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Sun YS, Huang DF, Chang FP, Chen WS, Liao HT, Chen MH, Tsai HC, Tsai MT, Tsai CY, Lai CC, Yu Yang C. Interstitial fibrosis increases the risk of end-stage kidney disease in patients with lupus nephritis. Rheumatology (Oxford) 2024:keae226. [PMID: 38696753 DOI: 10.1093/rheumatology/keae226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/27/2024] [Accepted: 04/06/2024] [Indexed: 05/04/2024] Open
Abstract
OBJECTIVE To evaluate the risk of end-stage kidney disease (ESKD) in lupus nephritis (LN) patients using tubulointerstitial lesion scores. METHODS Clinical profiles and histopathological presentations of 151 biopsy-proven LN patients were retrospectively examined. Risk factors of ESKD based on characteristics and scoring of their tubulointerstitial lesions (e.g. interstitial inflammation [II], tubular atrophy [TA], and interstitial fibrosis [IF]) were analyzed. RESULTS The mean age of 151 LN patients was 36 years old, and 136 (90.1%) were female. The LN cases examined included: class I/II (n = 3, 2%), class III/IV (n = 119, 78.8%), class V (n = 23, 15.2%), and class VI (n = 6, 4.0%). The mean serum creatinine level was 1.4 mg/dl. Tubulointerstitial lesions were recorded in 120 (79.5%) patients. Prior to receiving renal biopsy, 9 (6.0%) patients developed ESKD. During the follow-up period (mean, 58 months), an additional 47 patients (31.1%) progressed to ESKD. Multivariate analyses identified serum creatinine (hazard ratio [HR]: 1.7, 95% confidence interval [CI]: 1.42-2.03, p < 0.001) and IF (HR: 3.2, 95% CI: 1.58-6.49, p = 0.001) as independent risk factors of ESKD. Kaplan-Meier analysis further confirmed a heightened risk of ESKD associated with IF. CONCLUSION Tubulointerstitial involvement is commonly observed in histopathological presentation of LN. However, IF, rather than II, or TA, was found to increase the risk of ESKD in our cohort. Therefore, to predict renal outcome in LN patients prior to adjusting immunosuppressive treatment, degree of IF should be reviewed.
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Affiliation(s)
- Yi-Syuan Sun
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - De-Feng Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital
| | - Fu-Pang Chang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Department of Pathology, Taipei Veterans General Hospital
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ming-Han Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Hung-Cheng Tsai
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ming-Tsun Tsai
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital
| | - Chang-Youh Tsai
- Division of Rheumatology, Department of Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Chien-Chih Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chih- Yu Yang
- Institute of Clinical Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Faculty of Medicine, School of Medicine, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital
- Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, Taiwan
- Stem Cell Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Sun YS, Huang DF, Chen WS, Liao HT, Chen MH, Tsai MT, Yang CY, Lai CC, Tsai CY. Risk Factors and Incidence of Serious Infections in Patients With Systemic Lupus Erythematosus Undergoing Rituximab Therapy. J Rheumatol 2024; 51:160-167. [PMID: 37839817 DOI: 10.3899/jrheum.2023-0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/14/2023] [Indexed: 10/17/2023]
Abstract
OBJECTIVE To evaluate the risk and protective factors of serious infection (SI) in patients with systemic lupus erythematosus (SLE) within 180 days of rituximab (RTX) treatment. METHODS Patients with SLE treated with RTX were analyzed. SI was defined as any infectious disease requiring hospitalization. The clinical characteristics, laboratory profiles, medications, and incidence rate (IR) are presented. Multivariate Cox proportional hazards models and Kaplan-Meier analysis for risk factors of SI were performed. RESULTS A total of 174 patients with SLE receiving RTX treatment were enrolled. The overall IR of SIs was 51.0/100 patient-years (PYs). Pneumonia (30.4/100 PYs), followed by soft tissue infections, intra-abdominal infections, and Pneumocystis jiroveci pneumonia (all 6.1/100 PYs) were the leading types of SIs. Twelve patients died during the 180-day follow-up (crude mortality rate: 14.6/100 PYs). Chronic kidney disease (CKD), defined as an estimated glomerular filtration rate < 60 mL/min/1.73 m2 (hazard ratio [HR] 2.88, 95% CI 1.30-6.38), and a background prednisolone (PSL) equivalent dosage ≥ 15 mg/day (HR 3.50, 95% CI 1.57-7.78) were risk factors for SIs among all patients with SLE. Kaplan-Meier analysis confirmed the risk of SI for patients with SLE with CKD and a background PSL equivalent dosage ≥ 15 mg/day (log-rank P = 0.001 and 0.02, respectively). Hydroxychloroquine (HCQ) reduced the risk of SIs in patients with SLE (HR 0.35, 95% CI 0.15-0.82; log-rank P = 0.003). CONCLUSION SI was prevalent in patients with SLE after RTX treatment. Patients with SLE with CKD and high-dose glucocorticoid use required constant vigilance. HCQ may reduce the risk of SI among patients with SLE administered RTX.
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Affiliation(s)
- Yi-Syuan Sun
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - De-Feng Huang
- D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei
| | - Wei-Sheng Chen
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Hsien-Tzung Liao
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ming-Han Chen
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Ming-Tsun Tsai
- M.T. Tsai, MD, PhD, Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, and Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, and Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chih-Yu Yang
- C.Y. Yang, MD, PhD, Division of Nephrology, Department of Medicine, Veterans General Hospital, and Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, and Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, and Center for Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Yang Ming Chiao Tung University, Hsinchu, and Stem Cell Research Center, National Yang Ming Chiao Tung University, Taipei
| | - Chien-Chih Lai
- Y.S. Sun, MD, W.S. Chen, MD, H.T. Liao, MD, M.H. Chen, MD, PhD, C.C. Lai, MD, PhD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Veterans General Hospital, and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei;
| | - Chang-Youh Tsai
- C.Y. Tsai, MD, PhD, Division of Immunology and Rheumatology, Department of Medicine, Fu Jen Catholic University Hospital, New Taipei City, Taiwan.
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Li TH, Su CF, Lai CC, Chang YF, Wu FY, Chang YS, Chuang CC, Tsai CY. Epidemiology and risk factors for cytomegalovirus disease in autoimmune inflammatory rheumatic diseases: A nationwide population-based study in Taiwan. Int J Rheum Dis 2024; 27:e15067. [PMID: 38402435 DOI: 10.1111/1756-185x.15067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 01/13/2024] [Accepted: 01/22/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Tzu-Hao Li
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chin-Fang Su
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chih Lai
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Fan Chang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fang-Yi Wu
- Department of Data Science, College of Arts and Sciences, American University, Washington, DC, USA
| | - Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Cheng Chuang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chang-Youh Tsai
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
- Division of Allergy, Immunology & Rheumatology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
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Wang KC, Sun YS, Tsai HC, Liao HT, Lai CC, Chen WS, Lu LY, Chen MH. Increased risk of malignancy in HLA-B27-positive patients with ankylosing spondylitis requiring biologics for sustained inflammation: A long-term, single-center retrospective study. Mod Rheumatol 2024:roae004. [PMID: 38302085 DOI: 10.1093/mr/roae004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/10/2024] [Indexed: 02/03/2024]
Abstract
OBJECTIVES To assess the link between the administration of biologic disease-modifying antirheumatic drugs (bDMARDs) and the risk of malignancy in human leukocyte antigen B27 (HLA-B27)-positive patients with ankylosing spondylitis (AS) experiencing sustained inflammation. METHODS Between 2006 and 2021, 1445 HLA-B27-positive patients with AS were retrospectively evaluated. Among them, 112 patients required bDMARD therapy. The study compared conventional therapy with bDMARDs and investigated the risk factors for developing malignancies. RESULTS During 8253 patient-years of follow-up, 38 (2.6%) patients developed various malignancies, including lung, liver, breast, and colon cancer. The risk of malignancy was significantly higher in the bDMARD-treated group compared to PS-matched groups receiving conventional synthetic DMARDs (csDMARD) and non-steroidal anti-inflammatory drugs. The cumulative risk of malignancies increased significantly after 6 years of follow-up. All patients who developed malignancy after bDMARD therapy received tumor necrosis factor-α inhibitors. Requiring bDMARD therapy, requiring bDMARDs in combination with csDMARD therapy, and being diagnosed with AS after 30 years of age were independent risk factors for developing malignancy. CONCLUSIONS HLA-B27-positive AS patients with sustained inflammation requiring biologic therapy, particularly if diagnosed after age 30, may have an increased risk of malignancy. Regular cancer screenings are advisable for these patients while undergoing biologic treatment.
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Affiliation(s)
- Kai-Chun Wang
- Division of Allergy-Immunology-Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- The Doctoral Program of Clinical and Experimental Medicine, National Sun Yat-sen University, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Yi-Syuan Sun
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Cheng Tsai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Chih Lai
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ling-Ying Lu
- Division of Allergy-Immunology-Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, College of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Ming-Han Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Tsai HC, Chen WS, Sun YS, Lai CC, Yang YY, Chou WR, Liao HT, Tsai CY, Chou CT. Antibodies against Small Ubiquitin-like Modifier Activating Enzyme May Be a Protective Factor from Rapid Progressive Interstitial Lung Disease in Patients Bearing Antibodies against Melanoma Differentiation Associated Gene 5. J Clin Med 2024; 13:725. [PMID: 38337419 PMCID: PMC10856636 DOI: 10.3390/jcm13030725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/04/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Background: Anti-MDA5 antibody-bearing (anti-MDA5+)-dermatomyositis (DM) or polymyositis (PM) is notorious for causing rapidly progressive interstitial lung disease (RPILD) and/or cancers with high mortality rate. However, anti-MDA5 antibodies (Abs) are also found in other connective tissue diseases and their link with RPILD, especially with regard to the mortality rate, are unknown. Methods: We retrospectively recruited 71 patients bearing anti-MDA5-Abs in serum, stratified them in terms of a presence or absence of RPILD, and evaluated their clinical features, laboratory findings, associated myositis antibodies, concurrent connective tissue disease (CTD) as well as newly developed malignancies. Results: In total, 39 (55%) patients presented with DM/PM, but 32 (45%) did not. In total, 22 of the former and 11 of the latter developed RPILD eventually, accounting for a total of 46% of all MDA-5 bearing patients. On the other hand, 15 of all 71 (21.1%) patients had cancers. Among the 32 patients who did not have DM/PM, 27 (38.0% of all 71) had other CTDs, indicating that only 5 (7.0% of 71) patients did not have CTDs. Senility (odds ratio (OR) = 1.816, p = 0.032), presence of anti-Ro-52 antibody (OR = 1.676, p = 0.018), elevated C-reactive protein (CRP, OR = 4.354, p < 0.001) and carcinoembryonic antigen (CEA, OR = 2.625, p = 0.005) posed risks for RPILD. High lactose dehydrogenase (LDH, p = 0.009), CRP (p = 0.001) and CEA (p = 0.001), ferritin (p ≤ 0.001) and low albumin (p ≤ 0.001) were significantly associated with mortality. Anti-SAE antibodies were negatively correlated with RPILD as analyzed by univariate (OR = 0.245, p = 0.017) and multivariate (OR = 0.058, p = 0.036) regressions, indicating that they may be a protective factor in relation to RPILD (OR = 0.543, p = 0.008) or fatality (OR = 0.707, p = 0.012), which was also demonstrated in subgroup analyses. Conclusions: In contrast to various risk factors for RPILD or mortality, anti-SAE antibodies might conversely be a protective factor in anti-MDA5+ patients.
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Affiliation(s)
- Hung-Cheng Tsai
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-C.T.); (W.-S.C.); (Y.-S.S.); (C.-C.L.); (C.-T.C.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan;
| | - Wei-Sheng Chen
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-C.T.); (W.-S.C.); (Y.-S.S.); (C.-C.L.); (C.-T.C.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan;
| | - Yi-Syuan Sun
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-C.T.); (W.-S.C.); (Y.-S.S.); (C.-C.L.); (C.-T.C.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan;
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei Campus, Taipei 112, Taiwan
| | - Chien-Chih Lai
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-C.T.); (W.-S.C.); (Y.-S.S.); (C.-C.L.); (C.-T.C.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan;
| | - Ying-Ying Yang
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan;
- Institute of Clinical Medicine, National Yang-Ming Chiao Tung University, Taipei Campus, Taipei 112, Taiwan
- Division of Clinical Skills Training Center, Department of Medical Education, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Department of Medical Education, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Wen-Ru Chou
- Division of Chest Medicine, Department of Medicine, Fu Jen Catholic University Hospital, 69 Guitz Rd., New Taipei City 24352, Taiwan;
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-C.T.); (W.-S.C.); (Y.-S.S.); (C.-C.L.); (C.-T.C.)
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11267, Taiwan;
| | - Chang-Youh Tsai
- School of Medicine, Fu Jen Catholic University, New Taipei City 242, Taiwan
- Division of Immunology & Rheumatology, Department of Medicine, Fu Jen Catholic University Hospital, 69 Guitz Rd., New Taipei City 24352, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, Taipei 112, Taiwan; (H.-C.T.); (W.-S.C.); (Y.-S.S.); (C.-C.L.); (C.-T.C.)
