Shun-Jen Chang

The visual status of children ages 3 to 6 years in the vision screening program in Taiwan.

PURPOSE To investigate the current status of myopia, amblyopia, and strabismus of preschoolers in Taiwan. METHODS The records of a vision screening performed in 2005 at 4 preschools by a tertiary referral medical center in Kaohsiung, Taiwan were reviewed. Cycloplegic refraction, visual acuity by E chart, stereopsis by Titmus and National Taiwan University tests, and ocular alignment were analyzed. RESULTS Most (97.7%) of the children (n = 618) were able to perform visual acuity testing. There was good correlation between the results of cycloplegic spherical equivalent obtained by autorefraction and by retinoscopy (r = 0.934, p < 0.001). The prevalence of amblyopia was about 5%. A trend was found between amblyopia morbidity and the 4 age groups when a single criterion (best-corrected visual acuity <0.7) was used for all ages (decreased amblyopia incidence with increased age; p = 0.028, chi(2) test for trend). The prevalence of myopia was 3.0%, 4.2%, 4.7%, and 12.2% at ages 3, 4, 5, and 6 years, respectively. There was a trend of increased myopia with increased age (p = 0.021, chi(2) test for trend). CONCLUSIONS The prevalence of myopia in children ages 3 to 6 years in Taiwan was high compared with the prevalence in other countries. Criteria for amblyopia based on age difference and on the types of visual acuity test are recommended.

Gout and Type 2 diabetes have a mutual inter-dependent effect on genetic risk factors and higher incidences

OBJECTIVE To explore the causal relationship between gout and Type 2 diabetes based on genetic evidence and national outpatient database. METHODS Twenty male gout patients with early-onset, gout family history, without a habit of alcohol consumption or obesity before the first attack of gout were selected from hospital in 2010; and 42 unrelated male Chinese subjects were selected from HapMap as controls for genome-wide analysis study (GWAS). The comorbid diseases with gout were revealed by applying the significant single nucleotide polymorphisms (SNPs) to MetaCore platform, and the comorbid relationship was analysed by standardized incidence ratio (SIR) from outpatient database. RESULTS A total of 334 SNPs were significantly related to gout in GWAS (P < 10(-7)), and Type 2 diabetes was the most significantly associated disease with gout as recognized by 36 gene symbols correspondent to the above significant SNPs. The analysis of national outpatient database showed that the overall incident Type 2 diabetes was 1.50 cases per 1000 person-months among gout patients, which was higher than the overall incident gout (1.06 cases) among Type 2 diabetes. The age-adjusted SIR of incident Type 2 diabetes among gout was 2.59 (95% CI 2.42, 2.78), whereas the age-adjusted SIR for incident gout among Type 2 diabetes was 1.61 (95% CI 1.48, 1.74). CONCLUSION After excluding obesity and alcohol consumption behaviour, this study showed that patients with gout and Type 2 diabetes shared the common genetic factors most, and that there existed a mutual inter-dependent effect on higher incidences.

Astigmatism in preschool children in Taiwan.

PURPOSE To elucidate the prevalence of astigmatism and its corneal component, the association between the amount of astigmatism and its axis, and the association between the axis of astigmatism and body mass index (BMI) in Taiwanese preschool children. METHODS In this population-based study we analyzed 2 data sets, one obtained by retrospective review of vision-screening data and another obtained in a prospective observational study. Each study collected data for age, sex, and refraction status. Autokeratometry, height, and weight measurements were obtained only in the observational study. Astigmatism was classified as with-the-rule, against-the-rule, or oblique. RESULTS The prevalence of astigmatism was unassociated with age or sex in both data sets. The retrospective study (1,094 subjects; mean age, 5 years; range, 2.19-7.32 years) revealed that 13.3% of the subjects had astigmatism > or = 1.00 D, and most of them had with-the-rule astigmatism; 4.0% had high astigmatism (>1.50 D). Children with with-the-rule astigmatism had greater mean cylinder power than those with against-the-rule or oblique astigmatism. In the prospective study (190 subjects; mean age, 5.65 years; range, 3.79-6.68 years) astigmatism correlated with its corneal component. Preschoolers with with-the-rule astigmatism and with-the-rule corneal astigmatism had greater BMI and heavier weight than those with against-the-rule or oblique type. CONCLUSIONS Astigmatism is common in Taiwanese preschool children. The predominant types are with-the-rule and oblique astigmatism. Most patients with high astigmatism and high corneal astigmatism have with-the-rule type. High BMI or weight is associated with with-the-rule astigmatism and with with-the-rule corneal astigmatism.

