Browsing by Author "Yang, Ten-Fang"

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A Meta-analysis of the Evidence for Assisted Therapy with Platelet-Rich Plasma for Atrophic Acne Scars
(2019-12-01)
Hsieh, Tyng-Shiuan
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Chiu, Wen-Kuan
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Yang, Ten-Fang
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Wang, Hsian-Jenn
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Chen, Chiehfeng
Background A number of studies have investigated the role of platelet-rich plasma (PRP) as an assisted therapy for atrophic acne scars. However, the results are diverse, and no up-to-date meta-analysis was found that exclusively examined atrophic acne scar treatment. Objectives To perform a meta-analysis to assess improvements in the side effects of PRP and the effect of assisted therapy for atrophic acne scars. Methods This study followed PRISMA guidelines. A comprehensive search of the literature was carried out in September 2018 using the electronic databases of PubMed, EMBASE, MEDLINE, and the Cochrane Library. Results Seven articles were included in this review. All of the studies published utilized PRP as additive therapy. The major therapies included fractional carbon laser therapy and microneedling. Five studies (249 participants) reported four degrees of improvement on an improvement scale (degrees 3 and 4 were considered improvement in this analysis). Four studies (200 participants) reported mean improvement scores. A significantly higher degree of improvement was shown in the PRP group compared to the control group (OR = 8.19; 95% CI 4.32-15.52; p < 0.00001), as well as better mean improvement score (WMD = 23.73; 95% CI 18.60-28.87; p < 0.00001). Substantial heterogeneity was seen in the degree of improvement (I-2 = 54% p = 0.07) and the mean improvement score (I-2 = 75%; p = 0.008). There were overall fewer monitored side effects, including erythema and edema (in days), in the PRP groups; however, no significance was found. Conclusions This review shows that PRP is a useful assisted therapy for atrophic acne scars, which can achieve better improvement.
Assessment of Outcomes of a Metatarsal Bone Ostectomy for Chronic Plantar Ulcers A Preliminary Study
(2020-01-01)
Chiu, Wen-Kuan
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Yang, Ten-Fang
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Wang, Hsian-Jenn
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Chen, Chiehfeng
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生物科技學系
Background Clinical management of chronic plantar ulcers is a difficult issue in medical practice. Pressure overloading is a problem that needs to be resolved. Herein, we report a surgical method to reduce plantar pressure: a dorsal approach to a metatarsal ostectomy. Methods From March 2011 to October 2016, 16 patients suffering from chronic plantar ulcers underwent ostectomy procedures at Taipei Wan-Fang Municipal Hospital (Taipei Medical University). A bone segment about 0.5 to 1 cm long was removed via a dorsal foot approach. The plantar wound was treated with debridement only or was simultaneously covered with a skin graft. In total, 16 patients with an average age of 57.81 (SD, 11.6) years (12 males and 4 females) were included; 15 patients (93.75%) had a diagnosis of type 2 diabetes for a mean of 20.66 years (range, 5-30 years). The mean glycated hemoglobin was 9.14 g/dL (range, 5.2-13.2 g/dL). The mean plantar wound size was 5.72 cm(2). Four patients (25%) needed to receive a skin graft with a mean skin graft size of 8.13 cm(2). Results The mean follow-up time was 15.2 months. The plantar wounds completely healed in 14 patients (87.5%) in an average of 2.14 months. No plantar ulcer was complicated with recurrence, but transfer ulcers developed in 2 patients (12.5%) at an average of 7.5 months postoperatively. Conclusions Metatarsal ostectomy surgery via a dorsal foot approach is an efficient way to reduce pressure overloading of chronic plantar wounds. Our study provides an alternative method to treat this difficult problem with a high wound healing rate and less recurrence.