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Ou TS, Sun YS, Lai CC, Chen WS, Tsai HC, Chen MH, Chou CT, Chang FP, Peng YC, Tsai CC, Liao HT, Tsai CY. Immune-mediated diseases after vaccinations with AZD1222, BNT-162b2, &/or mRNA-1273: An observational investigation of 78 patients. Int Immunopharmacol 2024; 127:111455. [PMID: 38157699 DOI: 10.1016/j.intimp.2023.111455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 12/24/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Immune-mediated diseases (IMDs) after nucleic acid-based vaccines have been sporadically reported since their introduction during the worldwide COVID-19 crisis. Confirming their cause-effect association remains challenging. We analysed the effects of AZD1222 (ChAdOx1 nCoV-19), BNT-162b2, and/or mRNA-1273 on the development &/or deterioration of IMDs in terms of the time of clinical onsets of IMDs after exposure to these vaccines. METHODS We retrospectively reviewed 78 in-patients in Taipei Veterans General Hospital, who presented with IMDs within 120 days after receiving AZD1222, BNT-162b2, &/or mRNA-1273 vaccinations in Taiwan from May 2021 to April 2022. The duration from inoculation to development of IMD was analysed by two-tailed Kolmogorov-Smirnov (K-S) test for goodness of fit. RESULTS The average time to new IMDs or flare-up of the diseases following vaccinations was 36 ± 26 days for all 91 events in these 78 patients. The onset time of IMDs after vaccinations was not haphazard as analysed by two-tailed K-S test for overall 91 events (40 new and 51 deteriorating episodes, p < 0.001). The IMDs presenting as non-connective tissue diseases (non-CTDs) have a shorter duration of incubation after vaccinations than those of CTDs (<14.7 days, 95 % confidence interval [CI], 3.0 to 26.4, p = 0.014). Furthermore, systemic vasculitis and type 2 inflammatory diseases were observed exclusively in those receiving AZD1222. CONCLUSION AZD1222, BNT-162b2, or mRNA-1273 influence the activities of IMDs in ways yet to be explored. High index of suspicion to IMDs after nucleic acid-based vaccine inoculation against COVID-19 may be important for primary care physicians.
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Affiliation(s)
- Tao-Shen Ou
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Syuan Sun
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chien-Chih Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hung-Cheng Tsai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ming-Han Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fu-Pang Chang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Ching Peng
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chin Tsai
- Department of Pathology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Chang-Youh Tsai
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Immunology & Rheumatology, Department of Internal Medicine, Fu Jen Catholic University Hospital and College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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Yen YN, Garrido-Cumbrera M, Sun YS, Chen CH, Lai CC, Tsai HC, Chen WS, Liao HT, Tsao YP, Tsai CY, Chou CT. The Taiwanese Map of Axial Spondyloarthritis: Living with the Condition. Medicina (Kaunas) 2023; 59:1962. [PMID: 38004011 PMCID: PMC10673106 DOI: 10.3390/medicina59111962] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/14/2023] [Accepted: 10/24/2023] [Indexed: 11/26/2023]
Abstract
Background and Objective: The International Map of Axial Spondyloarthritis (IMAS) explores the physical, psychological, and social experiences of patients with axial spondyloarthritis (axSpA). This initiative is now being expanded to Taiwan as the Taiwanese Map of Axial Spondyloarthritis (TMAS). We aim to provide rheumatologists with insights into the perspectives of Taiwanese patients, enabling physicians to better understand the unmet needs of these patients and optimize their management. Materials and Methods: The TMAS is a cross-sectional study gathering data through an online survey of axSpA patients, promoted by the Ankylosing Spondylitis Caring Society of R.O.C. (ASCARES), conducted from July 2017 to March 2018 by Ipsos, and analyzed by the Health & Territory Research (HTR) group of the University of Seville. The questionnaire includes 99 questions that cover domains such as patient profile, diagnosis, habits/lifestyle, employment status, physical/psychological health status, social support, use of healthcare services, and treatments. Results: A total of 112 axSpA patients were included in this survey. The mean age was 38.6 years and 75.0% were male. The average diagnostic delay was 3 years, and 19.6% reported extra-articular manifestations. Out of the 49 respondents who reported HLA-B27 information, 35 were HLA-B27-positive. The disease burden was high, with a mean BASDAI score of 4.9 and 75.9% having a mild to moderate degree of spinal stiffness. Furthermore, they were socially and psychologically burdened, with 88.4% experiencing work-related issues and 25.9% suffering from anxiety. Conclusions: The TMAS sheds light on the overall perspective of axSpA patients in Taiwan. The TMAS shows shorter diagnostic delay compared to patients from the EMAS. However, high disease activity and significant psychological distress still trouble the patients, causing functional impairments and even leading to career failures. Understanding the perspective of axSpA patients can help rheumatologists adjust treatment strategies to their unmet needs and improve their disease outcomes.
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Affiliation(s)
- Yi-Ning Yen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (Y.-N.Y.); (C.-H.C.)
| | - Marco Garrido-Cumbrera
- Health & Territory Research (HTR), Universidad de Sevilla, 41004 Sevilla, Spain;
- Axial Spondyloarthritis International Federation (ASIF), London WC1N 3AX, UK
| | - Yi-Syuan Sun
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Chen-Hung Chen
- Division of Allergy, Immunology and Rheumatology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, New Taipei City 231, Taiwan; (Y.-N.Y.); (C.-H.C.)
| | - Chien-Chih Lai
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Hung-Cheng Tsai
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Wei-Sheng Chen
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
| | - Yen-Po Tsao
- Division of Holistic and Multidisciplinary Medicine, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan;
| | | | - Chang-Youh Tsai
- Division of Immunology and Rheumatology, Fu Jen Catholic University Hospital, College of Medicine, Fu Jen Catholic University, New Taipei City 243, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei 112, Taiwan; (Y.-S.S.); (C.-C.L.); (H.-C.T.); (W.-S.C.); (H.-T.L.); (C.-T.C.)
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8
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Chiou YR, Chang YS, Su CF, Li TH, Lai CC, Hwang DK, Wu FY, Chang YF. Risks of posterior segment ocular ischaemic events in patients with systemic lupus erythematosus: a population-based cohort study in Taiwan. Br J Ophthalmol 2023; 107:1687-1692. [PMID: 35922126 DOI: 10.1136/bjo-2022-321653] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/19/2022] [Indexed: 11/04/2022]
Abstract
BACKGROUD/AIM Ocular involvement in systemic lupus erythematosus (SLE) is often primarily recognised by ophthalmologists rather than internists. This study aims to investigate the incidence and risk factors for the occurrence of posterior ocular ischaemic events (OIE), including retinal vein occlusion (RVO), retinal artery occlusion (RAO) and ischaemic optic neuropathy (ION), in patients with SLE. METHODS A national database in Taiwan was used to identify 24 472 patients newly diagnosed with SLE and 244 720 age-matched and sex-matched controls between 1997 and 2012. New occurrences of OIE and confounding factors were recorded. The Kaplan-Meier method was used to compare the risk of OIE between the two groups. Fixed effect models were applied to evaluate the risk factors for OIE. RESULTS The mean age was 36.24±15.82 years and women accounted for 88.4%. Patients with SLE had significantly increased risk of overall OIE (HR 3.89, 95% CI 3.36 to 4.50, p<0.001) as well as each OIE subtype. End-stage renal disease (ESRD; HR 2.91, 95% CI 2.05 to 4.14, p<0.001), hypertension (HR 1.77, 95% CI 1.21 to 2.58, p=0.003) and congestive heart failure (HR 1.67, 95% CI 1.12 to 2.48, p=0.01) were associated with RVO development. Hypertension (HR 2.89, 95% CI 1.10 to 3.96, p=0.02) and ischaemic stroke (HR 3.58, 95% CI 1.97 to 6.48, p<0.001) had increased risk of RAO. ESRD was associated with ION (HR 3.03, 95% CI 1.41 to 6.51, p=0.004). Intravenous steroid was associated with RVO development (HR 2.54, 95% CI 1.67 to 3.84, p<0.001). CONCLUSIONS SLE increases the risk of developing OIE. Systemic comorbidities and higher dosage of steroid in patients with SLE are associated with severe ocular ischaemic complications.
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Affiliation(s)
- Yi-Ran Chiou
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
| | - Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Chin-Fang Su
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Tzu-Hao Li
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shin-Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - Chien-Chih Lai
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - De-Kuang Hwang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Fang-Yi Wu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Medical University, Shuang Ho Hospital, New Taipei City, Taiwan
| | - Yu-Fan Chang
- Department of Ophthalmology, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Hsinchu 30010, Taiwan
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9
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Huang WC, Hsieh SC, Wu YW, Hsieh TY, Wu YJ, Li KJ, Charng MJ, Chen WS, Sung SH, Tsao YP, Ho WJ, Lai CC, Cheng CC, Tsai HC, Hsu CH, Lu CH, Chiu YW, Shen CY, Wu CH, Liu FC, Lin YH, Yeh FC, Liu WS, Lee HT, Wu SH, Chang CC, Chu CY, Hou CJY, Tsai CY. 2023 Taiwan Society of Cardiology (TSOC) and Taiwan College of Rheumatology (TCR) Joint Consensus on Connective Tissue Disease-Associated Pulmonary Arterial Hypertension. Acta Cardiol Sin 2023; 39:213-241. [PMID: 36911549 PMCID: PMC9999177 DOI: 10.6515/acs.202303_39(2).20230117a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/17/2023] [Indexed: 03/14/2023]
Abstract
Background Pulmonary arterial hypertension (PAH), defined as the presence of a mean pulmonary artery pressure > 20 mmHg, pulmonary artery wedge pressure ≤ 15 mmHg, and pulmonary vascular resistance (PVR) > 2 Wood units based on expert consensus, is characterized by a progressive and sustained increase in PVR, which may lead to right heart failure and death. PAH is a well-known complication of connective tissue diseases (CTDs), such as systemic sclerosis, systemic lupus erythematosus, Sjogren's syndrome, and other autoimmune conditions. In the past few years, tremendous progress in the understanding of PAH pathogenesis has been made, with various novel diagnostic and screening methods for the early detection of PAH proposed worldwide. Objectives This study aimed to obtain a comprehensive understanding and provide recommendations for the management of CTD-PAH in Taiwan, focusing on its clinical importance, prognosis, risk stratification, diagnostic and screening algorithm, and pharmacological treatment. Methods The members of the Taiwan Society of Cardiology (TSOC) and Taiwan College of Rheumatology (TCR) reviewed the related literature thoroughly and integrated clinical trial evidence and real-world clinical experience for the development of this consensus. Conclusions Early detection by regularly screening at-risk patients with incorporations of relevant autoantibodies and biomarkers may lead to better outcomes of CTD-PAH. This consensus proposed specific screening flowcharts for different types of CTDs, the risk assessment tools applicable to the clinical scenario in Taiwan, and a recommendation of medications in the management of CTD-PAH.
