effects of intravenous vitamin C (IVVC) on mortality rate in critically ill patients.MethodsDatabases including Medline, Embase, and Cochrane Library were searched from inception to October, 2022 to identify RCTs. The primary outcome was the risk of overall mortality. Subgroup analyses were performed based on IVVC dosage (i.e., cut-off value: 100 mg/kg/day or 10000 mg/day). Trial sequential analysis (TSA) was used to examine the robustness of evidence.ResultsA total of 12 trials including 1,712 patients were analyzed. Although meta-analysis demonstrated a lower risk of mortality in patients with IVVC treatment compared to those without [risk ratio (RR): 0.76, 95% CI: 0.6 to 0.97, p = 0.02, I2 = 36%, 1,711 patients), TSA suggested the need for more studies for verification. Moreover, subgroup analyses revealed a reduced mortality risk associated with a low IVVC dosage (RR = 0.72, p = 0.03, 546 patients), while no beneficial effect was noted with high IVVC dosage (RR = 0.74, p = 0.13, I2 = 60%, 1,165 patients). The durations of vasopressor [mean difference (MD): −37.75 h, 404 patients) and mechanical ventilation (MD: −47.29 h, 388 patients) use were shorter in the IVVC group than those in the controls, while there was no significant difference in other prognostic outcomes (e.g., length of stay in intensive care unit/hospital) between the two groups.ConclusionAlthough intravenous vitamin C as a monotherapy reduced pooled mortality, durations of vasopressor use and mechanical ventilation, further research is required to support our findings and to identify the optimal dosage of vitamin C in the critical care setting.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022371090.
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- 2023
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9. Association of prognostic nutritional index with risk of contrast induced nephropathy: A meta-analysis
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Wei-Ting Chang, Cheuk-Kwan Sun, Jheng-Yan Wu, Po-Yu Huang, Ting-Hui Liu, Ying-Jen Chang, Yao-Tsung Lin, Fu-Chi Kang, and Kuo-Chuan Hung
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prognostic nutritional index ,contrast-induced nephropathy ,percutaneous coronary intervention ,myocardial infarction ,coronary angiography ,Nutrition. Foods and food supply ,TX341-641 - Abstract
BackgroundAlthough prognostic nutritional index (PNI) has been frequently applied in patients with malignancy or those during postoperative recovery, whether it is also an optimal indicator of the risk of contrast-induced nephropathy (CIN) in patients receiving coronary angiography remains uncertain. This meta-analysis aimed at investigating the clinical association of PNI with the risk of CIN in patients receiving coronary angiography or percutaneous coronary intervention.MethodsEmbase, Medline, Cochrane Library, and Google scholar were searched for studies until January 2023. The relationship between CIN risk and PNI (i.e., low vs. high) (primary outcome) as well as other variables (secondary outcomes) were analyzed using a random-effects model.ResultsOverall, 10 observational studies with 17,590 patients (pooled incidence of CIN: 18%) were eligible for analysis. There was a higher risk of CIN in patients with a low PNI compared to those with a high PNI [odd ratio (OR) = 3.362, 95% confidence interval (CI): 2.054 to 5.505, p
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- 2023
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10. Association of a low vitamin D status with risk of post-stroke depression: A meta-analysis and systematic review
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Kuo-Chuan Hung, Jheng-Yan Wu, Amina M. Illias, Chong-Chi Chiu, Ying-Jen Chang, Shu-Wei Liao, Kuei-Fen Wang, I-Wen Chen, and Cheuk-Kwan Sun
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vitamin D ,stroke ,depression ,nutrition ,post-stroke depression ,Nutrition. Foods and food supply ,TX341-641 - Abstract
BackgroundAlthough post-stroke depression (PSD) affects one-third of patients following an acute stroke, pooled evidence addressing the correlation between a low vitamin D status and the risk of PSD remains inconclusive.MethodsComprehensive database search of Medline, EMBASE, Cochrane library, and Google Scholar was performed from inception to December 2022. The primary outcome was the association of PSD risk with a low vitamin D status, while the secondary outcomes included the relationship between PSD and other risk factors.ResultsAnalysis of seven observational studies published between 2014 and 2022 with 1,580 patients showed pooled incidences of vitamin D deficiency (defined as 25[OH] D levels < 50 nmol/L) and PSD of 60.1 and 26.1%, respectively. Patients with PSD had a lower circulating vitamin D concentration compared to those without [mean difference (MD) =−13.94 nmol/L, 95% CI: −21.83 to −6.05, p = 0.0005, I2 = 91%, six studies, 1,414 patients]. Meta-analysis also demonstrated a correlation between a low vitamin D level and an increased PSD risk [odd ratio (OR) = 3.25, 95% CI: 1.57–6.69, p = 0.001, I2 = 78.7%, 1,108 patients], the heterogeneity of which was found to be associated with the incidence of vitamin D deficiency but not female proportion on meta-regression. Besides, female gender (OR = 1.78, 95% CI: 1.3–2.44, p = 0.003, I2 = 31%, five studies, 1,220 patients), hyperlipidemia (OR = 1.55, 95% CI: 1.01–2.36, p = 0.04, I2 = 0%, four studies, 976 patients), and high National Institutes of Health Stroke Scale (NIHSS) scores (MD = 1.45, 95% CI: 0.58–2.32, p = 0.001, I2 = 82%, five studies, 1,220 patients) were potential risk factors for PSD. For the primary outcome, the certainty of evidence was very low. Regarding secondary outcomes, the certainty of evidence was low for BMI, female gender, hypertension, diabetes, and stroke history, and very low for age, level of education, hyperlipidemia, cardiovascular disease, and NIHSS scores.ConclusionThe results suggested an association of a low circulating vitamin D level with an increased risk of PSD. Besides, female gender, hyperlipidemia, high NIHSS score were related to an increased risk or occurrence of PSD. The current study may imply the necessity of routine circulating vitamin D screening in this population.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42022381580.
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- 2023
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11. Assessing the Efficacy of Inferior Vena Cava Collapsibility Index for Predicting Hypotension after Central Neuraxial Block: A Systematic Review and Meta-Analysis
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Ying-Jen Chang, Chien-Cheng Liu, Yen-Ta Huang, Jheng-Yan Wu, Kuo-Chuan Hung, Ping-Hsin Liu, Chien-Hung Lin, Yao-Tsung Lin, I-Wen Chen, and Kuo-Mao Lan
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inferior vena cava collapsibility index ,hypotension ,spinal anesthesia ,meta-analysis ,central neuraxial block ,Medicine (General) ,R5-920 - Abstract
The use of ultrasonography to predict spinal-induced hypotension (SIH) has gained significant attention. This diagnostic meta-analysis aimed to investigate the reliability of the inferior vena cava collapsibility index (IVCCI) in predicting SIH in patients undergoing various surgeries. Databases, including Embase, Cochrane Library, Medline, and Google Scholar, were screened until 28 July 2023, yielding 12 studies with 1076 patients (age range: 25.6–79 years) undergoing cesarean section (CS) (n = 4) or non-CS surgeries (n = 8). Patients with SIH had a significantly higher IVCCI than those without SIH (mean difference: 11.12%, 95% confidence interval (CI): 7.83–14.41). The pooled incidence rate of SIH was 40.5%. IVCCI demonstrated satisfactory overall diagnostic reliability (sensitivity, 77%; specificity, 82%). The pooled area under the curve (AUC) was 0.85, indicating its high capability to differentiate patients at risk of PSH. The Fagan nomogram plot demonstrated a positive likelihood ratio (PLR) of 4 and a negative likelihood ratio (NLR) of 0.28. The results underscore the robustness and discriminative ability of IVCCI as a predictive tool for SIH. Nevertheless, future investigations should focus on assessing its applicability to high-risk patients and exploring the potential enhancement in patient safety through its incorporation into clinical practice.
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- 2023
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12. Mortality and risk factors associated with pulmonary embolism in coronavirus disease 2019 patients: a systematic review and meta-analysis
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Carlos Andrés Gómez, Cheuk-Kwan Sun, I-Ting Tsai, Yang-Pei Chang, Ming-Chung Lin, I-Yin Hung, Ying-Jen Chang, Li-Kai Wang, Yao-Tsung Lin, and Kuo-Chuan Hung
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Medicine ,Science - Abstract
Abstract To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of pulmonary embolism (PE) with mortality and risk factors for PE as well as the therapeutic benefit of anticoagulant prophylaxis. Embase, PubMed, Cochrane controlled trials register, and Web of Science databases were searched from inception to October 10, 2020. We included all published trials on PE in patients diagnosed with COVID-19 with eligibility of the trials assessed following the PRISMA guidelines. Sixteen clinical trials with 5826 patients were eligible. There were significant associations of PE with the male gender [odd ratio (OR) = 1.59, 95% CI 1.28–1.97], mechanical ventilation (OR = 3.71, 95% CI 2.57–5.36), intensive care unit admission (OR = 2.99, 95% CI 2.11–4.23), circulating D-dimer [mean difference (MD) = 5.04 µg/mL, 95% CI 3.67–6.42) and CRP (MD = 1.97 mg/dL, 95% CI 0.58– 3.35) concentrations without significant correlation between PE and mortality (OR = 1.31, 95% CI 0.82–2.08) as well as other parameters or comorbidities. After omitting one trial with strict patient selection criteria for anticoagulant prophylaxis, significant prophylactic benefit was noted (OR = 0.31, 95% CI 0.1–0.91). Our findings identified the risk factors associated with PE in COVID-19 patients and supported the therapeutic benefit of anticoagulant prophylaxis against PE in this patient population.
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- 2021
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13. A meta-analysis of randomized clinical trials on the impact of oral vitamin C supplementation on first-year outcomes in orthopedic patients
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Kuo-Chuan Hung, Min-Hsien Chiang, Shao-Chun Wu, Ying-Jen Chang, Chun-Ning Ho, Li-Kai Wang, Jen-Yin Chen, Kee-Hsin Chen, and Cheuk-Kwan Sun
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Medicine ,Science - Abstract
Abstract This meta-analysis aimed at investigating the impact of oral vitamin C supplementation on the post-procedural recovery of orthopedic patients, including functional outcomes and complex regional pain syndrome type I (CRPS I). Literature search using the Medline, Cochrane Library, and Embase databases from inception till March 2021 identified seven eligible randomized controlled trials with 1,361 participants. Forest plot revealed no significant difference in the functional outcomes at 6–12 months [standardized mean difference (SMD) = −0.00, 95% CI − 0.19 to 0.18, 467 patients], risk of overall complications (RR = 0.98, 95% CI 0.68 to 1.39, 426 patients), and pain severity at 3–6 months (SMD = − 0.18, 95% CI − 0.49 to 0.12, 486 patients) between patients with and without oral vitamin C supplementation. Pooled analysis showed that vitamin C treatment reduced the risk of CRPS I regardless of dosage (RR = 0.46, 95% CI 0.25 to 0.85, 1143 patients). In conclusion, the current meta-analysis demonstrated that oral vitamin C supplementation may reduce the risk of complex regional pain syndrome type I but did not improve the functional outcomes in orthopedic patients. Nevertheless, because of the small number of trials included in the present study, further large-scale clinical studies are warranted to support our findings.