Preliminary study of a traditional Chinese medicine formula in systemic lupus erythematosus patients to taper steroid dose and prevent disease flare-up

Systemic lupus erythematosus (SLE) is a chronic systemic autoimmune disease. Prolonged complete remission is rare. Most patients with SLE need long‐term treatment with glucocorticoid and immunomodulators. However, side effects because of the above medications are common. We evaluated the effect of adding‐on Dan‐Chi‐Liu‐Wei combination (DCLWC) on SLE patients with conventional therapy in tapering steroid and preventing disease flare‐up. This was a double‐blind and randomized controlled trial. Sixty‐six SLE patients were recruited into this study and 53 patients who fulfilled the 1997 revised criteria for the classification of SLE with an SLE disease activity index (SLEDAI) score of 2–12 and a steroid (measured with prednisolone) daily dose of less than 20 mg/d were enrolled. The patients were randomized into either an experimental or control group. We checked the urine analysis, hemogram, liver function, renal function, C3, C4, erythrocyte sedimentation rate, and anti‐dsDNA, evaluated the SLEDAI score, and recorded the steroid dose at 0 months, 3 months, and 6 months, respectively. After 6 months of study, the C4 and blood urea nitrogen level revealed a statistically significant difference in either group. There was a tendency toward a decreased SLEDAI score in the experimental group (p = 0.083) but not in the control group (p = 0.867). The steroid dose was not statistically significant in either group. Renal function and liver function revealed no statistically significant statistics changes in either group. Adding‐on DCLWC to conventional therapy for the treatment of SLE was safe and might have a borderline effect in decreasing disease activity, but it was not possible to taper the dosage of steroid after 6 months of clinical trial. Therefore, a long‐term follow‐up and a large‐scale study are necessary to confirm the effect of DCLWC.

ASSOCIATION BETWEEN CIGARETTE SMOKING AND HYPOXANTHINE GUANINE PHOSPHORIBOSYLTRANSFERASE ACTIVITY

The aim of this study was to investigate the association between smoking behavior and hypoxanthine guanine phosphoribosyltransferase (HGPRT) activity. A cross‐sectional study was performed of 82 men, including 38 non‐smokers and 44 smokers. Inosine monophosphate (IMP), the product of HGPRT (used as the index of activity), was measured in peripheral blood mononuclear cells using high‐performance liquid chromatography. The factors potentially associated with HGPRT activity included age, glutamyl oxaloacetic transaminase, glutamyl pyruvic transaminase, cholesterol, uric acid, triglycerides, creatinine, body mass index, gout, systolic blood pressure, diastolic blood pressure, alcohol consumption, and cigarette smoking. Mean HGPRT activity was 7.05 ± 3.44 nmol/106 viable cells/hour for all participants, and was significantly lower for smokers than for non‐smokers (6.24 ± 3.40 vs 7.98 ± 3.28 nmol/106 viable cells/hour; p = 0.02). In addition, as the number of smoked cigarettes increased, the HGPRT activity decreased (p < 0.05). The age at onset of cigarette smoking showed a positive correlation with HGPRT activity after adjusting for smoking duration, serum uric acid, and cigarettes smoked per year using a multiple regression model (p < 0.001). We concluded that the greater the number of cigarettes smoked, the lower the HGPRT activity, and that HGPRT activity was higher in smokers who had started smoking later.

