Laser Acupuncture for Carpal Tunnel Syndrome: A Single-Blinded Controlled Study.

Objectives: This study aimed to compare the efficacy of laser acupuncture (LA) treatment with that of placebo LA treatment in patients with idiopathic, mild-to-moderate carpal tunnel syndrome (CTS), as measured by subjective symptom assessments and objective changes in nerve conduction studies (NCSs). Design: A randomized, single-blinded, controlled study. Settings: A Teaching Hospital in the Taichung, Taiwan between March 2013 and November 2013. Subjects: 84 consecutive treatment-naive patients with CTS. Interventions: Participants were randomly divided into two treatment arms: (1) LA, administered at traditional Chinese acu-points on the affected side, once a day, 5 times a week, for 4 weeks (N = 43); and (2) placebo LA, administered using the same device and protocol, with the LA device switched off (N = 41). Outcome measures: Patients completed the Global symptom score (GSS) at baseline and two and four weeks later. The primary outcome was changes in GSS. NCSs were performed at baseline and repeated at the end of the study as a secondary outcome. Results: There was a significantly greater reduction in GSS in the LA group than in the placebo group at week 2 (-9.30 ± 4.94 vs. -2.29 ± 4.27, respectively, P < 0.01) and at week 4 (-10.67 ± 5.98 vs. -2.90 ± 5.61, respectively, P < 0.01). However, NCSs did not show significant difference between the two groups. Conclusions: LA may be more effective than placebo LA in the treatment of mild-to-moderate idiopathic CTS in terms of subjective measurement. For patients who fear needle-based treatment, such as acupuncture or local injections, or those who do not opt for early surgical decompression, LA treatment can be considered as an effective and alternative form of acu-points stimulation therapy.

An integrated model using the Taguchi method and artificial neural network to improve artificial kidney solidification parameters.

BACKGROUND: Hemodialysis mainly relies on the "artificial kidney," which plays a very important role in temporarily or permanently substituting for the kidney to carry out the exchange of waste and discharge of water. Nevertheless, a previous study on the artificial kidney has paid little attention to the optimization of factors and levels for reducing the solidification of the artificial kidney during the hemodialysis procedure. Thus, this study proposes an integrated model that uses the Taguchi method, omega formula, and back-propagation network to determine the optimal factors and levels for addressing this issue. METHODS: First, we collected the recommendations of medical doctors and nursing staff through a small group discussion, and used the Taguchi method to analyze the key factors at different levels. Next, the omega formula was used to convert the analysis results from the Taguchi method to assess the defect rate. Finally, we utilized back-propagation network algorithms to predict the optimal factors and levels for artificial kidney solidification, in order to confirm that the key factors and levels identified can effectively improve the solidification rate of the artificial kidney and thereby enhance the effect of hemodialysis. RESULTS: The research finding proposes the following as the optimal factors and levels for artificial kidney solidification: the amount of anticoagulation should be set at 500 units, the velocity of blood flow at 300 ml/min, the dehydration volume at 2.5 kg, and the vascular access type as autologous blood vessels. We obtained 270 sets of data from the patients of End Stage Renal Disease (ESRD) under the setting of the optimal combination of the factors at different levels; the defect rate of artificial kidney solidification is 12.9%, which is better than the defect rate of 32% in the original experiment. Meanwhile, the patient characteristics for physiological status in BMI, serum calcium, hematocrit, ferritin, and transferrin saturation percentage are improved by this study. CONCLUSION: This conclusion validates the ability of the proposed model in this study to improve the solidification rate of the artificial kidney, thereby confirming the model's use as a standard operation procedure in the hemodialysis experiment. The ideas behind and the implications of the proposed model are further discussed in this study.

NEUROPROTECTIVE EFFECT OF TERMINALIA CHEBULA EXTRACTS AND ELLAGIC ACID IN PC12 CELLS.

