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Background: Lung transplantation patients with coronavirus disease 2019 (COVID-19) have high mortality. However, the impact of the Omicron variant in lung transplantation patients is unclear. This study focuses on lung transplant patients diagnosed with COVID-19 during the Omicron wave, and investigate the clinical presentations, outcomes and pulmonary function., Methods: In this single-center retrospective study, we enrolled lung transplantation patients diagnosed with COVID-19 from January 2022 to December 2022. Demographic, laboratory and pulmonary function data were recorded. Pre-COVID-19 pulmonary function data were obtained from the closest routine test, and post-COVID-19 tests were arranged after release from isolation., Results: Of the 22 enrolled patients, four were admitted to general wards for treatment and observation, and two needed oxygen support. All of the patients recovered from COVID-19. There were no significant decreases in forced vital capacity (FVC) (2.3 ± 0.6 vs. 2.2 ± 0.8 L, p = 0.363) and forced expiratory volume in the first second (FEV1) (2.0 ± 0.6 vs. 1.9 ± 0.8 L, p = 0.269) after COVID-19 infection. Daily prednisolone dose and serum tacrolimus levels were significantly correlated to the duration of positive COVID-19 test and change in FEV1. Patients who did not receive a booster dose of COVID-19 vaccination had a significantly longer positive test duration (9.1 ± 4.1 vs. 26.6 ± 24.4 days, p = 0.05), and greater decrease in FEV1 (23.6 ± 137.3 vs. -331.8 ± 537.8 L, p = 0.040)., Conclusions: In this study, lung transplant patients infected with COVID-19 during the Omicron wave had low rate of severe disease and mortality. Immunosuppressive medications and COVID-19 vaccination were correlated with viral clearance and pulmonary function after COVID-19 infection., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Vitiligo is a common acquired disease of pigment loss. In lesions recalcitrant to non-invasive treatment, transplantation of cultured autologous melanocytes is an emerging choice. Conventionally, the recipient site is often prepared by laser-mediated or mechanical dermabrasion. Such preparation procedures have disadvantages including prolonged transplantation duration, long period for reepithelialization and potential scarring. We propose a method of preparing recipient sites by psoralen and controlled ultraviolet A (PUVA)-induced blistering followed by transplanting suspended melanocytes. We introduced this method in 10 patients with segmental vitiligo on their recipient site 3 to 5 days before transplantation and blistering developed in 2 to 3 days afterwards. On the day of transplantation, the blister roof could be peeled off easily without bleeding and the recipient site preparation could be completed in 20 min. The recipient site became reepithelialized within 1 week. Progressive repigmentation was observed for up to 6 months, with an average of 65.06% repigmentation in the recipient site without scarring at the end of follow-up. Hence, preparation of the recipient site by controlled PUVA-induced sunburn-like blistering can potentially facilitate melanocyte transplantation and prevent scarring., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: Perioperative immunosuppressants, such as surgical stress and opioid use may downregulate anti-cancer immunocytes for patients undergoing pancreatectomy. Thoracic epidural analgesia (TEA) may attenuate these negative effects and provide better anti-cancer immunocyte profile change than intravenous analgesia using opioid., Methods: We randomly assigned 108 adult patients undergoing pancreatectomy to receive one of two 72-h postoperative analgesia protocols: one was TEA, and the other was intravenous patient-controlled analgesia (IV-PCA). The perioperative proportional changes of immunocytes relevant to anticancer immunity-namely natural killer (NK) cells, cytotoxic T cells, helper T cells, mature dendritic cells, and regulatory T (Treg) cells were determined at 1 day before surgery, at the end of surgery and on postoperative day 1,4 and 7 using flow cytometry. In addition, the progression-free survival and overall survival between the two groups were compared., Results: After surgery, the proportions of NK cells and cytotoxic T cells were significantly decreased; the proportion of B cells and mature dendritic cells and Treg cells were significantly increased. However, the proportions of helper T cells exhibited no significant change. These results were comparable between the two groups. Furthermore, there were no significant differences in progression-free survival (52.75 [39.96] and 57.48 [43.66] months for patients in the TEA and IV-PCA groups, respectively; p = 0.5600) and overall survival (62.71 [35.48] and 75.11 [33.10] months for patients in the TEA and IV-PCA groups, respectively; p = 0.0644)., Conclusions: TEA was neither associated with favorable anticancer immunity nor favorable oncological outcomes for patients undergoing pancreatectomy., Competing Interests: Declaration of competing interest None declared., (Copyright © 2024 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background: The purpose of this study was to investigate the psychopathology and level of happiness and their association with the demographic data of the older population in long-term care situations in Taiwan., Methods: The study enrolled 500 participants who were the elderly in long-term care situations and used the Brief Symptom Rating Scale (BSRS-5) and Chinese Happiness Inventory (CHI) to determine the psychopathology and level of happiness. Multiple linear regression analysis (using a stepwise method) and a two-step cluster analysis were performed to examine the data., Results: The results revealed mean scores for total CHI and total BSRS-5 of 16.08 and 2.34, respectively. Regular exercise habits, higher living expense and having a job were positively associated with happiness. Being older and living in an apartment/condominium were factors negatively associated with happiness. Living in an apartment/condominium was positively associated with a higher BSRS-5 score. Four clusters were grouped according to the variables that contributed the most: housing, exercise habits, living expense and working status. The cluster with no work, no exercise habits and lower living expense had the highest BSRS-5 score and the lowest CHI score., Conclusion: We concluded that the association between demographic data and happiness is stronger than the association between demographic data and psychopathology in a community sample in Taiwan. Those who have steady work, higher living expense and regular exercise habits have better happiness and less psychopathology., Competing Interests: Declaration of competing interest The authors have no conflicts of interest relevant to this article., (Copyright © 2022 Formosan Medical Association. Published by Elsevier B.V. All rights reserved.)

