Browsing by Author "Wu, Han-Ping"

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An Initial Attack of Urinary Stone Disease Is Associated with an Increased Risk of Developing New-Onset Irritable Bowel Syndrome: Nationwide Population-Based Study
(2016-06-23)
Lei, Wei-Yuan
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Chang, Chih-Yu
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Wu, Jr-Hau
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Lin, Fei-Hung
;
Chen, Cheng Hsu
Background The neurotransmitter pathways in irritable bowel syndrome (IBS) and urinary stone attacks are both related to serotonin, and each disease may be influenced by viscero-visceral hyperalgesia. However, the relationship between urinary tract stone disease and IBS has never been addressed. We aimed to investigate the risk of suffering new-onset IBS after an initial urinary stone attack using a nationwide database. Methods A study group enrolled a total of 13,254 patients who were diagnosed with an initial urinary stone attack; a comparison group recruited 39,762 matched non-urinary stone participants during 2003 and 2007. We followed each patient for 3 years to determine new-onset IBS. We also used Cox proportional hazards models to analyze the risk of IBS between the study and comparison groups after modified by demographics, residence, patient characteristics and personal histories. Results The occurrence rates of IBS were 3.3% (n = 440) and 2.6% (n = 1,034) respectively in the study and comparison groups. A covariate-adjusted hazard ratio (HR) of IBS in the study group that was 1.28 times greater (HR = 1.29, 95% CI, 1.15-1.44) than that in the comparison group was showed in the stratified Cox proportional analysis. The adjusted HRs of IBS did not decrease after considering demographics and past histories. The majority of IBS (30.5%) occurred within the first 6 months after the stone attack. Conclusion Patients with an initial urinary stone attack are at increased risk of developing new-onset IBS. The HRs of IBS did not decrease even after adjusting for patient demographics and past histories. Most importantly, 30.5% of IBS occurred within the first 6 months after the urinary stone attack.
Clinical spectrum of rhabdomyolysis presented to pediatric emergency department
(2013-09-03)
Chen, Chun-Yu
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Lin, Yan-Ren
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Zhao, Lu-Lu
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Yang, Wen-Chieh
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Chang, Yu-Jun
Background: Rhabdomyolysis is a potentially life-threatening syndrome that can develop from a variety of causes. The aim of the work is to analyze the clinical spectrum and to evaluate the prevalence of various etiologies in children, who present to the emergency department (ED) with rhabdomyolysis. Methods: During a 6-year study period, we retrospectively analyzed the medical charts of patients, aged 18 years or younger, with a definite diagnosis of rhabdomyolysis and serum creatinine phosphokinase (CK) levels greater than 1000IU/L. We analyzed the clinical spectrum and evaluated the potential risk factors of acute renal failure (ARF). Results: Thirty-seven patients (mean age = 10.2 +/- 5.5 years), including 26 males and 11 females, were enrolled in the study. Two of the most common presented symptoms in these 37 patients were muscle pain and muscle weakness (83.8% and 73%, respectively). Dark urine was reported in only 5.4% of the patients. The leading cause of rhabdomyolysis in the 0- to 9-year age group was presumed infection, and the leading cause in the 10- to 18-year age group was trauma and exercise. The incidence of ARF associated with rhabdomyolysis was 8.1 % and no child needed for renal replacement therapy (RRT). We did not identify any reliable predictors of ARF or need for RRT. Conclusions: The classic triad of symptoms of rhabdomyolysis includes myalgia, weakness and dark urine are not always presented in children. The cause of rhabdomyolysis in younger age is different from that of teenager group. However, the prognosis of rhabdomyolysis was good with appropriate management.
Different urinalysis appearances in children with simple and perforated appendicitis
(2013-11-01)
Chen, Chun-Yu
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Zhao, Lu-Lu
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Lin, Yan-Ren
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Wu, Kang-Hsi
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Wu, Han-Ping
Purpose: This study aimed to determine whether routine urinalysis may serve as a tool in discriminating between acute appendicitis and perforated appendicitis in children. Basic procedures: We prospectively collected 357 patients with clinically suspected acute appendicitis. Urinalysis was performed in patients with clinically suspected acute appendicitis before surgical intervention. Routine urinalysis is composed of 2 examinations: chemical tests for abnormal chemical constituents and microscopic tests for abnormal insoluble constituents. Receiver operating characteristic curves for urine white blood cell (WBC) counts and urine red blood cell (RBC) counts in distinguishing between patients with simple appendicitis and patients with perforated appendicitis were also analyzed. Main findings: Urine ketone bodies, leukocyte esterase, specific gravity, pH, WBC, and RBC counts were all significant parameters among patients with normal appendices, simple appendicitis, and perforated appendicitis (all P < .05). Based on multivariate logistic regression analysis, positive urine ketone bodies and nitrate were significant parameters in predicting perforated appendicitis (P = .002 and P = .008, respectively). According to the results of receiver operating characteristic curves, the appropriate cutoff values were 2.0/high-power field for urine RBC counts and 4.0/high-power field for urine WBC counts in predicting perforated appendicitis in children. Principal conclusions: Routine urinalysis may serve to aid in discriminating between simple and perforated appendicitis. Clinically, we believe that these urine parameters may aid primary emergency physicians with decision making in patients with clinically suspected appendicitis. (C) 2013 Elsevier Inc. All rights reserved.