Clinical outcomes of infrarenal abdominal aortic aneurysms that underwent endovascular repair in a district general hospital
(2016-07)
Lee, Chih-Hsien
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Chang, Chien-Jung
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Huang, Jau-Kang
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Yang, Ten-Fang
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生物科技學系
Background: The purpose of this study was to compare the outcomes of elective endovascular abdominal aortic aneurysm repair (EVAR) and ruptured abdominal aortic aneurysm (rAAA) in patients at a district general hospital. Methods: A retrospective clinical study was conducted using data on 16 patients with elective abdominal aortic aneurysm (AAA) and nine patients with consecutive rAAA treated with EVAR from January 2010 to December 2014 in a district general hospital in Taiwan. Results: The preoperative characteristics of the two groups are listed. Thirty-six percent (9/25) of the patients were referred from other hospitals that did not offer surgical services. The percentage of patients with rAAA that were transferred from other hospitals was 55.5% (5/9). The stay durations in the intensive care unit for elective EVAR cases were shorter than those for emergent EVAR (1.75 +/- 1 d elective vs. 10 +/- 13.37 d emergent; P<0.019). The hospitalization days (11.06 +/- 4.07 d elective vs. 21.89 +/- 18.36 d emergent; P<0.031), operative time (183.63 +/- 57.24 min elective vs. 227.11 +/- 59.92 min emergent; P<0.009), and blood loss volumes (115.63 +/- 80.41 mL elective vs. 422.22 +/- 276.26 mL emergent; P<0.005) are shown; statistics for use of Perclose ProGlide (R) (7 cases elective vs. 0 case emergent; P<0.024) are compared. The overall 30-d mortality rate was 11.11% (1/9). Conclusions: The results confirm that EVAR surgery can be safely performed in a district general hospital with an integrated health care system. Using Perclose ProGlide (R) for selected cases may reduce blood loss and operative time.
Effect of Statin Therapy on Mortality in Patients With Infective Endocarditis
(2014-07-01)
Yang, Ten-Fang
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Chu, Hsi
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Ou, Shuo-Ming
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Li, Szu-Yuan
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Chen, Yung-Tai
The aim of our study was to determine whether pre-emptive statin therapy was associated with improved outcome of infective endocarditis (IE). We conducted a nationwide, population-based, propensity score-matched cohort study with the Taiwan\'s National Health Insurance Research Database. All patients with IE between January 2000 and December 2010 were enrolled. The primary outcome was in-hospital mortality. The secondary outcome included all-cause mortality within the first 3 months, 6 months, and one year after the diagnosis of IE. Among 13,584 patients with IE, we applied propensity score-matching on a 1:4 ratio, in which 370 statin users were matched to 1,480 statin non-users. Compared with statin non-users, statin users had a significantly lower risk of in-hospital mortality (adjusted hazard ratio [aHR] 0.65, 95% confidence interval [CI], 0.49-0.86). The reduction in mortality from IE remained significant for follow-up 3 months (aHR 0.68,95% CI, 0.53-0.88), 6 months (aHR 0.73,95% CI, 0.58-0.91), and 12 months (AIR 0.68,95% CI, 0.55-0.84). Statin therapy was associated with a reduced risk of ICU admission rates, shock events, the need for mechanical ventilation, but not significantly with the need for heart valvular replacement surgery. In conclusion, our study found that statin therapy is associated with a reduced risk of in-hospital and subsequent mortality of IE. (C) 2014 Elsevier Inc. All rights reserved.