Endothelin-1 Enhances Corneal Fibronectin Deposition and Promotes Corneal Epithelial Wound Healing after Photorefractive Keratectomy in Rabbits

The objective was to study the effects of endothelin‐1 (ET1) on corneal wound healing after photorefractive keratectomy (PRK) in rabbit corneas. Following PRK, 18 New Zealand white rabbits were treated with ET1 in the right eyes and with phosphate‐buffered salt solution (PBS) in the left eyes. Corneal epithelial wound size, corneal haze and corneal thickness were recorded. Corneal extracellular matrixes, including collagen types 3, 4 and 7, chondroitin sulfate and fibronectin, were investigated using immunohistochemistry study. ET1 increased the rate of healing of corneal epithelial wounds in rabbits. Anti‐fibronectin fluorescence was present at week 12 and week 24 in ET1‐treated eyes but not in the control eyes. There were no significant differences in corneal haze, corneal thickness and changes in other extracellular matrixes between ET1‐ and PBS‐treated eyes. ET1 can enhance the deposition of fibronectin in corneal stroma and promote corneal epithelial wound healing after PRK. The increase in fibronectin probably explains the increased healing rate of corneal epithelial wounds.

Effects of Zinc Compound on Body Weight and Recovery of Bone Marrow in Mice Treated with Total Body Irradiation

This study aimed to investigate if zinc compound would have effects on body weight loss and bone marrow suppression induced by total body irradiation (TBI). ICR mice were divided randomly into two groups and treated with test or control compounds. The test compound contained zinc (amino acid chelated with bovine prostate extract), and the control was reverse osmosis pure water (RO water). One week after receiving the treatment, mice were unirradiated, or irradiated with 6 or 3 Gy by 6MV photon beams to the total body. Body weight changes were examined at regular intervals. Three and 5 weeks after the radiation, animals were sacrificed to examine the histologic changes in the bone marrow. Lower body weight in the period of 1‐5 weeks after radiation and poor survival rate were found after the 6 Gy TBI, as compared with the 3 Gy groups. The median survival time after 6 Gy and 3 Gy TBI for mice given the test compound were 26 and 76 days, respectively, and the corresponding figures were 14 and 70 days, respectively, for mice given the control compound (p < 0.00001). With zinc supplement, the mean body weight in mice which received the same dose of radiation was 7‐8 g heavier than in the water‐supplement groups during the second and third weeks (p < 0.05). Hence, there was no statistically significant difference in survival rate between zinc and water supplement in mice given the same dose of irradiation. Histopathologically there was less recovery of bone marrow cells in the 6Gy groups compared with the 3Gy groups. In the 3 Gy water‐supplement group, the nucleated cells and megakaryocytes were recovered in the fifth week when recovery was still not seen in the 6Gy group. With zinc supplement, these cells were recovered in the third week. In this study, we found that zinc is beneficial to body weight in mice treated with TBI. Histologic examination of bone marrow showed better recovery of bone marrow cells in groups of mice fed with zinc. This study suggests that zinc can be used as supplements in cancer patients receiving radiotherapy to reduce radiation‐induced complications.

The characteristics of premature infants with transient corneal haze

Background The etiology of transient corneal haze in premature infants is not known and how it relates to clinical outcomes in premature infants is not clear. Objectives To study associated factors of transient corneal haze in premature infants. Methods We performed a retrospective study of 261 premature infants from retinopathy of prematurity (ROP) screening in the neonatal intensive care unit at a tertiary referral hospital. Characteristics of premature infants with and without corneal haze were analyzed by correlation tests, Chi-square tests, and logistic regressions were used for statistical analyses. Associations between corneal haze and birth weight (BW), gestational age at birth (GA), central corneal thickness, intraocular pressure, and other systemic and ophthalmic data were evaluated. Results The incidence of corneal haze was 13.4%. Lower BW, lower GA, packed red blood cells (RBC) transfusion, more days on oxygen, older maternal age, bronchopulmonary disease, and stage 3 ROP are associated with corneal haze. The severity of corneal haze decreased with infants’ postmenstrual age. Multivariate logistic regression analyses revealed that BW and maternal age are the most important predictors of corneal haze. Conclusion Low BW and older maternal age are the most important predictors of corneal haze in premature infants. Premature infants with corneal haze could carry more systemic and ocular morbidities. Hence they may require more clinical attention. Corneal haze is unlikely to hinder the treatment of ROP. However, it is possible that corneal haze could hinder the examination of ROP in some infants. If corneal haze does interfere with ROP screening, a closer, more conservative follow-up schedule with a senior ophthalmologist experienced in managing ROP is recommended.