Early Administration of Glutamine Protects Cardiomyocytes from Post-Cardiac Arrest Acidosis
(2016-01-01)
Lin, Yan-Ren
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Li, Chao-Jui
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Syu, Shih-Han
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Wen, Cheng-Hao
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Buddhakosai, Waradee
Postcardiac arrest acidosis can decrease survival. Effective medications without adverse side effects are still not well characterized. We aimed to analyze whether early administration of glutamine could improve survival and protect cardiomyocytes from postcardiac arrest acidosis using animal and cell models. Forty Wistar rats with postcardiac arrest acidosis (blood pH < 7.2) were included. They were divided into study (500 mg/kg L-alanyl-L-glutamine, n = 20) and control (normal saline,n = 20) groups. Each of the rats received resuscitation. The outcomes were compared between the two groups. In addition, cardiomyocytes derived from human induced pluripotent stem cells were exposed to HBSS with different pH levels (7.3 or 6.5) or to culture medium (control). Apoptosis-related markers and beating function were analyzed. We found that the duration of survival was significantly longer in the study group (n < 0.05). In addition, in pH 6.5 or pH 7.3 HBSS buffer, the expression levels of cell stress (p53) and apoptosis (caspase-3, Bcl-xL) markers were significantly lower in cardiomyocytes treated with 50 mM L-glutamine than those without L-glutamine (RT-PCR). L-glutamine also increased the beating function of cardiomyocytes, especially at the lower pH level (6.5). More importantly, glutamine decreased cardiomyocyte apoptosis and increased these cells' beating function at a low pH level.
Epidemiology and outcome analysis of children with traumatic out-of-hospital cardiac arrest compared to nontraumatic cardiac arrest
(2013-05-01)
Chen, Chun-Yu
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Lin, Yan-Ren
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Zhao, Lu-Lu
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Wu, Yung-Kang
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Chang, Yu-Jun
This study aimed to determine predictive factors for sustained return of spontaneous circulation (ROSC) in pediatric patients with traumatic out-of-hospital cardiac arrest (OHCA) and compared to those with nontraumatic OHCA. This was a retrospective prognostic study of children with OHCA presenting to the emergency department (ED) was conducted from 2005 to 2010. Related clinical factors that influenced sustained ROSC in traumatic OHCA patients were identified and compared to nontraumatic cases. Significant parameters in predicting sustained ROSC in traumatic OHCA children were also determined using multivariate logistic regression analysis, and etiologies of the ICU admissions were analyzed in patients with sustained ROSC. Among 2,978 critically ill children admitted to the ED, 150 were pediatric OHCA patients, including 76 traumatic cases and 74 nontraumatic cases. Of children with OHCA, initial sustained ROSC was achieved in 51 cases (34.0 %), including 31 traumatic cases and 20 of nontraumatic cases. Head and neck injuries were the majority of traumatic cases in the traumatic OHCA children, followed by abdominal injuries and chest injuries. However, abdominal injuries accounted for the highest rate to gain sustained ROSC, while chest injuries had the lowest rate for successful sustained ROSC. Significant factors associated with sustained ROSC in traumatic OHCA included initial cardiac rhythm (P < 0.05), the period from scene to hospital (P < 0.05), and the duration of in-hospital cardiopulmonary resuscitation (CPR) (P < 0.05). Significant factors related to sustained ROSC have been identified as initial cardiac rhythm, duration of in-hospital CPR, and the period from scene to hospital. Head and neck injuries were the majority of traumatic cases and the prevention in head and neck trauma may play an important part in public health aspects.
