Pei-Fang Lai

Flavonoids exert antioxidant activity by scavenging free radicals, chelating metals, and modulating antioxidant enzymes. The root extract of Glycine tomentella Hayata (GTE), a traditional Chinese medicinal herb contains flavonoids, particularly, isoflavones. However, its neuroprotective effects against anxiety remain unclear. In this study, the effects of GTE on anxiety-like behavior and oxidative stress in male Balb/c mice were investigated. The mice were administered GTE orally once daily for 14 d and subsequently, the anxiolytic-like effects of the extract were observed via elevated plus maze and open field tests. Oxidative stress levels in the treated mice were also measured. The results obtained identified daidzein (9.19 mg/g dry extract) and daidzin (2.95 mg/g dry extract) as the key isoflavones in GTE. Furthermore, free radical scavenging assays confirmed that GTE shows strong antioxidant activity, with an IC50 value of 8.82 μg/mL. It also showed pronounced anxiolytic effects, attenuating reactive oxygen species production in a dose-dependent manner. Mechanistic studies attributed these effects to the estrogenic activity of daidzein, which possibly modulates emotional state via estrogen receptor activation and systemic oxidative stress mitigation. These findings suggest that isoflavone-enriched GTE is a natural resource with potential for use as an antioxidant for mitigating anxiety.

Heat shock proteins (HSPs), which function as chaperones, are activated in response to various environmental stressors. In addition to their role in diverse aspects of protein production, HSPs protect against harmful protein-related stressors. Calycosin exhibits numerous beneficial properties. This study aims to explore the protective effects of calycosin in the heart under heat shock and determine its underlying mechanism. H9c2 cells, western blot, TUNEL staining, flow cytometry, and immunofluorescence staining were used. The time-dependent effects of heat shock analyzed using western blot revealed increased HSP expression for up to 2[ ]h, followed by protein degradation after 4[ ]h. Hence, a heat shock damage duration of 4[ ]h was chosen for subsequent investigations. Calycosin administered post-heat shock demonstrated dose-dependent recovery of cell viability. Under heat shock conditions, calycosin prevented the apoptosis of H9c2 cells by upregulating HSPs, suppressing p-JNK, enhancing Bcl-2 activation, and inhibiting cleaved caspase 3. Calycosin also inhibited Fas/FasL expression and activated cell survival markers (p-PI3K, p-ERK, p-Akt), indicating their cytoprotective properties through PI3K/Akt activation and JNK inhibition. TUNEL staining and flow cytometry confirmed that calycosin reduced apoptosis. Moreover, calycosin reversed the inhibitory effects of quercetin on HSF1 and Hsp70 expression, illustrating its role in enhancing Hsp70 expression through HSF1 activation during heat shock. Immunofluorescence staining demonstrated HSF1 translocation to the nucleus following calycosin treatment, emphasizing its cytoprotective effects. In conclusion, calycosin exhibits pronounced protective effects against heat shock-induced damages by modulating HSP expression and regulating key signaling pathways to promote cell survival in H9c2 cells.

Background: Triage plays a crucial role in the emergency department (ED) management of mass casualty incidents (MCIs) when resources are limited. This study aimed to compare the performance of simple triage and rapid treatment (START) with that of the Taiwan Triage and Acuity Scale (TTAS) for the ED triage of victims following an earthquake-related MCI. Methods: We retrospectively reviewed the records of victims presenting at our ED with earthquake-related injuries within 24 h of a large-scale earthquake. TTAS was initially used at our ED for this event, and START was performed by retrospectively reviewing the patient records in a blinded manner. Area under the receiver operating characteristic curve (AUC), sensitivity, and specificity of START and TTAS were determined for predicting ED discharge. Results: We enrolled 105 patients (predominantly women, 60.0%; median age, 45.0 years) in this study; most of them presented with traumatic injuries and were initially triaged as TTAS level III (78.1%), followed by TTAS level II (11.4%). Although the majority of the victims (81.0%) were discharged, four deaths occurred. A moderate agreement in differentiating emergency from nonemergency patients was observed between START and TTAS. Furthermore, both the triage systems showed similar predictions for ED disposition (START AUC/sensitivity/specificity: 0.709/82.35%/55.00%; TTAS AUC/sensitivity/specificity: 0.709/90.59%/45.00%). Conclusions: The present study demonstrated that START and TTAS have similar triage accuracy and ability to predict ED disposition. Our findings demonstrate that START may be used as an alternative to TTAS for the ED triage of victims following earthquake-related MCIs.

