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Biomedical subjects

T M Wang

Publications and source records attributed to T M Wang.

At least 19 recordsLinked to original sources
PubMed2001

Retina-specific cis-elements and binding nuclear proteins of carp rhodopsin gene.

The upstream cis-elements controlling the retina-specific expression of carp rhodopsin gene were fully characterized in vivo. Transgenic studies demonstrated that both carp neural retina leucine zipper response-like element (cNRE, within nucleotides (nt) -63 to -75) and carp-specific element (CSE, nt -46 to -52) were crucial to reporter gene expression in medaka retinae. The retina-specific expression rates of embryos injected with nt -1 to -641 and longer fragments were much higher than those of embryos injected with nt -1 to -138 and shorter fragments, indicating that an enhancer is located in the nt -138 to -641 region. Retinal extracts and the probe BAT-1 (nt -90 to -120) formed two DNA-protein complexes, B1 and B2. Retinal extracts and the probes cNRE and CSE formed the complexes N1 and C1, respectively. The protein factors in B1 and C1 were mammal-like cone-rod homeobox proteins.

Animals↗
PubMed2001

One-stage correction of neglected developmental dysplasia of the hip by open reduction and pemberton osteotomy.

BACKGROUND AND PURPOSE: Pemberton osteotomy is commonly used for correction of hip-dysplasia. Its application in treating hip dislocation is rarely reported. The purpose of this study was to determine the efficacy of one-stage open reduction and Pemberton osteotomy of neglected developmental dysplasia of the hip (DDH). METHODS: We retrospectively reviewed the clinical and radiographic results of one-stage total correction in 75 patients with neglected DDH (86 hips) from 1984 through 1996. Sixty-nine patients (77 hips) aged 13 to 76 months (mean, 21.5 mo) underwent open reduction, Pemberton osteotomy, and hip spica for 8 weeks. Seven patients (9 hips) aged 29 to 73 months (mean, 46.6 mo) underwent additional femoral shortening (another hip in one bilaterally involved patient underwent only open reduction and Pemberton osteotomy). RESULTS: Acetabular index improved markedly from 40.4 degrees (range, 25-60 degrees) preoperatively to 16.2 degrees (range, 0-30 degrees) postoperatively. Complications included redislocation in four patients (4 hips) and avascular necrosis in three patients (3 hips). Reoperation was performed in four patients (4 hips). All patients were followed up for at least 3 years. By Severin's classification, all operated hips had excellent (18) or good (68) final radiographic results. The functional results, evaluated by McKay's criteria, were also excellent (52 patients/60 hips) and good (23 patients/26 hips). CONCLUSIONS: Neglected DDH was safely and effectively treated by open reduction, Pemberton osteotomy, and optional femoral shortening with limited complications.

Age Factors↗
PubMed2000

Expression of p16(INK4A) induces dominant suppression of glioblastoma growth in situ through necrosis and cell cycle arrest.

Tumor suppressor genes may represent an important new therapeutic modality in the treatment of human glioblastoma (GBM). p16(INK4A) is a tumor suppressor gene with mutation and/or deletion found in many human tumors, including glioblastomas, melanoma, and leukemias. RT-2 rat GBM cell line was used to investigate if the p16 gene induces dominant suppression of glioblastoma growth. Close to 100% of tumor cells were infected by high titer pCL retrovirus encoding the full-length human p16 cDNA at 5 m.o.i. Infected cells showed a 98% reduction in colony forming assay and a 60% reduction in growth curves in vitro compared to vector control. Exogenous overexpression of p16 induced hypophosphorylation of Rb protein by Western blot analysis. Intracranial injection of p16-infected tumor cells into syngeneic rats resulted in a 95% reduction in tumor volume compared to the controls. Intratumoral injection of p16 retrovirus resulted in tumor necrosis and prominent human p16 transgene expressions. Proliferation marker PCNA was not detected in these human p16-expressed RT-2 tumor cells, suggesting the cells were unable to enter into S phase after p16 expression. In addition, direct repeat intracranial injections of p16 retrovirus prolonged animal survival 3.2-fold compared to the controls (48.4 +/- 13.4 vs 15.0 +/- 2.1 days, p < 0.001). Two out of ten rats were found with dormant tumors at day 60 after p16 retrovirus injection. These results showed that p16 is effective in inhibiting GBM growth in situ. The mechanisms of tumor growth reduction and necrosis in vivo might be due to G1 arrest triggered by p16 expression.