BACKGROUND: Alzheimer's disease (AD) is one of the common neurodegenerative disorders among elderly. The purpose of this study was to determine the neuroprotective effect and mechanisms of action underlying the Terminalia chebula extracts and ellagic acid by using beta-amyloid25-35 (Aß25-35)-induced cell toxicity in an undifferentiated pheochromocytoma (PC12) cell line. MATERIALS AND METHODS: The T. chebula extracts were prepared using the methanol, water, and 95% ethanol. Specifically, the ellagic acid was obtained in our laboratory. Assays including cell toxicity and changes in intracellular reactive oxygen species (ROS) and calcium level were evaluated to examine the neuroprotective effects and mechanisms of the T. chebula extracts and ellagic acid. RESULTS: The methanolic and water extracts of T. chebula and ellagic acid exhibited the strongest neuroprotective activity against Aß25-35-induced PC12 cell damages at 0.5-5.0 µg/ml. The ellagic acid also exhibited partial neuroprotective activity against H2O2-induced PC12 cell damages at 0.5-5.0 µg/ml. The methanolic and water extracts of T. chebula and ellagic acid protected PC12 cells from Aß25-35-mediated cell damages and enhanced cell viability thorough two key mechanisms by: (1) inhibiting ROS production and (2) reducing calcium ion influx. CONCLUSION: The T. chebula represents a promising plant-source as medicine in the application for the treatment of AD. Further investigation focusing on the active component of T. chebula extracts e.g., ellagic acid is crucial to verify the neuroprotective efficacy and mechanisms in vivo.

Upregulation of RPA2 promotes NF-κB activation in breast cancer by relieving the antagonistic function of menin on NF-κB-regulated transcription.

RPA2, a subunit of the heterotrimeric replication protein A (RPA) complex, is overexpressed in various cancers. In this study, we showed a significant RPA2 upregulation in breast cancer tissues and cell lines. Ectopic expression of RPA2 in MCF7 and MDA-MB-231 cells promoted cell proliferation, adhesion, migration and invasion, and induced epithelial-mesenchymal transition (EMT) of MCF7 cells. Ablation of RPA2 in MDA-MB-231 cells induced apoptosis and suppressed colony formation, EMT and invasion. Binding assays indicated that menin, the multiple endocrine neoplasia type 1 (MEN1) tumor suppressor gene product, interacted with RPA2. Ectopic expression of RPA2 inhibited the formation of the menin-NK-κB p65 complex and repressed the inhibitory effect of menin on expression of NF-κB-regulated genes that contribute to tumor progression. Conversely, knockdown of RPA2 promoted formation of the menin-p65 complex and repressed the expression of NF-κB-mediated genes. RPA2 expression was induced via an E2F1-dependent mechanism in MCF7 and MDA-MB-231 cells treated with NF-κB activators, TNF-alpha or lipopolysaccharide (LPS). These results suggested that RPA2-dependent tumorigenicity was mediated via enhancement of NF-κB activity by relieving the antagonistic function of menin on NF-κB-regulated transcription in breast cancer cells.

Clinical analysis of contributors to the delayed gallbladder opacification following the use of water-soluble contrast medium.

OBJECTIVES: Gallbladder opacification (GBO) on computed tomography (CT) imaging may obscure certain pathological or emergent conditions in the gallbladder, such as neoplasms, stones, and hemorrhagic cholecystitis. This study aimed to investigate the clinical contributing factors that could predict the presence of delayed GBO determined by CT. METHODS: This study retrospectively evaluated 243 consecutive patients who received enhanced CT or intravenous pyelography imaging and then underwent abdominal CT imaging within 5 days. According to the interval between imaging, the patients were divided into group A (1 day), group B (2 or 3 days), and group C (4 or 5 days). Three radiologists evaluated CT images to determine GBO. Fisher's exact test and multivariate backward stepwise elimination logistic regression were performed. RESULTS: Positive GBO was significantly associated with the interval between imaging studies, contrast type, contrast volume, renal function, and hypertransaminasemia (P<0.05). Multivariate backward stepwise elimination logistic regression analysis of the three groups identified contrast type and hypertransaminasemia as independent predictors of GBO in group B patients (odds ratio [OR], 13.52, 95% confidence interval [CI], 1.72-106.38 and OR, 3.43, 95% CI, 1.31-8.98, respectively; P<0.05). Hypertransaminasemia was the only independent predictor of GBO in group C patients with an OR of 7.2 (95% CI, 1.62-31.73). Hypertransaminasemia was noted in three patients (100%) who initially underwent imaging 5 days prior to GBO. CONCLUSION: Delayed GBO on CT imaging may be associated with laboratory hypertransaminasemia, particularly in patients receiving contrast medium over a period of ≥4 days. A detailed clinical history, physical examination, and further workup are of paramount importance for investigating the underlying cause behind the hypertransaminasemia.