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- 2021
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14. Satisfaction in parturients receiving epidural analgesia after prenatal shared decision-making intervention: a prospective, before-and-after cohort study
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Wan-Jung Cheng, Kuo-Chuan Hung, Chung-Han Ho, Chia-Hung Yu, Yi-Chen Chen, Ming-Ping Wu, Chin-Chen Chu, and Ying-Jen Chang
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Labor pain ,Epidural analgesia ,Shared decision-making ,Prenatal ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background The explanation of epidural analgesia by anesthesiologist would often begin after the parturient is admitted to the hospital. Because of labor pain, the decision of receiving epidural analgesia would often be made by the family members, instead of the parturient herself. We aimed to test whether earlier prenatal shared decision-making (SDM) interventions increase parturient’s comprehension and satisfaction of epidural labor analgesia, compared to conventional explanation after labor pain begun. Methods During the 28th week of gestation, we provided the SDM parturient health education as well as a leaflet with quick response codes. Scanning the code would link to education videoclips which explained what epidural analgesia is and its advantages and disadvantages. Original routine practice group parturients received explanation of analgesia after admission for delivery. To measure the satisfaction of labor pain service, the accessibility of information, and the communication with medical staff, we designed a questionnaire with reference to (1) Pregnancy and Maternity Care Patients’ Experiences Questionnaire (PreMaPEQ), (2) Preterm Birth Experience and Satisfaction Scale (P-BESS), and (3) Women’s Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ). The questionnaire was amended after a pretest involving 30 parturients who had received epidural analgesia. Scree test analysis and exploratory factor analysis were performed; then, the questionnaire was revised again. A total of 200 valid questionnaires were collected—100 each from the original routine practice group and the SDM group. Results The SDM group reported significantly higher satisfaction with and understanding of epidural analgesia, and a significantly higher satisfaction with the information received, and the quality of pain relief. After SDM intervention, significant increasement of the average satisfaction scores in question “my epidural is effective” (9.10%; mean difference: 0.38; 95% confidence interval, 0.17 ~ 0.59; p
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- 2020
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15. Characteristics and outcomes of patients requiring airway rescue by the difficult airway response team in the emergency department and wards: A retrospective study
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Ting-Sian Yu, Cheuk-Kwan Sun, Ying-Jen Chang, I-Wen Chen, Chien-Ming Lin, and Kuo-Chuan Hung
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airway response team ,emergency tracheal intubation ,survival rate ,Medicine - Abstract
Objective: In this retrospective cohort study, we aimed to determine the characteristics and outcomes of patients in the emergency department (ED) and wards who required emergency tracheal intubation by the difficult airway response team (DART). Materials and Methods: All patients between 18 and 80 years old receiving emergency tracheal intubation by the DART at a single tertiary referral hospital from January 2014 to December 2016 were reviewed and divided into ward and ED groups. Patient characteristics, comorbidities, indications for intubation, airway maintenance technique, and survival-to-discharge rates were analyzed and compared. Results: Totally, 192 patients (ward, n = 135; ED, n = 57) were eligible for the current study. Compared with the ward group, patients in the ED group were younger (58.9 ± 13 vs. 51.5 ± 15.6 years, P = 0.001), male-predominant (71.1% vs. 87.7%, P = 0.014), and had a higher incidence of trauma (6.7% vs. 22.8%, P = 0.001). The most common indications for tracheal intubation were respiratory distress (52.6%) and cardiac arrest (17.8%) in the ward group, and respiratory distress (31.6%) and airway protection (28.1%) in the ED group. Patients in the ED group received more fiberoptic intubations (42.1% vs. 17.8%, P = 0.039) and had a higher survival-to-discharge rate (87.7% vs. 44.4%, P < 0.001) than those in the ward group. Conclusions: Better recognition of differences in patient characteristics and indications for intubation in different units of the hospital may enable the DART to customize specialized equipment to improve efficiency and implement appropriate strategies for airway rescue to improve patient outcomes.
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- 2020
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16. Association between Fibrinogen-to-Albumin Ratio and Prognosis of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis
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Kuo-Chuan Hung, Yen-Ta Huang, Ying-Jen Chang, Chia-Hung Yu, Li-Kai Wang, Chung-Yi Wu, Ping-Hsin Liu, Sheng-Fu Chiu, and Cheuk-Kwan Sun
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fibrinogen-to-albumin ratio ,coronavirus disease 2019 ,mortality ,disease severity ,meta-analysis ,prognosis ,Medicine (General) ,R5-920 - Abstract
Although the fibrinogen-to-albumin ratio (F/R ratio) has been used as an inflammation marker to predict clinical outcomes in patients with cardiovascular diseases, its association with the prognosis of patients with coronavirus disease 2019 (COVID-19) remains unclear. Electronic databases including EMBASE, MEDLINE, Google Scholar, and Cochrane Library were searched from inception to 20 June 2022. The associations of F/R ratio with poor prognosis (defined as the occurrence of mortality or severe disease) were investigated in patients with COVID-19. A total of 10 studies (seven from Turkey, two from China, one from Croatia) involving 3675 patients published between 2020 and 2022 were eligible for quantitative syntheses. Merged results revealed a higher F/R ratio in the poor prognosis group (standardized mean difference: 0.529, p < 0.001, I2 = 84.8%, eight studies) than that in the good prognosis group. In addition, a high F/R ratio was associated with an increased risk of poor prognosis (odds ratio: 2.684, I2 = 59.5%, five studies). Pooled analysis showed a sensitivity of 0.75, specificity of 0.66, and area under curve of 0.77 for poor prognosis prediction. In conclusion, this meta-analysis revealed a positive correlation between F/A ratio and poor prognostic outcomes of COVID-19. Because of the limited number of studies included, further investigations are warranted to support our findings.
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- 2022
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17. Pregnancy outcomes following nonobstetric surgery during gestation: a nationwide population-based case-control study in Taiwan
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Chia-Hung Yu, Shih-Feng Weng, Chung-Han Ho, Yi-Chen Chen, Jen-Yin Chen, Ying-Jen Chang, Jhi-Joung Wang, Ming-Ping Wu, and Chin-Chen Chu
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Pregnancy ,Nonobstetric surgery ,Abortion ,Delivery outcome ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background Whether nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion or adverse delivery outcomes is still unclear. Methods We performed a retrospective case-control study using a Longitudinal Health Insurance Database (LHID 2000) containing claim-data of 1 million randomly selected beneficiaries. We compared the incidences and estimated the adjusted odds ratios (aOR) with 95% confidence interval (95% CI) for spontaneous abortion, adverse delivery outcomes, cesarean delivery, and prolonged hospital stay to determine the risk of adverse outcomes in women who had nonobstetric surgery during gestation as compared to those who did not have any surgery during gestation. Results After exclusion, we were left with 114,852 delivery and 3999 abortion cases in our study; and 462 (0.39%) of them had nonobstetric surgery under general or regional anesthesia during pregnancy. The leading surgeries were repair of cervical os (33.12%), appendectomy (17.32%), ovarian surgeries (13.64%), and fixation of fractured bone (8.01%).The risk of spontaneous abortion (4.23% vs. 2.43%, aOR:1.53; 95% CI: 1.01–2.31), antepartum hemorrhage (7.14% vs. 2.83%, aOR: 2.51; 95% CI: 1.74–3.61), pre-eclampsia/eclampsia (2.60% vs. 1.01%, aOR: 2.35; 95% CI: 1.30–4.23), gestational diabetes (2.38% vs. 0.69%, aOR: 3.12; 95% CI: 1.69–5.78), prematurity (9.06 vs. 4.90%, aOR: 3.31; 95% CI: 2.54–4.31), cesarean section (43.55% vs. 33.76%, aOR: 1.41; 95% CI: 1.17–1.71), and prolonged hospital stay (1.82% vs. 5.91%, aOR: 3.23; 95% CI: 2.16–4.83) were higher in those women who had nonobstetric surgery after adjusting for age and comorbidities. Conclusions Nonobstetric surgery during gestation were associated with a higher risk of spontaneous abortion, adverse delivery outcomes, cesarean section, and prolonged hospital stay.
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- 2018
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18. Epidemiological profile and obstetric outcomes of patients with peripartum congestive heart failure in Taiwan: a retrospective nationwide study
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Ying-Jen Chang, Chung-Han Ho, Jen-Yin Chen, Ming-Ping Wu, Chia-Hung Yu, Jhi-Joung Wang, Chia-Ming Chen, and Chin-Chen Chu
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Congestive heart failure ,Peripartum ,Epidemiological ,Obstetric outcomes ,Gynecology and obstetrics ,RG1-991 - Abstract
Abstract Background During pregnancy, the hyperdynamic physiology of circulation can exacerbate many cardiovascular disorders. Congestive heart failure (CHF) usually occurs during late pregnancy, which is significantly associated with a high level of maternal and neonatal morbidities and mortalities. The profile of women who develop peripartum CHF (PCHF) is unknown. We investigated the epidemiological profiles of PCHF. Methods In this retrospective cohort study, PCHF patients were identified using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes in Taiwan’s National Health Insurance Research Database. Risk factors and obstetric outcomes were compared in women with and without PCHF. Results From 2,115,873 birth-mothers in Taiwan between 1997 and 2013, we identified 512 with PCHF (incidence: 24.20/105). More women with than without PCHF were older (≥ 35, 18.16% vs. 9.62%), and had more multifetal gestations (7.42% vs. 1.40%), gestational hypertension (HTN) (19.2% vs. 1.31%), and gestational diabetes mellitus (4.10% vs. 0.67%). After the analysis had been adjusted for confounders, the leading comorbidities associated with PCHF were structural heart diseases (adjusted odds ratio [aOR]: 67.21; 95% confidence interval [CI]: 54.29–83.22), pulmonary diseases (aOR: 13.12; 95% CI: 10.28–16.75), chronic HTN (aOR: 11.27; 95% CI: 6.94–18.28), thyroid disease (aOR: 9.53; 95% CI: 5.27–17.23), and gestational HTN (aOR: 5.16; 95% CI: 3.89–6.85). PCHF patients also had a higher rate of cesarean sections (66.41% vs. 34.46%; p
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- 2017
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19. The Effect of Perioperative Vitamin C on Postoperative Analgesic Consumption: A Meta-Analysis of Randomized Controlled Trials
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Kuo-Chuan Hung, Yao-Tsung Lin, Kee-Hsin Chen, Li-Kai Wang, Jen-Yin Chen, Ying-Jen Chang, Shao-Chun Wu, Min-Hsien Chiang, and Cheuk-Kwan Sun
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vitamin C ,analgesic requirement ,surgery ,anesthesia ,Nutrition. Foods and food supply ,TX341-641 - Abstract
Because the analgesic effect of vitamin C against acute pain remains poorly addressed, this meta-analysis aimed at investigating its effectiveness against acute postoperative pain. A total of seven randomized controlled trials with placebo/normal controls were identified from PubMed, Cochrane Library, Medline, Google Scholar, and Embase databases. Pooled analysis showed a lower pain score (standardized mean difference (SMD) = −0.68, 95% CI: −1.01 to −0.36, p < 0.0001; I2 = 57%) and a lower morphine consumption (weighted mean difference (WMD) = −2.44 mg, 95% CI: −4.03 to −0.86, p = 0.003; I2 = 52%) in the vitamin group than that in the placebo group within postoperative 1–2 h. At postoperative 24 h, a lower pain score (SMD = −0.65, 95% CI: −1.11 to −0.19, p = 0.005; I2 = 81%) and lower morphine consumption (WMD = −6.74 mg, 95% CI: −9.63 to −3.84, p < 0.00001; I2 = 85%) were also noted in the vitamin group. Subgroup analyses demonstrated significant reductions in pain severity and morphine requirement immediately (1–2 h) and 24 h after surgery for patients receiving intravenous vitamin C but not in the oral subgroup. These findings showed significant reductions in pain score and opioid requirement up to postoperative 24 h, respectively, suggesting the effectiveness of perioperative vitamin C use. Further large-scale trials are warranted to elucidate its optimal intravenous dosage and effectiveness against chronic pain in the postoperative pain control setting.