Animals↗
PubMed2000

Improvement of health outcomes after continued implementation of a clinical pathway for radical nephrectomy.

The clinical pathway is an important tool for outcome management. We evaluated the overall effects of the continued implementation of a clinical pathway for radical nephrectomy on the length of hospital stay, admission charges, and the quality of medical care. The data obtained from the second-year implementation (group 3) of the clinical pathway were compared with the data from the first-year implementation (group 2) and the year preceding implementation (group 1). Thirty-seven consecutive patients with renal cell carcinoma underwent radical nephrectomy in group 1, 47 in group 2, and 55 in group 3; all were enrolled in this study. The length of hospital stay, average admission charges, and 8 quality indicators were measured in these patients. We also evaluated the variances in the implementation of the clinical pathway. The mean length of stay decreased by 14.0% (P = 0.0048) in group 2, and by 15.8% (P= 0.0014) in group 3, when compared to group 1. The total admission charges significantly decreased by 19.0% (P = 0.001) in group 2, and by 27.9% (P < 0.0001) in group 3, compared to the charges for group 1. A continued decrease in charges for operation and anesthesia, laboratory, pharmacy, and others were found 2 years after implementation of the clinical pathway. Among the 8 quality indicators, 2 were continuously improved in the second-year implementation of the clinical pathway, 2 were improved significantly in the second-year implementation only, and 4 showed no significant change at all. Variances from the clinical pathway decreased significantly after continued implementation. Continued implementation of the clinical pathway for radical nephrectomy can improve a physician's practice continuously by decreasing the length of hospital stay, admission charges, and variances, and by improving quality. However, the improved results after implementation of the clinical pathway should be maintained carefully to assure good health care.

Adult↗
PubMed2000

Prolonged and enhanced suppression of thymidylate synthase by weekly 24-h infusion of high-dose 5-fluorouracil.

We have recently demonstrated that HDFL (high-dose 5-FU 2600 mg m-2 week-1 and leucovorin 500 mg m-2 week-1, weekly 24-h infusion) is highly active in the treatment of gastric cancer. To further clarify the possible mechanism underlying the improved activity of HDFL compared with conventional 5-FU regimens, we conducted in vitro studies examining the effect of these regimens on the differential regulation of thymidylate synthase (TS) in NCI-N87, a human gastric cancer cell line. The expected serum concentrations of 5-FU are 100-200 mM (lasting for less than 30 min) and 5-10 mM (lasting for 24 h) for the conventional 5-FU regimens (bolus injection or short intravenous infusion of 5-FU 370-500 mg m-2) and the HDFL regimens, respectively. Western blot analysis revealed that 24-h exposure of NCI-N87 to 2.5-10.0 mM of 5-FU resulted in a dose-dependent depletion of free TS, lasting for more than 24 h. In contrast, 30-min exposure of NCI-N87 to 200 mM of 5-FU resulted in a less than 12-h depletion of free TS. Moreover, 24-h exposure to 5-FU resulted in a higher S-phase blockade and enhanced cytotoxicity. In both modes of 5-FU treatment, the initial rapid depletion of free TS was accompanied by a rapid increment of a higher-molecular-weight TS molecule, suggesting that rapid formation of the ternary complex was the key mechanism of 5-FU action during this period. Northern blot analysis showed that the steady-state mRNA of TS was not affected by either of the schedules. We conclude that 24-h exposure of gastric cancer cells to low concentration of 5-FU resulted in better suppression of free TS, a higher degree of S-phase blockade, and enhanced cytotoxicity compared to 30-min exposure to high concentration of 5-FU. These in vitro results may help explain the improved clinical efficacy of HDFL regimens compared to conventional 5-FU regimens.