Acute myocardial infarction: a comparison of the risk between physicians and the general population.

Physicians in Taiwan have a heavy workload and a stressful workplace, both of which may contribute to cardiovascular disease. However, the risk of acute myocardial infarction (AMI) in physicians is not clear. This population-based cohort study used Taiwan's National Health Insurance Research Database. We identified 28,062 physicians as the case group and randomly selected 84,186 nonmedical staff patients as the control group. We used a conditional logistic regression to compare the AMI risk between physicians and controls. Subgroup analyses of physician specialty, age, gender, comorbidities, area, and hospital level were also done. Physicians have a higher prevalence of HTN (23.59% versus 19.06%, P < 0.0001) and hyperlipidemia (21.36% versus 12.93%, P < 0.0001) but a lower risk of AMI than did the controls (adjusted odds ratio (AOR): 0.57; 95% confidence interval (CI): 0.46-0.72) after adjusting for DM, HTN, hyperlipidemia, and area. Between medical specialty, age, and area subgroups, differences in the risk for having an AMI were nonsignificant. Medical center physicians had a lower risk (AOR: 0.42; 95% CI: 0.20-0.85) than did local clinic physicians. Taiwan's physicians had higher prevalences of HTN and hyperlipidemia, but a lower risk of AMI than did the general population. Medical center physicians had a lower risk than did local clinic physicians. Physicians are not necessary healthier than the general public, but physicians, especially in medical centers, have a greater awareness of disease and greater access to medical care, which permits timely treatment and may prevent critical conditions such as AMI induced by delayed treatment.

Long-term prognosis of patients with carbon monoxide poisoning: a nationwide cohort study.

BACKGROUND: Carbon monoxide poisoning (COP) often produces severe complications and can be fatal. Because this topic has not been well delineated, we investigated long-term prognoses of patients with COP (COP[+]). METHODS: In this retrospective nationwide cohort study, 441 COP[+] patients and 8820 COP[-] controls (120) from 1999 to 2010 were selected from Taiwan's National Health Insurance Research Database. RESULTS: Thirty-seven (8.39%) COP[+] patients and 142 (1.61%) controls died (P<0.0001) during follow-up. Incidence rate ratios (IRR) of death were 5.24 times higher in COP[+] patients than in controls (P<0.0001). The risk of death was particularly high in the first month after COP (IRR: 308.78; 95% confidence interval [CI]: 40.79-2337.56), 1 to 6 months after (IRR: 18.92; 95% CI: 7.69-46.56), and 6-12 months after (IRR: 4.73; 95% CI: 1.02-21.90). After adjusting for age, gender, and selected comorbidities, the hazard ratio of death for COP[+] patients was still 4.097 times higher than for controls. Moreover, older age (≥30 years old), male gender, diabetes mellitus, hypertension, and low income were also independent mortality predictors. CONCLUSIONS: COP significantly increases the risk for long-term mortality. Early follow-up and secondary prevention of death are needed for patients with COP.

Moderating role of interior amenities on hospital medical directors' patient-related work stresses.

