1
|
Chang CC, Huang HC, Hsu SJ, Pun CK, Chuang CL, Hou MC, Lee FY. Ezetimibe treatment reduces oxidized low-density lipoprotein in biliary cirrhotic rats. J Chin Med Assoc 2024; 87:463-470. [PMID: 38380910 DOI: 10.1097/jcma.0000000000001075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
BACKGROUND In liver cirrhosis, chronic inflammation is associated with an increase in oxidative stress, and subsequently an increase in the concentration of oxidized low-density lipoprotein (ox-LDL). Ezetimibe is a lipid-lowering agent with anti-inflammation and anti-oxidative stress activities. This study aimed to investigate the effect of ezetimibe treatment on ox-LDL in cirrhotic rats. METHODS Biliary cirrhosis was induced in Sprague-Dawley rats with common bile duct ligation (BDL). Sham-operated rats served as surgical controls. Ezetimibe (10 mg/kg/d) or vehicle was administered in the sham-operated or BDL rats for 4 weeks, after which hemodynamic parameters, biochemistry data, and oxidative stress were evaluated. Plasma and intrahepatic ox-LDL levels were also examined, and hepatic proteins were analyzed to explore the mechanism of ezetimibe treatment. RESULTS The BDL rats had typical features of cirrhosis including jaundice, impaired liver function, hyperlipidemia, and elevated ox-LDL levels compared to the sham-operated rats. Ezetimibe treatment did not affect hemodynamics, liver biochemistry, or plasma lipid levels. However, it significantly reduced oxidative stress, plasma levels of ox-LDL, and tumor necrosis factor α. In addition, ezetimibe upregulated the hepatic protein expression of an ox-LDL scavenger (lectin-like ox-LDL rececptor-1), which resulted in reductions in intrahepatic ox-LDL and fat accumulation in the BDL rats. Nevertheless, ezetimibe treatment did not ameliorate hepatic inflammation or liver fibrosis. CONCLUSION Ezetimibe reduced plasma and intrahepatic ox-LDL levels in the cirrhotic rats. Furthermore, it ameliorated intrahepatic fat accumulation and oxidative stress. However, ezetimibe did not alleviate hepatic fibrosis or inflammation in the biliary cirrhotic rats.
Collapse
Affiliation(s)
- Ching-Chih Chang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chon-Kit Pun
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
2
|
Pun CK, Huang HC, Chang CC, Hsu SJ, Huang YH, Hou MC, Lee FY. Hepatic encephalopathy: From novel pathogenesis mechanism to emerging treatments. J Chin Med Assoc 2024; 87:245-251. [PMID: 38109364 DOI: 10.1097/jcma.0000000000001041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2023] Open
Abstract
Hepatic encephalopathy (HE) is one of the major complications of liver disease and significantly affects the quality of life (QOL) of patients. HE is common and frequently relapses in cirrhotic patients. The management of HE is supportive, and precipitating conditions should be eliminated. Most drugs used to treat HE are conventional and include nonabsorbable disaccharides such as lactulose, and antibiotics such as rifaximin. However, their therapeutic efficacy is still suboptimal, and novel therapeutic agents are urgently needed. In addition, the optimal management and diagnosis of minimal HE/covert HE are under debate. In this review, we focus on novel pathogenetic mechanisms such as central nervous system clearance, and emerging therapeutic targets of HE, such as fecal material transplantation. We also discuss different classifications and etiologies of HE.
Collapse
Affiliation(s)
- Chon Kit Pun
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Therapeutic and Research Center of Liver Cirrhosis and Portal Hypertension, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
3
|
Pun CK, Chang CC, Chuang CL, Huang HC, Hsu SJ, Huang YH, Hou MC, Lee FY. Dual angiotensin receptor and neprilysin inhibitor reduced portal pressure through peripheral vasodilatation and decreasing systemic arterial pressure in cirrhotic rats. J Chin Med Assoc 2023; 86:786-794. [PMID: 37462441 DOI: 10.1097/jcma.0000000000000959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Portal hypertension develops along with the progression of liver cirrhosis. Natriuretic peptides have been shown to reduce portal pressure but concomitantly activate the renin-angiotensin-aldosterone system (RAAS). Angiotensin receptor-neprilysin inhibitors (ARNIs) upregulate natriuretic peptides and avoid the adverse effects of RAAS activation. ARNIs have been shown to reduce portal pressure in rats with pre-hepatic portal hypertension, which involves relatively little liver injury. This study aimed to evaluate the relevant effects of an ARNI in rats with both liver cirrhosis and portal hypertension. METHODS Male Sprague-Dawley rats received common bile duct ligation to induce liver cirrhosis and portal hypertension. Sham-operated rats served as surgical controls. All rats were randomly allocated into three groups to receive distilled water (vehicle), LCZ696 (an ARNI), or valsartan for 4 weeks. Portal hypertension and relevant derangements were assessed after treatment. RESULTS Portal hypertension and hyperdynamic circulation developed in the cirrhotic rats. In the rats with cirrhosis and portal hypertension, both LCZ696 and valsartan reduced portal hypertension, mean arterial pressure, and systemic vascular resistance. The decrease in portal pressure was highly associated with the reduction in arterial pressure and systemic vascular resistance. Blood flow in hepatic, splanchnic, and portosystemic collateral systems was not altered. LCZ696 did not significantly influence liver injury or plasma cytokine levels. Liver fibrosis and splanchnic angiogenesis were not affected. CONCLUSION ARNI treatment exerted portal pressure lowering effects via peripheral vasodilatation and decreasing systemic arterial pressure in the rats with liver cirrhosis and portal hypertension. Caution should be taken when using ARNIs in liver cirrhosis.
Collapse
Affiliation(s)
- Chon Kit Pun
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Holistic and Multidisciplinary Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yi-Hsiang Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
4
|
Chiang CH, Chang CC, Huang HC, Chen YJ, Tsai PH, Jeng SY, Hung SI, Hsieh JH, Huang HS, Chiou SH, Lee FY, Lee SD. Corrigendum to "Investigation of Hepatoprotective Activity of Induced Pluripotent Stem Cells in the Mouse Model of Liver Injury". Biomed Res Int 2022; 2022:9794832. [PMID: 36471685 PMCID: PMC9719433 DOI: 10.1155/2022/9794832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 08/30/2023]
Abstract
[This corrects the article DOI: 10.1155/2011/219060.].
Collapse
Affiliation(s)
- Chih-Hung Chiang
- Institute of Pharmacology, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital and Su-Ao & Yuan-Shan Branch, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Ching-Chih Chang
- School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
- Division of General Medicine, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Hui-Chun Huang
- School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
- Division of Gastroenterology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Yi-Jen Chen
- School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Ping-Hsing Tsai
- Institute of Pharmacology, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
| | - Shaw-Yeu Jeng
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital and Su-Ao & Yuan-Shan Branch, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
- School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
| | - Shuen-Iu Hung
- Institute of Pharmacology, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
| | - Jung-Hung Hsieh
- Division of Urology, Department of Surgery, Taipei Veterans General Hospital and Su-Ao & Yuan-Shan Branch, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Hsu-Shan Huang
- Graduate Institute of Pharmacy, National Defense Medical Center, No. 161, Section 6, Minquan E. Road, Taipei 11490, Taiwan
| | - Shih-Hwa Chiou
- Institute of Pharmacology, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
- Department of Medical Research & Education, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Fa-Yauh Lee
- School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
- Division of Gastroenterology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| | - Shou-Dong Lee
- School of Medicine, National Yang-Ming University, No. 155, Section 2, Linong Street, Taipei 11221, Taiwan
- Division of Gastroenterology, Taipei Veterans General Hospital, No. 201, Section 2, Shih-Pai Road, Taipei 11217, Taiwan
| |
Collapse
|
5
|
Hsu SJ, Huang HC, Pun CK, Chang CC, Chuang CL, Huang YH, Hou MC, Lee FY. Sodium-Glucose Cotransporter-2 Inhibition Exacerbates Hepatic Encephalopathy in Biliary Cirrhotic Rats. J Pharmacol Exp Ther 2022; 383:25-31. [PMID: 35926870 DOI: 10.1124/jpet.122.001289] [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: 04/26/2022] [Revised: 06/24/2022] [Accepted: 07/07/2022] [Indexed: 12/15/2022] Open
Abstract
In liver cirrhosis, hepatic inflammation and abundant portal-systemic collaterals are indicated for the development of hepatic encephalopathy. Sodium-glucose cotransporter-2 (SGLT-2) inhibitors are a type of anti-diabetic agent which exert pleiotropic and anti-inflammatory effects. Diabetes and chronic liver disease often coexist, but the influence of SGLT-2 inhibition on liver cirrhosis and hepatic encephalopathy remains unknown. This study investigated the effect of SGLT-2 inhibition on cirrhotic rats. Biliary cirrhosis was induced in Sprague-Dawley rats via common bile duct ligation. A total of two weeks of treatment with the SGLT-2 inhibitor, empagliflozin 30 mg/kg/d, was applied. The motor activities, hemodynamics, biochemistry parameters, plasma levels of vascular endothelial growth factor (VEGF), and the severity of portal-systemic collateral shunts were measured. The hepatic histopathology and protein expressions were examined. We found that empagliflozin treatment did not affect hemodynamics, liver biochemistry, or blood glucose levels in cirrhotic rats. Empagliflozin did not affect hepatic inflammation and fibrosis. The protein expression of factors related to liver injury were not influenced by empagliflozin. However, empagliflozin decreased motor activities in cirrhotic rats and increased portal-systemic collateral shunts and VEGF plasma levels. In summary, SGLT-2 inhibition by empagliflozin did not ameliorate portal hypertension and hepatic inflammation in cirrhotic rats. In contrast, it exacerbated hepatic encephalopathy, which was evidenced by a decrease in motor activity. A possible mechanism could be an increase of portal-systemic shunts related to VEGF upregulation. Therefore, empagliflozin use should be cautious in cirrhotic patients regarding the development of hepatic encephalopathy. SIGNIFICANCE STATEMENT: Sodium-glucose cotransporter-2 inhibition by empagliflozin did not ameliorate portal hypertension and hepatic inflammation in cirrhotic rats. In contrast, it exacerbated hepatic encephalopathy through increased portal-systemic shunts related to VEGF up-regulation.
Collapse
Affiliation(s)
- Shao-Jung Hsu
- Division of General Medicine (H.C.H., C.C.C., C.L.C.) and Division of Gastroenterology and Hepatology (S.J.H., Y.H.H.), Department of Medicine (C.K.P., M.C.H., F.Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.J.H., H.C.H., C.C.C., Y.H.H., M.C.H., F.Y.L.)
| | - Hui-Chun Huang
- Division of General Medicine (H.C.H., C.C.C., C.L.C.) and Division of Gastroenterology and Hepatology (S.J.H., Y.H.H.), Department of Medicine (C.K.P., M.C.H., F.Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.J.H., H.C.H., C.C.C., Y.H.H., M.C.H., F.Y.L.)
| | - Chon Kit Pun
- Division of General Medicine (H.C.H., C.C.C., C.L.C.) and Division of Gastroenterology and Hepatology (S.J.H., Y.H.H.), Department of Medicine (C.K.P., M.C.H., F.Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.J.H., H.C.H., C.C.C., Y.H.H., M.C.H., F.Y.L.)
| | - Ching-Chih Chang
- Division of General Medicine (H.C.H., C.C.C., C.L.C.) and Division of Gastroenterology and Hepatology (S.J.H., Y.H.H.), Department of Medicine (C.K.P., M.C.H., F.Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.J.H., H.C.H., C.C.C., Y.H.H., M.C.H., F.Y.L.)
| | - Chiao-Lin Chuang
- Division of General Medicine (H.C.H., C.C.C., C.L.C.) and Division of Gastroenterology and Hepatology (S.J.H., Y.H.H.), Department of Medicine (C.K.P., M.C.H., F.Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.J.H., H.C.H., C.C.C., Y.H.H., M.C.H., F.Y.L.)
| | - Yi-Hsiang Huang
- Division of General Medicine (H.C.H., C.C.C., C.L.C.) and Division of Gastroenterology and Hepatology (S.J.H., Y.H.H.), Department of Medicine (C.K.P., M.C.H., F.Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.J.H., H.C.H., C.C.C., Y.H.H., M.C.H., F.Y.L.)
| | - Ming-Chih Hou
- Division of General Medicine (H.C.H., C.C.C., C.L.C.) and Division of Gastroenterology and Hepatology (S.J.H., Y.H.H.), Department of Medicine (C.K.P., M.C.H., F.Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.J.H., H.C.H., C.C.C., Y.H.H., M.C.H., F.Y.L.)
| | - Fa-Yauh Lee
- Division of General Medicine (H.C.H., C.C.C., C.L.C.) and Division of Gastroenterology and Hepatology (S.J.H., Y.H.H.), Department of Medicine (C.K.P., M.C.H., F.Y.L.), Taipei Veterans General Hospital, Taipei, Taiwan and Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan (S.J.H., H.C.H., C.C.C., Y.H.H., M.C.H., F.Y.L.)
| |
Collapse
|
6
|
Huang HC, Hsu SJ, Chang CC, Chuang CL, Hou MC, Lee FY. Effects of PCSK-9 Inhibition by Alirocumab Treatments on Biliary Cirrhotic Rats. Int J Mol Sci 2022; 23:ijms23137378. [PMID: 35806383 PMCID: PMC9267099 DOI: 10.3390/ijms23137378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/24/2022] [Accepted: 06/30/2022] [Indexed: 01/27/2023] Open
Abstract
Hyperlipidemia and oxidative stress with elevated oxidized low-density lipoprotein (ox-LDL) exacerbate hepatic inflammation and fibrosis. The plasma level of low-density lipoprotein (LDL) is controlled by proprotein convertase subtilisin/kexin 9 (PCSK9). Alirocumab is a monoclonal antibody that decreases LDL via inhibiting PCSK9 function. Apart from lipid-lowering effects, alirocumab exerts anti-inflammation, anti-angiogenesis and anti-oxidant effects. This study aims to investigate the impact of alirocumab treatment on common bile duct ligation (BDL)-induced biliary cirrhotic rats. After a 4-week treatment of alirocumab, the hemodynamic data, blood biochemistry, ox-LDL level, oxidative stress markers, severity of hepatic encephalopathy and abnormal angiogenesis of BDL rats were measured and compared to the control group. BDL rats presented cirrhotic pictures and elevated ammonia, total cholesterol, LDL and ox-LDL levels compared to the control group. Alirocumab decreased plasma levels of total cholesterol, LDL, and oxidative stress markers; however, it did not affect the hemodynamics, liver and renal biochemistry, and the plasma levels of ammonia and ox-LDL. The motor activities, portal-systemic collaterals and mesenteric vascular density were not significantly different between alirocumab-treated and control groups. In addition, it did not affect hepatic inflammation, intrahepatic angiogenesis, liver fibrosis and free cholesterol accumulation in the liver of BDL rats. In conclusion, PCSK9 inhibition by alirocumab treatment ameliorates hyperlipidemia and systemic oxidative stress in biliary cirrhotic rats. However, it does not affect the plasma level of ox-LDL, intrahepatic inflammation and fibrosis. In addition, PCSK9 inhibition has a neutral effect on abnormal angiogenesis and hepatic encephalopathy in biliary cirrhotic rats.