Background: On February 6, 2018, a magnitude-6.2 earthquake on the Richter scale struck Hualien, and that disaster killed 17 people and injured more than 300 people. Our hospital, the only tertiary hospital in eastern Taiwan, responded to a mass casualty incident (MCI) in two hours. Such a devastating earthquake infl uenced the health of the general population and the mental health of hospital staff. Thus, we aimed to analyze the medical problems in earthquake victims, the MCI response's operation, and the prevalence of post-traumatic stress disorder (PTSD) among healthcare providers. Methods: We reviewed the medical records to investigate the information on the medical requirement of victims. Questionnaires were collected from emergency department staff regarding the operation of the MCI and the effect of regular MCI drills. For a survey of PTSD among healthcare providers, we used the Chinese version of the Davidson Trauma Scale for the psychiatric assessment. Results: Among the 113 victims who entered the emergency room, almost 90% had a minor injury. The results of the operation of the MCI revealed that 71.5% of them knew the response process of the MCI and performed well. The hospital staff's mental health assessment showed 17.5% met the diagnostic criteria for PTSD one month after the disaster, and 3.2% met the criteria seven months after the earthquake. Personal psychiatric histories were the only risk factor for PTSD. Conclusions: Most earthquake victims presented to the emergency room with trauma injuries. Thus, we need to prepare more resources to manage surgical problems. To be well prepared for mass casualty events, the annual exercises play a signifi cant role. Besides, we can't ignore the mental health condition of healthcare providers after the disaster. We record this tragic earthquake's valuable experience and lessons and share them with others.

Introduction: Subarachnoid hemorrhage (SAH) is a critical disease, and people may get mortality on SAH. Another severe disease induced cardiac arrest is acute coronary syndrome (ACS), and our two cases share the typical characteristics of ACS electrocardiogram (ECG) with ST-segment elevation. The experience is rare and educable, so we present this article to remind emergency physicians in similar cases. Case presentation: Two post-resuscitation electrocardiogram (ECG)-proven cases of out-of-hospital cardiac arrest (OHCA) revealed ST-segment elevation. Discussion: However, the etiology of the arrest was proven to be subarachnoid hemorrhage (SAH) in the Emergency Department. In this article, we shared ECGs and brain CT scans as a reminder to ED doctors to bear in mind other differential diagnoses when ECGs show ST-segment elevation post-resuscitation. Conclusion: Cases such as these alert frontline ED physicians to the possibility of SAH in cardiac arrest patients and the potentially lethal consequence of inappropriate treatment.

There are 6 species of venomous snakes in Taiwan. Two of them, Deinagkistrodon acutus (D. acutus) and Daboia siamensis (D. siamensis), can cause significant coagulopathy. However, a significant proportion of patients with snakebites cannot identify the correct snake species after envenomation, which hampers the application of antivenom. Hence, the differential diagnosis between the two snakebites by clinical presentations is important. This study aims to compare their clinical and laboratory features for the purpose of differential diagnosis between the two snakebites. We retrospectively reviewed the medical records of patients who arrived at the emergency department due to D. acutus or D. siamensis envenomation, between 2003 and 2016, in one medical center in eastern Taiwan. Since these snakebites are rare, we also included 3 cases reported from another hospital in central Taiwan. In total, 15 patients bitten by D. acutus and 12 patients by D. siamensis were analyzed. Hemorrhagic bulla formation and the need for surgical intervention only presented for D. acutus envenomation cases (Both 53.3% vs. 0.0%, P = 0.003). As to laboratory features, lower platelet counts (20.0 × 103/μL [interquartile range, 14–66 × 103/μL] vs. 149.0 × 103/μL [102.3–274.3 × 103/μL], P = 0.001), lower D-dimer level (1423.4 μg/L [713.4–4212.3 μg/L] vs. 12,500.0 μg/L [2351.4–200,000 μg/L], P = 0.008), higher proportion of patients with moderate-to-severe thrombocytopenia (platelet count < 100 × 103/μL) (80% vs. 16.7%, odds ratio (OR) = 20.0, 95% CI, 2.77–144.31; P = 0.002), and lower proportion of patients with extremely high D-dimer (> 5000 ng/mL) (16.7% vs. 66.7%, adjusted OR = 0.1 (95% CI, 0.01–0.69; P = 0.036) were found among cases of D. acutus envenomation compared to D. siamensis envenomation. The combination of hemorrhagic bulla, thrombocytopenia, and a lack of extremely high D-dimer had good discriminatory power (area under the curve (AUC) = 0.965; 95% CI, 0.904–1.00) for distinguishing D. acutus from D. siamensis envenomation. The presentation of moderate to severe thrombocytopenia (platelet count < 100 × 103/μL) and hemorrhagic bulla formation may indicate D. acutus envenomation. However, the envenomed patient with extremely high D-dimer levels may indicate a D. siamensis envenomation. These findings may help diagnose and select the right antivenom in patients with unknown snakebites who present significant coagulopathy.