Background/purpose: Ifosfamide, a widely used chemotherapeutic agent, has been frequently associated with encephalopathy. A larger-scale study was conducted to identify risk factors of ifosfamide-related encephalopathy, including hepatic function., Methods: Adult patients who had completed at least one cycle of ifosfamide between January 2008 and December 2010 were included. Those with renal failure or liver failure were excluded. Data were collected through chart review. Patients with encephalopathy and patients without encephalopathy were compared on age, Eastern Cooperative Oncology Group (ECOG) performance status (PS), baseline serum creatinine (SCr) level, albumin level, white blood cell count, liver function, brain metastasis, and dosage of ifosfamide. Chi-square test or Fisher's exact test, Student t test, and univariate and multivariate logistic regressions were used for analysis., Results: This study enrolled 337 patients. Thirty-eight patients (11%) had ifosfamide-related encephalopathy. They had poorer ECOG PS; higher SCr level, white blood cell count, and aspartate aminotransferase level; and lower serum albumin level compared with patients without encephalopathy. Ifosfamide dosage, brain metastasis, and age were not significant risk factors. Multivariate analysis indicated that only ECOG PS, SCr level, and albumin level contributed significantly to the risk., Conclusion: To date, this is the largest-scale study to have analyzed the risk factors of ifosfamide-related encephalopathy. This study confirms that an ECOG PS of 2-4 and increased SCr level are significant risk factors of ifosfamide-related encephalopathy, whereas increased albumin level decreases the risk, consistent with previous reports. Higher aspartate aminotransferase levels have no significant impact. In contrast to previous studies, ifosfamide dosage and brain metastasis are not significant contributing factors., (Copyright © 2015. Published by Elsevier B.V.)

Background/purpose: Automation has long been awaited in parenteral drug dispensing. Pharmacists can benefit much in theory from a good automated device to handle the hazardous drugs used in chemotherapy. This paper describes the performance of the first chemotherapy-dispensing robot in the oncology pharmacy of a 2500-bed medical center. The objective of this paper is two-fold: (1) to assess the robot's performance in terms of its success rate and to summarize the causes of failure, and (2) to find out if the robot can decrease the full-time equivalents (FTEs) of the oncology pharmacy., Methods: We used the computer-generated log from the first week of May 2010 to that of July 2010, supplemented with the pharmacists' notes on the causes of failure, to determine the success rate and to analyze the incidences of failure. We also assessed the FTEs before and after implementing the robot., Results: Data showed that the success rate rose slowly from 76.8% to 95.3% over the 2-month recording period. The major mechanical problems encountered were air, clamping, and waste bin problems. Manual errors, such as loading wrong drugs or syringes, also caused failures. In terms of manpower saving, CytoCare failed to decrease the number of FTE pharmacists/technicians in our oncology pharmacy practice., Conclusion: We conclude that even though CytoCare could ease the risk of chemotherapy exposure and increase the precision of dosing, it was not able to improve the FTE pharmacists/technicians in our hospital., (Copyright © 2012. Published by Elsevier B.V.)