Collapse
Affiliation(s)
- Hui-Chun Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (H.-C.H.); (S.-J.H.); (C.-L.C.); (M.-C.H.); (F.-Y.L.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (H.-C.H.); (S.-J.H.); (C.-L.C.); (M.-C.H.); (F.-Y.L.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Ching-Chih Chang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (H.-C.H.); (S.-J.H.); (C.-L.C.); (M.-C.H.); (F.-Y.L.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Correspondence: ; Tel.: +886-2-28753253; Fax: +886-2-28757809
| | - Chiao-Lin Chuang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (H.-C.H.); (S.-J.H.); (C.-L.C.); (M.-C.H.); (F.-Y.L.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (H.-C.H.); (S.-J.H.); (C.-L.C.); (M.-C.H.); (F.-Y.L.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei 112, Taiwan; (H.-C.H.); (S.-J.H.); (C.-L.C.); (M.-C.H.); (F.-Y.L.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 112, Taiwan
| |
Collapse
|
7
|
Huang HC, Hsu SJ, Chang CC, Kao YC, Chuang CL, Hou MC, Lee FY. Lycopene treatment improves intrahepatic fibrosis and attenuates pathological angiogenesis in biliary cirrhotic rats. J Chin Med Assoc 2022; 85:414-420. [PMID: 35120355 DOI: 10.1097/jcma.0000000000000699] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Liver cirrhosis is characterized by liver fibrosis and pathological angiogenesis, which results in hyperdynamic circulation, portal-systemic collateral vascular formation, and abnormal angiogenesis. Lycopene is a nutrient mostly found in tomatoes. The beneficial effects of lycopene include anti-inflammation, anti-oxidation, anti-fibrosis, and anti-angiogenesis; however, the association between liver cirrhosis and pathological angiogenesis has yet to be studied. This study aimed to investigate the effects of lycopene on biliary cirrhotic rats. METHODS The efficacy of lycopene treatment in common bile duct ligation (BDL)-induced biliary cirrhotic rats was evaluated. Sham-operated rats served as surgical controls. Lycopene (20 mg/kg/day, oral gavage) or vehicle was administered to BDL or sham-operated rats for 4 weeks, after which the hemodynamics, liver biochemistry, portal-systemic shunting, liver and mesenteric angiogenesis, and hepatic angiogenesis-related protein expressions were examined. RESULTS Lycopene alleviated hyperdynamic circulation as evidenced by decreased cardiac index and increased peripheral vascular resistance (p < 0.05), but it did not affect portal pressure or liver biochemistry in the BDL rats (p > 0.05). Lycopene significantly diminished the shunting degree of portal-systemic collaterals (p = 0.04) and mesenteric vascular density (p = 0.01), and also ameliorated intrahepatic angiogenesis and liver fibrosis. In addition, lycopene upregulated endothelial nitric oxide synthase, protein kinase B (Akt) and phosphatidylinositol 3-kinases (PI3K), and downregulated vascular endothelial growth factor receptor 2 (VEGFR-2) protein expressions (p < 0.05) in the livers of the BDL rats. CONCLUSION Lycopene ameliorated liver fibrosis, hyperdynamic circulation, and pathological angiogenesis in biliary cirrhotic rats, possibly through the modulation of intrahepatic Akt/PI3K/eNOS and VEGFR-2 pathways.
Collapse
Affiliation(s)
- Hui-Chun Huang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Yun-Chieh Kao
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
8
|
Huang HC, Tsai MH, Chang CC, Pun CK, Huang YH, Hou MC, Lee FY, Hsu SJ. Microbiota transplants from feces or gut content attenuated portal hypertension and portosystemic collaterals in cirrhotic rats. Clin Sci (Lond) 2021; 135:2709-2728. [PMID: 34870313 DOI: 10.1042/cs20210602] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 11/28/2021] [Accepted: 12/06/2021] [Indexed: 12/13/2022]
Abstract
Liver cirrhosis and portal hypertension is the end of chronic liver injury with hepatic, splanchnic and portosystemic collateral systems dysregulation. Liver injury is accompanied by gut dysbiosis whereas dysbiosis induces liver fibrosis, splanchnic angiogenesis and dysregulated vascular tones vice versa, making portal hypertension aggravated. It has been proved that intestinal microbiota transplantation alleviates dysbiosis. Nevertheless, the influences of microbiota transplantation on cirrhosis-related portal hypertension are not so clear. Liver cirrhosis with portal hypertension was induced by bile duct ligation (BDL) in rats. Sham rats were surgical controls. Rats randomly received vehicle, fecal or gut (terminal ileum) material transplantation. The results showed that microbiota transplantation from feces or gut material significantly reduced portal pressure in cirrhotic rats (P=0.010, 0.044). Hepatic resistance, vascular contractility, fibrosis and relevant protein expressions were not significantly different among cirrhotic rats. However, microbiota transplantation ameliorated splanchnic hyperdynamic flow and vasodilatation. Mesenteric angiogenesis, defined by whole mesenteric window vascular density, decreased in both transplantation groups and phosphorylated endothelial nitric-oxide synthase (eNOS) was down-regulated. Portosystemic shunts determined by splenorenal shunt (SRS) flow decreased in both transplantation groups (P=0.037, 0.032). Shunting severity assessed by microsphere distribution method showed consistent results. Compared with sham rats, cirrhotic rats lacked Lachnospiraceae. Both microbiota transplants increased Bifidobacterium. In conclusion, microbiota transplantation in cirrhotic rats reduced portal pressure, alleviated splanchnic hyperdynamic circulation and portosystemic shunts. The main beneficial effects may be focused on portosystemic collaterals-related events, such as hepatic encephalopathy and gastroesophageal variceal hemorrhage. Further clinical investigations are mandatory.
Collapse
Affiliation(s)
- Hui-Chun Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Hung Tsai
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan
| | - Ching-Chih Chang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chon Kit Pun
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
9
|
Abstract
BACKGROUND Portal hypertension is a pathophysiological abnormality with distinct vascular derangements associated with liver cirrhosis. Dipeptidyl peptidase-4 (DPP-4) inhibitors are antidiabetic agents which exert pleiotropic vascular effects, but their relevant impact on portal hypertension and liver cirrhosis remains unclear. This study aims to clarify this issue. METHODS Rats receiving partial portal vein ligation (PVL) and common bile duct ligation (BDL) served as experimental models for portal hypertension and cirrhosis, respectively. After linagliptin (a DPP-4 inhibitor) treatment, the survival rate, hemodynamics, biochemistry parameters and liver histopathology were evaluated. In addition, the collateral vascular responsiveness and severity of portal-systemic shunting were examined. mRNA and protein expression in the vasculature and liver were also examined. RESULTS Linagliptin significantly reduced portal pressure (control vs linagliptin: 12.9 ± 1.2 vs 9.1 ± 2.0 mmHg, p = 0.001) and upregulated nitric oxide synthase expression in the collateral vessel, superior mesentery artery, and liver of PVL rats. However, the portal hypotensive effect was insignificant in BDL rats. Glucose plasma levels, liver and renal biochemistry parameters were not significantly altered by linagliptin. The degree of portal-systemic shunting and collateral vascular responsiveness were also not significantly altered by linagliptin treatment. Linagliptin did not improve liver fibrosis and hepatic inflammation in BDL rats. CONCLUSION DPP-4 inhibition by linagliptin reduced portal pressure in portal hypertensive rats but not in cirrhotic rats. It may act by decreasing intrahepatic resistance via upregulation of hepatic nitric oxide synthase in portal hypertensive rats.
Collapse
Affiliation(s)
- Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Shao-Yu Hsiung
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University School of Medicine, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
10
|
Huang HC, Ho HL, Chang CC, Chuang CL, Pun CK, Lee FY, Huang YH, Hou MC, Hsu SJ. Matrix metalloproteinase-9 inhibition or deletion attenuates portal hypertension in rodents. J Cell Mol Med 2021; 25:10073-10087. [PMID: 34647412 PMCID: PMC8572799 DOI: 10.1111/jcmm.16940] [Citation(s) in RCA: 3] [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: 06/25/2021] [Revised: 09/03/2021] [Accepted: 09/11/2021] [Indexed: 12/29/2022] Open
Abstract
Liver cirrhosis and portal hypertension are accompanied by hyperdynamic circulation, angiogenesis and portosystemic collaterals. Matrix metalloproteinases (MMPs) participate in fibrogenesis and angiogenesis, however, whether they can be targeted in cirrhosis treatment is unclear. Therefore, we performed three series of experiments to investigate this issue. Liver cirrhosis was induced by common bile duct ligation (BDL) in Sprague‐Dawley rats. Sham‐operated rats served as controls. Rats were randomly allocated to receive vehicle, minocycline (a nonselective MMP inhibitor) or SB‐3CT (MMP‐2 and −9 inhibitor) for 28 days in the first and second series, respectively. MMP‐9 knockout mice were used in the third series. The results showed that minocycline ameliorated portal hypertension, hemodynamic abnormalities, reduced collateral shunting, mesenteric vascular density, plasma VEGF level and alleviated liver fibrosis. SB‐3CT attenuated portal hypertension, hemodynamic derangements, reduced shunting, mesenteric vascular density, mesenteric VEGF protein expression, and liver fibrosis. Knockout BDL mice had significantly alleviated portal hypertension, liver fibrosis, liver α‐SMA and mesenteric eNOS protein expressions compared to wild‐type BDL mice. Liver SMAD2 phosphorylation was down‐regulated in all series with MMP inhibition or knock‐out. In conclusion, MMP‐9 inhibition or deletion ameliorated the severity of cirrhosis, portal hypertension, and associated derangements. MMP‐9 may be targeted in the treatment of liver cirrhosis.
Collapse
Affiliation(s)
- Hui-Chun Huang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hsin-Ling Ho
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ching-Chih Chang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chiao-Lin Chuang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chon Kit Pun
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsiang Huang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| |
Collapse
|
11
|
Chang CC, Huang HC, Lee WS, Chuang CL, Huang LJ, Lu DY, Yang YY, Hsu HC. Early clinical exposure improves medical students' recognition of the need for professionalism and interprofessional collaboration. J Chin Med Assoc 2021; 84:778-782. [PMID: 34225335 DOI: 10.1097/jcma.0000000000000575] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Medical students in Taiwan start their clerkship in their fifth year. A lack of early clinical exposure can mean they have a lack of medical professionalism and collaborative practice. This study investigates whether early engagement in hospital-based clinical practice could improve their understanding of these requirements. METHODS From 2017 to 2019, a total of 59 medical students at the end of their third year joined a 2-week summer camp at the hospital. Every participant was assigned to work with one patient and they accompanied this patient throughout their hospital course. The students were also asked to interview other medical professionals within the hospital and to write up interview reports. In addition, they had to complete pre- and postcamp questionnaires which included 10 questions to evaluate their recognition of professionalism, doctor-patient relationships, and interprofessional collaboration. Answers to the questions were all rated using a 5-score Likert scale. RESULTS The total postcamp Likert scores were significantly increased after the 2-week training camp compared with the precourse scores (pre- vs postcourse: 44.08 ± 0.45 vs 46.66 ± 0.33, p < 0.001). In addition, the students' recognition of medical professionalism, the importance of communication with patients, and their respect for other medical professionals were significantly improved after the 2-week training. CONCLUSION Our data showed that early clinical exposure through a preclerkship summer camp can help medical students improve their recognition of medical professionalism and interprofessional collaboration.
Collapse
Affiliation(s)
- Ching-Chih Chang
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Wen-Shin Lee
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan, ROC
| | - Chiao-Lin Chuang
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ling-Ju Huang
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Dai-Yin Lu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chi Hsu
- Faculty of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan, ROC
- Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
12
|
Huang LJ, Huang HC, Chuang CL, Chang SL, Tsai HC, Lu DY, Yang YY, Chang CC, Hsu HC, Lee FY. Role-play of real patients improves the clinical performance of medical students. J Chin Med Assoc 2021; 84:183-190. [PMID: 32925298 DOI: 10.1097/jcma.0000000000000431] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND This study aimed to evaluate whether the role-play (RP) of real patients by medical students as part of interactive clinical reasoning training can improve medical students' clinical performance. METHODS A total of 26 medical students volunteered to portray real patients within this program and were treated as the RP group while the other 72 students as the non-RP group. In the interactive morning meeting, the medical students practiced how to approach the RP student as if they were encountering a real patient. All students were evaluated by mini-clinical evaluation exercises (mini-CEX) before and after this training program. RESULTS We found that all students had an increased total mini-CEX score after 4-week training, especially for interviewing skills. Notably, after training, the RP students had significantly elevated total mini-CEX scores (51.23 ± 1.06 vs 53.12 ± 1.11, p = 0.028), and for counselling (7.15 ± 0.14 vs 7.54 ± 0.18, p = 0.015) and overall clinical competence (7.27 ± 0.15 vs 7.65 ± 0.16, p = 0.030). In contrast, the non-RP students had lower scores compared with the RP group, as revealed by both the pre- and post-training tests. Moreover, their mini-CEX scores were not improved after training. CONCLUSION Medical students who were motivated to RP real patients had better performance scores than those who did not. In addition, RP can enhance their counselling skills and clinical competences.
Collapse
Affiliation(s)
- Ling-Ju Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shu-Luen Chang
- Medical Department, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu, Taiwan, ROC
| | - Hung-Cheng Tsai
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Dai-Yin Lu
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Hui-Chi Hsu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| |
Collapse
|
13
|
Ho HL, Tsai MH, Hsieh YH, Huo TI, Chang CC, Lee FY, Huang HC, Hou MC, Lee SD. Folic acid ameliorates homocysteine-induced angiogenesis and portosystemic collaterals in cirrhotic rats. Ann Hepatol 2020; 18:633-639. [PMID: 31078441 DOI: 10.1016/j.aohep.2018.12.008] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Revised: 12/06/2018] [Accepted: 11/23/2018] [Indexed: 02/04/2023]
Abstract
INTRODUCTION AND OBJECTIVES Liver cirrhosis is characterized by increased intrahepatic resistance, splanchnic vasodilation/angiogenesis, and formation of portosystemic collateral vessels. Collaterals can cause lethal complications such as gastroesophageal variceal hemorrhage. Homocysteine is linked to vascular dysfunction and angiogenesis and higher levels have been reported in cirrhotic patients. It is also known that folic acid supplementation reverses the effects of homocysteine. However, the treatment effect in cirrhosis has yet to be investigated. MATERIAL AND METHODS Liver cirrhosis was induced in Sprague-Dawley rats with common bile duct ligation (CBDL). The CBDL rats randomly received (1) vehicle; (2) dl-homocysteine thiolactone (1g/kg/day); (3) dl-homocysteine thiolactone plus folic acid (100mg/kg/day); or (4) folic acid. On the 29th day, hemodynamic parameters, liver and renal biochemistry, protein expressions of proangiogenic factors, mesenteric vascular density and portosystemic shunting were evaluated. RESULTS In the cirrhotic rats, homocysteine increased mesenteric vascular density and the severity of shunting. It also up-regulated the protein expressions of mesenteric vascular endothelial growth factor (VEGF) and phosphorylated-endothelial nitric oxide synthase (p-eNOS). These effects were reversed by folic acid treatment (P<0.05). CONCLUSION Folic acid ameliorated the adverse effects of homocysteine in the cirrhotic rats, which may be related to down-regulation of the VEGF-NO signaling pathway.
Collapse
Affiliation(s)
- Hsin-Ling Ho
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Lo-Hsu Medical Foundation, Lotung Poh-Ai Hospital, Yilan, Taiwan
| | - Ming-Hung Tsai
- Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Lin-Kuo Medical Center, Chang Gung University, College of Medicine, Taoyuan, Taiwan
| | - Yu-Hsin Hsieh
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ia Huo
- Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ching-Chih Chang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Hui-Chun Huang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan
| |
Collapse
|
14
|
Lee FY, Yang YY, Huang CC, Huang LJ, Chang CC, Liang JF, Huang SS, Lee WS, Lu DY, Chuang CL, Yang LY, Huang HC, Shulruf B, Chen CH, Kao SY. Sustained effects of faculty leadership development modules for clinical instructors of core competences education in Taiwan: a four-year explanatory case study. BMC Med Educ 2020; 20:155. [PMID: 32414406 PMCID: PMC7226719 DOI: 10.1186/s12909-020-02065-w] [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] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND The Accreditation Council for Graduate Medical Education (ACGME) core competencies (CC) in general medicine-based primary care are essential for junior medical trainees. In this country, a regular faculty development (FD) program aimed at training faculty in instructing (teaching and assessing) these CC had operated. However, leadership was not emphasized. In a new intervention module, the roles and associated responsibilities of clinical instructors to conduct, design, and lead CC-based education were emphasis. AIMS This follow-up explanatory case study compares the effectiveness of intervention module with that of the previous regular module. METHODS The regular group (n = 28) comprised clinical instructors who participated in the FD module during the 2013-2014 year while the intervention group (n = 28) was composed of 2015-2016 participants. Prior to the formal (hands-on) training, participants in the intervention group were asked to study the online materials of the regular module. These participants then received a 30-h hands-on training in conducting, designing, and leading skills. Finally, they prepared a 10-h reflective end-of-module presentation of their real-world practices. RESULTS Following the training, a higher degree improvement in participants self-reported familiarity with CC education, self-confidence in their ability to deliver CC education and sustained involve CC education were noted among the intervention FD group, compared with the regular FD group. In the intervention group, senior academicians (associate and full professor) are more substantially involved in designing and leading CC-based courses than junior academicians (lecturers and assistant professors). Among non-teaching award winners of in the intervention FD group, the follow-up degree of sustained involvement in delivering, designing and leading CC-based courses was significantly higher than that of the regular group. CONCLUSIONS Our study demonstrated that leadership training in the intervention FD modules substantially motivated clinical instructors to become leaders in CC education.
