Browsing by Author "Chang, Chang-Cheng"

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A quantitative evaluation with an innovative wireless bio-impedance device to check improvement of limb lymphedema after receiving two-site vascularized lymph node transfer simultaneously in a patient
(2018-03-01)
Chang, Chang-Cheng
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Su, Chun-Lin
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Xu, Dai-Ru
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Lin, Bor-Shyh
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Chen, Hung-Chi
A quantitative real-time assessment of Buerger exercise on dorsal foot peripheral skin circulation in patients with diabetes foot
(2016-11-01)
Chang, Chang-Cheng
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Chen, Men-Yen
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Shen, Jen-Hsiang
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Lin, Yen Bin
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Hsu, Wen-Wei
Buerger exercise can improve the peripheral circulation of lower extremities. However, the evidence and a quantitative assessment of skin perfusion immediately after this exercise in patients with diabetes feet are still rare. We recruited 30 patients with unilateral or bilateral diabetic ulcerated feet in Chang Gung Memorial Hospital, Chia-Yi Branch, from October 2012 to December 2013. Real-time dorsal foot skin perfusion pressures (SPPs) before and after Buerger exercise were measured and analyzed. In addition, the severity of ischemia and the presence of ulcers before exercise were also stratified. A total of 30 patients with a mean age of 63.4 +/- 13.7 years old were enrolled in this study. Their mean duration of diabetes was 13.6 +/- 8.2 years. Among them, 26 patients had unilateral and 4 patients had bilateral diabetes foot ulcers. Of the 34 wounded feet, 23 (68%) and 9 (27%) feet were classified as Wagner class II and III, respectively. The real-time SPP measurement indicated that Buerger exercise significantly increased the level of SPP by more than 10mmHg (n=46, 58.3 vs 70.0mmHg, P<0.001). In terms of pre-exercise dorsal foot circulation condition, the results showed that Buerger exercise increased the level of SPP in severe ischemia (n=5, 22.1 vs 37.3 mm Hg, P=0.043), moderate ischemia (n=14, 42.2 vs 64.4 mm Hg, P=0.001), and borderline-normal (n=7, 52.9 vs 65.4 mm Hg, P=0.028) groups, respectively. However, the 20 feet with SPP levels more than 60 mm Hg were not improved significantly after exercise (n=20, 58.3 vs 71.5 mm Hg, P=0.239). As to the presence of ulcers, Buerger exercise increased the level of SPP in either unwounded feet (n=12, 58.5 vs 66.0 mm Hg, P=0.012) or wounded feet (n=34, 58.3 vs 71.5 mm Hg, P<0.001). The majority of the ulcers was either completely healed (9/34=27%) or still improving (14/34=41%). This study quantitatively demonstrates the evidence of dorsal foot peripheral circulation improvement after Buerger exercise in patients with diabetes.
Combined vitamin C sonophoresis and neodymium-doped yttrium aluminum garnet (NdYAG) laser for facial hyperpigmentation: An outcome observation study in Asian patients
(2016-09-10)
Chen, Yu-Tsung
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Chang, Chang-Cheng
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Hsu, Cherng-Ru
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Shen, Jen-Hsiang
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Shih, Chao-Jen
Background: The neodymium-doped yttrium aluminum garnet (NdYAG) laser therapy has been a popular technique for facial rejuvenation but certain adverse effects like post-inflammatory hyperpigmentation are issues of concern to Asian patients. Aims: To assess the outcome following combined treatment with vitamin C sonophoresis and NdYAG laser, in selected cases of facial hyperpigmentation. Methods: Twenty three women with dyschromia or melasma who had undergone five sessions of Q-switched NdYAG laser therapy followed by transdermal delivery of vitamin C via sonophoresis were selected after a retrospective review of case records. The objective and subjective clinical outcomes and the side effects, including erythema, scaling, pruritus, dryness and post-inflammatory hyperpigmentation were evaluated. Results: In both objective or subjective outcomes, 91.3% (21/23) of the patients showed an excellent or better outcome, while 8.7% (2/23) showed no change. A majority of the patients (73.9%, 17/23) experienced no post-inflammatory hyperpigmentation or had slight post-inflammatory hyperpigmentation which quickly resolved within 1 week. Only one (4.3%) patient had extreme post-inflammatory hyperpigmentation which lasted for over a month. Limitations: This was a retrospective study without a control group; a comparative study with a control group (patients treated with the laser alone, without vitamin C sonopheresis) is needed to determine the difference in the outcome. Conclusion: The use of vitamin C sonophoresis along with NdYAG laser may reduce the incidence of adverse effects in Asian patients. Patients experienced obvious improvement in hyperpigmentation and had lower chances of experiencing extreme or severe post-inflammatory hyperpigmentation.