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- 2020
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20. Age, Gender and Season Are Good Predictors of Vitamin D Status Independent of Body Mass Index in Office Workers in a Subtropical Region
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Li-Kai Wang, Kuo-Chuan Hung, Yao-Tsung Lin, Ying-Jen Chang, Zhi-Fu Wu, Chung-Han Ho, and Jen-Yin Chen
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occupational health ,hypovitaminosis D ,hypocalcemia ,subtropical ,season ,gender ,Nutrition. Foods and food supply ,TX341-641 - Abstract
This study aimed at determining the prevalence and predictors of hypovitaminosis D (serum 25-hydroxyvitamin D < 30 ng/mL) among office workers in a subtropical region from an electronic hospital database. Totally, 2880 office workers aged 26–65 years who received health examinations with vitamin D status and total calcium concentrations at a tertiary referral center were retrospectively reviewed. Subjects were divided into groups according to genders, age (i.e., 26–35, 36–45, 46–55, 56–65), body-mass index (BMI) (i.e., obese BMI ≥ 30, overweight 25 ≤ BMI < 30, normal 20 ≤ BMI < 25, and underweight BMI < 20) and seasons (spring/winter vs. summer/autumn) for identifying the predictors of hypovitaminosis D. Corrected total calcium level p < 0.001), there was no association between vitamin D status and corrected total calcium levels. A high prevalence (61.9%) of hypovitaminosis D among office workers in a subtropical region was found, highlighting the importance of this occupational health issue.
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- 2020
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21. Impact of intravenous dexmedetomidine on postoperative gastrointestinal function recovery: an updated meta-analysis.
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Yi-Chen Lai, Wei-Ting Wang, Kuo-Chuan Hung, Jen-Yin Chen, Jheng-Yan Wu, Ying-Jen Chang, Chien-Ming Lin, and I-Wen Chen
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Background: Postoperative ileus (POI) is a complication that may occur after abdominal or nonabdominal surgery. Intravenous dexmedetomidine (Dex) has been reported to accelerate postoperative gastrointestinal function recovery; however, updated evidence is required to confirm its robustness. Methods: To identify randomized controlled trials examining the effects of perioperative intravenous Dex on gastrointestinal function recovery in patients undergoing noncardiac surgery, databases including MEDLINE, EMBASE, Google Scholar, and Cochrane Library were searched on August 2023. The primary outcome was time to first flatus. Secondary outcomes included time to oral intake and defecation as well as postoperative pain scores, postoperative nausea/vomiting (PONV), risk of hemodynamic instability, and length of hospital stay (LOS). To confirm its robustness, subgroup analyses and trial sequential analysis were performed. Results: The meta-analysis of 22 randomized controlled trials with 2566 patients showed that Dex significantly reduced the time to flatus [mean difference (MD): -- 7.19 h, P<0.00001), time to oral intake (MD: -- 6.44 h, P=0.001), time to defecation (MD: -- 13.84 h, P=0.008), LOS (MD: -- 1.08 days, P<0.0001), and PONV risk (risk ratio: 0.61, P< 0.00001) without differences in hemodynamic stability and pain severity compared with the control group. Trial sequential analysis supported sufficient evidence favoring Dex for accelerating bowel function. Subgroup analyses confirmed the positive impact of Dex on the time to flatus across different surgical categories and sexes. However, this benefit has not been observed in studies conducted in regions outside China. Conclusions: Perioperative intravenous Dex may enhance postoperative gastrointestinal function recovery and reduce LOS, thereby validating its use in patients for whom postoperative ileus is a significant concern. [ABSTRACT FROM AUTHOR]
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- 2024
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22. Impact of prior bariatric surgery on risk and severity of COVID-19 infection: A meta-analysis of observational studies
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Kuo-Chuan, Hung, Hsiao-Tien, Chen, Chung-Hsi, Hsing, Kuo, Jinn-Rung, Chun-Ning, Ho, Yao-Tsung, Lin, Ying-Jen, Chang, Sheng-Fu, Chiu, and Cheuk-Kwan, Sun
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Intensive Care Units ,Observational Studies as Topic ,Nutrition and Dietetics ,Endocrinology, Diabetes and Metabolism ,Humans ,COVID-19 ,Bariatric Surgery ,Acute Kidney Injury ,Respiration, Artificial - Abstract
The association of prior bariatric surgery (BS) with infection rate and prognosis of coronavirus disease 2019 (COVID-19) remains unclear. We conducted a meta-analysis of observational studies to address this issue.We searched databases including MEDLINE, Embase, and CENTRAL from inception to May, 2022. The primary outcome was risk of mortality, while secondary outcomes included risk of hospital/intensive care unit (ICU) admission, mechanical ventilation, acute kidney injury (AKI), and infection rate.Eleven studies involving 151,475 patients were analyzed. Meta-analysis showed lower risks of mortality [odd ratio (OR)= 0.42, 95% CI: 0.27-0.65, p 0.001, IOur results showed a correlation between prior BS and less severe COVID-19, which warrants further investigations to verify.
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- 2022
23. Association of labor epidural analgesia exposure with long-term risk of autism spectrum disorder in offspring: A meta-analysis of observational studies
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Kuo-Chuan Hung, Jen-Yin Chen, Chung-Hsi Hsing, Chih-Wei Hsu, Ping-Hsin Liu, Ying-Jen Chang, Jui-Yi Chen, Sheng-Fu Chiu, and Cheuk-Kwan Sun
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Developmental and Educational Psychology - Abstract
To investigate the association between labor epidural analgesia exposure and the risk of autism spectrum disorder in offspring, this meta-analysis reviewed relevant literature from Medline, Cochrane Library, Google Scholar, and EMBASE databases from inception to May 2022 to evaluate the overall adjusted risk of autism spectrum disorder in offspring (primary outcome) and adjusted risks of autism spectrum disorder focusing on sibling-matched data, children who were delivered vaginally, and duration of labor epidural analgesia exposure (secondary outcomes). Pooled results of seven eligible observational studies involving 4,021,406 children revealed slightly higher risks of autism spectrum disorder in children with labor epidural analgesia exposure than those without (hazard ratio = 1.11, 95% confidence interval: 1.06–1.16, I2 = 67%, seven studies, level of evidence: very low). Consistent findings were found in subgroup analysis focusing on sibling data (hazard ratio: 1.10, 95% confidence interval: 1.02–1.18, I2 = 0%, five studies) and children delivered vaginally (hazard ratio: 1.11, 95% confidence interval: 1.06–1.17, I2 = 64%, seven studies). The tendency of an increased risk of autism spectrum disorder in children exposed to labor epidural analgesia 8 h (two studies). Although our results demonstrated a slightly increased risk of autism spectrum disorder in offspring with previous labor epidural analgesia exposure, the small effect size and lack of cumulative dose–response effect precluded tangible evidence supporting the association. Lay abstract A previous meta-analysis has demonstrated a superior analgesic efficacy of epidural analgesia (e.g. labor epidural analgesia) in comparison with non-epidural approaches. The widely accepted safety of labor epidural analgesia also endorses its current popularity in obstetric practice. However, the results of a recent large-scale longitudinal study that demonstrated a significant increase in risk of autism spectrum disorder in offspring from mothers with labor epidural analgesia exposure have raised some concerns over the safety of its use. The current meta-analysis aimed at examining the strength of evidence regarding this issue based on updated clinical data. Through systematically reviewing seven eligible observational studies involving 4,021,406 children from electronic databases, our results showed a slight but statistically significant increase in risk of autism spectrum disorder in children with exposure to labor epidural analgesia compared with those without. The finding was consistent in subgroup analysis focusing on siblings and children delivered vaginally. Nevertheless, despite the tendency of an increased risk of autism spectrum disorder in children exposed to labor epidural analgesia 8 h (data from two studies). In conclusion, the level of evidence linking labor epidural analgesia to autism spectrum disorder development in offspring was very low based on the latest data because of the small effect size and the finding of a lack of cumulative dose–response effect in the current analysis. Further studies are warranted to provide an insight into this issue.
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- 2022
24. Prophylactic effect of intravenous lidocaine against cognitive deficit after cardiac surgery: A PRISMA-compliant meta-analysis and trial sequential analysis
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Kuo-Chuan Hung, Chun-Ning Ho, Wei-Cheng Liu, Ming Yew, Ying-Jen Chang, Yao-Tsung Lin, I-Yin Hung, Jen-Yin Chen, Ping-Wen Huang, and Cheuk-Kwan Sun
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Adult ,Cognition ,Humans ,Lidocaine ,General Medicine ,Anesthetics, Local ,Cardiac Surgical Procedures ,Cognition Disorders - Abstract
This study aimed at providing an updated evidence of the association between intraoperative lidocaine and risk of postcardiac surgery cognitive deficit.Randomized clinical trials (RCTs) investigating effects of intravenous lidocaine against cognitive deficit in adults undergoing cardiac surgeries were retrieved from the EMBASE, MEDLINE, Google scholar, and Cochrane controlled trials register databases from inception till May 2021. Risk of cognitive deficit was the primary endpoint, while secondary endpoints were length of stay (LOS) in intensive care unit/hospital. Impact of individual studies and cumulative evidence reliability were evaluated with sensitivity analyses and trial sequential analysis, respectively.Six RCTs involving 963 patients published from 1999 to 2019 were included. In early postoperative period (i.e., 2 weeks), the use of intravenous lidocaine (overall incidence = 14.8%) was associated with a lower risk of cognitive deficit compared to that with placebo (overall incidence = 33.1%) (relative risk = 0.49, 95% confidence interval: 0.32-0.75). However, sensitivity analysis and trial sequential analysis signified insufficient evidence to arrive at a firm conclusion. In the late postoperative period (i.e., 6-10 weeks), perioperative intravenous lidocaine (overall incidence = 37.9%) did not reduce the risk of cognitive deficit (relative risk = 0.99, 95% confidence interval: 0.84) compared to the placebo (overall incidence = 38.6%). Intravenous lidocaine was associated with a shortened LOS in intensive care unit/hospital with weak evidence.Our results indicated a prophylactic effect of intravenous lidocaine against cognitive deficit only at the early postoperative period despite insufficient evidence. Further large-scale studies are warranted to assess its use for the prevention of cognitive deficit and enhancement of recovery (e.g., LOS).