Antimetabolites, Antineoplastic↗
PubMed2000

The effect of breast- and bottle-feeding on oxygen saturation and body temperature in preterm infants.

From July 1997 to June 1998, 25 preterm infants (birth weight < 1800 g) were included in a prospective study to compare the clinical effects of breast- and bottle-feeding. Oxygen saturation, heart rate, respiratory rate, and body temperature were recorded every minute for 20 minutes during feeding periods. Eighty pairs of breast- and bottle-feeding sessions were observed at the chronological age of 9.3 +/- 4.3 (range = 2.1-25.3) weeks. Oxygen saturation and body temperature of the preterm infants were significantly higher when they were directly breastfed. There were 2 episodes of apnea (breath pause more than 20 seconds) and 20 episodes of oxygen desaturation (PaO2 < 90%) during bottle-feeding and none during breastfeeding. We conclude that breastfeeding is a more physiological feeding method for the preterm infant and bottle-feeding may be more stressful.

Apnea↗
PubMed2000

Leiomyoma of the epididymis: case report.

Herein, we report on a rare case of leiomyoma of the epididymis. The case we present involved a 55-year-old patient who had had a painless left scrotal mass for 20 years. The mass was round and elastic and measured about 2 x 2 x 2 cm. We recognized the mass as a benign tumor by scrotal ultrasonography and performed an organ salvage operation for this patient. The final pathologic diagnosis of the mass was leiomyoma. Our report includes a detailed description of the ultrasonographic characteristics of this disease as well as a review of the literature. In general, sharp acoustic shadows with central hypoechoic lesions in heterogenous parenchyma are the distinctive characteristics of leiomyoma of the epididymis. We also discuss the possibility of a testis salvage operation for this type of disease. We conclude that the ultrasonographic characteristics can serve as an important guide for the surgeon to consider an organ salvage operation in cases of a painless scrotal mass.

Epididymis↗
PubMed1999

The implementation of clinical paths for six common urological procedures, and an analysis of variances.

OBJECTIVE: To evaluate the outcomes of treatment after implementing clinical paths for six common urological procedures, and analyse the variances from these paths. PATIENTS AND METHODS: The study comprised 1006 consecutive patients treated according to the recommendations of the clinical path for six common urological procedures; the results of treatment were compared with those from 1006 patients treated by the same physicians before implementing the clinical paths. Total admission charges were divided into five categories, i.e. operation and anaesthesia, laboratory, radiology, pharmacy and other. The differences in these five categories before and after implementation were determined; the variance data were also tracked and analysed. Five quality indicators were monitored during implementation and compared with the data before implementation. RESULTS: The mean length of hospital stay (LOS) and admission charges were significantly lower (P=0.03 and P<0.01) after implementation. The charges for laboratory, radiology, pharmacy and other were significantly decreased after the use of clinical paths. The common variations from the clinical paths were patient-related variance (33%) and discharge variance (26%). Variances affecting the LOS only or the admission charge only were more common than those affecting neither the LOS nor admission charges (both P<0.01), or both (both P<0.01). After implementation, the results of the five quality indicators were significantly improved and the number of patients with surgical complications was significantly reduced (P<0. 01), but the mortality and readmission rate did not increase. CONCLUSIONS: The implementation of clinical paths for six common urological procedures decreased the LOS, admission charges and surgical complications, and improved the quality of care. During implementation, variances can affect the LOS and/or admission charges.

Analysis of Variance↗
PubMed1999

Effects of implementation of 18 clinical pathways on costs and quality of care among patients undergoing urological surgery.