OBJECTIVE: Considering hospital medical directors' work stress, this study aims to examine how interior amenities might moderate the effect of work stress on their health. BACKGROUND: Previous studies have revealed that hospital medical directors-senior physicians in the management positions with high-demand jobs in clinical practices and management-had a lower self-rated health. METHODS: This was a cross-sectional survey study and 737 hospital medical directors in Taiwan were included. A developed and structured questionnaire covered the dimensions of patient-related work stress (i.e., physician-patient relationship stress and patient condition stress), hospital interior amenities (i.e., indoor plants, aquarium, music, art and exhibitions, and private or personalized spaces that are common or surround the workplace of healthcare professionals), and self-rated health status and health complaints. Hierarchical regressions were performed. RESULTS: Hospital medical directors' physician-patient relationship stresses were found to have more negative effects on their self-reported health status and complaints than do their patient condition stresses; however, only indoor plants were found to have moderating effects on their short-term health complaints (p < 0.05). On the other hand, the hospital medical directors' patient condition stresses were negatively related to their short-term health complaints; however, music, art and exhibitions, and private or personalized spaces in the workplaces had moderating effects (p < 0.05). CONCLUSIONS: Considering the unavoidable patient-related work stresses imposed on hospital medical directors, some proposed interior amenities can produce buffering effects on work stress to some extent. Future studies could focus on finding alternatives to relieve hospital medical directors' physician-patient relationship work stresses. KEYWORDS: Evidence-based design, physicians, privacy and security, satisfaction, work environmentPreferred Citation: Lin, B. Y.-J., Lin, Y.-K., Juan, C.W., Lee, S., Lin, C.-C. (2013). Moderating role of interior amenities on hospital medical directors' patient-related work stresses. Health Environments Research & Design Journal 6(2), pp 77-92.

Relationships of hospital-based emergency department culture to work satisfaction and intent to leave of emergency physicians and nurses.

Given the limited studies on emergency care management, this study aimed to explore the relationships of emergency department (ED) culture values to certain dimensions of ED physicians' and nurses' work satisfaction and intent to leave. Four hundred and forty-two emergency medical professionals completed the employee satisfaction questionnaire across 119 hospital-based EDs, which had culture value evaluations filed, were used as unit of analysis in this study. Adjusting the personal and employment backgrounds, and the surrounded EDs' unit characteristics and environmental factors, multiple regression analyses revealed that clan and market cultures were related to emergency physicians' work satisfaction and intent to leave. On the other hand, adhocracy, market and hierarchical cultures were related to emergency nurses' work satisfaction. There do exist different patterns among various culture types on various work satisfaction dimensions and intent to leave of emergency physicians and nurses. The findings could offer hospital and ED leaders insights for changes or for building a better atmosphere to enhance the work life of emergency physicians and nurses.

The role of leader behaviors in hospital-based emergency departments' unit performance and employee work satisfaction.

The role of the leader of a medical unit has evolved over time to expand from simply a medical role to a more managerial one. This study aimed to explore how the behavior of a hospital-based emergency department's (ED's) leader might be related to ED unit performance and ED employees' work satisfaction. One hundred and twelve hospital-based EDs in Taiwan were studied: 10 in medical centers, 32 in regional hospitals, and 70 in district hospitals. Three instruments were designed to assess leader behaviors, unit performance and employee satisfaction in these hospital-based EDs. A mail survey revealed that task-oriented leader behavior was positively related to ED unit performance. Both task- and employee-oriented leader behaviors were found to be positively related to ED nurses' work satisfaction. However, leader behaviors were not shown to be related to ED physicians' work satisfaction at a statistically significant level. Some ED organizational characteristics, however, namely departmentalization and hospital accreditation level, were found to be related to ED physicians' work satisfaction.

Abnormal protein expression in the corpus cavernosum impairs erectile function in type 2 diabetes.

OBJECTIVE: To investigate the changes in corporal relaxation, intracavernous pressure (ICP) and associated protein expression that control normal erectile function in rats with type 2 diabetes (T2D), as this disease is part of the 'metabolic syndrome' associated with a high rate of erectile dysfunction (ED) in men, resulting from failure of corpus cavernosum-mediated processes. MATERIALS AND METHODS: T2D was induced in rats by feeding them with a high-fat diet (HFD) followed by an injection with low-dose streptozotocin (STZ); they were then compared with rats that received a normal diet (ND). RESULTS: Hyperglycaemia and dyslipidaemia were induced in HFD + STZ rats, suggesting that T2D was established. The rats with T2D had associated ED, as both nonadrenergic noncholinergic-mediated corporal relaxation and increased ICP by cavernous nerve stimulation were significantly attenuated compared to the ND group. Western blot analysis revealed diabetes-associated lower expression of endothelial and neuronal nitric oxide synthase (e and nNOS), and cGMP-dependent protein kinase (PKG)-1alpha/beta expression in penile tissue than in the ND group. Contrary to the proteins that regulate corporal relaxation, there were relatively high levels of RhoA/Rho kinase receptor 1 (ROCK1) and ET-A receptor (ETAR) in T2D rats. However, the expressed level of phosphodiesterase-5 and insulin-like growth factor binding protein 3 was not altered significantly in response to T2D. CONCLUSION: Decreased expression of certain proteins that mediate the relaxant mechanism, associated with increased expression of certain proteins that mediate contractile mechanisms, might be important in the development of T2D-associated ED. In particular, down-regulated eNOS/nNOS/PKG1 as well as up-regulated ETAR/RhoA/ROCK1 might participate in the aetiology of ED in T2D.