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- 2022
25. A meta-analysis of randomized clinical trials on the impact of oral vitamin C supplementation on first-year outcomes in orthopedic patients
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Ying Jen Chang, Li Kai Wang, Shao-Chun Wu, Kuo-Chuan Hung, Cheuk-Kwan Sun, Chun Ning Ho, Kee Hsin Chen, Jen Yin Chen, and Min-Hsien Chiang
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medicine.medical_specialty ,Science ,MEDLINE ,Ascorbic Acid ,Cochrane Library ,Article ,Antioxidants ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Medical research ,Randomized controlled trial ,030202 anesthesiology ,law ,Internal medicine ,medicine ,Forest plot ,Humans ,Orthopedic Procedures ,Postoperative Period ,Randomized Controlled Trials as Topic ,030222 orthopedics ,Multidisciplinary ,Vitamin C ,business.industry ,Health care ,Strictly standardized mean difference ,Meta-analysis ,Orthopedic surgery ,Dietary Supplements ,Medicine ,business - Abstract
This meta-analysis aimed at investigating the impact of oral vitamin C supplementation on the post-procedural recovery of orthopedic patients, including functional outcomes and complex regional pain syndrome type I (CRPS I). Literature search using the Medline, Cochrane Library, and Embase databases from inception till March 2021 identified seven eligible randomized controlled trials with 1,361 participants. Forest plot revealed no significant difference in the functional outcomes at 6–12 months [standardized mean difference (SMD) = −0.00, 95% CI − 0.19 to 0.18, 467 patients], risk of overall complications (RR = 0.98, 95% CI 0.68 to 1.39, 426 patients), and pain severity at 3–6 months (SMD = − 0.18, 95% CI − 0.49 to 0.12, 486 patients) between patients with and without oral vitamin C supplementation. Pooled analysis showed that vitamin C treatment reduced the risk of CRPS I regardless of dosage (RR = 0.46, 95% CI 0.25 to 0.85, 1143 patients). In conclusion, the current meta-analysis demonstrated that oral vitamin C supplementation may reduce the risk of complex regional pain syndrome type I but did not improve the functional outcomes in orthopedic patients. Nevertheless, because of the small number of trials included in the present study, further large-scale clinical studies are warranted to support our findings.
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- 2021
26. The effect of cricoid pressure on tracheal intubation in adult patients: a systematic review and meta-analysis
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Shao-Chun Wu, Jen-Yin Chen, I-Wen Chen, Ying-Jen Chang, Kuo-Chuan Hung, Min-Hsien Chiang, Chao-Ting Hung, Yan-Yuen Poon, Cheuk-Kwan Sun, and Kee Hsin Chen
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Adult ,medicine.medical_treatment ,Laryngoscopes ,03 medical and health sciences ,0302 clinical medicine ,030202 anesthesiology ,Intubation, Intratracheal ,Sore throat ,Humans ,Medicine ,Intubation ,Cricoid pressure ,Laryngoscopy ,business.industry ,Tracheal intubation ,Pharyngitis ,030208 emergency & critical care medicine ,General Medicine ,Nurse anesthetist ,medicine.disease ,Anesthesiologists ,Anesthesiology and Pain Medicine ,Pulmonary aspiration ,Relative risk ,Anesthesia ,medicine.symptom ,business ,Airway ,business.employer - Abstract
This meta-analysis aimed to assess the impact of cricoid pressure (CP) application on intubation outcomes.Electronic databases (i.e., MEDLINE, PubMed, Embase, and Cochrane review) were searched from inception to 2 June 2020 for randomized-controlled trials that assessed the intubation outcomes in adult patients using laryngoscopic approaches with and without the application of CP (i.e., CP vs non-CP group). The primary outcome was the successful first-attempt intubation rate (SFAIR), and the secondary outcomes were intubation time, incidences of poor laryngoscopic views (i.e., Cormack and Lehane grade 3-4), airway complications, and pulmonary aspiration.A total of five trials (published from 2005 to 2018) were included, and all tracheal intubations were performed by anesthesiologists or nurse anesthetists with a video (n = 3) or Macintosh laryngoscope (n = 2) in the operating room. We found no significant difference in SFAIR (risk ratio [RR], 0.98; P = 0.37), incidence of poor laryngoscopic views (RR, 1.49; P = 0.21), and risk of sore throat (RR, 1.17; P = 0.73) between the two groups. Nevertheless, the intubation time on the first successful attempt was slightly longer (weighted mean difference = 4.40 sec, P = 0.002) and risk of hoarseness was higher (RR, 1.70; P = 0.03) in the CP group compared with in the non-CP group. The secondary outcome "pulmonary aspiration" was not analyzed because only one trial was available.The application of CP did not have a negative impact on the SFAIR or laryngoscopic view. Nevertheless, this maneuver may slightly prolong intubation time and increase the risk of postoperative hoarseness.RéSUMé: OBJECTIF : Cette méta-analyse a pour but d’évaluer l’impact de l’application d’une pression cricoïdienne (PC) sur les résultats de l’intubation. SOURCE : Les bases de données électroniques (c.-à-d., MEDLINE, PubMed, Embase, et Cochrane review) ont été examinées de leur création jusqu’au 2 juin 2020 pour en tirer les études randomisées contrôlées évaluant les résultats d’intubation chez les patients adultes utilisant des approches laryngoscopiques avec ou sans application de PC (soit groupe PC et non-PC). Le critère d’évaluation principal était le taux d’intubations réussies à la première tentative, et les critères secondaires incluaient le temps d’intubation, l’incidence de mauvaises vues laryngoscopies (grades 3-4 de Cormack et Lehane), les complications au niveau des voies aériennes et l’aspiration pulmonaire. CONSTATATIONS PRINCIPALES : Cinq études au total (publiées entre 2005 et 2018) ont été incluses, et toutes les intubations trachéales ont été réalisées par des anesthésiologistes ou infirmiers anesthésistes à l’aide d’un vidéolaryngoscope (n = 3) ou d’une lame de Macintosh (n = 2) en salle d’opération. Nous n’avons trouvé aucune différence significative dans le taux d’intubations réussies à la première tentative (risque relatif [RR], 0,98; P = 0,37), dans l’incidence de mauvaises vues laryngoscopiques (RR, 1,49; P = 0,21) ou dans le risque de maux de gorge (RR, 1,17; P = 0,73) entre les deux groupes. En revanche, le temps d’intubation lors de la première tentative réussie était légèrement plus long (différence moyenne pondérée = 4,40 sec, P = 0,002) et le risque d’enrouement était plus élevé (RR, 1,70; P = 0,03) dans le groupe PC que dans le groupe non-PC. Le critère d’évaluation secondaire « aspiration pulmonaire » n’a pas été analysé parce qu’une seule étude le mesurait. CONCLUSION : L’application de PC n’a pas eu d’impact négatif sur le taux d’intubations réussies à la première tentative ou la vue laryngoscopique. Par contre, cette manœuvre pourrait légèrement prolonger le temps d’intubation et augmenter le risque d’enrouement postopératoire.
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- 2020
27. Impact of combined epidural anaesthesia/analgesia on postoperative cognitive impairment in patients receiving general anaesthesia: a meta-analysis of randomised controlled studies
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I-Chia Teng, Cheuk-Kwan Sun, Chun-Ning Ho, Li-Kai Wang, Yao-Tsung Lin, Ying-Jen Chang, Jen-Yin Chen, Chin-Chen Chu, Chung-Hsi Hsing, and Kuo-Chuan Hung
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Adult ,Analgesia, Epidural ,Anesthesia, Epidural ,Pain, Postoperative ,Anesthesiology and Pain Medicine ,Postoperative Nausea and Vomiting ,Delirium ,Humans ,Cognitive Dysfunction ,General Medicine ,Anesthesia, General ,Critical Care and Intensive Care Medicine ,Randomized Controlled Trials as Topic - Abstract
To investigate the efficacy of combined epidural anaesthesia/analgesia (EAA) against postoperative delirium/cognitive dysfunction (POD/POCD) in adults after major non-cardiac surgery under general anaesthesia (GA).The databases of PubMed, Google Scholar, Embase and Cochrane Central Register were searched from inception to November 2021 for available randomised controlled trials (RCTs) that assessed the impact of EAA on risk of POD/POCD. The primary outcome was risk of POD/POCD, while the secondary outcomes comprised postoperative pain score, length of hospital stay (LOS), risk of complications, and postoperative nausea/vomiting (PONV).Meta-analysis of eight studies with a total of 2376 patients (EAA group: 1189 patients; non-EAA group: 1187 patients) revealed no difference in risk of POD/POCD between the EAA and the non-EAA groups [Risk ratio (RR): 0.68; 95% CI: 0.41 to 1.13, p = 0.14, IThis meta-analysis demonstrated that EAA had no significant impact on the incidence of POD/POCD in patients following non-cardiac surgery.
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- 2022
28. Association of Serum Zinc Concentration with Preservation of Renal Function After Bariatric Surgery: a Retrospective Pilot Study
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Cheuk-Kwan Sun, I-Wen Chen, Chun-Ning Ho, Jen-Yin Chen, Tien-Chou Soong, Zhi-Fu Wu, Ying-Jen Chang, I-Jung Feng, Chien-Ming Lin, Yu-Rong Hsu, and Kuo-Chuan Hung
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Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Bariatric Surgery ,Renal function ,Pilot Projects ,030209 endocrinology & metabolism ,Body Mass Index ,03 medical and health sciences ,0302 clinical medicine ,Diabetes mellitus ,Weight Loss ,Linear regression ,medicine ,Humans ,Retrospective Studies ,Nutrition and Dietetics ,Serum zinc ,business.industry ,Incidence ,Incidence (epidemiology) ,Middle Aged ,Prognosis ,medicine.disease ,Obesity ,Obesity, Morbid ,Surgery ,Zinc ,Treatment Outcome ,Zinc deficiency ,Female ,Kidney Diseases ,Laparoscopy ,030211 gastroenterology & hepatology ,Deficiency Diseases ,business ,Body mass index ,Biomarkers ,Glomerular Filtration Rate - Abstract
Although serum zinc level (Zn) is known to impact renal function in patients with diabetes, their correlation following bariatric surgery remains unknown. This study aimed at assessing the association of Zn with estimated glomerular filtration rate (eGFR) after laparoscopic sleeve gastrectomy (LSG). One hundred and twenty-nine patients in total (mean age, 38.1 ± 10.8; body mass index, 39.1 ± 5.1 kg/m2) with normal preoperative kidney function undergoing LSG at a single tertiary referral center were reviewed. The primary study endpoint was the relationship between Zn and post-LSG eGFR at 12-month follow-up. The secondary outcomes were the associations of percentage weight loss (%WL) with changes in Zn (△Zn) and eGFR (△eGFR). The incidence of zinc deficiency was 8.5%, 8.1%, and 29.9% at baseline, post-LSG and one- and 12-month follow-up, respectively. At 12-month follow-up, Zn dropped from 104.1 ± 19.2 to 85.3 ± 38.9 μg/dL (p = 0.001), while eGFR levels decreased from 106.6 ± 10.3 to 102.1 ± 19.4 mL/min per 1.73 m2 (p = 0.025). Zn correlated positively with eGFR at 6-month (r = 0.252, p = 0.037) and 12-month (r = 0.41, p = 0.001) follow-ups. Multiple linear regression analyses including baseline variables of age, sex, BMI, %WL, and diabetes identified Zn and %WL as independent predictors of eGFR at 12-month follow-up. There was no evidence of multicollinearity among these variables. Despite positive association between %WL and △eGFR (r = 0.222, p = 0.031), no correlation was noted between %WL and △Zn (r = − 0.129, p = 0.40). The results demonstrated a positive relationship between post-LSG serum zinc levels and preservation of renal function among patients with obesity in a surgical setting. Large-scale studies are warranted to support the findings.