Efficacy and Safety Evaluation of Picosecond Alexandrite Laser with a Diffractive Lens Array for Treatment of Melasma in Asian Patients by VISIA Imaging System
(2019-09-01)
Chen, Yu-Tsung
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Lin, Erh-Ti
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Chang, Chang-Cheng
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Lin, Bor-Shyh
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Chiang, Hsiu-Mei
Objective: To evaluate the efficacy and safety of picosecond (ps) 755-nm alexandrite laser with a diffractive lens array (DLA) generating laser-induced optical breakdown, which may be beneficial for melasma treatment. Background: Melasma is notorious for difficult to treat with any modality setting. Recently, picosecond alexandrite laser with DLA seems promising for dealing with it without intolerable complications. Methods: Twenty (N = 20) Asian female melasma patients with Fitzpatrick skin type IV were recruited for 3 treatment sessions of picosecond 755-nm alexandrite laser with DLA at a 4- to 6-week interval. The pulse duration was 750 ps. An 8-mm spot size and the fluence of 0.4 J/cm(2) was used over the target area with 2 passes per treatment area and around 2000-2500 passes in total. The repetition rate was 10 Hz. Melasma Area and Severity Index (MASI) score and VISIA (R) imaging system analysis were utilized for evaluation before treatment and 4 weeks after the completion of the third treatment session. The clinical improvement and adverse events were assessed by the physicians and patients, respectively. Results: The median age of the patients was 45 years (from 27 to 55 years). In the physicians' evaluation, 40% (n = 8) of patients showed good improvement and 40% (n = 8) of patients showed moderate improvement. The mean MASI score before and after laser therapy showed significant improvement from 9.0 +/- 4.8 to 6.5 +/- 3.7 (p < 0.001). VISIA analysis of the forehead presented significant improvement in spots (p = 0.007) and porphyrins (p = 0.032). Some patients experienced erythema (25%), pruritus (20%), and scaling (20%) but subsided within few days of using emollients and sunscreen. Only 5% (n = 1) of patients developed mild postinflammatory hyperpigmentation, which also subsided in 3 weeks. Conclusions: Three sessions of picosecond 755-nm alexandrite laser with a DLA were effective for melasma treatment in Asian patients with minimal side effects.
Epidermal grafting for leukoderma resulting from 1064-nm quality-switched neodymium-doped yttrium aluminium garnet laser toning
(2018-12-01)
Wang, Yen-Jen
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Chang, Chang-Cheng
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影像與生醫光電研究所
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Institute of Imaging and Biomedical Photonics
Leukoderma secondary to Q-switched 1064-nm neodymium-doped yttrium aluminium garnet laser is usually refractory to treatment. The pathogenesis was cumulative phototoxic damage to melanocytes and eventually resulted in melanocytopenia. Wood's light or UV imaging can help observe early leukoderma before it becomes apparent clinically and determine the degree of melanocytopenia before conducting a biopsy. NB-UVB phototherapy and 308-nm excimer laser can potentially worsen the pre-existing melasma lesions and may not be effective if the lesions have already become melanocytopenic. Epidermal grafting can replenish the hypopigmented area with melanocytes without worsening melasma.