Experience of endovascular repair of thoracic aortic dissection after blunt trauma injury in a district general hospital
(2016-06)
Lee, Chih-Hsien
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Huang, Jau-Kang
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Yang, Ten-Fang
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生物科技學系
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Department of Biological Science and Technology
Background: Traumatic thoracic aortic dissection is uncommon in clinical practice; however, it is associated with high morbidity and mortality. Thoracic aortic dissection is usually caused by sudden deceleration resulting from a traffic accident or fall. Aortic injury after blunt trauma is a critical condition. This study reported the outcomes of endovascular repair of acute traumatic aortic dissection in patients at a district general hospital. Methods: In this study, we retrospectively reviewed the clinical data of eight patients with acute traumatic aortic dissection after a blunt trauma who had undergone thoracic endovascular aortic repair (TEVAR) between January 2012 and December 2015 at a district general hospital in Taiwan. Results: The median age of the patients was 49 +/- 22 years (range, 20-77 years), and 6 of the 8 (75%) patients were men. Five patients were involved in traffic accidents, and 3 patients had fallen from heights. The injury severity score (ISS) of the patients ranged from 17 to 66. In all patients, the aortic injury was located near the origin of the left subclavian artery (LSA). Four patients had seal ostium of subclavian artery, left. None of the patients developed paraplegia or lower extremity ischemia. Moreover, all patients had concomitant injuries, and no patients died postoperatively. Conclusions: Endovascular repair is a rapid and minimally invasive therapy for patients with traumatic aortic injury and is associated with favorable technical results.
Intra-substance steroid injection for full-thickness supraspinatus tendon rupture
(2019-11-27)
Liu, Chung-Ting
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Yang, Ten-Fang
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交大名義發表
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生物科技學院
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National Chiao Tung University
Background The use of steroid injection for treatment of a full-thickness rotator cuff tear is still controversial. This study aimed to evaluate the effectiveness and safety of this treatment method. Methods Twelve patients in Group 1 received an intra-substance injection into rupture area of supraspinatus tendon with Diprospan 1 cc (betamethasone disodium phosphate 2 mg and betamethasone dipropionate 5 mg) and 1% xylocaine 1 cc. Twelve patients in Group 2 received an injection with normal saline 1 cc and 1% xylocaine 1 cc. The rupture size was measured by sonography before the injection, 3 months after the injection, and 6 months after the injection. Shoulder Pain and Disability Index (SPADI) score and Pain Visual Analogue Scale (VAS) score were measured and compared between the two groups before the injection, 1 week after the injection, 3 months after the injection, and 6 months after the injection. Results Pain and function improved more in Group 1 than in Group 2. The therapeutic effect lasted for at least 6 months in both groups. The size of the supraspinatus tendon rupture was not increased after injection in either group. Conclusions Intra-substance injection into rupture area of supraspinatus tendon with steroid and xylocaine is effective to reduce pain and improve function in patients with full-thickness supraspinatus tendon rupture without increasing the size of the rupture.
Is sequential free flap safe in oral cancer reconstruction in the same patient? An outcome and complication analysis
(2020-02-01)
Chiu, Wen-Kuan
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Chou, Chang-Yi
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Chen, Shyi-Gen
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Chen, Chiehfeng
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Wang, Hsian-Jenn
Background Sequential free flap reconstruction in patient with head and neck cancer can provide reliable and effective wound coverage. Only a few studies have reported on the outcome and complications analysis but without consensus on the recipient vessels and flap chosen. Herein, we presented the outcome and analysed the risk factors for complications in sequential free flap reconstruction. Patients and methods Patients who had sequential free tissue transfers due to cancer recurrence, second primary cancer, or secondary correction of the soft tissue contractures and volume deficits were all included. Variables extracted included demographics, comorbidities, free flap characteristics, infection, dehiscence and flap necrosis rates. Results In total, 40 patients with 92 free flaps were analyzed; 42 initial and 50 sequential free flaps. The most common recipient vessels for sequential flap were contralateral superficial thyroid vessels (68%). The most common flap for both initial and sequential free flap was anterolateral thigh flap (64.3 and 62%). The success rate of sequential free flap was 92.0 compared to 92.9% for initial free flap, which showed no significant difference. Female was independently associated with delayed wound healing with an odds ratio of 90.91 (95% confidence interval 0.001-0.17, P = 0.001), as well as diabetes with an odds ratio of 31.14 (95% confidence interval 2.60-373.19, P = 0.007). Sequential free flap was not a risk factor for any complication. Conclusions Sequential free flap is a reliable method for head and neck surgery without more complication rate comparing to initial free flap reconstruction. More attentions should be paid on patients with preferential risk for certain complications.