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- 2019
29. Malignant transformation of oral potentially malignant disorders in Taiwanese indigenous peoples: A nationwide retrospective cohort study
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I-An, Chen, Sheng-Fu, Chiu, Kuo-Chuan, Hung, Chia-Hung, Yu, Yi-Chen, Chen, Chung-Han, Ho, Wei-Fan, Chiang, and Ying-Jen, Chang
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Cohort Studies ,Hyperplasia ,Cell Transformation, Neoplastic ,Humans ,Mouth Neoplasms ,General Medicine ,Leukoplakia, Oral ,Mouth Diseases ,Precancerous Conditions ,Retrospective Studies - Abstract
Malignant transformation of oral potentially malignant disorders (OPMDs) is a potential cause of oral cancer. Currently, there is no research investigating the rate of malignant transformation of OPMDs into oral cancer in indigenous Taiwanese peoples. This study aimed to retrospectively investigate whether ethnicity (indigenous vs non-indigenous people) plays a role in increasing the malignant transformation rate of OPMDs into oral cancer. This study used data from the oral mucosal screening database and the Cancer Registry File, both of which originated from the National Health Insurance Research Database. We matched the baseline characteristics to control for confounding factors between indigenous peoples and non-indigenous peoples (17,768 indigenous subjects vs 71,072 non-indigenous subjects; 1:4 match) and compared the 2 cohorts. After matching for confounding factors such as age, sex, habits, and OPMD subtype, the malignant transformation rate was not statistically higher for indigenous people than for non-indigenous people. We also discovered that indigenous people with oral verrucous hyperplasia might have a higher chance of malignant transformation into oral cancer than the non-indigenous cohort. We conclude that ethnicity is not a risk factor for the malignant transformation of OPMDs into oral cancer; however, indigenous people with oral verrucous hyperplasia need to pay special attention and are suggested to undergo regular follow-ups for the occurrence of oral cancer.
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- 2022
30. Efficacy of high flow nasal oxygenation against hypoxemia in sedated patients receiving gastrointestinal endoscopic procedures: A systematic review and meta-analysis
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Kuo-Chuan Hung, Ying-Jen Chang, I-Wen Chen, Tien-Chou Soong, Chun-Ning Ho, Chung-Hsi Hsing, Chin-Chen Chu, Jen-Yin Chen, and Cheuk-Kwan Sun
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Adult ,Endoscopes, Gastrointestinal ,Anesthesiology and Pain Medicine ,Humans ,Anesthesia ,Hypoxia ,Propofol ,Endoscopy, Gastrointestinal - Abstract
To evaluate the impact of high flow nasal oxygenation (HFNO) on the risk of hypoxemia during gastrointestinal endoscopic procedures (GEPs) under sedation.Meta-analysis of randomized controlled trials.Gastrointestinal endoscopy.HFNO.Adults patients undergoing GEPs under sedation.The primary outcome was risk of hypoxemia, while the secondary outcomes included risks of severe hypoxemia, hypercapnia, need for jaw thrust or other airway interventions, and procedural interruption as well as procedure time, minimum SpOMedline, Google scholar, Cochrane Library, and EMBASE databases were searched from inception to July 2021. Seven randomized controlled trials (RCTs) involving 2998 patients published from 2019 to 2021 were included. All GEPs were performed under propofol sedation. Pooled results revealed significantly lower risks of hypoxemia [relative risk (RR) = 0.31, 95% CI:0.13-0.75; 2998 patients], severe hypoxemia (RR = 0.38, 95% CI:0.2-0.74; 2766 patients), other airway interventions (RR = 0.34, 95% CI:0.22-0.52; 2736 patients), procedural interruption (RR = 0.12, 95% CI:0.02-0.64, 451 patients) and a lower COOur results demonstrated the efficacy of high flow nasal oxygenation for reducing the risk of hypoxemia in patients receiving elective gastrointestinal endoscopic procedures under sedation. Further studies are warranted to verify its cost-effectiveness in the gastrointestinal endoscopy setting.
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- 2021
31. Comparison of video-stylet and conventional laryngoscope for endotracheal intubation in adults with cervical spine immobilization: A PRISMA-compliant meta-analysis
- Author
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I-Wen, Chen, Yu-Yu, Li, Kuo-Chuan, Hung, Ying-Jen, Chang, Jen-Yin, Chen, Ming-Chung, Lin, Kuei-Fen, Wang, Chien-Ming, Lin, Ping-Wen, Huang, and Cheuk-Kwan, Sun
- Subjects
Adult ,Immobilization ,Laryngoscopy ,Cervical Vertebrae ,Intubation, Intratracheal ,Video Recording ,Humans ,Pharyngitis ,General Medicine ,Laryngoscopes - Abstract
Although minimization of cervical spine motion by using a neck collar or manual in-line stabilization is recommended for urgent tracheal intubation (TI) in patients with known or suspected cervical spine injury (CSI), it may worsen glottic visualization. The overall performance of video-stylets during TI in patients with neck immobilization remains unclear. The current meta-analysis aimed at comparing the intubation outcomes of different video-stylets with those of conventional laryngoscopes in patients with cervical immobilization.The databases of Embase, Medline, and the Cochrane Central Register of Controlled Trials were searched from inception to June 2021 to identify trials comparing intubation outcomes between video-stylets and conventional laryngoscopes. The primary outcome was first-pass success rate, while secondary outcomes included overall success rate, time to intubation, the risk of intubation-associated sore throat, or tissue damage.Five randomized controlled trials published between 2007 and 2013 involving 487 participants, all in an operating room setting, were analyzed. The video-stylets investigated included Bonfils intubation fiberscope, Levitan FPS Scope, and Shikani optical stylet. There was no difference in first-pass success rate (risk ratio [RR] =1.08, 95% confidence interval [CI]: 0.89-1.31, P = .46], overall success rate (RR = 1.06, 95% CI: 0.93-1.22, P = .4), intubation time [mean difference = 4.53 seconds, 95% CI: -8.45 to 17.51, P = .49), and risk of tissue damage (RR = 0.46, 95% CI: 0.16-1.3, P = .14) between the 2 groups. The risk of sore throat was lower with video-stylets compared to that with laryngoscopes (RR = 0.45, 95% CI: 0.23-0.9, P = .02).Our results did not support the use of video-stylets as the first choice for patients with neck immobilization. Further studies are required to verify the efficacy of video-stylets in the nonoperating room setting.
- Published
- 2022
32. Efficacy of intraoperative intravenous lidocaine for postoperative analgesia following bariatric surgery: a meta-analysis of randomized controlled studies
- Author
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Kuo-Chuan Hung, Ying-Jen Chang, I-Wen Chen, Cheuk-Kwan Sun, Yang-Pei Chang, and Sheng-Fu Chiu
- Subjects
Adult ,medicine.medical_specialty ,Lidocaine ,Nausea ,Bariatric Surgery ,Cochrane Library ,Placebo ,law.invention ,Randomized controlled trial ,law ,Medicine ,Humans ,Anesthetics, Local ,Randomized Controlled Trials as Topic ,Pain, Postoperative ,business.industry ,Surgery ,Analgesics, Opioid ,Opioid ,Vomiting ,Morphine ,medicine.symptom ,Analgesia ,business ,medicine.drug - Abstract
Background The impact of intravenous lidocaine in adults undergoing laparoscopic bariatric surgeries (LBS) remains unclear. Objectives This study aimed at investigating the effect of intravenous lidocaine on postoperative opioid consumption and recovery following LBS. Setting Meta-analysis. Methods We searched databases including MEDLINE, Embase, Google Scholar, and the Cochrane Library for randomized controlled trials that evaluated the use of intravenous lidocaine compared to placebo only prior to May 2021. The primary outcome was 24-hour postoperative opioid consumption, while secondary outcomes included pain score, quality of recovery (QOR)-40 score, length of hospital stay (LOS), and postoperative nausea/vomiting (PONV). Results Seven trials (496 participants) were included. Intraoperative intravenous lidocaine significantly reduced 24-hour equivalent morphine consumption (mean difference [MD]: −11.97 mg; 95% confidence interval [CI]: −23.12 to −.83), pain score at 1 to 3 hours (MD: −.77; 95% CI: −1.5 to −.04), and LOS (MD: −8.93 hr; 95% CI: −13.41 to −4.44) without positive impact on 24-hour pain score and PONV. There was also an increase in time to first opioid requirement (MD: 20.23 min; 95% CI: 11.76–28.7) and QOR-40 score (MD: 24.38; 95% CI: 5.57–43.18). However, sensitivity analysis demonstrated evidence supporting the beneficial effect of lidocaine only for time to first opioid requirement and QOR-40. The associations of intraoperative intravenous lidocaine with reductions in morphine consumption, pain score at 1 to 3 hours, and LOS after LBS were also weak. Conclusion Intraoperative intravenous lidocaine during LBS prolonged time to first opioid requirement and improved quality of recovery postoperatively without 24-hour pain or nausea/vomiting benefits. Due to the small number of trials, larger studies are warranted to verify our findings.
- Published
- 2021
33. Sugammadex induced bradycardia and hypotension: A case report and literature review
- Author
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Yao-Tsung Lin, I-Chia Teng, Ying-Jen Chang, Jen-Yin Chen, Zhi-Fu Wu, and Chin-Chen Chu
- Subjects
Inotrope ,Bradycardia ,cardiac arrest ,Sugammadex ,Bronchospasm ,medicine ,Humans ,Clinical Case Report ,Laryngospasm ,Aged, 80 and over ,business.industry ,General Medicine ,medicine.disease ,Empyema ,Neostigmine ,Atropine ,Anesthesia ,Female ,medicine.symptom ,Hypotension ,business ,Research Article ,medicine.drug - Abstract
Rationale: There is evidence that sugammadex can facilitate extubation post-surgery and attenuate postoperative pulmonary complications resulting from postoperative residual neuromuscular blockade. However, it may induce adverse effects, including bronchospasm, laryngospasm, bradycardia, hypotension, and cardiac arrest. Here, we present a case of sugammadex-induced bradycardia and hypotension. Patient concerns: An 82-year-old female received video-assisted thoracic surgery decortication and wedge resection of the lung for empyema. Post-surgery, she developed bradycardia, hypotension, hypoxia, and weakness. Diagnoses: The patient was suspected to have sugammadex-induced bradycardia, hypotension, hypoxia and weakness. Interventions: The patient received immediate treatment with atropine (0.5 mg) for bradycardia. Glycopyrrolate (0.1 mg) and neostigmine (1 mg) were administered to improve the train-of-four (TOF) ratio. Outcomes: Following initial management, we observed improvement in the hemodynamics of the patient. She was discharged without any sequelae. Lessons: Sugammadex-induced bradycardia or cardiac arrest are rare; however, anesthesiologists must consider the possibility of the occurrence of such events and initiate appropriate management measures. Immediate treatment with atropine and inotropic or vasopressors is warranted if the patient presents with bradycardia.