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Affiliation(s)
- Wei-Chun Huang
- Department of Critical Care Medicine, Kaohsiung Veterans General Hospital, Kaohsiung.,School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Department of Physical Therapy, Fooyin University, Kaohsiung
| | - Song-Chou Hsieh
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei
| | - Yen-Wen Wu
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City.,Graduate Institute of Medicine, Yuan Ze University, Taoyuan
| | - Tsu-Yi Hsieh
- Attending Physician of Division of Allergy-Immunology-Rheumatology, Department of Internal Medicine.,Director of Division of Clinical Training, Department of Medical Education, Taichung Veterans General Hospital.,Program of Business, College of Business, Feng Chia University, Taichung
| | - Yih-Jer Wu
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital, Taipei.,Department of Medicine, MacKay Medical College, New Taipei City
| | - Ko-Jen Li
- Department of Internal Medicine, National Taiwan University Hospital.,National Taiwan University, College of Medicine
| | - Min-Ji Charng
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Division of Cardiology
| | - Wei-Sheng Chen
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Division of Allergy, Immunology and Rheumatology
| | - Shih-Hsien Sung
- Department of Medicine, Taipei Veterans General Hospital.,Institute of Emergency and Critical Care Medicine
| | - Yen-Po Tsao
- Division of Allergy, Immunology and Rheumatology.,Institutes of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Wan-Jing Ho
- Department of Cardiology, Chang Gung Memorial Hospital.,College of Medicine, Chang Gung University, Taoyuan
| | - Chien-Chih Lai
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Division of Allergy, Immunology and Rheumatology
| | - Chin-Chang Cheng
- Department of Internal Medicine, Pingtung Veteran General Hospital, Pingtung
| | - Hung-Cheng Tsai
- School of Medicine, National Yang-Ming Chiao-Tung University, Taipei.,Division of Allergy, Immunology and Rheumatology
| | - Chih-Hsin Hsu
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Cheng-Hsun Lu
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei
| | - Yu-Wei Chiu
- Division of Cardiology, Cardiovascular Medical Center, Far Eastern Memorial Hospital, New Taipei City.,Department of Computer Science and Engineering, Yuan Ze University, Taoyuan
| | - Chieh-Yu Shen
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Taiwan University Hospital, Taipei.,National Taiwan University, College of Medicine.,Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei
| | - Chun-Hsien Wu
- Division of Cardiology, Department of Internal Medicine
| | - Feng-Cheng Liu
- Division of Rheumatology/Immunology and Allergy, Department of Medicine.,Department of General Medicine, Tri-Service General Hospital, National Defense Medical Center.,Graduate Institute of Medical Sciences, National Defense Medical Center
| | - Yen-Hung Lin
- Division of Cardiology, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine.,Cardiovascular Center, National Taiwan University Hospital, Taipei
| | - Fu-Chiang Yeh
- Division of Rheumatology/Immunology and Allergy, Department of Medicine
| | - Wei-Shin Liu
- Division of Cardiology, Tzu-Chi General Hospital, Hualien
| | - Hui-Ting Lee
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, MacKay Memorial Hospital, Taipei.,Department of Medicine, MacKay Medical College, New Taipei City
| | - Shu-Hao Wu
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital, Taipei.,Department of Medicine, MacKay Medical College, New Taipei City
| | - Chi-Ching Chang
- Division of Allergy, Immunology & Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University.,Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei
| | - Chun-Yuan Chu
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital.,Faculty of Medicine.,Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung
| | - Charles Jia-Yin Hou
- Cardiovascular Center, Department of Internal Medicine, MacKay Memorial Hospital, Taipei.,MacKay Medical College
| | - Chang-Youh Tsai
- Division of Immunology & Rheumatology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
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10
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Lai CC, Sun YS, Chen WS, Liao HT, Chen MH, Tsai CY, Huang DF, Chou CT, Chang DM. Risk factors for mortality in systemic lupus erythematosus patients: Analysis of adult and pediatric cohorts in Taiwan. J Chin Med Assoc 2022; 85:1044-1050. [PMID: 36343272 DOI: 10.1097/jcma.0000000000000783] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Overall survival of systemic lupus erythematosus (SLE) patients significantly increased in recent decades, however, the relative risk of mortality is still high. Long-term survival outcome of pediatric SLE remains unclear. This study aims to explore the long-term survival rate and its predictors in patients with systemic lupus erythematosus (SLE). METHODS A retrospective, hospital-based cohort study was performed between 2004 and 2018 in a tertiary referral medical center in Taiwan. Data on comorbidities, medications, and causes of admission were collected for risk factor analysis using time-dependent multivariate Cox proportional hazards models. RESULTS A total of 2392 adults and 115 pediatric SLE patients were enrolled (female, n = 2157 and 95, respectively). The 10-year survival rates were 93.2%, 90.2%, 98.9%, and 100% in adult women, adult men, girls, and boys with SLE, respectively. The overall mortality rate was 2.09 case/100 patient-years (PY) for male SLE and 1.39 case/100 PY for female SLE patients. Male SLE patients did not have a statistically significantly higher mortality rate than female SLE patients in each age stratification. Infectious disease (n = 119), heart failure (n = 21), and cerebrovascular accident (n = 14) were the leading causes of death in adult SLE patients. Advanced age (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.03-1.05), treatment with mean dosage of systemic glucocorticoid equivalent to >10 mg/d of prednisolone (HR: 1.71, 95% CI: 1.14-2.57), comorbidities with malignancy (HR: 1.94, 95% CI: 1.22-3.09), chronic kidney disease (HR: 1.86, 95% CI: 1.25-2.77), hypertension (HR: 1.42, 95% CI: 1.01-1.98), and admission due to bacterial pneumonia (HR: 1.92, 95% CI: 1.12-3.31) and sepsis (HR: 2.78, 95% CI: 1.51-5.13) were independent risk factors for mortality in SLE patients. CONCLUSION SLE patients with advanced age, malignancy, chronic kidney disease, hypertension, treated with a higher average dosage of glucocorticoids, and admission due to bacterial pneumonia and sepsis have an increased risk of mortality.
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Affiliation(s)
- Chien-Chih Lai
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Syuan Sun
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Han Chen
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chang-Youh Tsai
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - De-Feng Huang
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chung-Tei Chou
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Deh-Ming Chang
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Institute of Clinical Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Immunology and Rheumatology, Fu Jen Catholic University Hospital, New Taipei City, Taiwan, ROC
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
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11
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Lai CC, Liu FL, Tsai CY, Wang SL, Chang DM. Di-(2-ethylhexyl) phthalate exposure links to inflammation and low bone mass in premenopausal and postmenopausal females: Evidence from ovariectomized mice and humans. Int J Rheum Dis 2022; 25:926-936. [PMID: 35855679 DOI: 10.1111/1756-185x.14386] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/13/2022] [Accepted: 06/28/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Phthalates induce inflammation and are ubiquitously used in daily life. We aim to study the impact of di-(2-ethylhexyl) phthalate (DEHP) exposure on inflammation and osteoporosis in premenopausal and postmenopausal females. METHODS Female 8-week-old C57BL/6JNarl mice received an ovariectomy (OVX) or a sham operation and were fed with DEHP or vehicle by oral gavage for 4 or 8 weeks. Their femurs were isolated for micro-computed tomography, and their serum was collected for inflammatory cytokine assays. Correlations between urinary phthalate metabolites and the lumbar spine bone mineral density (BMD) in premenopausal and postmenopausal volunteers were performed. RESULTS Among the OVX mice treated for 4 weeks, significant lower bone volume, bone volume/tissue volume, and trabecular number but significant higher trabecular bone pattern factor and structure model index were identified in the mice treated with DEHP than with vehicle. The OVX mice treated with DEHP for 4 weeks had significantly higher serum interleukin (IL)-1β, IL-10, IL-17A, interferon (IFN)-γ, tumor necrosis factor (TNF)-α, and Dickkopf-1 levels than those treated with vehicle. The sham mice treated with DEHP for 8 weeks showed an impaired femur trabecular microstructure and had significantly higher serum IL-1β, IL-6, IL-10, IL-17A, IFN-γ, and TNF-α than those treated with vehicle. DEHP metabolites were inversely correlated with the BMD of premenopausal women and the T-score of postmenopausal women. CONCLUSION DEHP treatment in OVX and sham mice results in osteoporosis and impairs the microstructure of the femur trabecula through inflammation. Phthalate exposure negatively affects the bone mass in both premenopausal and postmenopausal women. Thus, long-term avoidance is suggested.
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Affiliation(s)
- Chien-Chih Lai
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Fei-Lan Liu
- Biobank Management Center of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Youh Tsai
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Immunology and Rheumatology, Fu Jen Catholic University Hospital, New Taipei, Taiwan
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Deh-Ming Chang
- Division of Allergy, Immunology, and Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan.,Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
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12
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Lai CC, Chen JW, Chang JC, Kuo CY, Liu YC, Yang JC, Hsieh YT, Tseng SW, Pu YC. Two-Step Process of a Crystal Facet-Modulated BiVO 4 Photoanode for Efficiency Improvement in Photoelectrochemical Hydrogen Evolution. ACS Appl Mater Interfaces 2022; 14:24919-24928. [PMID: 35574762 DOI: 10.1021/acsami.2c03514] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
The photoactivity of nanoporous bismuth vanadate (BiVO4, BVO) photoanodes that were fabricated by a two-step process (electrodeposition and then thermal conversion) in photoelectrochemical (PEC) hydrogen (H2) evolution can be enhanced about 1.44-fold by improving the constitutive ratio of (111̅), (061), and (242̅) crystal facets. The PEC characterization was carried out to investigate the factors altering the performance, which revealed that the crystal facet modulation could improve the photoactivity of the BVO photoanodes. In addition, the orientation-controlled BVO thin-film electrodes are introduced as evidence that the present crystal facet modulation is the positive effect for BVO photoanodes in PEC. The investigation of energy band structures and interfacial charge carrier dynamics of the BVO photoanodes reveals that the crystal facet modulation could result in a shorter lifetime of charge carrier recombination and larger band bending at the interface between BVO and electrolytes. This outcome could improve the charge separation and charge transfer efficiencies of BVO photoanodes, promoting the efficiency of PEC H2 evolution. Moreover, this crystal facet modulation can combine with co-catalyst decoration to further improve the solar-to-hydrogen efficiency of BVO photoanodes in PEC. This study presents a potential strategy to promote the PEC activity by crystal facet modulation and important insights into the interfacial charge transfer properties of semiconductor photoelectrodes for the application in solar fuel generation.
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Affiliation(s)
- Chien-Chih Lai
- Department of Materials Science, National University of Tainan, Tainan 70005, Taiwan
| | - Jie-Wen Chen
- Department of Materials Science, National University of Tainan, Tainan 70005, Taiwan
| | - Jui-Cheng Chang
- Department of Chemical and Materials Engineering and Bachelor Program in Interdisciplinary Studies, National Yunlin University of Science and Technology, Douliu, Yunlin 64002, Taiwan
| | - Che-Yu Kuo
- Department of Materials Science, National University of Tainan, Tainan 70005, Taiwan
| | - Yu-Chen Liu
- Department of Physics, National Cheng Kung University, Tainan 70101, Taiwan
| | - Jan-Chi Yang
- Department of Physics, National Cheng Kung University, Tainan 70101, Taiwan
| | - Yi-Ting Hsieh
- Department of Chemistry, Soochow University, Taipei City 11102, Taiwan
| | - Shih-Wen Tseng
- Core Facility Center of National Cheng Kung University, Tainan 70101, Taiwan
| | - Ying-Chih Pu
- Department of Materials Science, National University of Tainan, Tainan 70005, Taiwan
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13
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Wang CC, Tseng KS, Tsao YP, Chen WS, Lai CC, Sun YS, Liao HT, Chen MH, Tsai CY. Real-world effectiveness and safety of golimumab in rheumatoid arthritis treatment: A two-center study in Taiwan. J Chin Med Assoc 2022; 85:175-182. [PMID: 34882100 DOI: 10.1097/jcma.0000000000000673] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The real-world outcomes of golimumab (GLM) use have been rarely studied in Asian patients with rheumatoid arthritis (RA). This study assessed the real-world effectiveness and safety of GLM in a Taiwanese cohort. METHODS One hundred and eight GLM-treated RA patients were enrolled. Predictors of a good European League Against Rheumatism (EULAR) response at 24 months and drug retention were identified through multivariate analyses. RESULTS After 24 months of GLM treatment, the mean Disease Activity Score using 28 joint counts with the erythrocyte sedimentation rate (DAS28-ESR) decreased from 6.7 to 3.1 (p < 0.001). Up to 58.9% of patients achieved a good EULAR response at 24 months. Multivariate logistic regression analysis revealed that after adjustment for other variables, a higher baseline C-reactive protein was an independent negative predictor of good EULAR responses (odds ratio, 0.82; 95% confidence interval [CI], 0.67-0.99; p = 0.043). During the mean follow-up period of 38.3 months, 15 (13.9%) patients discontinued GLM due to treatment failure. In multivariate analysis, high baseline ESR level, high DAS28-ESR, and the experience of biologic therapy were independent risk factors for GLM discontinuation (adjusted hazard ratio [HR], 1.03; 95% CI, 1.01-1.05; p = 0.003; adjusted HR, 2.93; 95% CI, 1.42-6.08; p = 0.004; and adjusted HR, 5.00; 95% CI, 1.75-14.26; p = 0.003, respectively). In receiver operator characteristic curve analysis, the optimal cutoff values of baseline ESR and DAS28-ESR for predicting drug survival were 52 mm/h (sensitivity: 60.0% and specificity: 77.4%) and 7.7 (sensitivity: 46.7% and specificity: 94.3%), respectively. During the follow-up period, 22 patients (20.4%) developed adverse events. The safety profile of GLM in this study was comparable with that in previous clinical trials. CONCLUSION GLM was effective and safe for the real-life management of Taiwanese RA patients and showed a high retention rate in biologic-naive patients compared with biologic-experienced patients.
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Affiliation(s)
- Chun-Chun Wang
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC
| | - Kuo-Sen Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan, ROC
| | - Yen-Po Tsao
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wei-Sheng Chen
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chien-Chih Lai
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Yi-Syuan Sun
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ming-Han Chen
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Chang-Youh Tsai
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
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Liao HT, Tsai CY, Lai CC, Hsieh SC, Sun YS, Li KJ, Shen CY, Wu CH, Lu CH, Kuo YM, Li TH, Chou CT, Yu CL. The Potential Role of Genetics, Environmental Factors, and Gut Dysbiosis in the Aberrant Non-Coding RNA Expression to Mediate Inflammation and Osteoclastogenic/Osteogenic Differentiation in Ankylosing Spondylitis. Front Cell Dev Biol 2022; 9:748063. [PMID: 35127698 PMCID: PMC8811359 DOI: 10.3389/fcell.2021.748063] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 11/09/2021] [Indexed: 12/17/2022] Open
Abstract
Ankylosing spondylitis (AS) or radiographic axial spondyloarthritis is a chronic immune-mediated rheumatic disorder characterized by the inflammation in the axial skeleton, peripheral joints, and soft tissues (enthesis, fascia, and ligament). In addition, the extra-skeletal complications including anterior uveitis, interstitial lung diseases and aortitis are found. The pathogenesis of AS implicates an intricate interaction among HLA (HLA-B27) and non-HLA loci [endoplasmic reticulum aminopeptidase 1 (ERAP1), and interleukin-23 receptor (IL23R), gut dysbiosis, immune plasticity, and numerous environmental factors (infections, heavy metals, stress, cigarette smoking, etc.) The latter multiple non-genetic factors may exert a powerful stress on epigenetic regulations. These epigenetic regulations of gene expression contain DNA methylation/demethylation, histone modifications and aberrant non-coding RNAs (ncRNAs) expression, leading to inflammation and immune dysfunctions. In the present review, we shall discuss these contributory factors that are involved in AS pathogenesis, especially the aberrant ncRNA expression and its effects on the proinflammatory cytokine productions (TNF-α, IL-17 and IL-23), T cell skewing to Th1/Th17, and osteoclastogenic/osteogenic differentiation. Finally, some potential investigatory approaches are raised for solving the puzzles in AS pathogenesis.