PURPOSE: We evaluated the effects on the costs and quality of care of implementation of 18 clinical pathways for urological operations. MATERIALS AND METHODS: From April 1997 to March 1998 patients undergoing 1 of 18 urological operations were treated according to clinical pathways. The outcomes in terms of length of hospital stay and admission charges of these patients were compared with those of patients treated between April 1996 and March 1997 before clinical pathways were implemented. We also selected 7 clinically relevant quality indicators to assess the quality of care before and after clinical pathway implementation. RESULTS: Of the 1,784 patients undergoing urological surgery from April 1997 to March 1998, 1,382 (77.5%) were treated according to 1 of the 18 clinical pathways. Before implementation 1,279 of 1,615 patients (79.2%) underwent these procedures. The length of hospital stay decreased from 5.5 to 4.9 days (p < 0.01) and the average hospital admission charges decreased by 12.9% (p < 0.01) after implementation. Five of the quality indicators, including the rate of surgical complications, were significantly improved after pathway implementation. The hospitalization rate was not affected (1.3 before versus 0.8% after implementation, p = 0.18). Variations from the clinical pathways occurred in 543 cases (39.3%) and affected the length of hospital stay only (11.6%) or the admission charge only (12.9%) more often than both (7.8%, p < 0.01) or neither (7.0%, p < 0.01). The most common variances in these patients were patient related (30.8%). CONCLUSIONS: Implementation of multiple clinical pathways in a urology department can improve urological practice by decreasing the length of hospital stay, admission charges and rate of surgical complications, and by improving the quality of care.

Adolescent↗
PubMed1999

Does the use of clinical paths improve the efficiency and quality of care under the case payment system for inguinal herniorrhaphy or transurethral prostatectomy?

BACKGROUND: We evaluated the effects of implementing clinical paths for both inguinal herniorrhaphy (IH) and transurethral prostatectomy (TURP) on the efficiency and quality of medical care under the case payment system. METHODS: Patients undergoing IH or TURP were treated using the guidelines for clinical paths under the case payment system (CPUCP). The results of treatment after implementation of CPUCP were compared with results for patients treated before implementation of CPUCP. We also compared results using eight quality indicators both before and after implementation of CPUCP. RESULTS: The post-CPUCP length of hospital stay decreased significantly in patients who underwent either IH (p < 0.001) or TURP (p = 0.008). The post-CPUCP total admission charges decreased (p = 0.001) by 7.5% in the IH group alone. Two quality indicators in the IH group and three quality indicators in the TURP group were significantly improved after implementation of CPUCP. The percentage of patients who completed treatment without deviation as recommended by the guidelines for CPUCP was about 60% in the IH group and about 70% in the TURP group. CONCLUSION: The results of this study indicate that the implementation of clinical paths under the case payment system for patients undergoing inguinal herniorrhaphy or transurethral prostatectomy can improve the efficiency and quality of medical care.

Critical Pathways↗
PubMed1999

Use of a medical decision support system to improve the preoperative diagnosis of prostate cancer with pelvic lymph node metastases.

BACKGROUND: We evaluated the effects of a medical decision support system on the preoperative diagnosis of prostate cancer with pelvic lymph node metastases. METHODS: The preoperative accuracy of staging prostate cancer with pelvic lymph node metastasis by the prostate cancer expert system (PCES) for 43 patients was compared to the accuracy of staging performed by 2 urological attending physicians and 5 residents, to test the validity of the PCES. The effect of PCES consultation on physicians' staging for prostate cancer with pelvic lymph node involvement was evaluated. RESULTS: In the diagnosis of prostate cancer with pelvic lymph node metastasis, PCES was significantly more accurate than the two attending physicians alone (p = 0.042; p = 0.008). All the urological residents' diagnoses were significantly less accurate than those of the PCES. After PCES consultation, all the urological residents increased diagnostic specificity significantly. Most residents usually used PCES for consultation only after the attending physician or department asked for the results. CONCLUSION: Owing to an increased ability for preoperative diagnosis of prostate cancer with pelvic lymph node metastasis, as supported by the PCES, some unnecessary pelvic lymphadenectomies may be avoided.