Lifting of epiglottis superior to preloaded bougie technique when only the epiglottis is visible: a randomized, cross-over simulated mannequin study
(2020-04-01)
Hung, Tzu-Yao
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Lin, Chieh-Hung
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Lin, Li-Wei
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Yeh, Yu-Hang
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Chen, Wei-Lun
Posture and Gender Differentially Affect Heart Rate Variability of Symptomatic Mitral Valve Prolapse and Normal Adults
(2016-07)
Chang, Chien-Jung
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Chen, Ya-Chu
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Lee, Chih-Hsien
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Yang, Ing-Fang
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Yang, Ten-Fang
Background: Heart rate variability (HRV) has been shown to be a useful measure of autonomic activity in healthy and mitral valve prolapsed (MVP) subjects. However, the effects of posture and gender on HRV in symptomatic MVP and normal adults had not been elucidated in Taiwan. Methods: A total of 118 MVP patients (7 males, 39 +/- 7 years old; and 111 females, 42 +/- 13 years old) and 148 healthy control (54 males, 28 +/- 4 years old; and 94 females, 26 +/- 6 years old) were investigated. The diagnosis of MVP was confirmed by cross-sectional echocardiography. A locally developed Taiwanese machine was used to record the HRV parameters for MVP and control groups in three stationary positions. Thereafter, the HRV time-domain parameters, and the frequency-domain parameters derived from fast Fourier transform or autoregressive methods were analyzed. Results: The MVP group showed a decrease in time domain parameters and obtunded postural effects on frequency domain parameters moreso than the control group. Though the parasympathetic tone was dominant in female (higher RMSSD, nHF and lower nLF vs. male), the sympathetic outflow was higher in MVP female (lower SDNN, NN50 and higher nLF vs. normal female). While the parasympathetic activity was lower in male, sympathetic outflow was dominant in MVP male (lower nHF and higher nLF vs. normal male). Conclusions: Both MVP female and male subjects had elevated levels of sympathetic outflow. The obtunded postural effects on frequency domain measures testified to the autonomic dysregulation of MVP subjects.
Pulsatile flows and wall-shear stresses in models simulating normal and stenosed aortic arches
(2010-03-01)
Huang, Rong Fung
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Yang, Ten-Fang
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Lan, Y. -K.
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生物科技學系
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Department of Biological Science and Technology
Pulsatile aqueous glycerol solution flows in the models simulating normal and stenosed human aortic arches are measured by means of particle image velocimetry. Three transparent models were used: normal, 25% stenosed, and 50% stenosed aortic arches. The Womersley parameter, Dean number, and time-averaged Reynolds number are 17.31, 725, and 1,081, respectively. The Reynolds numbers based on the peak velocities of the normal, 25% stenosed, and 50% stenosed aortic arches are 2,484, 3,456, and 3,931, respectively. The study presents the temporal/spatial evolution processes of the flow pattern, velocity distribution, and wall-shear stress during the systolic and diastolic phases. It is found that the flow pattern evolving in the central plane of normal and stenosed aortic arches exhibits (1) a separation bubble around the inner arch, (2) a recirculation vortex around the outer arch wall upstream of the junction of the brachiocephalic artery, (3) an accelerated main stream around the outer arch wall near the junctions of the left carotid and the left subclavian arteries, and (4) the vortices around the entrances of the three main branches. The study identifies and discusses the reasons for the flow physics' contribution to the formation of these features. The oscillating wall-shear stress distributions are closely related to the featured flow structures. On the outer wall of normal and slightly stenosed aortas, large wall-shear stresses appear in the regions upstream of the junction of the brachiocephalic artery as well as the corner near the junctions of the left carotid artery and the left subclavian artery. On the inner wall, the largest wall-shear stress appears in the region where the boundary layer separates.