Increased risk of major depression subsequent to a first-attack and non-infection caused urticaria in adolescence: a nationwide population-based study
(2014-07-11)
Kuo, Chia-Lun
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Chen, Chi-Yen
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Huang, Hui-Ling
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Chen, Wen-Liang
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Lee, Hua-Chin
Background: Non-infection caused urticaria is a common ailment in adolescents. Its symptoms (e.g., unusual rash appearance, limitation of daily activities, and recurrent itching) may contribute to the development of depressive stress in adolescents; the potential link has not been well studied. This study aimed to investigate the risk of major depression after a first-attack and non-infection caused urticaria. Methods: This study used the Taiwan Longitudinal Health Insurance Database. A total of 5,755 adolescents hospitalized for a first-attack and non-infection caused urticaria from 2005 to 2009 were recruited as the study group, together with 17,265 matched non-urticarial enrollees who comprised the control group. Patients who had any history of urticaria or depression prior to the evaluation period were excluded. Each patient was followed for one year to identify the occurrence of depression. Cox proportional hazards models were generated to compute the risk of major depression, adjusting for the subjects\' sociodemographic characteristics. Depression-free survival curves were also analyzed. Results: Thirty-four (0.6%) adolescents with non-infection caused urticaria and 59 (0.3%) non-urticarial control subjects suffered a new-onset episode of major depression during the study period. The stratified Cox proportional analysis showed that the crude hazard ratio (HR) of depression among adolescents with urticaria was 1.73 times (95% CI, 1.13-2.64) than that of the control subjects without urticaria. Moreover, the HR were higher in physical (HR: 3.39, 95% CI 2.77-11.52) and allergy chronic urticaria (HR: 2.43, 95% CI 3.18-9.78). Conclusion: Individuals who have a non-infection caused urticaria during adolescence are at a higher risk of developing major depression.
Pharmaceutical Poisoning Exposure and Outcome Analysis in Children Admitted to the Pediatric Emergency Department
(2011-02-01)
Lin, Yan-Ren
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Liu, Tzu-Hsuan
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Liu, Tzu-An
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Chang, Yu-Jun
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Chou, Chu-Chung
Background: Pharmaceuticals involved in childhood poisoning vary, and treatment of poison exposure can be a challenge for primary physicians when children are unconscious or histories are lacking. Knowledge of the clinical manifestations and prognosis of poisoning will help primary physicians perform appropriate clinical assessments. In this study, we aim to report on patient characteristics, outcomes, and clinical features of pediatric poisoning in the emergency department. Methods: We retrospectively evaluated the medical records of 87 children younger than 18 years of age and presented to the emergency department with pharmaceutical poisoning (2001-2008). The detailed categories of pharmaceutical were reported, and their associations with patient outcomes were analyzed. Furthermore, children were divided into two groups, based on the reasons for poison exposure (accidental or intentional poisoning). Clinical features and outcomes between accidental or intentional poisoning were analyzed, and the cut-off age for high risk of intentional poisoning was also calculated. Results: Age groups of adolescents (48.3%) and preschool age (32.2%) children were the major representation. Neurologic system agents (48.3%) and analgesics (18.4%) were the most common causes of poisoning. Among the two major agents above, anxiolytic/hypnotic drugs (lorazepam) and acetaminophen were the most frequent causes. Of all children, 70.1% had duration of major symptoms for <= 1 day, and intentional poisoning caused significantly longer duration of hospital stay than accidental poisoning did (p = 0.008). Moreover, female gender (p < 0.001), older age (p < 0.001), and analgesics (p = 0.008) were more predominantly associated with intentional poisoning in children, and the cut-off age for high risk of intentional poisoning was over 10.5 years. Conclusion: Neurologic system agents and analgesics were responsible for the majority of cases. Intentional poisoning caused longer hospital length of stay than accidental poisoning, and the factors associated with intentional poisoning were older age, female, and neurologic system agents. Copyright (C) 2011, Taiwan Pediatric Association. Published by Elsevier Taiwan LLC. All rights reserved.