Quantitative Evaluation of Rehabilitation Effect on Peripheral Circulation of Diabetic Foot
(2018-07-01)
Huang, Yao-Kuang
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Chang, Chang-Cheng
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Lin, Pin-Xing
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Lin, Bor-Shyh
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影像與生醫光電研究所
Diabetes may cause different foot problems, which could easily lead to infection, ulcers, and increasing risk of amputation due to nerve or vascular injury. In order to reduce the risk of amputation, Buerger's exercise is frequently used for rehabilitation to improve the blood circulation in lower limbs. However, it is difficult to evaluate the rehabilitation efficiency with Buerger's exercise objectively. In this study, a novel non-invasively optical system is developed to non-invasively monitor the change of the foot blood circulation before and after long-term Buerger's exercise. Radial basis function neural network is also used for classifying the healthy and diabetic groups from the change of relative total hemoglobin (HbT) concentration and tissue oxygen saturation (StO2) and providing an index to evaluate the rehabilitation efficiency with Buerger's exercise. Finally, the experimental results show that the relative HbT concentration and StO2 in lower limbs corresponding to different groups are significantly different and could be used as the factors for the classification of healthy subjects and diabetic foot patients. Moreover, the tendency of the relative HbT concentration and StO2 rise after the long-term rehabilitation with Buerger's exercise.
Re: Epidermal skin grafting in vitiligo: a pilot study
(2017-12-01)
Cheng, Kun-Lin
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Chang, Chang-Cheng
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Wang, Yen-Jen
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影像與生醫光電研究所
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Institute of Imaging and Biomedical Photonics
Successful salvage for the intractable massive chylous leakage in a cirrhotic patient A case report and literature review
(2017-12-01)
Su, Chun-Lin
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Chang, Geng-He
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Fang, Ku-Hao
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Chang, Chang-Cheng
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影像與生醫光電研究所
Rationale: Iatrogenic chylous leakage(CL) is a rare but potentially life-threatening complication after neck surgery. In cirrhotic patient, the massive CL is even more intractable and extremely dangerous due to portal hypertension. Patients concerns: A 54-year-old liver cirrhotic patient had milky fluid leakage from left neck drainage tube after neck dissection surgery and hypopharyngeal cancer ablation. Electrolyte imbalance and shock status were reported when conservative managements and exploratory surgical repair failed to terminate the leakage. Diagnosis: Massive CL up to>5L/day was recorded on the post-operative day (POD) 9. Interventions: A triangular-shaped pectoralis major (PM) muscle was designed to repair the lymph nodes dissected defect over left neck. Outcomes: After surgery, CL dramatically reduced to less than 300mL/day in the coming day without relapses and terminated on the 8th days. After 3 months, the wound completely healed and the food conduit passage was patent without fistula. Lessons: This report demonstrated the superiority of pectoralis major myocutaneous flap (PMMF) than the conservative treatment, local muscle flap, and radiologic or thoracoscopic duct ligation in cirrhotic patient with massive CL.