Collapse
Affiliation(s)
- Fa-Yauh Lee
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
| | - Ying-Ying Yang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan.
- Division of Clinical Skills Training Center, Taipei Veteran General Hospital , Taipei, Taiwan.
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
- Department of Medicine, Taipei Veteran General Hospital , Taipei, Taiwan.
| | - Chia-Chang Huang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Division of Clinical Skills Training Center, Taipei Veteran General Hospital , Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Ju Huang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Chih Chang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Jen-Feng Liang
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veteran General Hospital , Taipei, Taiwan
| | - Shiau-Shian Huang
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, Bali, Taiwan
| | - Wei-Shin Lee
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Dai-Yin Lu
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chiao-Lin Chuang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ling-Yu Yang
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veteran General Hospital , Taipei, Taiwan
| | - Hui-Chun Huang
- Division of General Medicine, Taipei Veteran General Hospital, Taipei, Taiwan
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Boaz Shulruf
- New South Wales Sydney University, Sydney, Australia
| | - Chen-Huan Chen
- Faculty of medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veteran General Hospital , Taipei, Taiwan
| | - Shou-Yen Kao
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- National Yang-Ming University, Taipei, Taiwan
- Department of Medical Education, Taipei Veteran General Hospital , Taipei, Taiwan
| |
Collapse
|
15
|
Huang HC, Tsai MH, Lee FY, Lin TY, Chang CC, Chuang CL, Hsu SJ, Hou MC, Huang YH. NAFLD Aggravates Septic Shock Due to Inadequate Adrenal Response and 11β-HSDs Dysregulation in Rats. Pharmaceutics 2020; 12:pharmaceutics12050403. [PMID: 32354071 PMCID: PMC7285211 DOI: 10.3390/pharmaceutics12050403] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 04/26/2020] [Accepted: 04/27/2020] [Indexed: 02/06/2023] Open
Abstract
Background: Non-alcoholic fatty liver disease (NAFLD) is linked with metabolic syndrome. Previous studies showed that obesity may disrupt adrenal function and adversely affect its counter-regulations against shock. This study hence evaluated adrenal function abnormalities in NAFLD with shock. Methods: Sprague-Dawley rats were fed with regular chow-diet (control) or high fat diet (HFD, 60% energy derived from fat). Blood tests were performed at the end of the 4th, 6th and 8th week, respectively. Experiments were performed at the end of the 8th week. Results: HFD rats developed NAFLD. HFD rats had 27% and 51% increase in plasma corticosterone at the 6th and 8th week in usual status. However, HFD rats had 5 times more reduction of mean arterial pressure in response to lipopolysaccharide-induced sepsis as compared to control rats. The corticosterone increment ratio was also lower in HFD rats, even after ACTH administration. 11β-HSD system tended to generate more corticosterone in HFD rats under hemodynamic stable status without shock and the trend was lost in HFD rats with septic shock. Conclusion: Rats with NAFLD had profound septic shock due to inadequate corticosterone response. This is, at least partly, due to 11β-HSDs dysregulation in sepsis.
Collapse
Affiliation(s)
- Hui-Chun Huang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 100, Taiwan; (H.-C.H.); (F.-Y.L.); (C.-C.C.); (C.-L.C.); (M.-C.H.); (Y.-H.H.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ming-Hung Tsai
- Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 320-338, Taiwan;
| | - Fa-Yauh Lee
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 100, Taiwan; (H.-C.H.); (F.-Y.L.); (C.-C.C.); (C.-L.C.); (M.-C.H.); (Y.-H.H.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Te-Yueh Lin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Ching-Chih Chang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 100, Taiwan; (H.-C.H.); (F.-Y.L.); (C.-C.C.); (C.-L.C.); (M.-C.H.); (Y.-H.H.)
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chiao-Lin Chuang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 100, Taiwan; (H.-C.H.); (F.-Y.L.); (C.-C.C.); (C.-L.C.); (M.-C.H.); (Y.-H.H.)
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Shao-Jung Hsu
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 100, Taiwan; (H.-C.H.); (F.-Y.L.); (C.-C.C.); (C.-L.C.); (M.-C.H.); (Y.-H.H.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Correspondence: ; Tel.: +886-2-28712121 (ext. 2014)
| | - Ming-Chih Hou
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 100, Taiwan; (H.-C.H.); (F.-Y.L.); (C.-C.C.); (C.-L.C.); (M.-C.H.); (Y.-H.H.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| | - Yi-Hsiang Huang
- Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei 100, Taiwan; (H.-C.H.); (F.-Y.L.); (C.-C.C.); (C.-L.C.); (M.-C.H.); (Y.-H.H.)
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
| |
Collapse
|
16
|
Hsu SJ, Huang HC, Chuang CL, Chang CC, Hou MC, Lee FY, Lee SD. Dual Angiotensin Receptor and Neprilysin Inhibitor Ameliorates Portal Hypertension in Portal Hypertensive Rats. Pharmaceutics 2020; 12:pharmaceutics12040320. [PMID: 32252377 PMCID: PMC7238216 DOI: 10.3390/pharmaceutics12040320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [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: 03/06/2020] [Revised: 03/29/2020] [Accepted: 03/30/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Portal hypertension is characterized by exaggerated activation of the renin-angiotensin-aldosterone axis. Natriuretic peptide system plays a counter-regulatory role, which is modulated by neprilysin. LCZ696 (sacubitril/valsartan) is a dual angiotensin receptor and neprilysin inhibitor. This study evaluated the effect of LCZ696 on portal hypertensive rats. Methods: Portal hypertension was induced by partial portal vein ligation (PVL) in rats. LCZ696, valsartan (angiotensin receptor blocker), or normal saline (control) was administered in PVL rats for 10 days. Then, hemodynamic and biochemistry data were obtained. The hepatic histology and protein expressions were surveyed. On the parallel groups, the portal-systemic shunting degrees were determined. Results: LCZ696 and valsartan reduced mean arterial pressure and systemic vascular resistance. LCZ696, but not valsartan, reduced portal pressure in portal hypertensive rats (control vs. valsartan vs. LCZ696: 15.4 ± 1.6 vs. 14.0 ± 2.3 vs. 12.0 ± 2.0 mmHg, control vs. LCZ696: P < 0.05). LCZ696 and valsartan improved liver biochemistry data and reduced intrahepatic Cluster of Differentiation 68 (CD68)-stained macrophages infiltration. Hepatic endothelin-1 (ET-1) protein expression was downregulated by LCZ696. The portal-systemic shunting was not affected by LCZ696 and valsartan. Conclusion: LCZ696 and valsartan reduced mean arterial pressure through peripheral vasodilation. Furthermore, LCZ696 significantly reduced portal pressure in PVL rats via hepatic ET-1 downregulation.
Collapse
Affiliation(s)
- Shao-Jung Hsu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-J.H.); (H.-C.H.); (M.-C.H.); (F.-Y.L.); (S.-D.L.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan;
| | - Hui-Chun Huang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-J.H.); (H.-C.H.); (M.-C.H.); (F.-Y.L.); (S.-D.L.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan;
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Chiao-Lin Chuang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan;
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ching-Chih Chang
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-J.H.); (H.-C.H.); (M.-C.H.); (F.-Y.L.); (S.-D.L.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan;
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Correspondence:
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-J.H.); (H.-C.H.); (M.-C.H.); (F.-Y.L.); (S.-D.L.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan;
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-J.H.); (H.-C.H.); (M.-C.H.); (F.-Y.L.); (S.-D.L.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan;
| | - Shou-Dong Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan; (S.-J.H.); (H.-C.H.); (M.-C.H.); (F.-Y.L.); (S.-D.L.)
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan;
| |
Collapse
|
17
|
Chen YC, Chang CC, Hsu WL, Chuang ST. Dairy cattle with bovine leukaemia virus RNA show significantly increased leukocyte counts. Vet J 2020; 257:105449. [PMID: 32546356 DOI: 10.1016/j.tvjl.2020.105449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 03/25/2020] [Accepted: 12/31/2019] [Indexed: 12/26/2022]
Abstract
Infection with bovine leukaemia virus (BLV), a retrovirus, causes dysfunction of the immune system and can have a marked economic impact on dairy industries due to decreased milk production and reduced lifespan in affected dairy cattle. The presence of proviral DNA has been the major diagnostic indicator of BLV infection. However in the course of BLV infection, the viral genome can be dormant, without detectable gene expression, resulting in limited impact on infected animals. At present, there is limited knowledge regarding haematological indices in dairy cattle that could indicate activation of the BLV genome and suggest reactivated BLV infection. In this study, BLV infection and BLV genome reactivation were evaluated based on the presence of BLV DNA and BLV env gene transcripts, respectively. BLV RNA transcription was confirmed. Among 93 whole blood samples obtained from asymptomatic dairy cattle, the prevalence of BLV proviral DNA and transcripts was 93.5% (n = 87/93) and 83.9% (n = 78/93), respectively. Between groups with and without BLV, the mean counts of white blood cells and lymphocytes in whole blood were significantly associated with the presence of BLV RNA (P < 0.05), but not with BLV proviral DNA. These results shed light on the activation status of the BLV genome and should be taken into account when evaluating the possible impact of BLV on cattle.
Collapse
Affiliation(s)
- Y C Chen
- Graduate Institute of Veterinary Pathobiology, College of Veterinary Medicine, National Chung Hsing University, 145 Xingda Rd., South Dist., Taichung 402, Taiwan
| | - C C Chang
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University, 145 Xingda Rd., South Dist., Taichung 402, Taiwan
| | - W L Hsu
- Graduate Institute of Microbiology and Public Health, College of Veterinary Medicine, National Chung Hsing University, 145 Xingda Rd., South Dist., Taichung 402, Taiwan.
| | - S T Chuang
- Department of Veterinary Medicine, College of Veterinary Medicine, National Chung Hsing University, 145 Xingda Rd., South Dist., Taichung 402, Taiwan.
| |
Collapse
|
18
|
Ma SB, Griffin D, Boyd SC, Chang CC, Wong J, Guy SD. Cryptococcus neoformans var grubii meningoencephalitis in a patient on fingolimod for relapsing-remitting multiple sclerosis: Case report and review of published cases. Mult Scler Relat Disord 2020; 39:101923. [PMID: 31986367 DOI: 10.1016/j.msard.2019.101923] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/27/2019] [Accepted: 12/31/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Fingolimod, a sphingosine-1-phosphate modulator used in the treatment of relapsing-remitting multiple sclerosis, has been associated with several cases of cryptococcosis. CASE REPORT We present a case of Cryptococcal meningoencephalitis attributable to Cryptococcus neoformans var. grubii, in a 58-year-old bird-keeper from Australia, after 7 years of fingolimod therapy. We discuss this in the context of previously reported cases, our understanding of fingolimod immune modulation, and known Cryptococcus pathobiology. CONCLUSION We suggest consideration of harm minimisation behaviours in patients requiring fingolimod, particularly in those with profound CD4 lymphopenia. Furthermore, we echo the call for improved post-marketing surveillance systems to determine the epidemiology of atypical infections with novel immunomodulatory treatments.
Collapse
Affiliation(s)
- S B Ma
- Western Health, Melbourne, Victoria, Australia.
| | - Dwj Griffin
- Western Health, Melbourne, Victoria, Australia; Alfred Health, Melbourne, Victoria, Australia
| | - S C Boyd
- Western Health, Melbourne, Victoria, Australia
| | - C C Chang
- Alfred Health, Melbourne, Victoria, Australia
| | - Jsj Wong
- Dorevitch Pathology, Heidelberg, Victoria, Australia
| | - S D Guy
- Western Health, Melbourne, Victoria, Australia
| |
Collapse
|
19
|
Abstract
BACKGROUND Rapamycin is a type of immunosuppressive agent that acts through inhibition of mammalian target of rapamycin (mTOR). Hepatopulmonary syndrome (HPS) is a lethal complication in cirrhotic patients. It is characterized by hypoxia and increased intrapulmonary shunts, in which pulmonary inflammation and angiogenesis play important roles. The current study aimed to evaluate the effect of rapamycin on HPS using the experimental model of common bile duct ligation (CBDL)-induced cirrhosis in rats. METHODS The rats received low-dose (0.5 mg/kg), high-dose (2 mg/kg) rapamycin, or vehicle from the 15th to the 28th day post CBDL. Then the mortality rate, hemodynamics, biochemistry parameters, arterial blood gas and plasma levels of vascular endothelial growth factor (VEGF) and tumor necrosis factor (TNF)-α were evaluated on the 28th day post CBDL. Pulmonary histopathological stains were performed, and protein expression was examined. In parallel groups, the intrapulmonary shunts of CBDL rats were measured. RESULTS Compared with the control, a high-dose rapamycin treatment decreased portal pressure and improved hypoxia in CBDL rats. It also reduced the plasma level of VEGF and TNF-α and decreased intrapulmonary shunts. Meanwhile, it ameliorated pulmonary inflammation and angiogenesis and downregulated the protein expression of mTOR, P70S6K, nuclear factor kappa B (NFκB), VEGF, and VEGF receptor 2. In contrast, low-dose rapamycin did not attenuate intrapulmonary shunts despite ameliorating portal hypertension. CONCLUSION High-dose rapamycin ameliorates HPS in cirrhotic rats as evidenced by the alleviated hypoxia and decreased intrapulmonary shunts. Downregulation of the mTOR/P70S6K, NFκB, and VEGF signaling pathways might play a key role.
Collapse
Affiliation(s)
- Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - I-Fang Hsin
- Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shao-Jung Hsu
- Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
20
|
Chang CC, Burr GS, Jull AJT, Russell J, Priyadarshi A, Lin M, Thiemens M, Biddulph D. Measurements of 129I in the Pacific Ocean at Scripps Pier and Pacific Northwest sites: A search for effects from the 2011 Fukushima Daiichi Nuclear Power Plant accident and Hanford. Sci Total Environ 2019; 689:1023-1029. [PMID: 31280148 DOI: 10.1016/j.scitotenv.2019.06.372] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2019] [Revised: 06/22/2019] [Accepted: 06/23/2019] [Indexed: 06/09/2023]
Abstract
Radionuclides from the Fukushima Daiichi Nuclear Power Plant were released directly into the ocean as a result of the Great East Japan Earthquake on March 11, 2011. This material became entrained in surface ocean currents and subsequently transported for great distances. In June 2011, a few months after the disaster, we began a surface ocean 129I monitoring program, with samples from Scripps Pier, La Jolla, California, USA, with the expectation that surface currents originating off the east coast of Japan would eventually carry radionuclides to the La Jolla site. After 7 years of ocean transport, a distinct signal has not yet arrived at Scripps Pier. We have however, recorded an interesting systematic seasonal 129I time series record that stems from surface circulation variations along the California coast. To provide a more comprehensive picture of the 129I budget in coastal surface waters off the west coast of the U.S., we also include 129I data from the Columbia River, and offshore sites along the coast of Washington State. Anthropogenic nuclides are carried by the Columbia River into the Pacific Ocean from the vicinity of the decommissioned Hanford nuclear facility. We find highly elevated 129I/127I values in the Columbia River, downstream from the Hanford site, but this anthropogenic 129I becomes significantly diluted once it reaches the Pacific Ocean. Nonetheless, its imprint persists in surface seawater off the west coast of the U.S. that has significantly higher 129I/127I levels than other surface sites in the Pacific Ocean.