Background/purpose: Data on hospitalized novel influenza A (H1N1) infected children are limited and urgently in demand. We conducted a clinical study to identify clinical features and risk factors associated with severe novel H1N1 infections of children in Taiwan., Methods: From July 24, 2009 to December 4, 2009, data from 61 hospitalized children infected with 2009 novel H1N1 were collected. Demographics, underlying medical conditions, clinical data, receipt of antiviral therapy, need for intensive care and outcome were analyzed to identify clinical features and risk factors of severe infections., Results: Of the 61 inpatients, the male to female ratio was 41 to 20 and the most common age group was between 6 and 12 years (36%). Almost all (98%) patients had fever, 53 (87%) patients received oseltamivir treatment and 51% of them received oseltamivir within 48 hours. Fourteen (23%) needed intensive care and 3 died. Obesity (a Body Mass Index ≥ 25 kg/m(2) in children ≥ 2 years of age, or a body weight ≥ the 95(th) percentile in children <2 years of age), dyspnea, C-reactive protein (CRP) > 3 mg/dL, pleural effusion, and delayed antiviral therapy were significantly associated with the need for intensive care and/or death., Conclusion: Obesity, dyspnea, CRP > 3 mg/dL, pleural effusion, and delayed antiviral therapy are significantly associated with severe novel H1N1 infections in children., (Copyright © 2012. Published by Elsevier B.V.)

Circulating antibodies of the acetylcholine receptor (AchRAb) are detectable in most patients with generalized myasthenia gravis (MG). A newly discovered antibody against muscle-specific kinase (MuSKAb) has been detected in 40-70% of AchRAb-negative MG patients. We report a series of Taiwanese MuSKAb-positive patients, and compare their clinical features with MuSKAb-negative patients and also with MuSKAb-positive Caucasians. Five out of 44 seronegative generalized MG patients (11.4%) were positive for MuSKAb. Patients with MuSKAb tended to have severe disability and bulbar involvement, and more often experienced crisis or impending crisis. Although all of these patients showed an initial response to immunosuppressant therapy, they had greater disability at follow-up. The clinical features of Taiwanese MuSKAb-positive patients were not different from those of Caucasians, except for a lower prevalence.

Cranial pachymeningitis is typically a diffuse granulomatous disease that involves the dura mater extensively without intra-axial involvement. We report a rare case of focal idiopathic hypertrophic pachymeningoencephalitis (IHP) focally affecting the right parietal dura mater and adjacent parietal lobule. A 43-year-old male suffered from acute onset of rhythmic twitching over the left abdominal muscles that had persisted for more than 4 hours. Neurologic examination revealed mild weakness and impaired sensation in the left lower limb. Electroencephalography disclosed active focal spikes in the right parietal region and brain magnetic resonance imaging showed a well-enhanced lesion involving the right parietal lobe and its overlying dura mater. Surgical removal of the lesion revealed infiltration by abundant chronic inflammatory cells without granuloma formation, caseous necrosis or vasculitis. After surgery, the patient was treated with steroid, which was tapered off 5 months later. Serial magnetic resonance imaging follow-up revealed that the parenchymal mass and perifocal edema had completely disappeared 6 months after the operation. We suggest that early recognition of this rare IHP, together with proper surgical intervention and concomitant steroid therapy, may be beneficial for long-term remission.

Schwannomas are benign, slow-growing tumors that arise from Schwann cells of the nerve sheath. Those originating from the sympathetic cervical chain are rare. Herein, we present three cases of cervical sympathetic chain schwannoma (CSCS) and describe our experience with the clinical presentation, surgical management, and outcomes of patients with this pathology. All three patients were found to have a pulsatile, non-tender mass located at the level of the angle of the mandible without cervical nerve function deficit. On imaging study, the location of the mass between the prevertebral muscle and carotid artery with outward displacement of the carotid sheath is a typical characteristic of CSCS. Operative excision and sacrifice of a portion of the sympathetic chain remains the treatment of choice. Postoperative Horner's syndrome is predictable and vagus nerve dysfunction or first bite syndrome is also possible.

