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Lee CH, Wang SL. Oral mirtazapine decreases the gastrointestinal adverse effects in cats on doxorubicin chemotherapy. Vet J 2024; 304:106087. [PMID: 38395251 DOI: 10.1016/j.tvjl.2024.106087] [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: 11/18/2023] [Revised: 01/22/2024] [Accepted: 02/20/2024] [Indexed: 02/25/2024]
Abstract
Anorexia, depression, and vomiting are the common adverse effects of chemotherapy in humans and animals. Mirtazapine is primarily used as an appetite stimulant and antiemetic in dogs and cats. Therefore, we evaluated the efficacy of mirtazapine in reducing the gastrointestinal adverse effects in cats receiving doxorubicin chemotherapy. This single-masked, placebo-controlled crossover study enrolled 11 cats with malignant mammary gland tumors. The cats were randomly assigned to receive either mirtazapine (1.88 mg/cat) or placebo every 48 h for 2 weeks from the first initiation of doxorubicin chemotherapy. Each cat was then crossed over to the alternate group on the subsequent chemotherapy with a 1-week wash-out period. The owners were asked to record appetite score, activity score, episodes of vomiting and diarrhea for 2 weeks after each doxorubicin administration. Cats treated with mirtazapine showed significantly increased bodyweight compared with those on placebo (P = 0.010). The appetite and activity scores during mirtazapine treatment was significantly higher than those during placebo treatment (P = 0.005 and 0.018, respectively). Furthermore, the prevalence of episodes of vomiting during mirtazapine treatment was significantly lower than that during placebo treatment (P = 0.026). Our results demonstrate that mirtazapine can significantly increase bodyweight, appetite, and activity and reduce vomiting in cats after doxorubicin chemotherapy.
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Affiliation(s)
- C H Lee
- Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan
| | - S L Wang
- Graduate Institute of Veterinary Clinical Sciences, School of Veterinary Medicine, National Taiwan University, Taipei 10617, Taiwan; National Taiwan University Veterinary Hospital, National Taiwan University, Taipei 10617, Taiwan.
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Cho YT, Lee CH, Lee JY, Chu CY. Targeting antibody-mediated complement-independent mechanism in bullous pemphigoid with diacerein. J Dermatol Sci 2024; 114:44-51. [PMID: 38508975 DOI: 10.1016/j.jdermsci.2024.03.001] [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: 09/20/2023] [Revised: 02/23/2024] [Accepted: 03/03/2024] [Indexed: 03/22/2024]
Abstract
BACKGROUND Bullous pemphigoid (BP) is an antibody-mediated blistering disease predominantly affecting the elderly. The pathogenesis involves both complement-dependent and complement-independent mechanisms. The therapeutic potential of targeting complement-independent mechanism has not yet been determined. The mainstay of treatment, corticosteroid, has many side effects, indicating the needs of better treatments. OBJECTIVE We tempted to establish an in vitro model of BP which resembles complement-independent mechanism and to examine the therapeutic potential of a novel anti-inflammatory agent, diacerein. METHODS Cultured HaCaT cells were treated with purified antibodies from BP patients, with or without diacerein to measure the cell interface presence of BP180, protein kinase C, and the production of proinflammatory cytokines. An open-label, randomized, phase 2 trial was conducted to compare topical diacerein and clobetasol ointments in patients with mild-to-moderate BP (NCT03286582). RESULTS The reduced presentation of BP180 at cell interface after treating with BP autoantibodies was noticed in immunofluorescence and western blotting studies. The phenomenon was restored by diacerein. Diacerein also reduced the autoantibody-induced increase of pro-inflammatory cytokines. Reciprocal changes of BP180 and protein kinase C at the cell interface were found after treating with BP autoantibodies. This phenomenon was also reversed by diacerein in a dose-dependent manner. The phase 2 trial showed that topical diacerein reduced the clinical symptoms which were comparable to those of topical clobetasol. CONCLUSION Diacerein inhibited BP autoantibody-induced reduction of BP180 and production of proinflammatory cytokines in vitro and showed therapeutic potential in patients with BP. It is a novel drug worthy of further investigations.
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Affiliation(s)
- Yung-Tsu Cho
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Chen HM, Hsu CY, Pan BL, Huang CF, Chen CT, Chuang HY, Lee CH. Association of Decreased Bone Density and Hyperlipidemia in a Taiwanese Older Adult Population. J Endocr Soc 2024; 8:bvae035. [PMID: 38505562 PMCID: PMC10949356 DOI: 10.1210/jendso/bvae035] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Indexed: 03/21/2024] Open
Abstract
Objective This study aimed to determine if a combination of 2 abnormal lipid profiles revealed a stronger association with low bone mass than a single blood lipid abnormality alone. Methods This study enrolled 1373 participants who had received a dual-energy x-ray absorptiometry scan from January 2016 to December 2016 in a medical center in southern Taiwan. Logistic regression was used to examine association between lipid profiles and osteopenia or osteoporosis after adjusting for covariates. Results Compared to people with total cholesterol (TC) < 200 mg/dL, those with TC ≥ 240 mg/dL tended to have osteopenia or osteoporosis (OR 2.61; 95% CI, 1.44-4.71). Compared to people with low-density lipoprotein cholesterol (LDL-C) < 130 mg/dL, those with LDL-C ≥ 160 mg/dL tended to develop osteopenia or osteoporosis (OR 2.13; 95% CI, 1.21-3.74). The association of increased triglyceride and decreased bone mass was similar, although not statistically significant. Those with the combination of TG ≥ 200 mg/dL and TC ≥ 240 mg/dL had a stronger tendency to have osteopenia or osteoporosis (OR 3.51; 95% CI, 1.11-11.13) than people with only one blood lipid abnormality. Similarly, people with TG ≥ 200 mg/dL and LDL-C ≥ 160 mg/dL had a stronger tendency to have osteopenia or osteoporosis (OR 9.31; 95% CI, 1.15-75.42) than people with only one blood lipid abnormality, after adjustment for the same covariates. Conclusion Blood levels of TC, LDL-C, and TG were associated with osteopenia or osteoporosis. Results indicate that individuals aged older than 50 years with abnormal lipid profiles should be urged to participate in a bone density survey to exclude osteopenia or osteoporosis.
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Affiliation(s)
- Hui-Ming Chen
- Department of Family Medicine and Occupational Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833401, Taiwan
| | - Chung-Yuan Hsu
- Division of Rheumatology, Allergy, and Immunology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833401, Taiwan
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333323, Taiwan
| | - Bo-Lin Pan
- Department of Family Medicine and Occupational Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833401, Taiwan
| | - Chih-Fang Huang
- Department of Family Medicine, Kaohsiung Municipal Feng-Shan Hospital, Kaohsiung, 830025, Taiwan
- Department of Long-Term Care and Management, Chung Hwa University of Medical Technology, Tainan, 717302, Taiwan
| | - Chao-Tung Chen
- Department of Family Medicine, Chang Gung Memorial Hospital, Chiayi, 613016, Taiwan
| | - Hung-Yi Chuang
- Department of Public Health, Kaohsiung Medical University, Kaohsiung, 807378, Taiwan
- Department of Environmental and Occupational Medicine, Kaohsiung Medical University Hospital, Kaohsiung, 807377, Taiwan
| | - Chih-Hung Lee
- School of Medicine, College of Medicine, Chang Gung University, Taoyuan, 333323, Taiwan
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, 833401, Taiwan
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Jhuang JR, Lee CH, Chiang CJ, Chen CJ, Lee WC. Reduced burden of Arsenic-Related cancers after water mitigation in Taiwan. Environ Int 2024; 185:108542. [PMID: 38461779 DOI: 10.1016/j.envint.2024.108542] [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] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 01/31/2024] [Accepted: 02/28/2024] [Indexed: 03/12/2024]
Abstract
BACKGROUND Epidemiological evidence has demonstrated an association between arsenic in drinking water and increased cancer incidence. This population-based study investigates the impact of a tap water supply system installation in Blackfoot disease-endemic regions of Taiwan on cancer incidence. METHODS By using the Taiwan Cancer Registry dataset, we enrolled patients aged 40-84 diagnosed with arsenic-related cancers, including hepatocellular carcinoma, small and squamous cell lung cancer, Bowen's disease, basal and squamous cell skin cancer, urothelial bladder cancer, and upper tract urothelial carcinoma between 1995 and 2019. Random-effects age-period-cohort models were used to estimate the cancer incidence data, and a stabilized kriging method was employed to interpolate incidence rates to more precise spatiotemporal units. RESULTS The results showed that the age-standardized incidence rates of all six types of studied cancers were consistently higher in Blackfoot disease-endemic areas than those in other areas from 1995 to 2019. However, the gap in incidence rates between Blackfoot disease-endemic areas and the remaining regions began to narrow approximately after the 1960 birth cohort when the tap water supply system installation commenced. For small and squamous cell lung cancer, Bowen's disease, and urothelial bladder cancer, the excess incidence rates sharply declined to null for those born after the year of arsenic mitigation. For upper tract urothelial carcinoma, the excess incidence rates decreased more gradually for those born after the year of arsenic mitigation. For hepatocellular carcinoma and basal and squamous cell skin cancer, the excess incidence rates remained constant. Spatiotemporal clusters of high incidence rates were identified in the core townships of Blackfoot disease-endemic areas. These clusters began to dissipate mainly after the 1960 birth cohort. CONCLUSION Arsenic mitigation from drinking water in Taiwan is associated with a reduced burden of small and squamous cell lung cancers, Bowen's disease, urothelial bladder cancer, and upper tract urothelial carcinoma.
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Affiliation(s)
- Jing-Rong Jhuang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chun-Ju Chiang
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan; College of Medicine, Fu-Jen Catholic University, New Taipei, Taiwan
| | - Wen-Chung Lee
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan; Taiwan Cancer Registry, Taipei, Taiwan; Institute of Health Data Analytics and Statistics, College of Public Health, National Taiwan University, Taipei, Taiwan.
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Li W, Sano R, Apatira M, DeAnda F, Gururaja T, Yang M, Lundgaard G, Pan C, Liu J, Zhai Y, Yoon WH, Wang L, Tse C, Souers AJ, Lee CH. Bruton's Tyrosine Kinase Inhibitors with Distinct Binding Modes Reveal Differential Functional Impact on B-Cell Receptor Signaling. Mol Cancer Ther 2024; 23:35-46. [PMID: 37735104 PMCID: PMC10762339 DOI: 10.1158/1535-7163.mct-22-0642] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/17/2023] [Accepted: 09/14/2023] [Indexed: 09/23/2023]
Abstract
Small molecule inhibitors of Bruton's tyrosine kinase (BTK) have been approved for the treatment of multiple B-cell malignancies and are being evaluated for autoimmune and inflammatory diseases. Various BTK inhibitors (BTKi) have distinct potencies, selectivity profiles, and binding modes within the ATP-binding site. On the basis of the latter feature, BTKis can be classified into those that occupy the back-pocket, H3 pocket, and the hinge region only. Hypothesizing that differing binding modes may have differential impact on the B-cell receptor (BCR) signaling pathway, we evaluated the activities of multiple BTKis in B-cell lymphoma models in vitro and in vivo. We demonstrated that, although all three types of BTKis potently inhibited BTK-Y223 autophosphorylation and phospholipase C gamma 2 (PLCγ2)-Y1217 transphosphorylation, hinge-only binders were defective in inhibiting BTK-mediated calcium mobilization upon BCR activation. In addition, PLCγ2 activation was effectively blocked by back-pocket and H3 pocket binders but not by hinge-only binders. Further investigation using TMD8 cells deficient in Rac family small GTPase 2 (RAC2) revealed that RAC2 functioned as a bypass mechanism, allowing for residual BCR signaling and PLCγ2 activation when BTK kinase activity was fully inhibited by the hinge-only binders. These data reveal a kinase activity-independent function of BTK, involving RAC2 in transducing BCR signaling events, and provide mechanistic rationale for the selection of clinical candidates for B-cell lymphoma indications.