The Application of Wireless Near Infrared Spectroscopy on Detecting Peripheral Circulation in Patients With Diabetes Foot Ulcer When Doing Buerger's Exercise
(2017-09-01)
Chen, Min-Ling
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Lin, Bor-Shyh
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Su, Cheng-Wei
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Lin, Yen-Bin
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Chen, Mei-Yen
Background and Objectives: The majority of patients with diabetes foot ulcer have peripheral arterial disease. The technique of near infrared spectroscopy (NIRS) used to monitor the dorsal foot blood circulation condition is by measuring the absorption differences between oxyhemoglobin and deoxy-hemoglobin. Study Designs/Materials and Methods: Patients with diabetic foot ulcer (DFU) treated in our wound care center were divided into two sub-groups based on the Duplex ultrasound or angiography. Patients with peripheral arterial disease (PAD) and non-peripheral arterial disease were divided into group A1 and A2, respectively. We applied wireless NIRS on patients' dorsal foot to assess the peripheral circulation by continuously detect the signal penetrating the tissue while patients were asked to do Buerger's exercise. The same procedure was also repeated on 15 healthy participants as control group B. Results: From January to August 2015, 30 patients with DFU (Group A) were enrolled in the study, 9 patients in Group A1 and 21 patients in Group A2. Tissue concentration of oxygenated hemoglobin (HbO2) in each group varied in a similar trend among five stages of Buerger's exercise. HbO2 concentration increases at post-exercise stages in all groups (P = 0.006 in Group A1, P = 0.223 in Group A2, P = 0.03 in Group B), however, there were significant difference in both pre-and postexercise stages (P = 0.001 and P = 0.01, respectively) between Group A and B. Moreover, significant differences (P = 0.0009) of HbO2 were also found between Group A1 and A2 in pre-exercise status, but no significant difference (P = 0.294) was found in postexercise status. Similar results were also found in total hemoglobin (Hb) concentration analyses. Conclusions: Buerger's exercise could increase peripheral HbO2 and totalHb circulation in patients with diabetes foot ulcer. The NIRS could continuously and quantitatively monitor real-time peripheral circulation inpostural changes and is novel to rehabilitation program. A larger scale study to prove the accuracy of NIRS system in detecting peripheral circulation could be worthwhile.(C) 2017 Wiley Periodicals, Inc.
The assessment of Buerger's exercise on dorsal foot skin circulation in patients with vasculopathic diabetic foot ulcer by using wireless near-infrared spectroscope: a cohort prospective study
(2018-07-01)
Lin, Bor-Shyh
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Chang, Chang-Cheng
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Su, Chun-Lin
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Li, Jhe-Ruei
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Chen, Min-Ling
The improvement of peripheral circulation is crucial for the care of vasculopathic diabetic foot ulcer (DFU). Near-infrared spectroscopy (NIRS) was used to investigate the effects of Buerger's exercise on dorsal foot skin circulation with novel technique of measuring the absorption difference in wavelength of light between oxy-hemoglobin (HbO(2)) and deoxy-hemoglobin (HbR). Patients with vasculopathic DFU who could tolerate Buerger's exercise three times a day at home for at least 8 weeks were enrolled (group A). They were divided into two subgroups: without previous percutaneous transluminal angioplasty (PTA) (group A1) vs. with previous PTA (group A2). Wireless NIRS were applied on patients' dorsal foot to assess the peripheral circulation in follow-up clinics. The patients' wound condition, follow-up time, and concentration of HbO(2) and total hemoglobin (HbT) before and after exercise rehabilitation program were documented. From May 2015 to February 2016, 14 patients with average age of 70.2 +/- 11.2 were enrolled in this study (group A), including eight without previous PTA (group A1), and six with previous PTA (group A2). The concentration of HbO2 and HbT were significantly increased after exercise rehabilitation program training in group A (p = 0.024 in HbO(2), p = 0.02 in HbT, n = 14) and group A2 (p = 0.021 in HbO(2), p = 0.028 in HbT, n = 6), while the concentration in group A1 were improved with borderline significance after exercise (p = 0.055 in HbO(2), p = 0.058 in HbT, n = 8). The majority of the ulcers were either completely healed (11/14 = 78.57%) or improving (3/14 = 21.43%). Buerger's exercise improved the peripheral circulation and wound condition in patients with vasculopathic DFU. The wireless apparatus is a novel and efficient tool to monitor rehabilitation program.
