Biomedical subjects

S J Chang

Publications and source records attributed to S J Chang.

At least 55 records · Page 3Linked to original sources

PubMed1999

Ventilation tube in adults with middle-ear effusion.

OBJECTIVE: This study was conducted to analyze the data concerning otitis media with effusion (OME) to configure its etiology, symptomatology, and outcome in adults. METHOD: A retrospective study of 198 consecutive cases (260 ears) of OME was conducted between July 1988 and June 1996. All of the patients were older than 16 years and were diagnosed for the first time. Tympanograms, initial symptoms, underlying diseases, extrusion of the ventilation tube, and recurrence rate of effusion were analyzed. RESULTS: Sinusitis was usually seen in patients 16 to 29 and over 60 years old, whereas nasopharyngeal carcinoma was prevalent in patients 30 to 59 years old. Ear stuffiness (75.3%) was the most prevalent initial symptom, followed by hearing impairment (74.2%). One hundred seventy-five ears from 132 patients had been followed up for more than 2 years. In four ears, ventilation tubes were removed by instrument; the ventilation tubes in the remaining 171 ears of 128 patients extruded spontaneously within 20 months (8.6 months on average). Recurrence of effusion within 2 years was noted in 78.8% (78/99 ears) of patients with head and neck tumours and in 27.3% (12/44 ears) of patients with sinusitis. CONCLUSION: Nasopharyngeal carcinoma and sinusitis were the main etiologies of OME in adults. In addition to treatment of sinusitis, nasopharyngeal check-up is mandatory in adults with OME.

Adolescent↗

PubMed1998

Risk factors for hemorrhagic stroke in Wonju, Korea.

Although stroke is a great public health challenge in Korea, there have have been few epidemiologic studies of the risk factors stroke. A case-control study was performed to evaluate the risk factors for hemorrhagic stroke in Wonju, Korea. Ninety-five subarachnoid hemorrhage (SAH) and 102 intracerebral hemorrhage (ICH) patients aged 21-86 years, and 267 controls were recruited among the inpatients of Wonju Christian Hospital during 1994-1995. Information was gathered through interview and examinations. After adjustment for age and sex, family and past history of hypertension, drinking habits, age of menarche, height, weight, body mass index, waist and hip circumference, earlobe crease, prothrombin time, white blood cell count, hemoglobin, and total cholesterol were all found to be significantly associated with both SAH and ICH. The risk factor significantly associated only with ICH was smoking habits. In multiple logistics analyses, the independent risk factors for SAH and ICH were the same. Those included family and past history of hypertension, age of menarche, earlobe crease, prothrombin time, white blood cell count, hemoglobin and total cholesterol. In general, the risk factors for SAH and ICH were similar with each other, except smoking habits. Risk factors found in this study congruent with previous studies were family and past history of hypertension, drinking habits, body mass index, prothrombin time, white blood cell count, and hemoglobin. Those incongruent or rather newly found were age of menarche, a big physique, earlobe crease, and total cholesterol.

Adult↗

PubMed1997

Flat depressed early colon cancer--a case report.

A flat depressed early colon cancer (FDEC) is characterized by non-polypoid growth pattern, no association of adenomatous tissues and a tendency of even small lesions toward submucosal invasion and lymph node metastasis. It supports de novo carcinogenesis of colorectal cancer, although most colorectal cancers arise in pre-existing adenoma (adenoma-carcinoma sequence). There have been few reports of small depressed cancers because of the difficulty in colonoscopic detection and the rapid development to ulcerating advanced cancers. We report a case of flat depressed early colon cancer confined to mucosa detected by indigo carmine contrast colonoscopy.

Colonic Neoplasms↗

PubMed1997

High prevalence of gout and related risk factors in Taiwan's Aborigines.