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Affiliation(s)
- Wei Li
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Renata Sano
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Mutiah Apatira
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Felix DeAnda
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | | | - Muhua Yang
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Greta Lundgaard
- Drug Discovery Science and Technology, AbbVie Inc., Lake County, Illinois
| | - Chin Pan
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Jing Liu
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Yongjiao Zhai
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Woo Hyun Yoon
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Longcheng Wang
- Oncology Discovery, AbbVie Inc., South San Francisco, California
| | - Chris Tse
- Oncology Discovery, AbbVie Inc., Lake County, Illinois
| | | | - Chih-Hung Lee
- Oncology Discovery, AbbVie Inc., South San Francisco, California
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Liao PJ, Lee CH, Wang SL, Chiou HY, Chen CJ, Seak CJ, Wu IW, Hsu KH. Low-to-Moderate Arsenic Exposure and Urothelial Tract Cancers with a Long Latent Period of Follow-Up in an Arseniasis Area. J Epidemiol Glob Health 2023; 13:807-815. [PMID: 37725327 PMCID: PMC10686965 DOI: 10.1007/s44197-023-00152-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 09/05/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Arsenic exposure can cause adverse health effects. The effects of long-term low-to-moderate exposure and methylations remain unclear. OBJECTIVE This study aims to examine the association between low-to-moderate arsenic exposure and urothelial tract cancers while considering the effects of methylation capacity. METHODS In this study, 5,811 participants were recruited from an arseniasis area in Taiwan for inorganic arsenic metabolite analysis. This follow-up study was conducted between August 1995 and December 2017. We identified 85 urothelial tract cancers in these participants, including 49 bladder and 36 upper urothelial tract cancer cases. A Cox proportional hazards model was employed. RESULTS The analyses revealed a significant association between concentrations of inorganic arsenic in water > 100 ug/L and bladder cancer occurrence, with a hazard ratio (HR) of 4.88 (95% CI 1.35-17.61). A monotonic trend was observed between concentrations of inorganic arsenic in water (from 0 to > 100 ug/L) and the incidence of urothelial tract cancer, including bladder cancer (p < 0.05) and upper urothelial tract cancers (p < 0.05). Participants with a lower primary methylation index or higher secondary methylation index had a prominent effect. CONCLUSIONS Rigorous regulations and active interventions should be considered for populations with susceptible characteristics.
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Affiliation(s)
- Pei-Ju Liao
- International Program of Health Informatics and Management, Chang Gung University, Taoyuan, Taiwan
- Master Degree Program in Health and Long-Term Care Industry, Chang Gung University, Taoyuan, Taiwan
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Hung-Yi Chiou
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Master Program in Applied Epidemiology, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei, Taiwan
| | - Chen-June Seak
- Department of Emergency Medicine, New Taipei Municipal Tucheng Hospital, New Taipei City, Taiwan
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan
- College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - I-Wen Wu
- Division of Nephrology, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Kuang-Hung Hsu
- Department of Emergency Medicine, Lin-Kou Medical Center, Chang Gung Memorial Hospital, Taoyuan, Taiwan.
- Laboratory for Epidemiology, Department of Health Care Management, and Healthy Aging Research Center, Chang Gung University, No. 259, Wen-Hwa 1St Road, Kwei-Shan, Taoyuan, 333, Taiwan.
- Research Center for Food and Cosmetic Safety, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan.
- Department of Safety, Health and Environmental Engineering, Ming Chi University of Technology, New Taipei City, Taiwan.
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Lee S, Choi YS, Do SH, Lee W, Lee CH, Lee M, Vojta M, Wang CN, Luetkens H, Guguchia Z, Choi KY. Kondo screening in a Majorana metal. Nat Commun 2023; 14:7405. [PMID: 37974022 PMCID: PMC10654600 DOI: 10.1038/s41467-023-43185-3] [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: 11/17/2022] [Accepted: 11/02/2023] [Indexed: 11/19/2023] Open
Abstract
Kondo impurities provide a nontrivial probe to unravel the character of the excitations of a quantum spin liquid. In the S = 1/2 Kitaev model on the honeycomb lattice, Kondo impurities embedded in the spin-liquid host can be screened by itinerant Majorana fermions via gauge-flux binding. Here, we report experimental signatures of metallic-like Kondo screening at intermediate temperatures in the Kitaev honeycomb material α-RuCl3 with dilute Cr3+ (S = 3/2) impurities. The static magnetic susceptibility, the muon Knight shift, and the muon spin-relaxation rate all feature logarithmic divergences, a hallmark of a metallic Kondo effect. Concurrently, the linear coefficient of the magnetic specific heat is large in the same temperature regime, indicating the presence of a host Majorana metal. This observation opens new avenues for exploring uncharted Kondo physics in insulating quantum magnets.
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Affiliation(s)
- S Lee
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science, Pohang, 37673, Republic of Korea
| | - Y S Choi
- Department of Physics, Sungkyunkwan University, Suwon, 16419, Republic of Korea
| | - S-H Do
- Materials Science and Technology Division, Oak Ridge National Laboratory, Oak Ridge, Tennessee, 37831, USA
| | - W Lee
- Center for Artificial Low Dimensional Electronic Systems, Institute for Basic Science, Pohang, 37673, Republic of Korea
- Rare Isotope Science Project, Institute for Basic Science, Daejeon, 34000, Republic of Korea
| | - C H Lee
- Department of Physics, Chung-Ang University, 84 Heukseok-ro, Seoul, 06974, Republic of Korea
| | - M Lee
- National High Magnetic Field Laboratory, Los Alamos National Laboratory, Los Alamos, New Mexico, 87545, USA
| | - M Vojta
- Institut für Theoretische Physik, Technische Universität Dresden, 01062, Dresden, Germany
| | - C N Wang
- Laboratory for Muon Spin Spectroscopy, Paul Scherrer Institute, Villigen PSI, 5232, Switzerland
| | - H Luetkens
- Laboratory for Muon Spin Spectroscopy, Paul Scherrer Institute, Villigen PSI, 5232, Switzerland
| | - Z Guguchia
- Laboratory for Muon Spin Spectroscopy, Paul Scherrer Institute, Villigen PSI, 5232, Switzerland
| | - K-Y Choi
- Department of Physics, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
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Hong CH, Lee CH. Ambient-stable topical rapamycin cream is effective in treating angiofibromas in tuberous sclerosis complex. Br J Dermatol 2023; 189:507-508. [PMID: 37672663 DOI: 10.1093/bjd/ljad334] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 09/02/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Dermatology, National Yang-Ming Chiao-Tung University College of Medicine, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
- School of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Lee SH, Jung Y, Lee MJ, Lee CH. Development of metal radioactive liquid reference material for proficiency test. Appl Radiat Isot 2023; 200:110970. [PMID: 37540991 DOI: 10.1016/j.apradiso.2023.110970] [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: 05/31/2023] [Revised: 07/21/2023] [Accepted: 07/31/2023] [Indexed: 08/06/2023]
Abstract
This study developed liquid reference materials containing various metals, to be used for quality assurance of radiation measurements of the most common metallic wastes generated during the operation or decommissioning of nuclear power plants. The liquid reference materials were prepared by assuming the dissolution of stainless-steel using acid and melting of the major metals present in the stainless steel, namely Fe, Ni, Cr, and Mn, along with the standard sources (134Cs, 137Cs, 60Co, 90Sr). The theoretical massic activity of the standard sources added to the samples and the measured reference values of the gamma and beta emitters in the samples were compared, and they showed good agreement within a one-sigma confidence interval (k = 1). Using the developed reference materials, a proficiency test was conducted on three domestic labs, and the results were evaluated using Z-score. While the evaluation results showed good agreement between the reference values and the reported values for 137Cs and 60Co, all participating labs reported lower values than the reference value for 134Cs. For 90Sr, two out of the three labs reported significantly higher values than the reference value. Based on the results of this study, the developed metal radioactive liquid reference material is expected to be registered as certified reference material (CRM) in the future. They will be used as the CRM for measuring and ensuring the quality of radioactive metal waste.
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Affiliation(s)
- S H Lee
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea.
| | - Y Jung
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - M J Lee
- Environmental Radioactivity Safety Team, Korea Research Institute of Standards and Science (KRISS), 267 Gajeong-ro, Yuseong-gu, Daejeon, 34113, Republic of Korea
| | - C H Lee
- Nuclear Decommissioning Research Institute (NDRI), 17 Techno 4-ro, Yuseong-gu, Daejeon, 34013, Republic of Korea
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Hong CH, Lee CH. A nationwide UK cohort study reveals an association between atopic dermatitis and venous thromboembolism. Br J Dermatol 2023; 189:363-364. [PMID: 37405430 DOI: 10.1093/bjd/ljad221] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/04/2023] [Indexed: 07/06/2023]
Affiliation(s)
- Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Dermatology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
- Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
- School of Medicine, National Sun Yat-Sen University, Kaohsiung, Taiwan
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Huang LY, Li ST, Lin SC, Kao CH, Hong CH, Lee CH, Yang LT. Gasdermin A Is Required for Epidermal Cornification during Skin Barrier Regeneration and in an Atopic Dermatitis-Like Model. J Invest Dermatol 2023; 143:1735-1745.e11. [PMID: 36965577 DOI: 10.1016/j.jid.2023.03.1657] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/27/2023]
Abstract
Atopic dermatitis is featured with impaired skin barrier. The stratum corneum and the intercellular tight junctions constitute the permeability barrier, which is essential to protect water loss in the host and prevent pathogen entry. The epidermal barrier is constantly renewed by differentiating keratinocytes through cornification, during which autophagy contributes to elimination of organelles and nucleus. The human GSDMA and its mouse homologs Gsdma1-3 are expressed in the suprabasal epidermis. Although a pyroptotic role of GSDMA/Gsdma1 in host defense against Streptococcus pyogenes has been reported, the physiological function of Gsdma1/a2/a3 in epidermal homeostasis remains elusive. Here, through repeated epidermal barrier disruption, we found that tight junction formation and stratum corneum maturation were defective in the Gsdma1/a3-deficient epidermis. Using comparative gene profiling analysis, mitochondrial respiration measurement, and in vivo tracing of mitophagy, our data indicate that Gsdma1/a3 activation leads to mitochondrial dysfunction and subsequently facilitates mitochondrial turnover and epidermal cornification. In calcipotriol (MC903)-induced atopic dermatitis-like animal model, we showed that Gsdma1/a3-deficiency selectively enhanced the T helper type 2 response. Remarkably, the GSDMA expression is reduced in the epidermis of patients with atopic dermatitis compared with that of normal individuals. Gsdma1/a3-deficiency might be involved in atopic dermatitis pathogenesis, likely through GSDMA-mediated epidermal differentiation and cornification.
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Affiliation(s)
- Li-Ying Huang
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Shao-Ting Li
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Shiang-Chi Lin
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan
| | - Cheng-Heng Kao
- Center of General Education, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hui Hong
- Department of Dermatology, School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taiwan; Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Liang-Tung Yang
- Institute of Cellular and System Medicine, National Health Research Institutes, Zhunan, Taiwan; Graduate Institute of Biomedical Sciences, China Medical University, Taichung, Taiwan.
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12
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Chu CY, Lee CH, Lee HE, Cho YT, Hsu CK, Chan TC, Hsieh SC, Wei KC. Taiwanese dermatological association (TDA) consensus for the management of pemphigus. J Formos Med Assoc 2023; 122:540-548. [PMID: 36564301 DOI: 10.1016/j.jfma.2022.12.005] [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: 06/12/2022] [Revised: 10/14/2022] [Accepted: 12/08/2022] [Indexed: 12/24/2022] Open
Abstract
Pemphigus is an uncommon but life-threatening autoimmune blistering disease characterized by the presence of antibodies against desmogleins. Without effective treatment, pemphigus can result in significant morbidity and mortality. Existing consensus statements on pemphigus management from international medical groups provide varying guidelines, especially on treatment. Thus, on January 4, 2020, a panel of seven dermatology experts from the Taiwanese Dermatological Association (TDA) and one rheumatology expert convened to develop a consensus for the management of pemphigus. These experts with extensive experience in pemphigus management were recommended by their respective teaching hospitals and primary care clinics in Taiwan and by the TDA. The meeting reviewed the available consensus statements from international dermatology groups, including the European Dermatology Forum (EDF), the European Academy of Dermatology and Venereology (EADV), and the International Bullous Diseases Consensus Group. Using these guidelines as a basis for discussion and consensus formulation, these experts formulated their consensus statement that provides practical, concise but comprehensive recommendations as to the diagnosis, treatment, and monitoring of pemphigus patients in Taiwan. This consensus serves as a clinical reference for physicians for the management of pemphigus in Taiwan or wherever it may be applicable.
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Affiliation(s)
- Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hua-En Lee
- Department of Dermatology, Chang Gung Memorial Hospital, Taipei Branch, Taiwan
| | | | - Chao-Kai Hsu
- Department of Dermatology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tom C Chan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Song-Chou Hsieh
- Division of Rheumatology, Immunology, and Allergy, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Kai-Che Wei
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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13
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Huang KS, Huang YH, Chen CT, Chou CP, Pan BL, Lee CH. Liver-specific metastases as an independent prognostic factor in cancer patients receiving hospice care in hospital. BMC Palliat Care 2023; 22:62. [PMID: 37221588 DOI: 10.1186/s12904-023-01180-x] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/03/2023] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Survival prediction is important in cancer patients receiving hospice care. Palliative prognostic index (PPI) and palliative prognostic (PaP) scores have been used to predict survival in cancer patients. However, cancer primary site with metastatic status, enteral feeding tubes, Foley catheter, tracheostomy, and treatment interventions are not considered in aforementioned tools. The study aimed to investigate the cancer features and potential clinical factors other than PPI and PaP to predict patient survival. METHODS We conducted a retrospective study for cancer patients admitted to a hospice ward between January 2021 and December 2021. We examined the correlation of PPI and PaP scores with survival time since hospice ward admission. Multiple linear regression was used to test the potential clinical factors other than PPI and PaP for predicting survival. RESULTS A total of 160 patients were enrolled. The correlation coefficients for PPI and PaP scores with survival time were -0.305 and -0.352 (both p < 0.001), but the predictabilities were only marginal at 0.087 and 0.118, respectively. In multiple regression, liver metastasis was an independent poor prognostic factor as adjusted by PPI (β = -8.495, p = 0.013) or PaP score (β = -7.139, p = 0.034), while feeding gastrostomy or jejunostomy were found to prolong survival as adjusted by PPI (β = 24.461, p < 0.001) or PaP score (β = 27.419, p < 0.001). CONCLUSIONS Association between PPI and PaP with patient survival in cancer patients at their terminal stages is low. The presence of liver metastases is a poor survival factor independent of PPI and PaP score.