Background/purpose: Patients with severe strokes may have different associated medical comorbidities from those with mild strokes. This study evaluated the neurologic and non-neurologic medical predictors of mortality in patients with severe cerebral infarction in the acute stage., Methods: Patients admitted to a neurologic intensive care unit (ICU) due to cerebral infarction were included. Neurologic and non-neurologic predictors for in-unit mortality were determined by logistic regression analyses. Two models using (A) neurologic factors and (B) combined neurologic and non-neurologic factors as mortality predictors were developed. The performance of the models in predicting overall, neurologic and non-neurologic mortalities was compared by areas under the receiver-operating characteristic curves (AUC) of the derived regressive equations., Results: Of 231 patients with cerebral infarction admitted to the ICU, 34 (14.7%) died during ICU stay. Conscious state and acute physiologic abnormalities were significant predictors of mortality. The length of ICU stay in patients with non-neurologic mortality was longer than in those with neurologic mortality (p = 0.044). The AUC of Model B was larger than that of Model A in predicting overall (0.768 +/- 0.045 vs. 0.863 +/- 0.033, p = 0.005) and non-neurologic mortalities (0.570 +/- 0.073 vs. 0.707 +/- 0.074, p = 0.009), while there was no difference in predicting death from neurologic causes (0.858 +/- 0.044 vs. 0.880 +/- 0.032, p = 0.217)., Conclusion: Impaired consciousness and acute physiologic abnormalities are independent predictors of mortality for severe ischemic stroke during the acute stage. Neurologic factors predict early mortality from intrinsic cerebral dysfunction, while non-neurologic factors, especially the associated physiologic abnormalities, predict late mortality from medical complications.

Rhesus (Rh) isoimmunization presenting as severe neonatal hemolytic disease is rare in RhD negative primigravidas of Chinese ethnicity. We report the case of a 32-year-old pregnant Taiwanese woman, RhD negative, who gave birth vaginally to two RhD-positive full-term fetuses 6 years apart. Antenatal follow-up was uneventful and there was no obvious fetal-maternal hemorrhage except at the performance of amniocentesis at the 19th week of the first pregnancy without anti-D immune globulin prophylaxis. Although anti-D immune globulins were administered to the mother within 1 hour after each birth, both of the newborns had severe neonatal hemolysis refractory to phototherapy and were rescued by exchange transfusions. Both of the children were well at age 7-years-old and one-year-old respectively In conclusion, with suspicion of fetal-maternal hemorrhage in RhD-negative pregnancies post amniocentesis, serial monitoring of indirect Coombs titer with appropriate management is mandatory.

We report three cases of Bethlem myopathy from three consecutive generations of a Taiwanese family, including one woman aged 70, one man aged 40, and a boy aged 8. The clinical features of the patients included autosomal dominant inheritance, childhood or adolescent onset, mainly proximal and extensor involvement, early diffuse joint contractures, and absence of cardiac involvement. These features fulfilled the diagnostic criteria for Bethlem myopathy. Though the clinical course of the disease was once thought to be benign, our female patient became wheelchair-bound at the age of 53. This suggests that the disease process in Bethlem myopathy is slow but ongoing.

Nonselective cation channels have been identified and linked to important cell functions in rat hepatocytes. In this study, we characterized inward rectifying nonselective cation channels in detail by the patch clamp technique in human HepG2 cells. Channel properties were studied with high resistance borosilicate pipettes in cell-attached and inside-out configurations. With Ringer's solution and KCl as pipette solutions, the conductances were 19.7 +/- 2.1 and 22.2 +/- 0.0 picosiemens (pS), and reversal potentials were 30.9 +/- 3.5 and 31.3 +/- 4.6 mV, respectively. The channel was permeable to Ba2+, and the sequence of permeability ratios was Na+ > K+ > Cs+ > Ba2+. In the cell-attached configuration, the channel had a higher opening probability at depolarizing potential than at hyperpolarizing. In the inside-out patches with symmetric Ringer's solution, the current voltage curve was linear with conductance of 19.8 +/- 0.9 pS. Reversal potential shifted from -0.2 +/- 1.0 mV to 23.2 +/- 1.0 mV when the bath solution was replaced by dilute Ringer's solution. In the inside-out configuration, the gating was Ca(2+)-dependent, and the opening probability increased with increasing intracellular calcium concentration ([Ca2+]i). An outward rectifying channel appeared when [Ca2+]i was less than 1 mumol/L. The nonselective channel was reversibly blocked by 10 mumol/L internal flufenamic acid. We conclude that Ca(2+)- and voltage-dependent nonselective cation channels are present in human HepG2 cells. The channels might be involved in the regulation of Ca2+ influx and are associated with activation of other ion channels.

Although the correlation between fibromuscular dysplasia (FMD) and intracranial aneurysm is well established, the combination of FMD with a giant aneurysm is rare. This paper reports a patient with extracranial FMD associated with a giant intracavernous aneurysm compromising the trigeminal and abducens nerve. A review of the literature uncovered only four documented cases of FMD with concurrent giant intracranial aneurysms. The present case adds further weight to the argument for including FMD in the differential diagnosis list when confronted with a patient with a giant intracranial aneurysm. Absence of adequate collaterals in this patient eliminated ligation as a treatment strategy for the aneurysm.