OBJECTIVE: To estimate the prevalence of gout and to examine its risk factors among Taiwan's Aborigines compared with non-Aborigines. METHODS: Data were collected from persons older than 40 years living in 3 aboriginal and 2 non-aboriginal districts in Taiwan by a community survey. Cases of gout were identified from self-reporting of a doctor's diagnosis based on clinical criteria. Baseline variables and biochemical data were examined as risk factors for the development of gout. RESULTS: The prevalence of gout history was found to be 15.2% (25/165) and 4.8% (11/231) among aboriginal men and women, respectively, compared with a prevalence rate of 0.3% among non-Aborigines. A logistic regression model showed that aboriginal men older than 60 years with hyperuricemia were more severely affected by gout than any other group (p < 0.05). CONCLUSION: A high prevalence of gout among Taiwanese Aborigines was observed in this study and race was the most significant risk factor associated with the disease.

Age Distribution↗

PubMed1996

Safety and immunogenicity of a serogroups A/C Neisseria meningitidis oligosaccharide-protein conjugate vaccine in young children. A randomized controlled trial.

OBJECTIVE: To assess the safety and immunogenicity of a bivalent serogroups A/C meningococcal oligosaccharide-protein conjugate vaccine compared with the licensed meningococcal polysaccharide vaccine. DESIGN: Randomized controlled trial. STUDY POPULATION: Ninety healthy 18- to 24-month-old children who were seen at a southern California Kaiser Permanente clinic. INTERVENTIONS: Vaccination with either the meningococcal conjugate vaccine (at 1 of 2 dosages) or the polysaccharide vaccine, with 2 doses given 2 months apart. MAIN OUTCOME MEASUREMENTS: Immune response to each vaccine dose as determined by measurement of serogroup-specific total antibodies by enzyme-linked immunosorbent assay (ELISA) and by assessment of serum bactericidal activity. RESULTS: Both vaccines appeared to be safe, and nearly all children responded with greater than 4-fold increases in antibody levels. The 2 dosages of the conjugate vaccine induced similar antibody responses; therefore, the data for the 2 conjugate vaccine groups were combined. Following 2 doses, ELISA antibody levels against group C meningococcus were significantly higher in conjugate vaccine recipients than in polysaccharide vaccine recipients (16.66 microg/mL vs. 8.31 microgm/mL; P<.001), but antibody levels against group A were not significantly different 22.75 microg/mL vs 21.24 microg/mL; P=.70). The serum bactericidal assays showed striking differences between the conjugate and polysaccharide vaccine groups. Geometric mean serum bactericidal titers were significantly higher in conjugate vaccine recipients (755.6 vs 37.6 for group A, P<.001; 3197.9 vs 11.4 for group C, P<.001). CONCLUSIONS: The immune response induced by this meningococcal oligosaccharide-protein conjugate vaccine was qualitatively different from that induced by the polysaccharide vaccine, and the antibodies it elicited provided greater functional activity.

Antibodies, Bacterial↗

PubMed1996

Risk factors of hepatitis C virus infection in a Taiwanese aboriginal community.

The aim of this study is to identify the risk factors associated with anti-HCV positive status in a Bunun aboriginal community in Taiwan. In a door-to-door survey we collected 712 blood samples, and employed an enzyme immunoassay for anti-HCV to detect the recombinant antigen of viral genome including one structural and two nonstructural proteins. The prevalence of anti-HCV was 16.9% for the whole community covering an age range of five years to 84 years, but it was 48% in individuals older than 45 years. The calculated annual incidence rate was 1.25%. Information about possible risk factors was obtained from questionnaires completed in 1992. Age, sex, village of residence, educational level, and the extraneous factor of having been iatrogenic injected during a period one or two years before the survey, showed a significant association with positive anti-HCV status. A dose response relationship between the rate of positive anti-HCV status and frequency of injections was found statistically significant (P < 0.001). Accordingly, a second visit was made to find the possible infection source, and according to information obtained from the recall of 211 interviewees, an illegal medical service was suspected of spreading the recent infection.

Adolescent↗

PubMed1996

Eustachian tube dysfunction in the pathogenesis of cholesteatoma: clinical considerations.