The Predictive Factors Associated With Comorbidities for Treatment Response in Outpatients With King Classification III Diabetes Foot Ulcers
(2018-12-01)
Su, Chun-Lin
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Chang, Chang-Cheng
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Peng, Yun-Shing
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Chen, Mei-Yen
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影像與生醫光電研究所
Objective: The aim of this study is to investigate the preexisting predictive factors associated with comorbidities for diabetic foot ulcer (DFU) in King classification III at an outpatient clinic. Method: This prospective study included 100 patients with DFU in King classification III treated at outpatient clinics in Chiayi Chang Gung Memorial Hospital from January 2011 to December 2011. The least follow-up time was 1 year. Medical documentations were in respect of patient's baseline characteristics, associated history, presence of comorbidities, follow-up time, and condition of wounds. Patients were divided into success group (healed or healing with wound reduction), stagnate group, and failure group (amputation or infection, need in-hospitalmedical service) in accordance with the treatment response of wounds. chi(2) Test, Fisher exact test, and 1-way analysis of variance were used for variables in 3-group comparison, whereas Student t test was applied in 2-group comparison. The predictive factors with P value less than 0.1 were further investigated using the model of univariate logistic regression. Results: With 3-group stratification according to treatment response-failure (n = 8), stagnate (n = 22), and success (n = 70)-the occurrence rate of retinopathy was higher in the treatment stagnate group (42.1%) than in the treatment failure (14.3%) and success groups (12.5%; P = 0.019); the rate of previous percutaneous transluminal angioplasty (PTA) history was higher in the treatment failure group (25%) than in the treatment stagnate (4.8%) and success groups (1.5%; P = 0.020). With 2-group stratification-failure (n = 8) versus nonfailure (n = 92), and success (n = 70) versus nonsuccess (n = 30)-PTA history was strongly associated with treatment failure (odds ratio [OR], 14.33; 95% confidence interval [CI], 1.71-120.32; P = 0.014), whereas retinopathy (OR, 0.21; 95% CI, 0.07-0.65; P = 0.006) was the major negative predictor for treatment success. Previous debridement met borderline significance to predict treatment nonsuccess (OR, 0.09; 95% CI, 0.01-1.01; P = 0.051). Sex, age, associated history, dyslipidemia, hypertension, coronary artery disease, cerebrovascular accident, chronic kidney disease, and end-stage renal disease and wound condition had no statistical significance. Conclusions: Previous PTA and retinopathy, which indicated preexisting severe vasculopathy, are univariate predictive factors for treatment failure and nonsuccess, respectively, in patients with King classification III DFU. With the subdivision of King classification III DFU, medical history taking and fundus examination are acceptable methods for risk screening at an outpatient clinic.
Using a Low Fluence Q-Switched 532/1064-nm Nd:YAG Laser for Facial Skin Depigmentation in Asian Patients Outcome and Complication Profile Analysis
(2016-08)
Shen, Jen-Hsiang
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Chang, Chang-Cheng
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Chen, Yu-Tsung
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Hsih, Chao-Jen
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Huang, Hsin
Background and Objectives: Low fluence Q-switched neodymium-doped yttrium aluminum garnet (Nd:YAG) lasers are widely applied for facial depigmentation. Nonetheless, few reports analyze the general outcome, complications, of single and combined therapy of 532/1064-nm Nd: YAG lasers in Asian patients with Fitzpatrick type IV skin. Study Design/Materials and Methods: We retrospectively reviewed all consecutive patients who completed 5 consecutive sessions at 1-month intervals of treatment with 1064-nm (spot size: 5-7 mm, 1.5-2.0 J/cm(2)) or combined with 532-nm (spot size, 2-3 mm; 0.5-1.5 J/cm(2)) Nd: YAG laser (Laseroptek, Korea) from October 2011 to March 2013. The patients, laser surgeon, and 3 blinded reviewers assessed the outcomes and complications. Improvement was