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Affiliation(s)
- Kun-Siang Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yun-Hwa Huang
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chao-Tung Chen
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chia-Pei Chou
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Bo-Lin Pan
- Department of Family Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
- Chang Gung University College of Medicine, Taoyuan, Taiwan.
- Institute of Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
- National Sun Yat-Sen University College of Medicine, Kaohsiung, Taiwan.
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14
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Parng SH, Wu LA, Kuo CC, Wu PJ, Tsai YY, Lee CH. Real-Time Fluorescence Measurement for Droplet Generation and Signal Detection in a Cylindrical Tube. ACS Omega 2023; 8:8397-8406. [PMID: 36910981 PMCID: PMC9996802 DOI: 10.1021/acsomega.2c07246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/10/2022] [Accepted: 12/19/2022] [Indexed: 06/18/2023]
Abstract
This study provides an approach for generating droplets in a cylindrical tube. This creative design utilizes a single tube to generate droplets for the emulsion polymerase chain reaction (PCR). We fabricated the multi-layered tube and detected samples in 1 mm microchannel length for the minimum disposable material used for droplet signal analysis. In this research, we verify the validity of the non-planar droplet chip with a single driving pump by experimentally analyzing the light intensity of the liquids during droplet processing in real time. Experimental observation shows that droplet diameter from 150 to 285 μm was obtained by the cylindrical tube with different dispersed liquid and gas pressure settings. Average size of droplets decreased by approximately 37% as the dispersed phase liquids change at the same flow pressure of 50 mbar. In this study, the effects of the laser site, 6-carboxyfluorescein (6-FAM) dye buffer, DNA reagent, and driving pressure are analyzed directly by the signal recorded during droplet generation in the cylindrical tube. Finally, we have developed a real-time detection method to count exon 19 deletion mutations of epidermal growth factor receptor (EGFR) in a droplet using a cylindrical tube. Two digital droplet PCR methods were compared in measuring the copy numbers of EGFR with the same target DNA concentration of 105 copies/μL.
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15
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Yeh CY, Su SH, Tan YF, Tsai TF, Liang PH, Kelel M, Weng HJ, Hsiao YP, Lu CH, Tsai CH, Lee CH, Clausen BE, Liu FT, Lee YL. PD-L1 Enhanced by cis-Urocanic Acid on Langerhans Cells Inhibits Vγ4 + γδT17 Cells in Psoriatic Skin Inflammation. J Invest Dermatol 2023:S0022-202X(23)00161-6. [PMID: 36868499 DOI: 10.1016/j.jid.2023.02.018] [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: 10/26/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 03/05/2023]
Abstract
Psoriasis is an IL-23/IL-17-mediated inflammatory autoimmune dermatosis and ultraviolet B (UVB) may contribute to immunosuppression and ameliorate associated symptoms. One of the pathophysiology underlying UVB therapy is through the production of cis-urocanic acid (cis-UCA) from keratinocytes. However, the detailed mechanism is yet to be fully understood. In the current study, we found filaggrin expression and serum cis-UCA levels were significantly lower in psoriasis patients than in healthy controls. We also noted that cis-UCA application inhibited psoriasiform inflammation through the reduction of Vγ4+ γδT17 cells in murine skin and draining lymph nodes. Meanwhile, CCR6 was down-regulated on γδT17 cells, which would suppress the inflammatory reaction at a distal skin site. We revealed that 5-HT2A receptor (HTR2A), the known cis-UCA receptor, was highly expressed on Langerhans cells (LCs) in the skin. cis-UCA also inhibited IL-23 expression and induced PD-L1 on LCs, leading to the attenuated proliferation and migration of γδT cells. Compared to the isotype control, α-PD-L1 treatment in vivo could reverse the anti-psoriatic effects of cis-UCA. PD-L1 expression on LCs was sustained through cis-UCA-induced MAPK/ERK pathway. These findings uncover the cis-UCA-induced PD-L1-mediated immunosuppression on LCs, which facilitates the resolution of inflammatory dermatoses.
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Affiliation(s)
- Chen-Yun Yeh
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Sheng-Han Su
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yeh Fong Tan
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; Taiwan International Graduate Program in Molecular Medicine, National Yang Ming Chiao Tung University and Academia Sinica, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Pi-Hui Liang
- School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Musin Kelel
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Hao-Jui Weng
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan; Department of Dermatology, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan; Department of Dermatology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ping Hsiao
- Department of Dermatology, Chung Shan Medical University and Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chun-Hao Lu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ching-Hui Tsai
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung
| | - Björn E Clausen
- Institute for Molecular Medicine, University Medical Center of the Johannes Gutenberg-University, Mainz 55131, Germany
| | - Fu-Tong Liu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Yungling Leo Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan; College of Public Health, China Medical University, Taichung, Taiwan.
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16
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Sari NY, Li TYW, Yeo S, Ngiam NJH, Lee CH, Evangelista LKM, Lee ECY, Yeo TC, Yip JWL, Poh KK, Kong WKF, Lin WQ, Lim YC, Sia CH, Wong RCC. Association of left atrial ejection fraction and cardiovascular outcomes in Asian patients with hypertrophic cardiomyopathy. Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.076] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public Institution(s). Main funding source(s): National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Fellowship Scheme
Background
The optimal method of risk stratification of hypertrophic cardiomyopathy (HCM) patients, especially in the Asian population, is unknown. Left atrial ejection fraction (LAEF) is an emerging risk marker for cardiovascular outcomes. This study aimed to investigate whether LAEF was associated with cardiovascular outcomes in Asian patients with HCM.
Methods
This was a retrospective cohort study performed in a tertiary academic centre involving 291 consecutive patients diagnosed with HCM between 2010 and 2017. We collected the relevant clinical characteristics of these patients and retrospectively analysed the index transthoracic echocardiograms for novel left atrial indices including LAEF. We obtained the maximum (LAVmax) and minimum left atrial volumes (LAVmin) using the biplane method of disks in apical 4- and 2-chamber views. LAEF was derived by dividing the difference between LAVmax and LAVmin by LAVmax. We assessed the patients for outcomes of (1) heart failure requiring admission, and (2) a composite of adverse outcomes including all-cause mortality, ventricular tachycardia / ventricular fibrillation (VT/VF) events, appropriate device therapy if an implantable cardioverter defibrillator (ICD) was implanted, stroke and heart failure hospitalization.
Results
The patients had a mean age of 59.0 ± 16.7 years-old at diagnosis and had a male preponderance (71.2%). The most common comorbidities were hypertension, diabetes mellitus and ischemic heart disease. On univariable logistic regression analysis, maximum and minimum left atrial volume index (LAVI) as well as LAEF showed a significant association with heart failure and the predefined composite outcome. On Cox regression analysis adjusting for variables of age, sex, left ventricular ejection fraction (LVEF), left ventricular maximal wall thickness >30mm, significant left ventricular outflow tract (LVOT) gradient of > 30mmHg and more than moderate mitral regurgitation, maximum and minimum LAVI as well as LAEF retained an association with heart failure admission but only minimum LAVI and LAEF were associated with the composite outcome [(OR 0.019, 95% CI 0.02-0.230, p=0.002), (OR 0.226, 95% CI 0.053-0.960, p=0.044), (OR 1.030, 95% CI 1.016-1.045, p<0.001), and (OR 1.016, 95% CI 1.005-1.026, p=0.004) respectively].
Conclusion
LAEF was an independently associated with congestive heart failure as well as a composite of adverse outcomes in Asian patients with HCM.
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Affiliation(s)
- N Y Sari
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T Y W Li
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - S Yeo
- National University of Singapore, Cardiology , Singapore , Singapore
| | - N J H Ngiam
- National University Health System, Medicine , Singapore , Singapore
| | - C H Lee
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - L K M Evangelista
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - E C Y Lee
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - J W L Yip
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - K K Poh
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - W K F Kong
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - W Q Lin
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - Y C Lim
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - C H Sia
- National University Heart Centre, Cardiology , Singapore , Singapore
| | - R C C Wong
- National University Heart Centre, Cardiology , Singapore , Singapore
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17
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Kulthanan K, Andriessen A, Jiang X, Lee CH, Zhang CF. A Review of the Challenges and Nuances in Treating Rosacea in Asian Skin Types Using Cleansers and Moisturizers as Adjuncts. J Drugs Dermatol 2023; 22:45-53. [PMID: 36607763 DOI: 10.36849/jdd.7021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Rosacea is primarily an inflammatory disease of facial skin associated with impaired skin barrier function. While it is commonly thought of as a Caucasian person's disease, it is likely underdiagnosed in people of color, including Asians, leading to missed and delayed diagnoses and increased morbidity. The purpose of this review is to highlight literature on rosacea in Asian people and the role of non-prescription skincare in managing rosacea. METHODS Four dermatologists (the panel) completed pre-meeting surveys and participated in a web meeting to discuss the role of skin care in treating rosacea in the Asia Pacific (APAC) region. The survey results were summarized, then presented during the virtual meeting. These survey results and relevant papers identified through a literature review were then discussed. This review shows the fruit of these discussions, as well as the advisors' expert opinions and experiences. RESULTS The panel crafted 5 consensus statements regarding the role of skin care in the treatment of rosacea in the APAC region. The most common forms of rosacea seen by the advisors are mostly erythematous and papulopustular. Among the panel, doxycycline is the most popular treatment for papulopustular rosacea. The panel prioritize gentleness when choosing skincare products for patients with rosacea. CONCLUSIONS In Asian patients with rosacea, adjunctive skincare is an important part of treatment, maintenance, and prescription treatment. Given the highly sensitive skin of certain Asian patients with rosacea, avoiding potentially irritating substances is crucial. J Drugs Dermatol. 2023;22(1):45-53. doi:10.36849/JDD.7021.
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Wu MM, Chen CW, Chen CY, Lee CH, Chou M, Hsu LI, Lee TC, Chen CJ. TIMP3 Gene Polymorphisms of -1296 T > C and -915 A > G Increase the Susceptibility to Arsenic-Induced Skin Cancer: A Cohort Study and In Silico Analysis of Mutation Impacts. Int J Mol Sci 2022; 23:ijms232314980. [PMID: 36499314 PMCID: PMC9735753 DOI: 10.3390/ijms232314980] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/25/2022] [Accepted: 11/25/2022] [Indexed: 12/04/2022] Open
Abstract
Long-term exposure to arsenic may induce several human cancers, including non-melanoma skin cancer. The tissue inhibitor of metalloproteinase (TIMP)-3, encoded by the TIMP3 gene, may inhibit tumor growth, invasion, and metastasis of several cancer types. In this study, we aimed to investigate effects of the TIMP3 -1296 T > C (rs9619311) and -915 A > G (rs2234921) single-nucleotide polymorphisms (SNPs) on skin cancer risk in an arsenic-exposed population, and to evaluate the influence of allele-specific changes by an in silico analysis. In total, 1078 study participants were followed up for a median of 15 years for newly diagnosed skin cancer. New cases were identified through linkage to the National Cancer Registry of Taiwan. A Cox regression analysis was used to evaluate the effects of TIMP3 variants. Transcription factor (TF) profiling of binding sites of allele-specific changes in SNPs was conducted using the JASPAR scan tool. We observed borderline associations between TIMP3 genotypes and skin cancer risk. However, when combined with high arsenic exposure levels, the rs9619311 C allele, rs2234921 G allele, or C-G haplotype groups exhibited a greater risk of developing skin cancer compared to the respective common homozygous genotype group. The in silico analysis revealed several TF motifs located at or flanking the two SNP sites. We validated that the C allele of rs9619311 attenuated the binding affinity of BACH2, MEIS2, NFE2L2, and PBX2 to the TIMP3 promoter, and that the G allele of rs2234921 reduced the affinity of E2F8 and RUNX1 to bind to the promoter. Our findings suggest significant modifications of the effect of the association between arsenic exposure and skin cancer risk by the TIMP3 rs9619311 and rs2234921 variants. The predicted TFs and their differential binding affinities to the TIMP3 promoter provide insights into how TIMP3 interacts with arsenic through TFs in skin cancer formation.