Collapse
Affiliation(s)
- Ching-Chih Chang
- University of Arizona AMS Laboratory, University of Arizona, Tucson, AZ, USA; Department of Geosciences, University of Arizona, Tucson, AZ, USA
| | - George S Burr
- University of Arizona AMS Laboratory, University of Arizona, Tucson, AZ, USA; Department of Geosciences, National Taiwan University Research Center for Future Earth, Taipei, Taiwan
| | - A J Timothy Jull
- University of Arizona AMS Laboratory, University of Arizona, Tucson, AZ, USA; Department of Geosciences, University of Arizona, Tucson, AZ, USA; Isotope Climatology and Environmental Research Centre, Institute for Nuclear Research, Debrecen, Hungary.
| | - Joellen Russell
- Department of Geosciences, University of Arizona, Tucson, AZ, USA
| | - Antra Priyadarshi
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, CA, USA
| | - Mang Lin
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, CA, USA
| | - Mark Thiemens
- Department of Chemistry and Biochemistry, University of California San Diego, La Jolla, CA, USA
| | - Dana Biddulph
- University of Arizona AMS Laboratory, University of Arizona, Tucson, AZ, USA
| |
Collapse
|
21
|
Li WB, Huber GM, Blok HP, Gaskell D, Horn T, Semenov-Tian-Shansky K, Pire B, Szymanowski L, Laget JM, Aniol K, Arrington J, Beise EJ, Boeglin W, Brash EJ, Breuer H, Chang CC, Christy ME, Ent R, Gibson EF, Holt RJ, Jin S, Jones MK, Keppel CE, Kim W, King PM, Kovaltchouk V, Liu J, Lolos GJ, Mack DJ, Margaziotis DJ, Markowitz P, Matsumura A, Meekins D, Miyoshi T, Mkrtchyan H, Niculescu I, Okayasu Y, Pentchev L, Perdrisat C, Potterveld D, Punjabi V, Reimer PE, Reinhold J, Roche J, Roos PG, Sarty A, Smith GR, Tadevosyan V, Tang LG, Tvaskis V, Volmer J, Vulcan W, Warren G, Wood SA, Xu C, Zheng X. Unique Access to u-Channel Physics: Exclusive Backward-Angle Omega Meson Electroproduction. Phys Rev Lett 2019; 123:182501. [PMID: 31763910 DOI: 10.1103/physrevlett.123.182501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 10/01/2019] [Indexed: 06/10/2023]
Abstract
Backward-angle meson electroproduction above the resonance region, which was previously ignored, is anticipated to offer unique access to the three quark plus sea component of the nucleon wave function. In this Letter, we present the first complete separation of the four electromagnetic structure functions above the resonance region in exclusive ω electroproduction off the proton, ep→e^{'}pω, at central Q^{2} values of 1.60, 2.45 GeV^{2}, at W=2.21 GeV. The results of our pioneering -u≈-u_{min} study demonstrate the existence of a unanticipated backward-angle cross section peak and the feasibility of full L/T/LT/TT separations in this never explored kinematic territory. At Q^{2}=2.45 GeV^{2}, the observed dominance of σ_{T} over σ_{L}, is qualitatively consistent with the collinear QCD description in the near-backward regime, in which the scattering amplitude factorizes into a hard subprocess amplitude and baryon to meson transition distribution amplitudes: universal nonperturbative objects only accessible through backward-angle kinematics.
Collapse
Affiliation(s)
- W B Li
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
- College of William and Mary, Williamsburg, Virginia 23185, USA
| | - G M Huber
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - H P Blok
- VU University, NL-1081 HV Amsterdam, Netherlands
- NIKHEF, Postbus 41882, NL-1009 DB Amsterdam, Netherlands
| | - D Gaskell
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T Horn
- Catholic University of America, Washington, D.C. 20064, USA
| | - K Semenov-Tian-Shansky
- National Research Centre Kurchatov Institute: Petersburg Nuclear Physics Institute, RU-188300 Gatchina, Russia
- Saint Petersburg National Research Academic University of the Russian Academy of Sciences, RU-194021 St. Petersburg, Russia
| | - B Pire
- CPHT, CNRS, École Polytechnique, IP Paris, 91128-Palaiseau, France
| | - L Szymanowski
- National Centre for Nuclear Research (NCBJ), 02-093 Warsaw, Poland
| | - J-M Laget
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - K Aniol
- California State University Los Angeles, Los Angeles, California 90032, USA
| | - J Arrington
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - E J Beise
- University of Maryland, College Park, Maryland 20742, USA
| | - W Boeglin
- Florida International University, Miami, Florida 33119, USA
| | - E J Brash
- Christopher Newport University, Newport News, Virginia 23606, USA
| | - H Breuer
- University of Maryland, College Park, Maryland 20742, USA
| | - C C Chang
- University of Maryland, College Park, Maryland 20742, USA
| | - M E Christy
- Hampton University, Hampton, Virginia 23668, USA
| | - R Ent
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - E F Gibson
- California State University, Sacramento, California 95819, USA
| | - R J Holt
- Caltech, Pasadena, California 91125, USA
| | - S Jin
- Kyungpook National University, Daegu, 702-701, Republic of Korea
| | - M K Jones
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - C E Keppel
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
- Hampton University, Hampton, Virginia 23668, USA
| | - W Kim
- Kyungpook National University, Daegu, 702-701, Republic of Korea
| | - P M King
- Ohio University, Athens, Ohio 45701, USA
| | - V Kovaltchouk
- Ontario Tech University, Oshawa, Ontario L1G 0C5, Canada
| | - J Liu
- Shanghai Jiao Tong University, Shanghai 200240, China
| | - G J Lolos
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - D J Mack
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - D J Margaziotis
- California State University Los Angeles, Los Angeles, California 90032, USA
| | - P Markowitz
- Florida International University, Miami, Florida 33119, USA
| | - A Matsumura
- Tohoku University, Sendai, Miyagi 980-8578, Japan
| | - D Meekins
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T Miyoshi
- Tohoku University, Sendai, Miyagi 980-8578, Japan
| | - H Mkrtchyan
- A.I. Alikhanyan National Science Laboratory, Yerevan 0036, Armenia
| | - I Niculescu
- James Madison University, Harrisonburg, Virginia 22807, USA
| | - Y Okayasu
- Tohoku University, Sendai, Miyagi 980-8578, Japan
| | - L Pentchev
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - C Perdrisat
- College of William and Mary, Williamsburg, Virginia 23187, USA
| | - D Potterveld
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - V Punjabi
- Norfolk State University, Norfolk, Virginia 23504, USA
| | - P E Reimer
- Physics Division, Argonne National Laboratory, Argonne, Illinois 60439, USA
| | - J Reinhold
- Florida International University, Miami, Florida 33119, USA
| | - J Roche
- Ohio University, Athens, Ohio 45701, USA
| | - P G Roos
- University of Maryland, College Park, Maryland 20742, USA
| | - A Sarty
- Saint Mary's University, Halifax, Nova Scotia B3H 3C3, Canada
| | - G R Smith
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - V Tadevosyan
- A.I. Alikhanyan National Science Laboratory, Yerevan 0036, Armenia
| | - L G Tang
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
- Hampton University, Hampton, Virginia 23668, USA
| | - V Tvaskis
- NIKHEF, Postbus 41882, NL-1009 DB Amsterdam, Netherlands
- VU University, NL-1081 HV Amsterdam, Netherlands
| | - J Volmer
- VU University, NL-1081 HV Amsterdam, Netherlands
- DESY, Hamburg 22607, Germany
| | - W Vulcan
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - G Warren
- Pacific Northwest National Laboratory, Richland, Washington 99352, USA
| | - S A Wood
- Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - C Xu
- University of Regina, Regina, Saskatchewan S4S 0A2, Canada
| | - X Zheng
- University of Virginia, Charlottesville, Virginia 22904, USA
| |
Collapse
|
22
|
Serruys PW, Takahashi K, Kogame N, Chichareon P, Modolo R, Chang CC, Tomaniak M, Komiyama H, Hamm C, Steg PG, Stoll HP, Onuma Y, Valgimigli M, Windecker S, Vranckx P. P2817Efficacy and safety of ticagrelor monotherapy in patients with complex percutaneous coronary intervention: insights from the Global Leaders trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1129] [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/Introduction
Optimal dual antiplatelet therapy (DAPT) in patients with complex percutaneous coronary intervention (PCI) with drug-eluting stents (DES) has not been fully investigated.
Purpose
To evaluate the efficacy and safety of 1-month DAPT followed by 23-month ticagrelor monotherapy in patients who underwent complex PCI.
Methods
The Global Leaders trial recruited 15,991 patients treated by default with a biolimus A9-eluting stent, and randomised in a 1:1 ratio either to the experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) or to the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy). Complex PCI includes at least one of the following characteristics; left main and/or multivessel PCI, long stenting (defined as total stent length≥46mm), and bifurcation treatment with two stents. The present sub-analysis of the trial evaluated at two years the primary endpoint (composite of all-cause death and new Q-wave myocardial infarction [MI] centrally adjudicated with the Minnesota code). In addition, the patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also evaluated at two years.
Results
Of 15,450 patients included in the present analysis, 5,188 (26.7%) patients underwent complex PCI. The experimental strategy, when compared with the reference one, had a significantly lower risk of the primary endpoint (3.56% vs. 5.33%, HR: 0.66; 95% CI: 0.51–0.86; p-value= 0.002; p-value for interaction= 0.019) in patients with complex PCI. Similarly, the experimental treatment was associated with a significantly reduced risk of POCE (14.41% vs. 16.88%, HR: 0.84; 95% CI: 0.74–0.97; p=0.016, p-value for interaction= 0.099) and NACE (15.77% vs. 18.37%, HR: 0.85; 95% CI: 0.74–0.97; p=0.014; p-value for interaction= 0.096). The reduction in ischemic events was predominantly observed in patients with 2 or more characteristics of complex PCI (Figure). In contrast, there was no significant difference in the risk of BARC type 3 or 5 bleeding between the two regimens (2.40% vs. 2.38%, HR: 1.01; 95% CI: 0.71–1.44; p-value=0.956; p-value for interaction= 0.935).
Central illustration
Conclusion
Together with other well-established clinical risk factors, the extent and complexity of stenting should be taken into account in tailoring antiplatelet regimens for secondary prevention. The 1-month DAPT followed by 23-month ticagrelor monotherapy reduced the ischemic events without increasing the risk of bleeding in patients who underwent complex PCI, when compared with the conventional DAPT.
Acknowledgement/Funding
The Global Leaders trial was supported by the resource from AstraZeneca, Biosensors, and The Medicines Company.
Collapse
Affiliation(s)
- P W Serruys
- Imperial College London, London, United Kingdom
| | - K Takahashi
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - N Kogame
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - P Chichareon
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - R Modolo
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - C C Chang
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - M Tomaniak
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - H Komiyama
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - C Hamm
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - P G Steg
- University Paris Diderot, Paris, France
| | - H P Stoll
- Biosensors Clinical Research, Morges, Switzerland
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - M Valgimigli
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - S Windecker
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - P Vranckx
- Heart Centre Hasselt, Hasselt, Belgium
| |
Collapse
|
23
|
Van Geuns RJ, Smits PC, Chang CC, Wlodarczyk A, Chevalier B, West N, Gori T, Barbato E, Tarantini G, Kocka V, Achenbach S, Dudek D, Escaned J, Tijssen J, Onuma Y. P2695ABSORB bioresorbable scaffold versus Xience metallic stent in acute coronary syndromes with treated with percutaneous coronary intervention. A subanalysis of the COMPARE-ABSORB trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1012] [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
The safety and efficacy of the ABSORB scaffold in ACS patients remain unclear. The COMPARE-ABSORB trial compares the ABSORB to the Xience stent in lesions and patients at high risk for restenosis Patients with STEMI and urgent PCI for non-STEMI were not excluded.
Methods
Patients included in the COMPARE-ABSORB trial undergoing PCI for ACS were eligible. Predefined implantation techniques for ABSORB was mandatory. Primary endpoint is target lesion failure (TLF) at 1 year, defined as a composite of cardiac death, target vessel myocardial infarction and clinically indicated target lesion revascularization.
Results
Of 1670 patients, 842 were treated for ACS. At 1-year, TLF occurred in 22 patients (5.0%) of the ABSORB group and in 14 patients (3.5%) of the Xience group (HR 1.44%; 95% CI 0.74%-2.82%, P=0.284). Definite device thrombosis occurred in 9 patients (2.0%) of the ABSORB group and in 2 patients (0.5%) of the Xience group (HR 4.10%; 95% CI 0.89%-18.9%, P=0.071).
Baseline characteristics ABSORB (n=442) XIENCE (n=400) Age, years (SD) 60.7 (9.6) 61.3 (9.1) Male 350/442 (79.2%) 313/400 (78.3%) Current smoker 159/439 (36.2%) 126/397 (31.7%) Diabetes mellitus 152/440 (34.5%) 138/399 (34.6%) Hypertension 298/442 (67.4%) 266/400 (66.5%) Hypercholesterolemia 255/442 (57.7%) 232/400 (58.0%) Family history of coronary artery disease 147/442 (33.3%) 103/400 (25.8%) Previous MI 61/442 (13.8%) 67/400 (16.8%) Established Peripheral Vascular Disease 27/442 (6.1%) 15/400 (3.8%) Previous PCI 83/442 (18.8%) 86/400 (21.5%) Previous CABG 1/442 (0.2%) 4/400 (1.0%) Previous stroke 15/442 (3.4%) 21/400 (5.3%) Renal Insufficiency 9/442 (2.0%) 13/400 (3.3%) Clinical presentation Unstable angina 149/442 (33.7%) 141/400 (35.3%) Non-ST elevation myocardial infarction 183/442 (41.4%) 156/400 (39.0%) ST elevation myocardial infarction 110/442 (24.9%) 103/400 (25.7%)
KM plot for target lesion failure
Conclusion
The COMPARE-ABSORB trial showed no difference in the primary endpoint at one year for the ACS subgroup. The signal for increased thrombosis remained, even with the optimized implantation protocol
Acknowledgement/Funding
Maasstad Hospital, Rotterdam, the Netherlands
Collapse
Affiliation(s)
- R J Van Geuns
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - P C Smits
- Maasstad Hospital, Cardiology department, Rotterdam, Netherlands (The)
| | - C C Chang
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - A Wlodarczyk
- Miedziowe Centrum Zdrowia, Department of Cardiology, Lubin, Poland
| | - B Chevalier
- Cardiovascular Institute Paris-Sud (ICPS), Massy, France
| | - N West
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom
| | - T Gori
- Johannes Gutenberg University Mainz (JGU), Mainz, Germany
| | - E Barbato
- Cardiovascular Center Aalst, Aalst, Belgium
| | | | - V Kocka
- Charles University of Prague, Prague, Czechia
| | - S Achenbach
- Friedrich Alexander University, Erlangen, Germany
| | - D Dudek
- Jagiellonian University Medical College, 2nd Department of Cardiology, Krakow, Poland
| | - J Escaned
- Hospital Clinic San Carlos, Madrid, Spain
| | - J Tijssen
- Academic Medical Center of Amsterdam, Amsterdam, Netherlands (The)
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| |
Collapse
|
24
|
Takahashi K, Chichareon P, Modolo R, Kogame N, Chang CC, Tomaniak M, Hamm C, Steg PG, Stoll HP, Onuma Y, Valgimigli M, Vranckx P, Windecker S, Serruys PW. P2811Impact of ticagrelor monotherapy on two-year clinical outcomes in patients with long stenting: insights from the Global Leaders trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1123] [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/Introduction
Data on the efficacy and safety of different antiplatelet regimens are limited in patients with increasing total stent length (TSL).