Aged↗
PubMed1998

Improvements in the efficiency of care after implementing a clinical-care pathway for transurethral prostatectomy.

OBJECTIVE: To investigate the efficiency of care, length of hospital stay and admission charges after implementing a clinical-care pathway for transurethral prostatectomy (TURP). PATIENTS AND METHODS: Changes in the length of hospital stay and admission charges were identified by comparing a series of 100 patients undergoing TURP and treated after implementing a clinical-care pathway with 100 patients treated by the same physicians before implementation. RESULTS: After implementing the care pathway, the mean length of hospital stay and admission charges were significantly lower (P < 0.01). The shorter length of stay was caused by a significant reduction (P < 0.05) in patient-related psychological/social delay after implementation. The number of laboratory tests and use of pharmacological agents were also significantly lower (P < 0.001) after implementation, with the decreases in these last variables significantly greater (P < 0.001) among junior physicians. CONCLUSIONS: The advantages of the TURP clinical-care pathway were the shorter hospital stay, arising from reduced patient-related psychological or social delay, and reduced admission charges consequent on the decreased use of laboratory tests and drugs, particularly for patients treated by junior physicians. These results suggest that physicians are likely to modify their management methods to improve efficiency when a clinical path is implemented.

Aged↗
PubMed1998

Improvement of medical care quality after implementation of a clinical path monitoring program for transurethral prostatectomy patients.

OBJECTIVES: The purpose of this study was to determine the effect on quality of care through the implementation of a clinical path for patients receiving transurethral prostatectomy. METHODS: We selected ten quality indicators with important clinical relevance as representative elements of the clinical path. These quality indicators were monitored during the entire hospitalization period of 100 consecutive patients who received transurethral prostatectomy. Monitoring data obtained from these patients were compared to data from 100 patients who received transurethral prostatectomy prior to implementation of the clinical path. Data was assessed to determine the relationship between quality indicators and management processes. RESULTS: Implementation of the clinical path for transurethral prostatectomy significantly decreased the percent of patients with incomplete preoperative tests on admission day, the duration of intravenous antibiotics administration, the percent of patients who required acute pain management postoperatively, the percent of patients who received postoperative bladder irrigation with normal saline and the percent of patients who had their Foley catheter removed after postoperative day 2. Three of the quality indicators had a significant relationship with management processes and may have directly affected the total admission charges. CONCLUSIONS: To evaluate the effect of the transurethral prostatectomy clinical path implementation on the quality of medical care, we compared ten quality indicators before and after implementation of this path. We concluded that implementation of the clinical path resulted in a statistically significant improvement in the quality of medical care.

Aged↗
PubMed1998

Squamous cell carcinoma of the bladder: a ten-year retrospective study.

BACKGROUND: There is a limited amount of information available on treatment efficacy and optimal management of squamous cell carcinoma of bladder. The goal of this study was to assess the long-term outcome of patients with squamous cell carcinoma of the bladder treated using different modalities. MATERIALS AND METHODS: Retrospective analysis of the medical records of 22 patients with squamous cell carcinoma of the bladder treated at Chang Gung Memorial Hospital from 1986 though 1996 was performed. The follow-up period ranged from 12 months to 111 months. RESULTS: The treatment modalities included transurethral resection in 7 patients, radical cystectomy with urinary diversion in 6 patients, preoperative radiation followed by total cystectomy in 8 patients, and partial cystectomy in one patient. The overall 5-year survival rate was 9%. Only 6 patients (27.3%) in this series were alive two years after diagnosis. Treatment using a combination of modalities including preoperative radiation followed by total cystectomy resulted in a 5-year survival rate of 12.5% in 8 patients. Total cystectomy alone in 6 patients resulted in a 5-year survival rate of 0%. However, the difference in survival rates between these 2 treatment groups was not statistically significant. CONCLUSION: Our results suggest that no definite significance concerning the role of preoperative radiation followed by total cystectomy could be drawn. The results were probably because most of our patients had locally advanced bladder cancer. Another consideration is the small sample size, which may have affected the significance. Although, cystectomy did not improve the 5-year survival rate of patients in this series, it improved the 2-year survival rate.