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Affiliation(s)
- Meei-Maan Wu
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan
- Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
- Correspondence:
| | - Chi-Wei Chen
- Department of Life Science, College of Sciences and Engineering, National Dong Hwa University, Hualien 97430, Taiwan
| | - Chiu-Yi Chen
- Master Program in Applied Molecular Epidemiology, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung 83325, Taiwan
| | - Mark Chou
- School of Public Health, College of Public Health, Taipei Medical University, Taipei 11031, Taiwan
| | - Ling-I Hsu
- Department of Research, Taiwan Blood Services Foundation, Taipei 10066, Taiwan
| | - Te-Chang Lee
- Institute of Biomedical Sciences, Academia Sinica, Taipei 11529, Taiwan
| | - Chien-Jen Chen
- Genomics Research Center, Academia Sinica, Taipei 11529, Taiwan
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Lee CH, Wu MZ, Lui DTW, Fong CHY, Ren QW, Yu SY, Yuen MMA, Chow WS, Huang JY, Xu A, Yiu KH, Lam KSL. Prospective associations of circulating thrombospondin-2 level with heart failure hospitalization, left ventricular remodeling and diastolic function in type 2 diabetes. Cardiovasc Diabetol 2022; 21:231. [PMID: 36335340 PMCID: PMC9637303 DOI: 10.1186/s12933-022-01646-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Circulating thrombospondin-2 (TSP2) levels were associated with the development of heart failure (HF) in recent studies. However, these studies included only a minority of patients with type 2 diabetes, which is associated with an increased HF risk. As hyperglycemia induces TSP2 expression and its tissue expression increases in type 2 diabetes, we investigated the prospective association of circulating TSP2 with incident HF hospitalization (HHF), and its associations with longitudinal changes of echocardiographic parameters in type 2 diabetes. Methods Baseline serum TSP2 levels were measured in 4949 patients with type 2 diabetes to determine its association with incident HHF using multivariable Cox regression analysis. In the echocardiographic study, baseline serum TSP2 levels were measured in another 146 patients with type 2 diabetes but without cardiovascular diseases who underwent detailed transthoracic echocardiography at baseline and after 1 year. Results Over a median follow-up of 7.8 years, 330 of 4949 patients (6.7%) developed incident HHF. Baseline serum TSP2 levels were independently associated with the development of HHF (HR 1.31, 95%CI 1.06–1.62, p = 0.014) after adjustments for baseline conventional cardiovascular risk factors, atrial fibrillation, estimated glomerular filtration rate, albuminuria and high-sensitivity C-reactive protein level, use of angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, loop-diuretics, aspirin, insulin, metformin and sodium-glucose co-transporter 2 inhibitors. Moreover, baseline serum TSP2 levels were independently associated with increase in average E/e’ and left atrial volume index (p = 0.04 and < 0.01, respectively). Conclusion Serum TSP2 levels were independently associated with both incident HHF and deterioration in diastolic function in type 2 diabetes. Trial registration Not Applicable Supplementary information The online version contains supplementary material available at 10.1186/s12933-022-01646-x.
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20
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Teo Y, Yong CL, Ou YH, Tam WW, Koo CY, Lee CH. Sleep apnea and temporal changes in cardiac repolarization in patients undergoing coronary artery bypass grafting. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1261] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
In coronary artery bypass grafting (CABG), despite re-establishing coronary reperfusion, myocardial recovery and restoration of contractility often occur later, and the risk of adverse cardiovascular events persists during the post-CABG period. The occurrence of adverse cardiovascular events is linked to abnorm-al cardiac repolarisation that can be measured by surface electrocardiograms (ECGs). Sleep apnoea is an emerging cardiovascular risk factor. The relationship between sleep apnoea, abnorm-al cardiac repolarisation, and the occurrence of adverse cardiovascular events is not well studied.
Purpose
We investigated the impact of sleep apnoea on the change in repolarisation after CABG, and if the change in repolarisation is associated with the occurrence of major adverse cardiac and cerebrovascular events (MACCE).
Methods
Between November 2013 and December 2018, 1007 patients from 4 hospitals underwent an overnight sleep study prior to a non-emergent CABG. ECGs were acquired prospectively within 48h before the CABG (T1), and within 24h after the CABG (T2). QTc intervals were measured in three consecutive heart beats in one lead - the preferential lead measurements were lead II, followed by lead V5. QTc intervals were measured using the BRAVO algorithm by Analysing Medical Parameters for Solutions (AMPS) LLC. The change of T2 from T1 for QTc (ΔQTc) was derived. The mean follow-up duration was 2.1 years. MACCE was a composite of cardiovascular death, myocardial infarction, stroke, and unplanned revascularisation.
Results
A total of 954 patients (median age: 62 years; male: 86%) survived the initial 24 hours and had quality ECGs for analysis. Lead II and V5 were measured in 72% and 25% of the cohort, respectively. A total of 115 patients developed MACCE (MACCE group). Compared with the non-MACCE group, the MACCE group was older, had (a) a higher prevalence of smoking, hypertension, diabetes mellitus, and chronic kidney disease, (b) higher apnoea-hypopnoea index (AHI) and oxygen desaturation index (ODI), and (c) a smaller ΔQTc (Table). In Cox regression analysis, a smaller ΔQTc was independently associated with occurrence of MACCE (HR: 1.003; 95% CI: 1.000–1.006; p=0.032).
Older age, history of previous stroke, chronic kidney disease, more severe sleep apnoea (higher AHI, ODI, and severe oxygen desaturation) were associated with smaller ΔQTc. After adjusting for the effects of confounding variables, a higher ODI was independently associated with a smaller ΔQTc (correlation coefficient: −0.58; p<0.001).
Conclusions
In patients undergoing a non-emergent CABG, a smaller ΔQTc during the first 24 hours after the CABG is associated with a higher incidence of MACCE. A higher pre-operative ODI based on a sleep study is an independent predictor of a smaller ΔQTc. This suggests that change in QTc within 24 hours after CABG could be due to sleep apnoea, and it is a novel predictor of occurrence of MACCE at medium term follow-up.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): Transition Award and Clinician Scientist Award from the National Medical Research Council of Singapore (award numbers: NMRC/TA/012/2012; NMRC/CSA-INV/002/2015)
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Affiliation(s)
- Y Teo
- National University of Singapore , Singapore , Singapore
| | - C L Yong
- National University of Singapore , Singapore , Singapore
| | - Y H Ou
- National University of Singapore , Singapore , Singapore
| | - W W Tam
- National University of Singapore , Singapore , Singapore
| | - C Y Koo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University of Singapore , Singapore , Singapore
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21
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Chew N, Ng CH, Kong G, Chin YH, Lim O, Lim WH, Dalakoti M, Khoo CM, Kong W, Poh KK, Foo R, Lee CH, Chan MY, Muthiah M, Loh PH. Metabolic associated fatty liver disease increases risk of adverse events after acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1414] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Metabolic Associated Fatty Liver Disease (MAFLD) was recently introduced as an alternative definition for fatty liver, that has been linked to an increased risk of systemic end-organ damage. However, current studies have not examined the impact of MAFLD on patients presenting with acute coronary syndrome (ACS). Here, we present a retrospective analysis on the short and long-term outcomes of ACS patients with MAFLD.
Methods
A retrospective analysis was conducted in a tertiary care centre. Hepatic steatosis and fibrosis was examined with hepatic steatosis index and fibrosis-4 (FIB-4) index. The primary and secondary outcomes of the analysis were long term all-cause mortality, and in-hospital all-cause mortality, stroke, heart failure and cardiogenic shock respectively. Adjusted analysis was conducted for primary and secondary outcomes with covariates including age, sex, race, type of ACS and previous myocardial infarction.
Results
A total of 5770 patients were included in the analysis, and 21% of ACS patients had concomitant MAFLD. MAFLD resulted in a 23% increase in long-term all-cause mortality compared to non-MAFLD (HR: 1.230, CI: 1.065 to 1.420, p=0.005). MAFLD increased the risk of in-hospital mortality, stroke, heart failure and cardiogenic shock compared to non-MAFLD. A sensitivity analysis conducted based on MAFLD with advance fibrosis, chronic kidney disease and diabetes also demonstrated significantly increased effect size magnitude of all-cause mortality, compared to non-MAFLD.
Conclusion
MAFLD represents an encapsulation of metabolism dysregulation and has been associated with increased risk of systematic disease. The present study shows that MAFLD is associated with significantly increased adverse prognostic outcomes after ACS compared to non-MAFLD. An increase in awareness of MAFLD is required beyond the field of hepatology for improvements in multidisciplinary care and management.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University Health System , Singapore , Singapore
| | - G Kong
- National University Health System , Singapore , Singapore
| | - Y H Chin
- National University Health System , Singapore , Singapore
| | - O Lim
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - M Dalakoti
- National University of Singapore , Singapore , Singapore
| | - C M Khoo
- National University Health System , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - R Foo
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - M Muthiah
- National University Health System , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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22
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Chew NWS, Ng CH, Kong G, Tan D, Lim WH, Kofidis T, Yip J, Loh PH, Chan KH, Low A, Lee CH, Yeo TC, Tan HC, Chan MY. Reconstructed meta-analysis of percutaneous coronary intervention versus coronary artery bypass grafting for left main disease. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1415] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery disease (LMCAD) have reported conflicting results.
Objectives
We performed a systematic review from inception to 23 May 2021 and one-stage reconstructed individual-patient data meta-analysis (IPDMA) that included 10-year mortality outcomes.
Methods
The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke and unplanned revascularization at 5 years. We did IPDMA using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups.
Results
Of 583 articles retrieved, 5 RCTs were included. A total of 4595 patients from these 5 RCTs were randomly assigned to PCI (N=2297) or CABG (N=2298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6% respectively (HR 1.093, 95% CI: 0.925–1.292; p=0.296). PCI conferred similar time-to-MI (RMST ratio 1.006, 95% CI: 0.992–1.021, p=0.391) and stroke (RMST ratio 1.005, 95% CI: 0.998–1.013, p=0.133) at 5 years. Unplanned revascularization was more frequent following PCI compared with CABG (HR 1.807, 95% CI: 1.524–2.144, p<0.001) at 5 years.
Conclusion
This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - D Tan
- National University of Singapore , Singapore , Singapore
| | - W H Lim
- National University of Singapore , Singapore , Singapore
| | - T Kofidis
- National University Heart Centre , Singapore , Singapore
| | - J Yip
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
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23
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Chew NWS, Ng CH, Xiao JL, Chan KH, Loh PH, Low A, Lee CH, Tan HC, Chan MY. Coronary artery bypass grafting versus percutaneous coronary intervention with stenting for multivessel coronary artery disease without left main coronary disease:reconstructed individual patient data. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1416] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background and aims
Data are emerging on 10-year mortality comparing coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) with stenting for multivessel disease (MVD) without left main (LM) involvement. We conducted an updated two-stage meta-analysis using reconstructed individual patient data to compare long-term mortality between CABG and PCI for patients with MVD without significant LM coronary disease.
Methods
Medline and Embase databases were searched for articles comparing CABG with PCI for MVD. A two-stage meta-analysis was conducted using reconstructed patient level survival data for all-cause mortality with subgroups by SYNTAX score. The shared-frailty and stratified Cox models were fitted to compare survival endpoints.
Results
We screened 1496 studies and included six randomized controlled trials with 7181 patients. PCI was associated with greater 10-year all-cause mortality risk (HR: 1.282, CI: 1.118–1.469, p<0.001) compared with CABG. In patients with low SYNTAX score, 10-year all-cause mortality after PCI was comparable to CABG (HR: 1.102, 0.822–1.479, p=0.516). However, in patients with moderate to high SYNTAX score, 10-year all-cause mortality was significantly higher after PCI compared with CABG (HR: 1.444, 1.122–1.858, p<0.001; HR: 1.856, 1.380–2.497, p<0.001 respectively).
Conclusion
This updated reconstructed individual patient-data meta-analysis revealed a sustained lower cumulative all-cause mortality of CABG over PCI for multivessel disease without LM involvement.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - C H Ng
- National University of Singapore , Singapore , Singapore
| | - J L Xiao
- National University of Singapore , Singapore , Singapore
| | - K H Chan
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
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24
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Chew N, Teo V, Tan C, Kong G, Chin YH, Ambhore A, Low A, Lee CH, Chan MY, Tan HC, Ph LOH. A 10-year cohort on prognostic outcomes in patients presenting with acute myocardial infarction complicated by cardiogenic shock and/or cardiac arrest. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1496] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Cardiogenic shock (CS) and cardiac arrest (CA) complicating acute myocardial infarction (AMI) portend unfavourable outcomes. This study examined the prognosis of patients presenting with AMI complicated by CS and/or CA.
Methods
Consecutive patients presented with AMI to a percutaneous coronary intervention-capable tertiary institution between 2011 and 2021 were studied. Patients were stratified based on the presence or absence of CS (CS+ or CS−) and CA (CA+ or CA−). The primary outcome was 30-day cardiovascular-related mortality. Subgroup analyses based on AMI-type and sex were conducted. Kaplan-Meier curves for cardiovascular-related mortality based on the AMI-type and sex were constructed.