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Affiliation(s)
- Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
- *Correspondence: Chang-Youh Tsai, ; Chia-Li Yu,
| | - Chien-Chih Lai
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Song-Chou Hsieh
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yi-Syuan Sun
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Ko-Jen Li
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chieh-Yu Shen
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Han Wu
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Hsun Lu
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Min Kuo
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tzu-Hao Li
- Division of Allergy, Immunology and Rheumatology, Taipei, Taiwan
- Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology and Rheumatology, Taipei Veterans General Hospital, National Yang-Ming Chiao-Tung University, Taipei, Taiwan
| | - Chia-Li Yu
- Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
- *Correspondence: Chang-Youh Tsai, ; Chia-Li Yu,
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15
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Su CF, Lai CC, Li TH, Chang YF, Lin YT, Chen WS, Tsao YP, Wang WH, Chang YS, Tsai CY. Epidemiology and risk of invasive fungal infections in systemic lupus erythematosus: a nationwide population-based cohort study. Ther Adv Musculoskelet Dis 2021; 13:1759720X211058502. [PMID: 34840609 PMCID: PMC8613894 DOI: 10.1177/1759720x211058502] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 10/14/2021] [Indexed: 12/14/2022] Open
Abstract
Introduction Infections are a leading cause of mortality in patients with systemic lupus erythematosus (SLE). Among various infections, invasive fungal infections (IFIs) have a particularly high mortality rate; however, studies examining IFIs in patients with SLE are limited. Methods Patients diagnosed as having SLE between 1997 and 2012 were enrolled from Taiwan's National Health Insurance Research Database along with age- and sex-matched non-SLE controls at a ratio of 1:10. IFIs were identified based on International Classification of Diseases, Ninth Revision, Clinical Modification codes and validated by the prescriptions of systemic antifungal agents. The incidence rate (IR), incidence rate ratio (IRR), and all-cause mortality rate of IFIs and its subtypes were analyzed. A Cox multivariate regression model with time-dependent covariates was applied to analyze independent risk factors for IFIs. Results A total of 24,541 patients with SLE and 245,410 non-SLE controls were included. We observed 445 IFI episodes in the SLE cohort, with an all-cause mortality rate of 26.7%. Candida spp. (52.8%) was the most common pathogen, followed by Cryptococcus spp. (18.2%) and Aspergillus spp. (18.2%). The IR of IFIs in the SLE cohort was 20.83 per 10,000 person-years, with an IRR of 11.1 [95% confidence interval (CI): 9.8-12.6] relative to the non-SLE controls. Juvenile patients with SLE aged ⩽18 years had the highest IRR of 47.2 (95% CI: 26.9-86.8). Intravenous steroid therapy administered within 60 days (hazard ratio: 29.11, 95% CI: 23.30-36.37) was the most critical risk factor for overall IFIs and each of the three major fungal pathogens. Distinct risk factors were found among different IFI subtypes. Conclusion Patients with SLE had a higher risk of IFIs, especially juvenile patients. Intravenous steroid therapy is the most critical risk factor for IFIs. This study provides crucial information for the risk stratification of IFIs in SLE. Plain Language Summaries Patients with systemic lupus erythematosus and physicians treating this patient group should be aware of the risk of invasive fungal infections.Invasive fungal infections (IFIs) are a severe complication with a high mortality rate among patients with systemic lupus erythematosus (SLE); however, studies on this topic are scant. We performed a nationwide population-based study in Taiwan to estimate the incidence and mortality of and risk factors for IFIs. We found an incidence rate of 20.83 per 10,000 person-years for IFIs, with a mortality rate of 26.7%. Juvenile patients aged ⩽18 years had the highest relative risk of IFIs. Although candidiasis was the most common IFI, cryptococcosis and aspergillosis should be concerned in juvenile patients as well. Intravenous steroid therapy was the most critical risk factor for all IFIs, and different immunosuppressive agents posed different risks in patients for acquiring certain fungal pathogens.Our findings provide pivotal epidemiological information and indicate risk factors for IFIs in patients with SLE. Age and exposure to specific immunosuppressants and steroids might help predict the risk of IFIs. Because the manifestation of these infections is sometimes indistinguishable from a lupus flare, physicians should be aware of this fatal complication, especially when patients are not responsive to immunosuppressive therapy. Early recognition, implication of diagnostic tools, and empirical antimicrobial agents can be the key to treating patients with IFIs. Additional studies are required to develop a risk management program for patients with SLE.
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Affiliation(s)
- Chin-Fang Su
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei
| | - Chien-Chih Lai
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei
| | - Tzu-Hao Li
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei
| | - Yu-Fan Chang
- Institute of Clinical Medicine, National Yang-Ming University, Taipei
| | - Yi-Tsung Lin
- Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei
| | - Wei-Sheng Chen
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei
| | - Yen-Po Tsao
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei
| | - Wen-Hsiu Wang
- Department of Medicine, Mackay Medical College, New Taipei City
| | - Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Medical University-Shuang Ho Hospital, No. 291, Zhongzheng Road, Zhonghe District, New Taipei City 23561
| | - Chang-Youh Tsai
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei
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16
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Kadam SA, Phan GT, Pham DV, Patil RA, Lai CC, Chen YR, Liou Y, Ma YR. Doping-free bandgap tunability in Fe 2O 3 nanostructured films. Nanoscale Adv 2021; 3:5581-5588. [PMID: 36133276 PMCID: PMC9418971 DOI: 10.1039/d1na00442e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 07/29/2021] [Indexed: 06/16/2023]
Abstract
A tunable bandgap without doping is highly desirable for applications in optoelectronic devices. Herein, we develop a new method which can tune the bandgap without any doping. In the present research, the bandgap of Fe2O3 nanostructured films is simply tuned by changing the synthesis temperature. The Fe2O3 nanostructured films are synthesized on ITO/glass substrates at temperatures of 1100, 1150, 1200, and 1250 °C using the hot filament metal oxide vapor deposition (HFMOVD) and thermal oxidation techniques. The Fe2O3 nanostructured films contain two mixtures of Fe2+ and Fe3+ cations and two trigonal (α) and cubic (γ) phases. The increase of the Fe2+ cations and cubic (γ) phase with the elevated synthesis temperatures lifted the valence band edge, indicating a reduction in the bandgap. The linear bandgap reduction of 0.55 eV without any doping makes the Fe2O3 nanostructured films promising materials for applications in bandgap engineering, optoelectronic devices, and energy storage devices.
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Affiliation(s)
- Sujit A Kadam
- Department of Physics, National Dong Hwa University Hualien 97401 Taiwan
| | - Giang Thi Phan
- Department of Physics, National Dong Hwa University Hualien 97401 Taiwan
| | - Duy Van Pham
- Department of Physics, National Dong Hwa University Hualien 97401 Taiwan
- Center for Condensed Matter Sciences, National Taiwan University Taipei 10617 Taiwan
| | - Ranjit A Patil
- Department of Physics, National Dong Hwa University Hualien 97401 Taiwan
| | - Chien-Chih Lai
- Department of Physics, National Dong Hwa University Hualien 97401 Taiwan
| | - Yan-Ruei Chen
- Institute of Physics, Academia Sinica Taipei 11529 Taiwan
| | - Yung Liou
- Institute of Physics, Academia Sinica Taipei 11529 Taiwan
| | - Yuan-Ron Ma
- Department of Physics, National Dong Hwa University Hualien 97401 Taiwan
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Nguyen DH, Sun JY, Lo CY, Liu JM, Tsai WS, Li MH, Yang SJ, Lin CC, Tzeng SD, Ma YR, Lin MY, Lai CC. Ultralow-Threshold Continuous-Wave Room-Temperature Crystal-Fiber/Nanoperovskite Hybrid Lasers for All-Optical Photonic Integration. Adv Mater 2021; 33:e2006819. [PMID: 33576143 DOI: 10.1002/adma.202006819] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 01/23/2021] [Indexed: 06/12/2023]
Abstract
Continuous-wave (CW) room-temperature (RT) laser operation with low energy consumption is an ultimate goal for electrically driven lasers. A monolithically integrated perovskite laser in a chip-level fiber scheme is ideal. However, because of the well-recognized air and thermal instabilities of perovskites, laser action in a perovskite has mostly been limited to either pulsed or cryogenic-temperature operations. Most CW laser operations at RT have had poor durability. Here, crystal fibers that have robust and high-heat-load nature are shown to be the key to enabling the first demonstration of ultralow-threshold CW RT laser action in a compact, monolithic, and inexpensive crystal fiber/nanoperovskite hybrid architecture that is directly pumped with a 405 nm diode laser. Purcell-enhanced light-matter coupling between the atomically smooth fiber microcavity and the perovskite nanocrystallites gain medium enables a high Q (≈1500) and a high β (0.31). This 762 nm laser outperforms previously reported structures with a record-low threshold of 132 nW and an optical-to-optical slope conversion efficiency of 2.93%, and it delivers a stable output for CW and RT operation. These results represent a significant advancement toward monolithic all-optical integration.
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Affiliation(s)
- Duc Huy Nguyen
- Department of Physics, National Dong Hwa University, Hualien, 974301, Taiwan
| | - Jia-Yuan Sun
- Department of Physics, National Dong Hwa University, Hualien, 974301, Taiwan
| | - Chia-Yao Lo
- Department of Optoelectronics and Materials Technology, National Taiwan Ocean University, Keelung, 20224, Taiwan
| | - Jia-Ming Liu
- Department of Electrical and Computer Engineering, University of California, Los Angeles, CA, 90095, USA
| | - Wan-Shao Tsai
- Department of Electric Engineering and Graduate Institute of Optoelectronic Engineering, National Chung Hsing University, Taichung, 40227, Taiwan
| | - Ming-Hung Li
- Department of Physics, National Dong Hwa University, Hualien, 974301, Taiwan
| | - Sin-Jhang Yang
- Department of Physics, National Dong Hwa University, Hualien, 974301, Taiwan
| | - Cheng-Chia Lin
- Department of Opto-Electronic Engineering, National Dong Hwa University, Hualien, 974301, Taiwan
| | - Shien-Der Tzeng
- Department of Physics, National Dong Hwa University, Hualien, 974301, Taiwan
| | - Yuan-Ron Ma
- Department of Physics, National Dong Hwa University, Hualien, 974301, Taiwan
| | - Ming-Yi Lin
- Department of Dermatology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, 100229, Taiwan
| | - Chien-Chih Lai
- Department of Physics, National Dong Hwa University, Hualien, 974301, Taiwan
- Department of Opto-Electronic Engineering, National Dong Hwa University, Hualien, 974301, Taiwan
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Wang WH, Lai CC, Huang YF, Li TH, Tsao YP, Chen WS, Chang YS. Pneumocystis jirovecii pneumonia in systemic lupus erythematosus: a nationwide cohort study in Taiwan. Arthritis Care Res (Hoboken) 2021; 74:1444-1450. [PMID: 33645012 DOI: 10.1002/acr.24584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 01/18/2021] [Accepted: 02/23/2021] [Indexed: 11/05/2022]
Abstract
OBJECTIVES To evaluate PJP infection risk in patients with SLE in Taiwan. METHODS We identified 24,367 patients with SLE from the National Health Insurance research database between 1997 and 2012 and compared the PJP incidence rates (IRs) with those in 243,670 age- and sex-matched non-SLE controls. PJP risk in the patients was evaluated using a Cox multivariate proportional hazards model. RESULTS The patients exhibited a significantly higher PJP risk than the controls, with an IR of 2.63 per 10,000 person-years and IR ratio of 27.65 (95% CI 17.2-45.3, p < 0.001). Male sex (hazard ratio [HR] 2.42, p < 0.01), end-stage renal disease (ESRD; HR 1.74, p = 0.01), recent use of mycofenolate mofetil (MMF; HR 4.43, P < 0.001), intravenous steroid pulse therapy (HR 108.73, p < 0.001), and average oral dose of >7.5 mg/day prednisolone or equivalent (HR 4.83, p < 0.001) were associated with PJP in SLE, whereas hydroxychloroquine use reduced its risk (HR 0.51, p = 0.01). Of note, cyclophosphamide was not associated with PJP infection in the multivariate Cox proportional hazard model. CONCLUSIONS Patients with SLE have a considerably high PJP risk. Cyclophosphamide does not increase PJP risk. Male sex, ESRD, MMF use, intravenous steroid pulse therapy, oral prednisolone or equivalent (>7.5 mg/day) are risk factors for PJP, whereas hydroxychloroquine use reduces PJP risk.
