Chen Long Wu

Mortality from dermal exposure to tetramethylammonium hydroxide

. However, industrialTMAH is in the form of a concentrated strong alkalineand thus might have severe hazardous effects. We herepresent a mortality case caused by dermal exposure toindustrial TMAH at work.CaseA 22-yr-old male engineer was accidentally drenchedwith concentrated TMAH solution (25%, pH 13.5) whileconducting routine examination of the pipe system in aplant manufacturing thin film transistor liquid crystaldisplays (TFT-LCDs). He was wearing a clean room suitwith plastic goggles, but not a mask. As TMAH sprayedover his head, he closed the valve and took a shower atthe nearby emergency shower facility immediately fordecontamination. When he was found by a co-workerabout 15 min later, he suffered from general weaknessand moderate salivation but was still conscious enoughto describe the accident. The paramedical team arrivedabout 30 min after the accident and found the patientlosing his consciousness with a Glasgow coma scale of 6(E

Prevention of poststroke depression with milnacipran in patients with acute ischemic stroke: A double-blind randomized placebo-controlled trial

Poststroke depression (PSD) is one of the most frequent neuropsychiatric consequences of stroke. It has been shown to be associated with both impaired recovery and increased mortality. The purpose of this study is to investigate the prophylactic effect of milnacipran in PSD. Ninety-two patients were enrolled in the 12 months of this double-blind randomized placebo-controlled trial. The assessment was performed at baseline, and at the first, third, sixth, ninth and 12th month after enrollment. The definition of PSD was in accordance with the diagnostic criteria of major depressive episode based on the Diagnostic and Statistical Manual, fourth edition. Forty-six patients were randomized to the treatment group with milnacipran and another 46 patients to the placebo group. No significant differences were found between the two groups in terms of sex (P=0.83), age (P=0.08), marital status (P=0.66), occupation (P=0.22), educational level (P=0.29), and drug side-effects (P=0.73). The incidence of depression in the two groups was 2.22% and 15.22%, respectively. Milnacipran was proved to have a statistically significant advantage in preventing PSD (P<0.05). In conclusion, milnacipran could prevent the development of depression in the first year following a stroke and is safe to use without significant adverse effects in stroke patients.

Long-term effects of stimulants on neurocognitive performance of Taiwanese children with attention-deficit/hyperactivity disorder

BackgroundAttention-deficit/hyperactivity disorder (ADHD) is a common behavioral and neurocognitive disorder in school-age children. Methylphenidate (MPH) is the most frequently prescribed CNS stimulant for ADHD. The aim of this study is to evaluate the changes in intelligence quotient and domains of neurocognitive function after long-term MPH treatment of Taiwanese children with ADHD.MethodsThe Wechsler Intelligence Scale (WISC-III) was administrated twice at an interval of at least one year for all 171 subjects (6–12xa0years) and 47 age- and gender-matched children without ADHD. The ADHD-Rating scale and Clinical Global Impression-Severity (CGI-S) were also used at the time of enrolment, and at 6xa0months and one year later.ResultsTaiwanese children with ADHD had lower Verbal IQ (VIQ) and Full IQ (FIQ) and performed poorly on several subtests of the WISC-III, including Similarities, Vocabulary, and Coding, compared to healthy children without ADHD. After one year of MPH treatment, significant decrements in all scores of the ADHD-Rating scale and CGI-S and increments in several domains of the WISC-III, including FIQ, VIQ, PIQ, Perceptual Organization Index (POI), Picture Completion, Picture Arrangement, Object Assembly, and Digit Span were observed. When the ADHD children under MPH treatment were subdivided into two age groups (6–8xa0years and 9–12xa0years), significantly better performance in some subtests and subscales of the WISC-III (such as Similarities, Comprehension, and Object assembly) was found in the 6–8xa0years age group.ConclusionsLong-term MPH treatment may improve the neurocognitive profiles of the ADHD children, as seen in their performance in several subtests and in the IQ scores on the WISC-III. And this improvement had no correlation with the decrement of ADHD symptoms. Starting stimulant treatment at as young an age as possible is advised due to the greater benefits in the 6–8xa0years age group, as seen in this study. More research in this area is also needed to confirm these results.

Incidence and risk factors of poststroke depression in patients with acute ischemic stroke: A 1-year prospective study in Taiwan

Background Poststroke depression (PSD) is one of the most frequent and devastating neuropsychiatric consequences of stroke. The purpose of this study was to investigate the incidence and risk factors for PSD in a general hospital in Taiwan. Methods One hundred and one patients with ischemic stroke were enrolled initially, and 91 (90.1%) completed the 1-year study. Assessments were performed at baseline, and at the 1st, 3rd, 6th, 9th, and 12th month after enrolment. The definition of PSD was in accordance with the diagnostic criteria of major depressive episode in the Diagnostic and Statistical Manual, fourth edition (DSM-IV). Results The accumulated incidence rates of PSD at the 1st, 3rd, 6th, and 9th, month were 4%, 8%, 9%, and 10%, respectively, and the overall incidence at 1 year was 11%. In multivariate regression analysis, female gender, higher depression score, and severity of stroke were significant risk factors. In subgroup analysis, a higher depression score was significantly associated with PSD, regardless of gender; however, stroke severity was a risk factor only in the female group. Conclusion The 1-year incidence of PSD was 11%, based on the DSM-IV diagnostic criteria. More attention should be paid to patients with more risk factors to enable earlier detection and intervention.