graded as follows: 1, 0%-25%; 2, 26%-50%; 3, 51%-75%; 4, 76-90%; and 5, greater than 90%. Postinflammatory hyperpigmentation (PIH) was documented according to the severity (1, slight; 2, moderate; 3, severe; and 4, extreme). Other post-laser side effects were also documented (eg, scaling, dryness, erythema, and pruritus). Results: Four male patients and 37 female patients were included with a mean age of 38.5 years (SD, 10.1 years). There were no significant differences on patients\', surgeon\'s, or blinded reviewers\' improvement gradings. (4.11 +/- 0.62 vs 4.30 +/- 0.46, P = 0.54; 3.88 +/- 0.66 vs 3.89 +/- 0.31, P = 0.50; 3.30 +/- 0.69 vs 3.74 +/- 0.38, P = 0.34). Transient minor side effect occurred as follows: erythema in 9 (22%), pruritus in 7 (17%), dryness in 6 (15%), and scaling in 6 (15%). There was no risk difference in these side effects between groups. The PIH scores were slight in 10 patients (4 in single and 6 in combined), severe in 4 (3 in single and 1 in combined), and extreme in 1 (single therapy). The PIH incidence also did not differ (33.3%, 35.3%; P = 0.58). Conclusions: We reported satisfactory outcomes after low-fluence Q-switched sole 1064-nmor combined 532/1064-nm therapy. The outcome and complication profiles did not differ between the groups. The PIH incidence was not low, but usually transient. The incidence of severe or extreme PIH was rare.
Using Wireless Near-Infrared Spectroscopy to Predict Wound Prognosis in Diabetic Foot Ulcers
(2020-01-01)
Lin, Bor-Shyh
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Chang, Chang-Cheng
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Tseng, Yuan-Hsi
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Li, Jhe-Ruei
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Peng, Yun-Shing
OBJECTIVE: To use wearable near-infrared spectroscopy (NIRS) to determine the effect of Buerger exercises on diabetic foot ulcer (DFU) healing. METHODS: Study authors enrolled 50 consecutive patients in a 1-year prospective observational study of DFUs. The patients were divided into groups by their arterial statuses: group A (no peripheral arterial disease [PAD]), group B (PAD without angioplasty), and group C (PAD with angioplasty). Tissue perfusion was assessed through wireless wearable NIRS to determine the effects of Buerger exercises on wound healing. MAIN RESULTS: The patients in group C were older, were more likely to have had an amputation, and had more severe wounds than did the patients in other groups. The requirements of insulin injection for diabetes mellitus control differed significantly (P=.024) among the three groups. At the end of the survey, 19 patients (38%) had unhealed DFUs. The NIRS revealed that most nonhealed patients in groups B and C shared higher resting hemoglobin levels and tissue blood volume and lower tissue oxygen concentration, which indicated inflammation accompanied by higher blood flow and oxygen consumption. Notably, the nonhealed patients in group C showed paradoxically reduced hemoglobin and tissue blood volume after the exercises. CONCLUSIONS: Although DFUs remain a challenge to treat, NIRS may prove valuable in predicting wound healing by identifying risk factors for poor wound prognosis, such as reduced hemoglobin and tissue blood volume after exercise.
Wood's lamp for vitiligo disease stability and early recognition of initiative pigmentation after epidermal grafting
(2017-12-01)
Wang, Yen-Jen
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Chang, Chang-Cheng
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Cheng, Kun-Lin
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影像與生醫光電研究所
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Institute of Imaging and Biomedical Photonics
The prerequisite for a successful vitiligo epidermal grafting surgery is the stable status of the disease. We used Wood's lamp to assess vitiligo activity to determine the disease stability, surgical grafting timing and the early recognition of re-pigmentation after grafting. Amelanotic lesions with sharply demarcated borders are typically stable and are good candidates for grafting. The re-pigmentation was first recognised under Wood's lamp as hypochromic islands, which progressed to normally pigmented islands. For patients more prone to relapse, follow up with Wood's lamp also provides more accurate surveillance.