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Affiliation(s)
- Wen-Hsiu Wang
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan.,Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - Chien-Chih Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yi-Fan Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan
| | - Tzu-Hao Li
- Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Chiayi Branch, Taichung Veterans General Hospital, Taiwan
| | - Yen-Po Tsao
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan.,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Chang AM, Chen YH, Lai CC, Pu YC. Synergistic Effects of Surface Passivation and Charge Separation to Improve Photo-electrochemical Performance of BiOI Nanoflakes by Au Nanoparticle Decoration. ACS Appl Mater Interfaces 2021; 13:5721-5730. [PMID: 33464818 DOI: 10.1021/acsami.0c18430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
We demonstrate that the photoactivity of bismuth oxyiodide (BiOI) nanoflake (NF) photocathodes in photo-electrochemical (PEC) water splitting can be significantly enhanced by about 24-fold by thermal calcination under an air atmosphere and then surficial decoration of Au nanoparticles (NPs). To understand the key factors affecting the PEC efficiency in Au NP-decorated BiOI NF photoelectrodes, incident photon-to-current conversion efficiency, electrochemical impedance spectroscopy, photovoltage, and electrochemically active surface area measurements were performed. The analytic results presented that thermal calcining could produce mesopores, increasing active sites on the surface of BiOI NFs. In addition, the synergistic effects of surface-state passivation and charge separation were observed for the surficial Au NP decoration on BiOI NFs. Transient absorption spectroscopy coupled with PEC measurements confirmed that the lifetime of photogenerated electrons on the conduction band of BiOI NFs can be prolonged by Au NP decoration, resulting in higher probability to carry out water reduction. The current investigation presents important insights into the mechanism of charge carrier dynamics in metal-semiconductor nano-heterostructures, which is contributive to develop photoelectrode materials in solar fuel production.
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Affiliation(s)
- An-Mi Chang
- Department of Materials Science, National University of Tainan, Tainan 70005, Taiwan
| | - Yu-Hung Chen
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan
| | - Chien-Chih Lai
- Department of Materials Science, National University of Tainan, Tainan 70005, Taiwan
| | - Ying-Chih Pu
- Department of Materials Science, National University of Tainan, Tainan 70005, Taiwan
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20
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Chen YP, Lai CC, Tsai WS. Full-color based on bismuth core-shell nanoparticles in one-step fabrication. Opt Express 2020; 28:24511-24525. [PMID: 32906991 DOI: 10.1364/oe.398903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 07/28/2020] [Indexed: 06/11/2023]
Abstract
Plasmonic resonances in metallic nanostructures are promising for the structure-dependent color-rendering effect. In this study, bismuth is selected as an alternative plasmonic material due to its large tunable range from near-ultraviolet to near-infrared. Various sizes of core-shell bismuth nanoparticles are fabricated on a large-area silicon substrate using a one-step thermal evaporation deposition process. Particle diameters, cross-sections, and arrangement are characterized at 12 featured sections, which reveal spectral shifts and full visible colors in a hue order with a color gamut that is close to sRGB. Color palettes on the chromaticity coordinates rendered from both measured and simulation reflection spectra are in very good accordance with the microscopic image colors of all sections.
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21
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Lai CC, Sun YS, Lin FC, Yang CY, Tsai CY. Bronchoalveolar lavage fluid analysis and mortality risk in systemic lupus erythematosus patients with pneumonia and respiratory failure. J Microbiol Immunol Infect 2020; 54:1048-1055. [PMID: 32675043 DOI: 10.1016/j.jmii.2020.07.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 06/23/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Our aim was to characterize etiologic diagnoses obtained from bronchoalveolar lavage fluid (BALF) and blood specimens, and to identify risk factors for mortality in systemic lupus erythematosus (SLE) patients with pneumonia and respiratory failure. METHODS We conducted a retrospective analysis of SLE patients with pneumonia and respiratory failure. Clinical characteristics, laboratory profiles, and microbiology in BALF and blood samples were evaluated. We performed univariable analyses to identify mortality risk factors. RESULTS All 24 patients (F:M = 21:3, median age 46.5 years; disease duration 11 years) received mechanical ventilation (median duration: 11 days). Pathogens identified in BALF included Pneumocystis jiroveci (12 patients [50%]), cytomegalovirus (CMV, 7 patients [29.2%]), and bacteria (11 patients [45.8%]). Thirteen patients (54.2%) yielded pathogens in blood (CMV in 8 patients [33.3%] and Escherichia coli in 5 patients [20.8%]). Eight developed septic shock, and 9 died within 30 days. Univariable analysis identified thrombocytopenia (odds ratio [OR]: 8.0, 95% confidence interval [CI]: 1.23-52.25), bacteremia within 30 days before or after endotracheal intubation (OR: 8.0, 95% CI: 1.23-52.5), and P. jiroveci pneumonia (PJP, OR: 7.0, 95% CI: 1.04-46.95) as risk factors for 30-day mortality. Kaplan-Meier analysis confirmed an increased risk of 30-day mortality with thrombocytopenia and bacteremia. CONCLUSION There are high prevalence rates of PJP and CMV infections as evidenced by BALF analyses in SLE patients with pneumonia and respiratory failure. BALF analysis can facilitate rescue therapy per pathogen. Thrombocytopenia, bacteremia, and PJP in SLE patients can increase their 30-day mortality, so warrant early and aggressive treatments.
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Affiliation(s)
- Chien-Chih Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan; Faculty of Medicine, National Yang-Ming University, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taiwan
| | - Yi-Syuan Sun
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan; Faculty of Medicine, National Yang-Ming University, Taiwan; Institute of Clinical Medicine, National Yang-Ming University, Taiwan
| | - Fang-Chi Lin
- Department of Chest Medicine, Taipei Veterans General Hospital, Taiwan
| | - Chih-Yu Yang
- Institute of Clinical Medicine, National Yang-Ming University, Taiwan; Division of Nephrology, Department of Medicine, Taipei Veterans General Hospital, Taiwan; Center for Intelligent Drug Systems and Smart Bio-devices (IDS(2)B), Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taiwan; Faculty of Medicine, National Yang-Ming University, Taiwan.
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Liu FL, Chen CL, Lai CC, Lee CC, Chang DM. Arecoline suppresses RANKL-induced osteoclast differentiation in vitro and attenuates LPS-induced bone loss in vivo. Phytomedicine 2020; 69:153195. [PMID: 32200293 DOI: 10.1016/j.phymed.2020.153195] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 01/13/2020] [Accepted: 02/21/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Areca nut has anti-inflammatory, antiparasitic, antihypertensive, and antidepressant properties. The pathological hallmarks of inflammatory joint diseases are an increased number of osteoclasts and impaired differentiation of osteoblasts, which may disrupt the bone remodeling balance and eventually lead to bone loss. PURPOSE The present study assessed the effects of arecoline, the main alkaloid found in areca nut, on osteoclast and osteoblast differentiation and function. METHOD M-CSF/RANKL-stimulated murine bone marrow-derived macrophages (BMMs) were incubated with several concentrations of arecoline, and TRAP staining and pit formation were assessed to monitor osteoclast formation. Quantitative real-time RT-PCR and western blot analyses were used to analyze the expression of osteoclast-associated genes and signaling pathways. The effects of arecoline on bone were investigated in an in vivo mouse model of lipopolysaccharide (LPS)-induced trabecular bone loss after oral administration of arecoline. Alizarin red S staining and assays to measure ALP activity and the transcription level of osteoblast-related genes were used to evaluate the effects of arecoline on osteoblast differentiation and bone mineralization. RESULTS In a dose-dependent manner, arecoline at concentrations of 50-100 μM reduced both the development of TRAP-positive multinucleated osteoclasts and the formation of resorption pits in M-CSF/RANKL-stimulated BMMs. In M-CSF/RANKL-stimulated BMMs, arecoline also suppressed the expression and translocation of c-Fos and NFATcl, and osteoclast differentiated-related genes via interference with the AKT, MAPK, and NF-kB activation pathways. Femur bone loss and microcomputed tomography parameters were recovered by oral administration of arecoline in the mouse LPS-induced bone loss model. Lastly, arecoline increased ALP activity, bone mineralization, and the expression of osteoblast differentiation-related genes, such as ALP and Runx2, in MC3T3-E1 cells. CONCLUSION Our data suggest that arecoline may attenuate or prevent bone loss by suppressing osteoclastogenesis and promoting osteoblastogenesis. These findings provide evidence supporting arecoline's use as a potential therapeutic agent in bone-loss disorders and diseases.
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Affiliation(s)
- Fei-Lan Liu
- Division of Allergy-Immunology-Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Biobank Management Center of the Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Biomedical Engineering, National Defense Medical Center, Taipei, Taiwan
| | - Chun-Liang Chen
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Chih Lai
- Division of Allergy-Immunology-Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chia-Chung Lee
- Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Deh-Ming Chang
- Division of Allergy-Immunology-Rheumatology, Taipei Veterans General Hospital, Taipei, Taiwan; Graduate Institutes of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.
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Van Pham D, Patil RA, Lin JH, Lai CC, Liou Y, Ma YR. Correction: Doping-free bandgap tuning in one-dimensional Magnéli-phase nanorods of Mo 4O 11. Nanoscale 2019; 11:23502. [PMID: 31782457 DOI: 10.1039/c9nr90265a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Correction for 'Doping-free bandgap tuning in one-dimensional Magnéli-phase nanorods of Mo4O11' by Duy Van Pham et al., Nanoscale, 2016, 8, 5559-5566.
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Affiliation(s)
- Duy Van Pham
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Ranjit A Patil
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Jin-Han Lin
- Institute of Physics, Academia Sinica, Taipei 11529, Taiwan
| | - Chien-Chih Lai
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Yung Liou
- Institute of Physics, Academia Sinica, Taipei 11529, Taiwan
| | - Yuan-Ron Ma
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
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Chou HS, Yang KD, Xiao SH, Patil RA, Lai CC, Vincent Yeh WC, Ho CH, Liou Y, Ma YR. Temperature-dependent ultraviolet photoluminescence in hierarchical Zn, ZnO and ZnO/Zn nanostructures. Nanoscale 2019; 11:13385-13396. [PMID: 31276145 DOI: 10.1039/c9nr05235f] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The temperature-dependent effects on the ultraviolet (UV) photoluminescence (PL) enhancement, blueshift, thermal quenching, and chromaticity of the two-dimensional (2D) Zn nanosheets, 2D-hierarchical ZnO nanostructures, and 2D-hierarchical ZnO/Zn nanostructures are presented. In this study, 2D Zn nanosheets were synthesized using a hot-plate metal vapor deposition technique, after which 2D-hierarchical ZnO nanostructures and ZnO/Zn were prepared from the 2D Zn nanosheets by a simple thermal annealing method. The enhancement and blueshift of the UV PL emissions from the three nanostructures at low temperatures arose from three distinct PL mechanisms. For the ZnO nanostructures, the UV PL emission enhancements and blueshifts at low temperature were due to the conversion of the free excitons (FXs) to neutral-donor-bound-excitons (D0Xs). The ZnO/Zn nanostructures possessed the highest UV PL intensities among the three nanostructures, because the free electrons from the Zn portions across the metal-semiconductor heterojunctions greatly assisted in enhancing the PL emissions. The enhancement and thermal quenching were quantitatively analyzed with simple normalization methods. The results show that all three kinds of nanostructures are excellent candidates for use in UV light emitters.
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Affiliation(s)
- Han-Sheng Chou
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Kai-Di Yang
- Graduate Institute of Applied Science & Technology and Department of Electronic & Computer Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Sheng-Hong Xiao
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Ranjit A Patil
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Chien-Chih Lai
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | | | - Ching-Hwa Ho
- Graduate Institute of Applied Science & Technology and Department of Electronic & Computer Engineering, National Taiwan University of Science and Technology, Taipei 106, Taiwan
| | - Yung Liou
- Institute of Physics, Academia Sinica, Taipei 11529, Taiwan
| | - Yuan-Ron Ma
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
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Li TH, Lai CC, Wang WH, Chen WS, Tsao YP, Tsai CY, Chang YS. Risk of severe herpes simplex virus infection in systemic lupus erythematosus: analysis of epidemiology and risk factors analysis in Taiwan. Ann Rheum Dis 2019; 78:941-946. [PMID: 30954968 DOI: 10.1136/annrheumdis-2018-214844] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 03/12/2019] [Accepted: 03/13/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Patients with systemic lupus erythematosus (SLE) are susceptible to herpes simplex virus (HSV) infection, which occasionally leads to severe complications including meningoencephalitis and keratitis. However, few attempts to analyse the associated incidence and risk factors have been made. METHODS We enrolled patients with SLE recorded between 1997 and 2012 and compared the incidence rate (IR) of severe HSV infection, including meningoencephalitis, septicaemia, ocular and visceral involvement, and other specific complications demanding hospitalisation, with that of a non-SLE cohort. A Cox multivariate proportional hazards model was applied to analyse the risk factors of severe HSV infection in patients with SLE. RESULTS A total of 122 520 subjects (24 504 patients with SLE and 98 016 age-matched and sex-matched non-SLE controls) were included, and a higher IR of severe HSV infection was revealed in the SLE group (IR ratio=3.93, p<0.001). In patients with SLE, previous oral and genital infection (HR=2.29, p=0.049), intravenous steroid pulse therapy (HR=5.32, p<0.001) and daily oral dose of over 7.5 mg of prednisolone (HR=1.59, p=0.024) were independent risk factors for severe HSV infection, whereas age of ≤18 (HR=0.45, p=0.029) was a protective factor. CONCLUSIONS Patients with SLE are at higher risk of severe HSV infection, and related risk factors include being older than 18 years, having a history of HSV mucocutaneous infection, recent receipt of steroid pulse therapy and a daily oral dose of steroid over 7.5 mg prednisolone.