Tetramethylammonium ion causes respiratory failure related mortality in a rat model

AIM OF THE STUDYnTetramethylammonium ion (TMA) is an emerging industrial chemical and has caused mortalities in humans. The present study was conducted to evaluate the effects of subcutaneously injected TMA on heart rate (HR), mean arterial blood pressure (MAP) and arterial blood gases (ABG) and to determine whether pretreatment using mechanical ventilation (MV) or atropine could prevent the mortality caused by TMA.nnnMETHODSnMale Wistar rats were anesthetized and catheterized in the femoral arterials for monitoring. We injected 25, 50, 100, and 200 μmol/kg of TMA s.c. in four groups of rats respectively and compared them to a control group. The effects of MV and atropine (1mg/kg, s.c.) pretreatment were evaluated by comparing the treatment groups with the 200 μmol/kg group. The primary outcome was survival curve, and the secondary endpoints included the changes of HR, MAP, and ABG, such as arterial pH, PaO(2), PaCO(2) and calculated HCO(3)(-).nnnRESULTSnTMA decreased HR, MAP, pH, and PaO(2), increased PaCO(2) and calculated HCO(3)(-) and resulted in death of all animals in the 200 μmol/kg group by 15 min. All animals pretreated with MV survived. Although all animals receiving atropine died, the mean survival time increased by 37 min. Both MV and atropinization improved HR, MAP, and ABG.nnnCONCLUSIONnThis rat model suggests that acute respiratory failure is responsible for the mortality caused by TMA, and therefore first aid should emphasize respiratory support. Atropinization prolonged survival time in the present study that possibly bought time for further management.

Predictors for suicidal ideation after occupational injury

Risk of suicide has been associated with trauma and negative life events in several studies. Our aim was to investigate the prevalence and risk factors of suicidal ideation, and the population attributable risk among workers after occupational injuries. We investigated workers who had been hospitalized for ≧3 days after occupational injuries between February 1 and August 31, 2009. A self-reported questionnaire including demographic data, injury condition, and the question of suicidal ideation was sent to 4498 workers at 3 months after their occupational injury. A total of 2001 workers (45.5%) completed the questionnaires and were included in final analysis. The prevalence of reporting suicidal ideation was 8.3%. After mutual adjustment, significant risk factors for suicidal ideation higher than serious in a self-rated severity scale (adjusted odds ratio, aOR=2.31; adjusted population attributable risk, aPAR=34.7%), total hospital stay for 8 days or longer (OR=1.98; aPAR=20.5%), intracranial injury (OR=2.30; aPAR=10.2%), and marriage status of being divorced/separated/widowed (OR=2.70; aPAR=10.0%). Three months after occupational injury, a significant proportion of workers suffered from suicidal ideation. Significant predictors of suicidal ideation after occupational injury included broken marriage, intracranial injury, injury severity, and total hospital stay. Identification of high risk subjects for early intervention is warranted.

The role of the chemical burns caused by hydroxide ion in the toxicity of dermal exposure to tetramethylammonium ion in a rat model

OBJECTIVEnTo evaluate the role of the chemical burns caused by hydroxide ion in the fatal effects of tetramethylammonium ion (TMA) in dermal exposure to tetramethylammonium hydroxide (TMAH), we conducted a rat study consisting of two-step treatments with dermal exposure to NaOH and tetramethylammonium chloride (TMACl).nnnMETHODSnIn the first step, NaOH or saline was administered in the gauze on the shaved skin for 5 min, and in the second step, TMAH, TMACl, or saline was administered in the same way. The mean blood pressure (MBP), heart rate (HR), and survival in rats were compared among seven groups.nnnRESULTSnDermal exposure to saline and then 2.75 M TMACl introduced limited and temporary non-fatal effects. Exposure to 2.75 M NaOH and then saline had almost no effects and caused no deaths. Treatments with more concentrated NaOH or TMACl resulted in suppressions of MBP and HR, and deaths were observed after the dosing of TMACl.nnnCONCLUSIONnThe toxicity of dermal exposure to TMA alone is limited, but fatal effects can be introduced by pre-treatment with hydroxide ion. Therefore, the chemical burn caused by hydroxide ion plays an essential role in the toxicity, implicating that effective neutralizing may help decreasing the fatality rate.