Pivotal role of curcuminoids on the antimutagenic activity of Curcuma zedoaria extracts.

In an investigation of the mutagenic activity of two extracts from rhizomes of Curcuma zedoaria (the mathanolic, CME, and the aqueous, CAE) and antimutagenic activity against mutagens, either 2-amino-3-methylimidazo (4,5-f) quinoline (IQ) or 4-nitroquinoline-N-oxide (4-NQO), in dosages of 1-50 microg/plate was assayed by using Salmonella typhimurium TA97, TA98, TA100, and TA102 strains. We found that the two extracts showed no mutagenicity when tested with all the tester strains either with or without the S9 mix. Moreover, the two extracts, particularly CME, presented a greater antimutagenicity than CAE did either in IQ or 4-NQO mutagens. However, the inhibition effect on lipid peroxidation was similar with both extracts. The amount of major antioxidants beta-carotene, ascorbic acid, and total polyphenols present in both CME and CAE were similar between each other. In contrast, the content of cucuminoids (44.3 mg/g extract) in CME were only found in small amounts in CAE (0.09 mg/g extract). Consequently, although both of the extracts showed similar antioxidant effects, the curcuminoids, which seem to be the main active principles from this plant, were suggested to play a pivotal role in antimutagenic activity.

Honokiol protects rats against eccentric exercise-induced skeletal muscle damage by inhibiting NF-kappaB induced oxidative stress and inflammation.

Honokiol, a bioactive component isolated from the Chinese herb Magnolia officinalis, is known for its potent antioxidative and anti-inflammatory effects. To study whether honokiol can protect skeletal muscle from sports injuries, we set up an eccentric exercise bout protocol for rats consisting of downhill running on a treadmill and examined the effect of oral administration of honokiol at 1 h before eccentric exercise at a dose of 5 mg/kg on day 1 (HK5 x 1) or 1 mg/kg/day for 5 consecutive days (HK1 x 5). Eccentric exercise was implemented for 3-5 consecutive days, and induced remarkable tissue damage. This damage was associated with an increase in serum creatine levels, increase in protein nitrotyrosylation, poly-ADP-ribose-polymerase (PARP) upregulation, lipid peroxidation, and leukocyte infiltration. The degree of muscle damage also paralleled dramatic gene expression for cyclooxygenase-2 (COX-2), inducible nitric oxide synthase (iNOS), and inflammation-associated cytokines (interleukin (IL)-1beta, IL-6, tumor necrosis factor-alpha, and monocyte chemoattractant protein-1), possibly through activation of nuclear factor kappa-B (NF-kappaB), a crucial proinflammatory transcription factor. Both honokiol treatments (HK5 x 1 and HK1 x 5) significantly ameliorated eccentric exercise-induced muscle damage as revealed by suppression of cell fragmentation, protein nitrotyrosylation and PARP upregulation, as well as reductions in lipid peroxidation and leukocyte infiltration, possibly through downregulating gene expression for COX-2, iNOS, and the proinflammatory cytokines by modulation of NF-kappaB activation. In conclusion, the present study demonstrates for the first time that honokiol exhibits protective effects against eccentric exercise-induced skeletal muscle damage in rats, probably by modulating inflammation-mediated damage to muscle cells.

Clinical spectrum of internal hernia: a surgical emergency.