Results
The study included 11,608 AMI patients, 283 of whom had CS+/CA+, 1,068 had CS+/CA−, 54 had CS−/CA+ and 10,203 had CS−/CA−. Cardiovascular-related mortality was significantly higher for CS+/CA+ (57.6%), followed by CS+/CA− (41.6%), CS−/CA+ (20.4%) and CS−/CA− (2.4%). Kaplan-Meier curves demonstrated CS+/CA+ group had the highest mortality (HR=36.26; 95% CI: 29.71–44.25, p<0.001), followed by CS+/CA− (HR=21.59; 95% CI: 18.47–25.24, p<0.001) and CS−/CA+ (HR=9.18; 95% CI: 5.02–16.80, p<0.001), with CS−/CA− as the reference. Those with NSTEMI had consistently higher cardiovascular-related mortality rates than their STEMI counterparts for all groups, apart from the CS+/CA+ group. The sex-specific analysis demonstrated that the survival curves for females with CS+/CA+, CS+/CA− and CS−/CA+ converged, whilst the survival curves for males diverged over time. The multivariable Cox regression revealed the presence of CS and CA are independent predictors of cardiovascular-related mortality, but not NSTEMI, when adjusted for age, gender, diabetes, left ventricular ejection fraction, chronic renal failure, and culprit vessel.
Conclusions
AMI associated with CA and CS portends the least favourable survival, followed by those with CS or CA alone. Excess mortality was observed in the traditionally perceived lower-risk groups, particularly in women. This calls for increased awareness amongst clinicians when managing this subset of high-risk patients.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N Chew
- National University Heart Centre , Singapore , Singapore
| | - V Teo
- National University of Singapore , Singapore , Singapore
| | - C Tan
- National University of Singapore , Singapore , Singapore
| | - G Kong
- National University of Singapore , Singapore , Singapore
| | - Y H Chin
- National University of Singapore , Singapore , Singapore
| | - A Ambhore
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - L O H Ph
- National University Heart Centre , Singapore , Singapore
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25
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Chen CY, Li YH, Lee CH, Lin HW, Lin SH. Legacy effects of infection in patients with heart failure: a national cohort study of 31,318 patients in Taiwan. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.858] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Although infection is a common cause of hospitalization in patients (pts) with heart failure (HF), the long-term cardiovascular (CV) prognosis in HF after infection is not well studied.
Methods and results
From 2009 to 2015, 310,485 pts with their first HF admissions and survival to discharge were identified from the National Health Insurance Research Database. Among the pts, 103,505 (33.3%) were readmitted within 1 year after HF discharge for infection, including pneumonia (44.2%), urinary tract infection (UTI) (37.9%), skin and soft tissue infections (9.7%), and others (8.1%). Those without admission for any infection were controls. We compared the primary composite endpoint, including all-cause death, acute myocardial infarction (AMI), stroke, and hospitalization for HF (HHF) between the 2 groups after the infection episode. After propensity score matching, the clinical characteristics (age 71.7±13.9 years, male 52.0%) and treatment were similar between the groups (n=15,659 in each group). In a mean follow-up time of 4.3±2.9 years, 86.2% pts with a history of infection admission and 63.6% pts in the control group met the primary endpoint. Multivariate Cox proportional hazards analysis showed the infection group had a higher risk of the primary composite endpoint (HR 1.760, 95% CI 1.714–1.807), including all-cause death (HR 1.587, 95% CI: 1.540–1.636), HHF (HR 1.993, 95% CI 1.922–2.066), AMI (HR 1.332, 95% CI 1.224–1.450), and stroke (HR 1.769, 95% CI 1.664–1.882). In infection group, HHF was the earliest outcome event with a mean time of 17.5 months and mortality is the second early event with a mean time of 23 months after discharge from the infection episode. Pneumonia carried a higher risk than UTI for the primary composite endpoint (HR 1.140, 95% CI 1.104–1.178).
Conclusions
One-third of HF pts discharged from the hospital experienced acute infection that required readmission. The pts had worse CV prognosis after readmission for infectious disease compared to those without infection
Funding Acknowledgement
Type of funding sources: Private hospital(s). Main funding source(s): This study is supported by National Cheng Kung University Hospital and Tainan Hospital, Ministry of Health and Welfare, Taiwan.
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Affiliation(s)
- C Y Chen
- National Cheng Kung University Hospital , Tainan , Taiwan
| | - Y H Li
- National Cheng Kung University Hospital , Tainan , Taiwan
| | - C H Lee
- National Cheng Kung University Hospital , Tainan , Taiwan
| | - H W Lin
- National Cheng Kung University Hospital , Tainan , Taiwan
| | - S H Lin
- National Cheng Kung University , Tainan , Taiwan
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26
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Chew NWS, Zhang A, Koh S, Ong JL, Kong G, Lim O, Kuntjoro I, Kong W, Low A, Lee CH, Chan MY, Yeo TC, Tan HC, Poh KK, Loh PH. Higher long-term mortality in patients with concomitant acute coronary syndrome and aortic stenosis. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1417] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Aortic stenosis (AS) and acute coronary syndrome (ACS) share similar cardiovascular risk factors, and their concomitant presentation is increasing in incidence with the aging population. Yet literature regarding the prognosis of patients with concomitant ACS and AS remains scarce.
Methods
This retrospective cohort study examined consecutive patients presenting with ACS (ST-segment elevation myocardial infarction [STEMI] and non-STEMI [NSTEMI]) and concomitant AS between 1 January 2011 and 31 March 2021 in a tertiary hospital. The cohort was divided into mild, moderate and severe AS based on index echocardiogram. The primary outcome was all-cause mortality. Kaplan-Meier curves were constructed to compare all-cause mortality among the three groups of patients, based on ACS type and left ventricular ejection fraction (LVEF). Multivariable Cox regression was performed to identify independent predictors of all-cause mortality.
Results
Of a total of 563 patients, 264 had mild (46.9%), 193 moderate (34.3%) and 106 severe AS (18.8%). The mean follow-up duration was 2.5 (± 2.4) years. Majority of patients (72.5%) presented with NSTEMI. Patients with moderate and severe AS had higher rates of all-cause mortality compared to those with mild AS (49.7% vs. 51.4% vs. 35.6% respectively, p=0.002). Concomitant moderate (HR 1.439, 95% CI 1.012–2.048, p=0.043) and severe AS (HR 1.844, 95% CI 1.159–2.933, p=0.010) were independent predictors of all-cause mortality after adjusting for age, gender, LVEF, ACS type, chronic kidney disease, diabetes, hypertension, coronary artery bypass grafting and aortic valve replacement as a time-dependent variable. The Kaplan-Meier curves demonstrated excess mortality in moderate and severe AS, compared to the mild AS group (p<0.001), with similar survival trends observed in the STEMI and the NSTEMI groups, as well as those with preserved LVEF.
Conclusion
Regardless of the ACS presentation type, long-term excess mortality in those with concomitant moderate or severe AS was observed. The adverse prognosis typically observed in patients with concomitant severe AS, in the setting of ACS, extends to patients with moderate AS.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- N W S Chew
- National University Heart Centre , Singapore , Singapore
| | - A Zhang
- National University Heart Centre , Singapore , Singapore
| | - S Koh
- National University Heart Centre , Singapore , Singapore
| | - J L Ong
- National University Heart Centre , Singapore , Singapore
| | - G Kong
- National University Heart Centre , Singapore , Singapore
| | - O Lim
- National University Heart Centre , Singapore , Singapore
| | - I Kuntjoro
- National University Heart Centre , Singapore , Singapore
| | - W Kong
- National University Heart Centre , Singapore , Singapore
| | - A Low
- National University Heart Centre , Singapore , Singapore
| | - C H Lee
- National University Heart Centre , Singapore , Singapore
| | - M Y Chan
- National University Heart Centre , Singapore , Singapore
| | - T C Yeo
- National University Heart Centre , Singapore , Singapore
| | - H C Tan
- National University Heart Centre , Singapore , Singapore
| | - K K Poh
- National University Heart Centre , Singapore , Singapore
| | - P H Loh
- National University Heart Centre , Singapore , Singapore
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27
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Tan MY, Safanama D, Goh SS, Lim JYC, Lee CH, Yeo JCC, Thitsartarn W, Srinivasan M, Fam DWH. Concepts and Emerging Trends for Structural Battery Electrolytes. Chem Asian J 2022; 17:e202200784. [PMID: 36136058 DOI: 10.1002/asia.202200784] [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: 07/28/2022] [Revised: 09/07/2022] [Indexed: 11/05/2022]
Abstract
The structural battery is a multifunctional energy storage device that aims to address the weight and volume efficiency issues that conventional batteries face, especially in electric transportation. By combining the functions of mechanical load bearing and energy storage, structural batteries can reduce the reliance on, or even eventually replace the main power source in an electric vehicle or a drone. However, one of the key challenges to be addressed before achieving multifunctionality in structural batteries would be the design of a suitable multifunctional structural battery electrolyte. The structural battery electrolyte is the constituent that provides mechanical integrity under flexural loads or impact and hence determines the electrochemical and much of the mechanical performance of a structural battery device. This concept paper aims to cover the key considerations and challenges facing the design of structural battery electrolytes. In addition, the main approaches to surmount these challenges are highlighted, keeping design aspects like sustainability and recyclability in view.
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Affiliation(s)
- Ming Yan Tan
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, Singapore, 138634, Singapore
| | - Dorsasadat Safanama
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, Singapore, 138634, Singapore
| | - Shermin S Goh
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, Singapore, 138634, Singapore
| | - Jason Y C Lim
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, Singapore, 138634, Singapore.,Department of Materials Science and Engineering, National University of Singapore (NUS), 9 Engineering Drive 1, Singapore, 117576, Singapore
| | - Chih-Hung Lee
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, Singapore, 138634, Singapore
| | - Jayven Chee Chuan Yeo
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, Singapore, 138634, Singapore
| | - Warintorn Thitsartarn
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, Singapore, 138634, Singapore
| | - Madhavi Srinivasan
- School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Ave, Singapore, 639798, Singapore
| | - Derrick Wen Hui Fam
- Institute of Materials Research and Engineering (IMRE), 2 Fusionopolis Way, Singapore, 138634, Singapore.,School of Materials Science and Engineering, Nanyang Technological University, 50 Nanyang Ave, Singapore, 639798, Singapore.,College of Design and Engineering, Department of Mechanical Engineering, National University of Singapore, 9 Engineering Drive 1, Block EA #07-08, Singapore, 117575, Singapore
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28
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Wong LS, Lee CH, Yen YT. Increased Epidermal Nerve Growth Factor without Small-Fiber Neuropathy in Dermatomyositis. Int J Mol Sci 2022; 23:ijms23169030. [PMID: 36012289 PMCID: PMC9408946 DOI: 10.3390/ijms23169030] [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] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 08/05/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022] Open
Abstract
Small-fiber neuropathy (SFN) is suggested to be involved in the pathogenesis of some types of autoimmune connective tissue diseases. SFN with a reduction in epidermal nerve fibers might affect sensory fibers and cause neuropathic symptoms, such as pruritus and pain, which are common in both dermatomyositis (DM) and cutaneous lupus erythematosus (CLE). Nerve growth factor (NGF) has been recognized as important in nociception by regulating epidermal nerve fiber density and sensitizing the peripheral nervous system. The present study aimed to investigate whether SFN was associated with the cutaneous manifestations of DM and CLE. We also investigated the relationship between SFN and axon guidance molecules, such as NGF, amphiregulin (AREG), and semaphorin (Sema3A) in DM and CLE. To explore the molecular signaling, interleukin (IL)-18 and IL-31, which have been implicated in the cutaneous manifestation and neuropathic symptoms in DM, were examined in keratinocytes. Our results revealed that intraepidermal nerve fiber density (IENFD) was unchanged in patients with DM, but significantly reduced in IENFD in patients with CLE compared with healthy control. Increased epidermal expression of NGF and decreased expression of Sema3A were demonstrated in patients with DM. Furthermore, IL-18 and IL-31 both induced the production of NGF from keratinocytes. Taken together, IL-18 and IL-31 mediated epidermal NGF expression might contribute to the cutaneous neuropathic symptoms in DM, while SFN might be important for CLE.