Purpose
To evaluate the impact of the experimental strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with increasing TSL.
Methods
The present post-hoc analysis of the Global Leaders trial evaluated the primary endpoint (the composite of the all-cause death and new Q-wave myocardial infarction [MI]) at two years in patients with increasing TSL. In addition, the patient-oriented composite endpoint (POCE) (the composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (the composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also assessed.
Results
The cohort of 15,450 patients treated with a biolimus-eluting biodegradable polymer stents were included in this analysis. In the longer TSL group (≥46mm), the experimental strategy significantly reduced the risk of the primary endpoint (3.78% vs. 5.68%, hazard ratio (HR): 0.67, 95% confidence interval (CI): 0.49–0.90, p=0.008, P interaction=0.042) as well as POCE (14.57% vs. 18.11%, HR: 0.79, 95% CI: 0.67–0.92, p=0.003, P interaction=0.010) and NACE (16.07% vs. 19.64%, HR: 0.80, 95% CI: 0.69–0.93, p=0.004, P interaction=0.012) at two years. The risk of BARC type 3 or 5 bleeding at two years was similar between the two antiplatelet regimens.
KM in patients with long stenting
Conclusion
Ticagrelor monotherapy significantly reduced the risk of the primary endpoint, POCE and NACE with a similar risk of BARC type 3 or 5 bleeding at two years in patients with the longer TSL.
Acknowledgement/Funding
The Global Leaders trial was supported by unrestricted grants from AstraZeneca, Biosensors, and The Medicines Company. ECRI (European Cardiovascular R
Collapse
Affiliation(s)
- K Takahashi
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - P Chichareon
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - R Modolo
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - N Kogame
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - C C Chang
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - M Tomaniak
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - C Hamm
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - P G Steg
- University Paris Diderot, Paris, France
| | - H P Stoll
- Biosensors Clinical Research, Morges, Switzerland
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - M Valgimigli
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - P Vranckx
- Heart Centre Hasselt, Hasselt, Belgium
| | - S Windecker
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - P W Serruys
- Imperial College London, London, United Kingdom
| |
Collapse
|
25
|
Takahashi K, Chichareon P, Chang CC, Tomaniak M, Modolo R, Kogame N, Stoll HP, Hamm C, Steg PG, Onuma Y, Valgimigli M, Vranckx P, Windecker S, Carrie D, Serruys PW. P2812Ischemic efficacy and bleeding safety of ticagrelor monotherapy in patients with multivessel percutaneous coronary intervention: insights from the Global Leaders trial. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1124] [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/Introduction
The optimal duration of DAPT after coronary stent implantation remains a matter of debate and a novel antiplatelet regimen without an increased risk of bleeding while maintaining an anti-ischemic efficacy is of paramount importance in patients at higher risk of ischemia.
Purpose
The aim of the present sub-study of the Global Leaders trial is to evaluate the efficacy and safety of the experimental antiplatelet strategy (1-month dual antiplatelet therapy [DAPT] followed by 23-month ticagrelor monotherapy) vs. the reference regimen (12-month DAPT followed by 12-month aspirin monotherapy) in patients with multivessel percutaneous coronary intervention (PCI).
Methods
The Global Leaders trial enrolled 15,991 patients treated by default with a biolimus A-9 eluting stent. The present sub-study of the trial sought to evaluate the impact of the long-term ticagrelor monotherapy on the primary endpoint (composite of all-cause death and new Q-wave myocardial infarction [MI] centrally adjudicated with the Minnesota code) at two years. In addition, the patient-oriented composite endpoint (POCE) (composite of all-cause death, any stroke, any MI, and any revascularization) and the net adverse clinical events (NACE) (composite of POCE and Bleeding Academic Research Consortium [BARC] type 3 or 5 bleeding) were also evaluated at two years.
Results
A total of 15,845 patients was included in this analysis, of whom 3,576 patients received multivessel PCI. At two years, the experimental strategy significantly reduced a risk of the primary endpoint (the composite of all-cause death and new Q-wave myocardial infarction [MI]) (3.05% vs. 4.85%, HR: 0.62, 95% CI: 0.44–0.88, p=0.006, Pinteraction=0.031) in patients with multivessel PCI. Similarly, the experimental treatment had a significant risk reduction in the patient-oriented composite endpoint (POCE), defined as the composite of all-cause death, any stroke, any MI, and any revascularization (13.37% vs. 16.74%, HR: 0.78, 95% CI: 0.66–0.93, p=0.005, Pinteraction=0.020) and the net adverse clinical events (NACE), defined as the composite of POCE and Bleeding Academic Research Consortium [BARC] defined bleeding type 3 or 5 (14.65% vs. 18.38%, HR: 0.78, 95% CI: 0.66–0.92, p=0.003, Pinteraction=0.014) at two years. There was no significant difference in BARC type 3 or 5 bleeding (2.44% vs. 2.65%, HR: 0.92, 95% CI: 0.61–1.39, p=0.685, Pinteraction=0.754) at two years between the two regimens.
KM in patients with multivessel PCI
Conclusion
The present study has demonstrated the experimental antiplatelet strategy, when compared with the reference regimen, could potentially have a favourable balance between ischemic efficacy and bleeding safety in patients who underwent multivessel PCI.
Acknowledgement/Funding
The Global Leaders trial was supported by unrestricted grants from AstraZeneca, Biosensors, and The Medicines Company. ECRI (European Cardiovascular R
Collapse
Affiliation(s)
- K Takahashi
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - P Chichareon
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - C C Chang
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - M Tomaniak
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - R Modolo
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - N Kogame
- University of Amsterdam, Amsterdam, Netherlands (The)
| | - H P Stoll
- Biosensors Clinical Research, Morges, Switzerland
| | - C Hamm
- Kerckhoff Heart and Thorax Center, Bad Nauheim, Germany
| | - P G Steg
- University Paris Diderot, Paris, France
| | - Y Onuma
- Erasmus Medical Centre, Rotterdam, Netherlands (The)
| | - M Valgimigli
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - P Vranckx
- Heart Centre Hasselt, Hasselt, Belgium
| | - S Windecker
- Preventive Cardiology & Sports Medicine, Inselspital Bern, Bern, Switzerland
| | - D Carrie
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - P W Serruys
- Imperial College London, London, United Kingdom
| |
Collapse
|
26
|
Chu CY, Cho YT, Jiang JH, Chang CC, Liao SC, Tang CH. Patients with chronic urticaria have a higher risk of psychiatric disorders: a population-based study. Br J Dermatol 2019; 182:335-341. [PMID: 31220338 DOI: 10.1111/bjd.18240] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND The prevalence of psychiatric comorbidities in patients with chronic urticaria (CU) in a national population is largely unknown. OBJECTIVES To investigate the prevalence of psychiatric disorders and psychiatric medication use in patients with CU in Taiwan. METHODS Data were sourced from Taiwan's National Health Insurance Research Database for 2011. Patients who had a primary/secondary International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis code of 708·1, 708·8 or 708·9 during 2011 with at least two outpatient visits and an antihistamine prescription were identified as CU cases. Patients with CU were classified into three disease severity groups according to their medication types. Psychiatric disorders were identified by patients having three outpatient visits with a primary or secondary diagnosis of a given psychiatric disease. Psychiatric medication use was defined by having at least four outpatient visits with prescriptions for anxiolytics, antidepressants or sleeping pills in 2010 or 2011. RESULTS Of the 167 132 patients with CU, 82·5% had mild CU, 17·0% had moderate CU and 0·4% had severe CU. Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication prescription than control groups. The relative risk (RR) of psychiatric disorders was 1·43 for patients with mild, 1·50 for patients with moderate and 2·32 for patients with severe CU vs. the controls (P < 0·001). For psychiatric medication prescription, the RRs were 1·95, 2·70 and 2·09, respectively, vs. controls (P < 0·001). CONCLUSIONS Patients with CU had a higher prevalence and risk of psychiatric disorders and psychiatric medication prescription than control groups. What's already known about this topic? Previous studies have shown a high prevalence of psychiatric comorbidities in patients with chronic urticaria (CU), with rates ranging from 35% to 60%. Anxiety, depression and somatoform disorders have been reported as the most prevalent mental disorders in patients with CU. What does this study add? Patients with CU had a higher prevalence of psychiatric disorders and psychiatric medication use than control groups in the general population. The relative risk (RR) of psychiatric disorders was 1·43 for those with mild CU, 1·50 for those with moderate CU and 2·32 for those with severe CU vs. controls. The RR for psychiatric medication use was 1·95 for those with mild CU, 2·70 for those with moderate CU and 2·09 for those with severe CU vs. controls. Mental health evaluations and management are important elements in CU management.
Collapse
Affiliation(s)
- C Y Chu
- Departments of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - Y T Cho
- Departments of Dermatology, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - J H Jiang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - C C Chang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| | - S C Liao
- Departments of Psychiatry, National Taiwan University Hospital and National Taiwan University College of Medicine, 7 Chung-Shan South Road, Taipei, 10002, Taiwan
| | - C H Tang
- School of Health Care Administration, Taipei Medical University, Taipei, Taiwan
| |
Collapse
|
27
|
Chang T, Ho HL, Hsu SJ, Chang CC, Tsai MH, Huo TI, Huang HC, Lee FY, Hou MC, Lee SD. Glucobrassicin Metabolites Ameliorate the Development of Portal Hypertension and Cirrhosis in Bile Duct-Ligated Rats. Int J Mol Sci 2019; 20:ijms20174161. [PMID: 31454890 PMCID: PMC6747388 DOI: 10.3390/ijms20174161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 08/11/2019] [Accepted: 08/24/2019] [Indexed: 01/24/2023] Open
Abstract
Patients suffering from liver cirrhosis are often complicated with the formation of portosystemic collateral vessels, which is associated with the progression of a splanchnic hyperdynamic circulatory state. Alleviating pathological angiogenesis has thus been proposed to be a feasible treatment strategy. Indole-3-carbinol (C9H9NO, I3C) and 3,3'-diindolymethane (DIM), formed by the breakdown of glucosinolate glucobrassicin, are prevalent in cruciferous vegetables and have anti-angiogenesis properties. We aimed to evaluate their influences on portal hypertension, the severity of mesenteric angiogenesis, and portosystemic collaterals in cirrhosis. Sprague-Dawley rats with common bile duct ligation (CBDL)-induced liver cirrhosis or sham operation (surgical control) were randomly allocated to receive I3C (20 mg/kg/3 day), DIM (5 mg/kg/day) or vehicle for 28 days. The systemic and portal hemodynamics, severity of portosystemic shunting, mesenteric angiogenesis, and mesenteric proangiogenic factors protein expressions were evaluated. Compared to vehicle, both DIM and I3C significantly reduced portal pressure, ameliorated liver fibrosis, and down-regulated mesenteric protein expressions of vascular endothelial growth factor and phosphorylated Akt. DIM significantly down-regulated pErk, and I3C down-regulated NFκB, pIκBα protein expressions, and reduced portosystemic shunting degree. The cruciferous vegetable byproducts I3C and DIM not only exerted a portal hypotensive effect but also ameliorated abnormal angiogenesis and portosystemic collaterals in cirrhotic rats.
Collapse
Affiliation(s)
- Ting Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Hsin-Ling Ho
- Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Lotong Poh-Ai Hospital, Yilan 26546, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan.
- Division of Gastroenterology and Hepatology, Department of Medicine, Lotong Poh-Ai Hospital, Yilan 26546, Taiwan.
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan.
| | - Ming-Hung Tsai
- Chang Gung University College of Medicine and Division of Gastroenterology and Hepatology, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan
| | - Teh-Ia Huo
- Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Medical Research, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Fa-Yauh Lee
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Ming-Chih Hou
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei 11217, Taiwan
- Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei 11217, Taiwan
| |
Collapse
|
28
|
Chang CC, Huang PC. Carbon allowance allocation in the shipping industry under EEDI and non-EEDI. Sci Total Environ 2019; 678:341-350. [PMID: 31075601 DOI: 10.1016/j.scitotenv.2019.04.215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/12/2019] [Accepted: 04/13/2019] [Indexed: 06/09/2023]
Abstract
The CO2 emissions targets in this study are based on the Paris Agreement, which aims to cut emissions in 2050 to half of the 2005 levels, with a focus on the shipping industry. This study uses data for various kinds of vessels following the guidelines set in the Energy Efficiency Design Index (EEDI) and examines emission levels and the results of using different strategies during three different business climates. Carbon allowance allocations and cost benefit ratios (CBR) are included. The results show that the minimal free carbon allowances in 2050 for vessels in keeping with EEDI or non-EEDI scenarios should be set so that (1) under prosperous business cycles they are 29% and 14%; (2) under steady business cycles 83% and 42%; (3) under sluggish business cycles 510% and 255%, respectively. In addition, when shipping companies follow the emission cap guidelines, the CBR in 2050 for vessels in both scenarios will be (1) 37.52% and 47.45% during prosperous business cycles; (2) 43.49% and 45.65%during steady business cycles; (3) and 53.60% and 53.83% during sluggish business cycles, respectively. The results indicate that during prosperous business cycles, although the free carbon allowance for shipping companies will be greatly insufficient, their profits will still be higher than during sluggish business cycles.
Collapse
Affiliation(s)
- Ching-Chih Chang
- Department of Transportation and Communication Management Science and the Research Center for Energy Technology and Strategy, National Cheng Kung University, No. 1, University Road, Tainan 70101, Taiwan.
| | - Po-Chien Huang
- Department of Transportation and Communication Management Science, National Cheng Kung University, No. 1, University Road, Tainan 70101, Taiwan
| |
Collapse
|
29
|
Chang CC, Lirng JF, Wang PN, Wang SJ, Chen CH, Yang LY, Huang WJ, Huang HC. A pilot study of integrating standardized patients in problem-based learning tutorial in Taiwan. J Chin Med Assoc 2019; 82:464-468. [PMID: 31008811 DOI: 10.1097/jcma.0000000000000109] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Problem-based learning (PBL) has been widely adopted in medical education; however, its application has been questioned due to the lack of interaction with a real patient. Standardized patients (SPs) might solve this problem. Herein, we tested the impact of integrating SPs in a PBL tutorial. METHODS In 2017, a total of 313 students, 66 facilitators, and 36 SPs were enrolled at National Yang-Ming University, Taiwan. The SPs presented the symptoms/signs of the cases then the students interviewed them to obtain the detail history. All students, facilitators, and SPs were invited to complete the questionnaires before and after this program. RESULTS Most SPs considered that both the second-year dental medical student and third-year medical students participated actively and were competent enough but students and facilitators considered that the fourth-year medical students might be more prepared. Overall, the students thought highly of the interactions with the SPs. Only about one-fifth felt that this design caused unnecessary pressure among the students and facilitators. They agreed that this program significantly inspired the student's learning motivation (pre- vs post-course: 4.1 ± 0.7 vs 4.3 ± 0.7, p < 0.001), increased their confidence level in interviewing patients (4.0 ± 0.8 vs 4.2 ± 0.7, p < 0.001), and encouraging critical thinking (4.0 ± 0.7 vs 4.2 ± 0.7, p < 0.001). CONCLUSION The SPs, facilitators, and students had different viewpoints with regards to integrating SPs in the PBL tutorial. However, a majority agreed that this design enhanced the motivation of students and supported such an application in PBL tutorials.