OBJECTIVE: This study was conducted to gain insight into the surgical management of cholesteatomas to prevent postoperative retraction of the tympanic membrane. DESIGN: A retrospective chart review of patients presenting between July 1988 and July 1992 was conducted. METHOD: Clinical observations were made on 85 ears from 81 patients who had tympanoplasty with mastoidectomy for middle ear cholesteatoma, with ossicular reconstruction if necessary, with a subsequent follow-up period of 36 to 84 months (mean, 60 +/- 13 months). RESULTS: The tympanic membrane in several cases became gradually retracted postoperatively; retraction generally commenced along the margin of the cartilage used for repairing the scutum defect, and was noted as early as 9 months, and after 5 years' follow-up, in as much as 66% in the 44 ears operated. CONCLUSIONS: Eustachian tube dysfunction was common postoperatively in cholesteatomatous ears; however, whether it was the etiology or the sequela of a cholesteatoma could not be deduced. Since a retraction pocket in the tympanic membrane can develop into a cholesteatoma, it may account for some cases with recurrence of cholesteatoma postoperatively. Therefore, the cartilage/perichondrium composite graft for repairing the bone defect should be as large as possible.

Adolescent↗

PubMed1995

Effect of neonatal immunization with diphtheria and tetanus toxoids on antibody responses to Haemophilus influenzae type b conjugate vaccines.

We randomly assigned 150 newborn infants to receive diphtheria and tetanus toxoids (DT) or Hib oligosaccharide conjugate (HbOC) at birth to determine whether exposure to the Haemophilus influenzae type b (Hib) conjugate vaccines' carrier proteins would enhance immune responses to subsequent administrations of HbOC or PRP-tetanus toxoid conjugate (PRP-T) at 2, 4, and 6 months of age. Their antibody responses were compared with those of 100 children immunized with HbOC or PRP-T beginning at 2 months of age. No serious adverse reactions were associated with neonatal vaccination. Administration of HbOC at birth did not lead to earlier or higher antibody levels. Newborn immunization with DT did not prime children for enhanced antibody responses. Moreover, Hib antibody levels were lower in DT-primed children than in children immunized beginning at 2 months of age. Diphtheria antibody levels, but not tetanus antibody levels, were also lower in children immunized with DT at birth. We conclude that neonatal immunization with Hib conjugate vaccines is not a means to provide earlier protection against invasive Hib disease. Newborn DT administration does not enhance subsequent antibody responses to Hib conjugate vaccines, and may lead to suppression of Hib and diphtheria antibody responses.

Antibodies, Bacterial↗

PubMed1995

Enhanced antibody responses in infants given different sequences of heterogeneous Haemophilus influenzae type b conjugate vaccines.

To evaluate the safety and immunogenicity of differing sequences of heterogeneous Haemophilus influenzae type b (Hib) conjugate vaccines, we randomly assigned 300 infants to one of six vaccination schedules. At 2, 4, and 6 months of age, subjects were given single or heterogeneous vaccines: Hib polysaccharide (PRP) conjugated to mutant diphtheria toxin (HbOC), PRP conjugated to outer-membrane protein of Neisseria meningitidis (PRP-OMP), or PRP conjugated to tetanus toxoid (PRP-T). No serious reactions were attributable to immunization with heterogeneous vaccines, and there were few significant differences in the rates of minor adverse reactions among groups. PRP-OMP was the only vaccine that induced an antibody response after the first dose, but significant booster responses were not seen after the second and third doses. Subjects given PRP-T vaccine responded well after two doses, but three doses of HbOC vaccine were needed for an equivalent antibody response. All the Hib vaccine schedules evaluated were immunogenic, and schedules initiated by PRP-OMP vaccine at 2 months of age, followed by two doses of either HbOC or PRP-T vaccine at 4 and 6 months of age, induced the highest antibody levels after each dose. Such schedules may be the best for protecting infants and children who are at greatest risk of having invasive Hib disease, such as American Indian children.

Aging↗

PubMed1995

Body mass index and hyperuricemia differences between aboriginal and non-aboriginal children in Taiwan.