Using a unilateral, focal, cortical, ischemia-reperfusion rat model, c-fos mRNA and Fos immunoreactivity in the brain were investigated. The study was divided into a series of reperfusion intervals which were carried out for a period of up to 7 days. The c-fos mRNA peaked in the ischemic cortex (about 15-fold) after 30 minutes of ischemia followed by 1 hour of reperfusion and dropped to baseline level after 1 day of reperfusion. Increased expression switched to the bilateral retrosplenial and frontal cortex, as well as the left (nonischemic) parietal cortex, at 3- or 5-days of reperfusion (about three- to fourfold). Fos immunohistochemical staining correlated positively with the surge of c-fos mRNA. Nuclear run-off transcription assays further indicated that the increase in c-fos mRNA was regulated at the transcriptional level not only in the ischemic cortex (30 min of ischemia, followed by 1 h of reperfusion) but also in the contralateral counterpart (30 min of ischemia, followed by 3 d of reperfusion). A link between altered gene expression and diaschisis is suggested. The distant/delayed c-fos expression is probably caused by loss of inhibition from the ischemic cortex through a polysynaptic transneural pathway.

A 43-year-old male was diagnosed as having cryptococcal meningitis based on his clinical condition, cerebrospinal fluid (CSF) profile and high titer CSF cryptococcal antigen. The patient received intravenous amphotericin B at a total dose of 91 mg over 5 days. The therapy was then abandoned due to acute hepatorenal failure. The patient's neurologic status remained stable for 2 months, after which he began experiencing somnolence, confusion and a personality change. Cranial computed tomography revealed multifocal white matter lesions, and a brain biopsy showed a demyelination change with concurrent IgM and C1q deposition. A clinical diagnosis of amphotericin B-induced leukoencephalopathy was made. The patient's clinical condition was partially reversed after low-dose steroid therapy.

A 28-year-old woman presented with a clinical picture of hyperthyroidism, goiter, ophthalmopathy, and an ensuing ischemic stroke. Cerebral angiography demonstrated moyamoya vessels around the Willis's circle and tubular stenosis of the bilateral extracranial internal carotid arteries. The combination of the above angiographic abnormalities occurring in a patient with Graves' disease is extremely rare. A pathogenic link between Graves' disease and certain specific vascular disorders is suspected.

We report a 49-year-old man with acute intermittent perioral and distal hand sensory dysfunction on the left side (cheiro-oral syndrome). The responsible lesion was confirmed by magnetic resonance imaging to be bilateral subdural hematomas with the larger side compressing the middle and lower thirds of the right postcentral gyrus. We emphasize that subdural hematoma should be considered in the differential diagnosis of cheiro-oral syndrome.

Nine patients with posterior urethral valves were seen at Chang Gung Memorial Hospital from 1985 to 1992. The age at presentation ranged from five days old to 28 years old. The presenting symptoms and signs included abdominal distension, urinary tract infection, respiratory distress, urinary ascites, and weak stream. Patients were examined by voiding cystourethrography and ultrasonography. Surgical management of these patients included primary valve ablation (three cases), cutaneous vesicostomy plus delayed valve ablation (five cases) and primary valve ablation with delayed ureteral reimplantation (one case). For small infants with posterior urethral valves (five cases), temporary vesicostomy and delayed valve ablation offers excellent results in preventing iatrogenic urethral stricture. However, for older children and young adults, the recommended treatment is primary valve ablation. For seven patients with nadir serum creatinine < 1.0 mg/dL, the renal function remained within the normal range, yet during follow-up, one case had renal insufficiency. Vesicoureteral reflux was found in five cases. Spontaneous resolution was noted in two cases after valve ablation, and three cases were controlled with prophylactic antibiotics. The experience of our series suggests that primary valve ablation may be traumatic to the neonatal urethra and temporary diversion would allow greater renal recovery during the neonatal period. With newer delicate instruments, valve ablation may be performed earlier and as a one-stage operation in the future.

Intractable hiccup is a rare manifestation of a brainstem lesion. We present five cases of intractable hiccups associated with medulla oblongata lesions: three of these had brainstem infarction compatible with Wallenberg's lateral medullary syndrome; one, clinically probable multiple sclerosis with a medullary lesion; and one, choroid plexus papilloma of the fourth ventricle with medullary compression. Using magnetic resonance imaging, it was demonstrated that the lesions affecting the dorsal and/or lateral medulla oblongata were responsible for the intractable hiccups.