- Published
- 2021
34. Impact of Preoperative Anemia on Postoperative Kidney Function Following Laparoscopic Bariatric Surgery
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Shao-Chun Wu, Tien-Chou Soong, Cheuk-Kwan Sun, Ying-Jen Chang, Kuo-Chuan Hung, I-Wen Chen, and Min-Hsien Chiang
- Subjects
Adult ,Male ,medicine.medical_specialty ,Anemia ,Endocrinology, Diabetes and Metabolism ,Bariatric Surgery ,Renal function ,030209 endocrinology & metabolism ,Kidney ,Body Mass Index ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,Weight loss ,hemic and lymphatic diseases ,Weight Loss ,medicine ,Humans ,Postoperative Period ,Risk factor ,Retrospective Studies ,Nutrition and Dietetics ,business.industry ,Perioperative ,Acute Kidney Injury ,Middle Aged ,Prognosis ,medicine.disease ,Obesity ,Obesity, Morbid ,Surgery ,Treatment Outcome ,Preoperative Period ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,Hemoglobin ,medicine.symptom ,business ,Body mass index ,Glomerular Filtration Rate - Abstract
Preoperative anemia is a risk factor for acute kidney failure after high-risk surgeries. We assessed the impact of preoperative anemia on kidney function in an obese Asian population after laparoscopic bariatric surgery. Patient characteristics, comorbidities, type of surgery, perioperative profiles, eGFR, and micronutrition were retrospectively reviewed in 341 patients with obesity undergoing bariatric surgery. All patients, who had a preoperative estimated glomerular filtration rates (eGFR) ≥ 90 mL/min/1.73 m2, were followed for 1 year and assigned to one of two groups: anemia or non-anemia group. Preoperative anemia was determined based on hemoglobin concentration. The Pearson’s correlation coefficient between preoperative body mass index (BMI) and preoperative eGFR of all patients was 0.169 (p = 0.005). Preoperatively, there were no significant differences in age, BMI, and eGFR between the anemia (n = 38) and non-anemia groups (n = 303). Patients in the anemia group had lower hemoglobin concentration at baseline, 1 month, and 12 months after surgery than those in the non-anemia group. Postoperative eGFR levels at 1 month (p = 0.993) and 1 year (p = 0.118) as well as hospital stay (p = 0.941) were comparable between the two groups. However, the percentage weight loss was significantly higher in the non-anemia group than that in the anemia group 1 year after bariatric surgery (30.0 ± 7.3% vs. 27.0 ± 8.1%; p = 0.041). Preoperative anemia did not negatively impact kidney function following laparoscopic bariatric surgery during the 12-month follow-up. Considering the potential adverse impact of anemia on postoperative weight loss, preoperative correction of anemia may be recommended.
- Published
- 2019
35. Pregnancy outcomes following nonobstetric surgery during gestation: a nationwide population-based case-control study in Taiwan
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Chung-Han Ho, Ming-Ping Wu, Chia-Hung Yu, Shih-Feng Weng, Chin-Chen Chu, Ying-Jen Chang, Jhi-Joung Wang, Yi-Chen Chen, and Jen-Yin Chen
- Subjects
Delivery outcome ,Cervix Uteri ,Abortion ,Nonobstetric surgery ,Fractures, Bone ,Gynecologic Surgical Procedures ,0302 clinical medicine ,Pre-Eclampsia ,Fracture Fixation ,Pregnancy ,Odds Ratio ,Eclampsia ,030212 general & internal medicine ,030219 obstetrics & reproductive medicine ,Pregnancy Outcome ,Obstetrics and Gynecology ,Gestational diabetes ,Premature Birth ,Gestation ,Female ,Research Article ,Adult ,medicine.medical_specialty ,Taiwan ,Reproductive medicine ,lcsh:Gynecology and obstetrics ,Young Adult ,03 medical and health sciences ,medicine ,Appendectomy ,Humans ,lcsh:RG1-991 ,Retrospective Studies ,Antepartum hemorrhage ,Cesarean Section ,business.industry ,Ovary ,Odds ratio ,Length of Stay ,medicine.disease ,Surgery ,Abortion, Spontaneous ,Pregnancy Complications ,Diabetes, Gestational ,Case-Control Studies ,Uterine Hemorrhage ,business - Abstract
Background Whether nonobstetric surgery during gestation is associated with a higher risk of spontaneous abortion or adverse delivery outcomes is still unclear. Methods We performed a retrospective case-control study using a Longitudinal Health Insurance Database (LHID 2000) containing claim-data of 1 million randomly selected beneficiaries. We compared the incidences and estimated the adjusted odds ratios (aOR) with 95% confidence interval (95% CI) for spontaneous abortion, adverse delivery outcomes, cesarean delivery, and prolonged hospital stay to determine the risk of adverse outcomes in women who had nonobstetric surgery during gestation as compared to those who did not have any surgery during gestation. Results After exclusion, we were left with 114,852 delivery and 3999 abortion cases in our study; and 462 (0.39%) of them had nonobstetric surgery under general or regional anesthesia during pregnancy. The leading surgeries were repair of cervical os (33.12%), appendectomy (17.32%), ovarian surgeries (13.64%), and fixation of fractured bone (8.01%).The risk of spontaneous abortion (4.23% vs. 2.43%, aOR:1.53; 95% CI: 1.01–2.31), antepartum hemorrhage (7.14% vs. 2.83%, aOR: 2.51; 95% CI: 1.74–3.61), pre-eclampsia/eclampsia (2.60% vs. 1.01%, aOR: 2.35; 95% CI: 1.30–4.23), gestational diabetes (2.38% vs. 0.69%, aOR: 3.12; 95% CI: 1.69–5.78), prematurity (9.06 vs. 4.90%, aOR: 3.31; 95% CI: 2.54–4.31), cesarean section (43.55% vs. 33.76%, aOR: 1.41; 95% CI: 1.17–1.71), and prolonged hospital stay (1.82% vs. 5.91%, aOR: 3.23; 95% CI: 2.16–4.83) were higher in those women who had nonobstetric surgery after adjusting for age and comorbidities. Conclusions Nonobstetric surgery during gestation were associated with a higher risk of spontaneous abortion, adverse delivery outcomes, cesarean section, and prolonged hospital stay.
- Published
- 2018
36. The Use of Propofol versus Dexmedetomidine for Patients Receiving Drug-Induced Sleep Endoscopy: A Meta-Analysis of Randomized Controlled Trials
- Author
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Cheuk-Kwan Sun, Yi-Ting Chen, Kuan-Yu Wu, I-Wen Chen, Kuo-Chuan Hung, Ying-Jen Chang, Min-Hsien Chiang, and Shu-Wei Liao
- Subjects
Sedation ,lcsh:Medicine ,Review ,Lower risk ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Respiratory function ,Dexmedetomidine ,030223 otorhinolaryngology ,Adverse effect ,hypoxemia ,propofol ,business.industry ,lcsh:R ,dexmedetomidine ,General Medicine ,medicine.disease ,Obstructive sleep apnea ,drug-induced sleep endoscopy ,Anesthesia ,medicine.symptom ,Propofol ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
The sedation outcomes associated with dexmedetomidine compared with those of propofol during drug-induced sleep endoscopy (DISE) remains unclear. Electronic databases (i.e., the Cochrane controlled trials register, Embase, Medline, and Scopus) were searched from inception to 25 December 2020 for randomized controlled trials (RCTs) that evaluated the sedation outcomes with dexmedetomidine or propofol in adult patients diagnosed with obstructive sleep apnea (OSA) receiving DISE. The primary outcome was the difference in minimum oxygen saturation (mSaO2). Five RCTs (270 participants) published between 2015 and 2020 were included for analysis. Compared with dexmedetomidine, propofol was associated with lower levels of mSaO2 (mean difference (MD) = −7.24, 95% confidence interval (CI) −12.04 to −2.44; 230 participants) and satisfaction among endoscopic performers (standardized MD = −2.43, 95% CI −3.61 to −1.26; 128 participants) as well as a higher risk of hypoxemia (relative ratios = 1.82, 95% CI 1.2 to 2.76; 82 participants). However, propofol provided a shorter time to fall asleep and a lower risk of failed sedation compared with dexmedetomidine. No significant difference was found in other outcomes. Compared with propofol, dexmedetomidine exhibited fewer adverse effects on respiratory function and provided a higher level of satisfaction among endoscopic performers but was associated with an elevated risk of failed sedation.
- Published
- 2021
37. Comparison of video-stylet and video-laryngoscope for endotracheal intubation in adults with cervical neck immobilisation: A meta-analysis of randomised controlled trials
- Author
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Shu-Wei Liao, I-Wen Chen, Jo-Chi Chin, Kuo-Chuan Hung, Ming Yew, Ying-Jen Chang, Chien-Ming Lin, Jen-Yin Chen, and Cheuk-Kwan Sun
- Subjects
Adult ,medicine.medical_specialty ,medicine.medical_treatment ,MEDLINE ,Video Recording ,Cochrane Library ,Laryngoscopes ,Critical Care and Intensive Care Medicine ,Immobilization ,medicine ,Intubation, Intratracheal ,Intubation ,Humans ,Laryngoscopy ,business.industry ,Tracheal intubation ,General Medicine ,Surgery ,Stylet ,Anesthesiology and Pain Medicine ,Meta-analysis ,Relative risk ,Cervical Vertebrae ,Cervical collar ,business ,Neck - Abstract
Background The efficacy of video-stylet versus video-laryngoscope for tracheal intubation in patients with cervical spine immobilisation, which is known to impede the intubation process, remains unclear. Methods We searched electronic databases including EMBASE, MEDLINE, Google scholar, and Cochrane Library for randomised controlled trials comparing video-stylets with video-laryngoscopes in human subjects with cervical spine immobilisation from inception to the 25th of January 2021. The primary outcome was the rate of successful first-attempt intubation, while secondary outcomes included overall intubation success rate, time for successful intubation, and risk of tissue damage. Results Five trials (709 patients) published between 2009 and 2020 met the inclusion criteria. There were four types of video-stylets and three types of video-laryngoscopes examined. Hard cervical collar was applied in four studies, while manual inline stabilisation was used in one study for cervical immobilisation. There was no difference in successful first-attempt intubation rate between the video-stylet and the video-laryngoscope groups [risk ratio (RR) = 0.96, 95% CI: 0.90 to 1.03, p = 0.3; I2 = 47%] (5 trials, 709 patients). The overall success rate (RR = 0.98, 95% CI: 0.96 to 1.0, p = 0.05; I2 = 0%), intubation time [mean difference (MD) = 5.24, 95% CI: -8.95 to 19.43, p = 0.47; I2 = 92%], and risk of tissue damage (RR = 0.87, 95% CI: 0.26 to 2.85, p = 0.81; I2 = 39%) were also comparable between the two groups. Conclusions This study validates the efficacy of both video-stylets and video-laryngoscopes for tracheal intubation in the situation of cervical spine immobiliz-sation. Further large-scale trials are warranted to support our findings in this clinical setting.