To explore the relationship between the body mass index (BMI) and uric acid in different races before growing up into adulthood, we selected a total of 1236 five to 14 year-old children in the period from March to December 1994. The children originated from three Aboriginal tribes (the Bunun, and the Paiwan tribes--classified as South-Aborigines and Atayal tribe as North-Aborigines) and two non-Aboriginal tribes (Fukein-Taiwanese and Hakka), all of whom are from the following four countries: Chien-Shih, Sandimen, Gaushuh and Sanmin. The results showed that the percentage of hyperuricemia (> or = 7.5 mg/dl) was 28.5% (352/1236) and of obesity (BMI > or = 22 kg/m2) was 9.5% (118/1236). Increased uric acid concentration was found to be related to age, sex, BMI, race, triglyceride (TG) and cholesterol levels in both the primary analysis and after the adjusted logistic regression model. Obesity did not vary with sex (OR = 1.0; 95% CI = 0.7-1.5), or with Aborigines in north Taiwan as compared with non-Aborigines (OR = 1.0, 95% CI = 0.6-1.6), but the logistic regression model adjusted for age indicated large BMI values for children with high serum uric acid concentration, triglyceride levels and the Aborigines who originated from south Taiwan. It was concluded from this study that both of the North-Aborigines and South-Aborigines made an important influence on serum uric acid concentration in children, especially the South-Aborigines made difference to BMI as compared with non-Aborigines and North-Aborigines.

Adolescent↗

PubMed1994

Immunogenicity of Haemophilus influenzae type b tetanus toxoid conjugate vaccine in young infants. The Kaiser-UCLA Vaccine Study Group.

In a prospective, randomized, double-blind efficacy trial, the immunogenicity of 10 lots of Haemophilus influenzae type b capsular polysaccharide-tetanus toxoid conjugate vaccine (PRP-T) was evaluated. More than 10,000 infants received PRP-T or hepatitis B vaccine at about 2, 4, and 6 months of age along with other childhood vaccines. In a subset of infants, geometric mean concentrations of total anticapsular antibody were 0.08, 0.79, and 5.29 micrograms/mL after the first, second, and third doses, respectively. Four lots of reconstituted lyophilized PRP-T vaccine were significantly more immunogenic than 6 lots of aqueous vaccine (P = .03). In a stepwise regression model, the most important additional factors affecting anticapsular antibody concentrations were the time between the third dose and the blood draw, race, and breast-feeding status at 6 months of age. Immune responses to diphtheria and tetanus toxoids were not significantly different for infants given PRP-T or hepatitis B vaccines along with diphtheria-tetanus toxoid-pertussis vaccine.

Antibodies, Viral↗

PubMed1994

[Mortality patterns of Taiwan aborigines due to accidents].

The purpose of this investigation was to study ethnic differences in mortality patterns due to accidents in the various aboriginal areas of Taiwan. Mortality data was collected from the National Health Department. To compare the accident mortality of aborigines with that of the general population of Taiwan, and then calculated standardized mortality ratios for accidents in the various aboriginal groups by using the cause specific accident mortality of the general population as standardized mortality and found that mortality in Taiwan between 1971 and 1990 was 60.1 per hundred thousand due all causes of injuries 72.2 (102.2 for males and 39.5 for females). The same figures for the aborigines were 194.9 (274.1 for males and 98.7 for females), respectively. The leading causes of accidental death among the aborigines were motor vehicle accidents, suicide, drowning, accidental falls for males and suicide, motor vehicle accidents and non-drug poisoning for females. Our investigations show that the standardized mortality ratio due to accidents in the aboriginal areas is two to three times higher than that in the general population of Taiwan. These figures were differences among the aboriginal tribes, despite similarities in medical care, environmental and economic circumstances. Mortality due to accidents, especially due to suicide and poisoning, in the Atayal and Bunun tribes were particularly higher than in other tribes. Thus, the risk of an accident in these regions may be associated not only with the environment and the lack of medical resources, but with some socio-cultural factors.

Accidents↗

PubMed1994

[Standardized incidence ratios for cancers in Taiwan aborigines, 1981-1987].