Selective and non-selective non-steroidal anti-inflammatory drugs differentially regulate pulmonary vein and atrial arrhythmogenesis
(2015-04-01)
Chang, Chien-Jung
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Cheng, Chen-Chuan
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Yang, Ten-Fang
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Chen, Yao-Chang
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Lin, Yung-Kuo
Background: Non-steroidal anti-inflammatory drugs (NSAIDs) increase the risk of atrial fibrillation (AF). This study investigated whether selective and non-selective NSAIDs differentially regulate the arrhythmogenesis of pulmonary veins and atria. Methods: Conventional microelectrodes were used to record action potentials (APs) in isolated rabbit PVs, sinoatrial node (SAN), left atrium (LA), and right atrium (RA) preparations before and after celecoxib or indomethacin administration. A whole-cell patch clamp was used to record the sodium-calcium exchanger (NCX) current, L-type calcium current (ICa-L), and late sodium current (INa-late) before and after celecoxib administration in isolated PV cardiomyocytes. Results: Celecoxib (0.3, 1, and 3 mu M) reduced PV spontaneous beating rates, and induced delayed afterdepolarizations and burst firings in four of eight PV preparations (50%, p < 0.05). Celecoxib also reduced SAN beating rates and decreased AP durations (APDs) in RA and LA, but did not change the resting membrane potential. Indomethacin (0.3, 1, 3, and 10 mu M) changed neither the PV or SAN beating rates nor RA APDs, but it reduced LA APDs. Celecoxib (3 mu M) significantly increased the NCX current and decreased the ICa-L, but did not change the INa-late. Ranolazine (10 mu M) suppressed celecoxib (3 mu M)-induced PV burst firings in 6 (86%, p < 0.05) of 7 PVs. KB-R7943 (10 mu M) suppressed celecoxib (3 mu M)-induced PV burst firings in 5 (71%, p < 0.05) of 7 PVs. Conclusions: Selective and non-selective NSAIDs differentially modulate PV and atrial electrophysiological characteristics. Celecoxib increased PV triggered activity through enhancement of the NCX current, which contributed to its arrhythmogenesis. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
Sitagliptin Modulates the Electrical and Mechanical Characteristics of Pulmonary Vein and Atrium
(2014-01-01)
Chang, Chien-Jung
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Yang, Ten-Fang
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Lee, Tin-I
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Chen, Yao-Chang
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Kao, Yu-Hsun
Background:The pulmonary veins (PVs) and atria are important foci during that period when atrial fibrillation (AF) is generated and maintained. It is well understood that hypertension and diabetes mellitus (DM) are important risk factors for AF. Dipeptidyl peptidase-IV (DPP-4) inhibitors are new agents in the fight against type 2 DM, though they have been found to have several cardiovascular effects. However, it is not clear whether DPP-4 may modulate the electrical and mechanical characteristics in hypertensive atrium or PVs. Methods: Conventional microelectrodes were used to record the action potentials (APs) in isolated PVs, right atrium (RA), and left atrium (LA) in Wistar-Kyoto rats (WKY) and spontaneously hypertensive rats (SHR) with or without sitagliptin (10 mg/kg) for 4 weeks. Results: WKY (n = 5), SHR (n =7), sitagliptin-treated WKY (n = 5) and sitagliptin-treated SHR (n = 7) had similar PV or sinoatrial spontaneous beating rates. However, the sitagliptin-treated WKY had fewer sinoatrial-PV beating rate differences than WKY, SHR or sitagliptin-treated SHR. WKY and SHR had shorter 90% (APD90) of RA AP duration than sitagliptin-treated WKY or sitagliptin-treated SHR. In contrast, WKY had longer LA APD90 than sitagliptintreated WKY, but SHR and sitagliptin-treated SHR had similar LA APD90. Sitagliptin-treated WKY or sitagliptintreated SHR had larger (RA-LA) APD90 differences than WKY or SHR, respectively. Moreover, as compared to WKY the post-rest potentiation of contraction was decreased in SHR, sitagliptin-treated WKY, and sitagliptin-treated SHR. Conclusions: Sitagliptin significantly affects the electromechanical characteristics of PVs and atria, which can be modulated by hypertension.