Recurrent Attack of Gouty Arthritis in Patients Hospitalized Due to Non-Gout Diseases: Case-Control Study

Recurrent attacks of gouty arthritis at Chang Gung Memorial Hospital (CGMH), Kaohsiung, was the most common reason for consultation by a rheumatologist. The purpose of this study was to survey the clinical manifestations and predisposing factors of acute flares for gouty patients hospitalized due to non-gout diseases. Methods. This study reviewed the clinical features and predisposing factors of 216 hospitalized patients (186 males and 30 females) with known previous diagnoses of gout who were admitted to CGMH, Kaohsiung, during a 15-month period between Jan 2003 and Mar 2004. All subjects were categorized into two groups. Group 1 comprised patients who developed a recurrent attack of gouty arthritis during hospitalization. Group 2 (control) consisted of subjects with a gout history and without a flare-up during admission. Each group 1 patient was age- (±5 years) and sex-matched with 2 control subjects. Results. Patient mean age was 59.1±14.7 years and the male-to-female ratio was 6.2:1 in group 1. The leading cause of recurrent attack in group 1 compared with group 2 was lack of antigout medication (adjusted odds ratio 4.6, 95% confidence intervals 2.34–9.06). During recurrent attacks 69.4% of patients developed monoarthritis, 48.5% had hyperuricemia, and 32.3% developed fever. Ankles were the joints affected most during recurrent attacks. Conclusion. Lack of antigout medication was a significant factor in the development of acute attacks of gouty arthritis in hospitalized patients admitted due to non-gout diseases. Education of patients and physicians to continue antigout therapy is strongly recommended to prevent recurrent attacks of gouty arthritis in hospitalized patients.

Evaluation of Tumor Markers in the Follow-Up of Breast Cancer Patients after Treatment

Purpose: This study evaluates the usefulness of serial CEA, TPA, CA153 and combined modalities in serum levels for screening recurrence in patients with primary breast cancer after surgery, chemotherapy, radiotherapy and hormone therapy. Materials and Methods: CEA, TPA, and CA153 serial serum determinations were performed on 332 patients (median follow-up: 48.9 months) with primary breast cancer. Within the group, there were 195 clinically diagnosed episodes of relapse during follow- up. Comparison among groups by cut-off value, and dynamic changes of 20% and 30% were done. Results: The sensitivity and specificity, determined for circulating tumor markers by cutoff levels were (for CEA)27.91%, 94.38%; (TPA) 63.37%, 53.13%; and (CM 53) 31.40%, 92.50%, respectively. Utilizing 20% dynamic change methods, CEA, TPA and CA1S3 showed sensitivities of 59.30%, 55.23% and 17.44%, and specificities of 18.75%, 38.13% and 99.38%, respectively. Conclusions: In this study, metastatic patients were classified into three categories of sites: viscera, bones and locoregional. Tumor marker sensitivity was clearly related to the site of recurrence; the lowest sensitivity was found in locoregional relapse and the highest was in patients with visceral metastasis, CA153 was more sensitive than CEA in monitoring breast cancer recurrence under cut-off methods but the results were reversed when serum concentration was evaluated by dynamic changes. For single markers, TPA presented the best sensitivity in all fields under cut-off methods, but was surpassed by CEA under dynamic changes for the detection of visceral metastasis. Unlike the other categories, when serum TPA values were determined by dynamic changes, the highest sensitivity was obtained for visceral metastasis detection. Significant elevation predicted new recurrence or tumor regrowth after complete remission. The combined use of CEA, TPA, and CA153 increased the overall sensitivity.