Biomedical subjects

Hsiu-Nien Shen

Publications and source records attributed to Hsiu-Nien Shen.

5 recordsLinked to original sources

PubMed2006

Nitric oxide production is paradoxically decreased after weight reduction surgery in morbid obesity patients.

Obesity is associated with vascular endothelial cell dysfunction (ECD). Studies on nitric oxide (NO) production of vascular system in these subjects may help delineate the pathogenesis of obesity-associated ECD. In this study, we recruited 69 severely obese patients who were treated with gastric partition surgery for weight reduction and 69 matched healthy controls for comparison. The following parameters were obtained in the healthy control subjects and in the obese subjects both before and after gastric partition surgery: body mass index, blood pressure, serum lipids, high sensitivity C-reactive protein (hs-CRP), adiponectin, total nitrite and nitrate (NO(x)), and 8-iso-prostaglandin F2alpha (8-iso-PGF2alpha), and insulin resistance index (as measured by homeostasis model assessment (HOMA-IR). At baseline, serum lipids, glucose, insulin, hs-CRP and 8-iso-PGF2alpha and HOMA-IR were all higher while adiponectin lower in the obese group than in the control group. The serum NO(x) levels were not different between the two groups. In the obese subjects, the adiponectin levels were significantly elevated but NO(x) markedly decreased after surgery. All other measurements, except for systolic blood pressure, were decreased after surgery. For healthy controls, the serum NO(x) levels were negatively associated with HOMA-IR and positively associated with serum adiponectin levels as analyzed by multiple linear regression analysis. In obese patients, the baseline serum NO(x) was positively associated with the serum TG levels. The changes of serum NO(x) levels after weight reduction surgery were positively associated with the changes of body mass index and serum TG levels. These observations suggested that, in the extremely obese patients, there might be excessive production and/or inactivation of NO and, after weight reduction surgery, the NO production was down-regulated. In conclusion, in the severely obese patients, the apparently normal NO production might be due to over-expression of iNOS. After gastric partition surgery, the NO production was significantly decreased which might be reflecting the usual status of NO production in obese subjects. The positive correlation between NO(x) and serum TG level might suggest that the metabolism of TG plays a role in the regulation of NO production.

Adult↗

PubMed2005

Intrathoracic kidney.

Intrathoracic kidney is a rare congenital anomaly. However, it should be included in the differential diagnosis of posterior mediastinal masses, as confirmation of the diagnosis obviates the need for further clinical studies, further treatment, and unnecessary surgery. Chest computed tomography (CT) is an important and efficient tool in confirming the diagnosis. We report a 50-year-old man who suffered from nonspecific chest pain for 2 years. He denied a history of major traumatic chest injury. Chest radiograph revealed a left posterior mediastinal mass, which was later confirmed by chest CT to be a congenital intrathoracic kidney.

Choristoma↗

PubMed2004

Outcome of coal worker's pneumoconiosis with acute respiratory failure.

STUDY OBJECTIVE: To investigate the clinical features and prognosis of patients with coal worker's pneumoconiosis (CWP) requiring invasive mechanical ventilation (MV) in the ICU for their first episode of acute respiratory failure (ARF), with special attention to the prognostic implication of radiographic progressive massive fibrosis (PMF). DESIGN: Retrospective study. SETTING: A 16-bed medical ICU at a community hospital. PATIENTS AND METHODS: We reviewed 53 patients with CWP and ARF requiring invasive MV in the ICU for the first time between August 1998 and March 2002. RESULTS: Of the 53 patients with CWP, 28 patients (53%) with PMF had their first ARF at a younger age than those without PMF (69.1 +/- 7.9 years vs 74.8 +/- 7.2 years, p = 0.008 [mean +/- SD]). Pneumonia (49%) was the most common cause of ARF. The mean APACHE (acute physiology and chronic health evaluation) II score was 26.0 +/- 9.9, and the mean ICU stay was 14.7 +/- 16.1 days. Twenty-one patients (40%) were weaned successfully in the ICU, with mean ventilator time of 17.0 +/- 25.1 days. The ICU and in-hospital mortality rates were 40% and 43%, respectively. The median survivals for all patients and the ICU survivors were 2.6 months and 14.3 months, respectively. Multivariate analysis showed the following risk (or protective) factors for the ICU mortality: PaCO(2) > 45 mm Hg at the time of intubation (adjusted odds ratio [OR], 0.04; 95% confidence interval [CI], 0.003 to 0.44), PaO(2)/fraction of inspired oxygen ratio < 200 mm Hg at the time of intubation (OR, 8.78; 95% CI, 1.36 to 56.48), and APACHE II score >or= 25 (OR, 11.99; 95% CI, 1.49 to 96.78). PMF was not associated with the ICU mortality (OR, 1.18; 95% CI, 0.20 to 7.10). CONCLUSIONS: Radiographic PMF was not associated with the ICU mortality in patients with CWP and ARF receiving invasive MV in the ICU. Although a substantial proportion of them could be weaned from the ventilator and discharged from the hospital, their long-term prognosis was poor.

APACHE↗

PubMed2003

Changes of heart rate variability during ventilator weaning.

STUDY OBJECTIVES: Despite the recognition that ventilator weaning is associated with a change in autonomic nervous system activity, there has not been any report concerning the change of heart rate variability (HRV), a reliable method to detect autonomic nervous system activity, in patients during weaning. The aim of this study was to investigate the change of autonomic nervous system activity during ventilator weaning by HRV analysis. DESIGN: Prospective study. SETTING: A 16-bed medical ICU of a tertiary university hospital. PATIENTS: Twenty-four patients receiving mechanical ventilation were included. Twelve patients with successful extubation after a spontaneous breathing trial (SBT) [T-piece trial] were classified as the success group; otherwise, the patients were placed in the failure group. INTERVENTIONS: None. MEASUREMENTS AND RESULTS: Variables, including the total power (TP), and the high-frequency (HF) and low-frequency (LF) components of HRV, were measured in three phases: assist/control mandatory ventilation, pressure support ventilation (PSV), and SBT. While shifting from PSV to SBT, the HRV components decreased significantly in the failure group (TP, p = 0.025; LF, p = 0.007; HF, p = 0.031), but not in the success group. CONCLUSIONS: By HRV analysis, reduced HRV and vagal withdrawal of the autonomic nervous system activity are the main changes in patients with weaning failure.

Aged↗

PubMed2002

Management of tension pneumatocele with high-frequency oscillatory ventilation.

We report the successful application of high-frequency oscillatory ventilation in a patient with tension pneumatocele (TP). The proposed check-valve mechanism for the development of pneumatoceles predicts that positive-pressure ventilation could lead to distension of these airspaces and formation of TPs. Therefore, high-frequency ventilation could be more applicable in conditions, such as massive air leak due to bronchopleural fistula, that are difficult to manage by conventional ventilator modes.

Bronchial Fistula↗