Adult↗
PubMed1998

The early effect of pelvic floor muscle exercise after transurethral prostatectomy.

PURPOSE: We evaluate the early effect of pelvic floor muscle exercise on the frequency of urination, terminal dribbling, urinary incontinence and satisfaction with life in patients after transurethral prostatectomy. MATERIALS AND METHODS: From February to October 1996, 50 patients who had undergone transurethral prostatectomy were selected for study. The first 25 men served as a control group and the next 25 were the experimental group. Pelvic floor muscle exercise was started after removal of the Foley catheter postoperatively in the experimental group. The patients were evaluated before pelvic floor muscle exercise and weekly at our outpatient department after discharge from the hospital. Results for the later 25 patients treated with the pelvic floor muscle exercise program were compared to those of the prior 25 patients. RESULTS: There was a statistically significant difference (p <0.05) in the strength of pelvic floor muscle contractions at 4 weeks, length of between void interval (p <0.01), terminal dribbling at week 4 (p <0.05) and urinary incontinence at weeks 3 and 4 between the 2 groups after pelvic floor muscle exercise. During this study no complication or mortality occurred and there were no cases of hospitalization for either group. After pelvic floor muscle exercise patients in the experimental group had better satisfaction with life than the control group (p <0.01). CONCLUSIONS: We conclude that pelvic floor muscle exercise seems to help reduce symptoms within the first 4 weeks after transurethral prostatectomy, and provides better psychological and social quality of life.

Aged↗
PubMed1997

Simultaneous determination of amoxycillin and clavulanic acid in pharmaceutical products by HPLC with beta-cyclodextrin stationary phase.

A simple, rapid and accurate method for simultaneous determination of amoxycillin and clavulanic acid using HPLC with beta-cyclodextrin stationary phase was developed. It involves the use of tetraethylammonium acetate (TEAA) as an additive reagent, methanol-buffer solution (pH 4.5) (35:65; v/v) as the mobile phase, detection at 225 mm and chromatogram within 12 min. Linearity and precision of the internal standard method have been obtained. Recoveries ranged from 99.25 to 105.63% for amoxycillin in the synthetic mixture. For clavulanic acid it was from 99.50 to 101.64%. This method is convenient and reproducible for analyses of these two components in different dosage forms.

Amoxicillin↗
PubMed1997

Diversity of DNA sequences among Vibrio cholerae O1 and non-O1 isolates detected by whole-cell repetitive element sequence-based polymerase chain reaction.

Vibrio cholerae strains isolated from patient, food and environmental sources in Taiwan and reference V. cholerae strains were examined by repetitive element sequence-based PCR (rep-PCR). Specimens from broth cultures were used directly in the PCR mixture with three different primers. The PCR fingerprinting profiles of toxigenic 01 isolates were not only homogeneous with primers from enterobacterial repetitive intergenic consensus (ERIC) sequences, but also allowed the differentiation from non-toxigenic O1 and non-O1 strains. Toxigenic 01 strains were further differentiated into El Tor and classical biotypes with primers designed from ERIC-related sequences of V. cholerae. Primers from the other V. cholerae repetitive DNA sequences, VCR, separated toxigenic El Tor strains into six groups and a unique pattern was also obtained in 16 isolates from imported cases of cholera and imported seafood. The results indicated that rep-PCR can be used to identify and differentiate different toxigenic 01, non-toxigenic 01 and non-O1 V. cholerae isolates.

Bacterial Typing Techniques↗