PURPOSE: To define the indicators of bowel ischemia caused by congenital or acquired internal hernia, based on our 10-year experience in one center. METHODS: We reviewed the medical records, imaging studies, and operative findings of 20 patients who underwent surgery for an internal hernia at our medical center between 1995 and 2005. The clinical characteristics and related indicators of the patients with, and those without bowel ischemia were compared and analyzed statistically. RESULTS: The subtypes of congenital internal hernia (CIH) included transmesenteric (n = 6, 60%), paraduodenal (n = 2, 20%), and pericecal (n = 2, 20%) hernia. The abdominal surgical procedures preceding acquired internal hernia (AIH) were Roux-en-Y anastomosis (n = 6, 60%) and appendectomy (n = 3, 30%). Transmesenteric hernia was the most prevalent type of CIH in children. Abdominal rebound tenderness, advanced leukocytosis (>18 000/mm(3)), or a high level of manual band form (>6%) were the positive predictive factors for bowel ischemia, whereas a history of chronic intermittent abdominal pain was a negative indicator. No recurrence was noted during the 10-year study period. The overall mortality rate was 20%, attributable to enteral bacteria sepsis in all cases. CONCLUSION: Internal hernia is a rare but lethal condition. Early diagnosis and prompt surgical intervention provide the only chance of a successful outcome.

Congenital left circumflex coronary artery atresia detected by 64-slice computed tomography: a case report.

A variety of coronary artery disorders, including intramyocardial coronary segments and coronary artery anomalies, can result in sudden cardiac death, especially in young adults. The detection of structural coronary artery abnormalities is important in the management of patients at risk of sudden cardiac death. Coronary artery anomalies occur in about 1% of the population. Congenital absence of left circumflex coronary artery (LCX) is a very rare vascular anomaly, and few cases have been reported in the literature, with a frequency of only 0.003% in all patients who underwent coronary angiography. Although coronary catheterization is the gold standard for the evaluation of coronary arterial patency disease, noninvasive computed tomography (CT) is considered the diagnostic method of choice for the detection and evaluation of coronary artery anomaly. Herein, we report the case of a 17-year-old girl who presented with exertional dyspnea and chest pain and who was studied at our emergency department with the final diagnosis of LCX atresia detected by 64-slice CT. She may be the first case of congenital LCX atresia proved by multislice CT.

The attitudes, concerns, gloving practices and knowledge of nurses in a Taiwanese hospital regarding AIDS and HIV.

Many studies have documented nurses' attitudes and concerns regarding AIDS/HIV, but little is known about Taiwanese nurses. We documented attitudes, concerns, gloving practices and practical AIDS/HIV knowledge of 1090 nurses from one metropolitan hospital in Changhua City, Taiwan. The response rate was 80.9%. Both HIV and hepatitis contraction in the workplace was nurses' main concern. Two hundred and ten nurses (19.3%) were seriously considering leaving nursing because of fear of contracting AIDS/HIV. Virtually all nurses considered it their right to be informed of the presence of HIV-positive patients in their direct work area and many believed that HIV testing of patients should be mandatory. Practical AIDS/HIV knowledge was deficient. These Taiwanese nurses have concerns and fears that might be related to deficiencies in practical AIDS/HIV knowledge. Continuous educational programmes are recommended to alleviate these nurses' attitudes and concerns regarding AIDS/HIV.

Traumatic cardiac injury following sternal fracture: a case report and literature review.

Myocardial injury used to be thought as one of the major complications associated with sternal fracture even though recent studies on injuries associated with fracture of sternum are contrary to this belief. Many authors now believe the presence of sternal fracture is no longer indicative of occult injuries to the underlying structure such as the heart. However, clinicians should still maintain a high index of suspicion for the presence cardiac tamponade in cases presented as blunt chest trauma as early diagnosis and surgical intervention is vital to the patient's survival. Presented is a case of a 38-year-old female patient transferred to our hospital after being injured in a motor vehicle accident. On arrival her blood pressure (BP) was 90/50 mmHg but it then dropped to 60/30 mmHg two hours later. Although her chest roentgenography and electrocardiography (ECG) did not reveal any significant findings, the two-dimensional echocardiography was performed and revealed a moderate amount of pericardial effusion. The chest computerized tomography (CT) scan later revealed sternal fracture and cardiac tamponade. A diagnosis of cardiac rupture resulting from sternal fracture following blunt chest trauma was made. Under midline sternotomy, her right atrial rupture was repaired. The patient was reported to be doing well during a three months, post-operative follow-up.