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Affiliation(s)
- Tzu-Hao Li
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Chiayi Branch, Taichung Veterans General Hospital, Chiayi City, Taiwan.,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - Chien-Chih Lai
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Divisionof Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wen-Hsiu Wang
- Division of Allergy, Immunology and Rheumatology, Mackay Memorial Hospital, Taipei, Taiwan.,Medicine, Mackay Medical College, Sanzhi, Taiwan
| | - Wei-Sheng Chen
- Divisionof Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Po Tsao
- Divisionof Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang-Youh Tsai
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei City, Taiwan.,Divisionof Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Sheng Chang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan .,Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.,Institute of Biomedical Informatics, National Yang-Ming University, Taipei, Taiwan
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Wang KC, Liao HT, Chen WS, Lai CC, Chou CT, Chen MH, Tsai CY. Real-world effectiveness and safety of rituximab in the treatment of rheumatoid arthritis: A single-center experience in Taiwan. Int J Rheum Dis 2019; 22:860-868. [PMID: 30761753 DOI: 10.1111/1756-185x.13511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 01/08/2019] [Accepted: 01/22/2019] [Indexed: 12/01/2022]
Abstract
AIM To assess the real-world effectiveness and safety of rituximab (RTX) at 24 months in patients with established rheumatoid arthritis (RA) and to identify predictors of low disease activity/remission and a good European League Against Rheumatism (EULAR) response. METHODS Seventy RTX-treated RA patients were enrolled. Predictors for low disease activity/remission and a good EULAR response at 24 months were identified by multivariate analyses. RESULTS At 24 months, the mean Disease Activity Score of 28 joints-erythrocyte sedimentation rate (DAS28-ESR) decreased from 6.88 ± 0.85 at baseline to 3.47 ± 0.85. Twenty-nine patients (41.4%) reached low disease activity/remission, while all patients had a moderate/good EULAR response. After adjustment by multivariate analyses, we found concomitant methotrexate at a dosage >10 mg/week (odds ratio [OR] 5.17; 95% CI 1.34-19.93; P = 0.017) predicted low disease activity/remission, and baseline DAS28 ≤6.5 (OR 4.97; 95% CI 1.22-20.30; P = 0.026) predicted good EULAR response at 24 months. The most common adverse events were infusion-related (5.7%), and there was no incidence of malignancy or mortality during the treatment. CONCLUSIONS RTX was effective and safe in real-life management of RA patients with high disease activity. Patients taking concomitant methotrexate and with lower baseline DAS28-ESR were more likely to benefit from RTX.
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Affiliation(s)
- Kai-Chun Wang
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chien-Chih Lai
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chung-Tei Chou
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ming-Han Chen
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
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Hung M, Huang DF, Chen WS, Lai CC, Chen MH, Liao HT, Tsai CY. The clinical features and mortality risk factors of cytomegalovirus infection in patients with systemic lupus erythematosus. J Microbiol Immunol Infect 2018; 52:114-121. [PMID: 30598425 DOI: 10.1016/j.jmii.2018.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Revised: 11/27/2018] [Accepted: 12/07/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND The clinical features and outcomes of cytomegalovirus (CMV) diseases in patients with systemic lupus erythematosus (SLE) are unknown. We analyzed such data from a medical center in Taiwan. METHODS We retrospectively reviewed the medical records of patients with SLE who were diagnosed with CMV diseases between 2006 and 2016 in Taipei Veterans General Hospital Taiwan. Clinical and laboratory parameters and treatment outcomes were analyzed. RESULTS The study enrolled 56 eligible patients with CMV diseases and separated them into survival (n = 24) and mortality (n = 32) groups. All cases showed a significantly high incidence of pneumonitis (71.43%). The patients in the mortality group had a higher SLE disease activity index (SLEDAI)-2000 (p = 0.009), more cases of recent methylprednisolone pulse therapy (p = 0.013) and pancytopenia (p = 0.001), stronger evidence of CMV infection demonstrated by polymerase chain reaction (PCR) in blood (p < 0.001) and bronchoalveolar lavage (p = 0.021), and more concurrent infections (bacteremia p = 0.026; fungemia p < 0.001). CONCLUSIONS Recent pulse therapy, pancytopenia, and concurrent infections constituted risk factors for mortality in patients with SLE and CMV infection. Among mortality patients, PCR rather than serological tests (IgM antibodies) helped to arrive at an earlier diagnosis.
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Affiliation(s)
| | - Deh-Feng Huang
- Division of Allergy, Immunology, & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University Faculty of Medicine, Taipei, Taiwan
| | - Chien-Chih Lai
- Division of Allergy, Immunology, & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University Faculty of Medicine, Taipei, Taiwan
| | - Ming-Han Chen
- Division of Allergy, Immunology, & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University Faculty of Medicine, Taipei, Taiwan
| | - Hsien-Tzung Liao
- Division of Allergy, Immunology, & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chang-Youh Tsai
- Division of Allergy, Immunology, & Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; National Yang-Ming University Faculty of Medicine, Taipei, Taiwan.
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Sun YS, Huang DF, Lin FC, Hsu CK, Sun IT, Chang SC, Tsai CY, Lai CC. Cytomegaloviral or Pneumocystis Jiroveci Pneumonia Increases Mortality in Systemic Lupus Erythematosus Patients with Pulmonary Hemorrhage: Evidence from Bronchoalveolar Lavage Fluid. J Rheumatol 2018; 46:251-258. [PMID: 30504509 DOI: 10.3899/jrheum.180104] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/10/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To evaluate the role of cytomegaloviral or Pneumocystis jiroveci pneumonia (CMV/PJP) in systemic lupus erythematosus (SLE) patients with pulmonary hemorrhage (PH). METHODS We retrospectively examined hospital records for 27 SLE patients with PH who received bronchoalveolar lavage fluid (BALF) analyses. Clinical profile and mortality rates were compared between groups with and without CMV/PJP. Risk factors for PH-related mortality were analyzed. RESULTS Among 27 SLE patients with PH, 15 had pathogens from BALF samples, and 8 had CMV/PJP. Although CMV/PJP was treated, the RR for 90- and 180-day mortality rates of SLE patients with CMV/PJP were higher than those without these infections (5.94, 95% CI 1.44-24.48; 7.13, 95% CI 1.81-28.06, respectively). Risk factors for 90- and 180-day mortality were presence of CMV/PJP (OR 14.2, 95% CI 1.83-109.9; OR 25.5, 95% CI 2.91-223.3, respectively) and use of pulse methylprednisolone for PH treatment (OR 12.0, 95% CI 1.48-97.2; OR 8.5, 95% CI 1.13-63.9, respectively). Factors increasing the 90-day mortality rate were duration of mechanical ventilation exceeding 14 days (OR 11.1, 95% CI 1.11-112.0) and use of aggressive immunosuppression close to PH onset (OR 7.56, 95% CI 1.09-52.4). Three of the 7 patients receiving aggressive immunosuppression died with the presence of CMV/PJP. CONCLUSION Owing to the high prevalence of CMV/PJP and its association with mortality, routine BALF analysis is recommended for all suitable SLE patients with PH. Use of aggressive immunosuppression does not benefit SLE patients with opportunistic infections during PH attack.
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Affiliation(s)
- Yi-Syuan Sun
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - De-Feng Huang
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Fang-Chi Lin
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Chih-Kai Hsu
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - I-Ting Sun
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Shi-Chuan Chang
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Chang-Youh Tsai
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan.,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University
| | - Chien-Chih Lai
- From the Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City; Faculty of Medicine, National Yang-Ming University, Taiwan and Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan. .,Y.S. Sun, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; D.F. Huang, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; F.C. Lin, MD, PhD, Department of Chest Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.K. Hsu, MD, Department of Chest Medicine, Taipei Veterans General Hospital Yuli Branch; I.T. Sun, MD, Department of Ophthalmology, E-Da Hospital, I-Shou University; S.C. Chang, MD, PhD, Professor, Department of Chest Medicine, Taipei Veterans General Hospital, and Institute of Emergency and Critical Care Medicine, National Yang-Ming University; C.Y. Tsai, MD, PhD, Professor, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, National Yang-Ming University; C.C. Lai, MD, Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, and Faculty of Medicine, and Institute of Clinical Medicine, National Yang-Ming University.
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Huang YF, Chang YS, Chen WS, Tsao YP, Wang WH, Liao HT, Tsai CY, Lai CC. Incidence and risk factors of osteomyelitis in adult and pediatric systemic lupus erythematosus: a nationwide, population-based cohort study. Lupus 2018; 28:19-26. [PMID: 30458691 DOI: 10.1177/0961203318811601] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this paper is to investigate the incidence rate, risk factors and outcome of osteomyelitis among patients with systemic lupus erythematosus (SLE). MATERIALS AND METHODS We conducted a cohort study using data for patients enrolled in the Taiwan National Health Insurance Database from 2000 to 2012. Patients with SLE and age- and sex-matched controls without SLE were enrolled. Primary endpoint was the first occurrence of osteomyelitis. Risks of osteomyelitis in SLE patients were analyzed with Cox proportional hazards regression models, including age, sex, comorbidities and medications. RESULTS Among 24,705 SLE patients (88.4% women, mean age 35.8 years) with a median follow-up of 9.1 years, 386 patients had osteomyelitis. The incidence rate ratio (IRR) of osteomyelitis in the SLE group vs the control group was 8.52 (95% confidence interval (CI) 7.24-10.05). The SLE group had higher incidence rates of osteomyelitis than the control group, especially in pediatric subgroups (IRR 41.1 95% CI 18.57-107.35). Compared to controls, SLE patients experienced osteomyelitis at a younger age (42.3 vs 58.1 years) but did not have an increased risk of mortality (hazard ratio 0.7; 95% CI 0.21-2.38). Age >60 years, male gender, malignancy within five years, prior bone fracture and higher daily prednisolone dose (>7.5 mg) cumulatively for >180 days increased risk for osteomyelitis. CONCLUSIONS SLE patients have a higher IRR of osteomyelitis than controls. Pediatric and elder SLE patients, patients with a history of bone fracture, malignancy within five years and higher-dose glucocorticoid use have a higher risk of osteomyelitis and should be carefully monitored.
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Affiliation(s)
- Y F Huang
- 1 Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Taitung Mackay Memorial Hospital, Taitung, Taiwan.,2 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Y S Chang
- 3 Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,4 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, Taipei, Taiwan
| | - W S Chen
- 2 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Y P Tsao
- 2 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - W H Wang
- 6 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Mackay Memorial Hospital, Taipei, Taiwan, and Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,7 Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan
| | - H T Liao
- 2 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,3 Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,5 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - C Y Tsai
- 2 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - C C Lai
- 2 Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.,5 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,8 Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan
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Hung ML, Liao HT, Chen WS, Chen MH, Lai CC, Tsai CY, Chang DM. Invasive aspergillosis in patients with systemic lupus erythematosus: a retrospective study on clinical characteristics and risk factors for mortality. Lupus 2018; 27:1944-1952. [DOI: 10.1177/0961203318796294] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective The objective of this paper is to analyze the clinical features, outcomes, mortality risk factors, and all-cause mortalities of invasive aspergillosis (IA) in patients with systemic lupus erythematosus (SLE). Methods Medical records were reviewed to identify SLE patients with IA from January 2006 to June 2017, at Taipei Veterans General Hospital, Taiwan. A total of 6714 SLE patients were included. Clinical/laboratory parameters and treatment outcomes were analyzed. Results Four patients (19.0%) had definite and 17 had probable (81.0%) IA. Seven patients (33.3%) survived and 14 died (66.7%). Concurrently, there were 19 pneumonias (90.5%), 17 cases of other infections (81.0%), eight bacteremia (38.1%), nine cytomegalovirus (CMV, 42.7%) and six Candida (28.6%) infections. In all 55 blood cultures, 38 (69.1%) yielded gram-negative bacilli, of which carbapenem-resistant A. baumannii accounted for eight (21.1%); 17 (30.9%) yielded gram-positive cocci, of which methicillin-resistant S. aureus accounted for six (35.3%); and vancomycin-resistant Enterococcus accounted for four (23.5%). Daily steroid dose ≥ 20 mg (hazard ratio (HR) 2.00), recent pulse steroid therapy (HR 2.80), azathioprine (HR 2.00), rituximab (HR 2.00), plasmapheresis (HR 2.00), acute respiratory distress syndrome (HR 2.00), concurrent infections (HR 5.667) and CMV viremia (HR 1.75) were higher in the fatality group. All p values were less than 0.05. Septic shock ( n = 7, 50% in the fatality group) is the most common cause of mortality. Conclusions High daily steroid dosing, recent pulse steroid therapy, azathioprine, rituximab, concurrent infections, and CMV viremia were mortality risk factors for IA in SLE.