The evaluation of a better intubation strategy when only the epiglottis is visible: a randomized, cross-over mannequin study
(2019-01-10)
Hung, Tzu-Yao
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Lin, Li-Wei
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Yeh, Yu-Hang
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Su, Yung-Cheng
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Lin, Chieh-Hung
BackgroundThe Cormack-Lehane (C-L) grade III airway is considered to be a challenging airway to intubate and is associated with a poor intubation success rate. The purpose of this study was to investigate whether the holding position, shapes, bend angles of the endotracheal tube (ET) and the stylet-assisted lifting of the epiglottis could improve the success rate of intubation.MethodsThirty-two participants, 26 physicians, 2 residents, and 4 nurse practitioners, with 12.095.38years of work experience in the emergency department and more than 150 annual intubation events, were enrolled in this randomized, cross-over mannequin study. We investigated the effects of straight-to-cuff ET shapes with 35 degrees and 50 degrees bend angles, banana-shaped ET with longitudinal distances of 28cm and 26cm, two methods of holding the ET (either on the top or in the middle), and lifting or not the epiglottis, on the intubation duration, its success rate, and its subjective difficulty. The aim of the study is to provide optimized intubation strategies for difficult airway with C-L IIb or III grades, when the inlet of the trachea cannot be visualized.ResultsThe two groups that lifted the epiglottis using the stylets, in bend angles of 35 degrees and 50 degrees, had the shortest duration of intubation (23.7514.24s and 20.72 +/- 6.90s, hazard ratios 1.54 and 1.85 with 95% confidence intervals [95% CI] of 1.01-2.34 and 1.23-2.78, respectively) and a 100% success rate in intubations. In the survival analysis, lifting of the epiglottis was the only significant factor (p<0.0001, 95% CI 1.34-2.11) associated with the success rate of intubation.ConclusionsThe use of the epiglottic lift as an adjunctive technique can facilitate the intubation and improve its success rate without increasing procedure difficulty, in C-L III airway, when only the epiglottis is seen.Trial registration ClinicalTrials Registry (https://clincaltrials.gov, identifier NCT03366311).
Use of a Perclose ProGlide Device for Percutaneous Endovascular Aortic Aneurysm Repair in a General Hospital Experience
(2016-10-01)
Lee, Chih-Hsien
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Huang, Jau-Kang
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Yang, Ten-Fang
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生物科技學系
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Department of Biological Science and Technology
Background: This study evaluated the safety and efficacy of percutaneous endovascular aortic aneurysm repair (EVAR) with a Perclose ProGlide device compared with endovascular aortic repair with surgical cutdown of common femoral artery in patients at a general hospital. Methods: A retrospective clinical study was conducted using data on 10 patients with elective EVAR, 7 patients with percutaneous EVAR, and 9 patients with consecutive rupture abdominal aortic aneurysm treated with emergency EVAR from January 2010 to December 2014. Results: The median length of intensive care unit stay for elective EVAR, percutaneous EVAR, and emergency EVAR cases: 1.80 +/- 0.92 days, 1.67 +/- 1.21 days, and 10.00 +/- 13.27 days, respectively; hospital days: 11.10 +/- 4.28 days, 11.00 +/- 4.10 days, and 21.89 +/- 18.35 days, respectively. Seven patients have no calcification in common femoral artery, and the use of a Perclose ProGlide device was under the guidance of sonography for percutaneous EVAR. The operative times of elective EVAR, percutaneous EVAR, and emergency EVAR were 192.3 +/- 52.0 minutes, 169.2 +/- 67.5 minutes, and 227.1 +/- 59.9 minutes, and blood loss volumes were 150.0 +/- 77.5 ml, 95.0 +/- 78.6 ml, and 422.2 +/- 276.3 ml, respectively. Technical success rate of Perclose ProGlide was 100%. Conclusions: Selective percuta-neous access of the femoral arteries for EVAR is safe and effective in the studied cases. The complications can be avoided with careful selection of patients based on preoperative imaging. Using Perclose ProGlide for select cases may reduce blood loss and operative time.