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Affiliation(s)
- Lai-San Wong
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yu-Ta Yen
- Department of Dermatology, Fooyin University Hospital, Pingtung 928, Taiwan
- Institute of Biomedical Sciences, National Sun Yat-sen University, Kaohsiung 804, Taiwan
- Correspondence: ; Tel.: +886-8-8323146; Fax: +886-7-7337612
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29
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Kuo BS, Li CH, Chen JB, Shiung YY, Chu CY, Lee CH, Liu YJ, Kuo JH, Hsu C, Su HW, Li YF, Lai A, Ho YF, Cheng YN, Huang HX, Lung MC, Wu MS, Yang FH, Lin CH, Tseng W, Yang J, Lin CY, Tsai PH, Chang HK, Wang YJ, Chen T, Lynn S, Liao MJ, Wang CY. IgE-neutralizing UB-221 mAb, distinct from omalizumab and ligelizumab, exhibits CD23-mediated IgE downregulation and relieves urticaria symptoms. J Clin Invest 2022; 132:157765. [PMID: 35912861 PMCID: PMC9337824 DOI: 10.1172/jci157765] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [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: 12/20/2021] [Accepted: 06/14/2022] [Indexed: 01/08/2023] Open
Abstract
Over the last 2 decades, omalizumab is the only anti-IgE antibody that has been approved for asthma and chronic spontaneous urticaria (CSU). Ligelizumab, a higher-affinity anti-IgE mAb and the only rival viable candidate in late-stage clinical trials, showed anti-CSU efficacy superior to that of omalizumab in phase IIb but not in phase III. This report features the antigenic-functional characteristics of UB-221, an anti-IgE mAb of a newer class that is distinct from omalizumab and ligelizumab. UB-221, in free form, bound abundantly to CD23-occupied IgE and, in oligomeric mAb-IgE complex forms, freely engaged CD23, while ligelizumab reacted limitedly and omalizumab stayed inert toward CD23; these observations are consistent with UB-221 outperforming ligelizumab and omalizumab in CD23-mediated downregulation of IgE production. UB-221 bound IgE with a strong affinity to prevent FcԑRI-mediated basophil activation and degranulation, exhibiting superior IgE-neutralizing activity to that of omalizumab. UB-221 and ligelizumab bound cellular IgE and effectively neutralized IgE in sera of patients with atopic dermatitis with equal strength, while omalizumab lagged behind. A single UB-221 dose administered to cynomolgus macaques and human IgE (ε, κ)-knockin mice could induce rapid, pronounced serum-IgE reduction. A single UB-221 dose administered to patients with CSU in a first-in-human trial exhibited durable disease symptom relief in parallel with a rapid reduction in serum free-IgE level.
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Affiliation(s)
- Be-Sheng Kuo
- United BioPharma, Inc., Hsinchu, Taiwan.,UBI Asia, Hsinchu, Taiwan.,United Biomedical, Inc., Hauppauge, New York, USA
| | | | | | | | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | | | - Cindy Hsu
- United BioPharma, Inc., Hsinchu, Taiwan
| | | | | | - Annie Lai
- United BioPharma, Inc., Hsinchu, Taiwan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Chang Yi Wang
- United BioPharma, Inc., Hsinchu, Taiwan.,UBI Asia, Hsinchu, Taiwan.,United Biomedical, Inc., Hauppauge, New York, USA
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30
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Ho JC, Wen HJ, Sun CW, Tsai SF, Su PH, Chang CL, Sun HL, Wang SL, Lee CH. Prenatal exposure to nickel and atopic dermatitis at age 3 years: a birth cohort study with cytokine profiles. J Eur Acad Dermatol Venereol 2022; 36:2414-2422. [PMID: 35841308 DOI: 10.1111/jdv.18425] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 06/15/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Nickel, the fifth most common element on Earth, is the leading inducer of contact allergies in humans, with potent immunological effects. Nickel-induced contact allergies predominantly affect females. Maternal exposure to nickel has been associated with several developmental abnormalities. However, how a maternal nickel exposure affects the development of atopic diathesis and immune abnormalities in children has never been addressed. OBJECTIVES We aimed to determine whether maternal Ni exposure affects the development of atopic dermatitis and immune abnormalities in their children. METHODS Using a birth cohort study, we analysed 140 mother-child pairs recruited in 2012-2015 from central Taiwan. Maternal exposure to nickel was estimated using urinary nickel levels measured by inductively coupled plasma mass spectrometry (ICP-MS). The serum levels of 65 analytes and IgE in 3-year-old children were profiled with a multiplex ELISA. The correlation between the maternal urinary nickel concentration and serum analyte levels was assessed using Spearmen's correlation. Multivariant regression analysis was performed to evaluate the association between maternal urinary nickel levels and serum analyte concentrations in their children. RESULTS The geometric means of the maternal urinary nickel and the children's serum IgE levels were 2.27 μg/L and 69.71 IU/ml, respectively. The maternal nickel exposure was associated with increased serum levels of IL-1β, IL-2, TNF-α, and leukaemia inhibitory factor (LIF) but with decreased serum levels of matrix metalloproteinase-1 (MMP-1), IL-2R, and eotaxin-1 in the children. In addition, the development of childhood atopic dermatitis at 3 years old was significantly associated with the child's serum levels of IgE and IL-2R, but it was negatively associated with the maternal nickel exposure. CONCLUSIONS This is the first study showing the potential immunological effects of maternal nickel exposure in their children at an early developmental stage.
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Affiliation(s)
- J C Ho
- Department of Dermatology, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - H J Wen
- National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan.,Institute of Earth Science, Academia Sinica, Taipei, Taiwan
| | - C W Sun
- National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan
| | - S F Tsai
- National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan
| | - P H Su
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - C L Chang
- Department of Pediatrics, Hsinchu Cathay General Hospital, Hsinchu, Taiwan
| | - H L Sun
- Department of Pediatrics, Chung Shan Medical University Hospital, Taichung, Taiwan.,School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - S L Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Taiwan.,Department of Public Health, National Defence Medical Centre, Taipei, Taiwan.,Department of Safety, Health, and Environmental Engineering, National United University, Miaoli, Taiwan
| | - C H Lee
- Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
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Lee PH, Huang SC, Wu PS, Tai HC, Lee CH, Lee JC, Kao YC, Tsai JW, Hsieh TH, Li CF, Li WS, Liu TT, Su YL, Yu SC, Huang HY. Molecular Characterization of Dermatofibrosarcoma Protuberans: The Clinicopathologic Significance of Uncommon Fusion Gene Rearrangements and Their Diagnostic Importance in the Exclusively Subcutaneous and Circumscribed Lesions. Am J Surg Pathol 2022; 46:942-955. [PMID: 35034038 DOI: 10.1097/pas.0000000000001866] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The clinicopathologic relevance of various gene rearrangements underlying dermatofibrosarcoma protuberans (DFSP) remains insufficiently characterized. In 188 DFSPs, we determined PDGFB, COL1A1, PDGFD, COL6A3, and EMILIN2 rearrangements by fluorescence in situ hybridization (FISH). The clinicopathologic significance of rearrangement types and factors related to recurrence and metastasis were statistically analyzed. In all, classic PDGFB rearrangement, cryptic COL1A1-PDGFB fusion, and PDGFD rearrangement were identified in 172 (91.4%), 8 (4.3%), and 8 (4.3%: 4 COL6A3-PDFGD, 4 EMILIN2-PDGFD) cases, respectively. In an index DFSP harboring the cryptic fusion, the COL1A1-PDGFB transcript was confirmed by both RNA sequencing and reverse transcription-polymerase chain reaction. In comparison with cases harboring classic PDGFB rearrangement, cryptic PDGFB-rearranged DFSPs usually exhibited higher 5'-COL1A1 copy numbers. In a combined reappraisal of published and current cases, COL6A3-PDGFD-positive DFSPs (n=16) predominated in females (n=14, 88%) and torso (n=14, 88%), especially the breast (n=7, 44%); EMILIN2-PDGFD-positive DFSPs (n=6) preferentially demonstrated near exclusively subcutaneous growth (n=5, 83%) and fibrosarcomatous transformation (n=5, 83%). In our cohort, local recurrence was related to fibrosarcomatous variant (P=0.029, odds ratio=3.478) and head and neck location (P=0.046, odds ratio=3.508). Distant metastasis only occurred in the fibrosarcomatous variant (9/73, 12.3%) but not in other cases. In conclusion, 8.6% of DFSPs are negative for PDGFB break-apart FISH, which, especially those with challenging subcutaneous and circumscribed manifestation, require complementary diagnosis by FISH assays targeting COL1A1 and PDGFD. The types of fusion gene rearrangements, head and neck location, and fibrosarcomatous transformation may account for clinicopathologic and prognostic variations in DFSPs and warrant future independent validation.
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Affiliation(s)
| | - Shih-Chiang Huang
- Department of Anatomic Pathology, Linkou Chang Gung Memorial Hospital, Chang Gung University, College of Medicine
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan
| | - Pao-Shu Wu
- Department of Pathology, MacKay Memorial Hospital
- Mackay Junior College of Medicine, Nursing, and Management
| | - Hui-Chun Tai
- Department of Pathology, Changhua Christian Hospital, Changhua
| | | | - Jen-Chieh Lee
- Department and Graduate Institute of Pathology, National Taiwan University Hospital, National Taiwan University College of Medicine
| | - Yu-Chien Kao
- Department of Pathology, Shuang Ho Hospital, Taipei Medical University
- Department of Pathology, School of Medicine, College of Medicine, Taipei Medical University
| | - Jen-Wei Tsai
- Department of Pathology, E-DA Hospital, I-Shou University
| | - Tsung-Han Hsieh
- Joint Biobank, Office of Human Research, Taipei Medical University, Taipei
| | - Chien-Feng Li
- Department of Medical Research, Chi-Mei Medical Center
| | - Wan-Shan Li
- Department of Pathology, Chi-Mei Medical Center, Tainan, Taiwan
| | - Ting-Ting Liu
- Departments of Anatomical Pathology
- Department of Medical Laboratory Science, I-Shou University, Kaohsiung
| | - Yu-Li Su
- Division of Medical Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine
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Cho YT, Chan TC, Lee CH, Chou WY, Hsiao PF, Chen YJ, Wu PY, Yang CW, Chiu TM, Chang YT, Wang WM, Hong CH, Tu WT, Huang YH, Tsai TF, Lan CC, Chu CY. Taiwanese dermatological association consensus for the definition, classification, diagnosis, and management of urticaria: A 2021 update. J Formos Med Assoc 2022; 121:1191-1203. [PMID: 35219557 DOI: 10.1016/j.jfma.2022.02.007] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2021] [Revised: 01/14/2022] [Accepted: 02/07/2022] [Indexed: 12/14/2022] Open
Abstract
Urticaria is a prevalent disease with substantial physical, psychological, and economic impacts. With the advent of understandings of the disease and the emerging evidence of treatments, the international guidelines for treating urticaria have been updated in recent years. In order to update the 2014 edition of the Taiwanese Dermatological Association (TDA) consensus of urticaria, a total of 17 dermatologists with extensive experience in urticaria management were invited to and attended the TDA consensus meetings. All the specific aspects of the content were approved by at least 75% of the experts in attendance. Comparing to the former edition, several substantial modifications were made. For diagnosis, D-dimer was added as the recommended routine test in patients with chronic spontaneous urticaria. For pharmacological management, treatment suggestions were simplified. The approved-dosed, the up-dosed second-generation antihistamines, omalizumab, and cyclosporine were listed as the first-line to the fourth-line treatment, respectively. In addition, the management for patients of special considerations, such as the elderly, children, and pregnant women, were all discussed and mentioned in the consensus. We hope the updated TDA consensus can serve as a reference for all physicians and can help the physicians providing up-to-dated managements for these patients.
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Affiliation(s)
- Yung-Tsu Cho
- Chen YY's Clinic, Keelung, Taiwan; Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Tom C Chan
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Cung Memorial Hospital, Kaohsiung, Taiwan
| | | | - Pa-Fan Hsiao
- Department of Dermatology, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan
| | - Yi-Ju Chen
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Po-Yuan Wu
- Department of Dermatology, China Medical University Hospital, Taichung, Taiwan
| | - Che-Wen Yang
- Department of Dermatology, Cathay General Hospital, Taipei, Taiwan
| | - Tsu-Man Chiu
- Department of Dermatology, Changhua Christian Hospital, Changhua, Taiwan
| | - Yun-Ting Chang
- Department of Dermatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Ming Wang
- Department of Dermatology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wei-Ting Tu
- Department of Dermatology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Yu-Huei Huang
- Department of Dermatology, Taipei Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Tsen-Fang Tsai
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Cheng-Che Lan
- Department of Dermatology, Kaohsiung Medical University Hospital, Taiwan
| | - Chia-Yu Chu
- Department of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan.
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Cheng AY, Lee CH. Skin infection by Mycobacterium farcinogenes-senegalense group in an immunocompetent patient: a case report. BMC Infect Dis 2022; 22:445. [PMID: 35538442 PMCID: PMC9087913 DOI: 10.1186/s12879-022-07409-z] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/24/2022] [Indexed: 11/10/2022] Open
Abstract
Background Mycobacterium farcinogenes–senegalense group mostly cause bovine farcy, which rarely infect human beings. We reported one case of cutaneous Mycobacterium farcinogenes–senegalense group infection in an immunocompetent victim. Case presentation A 66-year-old Taiwanese woman with hypertension developed tender nodules on her left dorsal foot for 2 months. Tissue culture identified Mycobacterium farcinogenes–senegalense group. The lesion was treated successfully with clarithromycin and sulfamethoxazole/trimethoprim, followed by surgical excision. Conclusions Mycobacterium farcinogenes–senegalense group infection should be considered as a potential pathogen of skin infection in immunocompetent patients.