Standardized incidence ratios (SIR) of malignant neoplasms in Taiwanese Aborigines were analyzed. In all, 995 cases of cancers had been reported in 30 Taiwanese Aboriginal communities between 1981 and 1987. In the same time period, 137, 159 cases were registered in Taiwan and carefully categorized according to race, gender, site and frequency of occurrence. Sex and tribe-specific standardized incidence ratios with 95% confidence interval were calculated. We found that the standardized incidence ratios of all cancers in Aborigines was lower than that in the general population of Taiwan for both Aboriginal men (0.72, 95% CI:0.67-0.78) and women (0.66, 95% CI:0.59-0.72). Of selected malignant neoplasms, SIR for nasopharyngeal carcinoma was slightly elevated in men, especially in the Bunun and Rukai tribes and significantly elevated in Paiwan women (2.95, 95% CI:1.65-4.87). The SIR for gastric cancer was significantly elevated for both men (SIR = 1.22, 95% CI:1.03-1.44) and women (1.48, 95% CI:1.14-1.92), especially in Atayal and Bunun men and Atayal women. There was a higher than expected level of incidence of penis cancer and other male genital cancers, especially in Paiwan people, with the SIR as large as 6.24 (95% CI:2.02-14.53). The SIR of lymph node cancer was significantly increased in Bunun (4.21, 95% CI:1.36-9.81) and Yamei women (CI:1.50-44.89), but not for all Aboriginal men. Colon, rectum, lung, bladder and oral cancers in aboriginal men and colon, rectum, lung, breast and cervical cancer in women occurred significantly less frequently than in the general population. The SIR of colon and rectum carcinoma was significant lower for both men (0.45, 95% CI:0.32-0.61) and women (0.25, 95% CI:0.13-0.42), particularly in the Atayal and Paiwan tribes. The SIR of lung cancer was 0.52 (95% CI:0.41-0.66) in Atayal, Bunun, Paiwan men and 0.58 (95% CI:0.38-0.86) in Paiwan women. There were significantly lower than expected levels of incidence of bladder (0.18, 95% CI:0.02-0.65) and oral cancer (0.29, 95% CI:0.08-0.74) for Atayal men. Aboriginal women had significantly lower SIR of cervical cancer (0.46) especially in Atayal, Bunun, Paiwan women and of breast cancer (0.38) especially in the Atayal and Paiwan women. But cancer of esophagus, liver, gallbladder, pancreas, and prostate occurred among Aboriginal people at the same rate as in the general Taiwan.

Adolescent↗

PubMed1994

[Prevalence of smoking, drinking and betel quid chewing and related factors among aborigines in Wufeng District].

This study surveyed the prevalence of smoking, drinking, betel quid chewing and related factors among adult Aborigines in Wufeng District, Hsinchu county, Northern Taiwan, as determined in a cross-sectional study (N = 504), based on random sampling. In house to house survey, 420 residents were interviewed in their homes by a structured questionnaire (with a response rate of 83.3%) and a complete set of data was collected for 360 Atayal and Saisiat Aborigines. The survey only included adults (N = 302), as the number of children were few. The life-time prevalence rate of smoking, drinking and betel quid chewing was 71.1%, 85.5%, 49.7% in men and 25.2%, 58.0%, 6.3% in women, respectively. In contrast, the one year prevalence rates were 61.0%, 65.4%, 27.0% in men and 16.8%, 25.97%, 1.4% in women, respectively. The result of multiple logistic regression were that (1) the male drinker and betel quid chewer was the highest risk group for smoking; (2) the male smoker was the highest risk group for drinking and (3) the married male smoker was the highest risk group for betel quid chewer.

Adolescent↗

PubMed1994

[The analysis of factors affecting the sexual behavior and antibody against syphilis of deep sea fishermen].

Prostitutes may be regarded as the reservoir of sexual transmitted diseases and their customers as the transmitters. The use of condom for sexual intercourse with prostitutes is an effective way of preventing sexually transmitted infections. Deep sea fishermen usually spend a long period of time sailing the oceans, and many have contacts with prostitutes when their boat stays in harbor. This is a study of the factors which affect the fishermen who are customers of prostitutes and condom using. In all 859 Taiwanese deep sea fishermen were interviewed and samples of their blood serum were collected between January and June of 1991. Of the interviewees, 628 (73.1%) used at one time the services of a prostitute; 84% of aborigines from reserved areas and 68% of aborigines from non-reserved areas. The factors which were found to be related to a sailor's tendency to become the customer of a prostitute after adjustments in logistic regressions were marital status, educational level, tobacco smoking and alcohol consumption. Of the 628 men 100 claimed to use condoms always, 110 sometimes and the remaining 414 men never. The vast majority of aborigines from reserved areas (113/124; 91.1%) never used condoms as compared with 84.0% of aborigines from non-reserved areas and 81.8% of non-aborigines (included Hakka). As might be expected, the lesser educate as well as the aborigines from reserved areas use condoms the least frequently.