Poison exposure and outcome of children admitted to a pediatric emergency department
(2011-05-01)
Lin, Yan-Ren
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Wu, Tung-Kung
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Liu, Tzu-An
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Chou, Chu-Chung
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Wu, Han-Ping
Background: This paper reports the characteristics, outcomes and clinical features of children with poisoning treated at an emergency department (ED). Methods: This retrospective study at an emergency department consisted of 140 children with poison exposure who were aged under 18 years. Their characteristics were analyzed in order to understand the differences between accidental and non-accidental poisoning. The poisonous materials were divided into two major categories (pharmaceuticals and non-pharmaceuticals) and their associations with patient outcomes were analyzed. Furthermore, the association was analyzed between the incidence of poison exposure and the season in which the poison exposure occurred. Results: The incidence of poison exposure was highest among adolescents and pre-school age children. Non-accidental poisoning was more common in older girls and accidental poisoning was more common in younger boys (P < 0.001). Neurological system agents were the most common cause of poisoning in the pharmaceutical group and cleansing products were the most common cause of poisoning in the non-pharmaceutical group. Neurological and gastrointestinal symptoms were the most common clinical presentations for the pharmaceutical and non-pharmaceutical groups, respectively. Furthermore, poisoning due to cleansing products and analgesics were associated with the longest duration of hospitalization. March was the highest risk month for pediatric poisoning (P=0.018). Conclusions: Cleansing products and analgesics were associated with the longest duration of hospitalization and intentional poison was more common in girls. World J Pediatr 2011;7(2):143-149
Predictive factors of the duration of a first-attack acute urticaria in children
(2011-10-01)
Lin, Yan-Ren
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Liu, Tzu-Hsuan
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Wu, Tung-Kung
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Chang, Yu-Jun
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Chou, Chu-Chung
Purposes: This study's aim was to determine the predictive factors of the duration of first-attack acute urticaria in children. Basic Procedures: The sample included 1075 children admitted to the emergency department with first-attack acute urticaria. Variables comprising the clinical features and past histories of children with duration of disease of 3 days or less, 4 to 7 days, 8 to 14 days, and 15 days or more were compared to determine the predictors of duration of acute urticaria. Main Findings: Age, various etiologies, clinical presentations, coexistent pyrexia or angioedema, and personal histories of allergic diseases were significant factors (all P < .05). Among allergic diseases, atopic dermatitis was the most significant predictor of duration of acute urticaria, and those with multiple allergic diseases had longer durations of urticaria (both P < .05). Oral plus injection forms of antihistamine or steroid were related to shorter duration of disease (P < .05). Principal Conclusions: Etiologies and personal allergy history may be the most important predictors of the duration of a first attack of acute urticaria. (C) 2011 Elsevier Inc. All rights reserved.
Predictors of survival and neurologic outcomes in children with traumatic out-of-hospital cardiac arrest during the early postresuscitative period
(2013-09-01)
Lin, Yan-Ren
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Wu, Han-Ping
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Chen, Wen-Liang
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Wu, Kuan-Han
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Teng, Tsung-Han
BACKGROUND: The outcome of children with traumatic out-of-hospital cardiac arrest (OHCA) is poor, and the information regarding survival in the postresuscitative period is limited. The aim of this study was to determine the clinical features during the early postresuscitative period that may predict survival or neurologic outcomes in children with traumatic OHCA. METHODS: Information on 362 children (<19 years) who presented to the emergency departments of three medical centers and experienced traumatic OHCA during the study period (January 2003 to December 2010) were retrospectively included. The postresuscitative clinical features during the early postresuscitative period, defined as the first hour after achieving sustained return of spontaneous circulation, which correlated with survival and neurologic outcomes were analyzed. RESULTS: Among 152 children (42%) who achieved sustained return of spontaneous circulation, 34 (9.4%) survived to discharge, and 11 (3%) had good neurologic outcomes (Pediatric Cerebral Performance Category Scale, 1 or 2). Early postresuscitative clinical features, which reflected initial cardiac output and end-organ perfusion, can predict the chance of survival. Such features included the following: high or normal blood pressure, normal heart rate, sinus rhythm, urine output of more than 1 mL/kg per hour, and noncyanotic skin color (all p < 0.05). Initial Glasgow Coma Scale (GCS) score of greater than 7 predicted a good neurologic outcome in survivors (p = 0.008). CONCLUSION: Predictors of survival were high or normal blood pressure, normal heart rate, sinus rhythm, urine output of more than 1 mL/kg per hour, and noncyanotic skin color. Most importantly, initial GCS score of greater than 7 predicted a good neurologic outcome in survivors. (Copyright (C) 2013 by Lippincott Williams & Wilkins)
Significant factors associated with severity and outcome of an initial episode of acute urticaria in children
(2010-11-01)
Liu, Tzu-Hsuan
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Lin, Yan-Ren
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Yang, Kuo-Chia
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Tsai, Yi-Giien
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Fu, Yun-Ching
The aim of this study was to determine the predictive factors of severity and duration of an initial episode of acute urticaria in children. This was a retrospective study of 1120 children of < 18 yr who presented to the emergency department (ED) with an initial episode of acute urticaria during the period January 1, 2001, to December 31, 2007. These patients were followed in the ED or outpatient department (OPD) until their symptoms subsided. Variables comprising mild, moderate, and severe urticaria were compared to determine the predictors of severity. The relationships between duration of urticaria and clinical features, including physician-diagnosed causes and treatment modalities, were also analyzed. Significant predictive factors of severity of an initial episode of acute urticaria in children included age, physician-diagnosed causes of urticaria, clinical presentation, coexistent pyrexia or angioedema, and personal allergic history (all p < 0.001). The duration of urticaria was dependent on the physician-diagnosed causes and treatment. Inhalants and unknown causes were predictive of longer duration, while contact materials were associated with shorter duration of urticaria (p < 0.001). Combination treatment comprising an oral plus injectable form of antihistamine or corticosteroid significantly shortened the duration of urticaria compared to single treatment (p < 0.001), especially in children receiving short-term aggressive treatment in the pediatric observation unit (POU) of the ED.