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Affiliation(s)
- An-Yu Cheng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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34
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Jiang ZH, Wong LS, Lee CH, Hsu TJ, Yu YH. Disseminated and localised herpes zoster following Oxford-AstraZeneca COVID-19 vaccination. Indian J Dermatol Venereol Leprol 2022; 88:445. [PMID: 35389012 DOI: 10.25259/ijdvl_819_2021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/01/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Zi-Han Jiang
- Department of Dermatology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Lai-San Wong
- Department of Dermatology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Ting-Jung Hsu
- Department of Dermatology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Yi-Hsiang Yu
- Department of Dermatology, Chang Gung Memorial Hospital - Kaohsiung Medical Center, Kaohsiung, Taiwan
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35
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Cheng AY, Lan J, Lee CH. Impaired Wnt/beta-catenin and protein patched homolog 1 signaling in extraocular sebaceous carcinoma: A clinical and histopathological study. J Dermatol 2022; 49:600-606. [PMID: 35318716 DOI: 10.1111/1346-8138.16351] [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: 12/13/2021] [Revised: 02/07/2022] [Accepted: 02/22/2022] [Indexed: 11/29/2022]
Abstract
Sebaceous carcinoma (SC) is a rare malignant neoplasm with sebaceous differentiation. SC is classified into eyelid and extraocular SC clinically. Most studies have focused on the eyelid SC in terms of pathogenesis, treatment, and prognosis. In skin, Wnt/beta-catenin and hedgehog signaling are two major pathways in sebaceous differentiation. We aimed to characterize the clinical and histopathological features of extraocular SC and to measure the expression of beta-catenin, lymphoid enhancer-binding factor 1 (LEF1), sonic hedgehog (Shh), and protein patched homolog 1 (PTCH) in extraocular SC. Ten cases of extraocular SC were identified from 2007 to 2020. The clinical features, microscopic findings, and prognosis were analyzed. Immunohistochemical stain for beta-catenin, LEF1, Shh, and PTCH were performed in extraocular SC and other benign sebaceous tumors including sebaceous hyperplasia, sebaceous adenoma, and sebaceoma. The male:female ratio was 4:6. The median onset age was 73.5 years (range, 43-88). Seven patients out of 10 were diagnosed after 60 years. Most extraocular SC were located on the head and neck with indurated plaque. Two patients had concurrent internal cancers and three patients showed lymph node metastasis at time of presentation. Five-year overall-survival was 40%. Beta-catenin was expressed membranously in all sebaceous hyperplasia, but was expressed variably in extraocular SC (1/5). While LEF1 was unequivocally expressed in normal hair follicles, LEF1 expression was absent in all extraocular SC and benign sebaceous tumors. Regarding the sonic hedgehog signaling, Shh and PTCH were all expressed in the cytoplasm of sebaceous hyperplasia, sebaceous adenoma, and sebaceoma. In contrast, PTCH was absent in all cases of extraocular SC and only 50% of the extraocular SC expressed cytoplasmic Shh. To conclude, extraocular SC commonly affects facial skin in the elderly. Inactivated Wnt/beta-catenin and aberrant hedgehog pathway may contribute to the carcinogenesis of extraocular SC. Further studies may be required to elucidate the causative mechanism of these pathways in extraocular SC.
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Affiliation(s)
- An-Yu Cheng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Jui Lan
- Department of Anatomic Pathology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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36
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Kim HB, Shim JK, Ko SH, Kim HR, Lee CH, Kwak YL. Effect of iron deficiency without anaemia on days alive and out of hospital in patients undergoing valvular heart surgery. Anaesthesia 2022; 77:562-569. [PMID: 35262180 DOI: 10.1111/anae.15681] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
Comprehensive evidence regarding the treatment of non-anaemic iron deficiency in patients undergoing valvular heart surgery is lacking. This study aimed to investigate the association between non-anaemic iron deficiency and postoperative outcomes in these patients. We retrospectively analysed 321 patients of which 180 (56%) had iron deficiency (defined as serum ferritin < 100 ng.ml-1 or < 300 ng.ml-1 with transferrin saturation < 20%). While the iron-deficient group had lower pre-operative haemoglobin levels than the non-iron deficient group (median (IQR [range]) 134 (127-141 [120-172]) g.l-1 , 143 (133-150 [120-179]) g.l-1 , p = 0.001), there was no between-group difference in allogeneic red blood cell transfusion. Median (IQR [range]) days alive and out of hospital at postoperative day 90 was 1 day shorter in the iron-deficient group (80 (77-82 [9-85]) days vs. 81 (79-83 [0-85]) days, p = 0.026). In multivariable analysis, only cardiopulmonary bypass duration (p = 0.032) and intra-operative allogeneic red blood cell transfusion (p = 0.011) were significantly associated with reduced days alive and out of hospital at postoperative day 90. Iron deficiency did not exert any adverse influence on secondary outcomes except length of hospital stay. Our findings indicate that non-anaemic iron deficiency alone is not associated with adverse effects in patients undergoing valvular heart surgery when it does not translate into an increased risk of allogeneic transfusion.
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Affiliation(s)
- H B Kim
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - J K Shim
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - S H Ko
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - H R Kim
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - C H Lee
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y L Kwak
- Department of Anaesthesiology and Pain Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Leung TP, Lee CH, Chang EWY, Lee QJ, Wong YC. Clinical outcomes of fast-track total knee arthroplasty for patients aged >80 years. Hong Kong Med J 2022; 28:7-15. [DOI: 10.12809/hkmj208911] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- TP Leung
- Joint Replacement Centre, Yan Chai Hospital, Hong Kong
| | - CH Lee
- Joint Replacement Centre, Yan Chai Hospital, Hong Kong
| | | | - QJ Lee
- Joint Replacement Centre, Yan Chai Hospital, Hong Kong
| | - YC Wong
- Joint Replacement Centre, Yan Chai Hospital, Hong Kong
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Abstract
The global prevalence of non‐alcoholic fatty liver disease (NAFLD) is rising, along with the epidemic of diabesity. NAFLD is present in >70% of individuals with type 2 diabetes. Although the mutually detrimental relationship between NAFLD and type 2 diabetes has been well established, a multitude of recent studies have further shown that type 2 diabetes is closely linked to the development of cirrhosis, hepatocellular carcinoma, liver‐related morbidity and mortality. In contrast, NAFLD also negatively impacts type 2 diabetes both in terms of its incidence and related adverse clinical outcomes, including cardiovascular and chronic kidney diseases. In response to these global health threats, clinical care pathways for NAFLD and guidelines for metabolic dysfunction‐associated fatty liver disease have been developed. Several antidiabetic agents have been evaluated for their potential hepatic benefits with promising results. Furthermore, type 2 diabetes patients are increasingly represented in clinical trials of novel therapeutics for NAFLD. However, despite the wealth of knowledge in NAFLD and type 2 diabetes, lack of awareness of the disease and the potential weight of this problem remains a major challenge, especially among clinicians who are outside the field of hepatology and gastroenterology. This review therefore aimed to provide all diabetes care providers with a summary of the latest evidence that supports NAFLD as an emerging diabetic complication of increasing importance, and to present the current recommendations, focusing on the assessment and therapeutic strategies, on the management of NAFLD among type 2 diabetes patients.
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Affiliation(s)
- C H Lee
- Department of Medicine, University of Hong Kong, Hong Kong SAR.,State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong SAR
| | - Dtw Lui
- Department of Medicine, University of Hong Kong, Hong Kong SAR
| | - Ksl Lam
- Department of Medicine, University of Hong Kong, Hong Kong SAR.,State Key Laboratory of Pharmaceutical Biotechnology, University of Hong Kong, Hong Kong SAR
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Lee CH, Su CJ, Lan J. A 10-case series of Merkel cell carcinoma in tropical Taiwan: Focusing on clinical outcomes and the interaction of oxidative stress and Merkel cell polyomavirus infections. DERMATOL SIN 2022. [DOI: 10.4103/ds.ds_12_22] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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40
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Ho JC, Yen CH, Lee CH. Extramammary Paget's disease: A retrospective study in a medical center in Taiwan. DERMATOL SIN 2022. [DOI: 10.4103/ds.ds_19_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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41
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Cheng YW, Wu CY, Wang BC, Lan KC, Ou SY, Lin LM, Liao HC, Wang CC, Lee CH. A Desperate Need for Psoriasis Health Care in Remote Regions as Revealed by a Live Interactive Teledermatology Program Serving Penghu Islands in Taiwan Strait. Telemed J E Health 2021; 28:1109-1116. [PMID: 34941459 DOI: 10.1089/tmj.2021.0349] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Introduction: Several studies indicated that teledermatology is good for people living on offshore islands. However, what disease benefits the most from interactive dermatology geographically in offshore islands remain uncertain. Objectives: This study aimed to investigate the seasonal and geographical distribution with different diseases in remote regions of Penghu islands in Taiwan Strait, thus to study the medical needs for specific disease in remote islands. The cost differences among three models by professional dermatologists were analyzed. Methods: This interactive teledermatology program serving Penghu Hospital, Ministry of Health and Welfare (MOHW-PH, March 2020 to February 2021) from a medical center in Taiwan recruited 145 patients with 280 patient-visits. The seasons, the timing from residential houses to MOHW-PH, the number of disease diagnosis, and the numbers of teledermatology visits are compared. The association of the distance from residential houses to MOHW-PH with different disease diagnosis was analyzed. Results: Eczema (33%), dermatophytosis (13%), and psoriasis (11%) were most common. Seasonal analysis showed dermatophytosis and eczema are more common in summer and winter, respectively. Geographical analysis showed that psoriasis has relatively higher case numbers, higher visits per case, with cases living in longer distances. The patient satisfaction was good (>95%). Among the three care modes of dermatologist, the cost estimation of interactive teledermatology and in-person clinic were similar yearly (2.4-2.9 million New Taiwan Dollars, roughly 80,000-90,000 USD). Conclusions: The study indicates that health care for psoriasis, being underprivileged but in desperate need in distant regions, could be delivered with quality and satisfaction by interactive teledermatology.
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Affiliation(s)
- Yu-Wen Cheng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chia-Ying Wu
- Administrative Office, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Bing-Chang Wang
- Penghu Hospital, Ministry of Health and Welfare, Penghu, Taiwan
| | - Kuo-Chung Lan
- Administrative Office, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Su-Yun Ou
- Penghu Hospital, Ministry of Health and Welfare, Penghu, Taiwan
| | - Li-Man Lin
- Administrative Office, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Hung-Chang Liao
- Penghu Hospital, Ministry of Health and Welfare, Penghu, Taiwan
| | - Chih-Chi Wang
- Administrative Office, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.,Department of Dermatology, Chang Gung University College of Medicine, Taoyuan, Taiwan
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Affiliation(s)
- Yi-Li Hou
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
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Andriessen A, Jiang X, Kulthanan K, Lee CH, Sinclair R, Zhang CF. Recommendations for Using Over-The-Counter Products as Adjunctive Acne Care in Asian Phototypes: Improving Treatment Outcomes and Managing Side Effects. J Drugs Dermatol 2021; 20:1213-1221. [PMID: 34784121 DOI: 10.36849/jdd.6259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Acne vulgaris (acne) is a common inflammatory skin disorder prevalent among all ethnic groups. This review aimed to investigate the current literature regarding the potential benefit of over-the-counter (OTC) adjuncts (eg, moisturizers, cleansers) for acne patients focusing on Asian phenotypes. METHODS An online procedure was employed to review the role of adjunctive OTC acne treatment. A panel consisting of dermatologists with expertise in treating Asian acne patients participated in a pre-meeting survey that collected information regarding their recommendation habits for OTC products in acne patients. Recommendations on using OTC products as an adjunct for treating acne in Asians are based on the pre-meeting survey results, evidence from literature presented during a series of plenary lectures, and discussions conducted during a stepwise program of sessions. RESULTS Many topical treatments have been associated with adverse events (AEs) (eg, skin dryness, erythema, scaling, stinging, burning, pruritus). Multiple studies on topical acne treatments have found that Asians display greater sensitivity and less tolerability than Caucasians to acne treatment. Skincare as an adjunct to acne treatment may reduce dryness or irritation, particularly important in Asians with acne. CONCLUSIONS Advisors agreed that cleansers and moisturizers should be considered for their beneficial adjunctive role in the armamentarium of acne treatment and maintenance strategies. J Drugs Dermatol. 2021;20(11): 1213-1221. doi:10.36849/JDD.6259.
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Kim BJ, Park JI, Nam JH, Lee JH, Lee CH, Son JW, Park JS, Shin DG, Kim U, Her SH, Chang KY, Ahn TH, Jeong MH, Rha SW, Kim HS. Clinical impact of intravascular ultrasound guidance in patients of ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention with drug eluting stent. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.2084] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There is little data about clinical role of intravascular ultrasound (IVUS)-guided Percutaneous (PCI) in the setting of ST-segment elevation myocardial infarction (STEMI).
Methods
From 2005 to 2018, a total of 8,129 patients who underwent PCI with STEMI were investigated from the Korea Acute Myocardial Infarction Registry-National Institute of Health database. Patients with Non-ST segment elevation myocardial infarction, cardiogenic shock, bare metal stent implantation, thrombolytic treatment, and coronary artery bypass graft surgery were excluded. We categorized patients into two groups based on the treatment strategy: IVUS-guided PCI group (n=1,544), and coronary angiography guidance (CAG)-guided PCI group (n=6,585). The primary endpoint was composite of major adverse cardiovascular (MACE), including, cardiac death, myocardial infarction (MI), repeat target vessel revascularization (TVR) and stent thrombosis (ST).