Adult↗

PubMed1993

Comparative immunogenicity of four Haemophilus influenzae type b conjugate vaccines in Alaska Native infants.

We compared the immunogenicity of the four available Haemophilus influenzae type b (Hib) conjugate vaccines in Alaska Native infants. Three of the vaccines, Hib oligosaccharide-CRM197 (HbOC), polyribosylribitol phosphate-diphtheria toxoid (PRP-D) and polyribosylribitol phosphate-tetanus toxoid (PRP-T), were given at 2, 4 and 6 months of age, and the PRP Neisseria meningitidis outer membrane protein (PRP-OMP) conjugate vaccine was given at 2 and 4 months of age. Enrollment was largely sequential by vaccine availability beginning with HbOC and ending with PRP-T. A total of 225 infants completed the full vaccination series. Groups of infants receiving the different vaccines did not differ significantly by sex, ethnicity, degree Alaska Native or age at vaccination. The only vaccine that induced a response with the first 2-month dose was PRP-OMP; 91% of infants had > or = 0.15 micrograms/ml and 57% had > or = 1.0 microgram/ml of anti-PRP antibody by 4 months of age. After two doses it also remained the most immunogenic. After the full three vaccine series, trials that requires cough of 21 days is excessively restrictive.

Alaska↗

PubMed1993

Comparison of naturally acquired and vaccine-induced antibodies to Haemophilus influenzae type b capsular polysaccharide.

The objective of this study was to assess qualitative differences in the types of Haemophilus influenzae type B (Hib) capsular polysaccharide (polyribosylribitol phosphate [PRP]) antibodies induced in children 15 to 27 months of age by (i) natural exposure, (ii) PRP vaccine, and by (iii) PRP-diphtheria toxoid conjugate vaccine, (iv) PRP-group B Neisseria meningitidis outer membrane vesicle conjugate vaccine, and (v) Haemophilus type B oligosaccharide conjugate vaccine (HbOC). The highest levels of total Hib-PRP antibody measured by radioimmunoassay and immunoglobulin G (IgG) measured by enzyme-linked immunosorbent assay were seen after HbOC immunization. IgG1 Hib-PRP antibodies predominated in all groups, and there were no differences between the groups in the proportion of IgG and IgA Hib-PRP antibodies. However, the proportions of IgM differed significantly by group. The highest proportions of IgM occurred in naturally acquired antibody and after PRP vaccine, and the lowest proportion occurred after HbOC vaccine. IgG light-chain V kappa type alpha PRP antibody was present in all groups, and the level correlated with the total IgG Hib-PRP antibody level. Therefore, HbOC induced the highest concentrations of V kappa II type alpha PRP antibody, and the naturally acquired antibody group had the lowest levels. IgG light-chain V kappa III antibody levels were also highest in the HbOC group, but there was no correlation between V kappa III antibody levels and total amount of IgG Hib-PRP antibody. These data demonstrate qualitative differences in the antibody repertoires induced by natural exposure, the Hib-PRP vaccine, and each of the different Hib conjugate vaccines. We doubt that there are major differences in the protection afforded by these different antibody repertoires, because these differences do not appear to correlate with differences in protective efficacy in older children.

Antibodies, Bacterial↗

PubMed1993

PSA after definitive radiotherapy for clinically localized prostate cancer.

A rising PSA level for clinically localized prostate cancer after definitive radiotherapy is an ominous finding that correlates with positive postirradiation biopsy and traditional clinical progression. The study detailed in this article found that the proportion of patients treated with radiotherapy who achieved stable PSA levels and were clinically free of disease was disappointingly low.

Aged↗