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Affiliation(s)
- ML Hung
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital & National Yang-Ming University Faculty of Medicine, Taiwan
| | - HT Liao
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital & National Yang-Ming University Faculty of Medicine, Taiwan
| | - WS Chen
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital & National Yang-Ming University Faculty of Medicine, Taiwan
| | - MH Chen
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital & National Yang-Ming University Faculty of Medicine, Taiwan
| | - CC Lai
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital & National Yang-Ming University Faculty of Medicine, Taiwan
| | - CY Tsai
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital & National Yang-Ming University Faculty of Medicine, Taiwan
| | - DM Chang
- Division of Allergy, Immunology & Rheumatology, Taipei Veterans General Hospital & National Yang-Ming University Faculty of Medicine, Taiwan
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Chen MH, Lee MH, Liao HT, Chen WS, Lai CC, Tsai CY. Health-related quality of life outcomes in patients with rheumatoid arthritis and ankylosing spondylitis after tapering biologic treatment. Clin Rheumatol 2018; 37:429-438. [DOI: 10.1007/s10067-017-3965-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 12/01/2017] [Accepted: 12/18/2017] [Indexed: 12/19/2022]
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Sun YS, Sun IT, Wang HK, Yang AH, Tsai CY, Huang CJ, Huang DF, Lai CC. Risk of complications of ultrasound-guided renal biopsy for adult and pediatric patients with systemic lupus erythematosus. Lupus 2018; 27:828-836. [PMID: 29301470 DOI: 10.1177/0961203317751048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective The objective of this paper is to identify the risk of complications of real-time ultrasound-guided renal biopsy in adult and pediatric patients with systemic lupus erythematosus (SLE). Materials and methods This retrospective study examined outcomes of 296 renal biopsy procedures in 275 SLE patients. Imaging-confirmed symptomatic hematoma was regarded as a major complication when intervention (blood transfusion, angiographic embolization, or surgery) was required or as a minor complication otherwise. Clinical and laboratory data were compared between groups with or without complications after initial or subsequent renal biopsy. Binary logistic regressions were used to evaluate complication risk of initial renal biopsy. Results Overall complication rate of initial renal biopsy was 8.7% (major: 2.9%, minor: 5.8%). Three patients expired from pulmonary hemorrhage, thrombotic microangiopathy, and pneumonia. Pediatric SLE patients tended to have a higher rate of major complications (12.5%) than adult patients (2.3%). According to multivariable analysis results, elevated serum creatinine (SCr) level (OR 1.45; 95% CI 1.17-1.81 per mg/dl), prolonged prothrombin time (PT) (OR 2.2; 95% CI 1.05-4.62 per second), and thrombocytopenia (OR 4.3; 95% CI 1.56-11.9) increased overall complication risk of initial renal biopsy. Age < 18 years (OR 8.43; 95% CI 1.21-58.8), thrombocytopenia (OR 16.4; 95% CI 2.44-110.5), and elevated SCr level (OR 1.97; 95% CI 1.36-2.86 per md/dl) increased risk of major complications. Thrombocytopenia, prolonged PT, and elevated SCr level were associated with complications after subsequent renal biopsy (all p = 0.01). Conclusions SLE patients, particularly patients under 18 years old or with elevated SCr level, prolonged PT, or thrombocytopenia, have an increased risk of complications after initial or subsequent renal biopsy.
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Affiliation(s)
- Y S Sun
- 1 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, 46615 Taipei Veterans General Hospital , Taipei City, Taiwan
| | - I T Sun
- 2 Department of Ophthalmology, 63344 E-Da Hospital , I-Shou University, Kaohsiung, Taiwan
| | - H K Wang
- 3 Department of Radiology, 46615 Taipei Veterans General Hospital , Taipei City, Taiwan.,6 Faculty of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - A H Yang
- 4 Department of Pathology, 46615 Taipei Veterans General Hospital , Taipei City, Taiwan.,6 Faculty of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - C Y Tsai
- 1 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, 46615 Taipei Veterans General Hospital , Taipei City, Taiwan.,6 Faculty of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - C J Huang
- 5 Division of Endocrinology and Metabolism, Department of Medicine, 46615 Taipei Veterans General Hospital , Taipei City, Taiwan.,6 Faculty of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - D F Huang
- 1 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, 46615 Taipei Veterans General Hospital , Taipei City, Taiwan.,6 Faculty of Medicine, National Yang-Ming University, Taipei City, Taiwan
| | - C C Lai
- 1 Division of Allergy, Immunology, and Rheumatology, Department of Medicine, 46615 Taipei Veterans General Hospital , Taipei City, Taiwan.,6 Faculty of Medicine, National Yang-Ming University, Taipei City, Taiwan.,7 Institute of Clinical Medicine, National Yang-Ming University, Taipei City, Taiwan
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Lai CC, Lo CY, Hsieh TH, Tsai WS, Nguyen DH, Ma YR. Ligand-Driven and Full-Color-Tunable Fiber Source: Toward Next-Generation Clinic Fiber-Endoscope Tomography with Cellular Resolution. ACS Omega 2016; 1:552-565. [PMID: 31457146 PMCID: PMC6640774 DOI: 10.1021/acsomega.6b00146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 10/03/2016] [Indexed: 06/10/2023]
Abstract
In many biomedical applications, broad full-color emission is important, especially for wavelengths below 450 nm, which are difficult to cover via supercontinuum generation. Single-crystalline-core sapphires with defect-driven emissions have potential roles in the development of next-generation broadband light sources because their defect centers demonstrate multiple emission bands with tailored ligand fields. However, the inability to realize high quantum yields with high crystallinity by conventional methods hinders the applicability of ultra-broadband emissions. Here, we present how an effective one-step fiber-drawing process, followed by a simple and controllable thermal treatment, enables a low-loss, full-color, and crystal fiber-based generation with substantial color variability. The broad spectrum extends from 330 nm, which is over 50 nm further into the UV region than that in previously reported results. The predicted submicrometer spatial resolutions demonstrate that the defect-ligand fields are potentially beneficial for achieving in vivo cellular tomography. It is also noteworthy that the efficiency of the milliwatt-level full-color generation, with an optical-to-optical efficiency of nearly 5%, is the highest among that of the existing active waveguide schemes. In addition, direct evidence from high-resolution transmission electron microscopy together with electron energy loss spectroscopy and crystal-field ligands reveals an excellent crystalline core, atomically defined core/cladding interfacial roughness, and significant enhancements in new laser-induced electronic defect levels. Our work suggests an inexpensive, facile, and highly scalable route toward achieving cellular-resolution tomographic imaging and represents an important step in the development of endoscope-compatible diagnostic devices.
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Affiliation(s)
- Chien-Chih Lai
- Department of Physics and Department of Opto-Electronic Engineering, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Road,
Shoufeng, Hualien 97401, Taiwan
| | - Chia-Yao Lo
- Institute
of Optoelectronic Sciences, National Taiwan
Ocean University, No.
2, Beining Road, Jhongjheng District, Keelung 20224, Taiwan
| | - Tsung-Hsun Hsieh
- Department
of Electrical and Computer Engineering, North Carolina State University, 890 Oval Drive, Raleigh, North Carolina 27606, United States
| | - Wan-Shao Tsai
- Department
of Applied Materials and Optoelectronics Engineering, National Chi Nan University, Daxue Road, Puli Township, Nantou 54561, Taiwan
| | - Duc Huy Nguyen
- Department of Physics and Department of Opto-Electronic Engineering, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Road,
Shoufeng, Hualien 97401, Taiwan
| | - Yuan-Ron Ma
- Department of Physics and Department of Opto-Electronic Engineering, National Dong Hwa University, No. 1, Sec. 2, Da Hsueh Road,
Shoufeng, Hualien 97401, Taiwan
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Lai CC, Lo CY, Nguyen DH, Huang JZ, Tsai WS, Ma YR. Atomically smooth hybrid crystalline-core glass-clad fibers for low-loss broadband wave guiding. Opt Express 2016; 24:20089-20106. [PMID: 27607618 DOI: 10.1364/oe.24.020089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
We demonstrate direct evidence for the first realization of atomically smooth sapphire crystalline fiber cores with a surface variation of only ~1.9 Å. The hybrid glass-clad crystalline cores were grown by a laser-based fiber drawing technique. Because of the improvement in crystal fiber quality, we were able, for the first time, to comprehensively and quantitatively elucidate the correlation between fiber nanostructure and optical loss. We also experimentally demonstrated that high-temperature treatment has a significant impact on defect relaxation and promotes excellent crystallinity, and hence enables low-loss optical wave guiding. The experimentally measured propagation losses in the order of 0.01-0.1 dB/cm are the lowest ever reported among conventional Ti:sapphire channel waveguides and ultrafast-laser-inscribed waveguides, and agree well with the theory. Through experiments and numerical calculation, we have demonstrated that low threshold and high efficiency of Ti:sapphire crystal fiber lasers are possible with the atomic-level roughness, low-loss propagation, and high crystallinity of the Ti:sapphire crystalline core.
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Wu TH, Lee HT, Lai CC, Yang AH, Loong CC, Wang HK, Yu CL, Tsai CY. Suppressor of cytokine signaling (SOCS) 1 is down-regulated in renal transplant recipients with rejection. Transpl Immunol 2016; 38:54-9. [DOI: 10.1016/j.trim.2016.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Revised: 07/09/2016] [Accepted: 07/12/2016] [Indexed: 01/14/2023]
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Patil RA, Su CW, Chuang CJ, Lai CC, Liou Y, Ma YR. Terahertz spin-wave waveguides and optical magnonics in one-dimensional NiO nanorods. Nanoscale 2016; 8:12970-12976. [PMID: 27304863 DOI: 10.1039/c6nr02531e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The two-magnon (2M) spin waves with a magnon frequency of 43 THz, generated by a polarized laser, were first observed in one-dimensional (1D) NiO nanorods. The 1D NiO nanorods of ∼700 nm length, which have perfectly in-plane antiferromagnetic spins lying on the (200) and (100) faces, are the smallest spin-wave waveguides. Due to the magneto-optical Faraday effect (MOFE), the significant change in the Faraday intensity can show the 2M information in the NiO nanorods. There are only two 2M-on and 2M-off states at various applied alternating-current magnetic fields and laser-incident angles, which make the 1D NiO nanorods excellent optical nanomagnonics.
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Affiliation(s)
- Ranjit A Patil
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
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Pham DV, Patil RA, Lin JH, Lai CC, Liou Y, Ma YR. Doping-free bandgap tuning in one-dimensional Magnéli-phase nanorods of Mo4O11. Nanoscale 2016; 8:5559-5566. [PMID: 26891201 DOI: 10.1039/c5nr08118a] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
We synthesized one-dimensional (1D) Magnéli-phase nanorods of Mo4O11 using the hot filament metal-oxide vapor deposition technique. The 1D Magnéli-phase Mo4O11 nanorods synthesized at 1000, 1050, 1100, 1150, and 1200 °C contain varying combinations of two orthorhombic (α) and monoclinic (η) phases, and various mixtures of Mo(4+), Mo(5+) and Mo(6+) cations, while those synthesized at a higher temperature look bluer. The shifts of the transmittance maximum and absorbance minimum of the 1D Magnéli-phase Mo4O11 nanorods are inversely and linearly proportional to the elevated temperature, verifying that the bandgaps (Eg) are inversely proportional to the elevated temperature. The bandgap (Eg) of the 1D Magnéli-phase Mo4O11 nanorods can be tuned by simply controlling the synthesis temperature without doping with other materials, giving the 1D Magnéli-phase Mo4O11 nanorods good potential for use in optoelectronic nanodevices and bandgap engineering.
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Affiliation(s)
- Duy Van Pham
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Ranjit A Patil
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Jin-Han Lin
- Institute of Physics, Academia Sinica, Taipei 11529, Taiwan
| | - Chien-Chih Lai
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
| | - Yung Liou
- Institute of Physics, Academia Sinica, Taipei 11529, Taiwan
| | - Yuan-Ron Ma
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
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Hung JH, Chang TC, Wu JJ, Lai CC, Huang FC, Huang YH. A cluster of Mycobacterium massiliense keratitis in foundry workers. Clin Microbiol Infect 2016; 22:386.e5-386.e8. [PMID: 26721784 DOI: 10.1016/j.cmi.2015.12.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 12/04/2015] [Accepted: 12/14/2015] [Indexed: 11/28/2022]
Abstract
Three consecutive workers from the same foundry had Mycobacterium massiliense keratitis. The strains isolated from each patient were identical. This is the first report of a non-surgery-related outbreak of non-tuberculous mycobacterial ocular infection. An investigation revealed that injured cornea with exposure to aerosolized non-tuberculous mycobacteria might account for this outbreak.
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Affiliation(s)
- J H Hung
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, Taiwan
| | - T C Chang
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - J J Wu
- Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - C C Lai
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, Taiwan
| | - F C Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, Taiwan
| | - Y H Huang
- Department of Ophthalmology, National Cheng Kung University Hospital, College of Medicine, Taiwan.