Results
IVUS-guided PCI was performed in 19% patients (1544/8129). After propensity score matching, there were no statistically difference in the rate of cardiac death (0% in IVUS vs. 0.26% in CAG, p=0.947), MI (2.01% vs. 2.01%, p=0.408), TVR (1.23% vs. 0.91%, p=0.131), ST (0.32% vs. 0.45%, p=0.828) and composite of MACE at 1 year between two groups (2.01% vs. 2.40%, p=0.843). Independent risk factors for MACE were diabetes mellitus and multi-vessel disease, but not IVUS-guided PCI (HR 1.167, 95% CI, 0.896–1.520, p=0.251).
Conclusion
This study suggests that routine usage of IVUS in the setting of STEMI may not be necessary. Large-scaled random study will be needed for further evaluation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- B J Kim
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J I Park
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J H Nam
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J H Lee
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - C H Lee
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J W Son
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - J S Park
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - D G Shin
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - U Kim
- Yeungnam University Hospital, Daegu, Korea (Republic of)
| | - S H Her
- St. Vincent's Hospital, College of Medicine, Suwon, Korea (Republic of)
| | - K Y Chang
- The Catholic University of Korea Seoul St. Mary's Hospital, Seoul, Korea (Republic of)
| | - T H Ahn
- Gachon University Gil Medical Center, Incheon, Korea (Republic of)
| | - M H Jeong
- Chonnam National University Hospital, Gwangju, Korea (Republic of)
| | - S W Rha
- Korea University Guro Hospital, Seoul, Korea (Democratic People's Republic of)
| | - H S Kim
- Seoul National University Hospital, Seoul, Korea (Republic of)
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Yu S, Li LH, Lee CH, Jeyakannu P, Wang JJ, Hong CH. Arsenic leads to autophagy of keratinocytes by increasing aquaporin 3 expression. Sci Rep 2021; 11:17523. [PMID: 34471155 PMCID: PMC8410848 DOI: 10.1038/s41598-021-96822-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/30/2020] [Accepted: 08/17/2021] [Indexed: 01/06/2023] Open
Abstract
Exposure to arsenic, a ubiquitous metalloid on Earth, results in human cancers. Skin cancer is the most common arsenical cancers. Both autophagy and aquaporin pathway are known to promote carcinogenesis. However, the mechanisms by which arsenic regulates aquaporin and autophagy in arsenical skin cancers remain elusive. This study aims to address how arsenic regulates aquaporin-3, the predominant aquaporin in epidermal keratinocytes, and how this process would induce autophagy. Quantitative real-time PCR and immunofluorescence were used to measure the expression of aquaporin 3 in arsenical skin cancers and arsenic-treated keratinocytes. Beclin-1 expression and autophagy were measured. We examined if blocking aquaporin 3 could interfere arsenic-induced autophagy in keratinocytes. Expression of aquaporin 3 is increased in arsenical cancers and in arsenic-treated keratinocytes. Arsenic induced autophagy in primary human keratinocytes. Notably, the arsenic-induced autophagy was inhibited by pretreatment of keratinocytes with aquaporin inhibitors Auphen or AgNO3, or RNA interference against aquaporin 3. The data indicates that the aquaporin 3 is an important cell membrane channel to mediate arsenic uptake and contributes to the arsenic-induced autophagy.
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Affiliation(s)
- Sebastian Yu
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dermatology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Dermatology, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ling-Hau Li
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Palaniraja Jeyakannu
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Jeh-Jeng Wang
- Department of Medicinal and Applied Chemistry, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chien-Hui Hong
- Department of Dermatology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan. .,Department of Dermatology, National Yang-Ming University, Taipei, Taiwan. .,Department of Dermatology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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46
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Hsu TJ, Yeh HH, Lee CH, Tseng HC. The Temporal Evolution of Distinct Skin Surface Microbiome in Asian Patients with Severe Hidradenitis Suppurativa during Effective Adalimumab Treatment. J Invest Dermatol 2021; 142:740-743.e2. [PMID: 34461127 DOI: 10.1016/j.jid.2021.07.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 07/26/2021] [Accepted: 07/27/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Ting-Jung Hsu
- Department of Dermatology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | | | - Chih-Hung Lee
- Department of Dermatology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Han-Chi Tseng
- Department of Dermatology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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47
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Chen KD, Huang YH, Guo MMH, Chang LS, Chu CH, Bu LF, Chu CL, Lee CH, Liu SF, Kuo HC. DNA Methylation Array Identifies Golli-MBP as a Biomarker for Disease Severity in Childhood Atopic Dermatitis. J Invest Dermatol 2021; 142:104-113. [PMID: 34293355 DOI: 10.1016/j.jid.2021.06.025] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 06/10/2021] [Accepted: 06/10/2021] [Indexed: 01/08/2023]
Abstract
In this study, we investigated the changes in global methylation status and its functional relevance in childhood atopic dermatitis (AD). Differences in epigenome-scale methylation events in peripheral blood associated with childhood AD were screened using DNA methylation arrays of 24 patients with AD compared with 24 control subjects. Of the 16,840 differentially methylated CpG regions between AD and control subjects, >97% CpG loci revealed hypomethylation in patients with childhood AD. Among the globally hypomethylated loci, we identified two CpG clusters within the golli-mbp locus of the MBP gene, which was functionally enriched by subnetwork enrichment analysis as an orchestrator among associated genes. The differential hypomethylation of the top-ranked cg24700313 cluster in the golli-mbp locus was validated by pyrosequencing in an independent cohort of 224 children with AD and 44 control subjects. DNA methylation was found to be negatively correlated with disease severity but showed no significant correlation with IgE levels after age adjustment. The multivariate correlation analysis represents a higher score in AD intensity with significantly increased IgE levels and decreased methylation levels in cg27400313. We concluded that methylation loss in the golli-mbp locus is an epigenetic factor associated with disease severity of childhood AD.
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Affiliation(s)
- Kuang-Den Chen
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Hsien Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Mindy Ming-Huey Guo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ling-Sai Chang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chi-Hsiang Chu
- Department of Statistics, National Cheng-Kung University, Tainan, Taiwan; Institute of Statistics, National University of Kaohsiung, Kaohsiung, Taiwan
| | - Li-Feng Bu
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Liver Transplantation Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chiao-Lun Chu
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Taiwan
| | - Shih-Feng Liu
- Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ho-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Kawasaki Disease Center, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Division of Pulmonary & Critical Care Medicine, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan; Department of Respiratory Therapy, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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48
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Liu KL, Tsai TL, Tsai WC, Tsai SF, Lee CH, Wang SL. Prenatal heavy metal exposure, total immunoglobulin E, trajectory, and atopic diseases: A 15-year follow-up study of a Taiwanese birth cohort. J Dermatol 2021; 48:1542-1549. [PMID: 34265871 DOI: 10.1111/1346-8138.16058] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 06/18/2021] [Indexed: 01/05/2023]
Abstract
Prenatal exposure to heavy metals may cause atopic diseases. Little association between cord blood total immunoglobulin E (CB-tIgE) levels and the occurrence of atopic diseases has been found. This study investigated the atopic status and tIgE trajectory trend in a Taiwanese birth cohort over 15 years. We also assessed the effect of maternal heavy metal exposure on maternal serum cytokine and CB-tIgE levels. We recruited 430 pregnant women during their third trimester in 2000-2001. Maternal urinary heavy metal concentrations and serum cytokine levels were measured. The CB-tIgE and serum tIgE levels of the women's children when they were aged 5, 8, 11, and 14 years were measured. The upper quartile of the maternal urinary arsenic concentration was associated with an increased risk of a CB-tIgE level higher than 1 IU/mL (odds ratio, 1.845; 95% confidence interval, 1.003-3.395). Serum tIgE trajectory levels were the highest in children with asthma, followed by those with atopic dermatitis and allergic rhinitis at the age of 5-14 years. Serum tIgE levels tended to peak at the age of 11 years in the atopic children but were stable from the age of 8 years in the non-atopic children. We first demonstrated that serum tIgE levels reached a trajectory peak in the atopic children aged 11 years. Prenatal exposure to arsenic may increase the risk of elevated CB-tIgE levels. Further investigation is warranted to elucidate the mechanism through which maternal serum cytokines affect the occurrence of atopic diseases in children.
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Affiliation(s)
- Kwei-Lan Liu
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Tsung-Lin Tsai
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan
| | | | - Shih-Fen Tsai
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shu-Li Wang
- National Institute of Environmental Health Sciences, National Health Research Institutes, Miaoli, Taiwan.,Department of Public Health, China Medical University, Taichung, Taiwan.,Department of Safety, Health, and Environmental Engineering, National United University, Miaoli, Taiwan.,Department of Public Health, National Defense Medical Center, Taipei, Taiwan
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49
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Tseng YJ, Lee CH, Chen WY, Yang JL, Tzeng HT. Inhibition of PAI-1 Blocks PD-L1 Endocytosis and Improves the Response of Melanoma Cells to Immune Checkpoint Blockade. J Invest Dermatol 2021; 141:2690-2698.e6. [PMID: 34000287 DOI: 10.1016/j.jid.2021.03.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/17/2021] [Accepted: 03/28/2021] [Indexed: 12/28/2022]
Abstract
Immune checkpoint molecules, especially PD-1 and its ligand PD-L1, act as a major mechanism of cancer immune evasion. Although anti-PD-1/PD-L1 monotherapy increases therapeutic efficacy in melanoma treatment, only a subset of patients exhibits long-term tumor remission, and the underlying mechanism of resistance to PD-1/PD-L1 inhibitors remains unclear. In this study, we demonstrated that cell surface retention of PD-L1 is inversely correlated with PAI-1 expression in vitro, in vivo, and in clinical specimens. Moreover, extracellular PAI-1 induced the internalization of surface-expressed PD-L1 by triggering clathrin-mediated endocytosis. The endocytosed PD-L1 was transported to lysosomes for degradation by endolysosomal systems, resulting in the reduction of surface PD-L1. Notably, inhibition of PAI-1 by pharmacological inhibitor with tiplaxtinin led to elevated PD-L1 expression on the plasma membrane, both in vitro and in vivo. Strikingly, targeting PAI-1 by tiplaxtinin treatment synergizes with anti-PD-L1 immune checkpoint blockade therapy in a syngeneic murine model of melanoma. Our findings demonstrate a role for PAI-1 activity in immune checkpoint modulation by promoting surface PD-L1 for lysosomal degradation and provides an insight into the combination of PAI-1 inhibition and anti-PD-L1 immunotherapy as a promising therapeutic regimen for melanoma treatment.
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Affiliation(s)
- Yu-Ju Tseng
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Wei-Yu Chen
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Jenq-Lin Yang
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan
| | - Hong-Tai Tzeng
- Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung City, Taiwan.
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50
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Hsu TJ, Yeh HH, Lee CH, Liu KL. Stevens-Johnson syndrome and toxic epidermal necrolysis in a referral center in Taiwan. Int J Dermatol 2021; 60:964-972. [PMID: 33848012 DOI: 10.1111/ijd.15586] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/05/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are potentially fatal adverse drug reactions. The characteristics of these diseases are changing with the use of novel drugs, posing new challenges to doctors. We aimed to review recent SJS/TEN cases in order to assist general practitioners with timely diagnosis and correct management. METHODS We conducted a retrospective chart review of SJS/TEN patients in a referral center in Taiwan from 2009 to 2019. We included 24 patients' charts and analyzed demographic data, medication histories, clinical courses, human leukocyte antigen (HLA) alleles, and long-term complications. RESULTS The average age was 63.4 years, and the average toxic epidermal necrolysis-specific severity of illness score was 1.9. The most common culprit drug was carbamazepine (33.3%), followed by antibiotics (12.5%) and nonsteroidal anti-inflammatory drugs (8.3%). Two cases were caused by immune checkpoint inhibitors, and one of them had a long latency of 210 days. Three out of the four patients carrying HLA-B*15:02 had carbamazepine-induced SJS/TEN. All patients were treated with systemic corticosteroids in the acute stage of the diseases. The length of in-hospital stay did not correlate with the average daily dose of corticosteroids. The overall mortality rate was 4.2%, and the disease-specific mortality rate was 0%. CONCLUSIONS The most common culprit drug was carbamazepine, which had strong association with HLA-B*15:02. There was no statistically significant correlation between in-hospital stay and the average daily dose of corticosteroids. Immune checkpoint inhibitor-related SJS/TEN may have an extended latent period.
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Affiliation(s)
- Ting-Jung Hsu
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Hsu-Hang Yeh
- Chen Chia-Wei Dermatology, Kaohsiung City, Taiwan
| | - Chih-Hung Lee
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
| | - Kwei-Lan Liu
- Department of Dermatology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan
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