The Post-Resuscitative Urinalysis Associate the Survival of Patients with Non-Traumatic Out-of-Hospital Cardiac Arrest
(2013-10-04)
Chang, Chin-Fu
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Li, Chao-Jui
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Ko, Chih-Jan
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Teng, Tsung-Han
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Lai, Shih-Chang
Objective: To analyze whether urine output and urinalysis results are predictive of survival and neurologic outcomes in patients with non-traumatic out-of-hospital cardiac arrest (OHCA). Methods: Information was obtained from 1,340 patients with non-traumatic OHCA who had achieved a sustained return of spontaneous circulation (ROSC). Factors that were associated with survival in the post-resuscitative period were evaluated. The association between urine output and fluid challenge in the early resuscitative period was analyzed and compared between the survivors and the non-survivors. The results of the initial urinalysis, including the presence of proteinuria and other findings, were used to evaluate the severity of vascular protein leakage and survival. The association between proteinuria and the neurologic outcomes of the survivors was also analyzed. The clinical features of capillary leakage were examined during the post-resuscitative period. Results: Of the 1,340 patients, 312 survived. A greater urine output was associated with a higher chance of survival. The initial urine output increased in proportion to the amount of fluid that was administered during early resuscitation in the emergency department for the survivors but not for the non-survivors (p<0.05). In the initial urinalysis, proteinuria was strongly associated with survival, and severe proteinuria indicated significantly poorer neurologic outcomes (p<0.05 for both comparisons). Proteinuria was associated with a risk of developing signs of capillary leakage, including body mass index gain and pitting edema (both p<0.001). Conclusion: The severity of proteinuria during the early post-resuscitative period was predictive of survival.
Use High-Flow Nasal Cannula for Acute Respiratory Failure Patients in the Emergency Department: A Meta-Analysis Study
(2019-10-13)
Huang, Cheng-Chieh
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Lan, Hao-Min
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Li, Chao-Jui
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Lee, Tsung-Han
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Chen, Wen-Liang
Objective. To evaluate the efficacy of high-flow nasal cannula (HFNC) therapy compared with conventional oxygen therapy (COT) or noninvasive ventilation (NIV) for the treatment of acute respiratory failure (ARF) in emergency departments (EDs). Method. We comprehensively searched 3 databases (PubMed, EMBASE, and the Cochrane Library) for articles published from database inception to 12 July 2019. This study included only randomized controlled trials (RCTs) that were conducted in EDs and compared HFNC therapy with COT or NIV. The primary outcome was the intubation rate. The secondary outcomes were the mortality rate, intensive care unit (ICU) admission rate, ED discharge rate, need for escalation, length of ED stay, length of hospital stay, and patient dyspnea and comfort scores. Result. Five RCTs (n = 775) were included. There was a decreasing trend regarding the application of HFNC therapy and the intubation rate, but the difference was not statistically significant (RR, 0.53; 95% CI, 0.26-1.09; p=0.08; I-2 = 0%). We found that compared with patients who underwent COT, those who underwent HFNC therapy had a reduced need for escalation (RR, 0.41; 95% CI, 0.22-0.78; p=0.006; I-2 = 0%), reduced dyspnea scores (MD -0.82, 95% CI -1.45 to -0.18), and improved comfort (SMD -0.76 SD, 95% CI -1.01 to -0.51). Compared with the COT group, the HFNC therapy group had a similar mortality rate (RR, 1.25; 95% CI, 0.79-1.99; p=0.34; I-2 = 0%), ICU admission rate (RR, 1.11; 95% CI, 0.58-2.12; p=0.76; I-2 = 0%), ED discharge rate (RR, 1.04; 95% CI, 0.63-1.72; p=0.87; I-2 = 0%), length of ED stay (MD 1.66, 95% CI -0.95 to 4.27), and hospital stay (MD 0.9, 95% CI -2.06 to 3.87). Conclusion. Administering HFNC therapy in ARF patients in EDs might decrease the intubation rate compared with COT. In addition, it can decrease the need for escalation, decrease the patient's dyspnea level, and increase the patient's comfort level compared with COT.