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Tsai CC, Hsieh CF, Hung CC, Chao CM, Lai CC. Sister Mary Joseph nodule. QJM 2015. [PMID: 26221042 DOI: 10.1093/qjmed/hcv135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- C C Tsai
- Department of Emergency Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - C F Hsieh
- Division of Geriatrics and Gerontology, Department of Internal Medicine and Department of Neurology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - C C Hung
- Department of Nursing, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - C M Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
| | - C C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
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Affiliation(s)
- C M Chao
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
| | - C C Lai
- Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan
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Affiliation(s)
- S Y Su
- Department of Emergency Medicine1 Tainan Municipal Hospital Department of Intensive Care Medicine2 Chi Mei Medical Center Department of Nursing3 Min-Hwei College of Health Care Management Tainan, Taiwan
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Lai CC, Gao WT, Nguyen DH, Ma YR, Cheng NC, Wang SC, Tjiu JW, Huang CM. Toward single-mode active crystal fibers for next-generation high-power fiber devices. ACS Appl Mater Interfaces 2014; 6:13928-13936. [PMID: 25077733 DOI: 10.1021/am503330m] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
We report what we believe to be the first demonstration of a facile approach with controlled geometry for the production of crystal-core ceramic-clad hybrid fibers for scaling fiber devices to high average powers. The process consists of dip coating a solution of polycrystalline alumina onto a high-crystallinity 40-μm-diameter Ti:sapphire single-crystalline core followed by thermal treatments. Comparison of the measured refractive index with high-resolution transmission electron microscopy reveals that a Ca/Si-rich intragranular layer is precipitated at grain boundaries by impurity segregation and liquid-phase formation due to the relief of misfit strain energy in the Al2O3 matrix, slightly perturbing the refractive index and hence the optical properties. Additionally, electron backscatter diffractions supply further evidence that the Ti:sapphire single-crystalline core provides the template for growth into a sacrificial polycrystalline cladding, bringing the core and cladding into a direct bond. The thus-prepared doped crystal core with the undoped crystal cladding was achieved through the abnormal grain-growth process. The presented results provide a general guideline both for controlling crystal growth and for the performance of hybrid materials and provides insights into how one might design single-mode high-power crystal fiber devices.
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Affiliation(s)
- Chien-Chih Lai
- Department of Physics, National Dong Hwa University , Hualien 97401, Taiwan
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Lai CC, Wang SH, Chen WS, Liu CJ, Chen TJ, Lee PC, Chang YS. Increased risk of osteoporotic fractures in patients with systemic sclerosis: a nationwide population-based study. Ann Rheum Dis 2014; 74:1347-52. [PMID: 24532679 DOI: 10.1136/annrheumdis-2013-204832] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 02/02/2014] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To identify the incidence rate (IR) and risk factors of osteoporotic fractures (OFs) among systemic sclerosis (SSc) patients. METHODS A cohort study was conducted using the Taiwan National Health Insurance database. Patients with SSc and respective age- and gender-matched controls without SSc were enrolled. The primary endpoint was the first occurrence of OF. The Cox proportional hazard model was used to investigate the risk factor of OFs in the SSc cohort. RESULTS Among 1712 SSc patients (77.8% female, mean age 50.3 years) with a median follow-up of 5.2 years, 54 patients developed vertebral fractures, 17 patients developed hip fractures, and 7 patients developed radius fractures (IR: 6.99, 2.18 and 0.90 per 1000 person-years, respectively). Compared with the controls, the incidence rate ratios (IRRs) (95% CIs) among SSc patients were 1.78 (1.30 to 2.39, p<0.001) for vertebral fractures and 1.89 (1.05 to 3.22, p=0.026) for hip fractures. The IRRs for overall OFs were 1.74 (1.32 to 2.27, p<0.001) for women and 1.06 (0.33 to 2.66, p=0.856) for men. The SSc patients experienced hip fractures at a younger age (67.2 vs 75.2 years, p=0.005), and had a higher 1-year mortality rate (13% vs 3%, p=0.006) of vertebral fractures than did the controls. Multivariable Cox regression analyses indicated that older age, being female, using daily prednisolone equivalent to >7.5 mg, and bowel dysmotility treated with intravenous metoclopramide are associated with OF. CONCLUSIONS SSc patients had a high IR of vertebral and hip fractures, especially those who were female, older, used a high dose of corticosteroid or experienced bowel dysmotility.
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Affiliation(s)
- Chien-Chih Lai
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan National Yang-Ming University, Taipei, Taiwan
| | - Shu-Hung Wang
- National Yang-Ming University, Taipei, Taiwan Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Wei-Sheng Chen
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan National Yang-Ming University, Taipei, Taiwan
| | - Chia-Jen Liu
- Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan Institute of Public Health & School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- National Yang-Ming University, Taipei, Taiwan Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pui-Ching Lee
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yu-Sheng Chang
- National Yang-Ming University, Taipei, Taiwan Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
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Chen MH, Chou HP, Lai CC, Chen YD, Chen MH, Lin HY, Huang DF. Lung involvement in primary Sjögren's syndrome: Correlation between high-resolution computed tomography score and mortality. J Chin Med Assoc 2014; 77:75-82. [PMID: 24342542 DOI: 10.1016/j.jcma.2013.11.001] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 09/05/2013] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Lung involvement is one of the major systemic manifestations of primary Sjögren's syndrome (pSS). This study aims to demonstrate the correlation between high-resolution computed tomography (HRCT), pulmonary function test (PFT) results, and outcome in these patients. METHODS Forty-four pSS patients were enrolled and their PFT results and HRCT findings/scores were retrospectively investigated. RESULTS All patients had reduced carbon monoxide-diffusing capacity (DLCO; <75% of the predicted value); <60% of the predicted value of peak expiratory flow (PEF), of forced vital capacity (FVC), and of forced expiratory volume in the 1st second (FEV1) were noted in 15 (34.1%) patients, 13 (29.5%) patients, and 12 (27.3%) patients, respectively. HRCT scores had a negative correlation with DLCO (r = -0.376, p = 0.012), but not with other PFT results. Twelve patients (27.3%) expired during a mean follow-up of 3.7 years; 11 (91.7%) patients died of respiratory failure in the lung-involved patients, of which three were present with pneumonia. The expired patients had lower predicted values of FEV1 (63.1 ± 19.4% vs. 79.0 ± 22.7%, p = 0.017), FVC (58.7 ± 20.4% vs. 77.1 ± 17.5%, p = 0.005), and PEF (54.3 ± 20.5% vs. 72.0 ± 24.8%, p = 0.035), and higher HRCT scores (9.2 ± 5.7 vs. 5.2 ± 3.5, p = 0.033) than those patients who survived. Patients with FEV1, FVC, PEF < 60% of the predicted value, or high HRCT score (13-18) presented shorter median overall survival (p = 0.005, p < 0.001, p = 0.021, p < 0.001, respectively). Multivariate analysis adjusted for PFT results showed that HRCT ≥13 was an independent risk factor for mortality (p = 0.007). CONCLUSION The clinical outcome of pSS patients with lung involvement in Taiwan is not very favorable. Although HRCT score was poorly correlated with PFT, high HRCT score was significantly associated with higher mortality.
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Affiliation(s)
- Ming-Han Chen
- Department of Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan, ROC; Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Ping Chou
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chien-Chih Lai
- Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yu-Dong Chen
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Huang Chen
- Department of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hsiao-Yi Lin
- Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - De-Feng Huang
- Division of Allergy, Immunology, Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
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Wang SH, Chang YS, Liu CJ, Lai CC, Chen WS, Chen TJ, Wang SJ. Association of systemic lupus erythematosus with a higher risk of cervical but not trochanteric hip fracture: a nationwide population-based study. Arthritis Care Res (Hoboken) 2013; 65:1674-81. [PMID: 23592551 DOI: 10.1002/acr.22028] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 03/27/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the incidence rates and risk factors of cervical and trochanteric hip fractures (HFs) among patients with systemic lupus erythematosus (SLE) based on a nationwide population-based data set. METHODS We conducted a cohort study using data from the Taiwan National Health Insurance database. Patients with SLE and their age- and sex-matched counterparts without SLE were identified. The primary end point was the first occurrence of HF. Cox proportional hazards model was used to evaluate the respective risk factors of cervical and trochanteric HFs in the lupus cohort. RESULTS Among 14,544 patients with SLE (90% women, mean age 38.1 years) with a mean followup of 6 years, 75 developed HF (incidence rate 8.60 per 10,000 person-years). Compared to controls, the incidence rate ratios (IRRs) for developing HF among lupus patients were 3.17 (95% confidence interval [95% CI] 1.92-5.39, P < 0.001) for cervical HF and 1.11 (95% CI 0.58-2.11, P = 0.571) for trochanteric HF. The IRRs for HF were 2.38 (95% CI 1.58-3.63, P < 0.001) for women and 1.06 (95% CI 0.21-4.93, P = 0.922) for men. Lupus patients with cervical HF were younger than controls with cervical HF (mean age 56.7 versus 67.8 years; P = 0.007). Multivariable Cox regression analyses showed that age, use of intravenous cyclophosphamide, higher dose of steroid, and stroke were associated with cervical HF, whereas age was the only associated factor for trochanteric HF. CONCLUSION SLE is associated with a higher risk for cervical but not trochanteric HF, and these 2 types of HFs have different risk factors.
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Affiliation(s)
- Shu-Hung Wang
- Taipei Veterans General Hospital and National Yang-Ming University, School of Medicine, Taipei, Taiwan
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Lai CC, Chen WS, Chang YS, Wang SH, Huang CJ, Guo WY, Yang WC, Huang DF. Clinical Features and Outcomes of Posterior Reversible Encephalopathy Syndrome in Patients With Systemic Lupus Erythematosus. Arthritis Care Res (Hoboken) 2013; 65:1766-74. [DOI: 10.1002/acr.22047] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 04/25/2013] [Accepted: 05/01/2013] [Indexed: 12/22/2022]
Affiliation(s)
- Chien-Chih Lai
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
| | - Wei-Sheng Chen
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
| | - Yu-Sheng Chang
- Shuang Ho Hospital, Taipei Medical University, New Taipei City, and National Yang-Ming University; Taipei Taiwan
| | - Shu-Hung Wang
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
| | - Chun-Jui Huang
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
| | - Wan-Yuo Guo
- Taipei Veterans General Hospital; Taipei Taiwan
| | | | - De-Feng Huang
- Taipei Veterans General Hospital, Taiwan and National Yang-Ming University; Taipei Taiwan
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Lai CC, Cheng NC, Wang CK, Tjiu JW, Lin MY, Huang SY. Simple and efficient defect-tailored fiber-based UV-VIS broadband white light generation. Opt Express 2013; 21:14606-14617. [PMID: 23787648 DOI: 10.1364/oe.21.014606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
We propose and demonstrate a facile approach for ultraviolet-visible broadband generation from a sapphire crystal core-borosilicate glass cladding hybrid fiber using a laser-heated pedestal growth technique. Considerable formation of F- and F(2)-type color emitters is effectively facilitated by Ti(4+) ions and Al(3+) vacancies, retaining efficient luminescence and high crystallinity of the sapphire core. These color centers intensify the ultraviolet, blue, and green emissions at 370, 450, and 540 nm, whereas the 650-nm red emission is contributed by Cr(3+) in the octahedral sites of the corundum structure. Over 1-mW white light with an optical-to-optical efficiency of up to nearly 5% and 1931 Commission International de l'Eclairage chromaticity coordinate of (0.287, 0.333) is achieved under 325-nm excitation.
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Affiliation(s)
- Chien-Chih Lai
- Department of Physics, National Dong Hwa University, Hualien 97401, Taiwan.
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Chang YS, Liu CJ, Chen WS, Lai CC, Wang SH, Chen TJ, Tzeng CH, Tsai CY, Wang SJ. Increased risk of subarachnoid hemorrhage in patients with systemic lupus erythematosus: a nationwide population-based study. Arthritis Care Res (Hoboken) 2013; 65:601-6. [PMID: 22965820 DOI: 10.1002/acr.21846] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2012] [Accepted: 08/27/2012] [Indexed: 11/12/2022]
Abstract
OBJECTIVE A relatively common occurrence of spontaneous subarachnoid hemorrhage (SAH) in patients with systemic lupus erythematosus (SLE) has been noted; however, the subsequent studies were conflicting. This nationwide population-based study aimed to evaluate the risk of SAH in patients with SLE. METHODS We identified 16,967 SLE patients from the Taiwan National Health Insurance (NHI) database between 2000 and 2006, and compared the incidence rate of SAH with 16,967 randomly selected age- and sex-matched non-SLE subjects. A Cox multivariable proportional hazards model was used to evaluate the risk factors of SAH in the SLE cohort. RESULTS The SLE cohort had a higher risk of SAH, with an incidence rate ratio of 4.84 (P < 0.001). Despite a younger age, the mortality rate after SAH was significantly higher in the SLE cohort compared to all of the non-SLE SAH patients identified from the 1 million NHI beneficiaries (60.0% versus 38.9%; P = 0.007). Age (hazard ratio [HR] 1.03, 95% confidence interval [95% CI] 1.01-1.05), platelet transfusion (HR 2.75, 95% CI 1.46-5.17), red blood cell transfusion (HR 7.11, 95% CI 2.81-17.97), and a mean daily steroid dose >10 mg of prednisolone or equivalent (HR 4.36, 95% CI 2.19-8.68) were independent risk factors for the new onset of SAH. CONCLUSION This study demonstrated that SAH is a rare but associated complication of SLE with a high mortality rate. Other than age, higher mean daily steroid use and a history of platelet or red blood cell transfusion were associated with the occurrence of SAH in patients with SLE.
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Affiliation(s)
- Yu-Sheng Chang
- Shuang Ho Hospital, Taipei Medical University, New Taipei City, and National Yang-Ming University, Taipei, Taiwan
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