- Published
- 2021
38. Mortality and risk factors associated with pulmonary embolism in coronavirus disease 2019 patients: a systematic review and meta-analysis
- Author
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Cheuk-Kwan Sun, Li-Kai Wang, Yang-Pei Chang, Ying-Jen Chang, Kuo-Chuan Hung, Carlos Andrés Gómez, I-Ting Tsai, Yao-Tsung Lin, I-Yin Hung, and Ming-Chung Lin
- Subjects
Male ,medicine.medical_specialty ,Coronavirus disease 2019 (COVID-19) ,Science ,medicine.medical_treatment ,MEDLINE ,Article ,law.invention ,Fibrin Fibrinogen Degradation Products ,Sex Factors ,Medical research ,law ,Internal medicine ,Anticoagulant prophylaxis ,medicine ,Humans ,Mechanical ventilation ,Multidisciplinary ,business.industry ,SARS-CoV-2 ,COVID-19 ,medicine.disease ,Intensive care unit ,Respiration, Artificial ,Pulmonary embolism ,Clinical trial ,Risk factors ,Meta-analysis ,Medicine ,Female ,business ,Pulmonary Embolism - Abstract
To determine, in patients with coronavirus disease 2019 (COVID-19) infection, the associations of pulmonary embolism (PE) with mortality and risk factors for PE as well as the therapeutic benefit of anticoagulant prophylaxis. Embase, PubMed, Cochrane controlled trials register, and Web of Science databases were searched from inception to October 10, 2020. We included all published trials on PE in patients diagnosed with COVID-19 with eligibility of the trials assessed following the PRISMA guidelines. Sixteen clinical trials with 5826 patients were eligible. There were significant associations of PE with the male gender [odd ratio (OR) = 1.59, 95% CI 1.28–1.97], mechanical ventilation (OR = 3.71, 95% CI 2.57–5.36), intensive care unit admission (OR = 2.99, 95% CI 2.11–4.23), circulating D-dimer [mean difference (MD) = 5.04 µg/mL, 95% CI 3.67–6.42) and CRP (MD = 1.97 mg/dL, 95% CI 0.58– 3.35) concentrations without significant correlation between PE and mortality (OR = 1.31, 95% CI 0.82–2.08) as well as other parameters or comorbidities. After omitting one trial with strict patient selection criteria for anticoagulant prophylaxis, significant prophylactic benefit was noted (OR = 0.31, 95% CI 0.1–0.91). Our findings identified the risk factors associated with PE in COVID-19 patients and supported the therapeutic benefit of anticoagulant prophylaxis against PE in this patient population.
- Published
- 2021
39. Long-term analgesic and opioid prescription after surgery under general or neuraxial anesthesia: A retrospective nationwide sampling study
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Ying-Jen Chang, Chin-Chen Chu, Chia-Hung Yu, Chung-Han Ho, Jen-Yin Chen, I-Yin Hung, and Yi-Chen Chen
- Subjects
medicine.medical_specialty ,Analgesics ,business.industry ,medicine.medical_treatment ,Analgesic ,Knee replacement ,Odds ratio ,Anesthesia, General ,Confidence interval ,Sampling Studies ,Surgery ,Analgesics, Opioid ,Anesthesiology and Pain Medicine ,Prescriptions ,Amputation ,Hip replacement ,Anesthesia ,Case-Control Studies ,Medicine ,Internal fixation ,Humans ,Medical prescription ,business ,Retrospective Studies - Abstract
Study objective Chronic postsurgical pain (CPSP) is a common and underreported but significant outcome following surgery. Pharmacological treatment with analgesics, including non-opioids and opioids, is frequently used. It has been debated whether neuraxial anesthesia can reduce persistent analgesic use. We aimed to survey long-term analgesic prescription after different surgeries under general and neuraxial anesthesia, using a nationwide database. Design Retrospective case-control study. Setting This study used data corresponding to the period from 2000 to 2016 from a longitudinal generation tracking database, which includes the claims data of 2 million randomly selected beneficiaries in Taiwan. Patients Patients (n = 110,654) who underwent herniorrhaphy, hip/knee replacement, and lower-limb open reduction internal fixation (ORIF) or amputation were enrolled. Interventions We categorized patients into general or neuraxial anesthesia groups, compared the rates of long-term analgesic prescription between the two groups, and estimated the adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) using multivariable logistic regression analysis. Main results Lower rates of long-term analgesic prescription were noted in patients who underwent herniorrhaphy (3 months post-surgery: aOR, 0.88; 95% CI, 0.84–0.93; 6 months post-surgery: aOR, 0.90; 95% CI, 0.84–0.96), hip replacement (3 months post-surgery: aOR, 0.91; 95% CI, 0.85–0.97), and lower-limb ORIF (3 months post-surgery: aOR, 0.91; 95% CI, 0.88–0.94; 6 months post-surgery: aOR, 0.95; 95% CI, 0.92–0.99) under neuraxial anesthesia than under general anesthesia. Lesser long-term opioid prescription after herniorrhaphy (3 months post-surgery: aOR, 0.52; 95% CI, 0.36–0.75; 6 months post-surgery: aOR, 0.58; 95% CI, 0.42–0.81) and lower-limb ORIF (3 months post-surgery: aOR, 0.55; 95% CI, 0.47–0.65; 6 months post-surgery: aOR, 0.67; 95% CI, 0.56–0.80) was observed under neuraxial anesthesia than under general anesthesia. Conclusions Neuraxial anesthesia may be associated with lower rates of long-term analgesic and opioid prescription after some surgeries, especially herniorrhaphy and lower-limb ORIF.
- Published
- 2021
40. A Real-Time Artificial Intelligence-Assisted System to Predict Weaning from Ventilator Immediately after Lung Resection Surgery
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Chao-Kun Chen, Li-Kai Wang, Jhi-Joung Wang, Kuo-Chuan Hung, Chia-Hung Yu, Chung-Feng Liu, Hung-Tze Tay, and Ying-Jen Chang
- Subjects
medicine.medical_specialty ,Health, Toxicology and Mutagenesis ,lcsh:Medicine ,Article ,Pulmonary function testing ,03 medical and health sciences ,Naive Bayes classifier ,0302 clinical medicine ,pulmonary function test ,pre-anesthetic consultation ,medicine ,Weaning ,Humans ,030212 general & internal medicine ,Lung ,030304 developmental biology ,Retrospective Studies ,0303 health sciences ,Ventilators, Mechanical ,business.industry ,Medical record ,Patient comprehension ,lcsh:R ,Public Health, Environmental and Occupational Health ,Bayes Theorem ,artificial intelligence ,Surgery ,machine learning ,lung resection ,Artificial intelligence ,Lung resection ,business ,Risk assessment ,staged weaning - Abstract
Assessment of risk before lung resection surgery can provide anesthesiologists with information about whether a patient can be weaned from the ventilator immediately after surgery. However, it is difficult for anesthesiologists to perform a complete integrated risk assessment in a time-limited pre-anesthetic clinic. We retrospectively collected the electronic medical records of 709 patients who underwent lung resection between 1 January 2017 and 31 July 2019. We used the obtained data to construct an artificial intelligence (AI) prediction model with seven supervised machine learning algorithms to predict whether patients could be weaned immediately after lung resection surgery. The AI model with Naïve Bayes Classifier algorithm had the best testing result and was therefore used to develop an application to evaluate risk based on patients’ previous medical data, to assist anesthesiologists, and to predict patient outcomes in pre-anesthetic clinics. The individualization and digitalization characteristics of this AI application could improve the effectiveness of risk explanations and physician–patient communication to achieve better patient comprehension.
- Published
- 2021
41. Comment on 'Effectiveness and safety of central pancreatectomy in benign or low-grade malignant pancreatic body lesions: a systematic review and meta-analysis'.
- Author
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Hsiu-Lan Weng, Ying-Jen Chang, Ming Yew, and Kuo-Chuan Hung
- Published
- 2024
- Full Text
- View/download PDF
42. Satisfaction in parturients receiving epidural analgesia after prenatal shared decision-making intervention: a prospective, before-and-after cohort study
- Author
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Chia-Hung Yu, Chung-Han Ho, Chin-Chen Chu, Yi-Chen Chen, Ming-Ping Wu, Wan-Jung Cheng, Ying-Jen Chang, and Kuo-Chuan Hung
- Subjects
Adult ,China ,medicine.medical_specialty ,Epidural analgesia ,Reproductive medicine ,Psychological intervention ,Gestational Age ,lcsh:Gynecology and obstetrics ,Cohort Studies ,03 medical and health sciences ,Labor pain ,0302 clinical medicine ,Patient Education as Topic ,Pregnancy ,Surveys and Questionnaires ,Humans ,Pain Management ,Prenatal ,Medicine ,Prospective Studies ,030212 general & internal medicine ,Shared decision-making ,lcsh:RG1-991 ,Labor, Obstetric ,030219 obstetrics & reproductive medicine ,business.industry ,Obstetrics and Gynecology ,Prenatal Care ,Delivery, Obstetric ,medicine.disease ,Confidence interval ,Exploratory factor analysis ,Analgesia, Epidural ,Patient Satisfaction ,Physical therapy ,Analgesia, Obstetrical ,Female ,Health education ,business ,Decision Making, Shared ,Research Article ,Cohort study - Abstract
Background The explanation of epidural analgesia by anesthesiologist would often begin after the parturient is admitted to the hospital. Because of labor pain, the decision of receiving epidural analgesia would often be made by the family members, instead of the parturient herself. We aimed to test whether earlier prenatal shared decision-making (SDM) interventions increase parturient’s comprehension and satisfaction of epidural labor analgesia, compared to conventional explanation after labor pain begun. Methods During the 28th week of gestation, we provided the SDM parturient health education as well as a leaflet with quick response codes. Scanning the code would link to education videoclips which explained what epidural analgesia is and its advantages and disadvantages. Original routine practice group parturients received explanation of analgesia after admission for delivery. To measure the satisfaction of labor pain service, the accessibility of information, and the communication with medical staff, we designed a questionnaire with reference to (1) Pregnancy and Maternity Care Patients’ Experiences Questionnaire (PreMaPEQ), (2) Preterm Birth Experience and Satisfaction Scale (P-BESS), and (3) Women’s Views of Birth Labor Satisfaction Questionnaire (WOMBLSQ). The questionnaire was amended after a pretest involving 30 parturients who had received epidural analgesia. Scree test analysis and exploratory factor analysis were performed; then, the questionnaire was revised again. A total of 200 valid questionnaires were collected—100 each from the original routine practice group and the SDM group. Results The SDM group reported significantly higher satisfaction with and understanding of epidural analgesia, and a significantly higher satisfaction with the information received, and the quality of pain relief. After SDM intervention, significant increasement of the average satisfaction scores in question “my epidural is effective” (9.10%; mean difference: 0.38; 95% confidence interval, 0.17 ~ 0.59; p p Conclusions An earlier prenatal SDM intervention with sufficient information through videoclips increased parturients’ comprehensions and satisfaction of epidural analgesia service. Trial registration ISRCTN registry, 14,256,563. Registered April 1st, 2020 (10.1186/ISRCTN14256563).