Collapse
Affiliation(s)
- Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Jiing-Feng Lirng
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Pei-Ning Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shuu-Jiun Wang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Neurology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ling-Yu Yang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - William J Huang
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| |
Collapse
|
30
|
Su CJ, Pan SW, Huang LJ, Yang LY, Yang YY, Hwang SJ, Chuang CL, Chang CC, Huang HC, Kao SY, Lee FY. Trios-OSCE-based simulation course enhances the subcompetency of emergency-stabilization for postgraduate year-1 residents. J Chin Med Assoc 2019; 82:407-412. [PMID: 31058714 DOI: 10.1097/jcma.0000000000000089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND For patient safety, this study aims to evaluate the effectiveness of additional objective structured clinical examination (OSCE)-based medical simulation courses to establish the "emergency-stabilization" subcompetency of postgraduate first year (PGY-1) residents. METHODS In the simulation course, trainees were randomly divided into three groups: intervention, regular, and control group as Trios-OSCE trainees, Single-OSCE trainees, or OSCE observers (feedback-givers) after attending the pre-OSCE common simulation workshop. Three PGY-1 residents rotated through the Trios OSCE long-station together, while single PGY-1 residents rotated through regular OSCE alone and the control group gave feedback after observation of their peers' OSCE performance. Using Queen's simulation assessment tool, either in Trios-OSCE or Single-OSCE, performance levels were rated as either inferior, novice, competent, advanced or superior in the "therapeutic actions" and "communication" domains. The "overall performances" of all trainees were graded by qualified assessors, experienced facilitators, and standardized senior nurse. RESULTS The proportion of "overall performance" of trainee's, rated by an experienced facilitator as "above competent level," was significantly higher in intervention group A than in regular group B. After training, the degree of increase in self-efficacy scores was higher among the intervention group than the regular and control groups. In the follow-up stage, a trend of increasing self-efficacy scores was noted in both the interventional and regular groups. For all trainees among the three groups, high postcourse value scores confirm that the new Trios-OSCE model meets the needs of trainees and also motivates the self-directed learning and self-reflection of trainees. CONCLUSION Our results provide initial evidence that the new emergency-stabilization-enhanced Trios-OSCE-based medical simulation course including the additional training capacity offered by adding an observer group had positive effects on PGY-1 residents' self-efficacy and clinical transfer.
Collapse
Affiliation(s)
- Chia-Jui Su
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Sheng-Wei Pan
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ling-Ju Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ling-Yu Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shinn-Jang Hwang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shou-Yen Kao
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
31
|
Goh SW, Adawiyah J, Md Nor N, Yap F, Ch'ng P, Chang CC. Skin eruption induced by dieting - an underdiagnosed skin disease in Malaysia. Malays Fam Physician 2019; 14:42-46. [PMID: 31289632 PMCID: PMC6612274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Prurigo pigmentosa is an inflammatory dermatosis characterized by a pruritic, symmetrically distributed erythematous papular or papulo-vesicular eruption on the trunk arranged in a reticulated pattern that resolves with hyperpigmentation. It is typically non-responsive to topical or systemic steroid therapy. The exact etiology is unknown, but it is more commonly described in the Far East countries. Dietary change is one of the predisposing factors. We report on nine young adult patients with prurigo pigmentosa, among whom five were on ketogenic diets prior to the onset of the eruptions. All cases resolved with oral doxycycline with no recurrence. We hope to improve the awareness of this uncommon skin condition among general practitioners and physicians so that disfiguring hyperpigmentation due to delayed diagnosis and treatment can be avoided.
Collapse
Affiliation(s)
- S W Goh
- MB BCh (Soton), MRCP (UK) Medical Department, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur Malaysia.,
| | - J Adawiyah
- MB BCh BAO, MMed (UKM) AdvMDerm (UKM), University Kebangsaan Malaysia Medical Centre, Kuala Lumpur Malaysia.,
| | - N Md Nor
- MBBCH (Cardiff), MRCP (UK), AdvMDerm (UKM), Medical Department, University Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia.
| | - Fbb Yap
- MD (UNIMAS), MRCP (UK), AdvMDerm (UKM), Universiti Tunku Abdul Rahman, Selangor, Malaysia,
| | - Pwb Ch'ng
- MD (UKM), MRCP (UK), AdvMDerm (UKM), Gleneagles Kuala Lumpur Kuala Lumpur, Malaysia,
| | - C C Chang
- MBBS (Malaya), MRCP (UK), AdvMDerm (UKM), Gleneagles Kuala Lumpur, Kuala Lumpur, Malaysia
| |
Collapse
|
32
|
Abstract
BACKGROUND Ivabradine is a funny current inhibitor which is administered to patients with congestive heart failure to reduce their heart rate (HR) and attenuate oxidative stress. Chronic liver diseases are characterized by portal hypertension and hyperdynamic circulation with tachycardia. The present study aimed to investigate the effect of ivabradine on portal hypertension. METHODS Male Sprague-Dawley rats received partial portal vein ligation (PVL) to induce portal hypertension. The PVL rats were randomly allocated to receive either vehicle or ivabradine treatment for 10 days. Then the hemodynamic data were collected. The levels of oxidative stress markers and the mRNA expression of nitric oxide synthase (NOS) were measured in the collateral vessel, the superior mesentery artery and the liver. In addition, the collateral vascular responsiveness to arginine vasopressin (AVP) was examined in the ivabradine-treated and vehicle-treated PVL rats. RESULTS Treatment with ivabradine significantly lowered the HR (174 ± 20 vs. 374 ± 9 beats/min; p < 0.001) and the superior mesentery arterial flow (SMAf) (6.6 ± 0.3 vs. 9.1 ± 0.7 mL/min/100 g BW; p = 0.005) of the PVL rats compared with the control group. The mean arterial pressure, cardiac index, systemic vascular resistance, portal pressure and serum levels of oxidative stress markers were not significantly affected by ivabradine treatment. In addition, the NOS expression and collateral vascular responsiveness to AVP were not significantly influenced by ivabradine treatment, either. CONCLUSION Ivabradine reduced the HR and SMAf in PVL rats, which alleviated the hyperdynamic circulatory state and splanchnic hyperemia of portal hypertension. However, whether these effects would help alleviate portal hypertension-related complications requires further clinical investigations.
Collapse
Affiliation(s)
- Ching-Chih Chang
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Wen-Shin Lee
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - I-Fang Hsin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shao-Jung Hsu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Divisions of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
- Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
33
|
Chuang CL, Chang CC, Hsu SJ, Huang HC, Lee FY, Huang LJ, Lee SD. Endotoxemia-enhanced renal vascular reactivity to endothelin-1 in cirrhotic rats. Am J Physiol Gastrointest Liver Physiol 2018; 315:G752-G761. [PMID: 30095297 DOI: 10.1152/ajpgi.00302.2017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Hepatorenal syndrome (HRS), a severe complication of advanced cirrhosis, is defined as hypoperfusion of kidneys resulting from intense renal vasoconstriction in response to generalized systemic arterial vasodilatation. Nevertheless, the mechanisms have been barely investigated. Cumulative studies demonstrated renal vasodilatation in portal hypertensive and compensated cirrhotic rats. Previously, we identified that blunted renal vascular reactivity of portal hypertensive rats was reversed after lipopolysaccharide (LPS). This study was therefore conducted to delineate the sequence of renal vascular alternation and underlying mechanisms in LPS-treated cirrhotic rats. Sprague-Dawley rats were randomly allocated to receive sham surgery (Sham) or common bile duct ligation (CBDL). LPS was induced on the 28th day after surgery. Kidney perfusion was performed at 0.5 or 3 h after LPS to evaluate renal vascular response to endothelin-1 (ET-1). Endotoxemia increased serum ET-1 levels ( P < 0.0001) and renal arterial blood flow ( P < 0.05) in both Sham and CBDL rats. CBDL rats showed enhanced renal vascular reactivity to ET-1 at 3 h after LPS ( P = 0.026). Pretreatment with endothelin receptor type A (ETA) antagonist abrogated the LPS-enhanced renal vascular response in CBDL rats ( P < 0.001). There were significantly lower inducible nitric oxide synthase (iNOS) expression but higher ETA and phosphorylated extracellular signal-regulated kinase (p-ERK) expressions in renal medulla of endotoxemic CBDL rats ( P < 0.05). We concluded that LPS-induced renal iNOS inhibition, ETA upregulation, and subsequent ERK signaling activation may participate in renal vascular hyperreactivity in cirrhosis. ET-1-targeted therapy may be feasible in the control of HRS. NEW & NOTEWORTHY Hepatorenal syndrome (HRS) occurred in advanced cirrhosis after large-volume paracentesis or bacterial peritonitis. We demonstrated that intraperitoneal lipopolysaccharide (LPS) enhanced renal vascular reactivity to endothelin-1 (ET-1) in cirrhotic rats, accompanied by inducible nitric oxide synthase inhibition, endothelin receptor type A (ETA) upregulation, and subsequent extracellular signal-regulated kinase activation in renal medulla. Pretreatment with ETA antagonist abrogated the LPS-enhanced renal vascular response in common bile duct ligation rats. These findings suggest that further clinical investigation of ET-1-targeted therapy may be feasible in the control of HRS.
Collapse
Affiliation(s)
- Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine , Taipei , Taiwan
| | - Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine , Taipei , Taiwan
| | - Shao-Jung Hsu
- Faculty of Medicine, National Yang-Ming University School of Medicine , Taipei , Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan
| | - Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine , Taipei , Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine , Taipei , Taiwan.,Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan
| | - Ling-Ju Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan.,Faculty of Medicine, National Yang-Ming University School of Medicine , Taipei , Taiwan.,Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital , Taipei , Taiwan
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine , Taipei , Taiwan.,Division of Gastroenterology, Department of Medicine, Cheng-Hsin General Hospital , Taipei , Taiwan
| |
Collapse
|
34
|
Nicholson A, Berkowitz E, Monge-Camacho H, Brantley D, Garron N, Chang CC, Rinaldi E, Clark MA, Joó B, Kurth T, Tiburzi BC, Vranas P, Walker-Loud A. Heavy Physics Contributions to Neutrinoless Double Beta Decay from QCD. Phys Rev Lett 2018; 121:172501. [PMID: 30411940 DOI: 10.1103/physrevlett.121.172501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Indexed: 06/08/2023]
Abstract
Observation of neutrinoless double beta decay, a lepton number violating process that has been proposed to clarify the nature of neutrino masses, has spawned an enormous world-wide experimental effort. Relating nuclear decay rates to high-energy, beyond the standard model (BSM) physics requires detailed knowledge of nonperturbative QCD effects. Using lattice QCD, we compute the necessary matrix elements of short-range operators, which arise due to heavy BSM mediators, that contribute to this decay via the leading order π^{-}→π^{+} exchange diagrams. Utilizing our result and taking advantage of effective field theory methods will allow for model-independent calculations of the relevant two-nucleon decay, which may then be used as input for nuclear many-body calculations of the relevant experimental decays. Contributions from short-range operators may prove to be equally important to, or even more important than, those from long-range Majorana neutrino exchange.
Collapse
Affiliation(s)
- A Nicholson
- Department of Physics and Astronomy, University of North Carolina, Chapel Hill, North Carolina 27516-3255, USA
- Department of Physics, University of California, Berkeley, California 94720, USA
| | - E Berkowitz
- Institut für Kernphysik and Institute for Advanced Simulation, Forschungszentrum Jülich, 54245 Jülich, Germany
| | - H Monge-Camacho
- Department of Physics, The College of William & Mary, Williamsburg, Virginia 23187, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - D Brantley
- Department of Physics, The College of William & Mary, Williamsburg, Virginia 23187, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Physics Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - N Garron
- Theoretical Physics Division, Department of Mathematical Sciences, University of Liverpool, Liverpool L69 3BX, United Kingdom
| | - C C Chang
- Department of Physics, University of California, Berkeley, California 94720, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Interdisciplinary Theoretical and Mathematical Sciences Program (iTHEMS), RIKEN 2-1 Hirosawa, Wako, Saitama 351-0198, Japan
| | - E Rinaldi
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- RIKEN-BNL Research Center, Brookhaven National Laboratory, Upton, New York 11973, USA
| | - M A Clark
- NVIDIA Corporation, 2701 San Tomas Expressway, Santa Clara, California 95050, USA
| | - B Joó
- Scientific Computing Group, Thomas Jefferson National Accelerator Facility, Newport News, Virginia 23606, USA
| | - T Kurth
- NERSC Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
| | - B C Tiburzi
- Department of Physics, The City College of New York, New York, New York 10031, USA
- Graduate School and University Center, The City University of New York, New York, New York 10016, USA
| | - P Vranas
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Physics Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| | - A Walker-Loud
- Department of Physics, University of California, Berkeley, California 94720, USA
- Nuclear Science Division, Lawrence Berkeley National Laboratory, Berkeley, California 94720, USA
- Physics Division, Lawrence Livermore National Laboratory, Livermore, California 94550, USA
| |
Collapse
|
35
|
Hsieh YH, Huang HC, Chang CC, Chuang CL, Lee FY, Hsu SJ, Huang YH, Hou MC, Lee SD. Nucleos(t)ide Analogs Do Not Independently Influence Hepatic Fibrosis and Portal Hypertension beyond Viral Suppression in CBDL-Induced Cirrhotic Rat. J Pharmacol Exp Ther 2018; 367:260-266. [PMID: 30194095 DOI: 10.1124/jpet.118.250431] [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: 05/26/2018] [Accepted: 08/07/2018] [Indexed: 11/22/2022] Open
Abstract
Chronic hepatitis is the major cause of liver cirrhosis and portal hypertension. Several factors affect portal pressure, including liver fibrosis, splanchnic vasodilatation, and pathologic angiogenesis. Nucleos(t)ide analogs (NUCs), the oral antiviral agents, effectively attenuate chronic hepatitis B-related liver cirrhosis and portal hypertension via viral suppression and alleviation of hepatitis. On the other hand, NUCs affect tumor necrosis factor (TNF)-α, vascular endothelial growth factor (VEGF), and nitric oxide, which participate in fibrogenesis, vasodilatation, and angiogenesis. However, whether NUCs independently influence liver fibrosis and portal hypertension beyond viral suppression is unknown. This study thus aimed to evaluate the influences of three frequently used NUCs in rats with nonviral cirrhosis. Male Sprague-Dawley rats received common bile duct ligation (CBDL) to induce cholestatic cirrhosis and portal hypertension. The rats were randomly allocated into four groups, treated by mouth with lamivudine (30 mg/kg per day), entecavir (0.09 mg/kg per day), tenofovir (50 mg/kg per day), or distilled water (vehicle control) from the 15th day after CBDL. On the 29th day, liver cirrhosis- and portal hypertension-related parameters were evaluated. The results showed that chronic NUCs treatment did not affect hemodynamic parameters, plasma TNF-α concentration, and hepatic fibrogenesis protein expressions in rats with nonviral cirrhosis. Though the mesenteric VEGF receptor 2 phosphorylation was downregulated in NUCs-treated groups, the splanchnic angiogenesis was not influenced. In conclusion, lamivudine, entecavir, and tenofovir had no additional effects on liver cirrhosis and portal hypertension in rats with nonviral cirrhosis.