Predictors of Successful Noninvasive Ventilation Treatment for Patients Suffering Acute Respiratory Failure

Background: To identify predictors of successful noninvasive ventilation (NIV) treatment for patients with acute respiratory failure. Methods: This was a prospective intervention study of the intensive care unit of a teaching hospital in Chia‐Yi, Taiwan. Patients were enrolled if they had acute respiratory failure and had been admitted to the intensive care unit of our hospital between October 1, 2004 and September 30, 2005 inclusively. Results: All 86 patients who satisfied the studys inclusion criteria agreed to participate in the study, and each patient was followed‐up until the discontinuation of NIV treatment or their death. We measured the Acute Physiology and Chronic Health Evaluation (APACHE) II score prior to their treatment and also conducted serial measurements of respiratory rate (RR), tidal volume, rapid shallow breathing index, maximal inspiratory pressure (PImax), and maximal expiratory pressure (PEmax) prior to, and 30 minutes and 60 minutes subsequent to NIV treatment (denoted by, respectively, the subscripted numbers 0, 30 and 60). NIV treatment was determined as being successful for 55 patients (the success group, for which individuals endotracheal intubation was avoided) and as being a failure for 31 patients (the failure group). APACHE II scores prior to treatment, PImax30 (PImax 30 minutes subsequent to NIV), RR30(RR 30 minutes subsequent to NIV), and RR60 (RR 60 minutes subsequent to NIV) were all significantly lower for the success group than for the failure group. The success group also had significantly better values for RR during the first 30 minutes of NIV treatment and for PEmax during the first 60 minutes of NIV treatment compared to individuals from the failure group. Conclusion: APACHE II scores recorded prior to NIV treatment, PImax30, R30, RR60, as well as improvements to RR during the first 30 minutes of NIV treatment and to PEmax during the first 60 minutes of NIV treatment were predictors of successful NIV treatment for patients suffering from acute respiratory failure. Such parameters may be helpful in selecting patients to receive NIV treatment and also for deciding when early termination of the treatment is appropriate.

Medical response to 2016 earthquake in Taiwan.

www.thelancet.com Vol 388 July 9, 2016 129 In his Offl ine, Richard Horton writes that in one Bedouin village, “with such unstable electricity supplies, immunisation programmes cannot be implemented safely. Children must go to Beersheva to receive vaccinations.” The situation in the Bedouin community is vastly diff erent from that described, and for a Bedouin mother or father to take more than half an hour to reach a vaccination clinic is a rare case indeed. Currently, 27 mother-andchild clinics throughout Israel, called milk-drop stations, provide services for the Bedouin community, including counselling, pregnancy follow-ups, vaccinations, screening tests, and health promotion programmes. Of those clinics, 21 are serving solely the Bedouin 220 000 population—a denser network than in any other subgroup in Israel. A mobile clinic is also operated to reach the farthest outskirts of Bedouin dispersal. Because the Bedouin population is, in part, widely dispersed in the Negev area, and because of the low socioeconomic situation of this community, we believe that such an extensive approach to prevention is justified. The resulting vaccination coverage rates for all components of the childhood immunisation schedule average 93–96%, and are similar or higher in Bedouins than in other communities in the Southern District of Israel. This insistent approach towards prevention in the Bedouin community, and the ensuing high vaccination rates, are the main reasons for the success of the Health Ministry campaign during the silent poliovirus introduction into this community, as thousands carried the virus and not a single clinical case of poliomyelitis occurred.

Respiratory symptoms among search and rescue workers who responded to the 2016 Taiwan earthquake

Objectives High respiratory hazards among search and rescue workers (SRWs) emerged after the World Trade Center attacks on 11 September 2001. There have been limited studies on respiratory symptoms among earthquake SRWs. We investigated the respiratory symptoms and the use of respiratory protective equipment among the SRWs who responded to the 2016 Taiwan earthquake. Methods On 6 February 2016, a 6.4-magnitude earthquake struck southern Taiwan and caused 513 injuries and 117 deaths. During the 9-day field operation, 519 firefighters affiliated with the Tainan City Government Fire Bureau participated in the search and rescue response. A standardised, self-completed questionnaire was used to collect data on demographics, dust exposures, personal protective measures and health outcomes 3u2009weeks after the earthquake. Descriptive and multivariate analyses adjusting for demographics and exposure variables were performed for new or worsened outcomes. Results Of the 519 SRWs, 414 (80%) responded to the questionnaire. Of these SRWs, 153 (37%) reported new or worsened respiratory symptoms, with cough (23%) as the leading symptom, followed by rhinorrhoea or nasal congestion (22%) and chest tightness (6%). More than 90% of the symptoms persisted to the third week after the earthquake. The prevalence of new or worsened respiratory symptoms was significantly higher among SRWs with a higher level of exposure to dust. Prior training in response to respiratory pollutants was only 5%. Conclusions There were significant respiratory hazards among earthquake SRWs. The persistent symptoms and low coverage of training warrant further regular examination and occupational health programmes.