- Published
- 2020
43. Age, Gender and Season Are Good Predictors of Vitamin D Status Independent of Body Mass Index in Office Workers in a Subtropical Region
- Author
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Kuo-Chuan Hung, Yao-Tsung Lin, Jen-Yin Chen, Chung-Han Ho, Li-Kai Wang, Ying-Jen Chang, and Zhi-Fu Wu
- Subjects
Male ,Younger age ,Overweight ,Logistic regression ,hypocalcemia ,Body Mass Index ,0302 clinical medicine ,polycyclic compounds ,Prevalence ,gender ,Medicine ,030212 general & internal medicine ,Vitamin D ,Nutrition and Dietetics ,Incidence (epidemiology) ,Age Factors ,Middle Aged ,Occupational Diseases ,hypovitaminosis D ,Female ,Seasons ,Underweight ,medicine.symptom ,lcsh:Nutrition. Foods and food supply ,Adult ,Taiwan ,Nutritional Status ,030209 endocrinology & metabolism ,lcsh:TX341-641 ,Office workers ,Article ,03 medical and health sciences ,Sex Factors ,Vitamin D and neurology ,Humans ,Obesity ,Aged ,Retrospective Studies ,Tropical Climate ,business.industry ,Vitamin D Deficiency ,Logistic Models ,subtropical ,age ,occupational health ,Calcium ,business ,Body mass index ,season ,Food Science ,Demography - Abstract
This study aimed at determining the prevalence and predictors of hypovitaminosis D (serum 25-hydroxyvitamin D <, 30 ng/mL) among office workers in a subtropical region from an electronic hospital database. Totally, 2880 office workers aged 26&ndash, 65 years who received health examinations with vitamin D status and total calcium concentrations at a tertiary referral center were retrospectively reviewed. Subjects were divided into groups according to genders, age (i.e., 26&ndash, 35, 36&ndash, 45, 46&ndash, 55, 56&ndash, 65), body-mass index (BMI) (i.e., obese BMI &ge, 30, overweight 25 &le, BMI <, 30, normal 20 &le, 25, and underweight BMI <, 20) and seasons (spring/winter vs. summer/autumn) for identifying the predictors of hypovitaminosis D. Corrected total calcium level <, 8.4 mg/dL is considered as hypocalcemia. Multivariate logistic regression demonstrated that females (AOR 2.33, (95% CI: 1.75, 3.09)), younger age (4.32 (2.98, 6.24), 2.82 (1.93, 4.12), 1.50 (1.03, 2.17)), and season (winter/spring) (1.55 (1.08, 2.22)) were predictors of hypovitaminosis D, whereas BMI was not in this study. Despite higher incidence of hypocalcemia in office workers with hypovitaminosis D (p <, 0.001), there was no association between vitamin D status and corrected total calcium levels. A high prevalence (61.9%) of hypovitaminosis D among office workers in a subtropical region was found, highlighting the importance of this occupational health issue.
- Published
- 2020
44. Antimalarial primaquine for skin infiltration analgesia in rats
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Ying Jen Chang, Kuo Sheng Liu, Jhi-Joung Wang, Yu Wen Chen, and Ching Hsia Hung
- Subjects
Male ,Primaquine ,Time Factors ,Lidocaine ,Pharmaceutical Science ,Amodiaquine ,Pharmacology ,Administration, Cutaneous ,Rats, Sprague-Dawley ,03 medical and health sciences ,Antimalarials ,0302 clinical medicine ,030202 anesthesiology ,Chloroquine ,medicine ,Potency ,Animals ,Anesthetics, Local ,ED50 ,Skin ,Dose-Response Relationship, Drug ,business.industry ,Hydroxychloroquine ,Rats ,Infiltration analgesia ,Analgesia ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Objectives The purpose of this study was to estimate the ability of antimalarial medications to induce local infiltration analgesia. Methods Using a rat model of skin infiltration anaesthesia, the effects of antimalarial medications (primaquine, chloroquine, hydroxychloroquine and amodiaquine) were compared with the application of lidocaine. Key findings At a dose of 3 μmol, primaquine and chloroquine displayed better potency (all P < 0.05) and greater duration (all P < 0.01) of cutaneous analgesia than lidocaine, whereas the other antimalarial medications showed a similar potency and duration of cutaneous analgesia when compared with lidocaine. When a dose of 3 μmol antimalarial medication was used, primaquine was the most potent and had the longest duration of action among four antimalarial medications. The relative potency ranking (ED50, 50% effective dose) has been found to be primaquine [2.10 (1.87 – 2.37) μmol] > lidocaine [6.27 (5.32 –7.39) μmol] (P < 0.01). Infiltration analgesia of skin with primaquine had a greater duration of action than did lidocaine on the equipotent (ED25, ED50, ED75) basis (P < 0.01). Conclusions Primaquine and chloroquine have greater potency and longer lasting skin analgesia when compared with lidocaine, while the other antimalarials display a similar potency in comparison with lidocaine.
- Published
- 2020
45. Chloroquine for prolonged skin analgesia in rats
- Author
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Ying Jen Chang, Jhi-Joung Wang, Yu Wen Chen, Ching Hsia Hung, and Kuo Sheng Liu
- Subjects
0301 basic medicine ,Male ,Epinephrine ,medicine.drug_class ,Injections, Subcutaneous ,Analgesic ,Cutaneous Trunci ,Pain ,Pharmacology ,Rats, Sprague-Dawley ,03 medical and health sciences ,Subcutaneous injection ,0302 clinical medicine ,Chloroquine ,medicine ,Animals ,Local anesthesia ,Anesthetics, Local ,Skin ,Bupivacaine ,Dose-Response Relationship, Drug ,business.industry ,Local anesthetic ,General Neuroscience ,Rats ,030104 developmental biology ,Analgesia ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
The purpose of this study was to investigate the ability of chloroquine and chloroquine in combination with vasoconstrictor epinephrine to act as a local anesthetic in skin analgesia. After subcutaneous injection of drugs in rats, the inhibition of the cutaneous trunci muscle reflex (CTMR) is designed for evaluation of the cutaneous analgesic effect. The analgesic effect of chloroquine was compared with that of bupivacaine or coadministration of chloroquine and epinephrine. Chloroquine produced exactly the same local anesthesia as bupivacaine did in a dose-dependent manner. On the ED50 (50 % effective dose) basis, the analgesic potency was chloroquine (4.81 [4.45–5.20] μmol)
- Published
- 2020
46. Efficacy of greater occipital nerve block for pain relief in patients with postdural puncture headache
- Author
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Ying-Jen Chang, Kuo-Chuan Hung, I-Wen Chen, Chi-Lin Kuo, I-Chia Teng, Ming-Chung Lin, Ming Yew, Shu-Wei Liao, Chung-Yi Wu, Chia-Hung Yu, Kuo-Mao Lan, and Cheuk-Kwan Sun
- Subjects
General Medicine - Published
- 2021
47. Association of hernia with subsequent aortic aneurysm in geriatric patients
- Author
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Kuo-Chuan Hung, Ying-Jen Chang, Shih-Feng Weng, Cheuk-Kwan Sun, Chin-Chen Chu, Jhi-Joung Wang, and Yi-Chen Chen
- Subjects
Adult ,Male ,Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Hernia, Inguinal ,030204 cardiovascular system & hematology ,Thoracic aortic aneurysm ,Young Adult ,03 medical and health sciences ,Aortic aneurysm ,0302 clinical medicine ,Humans ,Medicine ,Hernia ,Aged ,Retrospective Studies ,business.industry ,Proportional hazards model ,Incidence ,Incidence (epidemiology) ,Hazard ratio ,Age Factors ,Middle Aged ,medicine.disease ,Abdominal aortic aneurysm ,Aortic Aneurysm ,Surgery ,Inguinal hernia ,030228 respiratory system ,cardiovascular system ,Female ,Cardiology and Cardiovascular Medicine ,business - Abstract
Objective Although inguinal hernia and aortic aneurysm share similar pathogenic mechanisms of collagen and elastin destruction, their clinical association in geriatric patients is inconclusive. We assessed the association between hernia and the subsequent occurrence of aortic aneurysm in geriatric patients. Methods Adult patients with hernias between 2000 and 2012 were identified from a longitudinal claims database of 1 million beneficiaries from Taiwan's National Health Insurance program, and a control group of patients without hernia were matched by propensity score in a ratio of 1:3. Patients previously diagnosed with aortic aneurysms or connective tissue diseases were excluded. Follow-up ended on December 31, 2013. The incidence rate of aortic aneurysm was compared between patients with hernia and those without. Cox proportional hazards models were used to estimate relative hazards. Results After propensity score matching, there were 16,933 patients with hernia (aged 20-64 years: 10,326; ≥65 years: 6607) and 50,799 patients without hernia (aged 20-64: 30,978; ≥65: 19,821). Patients with hernia had a greater incidence rate and hazard ratio of aortic aneurysm than did patients without hernia (6.4 vs 4.8/10,000 person-years; adjusted subdistribution hazard ratio [sdHR], 1.34; 95% confidence interval [CI], 1.02-1.76; P = .03), especially for those aged ≥65 years (15.6 vs 10.4/10,000 person-years; adjusted sdHR, 1.44; 95% CI, 1.07-1.94; P = .01) In addition, geriatric patients with hernia were associated with a marginally greater risk of thoracic (adjusted sdHR, 1.66; 95% CI, 0.96-2.86) and abdominal (adjusted sdHR, 1.36; 95% CI, 0.96-1.94) aortic aneurysm rupture. Conclusions Geriatric patients with hernia were associated with a greater incidence of aortic aneurysm than were those without.
- Published
- 2021
48. Association of surgical pleth index with late postoperative analgesic requirement: A retrospective study
- Author
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Kuo-Chuan Hung, I-Jung Feng, Cheuk-Kwan Sun, Zhi-Fu Wu, Chien-Ming Lin, Jen-Yin Chen, Ying-Jen Chang, I-Wen Chen, and Chun-Ning Ho
- Subjects
Analgesics ,Pain, Postoperative ,Index (economics) ,business.industry ,Analgesic ,MEDLINE ,Retrospective cohort study ,Anesthesiology and Pain Medicine ,Anesthesia ,Humans ,Medicine ,Analgesia ,business ,Retrospective Studies - Published
- 2020
49. Impact of Trachway® video stylet use on perioperative dental injury: A retrospective study
- Author
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Jen-Yin Chen, Yu-Hsuan Shih, Chuan-Yi Kuo, Chin-Chen Chu, Kuo-Chuan Hung, Cheuk-Kwan Sun, and Ying-Jen Chang
- Subjects
medicine.medical_specialty ,Anesthesiology and Pain Medicine ,business.industry ,General surgery ,Anesthesia ,Medicine ,Retrospective cohort study ,Perioperative ,Dental injury ,business ,Stylet - Published
- 2020
50. Postoperative outcomes of lung separation with double-lumen tubes and bronchial blockers
- Author
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Chia-Hung Yu, Yi-Chen Chen, Ying-Jen Chang, Fu-Wen Liang, Jen-Yin Chen, Chung-Han Ho, and Chin-Chen Chu
- Abstract
Objectives The choice between a double-lumen tube (DLT) and a bronchial blocker (BB) for lung isolation remains controversial. The aim of this study was to determine if the features of these lung isolation devices affect postoperative pulmonary outcomes. Methods We retrospectively identified claims by patients who underwent surgery under lung isolation in 2000–2012 in the Taiwan National Health Insurance Research Database. After matching for age, sex, and year of surgery, 1898 patients were enrolled in the BB group and 5694 in the DLT group. The risks of readmission in the first postoperative year with pulmonary complications, in-hospital death, and one-year mortality were estimated using conditional logistic regression analysis. Results Patients in the BB group had higher risks of readmission with pulmonary infection (adjusted odds ratio [aOR], 1.46; 95% confidence interval [CI], 1.22–1.74), respiratory failure (aOR, 1.38; 95% CI, 1.09–1.76), in-hospital deaths (aOR, 2.03; 95% CI, 1.40–2.94), and one-year mortality rate (aOR, 1.94; 95% CI, 1.60–2.35) in the first postoperative year than did those in the DLT group after adjusting for the type of surgery, difficult airway condition, hospital accreditation level, and underlying comorbidity. Patients in the BB group had longer median (interquartile range) stays in the intensive care unit (1 [0–4] versus 1 [0–3] days, P < 0.001) and in hospital (16 [10–26] versus 13 [8–22] days, respectively, P < 0.001). Conclusions Patients undergoing thoracic surgery are more likely to experience postoperative pulmonary complications related to BB than to DLT.
- Published
- 2019
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