Collapse
Affiliation(s)
- Yu-Hsin Hsieh
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| | - Hui-Chun Huang
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| | - Ching-Chih Chang
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| | - Chiao-Lin Chuang
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| | - Shao-Jung Hsu
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| | - Yi-Hsiang Huang
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| | - Ming-Chih Hou
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| | - Shou-Dong Lee
- Division of Gastroenterology and Hepatology, Department of Medicine (Y.-H.Hs, H.-C.H., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H.) and Division of General Medicine, Department of Medicine, (Y.-H.Hs, H.-C.H., C.-C.C., C.-L.C.), Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan (H.-C.H., C.-C.C., C.-L.C., F.-Y.L., S.-J.H., Y.-H.Hu, M.-C.H., S.-D.L.); and Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan (S.-D.L.)
| |
Collapse
|
36
|
Huang CC, Hsu HC, Yang LY, Chen CH, Yang YY, Chang CC, Chuang CL, Lee WS, Lee FY, Hwang SJ. Peer-assisted learning model enhances clinical clerk's procedural skills. J Chin Med Assoc 2018; 81:747-753. [PMID: 29779999 DOI: 10.1016/j.jcma.2017.06.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Failure to transfer procedural skills learned in a laboratory to the bedside is commonly due to a lack of peer support/stimulation. A digital platform (Facebook) allows new clinical clerks to share experiences and tips that help augment their procedural skills in a peer-assisted learning/teaching method. This study aims to investigate the effectiveness of the innovation of using the digital platform to support the transfer of laboratory-trained procedural skills in the clinical units. METHODS Volunteer clinical clerks (n = 44) were enrolled into the peer-assisted learning (PAL) group, which was characterized by the peer-assisted learning of procedural skills during their final 3-month clinical clerkship block. Other clerks (n = 51) did not join the procedural skills-specific Facebook group and served as the self-directed learning regular group. The participants in both the PAL and regular groups completed pre- and post-intervention self-assessments for general self-assessed efficiency ratings (GSER) and skills specific self-assessed efficiency ratings (SSSER) for performing vein puncture, intravenous (IV) catheter and nasogastric (NG) tube insertion. Finally, all clerks received the post-intervention 3-station Objective Structured Clinical Skills Examination (OSCE) to test their proficiency for the abovementioned three procedural skills. RESULTS Higher cumulative numbers of vein punctures, IV catheter insertions and NG tube insertions at the bedside were carried out by the PAL group than the regular group. A greater improvement in GSERs and SSSERs for medical procedures was found in the PAL group than in the regular group. The PAL group obtained higher procedural skills scores in the post-intervention OSCEs than the regular group. CONCLUSION Our study suggested that the implementation of a procedural skill-specific digital platform effectively helps clerks to transfer laboratory-trained procedural skills into the clinical units. In comparison with the regular self-directed learning group, the peer-assisted learning characteristics of Facebook give additional benefits to the PAL group by enhancing their procedural skills.
Collapse
Affiliation(s)
- Chia-Chang Huang
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Institute of Clinical Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Hui-Chi Hsu
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC; Camillians Saint Mary's Hospital, Luodong, Yilan, Taiwan, ROC
| | - Ling-Yu Yang
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chen-Huan Chen
- Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Ying-Ying Yang
- Division of Clinical Skills Training, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
| | - Ching-Chih Chang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Wei-Shin Lee
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| | - Shinn-Jang Hwang
- Taipei Veterans General Hospital, Taipei, Taiwan, ROC; School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC
| |
Collapse
|
37
|
Prouty NG, Roark EB, Mohon LM, Chang CC. Uptake and distribution of organo-iodine in deep-sea corals. J Environ Radioact 2018; 187:122-132. [PMID: 29452767 DOI: 10.1016/j.jenvrad.2018.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 10/04/2017] [Revised: 12/18/2017] [Accepted: 01/04/2018] [Indexed: 06/08/2023]
Abstract
Understanding iodine concentration, transport, and bioavailability is essential in evaluating iodine's impact to the environment and its effectiveness as an environmental biogeotracer. While iodine and its radionuclides have proven to be important tracers in geologic and biologic studies, little is known about transport of this element to the deep sea and subsequent uptake in deep-sea coral habitats. Results presented here on deep-sea black coral iodine speciation and iodine isotope variability provides key information on iodine behavior in natural and anthropogenic environments, and its geochemical pathway in the Gulf of Mexico. Organo-iodine is the dominant iodine species in the black corals, demonstrating that binding of iodine to organic matter plays an important role in the transport and transfer of iodine to the deep-sea corals. The identification of growth bands captured in high-resolution scanning electron images (SEM) with synchronous peaks in iodine variability suggest that riverine delivery of terrestrial-derived organo-iodine is the most plausible explanation to account for annual periodicity in the deep-sea coral geochemistry. Whereas previous studies have suggested the presence of annual growth rings in deep-sea corals, this present study provides a mechanism to explain the formation of annual growth bands. Furthermore, deep-sea coral ages based on iodine peak counts agree well with those ages derived from radiocarbon (14C) measurements. These results hold promise for developing chronologies independent of 14C dating, which is an essential component in constraining reservoir ages and using radiocarbon as a tracer of ocean circulation. Furthermore, the presence of enriched 129I/127I ratios during the most recent period of skeleton growth is linked to nuclear weapons testing during the 1960s. The sensitivity of the coral skeleton to record changes in surface water 129I composition provides further evidence that iodine composition and isotope variability captured in proteinaceous deep-sea corals is a promising geochronometer as well as an emerging tracer for continental material flux.
Collapse
Affiliation(s)
- Nancy G Prouty
- US Geological Survey, 2885 Mission St., Santa Cruz, CA 95060, United States.
| | - E Brendan Roark
- Department of Geography, Texas A&M University, College Station, TX 77843, United States
| | - Leslye M Mohon
- Department of Geography, Texas A&M University, College Station, TX 77843, United States
| | - Ching-Chih Chang
- University of Arizona, Department of Geosciences, Tuscon, AZ 85721, United States
| |
Collapse
|
38
|
Dixon PC, Stirling L, Xu X, Chang CC, Dennerlein JT, Schiffman JM. Aging may negatively impact movement smoothness during stair negotiation. Hum Mov Sci 2018; 60:78-86. [PMID: 29843055 DOI: 10.1016/j.humov.2018.05.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [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: 05/09/2017] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/25/2022]
Abstract
Stairs represent a barrier to safe locomotion for some older adults, potentially leading to the adoption of a cautious gait strategy that may lack fluidity. This strategy may be characterized as unsmooth; however, stair negotiation smoothness has yet to be quantified. The aims of this study were to assess age- and task-related differences in head and body center of mass (COM) acceleration patterns and smoothness during stair negotiation and to determine if smoothness was associated with the timed "Up and Go" (TUG) test of functional movement. Motion data from nineteen older and twenty young adults performing stair ascent, stair descent, and overground straight walking trials were analyzed and used to compute smoothness based on the log-normalized dimensionless jerk (LDJ) and the velocity spectral arc length (SPARC) metrics. The associations between TUG and smoothness measures were evaluated using Pearson's correlation coefficient (r). Stair tasks increased head and body COM acceleration pattern differences across groups, compared to walking (p < 0.05). LDJ smoothness for the head and body COM decreased in older adults during stair descent, compared to young adults (p ≤ 0.015) and worsened with increasing TUG for all tasks (-0.60 ≤ r ≤ -0.43). SPARC smoothness of the head and body COM increased in older adults, regardless of task (p < 0.001), while correlations showed improved SPARC smoothness with increasing TUG for some tasks (0.33 ≤ r ≤ 0.40). The LDJ outperforms SPARC in identifying age-related stair negotiation adaptations and is associated with performance on a clinical test of gait.
Collapse
Affiliation(s)
- P C Dixon
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA; Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA
| | - L Stirling
- Department of Aeronautics and Astronautics, Massachusetts Institute of Technology, Cambridge, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, USA
| | - X Xu
- Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA
| | - C C Chang
- Department of Industrial Engineering & Engineering Management, National Tsing Hua University, Taiwan, ROC
| | - J T Dennerlein
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, USA; Bouvé College of Health Sciences, Northeastern University Boston, USA Sciences, Northeastern University, Boston, USA.
| | - J M Schiffman
- Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA
| |
Collapse
|
39
|
Naderi A, Koschella A, Heinze T, Shih KC, Nieh MP, Pfeifer A, Chang CC, Erlandsson J. Corrigendum to "Sulfoethylated nanofibrillated cellulose: Production and properties" [Carbohydr. Polym. 169 (2017) 515-523]. Carbohydr Polym 2018; 179:1. [PMID: 29111030 DOI: 10.1016/j.carbpol.2017.09.021] [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] [Indexed: 11/16/2022]
Affiliation(s)
- A Naderi
- Innventia AB, Box 5604, SE-11486 Stockholm, Sweden.
| | - A Koschella
- Friedrich Schiller University of Jena, Institute for Organic Chemistry and Macromolecular Chemistry, Center of Excellence for Polysaccharide Research, Humboldtstraße 10, D-07743, Jena, Germany.
| | - T Heinze
- Friedrich Schiller University of Jena, Institute for Organic Chemistry and Macromolecular Chemistry, Center of Excellence for Polysaccharide Research, Humboldtstraße 10, D-07743, Jena, Germany.
| | - K C Shih
- Department of Chemical & Biomolecular Engineering, 97 North Eagleville Road, Storrs, CT-06269-3136, United States; Department of Agricultural Chemistry, Taiwan.
| | - M P Nieh
- Department of Chemical & Biomolecular Engineering, 97 North Eagleville Road, Storrs, CT-06269-3136, United States.
| | - A Pfeifer
- Friedrich Schiller University of Jena, Institute for Organic Chemistry and Macromolecular Chemistry, Center of Excellence for Polysaccharide Research, Humboldtstraße 10, D-07743, Jena, Germany.
| | - C C Chang
- ThINC Facility at Advanced Energy Research & Technology Center, 1000 Innovation Road, Stony Brook, NY, 11794-6044, United States.
| | - J Erlandsson
- Department of Fibre and Polymer Technology, KTH - Royal Institute of Technology, Teknikringen 56, SE-100 44 Stockholm, Sweden.
| |
Collapse
|
40
|
Abstract
Tracheal bronchus is a congenital anatomical variant of patients with accessory bronchus in the right upper lobe deriving directly from the supracarinal trachea. Pre-operative consultation with the anesthesiologist is important for patient safety and can avoid adverse effects induced by endotracheal intubation. In this report, we described a case of tracheal bronchus in which general anesthesia was performed for video-assisted thoracoscopic surgery. We discussed some of the issues surrounding to complications in tracheal bronchus.
Collapse
Affiliation(s)
- K M Lai
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - M H Hsieh
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - F Lam
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan
| | - C Y Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - T L Chen
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - C C Chang
- Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| |
Collapse
|
41
|
Cheng TY, Lee WS, Huang HC, Lee FY, Chang CC, Lin HC, Lee SD. The effects of pioglitazone in cirrhotic rats with hepatopulmonary syndrome. J Chin Med Assoc 2017; 80:683-689. [PMID: 28969989 DOI: 10.1016/j.jcma.2017.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2017] [Revised: 08/16/2017] [Accepted: 06/12/2017] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Hepatopulmonary syndrome (HPS) is characterized by oxygen desaturation and increased intrapulmonary shunting formation in cirrhosis. Due to an unclarified mechanism, there is still no effective therapy except liver transplantation. Recent studies revealed that pulmonary angiogenesis may participate in pathogenesis, in which nitric oxide (NO) and vascular endothelial growth factor (VEGF) play roles. Pioglitazone, a peroxisome proliferator-activated receptor gamma agonist, exerts anti-angiogenesis effect. However, whether pioglitazone influences pulmonary angiogenesis, shunting and HPS remains unexplored. METHODS Cirrhosis with HPS was induced in Spraque-Dawley rats with common bile duct ligation (CBDL). Pioglitazone (10 mg/kg/day, oral gavage) or vehicle was administered from 8th to 28th day post CBDL. On the 28th day, the mortality rate, hemodynamic parameters, concentrations of plasma glucose and liver biochemistry parameters, and arterial blood gas data were evaluated. Lungs were dissected for protein expression analyses. In another series, intrapulmonary shunting degree was determined by color microsphere method in paralleled groups. RESULTS The survival rates were similar in HPS rats with or without pioglitazone administration. Pioglitazone did not influence the hemodynamic parameters, glucose and liver biochemistry levels, oxygen saturation and alveolar arterial gradient, but significantly down-regulated pulmonary VEGF protein expression, endothelial NO synthase (eNOS) activation, and decreased intrapulmonary shunts. Pioglitazone significantly decreased intrapulmonary shunts as compared with the vehicle (18.1 ± 4.5 vs. 9.8 ± 3.6, p = 0.015). CONCLUSION Pioglitazone down-regulated VEGF, eNOS and decreased intrapulmonary shunts without improving oxygenation. The current finding suggests a multifactorial mechanism of HPS that could not be successfully overcome merely by pioglitazone-induced anti-angiogenesis and shunting reduction.
Collapse
Affiliation(s)
- Tsung-Yi Cheng
- Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Wen-Shin Lee
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
| | - Han-Chieh Lin
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Division of Gastroenterology, Department of Medicine, Cheng Hsin General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
42
|
Faber GS, Koopman AS, Kingma I, Chang CC, Dennerlein JT, van Dieën JH. Continuous ambulatory hand force monitoring during manual materials handling using instrumented force shoes and an inertial motion capture suit. J Biomech 2017; 70:235-241. [PMID: 29157658 DOI: 10.1016/j.jbiomech.2017.10.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [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: 06/20/2017] [Revised: 09/20/2017] [Accepted: 10/15/2017] [Indexed: 11/17/2022]
Abstract
Hand forces (HFs) are commonly measured during biomechanical assessment of manual materials handling; however, it is often a challenge to directly measure HFs in field studies. Therefore, in a previous study we proposed a HF estimation method based on ground reaction forces (GRFs) and body segment accelerations and tested it with laboratory equipment: GFRs were measured with force plates (FPs) and segment accelerations were measured using optical motion capture (OMC). In the current study, we evaluated the HF estimation method based on an ambulatory measurement system, consisting of inertial motion capture (IMC) and instrumented force shoes (FSs). Sixteen participants lifted and carried a 10-kg crate from ground level while 3D full-body kinematics were measured using OMC and IMC, and 3D GRFs were measured using FPs and FSs. We estimated 3D hand force vectors based on: (1) FP+OMC, (2) FP+IMC and (3) FS+IMC. We calculated the root-mean-square differences (RMSDs) between the estimated HFs to reference HFs calculated based on crate kinematics and the GRFs of a FP that the crate was lifted from. Averaged over subjects and across 3D force directions, the HF RMSD ranged between 10-15N when using the laboratory equipment (FP + OMC), 11-18N when using the IMC instead of OMC data (FP+IMC), and 17-21N when using the FSs in combination with IMC (FS + IMC). This error is regarded acceptable for the assessment of spinal loading during manual lifting, as it would results in less than 5% error in peak moment estimates.
Collapse
Affiliation(s)
- G S Faber
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA.
| | - A S Koopman
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - I Kingma
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - C C Chang
- Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA; Department of Industrial Engineering & Engineering Management, National Tsing Hua University, Taiwan, ROC
| | - J T Dennerlein
- Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, MA, USA
| | - J H van Dieën
- Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences, Amsterdam, The Netherlands
| |
Collapse
|
43
|
Ko HH, Chang CC, Lin CH, Kuo YH, Chen IS, Chang HS. Bioactive chemical constituents isolated from the root of Neolitsea acuminatissima. Am J Transl Res 2017. [DOI: 10.1055/s-0037-1608145] [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] [Indexed: 10/18/2022]
Affiliation(s)
- HH Ko
- Department of Fragrance and Cosmetic Science, Kaohsiung Medical University, Kaohsiung, Taiwan
- Research Center for Natural Products and Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - CC Chang
- Department of Fragrance and Cosmetic Science, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - CH Lin
- Research Center for Natural Products and Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - YH Kuo
- Department of Chinese Pharmaceutical Science and Chinese Medicine Resources, China Medical University, Taichung, Taiwan
- Department of Biotechnology, Asia University, Taichung, Taiwan
| | - IS Chen
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - HS Chang
- Research Center for Natural Products and Drug Development, Kaohsiung Medical University, Kaohsiung, Taiwan
- School of Pharmacy, Kaohsiung Medical University, Kaohsiung, Taiwan
| |
Collapse
|
44
|
Åmellem I, Suresh S, Chang CC, Tok SSL, Tashiro A. A critical period for antidepressant-induced acceleration of neuronal maturation in adult dentate gyrus. Transl Psychiatry 2017; 7:e1235. [PMID: 28925998 PMCID: PMC5639251 DOI: 10.1038/tp.2017.208] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 11/15/2022] Open
Abstract
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly used medications for mood and anxiety disorders, and adult neurogenesis in the dentate gyrus has been shown to be involved in the behavioral effects of SSRIs in mice. Studies have shown the varied effects of chronic treatment with SSRIs on adult neurogenesis. One such effect is the acceleration of neuronal maturation, which affects the functional integration of new neurons into existing neuronal circuitry. In this study, we labeled new neurons by using GFP-expressing retroviral vectors in mice and investigated the effect of an SSRI, fluoxetine, on these neurons at different time points after neuronal birth. Chronic treatment with fluoxetine accelerated the dendritic development of the newborn neurons and shifted the timing of the expression of the maturational marker proteins, doublecortin and calbindin. This accelerated maturation was observed even after sub-chronic treatment, only when fluoxetine was administered during the second week of neuronal birth. These results suggest the existence of a 'critical period' for the fluoxetine-induced maturation of new neurons. We propose that the modified functional integration of new neurons in the critical period may underlie the behavioral effects of fluoxetine by regulating anxiety-related decision-making processes.