Objectives: The objective of this study is to investigate the feelings (well-being) of emergency physicians in Taiwan regarding their job and the relationship between these feelings and the work environment. Materials and Methods: A?questionnaire was used to survey emergency physicians across Taiwan from January to June 2014. The questionnaire contents were categorized into five specific factors that could affect well-being, including “emergency quality, emergency safety, support environment, workload, and salary and benefits.” Well-being was rated directly on a scale of 1–10, with 10 indicating the highest level of happiness. Physician retention was also surveyed. The correlations among the five factors, well-being, and physician retention were analyzed. The five factors were quantified as a “happiness index” and compared between religious and nonreligious hospitals and medical centers and regional hospitals. Results: A?total of 398 questionnaires were received, and the response rate was 39%. Of these, 42.7% of responders reported high ratings for well-being (scores of 7–10, 1 is the worse, and 10 is the best) and 40.3% felt neutral (scores of 5–6). Only 12.3% doctors did not think they would stay at the same position for the next 3?years. All five factors had moderately significant correlations with each other (γ = 0.195–0.534, γ< 0.01). All five factors also significantly correlated with well-being. Emergency safety (γ = 0.121, γ< 0.05), salary and benefits (γ = 0.143, γ< 0.05), and well-being (γ = 0.189, γ< 0.01) were correlated with physician retention. The happiness indices of emergency quality, support environment, and workload were significantly higher in regional hospitals than medical centers. Conclusions: All five indicators had impacts on well-being. The respondents reported heavy workloads, including high stress and even poorly met physiological needs. In addition, the threat of violence, salaries, and well-being correlated with physician retention. Hospital administrators can make efforts to improve the well-being of doctors and physician retention by adjusting environmental factors.

ObjectiveThe purpose of this study was to determine the etiologies of altered mental status (AMS) in an emergency department (ED) and the associated contributing factors.Materials and MethodsA retrospective chart review of the medical records was performed from January 2006 through December 2006 in a medical center in eastern Taiwan among the ED patients with AMS. Data collected included sex, age, date of ED visit, chief complaint, disposition, admission diagnosis, date of admission, location admitted to (ordinary ward or intensive care unit), diagnosis at discharge, and date of discharge from hospital.ResultsOf the 595 patients analyzed during the study period, which accounted for 1.3% of total ED census, the mean age was 51.55 years. The three leading etiologies of AMS were trauma, hypoglycemia, and stroke. Among them, trauma had higher incidences in the summer and winter; hypoglycemia had increased tendencies in the spring; the population of stroke patients increased in the summer and fall. Of the cases studied, 51.3% were admitted with a mean length of stay of 13.54 days; incidence of death was 12.4%. Other conditions with admission rate > 50% were hypoxia and stroke. The diagnoses with the lowest admission rate were psychosis, trauma and alcohol abuse. One third of AMS patients was younger than 40 years and the other one third was older than 70 yearsConclusionIt is important for ED physicians to be knowledgeable about the etiologies of patients with AMS in general, special subgroups, and the etiologic tendencies during the different seasons. Ranking results for the different etiologies of AMS in our study differed from the results of previous studies due to differences of local culture and residents in eastern Taiwan

The malignant transformation of an ovarian mature cystic teratoma is rare. We presented such a case of a 46-year-old woman with characteristic computed tomography (CT) findings. The patient had suffered from fullness and tenderness of the lower abdomen for one year. A high serum CA-125 level was noted. Computed tomography images showed a left adnexal mass with fat, calcification and soft tissue components, and areas of invasion through the teratoma wall. The histologic diagnosis was compatible with a squamous cell carcinoma arising from a mature cystic teratoma of the ovary.