Collapse
Affiliation(s)
- I Åmellem
- Kavli Institute for Systems Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway,St Olavs Hospital, Trondheim, Norway,Warwick-NTU Neuroscience Programme, School of Biological Sciences, Nanyang Technological University, Singapore,Warwick-NTU Neuroscience Programme, School of Life Sciences, University of Warwick, Coventry, UK,Warwick-NTU Neuroscience Programme, School of Biological Sciences, Nanyang Technological University, 11 Mandalay Road #12-01B, Singapore 308232. E-mail: or
| | - S Suresh
- Warwick-NTU Neuroscience Programme, School of Biological Sciences, Nanyang Technological University, Singapore,Warwick-NTU Neuroscience Programme, School of Life Sciences, University of Warwick, Coventry, UK
| | - C C Chang
- Warwick-NTU Neuroscience Programme, School of Biological Sciences, Nanyang Technological University, Singapore,Warwick-NTU Neuroscience Programme, School of Life Sciences, University of Warwick, Coventry, UK
| | - S S L Tok
- Warwick-NTU Neuroscience Programme, School of Biological Sciences, Nanyang Technological University, Singapore,Warwick-NTU Neuroscience Programme, School of Life Sciences, University of Warwick, Coventry, UK
| | - A Tashiro
- Kavli Institute for Systems Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway,St Olavs Hospital, Trondheim, Norway,Warwick-NTU Neuroscience Programme, School of Biological Sciences, Nanyang Technological University, Singapore,Warwick-NTU Neuroscience Programme, School of Life Sciences, University of Warwick, Coventry, UK,Warwick-NTU Neuroscience Programme, School of Biological Sciences, Nanyang Technological University, 11 Mandalay Road #12-01B, Singapore 308232. E-mail: or
| |
Collapse
|
45
|
Ko MT, Huang HC, Lee WS, Chuang CL, Hsin IF, Hsu SJ, Lee FY, Chang CC, Lee SD. Metformin reduces intrahepatic fibrosis and intrapulmonary shunts in biliary cirrhotic rats. J Chin Med Assoc 2017; 80:467-475. [PMID: 28676445 DOI: 10.1016/j.jcma.2017.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Revised: 05/23/2017] [Accepted: 03/27/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Liver fibrosis causes portal hypertension which dilates collateral vasculature and enhances extra-hepatic angiogenesis including intrapulmonary shunts, which subsequently complicates with hepatopulmonary syndrome. Metformin is an anti-diabetic agent which possesses anti-inflammation and anti-angiogenesis properties. This study evaluated the effect of metformin treatment on liver and lung in a non-diabetic rat model with biliary cirrhosis induced via common bile duct ligation (CBDL). METHODS CBDL rats were fed with metformin 150 mg/kg/day during the 8th-28th day post operation. The hemodynamic and biochemistry parameters were tested, and blood gas analysis was performed. The liver and lung were dissected for protein analysis and immuno-histochemical stains. Intrapulmonary shunting degree was determined using color microsphere method. RESULTS Metformin treatment neither induced obvious hypoglycemic event nor altered hemodynamics in cirrhotic rats. The plasma levels of alanine aminotransferase were significantly reduced by metformin (control vs. metformin: 269 ± 56 vs. 199 ± 21 IU/L, P = 0.02). Sirius Red stains and CD-68 stains showed that metformin reduced intrahepatic fibrosis and CD-68-positive macrophages. Metformin did not influence hypoxia and intrapulmonary angiogenesis; however, it significantly reduced intrapulmonary shunts (31.7 ± 10.1 vs. 15.0 ± 6.6%, P = 0.006.). Furthermore, metformin reduced the protein expressions of COX-2 and PI3K in liver and COX-1 in lung. CONCLUSION Metformin reduced liver injury and improved hepatic fibrosis in cirrhotic rats. It also attenuated the intrapulmonary shunts. However, the effects of metformin on pulmonary angiogenesis and hypoxia were insignificant.
Collapse
Affiliation(s)
- Mu-Tzu Ko
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Hui-Chun Huang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Wen-Shin Lee
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Chiao-Lin Chuang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - I-Fang Hsin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Division of Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Shao-Jung Hsu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC
| | - Ching-Chih Chang
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan, ROC; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC.
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC; Cheng-Hsin General Hospital, Taipei, Taiwan, ROC
| |
Collapse
|
46
|
Li HY, Duan Y, Yang BQ, Chang CC, Liu N, Zhang LX, Lin S. [Analysis of the correlation between deep medullary veins and clinical prognosis of middle cerebral artery stroke]. Zhonghua Yi Xue Za Zhi 2017; 97:1956-1959. [PMID: 28693074 DOI: 10.3760/cma.j.issn.0376-2491.2017.25.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the relativity between the distribution of deep medullary vein (DMV) in patients with middle cerebral artery stroke and clinical prognosis by using susceptibility-weighted imaging (SWI). Methods: A total of 144 cases of middle cerebral artery stroke patients and 55 healthy volunteers were retrospectively analyzed from January 2015 to October 2015 in order to investigate the symmetrical characteristic and the classification of DMV, then 30 cases were followed up. Kappa test was used to consider the consistency of judging DMV symmetry and type data by two radiologists. Results:Kappa value in DMV symmetry and DMV type were 0.875 and 0.852. Chi-square test analysis revealed a statistically significant difference of DMV symmetry between healthy control and stroke group(χ(2)=31.046, P=0.000). There was correlation between DMV type and NIHSS score in stroke group (r(s)=0.208, P=0.025). There was no statistically significant difference of DMV distribution in the different periods of stroke group (P=0.110). But there was statistically significant difference of DMV distribution between acute and chronic stroke (P=0.018). Among 30 follow-up cases, 18 cases with asymmetry DMV changed into symmetry after stroke therapy. In 8 cases with symmetry DMV, the diameter of DMV became smaller after treatment. In 4 cases, DMV had no changes. Conclusions: DMV in patients of MCA stroke are mostly asymmetry distribution. DMV classification can be used as an imaging standard to predict the prognosis of stroke patients.
Collapse
Affiliation(s)
- H Y Li
- Department of Radiology, the General Hospital of Shenyang Military Region, Shenyang 110016, China
| | | | | | | | | | | | | |
Collapse
|
47
|
Duan Y, Yang BQ, Chang CC, Zhou J, Li HY, Xu ZH, Wang ZW, Li DY. [Preliminary study on assessment of lexiscan-induced blood-brain barrier opening and its level by CT perfusion imaging]. Zhonghua Yi Xue Za Zhi 2017; 96:2825-2829. [PMID: 27686551 DOI: 10.3760/cma.j.issn.0376-2491.2016.35.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the level of lexiscan-induced blood-brain barrier opening of healthy rabbits via CT perfusion weighted imaging (PWI) scan. Methods: Between November 2014 and May 2015, thirty New Zealand white rabbits were randomly assigned into three groups: the experimental group A1 which received one injection of lexiscan(1 ml/kg); the experimental group A2 which received three times injection of lexiscan(total dose: 1.5 ml/kg), finished within 15 minutes; the control group B which was injected the same volume normal saline(1 ml/kg), after 30 minutes, CT PWI scan was performed. Then cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and permeability surface(PS) of the region of interest of each group were acquired and compared statistically. Five cases of each group were injected with 2% Evans blue intravenously posterior to imaging. After one hour of infusion, all the animals were killed. Their brains were examined for the determination of Evans blue distribution. Results: Both the values of CBF and CBV and the staining with Evans blue of the group A1(CBF: (89.88±2.21), (81.42±4.28) ml·(100 g)-1·min-1; CBV: (3.97±0.43), (3.66±0.16) ml/g)and group A2 (CBF: (75.16±0.84), (63.66±7.21) ml·(100 g)-1·min-1; CBV: (4.07±0.01), (3.75±0.05) ml/g) were higher than those of the group B(CBF: (20.08±5.08), (14.58±8.62) ml·(100 g)-1·min-1; CBV: (0.85±0.04), (0.65±0.17) ml/g), the differences were all statistically significant (all P<0.01). While there was no statistically difference between group A1 and group A2(P>0.05). The value of PS of the group A2((22.43±8.09), (20.20±7.01)ml·(100 g)-1·min-1 )was higher than that of group A1((13.82±4.44), (10.12±2.44)ml·(100 g)-1·min-1) and group B(0.00, 0.00)(the lowest one), the differences were all statistically significant(all P<0.01). The value of MTT of the group A1((2.50±0.82, 2.47±0.10) s) had no statistical difference with group A2 and group B, while the value of group A2((4.50±0.17), (4.72±0.15) s) was higher than that of group B((1.88±0.09), (1.99±0.00) s), the differences were all statistically significant (P<0.05). Conclusion: Changes in hemodynamics of lexiscan-induced blood-brain barrier opening can be monitored by CT PWI scan. When the total dose of lexiscan increasing, the level of the BBB opening is higher with significantly increased CBF, CBV, PS and MTT.
Collapse
Affiliation(s)
- Y Duan
- *Department of Radiology, the General Hospital of Shenyang Military Region, Shenyang 110016, China
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Chang CC, Lee WS, Chuang CL, Hsin IF, Hsu SJ, Chang T, Huang HC, Lee FY, Lee SD. Effects of raloxifene on portal hypertension and hepatic encephalopathy in cirrhotic rats. Eur J Pharmacol 2017; 802:36-43. [PMID: 28238769 DOI: 10.1016/j.ejphar.2017.02.039] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/22/2017] [Accepted: 02/22/2017] [Indexed: 01/13/2023]
Abstract
Raloxifene, a selective estrogen receptor modulator, has been used extensively for osteoporosis. In addition to the effect of osteoporosis treatment, emerging evidences show that raloxifene affects the vascular function in different tissues. Cirrhosis is characterized with portal hypertension and complicated with hepatic encephalopathy. Portal hypertension affects portal-systemic shunt which leads to hepatic encephalopathy that the vascular modulation might influence severity of hepatic encephalopathy. Herein, we evaluated the impact of raloxifene on bile duct ligation (BDL)-induced cirrhotic rats. The female Sprague-Dawley rats received BDL plus ovariectomy or sham-operation. Four weeks later, rats were divided into 2 subgroups respectively to receive of raloxifene (10mg/kg/day) or saline (vehicle) for 14 days. On the 43th day, motor activities and hemodynamic parameters were measured. Hepatic and vascular mRNA and protein expressions were determined. The histopathological change of liver was examined. We found that the liver biochemistry, ammonia level and motor activity were similar between cirrhotic rats with or without raloxifene administration. The hemodynamic parameters were not significantly different except that raloxifene reduced portal venous inflow. Raloxifene exacerbated hepatic fibrosis and up-regulated hepatic endothelin-1 and cyclooxygenase 2 protein expressions. In addition, raloxifene modulated the mRNA expressions of endothelial nitric oxide synthase, cyclooxygenase and endothelin-1 in the superior mesenteric artery and collateral vessel. In conclusion, raloxifene aggravates hepatic fibrosis and decreases portal venous inflow in cirrhotic rats without adversely affecting portal hypertension and hepatic encephalopathy. The modulation of hepatic and vascular endothelin-1, endothelial nitric oxide synthase and cyclooxygenase expressions may play a role in the mechanism.
Collapse
Affiliation(s)
- Ching-Chih Chang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Shin Lee
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chiao-Lin Chuang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - I-Fang Hsin
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Endoscopy Center for Diagnosis and Treatment, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Institute of Pharmacology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shao-Jung Hsu
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Ting Chang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hui-Chun Huang
- Division of General Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
| | - Fa-Yauh Lee
- Division of Gastroenterology and Hepatology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.
| | - Shou-Dong Lee
- Faculty of Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Cheng-Hsin General Hospital, Taipei, Taiwan
| |
Collapse
|
49
|
Chang YS, Chang CC, Chen YH, Chen WS, Chen JH. Risk of infective endocarditis in patients with systemic lupus erythematosus in Taiwan: a nationwide population-based study. Lupus 2017; 26:1149-1156. [PMID: 28420053 DOI: 10.1177/0961203317694260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objectives Patients with systemic lupus erythematosus are considered vulnerable to infective endocarditis and prophylactic antibiotics are recommended before an invasive dental procedure. However, the evidence is insufficient. This nationwide population-based study evaluated the risk and related factors of infective endocarditis in systemic lupus erythematosus. Methods We identified 12,102 systemic lupus erythematosus patients from the National Health Insurance research-oriented database, and compared the incidence rate of infective endocarditis with that among 48,408 non-systemic lupus erythematosus controls. A Cox multivariable proportional hazards model was employed to evaluate the risk of infective endocarditis in the systemic lupus erythematosus cohort. Results After a mean follow-up of more than six years, the systemic lupus erythematosus cohort had a significantly higher incidence rate of infective endocarditis (42.58 vs 4.32 per 100,000 person-years, incidence rate ratio = 9.86, p < 0.001) than that of the control cohort. By contrast, the older systemic lupus erythematosus cohort had lower risk (adjusted hazard ratio 11.64) than that of the younger-than-60-years systemic lupus erythematosus cohort (adjusted hazard ratio 15.82). Cox multivariate proportional hazards analysis revealed heart disease (hazard ratio = 5.71, p < 0.001), chronic kidney disease (hazard ratio = 2.98, p = 0.034), receiving a dental procedure within 30 days (hazard ratio = 36.80, p < 0.001), and intravenous steroid therapy within 30 days (hazard ratio = 39.59, p < 0.001) were independent risk factors for infective endocarditis in systemic lupus erythematosus patients. Conclusions A higher risk of infective endocarditis was observed in systemic lupus erythematosus patients. Risk factors for infective endocarditis in the systemic lupus erythematosus cohort included heart disease, chronic kidney disease, steroid pulse therapy within 30 days, and a recent invasive dental procedure within 30 days.
Collapse
Affiliation(s)
- Y S Chang
- 1 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,2 Division of Allergy, Immunology, and Rheumatology, Shuang Ho Hospital, Taipei Medical University, Taiwan
| | - C C Chang
- 1 Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,3 Division of Rheumatology, Immunology and Allergy, Department of Internal Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Y H Chen
- 4 Biostatistics Center, College of Management, Taipei Medical University, Taiwan
| | - W S Chen
- 5 Division of Rheumatology, Immunology, and Allergy, Taipei Veterans General Hospital, Taiwan
| | - J H Chen
- 6 Biostatistics Center and Graduate Institute of Data Science, College of Management, Taipei Medical University, Taiwan
| |
Collapse
|
50
|
Tuan PH, Chang CC, Chang FL, Lee CY, Sung CL, Cho CY, Chen YF, Su KW. Modelling end-pumped passively Q-switched Nd-doped crystal lasers: manifestation by a Nd:YVO 4/Cr 4+:YAG system with a concave-convex resonator. Opt Express 2017; 25:1710-1722. [PMID: 29519025 DOI: 10.1364/oe.25.001710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
A theoretical model for the passively Q-switched (PQS) operation which includes the spatial overlapping between the pump and lasing modes under the thermal lensing effect is developed to give a transcendental equation that can directly determine the critical parameters such as pulse energy, pulse repetition rate, and pulse width for the PQS performance. More importantly, an analytical function which gives the approximate solution for the transcendental equation as well as a specific critical criterion for good PQS operation are derived for practical analyses and design. A Nd:YVO4/Cr4+:YAG system with a concave-convex resonator which can achieve fairly stable PQS pulse trains even at a high pump level is further exploited to manifest the proposed spatially dependent model. The good agreement between the experimental results and the theoretical predictions is verified to show the feasibility of the proposed model for designing high-power PQS lasers with high accuracy.
Collapse
|